Psychiatry - Pathology (Part 2)

Question 1

Obsessive-compulsive disorder is associated with what movement disorder?

Answer 1

Tourette’s syndrome

Question 2

Obsessive-compulsive personality disorder has similar symptoms as obsessive-compulsive disorder with what major difference?

Answer 2

Obsessive-compulsive disorder is ego dystonic whereas obsessive-compulsive personality disorder is ego syntonic

Question 3

How long must symptoms be present to consider a diagnosis of posttraumatic stress disorder?

Answer 3

At least 1 month

Question 4

What disorder is a precursor to posttraumatic stress disorder?

Answer 4

Acute stress disorder, which lasts no longer than 1 month

Question 5

A war veteran describes recurrent nightmares and flashbacks of her close friend being brutally killed and burned on the battlefield. These flashbacks have lasted for 4 months since she returned from Iraq. What is the most likely diagnosis?

Answer 5

Posttraumatic stress disorder

Question 6

A person who had her hand amputated as a result of a food-processing incident has recurrent flashbacks. She cannot go into a kitchen without having intense fear, and this has lasted for 3 months. What disorder does this patient have?

Answer 6

Posttraumatic stress disorder

Question 7

How is posttraumatic stress disorder treated?

Answer 7

Psychotherapy and selective serotonin reuptake inhibitors

Question 8

A person who had his hand amputated as a result of a food-processing incident has recurrent flashbacks. He cannot go into a kitchen without having intense fear, and this has lasted for a period of 2 weeks. What disorder does this patient have?

Answer 8

Acute stress disorder

Question 9

The re-experiencing of traumatic events leads to what symptoms?

Answer 9

Feelings of horror, helplessness, fear

Question 10

Define adjustment disorder.

Answer 10

Emotional symptoms in response to an identifiable stressor that lasts less than 6 months

Question 11

What are some of the symptoms associated with generalized anxiety disorder?

Answer 11

Sleep problems, fatigue, difficulty concentrating

Question 12

What drugs are used in the management of generalized anxiety disorder?

Answer 12

Benzodiazepines, selective serotonin reuptake inhibitors, and buspirone

Question 13

A patient presents with a chief complaint that he is a “worrier.” He says he worries about everything all the time. What is the most likely diagnosis?

Answer 13

Generalized anxiety disorder

Question 14

By definition, the symptoms of generalized anxiety disorder must last how long to be clinically significant?

Answer 14

>6 months

Question 15

A 34-year-old male presents with epigastric pain that radiates to the back. He has been admitted previously for a similar complaint as well as for opiate overdose. Physical exam shows epigastric pain that is not present with distraction. Amylase and lipase are normal. What is the likely diagnosis?

Answer 15

Chronic pancreatitis

Question 16

Compare malingering and factitious disorder.

Answer 16

Whereas the complaints of an individual who is malingering cease after the gain is achieved, the complaints of an individual with factitious disorder continue; also, malingering is a conscious action whereas factitious disorder is a product of unconscious

Question 17

A mother is found to be injecting feces into the intravenous line of her 3-year-old daughter to keep her in the hospital. What is this psychiatric syndrome called?

Answer 17

Munchausen’s syndrome by proxy

Question 18

A patient in the emergency department is requesting to be admitted for the hundredth time this year. He has a history of multiple invasive procedures, and he seems to enjoy being in the hospital. What is this condition called?

Answer 18

Munchausen’s syndrome

Question 19

Define the difference between malingering and factitious disorder with respect to obtaining medical care.

Answer 19

In malingering, patients avoid medical treatment; in factitious disorder, patients are willing to obtain any medical treatment offered

Question 20

What somatoform disorder is characterized by motor and sensory symptoms that are unconsciously produced, incongruent with physical examination, and follow an acute stressor?

Answer 20

Conversion disorder

Question 21

A patient presents with prolonged diffuse pain that has been extensively worked up with no etiology found. What is his diagnosis?

Answer 21

Pain disorder

Question 22

A woman presents to her primary care physician of 12 years with back pain. She describes it as acute-onset, nonradiating pain. She had a similar description for leg pain a few months ago. She has a history of irritable bowel syndrome, heartburn, dyspareunia, and tingling in her feet. Diagnostic workup has been negative thus far. What is a good working diagnosis for this patient?

