HOSA: Behavioral Health
A 45-year-old man presents after swallowing a pen. A review of his previous visits shows two prior evaluations for the same thing. He reports this is because of post-traumatic stress disorder. An X-ray confirms the presence of a pen in the esophagus. What is his most likely diagnosis? Borderline personality disorder Drug-seeking behavior Malingering Munchausen syndrome
D-Munchausen syndrome Munchausen syndrome is a form of factitious disorder in which patients feign illness for some sort of personal gain.
Which of the following risk factors is the strongest predictor of suicide? Access to firearms History of depression Male sex Prior history of suicide attempts
D-Prior history of suicide attempts
A 30-year-old woman presents to your office requesting medication to help her quit smoking. Which of the following is a contraindication to prescribing bupropion? Cardiovascular disease Chronic obstructive pulmonary disease Depression Seizure disorder
D-Seizure disorder Bupropion decreases the seizure threshold and is therefore contraindicated in patients with seizure disorder Question: Which smoking cessation medication is recommended for patients who are concerned about post-cessation weight gain? Answer: Bupropion.
Which one of the following statements is an important feature of somatization disorder that helps differentiate it from conversion disorder, malingering, or hypochondriasis? -Abdominal pain that is recurring over many years after multiple negative workups -Physical symptoms disproportionate to a demonstrable organic disease -Sudden dramatic onset of a single symptom, typically simulating some non-painful neurologic disorder where there is no anatomical explanation -Symptoms that are intentionally produced in the absence of apparent external incentives
A-Abdominal pain that is recurring over many years after multiple negative workups Somatization refers to a tendency to experience and communicate psychological distress as physical symptoms in the absence of identifiable pathology. Question: What is the most common goal of malingering patients in the emergency department? Answer: Obtaining drugs.
Social or medical problems that result from substance use is defined by which of the following terms? Abuse Dependence Intoxication Tolerance
A-Abuse Question: Approximately what is the prevalence of substance use disorders in the general population of the United States? Answer: 8% of general adult populaiton.
A 21-year-old man runs a successful business as a methamphetamine cook. He frequently uses his own product. Recently, he has not been able to fill his typical orders due to being "high" all the time. Which of the following would best describe his substance use? Abuse Dependence Tolerance Withdrawal
A-Abuse Substance abuse is defined as a maladaptive pattern of recurrent substance use leading to clinically significant impairment or distress. This can manifest as failure to fulfill work Question: The National Survey on Drug Use and Health lists which three illicit drugs as the most commonly abused? Answer: Marijuana, cocaine and hallucinogens.
A 53-year old previously healthy woman visits her primary care physician to review the results from the biopsy obtained from the solitary 8 mm polyp discovered in her colon by a routine colonoscopy. The report confirms that this is a hyperplastic polyp. Her family history is negative for colon cancer. Which one of the following is the most appropriate interval for follow-up colonoscopy in this patient? 1 year 10 years 3 years 5 years
B-10 years Small hyperplastic polyps, which are defined as less than 10 mm in size, are not neoplastic and are considered low risk. For patients at low risk the recommended interval between screening colonoscopies in 10 years. Question: What is the treatment for familial adenomatous polypsosis (FAP)? Answer: Prophylactic colectomy.
Screening for lung cancer with low-dose computed tomography of the chest is indicated for which one of the following patients with a 30-pack-year smoking history? A 50-year-old current smoker A 60-year-old who quit smoking 10 years ago A 75-year-old who quit smoking 20 years ago An 85-year-old current smoker
B-A 60-year-old who quit smoking 10 years ago 55 to 80 who have a 30 pack-year smoking history and currently smoke or who have quit within the past 15 years Question: What is the most effective way to decrease the mortality and morbidity associated with lung cancer? Answer: Smoking cessation.
A 4-year-old boy is seen in your office for routine physical. His mother is concerned that he is not speaking like a normal 4 year-old. On further evaluation you notice that he has poor eye contact, rapid hand movements and he is preoccupied by repeatedly spinning the wheels on the toy cars he brought with him. What is the most likely diagnosis? Attention deficit hyperactive disorder Autism spectrum disorder Expressive speech delay Obsessive compulsive disorder
B-Autism spectrum disorder Autistic disorder is a clinical diagnosis. The core features include impaired social interactions, communication, and behavior. Early social skills deficits include poor eye contact, lack of interactive play, and lack of interest in other children Question: What tool is commonly used at 18 months of age to screen for an autism spectrum disorder? Answer: M-CHAT questionnaire.
Which of the following is consistent with a diagnosis of bulimia? Congestive heart failure Contraction alkalosis Hyperkalemia Hypothermia
B-Contraction alkalosis Question: What is Russell's sign? Answer: The presence of calluses on the knuckles that result from induced vomiting in bulimia.
What is the most common form of child abuse in the United States? Emotional Neglect Physical Sexual
B-Neglect Neglect is the most common type of child maltreatment in the United States (78.5%) and is caregiver failure to meet basic nutritional, medical, educational, and emotional needs of a child. Question: Which 3 populations of abuse require reporting to authorities? Answer: Elder abuse, animal abuse and child abuse. Note, reporting of domestic abuse is not mandated by law.
Screening for osteoporosis should be performed in which one of the following groups? 55-year old man with type 2 diabetes mellitus 55-year old woman with a BMI 30 kg/m2 65-year old previously healthy woman 75-year old previously healthy man
C-65-year old previously healthy woman all women 65 years or older and at-risk women aged 50-64 should undergo universal screening for osteoporosis (obesity is a protective factor d/t peripheral estrogen). Question: What is the diagnostic criteria used to diagnose osteoporosis? Answer: A T-score less than -2.5 on DEXA.
Which of the following is a valid statement regarding a well-documented adverse effect causally related to a vaccine administration? -Inactivated influenza vaccine can cause clinical influenza -Measles vaccine is associated with autism -The oral polio vaccine causes paralytic disease in immune deficient individuals -Thimerasol, a preservative contained in most vaccines, is associated with mental retardation in infants receiving thimerasol-based vaccines
C-The oral polio vaccine causes paralytic disease in immune deficient individuals Oral polio vaccine is a live attenuated viral vaccine Question: List some common live-attenuated vaccines? Answer: Herpes zoster, Influenza, Mumps/Measles/Rubella, Rotavirus, Typhoid, Vaccinia (Small pox), Yellow fever.
During an intake history, a patient describes her husband as a violent, angry man. You suspect domestic violence of a physical nature. You counsel the woman that serious injury or death most commonly occurs during which of the following situations? After an argument about financial issues After an argument about sex-life issues When she tries to leave the husband When the husband tries to apologize for his actions
C-When she tries to leave the husband assaults occur more commonly near the end of relationships. Up to 75% of domestic assaults occur during an attempt to report abuse or leave an abusive relationship.
A 29-year-old woman presents to your office with a complaint of worsening anxiety. Which additional finding would suggest a diagnosis of generalized anxiety disorder rather than panic disorder? Anxiety occurring more days than not for at least six months Changes in personality Excessive concern about medically unexplained symptoms Frequent periods of intense fear
A-Anxiety occurring more days than not for at least six months GAD is characterized by excessive and persistent worrying that occurs more days than not for six or more months. Other clinical manifestations include insomnia, headaches, difficulty relaxing, and fatigue Question: What disorder is characterized by anxiety occurring within three months of an identifiable stressor? Answer: Adjustment disorder.
