PSYCH PACKRAT (PHYSICIAN ASSISTANT CLINICAL
KNOWLEDGE RATING AND ASSESSMENT TOOL)
QUESTIONS WITH COMPLETE SOLUTIONS
192. Clinical Therapeutics/Psychiatry/Behavioral Medicine
Which of the following is effective in the long-term treatment of
panic attacks?
Answers
A. Triazolam (Halcion) B. Propranolol (Inderal) C. Lorazepam
(Ativan) D. Fluoxetine (Prozac) Correct Answer Explanations
(u) A. Triazolam is a benzodiazepine used for sleep.
(u) B. Propranolol blocks the peripheral symptoms associated
with panic attacks (palpitations, tremors). It is not effective for
treating the underlying disorder.
(u) C. Lorazepam may be used for urgent treatment of panic
disorders, but should not be used for long-term treatment.
(c) D. SSRI's, such as fluoxetine, are the initial drugs of choice
for the long-term treatment of panic disorders.
21. A 65 year old patient has a long history of schizophrenia that
is treated with phenothiazines. On an unrelated clinic visit, the
patient has difficulty sticking out her tongue, facial tics,
increased blink frequency, and lip-smacking behavior. These
involuntary movements are most suggestive of
A. tardive dyskinesia
B. Parkinson's disease
C. Huntington's disease
D. Gilles de la Tourette's syndrome Correct Answer (c) A.
Tardive dyskinesia is characterized by abnormal involuntary
movements of the face, mouth, tongue, trunk and limbs and may
,develop after months or years of treatment with neuroleptic
drugs
B. Infrequent blinking, tremor, rigidity, and bradykinesia are
characteristic of Parkisonism.
C. Although part of the differential for involuntary movements,
this disease has a positive family history and usually appears by
age 50.
D. Facial motor tics are the most common manifestation of this
disorder, but symptoms begin before age
A 26-year-old woman complains of a lack of energy and
decreased sleep at night. Her lack of sleep has interfered with
her work and social activities. She awakens several times each
night and checks her doors and windows to ensure they are
closed and locked. This is an example of
A. agoraphobia
B. alcohol abuse
C. obsessive-compulsive disorder
D. panic disorder Correct Answer A. Agoraphobia is the fear
of being alone in public places. This person does not display this
characteristic.
B. There is no evidence of alcohol abuse
(c) C. This person displays a compulsive behavior by reassuring
herself that the doors and windows are locked an secure; thereby
her anxiety regarding her safety is reduced. This behavior is
resulting in interference with her normal daily routine.
D. A panic disorder is characterized by a brief period of anxiety
and fear, accompanied by somatic symptoms, such as
palpitations and tachypnea
,A person who witnessed the World Trade Towers attack
complains of sleep disturbances associated with recurrent
distressing dreams of the attacks, withdrawal from friends,
sensations of foreboding on the anniversary date, and
depression. This person is most likely suffering from
A. major depressive disorder
B. posttraumatic stress disorder
C. generalized anxiety disorder
D. dysthymic disorder Correct Answer A. Although there are
some similarities between this and a major depressive disorder,
there is no display of feelings of guilt, diminished concentration,
fatigue or loss of energy, significant weight loss, or recurrent
thoughts of death, as characteristic of major depressive disorder.
(c) B. This is a classic presentation for post-traumatic stress
disorder, when a person has experienced an event that would be
traumatic to almost anyone. All of this person's complaints are
characteristic of PTSD
C. Generalized anxiety disorder displays restlessness, easy
fatigability, difficulty in concentrating, irritability, sleep
disturbances or muscle tension (3 of these 6 are required)
associated with anxiety and worry.
D. For a diagnosis of dysthymic disorder, the person must
display, while depressed, 2 or more of the following: an eating
disturbance, sleep disturbances, low energy or fatigue, low self-
esteem, changes in concentration or indecisiveness, and feelings
of hopelessness
Clinical Intervention/Psychiatry/Behavioral Medicine
A 17 year-old female is seen who has a history of eating large
amounts of food at night 3 to 4 times weekly. These episodes are
always followed by extreme guilt and either induced vomiting or
, hours of strenuous exercise. She excels at work and school and
maintains many active relationships. Her physical examination
reveals a normal BMI and an otherwise normal exam. What is
the best initial intervention for this patient?
A. Begin an anxiolytic
B. Immediate hospitalization
C. Start an antidepressant
D. Test for substance abuse Correct Answer Explanations
(u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. Uncomplicated bulimia generally does not require
hospitalization as the physical manifestations encountered in
bulimia are generally mild if present at all. Some patients with
bulimia have concomitant substance abuse issues but her
successful relationships and work activities lessen the
probability. Antidepressants, not anxiolytics, have been found
helpful in lessening the binge/purge cycles and improving
overall well-being even outside of comorbid mood disorders.
(u) D. See C for explanation.
Clinical Intervention/Psychiatry/Behavioral Medicine
A 22 year-old female presents to the emergency department with
rapid heart rate. She appears quite thin and dehydrated. She
denies that she is thin, stating "I am so fat that I can hardly stand
myself! That is why I exercise every day." She runs twelve to
fifteen miles a day, and on weekends also bicycles forty to fifty
miles. Her LMP was six months ago. On exam, she is 5' 6" tall
and weighs 98 pounds. Temp 98 degrees F, pulse 100,
respirations 18, BP 98/60. EKG shows sinus tachycardia.