Answer 22

Somatization disorder

Question 23

A patient presents at multiple visits with a preoccupation and fear that she might have a serious illness, despite being reassured of her health many times. What is this condition called?

Answer 23

Hypochondriasis

Question 24

A supermodel presents to a plastic surgeon with a complaint that her nose does not look right. She has had 12 cosmetic surgeries on her nose in the past. What somatoform disorder does this patient have?

Answer 24

Body dysmorphic disorder

Question 25

Somatoform disorders are more common in which sex?

Answer 25

Females

Question 26

How do malingering patients differ from those with somatoform disorders?

Answer 26

Malingering is a product of conscious actions whereas somatoform disorders are products of the unconscious

Question 27

Which organ systems must be involved to diagnose somatization disorder?

Answer 27

Gastrointestinal, sexual and neurologic symptoms must be present

Question 28

Define personality trait.

Answer 28

A personality trait is a consistent way a person processes his/her environment and his/her role in it

Question 29

How does a personality disorder differ from a personality trait?

Answer 29

A personality trait is a consistent way a person processes his/her environment and his/her role in it. A personality disorder is a condition in which this trait becomes inflexible and maladaptive

Question 30

True or False? Personality disorders are usually diagnosed during childhood.

Answer 30

FALSE ## Footnote personality disorders are not usually diagnosed in children; however, personality disorder patterns are generally stable by early adulthood

Question 31

Cluster A personality disorders have a genetic association with which psychiatric disorder?

Answer 31

Schizophrenia

Question 32

What cluster A personality disorder is characterized by distrust and suspiciousness?

Answer 32

Paranoid personality disorder

Question 33

A 28-year-old woman is constantly accusing her mother of stealing her money and spying on her when she is at work. She eventually moves away from her mother and constantly changes her e-mail to maintain control over her privacy. What type of personality disorder does this patient exhibit?

Answer 33

Paranoid personality disorder

Question 34

What is the main ego defense mechanism used by persons with paranoid personality disorder?

Answer 34

Projection ## Footnote accusing others of things the patient is actually guilty of

Question 35

Name the three cluster A personality disorders.

Answer 35

Paranoid, schizoid, and schizotypal

Question 36

The mother of a 22-year-old woman comes to her physician reporting that her daughter is acting "weird." She does not have friends, chooses to work the night shift, and interacts with her only during meals. Upon questioning, the daughter does not express any sadness about her isolation, nor does she find anything wrong with it. What is the likely diagnosis?

Answer 36

Schizoid personality disorder

Question 37

Compare schizoid and avoidant personality disorders.

Answer 37

In schizoid personality disorder, patients are not bothered by social isolation whereas in avoidant personality disorder patients desire social contact but are unable to achieve it

Question 38

A person with which personality disorder is interpersonally awkward and often has odd beliefs or magical thinking?

Answer 38

Schizotypal personality disorder

Question 39

A 45-year-old male believes that each night the moon is full he must sleep outside to absorb its gravitational pull to rid his body of disease. What type of personality disorder does this patient exhibit?

Answer 39

Schizotypal personality disorder

Question 40

What cluster of personality disorders is characterized by dramatic, emotional, or erratic behaviors?

Answer 40

Cluster B

Question 41

Name the four cluster B personality disorders.

Answer 41

Antisocial, borderline, histrionic, and narcissistic

Question 42

A 20-year-old male has multiple arrests for assault and robbery. He has a history of arson as a teenager. During the interview, he threatens the physician with physical harm. What is the likely diagnosis?

Answer 42

Antisocial personality disorder

Question 43

What personality disorder is characterized by excessive emotionality and attention-seeking and sexually provocative behaviors?

Answer 43

Histrionic personality disorder

Question 44

Name two conditions that have a genetic association with cluster B personality disorders.

Answer 44

Mood disorders and substance abuse

Question 45

A woman presents to a new psychiatrist. She reports symptoms of depression related to a series of short-lived relationships and multiple sexual partners. During her interview, the psychiatrist notices a number of shallow cuts on the forearms. What is the likely diagnosis?

