Psichia pt2 QUESTIONS AND WELL
VERIFIED ANSWERS
159. A 55-year-old man comes to the physician with the chief complaintof daytime drowsiness.
He states that although he goes to bed at 10 PM and doesn't get up until 6 AM, he is chronically
tired and must take naps during the day. He wakes up in the morning with a headache and a
dry mouth.His wife states that he snores loudly. Which of the following is the most likely
diagnosis? - ANSWER>>a. Obstructive sleep apnea
160. A 28-year-old woman is a patient of the internal medicine service, being treated for
diabetic ketoacidosis. The attending physician consults the psychiatric service because the
patient is refusing to learn how to measure her blood glucose levels, and the physicians note
that she is "difficult to deal with." The patient states, and can demonstrate that she
understands the reasons for monitoring her blood glucose levels and, further, is not afraid of
the needle sticks necessary to draw her blood for testing. Which of the following is the most
likely reason for this patient's noncompliance? - ANSWER>>b. The patient is experiencing a
negative transference to her physician.
161. A 24-year-old woman is hospitalized after a suicide gesture during which she superficially
slashed both her wrists. At the team meeting 3 days later, the male resident argues that the
patient has been doing quite well, seems to be responding to therapy, and should be allowed to
leave on a pass. The nursing staff angrily argues that the resident is showing favoritism to the
patient, and because of her poor compliance with the unit rules, she should not be allowed out.
The resident insists the nurses are being punitive. The defense mechanism being used by the
patient in this scenario is a feature of which of the following personality disorders? -
ANSWER>>c. Borderline
162. A 45-year-old woman, who has been on chronic steroid treatment for her asthma, has thin
arms and legs but has a large amount of fat deposited on her abdomen, chest, and shoulders.
Her skin is thin and atrophic, and she bruises easily. She has purple striae on her abdomen.
Physical examination shows elevated blood pressure and laboratory tests show decreased
glucose tolerance. Which of the following psychiatric conditions is the most likely diagnosis? -
ANSWER>>c. Substance-induced mood disorder
,163. A 69-year-old man with a diagnosis of delirium has symptoms of psychosis which include:
frightening auditory and visual hallucinations and paranoid delusions. Which of the following
medications should be chosen first for this man's symptoms? - ANSWER>>a. Haloperidol
164. A 34-year-old man recurrently perceives the smell of rotten eggs. This kind of hallucination
is most commonly seen in patients with which of the following diagnoses? - ANSWER>>d.
Partial complex seizures
165. A 40-year-old woman's cognitive functions have progressively deteriorated for several
years, to the point where she needs nursing home-level care. She is depressed, easily irritated,
and prone to aggressive outbursts, adramatic change from her premorbid personality. She also
presents with irregular, purposeless, and asymmetrical movements of her face, limbs, and
trunk, which worsen when she is upset and disappear in sleep. Her MRI shows atrophy of the
caudal nucleus and the putamen. Which of the following is the most likely diagnosis of this
patient? - ANSWER>>c. Huntington disease
166. A 37-year-old mildly retarded man with trisomy 21 syndrome has been increasingly
forgetful. He makes frequent mistakes when counting change at the grocery store where he has
worked for several years. In the past, he used to perform this task without difficulty. He often
cannot recall the names of common objects, and he has started annoying customers with his
intrusive questions. Which of the following is the most likely diagnosis of this patient? -
ANSWER>>c. Alzheimer disease
167. A 72-year-old retired English professor with a long history of hypertension has been having
difficulties with tasks he used to find easy and enjoyable, such as crossword puzzles and letter
writing, because he cannot remember the correct words and his handwriting has deteriorated.
