Smarty pants practice questions part 1 -done

Of patients with generalized anxiety disorder, what percentage have at least one other similar psychiatric disorder at some time in their life? A 10% B 30% C 50% D 80%

80%

In young women with an eating disorder, at what point would you expect her menstrual periods to resume? A 75% of ideal body weight B 80% of ideal body weight C 90% of ideal body weight D 100% of body weight E It is unusual for menstrual cycles to resume with any weight gain

90% of ideal body weight

In young women with an eating disorder, at what point would you expect her menstrual periods to resume? A 75% of ideal body weight B 80% of ideal body weight C 90% of ideal body weight D 100% of body weight E It is unusual for menstrual cycles to resume with any weight gain.

90% of ideal body weight

Which of the following presentations is characteristic of dissociative amnesia? A A 29-year-old nun is surprised when a man states that he saw her at an exotic dancing establishment several days ago. She denies these accusations and truly has no memory of the event. B A 39-year-old man presents stating that several times in the last month he felt as if he was outside of his body. He struggles to describe the experience but says the feeling best approximates "watching a movie of herself." C A 21-year-old woman is reported missing by her parents in Miami. Years later it is discovered that she is living in Texas. She has no recollection of her previous life in Miami. D A 25-year-old woman is brought to the emergency room by EMS when she was found naked in a clothing store. Her family and friends said that for the last 2 weeks she had been increasingly grandiose, had been sleeping 3-4 hours per night, and had not gone to work. E An 82-year-old man is found several states away from his home and is not oriented to person, place, or time.

A 21-year-old woman is reported missing by her parents in Miami. Years later it is discovered that she is living in Texas. She has no recollection of her previous life in Miami.

Which of the following statements about the etiology of depression is true? A A genetic component is nearly always present B Decreased prolactin levels are responsible for depression in children C Major depressive disorder requires a "triggering event" D A bidirectional association is noted between depression and coronary artery disease

A bidirectional association is noted between depression and coronary artery disease

an 8-year-old boy is brought in by his mother due to his poor performance in school. She learned from his teachers that he will often yell out answers in class, will not wait in line, has trouble making friends, and obeying the rules of games. The mother states that he has been like this for "as long as she can remember." She is exhausted and has trouble taking care of him at home. On exam, you see a very active young child who during the exam grabs your ID badge and your stethoscope several times. Otherwise, his exam is within normal limits.

ADHD

Which of the following statements is correct about ADHD? A ADHD is one of the most heritable psychiatric disorders B ADHD is more common in girls than boys C ADHD is rarely associated with other clinical diagnoses D ADHD is largely caused by environmental exposure

ADHD is one of the most heritable psychiatric disorders

Which of the following disorders often appear together in the same individual at various life stages? A mental retardation, attention-deficit/ hyperactivity disorder (ADHD), and learning disability B childhood depression, ADHD, and early-onset adult schizophrenia C ADHD, conduct disorder, and antisocial personality disorder D adjustment disorder, ADHD, and major depression E ADHD, bipolar disorder, and conduct disorder

ADHD, conduct disorder, and antisocial personality disorder

A 21-year-old female visits your office on a break from college complaining that she cannot sleep at night. She says that at 3:00 AM each night she awakens and cannot go back to sleep. The patient says that she previously enjoyed playing lacrosse for a club team but dropped out after losing interest. Upon further questioning, she describes herself as 'miserable' over the past few months and says she has begged her parents to let her take time off from school. She admits to suicidal ideation and describes a plan she 'thinks about all the time' to take her own life. Which of the following is the most appropriate next step for this patient? A Speak with her parents B Admit to the hospital C Call the health center at her college D Depression screening test E Administer fluoxetine

Admit to the hospital

Which of the following is not recognized as one of the diagnostic criteria of major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)? A Fatigue B Agitation not influenced by external stimuli C Sleep disturbance D Significant weight change

Agitation not influenced by external stimuli

a 17-year-old female who is in your office for an annual sports physical. She is the star of her high school track team. She has not menstruated for 5 months. Her BMI is 15 kg/m2. On physical exam, you note calluses on the back of her hands and fine hair on her arms. She states that she only eats vegetables but has been trying to cut back as she thinks she is holding excess body fat

Anorexia nervosa

a 19-year-old female who has lost 40 pounds over the last 6 months. Her body mass index is 16. When asked about her most recent meal, the patient reports that she ate an apple the previous morning.