Answer 45

Borderline personality disorder

Question 46

A patient storms out of the office after waiting in the waiting room for 10 minutes, exclaiming, "Doesn't the doctor realize who I am and how busy my schedule is?" With what personality disorder is this patient' behavior most consistent?

Answer 46

Narcissistic personality disorder

Question 47

Describe the major defense mechanism of patients with borderline personality disorder.

Answer 47

Splitting ## Footnote views one group as "all good" and another as "all bad"

Question 48

A 25-year-old male presents to a new psychiatrist. He reports sadness that he does not fit in at work. He does not eat with his coworkers at lunch because he feels that they will not talk to him. He reports feeling this way in college. When invited to work parties, but makes up an excuse so he does not have to go. What is the likely diagnosis?

Answer 48

Avoidant personality disorder

Question 49

A patient's wife complains of a preoccupation with order, perfectionism, and control. What personality disorder might this patient have?

Answer 49

Obsessive-compulsive personality disorder

Question 50

What cluster of personality disorders is characterized by increased anxiety or fear?

Answer 50

Cluster C

Question 51

A patient presents with low self-confidence. She is submissive, clinging, and in constant need of reassurance. What type of personality disorder might this patient have?

Answer 51

Dependent personality disorder

Question 52

Name the three cluster C personality disorders.

Answer 52

Avoidant, obsessive-compulsive, and dependent

Question 53

What are the durations of brief psychotic disorder, schizophreniform disorder, and schizophrenia?

Answer 53

Brief psychotic disorder lasts \<1 month, schizophreniform disorder lasts 1-6 months, and schizophrenia lasts \>6 months

Question 54

How does schizotypal disorder differ from schizophrenia?

Answer 54

The odd and disordered thinking in schizophrenia is more pronounced and disruptive.

Question 55

True or False? Unlike people with anorexia, most people with bulimia may have a normal body weight.

Answer 55

TRUE ## Footnote anorexia is defined as a weight less than 85% of ideal body weight

Question 56

What physical signs of induced vomiting may be seen in a patient with bulimia?

Answer 56

Parotitis, enamel erosions, electrolyte disturbances, and dorsal hand calluses

Question 57

What methods of weight control other than vomiting are used by patients with bulimia?

Answer 57

Laxative abuse

Question 58

True or False? Individuals with anorexia nervosa realize that they are underweight.

Answer 58

FALSE

Question 59

Metatarsal stress fractures are indicative of what consequence of anorexia?

Answer 59

Decreased bone density ## Footnote body image distortion is an element of the disorder

Question 60

True or False? Electrolyte imbalances are specific to anorexia nervosa and not to bulimia nervosa.

Answer 60

FALSE ## Footnote both patient populations may present with alkalosis or other electrolyte imbalances

Question 61

Anorexia nervosa is defined by body weight below what percentage of ideal body weight?

Answer 61

85%

Question 62

What psychiatric mood disorder is commonly associated with anorexia nervosa?

Answer 62

Depression

Question 63

Define gender identity disorder.

Answer 63

Persistent discomfort with one's sex and identification as the opposite sex

Question 64

A patient is considered to be dependent on a substance if he or she demonstrates how many maladaptive signs of dependence during a 1-year period?

Answer 64

Three or more

Question 65

What are the seven maladaptive signs of substance dependence?

Answer 65

Tolerance; withdrawal; substance taken in larger amounts or over longer time than desired; persistent desire to or attempts to cut down on use; significant energy spent obtaining, using, or recovering from substance use; important social, occupational, or recreational activities reduced because of substance use; and continued use despite knowing the problems that the substance causes

Question 66

Is recurrent use of a substance resulting in a failure to fulfill major obligations at work, school, or home a criterion for substance abuse, dependence, or both?

Answer 66

Both

Question 67

Are recurrent substance-related legal problems a criterion for substance abuse, dependence, or both?

Answer 67

Abuse

Question 68

Is continued substance use despite persistent problems caused by the substance a criterion for substance abuse, dependence, or both?

Answer 68

Both

Question 69

What are the four criteria of substance abuse?

