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Old 02-04-2016
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Default Help! NBME psychology questions

Hi all,

Anyone can help me with those questions from NBME? It's confusion to me. By the way, how you guys prepare your psychology? Any special materials to go over? Thanks!!

1. A 47-year-old woman is brought to the emergency department by her husband because of increasing confusion during the past 2 days. On arrival, she has a generalized tonic-clonic seizure lasting 4 minutes. She has bipolar disorder treated with several medications, but her husband is unsure of their names. He knows that she sometimes takes ibuprofen for mild arthritis pain caused by exercise. He says that she has been active and exercising more lately, but he cannot think of other changes in her
rolJline. She has no history of seizure disorder. She is oriented to person but not to place and time. Her pulse is 9O/min, and blood pressure is 140/90 mm Hg. On physical examination, she is tremulous and somno!ent There is bilateral nystagmus. AIl ECG shows a second-degree atrioventricular block. The most likely cause of this patient's symptoms is an adverse effect of which of the following medications?
A) Bupropion
B) Haloperidol
C) Lithium
D) Risperidone
E) Valproic acid

2. Five weeks after being discharged from the hospital after treatment for a psychotic episode, a 27 -year-okJ man comes to the physician for a follow-up examination. Durirrg hospitalization, he claimed that he was instructed by the Lord to found a new religion and that a famous gospel singer was inlOV€ with him. Today, he says that he still hears the voices of the Lord and members of the church he attends in his apartment and
when he shops in the supermarket He no longer believes the world ne€ds a new religion because the Lord is no longer instructing him to create one. He states, "My father in heaven tells me that he is at peace, and therefore, so am I." Current medications include risperidone and lorazepam. He drinks one to two beers on weekends. He used marijuana regularly in coltege but has abstained for the past 5 years. He appears clean and is casually dressed. His temperature is 36.rC (98°F),
pulse is 72Jmin, respirations are 20/min, and blood pressure is 130/72 mm Hg. Physical examination shows no abnormalities. Mental status examination shows a calm affect. He is cooperative, alert, and oriented to person, place, and time. Based on this information, which of the followirrg is the most likely current diagnosis for this patient?
~ A) Bipolar disorder
~ B) Cyclothymic disorder
~ C) Delusional disorder
~ D) Schizoaflective disorder
~ E) Substance-induced mood disorder

3. A 37-year-old male police officer comes to the physician at the request of his superiors 1 week after he witnessed a terrorist bombing during which several civilians and three fellow police officers were killed. He sustained only minor injuries and assisted in rescuing survivors and gathering body parts. Since the bombing, he has felt emotionally
numb and has been unable to enjoy activities he used to find pleasurable. He has continued to work but has requested assignments far removed from the site of the attack. He describes his sleep as fitful. Two years ago, he sustained a bullet wound to the right calf, which left him with a slight limp. He has no other history of medical or psychiatric illness. He says he used to drink one to two beers nightly but has been drinking two to three beers nightly for the past week. Physical examination confirms the previous gunshot injury to the calf and shows no other abnormalities. On mental status examination, he is irritable and says he is not depressed. He tells the physician, ''They made me come. I'm not interested in talking with anyone. I just want to spend time with my buddies and be left alone" Which of the following is the most appropriate initial step in management?
A) Encourage the patient to discuss the trauma in detail
B) Provide information about the range of reactions to trauma
C) Recommend group therapy with other trauma survivors
D) Recommend a l -month medical leave of absence from active duty
E) Recommend a physician-led trauma debriefing series
F) Recommend a 12-step program
G) Begin clonazepam therapy
H) Begin fluoxetine therapy
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dashi (02-06-2016)

Old 02-06-2016
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1st...resperidonor bupropion?
2nd... schizoeffective
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Old 02-06-2016
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3rd i think we do group therapy for acute or ptsd,,,not sure
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Old 02-07-2016
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1) Lithium
Patients with acute lithium toxicity often present with symptoms of nausea, vomiting, and diarrhea; neurologic findings develop late in acute poisoning.
Patients with chronic lithium toxicity often present with neurologic symptoms and signs. Neurologic findings can include sluggishness, ataxia, confusion or agitation, and neuromuscular excitability. Severe poisoning can lead to seizures, nonconvulsive status epilepticus, and encephalopathy.
The differential diagnosis for lithium poisoning includes serotonin syndrome and neuroleptic malignant syndrome.
Serum lithium concentrations can be useful for determining the severity of an overdose or the need for hemodialysis and should be obtained in any patient with suspected toxicity. However, lithium concentrations often do not correlate with clinical signs of toxicity.
An elevated temperature may be seen in either SS or NMS, fever can also precipitate lithium toxicity in a patient on chronic therapy. NMS is characterized by "lead pipe" rigidity. Patients with either SS or lithium toxicity may manifest clonus, but in SS this is most prominent in the lower extremities. Valproic acid also somewhat fits in the profile of toxicity.

2) Psychotic symptoms in the absence of the mood symptoms ==> schizoaffective.

3)Provide information about the range of reactions to trauma. Pt lacks insight in his condition => provide information. Group therapy requires understanding of issues and commitment to treatment.
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Old 02-17-2016
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1. Lithium The person has bipolar and the SE presented are pretty typical lithium overdose
2. Delusional Disorder? I think schizoaffective is psychotic + mood symptoms but I'm not sure about this one
3. Debriefing? I think this is a weird questions. The person has acute stress disorder but debriefing is such an outdated technique...

Last edited by bigheadvic; 02-17-2016 at 06:28 PM.
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