psychiatry 2024

A 65-year-old retired steelworker who has never had any sexual dysfunction experiences difficulty in obtaining and maintaining an erection shortly after he starts taking a medication prescribed by his primary care physician. Which of the following medications is most likely to cause such a side effect? [ ] Propranolol [ ] Amoxicillin [ ] Lorazepam [ ] Bupropion [ ] Thyroid hormones

[X] Propranolol

A 72-year-old woman is admitted to the burn unit with second- and third-degree burns covering 35% of her body, which she received in a house fire. At 8 pm on the fourth day of her hospital stay, she pulls out her IV and begins screaming that people are trying to hurt her. Several hours later she is found to be difficult to arouse and disoriented. Which of the following is the most likely diagnosis? [ ] Emergence of an underlying dementia [ ] Brief reactive psychosis [ ] Acute manic episode [ ] Delirium [ ] Acute stress disorder

Delirium

A 65-year-old retired steelworker who has never had any sexual dysfunction experiences difficulty in obtaining and maintaining an erection shortly after he starts taking a medication prescribed by his primary care physician. Which of the following medications is most likely to cause such a side effect? [ ] Propranolol [ ] Amoxicillin [ ] Lorazepam [ ] Bupropion [ ] Thyroid hormones

[X] Propranolol

Which of the following is the most common cause of delirium in the elderly? [ ] Substance abuse [ ] Accidental poisoning [ ] Hypoxia [ ] Use of multiple medications [ ] Alcohol withdrawal

[X] Use of multiple medications

A 72-year-old man with a long history of recurrent psychotic depres- sion is hospitalized during a relapse. He has prostatic hypertrophy, coro- nary heart disease, and recurrent orthostatic hypotension. Which of the following is the most appropriate antipsychotic medication for this patient? [ ] Chlorpromazin [ ] Clozapine [ ] Thioridazine [ ] Haloperidol [ ] Olanzapine

] Haloperidol

A 5-year-old boy is brought to the psychiatrist because he has diffi- culty paying attention in school. He fidgets and squirms and will not stay seated in class. It is noted that at home he talks excessively and has diffi- culty waiting for his turn. His language and motor skills are appropriate for his age. Which of the following is the most likely diagnosis? [ ] A Oppositional defiant disorder (ODD) [ ] B Attention-deficit hyperactivity disorder (ADHD) [ ] C Pervasive developmental disorder [ ] D Separation anxiety disorder [ ] E Mild mental retardation

[ ] B Attention-deficit hyperactivity disorder (ADHD)

A 28-year-old taxi driver is chronically consumed by fears of having accidentally run over a pedestrian. Although he tries to convince himself that his worries are silly, his anxiety continues to mount until he drives back to the scene of the "accident" and proves to himself that nobody lies hurt in the street. This behavior best exemplifies which of the following? [ ] A compulsion secondary to an obsession [ ] An obsession triggered by a compulsion [ ] A delusional ideation [ ] A typical manifestation of obsessive-compulsive personality disorder [ ] phobia

[ ] A compulsion secondary to an obsession

A 72-year-old man develops acute urinary retention and blurred vision after taking an antidepressant for 3 days. Which of the following medications is most likely to cause such side effects? [ ] Venlafaxine [ ] Paroxetine [ ] Bupropion [ ] Nefazodone [ ] Amitriptyline

[ ] Amitriptyline

A 24-year-old woman is hospitalized after a suicide gesture during which she superficially slashed both her wrists. At the team meeting 3 days later, the male resident argues that the patient has been doing quite well, seems to be responding to therapy, and should be allowed to leave on a pass. The nursing staff angrily argues that the resident is showing favoritism to the patient, and because of her poor compliance with the unit rules, she should not be allowed out. The resident insists the nurses are being punitive. The defense mechanism being used by the patient in this scenario is a feature of which of the following personality disorders? [ ] Narcistic [ ] Histrionic [ ] Borderline [ ] Anticsocial [ ] dependent

[ ] Borderline

A 20-year-old woman is brought to the emergency room by her fam- ily because they have been unable to get her to eat or drink anything for the past 2 days. The patient, although awake, is completely unresponsive both vocally and nonverbally. She actively resists any attempt to be moved. Her family reports that during the previous 7 months she became increasingly withdrawn, socially isolated, and bizarre; often speaking to people no one else could see. Which of the following is the most likely diagnosis? [ ] Schizoaffective disorder [ ] Delusional disorder [ ] Schizophreniform disorder [ ] Catatonia [ ] PCP intoxication

