Diagnoses - Part 4 of 4

Question 1

Risk factor for PTSD

Answer 1

PRIOR CHILDHOOD ADVERSITY

Question 2

Psych d/o in violent people

Answer 2

SUBSTANCE RELATED D/O

Question 3

25 y/o F is brought to ER after being severely beaten by her BF. Following medical stabilization, first step in an acute psychological intervention is:

Answer 3

HELP HER RECOGNIZE THAT IMMEDIATE DANGER HAS PASSED AND SHE IS IN A SAFE PLACE

Question 4

14 y/o brought to ED after telling mom that she had been raped by stepdad. On psych eval, pt reports feeling “okay” and denies acute distress. Pt is calm during interview and appears generally unaffected by recent trauma. On further questioning, pt appears confused and believes she is at a friend’s house. Which is the preferable intervention?

Answer 4

EMPLOY GROUNDING STRATEGIES TO ORIENT PT

Question 5

Which of the following is the most common psychiatric diagnosis associated with violent acts?

Answer 5

SUBSTANCE USE DISORDERS

Question 6

One of the most common psych d/o found in individuals who commit violence against others (even more than IED, BMD, MDD, CPS):

Answer 6

SUBSTANCE RELATED D/O

Question 7

Homicide and homicidal behaviors are most often related to which of the following factors?

Answer 7

EMOTIONS NOT ASSOCIATED WITH MENTAL ILLNESS.

Question 8

Adult male presents to clinic with broken hand due to first time DV toward his same-age spouse. Best response by psychiatrist?

Answer 8

TELL THE PATIENT THAT VIOLENCE IS HIS RESPONSIBILITY AND HE NEEDS TO STOP IT

Question 9

M pt BIB to ED by police after he threatening to kill his wife and admits that has thoughts of harming his spouse ever since learning of her infidelity, saying “I want her to hurt like I do now.” The pt doesn’t display delusions and mood problems. He admits to drinking occasionally, but in the last week and prior to violence. Next step:

Answer 9

REFER PT BACK TO LAW ENFORCEMENT

Question 10

What does NOT predict violence?

Answer 10

NON-VIOLENT CRIMINAL ACTIVITY

Question 11

What is the relationship of violence to mental d/o?

Answer 11

MENTAL D/O HEIGHTENS RISK IN SOME, DECREASES RISK IN OTHERS

Question 12

Homicide and homicidal behaviors are most often related to what factors?

Answer 12

EMOTIONS NOT ASSOCIATED WITH MENTAL ILLNESS

Question 13

70 y/o presents with fearfulness, anger and agitation after moving in with adult child. On first visit pt is resigned and timid during exam. Which is most consistent with pt’s behaviors?

Answer 13

PSYCHOLOGICAL ABUSE

Question 14

18 y/o F in ED, just raped. Immediate intervention:

Answer 14

PROVIDE SUPPORT AND ALLOW TO VENT

Question 15

Characteristic of women with increased risk of battery

Answer 15

PREGNANCY

Question 16

Females have comparable rates to males for:

Answer 16

DOMESTIC VIOLENCE

Question 17

20 y/o pt brings 2 y/o child to ER with multiple bruises. Mother says he fell down stairs. Mother has healing black eye and cut lip. Says she slipped on ice and hit head. X-ray of child’s arm show hairline fx and healing callus. What action should psychiatrist take first?

Answer 17

ADMIT CHILD FOR CARE AND PROTECTION DESPITE MOTHER’S OBJECTIONS

Question 18

A finding that should raise a concern for child abuse?

Answer 18

SYMMETRICAL BRUISING IN A 24-MONTH-OLD

Question 19

42yr old female with depression, Spanish speaking, usually seen by psychiatrist with interpreter, but this time bilingual husband will serve as interpreter, psychiatrist sees unexplained injuries and suspects abuse by husband, at next appointment pt comes with close bilingual friend and requests friend to join session, pt says husband is parking car and will be in shortly, what would be the best approach to clarify to clarify suspicions of abuse?

Answer 19

BEGIN SESSION WIT PT, INTERPRETER, AND PTS FRIEND WHILE HAVING THE HUSBAND REMAIN OUTSIDE

Question 20

Pt confides to the psych MD that the pt’s spouse has been physically abusing the pt. In all cases, the psych MD should do what before the pt leaves office?

Answer 20

DETERMINE WHETHER THE PATIENT IS IN PRESENT DANGER

Question 21

What is the first priority in ER management of a rape victim?

Answer 21

ESTABLISHING PSYCHOLOGICAL SAFETY

Question 22

Duty as outlined by Tarasoff

Answer 22

PROTECT THE POTENTIAL VICTIM OF A DANGEROUS PATIENT

Question 23

35 yo uninjured in an accident but witnessed deaths of co-workers. The following day reports emotional numbness, intrusive images, inability to sleep since the accident. Most appropriate intervention

Answer 23

NORMALIZING STRESS REACTION AND MOBILIZING RELATIONAL SUPPORTS

Question 24

Mother of 2 school aged kids dies unexpectedly. What with improve psychological outcome

for the children?

Answer 24

ENSURING AVAILABILITY OF PSYCHOSOCIAL SUPPORTS

Question 25

Across all cultures, what stressful life changes is correlated with greatest increase in death and illness in the subsequent 2 years?

