Psych Flashcards
Which complication can be found in anorexia nervosa and not bulimia?
a. salivary gland hypertrophy
b. psychopathology
c. petechial hemorrhages
d. hypokalemia
e. osteoporosis
e. Osteoporosis is found in anorexia nervosa due to lack of calcium intake, deceased estrogen and increase in cortisol. Bulimia nervosa has multiple med complications in the cardio, dental, derm, endo, GI and neruo systems
What is another name for multiple personalities?
a. dissociative amnesia
b. dissociative fugue
c. depersonalization
d. dissociative disorder not otherwise specified
e. dissociative identity disorder
e. Dissociative identity disorder is also called multiple personality disorder. Usually at least 2 personalities both distinct in their own rights.
Which of the following are predictive or diagnostic of anorexia nervosa?
a. less than 85% of normal weight expected
b. homosexual orientation in females
c. promiscuity
d. menorrhagia
a. Diagnostic criteria for anorexia nervosa include a weight loss to 85% of the required body weight. Homosexuality in MEN, not women, is a predisposing factor. Anorexia is associated with AMENORRHEA and DECREASED interest in sex.
Which medication when co-administrated with lithium may cause a potential fatal neurotoxicity?
a. CCB
b. K+ sparing diuretics
c. loop diuretics
d. ACE-I
a. The combo of taking a CCB w/ lithium can potentially cause a fatal neurotoxicity.
What is the most common personality disorder in prison populations?
a. paranoid
b. antisocial
c. borderline
d. avoidant
b. 3/4 of the prison population has antisocial personality disorder.
What diagnosis should be given to a patient who has non- bizarre delusions for at least a month and no other sx?
a. schizoaffective disorder
b. delusional disorder
c. brief psychotis disorder
d. schizophrenifrom disorder
b. Delusional disorder presents with non-bizarre delusions for at least a month. The disorder does not present with any other sx.
A colleague is frustrated with one of his patients. he describes her as being extremely dramatic and overly provocative in her dress and behavior. She uses rapidly shifting emotions to maintain her position as the center of attention. He is concerned that she believes that their provider-patient relationship is much more than it actually is. Which of the following is the most likely diagnosis you might suggest to him?
a. narcissistic PD
b. dependent PD
c. histrionic PD
d. schizotypal PD
c. Commonly seen as emotionally shallow and obsessed with their physical appearance. They believe relationships to be much deeper and more solid than they actually even are.
A person with an exaggerated sense of entitlement and uniqueness and who believes they can only be understood by people of significance is described to you by a colleague. They go on to state the person is arrogant, is lacking in empathy and can be manipulative with relationships. What PD best fits this scenario?
a. histrionic
b. narcissistic
c. antisocial
d. borderline
b. This person usually has fantasies of unlimited success and have a strong need for admiration form others. Treatment is made difficult as they do not accept criticism or any attack on their “narcissistic supply”.
A 9-year-old male is reported by his mother to be excessively and deliberately annoying to her and others at home and school, most always to those he knows well. She states that over the last year he frequently loses his temper, argues with adults, is easily annoyed by others and consistently blames others for his mistakes. She admits that he is not violent and really does not do anything out of the social norm. There have been no changes in his surroundings, exposures or life events. Which of the following is the most likely diagnosis?
a. tourette disorder
b. adjustment disorder
c. disruptive behavior disorder
d. oppositional defiant disorder
d. The diagnosis is indicated in this case due to the age of the patient, age of onset and the deliberate and frequent attempts to counter well-known adult authority. Adjustment disorder is the same EXCEPT there has to be a change in surroundings or life circumstances.
Hypochondriacal patients can mimic which disorder?
a. bipolar disorder
b. acute stress disorder
c. OCD
d. dissociative disorder
c. Hypochondriacs feels there is something wrong with their body. Patients seek reassurance and make frequent visits for medical care. Hypochondriacs can mimic OCD obsessions.
Mr. Smith leaves home and does not return nor does he go to work. A friend of Mr. Smith sees him in another state while on vacation. When he approaches Mr. Smith, he does not recognize him and has a total different demeanor. What type of disorder does he have?
a. amnesia
b. dissociative disorder
c. schizophrenia
d. dissociative identity disorder
e. depersonalization
b. Dissociative or psychogenic fugue is caused by a stressful even that causes amnesia and people to assume another identity.
