Psych EOR Practice Questions |\ |\ |\ |\
with answers |\
31M with MDD depression responding to venla 150 QD -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
acknowledges relationship probs d/t poor labido - worsened with |\ |\ |\ |\ |\ |\ |\ |\ |\
med but present prior, mood has improved - Tx strategy?
|\ |\ |\ |\ |\ |\ |\ |\ |\
A) Decrease dose
|\ |\
B) Switch to norepi and dopamine reuptake inhibitor
|\ |\ |\ |\ |\ |\ |\
D) Switch to SSRIs
|\ |\ |\
C) Augment with sildenafil
|\ |\ |\
A) Decrease dose
|\ |\
B) Switch to norepi and dopamine reuptake inhibitor -
|\ |\ |\ |\ |\ |\ |\ |\ |\
Bupropion 75-150mg 1-2 max before intercourse or skip SSRI or
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
SNRI the day before intercourse- better to augment rather stop
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
what is working
|\ |\
D) Switch to SSRIs
|\ |\ |\
C) Augment with sildenafil - Augmenting is a good option, but
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
rather with bupropion - PCP can prescribe viagra with further
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
workup
*Pharm decreasing dopaminergic fxn increases sexual dysfxn
|\ |\ |\ |\ |\ |\ |\
thus switching to SDRI improve do
|\ |\ |\ |\ |\
Which of the following sx is not consistent with persistent
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
depressive disorder? |\
A) Depressed Mood
|\ |\
B) Hopelessness
|\
C) Insomnia
|\
D) Poor appetite
|\ |\
E) Suicidal thoughts
|\ |\
,Suicidal thoughts – PDD is not as severe as MDD, this sx
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
makes more severe |\ |\
Pt presents following a breakup with his girlfriend a month ago.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
He reports that for the last 4 wks he has been experiencing low
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
mood, psychomotor slowing, increased appetite, and
|\ |\ |\ |\ |\ |\
hypersomnolence. He also reports multiple episodes of |\ |\ |\ |\ |\ |\ |\
tearfulness when he perceives rejection from his coworkers. What
|\ |\ |\ |\ |\ |\ |\ |\
diagnosis is most likely with these symptoms?
|\ |\ |\ |\ |\ |\ |\
A) Bipolar disorder
|\ |\
B) Mdd with catatonic features
|\ |\ |\ |\
C) Mdd with atypical feature
|\ |\ |\ |\
D) Dependent personality disorder
|\ |\ |\
E) Persistent dysthymic disorder
|\ |\ |\
MDD w atypical features - |\ |\ |\ |\ |\
Low mood, psychomotor slowing, hypersomnolence - all typical
|\ |\ |\ |\ |\ |\ |\ |\
sx of MDD
|\ |\
increased appetite - less typical to MDD but still common
|\ |\ |\ |\ |\ |\ |\ |\ |\
tearfulness when he perceives rejection - this is atypical to MDD
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
and makes the correct dx MDD w atypical features
|\ |\ |\ |\ |\ |\ |\ |\
7yo boy brought by parents who are at wits end. pt has 10-15
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
tantrums q d sometime 2-3/h during some he punches walls and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
doors and sometimes bangs his head, has extremely low
|\ |\ |\ |\ |\ |\ |\ |\ |\
frustration tolerance and little things set him off, in between
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
tantrums he is cranky and irritable,. attends special school. had
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
this behavior since he was a toddler, gradually increasing in
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
severity
A) bipolar disorder
|\ |\
B) adhd
|\
C) disruptive mood dysregulation disorder
|\ |\ |\ |\
D) intermittent explosive disorder
|\ |\ |\
E) oppositional defiant disorder
|\ |\ |\
,C) disruptive mood dysregulation disorder
|\ |\ |\ |\
66M brought to clinicl by wife, weepy, responds lowly to queries,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
poor hygreine, AOx3, does not respond to other queries, wife
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
denies past hx of depression. What is the next clinical step?
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
A) complete medical work up
|\ |\ |\ |\
B) start paroxetine
|\ |\
C) start citalopram
|\ |\
D) monitor and follow up in 1 mo
|\ |\ |\ |\ |\ |\ |\
E) refer for ECT eval
|\ |\ |\ |\
Complete medical work-up - so new - need to r/o organic |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
reasons be |\
26F brought to clinic by BF notes a dramatic shift in mood over
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
last few days - fidgety, dysphoric, cheerful, freely admits to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
suicidal thoughts with no plan, pmh for medical conditions with
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
meds that she has stopped taking, recent drug use but stopped.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
What drug/med did she most likely stop using recently?
|\ |\ |\ |\ |\ |\ |\ |\
A) alcohol
|\
B) amphetamine
|\
C) interferon
|\
D) prednisone
|\
E) isotretinoin
|\
amphetamine - stimulant withdrawal |\ |\ |\
22 yo f presents to ED with 4 days sustained low food anhedonia,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
low app, hypersomnolence, Not suicidal, So tearful difficult to get
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
more hx
|\ |\
Most likely dx based on this limited info?
