Quiz 07/27/2022

A 31-year-old female with depression, anxiety, and migraines presents to the ED for altered mentation. On arrival, she has a temperature of 41 degrees Celcius, HR 130, and a systolic blood pressure of 190. On exam, she is diaphoretic and agitated, with increased tone, hyperreflexia, shivering, and dilated pupils.

You call her family who states that the patient has a hard time keeping down a job, frequently moving from state to state. She has had a number of different psychiatrists over the years, and you, therefore, are unable to find a comprehensive medication list. In her purse, she has a pill bottle of sertraline, with 85/90 pills remaining.

Which of the following other medications is this patient likely taking?

A 27-year-old woman comes into the clinic with the chief complaint of low energy and depressed mood. Ever since her mother died 3 years ago, she has felt fatigued and does not want to socialize with friends or family. She has had a poor appetite and has lost over 15 pounds in the past year. Additionally, she dropped out of college earlier this year due to difficulty concentrating on her studies. Which of the following is the most appropriate diagnosis?

A 25-year-old woman with no significant medical history comes to the clinic for a routine physical exam. During the interview, she states that she is in a relationship with a famous singer for the last three months. She says his song lyrics are about her and his social media contains hidden messages that only she understands. The singer recently filed for a restraining order, but the patient says that’s “just for show.” She works at a local coffee shop and just recently got a promotion to manager. She denies any drug or alcohol use and takes no medications. Which of the following is the most likely diagnosis?

A 65-year-old man with a history of severe depression is bought to the clinic by his wife after losing 15 pounds in the last month. The patient states that he believes that his stomach and intestines have been removed and that he died several weeks ago. Which of the following is the most likely diagnosis?

A 9-year-old boy presents with his mother for 18 months of multiple complaints. He reports having continuous thoughts of needing to wash his hands and building anxiety until he can perform the action. He spends more than an hour in total every day washing his hands. He also has stereotyped movements on exam with head turning and shoulder shrug, and will sometimes shout random words. Lab and imaging workup is negative. Which of the following medications, paired with cognitive behavioral therapy, is most indicated?

Which of the following drug-mechanism pairs is incorrect?

A 27-year-old woman comes to the clinic for a routine checkup. She appears shy and does not make much eye contact. She mentions that she doesn’t have many friends because feels like she doesn’t deserve them and is fearful of rejection. She has had some depressive episodes in the past, but “does not want to bother anyone” about it. Which of the following is the most likely diagnosis?

A 24-year-old man comes to the emergency room with severe left-hand pain after a fall at home. The patient refuses to allow the nurse or doctor to do a physical exam. A hand X-ray is unremarkable. She insists that all she needs is a note for two weeks of paid leave from her job. Which of the following is the most likely diagnosis?

A 21-year-old man is brought into the clinic by his roommate due to bizarre behavior. For the last 10 months, the patient has been intermittently skipping classes and trying to soundproof his dorm room because he believes the government is watching him. His roommate says that on two separate occasions he caught the patient talking to himself under the bed covers. The neurological exam is normal but the patient refuses to make eye contact and his speech is pressured and tangential. Which of the following is the most likely diagnosis?

Which of the following neurological diseases has a higher incidence in patients with systemic lupus erythematosus (SLE)?

A 37-year-old retired nurse is being evaluated in the emergency room for excessive diarrhea. She has been in the emergency department multiple times in the past for similar complaints and diagnostic testing has repeatedly been unremarkable. While casually talking to the nursing staff, the patient accidentally knocks over her purse and several bottles of laxatives fall out. Which of the following is the most likely diagnosis?

Which of the following medications is the most effective in the management of PTSD-associated nightmares?

A 28-year-old patient who you just diagnosed with non-epileptic spells admits to insomnia, low energy, increased appetite, loss of interest in activities he used to enjoy, and difficulty concentrating. Additionally, he endorses periods of pressured speech, racing thoughts, easy distractibility, and delusions of grandeur. Despite these symptoms, he continues to fulfill the duties of his high-paying job. In addition to non-epileptic spells, he also carries a diagnosis of which of the following?

Which of the following medications used in the management of attention deficit hyperactivity disorder (ADHD) can worsen comorbid Tourette syndrome if present?

An 83-year-old man with a history of Parkinson’s disease is brought to the office with worsening hallucinations. She says that she sees things around the house and is starting to get paranoid that their neighbors are spying on them. Which of the following medications would help this patient’s symptoms?

A 48-year-old man with a 20-year history of HIV stable on HAART therapy presents to your clinic accompanied by his partner who states that the patient has had mounting difficulties over the last 3 years. Most recently he has been unable to effectively manage finances, cook for himself, or arrange appointments. What is the best diagnosis at this time?

Which of the following medications has a relatively low risk of sexual dysfunction?

A 32-year-old man with a past medical history of major depressive disorder is brought to the emergency department by his roommate who states that a few days ago the patient stopped taking his medications. Vital signs were within normal limits. On examination, the patient was non-verbal except for occasionally repeating words spoken by the examiner. He would not follow commands. When his arms were positioned off the bed they remained there for several minutes. CT head and CTA of the head and neck were normal. Which of the following is the most appropriate next step in treatment?

Which of the following is not a risk factor for suicide?

A 33-year-old woman with a past medical history of depression is brought to the clinic by her husband because of atypical behavior. For the past three weeks, her thoughts have become progressively more disorganized. She is also having auditory hallucinations. Similar behavior has been seen intermittently over the past five years. Despite having a history of depression, her husband says the depression has been well controlled for the last three months. Which of the following is the most likely diagnosis?

