BEHAVIORAL SCIENCE NBME ACTUAL EXAM REVIEW
2026/2027 | Complete Solution with Detailed Rationales |
USMLE Step Preparation | Pass Guaranteed - A+ Graded
Section 1: Human Development and Learning Theories (Questions 1–15)
Q1: A 4-year-old boy is brought to the pediatrician for a well-child visit. His mother
reports that he has become increasingly defiant, frequently saying "no" to simple
requests and insisting on dressing himself, even when he cannot match his clothes
properly. He becomes extremely upset if his routine is disrupted. According to Erikson's
stages of psychosocial development, which crisis is this child currently navigating?
A. Trust vs. Mistrust
B. Autonomy vs. Shame and Doubt
C. Initiative vs. Guilt
D. Industry vs. Inferiority
Correct Answer: B [CORRECT]
Rationale: This question tests Erikson's stages of psychosocial development. The key
clues are: age 4 years, defiance/autonomy struggles ("no," dressing himself), and
distress with routine changes.
● Autonomy vs. Shame and Doubt (ages 1.5–3 years) involves the child's
developing sense of self-control and independence. The "terrible twos"
(extending to age 3-4) feature negativism, self-feeding/dressing attempts, and
need for routine. The child's behavior represents normal autonomy-seeking.
, ● Distractor A (Trust vs. Mistrust): This is the infancy stage (0–1 year) focused on
caregiver reliability. Incorrect because the child is 4 years old, well past this
stage.
● Distractor C (Initiative vs. Guilt): This occurs ages 3–5 years and involves
purposeful activity, leadership, and exploration beyond simple autonomy. While
there's overlap, the specific description emphasizes control struggles (autonomy)
rather than initiative/guilt about purposeful action. The "no" behavior and dressing
battles specifically indicate autonomy issues.
● Distractor D (Industry vs. Inferiority): This is the school-age stage (6–12 years)
focused on competence and achievement. Far too advanced for a 4-year-old.
NBME Trap: Students often confuse Initiative vs. Guilt with Autonomy vs. Shame
because both span the preschool years. The distinguishing feature is that autonomy
concerns self-control and independence battles, while initiative concerns purposeful
planning and leadership. The negativism and self-care struggles here point specifically
to autonomy.
Q2: A 6-month-old infant is evaluated by a pediatrician. The mother mentions that the
baby now recognizes her face, smiles selectively at familiar people, and shows clear
distress when strangers approach. However, the infant does not yet exhibit separation
anxiety when the mother leaves the room. According to attachment theory and
developmental milestones, which statement best describes this infant's attachment
status?
A. Secure attachment with normal stranger anxiety development
B. Insecure-avoidant attachment pattern
C. Indiscriminate sociability suggesting attachment disruption
D. Disorganized attachment with fearful behavior
Correct Answer: A [CORRECT]
,Rationale: This question assesses attachment theory and infant social-emotional
milestones. At 6 months, infants typically demonstrate specific attachment behaviors
including:
● Social smile (developed by 2 months, now refined)
● Stranger anxiety (peaks 6–12 months) - the infant shows wariness of strangers
● Separation anxiety typically emerges later (8–14 months)
The infant's behavior is age-appropriate and indicates secure attachment formation.
Stranger anxiety without separation anxiety is the expected 6-month pattern.
● Distractor B (Insecure-avoidant): These infants show minimal distress with
strangers or separation, appearing indifferent. This infant clearly shows stranger
distress, ruling out avoidant attachment.
● Distractor C (Indiscriminate sociability): This pattern (friendly to all strangers
without wariness) suggests reactive attachment disorder or institutional
deprivation. The infant here shows appropriate stranger wariness.
● Distractor D (Disorganized attachment): Characterized by fearful, contradictory
behaviors (approaching while looking away, freezing). No evidence of fear or
disorganization is present.
NBME Trap: Students may think "no separation anxiety = problem," but separation
anxiety is a later-developing milestone. Its absence at 6 months is normal, not
pathological.
Q3: A 16-year-old high school student is seen for a routine physical. He reports
experimenting with cigarettes and alcohol "a few times" with friends but states he does
not use regularly. When asked about his future, he describes ambitious career plans but
admits he hasn't considered how substance use might affect these goals. According to
the Transtheoretical Model (Stages of Change), which stage best characterizes this
adolescent?
A. Precontemplation
, B. Contemplation
C. Preparation
D. Action
Correct Answer: A [CORRECT]
Rationale: This question tests the Transtheoretical Model (Prochaska & DiClemente).
The key features are:
● Experimentation without regular use (not yet a established behavior to change)
● No consideration of health risks ("hasn't considered how substance use might
affect goals")
● No intention to change in the near future (defined as next 6 months)
This describes Precontemplation - the individual is not yet acknowledging the need for
behavior change.
● Distractor B (Contemplation): The individual recognizes the problem and intends
to change within 6 months, but has not yet taken action. This adolescent has not
recognized substance use as a problem requiring change.
● Distractor C (Preparation): The individual intends to take action within 30 days
and may have made small changes. No such intention exists here.
● Distractor D (Action): The individual has made overt behavioral changes within
the last 6 months. No changes have been attempted.
NBME Trap: Students may select "Contemplation" thinking the patient is "thinking about"
substance use. However, the model specifically assesses readiness to change a
behavior, not mere awareness of the behavior. Without recognition that change is
needed, the patient remains in Precontemplation.
