Question bank

A 68-year-old widow presents to the primary care clinic for a routine appointment. Her current medical problems include hypertension, obesity, and chronic obstructive pulmonary disease. She has no significant psychiatric history, although she saw a psychologist for eight sessions after her husband died. She does not drink alcohol or use illicit drugs. She has smoked one-and-a-half to two packs of cigarettes per day for the past 45 years and she wishes to quit. She has heard about some of the options but is unsure which would be the most effective. After being informed of the various choices, she decides to proceed with medication. Which of the following medications is most useful for tobacco cessation?

A32-year-old female presents to the outpatient clinic with complaints of ongoing headaches. For the past 8 months, she has had recurrent headaches which she describes as bilateral, occipital, with a tight/squeezing pain, lasting for several hours and relieved with nonsteroidal anti-inflammatory medication (NSAIDs). Further questioning reveals chronic feelings of fatigue and poor concentration. She admits to "constantly worrying" about her job performance as well as issues involving her relationship with a live-in boyfriend. In fact, her focusing on these concerns interferes with her sleep. As a result, she has on more than one occasion awakened with extreme panic, tremors, diaphoresis, nausea, and palpitations. Her medical problems include gastroesophageal reflux disease that is treated with famotidine. She drinks an occasional glass of wine and denies drug use. Which of the following is her most likely diagnosis?

The patient is an 18-year-old male brought into the emergency room in the early morning by his friends after attending a dance party. He is agitated, pacing the hallway but unsteady. Despite this, he claims that he feels "wonderful" and states, "Everything will be all right." He also seems focused on seeing many colored flashes and hearing "all conversations at once." He has no known medical problems and is not taking any medication. He does admit to ingesting something early on, which he was told would help him "party all night." On physical examination, he has an elevated BP and pulse, dilated pupils, and significant diaphoresis. This same patient is eventually admitted for detox and successfully completes a drug treatment program. He is attending college and performing well. He returns to the urgent care clinic with complaints of reoccurring experiences similar to those he had when he was "high," such as flashing lights, intensified sounds, and halos. He is greatly upset about these and feels that they interfere with his studying. A complete physical examination and blood work (including toxicology screen) are negative. Administration of which of the following medications may worsen his symptoms?

The patient is a 48-year-old Marine veteran who has self-referred to the emergency room. He complains of feeling "depressed" and suicidal for the past several days. He admits to using "crack" cocaine daily for the past 3 weeks, but he is vague regarding how he obtains and affords his drugs. He also drinks several 40 oz beers three to four times per week and smokes marijuana "on occasion." He has been homeless, staying with "friends" and in shelters. He last used cocaine this morning and wishes to be admitted for detoxification. Which of the following is most likely to be a comorbid diagnosis in this individual?

The patient is a 48-year-old Marine veteran who has self-referred to the emergency room. He complains of feeling "depressed" and suicidal for the past several days. He admits to using "crack" cocaine daily for the past 3 weeks, but he is vague regarding how he obtains and affords his drugs. He also drinks several 40 oz beers three to four times per week and smokes marijuana "on occasion." He has been homeless, staying with "friends" and in shelters. He last used cocaine this morning and wishes to be admitted for detoxification He is subsequently admitted to the mental health unit but the next day is evaluated for complaints of withdrawal symptoms. He complains of insomnia, listlessness, irritability, and worsening dysphoria. Which of the following would be the most appropriate treatment strategy for his current condition?

A38-year-old married woman presents to her urgent care clinic complaining of "crying spells" for several weeks since the termination of her employment. She admits to feeling "down all the time." She also has difficulty falling asleep, poor energy, decreased appetite, and is "not able to enjoy anything." She fears that her condition will never improve. She has begun to feel that "it wouldn't matter if I died," but she denies any suicidal plan or intent. She drinks one to two mixed drinks per week and denies any drug use. It is decided to begin antidepressant therapy with paroxetine (Paxil) 20 mg at bedtime. If there is no significant improvement in her symptoms, but the medication is tolerated, after what length of time should a dosage increase be considered?

