behavioral health final
75%
Individual with Autism / Pervasive developmental disorder have mental retardation approximately what percent of the time?
anxiety disorders can result in initial insomnia, early awakening, and a sense of non-restful/non-refreshing sleep. T or F
True
bipolar disorder (SSRI can induce manic episode)
failure to get family history can result in tx that dramatically exacerbates what?
what is a pathognomonic sign of child abuse?
forced immersion burn patterns
phobia
freshman with history of fear of blood. she tells you it is irrational to have this fear but she avoids classes and situations with blood, dx?
severity and duration of symptoms
how is cyclothymic disorder distinguished from bipolar disorder?
anhedonia
in addition to memory impairment, each of the following may provide evidence of dementia EXCEPT
hallucinations
in distinguishing delirium from dementia, each of the following characteristics of delirium may be useful EXCEPT
Alzheimer's disease
individuals with down's syndrome have a high incidence of which of the following?
escherichia coli in the urinary tract
infectious etiologies associated with dementia include each of the following EXCEPT
feeding them a rigid structural diet
all the following are elements of elderly abuse and mistreatment EXCEPT
inform the mother that you are required by law to report any possible child abuse
1 yr old boy is brought to the ED for evaluation of a loss of consciousness after a fall. the child is currently awake and alert with no neurologic deficits, but has multiple bruises in various stages of healing. the mother states the child is rather clumsy. what is the most appropriate course of action?
calculation/assessment of BMI
16 y/o female is brought to the provider by her mother, who states that her daughter has been steadily losing weight. the adolescent denies there is a problem and states that she is in no way underweight. the provider determines that the patient is 5'6" and weighs 90lbs. which of the following would be the next best step?
anorexia nervosa
16 y/o girl is brought to the clinic by her mother. her mother says that her daughter has not been eating well in the last few months. she has been skipping at least 1 meal per day and has constantly been losing weight; however, she continues to exercise rigorously every day. she has amenorrhea for the past 4 months. on physical exam, the patient has dry skin, lanugo, parotid gland enlargement, and dental enamel erosion. BMI is 16. question: what is the most likely diagnosis?
bulimia nervosa
17 y/o female who is 5'2" and 135lbs (unchanged from last visit) is seen in your office for frequent use of antacids and weakness. her mother is concerned because she can hear her daughter in her locked bathroom sometimes vomiting after she eats a large meal. she also has found empty bottles of laxatives. she fears she may have an ulcer. she is a popular cheerleader at school who is a little heavier than the rest of the girls on the squad. you examine the girl and find the following: erosion of the enamel on her teeth, a rapid irregular, irregular pulse, decreased deep tendon reflexes, and a generalized muscle weakness. the labs you draw come back with potassium of 2.5. her other electrolytes are also abnormal. what is the most likely diagnosis?
anhedonia
30 y/o man presents to the office complaining of feeling "down" for the past month. he has had difficulty falling asleep and staying asleep, experienced severe fatigue, guilt, poor appetite, and thoughts of wanting to take his life. he does not recall ever feeling this bad. he has stopped talking with his friends and has no interest in doing anything. which of the following must be present to make the diagnosis of Major Depressive Disorder?
anorexia nervosa
17 y/o high school senior,. who is 168cm (66inches) tall and weighs 31.8kg (70lbs), is admitted to the hospital. she talks a great deal about fears of losing control and becoming fat. she diets rigorously and exercises regularly and though emaciated in appearance, she insists that her cheeks, abdomen, hips, and thighs are too heavy. she is unconcerned that her menstrual periods have ceased. the clinical staff notes that she orders dietary food, spreads it about her plate, and eats little. her parents are concerned about her weight but are not sure she should be hospitalized. what is the most likely diagnosis?
conversion disorder
19 y/o girl is brought to the emergency room by her parents because of sudden blindness. the patient is from an intensively religious background. she states that she cannot see anything, and she believes that her condition is divine punishment for her sinful behavior. she also states that she "gracefully accepts god's will". physical examination shows intact visual reflexes. what is the most likely diagnosis?
panic attack
19 y/o pounding heart, sweating, coldness, difficulty breathing, study for exam and had a lot of caffeine, felt like he was going to die. ECG no pathology most likely diagnosis?