A 17-year-old boy is brought to the emergency department by his friends. They were at a house party and found their friend unconscious after he ingested an unknown substance. On physical exam, vital signs are temp 96°F, heart rate 50, respiratory rate of 4, and oxygen saturation 92% on room air. The boy's pupils are miotic. On lung auscultation, there are crackles bilaterally. You administer supplemental oxygen. Which of the following is the most appropriate clinical intervention? Administer intravenous naloxone Begin intravenous fluids with sodium bicarbonate Initiate therapy with benzodiazepines Perform gastric lavage
A-Administer intravenous naloxone Question: What are the clinical signs of subcutaneous heroin injection? Answer: Fat necrosis, lipodystrophy, atrophy over the extremities, and skin abscesses.
A 4-year-old girl presents to clinic for a well-child check and routine vaccination. History reveals that the patient and her mother have been residing in a homeless shelter for the past three months. Which of the following should be completed at this visit? Administration of all vaccines and placement of TST today Administration of all vaccines today, placement of the TST in 6 weeks Administration of inactivated vaccines and placement of the TST today Placement of the TST today, administration of all vaccines in 6 weeks
A-Administration of all vaccines and placement of TST today tuberculin skin test (TST) The above patient is due for her four-year immunizations, including MMR, Varicella, IPV, and DTaP. Both the MMR and Varicella vaccines contain live virus, while the IPV and DTaP vaccines do not
You finish taking a history of a patient at risk for suicide. Which of the following would suggest the highest likelihood of committing suicide? Age over 85 years Cohabitation with parents Married with children Tactile hallucinations
A-Age over 85 years The greatest suicide rate is in elderly white males over 85 years old
You examine a 2-year-old boy for a routine health visit. He eats a healthy diet. He can speak six words. He can also point to one body part. He is able to walk up the steps. You give him a crayon and he is able to scribble. His length is at the 45th percentile and weight is the 30th percentile. Physical examination is normal. The family recently acquired a puppy and has not yet been given vaccinations. You discuss rabies with the family. Which of the following is the best statement regarding rabies? All bites from animals that can be infected with rabies virus carry a risk of transmission Post-exposure prophylaxis should be given within a week if an exposing animal is suspected to be rabid Rabies cases among domestic animals have increased in the United States The risk of acquisition of rabies does not increase with multiple bites
A-All bites from animals that can be infected with rabies virus carry a risk of transmission The risk of acquisition increases with multiple bites, and with bites in closer proximity to the central nervous system (CNS). Children, presumably because of their size are more at risk as well. Question: What is the passive immunization to rabies? Answer: Rabies immunoglobulin.
A 14-year-old boy is in clinic for a well-child visit. He is a straight-A student and plays baseball in school. He eats a healthy and balanced diet. He has a lot of friends in school and enjoys hanging out with them. He likes to ride his bicycle on the weekends. Which of the following is the best advice you would give to the boy and his parents regarding bicycle injuries? Appropriate helmets are those with a firm polystyrene liner that fit properly on the head Helmets effectively reduce the risk of head injury by 55% Helmets reduce the risk of brain injury by 48% Parents should buy a larger helmet to give the child growing room
A-Appropriate helmets are those with a firm polystyrene liner that fit properly on the head Question: What can significantly decrease the risk and severity of head injuries among all-terrain vehicle (ATV) riders? Answer: Helmets.
A 74-year-old woman is brought to her primary care provider by her adult son. The son says she has been very difficult at home and is "losing it." He seems very frustrated about her diminishing ability to take care of herself the way she used to and no longer thinks he can trust her watching his children. At her last visit you noted mild cognitive impairment. Today, she appears withdrawn and hesitates to make eye contact with you. She lets her son do most of the talking. Which of the following is the most appropriate next step? Ask the son to step out so you can speak with the patient alone Assess the patient's risk for depression Complete a mini-mental exam Discuss with the son the challenges of having a parent with dementia
A-Ask the son to step out so you can speak with the patient alone All patients, regardless of age, ought to be given a chance to speak with their physician alone Question: Which types of abuse require mandated reporting? Answer: Child abuse and elder abuse.
Which of the following statements is true regarding teenage suicide? Attempts are more common in girls than boys Boys complete suicide most commonly by ingesting a poisonous substance Girls complete suicide more often than boys Suicide rates are decreasing in teenagers
A-Attempts are more common in girls than boys Question: Based on the 2007 Youth Risk Behavior Survey, what percentage of students in grades 9 through 12 reported that they had seriously considered attempting suicide in the 12 months preceding the survey? Answer: 14.5%.
You suspect bipolar I disorder or major depression in a 17-year-old student. Which of the following tools is most appropriate in making one of these diagnoses? Beck Depression Inventory for Primary Care Mood Disorder Questionnaire My Mood Monitor Myers-Briggs Type Indicator
A-Beck Depression Inventory for Primary Care adapted from the Beck Depression Inventory, a 21-question multiple-choice self-report inventory and one of the most widely used instruments for measuring the severity of depression. Question: Which two common medical conditions need to be evaluated in a patient with a new diagnosis of depression? Answer: Diabetes and lipid disorders.
Which of the following diagnostic criteria differentiate Tourette syndrome from other neurological disorders? Childhood onset Comorbid symptoms of depression Developmental delay Observation of tics on physical exam
A-Childhood onset One diagnostic criterion for TS is onset before age 18 years. Other criteria for diagnosis include the presence of multiple motor and one or more vocal tics, persistence of tics for more than one year, and the symptoms not being related to a medical condition or physiologic effects of a substance. Question: How does coprolalia clinically manifest in patients with Tourette syndrome? Answer: Vocal tic with involuntary use of obscene words
Which one of the following screening practices is recommended for the adolescent/young adult population by the U.S. Preventive Services Task Force? Chlamydia screening in sexually active females Lipid screening Scoliosis screening Testicular examination
A-Chlamydia screening in sexually active females Screening for Chlamydia in all sexually active, non-pregnant women 18-25 years of age is recommended. Question: What is the treatment for Clamydia trachomatis? Answer: Azithromycin or Doxycycline.
A 18-year-old man presents to the ED in police custody after using an unknown drug. Vital signs are BP 170/85, HR 120, T 37.8°C, RR 18, and pulse ox 99% on room air. On exam, he is agitated and diaphoretic. His pupils are 7 mm and reactive. Which of the following substances did this patient most likely use? Cocaine Dextromethorphan Fluoxetine Phencyclidine
A-Cocaine Cocaine Intoxication: Sympathomimetic toxidrome Diaphoresis (unlike in anticholinergic overdose) Seizures Wide-complex dysrhythmias (rx: sodium bicarbonate) Rx: BZDs Avoid ßBs
A 2-year-old boy presents with a burn to his right hand as seen above (multiple sharply demarcated round burns with a central eschar (cigarette burns)). The patient's mother states that he mistakenly got burned by hot water when she tipped a hot tea kettle over. What management is indicated? Consultation with child services for suspected abuse Consultation with plastic surgery for skin grafting Discharge home with silvadene and follow up Transfer to a burn center
A-Consultation with child services for suspected abuse. Question: What is the significance of the Tarasoff vs. Regents case? Answer: This case establishes the physicians duty to breach patient confidentiality if the patient poses a significant threat to a 3rd party.
Which of the following medical conditions excludes a child from participation in sports? Current fever History of HIV infection History of persistent asthma Known seizure disorder
A-Current fever Question: Why should children receiving chemotherapy with anthracyclines be restricted from competitive sports? Answer: Cardiotoxic effects of the medication that can lead to heart failure.
