even more questions

Question 1

What is Voyeuristic disorder?

what is duration of symtpoms?

What is the treatment?

Answer 1

recurrent/intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing or engaging in sexual activity.

at least 6 months

psychotherapy and SSRI

Question 2

What is exhbitionistic disorder?

What is the duration of symptoms?

what is the treatment?

Answer 2

recurrent/intense sexual arousal from exposing one’s genitals to an unsuspecting person.

at least 6 months

psychotherapy and SSRI

Question 3

what is Frotteuristic disorder?

what is the treatment?

Answer 3

sexual gratification by touching/rubbing against a non-consenting person.

psychotherapy and behavior therapy

Question 4

what is sexual masochism disorder?

what is the treatment

Answer 4

sexual gratification in response to undergoing humilitation, bondage or suffering

psychotherapy and medications to decrease sex drive (antidepressants)

Question 5

What is sexual sadism?

what is the treatment?

Answer 5

sexual gratification in response to inflicting humiliation, bondage or suffering

no treatment unless causing significant distress or harm - psychotherapy and SSRI + testosterone blockers

Question 6

What is fetishistic disorder

what is the treatment

Answer 6

sexual arousal obtained by a specific object

psychotherapy, drugs or both.
SSRI has limited success.

Question 7

what is pedophilic disorder?

what is the treatment

Answer 7

intense sexual urges/fantasies watching, touching, or engaging in sexual activities with a child (typically less than 13yo).

IM medroxyprogesterone (leuprolide)

Question 8

43 yo woman comes to the office d/t painful and swollen knee sustained when she tripped while walking outside her home. She blames the injury on “bad energy” that she was getting from her next-door neighbor, whom she believes does not like her. The pt thinks she “has a sixth sense” to detect “negative people” but does not believe there is any specific plot to harm her. She lives alone, sayig “I prefer it this way”. She has vitamin D insufficiency and has been prescribed Vitamin D supplements, but she does not take them becasue “she is not sure what is in those things”. The right knee is painful and swollen. The pt is dressed in multiple layers of mismatched clothing. **Which of the following is most likely diagnosis? **

A. Delusional disorder
B. Paranoid Personality Disorder
C. Schizoid Peronality Disorder
D. Schizophenia
E. Schizotypal personality disorder

Answer 8

E. Schizotypal personality disorder

pts eccentric behaviors, odd beliefs, and interpersonal deficits are characteristic of schizotypal personality d/o. Magical thinking , suspiciousness and paranoid ideation can occur but are not of delusional proportions.

Question 9

a 34 yo woman comes for an employment physical. pt says “i’d rather not be here, but my job requires labs every 2 years.” While getting blood drawn, she starts to feel anxious, nauseated, SOB and “feels like the room is spinning’. the pt has had similar episodes since childhood, whichh began after a bike accident during which she cut her knee and bled profusely. Medical history is significant for asthma and type 2 diabetes. Vitals and PE are unremarkable.
Which of the following is the most likely diagnosis?

A. Anxiety due to medical condition
B. Illness anxiety disorder
C. Panic disorder
D. PTSD
E. Specific Phobia

Answer 9

E. Specific phobia

pt has marked anxiety reponse and fear with blood draws (specific phobic stimulus) with a hx of avoidance behavior is consistent with specific phobia.

Question 10

54yo male comes into the office d/t concerns about having pancreatic cancer after a coworker died of the disease 6months ago. the pt has no epigastric pain, jaundice, or weight loss. however, he worries constantly becuase, in researching the illness, he read that it may not have obvious symptoms in the early stages and can be rapidly fatal. The pt saw another healthcare provider 2 months ago and PE, labs, and abdominal CT were normal. However, the pt has noticed occasional stomach noises after eating and would like to have additional testing done.
which of the following is the most likely diagnosis for the pt?

A. conversion disorder
B. factitious disorder
C. Generalized anxiety disorder
D. Illness anxiety disorder
E. Somatic symptom disorder

Answer 10

E. Somatic Symptom Disorder

Question 10

28yo woman brought into the office by her husband, who is concerned about her recent behavior. for the past 6months, the pt refused to eat any food that is not prepackaged out of fear of becoming ill. Before eating, she carefully examines the food on the plate, checking for any possible contaminants. the pt believes that someone has been poisoning her food, whcih has caused her to feel more fatigued than usual. she has continued to work but seldom interacts with coworkers. The pt has no psychiatric history.
exam shows 5lb weight loss since prior visit 9 months ago. the pts mood is anxious, and her affect is tense. Which of the following is the most likely diagnosis for this patient?