What type of disorder develops within 3 months of an identified stressor such as finances, going to school, divorce, or an illness in their life. The stressor causes impairment in their job and relationships, but the sx resolve within 6 months. Most likely diagnosis?
a. depression
b. bereavement
c. PTSD
d. personality disorder
e. adjustment disorder
e. A response to a stressor that disturbs the mood of the patient causes impairment in function. Anxiety and depression are associated with adjustment disorders.
DSM 4 classifies disorders into five axes. What type of info should be provided on Axis 4?
a. global assessment
b. clinical disorders
c. medical conditions
d. psychosocial stressors
e. personality disorders
d. That is it…
Generally patients who are malingering…
a. use illness to attain a goal
b. have avoidant personalities
c. follow prescribe tx regimens
d. have a hx that agrees with their physical sx
a. Patients that are malingerers do not want to improve until the goal is met.
What is the main communication deviance associated with autistic children?
a. use of stereotyped phrases
b. increased receptive language skills
c. use of clanging speech patterns
d. increased meaningful expressive language
a. Echolalia and stereotyped words and phrases are commonly used by autistic children with little understanding of what is being vocalized.
Which process is NOT assessed during the mental status exam?
a. judgment
b. affect
c. intelligence quotient
d. cognition
e. insight
c. Intelligence quotient is measured through IQ tests.
A patient presents to your office claiming that the FBI is trying to poison him. What are these types of beliefs called?
a. somatic delusion
b. delusion of persecution
c. illusion
d. delusion of grandeur
e. hallucination
b. Patients who have delusions of persecutions often feel that people are taking pictures and tape recording them.
What question does the “C” represent in the ETOH abuse screening tool CAGE?
a. Have you ever felt the need to cut down?
b. Has anyone ever cautioned you not to drink?
c. Have you been caught having an “eye opener” in the morning?
d. Has anyone ever criticized you about drinking?
e. Do you care that you are feeling guilty about drinking?
a. There are four questions and if a patient responds yes to two of the questions, it is considered to be positive for abuse.
A phobia is an excessive fear of an object or place that leads to or can be preceded by…
a. panic attack
b. depression
c. hallucinations
d. delusions
e. confabulations
a. In attempts to avoid the “problem” patients can develop anxiety or panic attacks.
A 33 yo woman presents with a 3 year hx of a persistent, unfluctuating depressed mood. She also notes persistent insomnia, poor concentration and very little appetite. She denies previous similar sx, substance abuse, current prescriptive drug use and has had no change in her overall life circumstances. She remains functional at work and in most relationships. On the basis of the info presented, what is the most likely diagnosis?
a. dysthymic disorder
b. premenstrual dysphoric disorder
c. MDD
d. cyclothymic disorder
a. The main historical component that points to this diagnosis is the the long term (equal to or greater that 2 years), unfluctuating sx, w/o mention of manic or hypomanic sx (which are typical of cyclothymic disorders).
Of the following, which is the criterion that differentiates a manic versus a hypomanic episode?
a. duration of sx
b. presence of pressured speech
c. involvement in high risk activities
d. exhibiting decreased need for sleep
a. Mania: at least a week or longer
Hypomania: at least 4 days
What is the hallmark of a manic episode?
a. hypersomnolence
b. psychosis
c. depression
d. anxiety
e. irritability
e. At times, the patient can have a euphoric mood, which can result in denial of their illness.
Ms. Smith is diagnosed with a panic disorder. Based on her hx, you decide to treat her with an MAOI. Which SE is the most common for this med?
a. orthostatic hypotension
b. paresthesias
c. muscle plain
d. myoclonus
e. inducing maina in bipolar patient
a. Weight gain, edema, insomnia, and sexual dysfunction may also occur.
What type of pharm agent would be used as 1st line med to treat OCD?
a. risperidone
b. lonazepam
c. fluoxetine
d. trazadone
e. venlafaxine
c. Use of an SSRI in combo with behavioral therapy is recommended.
Ms. Jones wakes up from a deep sleep after having a nightmare. The nightmare caused her to re-experience the time she received 3rd degree burns on her arms. The next day at work, she was very jumpy and had difficulty concentrating. Most likely diagnosis?
a. adjustment disorder
b. PTSD
c. personality disorder
d. anxiety
e. schizophrenia
b. Treatment needs to begin ASAP, though sometimes the sx do not occur until quite a while after the initial traumatic event.