Anorexia nervosa

Which of the following is required for a diagnosis of ADHD? A Prolonged lethargy lasting at least 3 months B Presence of a comorbid psychiatric disorder C Positive findings on brain imaging (such as functional MRI or single-photon emission CT [SPECT]) D At least six symptoms of inattention or hyperactivity-impulsivity (or both) that have persisted for at least 6 months

At least six symptoms of inattention or hyperactivity-impulsivity (or both) that have persisted for at least 6 months

A 4-year-old boy is noted to have impaired language development, compulsive repetitive behavior, impaired intelligence, and a preoccupation with inanimate objects. The most likely diagnosis is A Conductive hearing loss B Attention-deficit disorder C Autism D Manic- depressive disorder E Dyslexia

Autism

a 3-year-old boy is brought to your office by his mother due to abnormal behavior. She reports that he does not appear to respond to affection, does not look her in the eyes, and constantly lines up his toys. He becomes agitated when she tries to take him away from his toys or if the mother cooks a different meal for dinner. On physical examination, he does not respond to questions and is distracted by the texture of the exam-table cloth.

Autism

A 7-year-old male is brought to the pediatric clinic by his father for his annual well-child check. The father admits that he worries about his son and some of his behaviors. The father says the child does not show emotion, fails to interact with kids at school, and makes poor eye contact. He also spends hours and hours stacking colored blocks. The teacher has also reached out to the child's parents with concerns. Which of the following is the most likely diagnosis? A Conduct disorder B Oppositional deviant disorder C Social anxiety D Autism spectrum disorder E Normal behavior

Autism spectrum disorder

a 22-year-old female who admits to episodes of binge eating 3-4 days per week off and on for the past 3 years. She eats very quickly until she feels "stuffed" and she reports eating large amounts of food even when she is not hungry. Because she is embarrassed by her behavior she often chooses to eat alone. Afterward, she reports feeling disgusted, depressed, and guilty. The patient is 5 ' 7" and weighs 225 pounds, her BP is 135/75 and her fasting blood sugar is 121. She takes Fluoxetine (Prozac) 20 mg q day for depression.

Binge Eating Disorder

a 27-year-old man accompanied by his girlfriend. In the office, he seems to be running from topic to topic without a clear message. His speech is pressured. The patient's girlfriend reports that he took steroids recently for a bad sinus infection and since he started them, his behavior has been abnormal. After discontinuing the medication, he has still been having symptoms. He has not had a normal night of sleep for the past ten days, and he just bought a new sports car though he has no need for one or the money to afford it. She also reports that she has caught him with multiple other women in the past few days, though they were in a committed relationship. The physical exam is benign and the patient's vital signs are within normal limits.

Bipolar I disorder This is an example of bipolar I (rather than bipolar II which is defined by a hypomanic episode where the patient is not experiencing full-blown mania).

a 19-year-old male who has had bouts of sadness for the course of 1 year in which he says that oftentimes cannot even get out of bed so he tells his parents he is ill. Jim states that he recently felt so energized that he could not keep his thoughts straight and jumped from one idea to another. During this energized state, he did become irritable and others stated that he was louder than usual and wondered if he took something that increased his energy. During the week of high energy, he maxed out two of his credit cards and is not sure how he will pay them off before he goes to school in the fall. It was only a week later that he became so depressed that he did not find any pleasure in anything he did, was so tired he did not want to get out of bed which has continued to be a struggle today.

Bipolar II disorder

Which of the following accurately describes how an SSRI functions? A Inhibits chemicals that remove neurotransmitters in the body B Increases the available amount of neurotransmitters in the brain C Blocks the reabsorption of the neurotransmitter at the cellular level in the brain D Induces brief seizures through the use of electric currents passed through the brain

Blocks the reabsorption of the neurotransmitter at the cellular level in the brain

a 24-year-old male with a history of acne is at your office for concerns of acne scarring on his face. On exam, you notice very few scattered pustules but no noticeable scarring. You recommend he use topical benzoyl peroxide cream and send him home. The patient returns for follow-up three months later this time very concerned. He reports that he is having trouble sleeping at night because of concern over his appearance, he feels people are staring at him because of his acne, he is very self-conscious, he has been avoiding social events, and has trouble approaching girls. He is having trouble concentrating in class and it is now affecting his grades. He washes his face at least 6 times per day and admits to spending several hours each day in front of the mirror. He is requesting something stronger for his acne and heard from a friend about Accutane. Again on the exam, you notice only very mild comedomes but no visible scarring.

