Psych Review
A 32 year-old female presents to the office with the complaint of worry which she can not control for the last six months. She tells you that she has symptoms at least four times per week consisting of sleep disturbances, difficulty concentrating and irritability. What is the most likely diagnosis? A. Panic disorder B. Generalized anxiety disorder C. Posttraumatic stress disorder D. Obsessive-compulsive disorder
B. A patient needs to have symptoms more days than not for six months or more with 3/6 symptoms to diagnose generalized anxiety disorder.
A 35 year-old male patient comes back to the office for a follow-up visit. He remarks that after 5 weeks on fluoxetine (Prozac) 20 mg per day, he still feels depressed but he denies suicidal ideations. What should you do to help this patient? A. Switch to tricyclic antidepressant B. Increase the dose of fluoxetine C. Switch the patient to divalproex (Depakote) D. Admit the patient to the behavioral health unit
B. An antidepressant should be raised to the recommended level and maintained at that level for 4-5 weeks, this patient was on too low of a dose.
What are the most effective agents in treating somatoform spectrum pain disorder? A. Analgesics B. Antidepressants C. Antipsychotics D. Anxiolytics
B. Antidepressants, especially SSRIs and TCAs are the main pharmacologic treatments used in somatoform spectrum pain disorder as analgesics and anxiolytics provide little to no relief and generally result in dependency. As there is no associated psychosis, delusions or hallucinations antipsychotics are not helpful.
Neuroleptic Malignant Syndrome --> Sidebar on Pharmacotherapy per UTD
A reasonable approach is to start with benzodiazepines (lorazepam or diazepam) along with dantrolene in moderate or severe cases, followed by the addition of bromocriptine or amantadine
Which of the following is the treatment of choice for benzodiazepine intoxication? A. Flumazenil (Romazicon) B. Naloxone (Narcan) C. Chlordiazepoxide (Librium) D. Clonidine (Catapres) E. Sodium Bicarbonate
A.
A 25 year-old female presents with signs and symptoms of depression. She does not have any other known medical problems. What diagnostic study is indicated in the initial evaluation of this patient? A. Thyroid stimulating hormone (TSH) B. Prolactin C. Growth hormone (GH) D. Cortisol e. Estradiol
A. Patients who are presenting with symptoms of depression should be evaluated with a TSH because 10 percent of patients evaluated for depression have previously undetected thyroid dysfunction.
A 45 year-old female presents with her daughter who is concerned because her mom will not leave the house. The patient describes feeling anxious in crowds and places where there are no easy means of escape. Which of the following is the most likely diagnosis in this patient? A. Agoraphobia B. Generalized anxiety disorder C. Obsessive-compulsive disorder D. Panic attack
A. Though all of the anxiety disorders can have comorbid agoraphobia the case describes only those symptoms inherent to this primary diagnosis. Agoraphobia can occur with generalized anxiety disorder and a panic attack can occur as a result of agoraphobia.
A 54 year-old patient has acute onset of palpitations, tremulousness, profuse sweating, shortness of breath, and numbness and tingling of the extremities. Physical examination reveals a pulse of 104 beats/min and regular, respiratory rate of 30/min, blood pressure of 160/95 mm Hg. Arterial blood gases reveal a low pCO2. ECG shows no acute changes. The most likely diagnosis is: A. anxiety neurosis. B. atrial fibrillation. C. depressive neurosis. D. myocardial infarction.
A. Anxiety is characterized by short-lived, recurrent, unpredictable episodes of intense anxiety accompanied by marked physiological manifestations.
Early clues to impending delirium tremens include: A. agitation and decreased cognition. B. visual hallucinations and diaphoresis. C. autonomic hyperactivity and dehydration. D. mental confusion and sensory hyperacuity.
A. Anxiety, decreased cognition, tremulousness, increasing irritability, and hyperactivity are common early clues to impending delirium tremens. -Mental confusion, tremor, sensory hyperacuity, visual hallucinations, autonomic hyperactivity, diaphoresis, dehydration, electrolyte disturbances, seizures, and cardiovascular abnormalities are common signs and/or symptoms of full-blown delirium tremens.
A patient with advanced AIDS complicated by toxoplasmosis presents with altered mental status, recent onset of seizures, and focal neurologic deficits. Which of the following diagnostic studies is most helpful? A. EEG B. MRI C. lumbar puncture D. Toxoplasma gondii antibody titers
B. An MRI showing multiple isodense or hypodense ring-enhancing mass lesions is the most useful test for such a patient. -Lumbar puncture is contraindicated secondary to possible mass effect. -Antibody titers cannot be depended upon since most patients have IgG titers that reflect past infection, significant rises are infrequent, and IgM antibody is rare.
