Pretest Psychiatry

27. A 59-year-old man goes to a psychiatrist for a 3-month history of panic attacks. He notes for the past 3 months he has experienced "out of the blue," extreme episodes of fearfulness that last about 20 minutes. During that time he experiences palpitations, sweating, shortness of breath, and trembling. He denies any substance abuse, and has never had symptoms like this before these past 3 months. Which of the following signs or symptoms would likely lead the physicians to expect a diagnosis of anxiety secondary to a general medical condition in this case?

a. The patient's age

69. A 20-month-old girl is admitted to a pediatric ward because she weighs only 15 lb. An extensive medical work-up does not reveal any organic cause for the child's failure to thrive. The child is listless and apathetic and does not smile. The parents rarely come to visit, and when they do, they do not pick the child up and do not play or interact with her. Which of the following statements best explains this scenario?

a. Lack of adequate emotional nurturance causes depression and failure to thrive in infants.

18. A 69-year-old man is brought to see his physician by his wife. She notes that over the past year he has experienced a slow, stepwise decline in his cognitive functioning. One year ago she felt his thinking was "as good as it always had been," but now he gets lost around the house and can't remember simple directions. The patient insists that he feels fine, though he is depressed about his loss of memory. He is eating and sleeping well. Which of the following is the most likely diagnosis?

a. Multi-infarct dementia

72. A 25-month-old boy plays with a ball, which rolls under a couch. The boy promptly crawls under the couch to retrieve the ball. According to Piaget's theories of cognitive development, which thinking process best describes this child's behavior?

a. Object permanence

22. The patient above becomes physically violent in the emergency room, attempting to strike a nurse and struggling with security. Which of the following actions should the psychiatrist take now?

a. Order full leather restraints

33. Which of the following terms best fits the definition "the proportion of a population affected by a disorder at a given time"?

a. Prevalence

93. The illogical, bizarre, and incoherent images that often make up dreams are an example of what type of thinking?

a. Primary process

82. A 20-month-old male infant is placed in an emergency department of children and family services shelter after his mother is hospitalized as the result of a car accident. Three days after the separation, the child spends almost every waking moment crying and calling and searching for his mother. The fourth day after the separation, when the mother of the child comes to the shelter to reclaim her child, he rejects her offers of affection, instead clinging to the nurse's aide who has been his caretaker. Which of the following terms most accurately describes this infant's reactions to a forced separation?

a. Protest

59. Normality is an idealized fiction.

a. Sigmund Freud

70. A 25-year-old woman sees a psychiatrist for a chief complaint of having a depressed mood for her "entire life." She begins psychotherapy and sees the physician once per week. After 3 months of therapy, she tells the psychiatrist that she is very afraid of him because he is "so angry all the time." She behaves as if this is true and that the psychiatrist will explode with rage at any minute. The psychiatrist is not normally seen as an angry person and is unaware of any anger toward the patient. Which of the following defense mechanisms is this patient likely displaying?

d. Projection

66. A 23-year-old woman constantly goes to great lengths to avoid being criticized, even when this requires going against her own beliefs and wishes. Although she is good-looking and successful, she is tormented by doubts about her abilities and her physical appearance. According to Kohutian theory, which of the following is most likely to explain her behavior?

c. A lack of self-esteem, which causes a constant need for validation

45. A 32-year-old man complains of depressed mood, poor concentration, a 25-lb weight gain, and hypersomnia. He is subsequently diagnosed with hypothyroidism.

c. Axis III

36. A 32-year-old patient is being interviewed in his physician's office. He eventually answers each question, but he gives long answers with a great deal of tedious and unnecessary detail before doing so. Which of the following symptoms best describes this patient's presentation?

c. Circumstantiality

57. A 3-year-old boy stands on one side of a large sculpture and is asked to describe what he sees. When asked to describe what a person on the other side of the sculpture sees, the child answers that the other person sees just what he

c. Cognitive development

50. A 20-month-old boy loves running around and exploring the environment, but every few minutes he returns to his mother to check on her and solicit a quick hug. Which of the following best describes this behavior, according to Margaret Mahler?