DSM-V and ICD-10
2 classification systems of the dx of mental disorders?
antisocial personality disorder
20-year-old man is referred by his college for behaviors that they feel are about to cause him to be expelled from school. he has been in trouble with the law for theft, bringing a weapon to school, and his mother reports he has been hanging around with a gang of boys that have been stealing cars and damaging property belonging to others. what is the most likely diagnosis?
specific phobia
25 y/o single woman describes a lifelong history of being "scared of heights." she becomes uncomfortable when at an elevator higher than 3 stories, and, whenever traveling, or shopping, she becomes preoccupied with the exact heights of buildings. whenever she finds herself as a significant distance from the ground, she has severe anxiety symptoms including trembling, lightheadedness, numbness and tingling, and a fear of dying. what is the most likely diagnosis?
unipolar depression
27 y/o female reports daily depressed mood for 3 months with decreased sleep, interest, appetite, and energy. she denies any periods of elated, expansive mood or behavior in the last few years, but reports irritable mood for the past month. she denies decreased need for sleep, flight of ideas, or increased talkativeness. her husband reports that she has been spending more money recently. what is the likely diagnosis?
panic disorder
27 y/o increased difficulty sitting through lecture, past 6 months repeated episode heart pounding, difficulty breathing, light headed most likely diagnosis?
bipolar type 2
29 y/o man reports daily depressed mood for 6 months with increased sleep and appetite and decreased interest and concentration. upon further question, he denies any periods of euphoric mood but his wife relates that he seems to have a few days of up mood every now and then. when he is always on the go, not sleeping, all in to helping her clean the house, and more talkative then usual. he denies that those up periods interfere with his functioning. in fact, he thinks he functions better during those periods. what is the likely diagnosis?
SSRI (fluoxetine)
32 y/o presents with weight loss. lost 10lbs. patient feels empty and lacks interest in her life. feeling guilty since death of her husband 1 yr ago. appetite is decreased. suitable tx?
maligering
32 y/o woman presents to the ER with a superficial laceration across the palm of her right hand. she says that she accidentally cut herself while dicing vegetables. when you return to the room, she requests pain medication and a note for the local judge exempting her from jury duty. which of the following is the most likely diagnosis?
fluoxetine
32 y/o woman presents to the outpatient clinic due to weight loss. she has lost 10lbs in the past month. the patient feels empty, and she lacks interest in her life. she has also been feeling guilty since the death of her husband 1 yr ago. the patient doesn't enjoy anything that she used to in the past. her appetite is decreased, but she is otherwise healthy. question: what is the most suitable treatment?
fluoxetine
32 year-old woman presents to the outpatient clinic due to weight loss. she has lost 10lbs in the past month. the patient feels empty, and she lacks interest in her life. she has also been feeling guilty since the death of her husband 1 yr ago. the patient doesn't enjoy anything that she used to in the past. her appetite is decreased, but she is otherwise healthy. Question: what is the most suitable treatment?
narcissistic personality disorder
35 year-old man works on broadway as an actor. he demands that he always be casted as the leading man because anything less is below his status. he is constantly combing his hair and looking in a mirror. when worknig with other performers, if he doesn't have the most number of lines of dialog, he demands that the writers re-write the script so that he does. he is always demeaning of the other performers and laughs at them if they make a mistake. he knows that everyone around him is jealous of him because "he is flawless". he often crashes theater executive's parties because he knows that "they just forgot to invite me". he is constantly reading reviews of the shows he is in and if critics don't praise him, he says 'they don't know what they're talking about". what is the most likely diagnosis?
