Deck 13: Psychiatry and Psychotherapy

Question 1

A 48-year-old woman presented to the office complaining of sexual abnormalities in the last year. The patient does not feel the urge for sex and refuses sex with her husband. She is emotionally attracted to her husband and fears that this might affect their relationship. She does not have any abnormality with vaginal lubrication or orgasm, but her mind wanders during sex. She has been working intensively in her office for the last 3 months. The patient has a depressive episode, and she is on Bupropion right now. The patient has normal physical examination findings and normal laboratory studies. Which of the following is the most likely diagnosis?

A)Adjustment disorder
B)Antidepressant-induced sexual dysfunction
C)Female orgasmic disorder
D)Female sexual interest/arousal disorder
E)Genito-pelvic pain/penetration disorder
F)Normal menopausal changes

Answer 1

Female sexual interest/arousal disorder

Question 2

An 18-year-old woman presented to the office due to left arm pain after a fall. The patient fell on her arm, while she was working out at the gym where she uses to exercise regularly. The patient has no prior medical or surgical history. She uses several diets for weight loss, and she is now on a vegan diet. Her last menstrual period was 4 months ago. She does not use tobacco, alcohol, or illicit drugs. Temperature is 36.1 C (97 F), blood pressure is 92/60 mm Hg, and pulse is 53/min. BMI is 18.1 kg/m2. Weight is 51.7 kg (110.2 lb) and height is 169 cm. Physical examination shows tenderness in the left arm. There is parotid enlargement with fine hair widespread over the extremities. A urine pregnancy test is negative. X-rays reveal a nondisplaced fracture of the left humerus and generalized radiolucency of the bone. Which of the following is the most likely diagnosis?

A)Anorexia nervosa
B)Avoidant/restrictive food intake disorder
C)Bulimia nervosa
D)Pellagra
E)Rickets
F)Scurvy

Answer 2

Anorexia nervosa

Question 3

A 38-year-old man presented to the office due to decreased sexual interest. He has been in a new relationship for the last 6 months, and he is attracted to his partner. A 35-year-old man comes to the office due to a lack of sexual interest. When the patient is asked about sex, he admits that he usually has an orgasm in less than one minute, and this is causing him embarrassment. The patient has chronic insomnia and a history of major depressive disorder. He takes his medication Trazodone. He does not use illicit substances. Vital signs are within normal limits. Which of the following is the most likely diagnosis?

A)Erectile disorder
B)Male hypoactive sexual desire disorder
C)Premature ejaculation
D)Sexual dysfunction due to diabetes
E)Sexual dysfunction due to major depressive disorder
F)Substance/medication-induced sexual dysfunction

Answer 3

Premature ejaculation

Question 4

A 75-year-old man presented to the office for a follow-up appointment. Diabetes mellitus type 2, coronary artery disease, and hypertension are among the patient's medical conditions. The patient is on metformin, atorvastatin, lisinopril, and nitroglycerin. During the evaluation, the patient expressed his concern about not being able to get an erection and asked about the possibility of taking Sildenafil. Which of the following responses is the right response for the patient's question?

A)"This condition could be sensitive, I could see that you look uncomfortable."
B)"I could understand your problem, but we don't use such medications for old age patients."
C)"Medications used for erectile dysfunction alter many functions in the body, and could have many side effects."
D)"I am glad you mentioned this problem, I reassure you that this is a very common problem for men at this age."
E)"Medications are not effective at your age ."

Question 5

A 25-year-old woman, G2P2, presented to the office 8-week postpartum for a regular postpartum checkup. The patient complains of fatigue and decreased energy for the last weeks. She has decreased appetite. The baby is healthy and in a good state, but the mother keeps saying that she is a bad mother for her child. The husband reports that she is always crying in the house. Physical examination is normal. The patient has no suicidal ideation or thoughts of harming the baby. Which of the following is the most likely diagnosis?