In which of the following conditions would ECT be effective?
a. somatization
b. anxiety disorders
c. MDD
d. personality disorders
e. geriatric patients who can take antidepressants
c. ECT can be used in patients that don’t respond to meds, have severe psychotic sx, or stupor or are homicidal or suicidal.
A patient who is intoxicated presents to the ED. On ocular exam, you notice mydriasis (dilation of the pupil of the eye). Which substance is he using?
a. sedatives
b. PCP
c. opioids
d. cocaine
d. Cocaine = dilation
Opioids = constriction
PCP = nystagmus
A patient reports having repetitious impulses and images that come to the forefront of her thoughts frequently throughout the day. These cause her a great deal of anxiety even though she knows they should not. What term best fits the patient’s description?
a. anhedonia
b. compulsions
c. abstraction
d. obsessions
d. These are obsessions and thats it.
A 24 yo presents with difficulty sleeping and jumpiness since returning from his tour of duty in Iraq 1 year ago. He also notes poor concentration, fatigue and having no emotions. He avoids leaving his home, has lost three jobs in the last few months and has numerous speeding tickets. He remains distant from his family but finds some comfort talking to his surviving friends at the local bar. Most likely diagnosis?
a. bipolar I disorder
b. MDD
c. PTSD
d. social phobia disorder
c. Returning from war… think PTSD… that is it.
A misinterpretation of an external stimulus is…
a. delusion
b. hallucination
c. illusion
d. neologism
e. tactile hallucination
c. Illusions are associated with external stimuli whereas hallucinations are not.
Which of the following indicates a poor prognosis for someone diagnosed with schizophrenia?
a. acute onset
b. co-morbid mood disorder
c. obvious precipitating event
d. younger age at diagnosis
d. A younger age of onset/diagnosis along with insidious onset, social isolation, family hx of schizophrenia and negative sx all portend a poor prognosis.
Which antidepressant has the longest half-life?
a. trazadone
b. venlafaxine
c. fluoxetine
d. paroxetine
c. Fluoxetine half-life = 4-14 days. Doesn’t cause discontinuation syndrome like the rest of the meds listed.
Patient presents to ED with ETOH withdrawal syndrome. What pharm agent of choice should be administrated?
a. clonidine
b. phenobarbital
c. neuroleptics
d. benzos
e. methadone
d. Dosage should start out high and titrate downward as the patient improves.
Which pharm or group of agents can cause erectile disorders?
a. clomipramine
b. sympathomimetics
c. lithium
d. trazadone
e. antianxiety agents
c. Lithium impairs the ability to have an erection.
Which system is NOT affected by the common SE of lithium?
a. skin
b. cardio
c. endo
d. GI
e. msk
e. Sx can include decreased appetite, nausea, vomiting, diarrhea, polyuria, EKG changes, hyperthyroidism, hypothyroidism, tremor, cognitive changes, skin eruptions and weight gain.
A mother brings her 5 yo child to the hospital after the child collapses at home. The mother states the child has been having diarrhea for the last 3 days. She has tried to get him to drink fluids. Upon further questioning, the mother states that the child has had 12 loose stools/day for the last 3 days. Exam reveals the child to be responsive, but lethargic and dehydrated. The child is admitted to the hospital and mom is very involved in the child’s care. While mom is there, the child is improving slightly, but still having multiple loose stools. When the mother had to leave to go to work, the child responded well to tx without any further episodes of diarrhea. Most likely diagnosis?
a. Munchausen syndrome
b. schizophrenia
c. malingering
d. Munchausen by proxy
e. factitious disorder
d. Munchausen by proxy is when a parent, usually the mother, exaggerates, induces or create an illness in their child.
Which of the following criteria us considered to be high risk factor for “successful” suicide?
a. people who live in climates with limited sun
b. low socioeconomic status
c. male
d. committed religious beliefs
c. male
QT interval delay may occur in which antipsychotic med?
a. risperidone
b. olanzapine
c. ziprasidone
d. quetiapine
e. aripiprazole
c. It is important to screen patients for cardiac risk factors.