CBT/SSRI
36 y/o suffer from recurrent nightmares, flash back, hypervigilance, and emotional numbing, best help tx for patient?
illness anxiety disorder
40 y/o man returns to his internist for the 5th time in 9 months complaining of numbness in his toes and indigestion. his medical workup has been unremarkable he is now longer worried about MS, but is now concerned about celiac disease and requests a GI consult. which of the following is the most likely diagnosis?
obsessive compulsive disorder
65 y/o woman is referred to you by her primary physician for an evaluation of behaviors which consist of constantly cleaning the house, and checking her stove, refrigerator, and lights so much that her husband has become annoyed with her. she repeats these behaviors repeatedly for no apparent reason. what would be your provisional diagnosis?
strep infection
9 y/o child hx of motor and vocal tics with OCD symptoms, worse in winter/early spring. which pathology would be most important to r/o?
fluoxetine
A 22-year-old college student is brought to the office by his roommate because he feels there is "something wrong" with him. He states that he spends hours cleaning himself several times a day and takes a shower for 2 hours in the morning. The patient states, "I just want to be clean!" What should this patient be treated with?
Haldol
A 25-year-old man has a 6-month history of believing that 'people' are trying to put 'bad thoughts' into his head and make him do 'bad things.' He finds special messages from them in TV news reports and in the newspaper. He is agitated and paces constantly. His affect is inappropriate, and he laughs as he tells of his persecution. Physical examination is within normal limits. Drug screen is negative. what is the pharmacological tx of choice?
hypothyroidism
A 25-year-old man is brought to the urgent care center by his friend. He says that his friend has not been acting like himself for the past 10 days. He says he has been playing music extremely loudly and dancing to it all night. During the day, he goes shopping, and he has maxed out on all his credit cards. He has also been picking up a different woman every day in the past few days and taking them home, even though he has a steady girlfriend. He has hardly slept in the last few days. When his friend tried speaking to him, he just got annoyed and told him that the friend is jealous that he is having such a good time; the patient added that he is going to kill everyone who comes in his way, including the President. However, for the past 2 days, his mood has suddenly gone down, and he has mostly been in bed sleeping, refusing to eat, and crying most of the time; the evening of presentation, he tried to slit his wrists, and his friend stopped him and brought him to the hospital. The patient is diagnosed with a psychiatric illness and is put on maintenance therapy. what is a possible side effect of the drug of choice for this disorder?
abnormalities of the prefrontal cortex
A 25-year-old man is diagnosed with schizophrenia with predominantly negative symptoms. The patient has shown reduced performance in working memory tasks such as the Wisconsin Card Sorting Test. Question: While viewing a magnetic resonance imaging (MRI) scan of the patient's brain, what would you expect to be the most significant finding with respect to his negative symptoms?
paroxetine
A 25-year-old woman has a 2-month history of panic attacks that occur more than 3 times a week. After a thorough history and examination of the patient, she is diagnosed with a panic disorder. What is the first-line drug used in the pharmacological management of a panic disorder, in association with psychotherapy?
lthium
A 25-year-old woman presents after collapsing at work. She has a medical history significant for a mood disorder that causes her to have wild mood swings and reckless behavior. She was diagnosed with this disorder 1 year ago; since then, she has been taking her prescribed medication. Her symptoms consist of nausea, vomiting, fatigue, tremor, and hyperreflexia. Lab results show an elevation in BUN and creatinine and elevated serum drug levels, but the results are otherwise normal. Question: What drug is most likely responsible for her symptoms?
serum lithium level 1.8
A 27-year old man with a history of bipolar disorder presents with confusion, agitation, and tremor; on examination he is disoriented and fearful, ataxic, and has tremor and myoclonus. The smell of his breath is reminiscent of lake water. what finding on diagnostic testing is most likely?
severe child abuse
A 28-year-old woman begs to make the voices in her head stop arguing. She is very soft-spoken, polite, and well-groomed. She explains that she often becomes confused and finds herself in unfamiliar places. She believes that 1 of the voices might be trying to kill her. She has a history of alcohol abuse, but no drug abuse. She has an extensive medical history of unexplained injuries, stomach problems, and unusual bruising beginning in early childhood. The woman denies being physically or sexually abused as a child, but states that she has weird nightmares about a strange dark figure standing over the bed of a small child; she does not recognize the child or the man. The following week the patient's behavior is very different; she is speaking loudly, acts as if she never has seen you before, refuses to answer most questions, and is very uncooperative. According to the post-traumatic model, what is the most likely etiologic cause for this client's symptoms?