Which of the following is adequate for a new diagnosis of schizophrenia? Delusions and disorganized speech for 6 months Delusions and hallucinations for 2 weeks Flat affect and avolition Hallucinations and chronic alcohol use
A-Delusions and disorganized speech for 6 months Schizophrenia: ≥ 2 symptoms: Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms Brief psychotic disorder: < 1 month Schizophrenia: > 6 months Schizophreniform disorder: 1-6 months Schizoaffective disorder: psychosis + mania or depression Question: What are neologisms? Answer: Neologisms are nonsense words invented by the patient. This is a common symptom in schizophrenia.
Which of the following represents the classic order of the stages of grief? -Anger, Denial, Bargaining, Depression, Acceptance -Bargaining, Anger, Denial, Depression, Acceptance -Denial, Anger, Bargaining, Depression, Acceptance -Depression, Denial, Anger, Bargaining, Acceptance
C-Denial, Anger, Bargaining, Depression, Acceptance Question: Which gender is more likely to experience all 5 stages of grief? Answer: Women are more likely than men to experience all 5 stages.
A 46-year-old man with a history of depression presents with a self inflicted laceration to the left arm. The wound is superficial and the patient states that he didn't want to hurt himself. He reports that he is recently divorced, lives alone, and has increased stress at work. These stressors have worsened his depression. Which of the following treatments is most likely indicated for this patient? Emergency psychiatric evaluation Outpatient referral to psychiatry Prescribe antidepressant and discharge with follow up Prescribe anxiolytic and discharge
A-Emergency psychiatric evaluation This patient presents with a possible suicide attempt and a number of high risk factors for suicidality warranting an emergency evaluation from psychiatry. Patients often present to the emergency department after an attempt that may appear minor
Which of the following best defines delusions? Erroneous beliefs that usually involve a misinterpretation of perceptions or experiences Hallucinations occurring in the absence of insight into their pathological nature Marked disorientation, confusion, and fluctuating consciousness Sensory perceptions without external stimulation
A-Erroneous beliefs that usually involve a misinterpretation of perceptions or experiences Question: Which of the following is the most common type of delusion? Answer: Persecutory.
A 31-year-old woman presents to your office with a complaint of feeling depressed. In the past two months she has lost 10 pounds, is experiencing insomnia, has low energy, difficulty concentrating, and feels worthless. She denies thoughts of suicide. Which of the following is the most appropriate therapy? Escitalopram Imipramine Lithium Risperidone
A-Escitalopram First-line treatment for depression is pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) such as escitalopram, psychotherapy, or a combination of both. Question: True or false: Depression is more common among men than women? Answer: False.
Which of the following clinical scenarios in a patient with chronic ethanol use should prompt admission to the hospital? Fever, tachycardia, hypertension Intoxication with vomiting Mild tachycardia, tongue fasciculations Normal vital signs, one seizure six hours ago
A-Fever, tachycardia, hypertension major alcohol withdrawal which is a constellation of symptoms which may include anxiety, irritability, tremors, tachycardia, fever, hypertension, decreased seizure threshold and both auditory and visual hallucinations. Question: Before what day of abstinence is it rare for delirium tremens to develop? Answer: Day three.
A 14-year-old presents for a well child visit. She is healthy and has no complaints. A review of her past immunizations shows that she is up to date on all required immunizations at her 8-year-old well child visit. She also received the Human papillomavirus vaccine at age 11 and 12, and quadrivalent meningococcal vaccine and TdaP at age 12. Which one of the following vaccines should she receive at this visit? Human papillomavirus vaccine Inactivated poliovirus Measles Rubella
A-Human papillomavirus vaccine She is up to date on all immunizations at age 8, so it can be assumed that she has received her rubella (D), measles (C), and polio vaccinations (B).
Which of the following is the most common type of child abuse? Neglect Physical Psychological Sexual
A-Neglect Question: Shaken baby syndrome, a common form of infant abuse, typically leads to which pathological findings? Answer: Intracerebral hemorrhage, intracranial hypertension and permanent neurological damage.
A splinter went deep into the arm of a man while he was working in the yard. After thorough wound cleansing, you inquire about his tetanus status. He is certain that he received all of his childhood vaccines and a "tetanus booster" 4 years ago, but does not know which vaccine he received. Which one of the following is the best choice for this patient regarding tetanus immunization at this time? No immunization Tetanus immune globulin Tetanus toxoid Tetanus toxoid with reduced diphtheria
A-No immunization No additional vaccine is needed at this time since received his initial childhood vaccinations as well as a tetanus booster within the past 5 years. Question: When should the tDap vaccine be administered during pregnancy? Answer: Tdap should be administered to all pregnant women at 27-36 weeks of gestation.
On a Sunday afternoon, a surgical oncologist and his family attend a football game in the city where he practices. While at the game, he runs into a physician colleague that works at the same institution. After some casual small talk, his colleague inquires, "Are you taking care of Mr. Clarke, my personal trainer? I heard through the grapevine that he has melanoma, and I didn't know if you had started him on any chemotherapy or performed any surgical intervention yet. Hopefully you'll be able to take very good care of him." In this situation, the surgical oncologist may confirm which of the following? No information at all Only that Mr. Clarke is his patient The patient's diagnosis The patient's treatment plan
A-No information at all a PA must not discuss any information regarding a patient's care with anyone who is not actively involved in that patient's care. Question: At what age is a patient allowed to express his or her concerns to a physician without a family member or guardian present? Answer: At any age.
A patient with chronic spinal pain begins to obtain off-the-street opioids in an attempt to enhance his prescribed opioid analgesics. In addition to psychotherapy for substance dependence, you prescribe which of the following substitution adjuvant medications? Bromocriptine Buprenorphine and naloxone Disulfiram Modafinil
B-Buprenorphine and naloxone The goal of this is to provide a clinically supervised, stable dose of a partial opioid agonist (buprenorphine) and opioid-antagonist (naloxone) to provide pain and craving control, which allows the addict to function while reducing the negative aspects of addiction.
A 6-month-old infant boy presents to his pediatricians office for a follow-up visit. His parents are concerned about his immunizations because an otherwise healthy and normal older brother died of varicella complications at a year of age. They are aware of the fact that varicella virus is highly infectious. They request your advice about their son's varicella immunization schedule. Which one of the following recommendations is most appropriate? -Administer the killed varicella vaccine at 12 months and 2 years of age -Administer the live varicella vaccine at 12 months and 4 years of age -Evaluate this infant for immune deficiency and administer a dose of varicella-zoster immune globulin (VZIG) prior to any further immunizations -Immunize this 6-month-old infant with his first dose of live varicella vaccine at this visit and the second dose at 9 months of age
B-Administer the live varicella vaccine at 12 months and 4 years of age This child should be immunized following the Advisory Committee on Immunization Practices (ACIP) recommendations. The specific recommendation is to administer the live varicella vaccine at 12 to 15 months and 4 to 6 years of age. The history of a fatal case of varicella in the older brother at a year of age does not imply any immune problem in the younger brother.
A 29-year-old woman presents to the psychiatric clinic for a "lifetime" of intense anxiety not relieved by 12-weeks on fluoxetine. She reports low self-esteem, feeling "very uneasy" in social situations, and says she wishes she could make friends but worries that she'll say something "dumb" to people. Which of the following personality disorders does she most likely have? Antisocial personality disorder Avoidant personality disorder Dependent personality disorder Paranoid personality disorder
B-Avoidant personality disorder Avoidant personality disorder is characterized by this patient's symptoms of low self-esteem and desire for relationships which remains fruitless due to persistent fear of rejection. Other symptoms of avoidant personality disorder include a hypersensitivity to criticism and failure, often making patients unable to hold jobs and maintain relationships.