d. Rapprochement

24. A psychiatrist is seeing a patient in his outpatient practice. The patient treats the psychiatrist as if he were unreliable and punitive, though he had not been either. The patient's father was an alcoholic who often did not show up to pick her up from school and frequently hit her. The psychiatrist begins to feel as if he must overprotect the patient and treat her gingerly. Which of the following psychological mechanisms best describes the psychiatrist's behavior?

c. Countertransference

92. Which of the following best represents the process that transforms the raw unconscious wishes and impulses of a dreamer into images more acceptable to the superego?

c. Dream work

64. Normality is the ability to master the progressive life stages successfully. (ie, trust vs. mistrust through ego integrity vs. despair).

c. Erik Erikson

34. A diagnostic test has a sensitivity of 64% and a specificity of 99%. Such a test would carry the risk of which kind of problem?

c. False negatives

20. A 6-year-old girl is brought to the physician by her mother, who says the child has been falling behind at school. She notes that the girl did not speak until the age of 4. She is friendly at school, but is unable to complete most tasks, even when aided. She is noted to have a very short attention span and occasional temper tantrums at school and at home. Which of the following tests would be most helpful in establishing the diagnosis?

c. IQ testing

5. A 56-year-old man has been hospitalized for a myocardial infarction. Two days after admission, he awakens in the middle of the night and screams that there is a man standing by the window in his room. When the nurse enters the room and turns on a light, the patient is relieved to learn that the "man" was actually a drape by the window. This misperception of reality is best described by which of the following psychiatric terms?

c. Illusion

8. A psychiatric resident is called to consult on the case of a 75-year-old woman who had undergone a hip replacement 2 days before. On examination, the resident notes that the patient states the date as 1956, and she thinks she is at her son's house. These impairments best illustrate which aspect of the mental status examination?

d. Orientation

35. A 56-year-old man is brought to the physician's office by his wife because she has noted a personality change during the past 3 months. While the patient is being interviewed, he answers every question with the same three words. Which of the following symptoms best fits this patient's behavior?

d. Perseveration

94. A young man is often the object of his friends' jokes because he drops to the floor whenever he is having a good laugh. Which of the following is this man most likely suffering from?

a. Cataplexy

53. Piaget is best known for which of the following theories?

a. Cognitive development

41. Factitious disorder

a. Conscious, intentional production of symptoms with primary gain

73. According to Sigmund Freud, which of the following best describes primary processes?

b. Nonlogical and primitive

77. A writer of mystery novels, who has never had legal problems, jokes about his "dark side" and his hidden fantasies about leading an exciting life of crime. Which of the following defense mechanisms is being used by this man?

b. Sublimation

100. After being struck on the head by a four-by-four piece of wood, a previously serious and dependable construction worker starts making inappropriate sexual remarks to his coworkers, is easily distracted, and loses his temper over minor provocations. What part of his brain has most likely been damaged?

e. Frontal lobe

52. Which of the following theorists focused primarily on the importance of early parental behavior, such as mirroring, leading to the development of a cohesive and stable sense of self?

e. Kohut

4. An 18-year-old man is seen by a psychiatrist in the emergency room. During the history, the patient is asked to describe his mood. He answers the following, "My mood is flextitating, I am up and down." The patient is exhibiting which of the following thought disorders?

e. Neologism

96. Benzodiazepines, barbiturates, and many anticonvulsants exert their influence through which of the following types of receptors?

e. γ-Aminobutyric acid (GABA)-ergic

74. Erikson's developmental theories differ from Freud's in that Erikson placed greater emphasis on which of the following?

a. Cultural factors in development

85. A woman brings her 2-year-old (27 month) son to a psychiatrist for evaluation of his language development. She notes that her son can respond to simple directions and can refer to himself by name. He is intelligible approximately 30% of the time, and he can use language to ask for his needs. He does not understand most adjectives. Which of the following most accurately describes the status of this child's language development?

a. Delayed in the mastery of comprehension; delayed in the mastery of expression.