paroxetine
A 29-year-old male who is an architect by occupation approaches a psychiatrist regarding sexual dysfunction. He has been married for 5 years and has 1 child, a 3-year-old daughter. He complains of ejaculation prior to complete penetration. He says that this problem leaves his wife unsatisfied, and as a result is causing problems in his married life. The medical, physical, and neuropsychiatric examinations determine that he is medically, physically, and mentally healthy, with no evidence of any thought disorder or mood disorder. which of the following would be the most reasonable therapeutic option?
naloxone
A 29-year-old man is found unconscious by his roommate. He has a history of manic-depression and substance abuse. His roommate states that he recently broke up with his girlfriend and was laid off from his job. When the paramedics arrive, the patient is nonresponsive and nearly apneic. His pulse is palpable and regular at a rate of approximately 80 beats per minutes. His pupils are pinpoint but equal. in addition to immediate CPR, tx with what drug therapy is most likely to be lifesaving?
obtain a skeletal survey to rule out child abuse
A 3-month-old boy presents with a 12-hour history of lethargy. Physical exam reveals a child who cries and becomes irritable when examined. There is edema noted over the left side of the head. There is no papilla edema, and his mother denies a history of the child vomiting. There is a single faint bruise on the upper lip. A CT of the head reveals a linear skull fracture of the left parietal bone; there is no evidence of intracranial injury. On further questioning, the mother states, "My baby rolled over the sofa onto a carpeted floor 2 days ago."
fluoxetine (prozac)
A 32-year-old woman presents for follow up of her depression. Her symptoms began after the birth of her child 3 months ago, and she is doing better on her present regimen of antidepressant medication. Past psychiatric history is positive for bulimia and depression as a teenager. She presents today to admit that she has been skipping doses of her medicine, often forgetting a day or 2 of the doses. She has been traveling for work and often leaves the medication at home by mistake. what antidepressant would be the best choice for this patient, given her noncompliance?
bupropion
A 32-year-old woman presents for follow up of her depression. Her symptoms began after the birth of her child 3 months ago, and she is doing better on her present regimen of antidepressant medication. Past psychiatric history is positive for bulimia and depression as a teenager. She presents today to admit that she has been skipping doses of her medicine, often forgetting a day or 2 of the doses. She has been traveling for work and often leaves the medication at home by mistake. what drug is most likely to benefit this client?
Thiamin IV
A 32-year-old woman presents to the outpatient clinic due to weight loss. She has lost 10 pounds in the past month. The patient feels empty, and she lacks interest in her life. She has also been feeling guilty since the death of her husband 1 year ago. The patient doesn't enjoy anything that she used to in the past. Her appetite is decreased, but she is otherwise healthy. what is the most appropriate next step in this patient's management?
fluoxetine
A 32-year-old woman presents to the outpatient clinic due to weight loss. She has lost 10 pounds in the past month. The patient feels empty, and she lacks interest in her life. She has also been feeling guilty since the death of her husband 1 year ago. The patient doesn't enjoy anything that she used to in the past. Her appetite is decreased, but she is otherwise healthy. what is the most suitable treatment?
wernicke's encephalopathy
A 57-year-old man presents to the emergency department complaining of difficulty with his vision. He is well known to the department due to frequent visits for alcohol-related complaints. He cannot give any history as to his recent whereabouts. •Physical exam reveals a disheveled male patient who appears older than his stated age. Vital signs show: BP 155/80 mm Hg; pulse 100; respiration 16; temp 37.5°C (99.5°F). •HEENT exam reveals a marked aroma of alcohol. Heart and lung exams are unremarkable. Abdominal exam shows mild, diffuse tenderness without re- bound or guarding. Neurologic exam reveals lateral rectus palsy, marked bilateral nystagmus, and an ataxic gait. Short-term memory is poor. Question: What is the etiology of this patient's complaints.
elevated serum ammonia
A 62-year old man presents with the gradual onset of confusion, somnolence, and flapping of the hands when the arms are outstretched. Question: What is the most likely abnormality to be seen on laboratory evaluation?