Body Dysmorphic Disorder

In children, what is a common physical sign of sexual abuse? A Bruising on the legs B Bruising on the arms C Bruising in the genital area D Bruising on the torso E Bruising on the face

Bruising in the genital area

A 20-year-old college student presents to her dentist. Her vital signs are normal, and her weight is 120 lb. On examination, extensive upper dental erosion is noted. The most likely diagnosis is A OCD B Anorexia nervosa C Hypothyroidism D Crohn's disease E ulimia nervosa

Bulimia nervosa

a 14-year-old is female who is brought to your clinic by her mother who claims to hear the child vomiting after dinner in the evenings. The patient reportedly denies vomiting and feels fine. On physical exam, you notice petechial hemorrhages of the soft palate and conjunctiva. Further exam reveals scars on her knuckles, swollen parotid glands, dental erosions. Her weight is normal. Lab tests reveal hypochloremia and hypokalemia.

Bulimia nervosa

A mother brings her 6-year-old son to the office for a complete assessment. She states that "there is something very wrong with him." He just sprinkled baby powder all over the house, and last night he opened a bottle of ink and threw it on the floor. He is unable to sit still at school, is easily distracted, has difficulty waiting his turn in games, has difficulty in sustaining attention in play situations, talks all the time, always interrupts others, does not listen when talked to, and is constantly shifting from one activity to another. As you enter the examining room, the child is in the process of destroying it. On examination (what examination you can manage), you discover that there are no physical abnormalities demonstrated. What is the most likely diagnosis in this patient? A mental retardation B childhood depression C attention-deficit/hyperactivity disorder (ADHD) D maternal deprivation E childhood schizophrenia

C attention-deficit/hyperactivity disorder (ADHD)

a 4-year-old girl is brought to the emergency department by her mom because the child was found to be lethargic after being picked up from a new daycare. The child has been attending the new daycare for the past week. Medical history is noncontributory. Physical examination shows multiple bruises on the buttocks, a small circular burn mark on the arm, and retinal hemorrhages. A chest radiograph is obtained and shows a right-sided rib fracture.

Child Abuse

A 52-year-old male is referred to psychiatry by his PCP after 3 weeks of erratic behavior. The patient has been driving to a casino 60 miles away after work every night to gamble and returning directly to work the following morning. He stresses, however, that "it isn't a problem" because he is still "full of energy" during the day at his banking job, which he "could do in [his] sleep anyway." He has not sought psychiatric treatment in the past, but reports an episode of self-diagnosed depression 2 years ago. The patient's medical history is significant for diabetes, hypertension, hepatitis C, stage II chronic kidney disease, and congenital long QT syndrome. The patient's toxicology screen is negative for illicit drugs in the PCP's office. EKG is shown here. Which of the following of the patient's medical conditions is a contraindication for lithium therapy? A Type II diabetes mellitus B Hypertension C Prolonged QT D Hepatitis C E Chronic kidney disease

Chronic kidney disease

Which of the following is an evidence-supported concern in children with ADHD? A Comorbid bipolar disorder B Increased risk for cardiac conditions C An associated underlying immunodeficiency disease D Foods that contain food coloring or that are high in simple sugars, which exacerbate symptoms

Comorbid bipolar disorder

a 13-year-old boy is brought in by police officers to the emergency department, where his parents soon arrive. He was placed under arrest and charged with destruction of property as well as assault and battery after police arrived at the scene and found the patient beating the owner of a liquor store with a baseball bat. According to police, the patient cut his arm on a piece of glass while jumping through a store window in an attempt to evade arrest. The police officer tells you, "We know this one ... he's a regular customer of ours. We've had him down at juvenile hall more times than I can count." The patient's parents tell you that his aggressive behavior started in the past couple of years: "Sure, he would argue and fight with us when he was younger, but he didn't start getting arrested until he was about eleven." His parents recount a number of disturbing instances of cruelty to animals, leading to the death or maiming of several neighborhood cats. After an examination, you note that his wounds are not serious. His vital signs are within normal limits. The patient appears cheerful and unconcerned. He is worried about getting the blood off of his favorite baseball bat more than about the fate of the man he injured.

Conduct disorder

a 14-year-old who is referred to your office for unusual animal cruelty and bullying at school.

Conduct disorder

a 24 year old male with c/o episodes of depression and hypomania for 2 years. PMH is significant for bipolar disorder.