56. A 32-year-old woman is given the news by her physician that she has breast cancer and will need surgery, followed by chemotherapy. She returns home after the appointment, and her husband asks how the visit went. She tells him that "everything was fine." For the rest of the evening, she behaves as if there had been no bad news given to her. In fact, she appears to be in good spirits. Which of the following defense mechanisms is likely being employed by this woman?

a. Denial

75. A woman has a verbal altercation with her boss at work. She meekly accepts his harsh words. That night, she picks a fight with her husband. Which of the following defense mechanisms is being used by this woman?

a. Displacement

23. The patient in question 21 is eventually placed in full leather restraints. He struggles against them and screams racial slurs repeatedly. What action should the psychiatrist take next?

a. Give haloperidol 5 mg IM and lorazepam 2 mg IM

89. A 5-year-old girl loves her father's attention and becomes irritated with her mother when her mother kisses her father. The child tells her father she wants to marry him when she grows up. Which Freudian theory best describes the developmental stages this child is in?

d. Oedipal

58. A 70-year-old woman is admitted to the hospital after a fall in which she broke her left hip. She is a difficult patient during her rehabilitation phase, passively resisting attempts to get her up and walking, contending that it does not matter whether she regains her capacity to walk on her own since she is so advanced in age. She states that while she is fearful of dying, she feels disgust at her own body because it is "falling apart." Which of the following Eriksonian states is this patient most likely working through?

a. Integrity versus despair

48. A 6-month-old male infant is noted by his mother to be difficult to care for. He is very difficult to feed or soothe, and often responds to cuddling by crying and becoming rigid in his mother's arms. Physical examination and laboratory work are all entirely normal. Which of the following psychiatric disorders is this infant at a higher risk to display in his early school years?

a. Conduct disorder

25. A patient is able to appreciate subtle nuances in thinking and can use metaphors and understand them. This patient's thinking can be best defined by which of the following terms?

b. Abstract

88. The parents of a 2-year-old child come to see the child's pediatrician because their once happy-go-lucky infant has become oppositional and obstinate. Which Freudian theory best describes the developmental stage this child is in?

b. Anal

47. A 23-year-old woman works in a sheltered workshop. She is unable to make change for a dollar or read beyond a second-grade level. She has a genetic makeup of 47 chromosomes with three copies of chromosome 21.

b. Axis II

37. An 18-year-old man is brought to the emergency room by the police after he is found walking along the edge of a high building. In the emergency room, he mumbles to himself and appears to be responding to internal stimuli. When asked open-ended questions, he suddenly stops his answer in the middle of a sentence, as if he has forgotten what to say. Which of the following symptoms best describes this last behavior?

b. Blocking

2. A 32-year-old woman is seen in an outpatient psychiatric clinic for the chief complaint of a depressed mood for 4 months. During the interview, she gives very long, complicated explanations and many unnecessary details before finally answering the original questions. Which of the fol- lowing psychiatric findings best describes this style of train of thought?

b. Circumstantiality

16. A 23-year-old woman comes to the emergency room with the chief complaint that she has been hearing voices for 7 months. Besides the hallucinations, she has the idea that the radio is giving her special messages. When asked the meaning of the proverb "People in glass houses should not throw stones," the patient replies, "Because the windows would break." Which of the following mental status findings does this patient display?

b. Concrete thinking

40. Malingering

b. Conscious, intentional production of symptoms with secondary gain

31. A 29-year-old man is brought to the emergency room by his wife after he woke up with paralysis of his right arm. The patient reports that the day before, he had gotten into a verbal altercation with his mother over her intrusiveness in his life. The patient notes that he has always had mixed feelings about his mother, but that people should always respect their mothers above all else. Which of the following diagnoses best fits this patient's clinical picture?

b. Conversion disorder

97. The observation that levodopa (a drug used to treat Parkinson disease) can cause mania and psychosis in some patients supports which neurochemical theory of psychiatric behavior?

b. Dopamine

3. A 23-year-old man comes to the psychiatrist with a chief complaint of a depressed mood. He is very anxious and obviously uncomfortable in the physician's office. Which of the following actions should be used to help develop rapport with this patient?

b. Express compassion with the difficult position the patient is in.