Thiamine
A 68-year-old man presents with his wife of 38 years. She states that since her husband retired 3 years ago, he just sits home and drinks an entire bottle of either Jack Daniels or Chivas Regal every day, and he eats very little. She also mentions that she thinks he may have broken his hip in a fall last weekend, but he is too drunk to feel pain. in addition to detox with benzodiazepine prior to repair of his hip fx, what is needed to prevent neurologic sequelae?
neuroleptic malignant syndrome
A patient is experiencing severe muscle rigidity, elevated temperature, and some confusion. His BP is elevated; he has elevated CPK; and he is experiencing loss of appetite. He has been extremely restless in the past week and has been given an increase in his oral haloperidol for agitation, in addition to 50mg diphenhydramine (Benadryl) po hs. what is the most likely diagnosis?
lorazepam (ativan)
A patient with hepatic insufficiency is admitted with severe alcohol withdrawal. Which of the following benzodiazepines would be the most appropriate treatment?
schizoid personality disorder
A woman in her early 50's is being seen at a behavioral health clinic. She has been encouraged by her family and her employer to attend. The primary reason is that "she has serious problems relating to other people." Most people describe her as especially solitary, indifferent, and emotionally cold. They feel that her quality of life suffers from this lack of social inclination, and that problems with loneliness may worsen as she gets older. She has always been single and has never had any friends to speak of, even as a child. what is the most likely provisional diagnosis from the DSM-IV based on this information?
antisocial personality disorder
An 16-year old high school dropout recently set a fire in his old school classroom because he was dared to do so by other students. He has been sent to you for evaluation. You interview him and find that he had a number of problems related to truancy and fighting in school; he has been found with liquor in his locker at school, and he always seems to feel that someone else is responsible for his having done something. When he was 10, the patient burned down a barn; last year, he and some friends threw rocks at passing cars on the expressway. What is the provisional diagnosis?
Attention deficit hyperactivity disorder
An 8-year-old boy presents for evaluation of problems at school and at home. His parents report that he does not pay attention in class; he is frequently in trouble for disrupting the class, and he often forgets to do his schoolwork. He has had similar problems since starting school (in kindergarten), but they are becoming more problematic; his teacher suggested medical evaluation. The teacher reports the patient often seems distracted. He rarely sits still at his desk; he fidgets often, and when he does pay attention to the class discussions, he blurts out comments without waiting his turn. •HIs parents report that the boy has always been 'on the go' and talks excessively; he does not seem to listen when spoken to. He seems capable of doing his schoolwork, but he appears to make careless mistakes. The parents feel the boy is generally well-adjusted; he enjoys sports, has friends, and sleeps well. The parents deny any known medical history, and his prenatal course and delivery were unremarkable. He has never had any surgeries; he takes no medications and does not have any allergies. He lives at home with his biological parents and a younger sister. •On physical exam, the boy appears normally developed. Some increased motor activity is noted, but the physical exam is otherwise normal. what is the most likely diagnosis?
the disorder does not persist into adulthood
Each of the following is true about attention deficit hyperactivity disorder ADHD EXCEPT
a patient who is not oriented cannot be psychotic
MMSE, is an important 1st step because -
social phobia
Mr H tells Mrs H that they have to go to a company party next week if he wants to be considered for a promotion. Mrs H asks her husband if she has to go and that she doesn't feel comfortable in crowds because of her weight and that she is embarrassed when people stare at her. he says that it will look bad if she doesn't go with him. she starts to have palpitations, diaphoresis, and nausea. she knows this is not the way she should respond when asked to attend a social event but it happens every time she is faced with this decision. next week comes and she forces herself to go with her husband. as they get ready to enter the event, she becomes jittery, her heart starts to race and she vomits in the driveway of the house. what is the most likely diagnosis?
criticize the surgical team for failure to recognize and treat the delirium earlier.