[ ] Catatonia

A 29-year-old man is brought to the hospital because he was found running around on the streets with no shoes on in the middle of winter, screaming to everyone that he was going to be elected president. Upon admission to the hospital, he was stabilized on olanzapine and lithium and then discharged home. Assuming the patient is maintained on the olanza- pine and the lithium, which of the following tests should be performed at least once per year? [ ] mri of the brain [ ] liver function test [ ] Creatinin [ ] Rectal exam to look for the presence of blood in the stool [ ] ecg

[ ] Creatinin

spm 18 del 1: A 36-year-old woman is brought to the psychiatrist by her husband because for the past 8 months she has refused to go out of the house, believing that the neighbors are trying to harm her.

[ ] Delusional disorder

spm 18 del 2: She is afraid that if they see her they will hurt her, and she finds many small bits of evidence to support this. This evidence includes the neighbors' leaving their garbage cans out on the street to try to trip her, parking their cars in their driveways so they can hide behind them and spy on her, and walking by her house to try to get a look into where she is hiding. She states that her mood is fine and would be "better if they would leave me alone." She denies hearing the neighbors or anyone else talk to her, but is sure that they are out to "cause her death and mayhem." Which of the following is the most likely diagnosis? . [ ] Delusional disorder [ ] Schizophreniform disorder [ ] Schizoaffective disorder [ ] Schizophrenia [ ] . Major depression with psychotic features

[ ] Delusional disorder

A young woman, who has a very limited memory of her childhood years but knows that she was removed from her parents because of their abuse and neglect, frequently cannot account for hours or even days of her life. She hears voices that alternately plead, reprimand, or simply comment on what she is doing. Occasionally, she does not remember how and when she arrived at a specific location. She finds clothes she does not like in her closet, and she does not remember having bought them. Her friends are puzzled because sometimes she acts in a childish dependent way and at other times becomes uncharacteristically aggressive and controlling. These symptoms are most commonly seen in which of the following disorders? [ ] Dissociative amnesia [ ] Korsakoff dementia [ ] Depersonalization disorder [ ] Dissociative identity disorde [ ] Schizophrenia

[ ] Dissociative identity disorde

A 14-year-old boy is brought to the psychiatrist because for the past 15 months he has been irritable and depressed almost constantly. The boy notes that he has difficulty concentrating, and he has lost 5 lb during that time period without trying. He states that he feels as if he has always been depressed, and he feels hopeless about ever feeling better. He denies suici- dal ideation or hallucinations. He is sleeping well and doing well in school, though his teachers have noticed that he does not seem to be able to con- centrate as well as he had previously. Which of the following is the most likely diagnosis? [ ] Major depression [ ] Dysthymic disorder [ ] Mood disorder secondary to a general medical condition [ ] Normal adolescence [ ] cyclothymia

[ ] Dysthymic disorder

. A 19-year-old man is brought to the emergency room by his dis- traught parents, who are worried about his vomiting and profuse diarrhea. On arrival, his pupils are dilated, his blood pressure is 175/105 mm Hg, and his muscles are twitching. His parents report that these symptoms started 2 hours earlier. For the past few days he has been homebound because of a sprained ankle, and during this time he has been increasingly anxious and restless. He has been yawning incessantly and has had a runny nose. Which of the following drugs is this man most likely to be with- drawing from? [ ] Heroin [ ] Alk [ ] PCP [ ] Benzo

[ ] Heroin

A middle-aged man is chronically preoccupied with his health. For many years he feared that his irregular bowel functions meant he had can- cer. Now he is very worried about having a serious heart disease, despite his physician's assurance that the occasional "extra beats" he detects when he checks his pulse are completely benign. Which of the following is the most likely diagnosis? [ ] Somatization disorder [ ] Hypochondriasis [ ] Delusional disorder [ ] pain disorder [ ] conversion disorder

[ ] Hypochondriasis

A 42-year-old man comes to the emergency room with the chief com- plaint that "the men are following me." He also complains of hearing a voice telling him to hurt others. He tells the examiner that the news anchorman gives him special messages about the state of the world every night through the TV. Which of the following psychiatric findings best describes this last belief of the patient? [ ] Grandiose delusion [ ] b. Illusion [ ] Loose association [ ] Idea of reference [ ] Clouding of consciousness