Answer 25

DEATH OF A SPOUSE

Question 26

50 y/o Cambodian woman with 2 kids suffered catastrophic trauma from the Pol Pot regime in Cambodia (rape, abuse, watched family starve, escaped refugee camp with 2 kids). Has PTSD/MDD sx that are increased when her now grown daughter dates man patient doesn’t like. Needs supportive therapy, antidepressant, AND?

Answer 26

GROUP THERAPY OF PEOPLE OF THE PATIENT’S OWN BACKGROUND WHO SHARE THE SAME EXPERIENCE

Question 27

28 y/o graduate student BIB wife and reports a change in his behavior since he witnessed a fatal motor vehicle collision 3 wks ago. Pt felt feeling of helpless, horrified at time of accident. Now pt feels like “his spirit leaves his body.” And feels numb and detached, and dreams about events. Dx:

Answer 27

ACUTE STRESS

Question 28

A 28 yo patient presents to the ED after experiencing a sexual assault 1 week earlier. Although the patient cannot recall all aspects of the event, she remembers feeling helpless, detached, and as if her surroundings were not real during the assault. For the past week the pt has has difficulty sleeping due to nightmares about the assault and has not been able to talk about the event with any of her friends. She is also experiencing intermittent episodes of palpitations, SOB, dizziness, and nausea throughout the day. Dx?

Answer 28

ACUTE STRESS DISORDER

Question 29

How would a social biologist describe adaptive benefit of PTSD?

Answer 29

HYPERVIGILANCE ALLOWS FOR QUICK SENSING OF REAL THREATS

Question 30

Which group children are at greatest risk for death resulting from child abuse?

Answer 30

BIRTH TO 3 Y/O OLD

Question 31

A patient presents to the ED after witnessing a tragic MVA in which they witnessed a death. What symptom present immediately following the event increases the individual’s risk of developing PTSD?

Answer 31

DISSOCIATION

Question 32

What symptom commonly develops relatively late in children with PTSD?

Answer 32

SENSE OF FORESHORTENED FUTURE

Question 33

Comorbid disorder in men with PTSD

Answer 33

ETOH ABUSE/DEPENDENCE

Question 34

What symptom is more likely to occur in acute stress d/o than in PTSD?

Answer 34

REDUCTION IN AWARENESS OF SURROUNDINGS

Question 35

Important determinant factor to whether an individual who was exposed to trauma will develop PTSD?

Answer 35

SEVERITY AND PROXIMITY OF TRAUMA

Question 36

A risk factor for child abuse:

Answer 36

FINANCIAL STRESS

Question 37

Which of the following is a risk factor for child abuse?

Answer 37

PRESENCE OF A STEP-PARENT

Question 38

In the US, which of the following is the most common precipitant of PTSD in children and adolescents?

Answer 38

INTRAFAMILIAL VIOLENCE

Question 39

Acute stress d/o differentiated from PTSD by

Answer 39

DURATION OF SYMPTOMS

Question 40

29 y/o pt reports having been robbed at knifepoint almost a month ago. Pt escaped unharmed, but has been experiencing a sense of unreality, detachment, and dampened emotions that is interspersed with periods of intense physiological arousal. These symptoms are causing difficulties at work. The most likely Dx?

Answer 40

ACUTE STRESS DISORDER

Question 41

45 y/o pt w lung cancer and depression. Physical and emotional symptoms are stable, pt worries that “family always seems on edge w me.” Family meeting shows children fear losing father, frustrated that lives seem “on hold”. Daughter feels she can’t invite friends over out of fear of “stressing her father.” Father feels guilty about this but does prefer quiet environment. Best strategic systemic approach to problem?

Answer 41

TASK FAMILY WITH COMING UP WITH PRACTICAL SCHEDULE

Question 42

Childhood physical and sexual abuse increases the risk for which anxiety do?

Answer 42

PANIC DISORDER

Question 43

Which of the following is the best predictor of whether or not a patient who sustained a significant trauma will develop early PTSD morbidity?

Answer 43

THE NATURE AND SEVERITY OF THE TRAUMA

Question 44

Sx for a pt 2 months after traumatic experience:

Answer 44

INCREASED AROUSAL AND INTRUSIVE THOUGHTS

Question 45

Adding which class of medication to an SSRI is an effective augmentation for treatment of PTSD?

Answer 45

ATYPICAL ANTIPSYCHOTICS

Question 46

Student presents for psych eval with continued anxiety, hyperalertness, flashbacks, and social avoidance after barely escaping an attacker 1 month ago. These symptoms are expected to last no longer than ___?

Answer 46

4 WEEKS

Question 47

An intoxicated pt in ER throws a food tray at security guard, no respond to verbal redirection and refused to take meds by po. Pt is now pacing, cursing and threatening to “hurt someone”. The most appropriate meds:

Answer 47

LORAZEPAM 2MG IM, REPEATED IN 45 MIN IF NO RESPONSE

Question 48

35 hospitalized w/ concussion following MVC with only minor lacerations and bruises. One week later has generalized pain, dizziness, difficulty sleeping and recurrent nightmares. Now fears driving. What is most likely explanation?

Answer 48

CUTE STRESS DISORDER

Question 49

Military veteran from war zone with memory problems. Which finding would support dissociative amnesia? Closed head injury, decreased procedural memory, anterograde & retrograde amnesia, memory deficits limited to few traumatic episodes, vague recall of all memories since childhood

Answer 49

MEMORY DEFICITS LIMITED TO FEW TRAUMATIC EVENTS

Question 50

After child survives natural disaster, what is a protective factor to protect against developing PTSD

Answer 50

AVAILITY OF PEER SUPPORT