Cyclothymic disorder

a 34-year-old female who reports that several times last month she felt as if she was outside of her body. She struggles to describe the experience but says the feeling best approximates "watching a movie of herself."

Depersonalization/derealization disorder

a 23-year-old female is reported missing by her parents in California. Years later, it is discovered that she is living in New York. She has no recollection of her previous life in California.

Dissociative amnesia

a 43-year-old schoolteacher is surprised when a parent states that she saw him at a strip club several days ago. He denies these accusations and truly has no memory of the event.

Dissociative identity disorder

a 25-year-old woman who comes to your office for a new patient visit. Her complaints are 6 months of constant pelvic pain and low back pain, intermittent myalgias, insomnia for "many years," and feeling tired. When you ask about bruises of varying ages on arms, legs, and face, she notes that she is clumsy and bumps into things a lot. Her husband accompanies her to the visit and refuses to leave the room for the physical examination. On pelvic examination, purulent cervical discharge is noted, along with cervical motion tenderness. Her husband inquires as to why you are using so many tubes for laboratory specimens.

Domestic violence

a 75-year-old woman comes to the ED with her spouse because she fell in the shower. The husband says that his wife used to be highly functional and independent, but her function has declined over the past year. He answers all her questions for her and appears overly concerned about her health and functional status. When asked to leave the room so that the patient can be examined, he refuses. Her appearance is unkempt, and her clothes are dirty. While discussing the management of the patient's clinical situation, you offer help in the form of home health services, but the husband refuses.

Elder Abuse

a 25-year-old male PA student presents to student health with a chief complaint of picking at his skin. He states that at times he has urges to pick his skin that he struggles to suppress. Typically, he will participate in the act during finals or when he has "too many assignments to do." The patient states that he knows that his behavior is not helping his situation and is causing him harm; however, he has trouble stopping. On physical exam, you note a healthy young man with scars on his arms and face. His neurological exam is within normal limits.

Excoriation Disorder

a 23-year-old male who goes to city park during the summer months in an overcoat. He enjoys walking around the park exposing his genitals to strangers. He then runs away so as to avoid getting caught.

Exhibitionistic disorder

A 50-year-old male presents to your clinic complaining of intense fear of snakes for 2 years. Whenever he sees a picture of snakes or hears someone talking about snakes, he gets diaphoretic, nervous, and has an intense sense of doom. Which of the following is the first-line treatment for his most likely diagnosis? A Benzodiazepines B Propranolol C Exposure therapy D SSRIs

Exposure therapy

a 33-year-old woman with a chief complaint of trouble having intercourse. She is completely disinterested in sex and she is not receptive to her partner's attempts to initiate foreplay. She reports that when they do have sex she never achieves orgasm. This is affecting her current relationship with her boyfriend.

Female sexual interest/arousal disorder

a female brings her 29-year-old boyfriend to a couples therapist because she is uncomfortable with his behavior. She found him clutching her feet during intercourse, and noticed that he insists on being able to see her feet while they engage in sexual acts.

Fetishistic disorder

a 29-year-old male who was brought in by his wife and older brother. According to them, the patient has a desire to rub his privet area against other people, when the opposing person is not looking. He has done this action in their home, and to his wife when she is doing the dishes, or even cooking dinner and began to rub against his brother when he would be helping his with things around the house.

Frotteuristic disorder

Which of the following is necessary for a diagnosis of major depressive disorder with seasonal pattern? A At least four episodes of depressive disturbance in the previous 2 years B Full remission must occur at a characteristic time of year C Seasonal episodes must be at least equal to nonseasonal episodes D Seasonal-related psychosocial stressors must be present

Full remission must occur at a characteristic time of year

a 35-year-old female with a complaint of worry which she cannot control for the last year. She tells you that her symptoms daily consisting of sleep disturbances, difficulty concentrating, and irritability. She reports her symptoms started around age 17 but have worsened.