A 19-year-old man presents with his parents who state that their son has shown signs of impulsivity, pressured speech, racing thoughts, and a decreased need for sleep over the last 3-4 weeks that has caused him to miss school. What is the most likely diagnosis? Attention-Deficit/Hyperactivity Disorder Bipolar disorder Major depressive disorder Schizophrenia
B-Bipolar disorder Manic episodes are distinct periods of abnormally and persistent moods that can be euphoric, expansive, or irritable. Manic patients often have greatly inflated self-esteem, confidence, decreased need for sleep, pressured speech, racing or crowded thoughts, distractibility, increased involvement in goal-directed activities
A 28-year-old previously healthy woman presents to your office with a complaint of feeling depressed. In the past 6 months she feels very tired despite sleeping 10-12 hours per night, has no desire to exercise like she did previously, has lost 10 pounds and complains of not having an appetite. She admits to having thoughts of wishing she weren't alive anymore, although denies being suicidal. Which of the following is considered first-line therapy for this patient? Amitriptyline Citalopram Olanzapine Phenelzine
B-Citalopram Diagnosis of depression is made when patients have at least one episode of major depression and no history of mania or hypomania. An episode of major depression lasts at least two weeks and includes having five or more symptoms of depression including anhedonia, depressed mood, change in appetite or weight, insomnia or hypersomnia, low energy, inability to concentrate, feeling guilty or worthless, and thoughts of death or suicide. Selective serotonin reuptake inhibitors (SSRIs), such as citalopram, are considered first-line pharmacologic treatment
Which of the following is most consistent with alcohol withdrawal? Agitation and increased appetite Delirium, hallucinations, tremor Depressed mood with diarrhea Dilated pupils, runny nose and watery eyes
B-Delirium, hallucinations, tremor
A 45-year-old man who lives alone and is a highly functional working individual, tells you that the police are coming into his home each night and stealing food from his refrigerator and unlocking all the doors. Which of the following is the most likely diagnosis? Delirium Delusional disorder Depression Schizophrenia
B-Delusional disorder The term delusional disorder refers to a condition whose core feature is persistent, nonbizarre delusions not explained by other psychotic disorders. It is a fixed false belief that has a certain level of plausibility Question: Should you directly challenge a delusional patient about his or her false beliefs? Answer: No, avoid directly challenging the patient but do not pretend to be in full acceptance.
A 26-year-old woman is brought in by her husband for evaluation. He states that over the last week, she has exhibited a number of concerning symptoms including tremors and seizures. On entering the room, the patient is noted to be resting comfortably. When asked about the tremor, the patient begins to exhibit coarse diffuse tremors. During the evaluation the patient has generalized shaking but is able to respond to questions. Further discussion with the patient's husband reveals that they are currently going through a separation and there has been a lot of stress at home. Which of the following disorders accounts for the patient's symptoms? Conversion disorder Factitious disorder Hypochondriasis Somatization
B-Factitious disorder Factitious disorder is characterized by falsified general medical or psychiatric symptoms. Patients deceptively misrepresent, simulate, or cause symptoms of an illness or injury in themselves, even in the absence of obvious external rewards such as financial gain, housing, or medications.
The leading type of death from an unintentional injury in adults aged 65 and older is due to which of the following? Automobile accidents Falls Fire-related injuries Gunshot wounds
B-Falls Falls are the leading type of injury for adults aged 65 and older. Between 30-40% of community-dwelling adults in this age group have at least 1 fall per year
You examine a 3-year-old girl for drowning. She was unsupervised for a few minutes and later her mother found her by the pool. The mother called 911 and CPR was performed for 5 minutes. Upon arrival in the emergency room she is unresponsive and is immediately intubated. Her blood pressure is 70/50 mm Hg, heart rate is 125 beats per minutes, and pulse oximetry reading is 95%. Which of the following is the correct statement regarding water safety? Adolescents who had swimming lessons are allowed to swim alone Fencing that surrounds a pool with a self-locking gate reduces the risk of drowning Less supervision is fine for toddlers who had swimming lessons Water wings and floaters can be relied upon as drowning prevention measures
B-Fencing that surrounds a pool with a self-locking gate reduces the risk of drowning Children and adolescents should never swim alone regardless of their swimming abilities. Even as they become more independent and participate in recreational activities without their parents, they should be encouraged to seek areas that are watched by lifeguards
A 27-year-old woman presents to your office with complaints of depression and thoughts of suicide. She is interested in starting both counseling and medication to address her symptoms. Which of the following is the safest medication to consider prescribing? Amitriptyline Fluoxetine Nortriptyline Venlafaxine
B-Fluoxetine Selective serotonin reuptake inhibitors (SSRIs) seem to be safer in the case of an overdose than other agents. SSRIs, such as fluoxetine, are therefore the agents of choice in the treatment of depression for patients who are potentially suicidal.
A 45-year old man with diabetes mellitus sees you for the first time. If the patient has not previously received it, which one of the following vaccines is recommended for him? Hepatitis A Hepatitis B Meningococcal Varicella zoster
B-Hepatitis B hepatitis B vaccine should be administered to all previously unvaccinated adults aged 19-59 with diabetes mellitus Question: What are the 3 values used to diagnose diabetes mellitus type 2? Answer: Need 2: Fasting blood sugar > 125 mg/dL, HBA1c of 6.5%, glucose tolerance test results > 200 mg/dL or a random plasma glucose level > 200mg/dL + symptoms of hyperglycemia.
You examine a 12-month-old girl for a health supervision visit. She is asymptomatic and the mother has no complaints. The family lives in a house built in 1940s and so you perform a lead level in clinic which was read as elevated. You send the girl for a venous lead level at the hospital and the lead level obtained is 10. What is the next best step? Give more iron supplements Make changes in the home No intervention needed Treat with chelation
B-Make changes in the home For patients found to have mild elevations, (a level of 10-20) changes in the home should be made. Management usually requires the assistance of public health and housing agencies as well as education for the parents. The family should move out of a lead-contaminated apartment until repairs are completed.
You examine a 12-month old boy in clinic for possible measles exposure. He stayed at his grandmother's house two days ago where he played with his cousin. The mother is concerned because the boy's cousin developed measles that is confirmed by the laboratory. The mother denies any symptoms on the boy. The boy has not had his measles vaccination. Which of the following is the best therapy for the boy? Measles immune globulin Mumps, measles, rubella vaccination Ribavirin Vitamin A
B-Mumps, measles, rubella vaccination the administration of live measles vaccine within 72 hours of the exposure is preferable to immune serum globulin administration. Measles immune globulin (A) can prevent or diminish the severity of measles if administered to nonimmune individuals within six days of exposure. However,
An 8-year-old boy presents for a well-child check. He wants to join his school's basketball team that involves weightlifting. His mother has concerns regarding whether this is appropriate for a child his age. Which of the following is the most accurate statement regarding resistance training? Most injuries related to resistance training are the result of weightlifting movements such as modified cleans, pulls, and presses Resistance training can begin as early as age 6 with appropriate supervision Resistance training is appropriate for children who are at least 10 years of age or are at least 4 feet 5 inches in stature The mechanical stress from heavy resistance training can negatively impact linear growth during childhood and early adolescence
B-Resistance training can begin as early as age 6 with appropriate supervision Which school team sport has the highest injury rate in the United States? Answer: Football, followed by wrestling.
Which one of the following cardiac rhythm abnormalities is most common in patients with anorexia nervosa? Atrial fibrillation Sinus bradycardia Sinus tachycardia Ventricular fibrillation
B-Sinus bradycardia Sinus bradycardia is almost universally present in patients with anorexia nervosa. It is hypothesized that this is due to vagal hyperactivity resulting from an attempt to decrease the amount of cardiac work by reducing cardiac output.