15. A 32-year-old woman comes to the psychiatrist with a chief complaint of anxiety. She notes that she worries about paying the mortgage on time, whether or not she will get stuck in traffic and be late for appointments, her husband's and daughter's health, and the war in Iraq. She notes that she has always been anxious, but since the birth of her daughter 2 years ago, the anxiety has worsened to the point that she feels she cannot function as well as she did previously.

b. Generalized anxiety disorder

91. Which of the following is the single most significant developmental event of middle childhood (typically defined as between the ages of 6 and 12)?

b. Going to school

67. A 16-year-old boy is diagnosed with osteosarcoma. Surgery and chemotherapy are not successful as treatments, and it is apparent that the child will die from his disease. The child, rather than focusing on his death, seems more concerned with the fact that he has lost all his hair from the chemotherapy. He is difficult to work with in the hospital, as he insists on seeing visitors only when he chooses to and wants to work with only his favorite nurses. Which of the following is the best explanation for his behavior?

b. He is an adolescent and these responses are quite typical for the age group.

21. A 30-year-old man is brought to the emergency room after threatening to kill his 19-year-old girlfriend after she told him she was breaking up with him. The patient smells strongly of alcohol. The patient is from a high socioeconomic status and reports many social supports. Which of the following pairs of factors make this patient's risk of violent behavior higher?

b. His alcohol use and the impending breakup with the girlfriend

39. A patient with a chronic psychotic disorder is convinced that she has caused a recent earthquake because she was bored and wishing for something exciting to occur. Which of the following symptoms most closely describes this patient's thoughts?

b. Magical thinking

62. Normality is characterized by strength of character, the capacity to deal with conflicting emotions, the ability to love, and to experience pleasure without conflict.

b. Melanie Klein

10. A 23-year-old woman comes to the psychiatrist because she "cannot get out of the shower." She tells the psychiatrist that she has been unable to go to her job as a secretary for the past 3 weeks because it takes her at least 4 hours to shower. She describes an elaborate ritual in which she must make sure that each part of her body has been scrubbed three times, in exactly the same order each time. She notes that her hands are raw and bloody from all the scrubbing. She states that she hates what she is doing to herself but becomes unbearably anxious each time she tries to stop. She notes that she has always taken long showers, but the problem has been worsening steadily for the past 5 months. She denies problems with friends or at work, other than the problems that currently are keeping her from going to work. Which of the following is the most likely diagnosis?

b. Obsessive-compulsive disorder

9. A 52-year-old man is sent to see a psychiatrist after he is disciplined at his job because he consistently turns in his assignments late. He insists that he is not about to turn in anything until it is "perfect, unlike all of my colleagues." He has few friends because he annoys them with his demands for "precise timeliness" and because of his lack of emotional warmth. This has been a lifelong pattern for the patient, though he refuses to believe the problems have anything to do with his personal behavior. Which of the following is the most likely diagnosis for this patient?

b. Obsessive-compulsive personality disorder

49. A 2-year-old girl is being toilet trained by her parents. Each time she soils her diaper, she is told that she is a very bad girl and she is punished by having a toy taken away. When she uses the toilet appropriately, she is not praised by her parents. Which of the following sequelae is the child most likely to experience as a result of this kind of parental behavior?

b. Shame and self-doubt

84. A 3-year-old boy is brought to the physician by his mother, who is concerned about his behavior. She states that he repeatedly is physically aggressive toward a doll. He throws the doll around the room and hits it with his hand while saying, "Bad Johnny." The boy had not displayed this behavior until 3 months previously. The mother mentions that the only change she can think of that occurred approximately 3 months previously is that the boy started in day care. Which of the following is the most likely explanation for this behavior?

b. The boy is engaging in fantasy play.