A 25 year-old female presents to the emergency department after she collapsed at work. Medical history is significant for a mood disorder that causes her to have "wild mood swings and reckless behavior" according to her husband. She was diagnosed a year ago and since has been treated with several medications. Her symptoms today consist of nausea, vomiting, fatigue, tremor, and hyperreflexia. Lab results show an elevated BUN and creatinine, low sodium and elevated drug levels. All other results are normal. Which of the following medications is most likely the cause of her symptoms? A. Lithium (Lithobid) B. Lorazepam (Ativan) C. Carbamazepine (Tegretol) D. Risperidone (Risperdal)
A. Any sodium loss results in increased lithium levels. Signs and symptoms include vomiting and diarrhea which exacerbate the problem. Tremors, muscle weakness, confusion, vertigo, ataxia, hyperreflexia, rigidity, seizures, and coma may also be present.
Which of the following medications used in the management of anxiety has a delayed onset of action? A. buspirone (BuSpar) B. diphenhydramine (Benadryl) C. lorazepam (Ativan) D. butalbital (Fiorinal)
A. Buspirone takes several days to weeks for it to have clinical activity.
A patient with obsessive compulsive disorder would most likely have which of the following findings? A. Raw, red hands B. Priapism C. Memory impairment D. Abdominal pain
A. Common manifestations of obsessive compulsive disorder include phobias of germ and contaminants which results in frequent handwashing leading to chafed and reddened hands. The other answers are inconsistent with obsessive compulsive disorder.
A 20 year-old female presents with episodes of binge eating, overuse of laxatives, and periods of starvation. Which of the following is the best treatment option for this patient? A. fluoxetine (Prozac) B. gabapentin (Neurontin) C. amitriptyline (Elavil) D. phenelzine (Nardil)
A. Fluoxetine, a SSRI, is the drug of choice for the treatment of bulimia nervosa.
Higher doses of SSRIs are usually required in which of the following conditions? A. Obsessive-compulsive disorders B. Depression C. Manic depression D. Panic disorder
A. Higher doses of SSRIs are needed in the treatment of OCD for a beneficial effect.
A patient with known drug dependence mentions that he commonly sees sounds and hears colors. What is his drug of choice? A. Lysergic acid diethylamide B. Cannabis sativa C. Cocaine D. Heroin
A. Lysergic acid diethylamide is LSD, the phenomenon that this patient is experiencing is called synesthesia, which is common in patients who abuse hallucinogens.
A 24 year-old female presents to your office for a physical examination. She is dressed in a low cut blouse and a short skirt. She is dramatic, emotional and sexually provocative. She complains of difficulty being intimate with men. On further questioning, she seems to overemphasize the severity of her current cold. After a full history and physical examination you suspect what personality disorder? A. Histrionic B. Borderline C. Narcissistic D. Antisocial E. Dependent
A. Patients who are histrionic are attention seekers, and exaggerate their thoughts and feelings, they are often sexually provocative.
What behavior would be most typical for a patient diagnosed with schizoid personality disorder? A. Chooses solitary activities B. Odd thinking and speech C. Reckless disregard for safety of others D. Uses physical appearance to draw attention
A. Persons with schizoid personalities are very withdrawn and do not seek or enjoy relationships and are indifferent to praise or criticism. They generally appear cold and unfeeling to others.
A child has been under treatment for attention-deficit hyperactivity disorder (ADHD). No response has occurred with behavioral adaptations. Which of the following categories of medication should this patient be given? A. stimulants B. anxiolytics C. antipsychotics D. antidepressants
A. Stimulants, such as methylphenidate (Ritalin), are effective in 50 to 80% of children with ADHD.
A 65 year-old patient has a long history of schizophrenia that is treated with phenothiazines. On an unrelated clinic visit, the patient has difficulty sticking out her tongue, facial tics, increased blink frequency, and lip-smacking behavior. These involuntary movements are most suggestive of A. tardive dyskinesia. B. Parkinson's disease. C. Huntington's disease. D. Tourette's syndrome.
A. Tardive dyskinesia is characterized by abnormal involuntary movements of the face, mouth, tongue, trunk, and limbs and may develop after months or years of treatment with neuroleptic drugs.
