Question bank

A43-year-old morbidly obese woman presents to your office with a 3-week history of increasing vulvar burning. She has had no new sexual partners or practices. She has not noticed any change in her vaginal discharge. She has attempted to medicate herself with over-thecounter antifungals, herbal creams, and old antibiotics, none of which have provided relief. On examination, her entire labia majora and minora are markedly erythematous and tender to the touch. Her vaginal mucosa appears to have normal rugae. Her vaginal pH is normal and whiff test is negative. The wet mount shows a few WBCs and normal squamous cells. What is the most likely diagnosis?

A24-year-old cocaine addict with no previous psychiatric history, reports that he had been bingeing on cocaine for 2 months earlier in the year. He stopped using cocaine 2 months ago, and he has been very sad and tearful for the entire period since he stopped his cocaine use. Identify the diagnosis below that best describes the situation. major depressive disorder, recurrent bipolar I disorder

A23-year-old university student has lost interest in his master's degree program. His two friends who bring him to the psychiatrist say he has been isolating himself in his room and has covered all electrical appliances and outlets with duct tape claiming that "electromagnetic waves are disturbing the microchip in my brain." He acknowledges that he once took a medication for the same problem with the "microchip," but then he became unbearably restless, could not sit still, and felt that he was "crawling" inside. According to the patient's psychiatric symptoms, select the most appropriate medication. Presume no medical problems other than those mentioned. amitriptyline clozapine divalproex fluoxetine hypericum perforatum

A 22-year-old White female (gravida 2, para 1, abortus 1) comes to your office with a 3-week history of lower abdominal pain and increased vaginal discharge. She has a prior history of an ectopic pregnancy at age 16. Her last menstrual period (LMP) was 7 days ago, and she has had unprotected vaginal intercourse with a new sexual partner several times over the past few weeks. Her temperature is 38.0°C; her vital signs are stable. She has bilateral lower quadrant tenderness but no peritoneal signs. On speculum examination, she has foul smelling green discharge emanating from her cervix. She has cervical motion tenderness on bimanual examination and is tender in both adnexae. Her wet mount shows copious white cells. Her urine - hCG is (-).

A35-year-old man comes into the hospital with deep sadness and suicidal thoughts. He reports having experienced similar episodes in the past; he says he has also experienced two periods of extremely elated moods, during which he talked nonstop, went without sleep, and believed he was God. Identify the diagnosis below that best describes the situation. major depressive disorder, recurrent bipolar I disorder

A 22-year-old White female (gravida 2, para 1, abortus 1) comes to your office with a 3-week history of lower abdominal pain and increased vaginal discharge. She has a prior history of an ectopic pregnancy at age 16. Her last menstrual period (LMP) was 7 days ago, and she has had unprotected vaginal intercourse with a new sexual partner several times over the past few weeks. Her temperature is 38.0°C; her vital signs are stable. She has bilateral lower quadrant tenderness but no peritoneal signs. On speculum examination, she has foul smelling green discharge emanating from her cervix. She has cervical motion tenderness on bimanual examination and is tender in both adnexae. Her wet mount shows copious white cells. Her urine - hCG is (-). Which of the following would be the most appropriate treatment regimen for this patient?

A 3-year-old boy spends hours rocking in a chair or spinning the blades of a toy windmill; his parents say he never cries when he falls. Select the diagnosis with which it is most likely to be associated.

A 14-year-old nulligravid female is brought to the ER by her parents with a 12-hour history of severe, intermittent left lower quadrant pain. She has had nausea and vomiting for the past 2 hours. On history, the patient experienced menarche at age 12 and denies past or current contact with a sexual partner. Her last normal menstrual period was 3 weeks ago. On examination, she is afebrile, pulse 100, BP 110/70, respiratory rate (RR) 20. She is visibly uncomfortable. She has no costovertebral tenderness, has diminished bowel sounds, her abdomen is nondistended, and exhibits rebound and guarding in both lower quadrants. She is unable to tolerate a pelvic examination due to pain. Laboratory values are as follows: WBC 13, HCT 39, -hCG (-), UA (-). Apelvic ultrasound shows a normal nonpregnant uterus, normal right adnexa, and an 8-cm left adnexal mass with a 3-cm solid component The most likely etiology of this patient's pain is which of the following?