28. A 24-year-old man returns from Iraq after a 13-month tour of duty. During that tour he was involved in battle situations and saw one of his friends injured by a car bomb. What percentage of American soldiers returning home from Iraq have posttraumatic stress disorder (PTSD)?

c. 15% to 20%

11. A 37 year-old man with chronic schizophrenia is brought to see a new psychiatrist for treatment. While taking the history, the psychiatrist finds that the patient functions with a flat affect and circumstantial speech all the time. He has few friends. He is able to hold a menial job at the halfway house where he lives, and his behavior is not influenced by delusions or hallucinations currently. What should the psychiatrist rate the patient on Axis V (global assessment of functioning)?

c. 55

79. A 45-year-old man accidentally crashes his car into another vehicle. He feels extremely guilty, and in order to avoid these feelings of selfreproach, he explains in meticulous detail to anyone listening all of the steps leading up to his accident. Which of the following defense mechanisms is this patient displaying?

c. Intellectualization

87. A woman brings her 5-year-old daughter in to a psychiatrist for an evaluation of her emotional development. The child can understand the causes of many emotions, but cannot react to the feelings of others correctly. The daughter likes attention and approval, but does not show sensitivity to criticism or care about the feelings of others. Which of the following most accurately describes the status of this child's emotional development?

c. Normal in the mastery of emotional skills; delayed in the mastery of emotional behavior.

76. A 24-year-old woman lives with her mother, whom she intensely dislikes. She feels embarrassed by this, and compensates by hovering over her mother, attending to her every need. Which of the following defense mechanisms is being used by this woman?

c. Reaction formation

12. A 28-year-old man comes to the psychiatrist because his employer required it. The patient says that he does not know why the employer required it--that his job is good and that he likes it because it requires him to sit in front of a computer screen all day. He notes he has one friend whom he has had for more than 20 years and "doesn't need anyone else." The friend lives in another state and the patient has not seen him for at least a year. The patient denies any psychotic symptoms. His eye contact is poor and his affect is almost flat.

c. Schizoid personality disorder

68. A 23-year old man impulsively steals a pack of gum at a convenience store. He has never stolen anything previously, and almost immediately upon exiting the store with the gum, he begins to feel extremely guilty. Which of the following concepts introduced by Freud is most likely responsible for this man's emotional response to his theft?

c. Superego

80. A 45-year-old woman is admitted to the hospital after her son finds her unconscious at home. She is treated for diabetic ketoacidosis and her recovery is a difficult one, necessitating that she stay in the hospital for 5 days. During this period of time, she is often angry, irrational, and demanding, all of which are not her usual modes of behavior or thinking, according to her husband. What is the most likely explanation for the change in this woman's behavior?

c. The stress of her illness and hospital stay is causing her to regress.

54. A 2-year-old child carries around an old, tattered blanket wherever he goes. When he is sad or upset, he calms himself by hugging and stroking his blanket. He also needs it to settle down before sleep. For this child, which of the following does his blanket best represent?

c. Transitional object

42. Somatization disorder

c. Unconscious, unintentional production of symptoms

43. Conversion disorder

c. Unconscious, unintentional production of symptoms

81. A 38-year-old woman comes to a psychiatrist for help with the management of her obsessive-compulsive disorder. She describes an impulse that she has frequently and that frightens her. This impulse is to murder her three children by blowing out the pilot light on her home's heater, thereby blowing up her house. As a result, she finds herself checking on the pilot light in her home at least 30 times a day. She carries a book of matches with her during these checks so that she might immediately relight the pilot light if she finds that it is out. Which of the following defense mechanisms does this act of checking the pilot light represent?

c. Undoing

55. A 4-year-old child is brought to the psychiatrist by her mother. Although the child is developing normally, she is scheduled to have her tonsils removed. The mother wishes to make this operation as smooth and atraumatic as possible. Using Piaget's theory, what should the psychiatrist tell the mother about how this upcoming event should be explained to the child?

c. Verbal explanations will not be helpful. The upcoming event should be role played with the child through the use of dolls and toys.