A 26 year-old female arrives in the emergency department with friends who say she was standing in front of her church, dressed in a white bathrobe, claiming to be the Virgin Mary and handing out $100 bills to all passers-by. Her friends noted that she had been depressed lately, but now seems completely euphoric. She had a similar episode two years ago. Which of the following is the most appropriate treatment? A. Inpatient olanzapine (Zyprexa) therapy B. Inpatient electroconvulsive therapy C. Outpatient paroxetine (Paxil) therapy D. Outpatient psychotherapy
A. Treatment of the manic phase is usually done in the hospital to protect patients from behaviors associated with grandiosity (spending inordinate amounts of money, making embarrassing speeches, etc.). Lithium, valproate, and olanzapine are considered effective in the manic stage; the depressive stage is treated with antidepressants. So she's Bipolar with psychotic features? IDK
A 52 year-old female complains of bouts of anxiety and depression, the latter very deep but short lived (<24 hours). She states "I often feel like I am going to jump out of my skin". Her menses have become less frequent over the past 6 months. She denies suicidal ideations. She is not sleeping through the night. Which of the following the most appropriate next step in this patient? A. Check a follicle-stimulating hormone level B. Start a tricyclic antidepressant C. Refer her to a psychiatrist D. Endometrial biopsy E. Obtain a prolactin level
A. An FSH level should be assessed in this patient to evaluate for menopause as a cause for her psychiatric symptoms.
A patient with schizophrenia states that newspapers and the television are constantly talking about him though they never mention his name. What term best fits this description? A. Cosmic identity B. Ideas of reference C. Retrospective falsification D. Thought broadcasting
B. -Ideas of reference are part of the abnormal thought content that is hallmark in schizophrenic patients. -Cosmic identity refers to a patient's belief that they have physically and mentally fused with the universe. -Thought broadcasting is the belief that others can read the patient's mind or that their thoughts are broadcast over the radio or similar media. -A distorted memory filtered through a person's present emotional state refers to retrospective falsification.
A mother brings her teenage daughter to the emergency department. The teenager is anxious, tremulous, and in a dysphoric mood. She reports recent nightmares and insatiable hunger. Which of the following diagnostic tests would likely yield the most important information? A. Serum TSH B. Urine drug screen C. Minnesota Multiphasic Personality Inventory (MMPI) D. Electroencephalogram (EEG)
B. A drug screen would be helpful for many drugs of abuse that might cause these symptoms, but may not be definitive for amphetamines. -While hyperthyroidism can cause tremor and sometimes hunger, it is not associated with a dysphoric mood. It also generally occurs in early adulthood.
A patient presents with an episode of an expansive, elevated mood during which she cleaned excessively without sleeping. Which of the following is the most likely diagnosis? A. Major depressive disorder B. Bipolar disorder C. Schizoaffective disorder D. Dysthymic disorder
B. Bipolar disorder is characterized by episodic mood shifts from depression to manic type moods which is often rapid with depression lasting longer than manic episodes. Bipolar disorder may initially present with a manic episode.
Which of the following laboratory abnormalities is most commonly noted in bulimia nervosa? A. glycosuria B. hypokalemia C. metabolic acidosis D. hyperalbuminemia
B. Episodes of binge eating are followed by purging in the bulimic patient. Vomiting and laxative abuse are the most common methods of purging, leading to hypokalemia.
A 25 year-old female graduate student presents to the student health center for the eighth time in three weeks to be sure she does not have meningitis. She read that there was a student on campus who had meningitis last month, and now she has headaches and is requesting to be tested to make sure she does not have meningitis. She has been evaluated at each visit, and physical examination has been completely normal each time. Which of the following is the most likely diagnosis? A. Conversion disorder B. Illness Anxiety Disorder C. Malingering D. Somatic Symptom disorder
B. Excessive concern about having or developing a serious, undiagnosed general medical disease
A patient tells you that he is receiving special messages from the TV every night at 7:00 pm. This is an example of which of the following? A. Delusions B. Ideas of reference C. Paranoia D. Suicidal ideation
B. Ideas of reference are fixed beliefs that people are referring to you and about you through media.
What laboratory test must be monitored frequently in patients who are taking clozapine (Clozaril)? A. Thyroid stimulation hormone B. White blood cell count C. Platelet count D. Aspartate aminotransferase
B. Leukopenia, granulocytopenia, and agranulocytosis occur in approximately 1% of patients on this medication, clozapine should not be dispensed without proof of monitoring.
