BH - M2 - 40% Flashcards
A 25-year-old female presents to her physician with chronic pain, fatigue, difficulty sleeping, and fluctuating weight. Her prior medical history is unremarkable and these symptoms have occurred recently. Her physical exam, lab results, and imaging appear to all be within normal limits. Based on the physician’s interactions with the patient, the physician suspects that personality factors may play a role in the patient’s health behaviors and makes a referral to a psychologist for further consultation. Which of the following psychological tests would be most appropriate in helping characterize the woman’s personality traits? A) WISC B) BDI C) WAIS D) WMS E) MMPI
Correct answer is E.
•The Wechsler Intelligence Test for Children (WISC) is a measure of intelligence.
•The Beck Depression Inventory (BDI) is a self-report measure of depression symptoms.
•The Wechsler Adult Intelligence Scale (WAIS) is an intelligence test.
•The Wechsler Memory Scale (WMS) is a test of various components of verbal and non-verbal memory. And the •Minnesota Multiphasic Personality Inventory (MMPI) is a widely used measure of personality.
Psychological Testing
A 23-year-old male presents to the emergency department following homicidal threats directed towards his job supervisor. He also had a recent history of making a number of paranoid statements (i.e., “The government is watching me through my work computer screen”) and a decline in hygiene behaviors. The on-call psychiatrist in the emergency department admits the patient to the hospital psychiatric ward. In the psychiatric ward, a staff psychologists elects to use a “projective” test, which is thought to expose a person’s unconscious thoughts and feelings as part of her assessment battery. Which of the following is an example of a projective test? A) MMPI B) Rorschach C) Stanford-Binet Intelligence Test D) BDI E) HAM-D
Correct answer is B.
The Rorschach Inkblot Test asks patients to respond to ambiguous stimuli by asking “What might this be?”
Psychological Testing
A 41-year old woman was referred for psychological testing to assess for cognitive changes following a right hemisphere temporal lobectomy to treat medically refractory epilepsy. The woman was given a battery of neuropsychological tests prior to the surgery and then again after her surgery and a period of recovery. What test characteristic is particularly important for this scenario in order to interpret any changes between the two test administrations? A) Validity B) Normative data C) Reliability D) Discrimination E) Specificity
Correct answer is C.
•Reliability refers to the accuracy and consistency of a measure.
•Validity refers to a test’s “usefulness” or ability to measure a content domain that corresponds to the real world.
•Normative data refers to a defined population or reference sample.
•Discrimination refers to how well a test item differentiates high vs. low performers.
Psychological Testing
A psychologist administered the Wechsler Adult Intelligence Scale to a patient and is now interpreting the results. What method should the psychologist use to determine where this person’s score falls in relation to other people the same age.
A) Use professional judgment to determine if a score is unusually high or low.
B) Calculate the percentage of correct verses incorrect responses.
C) Compare this person’s scores to normative data available from the test publisher.
D) Estimate the standard deviation between this test and other tests that were given at the same time.
E) Calculate the test-retest reliability.
Correct answer is C.
Normative data is used to evaluate where an individual’s score falls relative to other scores in a predefined reference sample.
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Psychological Testing
A 58-year-old male presented to his physician reporting ongoing headaches and difficulties in attention and memory since a right- hemisphere stroke approximately 4 months ago. During the clinical interview, the patient reports that he completed appropriate rehabilitation therapies but despite therapies, these difficulties have resulted in problems at work and increased stress in the home. The physician would like to know more about this patient’s specific areas of cognitive strengths and weaknesses. Which of the following would provide the physician with the most complete set of results pertaining to specific areas of cognitive strengths and weaknesses? A) Neuropsychological Testing B) Computed Tomagraphy Scan C) Personality Testing D) Electroencephalography E) Projective Testing
Correct answer is A.
In order to obtain a comprehensive assessment of cognitive strengths and weaknesses, the physician would refer this patient for neuropsychological testing.
•Answers C and D are brain imaging/labs that assess brain structure and activity, but do not identify specific cognitive strengths and weaknesses.
•Answers B and E largely assess psychopathology and emotional functioning but are not used to solely assess cognitive functioning.
Psychological Testing
A mother brings her 6-year-old son to the pediatrician following a number of school-related disruptive behaviors. The mother reported that her son’s teacher describes her son as having difficulty with learning, being easily distracted, disruptive in class, fidgety, yelling, crying frequently, and impatient with peers. However, the mother has not observed these difficulties in the home. How should the physician proceed?
