PSYCH

Question 1

A worried parent comes to you because they found their 6 year old boy recently lighting small fires in his backyard. Additionally, he was found stabbing rabbits. What d/o do you suspect?

Answer 1

Conduct disorder (anti-social d/o but patient is under 18)

Question 2

A parent presents to you with their 7 year old son who has had numerous notes sent home to her from her son’s teacher, saying that he often “talks back” to her in class. He rarely listens to both the parent and the teacher. What d/o do you suspect?

Answer 2

Oppositional defiant disorder

Question 3

A 6 y.o. girl is constantly telling her mom that she has a stomach ache and cannot go to school. She is usually found playing in her backyard 10 minutes later. What d/o do you suspect?

Answer 3

Separation anxiety disorder

Question 4

A worried parent presents to you with her 3 year old son who she said in the past year started wetting the bed again. He was initially able to speak and walk fine until the past couple months and is now barely able to crawl. What d/o do you suspecct?

Answer 4

Childhood disintegrative d/o –marked regression in multiple areas of functioning after at least 2 years of apparently normal development. More common in boys.

Question 5

Neurotransmitter changes seen in anxiety

Answer 5

Increased NE
Decreased GABA
Decreased 5-HT

Question 6

Neurotransmitter changes seen in depression

Answer 6

Decreased NE
Decreased 5-HT
Decreased dopamine

Question 7

Neurotransmitter changes seen in Alzheimer’s disease

Answer 7

Decreased ACh

Question 8

Neurotransmitter changes seen in Huntington’s disease

Answer 8

Decreased GABA
Decreased ACh
Increased dopamine

Question 9

Neurotransmitter changes seen in Parkinson’s disease

Answer 9

Decreased dopamine
Increased 5-HT
Increased ACh

Question 10

Russell’s sign

Answer 10

Seen in bulimics – dorsal hand calluses from induced vomiting

Question 11

What name is given to chronic compulsive hair pulling common in young girls?

Answer 11

Trichotillomania

Question 12

What is the difference between binge eating d/o and compulsive eating d/o?

Answer 12

In both, purging is NOT present.
Binge eating: patients have negative feelings towards food but eat anyway.
Compulsive eating: fantasizes about food constantly

Question 13

What electrolyte changes are seen in patients with excessive purging over time?

Answer 13

Hypokalemic hypochloremic metabolic alkalosis

Question 14

Drug that causes constricted pupils

Answer 14

Opioids

Question 15

3 types of drugs that cause pupillary dilation

Answer 15

Amphetamines
Cocaine
LSD

Also: muscarinic antagonists like atropine

Question 16

Both of these drug intoxications can cause severe depression, headache, fatigue, insomnia/hypersomnia, and hunger

Answer 16

Cocaine

Amphetamine

Question 17

An overdose of this drug can cause pinpoint pupils, N/V, and seizures

Answer 17

Opioid OD

Question 18

An overdose of this drug can cause belligerence, impulsiveness, nystagmus, homicidal ideations, and psychosis

Answer 18

PCP OD

Question 19

Intoxication with this drug can cause anxiety/depression, delusions, hallucinations, and flashbacks

Answer 19

LSD intoxication

Question 20

Withdrawal from these 3 drugs can cause rebound anxiety, tremors, and seizures; it is life-threatening

Answer 20

Alcohol
Benzos
Barbiturates

Question 21

Withdrawal of this substance can cause anxiety, piloerection, yawning, fever, rhinorrhea, nausea, and diarrhea

Answer 21

Opioid withdrawal

Question 22

A woman has believed she has been married to Brad Pitt for the past 3 months. Other than this belief, her functioning appears normal and her work is not affected by this belief. What disorder does she most likely suffer from?

Answer 22

Delusional disorder

Question 23

A woman believes her neighbors are spying on her and have even set up cameras to watch her daily activities. You bring in the husband, expecting him to tell you he thinks she is being ridiculous. Instead, he backs up her beliefs and completely shares them. What phenomenon is this?

Answer 23

Folie a deux –shared psychotic disorder. Development of delusions in a person in a close relationship wit hsomeone with delusional disorder.

Question 24

When do hypnagogic hallucinations occur?

Answer 24

While GOING to sleep. Usually auditory. Associated with narcolepsy.

Question 25

When do hypnopompic hallucinations occur?

Answer 25

While waking from sleep. Associated with narcolepsy.

Question 26

Which hallucinations are more commonly a feature of medical illness? Which are more commonly a feature of psychiatric illness?