General anxiety disorder

A 75-year-old gentleman with a psychiatric history is brought to the emergency room by his wife. She feels that he has been acting exceedingly depressed and is now continuously talking about ending his misery. Answering yes to which of the following questions is the most concerning? A Do you take psychiatric medications? B Have you ever tried to commit suicide in the past? C Are you depressed? D Has anyone in your family committed suicide? E Do you have access to a gun

Have you ever tried to commit suicide in the past?

a 25-year-old female is brought to your office by her mother who is concerned about her recent behaviors. The mother states that her daughter has been collecting "useless items" in her apartment over the last year. When she tried to persuade her daughter to throw away several years' worth of old newspapers, her daughter had an angry outburst and refused to speak to her for two weeks. The patient reluctantly admits that she keeps "most things just in case they become useful later on." She also states that she has felt less interested in seeing friends because she does not want them to come over to her apartment. She has also not been sleeping well, as her bed has become an additional storage space and she must sleep on her futon instead. The patient states that she is frustrated with herself and feels hopeless, and she sometimes wishes she were "away from all of this," but she cannot control her behaviors

Hoarding Disorder

Which of the following is true regarding Intimate partner violence (IPV) A Is higher among Caucasian women as compared with other ethnic classes B Affects men and women equally C Rarely affects the elderly D Increases during pregnancy E Is rarely associated with a spouse

Increases during pregnancy

A 36-year-old woman admits that her husband has abused her for over ten years. You should inform the woman that she is at most risk for injury or death A Just before a holiday B Just after leaving an abusive spouse C When an abusive spouse arrives home after work D When an abusive spouse has been drinking heavily

Just after leaving an abusive spouse

Which of the following medications is used in the classic treatment of bipolar disorder? A Lithium B Sertraline C Amitriptyline D Phenytoin E Alprazolam

Lithium

a 33-year-old woman complaining of fatigue and decreased interest in "the things that used to make me happy." She is sleeping less and eating less, and she says that she is forcing herself to eat "because I know I have to eat something." She finds herself spending less time with her kids and husband as she retreats to her room. She feels guilty that she lacks the energy and enthusiasm she used to have.

Major depressive disorde

a 53-year-old male complaining of a lack of desire for sex with his wife causing him marked distress for the past year. His wife has been very hurt by his lack of response to her advances and he reports that this is having a significant strain on their relationship. Prior to this, he was interested in sex and he and his wife would have intercourse 1-2x per month. He is very active and continues to compete in triathlons. He has no significant past medical history.

Male hypoactive sexual desire disorder

Which of the following electrolyte abnormalities is associated with bulimic patients? A Metabolic acidosis B Respiratory acidosis C Metabolic alkalosis D Respiratory alkalosis E Normal electrolytes

Metabolic alkalosis

a 26-year-old PA student presents to the student health center with the complaint being unable to sleep. Although he is a very successful student, over the past few months he has become increasingly preoccupied with failing. The patient states that he wakes up 10-15 times per night to check his textbooks for factual recall. He has tried unsuccessfully to suppress these thoughts and actions, and he has become extremely anxious and sleep-deprived. He has no past medical history and family history is significant for a parent with Tourette's syndrome. He is started on a first-line medication for his disorder, but after eight weeks of use, it is still ineffective.

Obsessive-compulsive disorder

Which of the following is recognized as a symptom of the predominantly inattentive type of ADHD? A Fidgeting with or tapping hands or feet B Often loses things necessary for tasks or activities C Excessive talking D Interrupting others

Often loses things necessary for tasks or activities

a 10-year-old boy whose parents c/o constant arguments. His parents state that he has "been a handful." He argues all the time. He is always angry and is easily agitated. He seems to enjoy making others upset. At school, he does not listen to his teachers and argues with them all the time. His parents report that they are "fed up" with him and his behavior is "putting a lot of strain on our marriage." Past medical history is significant for ADHD with panic disorder.

Oppositional defiant disorder

a 15-year-old who back talks and resists following instruction from parents or authorities

Oppositional defiant disorder

a 33-year-old male gymnastics teacher insists that all his students take a shower after class. He supervises the children showering and becomes sexually aroused.

Pedophilic disorder

a 30-year-old married male who feels down most of the time for the past three years. He experiences frequent, intrusive thoughts that he is not good enough, despite personal and professional successes. He tries to overcompensate for his thoughts by taking on more than he can handle, which leads to failure and furthers his feelings of inadequacy. His wife suggests that he seek help after finding him crying.

Persistent depressive disorder

What is the most common psychological effect of sexual abuse in children? A Anxiety B Depression C Post-Traumatic Stress Disorder (PTSD) D Obsessive Compulsive Disorder (OCD) E Attention Deficit Hyperactivity Disorder (ADHD)

Post-Traumatic Stress Disorder (PTSD)

a 26-year-old patient is complaining of depression and anxiety just prior to her menses. The symptoms have been going on for more than 1 year, but are now starting to interfere with her relationships and her productivity at work. One week prior to menses each month she experiences a depressed mood, a feeling of being on edge, increased irritability, difficulty sleeping, a feeling of being overwhelmed, and is easily fatigued. She charted her symptoms daily in a log and returned to the office two cycles later. The log is consistent with the history. Her physical examination and general laboratory profile showed no abnormalities.