A) Prescribe stimulant medication for ADHD
B) Refer the patient to parent-child behavior therapy
C) Prescribe Prozac for mood dysregulation
D) Refer the patient for a psychological evaluation
E) Order magnetic resonance imaging (MRI)
Correct answer is D.
This patient presents with a number of educational and emotional/behavioral concerns, primarily observed in the school. The mother has not observed these behaviors and given the learning and emotional/behavioral concerns, a psychological assessment that includes intellectual, educational, and emotional/behavioral testing should be completed.
•Answer A is incorrect because the physician cannot make the determination of ADHD without having formal parent and teacher observations documenting symptomatology in both home and school settings; also, the parent did not endorse observing these behaviors in the home.
•Answer B is incorrect because the behaviors are observed only in the school and although behavioral therapy may be helpful, a psychological assessment should be completed prior to determining treatment recommendations.
•Answer C is incorrect because there is not enough information to conclude whether the patient’s presentation is due to emotional/behavioral, cognitive, or learning difficulties. Multiple differential diagnoses (i.e., learning disability, intellectual disability, ADHD, disruptive behavior disorder, etc.) need to be ruled out prior to prescribing any medication.
•Answer E is incorrect because the behaviors are only observed in the school setting; the question does not suggest any neurological concerns to warrant MRI.
Psychological Testing
A 32-year-old man with non-Hodgkin lymphoma comes to the physician 6 days after finishing an initial chemotherapy regimen. His leukocyte count is 1600/mm3, indicating greater bone marrow suppression than expected. When questioned, the patient says that he has been taking Madagascar periwinkle as an herbal remedy for his condition. He obtains this substance from an herbalist. Which of the following is the most appropriate response by the physician?
(A) Ask the patient to stop using the herbal supplement because supplements are generally ineffective
(B) Continue the patient’s chemotherapy and consult with the herbalist
(C) Discuss the patient’s values regarding herbal use and knowledge of side effects
(D) Report the herbalist to the Food and Drug Administration
(E) Suggest that the patient take daily multivitamin and protein supplements in addition to the herbal supplement.
Correct Answer: C – The physician has begun the process of collaborating with the patient and engaging in the exploratory model
Cultural Competence
A 40-year-old Latina woman who has been diagnosed with iron-deficiency anemia tells the physician that an espiritista in her community told her to treat her illness by drinking a quart of goat’s milk a day. Goat’s milk poses no danger to this patient. What is the physician’s most appropriate next statement to the patient?
(A) “There is no medical evidence that goat’s milk is beneficial in the treatment of anemia.”
(B) “Folk healers are not trained in modern medicine.”
(C) “Try the goat’s milk for a month and if you do not feel better, I will give you medication.”
(D) “There are medical treatments for your condition that can be used along with the espiritista’s recommendation.”
(E) “I cannot treat your condition until you stop going to the espiritista.”
Correct Answer: D – People from many cultures use folk healers and folk remedies. As long as the treatment will not harm the patient, the physician should try to work alongside such healers, not separate patients from their cultural beliefs. Because in this case the folk treatment is innocuous, the patient can continue using it along with traditional medicine.
Cultural Competence
A 29-year-old Muslim woman, who is experiencing severe pelvic pain, is brought to the emergency room by her husband. When instructed to disrobe and put on a hospital gown, she refuses unless she can be assured that she will be examined by a female. What is the physician’s most appropriate next statement to the patient?
(A) “I will try to locate a female physician but if I cannot do so, I must examine you.”
(B) “I am a board-certified physician and am as qualified as a female doctor to examine and treat you.”
(C) “I will try to locate a female physician; if I cannot do so, how can I help you be more comfortable with me as your doctor?”
(D) “I cannot help you if you will not cooperate.”
(E) “Severe pelvic pain is sometimes a life-threatening emergency, and I need to examine you as soon as possible.”
Correct Answer: C – If a woman expresses a preference that the examining physician should be female, the physician should try to honor the patient’s wishes. This is not an uncommon request among Muslim women. If this is not possible, the patient should be consulted for alternative acceptable strategies. For example, she may suggest having her husband or other family member (e.g., her mother) present when she is examined by the male physician. Trying to impress the patient with one’s credentials or to frighten her into compliance is not an appropriate or effective strategy.