He has also been having difficulty remembering the events of previous days and he
moves and thinks at a slower pace. These symptoms have been progressing slowly in a step-
wise fashion over time. Subsequently, he develops slurred speech. Which of the following is the
most likely diagnosis? - ANSWER>>a. Multi-infarct dementia
168. A previously healthy 60-year-old man undergoes a corneal transplant. Three months later,
he is profoundly demented, demonstrates myoclonic jerks on examination, and has an EEG that
Pretest_Psychiatry Q&A 5"1of1"11
shows periodic bursts of electrical activity superimposed on a slow background. Which of the
following is the most likely diagnosis? - ANSWER>>c. Creutzfeldt-Jakob disease
,169. A 53-year-old man is admitted to the cardiac intensive care unit after a myocardial
infarction. The day after he is admitted, when the physician enters the room, the patient loudly
declares that he "feels fine" and proceeds to get down on the floor to demonstrate this
assertion by doing push-ups. Once persuaded to get back into bed, the patient becomes angry
about the poor food quality and feels that only the "most qualified" specialist in the hospital
should be treating him because he is, after all, the CEO of his own company. The patient's wife
notes that this demanding behavior and haughty attitude are not unusual for him. Which of the
following psychiatric diagnoses is most likely for this patient? - ANSWER>>c. Narcissistic
personality disorder
170. A 22-year-old college student comes to the physician with the complaint of shortness of
breath during anxiety-provoking situations, such as examinations. She also notes perioral
tingling, carpopedal spasms, and feelings of derealization at the same time. All of the symptoms
pass after the anxiety over the situation has faded. The episodes have never occurred "outof
the blue." Which of the following is the most likely diagnosis? - ANSWER>>c. Hyperventilation
171. Which of the following treatments should the physician suggest first for the patient in the
vignette above? - ANSWER>>c. Rebreathe into a paper bag during the episode
172. A 25-year-old woman is brought to the physician by her boyfriend after he noticed a
change in her personality over the preceding 6 months. He states that she frequently becomes
excessively preoccupied with a single theme, often religious in nature. She was not previously a
religious person. He also notes that she often perseverates on a theme while she is speaking,
and that she is overinclusive in her descriptions. Finally, he notes that while previously the two
had a satisfying sexual life, now the patient appears to have no sex drive whatsoever. The
physician finds the patient to be very emotionally intense as - ANSWER>>b. Temporal lobe
epilepsy
173. A 23-year-old man comes to the physician with the complaint that his memory has
worsened over the past 2 months and that he has difficulty concentrating. He has lost interest
in his friends
Pretest_Psychiatry Q&A 5"2of1"11
and his work. He has difficulty with abstract thoughts and problem solving. He has also felt
depressed. MRI scan shows parenchymal abnormalities. Which of the following is the most
likely diagnosis? - ANSWER>>c. HIV-related dementia
174. A 37-year-old alcoholic is brought to the emergency room after he was found unconscious
in the street. He is hospitalized for dehydration and pneumonia. While being treated, he
, becomes acutely confused and agitated. He cannot move his eyes upward or to the right, and
he is ataxic. Which of the following is the most likely diagnosis? - ANSWER>>d. Wernicke
encephalopathy
175. Which of the following is the most appropriate treatment for the patient in the vignette
above? - ANSWER>>e. Thiamine
176. A 65-year-old woman is brought to the physician because she has become easily
distractible, apathetic, and unconcerned about her appearance. She has trouble remembering
familiar words and locations, and she experiences urinary incontinence. On physical
examination, her gait is seen to be ataxic. When copying a complex picture, she makes many
mistakes. The patient most likely has which of the following disorders? - ANSWER>>e. Normal-
pressure hydrocephalus
177. A 43-year-old woman comes to the emergency room with a temperature of 38.3°C (101°F)
and a large suppurating ulcer on her left shoulder. This is the third such episode for this woman.
Her physical examination is otherwise normal, except for the presence of multiple scars on her
abdomen. Which of the following is the most likely diagnosis? - ANSWER>>d. Factitious disorder
178. Which of the following etiologies is most likely underlying the behavior of the woman in
the vignette above? - ANSWER>>a. Primary gain
179. A 26-year-old man comes to the emergency room with the chief complaint of suicidal
ideation. He is admitted to the psychiatric ward, where he is noncompliant with all treatment
regimens and does not show any psychiatric symptoms other than his insistence that he is
suicidal. It is subsequently discovered that he is wanted by the police, who have a warrant for
his arrest. Which of the following best describes this behavior? - ANSWER>>b. Secondary gain
180. A 32-year-old woman who has a chronic psychiatric disorder, multiple medical problems,
and alcoholism comes to the physician because her breasts have started leaking a whitish fluid.
