Behavioral Medicine Quiz 2 MCQs
Case: A 28-year-old woman presents to a psychiatric clinic hearing voices in her head that keep arguing; she believes that one of the voices might be trying to kill her. She is very soft spoken, polite, and well-groomed. She explains that she often becomes confused and finds herself in unfamiliar places. She has a history of alcohol abuse, but no drug abuse. Her medical files show an extensive medical history for unexplained injuries, stomach problems, and unusual bruising beginning in early childhood. The women 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 woman comes back to the clinic and her behavior appears to be very different from the previous week. She speaks loudly and acts as if she has never seen the psychiatrist before. She is very uncooperative and refuses to answer most questions. 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 papilledema, 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." Question: What is the best management in this case? A. Give 80cc of 0.9% normal saline (i.e 20mL/Kg) B. Give intravenous mannitol to lower intracranial pressure C. Discharge the child after a 4 hour observation period if the infant is asymptomatic D. Discharge the child immediately with instructions about precautions following head injury E. Obtain a skeletal survey to rule out child abuse
E. Obtain a skeletal survey to rule out child abuse
6. Characteristic features of dementia with Lewy bodies include each of the following EXCEPT A. Incontinence B. Well-formed visual hallucinations C. Parkinsonism D. Fluctuating cognitive impairment E. memory impairment
A. Incontinence
Case: 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. Question: What is the most likely diagnosis? A. Neuroleptic malignant syndrome B. Come down with a flu-like viral infection C. Problems with his cytochrome P450 D. A drug interaction E. Manufactured his symptoms
A. Neuroleptic malignant syndrome
11. All of the following are TRUE about HIV infection EXCEPT A. Dementia is often a late manifestation of HIV infection because the retrovirus does not infect the CNS until late in the course B. When HIV does infect the CNS, subcortical structures are more damaged than cortical areas C. Care for many patients with HIV/AIDS may be hampered by clinicians' discomfort with the lifestyles they do not share or understand D. Viruses similar to HIV also cause progressive immunologic and neurological decline E. Both CD4 count and presence of complication determine a diagnosis of AIDS
A. Dementia is often a late manifestation of HIV infection because the retrovirus does not infect the CNS until late in the course
5. Each of the following blood tests is recommended when screening for dementia EXCEPT A. ESR B. Vitamins B12 level C. CBC D. Thyroid function E. syphilis serology
A. ESR
Case: A 62-year old man presents with the gradual onset of confusion, somnolence, and flapping of the hands when the arms are outstretched. Question: Question: What is the most likely abnormality to be seen on laboratory evaluation? A. Elevated serum ammonia B. Hypoglycemia C. Elevated serum uric acid D. Elevated white blood cell count E. Hypercalcemia
A. Elevated serum ammonia
Case: 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. Question: What is the most suitable treatment? A. Fluoxetine B. Amitriptyline C. Lithium D. Phenothiazine E. Buspirone
A. Fluoxetine
Case: 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. Question: What antidepressant would be the best choice for this patient, given her noncompliance? A. Fluoxetine (Prozac) B. Sertraline (Zoloft) C. Paroxetine (Paxil) D. Bupropion (Wellbutrin) E. Phenelzine
A. Fluoxetine (Prozac)
Question: Risk factors for child abuse include all of the following EXCEPT A. Poverty B. Low birth weight C. Being a handicapped child D. Being behaviorally disordered E. Having a parent who was abused
A. Poverty A. Although the cases one hears about are in families of low socioeconomic class, this is not a risk factor for child abuse
Question: 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? A. Severe child abuse B. Genetics C. Witnessing a traumatic event D. The therapist planting dissociative suggestions E. High score on hypnotizability scales
A. Severe child abuse