A patient is started on a new antipsychotic medication for his disorder. Three days later he develops altered consciousness, lead-pipe rigidity, diaphoresis and catatonia. Vital signs reveal respiratory rate of 20, temperature of 105.6 degrees F, and pulse oximetry of 95% room air. Which of the following would be the most appropriate initial intervention in this patient? A. Immediate oral SSRI's and Benadryl B. Supportive care with fluids and antipyretics C. IV antibiotics and naloxone D. Intubation and mechanical ventilation
B. Neuroleptic malignant syndrome is characterized by extrapyramidal signs, blood pressure changes, altered consciousness, hyperpyrexia, muscle rigidity, dysarthria, cardiovascular instability, fever, pulmonary congestion and diaphoresis. Controlling fever and fluid support are the best initial management. With a normal pulse oximetry mechanical ventilation is not indicated.
A 38 year-old female is brought to the emergency room with a complaint of paralysis of her arms bilaterally. Her history is significant for a sexual assault two days previously. Her physical examination is unremarkable with normal reflexes. There is no apparent physical explanation for her paralysis. What is the most likely diagnosis? A. Body dysmorphic disorder B. Conversion disorder C. Hypochondriasis D. Factitious disorder
B. Patients have abrupt loss of motor or sensory function caused by psychological factors that often precede the physical symptoms
A 24 year-old male presents to the emergency room via ambulance. He was found by the police walking naked on the highway. His speech is minimal but disorganized and he appears to be responding to auditory hallucinations. With further questioning, he is preoccupied with the delusion of the FBI listening in on his conversations. His mother tells you that he has been acting bizarre for two months now. What is the most likely diagnosis? A. Schizophrenia B. Schizophreniform disorder C. Schizoaffective disorder D. Schizotypal personality disorder
B. Schizophreniform disorder is characterized by the same features as schizophrenia except the total duration of the illness is at least one month and less than six months.
A 36 year-old man has a 30 pack-year history of smoking cigarettes and wants to quit. He is otherwise healthy at this time. Which of the following drugs would be appropriate for him? A. Amitriptyline (Elavil) B. Bupropion (Wellbutrin) C. Fluoxetine (Prozac) D. Venlafaxine (Effexor)
B. The only two approved drugs for aiding smoking cessation are nicotine and bupropion.
Which of the following is the most appropriate management of acute psychosis in a patient with schizophrenia? A. Amitriptyline (Elavil) B. Fluphenazine (Prolixin) C. Lithium (Eskalith) D. Sertraline (Zoloft) E. Seligiline (Eldepryl)
B. There are numerous options used in the management of acute psychosis including benzodiazepines and the typical antipsychotics such as fluphenazine or haloperidol. Antidepressants and lithium have no benefit in the treatment of acute psychosis.
What class of medications has been found most beneficial in the treatment of alcoholism not associated with a concomitant psychiatric illness? A. Antipsychotics B. Benzodiazepines C. Melatonin agonists D. Selective serotonin reuptake inhibitors
B. Though no pharmacologic therapies have substantial supportive data in treating alcoholism not associated with a mood or anxiety disorder short term use of benzodiazepines has the greatest benefit especially with acute cessation of alcohol. (this feels questionable, but I'll roll with it)
On performing a mental status examination you notice that the patient tends to repeat words and phrases out of context to your questions. This type of thought disorder is defined as which of the following? A. Flight of ideas B. Perseveration C. Circumstantiality D. Derailment
B. Definition of perseveration is the persistent repetition of words or concepts in the process of speaking. This is often seen in cognitive disorders, schizophrenia, and other mental illness. -Flight of ideas thoughts move from one topic to another with rapid speech. -Circumstantiality includes much detail, but information is not relevant. -Derailment is speech with loose associations and sentences that do not make sense.
Which of the following is the most appropriate intervention for a patient suffering from a specific phobia, such as fear of snakes? A. Lithium B. Behavioral therapy C. Insight-oriented therapy D. Electroconvulsive therapy
B. Specific phobias most commonly are treated with behavioral therapy including exposure therapy utilizing systemic desensitization. Hypnosis, supportive therapy and family therapy may also be useful adjunct treatment. -Insight-oriented therapy, while helpful in allowing patients to understand the origin of their fear and potential reasons for secondary gain, will not help to alleviate the patient's phobic symptoms.
A 36 year-old woman admits that her husband has abused her for over ten years. You should inform the woman that she is at most risk for injury or death A. just before a holiday. B. just after leaving an abusive spouse. C. when an abusive spouse arrives home after work. D. when an abusive spouse has been drinking heavily.