A32-year-old woman reports that she has been in a low-grade, chronically depressed mood for more days than not for the past 3 years. She reports that she has never had a period of severely depressed mood, but the low-grade feeling of sadness has not gone away for more than 2 or 3 days at a time over the past 3 years. Identify the diagnosis below that best describes the situation. major depressive disorder, recurrent bipolar I disorder

A45-year-old woman, seen by her medical internist, has been experiencing fears that she may have a serious illness. She complains that after eating she experiences "a lot of gas" and abdominal pain, followed by diarrhea on occasion. Her heart at times seems to be beating rapidly, and she feels faint at times, has chest "discomfort," and wonders if she is having a heart attack. Multiple tests have identified only a mild irritable bowel syndrome. The woman's fears are not allayed by this. She makes repeated calls to be seen by her doctors as well as seeking consultation from other specialists. She insists that "there's something there" and believes the doctors are not taking her seriously. Which of the following is the most likely diagnosis?

A21-year-old male college student reports a 1- month period of intensely depressed mood, with marked anxiety, sleep disturbance, and weight loss. He has never before experienced an episode of a mood disorder. According to the clinical vignette, select the pharmacotherapeutic agent which is most likely to be helpful to the patient. buspirone

A 41-year-old woman has a long history of chronic paranoid schizophrenia. She experiences auditory and visual hallucinations and has had difficulty maintaining a job. According to the clinical vignette, select the pharmacotherapeutic agent which is most likely to be helpful to the patient. buspirone

A 45-year-old woman reports a 6-month history of free-floating anxiety, which makes her feel tense most of the time on most days. According to the clinical vignette, select the pharmacotherapeutic agent which is most likely to be helpful to the patient. buspirone

A7-year-old boy presents with his mother who reports he cannot pay attention and is having severe problems at school because of this and his hyperactivity. According to the clinical vignette, select the pharmacotherapeutic agent which is most likely to be helpful to the patient. buspirone

Identify the following personality disorders with the symptoms listed below. Unwilling to take personal risks; perceives self as inept, unappealing, inferior antisocial avoidant borderline dependent histrionic narcissistic

Identify the defense mechanisms with the descriptions below. Becoming angry with one's spouse at a party and deciding to wait until a more appropriate time to express it acting out altruism displacement intellectualization passive-aggressive behavior

Identify the defense mechanisms of a person being afraid of one's rage and anger and presenting as unusually meek and mild acting out altruism displacement intellectualization passive-aggressive behavior

Identify the defense mechanisms of a person accusing another of being angry and jealous when the feelings belong to oneself acting out altruism displacement intellectualization passive-aggressive behavior

Match the antidepressant with the side effect or characteristic of an SSRI with a half-life of 46 days phenelzine venlafaxine

A40-year-old man has a history of severe alcohol dependence and is very interested in whatever help he can get to avoid relapsing in his alcohol use. According to the clinical vignette, select the pharmacotherapeutic agent which is most likely to be helpful to the patient. buspirone

Identify the most likely diagnosis with the case descriptions below. A 35-year-old woman complains that she has been to multiple doctors, none of whom have been able to effectively treat or even diagnose the cause of her chronic stomach pain and diarrhea, repeated problems swallowing, headache, and recurrent back pain. The symptoms have been present on and off for most of her adult life. body dysmorphic disorder conversion disorder factitious disorder

A 53-year-old man reports that he is currently in one of his "up" periods. He states that he feels very good, and he is quite talkative, but he reports that he is having no trouble keeping his job, and he is sleeping well. He has never had any periods of elevated mood that have substantially interfered with his working, and he has never needed hospitalization for his "up" periods. However, he has suffered two periods of severe depression, each requiring hospitalization for suicidal thoughts, the most recent having occurred 3 years ago. Identify the diagnosis below that best describes the situation. major depressive disorder, recurrent bipolar I disorder