A)Acute stress disorder
B)Adjustment disorder
C)Generalized anxiety disorder
D)Normal postpartum reaction
E)Postpartum depression

Question 6

An 80-year-old woman is brought to the office due to memory impairment. One month ago, the patient started having problems with her memory. She has been forgetting the place of her keys, has had difficulty remembering the time of her medications, and has neglected to feed her dog on multiple occasions. She has an interest in reading and playing with her grandchildren. She has decreased sleep time, diminished appetite, and low energy. The patient has hypertension and type 2 diabetes, for which she takes medications. The patient feels guilty and worthless. Temperature is 36.7 C (98.1 F), blood pressure is 121/80 mm Hg, the pulse is 76/min, and respirations are 16/min. Neurological examination reveals no focal deficits. Montreal Cognitive Assessment score is 22 (normal: more than or equal to 26/30). Which of the following is the most likely diagnosis?

A) Alzheimer's disease
B)Dementia with Lewy bodies
C)Depression-related cognitive impairment
D)Frontotemporal dementia
E)Normal aging
F)Vascular dementia

Question 7

A 72-year-old man with known metastatic prostatic cancer presented to the office due to a depressed mood. The patient has been sad most of the time and cries often when thinking about his course of the disease. He has lost appetite with a 6 kg weight loss over the past month. He has difficulty sleeping with multiple awakenings. He has been withdrawn from his family and does not go for family visits. A mental examination shows depressed mood and affect. She has no suicidal ideation. Which of the following presentations is most indicative of major depressive disorder in this patient?

A)Loss of interest in family
B)Low energy
C)Sleep disturbance
D)Thoughts of dying
E)Weight loss

Question 8

A 40-year-old man presented to the office complaining of insomnia for the last month. He lost his job 6 weeks ago and started feeling low mood, irritability, and guilt. He stays in bed most of the time. He has lost 4.5 kg over the last month. The patient noticed decreased concentration. Physical examination is normal. Which of the following is the most likely diagnosis in this patient?

A)Adjustment disorder with depressed mood
B)Bipolar II disorder
C)Depressive disorder due to another medical condition
D)Major depressive disorder
E)Persistent depressive disorder
F)Premenstrual dysphoric disorder
G)Substance-induced depressive disorder

Question 9

A 75-year-old man is brought to the emergency department due to suicidal thoughts. The patient is diagnosed with major depressive disorder. His family history is positive for bipolar disorder and completed suicide with his father. The patient has been admitted to the hospital twice due to suicidal attempts. The patient is recovering from alcohol use disorder and attends weekly Alcoholics Anonymous meetings at her church. The patient reports that he has a firearm hidden in the house. Which of the following is the strongest risk factor?

A)Access to firearms
B)Age more than 70
C)Female sex
D)History of childhood trauma
E)History of completed suicide in a parent
F)History of suicide attempt
G)Major depressive disorder
H)Recent marital separation

Question 10

A 42-year-old woman is admitted to the hospital with suicidal thoughts. Since last month, the patient has become increasingly depressed. Her concentration on her work as an accountant has decreased. She has decreased appetite and difficulty sleeping. She has been absent from her work over the last week and refused to leave her house. The patient has no medical or psychiatric history. The evaluation shows a weight loss of 5 kg over the past period. Mental status examination shows a depressed mood. She feels guilty for all the evil found in the world and heard voices in her head telling her that she is the worst person in the world. Which of the following is the most suitable diagnosis for this patient?

A)Bipolar disorder with psychotic features
B)Delusional disorder
C)Major depressive disorder with psychotic features
D)Schizoaffective disorder
E)Schizophrenia
F)Schizophreniform disorder

Question 11

An 18-year-old man is brought to the clinic due to recent recurrent episodes of wandering in the street. The first episode was reported by the parents two years ago, but recently episodes occur more frequently after a street fight he had with his friend. The patient says that he spaces out easily. He says " I lose sensation to the world around me like I am dreaming, or I am watching the life of another person". He has no medical or surgical condition. Physical and neurologic examinations are normal. Mental examination shows anxious affect. Which of the following is the most likely diagnosis?