Case: A 45-year-old man presents after throwing up repeatedly; the emesis looks like coffee grounds. The man is a known alcoholic who recently lost his job. He notes that his stool has been dark for the last few weeks. He has felt sick since the previous morning and has not had a drink since then; he feels very shaky. Physical examination reveals a yellowish appearance of skin and sclerae, extended abdomen, 3 spider nevi on the neck, and dilated cutaneous veins around the umbilicus. The liver is palpable 1 hand width beneath the rib cage, and there seems to be free fluid in the abdomen. Pupils are midsize and reactive. BP is 160/65 mm Hg, heart rate is 90 BPM; respiratory rate is 20/min, weight is 75 kg (165 lb), height is 185 cm (6 feet), and blood glucose is 50 mg/dL. There is concern about his alcoholism and low blood sugar. Question: What is the most appropriate next step in this patient's management? A. Thiamin IV B. Dextrose IV C. Benzodiazepines D. Blood transfusion E. Haloperidol
A. Thiamin IV
Case: 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? A. Abnormal functioning of the left middle temporal cortex B. Abnormalities of the prefrontal cortex C. Reduction in the size of the hippocampus D. Reduction in the size of the amygdala E. Enlarged lateral ventricles
B. Abnormalities of the prefrontal cortex
9. Individuals with Down's syndrome have a high incidence which of the following? A. Multi-infarct dementia B. Alzheimer's dementia C. Dementia pugilistica D. NPH E. All of the above
B. Alzheimer's dementia
Case: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. Question: What is the most likely diagnosis? A. Asperger disorder B. Attention deficit hyperactivity disorder C. Panic disorder D. Absence seizure disorder E. Post-traumatic stress disorder
B. Attention deficit hyperactivity disorder
10. 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 A. Diagnosis of post-operative delirium and recommendation of appropriate work-up and pharmacotherapy B. Criticize the surgical team for failure to recognize and treat the delirium earlier C. Education of the surgical staff about the delirium and its possible etiologies D. Suggestion it the nursing staff that they provide orienting cues for Mrs. A E. Availability should the patient become acutely agitated
B. Criticize the surgical team for failure to recognize and treat the delirium earlier
Case: 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. Question: What is a possible side effect of the drug of choice for this disorder? A. Cushing's syndrome B. Hypothyroidism C. Hypoparathyroidism D. Hypocalcemia E. Hypoglycemia
B. Hypothyroidism
Case: 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? A. Carbamazepine B. Lithium C. Lorazepam D. Valproic acid E. Risperidone
B. Lithium
Question: A patient with hepatic insufficiency is admitted with severe alcohol withdrawal. Which of the following benzodiazepines would be the most appropriate treatment? A. Chlordiazepoxide (Librium) B. Lorazepam (Ativan) C. Alprazolam (Xanax) D. Diazepam (Valium) E. Clonazepam (Klonopin)
B. Lorazepam (Ativan)
Case: 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. Question: What finding on diagnostic testing is most likely? A. Serum sodium 125 meq/l B. Serum lithium level 1.8 meq/l C. Serum thyroxine level 0.2 μg/dl D. 3 Hz spike-and-wave forms on EEG E. Serum creatinine 5.0 mg/dl
B. Serum lithium level 1.8 meq/l
Question: Each of the following is true about attention deficit hyperactivity disorder ADHD EXCEPT A. ADHD is the most common psychiatric disorder in children B. The disorder does not persist into adulthood C. Symptoms must be present before the age of 7 years D. Impairment in functioning must occur in more than one setting E. Stimulants are the first line of treatment
B. The disorder does not persist into adulthood
Case: 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. Question: What is the pharmacological treatment of choice? A. Clorazepate (Tranxene) 30 mg/d B. Lorazepam (Ativan) 2 mg/d C. Haloperidol (Haldol) 5 to 20 mg/d D. Amitriptyline (Elavil) 150 mg/d E. Imipramine (Tofranil) 25 mg/d
C. Haloperidol (Haldol) 5 to 20 mg/d
Case: 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. Question: Which of the following would be the most reasonable therapeutic option? A. Lithium B. Fluvoxamine C. Paroxetine D. Quetiapine E. Valproate
C. Paroxetine
Question: 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? A. Alprazolam B. Clonazepam C. Paroxetine D. Imipramine E. Clomipramine
C. Paroxetine