Mrs. A is a 70 y/o female admitted to the surgical service after she fell and fractured her right hip. Three days after surgery, she is confused, disoriented, and inattentive. All of the following are appropriate functions of the medical team in this case EXCEPT
poverty
Risk factors for child abuse include all of the following EXCEPT
Her partner will not give up control
THE AFTERNOON CLINIC IS ALMOST FINISHED. A 22-YEAR-OLD WHITE FEMALE COMES IN FOR HER SCHEDULED APPOINTMENT. THE CHART STATES SHE IS THERE FOR AN URI (UPPER RESPIRATORY INFECTION). AS SHE EXPLAINS HER SYMPTOMS,YOU NOTICE 4 SMALL ROUND BRUISES IN A ROW ON THE RIGHT BICEP. WHILE VITAL SIGNS ARE:TEMPERATURE 99.6° , HEART RATE 78, BLOOD PRESSURE 120/60, AND RESPIRATION 16.YOU PROCEED TO ASK HER HOW SHE GOT THE BRUISES. SHE STATES THAT SHE FELL DOWN THE FRONT STEPS AT HOME.YOU ASK GENTLY, "HAS YOUR PARTNER HIT YOU?" SHE STARTS TO CRY AND SAYS "YES." SHE GOES ON TO STATE THAT SHE HAS TRIED TO LEAVE BEFORE, BUT HE HAS ALWAYS BEEN SO NICE AFTERWARDS AND FELT SO SORRY. LISTENING TO HER LUNGS,YOU NOTICE A NUMBER OF BRUISES AROUND THE KIDNEYS.THEY RANGE IN COLOR FROM DARK BLUE TO YELLOW.THE LUNGS ARE CLEAR; HEART RATE IS REGULAR RATE AND RHYTHM. WHAT MIGHT YOU TELL HER?
escitalopram (lexapro)
The patient is a 36-year-old man who presents to your office suffering uncontrollable shaking, which manifests in social situations. Her confides in you that it has ended 3 jobs and 3 relationships in the previous 6 years. what should you recommend?
clozapine (clozaril)
What medication necessitates a standing weekly blood draw?
carbamazepine
Which of the following anticonvulsant drugs induces its own metabolism when first initiated?
donepezil (atricept)
You have completed comprehensive testing on an 80-year-old woman, and the diagnosis is dementia of the Alzheimer's type. You believe she is in the very early stages of the disease and want to try a medication to possibly slow disease progression. what drug may be an effective tx?
panic attack
a 19 y/o college student presents with pounding heart, sweating, coldness, and difficult in breathing. he said that he was studying for an important exam and drinking lots of caffeine, and he then started to feel like he was going to die of an attack. examination, ECG, and tests do not demonstrate any pathology. question: what is the most likely diagnosis?
borderline personality disorder
a 22 y/o woman presents to the clinic for evaluation of a possible STI. while there, you note that she is performing as a prostitute having as many as 4 sexual encounters per day. she says she left home because her mom had left when she was 5 and her father was a drunk who abused her sexually as well. she feels that this is the only profession she can do. you also note that there are scars on both her wrists from attempted suicides previously as well as track marks from IV drug use. she has had many partners in the past and most have been physically abusive to her. she argues with you that she can take care of herself and doesn't need help, when she suddenly breaks into tears, then suddenly has a burst of anger and hits you with her purse saying you called the "cops" on her. what is the most likely diagnosis?
bulimia nervosa
a 25 y/o woman presents for an annual physical exam that is required by her new employer. as you progress through the history and review of systems you come across very few positive responses. however, when completing the physical exam you note the following: 25 year old female appearing her stated age, of normal size and weight, large calluses on many fingers both hands and severe discoloration of teeth with some having exposed dentin. what is the most likely diagnosis?