A)Absence seizures
B)Brief psychotic disorder
C)Depersonalization/derealization disorder
D)Dissociative amnesia
E)Dissociative identity disorder
F)Post-traumatic stress disorder

Question 12

A 73-year-old woman is admitted to the hospital due to pneumonia. The patient is known to have hypertension and diabetes mellitus type two. Physical examination shows decreased breath sound in the right lung, with crackles and wheezes. A right lung consolidation is confirmed by radiological imaging. The patient has been prescribed the proper antibiotics. On the first day of admission, the patient reports visual hallucinations of animals around her in the room. Vital signs are normal. She has disorientation and can't cooperate with the medical examination. Which of the following interventions is most likely indicated to prevent further worsening of his condition?

A)Facilitating uninterrupted nocturnal sleep
B)Providing sedation by administering a benzodiazepine
C)Reducing daytime visual stimulation by closing window blinds
D)Reducing hyperstimulation by removing hearing aids
E)Treating pain with nonpharmacologic aids only

Question 13

A 73-year-old woman is admitted to the hospital due to pneumonia. The patient is known to have hypertension and diabetes mellitus type two. Physical examination shows decreased breath sound in the right lung, with crackles and wheezes. A right lung consolidation is confirmed by radiological imaging. The patient has been prescribed the proper antibiotics. On the first day of admission, the patient reports visual hallucinations of animals around her in the room. The patient started shouting accusing the hospital of giving her toxic materials in her blood, and then fell asleep suddenly. She became violent and needs restraints. Vital signs are normal. She has disorientation and can't cooperate with the medical examination. Which of the following is the most likely explanation for this patient's current behavior?

A) Alzheimer's disease
B)Brief psychotic disorder
C)Delirium
D)Depression with psychotic features
E)Frontotemporal dementia
F)Vascular dementia

Question 14

While a resident was finishing his shift, he received a call saying that his patient in room 211 wants to leave. The patient was admitted today due to a high-grade fever. The physician started discussing with the patient the cause he is asking to leave for. The patient became agitated and said, " you are misbehaving with me, you are not a real doctor!". The situation reminded the resident of his father who has frequently doubted his achievements. He angrily informed the patient, "You won't leave this hospital, I am ordering anxiolytic to calm you down" Which of the following best explains the resident's response to the patient?

A)Countertransference
B)Passive aggression
C)Projection
D)Reaction formation
E)Regression
F)Transference

Question 15

A 30-year-old new pregnant woman visit her doctor for regular pregnancy follow up. She has a history of feeling anxious and sweats when she is in the examination room with her primary care physician. The patient sweats and feels her heart start to race during physical examination whenever she sees the stethoscope. This patient's response to her physician's stethoscope is an example of which of the following phenomena?

A)Classical conditioning
B)Negative punishment
C)Negative reinforcement
D)Operant conditioning
E)Reaction formation
F)Regression

Question 16

A 28-year-old male intern is currently on a trauma surgery service. After a busy overnight shift, it was impossible to prepare to present all of the patients on the team's list given the workload. At morning rounds, the chief resident made a sarcastic comment that the intern "really put a lot of effort into preparing for rounds." After rounds, while managing the floor with the third year medical student, the intern berates the student that she "needs to step up her game and do a better job." Which of the following is the best explanation for this intern's behavior toward the medical student?

A)Acting out
B)Denial
C)Displacement
D)Intellectualization
E)Reaction formation
F)Splitting
G)Sublimation

Question 17

An 8-year-old girl presents to the psychiatrist to discuss the recent divorce of her parents. The girl explains that her mother is the most caring and loving mother anyone could ever have and that she will be spending the majority of her time with her mother. On the other hand, she exclaims that her father is an evil person and hates him. Which of the following is the most likely explanation for this patient's behavior?