|\ |\ |\ |\ |\ |\ |\
A) Other specified depressive disorder
|\ |\ |\ |\
B) Borderline Personality Disorder
|\ |\ |\
C) Cyclothymia
|\
D) Disruptive mood dysregulation disorder
|\ |\ |\ |\
E) Adjustment disorder with depressive features
|\ |\ |\ |\ |\
, Other specified depressive disorder (depressive symptoms,
|\ |\ |\ |\ |\ |\
cause clinically significant distress but doesn’t meet other criteria
|\ |\ |\ |\ |\ |\ |\ |\
aka depressive sx with insufficient sx) - not enough info for
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
anything else - current brief depressive 2-15days, once per
|\ |\ |\ |\ |\ |\ |\ |\ |\
month x 12 months, always less than 2 weeks - like depression
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
but doesn't fully meet criteria
|\ |\ |\ |\
Major depressive disorder most likely to be comorbid with?
|\ |\ |\ |\ |\ |\ |\ |\
A) Substance use disorders
|\ |\ |\
B) Anxiety disorders
|\ |\
C) Personality disorders
|\ |\
D) Impulse control disorders
|\ |\ |\
E) Psychotic disorders disorders
|\ |\ |\
Anxiety disorders - Most common but can be comorbid with
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
any of these |\ |\
MDD has 72% lifetime comorbidity with any other psychiatric
|\ |\ |\ |\ |\ |\ |\ |\ |\
disorder
#1 Anxiety 60% |\ |\
#2 SUD - 25%
|\ |\ |\
#3 Impulse control - adhd, conduct disorder,explosive disorder
|\ |\ |\ |\ |\ |\ |\
55 yo female, crying spells, fatigue, sad anxious mood, hx -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
fatigue, LH, muscle weakness, F, WL, N, D, HA, sweating, joint
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
pain, darkening of palmar creases - most likely dx?
|\ |\ |\ |\ |\ |\ |\ |\
A) Hypocortisol / addisons diease
|\ |\ |\ |\
B) Hyperadrenalcortisolism/Cushing
|\
C) Cortical encephalopathy
|\ |\
D) Lymphocytic thyroiditis - hashimotos
|\ |\ |\ |\
E) SLE
|\
Hyperadrenalcortisolism/Cushing --> dark palmar creases |\ |\ |\ |\ |\
key
with answers |\
31M with MDD depression responding to venla 150 QD -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
acknowledges relationship probs d/t poor labido - worsened with |\ |\ |\ |\ |\ |\ |\ |\ |\
med but present prior, mood has improved - Tx strategy?
|\ |\ |\ |\ |\ |\ |\ |\ |\
A) Decrease dose
|\ |\
B) Switch to norepi and dopamine reuptake inhibitor
|\ |\ |\ |\ |\ |\ |\
D) Switch to SSRIs
|\ |\ |\
C) Augment with sildenafil
|\ |\ |\
A) Decrease dose
|\ |\
B) Switch to norepi and dopamine reuptake inhibitor -
|\ |\ |\ |\ |\ |\ |\ |\ |\
Bupropion 75-150mg 1-2 max before intercourse or skip SSRI or
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
SNRI the day before intercourse- better to augment rather stop
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
what is working
|\ |\
D) Switch to SSRIs
|\ |\ |\
C) Augment with sildenafil - Augmenting is a good option, but
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
rather with bupropion - PCP can prescribe viagra with further
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
workup
*Pharm decreasing dopaminergic fxn increases sexual dysfxn
|\ |\ |\ |\ |\ |\ |\
thus switching to SDRI improve do
|\ |\ |\ |\ |\
Which of the following sx is not consistent with persistent
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
depressive disorder? |\
A) Depressed Mood
|\ |\
B) Hopelessness
|\
C) Insomnia
|\
D) Poor appetite
|\ |\
E) Suicidal thoughts
|\ |\
,Suicidal thoughts – PDD is not as severe as MDD, this sx
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
makes more severe |\ |\
Pt presents following a breakup with his girlfriend a month ago.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
He reports that for the last 4 wks he has been experiencing low
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
mood, psychomotor slowing, increased appetite, and
|\ |\ |\ |\ |\ |\
hypersomnolence. He also reports multiple episodes of |\ |\ |\ |\ |\ |\ |\
tearfulness when he perceives rejection from his coworkers. What
|\ |\ |\ |\ |\ |\ |\ |\
diagnosis is most likely with these symptoms?