8. Activities of daily (ADL's) include each of the following EXCEPT A. Bathing B. Dressing C. Using the telephone D. Toileting E. Feeding
C. Using the telephone
Case: 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. A. Minor alcohol withdrawal B. Delirium tremens C. Wernicke's encephalopathy D. Subacute cerebellar degeneration E. Alcoholic ketoacidosis
C. Wernicke's encephalopathy
Question: Which of the following anticonvulsant drugs induces its own metabolism when first initiated? A. Carbamazepine B. Phenytoin C. Valproic acid D. Lamotrigine E. Gabapentin
Carbamazepine
Question: Individual with Autism / Pervasive developmental disorder have mental retardation approximately what percent of the time? A. 10% B. 25% C. 50% D. 75% E. 100%
D. 75%
Case: A 70-year-old woman presents with a poor appetite and a history of depressive disorder with seasonal pattern. Every October or November, she has decreased appetite, decreased energy, and wants to sleep all of the time and hibernate. Question: What drug is most likely to benefit this client? A. Paroxetine B. Fluoxetine C. Sertraline D. Bupropion E. Amitriptyline
D. Bupropion
Question: What medication necessitates a standing weekly blood draw? A. Haloperidol (Haldol) B. Chlorpromazine (Thorazine) C. Valproic acid (Depakote) D. Clozapine (Clozaril) E. Carbamazepine (Tegretol)
D. Clozapine (Clozaril)
Case: 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. Question: What drug may be an effective treatment? A. Cognex (Tacrine HCL) B. Vitamin E C. Risperdal (Risperidone) D. Donepezil (Aricept) E. Haldol (Haloperidol)
D. Donepezil (Aricept)
7. Drugs which have been shown to have some benefit in Alzheimer's disease include each of these EXCEPT A. Tacrine B. Donepezil C. Vitamins E D. L-dopa E. Selegiline
D. L-dopa
Case: 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. Question: In addition to immediate cardiopulmonary resuscitation, treatment with what drug therapy is most likely to be lifesaving? A. Atropine B. Epinephrine C. Flumazenil D. Naloxone E. Phenobarbital
D. Naloxone
3. Each of the following drugs is commonly associated with impaired cognitive function EXCEPT A. Antihypertensives B. Narcotics C. Benzodiazepines D. SSRIs E. Anticholinergics
D. SSRIs
In schizophrenia, the primary neurotransmitter disturbance is that of A. Dopamine B. Serotonin C. Acetylcholine D. Norepinephrine E. GABA
Dopamine
1. In addition to memory impairment, each of the following may provide evidence of dementia EXCEPT A. Aphasia B. Apraxia C. Agnostic D. Executive dysfunction E. Anhedonia
E. Anhedonia
Case: 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. Question: What should you recommend? A. Haloperidol (Haldol) B. Olanzapine (Zyprexa) C. Lanoxin (Digoxin) D. Sodium chloride, salt water, (Ocean) - intranasal drops as a placebo E. Escitalopram (Lexapro)
E. Escitalopram (Lexapro)
Question: 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? A. Phenelzine B. Imipramine C. Bupropion D. Amitriptyline E. Fluoxetine
E. Fluoxetine
REGARDING SPOUSAL ABUSE, ALL OF THE FOLLOWING STATEMENTS ARE CORRECT EXCEPT A. THE ABUSING SPOUSE IS LIKELY TO HAVE BEEN ABUSED AS A CHILD B. THE ABUSED SPOUSE IS LIKELY TO HAVE BEEN ABUSED AS A CHILD C. SPOUSAL ABUSE IS OFTEN CARRIED OUT BY MEN WHO ARE DEPENDENT AND NON-ASSERTIVE D. ABUSED HUSBANDS HIDE THE PROBLEM FOR FEAR OF RIDUCULE E. PREGNANCY USUALLY RESULTS IN A REDUCTION OF ABUSE
E. PREGNANCY USUALLY RESULTS IN A REDUCTION OF ABUSE
Case: 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. Question: In addition to detoxification with a benzodiazepine prior to repair of his hip fracture, what is needed to prevent neurologic sequelae? A. Ascorbic acid B. Beta-carotene C. A daily bottle of whiskey D. Pyridoxine E. Thiamine F. A daily case of beer
E. Thiamine
2. In distinguishing delirium from dementia, each of the following characteristics of delirium may be useful EXCEPT A. An acute or subacute onset B. Hallucinations C. A fluctuating course D. Impaired attention E. an impaired level of consciousness
Hallucinations
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. Her Question: What might you tell her? A. Ask her if her partner is under stress B. Ask her if her partner was drinking C. Discuss her symptoms of URI (upper respiratory infection) D. Her partner will not give up control E. Tell her she needs to give him one more chance
Her partner will not give up control