A)Acting out
B)Displacement
C)Passive aggression
D)Projection
E)Reaction formation
F)Splitting

Question 18

A 42-year-old biochemist receives negative feedback from a senior associate on a recent project. He is placed on probation within the company and told that he must improve his performance on the next project to remain with the company. He is distraught and leaves his office early. When he gives an account of the episode to his wife, she says, "I'll always be proud of you no matter what because I know that you always try your best." Later that night, he tearfully accuses her of believing that he is a failure. Which of the following psychological defense mechanisms is he demonstrating?

A)Acting out
B)Displacement
C)Identification
D)Projection
E)Reaction formation
F)Regression

Question 19

A 19-year-old man in a 3-month relationship with a woman experiences frequent sexual fantasies about male coworkers. He lives in a suburban town and has never knowingly been in contact with anyone who is not heterosexual. Two days ago, he joined a local group seeking to criminalize homosexual activity. Together with other members, he verbally and physically assaulted a same-sex couple on their way home from dinner. Which of the following psychological defense mechanisms is he demonstrating?

A)Displacement
B)Projection
C)Rationalization
D)Reaction formation
E)Splitting
F)Suppression

Question 20

A 45-year-old woman started psychotherapy due to depression affecting her productivity at her job as an accountant. Psychotherapy sessions made progress with her depression, and she feels now better. The patient has had an insight into her childhood, especially since her mother was not always available for her. Recently, she told her mom " I am really sad that I never found you beside me". Two days ago, the psychotherapist canceled the session due to an emergency in the hospital. In the following session, the patient says" I am not your priority, and you don't want to listen to me". Which of the following is the explanation for The patient's response to the physician?

A)Acting out
B)Displacement
C)Projection
D)Reaction formation
E)Regression
F)Transference

Question 21

A 14-year-old woman comes to the office due to discolored vaginal discharge with a bad smell. The patient is accompanied by her mother. She has noticed an increased amount of vaginal discharge for the last 3 days, but without vaginal bleeding. She does not complain of abdominal or pelvic pain. She has been sexually active with a new partner and uses condoms for contraception. Her last menstrual period was 10 days ago. The patient does not have prior medical or surgical history. Vital signs are normal. Physical examination shows normal abdominal examination. The patient refused the pelvic examination. Which of the following is the best action?

A)Do the pelvic examination with benzodiazepine administration.
B)Ask the patient's mother to leave the room and proceed with the examination
C)Distract the patient with questions while performing the examination
D)Do not perform the examination and ask the patient if she will perform self-collection for testing
E)Obtain permission from the patient's mother to proceed with the examination

Question 22

A 17-year-old girl comes to the office for health care follow up. She is a known case of cystic fibrosis. She is doing well with no new compliants. She takes his prophylactic medications regularly. Her physical examination shows no abnormalitis. Review of her records shows that she is due for her annual influenza vaccination. Prior to administration of the vaccine, her skin is disinfected with 70% isopropanol.  Which of the following mechanisms is most likely responsible for the antiseptic properties of isopropanol?

A)Coagulation of the cytoplasm
B)Cross-linking of proteins
C)Disruption of cell membranes
D)Halogenation of proteins
E)Production of free radicals

Question 23

A 45-year-old woman started psychotherapy due to depression affecting her productivity at her job as an accountant. Psychotherapy sessions made progress with her depression, and she feels now better. The patient has had an insight into her childhood, especially since her mother was not always available for her. Recently, she told her mom " I am really sad that I never found you beside me". Two days ago, the psychotherapist canceled the session due to an emergency in the hospital. In the following session, the patient says" I am not your priority, and you don't want to listen to me". Which of the following is the explanation for The patient's response to the physician?

A)Acting out
B)Displacement
C)Projection
D)Reaction formation
E)Regression
F)Transference