Which of the following is correct with regards to autism? Caused by thimerosal-containing vaccines Developmental screening tests have good sensitivity for autism Early intervention with a multidisciplinary approach improves outcomes Onset typically occurs after the age of 5
C-Early intervention with a multidisciplinary approach improves outcomes The term autism refers to a spectrum of pervasive developmental disorders characterized by various degrees of impaired social interaction and communication and repetitive, stereotyped patterns of behavior. These patients like aloneness, are hypersensitive to touch, desire sameness in every day activity, often have a lack of understanding, and can have good rote memory skills.
A 7-year-old boy presents to your office for a well-child check. His mother has concerns regarding his car booster seat. Which of the following is the most accurate statement regarding car safety seats? All children should be restrained in the rear seats of vehicles for optimal protection until they have outgrown the highest weight or height allowed by the manufacturer of their belt-positioning booster seat, typically after 12 years of age. All children should be transitioned to belt-positioning booster seats as early as possible for optimal protection. All children should use a belt-positioning booster seat until the vehicle lap-and-shoulder seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 years of age. All infants and toddlers should ride in a rear-facing car safety seat until they are 1 year of age or older.
C-All children should use a belt-positioning booster seat until the vehicle lap-and-shoulder seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 years of age.
Which of the following is true regarding anorexia nervosa? Affects men more than women Anti-depressants are an effective treatment Associated with a body image disturbance Menorrhagia is an early symptom
C-Associated with a body image disturbance An individual with anorexia nervosa refuses to maintain a minimally normal body weight, is fearful of gaining weight, and exhibits a distorted body self-image. The patient's body image is the predominant measure of self-worth, along with denial of the seriousness of the illness.
What is considered the first-line therapy for bulimia? Antidepressants Antipsychotics Cognitive behavioral therapy Weight management plan
C-Cognitive behavioral therapy Bulimia: Recurrent binge eating Overconcern with body shape/weight Weight: normal or above normal Submandibular gland enlargement Calluses over dorsal aspect of fingers Dental enamel erosion Rx: cognitive behavioral therapy (first-line), SSRIs (second-line) Question: What physical health problems are associated with bulimia? Answer: Electrolyte disturbances, loss of dental enamel, and esophageal tears.
A 14-year-old boy has been described by others as the "school bully." For the past 16 months he stole money from his parents, got into fights at school almost daily, failed to turn in most of his homework, and destroyed multiple items both at home and school. During parent-principal meetings the young boy denies having remorse for his actions and considers himself just a "normal" 14-year-old. Which of the following disorders is this individual suffering from? Antisocial personality disorder Attention deficit hyperactivity disorder Conduct disorder Obsessive compulsive personality disorder
C-Conduct disorder Conduct disorder criteria involves symptoms from 3 of 4 categories that include aggression to people and animals, destruction of property, deceitfulness or theft, serious violation of the rules. Symptoms must persist for over 12 months with at least 1 criterion for the past 6 months. They must also be under the age of 18. Question: A patient with conduct disorder diagnosed at 15 years of age may go on to develop which personality disorder as an adult? Answer: Antisocial personality disorder.
A mother presents to clinic with her 15-year-old son. She is concerned because over the past 2 years he has been having significant behavioral problems. At home he is bullying his younger siblings, staying out past curfew, and she recently caught him setting fires in the backyard. At school he is consistently truant and failing all of his classes. Last weekend police picked him up for spray-painting graffiti on a local church. When asked to explain his behavior, the patient says, "I don't have to explain anything, I can do what I want." This patient meets criteria for which of the following disorders? Antisocial personality disorder Attention deficit/hyperactivity disorder Conduct disorder Oppositional-defiant disorder
C-Conduct disorder conduct disorder is characterized by behavior which violates the basic rights of others, societal norms, or age-appropriate rules in a repetitive and persistent manner. At least 3 criteria need to be present for the past 12 months
A recently adopted 6-year-old from an Eastern Europe presents to your office with his parents for a first time visit. His past medical history and physical exam is unremarkable. His parents do not know his immunization history, so you order the appropriate vaccine and immunoglobulin titers in addition to standard testing. His titers are all negative and laboratory work-up is otherwise unremarkable. What immunizations should he receive? DTaP, HepA, HepB, HiB, IPV, MMR, PCV13, Varicella DTaP, HepA, HepB, IPV, MMR, PCV13, Varicella DTaP, HepA, HepB, IPV, MMR, Varicella Tdap, HepA, HepB, IPV, MMR, PCV13, Varicella
C-DTaP, HepA, HepB, IPV, MMR, Varicella No HiB >5yrs w/o risk factors PCV13 for ages 24-59mo Question: What is the maximum age to start Rotavirus vaccine? Answer: For rotavirus vaccine, the maximum age for the first dose is 14 weeks 6 days, and for the final dose, the maximum age is 8 months 0 days.
An 18-year-old woman with a history of frequent visits to the ED presents with multiple superficial lacerations to her left wrist. She is agitated and states she is suicidal. She is yelling at the nurses and demands to be seen only by the psychiatrist. Which of the following is the most appropriate next step in management? Administer 5 mg of intramuscular haloperidol Consult the psychiatry service Engage in conversation and discuss her symptoms and validate her distress Place her alone in a private room and wait for her to calm down
C-Engage in conversation and discuss her symptoms and validate her distress Borderline personality disorder (BPD) is a common emergency psychiatric presentation. BPD is characterized by unstable personal relationships, unstable self-image, and inappropriate behaviors. The disorder may include chronic feelings of emptiness, which may be misdiagnosed as depression, or lability of mood
A 21-year-old woman presents to your office for her annual exam. While taking the patient's history, she reveals that she has been eating excessive amounts of food and then vomiting almost daily for the past six months. She has started working with a nutritionist and is seeing a cognitive behavioral therapist but would like to know if there are any medications that might help her treatment. Which of the following is the most appropriate medication for this patient? Desipramine Diazepam Fluoxetine Lorazepam
C-Fluoxetine Treatment for bulimia nervosa includes psychotherapy, nutritional rehabilitation, pharmacotherapy and management of medical complications. The selective serotonin reuptake inhibitor (SSRI) fluoxetine is the only SSRI approved for use in treating bulimia nervosa and is considered first-line. Question: Which antidepressant is contraindicated in patients with eating disorders? Answer: Bupropion.
Which one of the following is recommended for routine prenatal care? Cystic fibrosis carrier testing Hepatitis C antibody testing HIV screening Parvovirus antibody testing
C-HIV screening All pregnant women should be offered screening for asymptomatic bacteriuria, syphilis, rubella, and hepatitis B and human immunodeficiency virus infection early in pregnancy. Question: At which gestational age should Rhogram be administered to an Rh neg woman? Answer: 28 weeks.
Routine vaccination against which of the following organisms has significantly reduced the risk of bacterial meningitis among children? Borrelia burgdorferi Escherichia coli Haemophilus influenzae Listeria monocytogenes
C-Haemophilus influenzae Question: What are the 3 most common causes of meningitis in neonates? Answer: Group B streptococcus, Escherichia coli and Listeria
What are the components of the "female athlete triad"? Anemia, iron deficiency, menorrhagia Delayed puberty, ligamentous injuries, weight loss Low bone density, menstrual dysfunction, low energy availability menstrual dysfunction, hirsutism, ovarian cysts
C-Low bone density, menstrual dysfunction, low energy availability
A 15-year-old girl presents to clinic for a well child check. During her Home and Environment, Education and Employment, Activities, Drugs, Sexuality, Suicide and Depression (HEADSS) exam, she admits to using marijuana on a weekly basis for the past six months. She also drinks alcohol to excess once every few weeks. She denies smoking tobacco or using any other illicit substances. Which of the following is the most accurate information to give this patient? Chronic marijuana use improves focus and performance In human studies, marijuana has shown teratogenicity Marijuana can cause dependence and withdrawal Tetrahydrocannabinol concentrations are lower in today's marijuana compared to prior decades
C-Marijuana can cause dependence and withdrawal Question: Which behavioral interventions are effective in treating marijuana dependence? Answer: Cognitive-behavioral therapy and motivational incentives.