Answer 26

``` Visual = medical illness Auditory = psychiatric illness ```

Question 27

Tactile hallucinations, such as the feeling that you have bugs crawling all over your skin, are common with which 2 drugs?

Answer 27

Alcohol (withdrawal) | Cocaine abusers

Question 28

Difference between hallucinations, delusions, and illusions.

Answer 28

In hallucinations, you have a perception of something being there that is not actually there. Delusions are false beliefs about oneself or others that persist despite the facts. Illusions are misinterpretations of something that is actually there, such as believing a coatrack to be a person.

Question 29

38 y.o. man with long hx of psychiatric illness is brought to the ER by ambulance. His appearance is unkempt and he laughs inappropriately. During the interview, his speech is incoherent. Which psychiatric illness do you suspect?

Answer 29

Schizophrenia, disorganized type.

Question 30

On your psychiatric rotation, you come across a patient who is immobile in bed and generally unresponsive. When you try to talk to him, he simply repeats words that you use back to you with flat affect. What psychiatric illness do you suspect he suffers from?

Answer 30

Schizophrenia, catatonic type. Repeating words back to you = echolalia.

Question 31

24 y.o. female is brought in to your office by her boyfriend, who said that ever since her miscarriage 2 weeks ago, she has been acting differently. She stopped eating, began dressing in all black and had hallucinations at night, feeling like bugs were crawling all over her skin. She even began sleeping on the couch due to this fear. What psychiatric illness do you suspect?

Answer 31

Brief psychotic disorder --

Question 32

Positive sx of schizophrenia

Answer 32

Think of these as adding something that was not previously there. Delusions, hallucinations (auditory, usually), disorganized speech, loose associations, disorganized or catatonic behavior

Question 33

Negative sx of schizophrenia

Answer 33

Taking away something that was previously there. | Flat affect, social withdrawal, lack of motivation and speech, thought block, poor grooming

Question 34

What are the criteria for the dx of mania?

Answer 34

``` DIG FAST Distractibility Irresponsibility Grandiosity Flight of ideas Activity/agitation Decreased sleep Talkativeness ```

Question 35

Schizophreniform

Answer 35

Schizophrenia symptoms lasting >1 month but <6 months.

Question 36

This patient is content with living in the woods and tells you he does not like people. He also rarely smiles or shows emotion. However, he does not have any psychotic episodes. What personality disorder do you suspect?

Answer 36

Schizoid

Question 37

This patient is socially awkward and often dresses in abstract outfits. He regularly participates in the renaissance fair, getting much more involved than most. What personality d/o do you suspect?

Answer 37

Schizotypal

Question 38

40 y.o. woman tells you during one of her office visits that she is in love with you. You refer her to someone else, and she attempts suicide. What type of personality d/o do you suspect?

Answer 38

Borderline Splitting is the major defense mechanism.

Question 39

A 55 y.o. woman comes to your office wearing all black including a black miniskirt and black feather boa. She also is wearing an excessive amount of lipstick and you notice her having conversations with many of the other patients in the waiting room. What type of personality d/o do you suspect?

Answer 39

Histrionic

Question 40

40 y.o. man tells you that he is a virgin and has never even had a girlfriend. He expresses desire for intimacy, but tells you that he is far too afraid of women turning him down. What personality d/o do you suspect?

Answer 40

Avoidant

Question 41

A 60 y.o. man admitted for chest pain jumps out of bed and does 50 pushups to show the nurses he has not had a heart attack. What defense mechanism is he using?

Answer 41

Denial

Question 42

Which defense mechanism underlies all other defense mechanisms?

Answer 42

Repression

Question 43

A 65 year old asks her husband to stay in the hospital overnight with her because she is afraid to be alone. What defense mechanism is she using?

Answer 43

Regression

Question 44

A man yells at his family when he has had a bad day at work. What defense mechanism is he using?

Answer 44

Displacement

Question 45

A child abuser was himself abused as a child. What defense mechanism is this?

Answer 45

Identification

Question 46

A veteran can describe horrific war details without any emotion. What defense mechansim is this?

Answer 46

Isolation

Question 47

A patient presents to the ER saying they have suddenly lost function of their arm. They appear ambivalent about this, and all tests and PE come back negative. What d/o do you suspect?

Answer 47

Conversion d/o

Question 48

A nurse has episodes of hypoglycemia. Blood analysis reveals no elevation in C-protein. What is her dx?

Answer 48

Munchausens OR malingering. Munchausens is she is injecting herself with insulin without knowing why. Malingering is she is injecting herself with insulin to get out of work.

Question 49

A patient uses his aggression to succeed in business ventures. What defense mechanism is this?

Answer 49

Sublimation

Question 50

A closet homosexual hates homosexuals because of the way they make him feel. What defense mechanism is this?

Answer 50

Projection

Question 51

Dr. Frasier Crane uses intellectual processes to avoid affective expression. What defense mechanism is this?

Answer 51

Intellectualization

Question 52

The belief that people are either all good or all bad is which defense mechanism?

Answer 52

Splitting

Question 53

A patient often changes her character or personal identity in order to avoid personal distress. What defense mechanism is this?

Answer 53

Disassociation

Question 54

A patient constantly tries to offer an explanation for her unacceptable beliefs and behaviors. What defense mechanism is this?

Answer 54

Rationalization

Question 55

A recovering heroine addict is overhead bashing heroine addicts for their lack of self control. What defense mechanism is he using?

Answer 55

Reaction formation --a thought is avoided and replaced by an unconscious emphasis on the opposite