A patient describes a desire for close relationships and to be more successful at work. However, she views herself as being undesirable and inferior. Because of these feelings she avoids social activities and extra occupational projects out of fear of criticism, rejection and embarrassment. Most likely diagnosis?
a. avoidant PD
b. borderline PD
c. histrionic PD
d. schizoid PD
a. An individual with avoidant personality disorder differs from schizoid in that they desire interaction and closeness but are unable to overcome their deep seated self-beliefs and fears.
What type of schizophrenia is characterized by self-injury, harm to others, mutism or rigidity?
a. paranoid
b. undifferentiated
c. disorganized
d. catatonic
e. schizophreniform
d. catatonic
Which disorder is characterized by episodes of hypomania and depression for greater than 2 years?
a. dysthymia
b. MDD
c. cyclothymia
d. bipolar
e. mood disorder
c. Sx are milder than a regular depressive or manic episode.
A 32 yo male presents to your office with complaint of low back pain for 7 months. The patient states he was initially injured on the job while trying to life a 50 pound barrel off a truck. He denies any paresthesias or bowel/bladder problems associated with the low back pain. The pt states that he had been given NSAIDs and a muscle relaxer, followed by PT. X-rays that were taken 5 months ago were reported as normal. He was place on light duty at that time. The patient has seen man doctors who have “not helped him”. Another person who works with the pt was at the clinic and stated the pt has had problems with one of his other coworkers. You consider trying the patient on an antidepressant 1st and then possibly sending him to a pain clinic if there is no success. Most likely diagnosis?
a. somatoform disorder
b. hypochondriasis
c. drug addiction
d. somatoform pain disorder
e. schizophreniform
d. Somatoform pain disorder is a focus on pain for greater than 6 months.
What is a commonly shared feature of bipolar disorder and ADHD in ped patients?
a. disruptive
b. obsessed with ideas
c. behavior problems
d. impaired concentration
e. insomnia
c. Behavior problems are a commonly shared feature of ped ADHD and bipolar disease.
A child who has oppositional defiant disorder is at high risk for developing which disorder?
a. mood disorder
b. personality disorder
c. conduct disorder
d. ADHD
e. developmental disorder
c. Oppositional defiant disorder is a less intense form of conduct disorder. Children who continue with the chronic behavior are at risk of developing conduct disorder.
A 24 yo woman comes to your office complaining of anxiety. The patient had witnessed a traumatic event 3 days earlier that made her feel fearful. She has not been able to tell her family about this experience. She now feels like she is numb and in a dazed, dreamlike state with poor concentration and difficulty sleeping. She experienced a flashback or the event yesterday. Most likely diagnosis?
a. PSTD
b. dissociative fugue
c. psychosis
d. acute stress disorder
e. depersonalization
d. Acute stress disorder is characterized by experiencing or witnessing a traumatic event when the person felt threatened by death or injury of the people they witnessed, Sx usually occur within a month of the event, last 2 days, and resolve in a month. If not treated at the early stages, the patient is at risk for developing PTSD.
What lab tests should be run to rule out other causes in children who have ADHD?
a. thyroid levels
b. LDH
c. ferritin
d. folic acid
e. CBC
a. Serum lead levels and thyroid function tests should be done to rule out other causes of the sx.
Which pharm agent most frequently causes postural hypotension?
a. quetiapine
b. risperidone
c. olanzapine
d. ziprasidone
a. Quetiapine is more frequently associated with postural hypotension as well as somnolence and dizziness.
Which SSRI has a less sedating effect and is most likely to cause insomnia in some patients?
a. fluoxetine
b. sertraline
c. paroxetine
d. fluvoxamine
e. citalopram
a. Fluoxetine has mild sedating properties but has a high probability of insomnia.
Which of the following do the majority of patients with dissociative identity disorder also meet diagnostic criteria for?
a. schizophrenia
b. PTSD
c. bipolar II disorder
d. MDD
b. DID formerly known as multiple personality disorder, is classified as a trauma spectrum disorder due to the strong link with early childhood trauma and/or maltreatment.
Which nonnicotine related agent has bee approved by the FDA as a 1st line med in the treatment of smoking cessation?
a. nortriptyline
b. clonidine
c. bupropion
d. fluoxetine
c. Bupropoin SR has been approved by the FDA for smoking cessation.
When admitting a patient for anorexia nervosa, what lab finding would you expect to see?
a. metabolic acidosis
b. hyperkalemia
c. decreased serum bicarbonate level
d. leukopenia
d. Leukopenia is seen in anorexia nervosa.