Which of the following is true regarding attention deficit hyperactivity disorder? Characterized by speech delay, poor eye contact, and lack of stranger anxiety More prevalent in girls than boys Most frequently diagnosed behavioral disorder in children Symptoms most commonly begin in adolescence
C-Most frequently diagnosed behavioral disorder in children present in 2 areas of social interaction (home and school); must have been present prior to age 12 years; must have persisted for longer than 6 months; and must be maladaptive or inappropriate for the child's developmental stage.
The DSM-5 groups personality disorders into 3 categories: odd/eccentric, dramatic/erratic and anxious/fearful. Which of the following is the correct personality disorder and cluster? Avoidant personality disorder - odd/eccentric (cluster A) Borderline personality disorder - odd/eccentric (cluster A) Narcissistic personality disorder - dramatic/erratic (cluster B) Schizoid personality disorder - anxious/fearful (cluster C)
C-Narcissistic personality disorder - dramatic/erratic (cluster B) Question: Can psychotropic drugs be the mainstay of treatment for personality disorders? Answer: No, a treatment plan that focuses largely or exclusively on medications probably will not meet the needs of a patient with a personality disorder.
A 35-year-old man with a history of alcohol abuse presents to your office with complaints of a 3-day history of abdominal pain and vomiting after a night of binge drinking. He has not eaten in days. Laboratory values show an elevated anion gap, ketonemia and normal glucose levels. In addition to thiamine, what other treatment should be provided for this patient? Bicarbonate and insulin Glucagon and hydrocortisone Normal saline and glucose Pyridoxine
C-Normal saline and glucose alcoholic ketoacidosis, which is defined by the clinical triad of ketones in the blood or urine, an elevated anion gap and a normal glucose level. Treatment of includes vigorous volume repletion with normal saline, along with administration of thiamine and glucose Question: What is the clinical diagnostic triad for Wernicke encephalopathy? Answer: Memory impairment, gait disorders and oculomotor dysfuction.
An 82-year-old woman presents for evaluation of pain on her sacrum. The patient is alert and oriented to person, place, and time. Physical examination is notable for a stage II decubitus ulcer. Multiple bruises are noted on her legs as well. She acknowledges that she remains in bed most of the day and sometimes her son who is her caretaker forgets to give her meals or change her diaper. He also squeezes her legs hard when she does not move quickly enough. You are concerned about elder neglect and abuse. She does not wish to report her son or speak with social work. Which is your most appropriate action? Call the son to discuss the case Discharge the patient home Notify adult protective services Psychiatry consultation for capacity determination
C-Notify adult protective services Question: What other population is protected under the laws of elder abuse? Answer: Persons with disabilities, often referred to as dependent adults.
A 67-year-old woman presents to your office accompanied by her adult daughter with a complaint of anxiety. She says that she's always been a "worrier," but since the birth of her grandchild last year her anxiety has gotten worse. Further discussion reveals that she sleeps only 2-3 hours per night, has daily headaches, and her daughter complains that she calls their house at least 15 times every day asking about her grandchild's safety. Which of the following is the most appropriate therapy? Imipramine Lorazepam Paroxetine Quetiapine
C-Paroxetine First-line medications for Generalized anxiety disorder (GAD) include SSRI's or SNRI's, including paroxetine. Psychotherapy is also recommended in the treatment of GAD. If one SSRI does not have the desired effect, then a trial of a different SSRI is used prior to initiating a second-line medication.
Which of the following is included in the criteria of substance abuse? Great deal of time spent in activities to obtain, use, or recover substances Persistent desire or unsuccessful efforts to cut down or control use Persistent or recurrent social or interpersonal problems caused or exacerbated by substance Substance taken in larger amount or for longer period than intended
C-Persistent or recurrent social or interpersonal problems caused or exacerbated by substance One or more of the following must be seen in a 12-month period: continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by substance, recurrent substance related legal problems, recurrent use in physically hazardous situations, recurrent use resulting in failure to fulfill major role obligation at work, home, or school. Substance Abuse Use → impairment or distress Not dependent
A 19-year-old woman refuses to go to any park or playground because of an excessive fear and anxiety that she may see a dog. She has never been bitten or had a previous bad experience with a dog. Which of the following conditions is she most likely suffering from? Generalized anxiety disorder Panic disorder Phobia Post-traumatic stress disorder
C-Phobia Phobic Disorder Excessive/unreasonable fear interfering with normal function Provocation: specific feared object/situation exposure Leads to avoidance behavior Rx: cognitive behavioral therapy Question: What is the most common type of phobia? Answer: Social phobia is now known to be one of the most common psychiatric disorders in the general population with a 13.3% lifetime prevalence.
You examine a five-year-old girl for a routine child check. She likes to sing and dance. She knows her name and address. She is also able to draw a person with six body parts. She also eats fruits, vegetables, fish and meat. Physical examination is normal. Her mother has no concerns. The girl is excited for the coming break because the family is going to the beach. Which of the following is the correct statement regarding sun exposure? Sunburn is primarily due to UV-A exposure Sunscreen should be applied generously 5 minutes before going outdoors Sunscreen should not be used on infants < 6 months of age Use a broad-spectrum, water-resistant sunscreen product with a minimum SPF of 15
C-Sunscreen should not be used on infants < 6 months of age Sunburn is primarily due to UV-A exposure (A) is wrong because it is due to UV-B. Sunscreen should be applied generously 5 minutes before going outdoors (B) is not correct because sunscreen should be applied 15 minutes prior to sun exposure. Using a broad-spectrum, water-resistant sunscreen product with a minimum SPF of 15 (D) is false because minimum SPF should be 30.
You provide care to a middle-aged man with hypertension and diabetes. He recently lost his job, and you are concerned that he may be exhibiting mild symptoms of depression. According to the US Preventive Services Task Force, screening for depression is recommended if which of the following exists? A local suicide prevention hotline routinely handles calls from your surrounding area The patient has a strong social support of friends, family and coworkers There is a cognitive-behavior therapist that works in your clinic You have developed a detailed depression screening form
C-There is a cognitive-behavior therapist that works in your clinic The US Preventive Services Task Force recommends that adults should only be screened for depression when there is staff-assisted care and support available to make an accurate diagnosis, offer effective treatment and provide follow-up care
Which of the following distinguishes conduct disorder from oppositional defiant disorder? Angry and resentful Argues with adults Deliberately trying to annoy someone Physical aggression towards others
D-Physical aggression towards others Conduct disorder is characterized by a persistent pattern of serious rule-violating behavior, including behaviors that harm (or have the potential to harm) others. The patient with conduct disorder typically shows little concern for the rights or needs of others. Question: What is the primary evidence-based treatment for youths with conduct disorder? Answer: Social competence training, parent and family skills training, medications, academic engagement and skills building, and school interventions.