A. Delusional Disorder
B. Illness anxiety disorder
C. OCD
D. Paranoid personality disorder
E. Schizophrenia

Answer 10

A. Delusional Disorder

pt has persistent delusions about being poisioned with no other prominent psychotic symptoms. Her behavior unrelated to her delusions does nto appear to be bizarre or odd, and she is still able to function at work.
Delusions are fixed false believes that are contrary to rational argument or accepted cultral, religious or societal beliefs.

Question 11

23yo male comes to the office at his gf’s insistence. she says that the pts frequent snoring keeps her up at night and that the last 4 months he has twice fallen asleep while they were talking. in the same period, the pt says that he has regularly fallen asleep in the afternoon while reading or watching TV but typically feels refreshed after a brief nap. the pt says that he sometimes hears a voice calling his name prior to falling asleep. He also reports uncharacteristic episodes of clumsiness in which he has suddently dropped objects or fallen to his knees.
which of the following is the most likely diagnosis for the pt?

A. delayed sleep-wake phase disorder
B. insufficient sleep
C. Narcolepsy
D. obstructive sleep apnea
E. REM sleep behavior disorder

Answer 11

C. Narcolepsy

chronic sleep disorder characterized by frequent, overwhelming urges to sleep. Commonly associated with cataplexy, a sudden loss of muslce tone that occurs in response to intense emotions. narcolepsy results from the depletion of hypocretin (orexin)-secreting neurons int he lateral hypothalmus that are involved in maintaining wakefulness.

Question 12

a 32 yo woman is brought into the office by her husband due to his concern about her increasing social withdrawal. the pt prefers to stay at home. when she must run errands, she insists that her husband accompany her. SHe stopped working 2 years ago due to severe episodes of anxiety that would occur unpredictably for no apparent reason. since that time, the pt has continued to have these episodes several times a week and has become more socially isolated due to her fears of having another episode. She avoids seeing her freinds except for when they come to her home. the pt feels badly that she is no longer working and contributing to the household finances. she has occasional difficulty falling asleep and problems with concentration. although she is not looking for work, she keeps her home clean, cooks nightly and enjoys watching television.
which of the following is the most likely cause of this patients social withdrawal?

A. avoidant personality disorder
B. dependent personality disorder
C. panic disorder
D. persistent depressive disorder
E. social anxiety disorder

Answer 12

C. panic disorder

Question 13

37yo woman comes into the office d/t low energy and fatigue. she recently recieved a promotion at work and was very excited and motivated at first, but now she finds herslef procrastinating and having difficulty concentrating. For many years, the pt has had unpredictable “mood swings” consisting of periods of low energy and “up periods” in whcih she feels more energetic and optimistic. These vary in length from days to weeks and have no clear relationship to situations in her life. She has no hx of MDD or psychosis. She drinks 1-2 glasses of wine several times per week. Mental status exam shows a sad affect and some lapses in concerntration, although the pt brightens easily.
which of the following is the most likely diagnosis for the patient?

A. Bipolar 1 disorder
B. Bipolar 2 disorder
C. Borderline Personality disorder
D. Cyclothymic disorder
E. Substance induced mood disorder

Answer 13

D. cyclothymic disorder

pts hx of chronic. fluctuating mood disturbances for many years is suggestive of cylothymic disorder. her symptoms are mild and she does not have the sufficient hx of the diangosis for either a current of past MDD or hypomanic/manic episodes.
cyclothymic disorder falls within the bipolar spectrum and represents a less severe form of the illness.
dx requires >2 years duration and insufficient number of symptoms and severity to meet full criteria for hypomanic, manic or depressive episodes

Question 14

10yo boy brought to the office by his mother for evaluation of behavioral issues. He began having difficulty approximately one year earlier when the family moved. his teachers noticed that he frequently makes excuses about not doing his homework or disobeying classroom rules. he also struggled to get along with peer ans bullied other students on several occasions. over the past year, the pt has insigated numberous fights. although his teachers have attempted to discipline him, his behaviors have worsened. More recently, his mother caught him stealing money from her wallet and deliverately injuring his younger brother during a fight.
what is his most likely diagnosis?