B. Women are more likely to be assaulted or murdered when attempting to report the abuse or leave the abusive relationship; up to 75% of domestic assaults occur after separation.
You are treating a patient for her first episode of major depression. She has no medical problems and there is no family history of psychiatric disorders. In addition to psychotherapy, which class of drugs should be your first choice for the treatment of this patient? A. Monamine oxidase inhibitors (MAOIs) B. Tricyclic antidepressants (TCAs) C. Selective serotonin reuptake inhibitors (SSRIs) D. Serotonin dopamine antagonists (SDAs) E. Atypical antipsychotics
C. SSRIs are the first line treatment for depression because of ease of use, safety, and broad spectrum of treatment.
A 22 year-old female presents to the emergency department with rapid heart rate. She appears quite thin and dehydrated. She denies that she is thin, stating "I am so fat that I can hardly stand myself! That is why I exercise every day." She runs twelve to fifteen miles a day, and on weekends also bicycles forty to fifty miles. Her LMP was six months ago. On exam, she is 5' 6" tall and weighs 98 pounds. Temp 98 degrees F, pulse 100, respirations 18, BP 98/60. EKG shows sinus tachycardia. Laboratory findings include Na 138 mEq/L, K 2.8 mEq/L, Cl 91 mEq/L, BUN 35 mg/dL, Creatinine 1.1 mg/dL. Which of the following is the next most appropriate treatment? A. Propylthiouracil (PTU) and individual psychotherapy B. Hormone replacement and cognitive therapy C. Weight restoration and family therapy D. IV hydration and antidepressant therapy
C. Anorexia nervosa requires a comprehensive, multidisciplinary approach to treatment that integrates medical management, individual psychotherapy, and family therapy. Currently, the best results have been shown with weight restoration accompanied by family therapy for patients with adolescent-onset anorexia nervosa and individual therapy for patients with onset after 18 years of age. Inpatient treatment is often required.
A 26 year-old female has a long history of sexual promiscuity and substance abuse. She frequently expresses anger when she feels abandoned. She also has difficulty in controlling her anger at times. Her past relationships have been intense and short-lived. She has attempted suicide twice in the past 18 months. This patient exhibits which of the following disorders? A. bipolar B. avoidant personality C. borderline personality D. dissociative
C. Borderline personality disorder is characterized by instability of interpersonal relationships, marked impulsivity that is potentially self-damaging, inappropriate, intense anger or control of anger, recurrent suicidal attempts, gestures or threats, and identity disturbances. All of these are exhibited in this patient.
A mother brings in her five year-old boy for his school physical. She voices some concerns about his readiness for school, saying he seems to be socially immature. She has noticed he does not interact with other children well, and that when he plays with them, he has a tendency to "place them" and then run around them as if they were statues. He rarely cries when he is hurt, and he shrugs off any attempt to hug him. He has good attention to details, and will sit and draw the same geometric shapes over and over again, but does not seem interested in learning the alphabet. He avoids eye contact with anyone. Which of the following is the most likely diagnosis? A. Normal 5 year-old B. Social phobia C. Autism D. Avoidant personality
C. Children with autism do not tend to make eye contact, and even avoid it. They do not accept comfort when hurt and stiffen up when hugged. They do not tend to play with others, and do not tend to imitate grown-ups in play. They approach play in a more mechanical way, using others as props rather than interacting with them.
A 63 year-old retired engineer presents with one month of difficulty sleeping. He has a hard time staying asleep and says he is just restless. He also states that he has been more forgetful and can't pay attention very well. He lives with his wife. He denies fever, chills, recent trauma, or difficulty walking. When asked about the specifics of his symptoms, he repeatedly replies, "I don't know," without really trying. He states his wife thinks he just sits around the house all day since he retired. His neurological exam is unremarkable, except for some mild psychomotor retardation. Which of the following is the most likely diagnosis? A. Dementia B. Delirium C. Depression D. Dissociative disorder
C. Depression often presents with difficulty thinking and concentrating, lessened sleep, and withdrawal from activities. "Pseudodementia": The presentation of depression as dementia has been called "pseudodementia" or, more recently, "dementia of depression." Patients with depression may have signs of psychomotor slowing and give poor effort on testing ("I just can't do this"), while those with dementia often try hard but respond with incorrect answers.