Premenstrual dysphoric disorder (PMDD)

Laboratory findings seen in anorexia nervosa include A Hyperkalemia B Leukocytosis C Prolonged QT interval on electrocardiogram D Metabolic acidosis E Elevated sedimentation rate

Prolonged QT interval on electrocardiogram

One theory of persistent depressive disorder states that the disorder is the result of anger experienced in childhood that manifests as self-loathing and results in depressed mood and maladaptive thoughts. What type of theory would this be classified as? A Behavioral B Humanistic C Cognitive D Psychodynamic

Psychodynamic

What is considered first line in the long term treatment of panic disorder A Benzodiazepines B TCAs C SSRIs D Wellbutrin

SSRIs paroxetine, fluoxetine, sertraline, and venlafaxine

A 26-year-old female presents to her primary care physician with several months of mood swings, which she feels are affecting her work and personal relationships. She states that on roughly a quarter of days each month, she feels highly irritable, sensitive to criticism and rejection, and easily saddened. She also feels that her appetite varies greatly, and on the days when she is particularly emotional, she also feels especially hungry. As a result of these symptoms, her performance at work has suffered, and her boyfriend has been complaining that she is difficult to live with. She is anxious that she cannot "get my mood under control." The patient has no past medical history, regular periods every 28 days, and no obstetric history. She uses condoms for contraception. Her mother has major depressive disorder, and her father has hypertension and coronary artery disease. At this visit, the patient's temperature is 98.4°F (36.9°C), pulse is 75/min, blood pressure is 130/76 mmHg, and respirations are 13/min. She appears slightly anxious but has overall normal affect and is pleasantly conversational. Physical exam is unremarkable. Which of the following is the best next step in management? A Reassurance B Selective serotonin reuptake inhibitor C Combined oral contraceptive therapy D Serotonin-norepinephrine reuptake inhibitor E Cognitive behavioral therapy

Selective serotonin reuptake inhibitor

a 9-year-old girl who you are seeing for a wellness checkup. The girl's past medical history is non-contributory, and she has met all her developmental milestones. Her parents were recently called into the office as the girl was found touching the genitals of one of her classmates. The girl is asked what has happened and what she thinks is going on but she is too shy to reply. The girl and her mother recently moved in with a family member. They live in low-income housing subsidized by the government and are currently on food stamps. The mother states that her daughter has been particularly argumentative lately and that they have gotten into arguments in which her daughter screamed at her and locked herself in the bathroom.

Sexual abuse

a 23-year-old male who concerned that his behavior has resulted in his inability to maintain a relationship. He reveals that he requires his partners to strangle him and humiliate him in order for him to achieve and maintain an erection.

Sexual masochism disorder

a 42-year-old white man seeking help for depression and suicidal ideations. In a detailed interview, the patient reveals his involvement in sexual acts that make him guilty. He reports that he and his girlfriend of the last two years had been involved in cutting and drawing blood from each other's bodies while engaging in sexual activity. The two also drink each other's blood while involved in these sexual activities, and he reports that cutting and drinking his partner's blood is the only way that he can reach orgasm. On physical exam, you note numerous scars on his arms and chest that are very deep and in different stages of healing.

Sexual sadism disorder

What patient demographic is at highest risk for the development of anorexia nervosa? A College aged swimmer B High school football player C Married, 50 year old, heterosexual female D Single, 20 year old, homosexual male

Single, 20 year old, homosexual male

Which of the following is generally accepted as the most effective first-line therapeutic option in children with ADHD? A Norepinephrine reuptake inhibitors B Behavioral psychotherapy alone C Stimulants and cognitive therapy D Cognitive therapy alone

Stimulants and cognitive therapy

a 44-year-old physician with a history of alcohol abuse and depression is transferred to the ER after being found on the floor of his apartment next to an empty bottle of oxycontin and a handle of whiskey. Prior to this event, he had been giving away large amounts of money and was very thorough in creating a will.

Suicidal/homicidal behaviors

During what phase of the menstrual cycle do symptoms of PMDD manifest?

Symptoms occur during the luteal phase of the menstrual cycle and resolve with menstruation.