A. Adjustment disorder
B. Antisocial personality disorder
C. ADHD
D. Conduct disorder
E. ODD

Answer 14

D. conduct disorder

Question 15

28yo male comes into the office because he “is not feeling like himself”. This change began soon after his older brother died of cancer 3 months ago. The pt feels sad and has lost interest in work and going out with friends on weekends. he often awakens very early in the morning and is unable to fall back asleep. the pt feels “very down”, especially when he first wakes up, and says that his mood rarely improves during the day. His poor energy and concerntation have started to affect his performacne at work. He has been eating less and has lost 12lbs over the past few weeks. the pt has no psych history.
Which of the following is the most likely dx?

A. acute stress disorder
B. MDD
C. Normal grief reaction
D. Persistent depressive disorder
E. persistent complex bereavement disorder

Answer 15

B. MDD

Question 16

32yo male comes to the office due to abdominal cramps that here initially mild last night but gradually worsened in intensity. Since this morning, he has had 4 loose stools. the pt has also had persistent nausea but no vomiting. BP is 144/98, pulse 88bpm, respirations 16/min. PE shows diaphrotetic, thin man in considerable distress with excessive lacrimation and rhinorrhea. pupils are dilated. this pts clinical presentation is most consistent with withdrawal from which of the following?

A. alcohol
B. clonazepam
C. Cocaine
D. Heroin
E. Paroxetine

Answer 16

D. Heroin

opioid withdrawal symptoms begin within 6-12 hours, can peak within 72 hours and may continue for several days. common symptoms are myalgia, arthralgia, nausea,vomiting, diarrhea, abdominal cramps, rhinorrhea, lacrimation and weating.
on exam pt may be restless and irritable with elevated HR and BP. Pupillary dilation, piloerection and yawing may be evident.

Question 17

28yo male comes into the office d/t anxiety. the pt was recently promoted at work, requiring a move from the second to the fifteeth floor. every time the pt uses the elevator, his heart starts pounding and he feels that he cannot catch his breath and is going to faint. the last time he was on the elevator, he had a panic attack and had to ask to get off. Now even looking at the staris or an elevator causes anxiety. the pt had similar episodes for several years and has feared heights since his brother suffered severe injureis from a fall 15years ago.
which of the following is the best treatment of the patients condition?

A. alprazolam
B. Exposure therapy
C. Propranolol
D. Sertaline
E. Trauma-focused psychotherapy

Answer 17

B. Expsure therapy

pt has a specific phbia. first line treatment is CBT with expsure therapy - systematic desensitization

Question 18

11yo boy brought in by his mother due to behavioral issues. the pt started middle school 6 months ago and “has not been himself” for the past month. The pt has become increasingly argumentative with his parents and becomes irritable with his siblings for no clear reason. He spends most of his time in his bedroom and comes out infrequently to eat because he is “not hungry”. The pt struggles to fall or stay asleep and then is tired the next day. He used to spend time with his friends after school but recently stopped. In addition, the pts grades have dropped and he is not focused in class. during the exam, he is sullen, makes poor eye contact, and fidgets with his clothes.
which of the following is the most likely diagnosis?

A. ADHD
B. Disruptive mood dysregulation disorder
C. MDD
D. Normal, age appropriate behavior
E. schizoid personality disorder

Answer 18

C. MDD

Question 19

27yo male brought to ED by his wife. says that he has been “acting crazy” for the last 2 weeks. He has hardly slept the past 7 days and instead has worked on miscellaneous projects around the house. The pt spent several thousand dollars on new power tools to accomplish these tasts. When questioned, his speech is pressured. He feels “spectacular” and is creating “ an architectural masterpiece”. The pt has had two previous depressive episodes. which of the following meds is the most appropriate agent for long-term management of this patient?

A. Bupropion
B. Chlorpromazine
C. Haloperidol
D. Paroxetine
E. Valproate

Answer 19

E. Valproate

pt likely has a manic episode of bipolar 1. BIpolar disoder requires maintenance treatment with meds that have mood-stabilizing properties to decrease the risk of recurrent mood episodes. preferred med treatment include lithium, anticonvulants valproate and lamotrigine and SGA Quetiapine.

