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159 questions
A 58-year-old woman with a history of chronic paranoid schizophrenia, who has been continuously treated with antipsychotics for the past 20 years, lives in a community-based residential facility. She has recently suffered an increase in auditory hallucinations, and her haloperidol dose has been increased from 2.5 to 10 mg/day. Four days later, she is brought by a visiting nurse to the emergency room, where she presents with confusion, marked flexor and extensor rigidity in her legs and arms, and a temperature of 103.5°F. Her bl ood pressure is160/120 mmHg, her pulse is 120/min and irregular. Which of the following is the most likely diagnosis that best describes this woman's current condition? neuroleptic malignant syndrome (NMS)
A 58-year-old woman with a history of chronic paranoid schizophrenia, who has been continuously treated with antipsychotics for the past 20 years, lives in a community-based residential facility. She has recently suffered an increase in auditory hallucinations, and her haloperidol dose has been increased from 2.5 to 10 mg/day. Four days later, she is brought by a visiting nurse to the emergency room, where she presents with confusion, marked flexor and extensor rigidity in her legs and arms, and a temperature of 103.5°F. Her bl ood pressure is160/120 mmHg, her pulse is 120/min and irregular. Which of the following is the most important laboratory test to evaluate the possibility of the diagnosis?
A 58-year-old woman with a history of chronic paranoid schizophrenia, who has been continuously treated with antipsychotics for the past 20 years, lives in a community-based residential facility. She has recently suffered an increase in auditory hallucinations, and her haloperidol dose has been increased from 2.5 to 10 mg/day. Four days later, she is brought by a visiting nurse to the emergency room, where she presents with confusion, marked flexor and extensor rigidity in her legs and arms, and a temperature of 103.5°F. Her bl ood pressure is160/120 mmHg, her pulse is 120/min and irregular. Which of the following is most likely to be an effective treatment for this condition?
Narcolepsy is a primary sleep disorder with all of the following symptoms except which of the following?
A 37-year-old woman telephones to alert her psychiatrist that she has developed a severe pain in her right eye that has persisted for about 5 hours. She has no history of migraine headaches. The psychiatrist is treating her with 150 mg imipramine for major depression. She denies any recent injury or infection in this eye. She wears corrective lenses for nearsightedness. Which of the following is the most appropriate step in management?
A 40-year old man has been treated for chronic paranoid schizophrenia for many years with a typical neuroleptic. To decrease his risk for tardive dyskinesia, his psychiatrist wants to change his medication to an atypical antipsychotic. Which of the following atypical antipsychotics is limited in its use by the risk of agranulocytosis, which occurs in 12% of all patients treated? aripiprazole
A 45-year-old homeless schizophrenic patient presents to you with suicidal ideation. You interview him and find out he is a divorced Roman Catholic. He recently lost his job after being caught a second time drinking on the job. He had attempted suicide impulsively 5 years previous by overdosing. He is not currently psychotic. He bought a handgun and ammunition recently and has been thinking about shooting himself in the head. He has gotten as close to acting on it as having loaded the gun and held it up to his head this morning. Someone walking by stopped him and convinced him to come and see you. He is ambivalent about seeking help. Which of the following is not associated with an increased suicide risk?
A 45-year-old homeless schizophrenic patient presents to you with suicidal ideation. You interview him and find out he is a divorced Roman Catholic. He recently lost his job after being caught a second time drinking on the job. He had attempted suicide impulsively 5 years previous by overdosing. He is not currently psychotic. He bought a handgun and ammunition recently and has been thinking about shooting himself in the head. He has gotten as close to acting on it as having loaded the gun and held it up to his head this morning. Someone walking by stopped him and convinced him to come and see you. He is ambivalent about seeking help Which of the following is the most appropriate immediate treatment recommendation?
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 most appropriately describes this woman's disorder?
During the course of psychotherapy with a woman who has a severe phobia of cars, it is discovered that her first sexual experience, which was a humiliating one for her, took place in an automobile. What is the defense mechanism illustrated by this phobia called?
A 30-year-old woman complains that she has had sleep disturbances since the start of her depression 2 months ago. Which of the following is an accurate description of typical sleep abnormalities in depression?
A 78-year-old woman is seen by a psychiatrist for depression. She is fairly cooperative in responding to questions. She admits to feeling blue; she "catnaps" throughout the day and is up at night; and her appetite is very poor. She thinks of death frequently but denies feeling suicidal. There is no past psychiatric history. On the MMSE, she obtains a score of 14. Her depressive symptoms have been present for "several days." Which of the following is highly suggested by the findings?
A 40-year-old man has been unsuccessfully treated for depression with two different medications for the past 3 months. He has a number of medical problems, and he recently was hospitalized after threatening suicide. His psychiatrist is considering the use of ECT for the patient. The patient has consented to ECT, and the pre ECT workup has been completed. Which of the following medications could routinely be continued through a course of ECT?
A 40-year-old woman with no previous psychiatric history seeks help from her internist for a sleep problem. Initially, she is able to fall asleep but then sleeps fitfully, and finally around 4:00 a.m. decides to stay up. She averages approximately 34 hours of sleep per night, and this has been occurring for the last 3 weeks. She finds herself quite tired and "blue" during the day but is unable to nap. Mornings are "the worst" for her, but she feels better toward the end of the day. There has been a 15-lb weight loss because "I'm just not hungry." She denies any physical problems except for constipation. As a gradeschool teacher, she feels extremely stressed but sees no way out and no way to improve the situation. At times, suicide seems like a possible option, and she admits to spending long hours brooding on how to do it. A physical examination is unremarkable. Which of the following is the most likely diagnosis?
A 40-year-old woman with no previous psychiatric history seeks help from her internist for a sleep problem. Initially, she is able to fall asleep but then sleeps fitfully, and finally around 4:00 a.m. decides to stay up. She averages approximately 34 hours of sleep per night, and this has been occurring for the last 3 weeks. She finds herself quite tired and "blue" during the day but is unable to nap. Mornings are "the worst" for her, but she feels better toward the end of the day. There has been a 15-lb weight loss because "I'm just not hungry." She denies any physical problems except for constipation. As a gradeschool teacher, she feels extremely stressed but sees no way out and no way to improve the situation. At times, suicide seems like a possible option, and she admits to spending long hours brooding on how to do it. A physical examination is unremarkable Which of the following is the most appropriate treatment choice?
Which of the following is considered a negative symptom of schizophrenia?
Which of the following medications may be appropriate for treating children with attention deficit disorder?
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?
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?
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