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Old 07-18-2016
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Default Psychiatry

Hello guys I'm studying psychiatry and came across these questions was wondering if anyone would like to help to figure these out?

Thank you!

3. A 52-year-old woman comes to the physician for a routine follow-up examination. She has received inpatient psychiatric treatment several times since the age of 25 years for auditory hallucinations and the belief that her thoughts and movements were being controlled by a local television station; her last admission to the hospital was 10 years ago. Treatment with haloperidol for the past 20 years has decreased the occurrence of symptoms. She attempted suicide at the ages of 30 and 38 years. She lives in a supervised residence and does not work. During the examination, she repeatedly smacks her lips and slightly protrudes her tongue. When the physician asks if she is chewing gum, she laughs and opens her mouth to show she is not. She can hold her mouth and tongue still when asked but begins lip smacking when the physician resumes the examination. Which of the following is the most appropriate next step in pharmacotherapy?

A) Continue haloperidol and add alprazolam
B) Continue haloperidol and add propranolol
C) Discontinue haloperidol
D) Discontinue haloperidol and begin chlorpromazine
E) Discontinue haloperidol and begin risperidone

5. A 30-year-old woman has had frontal headaches, stomach upset, and poor appetite for 4 weeks; she has had a 2-kg (5-1b) weight loss during this period. She has pain in the left upper quadrant of the abdomen 1 to 3 hours after eating dinner. Over-the-counter antacids have been ineffective. She blames herself for not taking better care of her body. The headaches occur at night and awaken her. She feels fatigued in the morning and has difficulty getting up and going to work. Over the past month, her supervisor has complained about her recent errors, which she attributes to difficulty concentrating. She says that she is so tired when she comes home that she has stopped going out with her friends and just goes to sleep. Which of the following is the most likely diagnosis?

A) Adjustment disorder with depressed mood
B) Borderline personality disorder
C) Dysthymic disorder
D) Major depressive disorder
E) Somatization disorder
F) Ulcerative colitis

6. Five weeks after being discharged from the hospital after treatment for a psychotic episode, a 27-year-old man comes to the physician for a follow-up examination. During hospitalization, he claimed that he was instructed by the Lord to found a new religion and that a famous gospel singer was in love 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 needs 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 college but has abstained for the past 5 years. He appears clean and is casually dressed. His temperature is 36.7C (98F), pulse is 72/min, 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 following is the most likely current diagnosis for this patient?

A) Bipolar disorder
B) Cyclothymic disorder
C) Delusional disorder
D) Schizoaffective disorder
E) Substance-induced mood disorder

7. A 72-year-old woman comes to the physician because of a 3-month history of fatigue and difficulty sleeping. She has had a 5.4-kg (12-1b) weight loss during this period because of decreased appetite. Her husband died 18 months ago. She has a 15-year history of hypertension treated with verapamil and a 3-month history of insomnia treated with zolpidem. Laboratory studies 1 week ago showed no abnormalities. She is 170 cm (5 ft 7 in) tall and weighs 60 kg (133 lb); BMI is 21 kg/m 2. Her pulse is 74/min, and blood pressure is 131/84 mm Hg. Physical examination shows no abnormalities. Mental status examination shows an irritable and tearful mood. She expresses hopelessness about the future. Which of the following is the most likely finding in this patient?

A) Decreased hemoglobin concentration
B) Decreased serum vitamin B (thiamine) concentration
C) Increased percentage of bands on complete blood count
D) Increased serum cortisol concentration
E) Increased serum prolactin concentration

17. An unconscious 7-year-old boy is brought to the emergency department by his parents. The family emigrated from rural Southeast Asia 4 years ago. An interpreter is used because the parents do not speak English. They say, "Our child has been possessed by a spirit since birth who speaks through his mouth with spit and blood and then takes his powers away." He has had these spells all of his life. He does not attend school. They recently sacrificed a piglet as an offering to the spirit, but there has been no change in the child's condition. The parents seem devoted. He awakens during the physical examination and smiles vacantly at his parents. He appears confused and speaks in monosyllables. No other abnormalities are noted. Which of the following is the most appropriate next step in diagnosis?