Which of the following is the most likely cause of this symptom? - ANSWER>>a. Haloperidol
181. Which of the following endogenous substances is likely to have caused this phenomenon
from the vignette above? - ANSWER>>d. Prolactin
182. A 3-year-old child is brought to the emergency room by his parents after they found him
having a generalized seizure at home. The child's breath smells of garlic, and he has bloody
VERIFIED ANSWERS
159. A 55-year-old man comes to the physician with the chief complaintof daytime drowsiness.
He states that although he goes to bed at 10 PM and doesn't get up until 6 AM, he is chronically
tired and must take naps during the day. He wakes up in the morning with a headache and a
dry mouth.His wife states that he snores loudly. Which of the following is the most likely
diagnosis? - ANSWER>>a. Obstructive sleep apnea
160. A 28-year-old woman is a patient of the internal medicine service, being treated for
diabetic ketoacidosis. The attending physician consults the psychiatric service because the
patient is refusing to learn how to measure her blood glucose levels, and the physicians note
that she is "difficult to deal with." The patient states, and can demonstrate that she
understands the reasons for monitoring her blood glucose levels and, further, is not afraid of
the needle sticks necessary to draw her blood for testing. Which of the following is the most
likely reason for this patient's noncompliance? - ANSWER>>b. The patient is experiencing a
negative transference to her physician.
161. A 24-year-old woman is hospitalized after a suicide gesture during which she superficially
slashed both her wrists. At the team meeting 3 days later, the male resident argues that the
patient has been doing quite well, seems to be responding to therapy, and should be allowed to
leave on a pass. The nursing staff angrily argues that the resident is showing favoritism to the
patient, and because of her poor compliance with the unit rules, she should not be allowed out.
The resident insists the nurses are being punitive. The defense mechanism being used by the
patient in this scenario is a feature of which of the following personality disorders? -
ANSWER>>c. Borderline
162. A 45-year-old woman, who has been on chronic steroid treatment for her asthma, has thin
arms and legs but has a large amount of fat deposited on her abdomen, chest, and shoulders.
Her skin is thin and atrophic, and she bruises easily. She has purple striae on her abdomen.
Physical examination shows elevated blood pressure and laboratory tests show decreased
glucose tolerance. Which of the following psychiatric conditions is the most likely diagnosis? -
ANSWER>>c. Substance-induced mood disorder
,163. A 69-year-old man with a diagnosis of delirium has symptoms of psychosis which include:
frightening auditory and visual hallucinations and paranoid delusions. Which of the following
medications should be chosen first for this man's symptoms? - ANSWER>>a. Haloperidol
164. A 34-year-old man recurrently perceives the smell of rotten eggs. This kind of hallucination
is most commonly seen in patients with which of the following diagnoses? - ANSWER>>d.
Partial complex seizures
165. A 40-year-old woman's cognitive functions have progressively deteriorated for several
years, to the point where she needs nursing home-level care. She is depressed, easily irritated,
and prone to aggressive outbursts, adramatic change from her premorbid personality. She also
presents with irregular, purposeless, and asymmetrical movements of her face, limbs, and
trunk, which worsen when she is upset and disappear in sleep. Her MRI shows atrophy of the
caudal nucleus and the putamen. Which of the following is the most likely diagnosis of this
patient? - ANSWER>>c. Huntington disease
166. A 37-year-old mildly retarded man with trisomy 21 syndrome has been increasingly
forgetful. He makes frequent mistakes when counting change at the grocery store where he has
worked for several years. In the past, he used to perform this task without difficulty. He often
cannot recall the names of common objects, and he has started annoying customers with his
intrusive questions. Which of the following is the most likely diagnosis of this patient? -
ANSWER>>c. Alzheimer disease
167. A 72-year-old retired English professor with a long history of hypertension has been having
difficulties with tasks he used to find easy and enjoyable, such as crossword puzzles and letter
writing, because he cannot remember the correct words and his handwriting has deteriorated.