[ ] Idea of reference

A 23-year-old woman arrives at the emergency room complaining that, out of the blue, she had been seized by an overwhelming fear, associated with shortness of breath and a pounding heart. These symptoms lasted for approximately 20 minutes, and while she was experiencing them, she feared that she was dying or going crazy. The patient has had four similar episodes during the past month, and she has been worrying that they will continue to recur. Which of the following is the most likely diagnosis? [ ] Acute psychotic episode [ ] Hypochondriasis [ ] Panic disorder [ ] Generalized anxiety disorder [ ] Posttraumatic stress disorder

[X] Panic disorder

A 24-year-old woman comes to the emergency room with the chief complaint that "my stomach is rotting out from the inside." She states that for the last 6 months she has been crying on a daily basis and that she has decreased concentration, energy, and interest in her usual hobbies. She has lost 25 lb during that time. She cannot get to sleep, and when she does, she wakes up early in the morning. For the past 3 weeks, she has become con- vinced that she is dying of cancer and is rotting on the inside of her body. Also, in the past 2 weeks she has been hearing a voice calling her name when no one is around. Which of the following is the most likely diagnosis? [ ] Delusional disorder [ ] Schizoaffective disorder [ ] Schizophreniform disorder [ ] Schizophrenia [ ] Major depression with psychotic features

[ ] Major depression with psychotic features

.An elderly man has been profoundly depressed for several weeks. He cries easily and is intensely preoccupied with trivial episodes from his past, which he considers unforgivable sins. This patient awakens every morning at 3 AM and cannot go back to sleep. Anything his family has tried to cheer him up has failed. He has completely lost his appetite and appears gaunt and emaciated. [ ] Melancholic depression [ ] ?

[ ] Melancholic depression

A 23-year-old woman arrives at the emergency room complaining that, out of the blue, she had been seized by an overwhelming fear, associ- ated with shortness of breath and a pounding heart. These symptoms lasted for approximately 20 minutes, and while she was experiencing them, she feared that she was dying or going crazy. The patient has had four similar episodes during the past month, and she has been worrying that they will continue to recur. Which of the following is the most likely diagnosis? [ ] Acute psychotic episode [ ] Hypochondriasis [ ] Panic disorder [ ] Generalized anxiety disorder [ ] Posttraumatic stress disorder

[ ] Panic disorder

A29-year-oldwomanwithapreviousdiagnosisofbipolardisorderis hospitalized during an acute manic episode. She is elated, sexually provocative, and speaks very fast, jumping from one subject to another. She tells the nurses that she has been chosen by God to be "the second vir- gin Mary." BUN, creatinine, electrolytes, TSH, and an ECG are within nor- mal limits. What other test is necessary before starting the patient on lithium? [ ] Pregnancy test [ ] total bilirubin [ ] EEG [ ] Iron-binding capacity [ ] Chest x-ray

[ ] Pregnancy test

A 65-year-old retired steelworker who has never had any sexual dysfunction experiences difficulty in obtaining and maintaining an erection shortly after he starts taking a medication prescribed by his primary care physician. Which of the following medications is most likely to cause such a side effect? [ ] Propranolol [ ] Amoxicillin [ ] lorazepam [ ] bupropion [ ] thyroid hormones

[ ] Propranolol

spm 26 del 1: A 21-year-old man is brought to the emergency room by his parents because he has not slept, bathed, or eaten in the past 3 days. The parents report that for the past 6 months their son has been acting strangely and "not himself." They state that he has been locking himself in his room, talk- ing to himself, and writing on the walls. Six weeks prior to the emergency room visit, their son became convinced that a fellow student was stealing his thoughts and making him unable to learn his school material. In the past 2 weeks, they have noticed that their son has become depressed and has stopped taking care of himself, including bathing, eating, and getting dressed.