Answer 69

Recurrent use resulting in failure to fulfill major obligations, recurrent use in physically hazardous situations, recurrent substance-related problems, and continued use despite persistent problems caused by use; in addition, the patient must never have met the criteria for dependence

Question 70

True or False? Individuals who suffer from substance abuse usually meet criteria for substance dependence as well.

Answer 70

FALSE ## Footnote to be diagnosed with substance abuse the patient must not meet criteria for dependence

Question 71

A patient in the hospital for withdrawal is noted to be agitated, anxious, and sleepless. What type of drug might the patient have been abusing?

Answer 71

A sedating agent

Question 72

A patient presents with disinhibition, slurred speech, ataxia, and an elevated γ-glutamyl transferase level. This patient is most likely intoxicated with what substance?

Answer 72

Alcohol

Question 73

A man assaults a person in the waiting room. The staff cautiously approach the man, who has both vertical and horizontal nystagmus. This patient is most likely intoxicated with what substance?

Answer 73

Phencyclidine

Question 74

A patient presents with pupillary dilation, florid hallucinations, delusions, tachycardia, and hypertension. What drug did this patient most likely use?

Answer 74

This patient is probably intoxicated with a stimulating agent like amphetamines or cocaine

Question 75

A patient presents with a respiratory rate of eight breaths per minute, pinpoint pupils, and vomiting. This patient is most likely intoxicated with what substance?

Answer 75

Opioids

Question 76

A patient who is being treated for anxiety is brought to the emergency room with symptoms of respiratory depression. She has a history of alcohol abuse. She is most likely intoxicated with which of the following: cocaine, phencyclidine, lysergic acid diethylamide, or barbiturates?

Answer 76

Barbiturates

Question 77

A patient with chronic pain presents with constipation. The use of what class of drugs commonly causes constipation?

Answer 77

Opioids

Question 78

A patient is brought to the emergency room with amnesia, ataxia, somnolence, and depression. She states that she recently took some medication for anxiety, and she denies any alcohol or barbiturate use. This patient may be intoxicated with what substance?

Answer 78

Benzodiazepines

Question 79

What commonly abused class of drugs is also used for the treatment of attention-deficit/hyperactivity disorder?

Answer 79

Amphetamines

Question 80

A patient who abuses drugs rushes into the clinic stating that he is being followed by a killer. He then states that he is having chest pain, and he undergoes sudden cardiac arrest shortly thereafter. This patient is most likely intoxicated with what common street drug?

Answer 80

Cocaine

Question 81

A patient presents with visual hallucinations and vivid nightmare-like flashbacks of his childhood. His pupils are dilated. This patient is most likely intoxicated with what?

Answer 81

Lysergic acid diethylamide

Question 82

Parents present with their teenage daughter. They note that she has recently been socially withdrawn and that she has also been eating more. The patient complains of dry mouth, but says she otherwise feels great. This patient may be intoxicated with what substance?

Answer 82

Marijuana

Question 83

A patient presents with restlessness, insomnia, increased urination and a cardiac arrhythmia. The social history should include questions that ask about the use of what legal drug: acetaminophen, aspirin, caffeine, or ibuprofen?

Answer 83

Caffeine

Question 84

What are the symptoms of alcohol withdrawal?

Answer 84

Tremor, hypertension, delirium tremens, and hallucinations

Question 85

What are the symptoms of opioid withdrawal?

Answer 85

Sweating, dilation of pupils, diarrhea, yawning, rhinorrhea, and anxiety

Question 86

What are the symptoms of an amphetamine "crash"?

Answer 86

Depression, hypersomnolence, stomach cramps, hunger, and headache

Question 87

What are the symptoms of a cocaine "crash"?

Answer 87

Severe psychologic craving, suicidality, and severe depression

Question 88

What is the major symptom of phencyclidine withdrawal?

Answer 88

The sudden onset of severe, random, homicidal violence

Question 89

What are the major symptoms associated with barbiturate withdrawal?

Answer 89

Life-threatening cardiovascular collapse, anxiety, seizures, and delirium (ie, symptoms similar to those associated with alcohol withdrawal)

Question 90

What are the major symptoms associated with benzodiazepine withdrawal?

Answer 90

Rebound anxiety, seizures, tremor, and insomnia

Question 91

What are the symptoms associated with caffeine withdrawal?