A wife is upset about how her husband has behaved after receiving a new diagnosis of terminal lung cancer. He has spent the last few days on the internet feverishly looking up his old girlfriends in an attempt to find phone numbers and call them. He has only slept a few hours in this time period, and has eaten only pretzels and soda. When the wife is finally able to get his attention, she asked him what he was doing, to which he responded "I feel great, so I thought I'd catch up with some old friends." He does not meet diagnostic criteria for a manic episode, and has no history of bipolar disorder. You suspect he may be in which stage of the Kubler-Ross grief reaction? Anger Bargaining Catastrophizing Denial
D-Denial Grief Reaction Stages: denial, anger, bargaining, depression, acceptance Nonpathologic symptoms: guilt, weight loss, simple hallucinations Pathologic symptoms: >12 months, severe functional impairment, suicidal ideation, psychotic symptoms
A 54-year-old man with chronic alcohol abuse presents with confusion and visual hallucinations. Vital signs are HR 113, BP 164/95, finger stick blood glucose 113, and T 100.5°F. Physical examination reveals a disheveled man with tremors, tongue fasciculations, and agitation. What management should be pursued? Admission to psychiatry for management Cyproheptadine Dantrolene Diazepam
D-Diazepam Ethanol Withdrawal: Autonomic hyperactivity (↑ HR, ↑ BP, diaphoresis) Visual, tactile hallucinations Seizures Delirium tremens: autonomic hyperactivity, psychosis, peaks 2-5 days after cessation Tremulousness → hallucinations → seizures → delirium tremens Rx: BZDs
A 29-year-old woman presents to her annual visit for routine screening and diagnostic tests. She is up to date on her Papanicolaou test and her vaccines. She has no significant medical or family history and has been married to her husband for 8 years. Which one of the following supplementations should be advised for this patient? Aspirin for coronary artery disease prevention Aspirin for stroke prevention Calcium Folic acid
D-Folic acid all women planning or capable of pregnancy should take a daily supplement containing 0.4-0.8 mg of folic acid.
A 30-year-old woman presents to her family physician for her annual exam. Her last Papanicolaou test with HPV co-testing was 4 years ago. She has 2 children and underwent a bilateral tubal ligation with her last cesarean section. She does not smoke or have any significant past medical history. Her mother died of breast cancer at age 45. Her aunt was treated with chemotherapy and surgery for ovarian cancer. Which of the following prevention measures or diagnostic studies should this patient initially undergo? BRCA screening Genetic counseling National Cancer Institute Breast Cancer Risk Assessment Tool Ontario Family History Assessment Tool
D-Ontario Family History Assessment Tool Question: Which medications are considered risk-reducing medications for women who are at an increased risk of breast cancer? Answer: Tamoxifen & raloxifene. Inclusion criteria: Women who are asymptomatic, > 35 years old, and who are at increased risk of breast cancer, negative history for DVT and low risk for adverse medication side effects.
The parents of a 7-year-old boy ask you to evaluate him because of increasing concerns about his temper tantrums over the past 9 months. He becomes angry and hostile, argues constantly, and refuses to follow rules or directions. The boy often becomes aggressive and destructive, breaking his toys and sweeping his dinner plate and glass of milk onto the floor. The parents believe that their son is deliberately behaving this way to annoy them. This history is most consistent with which one of the following? Antisocial personality disorder Bipolar disorder Conduct disorder Oppositional defiant disorder
D-Oppositional defiant disorder a pattern of negative, hostile, and defiant behavior lasting at least 6 months Question: Antisocial personality disorder is part of which cluster group? Answer: Cluster B.
An 18-year-old woman complains of heart palpitations, diaphoresis, nausea, shaking of her whole body along with a choking sensation. These symptoms have occurred 3-4 times per week for the last 2 weeks. She states that the symptoms are most common shortly before going to bed and begin suddenly peaking in 10 minutes and eventually spontaneously resolving. These symptoms are accompanied with the intense fear that she is going to die. Which of the following is the most likely diagnosis? Angina Bipolar disorder Generalized anxiety disorder Panic attack
D-Panic attack Panic attacks are discrete periods of intense fear in the absence of real danger, accompanied by at least 4 of 13 cognitive and physical symptoms. The attacks have a sudden onset, build to a peak quickly, and are often accompanied by feelings of doom
A 56-year-old widow comes to the physician at the request of her daughter. The patient's husband passed away unexpectedly 14 months ago from a heart attack. She tells you that she has been having a very difficult time since her husband's death. She hasn't been sleeping well because she can't get used to sleeping alone. She no longer enjoys going over to her daughter's house and finds interacting with her grandchildren too tiresome. She says she keeps thinking about the day her husband died and feels guilty about not being able to get him to the hospital sooner. She denies any plans to hurt herself, but does say she wonders if she'd be better off if she could join her husband. Which of the following diagnoses is most appropriate? Acute stress disorder Major depressive disorder Normal grief Persistent complex bereavement disorder
D-Persistent complex bereavement disorder Not only do symptoms persist beyond 12 months, but they are generally severe in nature and interfere with daily functioning. Also called complicated grief disorder
A previously healthy 10-year-old girl presents to your office with a complaint of repetitive, intermittent shoulder shrugging that began one year ago. She says that she can sense when the movement is going to occur, then feels relief after doing it. Her mother says that her daughter is becoming more socially withdrawn because she is embarrassed about these movements. She denies any other complaints. Which of the following is the most appropriate therapy? Clonidine Fluoxetine Methylphenidate Pimozide
D-Pimozide Tourette syndrome presents generally before age 11. Clinical manifestations of TS include motor or vocal tics. Tics may be treated with antidopaminergic medications such as pimozide Question: True or false: most tics in patients with Tourette syndrome resolve by age 18? Answer: True.
A 55-year-old man with COPD presents to his primary care physician. He has a 20 pack-year smoking history and requests a prescription for smoking cessation. His last colonoscopy was five years ago and he received the influenza vaccine earlier this year. Which of the following should also be offered to the patient? Abdominal aortic ultrasound Colonoscopy Influenza vaccine Pneumococcal vaccine
D-Pneumococcal vaccine Pneumococcal vaccine is recommended for all adults aged 65 or older. Patients aged 2 years or older who are immunocompromised or who have chronic diseases should also receive the pneumococcal vaccine
A 16-year-old girl presents to the ED via ambulance for general pain. She is a refugee from a conflict area who is known to have frequent nighttime visits to the ED over the past year for the same chief complaint. She's undergone multiple medical workups that have all been negative. In the ED she appears angry, irritable, and demonstrates hypervigilance. After a brief conversation with the patient her pain resolves and she feels much better. Which of the following is the most likely diagnosis? Adjustment disorder Borderline personality disorder Malingering Posttraumatic stress disorder
D-Posttraumatic stress disorder Posttraumatic stress disorder (PTSD) is a long-lasting anxiety response following a traumatic or catastrophic event. patients having difficulty falling or staying asleep, problems with concentration, hypervigilance, irritability, angry outbursts, and increased startle response.
Which of the following is considered a negative symptom of schizophrenia? Delusions Disorganized speech Hallucinations Poverty of speech
D-Poverty of speech Negative symptoms in schizophrenia include alogia or poverty of speech, avolition or lack of purposeful action and affective flattening or decreased emotional reactivity Positive symptoms may include: delusions (A), disorganized speech (B), hallucinations (C),
A 21-year old woman sees you because of a depressed mood since the birth of her son 2 months ago. She is breastfeeding, and her baby is doing well. She denies any suicidal or homicidal ideation and has never had thoughts about hurting the baby. She has a history of depression 2 years ago that was associated with starting college. She began taking sertraline, changed her schedule, and spent more time exercising. Within 6 months her depression resolved and she stopped the medication. She reports this current depression feels worse than her previous depression. Which one of the following would be the most appropriate medication for this patient? Amitriptyline Diazepam Phenytoin Sertraline
D-Sertraline Selective serotonin reuptake inhibitors such as sertraline are the most commonly used medications for postpartum depression. They have fewer side effects and are considered safer than tricyclic antidepressants, especially in depressed women. In one study, infant serum levels of sertraline and paroxetine were undetectable.
