Saturday, November 10, 2007

ANXIETY DISORDER AND MOOD DISORDER

1.A 32-year-old woman takes her 6-year-old son to a physician’s office. She says that the child often experiences episodes of breathing problems and abdominal pain. The child’s medical record shows many office visits and four abdominal surgical procedures, although no abnormalities were ever found. Physical examination and laboratory studies are unremarkable. When the doctor confront the mother with the suspicion that she is fabricating the illness in the child, the mother angrily grabs the child and leaves the office immediately. This is an example of

A.malingering
B.somotoform pain disorder
C.factitious disorder
D.conversion disorder
E.factitious disorder by proxy

2.From above case, what is the first thing the physician should do?
A.Notify the appropriate state social service agency to report the physician’s suspicions.
B.Call a pediatric pulmonologist to determine the cause of the dyspnea
C.Take the child aside and ask him how he feels
D.Wait until the child’s next visit before taking any action
E.Call a pediatric gastroenterologist to determine the cause of the abdominal pain

3.A 35-year-old man tells his physician that he is often late for wok because he has difficulty waking up on time. He attributes this problem to the fact that he gets out of bed repeatedly during the night to recheck the locks on the doors and to be sure the gas jets on the stove are turned off. His lateness is exacerbated by his need to count all of the traffic lights along the route. If he suspects that he missed a light, he becomes quite anxious and must then go back and recount them all. Physical examination and laboratory studies are unremarkable. Of the following, the most effective long-term treatment for this patient is most likely to be
A.buspirone
B.a β-blocker
C.an antidepressant
D.a benzodiazepine
E.a support group

4.Three months after moving, a teenager who was formerly outgoing and a good student seems sad, loses interest in making friends, and begins to do poor work in school. His appetite in normal and there is no evidence of suicidal ideation. Which disorder best fits this clinical picture?
A.adjustment disorder
B.social phobia
C.specific phobia
D.generalized anxiety disorder
E.obsessive compulsive disorder


5.Which of the following events is most likely to result in post-traumatic stress disorder?
A.Divorce
B.Bankruptcy
C.Diagnosis of diabetes mellitus
D.Changing residence
E.Robbery at knifepoint

6.A 26-year-old medical student comes to the emergency room with increased heart rate, sweating, and shortness of breath. The student is convinced that she is having an asthma attack and that she will suffocate. The symptoms started that she will suffocate. The symptoms started suddenly during a car ride to school. The student has had episodes such as this on at least three previous occasions over the past 2 weeks. She has no history of asthma and other than an increased pulse rate, physical findings are unremarkable. Which of the following disorder best fits this clinical picture?
A.Obsessive compulsive disorder (OCD)
B.Panic disorder
C.Acute stress disorder
D.Generalized anxiety disorder (GAD)
E.Hypochondriasis

7.Of the following, the most effective treatment for the above case?
A.buspirone
B.a β-blocker
C.an antidepressant
D.a benzodiazepine
E.a support group

8.Which will be the most effective long-term treatment for the above case?
A.buspirone
B.a β-blocker
C.an antidepressant
D.a benzodiazepine
E.a support group

9.A 45-year-old woman says that she frequently feels “nervous” and often has an “upset stomach” which includes heartburn, indigestion and diarrhea. She has had this problem since she was 26 years of age and notes that other family members also are “tense and nervous”. Which of the following disorders best fits this clinical picture?
A.Panic disorder
B.Malingering
C.OCD
D.GAD
E.Acute stress disorder

10.Of the following the most effective long-term treatment for the above case is
A.psychotherapy
B.propranolol
C.buspirone
D.diazepam
E.alprozolam

11.A 45-year-old woman has a 20-year history of vague physical complaints including nausea, painful menses, and loss of feeling in her legs. Physical examination and laboratory workup are unremarkable. She says that she has always had physical problems but that her doctors never seem to identity their cause. Which disorder best fits this clinical picture?
A.OCD
B.GAD
C.Masked depression
D.Somatization disorder
E.Hypochondriasis

12.A 45-year-old woman claims that she injured her hand at work. She asserts that the pain caused by her injury prevents her from working. She has no further hand problems after she receives a $40,000 workmen’s compensation settlement. This clinical presentation is an example of
A.factitious disorder
B.factitious disorder by proxy
C.malingering
D.conversion disorder
E.masked depression