Along with lithium levels which of the following laboratory levels should be monitored in patients taking lithium for bipolar disorder? A Potassium B TSH C CBC D Uric Acid

TSH

Which of the following statements about fluoxetine is true? A Side effects often include dry mouth, urinary retention, and blurred vision B The treatment of panic disorder typically requires higher doses than the recommended starting dose for depression. C The mechanism of action involves the reuptake of dopamine at the postsynaptic junction. D The drug has significant anticholinergic activity. E Treatment of bulimia typically requires higher doses than the recommended starting dose for depression

Treatment of bulimia typically requires higher doses than the recommended starting dose for depression

Which of the following statements about the treatment of major depressive disorder is true? A Treatment should be altered if the patient does not have an adequate response to pharmacotherapy in 3-4 weeks B Clinical response to pharmacotherapy is typically seen within 1-2 weeks C Pharmacotherapy is not indicated in patients who have had more than two depressive episodes D Treatment should be continued for 4-9 months in patients with a first episode of major depression not associated with suicidality

Treatment should be continued for 4-9 months in patients with a first episode of major depression not associated with suicidality

a 15-year-old girl who is brought to your office by her mother. The patient has no prior medical history, but after having been in a car accident, she started pulling her hair out. Distressed by her daughter's appearance, her mother asks for your help.

Trichotillomania (Hair-Pulling Disorder)

An adult must have symptoms of persistent depressive disorder for what length of time in order to meet DSM 5 criteria and receive a diagnosis? A Two years B Six months C One year D Two weeks

Two years

a 20-year-old male college student was reported by others for spying through the windows of his fellow female dormmates.

Voyeuristic disorder

A 27-year-old woman is presenting to her physician assistant with a constellation of physical and affective symptoms that she believes are associated with her menstrual cycle. Which of the following is consistent with premenstrual syndrome and does not warrant further testing? A Difficulty swallowing B Sudden bleeding C Weight gain D Breast size decrease E Cold intolerance

Weight gain

The diagnosis of conduct disorder is made when which of the following criteria is (are) fulfilled? A repetitive and persistent patterns of behavior that violate the rights of others B stealing C lying D vandalism E a and any two of b, c, and d

a and any two of b, c, and d The diagnosis of conduct disorder requires a repetitive and persistent pattern of behavior that violates the basic rights of others or age-appropriate rules of society, manifested by at least three of the following behaviors: stealing running away from home staying out after dark without permission lying so as to "con" people deliberately setting fires repeatedly being truant (beginning before the age of 13 years) vandalizing being cruel to animals bullying being physically aggressive forcing someone else into sexual activity Conduct disorder is a purely descriptive label for a heterogeneous group of children and adolescents. Many of these individuals also lack appropriate feelings of guilt or remorse, empathy for others, and a feeling of responsibility for their own behavior.

Which of the following are pharmacologic treatment options in attention-deficit/hyperactivity disorder (ADHD) A methylphenidate or its derivatives B dextroamphetamine or amphetamine derivatives C magnesium pemoline D modafinil E a or b

a or b methylphenidate or its derivatives dextroamphetamine or amphetamine derivatives

Conduct disorder appears to result from an interaction of which of the following factors? A temperament B attention to problem behavior and ignoring of good behavior C association with a delinquent peer group D a and c E a, b, and c

a, b, and c

The differential diagnosis of attention-deficit/hyperactivity disorder (ADHD) includes which of the following? A adjustment disorder B bipolar disorder C anxiety disorder D childhood schizophrenia E a, b, and c

a, b, and c

Which of the following is (are) true regarding the prevalence of attention-deficit/hyperactivity disorder (ADHD) A prevalence rates are higher in preschool children than in school-age children B affected boys outnumber girls in surveys of school-age children C prevalence rates decline as a cohort of children ages into adulthood D a, b, and c E none of the above

a, b, and c

A 25-year-old woman comes to the office for a new patient visit. Her complaints are 6 months of constant pelvic pain and low back pain, intermittent myalgias, insomnia for "many years," and feeling tired. When you ask about bruises of varying ages on arms, legs, and face, she notes that she is clumsy and bumps into things a lot. Her husband accompanies her to the visit and refuses to leave the room for the physical examination. On pelvic examination, purulent cervical discharge is noted, along with cervical motion tenderness. Her husband inquires as to why you are using so many tubes for laboratory specimens. Which of the following should be considered to be part of the differential diagnosis in this patient? A intimate partner violence (IPV) B pelvic inflammatory disease C pregnancy D bleeding disorder E all of the above

all of the above

Which of the following is (are) associated with attention-deficit/hyperactivity disorder (ADHD) A feelings of low self-esteem B feelings of depression C impaired interpersonal relationships D a reduction in life successes E all of the above

all of the above

Which treatment( s) is (are) used to manage symptoms of conduct disorder? A behavioral therapy B mood stabilizers C alpha agonists D beta blockers E all of the above

all of the above

Which of the following benzodiazepines has the shortest half life A diazepam (Valium) B chlordiazepoxide (Librium) C clorazepate (Tranxene) D alprazolam (Xanax) E clonazepam (Klonopin)

alprazolam (Xanax)