A) Contact child protective services
B) Psychoeducational assessment
C) Family therapy
D) Throat culture
E) X-ray of the chest

27. An 8-month-old male infant who was adopted recently is brought to the physician because of poor weight gain. He was born at term and weighed 2410 g (5 lb 5 oz). He was formula fed at birth and has consistently been below the 3rd percentile for weight. Currently, his diet consists of 16 ounces of iron-fortified cow milk formula, juice, cereal, prepared fruit, and pureed green vegetables. There is no history of vomiting. He has one formed stool daily. He is alert and appears well. He currently weighs 7002 g (15 lb 7 oz). On examination, he says "mama" and "bye-bye" while waving. He sits unsupported. He is wary of strangers. There are narrow palpebral fissures, epicanthal folds, a thin upper lip with a "fish mouth" appearance of the oral cavity, and an indistinct nasal philtrum. His ears are normally set, the nasal bridge is flattened, and the tongue is not enlarged. There is a single palmar crease on the left hand. Cardiopulmonary examination shows no abnormalities. There is no hepatosplenomegaly, and no masses are palpated. There is no peripheral edema. Which of the following is the most likely diagnosis?

A) Celiac disease
B) Down syndrome
C) Fetal alcohol syndrome
D) Psychosocial deprivation
E) Silver-Russell syndrome

29. A 57-year-old man comes to the physician with his wife because of a 1-month history of bizarre behavior at night. His wife says that most nights he falls asleep at approximately 11 pm and begins kicking and groaning in the bed shortly after 12:30 am. Seven times during this period, he has jumped out of the bed and run back and forth across the room, punching the air. She tries to wake him during these episodes because she is afraid that he might hurt her or himself. She reports that when she succeeds, he seems alert but tells her that he was being attacked and needed to defend himself or escape. The patient tells the physician that he does not recall the behavior his wife is describing but remembers having a recurrent dream in which he is in danger and cannot breathe. Vital signs are within normal limits. Physical examination shows no abnormalities. On mental status examination, he has a pleasant and full range of affect. His thought process is rational and goal directed. He says that based on his wife's description of his behavior at night, he is afraid that he might hurt her. Results of laboratory studies are within the reference range. Which of the following is the most likely diagnosis?

A) Central sleep apnea
B) Nocturnal panic disorder
C) Nocturnal paroxysmal dystonia
D) REM sleep behavior disorder
E) Restless legs syndrome
F) Sleep-related complex partial seizure disorder
G) Sleep terror disorder

32. A 23-year-old man comes to the physician because of anxiety since beginning a second part-time job as a courier for a photographer 6 weeks ago. He reports a fear of heights and of riding in elevators. He takes stairs and escalators whenever possible, which prevents him from completing his deliveries on time. He has not had panic attacks. He has no history of serious illness and takes no medications. His temperature is 36.8C (98.2F), pulse is 80/min, respirations are 18/min, and blood pressure is 118/73 mm Hg. Physical examination shows no abnormalities. On mental status examination, he has an anxious mood and full range of affect. He reports no symptoms of depression or suicidal ideation. Which of the following is the most appropriate next step in management?

A) Cognitive behavioral therapy
B) Interpersonal therapy
C) a-Adrenergic agonist therapy
D) I3-Adrenergic blocker therapy
E) Selective serotonin reuptake inhibitor therapy

36. A 27-year-old woman comes to the physician for an examination prior to starting a new job. She has a 10-year history of binge-eating and self-induced vomiting. She takes no medications. She does not drink alcohol or use illicit drugs. She is 178 cm (5 ft 10 in) tall and weighs 72 kg (160 lb); BMI is 23 kg/m 2. Her temperature is 37C (98.6F), pulse is 70/min, respirations are 10/min, and blood pressure is 120/70 mm Hg. Physical examination shows yellow dental enamel and abdominal striae. Serum studies are most likely to show which of the following abnormalities?

A) Decreased bicarbonate concentration
B) Increased amylase activity
C) Increased magnesium concentration
D) Increased potassium concentration
E) Increased sodium concentration

38. A 47-year-old woman comes to the physician 2 hours after the onset of heart palpitations. She had a myocardial infarction 6 years ago and is suddenly afraid that she might be having another heart attack. She does not have chest pain. She says that 2 hours ago, she was feeling "extremely good and enjoying how things seemed to be moving slowly around me." An exercise stress test 2 months ago showed no abnormalities. She has been taking alprazolam up to three times daily for 3 years for anxiety and took her last dose 3 hours ago. Her father died of a myocardial infarction at the age of 46 years. She had not used an illicit substance for 20 years, but 2 months ago, she was promoted to a managerial position and began smoking marijuana daily to relax. Her temperature is 37.5C (99.5F), pulse is 120/min, respirations are 20/min, and blood pressure is 150/95 mm Hg. Physical examination shows dry oral mucosa and injected conjunctivae. Neurologic examination shows difficulty with finger-nose testing. On mental status examination, she has an anxious affect, and she repeatedly asks for something to be done. Her speech is staccato and rushed but clear and rational. An ECG shows sinus tachycardia. Which of the following is the most likely cause of this patient's current symptoms?