ask him directly if he ever has thoughts of doing away with himself
a 30 y/o farmer comes to see you because he is having "another fit of the blues and just feels tired and miserable". he is waking up early in the morning and lies there in bed thinking and feeling low. he is not eating well and has lost 15lbs. as he talks, he begins to cry and tells you he cries often now, but "it doesn't do any good". he has had these spells before when he was a teenager, and he had an uncle who "used to get real low." his physical exam is normal. you are concerned about the possibility of suicide. what do you do next?
general anxiety disorder
a 32 y/o accountant complains of fatigue, poor sleep, restlessness, and worry about a tax audit. he has been feeling this way for about 9 months. he says he can't seem to control these feelings and has been irritable at work and doesn't seem to be able to focus on his work. he even has had trouble socializing outside of work. all of his past medical history is negative and your physical exam is totally normal. what is the most likely diagnosis?
CBT and SSRI
a 37 y/o college professor with a history of GAD and MDD has been referred to psychiatry by his PCP. his symptoms have been relatively well controlled up until last semester when he received negative reviews from his students. he has started to doubt his ability to teach, worry about his career, and ruminate on each lesson plan. he worries that his reputation among his students has been irrevocably damaged, which makes him feel despondent. the professor desparately wants to get help, but is hesitant to try any medication that will impair his intellectual prowess. which of the following is the most effective treatment approach?
borderline
a 48 y/o woman has a history of poor interpersonal relationships chronic headaches, and previous suicide attempts. she has an extremely demanding attitude and often directs her anger towards others. what personality disorder is most likely diagnosis?
flat affect
a mixed episode of mania and depression could be characterized by all of the following EXCEPT
binge eating disorder, bulimia nervosa, anorexia nervosa
a severe disturbance in eating habits and an excessive concern or dissatisfaction with body shape or weight are the hallmarks of which disorder?
nightmares
a sleep disorder that is REM related and involves muscle paralysis is
narcissistic personality disorder
a successful businessman presents in your office at the behest of his adult children, who are concerned that he shows little interest in them or the grandchildren. he reports that he chose to see you after researching your credentials because he only deals with the "best". he spends a good deal of the session informing you of his intellect, business acumen, and prowess with women. though he does appear to appreciate his wife's "model-like" appearance. what would your diagnosis most likely be?
posttraumatic stress disorder (PTSD)
a survivor of hurricane katrina in New Orleans has been having recurring nightmares about the hurricane and difficulty sleeping because of them. her husband died in the event and she feels like it is her fault that he died. her visiting aunt says she is easily startled and has anger outbursts for no apparent reason. she also has been drinking excessive amount of alcohol to "feel better" and won't talk about the event. throughout the day she will have sudden fear that another hurricane is coming to get her. what is the diagnosis
using the telephone
activities of daily living (ADL's) include each of the following except
fluphenazine
all are atypical antipsychotic agents except
major depressive disorder, with seasonal pattern
an 80 y/o woman has been a resident in a nursing home for 2 years and has adjusted very well but is seeing a social worker in the facility. the social worker refers her to you for a psychiatric evaluation. the patient says for the last 5 years she has a pattern of becoming sad, loses her appetite, and wanting to sleep and eat candy bars in the fall of each year. question: what is your provisional diagnosis?
incontinence
characteristic features of dementia with lewy bodies include each of the following EXCEPT
schizoid
characteristics described as odd, eccentric, or weird are seen in people diagnosed with the following personality disorders:
True
even if a behavior is viewed as abnormal within a given culture, disruptive to those who encounter the patient, or considered weird, the diagnosis of mental disorder requires that it also causes distress or disability. T or F
anhedonia
down for the past month, difficulty sleeping, fatigue, guilt, poor appetite, SI, stopped talking to friends, not enjoying life, present to dx MDD is what
yellow, box, fly
dr barker's gift
L-dopa
drugs which have been shows to have some benefit in alzheimer's disease include each of these EXCEPT
ESR
each of the following blood tests is recommended when screening for dementia EXCEPT
SSRIs
each of the following drugs is commonly associated with impaired cognitive function EXCEPT
confronting the patient with the diagnosis
each of the following treatments for somatoform disorder have been shown to be helpful EXCEPT
post-traumatic stress disorder
numerous psychological problems are caused by persistent, recurring experiences of intrusive thoughts related to a traumatic event in which a patient is involved or witnesses serious injury, death, or physical threat(s) to themselves or others. the problems include intense fear, helplessness or horror, physiological reaction to cues that symbolize the event, avoidance, diminished interest in significant activities, a feeling of detachment, restricted range of affect, and a feeling of a foreshortened future. these are features of what condition?