Which of the following symptoms is generally not characteristic of GAD? A awakening with apprehension and unrealistic concern about future misfortune B worry out of proportion to the likelihood or impact of feared events C a 6-month or longer course of anxiety and associated symptoms D association of the anxiety with depression E anxiety exclusively focused on health concerns

anxiety exclusively focused on health concerns

Which of the following pharmacologic agents is not recommended in the treatment of GAD? A venlafaxine B buspirone C benzodiazepines D selective serotonin reuptake inhibitors (SSRIs) E clozapine

clozapine

What is the psychotherapy of choice for this GAD? A cognitive-behavioral therapy (CBT) B hypnosis C supportive psychotherapy D psychoanalytic psychotherapy E none of the above

cognitive-behavioral therapy (CBT)

a 16-year-old male who has demonstrated significant behavioral and impulsive problems since early childhood, which were manifested more prominently when he was four. During this time he was removed from his mothers care due to her continuous substance abuse. She reported using alcohol, cocaine, and crack cocaine during her pregnancy. He has a history of repeated violations of school rules and disruption in class. He often was aggressive and cut school. He also reported torturing animals and doing "sexual things" to them. He once set his grandmother's bed on fire while she was sleeping in it. Another disclosure involved playing in the backyard of his grandmother's home where he burned several toys. Psychological testing was carried out and his results indicated an average IQ using the Wechsler Intelligence Scale for Children. His scale scores included a verbal score of 93, performance score of 104 and a full scale score of 95. Further testing revealed his struggles with an extremely low self-esteem. He also provided somewhat odd answers on a sentence completion assessment, mentioning several times "that I wish I was never born."

conduct disorder

What is the second leading cause of death in adolescents aged 15 to 19 years? A drowning B suicide C firearms D all-terrain vehicle accidents E alcohol

firearms

Bipolar II disorder is characterized by A history of depression and one episode of hypomania B history of more mania than depression C prolonged (> 2-yr) periods that include both hypomanic and depressive episodes D none of the above

history of depression and one episode of hypomania

A phobia is an excessive fear of an object or place that leads to or can be preceded by: A panic attack B depression C hallucinations D delusions E confabulations

panic attack

a 30-year-old male who arrives at your ED in distress stating that he had " a heart attack." The event started suddenly and was associated with diaphoresis, chest pain, tachycardia, and tachypnea. Troponins and ECG are within normal limits. Upon further questioning, he reports some numbing around his lips and that he has such episodes every few days for the past three months. The attacks have become so severe that he has been missing work and didn't go to last week's Christmas party. He denies recreational or illicit drug use. He further shares that he recently divorced and has had no social support. Recent lab results have all been normal or within standard limits, including TSH and vitamin B12.

panic disorder

a lab technician calls to tell you that a 22-year-old man you have sent for a blood draw is very anxious. He says he is terrified of having his blood drawn and almost faints at the sight of the needle

phobia

When women without symptoms are screened by clinicians for domestic violence A the majority become angry or express being offended B the risk of harm to the affected patient is increased when screening is done in the presence of the abusive partner C few women believe that screening is of benefit or that it makes getting help easier D posters, brochures, and other materials in an office with culturally sensitive information about domestic violence can lead to more victims providing information to clinicians when asked about domestic violence E all of the above

posters, brochures, and other materials in an office with culturally sensitive information about domestic violence can lead to more victims providing information to clinicians when asked about domestic violence

Who is the person who usually makes this diagnosis? attention-deficit/hyperactivity disorder (ADHD) A the child psychiatrist B the family physician C the mother or father D the schoolteacher E the grandparents

the schoolteacher

Which of the following is a symptom of lithium toxicity? A weight gain B psoriatic rash C agranulocytosis D tremor E polyuria

tremor

GAD is more common in which of the following? A elderly white men B school-age children C married people D those of higher socioeconomic status E young to middle-aged women

young to middle-aged women