A) Acute myocardial infarction
B) Anxiolytic intoxication
C) Anxiolytic withdrawal
D) Generalized anxiety disorder
E) Histrionic personality disorder
F) Hypochondriasis
G) Major depressive disorder
H) Marijuana intoxication
I) Panic disorder

42. A 52-year-old man with schizophrenia comes to the physician for a follow-up examination. At his last examination 1 week ago, the physician noticed that the patient tongue occasionally protruded. When asked, the patient was unaware of this movement, but he was able to voluntarily prevent it. At that time, physical examination showed normal muscle strength. He had been taking risperidone for 5 years; treatment was discontinued to stop his tongue movements. Today, examination shows worsening tongue movements and writhing choreoathetoid movements of the upper extremities. Which of the following is the most likely underlying cause of this patient's symptoms?

A) Atrophy of the caudate nucleus
B) Increased acetylcholine
C) Increased sensitivity of the dopamine receptors
D) Loss of volume in the basal ganglia
E) Vascular changes in the small vessels

43. A 77-year-old man comes to the physician at his wife's insistence because of a 2-year history of progressive memory problems. His wife notes that he often asks questions that have been answered minutes earlier. On three occasions, he got lost while walking a few blocks from their house, and he has forgotten to turn off the burner several times when making coffee. He has been otherwise healthy. He takes no medications. He is awake and alert. Physical examination shows no abnormalities. On questioning, he states that he has not been aware of any memory problems. His Mini-Mental State Examination score is 21/30. He recalls one of three objects after 2 minutes. An MRI of the brain shows moderate atrophy. Administration of a medication with which of the following properties is the most appropriate treatment?

A) Anticholinergic
B) Antidopaminergic
C) Antiserotonergic
D) Cholinergic
E) Dopaminergic
F) Serotonergic

44. A 7-year-old girl is brought to the physician because her parents are concerned about her recent preoccupation with death. Her dog died 2 months ago, and since th time she has repeatedly asked her parents if they are going to die. When her mother travels, the daughter worries that the plane will crash. She has begun to talk wi her friends about the possibility of their parents dying. She continues to excel academically and participate in sports. Her pulse is 86/min, and blood pressure is 110/70 mm Hg. Physical examination shows no abnormalities. Mental status examination shows a neutral mood and an appropriately reactive affect. Which of the following is the most likely explanation for these findings?

A) Bereavement
B) Obsessive-compulsive disorder
C) Post-traumatic stress disorder
D) Separation anxiety disorder
E) Age-appropriate behavior

47. A 27-year-old man comes to the physician because of anxiety about a major speech that he must deliver in 3 days. He has a great fear of public speaking and is convinced that his apprehension and tremulous delivery will damage his performance. He requests a tranquilizer to help with his anxiety. He takes theophylline and uses corticosteroid and albuterol inhalers for asthma. He has a family history of alcohol dependence. He does not drink alcohol or use drugs. His pulse is 66/min, respirations are 12/min, and blood pressure is 132/80 mm Hg. Examination shows normal findings.

A) Bupropion
B) Buspirone
C) Chlorpromazine
D) Fluoxetine
E) Haloperidol
F) lmipramine
G) Lorazepam
H) Perphenazine
I) Propranolol

Hoping someone would like to go over the answers, and please correct me for the answers below

3) Patient has Tardive Dyskinesia? should we discontinue haloperidol and switch to an atypical antipsychotic? so the correct could be C?

5)Don't really know what she has, thought it was somatization but E is wrong

6) Schizoaffective disorder? Could this be the diagnosis even if the patient didn't have a depressive episode previously stated on the question?

7) Vitamin deficiency, B since she is not eating? Don't think she meets criteria for MDD, if she did then D would be the answer.

17) Patient needs EEG..does he suffer from seizures?

27) Thought maybe fetal alcohol syndrome

29)B? not sure

32)Patient with specific phobia can be treated with desensitization, benzo or Beta blockers.. however D was wrong

36) Increased amylase activity

38) H: Marijuana intoxication

42) Thought this Patient had Hungtinton's but A is wrong

43) Cholinergic med D?

44) age appropriate behavior E?

47) Patient has social performance phobia, SSRI, D?

Thank you all in advance,

Last edited by DocMinion; 07-18-2016 at 08:11 PM. Reason: Additional spacing added. Modified content.
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Old 07-20-2016
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