[ ] Schizoaffective disorder

spm 26 del 2:On examination, the patient is dirty, disheveled, and crying. He complains of not being able to concentrate, a low energy level, and feeling suicidal. Which of the following is the most likely diagnosis for this patient? [ ] Schizoaffective disorder [ ] schizophrenia [ ] bipolar I disoder [ ] schizoid personality disorder [ ] delusional disorder

[ ] Schizoaffective disorder

Every morning on school days, an 8-year-old girl becomes tearful and distressed and claims she feels sick. Once in school, she often goes to the nurse, complaining of headaches and stomach pains. At least once a week, she misses school or is picked up early by her mother due to her complaints. Her pediatrician has ruled out organic causes for the physical symptoms. The child is usually symptom free on weekends, unless her par- ents go out and leave her with a babysitter. Which of the following is the most likely diagnosis? [ ] Separation anxiety disorder [ ] major depression [ ] somatization disorder [ ] generalized anxietx disorder [ ] attachment disorder

[ ] Separation anxiety disorder / mahin

A 34-year-old secretary climbs 12 flights of stairs every day to reach her office because she is terrified by the thought of being trapped in the elevator. She has never had any traumatic event occur in an elevator; nonetheless, she has been terrified of them since childhood. Which of the following is the most likely diagnosis? [ ] Social phobia [ ] Performance anxiety [ ] Generalized anxiety disorder [ ] Specific phobia [ ] Agoraphobia

[ ] Specific phobia

A 56-year-old woman who was diagnosed with paranoid schizo- phrenia in her early twenties has received daily doses of various typical neuroleptics for many years. For the past 2 years, she has had symptoms of tardive dyskinesia. Discontinuation of the neuroleptic is not possible because she becomes aggressive and violent in response to command hal- lucinations when she is not medicated. Which of the following actions should be taken next? [ ] Start the patient on benztropine [ ] Start the patient on amantadine [ ] Start the patient on propranolol [ ] Start the patient on diphenhydramine [ ] Switch the patient to clozapine

[ ] Switch the patient to clozapine

A 54-year-old man with a chronic mental illness seems to be con- stantly chewing. He does not wear dentures. His tongue darts in and out of his mouth, and he occasionally smacks his lips. He also grimaces, frowns, and blinks excessively. Which of the following disorders is most likely in this patient? [ ] Tourette syndrome [ ] Akathisia [ ] Tardive dyskinesia [ ] Parkinson disease [ ] Huntington disease

[ ] Tardive dyskinesia

A 29-year-old woman with a previous diagnosis of bipolar disorder is hospitalized during an acute manic episode. She is elated, sexually provocative, and speaks very fast, jumping from one subject to another. She tells the nurses that she has been chosen by God to be "the second virgin Mary." BUN, creatinine, electrolytes, TSH, and an ECG are within normal limits. What other test is necessary before starting the patient on lithium? [ ] Pregnancy test [ ] Total bilirubin [ ] EEG [ ] Iron-binding capacity [ ] Chest x-ray

[X] Pregnancy test

A 20-year-old man is admitted to the emergency department after an automobile accident, in which his friend drove their car into a light pole. In the emergency department, the man smells strongly of alcohol, and his blood alcohol level is 300 mg/dL. However, he does not show any typical signs of intoxication. His gait is steady, his speech is clear, and he does not appear emotionally disinhibited. Which of the following is the most likely explanation for such a presentation? [ ] The adrenaline generated in the patient because of the effects of the car crash has counteracted the alcohol in his system. [ ] A value of 300 mg/dL is below the intoxication level. [ ] The man has developed a tolerance to the effects of alcohol. [ ] There has been a laboratory error. [ ] The man has recently used cocaine, whose effects counteract the effects of alco- hol intoxication.

[ ] The man has developed a tolerance to the effects of alcohol.

37-year-old alcoholic is brought to the emergency room after he was found unconscious in the street. He is hospitalized for dehydration and pneumonia. While being treated, he becomes acutely confused and agitated. He cannot move his eyes upward or to the right, and he is ataxic. Which of the following is the most likely diagnosis? [ ] Alcohol intoxication [ ] Korsakoff syndrome [ ] Alcohol delirium [ ] Wernicke encephalopathy [ ] Alcohol seizures

[ ] Wernicke encephalopathy

. A 32-year-old woman is brought to the emergency room by the police after she was found standing in the middle of a busy highway, naked, commanding the traffic to stop. In the emergency room she is agitated and restless, with pressured speech and an affect that alternates between euphoric and irritable. Her father is contacted and states that this kind of behavior runs in the family. Which of the following is the most likely diagnosis? [ ] Delirium [ ] bipolar disorder, manic [ ] bipolar disorder, misxed state [ ] cyclothymia [ ] schizophrenia