Answer 91

Headache, lethargy, depression, and weight gain

Question 92

What are the symptoms associated with nicotine withdrawal?

Answer 92

Irritability, headache, weight gain, anxiety, and craving

Question 93

What medications are used to treat delirium tremens?

Answer 93

Benzodiazepines

Question 94

True or False? Opioid withdrawal is treated with naloxone.

Answer 94

FALSE ## Footnote opioid overdose can be treated with either naloxone or naltrexone, withdrawal is treated symptomatically

Question 95

What drug can be detected in urine up to 1 month after last use?

Answer 95

Marijuana

Question 96

Because heroin is injected intravenously, heroin users may get endocarditis on which side of the heart?

Answer 96

The right side; it is rare to see right-sided endocarditis in nonintravenous drug users

Question 97

Intravenous drugs users are at increased risk of what conditions?

Answer 97

Viral hepatitis, AIDS, right-sided endocarditis, skin abscesses

Question 98

Suboxone is a combination of what two drugs?

Answer 98

It is a combination of naltrexone and buprenorphine (partial agonist); it is a longer acting drug with fewer withdrawal symptoms than methadone

Question 99

Why do heroin abusers have hemorrhoids?

Answer 99

Because of chronic opioid-induced constipation

Question 100

Suboxone has a lower abuse potential secondary to what adverse effect?

Answer 100

When injected, suboxone causes withdrawal symptoms due to the addition of naltrexone

Question 101

What two drugs competitively inhibit opioid receptors?

Answer 101

Naloxone and naltrexone

Question 102

What long-acting oral opioid is used for heroin detoxification or maintenance?

Answer 102

Methadone

Question 103

What drug inhibits acetaldehyde dehydrogenase and is useful for alcoholism treatment?

Answer 103

Disulfiram

Question 104

What is the triad of signs of Wernicke-Korsakoff syndrome?

Answer 104

Confusion, ophthalmoplegia, and ataxia

Question 105

What are the clinical manifestations of chronic alcoholism?

Answer 105

Alcoholic cirrhosis, pancreatitis, hepatitis, peripheral neuropathy, testicular atrophy

Question 106

A deficiency of what substance may result in Wernicke-Korsakoff syndrome?

Answer 106

Thiamine (vitamin B₁); commonly seen in alcoholics who derive most of their caloric intake from alcohol

Question 107

What neurologic pathology is associated with Wernicke-Korsakoff syndrome?

Answer 107

Bilateral necrosis of the mamillary bodies

Question 108

What is the treatment for Wernicke-Korsakoff syndrome?

Answer 108

Intravenous thiamine (vitamin B₁); it should be given before any dextrose-containing fluids

Question 109

A deficiency of what vitamin may result in confusion, ophthalmoplegia, and ataxia in alcoholics?

Answer 109

Thiamine (vitamin B₁)

Question 110

A patient presents to the emergency room with confusion and vomiting. He violently vomits gastric contents a few times. This is followed by hematemesis. What is the likely explanation?

Answer 110

Mallory-Weiss syndrome, caused by prolonged vomiting/retching that leads to lacerations of the esophagus

Question 111

If Wernicke's encephalopathy is not quickly treated, it may progress to the development of what disease?

Answer 111

Korsakoff's psychosis, which consists of irreversible memory loss, confabulation, and personality change

Question 112

A patient presents with painful hematemesis after a night of binge drinking; what can cause this specific finding?

Answer 112

Mallory-Weiss syndrome

Question 113

How do presentations of esophageal varices differ from Mallory-Weiss tears?

Answer 113

Varices are painless whereas Mallory-Weiss tears are painful

Question 114

Irreversible memory loss, confabulation, and personality change describe which condition associated with alcohol abuse?

Answer 114

Korsakoff's psychosis

Question 115

Delirium tremens are a potentially deadly alcohol withdrawal syndrome that peaks how many days after an alcoholic's last drink?

Answer 115

2 to 5 days

Question 116

List the symptoms of alcohol withdrawal.

Answer 116

Tachycardia, tremors, and high blood pressure followed by psychotic symptoms

Question 117

Delirium tremens are treated with what class of drugs?

Answer 117

Benzodiazepines