A 19 year-old woman has been consuming up to six beers daily since she was 16. She is now pregnant with her first child, has had little prenatal care, and is due to deliver in four weeks. Of the following, which neonatal problems should you anticipate? A. kernicterus B. hydrocephalus C. low birth weight D. teeth discoloration E. Hydrops fetalis
C. Fetal alcohol syndrome is a common cause of low birth weight.
Formications are most commonly associated with which of the following? A. Delusional disorder B. Adverse drug reaction C. Alcohol withdrawal D. Obsessive compulsive disorder
C. Formications are the sensation of insects crawling on the skin and is commonly associated with delirium tremens from alcohol withdrawal and cocaine addiction. FUN FACT: Formic --> as in formic acid --> as in Formicidae --> which is the ANT family in taxonomy! (Thank you Barratt and your environmental lecture...)
Which of the following dietary substances interact with monoamine oxidase-inhibitor antidepressant drugs? A. Lysine B. Glycine C. Tyramine D. Phenylalanine
C. Monoamine oxidase inhibitors are associated with serious food/drug and drug/drug interactions. Patient must restrict intake of foods having a high tyramine content to avoid serious reactions. Tyramine is a precursor to norepinephrine.
A 36 year-old patient presents requesting something to help him sleep. He reports that he has always had a problem sleeping, admits to feeling nervous most days for the last 2 years, and that he has always been "uptight" and a "worry wart." During the previous eight months he has frequently felt tense, shaky, sweaty, with palpitations and frequent headaches. He reports being irritable with his 5 year-old son. Which of the following is the best treatment option for this patient? A. Alprazolam (Xanax) B. Haloperidol (Haldol) C. Paroxetine (Paxil) D. Diphenhydramine (Benadryl)
C. SSRI's, specifically Paxil, are the mainstay for treatment of generalized anxiety disorder.
A 33 year-old hypertensive patient presents with increasing feelings of worthlessness and hopelessness over the past several months. Other symptoms include frequent crying episodes, loss of appetite, weight loss, insomnia with daytime sleepiness, and thoughts of suicide without any specific plans in place at this time. Which of the following would be the most appropriate first-line medication for this patient? A. amitriptyline (Elavil) B. bupropion (Wellbutrin) C. fluoxetine (Prozac) D. phenelzine (Nardil) E. Mertazapine (Remeron)
C. SSRIs are the drugs of first choice for treating major depression. -Bupropion is a second-line drug for treating major depression and should be avoided in patients with hypertension.
Which of the following classes of antidepressants is associated with anticholinergic side effects, including cardiac dysrhythmias, dry mouth, sedation, and orthostatic hypotension? A. Selective serotonin reuptake inhibitors B. Monoamine oxidase inhibitors C. Tricyclic antidepressants D. Atypical antidepressants
C. TCA's have well known anticholinergic effects. -MAOI's mainly cause orthostatic hypotension and sympthomimetic effects.
A 28 year-old male patient is being treated for depression and has been taking paroxetine (Paxil) for the past two and a half months with a marked improvement in symptoms. The patient reports problems with sexual functioning which he believes is related to the medication. Which of the following is an immediate concern with abrupt discontinuation of the medication? A. increased risk of suicide B. diminished sexual functioning C. risk of drug withdrawal symptoms D. worsened depressive symptoms
C. The greatest risk of abrupt withdrawal of short acting SSRIs is a withdrawal syndrome or withdrawal delirium which represents cholinergic rebound.
Which of the following is the most appropriate intervention in suspected child abuse? A. Arrange for the arrest of the parents. B. Confront the suspected assailant in front of the child. C. Assure the safety of the child, with hospitalization if necessary. D. Contact social service department after discharge of the child.
C. The primary goal should be the safety and well-being of the child. Hospitalization may be the only way the clinician has to remove the child from the care of a possible abusive home if no other recourse is available due to a lack of social services and investigators.
A patient is evaluated for extreme fears of abandonment and an inability to care for himself throughout his adult life. He avoids disagreements and has difficulty initiating projects or acting on his own thoughts and ideas. Advice and reassurance are sought for even minor daily details. There are no reported suicidal tendencies or signs of self harm. What is the most likely personality disorder? A. Narcissistic B. Borderline C. Dependent D. Obsessive-compulsive
C. These patients are constantly seeking external support and will do even unpleasant things for others to gain approval and nurturing. -Narcissistic patients are egotistic and would not seek the opinion of others. -Patients with borderline disorder can share some of these traits as they make aggressive efforts to avoid abandonment but the suicidal tendencies, impulsivity and self mutilation differentiate it. -Obsessive-compulsive patients do not rely on external support and obey very strict personal rules of perfection and efficiency and choose not to rely on others.