65. A young woman with a history of childhood neglect feels suddenly worthless and devastated when her supervisor makes a mildly negative comment about her work performance. According to Heinz Kohut, which of the following explanations accounts for her hypersensitivity to criticism?

d. A fragmented sense of self due to the empathic failure of her parents

78. A 35-year-old man is being seen by his psychiatrist for depressed mood. The patient is irritated at his therapist for pushing him on several issues in the last session. The patient does not show up or call for his next session. Which of the following defense mechanisms is this patient displaying?

d. Acting out

30. A 19-year-old woman presents to the emergency room with the chief complaint of a depressed mood for 2 weeks. She notes that since her therapist went on vacation she has experienced suicidal ideation, crying spells, and an increased appetite. She states that she has left 40 messages on the therapist's answering machine telling him that she is going to kill herself and that it would serve him right for leaving her. Physical examination reveals multiple well-healed scars and cigarette burns on the anterior aspect of both forearms. Which of the following diagnoses best fits this patient's clinical presentation?

d. Borderline personality disorder

6. A 22-year-old woman is seen by a psychiatrist in the emergency room after she is found walking in the middle of a busy street with no shoes on. During her interview she is asked to count backwards from 100 by 7's. Which of the following best describes the cognitive functions being tested by this request?

d. Concentration

26. A 65-year-old man, who had been hospitalized for an acute pneumonia 3 days previously, begins screaming for his nurse, stating that "there are people in the room out to get me." He then gets out of bed and begins pulling out his IV line. On examination, he alternates between agitation and somnolence. He is not oriented to time or place. His vital signs are as follows: pulse, 126 beats per minute; respiration, 32 breaths per minute; blood pressure (BP), 80/58; temperature, 39.2°C (102.5°F). Which of the following diagnoses best fits this patient's clinical picture?

d. Delirium

7. 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?

d. Delirium

44. A 45-year-old man with a chronic psychotic disorder is interviewed after being admitted to a psychiatric unit. He mimics the examiner's body posture and movements during the interview. Which of the following terms best characterizes this patient's symptom?

d. Echopraxia

29. A 23-year-old man presents to the emergency room with the history of a fever up to 38°C (100.5°F) intermittently over the past 2 weeks, a persistent cough, and a 10-lb weight loss in the past month. He notes that he has also been becoming increasingly forgetful for the past month and that his thinking is "not always clear." He has gotten lost twice recently while driving. Which of the following diagnostic tests will be most helpful with this patient?

d. HIV antibody test

1. 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?

d. Idea of reference

60. Normality is the ability to acculturate and be content in one's world.

d. Karl Menninger

19. 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?

d. Make sure the physical environment is safe for the interviewer

86. A woman brings her 3-year-old son to a psychiatrist for evaluation of his cognitive development. She notes that he can understand the concepts of egocentrism ("I am eating this and I want you to eat it too.") as well as that of irreversibility ("I left that store and now I don't know how to get back to it."), but not the idea of reversibility (cannot play a game of checkers backwards). He can count several objects, but does not understand humor or understand good and bad. Which of the following most accurately describes the status of this child's cognitive development?

d. Normal in cognitive spatial changes development; normal in cognitive achievement development.

98. A 24-year-old man with Tourette disorder comes to his psychiatrist because he has just gotten engaged. He states that his father also has Tourette's and he is worried that when he becomes a father he will pass the disorder on to his children. No one on his mother's side of the family has Tourette's that he is aware of. What is the best response for the psychiatrist to give this patient?

d. There is a definite genetic component to Tourette's, but this is multigenic and so difficult to characterize the chances of your children having it. Only 10% of Tourette's patients do not have a relative with it, so you are likely to pass this disorder on.