hopelessness
of the following which is the most accurate predictor of potential for suicidal behavior?
hopelessness
of the following, which is the most accurate predictor of potential for suicidal behavior?
mood
patient says he is sad and has little interest in doing things that were previously engaging for him. you are assessing his -
PTSD
psychological problems, traumatic events witnessed, serious injury or death most likely diagnosis?
initial insomnia
red flag for ADHD disorder
hopelessness
red flag for MDD disorder
flat affect
red flag for schizophrenia
olfactory hallucinations
red flag for seizure disorder
pregnancy results in a reduction of abuse
regarding spousal abuse, all of the following statements are correct except:
somatization disorder
the disorder marked by any symptoms, some accompanied by pain and some not, spanning different organ systems over a great number of years and marked by inconsistency of symptom recall at each follow up is
paranoid personality disorder
the local bank VP comes to see you in the office for "chest congestion". when you walk into the exam room, you note that he is very tense, anxious, and looking around the room as if looking for something. you welcome him and ask what the problem is today. he quickly looks around and asks you to shut the door and to whisper. he whispers that he knows the bank president is "out to get him" and that the other employees are helping him. you ask him how he knows this for sure. he says that he just knows. he admits to a mistake of $2.30 on the balance statement for the month and even though the president says it is okay, he knows that it will be used against him. he says that he can't talk to anyone at the bank about it because he knows they will tell the president about the conversation. in fact, he saw one of the tellers go into the president's office and close the door. he says he knows that they were talking about him. what is the most likely diagnosis?
conversion disorder
the somatoform disorder which classically presents with a pseudoneurologic symptom is
border line and shizotypal
there is an increased incidence of suicide in which of the following personality disorders?
vision and olfactory
what is not part of the complete MSE
using too low a dose for too short a time
what is the most common clinical mistake in treating major depressive disorder with pharmacotherapy?
SI, HI, mood
what other aspects of the MSE are actually subjective
<10%
what percentage of patients who meet criteria for a psychiatric disorder DO NOT have a somatic symptom as their chief complaint?
another patient's response to the medication
when discussing medication options/treatment with patients, which of the following would not be a necessary component of that discussion?
mood stabilizer
which is the best first line treatment in a patient with bipolar II
amoxapine
which of the following agents may be MOST LIKELY to cause acute dystonic reaction
the patient's gender and race
which of the following areas of information is NOT useful when assessing the lethality of prior suicide attempt?
a 2-month-old with a transverse fracture of the humerus from a fall out of bed
which of the following injuries is most suggestive of child abuse?
bupropion
which of the following is most likely to induce seizures?
Major depression
which of the following psychiatric illnesses is MOST OFTEN present in patients who commit suicide?
a 23 y/o woman who has newly been diagnosed with lupus, experiences profound depression after her first course of steroids
which of the following scenarios is most clearly consistent with a diagnosis of substance/medication induced depressive disorder
she might be a victim of domestic violence
you are seeing a 32 y/o woman in the emergency department who is accompanied by her boyfriend. she appears depressed and nervous at the same time. she states she is there for a sore throat. when you approach her, the boyfriend also moves closer to her. you note a bruise on her neck that has an unusual appearance. when you ask her about it, her boyfriend says she tripped and hit her neck on the kitchen table and she hangs her head. what is the most likely problem this women has?