[ ] bipolar disorder, manic

A demanding 25-year-old woman begins psychotherapy stating that she is both desperate and bored. She reports that for the past 5 or 6 years she has experienced periodic anxiety and depression and has made several suicidal gestures. She also reports a variety of impulsive and self-defeating behaviors and sexual promiscuity. She wonders if she might be a lesbian, though most of her sexual experiences have been with men. She has abruptly terminated two previous attempts at psychotherapy. In both cases she was enraged at the therapist because he was unwilling to prescribe anx- iolytic medications. Which of the following is the most likely diagnosis? [ ] Dsythymia [ ] Histrionic personality disorder [ ] borderline personality disorder [ ] Impulse control disorder, not otherwise specified [ ] Antisocial personality disorder

[ ] borderline personality disorder

A 72-year-old woman is admitted to the burn unit with second- and third-degree burns covering 35% of her body, which she received in a house fire. At 8 pm on the fourth day of her hospital stay, she pulls out her IV and begins screaming that people are trying to hurt her. Several hours later she is found to be difficult to arouse and disoriented. Which of the fol- lowing is the most likely diagnosis? [ ] Emergence of an underlying dementia [ ] Brief reactive psychosis [ ] delirium [ ] acute stress disorder [ ] acute manic disorder

[ ] delirium

A 35 years-old man stumbles into the emergency room. His plus is 100 beats per minute, his blood pressure is 170/95 mmHg, and he is diaphoretic. He is tremulous and has difficulty relating a history. He does admit insomnia the past two nights and sees spiders walking on the wall. He has been a drinker since 19, but has not had a drink in three days. Which of the following is the most likely? [ ] Alcohol-induced psychotic disorder [ ] Wernicke's psychosis [ ] Alcohol withdrawal delirium [ ] Alcohol intoxication [ ] Alcohol idiosyncratic intoxication

[X] Alcohol withdrawal delirium

A 5-year-old boy is brought to the psychiatrist because he has difficulty paying attention in school. He fidgets and squirms and will not stay seated in class. It is noted that at home he talks excessively and has difficulty waiting for his turn. His language and motor skills are appropriate for his age. Which of the following is the most likely diagnosis? [ ] Oppositional defiant disorder (ODD) [ ] Attention-deficit hyperactivity disorder (ADHD) [ ] Pervasive developmental disorder [ ] Separation anxiety disorder [ ] Mild mental retardation

[X] Attention-deficit hyperactivity disorder (ADHD)

A 20-year-old woman is brought to the emergency room by her family because they have been unable to get her to eat or drink anything for the past 2 days. The patient, although awake, is completely unresponsive both vocally and nonverbally. She actively resists any attempt to be moved. Her family reports that during the previous 7 months she became increasingly withdrawn, socially isolated, and bizarre; often speaking to people no one else could see. Which of the following is the most likely diagnosis? [ ] Schizoaffective disorder [ ] Delusional disorder [ ] Schizophreniform disorder [ ] Catatonia [ ] PCP intoxication

[X] Catatonia

A 25-year-old woman is dropped on the doorstep of a local emergency room by two men who immediately leave by car. She is agitated and anxious, and she keeps brushing her arms and legs "to get rid of the bugs." She clutches at her chest, moaning in pain. Her pupils are wide, and her blood pressure is elevated. Which of the following substances is she most likely using? [ ] Alcohol [ ] Heroin [ ] Alprazolam [ ] LSD [ ] Cocaine

[X] Cocaine

The benzodiazepines' action depends on their interaction with which of the following receptors? [ ] GABA [ ] Serotonin [ ] NMDA-glutamate [ ] Dopamine [ ] Acetylcholine

[X] GABA

A 72-year-old man with a long history of recurrent psychotic depression is hospitalized during a relapse. He has prostatic hypertrophy, coronary heart disease, and recurrent orthostatic hypotension. Which of the following is the most appropriate antipsychotic medication for this patient? [ ] Chlorpromazine [ ] Clozapine [ ] Thioridazine [ ] Haloperidol [ ] Olanzapine

[X] Haloperidol

An 18-year-old man is brought to the emergency room by police after he is found wandering in the street, screaming loudly at passersby. In the emergency room he is placed in an examination room, and paces the floor and pounds his fist against the door repeatedly. Which of the following actions should be taken by the psychiatrist first? [ ] Rule out an organic mental disorder [ ] Rule out psychosis [ ] Give the patient 5 mg of haloperidol IM [ ] Make sure the physical environment is safe for the interviewer [ ] Put the patient into soft restraints

[X] Make sure the physical environment is safe for the interviewer