A 48 year-old alcoholic, whose last drink was 6 days ago, presents to the clinic complaining of palpitations and intermittent abdominal pain. On physical examination, blood pressure is 170/110 mm Hg, pulse 124/min, respirations 22/min, and temperature 100.4 degrees F. The patient is agitated and excitable. Cardiovascular examination reveals tachycardia without murmurs, gallops, or rubs, and is otherwise normal. Which of the following is the most appropriate intervention? A. start antihypertensive medication B. begin a cardiac work-up for angina C. admit to the hospital for alcohol withdrawal D. consult social services for appropriate disposition
C. This patient is exhibiting the signs and symptoms of alcoholic withdrawal characterized by delirium, autonomic hyperactivity, perceptual distortions, and fluctuating levels of psychomotor activity. Seizures are a common occurrence prior to DTs, but the delirium may occur without preceding seizures. This is a medical emergency, and if untreated, it has a mortality rate of 20%.
A 17 year-old female is seen who has a history of eating large amounts of food at night 3 to 4 times weekly. These episodes are always followed by extreme guilt and either induced vomiting or hours of strenuous exercise. She excels at work and school and maintains many active relationships. Her physical examination reveals a normal BMI and an otherwise normal exam. What is the best initial intervention for this patient? A. Begin an anxiolytic B. Immediate hospitalization C. Start an antidepressant D. Test for substance abuse
C. Uncomplicated bulimia generally does not require hospitalization as the physical manifestations encountered in bulimia are generally mild if present at all. Some patients with bulimia have concomitant substance abuse issues but her successful relationships and work activities lessen the probability. Antidepressants, not anxiolytics, have been found helpful in lessening the binge/purge cycles and improving overall well-being even outside of comorbid mood disorders.
A mother brings her 6 year-old boy for evaluation of school behavior problems. She says the teacher told her that the boy does not pay attention in class, that he gets up and runs around the room when the rest of the children are listening to a story, and that he seems to be easily distracted by events outside or in the hall. He refuses to remain in his seat during class, and occasionally sits under his desk or crawls around under a table. The teacher told the mother this behavior is interfering with the child's ability to function in the classroom and to learn. The mother states that she has noticed some of these behaviors at home, including his inability to watch his favorite cartoon program all the way through. Which of the following is the most likely diagnosis? A. Antisocial disorder B. Dysthymic mood disorder C. Obsessive-compulsive disorder D. Attention deficit hyperactivity disorder
D. ADHD is characterized by inattention, including increased distractibility and difficulty sustaining attention; poor impulse control and decreased self-inhibitory capacity; and motor overactivity and motor restlessness, which are pervasive and interfere with the individual's ability to function under normal circumstances.
In what region of the brain are cerebrovascular lesions most likely to cause post-event depressive symptoms? A. Cerebellum B. Occipital C. Pons D. Temporal
D. Cerebrovascular lesions in the anterior brain regions are more common than the posterior areas. The temporal lobe and the diencephalon are especially prone to post event depression.
Which of the following effects result from cigarette smoking and contributes to atherogenesis? A. transient decrease in blood pressure B. polycythemia with relative hyperoxemia C. decreased blood viscosity D. chronic inflammation
D. Cigarette smoking induces a chronic inflammatory state, which is believed to contribute to atherogenesis. -Smoking leads to a transient increase in blood pressure, not a decrease. -Smoking induces a hypoxic state, leading to polycythemia. However, because of increased carbon monoxide, there is still a relative hypoxemia rather than increased levels of oxygen. -Smoking leads to increased blood viscosity, not decreased.
Which of the following medical complications of eating disorders is due to purging (vomiting/laxative abuse)? A. Intestinal obstruction B. Reduced thyroid metabolism C. Amenorrhea D. Electrolyte abnormalities
D. Electrolyte abnormalities, particularly hypokalemia, hypochloremic alkalosis, and hypomagnesemia may occur as a result of purging.
A 25 year-old male on a behavioral medicine unit is given haloperidol (Haldol) IM for a violent psychotic outburst. Initially he quiets down, but about an hour later develops confusion, an inability to open his mouth, and a temperature of 40 degrees C. Initial treatment should consist of which of the following? A. Additional Haldol B. Corticosteroid C. Benzodiazepine D. Dantrolene
D. In addition to supportive treatment, the most commonly used medications for neuroleptic malignant syndrome are dantrolene (Dantrium) and bromocriptine (Parlodel).