Q4: A 70-year-old retired professor is adjusting to life after his wife's death. He reports
volunteering at a local library, mentoring graduate students, and taking pride in his
grandchildren's achievements. He states, "I want to leave something positive for the
2026/2027 | Complete Solution with Detailed Rationales |
USMLE Step Preparation | Pass Guaranteed - A+ Graded
Section 1: Human Development and Learning Theories (Questions 1–15)
Q1: A 4-year-old boy is brought to the pediatrician for a well-child visit. His mother
reports that he has become increasingly defiant, frequently saying "no" to simple
requests and insisting on dressing himself, even when he cannot match his clothes
properly. He becomes extremely upset if his routine is disrupted. According to Erikson's
stages of psychosocial development, which crisis is this child currently navigating?
A. Trust vs. Mistrust
B. Autonomy vs. Shame and Doubt
C. Initiative vs. Guilt
D. Industry vs. Inferiority
Correct Answer: B [CORRECT]
Rationale: This question tests Erikson's stages of psychosocial development. The key
clues are: age 4 years, defiance/autonomy struggles ("no," dressing himself), and
distress with routine changes.
● Autonomy vs. Shame and Doubt (ages 1.5–3 years) involves the child's
developing sense of self-control and independence. The "terrible twos"
(extending to age 3-4) feature negativism, self-feeding/dressing attempts, and
need for routine. The child's behavior represents normal autonomy-seeking.
, ● Distractor A (Trust vs. Mistrust): This is the infancy stage (0–1 year) focused on
caregiver reliability. Incorrect because the child is 4 years old, well past this
stage.
● Distractor C (Initiative vs. Guilt): This occurs ages 3–5 years and involves
purposeful activity, leadership, and exploration beyond simple autonomy. While
there's overlap, the specific description emphasizes control struggles (autonomy)
rather than initiative/guilt about purposeful action. The "no" behavior and dressing
battles specifically indicate autonomy issues.
● Distractor D (Industry vs. Inferiority): This is the school-age stage (6–12 years)
focused on competence and achievement. Far too advanced for a 4-year-old.
NBME Trap: Students often confuse Initiative vs. Guilt with Autonomy vs. Shame
because both span the preschool years. The distinguishing feature is that autonomy
concerns self-control and independence battles, while initiative concerns purposeful
planning and leadership. The negativism and self-care struggles here point specifically
to autonomy.
Q2: A 6-month-old infant is evaluated by a pediatrician. The mother mentions that the
baby now recognizes her face, smiles selectively at familiar people, and shows clear
distress when strangers approach. However, the infant does not yet exhibit separation
anxiety when the mother leaves the room. According to attachment theory and
developmental milestones, which statement best describes this infant's attachment
status?
A. Secure attachment with normal stranger anxiety development
B. Insecure-avoidant attachment pattern
C. Indiscriminate sociability suggesting attachment disruption
D. Disorganized attachment with fearful behavior
Correct Answer: A [CORRECT]
,Rationale: This question assesses attachment theory and infant social-emotional
milestones. At 6 months, infants typically demonstrate specific attachment behaviors
including:
● Social smile (developed by 2 months, now refined)
● Stranger anxiety (peaks 6–12 months) - the infant shows wariness of strangers
● Separation anxiety typically emerges later (8–14 months)
The infant's behavior is age-appropriate and indicates secure attachment formation.
Stranger anxiety without separation anxiety is the expected 6-month pattern.
● Distractor B (Insecure-avoidant): These infants show minimal distress with
strangers or separation, appearing indifferent. This infant clearly shows stranger
distress, ruling out avoidant attachment.
● Distractor C (Indiscriminate sociability): This pattern (friendly to all strangers
without wariness) suggests reactive attachment disorder or institutional
deprivation. The infant here shows appropriate stranger wariness.
● Distractor D (Disorganized attachment): Characterized by fearful, contradictory
behaviors (approaching while looking away, freezing). No evidence of fear or
disorganization is present.
NBME Trap: Students may think "no separation anxiety = problem," but separation
anxiety is a later-developing milestone. Its absence at 6 months is normal, not
pathological.
Q3: A 16-year-old high school student is seen for a routine physical. He reports
experimenting with cigarettes and alcohol "a few times" with friends but states he does
not use regularly. When asked about his future, he describes ambitious career plans but
admits he hasn't considered how substance use might affect these goals. According to
the Transtheoretical Model (Stages of Change), which stage best characterizes this
adolescent?
A. Precontemplation
, B. Contemplation
C. Preparation
D. Action
Correct Answer: A [CORRECT]
Rationale: This question tests the Transtheoretical Model (Prochaska & DiClemente).
The key features are:
● Experimentation without regular use (not yet a established behavior to change)
● No consideration of health risks ("hasn't considered how substance use might
affect goals")
● No intention to change in the near future (defined as next 6 months)
This describes Precontemplation - the individual is not yet acknowledging the need for
behavior change.
● Distractor B (Contemplation): The individual recognizes the problem and intends
to change within 6 months, but has not yet taken action. This adolescent has not
recognized substance use as a problem requiring change.
● Distractor C (Preparation): The individual intends to take action within 30 days
and may have made small changes. No such intention exists here.
● Distractor D (Action): The individual has made overt behavioral changes within
the last 6 months. No changes have been attempted.
NBME Trap: Students may select "Contemplation" thinking the patient is "thinking about"
substance use. However, the model specifically assesses readiness to change a
behavior, not mere awareness of the behavior. Without recognition that change is
needed, the patient remains in Precontemplation.
Q4: A 70-year-old retired professor is adjusting to life after his wife's death. He reports
volunteering at a local library, mentoring graduate students, and taking pride in his
grandchildren's achievements. He states, "I want to leave something positive for the