13.A 34-year-old man experience a sudden hemiparesis, but appears unconcerned. He reports that just before the onset of paralysis, he saw his girlfriend with another man. Physical examination fails to reveal evidence of a medical problem. Which disorder best fits this clinical picture?
A.conversion disorder
B.body dismorphic disorder
C.GAD
D.OCD
E.Hypochondriasis

14.A 28-year-old woman seeks facial reconstructive surgery for her “sagging” eyelids. She rarely goes out in the daytime because she believes that this characteristics makes her look “like a grandmother”. On physical examination, her eyelids appear completely normal. Which disorder best fits this clinical picture?
A.conversion disorder
B.body dismorphic disorder
C.GAD
D.OCD
E.Hypochondriasis

15.A 37-year-old man says that he has been “sickly” for the past 3 months. He fears that he has stomach cancer. The patient is unshaven and appears thin and slowed down. Physical examination including a gastrointestinal workup is unremarkable except that the patient has lost 15 pounds since his last visit 1 year ago. Which disorder best fits this clinical picture?
A.conversion disorder
B.body dismorphic disorder
C.masked depression
D.adjustment disorder
E.Hypochondriasis

16.A 30-yeaer-old man is upset because he must take a client to dinner in a restaurant. Although he knows the client well, he is so afraid of making a mess while eating that he says he is not hungry and sips from a glass of water instead of ordering a meal. Which disorder best fits this clinical picture?
A.Conversion disorder
B.Social phobia
C.GAD
D.Specific phobia
E.Hypochondriasis

17.A 59-year-old woman, who was diagnosed with advanced lung cancer 3-months ago, has lost 20 pounds, wakes frequently during the night, and has very little energy. Over the past month she has been preoccupied with feelings of guilt about “people I have hurt in my life” and expresses concern that she will die in pain. The sign or symptoms most likely to indicate that this patient is experiencing a major depressive episode rather than a normal reaction to serious illness is
A.weight loss
B.difficulty sleeping
C.decreased energy
D.concern about dying in pain
E.preoccupation with feelings of guilt

18.A 50-year-old female high school teacher reports that she has been “feeling very low” for the past 3 months. She often misses work because she feels tires and hopeless and has trouble sleeping. When the physician interviews her she says, “Doctor, the Lord calls all his children home”. This patient is most likely to have
A.cyclothymic disorder
B.major depressive disorder
C.hypomania
D.hypochondriasis
E.bipolar disorder

19.In ____________, people experience either severe depressions or mania.
A.bipolar I disorder
B.dysthymia
C.depression with atypical features
D.double depression
E.bipolar II disorder

20.A 25-year-old male patient who is slow moving and has a flat affect is put on fluoxetine (Prozac). Within 2 weeks, the patient is showing greatly increased activity level, flight of ideas, and pressured speech. In this patient, the medication has
A.precipitated a manic episode
B.had a toxic effect
C.had a delayed effect
D.increased depression
E.increased anxiety

21.The most effective long-term treatment for cyclothymic disorder is
A.lithium
B.psychotherapy
C.ECT
D.A heterocylic antidepressant
E.A monoamine oxidase inhibitor

22.A person who alternates between episodes of hypomania and moderate depression chronically for at least 2 years would be diagnosed as having:
A.Bipolar I Disorder.
B.Bipolar II Disorder.
C.Cyclothymic disorder.
D.Rapid cycling bipolar disorder.
E.Dysthymic disorder

23.A 65-year-old Catholic male patient has been abusing alcohol for the past 15 years. His history reveals that his wife recently asked him for a separation. Which of the following characteristics is this patient’s greatest risk factor for suicide
A.Male sex
B.Religion
C.Marital separation
D.Age
E.Alcoholism

24.The most effective treatment for mania is
A.ECT
B.Lithium
C.A heterocyclic antidepressant
D.A monoamine oxidase inhibitor
E.Psychotherapy

25.A person who had been experiencing (for the past 3 years) a mild form of a loss of interest in his or her usual activities, in addition to psychomotor agitation, increased appetite, insomnia, and thoughts of committing suicide, would be diagnosed as having:
A.Cyclothymic disorder
B.Biplolar II disorder.
C.Major depression.
D.Dysthymia
E.Double depression.