Question 20

5yo girl brought to the office for eval of night awakenings. the pt has awakened screaming once or twice each month over the past month shortly after going to sleep. during these episodes, she is SOB, crying and sweating and her face is flushed. The pt appears frightened, does not respond to her parents attempts at comforting her, and she continues to cry. she eventually goes back to sleep on her own and does not recall the incident in the morning. Until starting kindergarten 2 months ago, the pt stayed home with her mother and she no longer naps during the day. Vitals and PE are unremarkable.
Which of the following is the best next step in the management of this patient?

A. CBT
B. Daytime naps
C. Intranasal Desmopressin
D. Polysomnography
E. Reassuracne

Answer 20

E. Reassurance

sleep terrors are commonly seen in childrens 2-12, with peak at 5-7yo. In healthy child with classic presentation, the dx is clinical and no further workup is required. parents should be reassured that sleep terrors are not dangerous and usually resolve spontaneously within 1-2 years.

Question 21

40yo woman comes to ED fearing she is having a heart attack. while clutching her chest and breathing heavily she says, “i feel like im dying”. blood pressure is 125/86, pulse 110bpm and regular. Lab eval and EKG are normal. pain resolves within 10min wihtout treatment and the pt reports “i was taking the bus home from work when my chest started feeling really right. Im lucky my friend was there and able to help me get to the hospital. what if shes not there next time?”. She describes experiencing similar episodes that are characterized by a pounding heart, trembling, dizziness and sweating.
this pt most likely has which of the following additional disorders?

A. Acute stress disorder
B. agoraphobia
C. Brief psychotic disorder
D. Dependent personality disorder
E. Separation anxiety disorder

Answer 21

B. agoraphobia

pt likely has panic disorder. pts with panic disorders often develop agoraphobia which is characterized by avoidance of multiple situations where they feel trapped and helpfuless in the event of a panci attack.

Question 22

28yo woman comes to the ED with nausea and abdominal pain. the pt states “if i didnt have this pain everything would be okay”. she tearfully reports that over the past year numerous healthcare providers have been unable to help her. she has significant anxiety about her state of health. The pt has been eating poorly due to her abdominal pain and nausea and has lost weight. she has also had a headache and low back and neck pain that have persisted despite high doses of analegsics, whcih she has receently stopped taking. Her chonic pain prevents her from participating in most activities. physcial exam, CBC and serum chemisteries are normal. which of the following is the most likely cause of this patients condition?

A. conversion disorder
B. Factitious disoder
C. illness anxiety disorder
D. Malingering
E. SOmatic symptom disorder

Answer 22

E. somatic symptom disorder

Question 23

19yo male evaluated for hand injury. he says “i was just minding my business at work when this dog bit me”. The pt recently started maintenance work for a wealthy apartment complex and his “entreprenureial skills” have made him “richer than a doctor”. He has been fired from multiple jobs for getting into arguments iwth coworkers and being repeatedly late to work. As an adolescent, hre regularly msised school and spent time in a detention center for breaking into his teachers home.
which of the following is his most likely diagnosis?

A. antisocial personality disorder
B. borderline personality
C. conduct disorder
D. narcissistic
E. ODD

Answer 23

A. antisocial personality

Question 24

28yo female brought to hospital due to depressed mood, disorganized behavior and hearing voices. Over past 2 months, pt has developed worsening AH and now fears that her family has been replaced by imposters. she is afraid to leave the hosue, stays in bed most of the day, sleeps longer than usual, is not eating and is unable to care for herself. The pt has had 4 hosptializations for depressive and psychotic csymptoms over the past 8 years. Between hospitalizations, she has had a rare month-long periods during which she is not depressed but continues to hear voices. On mental status exam, the pts mood is depressed and she has current SI.
whcih of the following is the most likely diagnosis?

A. bipolar 1 with psychotic features
B. Delusional disorder
C. schizoaffective disorder
D. schizophrenia
E. schizophreniform disorder

Answer 24

C. Schizoaffective disorder

major mood episodes with concurrent symptoms of schizophrenia for atleast one month.