A5-year-old boy is reported by his kindergarten teacher to be easily distracted, impulsive, in need of continual supervision, but not hyperactive Select the diagnosis with which it is most likely to be associated. childhood depression

A76 year old White female presents to her family practitioner complaining of vaginal pressure, dyspareunia, urinary incontinence, and difficulty emptying her bladder for the past 4 weeks. Seven years ago she had a prolapsed "bladder tacking" procedure. Her postvoid residual urine in the office measures 250 mL. The most notable finding on pelvic examination is seen in Figure. Which of the following would be the most appropriate action to take at this time?

A76 year old White female presents to her family practitioner complaining of vaginal pressure, dyspareunia, urinary incontinence, and difficulty emptying her bladder for the past 4 weeks. Seven years ago she had a prolapsed "bladder tacking" procedure. Her postvoid residual urine in the office measures 250 mL. The most notable finding on pelvic examination is seen in Figure. What is the most likely etiology of her urinary retention?

A 9-year-old boy has had persisting difficulties in language and interpersonal relationships since the age of 2 years, and, although he can barely read, he is able to perform arithmetic calculations at the fifth-grade level. Select the diagnosis with which it is most likely to be associated.

A43-year-old Black female (gravida 3, para 3) with a previous tubal ligation, presents to your office complaining of increasing menorrhagia, dysmenorrhea, and fatigue over the past 6 months. On examination, her vital signs are normal, and on abdominal examination you palpate a firm, mobile mass just below the umbilicus. On pelvic examination, there is a moderate amount of old blood coming from the cervical os. A urine pregnancy test is negative, her last pap smear was normal and her spun HCT today is 28%. Which pharmacologic agent would potentially result in an improvement in her HCT and help to decrease uterine size?

A 42-year-old married woman reports being raped in an elevator 1 year ago. Her arms were fractured in the assault but have healed nicely. Still she reports difficulty sleeping, having nightmares of the attack several times per week ever since the assault. She avoids using the elevator and does not want to talk about the incident with anyone. She has been unable to return to work. Her husband feels she has been hypervigilant and irritable, and has been resistive to going out socially. She has a depressed mood. Her husband is encouraging her to seek disability. Which of the following is the most likely diagnosis?

A43-year-old Black female (gravida 3, para 3) with a previous tubal ligation, presents to your office complaining of increasing menorrhagia, dysmenorrhea, and fatigue over the past 6 months. On examination, her vital signs are normal, and on abdominal examination you palpate a firm, mobile mass just below the umbilicus. On pelvic examination, there is a moderate amount of old blood coming from the cervical os. A urine pregnancy test is negative, her last pap smear was normal and her spun HCT today is 28%. Which diagnostic test would be most costeffective in confirming a diagnosis?

A 14-year-old nulligravid female is brought to the ER by her parents with a 12-hour history of severe, intermittent left lower quadrant pain. She has had nausea and vomiting for the past 2 hours. On history, the patient experienced menarche at age 12 and denies past or current contact with a sexual partner. Her last normal menstrual period was 3 weeks ago. On examination, she is afebrile, pulse 100, BP 110/70, respiratory rate (RR) 20. She is visibly uncomfortable. She has no costovertebral tenderness, has diminished bowel sounds, her abdomen is nondistended, and exhibits rebound and guarding in both lower quadrants. She is unable to tolerate a pelvic examination due to pain. Laboratory values are as follows: WBC 13, HCT 39, -hCG (-), UA (-). Apelvic ultrasound shows a normal nonpregnant uterus, normal right adnexa, and an 8-cm left adnexal mass with a 3-cm solid component. Which of the following would be the next appropriate step in managing this patient?

Of the following, which is considered a cortical dementia?

A 56-year-old thin, White woman, who has recently undergone a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy for a stage IB, grade 1, endometrioid tumor of the uterus, presents to your office complaining of hot flashes and vaginal dryness. She wants advice about the use of estrogen replacement in women treated for endometrial cancer. Which of the following is the best treatment for this woman?

A39-year-old woman with a long-standing history of normal pap smears undergoes a total abdominal hysterectomy for a large uterine fibroid and menorrhagia. Six months after her hysterectomy she had a negative vaginal pap smear from the vaginal apex. She presents to your clinic today for a routine physical examination. Based on the American College of Obstetricians and Gynecologists recommendations, when should this patient have pap smears?

A middle-aged man with depression requests help for his symptoms of low self-esteem and feelings that "life is bad no matter what you do." He prefers to use no medication and expresses the desire to not be in therapy "for years." There is no previous psychiatric treatment. Which of the following therapies would be the most helpful?