A mother brings her 12-month-old daughter for routine vaccinations. She is up to date with her vaccinations. The girl has a history of a simple febrile seizure at 10 months of age and has a history of respiratory distress after eating eggs. She lives with her parents and her paternal grandmother who is currently undergoing chemotherapy for breast cancer. Because of anxiety of her daughter getting a fever and a febrile seizure, the patient's mother would like to spread out her vaccines. Today she would like her daughter to get the varicella vaccine. She would like to bring the patient back to the office in 2 weeks to get her measles-mumps-rubella (MMR) vaccine but you explain this is contraindicated. Why can the patient not get the MMR vaccine then? Her risk of vaccine-induced seizure She has an anaphylactic egg allergy She is living with an immunosuppressed family member She must wait 4 weeks between live vaccines
D-She must wait 4 weeks between live vaccines Live vaccines include the varicella vaccine, the MMR vaccine, the intranasal influenza vaccine, the rotavirus vaccine, the yellow fever vaccine, the BCG vaccine, the typhoid vaccine, the rabies vaccine, and the oral polio vaccine. Live vaccines must replicate to cause an immune response. Antibodies developed after the first live vaccine can interfere with viral replication of the subsequent vaccine if live vaccines are given apart are given too close together. Question: What are contraindications to getting rotavirus? Answer: History of intussusception, weakened immune system, or life-threatening reactions to prior doses of the vaccine.
Which of the following conditions should prompt administration of the meningococcal vaccine prior to the standard 11 years of age? Cystic fibrosis Diabetes mellitus Hypoplastic left heart Sickle cell anemia
D-Sickle cell anemia Children with sickle cell anemia (D) who no longer have a functional spleen should receive the meningococcal vaccine. Patients with sickle cell anemia are at high risk of developing functional or anatomical asplenia due to splenic infarction from vascular occlusion by defective red blood cells. Autosplenectomy dramatically increases the risk of serious infections from encapsulated organisms including Neisseria meningitides, Streptococcus pneumoniae and Haemophilus influenzae.
A 27-year-old woman presents to your office with complaints of pain and discomfort. She tells you that she has seen numerous doctors and none of them have been able to help her. Her symptoms today include nausea, gluten sensitivity, irregular menses, weakness in her legs, headache, dysuria, dyspareunia, and back pain. She would like you to do a CT scan to determine the cause of her complaints. Which of the following is the most likely diagnosis? Chronic pain syndrome Factitious disorder Munchausen's syndrome Somatization disorder
D-Somatization disorder Somatoform Disorders Genuine sx with no identifiable cause F > M Conversion disorder: sudden loss of sensory or motor function Hypochondriasis: Preoccupation with having illness Pain disorder Somatization disorder: many complaints in ≥ 1 organ systems Rx: Reassurance, minimize providers
A 28-year-old man presents to the emergency department by ambulance. His family called for help after finding him unresponsive at home with a syringe on the floor beside him. His blood pressure is 120/78 mm Hg, pulse 95/min, and respirations are 6/min and shallow. On physical exam he is non-responsive to questions, his skin is cool with cyanosis, and his pupils are minimally reactive to light and constricted. Which of the following is the most appropriate next step in management? Administer naloxone Administer sodium bicarbonate Place a nasogastric tube and administer activated charcoal Support airway and breathing
D-Support airway and breathing ABC's Question: What medication is commonly used for maintenance therapy for opiate use disorder? Answer: Methadone.
A 23-year-old man with a history of opiate abuse presents with tachycardia, hypertension and mydriasis. Which of the following is true regarding management? Antiemetics should be witheld as they may cause serious side effects Consider ICU admission for the potential for symptoms to worsen Naloxone should be given Symptom control may be achieved with clonidine
D-Symptom control may be achieved with clonidine This patient presents with opiate withdrawal and management should focus on the relief of symptoms.Opiate withdrawal is not life-threatening. Supportive and symptomatic care can decrease the patient's discomfort. Clonidine has been used to mitigate symptoms as have antiemetics. Question: What is the duration of action for naloxone? Answer: Naloxone will reverse opiate effects for 1-2 hours.
Which of the following vaccines does the Centers for Disease Control and Prevention consider safe for administration during pregnancy? HPV (human papillomavirus) LAIV (live, attenuated influenza vaccine) MMR (measles, mumps, rubella) Tdap (tetanus, diphtheria, pertussis)
D-Tdap (tetanus, diphtheria, pertussis) and the vaccine is considered safe at any point in pregnancy. Question: True or False: Varicella vaccination is contraindicated in pregnancy? Answer: True.
A 58-year old postmenopausal woman presents with painless vaginal bleeding. Her last menses occurred 5 years ago. She reports that her Papanikolaou smears have always been normal; the last one was obtained a year ago. Which of the following is the next step in management? Colposcopy with endocervical curettage Hysteroscopy Repeat Papanikolaou smear Transvaginal ultrasound
D-Transvaginal ultrasound An endometrial thickness less than 3-4 mm excludes most endometrial pathology in women with postmenopausal vaginal bleeding. A transvaginal ultrasound can identify other causes of vaginal bleeding such as polyps and fibroids Question: What is the most common type of endometrial carcinoma? Answer: Adenocarcinoma.
A nine-month-old girl is seen in clinic for a routine child visit. She is able to pull to stand, plays peek-a-boo, copies sounds and gestures of others, and clingy with parents. She eats cereal and table food. You discuss car seat safety with her parents. Which of the following is the best advice would you give her parents? Front seat is much safer than the rear seat for children Frontal airbags appear to offer good protection to children in crashes Side airbags do not pose a risk for children who are in the front seat Use of child restraint devices can be expected to reduce fatalities by 71%
D-Use of child restraint devices can be expected to reduce fatalities by 71% Question: What type of injury is most commonly involved in bicycle accidents? Answer: Head trauma
A patient with schizophrenia is starting treatment with clozapine. Which of the following needs to be monitored weekly? Electrocardiogram Fasting plasma glucose Hemoglobin and hematocrit White blood cell and absolute neutrophil count
D-White blood cell and absolute neutrophil count clozapine involves a risk of life-threatening agranulocytosis, therefore regular monitoring of white blood cell and absolute neutrophil count (ANC) is required
A 60-year-old man who has a 20-pack-year smoking history presents to his pulmonologist for an evaluation of his COPD. He recently quit smoking 5 years ago and underwent a colonoscopy 8 years ago. He received his pneumococcal vaccine four years ago and his influenza vaccine this year. Which of the following should be offered to this patient? A second dose of the pneumococcal vaccine Annual screening for lung cancer with low-dose computed tomography scan Tuberculin skin testing Zoster vaccine
D-Zoster vaccine A single dose of the zoster vaccine is recommended for adults aged 60 regardless of whether they report a previous episode of herpes zoster. What is the first-line treatment for an immunocompetent adult with Herpes zoster? Answer: Famciclovir or Valacyclovir.
A 65-year-old woman with Crohn's disease that is well controlled on infliximab presents to her primary care physician. As you are updating her immunization status, which one of the following should be noted? Hepatitis A vaccine is contraindicated Pneumococcal vaccine is contraindicated Tetanus toxoid is contraindicated Zoster vaccine is contraindicated
D-Zoster vaccine is contraindicated The varicella zoster vaccine is a live attenuated vaccine and therefore is contraindicated in this patient due to her immunocompromised state. Bonus Question: What is the antibody associated with Crohn's disease? Answer: ASCA is present in 60-70% of patients with Crohn's disease.