Cultural Competence
A 67-year-old Korean male immigrant to the US presents to his physician for follow-up related to his history of lung cancer. The patient has recently completed oncology treatments and states that he no longer needs follow- up appointments. He also requests that future communication be completed through his eldest daughter, who has accompanied him to this visit. The physician has limited experience working with Asian-American immigrants but has observed that Asian-Americans are too proud to receive treatment from physicians outside their ethnicity. What is the physician’s belief an example of? (A) Explicit Bias (B) Clinical Reality (C) Cultural Competence (D) Cultural Humility (E) Explanatory Model
Correct Answer: A—This physician has developed an explicit bias or belief about Asian-Americans that is based on his observations of the group. This bias appears to be based on his own observations but is not necessarily substantiated, even by his current patient.
Cultural Competence
A 45 year-old gender-nonconforming patient with a history of diabetes presents to their primary care physician for a routine exam. The patient’s blood sugar levels remain uncontrolled and the physician inquires about medication management. The patient offers that their, “sister has diabetes too and she’s fine without taking medication.” If the physician wants to elicit the patient’s explanatory model of illness, which of the following is the physician’s best response?
A) What is your sister’s blood glucose level?
B) Tell me more about what you think has caused your diabetes
C) Tell me more about your diet in the past 7 days
D) Why don’t you take your medication?
Correct answer: B- Tell me more about what you think has caused your diabetes is most likely to elicit the patient’s explanatory model and uses non-judgmental language.
Cultural Competence
A 52-year-old woman is admitted to the hospital because of breast cancer metastatic to the liver. Her prognosis is poor. She begs her husband to stay with her at the hospital because she is afraid to be left alone during the night. Which of the following defense mechanisms best explains her behavior? A) Denial B) Displacement C) Regression D) Repression E) Sublimation
Correct Answer: C – The patient is coping with her emotional distress by reverting to a developmentally earlier mode of functioning.
A) Denial: Deal with emotional conflict or internal or external stressors by refusing to acknowledge some painful aspect of external reality or subjective experience that would be apparent to others. The term psychotic denial is used when there is gross impairment in reality testing.
B) Displacement: Deal with emotional conflict or internal or external stressors by transferring a feeling about, or a response to, one object onto another (usually less threatening) substitute object.
C) Regression: By another anxiety-evading mechanism known as regression, the personality may suffer a loss of some of the development already attained and may revert to a lower level of adaptation and expression.
D) Repression: Deal with emotional conflict or internal or external stressors by expelling disturbing wishes, thoughts, or experiences from conscious awareness. The feeling component may remain conscious, detached from its associated ideas.
E) Sublimation: Deal with emotional conflict or internal or external stressors by channeling potentially maladaptive feelings or impulses into socially acceptable behavior (e.g., contact sports to channel angry impulses)
Personality Theory
A 16-year-old girl who has never had a sexual relationship and has no psychiatric history has sexual encounters with multiple partners in the months after her mother’s death. Which of the following defense mechanisms is this girl demonstrating? A) Acting out B) Splitting C) Projection D) Reaction formation E) Displacement
Correct Answer: A – This teenager is acting out her depression and anxiety over the loss of her mother in socially unacceptable behavior.
A) Acting out
B) Splitting: Deal with emotional conflict or internal or external stressors by compartmentalizing opposite affect states and failing to integrate the positive and negative qualities of the self or others into cohesive images. Because ambivalent affects cannot be experienced simultaneously, more balanced views and expectations of self or others are excluded from emotional awareness. Self and object images tend to alternate between polar opposites: exclusively loving, powerful, worthy, nurturant, and kind – or exclusively bad, hateful, angry, destructive, rejecting, or worthless.
C) Projection: Deal with emotional conflict or internal or external stressors by falsely attributing to another his or her own unacceptable feelings, impulses, or thoughts.
D) Reaction formation: Deal with emotional conflict or internal or external stressors by substituting behavior, thoughts, or feelings that are diametrically opposed to his or her own unacceptable thoughts or feelings (this usually occurs in conjunction with their repression).
Personality Theory
A 28-year-old medical student who has unconscious, violent feelings decides to apply for a residency in surgery. Which defense mechanism is this student using? A) Acting out B) Projection C) Sublimation D) Reaction formation E) Displacement
Correct Answer: C – In sublimation, the medical student reroutes his or her unconscious, unacceptable wish for committing a violent act to a socially acceptable route (cutting people during surgery).
Personality Theory
A 45-year-old woman who lost a son in a vehicle accident due to his failure to wear a seatbelt decides to initiate a “wear a seatbelt” campaign to help prevent other parents from having to endure what she has. Which level of consciousness does this woman likely have regarding her grief? A) Unconscious B) Preconscious C) Repressed D) Converted E) Conscious
Correct answer: E – This woman is using the mature defense of altruism, which reflects a conscious integration of feelings and a deliberate choice to channel her grief in a helpful way.
Personality Theory