|\ |\ |\ |\ |\ |\ |\
A) Bipolar disorder
|\ |\
B) Mdd with catatonic features
|\ |\ |\ |\
C) Mdd with atypical feature
|\ |\ |\ |\
D) Dependent personality disorder
|\ |\ |\
E) Persistent dysthymic disorder
|\ |\ |\
MDD w atypical features - |\ |\ |\ |\ |\
Low mood, psychomotor slowing, hypersomnolence - all typical
|\ |\ |\ |\ |\ |\ |\ |\
sx of MDD
|\ |\
increased appetite - less typical to MDD but still common
|\ |\ |\ |\ |\ |\ |\ |\ |\
tearfulness when he perceives rejection - this is atypical to MDD
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
and makes the correct dx MDD w atypical features
|\ |\ |\ |\ |\ |\ |\ |\
7yo boy brought by parents who are at wits end. pt has 10-15
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
tantrums q d sometime 2-3/h during some he punches walls and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
doors and sometimes bangs his head, has extremely low
|\ |\ |\ |\ |\ |\ |\ |\ |\
frustration tolerance and little things set him off, in between
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
tantrums he is cranky and irritable,. attends special school. had
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
this behavior since he was a toddler, gradually increasing in
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
severity
A) bipolar disorder
|\ |\
B) adhd
|\
C) disruptive mood dysregulation disorder
|\ |\ |\ |\
D) intermittent explosive disorder
|\ |\ |\
E) oppositional defiant disorder
|\ |\ |\
,C) disruptive mood dysregulation disorder
|\ |\ |\ |\
66M brought to clinicl by wife, weepy, responds lowly to queries,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
poor hygreine, AOx3, does not respond to other queries, wife
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
denies past hx of depression. What is the next clinical step?
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
A) complete medical work up
|\ |\ |\ |\
B) start paroxetine
|\ |\
C) start citalopram
|\ |\
D) monitor and follow up in 1 mo
|\ |\ |\ |\ |\ |\ |\
E) refer for ECT eval
|\ |\ |\ |\
Complete medical work-up - so new - need to r/o organic |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
reasons be |\
26F brought to clinic by BF notes a dramatic shift in mood over
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
last few days - fidgety, dysphoric, cheerful, freely admits to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
suicidal thoughts with no plan, pmh for medical conditions with
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
meds that she has stopped taking, recent drug use but stopped.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
What drug/med did she most likely stop using recently?
|\ |\ |\ |\ |\ |\ |\ |\
A) alcohol
|\
B) amphetamine
|\
C) interferon
|\
D) prednisone
|\
E) isotretinoin
|\
amphetamine - stimulant withdrawal |\ |\ |\
22 yo f presents to ED with 4 days sustained low food anhedonia,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
low app, hypersomnolence, Not suicidal, So tearful difficult to get
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
more hx
|\ |\
Most likely dx based on this limited info?
|\ |\ |\ |\ |\ |\ |\
A) Other specified depressive disorder
|\ |\ |\ |\
B) Borderline Personality Disorder
|\ |\ |\
C) Cyclothymia
|\
D) Disruptive mood dysregulation disorder
|\ |\ |\ |\
E) Adjustment disorder with depressive features
|\ |\ |\ |\ |\
, Other specified depressive disorder (depressive symptoms,
|\ |\ |\ |\ |\ |\
cause clinically significant distress but doesn’t meet other criteria
|\ |\ |\ |\ |\ |\ |\ |\
aka depressive sx with insufficient sx) - not enough info for
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
anything else - current brief depressive 2-15days, once per
|\ |\ |\ |\ |\ |\ |\ |\ |\
month x 12 months, always less than 2 weeks - like depression
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
but doesn't fully meet criteria
|\ |\ |\ |\
Major depressive disorder most likely to be comorbid with?
|\ |\ |\ |\ |\ |\ |\ |\
A) Substance use disorders
|\ |\ |\
B) Anxiety disorders
|\ |\
C) Personality disorders
|\ |\
D) Impulse control disorders
|\ |\ |\
E) Psychotic disorders disorders
|\ |\ |\
Anxiety disorders - Most common but can be comorbid with
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
any of these |\ |\
MDD has 72% lifetime comorbidity with any other psychiatric
|\ |\ |\ |\ |\ |\ |\ |\ |\
disorder
#1 Anxiety 60% |\ |\
#2 SUD - 25%
|\ |\ |\
#3 Impulse control - adhd, conduct disorder,explosive disorder
|\ |\ |\ |\ |\ |\ |\
55 yo female, crying spells, fatigue, sad anxious mood, hx -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
fatigue, LH, muscle weakness, F, WL, N, D, HA, sweating, joint
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
pain, darkening of palmar creases - most likely dx?
|\ |\ |\ |\ |\ |\ |\ |\
A) Hypocortisol / addisons diease
|\ |\ |\ |\
B) Hyperadrenalcortisolism/Cushing
|\
C) Cortical encephalopathy
|\ |\
D) Lymphocytic thyroiditis - hashimotos
|\ |\ |\ |\
E) SLE
|\
Hyperadrenalcortisolism/Cushing --> dark palmar creases |\ |\ |\ |\ |\
key