A 17-year-old female with a past medical history of anxiety, depression, and irritable bowel syndrome presents to the emergency room after a transient clinical episode. Her mother states that they were eating dinner when her daughter dropped to the floor and began having generalized shaking movements of her arms and her legs. She was unresponsive during the event and her eyes were closed. The event lasted approximately 30 seconds and there was no post-ictal confusion. In the emergency room, the patient has another event, where pelvic thrusting and asynchronous movements were appreciated for 2 minutes before resolution. The patient stated that she remembered having no control of her body during the event in question. Based on the most likely diagnosis, which of the following is the most appropriate treatment?

A 34-year-old male presents with personality changes that started after a motor vehicle accident-related traumatic brain injury. His family has noticed that since the accident, the patient no longer actively seeks out hobbies that he once enjoyed. He will often forget to eat meals unless prompted, even if the food is placed in front of him. Which of the following medications would most likely help with his behavior?

A 32-year-old man with a past medical history significant for major depressive disorder is brought to the emergency department after he was found by his roommate attempting suicide by hanging. His roommate states that he has been noncompliant with his medications and had been going through a depressive episode before his suicide attempt. After 6 weeks of trying several different antidepressants while on the inpatient psychiatric service, his major depression symptoms have not improved. Which of the following is the most appropriate next step in treatment?

A 24-year-old female with a past medical history of major depressive disorder with her last major depressive episode 6 months ago is brought to the emergency room by her boyfriend because of unusual behavior. For the past 4 weeks, the patient has had bizarre delusions, auditory hallucinations, and disorganized speech. She believes that her boyfriend is having a sexual relationship with a character from one of the early morning soap operas on television. Outside of her psychiatric symptoms, her neurologic examination is normal. Which of the following is the most likely diagnosis?

A 23-year-old female with a past medical history of depression presents with right arm paralysis that started after she found out her boyfriend died from a motor vehicle accident. Her physical exam shows no effort during muscle strength testing and positive withdrawal when a noxious stimulus is applied. The rest of the neurological examination, including reflexes, was normal. MRI of the brain and cervical spine were unremarkable. Which of the following is the most likely diagnosis?

Which of the following is the mechanism of action of prazosin?

Which of the following can increase the risk of seizures while taking bupropion?

An 80-year-old woman with a history of Parkinson’s disease that is well controlled with carbidopa-levodopa presents with her husband for evaluation of delusions. Her husband states that the patient believes that she is being consistently monitored by the FBI and will avoid eating certain foods for fear of being poisoned. She is also constantly worried that her husband will leave her for a younger woman. Which of the following medications would be the most appropriate FDA-approved treatment for these symptoms?

Which one of the following pairs regarding antipsychotic drugs and their adverse effects is incorrect?

A 31-year-old male comes to the clinic for evaluation of recurrent nightmares after returning from a tour of duty with the military two months ago. He is unable to concentrate on his new desk job and flinches every time he hears a door close. While once an avid bowler, he no longer goes to the bowling alley because the sounds of the pins falling remind him of bomb explosions. Which of the following is the most likely diagnosis?

A 15-year-old boy with a past medical history of ADHD presents with odd behaviors including shrugging his shoulders and blinking frequently. His mother also states that he used to have some similar movements when he was younger, but they seem to have worsened since starting a new medication for his ADHD. Which of the following medications is most likely responsible for his symptoms?

An 8-year-old male is seen in the clinic for difficulty paying attention at school and at home for the past 9 months. His mother reports that his elementary school teacher has called the home multiple times because the patient will often run around the classroom during assignments and frequently interrupts classmates. The mother states that at home, the patient has difficulty sitting still long enough to finish his dinner and homework. This patient’s condition is best treated with a medication that has what action?

Which of the following is the mechanism of action of clonidine?

A 22-year-old woman with a previously diagnosed history of prior suicide attempts, EEG-confirmed epilepsy, and non-epileptic seizures comes to your clinic to establish herself as a new patient under your care. Upon entering the room she immediately tells you about her horrible relationship with her last epileptologist and how abandoned she felt when he decided to retire. While gathering her social history, she endorses a history of excessive spending on new cars, reckless driving, and alcohol-driven physical altercations. Which of the following personality disorders is most consistent with this clinical presentation?

A 19-year-old female with a past medical history of anorexia and insomnia presents with major depressive disorder. Which of the following medications is the most appropriate at this time?

The usage of bupropion increases the risk of which of the following?

A 19-year-old boy presents with his mother for complaints of frequent eye blinking and shoulder-shrugging spells occurring multiple times a day. He also has frequent episodes of humming a three-note tune randomly throughout the day. He has had these problems since he was 17. He had an MRI brain and EEG that were negative. He takes no medications. The symptoms do not impact his activities of daily living, but he does feel embarrassed by the symptoms. He went to cognitive behavioral therapy for this for a year and has not seen a benefit. Which of the following is a first-line medication for this patient?

Which of the following medications has the highest risk for QT prolongation?

A 12-year-old male is brought to the clinic accompanied by his father who states that for the past 4 months he has been randomly flailing his arm during class and calling out in the middle of the teacher’s lectures. He has been sent to the principal’s office twice in the past month for his disruptions. His father states that this is very out of character for him. In the clinic, the patient has intermittent movements of his right arm, where he raises his arm above his head and then slaps it down on his leg. Additionally, during the exam, he blurts out words that do not make contextual sense in the conversation. Two months later, the patient follows up with his father who states that all of the abnormal movements and vocalizations have resolved. What is the most likely diagnosis?

Huntington’s disease is most commonly associated with which of the following?

A 68-year-old male presents with complaints of insomnia for 2 years. On further questioning, he also endorses a 2 years period of feelings of guilt about his sleeping, considerably low appetite (current BMI = 17), and low energy. He used to enjoy checkers but has lost interest in most activities these days. He denies suicidal ideation. He has previously declined medications to help with this, but he says he is ready to try something. Which of the following medications is most appropriate?