What laboratory test should be followed routinely every six to twelve months in patients taking lithium? A. Complete blood count with differential B. Deionized Calcium C. Potassium D. Thyroid stimulating hormone E. 25-hydroxyvitamin D
D. Lithium induces hypothyroidism because of the decrease in concentration of circulating thyroid hormones.
Which of the following is the leading cause of injury-related death in children between the ages of 1 and 15? A. Drowning B. Firearms C. House fires D. Motor vehicle injuries
D. Motor vehicle injuries are the leading cause of death in children.
What laboratory test should be closely monitored in patients on long-term lithium treatment for bipolar disorder? A. ALT B. Calcium C. Lipase D. TSH
D. Patients with bipolar disorder and those on long term lithium therapy are prone to hypothyroidism severe enough to require treatment. Liver and pancreatic complications are not a common concern. Electrolyte/renal issues can arise with poor fluid intake and severe vomiting and diarrhea, calcium does not require routine monitoring.
A 56 year-old man is admitted to a hospital unit for evaluation of rectal bleeding and weight loss. He has a strong family history of cancer. Soon after admission, a barium enema is scheduled. The patient refuses the "prep" because he fears x-ray radiation. He states he has had previous x-rays, but becomes frightened at the thought of an x-ray and "can't face it." The most likely diagnosis is: A. hysterical personality. B. dissociative state. C. conversion reaction. D. phobic neurosis.
D. Phobic neurosis is a phobic ideation of displacement where the patient transfers feelings of anxiety from the object to one that can be avoided.
A 17 year-old patient presents to the emergency department with agitation and hallucinations, and has one seizure. He admits to using "some drugs" but does not know what they were. On physical examination, temperature is 103 degrees F, BP 140/90, pulse 120, respirations 20. Remainder of the examination is unremarkable. Which of the following diagnostic studies will be of most help in managing this patient? A. Drug screen B. Urine dipstick C. Complete blood count D. Serum creatinine kinase
D. Serum creatinine kinase is the most sensitive test to detect rhabdomyolysis, a serious complication of seizures and hyperthermia related to drug abuse. -Although a drug screen may identify specific drugs, the results will not alter the care of this patient.
What patient demographic is at highest risk for the development of anorexia nervosa? A. College aged swimmer B. High school football player C. Married, 50 year old, heterosexual female D. Single, 20 year old, homosexual male
D. (I'm a statistic...) Homosexual males are at increased risk for anorexia nervosa due to the strong community desire for slimness. This is not the case in the lesbian community. Wrestlers are at the greatest risk group among athletes along with ballet dancers. Though anorexia nervosa is more common in the female population, its onset is far more typical in the teens to early 20's.
Who is the most likely adult to sexually abuse a child? A. School teacher B. Friend of the family C. Scout leader D. Family member
D. Adults within the immediate or extended family perpetrate the most child sexual abuse, usually this is a trusted member of the family.
Which of the following drugs is first-line therapy for schizophrenia? A. Chlorpromazine (Thorazine) B. Clozapine (Clozaril) C. Haloperidol (Haldol) D. Olanzapine (Zyprexa)
D. Initial pharmacologic therapy of schizophrenia should begin with one of the newer, "atypical" antipsychotic drugs, such as olanzapine, risperidone, quetiapine, ziprasidone, and clozapine because their side effect profile is significantly better than the older drugs, and they may be more effective for negative psychotic symptoms. - Clozapine should not be considered a first-line therapy because of its hematopoietic and hepatic side effects.
A 9 year-old male is brought in by his mother who reports the patient has exhibited an extremely negative attitude for the past year. He seems angry much of the time and frequently loses his temper. Arguing over even trivial details is common place and he seems to take delight in annoying his family. His grades and conduct at school remain excellent. He has few friends, though he has never been seen bullying or destroying others' property. What is the most likely diagnosis? A. Attention deficit disorder B. Conduct disorder C. Antisocial personality disorder D. Oppositional defiant disorder
Oppositional defiant disorder (ODD) best fits this scenario and is differentiated from conduct disorder by the lack of bullying and the lack of destruction of property. Many children with ODD do drift into conduct disorders over time. His good grades and conduct at school lessen the probability of untreated ADD. Personality disorders (i.e. antisocial personality disorder) can not be diagnosed at this early an age.