He has also been having difficulty remembering the events of previous days and he
moves and thinks at a slower pace. These symptoms have been progressing slowly in a step-
wise fashion over time. Subsequently, he develops slurred speech. Which of the following is the
most likely diagnosis? - ANSWER>>a. Multi-infarct dementia
168. A previously healthy 60-year-old man undergoes a corneal transplant. Three months later,
he is profoundly demented, demonstrates myoclonic jerks on examination, and has an EEG that
Pretest_Psychiatry Q&A 5"1of1"11
shows periodic bursts of electrical activity superimposed on a slow background. Which of the
following is the most likely diagnosis? - ANSWER>>c. Creutzfeldt-Jakob disease
,169. A 53-year-old man is admitted to the cardiac intensive care unit after a myocardial
infarction. The day after he is admitted, when the physician enters the room, the patient loudly
declares that he "feels fine" and proceeds to get down on the floor to demonstrate this
assertion by doing push-ups. Once persuaded to get back into bed, the patient becomes angry
about the poor food quality and feels that only the "most qualified" specialist in the hospital
should be treating him because he is, after all, the CEO of his own company. The patient's wife
notes that this demanding behavior and haughty attitude are not unusual for him. Which of the
following psychiatric diagnoses is most likely for this patient? - ANSWER>>c. Narcissistic
personality disorder
170. A 22-year-old college student comes to the physician with the complaint of shortness of
breath during anxiety-provoking situations, such as examinations. She also notes perioral
tingling, carpopedal spasms, and feelings of derealization at the same time. All of the symptoms
pass after the anxiety over the situation has faded. The episodes have never occurred "outof
the blue." Which of the following is the most likely diagnosis? - ANSWER>>c. Hyperventilation
171. Which of the following treatments should the physician suggest first for the patient in the
vignette above? - ANSWER>>c. Rebreathe into a paper bag during the episode
172. A 25-year-old woman is brought to the physician by her boyfriend after he noticed a
change in her personality over the preceding 6 months. He states that she frequently becomes
excessively preoccupied with a single theme, often religious in nature. She was not previously a
religious person. He also notes that she often perseverates on a theme while she is speaking,
and that she is overinclusive in her descriptions. Finally, he notes that while previously the two
had a satisfying sexual life, now the patient appears to have no sex drive whatsoever. The
physician finds the patient to be very emotionally intense as - ANSWER>>b. Temporal lobe
epilepsy
173. A 23-year-old man comes to the physician with the complaint that his memory has
worsened over the past 2 months and that he has difficulty concentrating. He has lost interest
in his friends
Pretest_Psychiatry Q&A 5"2of1"11
and his work. He has difficulty with abstract thoughts and problem solving. He has also felt
depressed. MRI scan shows parenchymal abnormalities. Which of the following is the most
likely diagnosis? - ANSWER>>c. HIV-related dementia
174. A 37-year-old alcoholic is brought to the emergency room after he was found unconscious
in the street. He is hospitalized for dehydration and pneumonia. While being treated, he
, becomes acutely confused and agitated. He cannot move his eyes upward or to the right, and
he is ataxic. Which of the following is the most likely diagnosis? - ANSWER>>d. Wernicke
encephalopathy
175. Which of the following is the most appropriate treatment for the patient in the vignette
above? - ANSWER>>e. Thiamine
176. A 65-year-old woman is brought to the physician because she has become easily
distractible, apathetic, and unconcerned about her appearance. She has trouble remembering
familiar words and locations, and she experiences urinary incontinence. On physical
examination, her gait is seen to be ataxic. When copying a complex picture, she makes many
mistakes. The patient most likely has which of the following disorders? - ANSWER>>e. Normal-
pressure hydrocephalus
177. A 43-year-old woman comes to the emergency room with a temperature of 38.3°C (101°F)
and a large suppurating ulcer on her left shoulder. This is the third such episode for this woman.
Her physical examination is otherwise normal, except for the presence of multiple scars on her
abdomen. Which of the following is the most likely diagnosis? - ANSWER>>d. Factitious disorder
178. Which of the following etiologies is most likely underlying the behavior of the woman in
the vignette above? - ANSWER>>a. Primary gain
179. A 26-year-old man comes to the emergency room with the chief complaint of suicidal
ideation. He is admitted to the psychiatric ward, where he is noncompliant with all treatment
regimens and does not show any psychiatric symptoms other than his insistence that he is
suicidal. It is subsequently discovered that he is wanted by the police, who have a warrant for
his arrest. Which of the following best describes this behavior? - ANSWER>>b. Secondary gain
180. A 32-year-old woman who has a chronic psychiatric disorder, multiple medical problems,
and alcoholism comes to the physician because her breasts have started leaking a whitish fluid.
Which of the following is the most likely cause of this symptom? - ANSWER>>a. Haloperidol
181. Which of the following endogenous substances is likely to have caused this phenomenon
from the vignette above? - ANSWER>>d. Prolactin
182. A 3-year-old child is brought to the emergency room by his parents after they found him
having a generalized seizure at home. The child's breath smells of garlic, and he has bloody