90. Which of Freud's theories deals with a model of the mind divided into three regions--conscious, unconscious, and preconscious?

d. Topographic

63. Normality is the ability to be socially connected and be productive, this leads to mental health and the capability of adaption.

e. Alfred Adler

46. A 46-year-old college professor has been unable to go to work for the past 6 weeks because of his psychiatric symptoms.

e. Axis V

95. An 18-year-old man is admitted to the psychiatric unit after his parents find him in his room muttering to himself and convinced that people are going to hurt him. During his stay in the hospital, the patient is frequently found standing in the center of his room with both arms over his head, immobile. The patient can maintain this position for hours at a time. Which of the following best describes this patient's posturing?

e. Catalepsy

51. A woman brings her 18-month-old child to the psychiatrist, worried that he is not developing normally. The psychiatrist tests the child in three arenas, motor & sensory behavior, adaptive behavior, and personal & social behavior and finds the following (the highest level of skill the child achieves during these tests is outlined): Motor & Sensory Behavior Adaptive Behavior Personal & Social Behavior Can hurl ball and walk up Can build a tower Has separation anxiety stairs with one hand held of 3-4 cubes; when taken away scribbles from his mother; holds spontaneously own bottle

e. Delayed development in all three areas

38. A 26-year-old woman with panic disorder notes that during the middle of one of her attacks she feels as if she is disconnected from the world, as though it were unreal or distant. Which of the following terms best describes this symptom?

e. Derealization

17. A 22-year-old woman is seen in the emergency room after a suicide attempt. She swallowed 10 aspirin in the presence of her mother, with whom she had just had an argument. The patient has a long history of cutting herself superficially with razor blades, which her psychiatrist of the last 5 years confirms by telephone. The patient currently lives in a stable environment (a halfway house) where she has been for 3 years. Which of the following option is the best course of action for the physician in the emergency room?

e. Discharge the patient back to outpatient therapy and the halfway house

83. A 17-month-old girl is playing with her mother. Her mother hides a large red ball from the child and encourages her to find it. The girl looks under several pieces of furniture and finally finds the ball hidden behind the couch. The mother enjoys this game, because 2 months previously, if she had tried to play this game, the child simply would not have been able to understand that once the ball was out of sight it still existed. This advance in cognitive ability is most accurately described by which of the following terms?

e. Object permanence

99. A 46-year-old man is being monitored in a sleep study laboratory. After he has been asleep for 90 minutes, his EEG shows low-voltage, random fast activity with sawtooth waves. When awakened during this period, the patient reports that he was dreaming. Which of the following sleep stages was this patient in when awakened?

e. Rapid eye movement (REM)

32. A 28-year-old business executive sees her physician because she is having difficulty in her new position, as it requires her to do frequent public speaking. She states that she is terrified she will do or say something that will cause her extreme embarrassment. The patient says that when she must speak in public, she becomes extremely anxious and her heart beats uncontrollably. Based on this clinical picture, which of the following is the most likely diagnosis?

e. Social phobia

71. A healthy 9-month-old girl is brought to her pediatrician by her concerned parents. Previously very friendly with everyone, she now bursts into tears when she is approached by an unfamiliar adult. Which of the following best describes this child's behavior?

e. Stranger anxiety

13. A 42-year-old woman is admitted to the hospital for complaints of abdominal pain. Her history notes that her mother was a nurse and she herself is trained as a phlebotomist. On physical examination, she presents with multiple abdominal scars and marked abdominal tenderness. The patient is evasive when asked where she had the surgeries, but she can describe in great detail what was done in each.

f. Factitious disorder

61. Normality is the ability to take responsibility for one's own actions and live without fear, guilt, or anxiety.

f. Otto Rank

14. An 18-year-old man is brought to the emergency room by his college roommate, after the roommate discovered that the patient had not left his room for the past 3 days, neither to eat nor to go to the bathroom. The roommate noted that the patient was kind of "weird." Mental status examination reveals that the patient has auditory hallucinations of two voices commenting upon his behavior. The patient's parents note that their son has always been somewhat of a loner and unpopular, but otherwise did fairly well in school.

h. Schizophreniform disorder