Laboratory findings include Na 138 mEq/L, K 2.8 mEq/L, Cl 91
KNOWLEDGE RATING AND ASSESSMENT TOOL)
QUESTIONS WITH COMPLETE SOLUTIONS
192. Clinical Therapeutics/Psychiatry/Behavioral Medicine
Which of the following is effective in the long-term treatment of
panic attacks?
Answers
A. Triazolam (Halcion) B. Propranolol (Inderal) C. Lorazepam
(Ativan) D. Fluoxetine (Prozac) Correct Answer Explanations
(u) A. Triazolam is a benzodiazepine used for sleep.
(u) B. Propranolol blocks the peripheral symptoms associated
with panic attacks (palpitations, tremors). It is not effective for
treating the underlying disorder.
(u) C. Lorazepam may be used for urgent treatment of panic
disorders, but should not be used for long-term treatment.
(c) D. SSRI's, such as fluoxetine, are the initial drugs of choice
for the long-term treatment of panic disorders.
21. A 65 year old patient has a long history of schizophrenia that
is treated with phenothiazines. On an unrelated clinic visit, the
patient has difficulty sticking out her tongue, facial tics,
increased blink frequency, and lip-smacking behavior. These
involuntary movements are most suggestive of
A. tardive dyskinesia
B. Parkinson's disease
C. Huntington's disease
D. Gilles de la Tourette's syndrome Correct Answer (c) A.
Tardive dyskinesia is characterized by abnormal involuntary
movements of the face, mouth, tongue, trunk and limbs and may
,develop after months or years of treatment with neuroleptic
drugs
B. Infrequent blinking, tremor, rigidity, and bradykinesia are
characteristic of Parkisonism.
C. Although part of the differential for involuntary movements,
this disease has a positive family history and usually appears by
age 50.
D. Facial motor tics are the most common manifestation of this
disorder, but symptoms begin before age
A 26-year-old woman complains of a lack of energy and
decreased sleep at night. Her lack of sleep has interfered with
her work and social activities. She awakens several times each
night and checks her doors and windows to ensure they are
closed and locked. This is an example of
A. agoraphobia
B. alcohol abuse
C. obsessive-compulsive disorder
D. panic disorder Correct Answer A. Agoraphobia is the fear
of being alone in public places. This person does not display this
characteristic.
B. There is no evidence of alcohol abuse
(c) C. This person displays a compulsive behavior by reassuring
herself that the doors and windows are locked an secure; thereby
her anxiety regarding her safety is reduced. This behavior is
resulting in interference with her normal daily routine.
D. A panic disorder is characterized by a brief period of anxiety
and fear, accompanied by somatic symptoms, such as
palpitations and tachypnea
,A person who witnessed the World Trade Towers attack
complains of sleep disturbances associated with recurrent
distressing dreams of the attacks, withdrawal from friends,
sensations of foreboding on the anniversary date, and
depression. This person is most likely suffering from
A. major depressive disorder
B. posttraumatic stress disorder
C. generalized anxiety disorder
D. dysthymic disorder Correct Answer A. Although there are
some similarities between this and a major depressive disorder,
there is no display of feelings of guilt, diminished concentration,
fatigue or loss of energy, significant weight loss, or recurrent
thoughts of death, as characteristic of major depressive disorder.
(c) B. This is a classic presentation for post-traumatic stress
disorder, when a person has experienced an event that would be
traumatic to almost anyone. All of this person's complaints are
characteristic of PTSD
C. Generalized anxiety disorder displays restlessness, easy
fatigability, difficulty in concentrating, irritability, sleep
disturbances or muscle tension (3 of these 6 are required)
associated with anxiety and worry.
D. For a diagnosis of dysthymic disorder, the person must
display, while depressed, 2 or more of the following: an eating
disturbance, sleep disturbances, low energy or fatigue, low self-
esteem, changes in concentration or indecisiveness, and feelings
of hopelessness
Clinical Intervention/Psychiatry/Behavioral Medicine
A 17 year-old female is seen who has a history of eating large
amounts of food at night 3 to 4 times weekly. These episodes are
always followed by extreme guilt and either induced vomiting or
, hours of strenuous exercise. She excels at work and school and
maintains many active relationships. Her physical examination
reveals a normal BMI and an otherwise normal exam. What is
the best initial intervention for this patient?
A. Begin an anxiolytic
B. Immediate hospitalization
C. Start an antidepressant
D. Test for substance abuse Correct Answer Explanations
(u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. Uncomplicated bulimia generally does not require
hospitalization as the physical manifestations encountered in
bulimia are generally mild if present at all. Some patients with
bulimia have concomitant substance abuse issues but her
successful relationships and work activities lessen the
probability. Antidepressants, not anxiolytics, have been found
helpful in lessening the binge/purge cycles and improving
overall well-being even outside of comorbid mood disorders.
(u) D. See C for explanation.
Clinical Intervention/Psychiatry/Behavioral Medicine
A 22 year-old female presents to the emergency department with
rapid heart rate. She appears quite thin and dehydrated. She
denies that she is thin, stating "I am so fat that I can hardly stand
myself! That is why I exercise every day." She runs twelve to
fifteen miles a day, and on weekends also bicycles forty to fifty
miles. Her LMP was six months ago. On exam, she is 5' 6" tall
and weighs 98 pounds. Temp 98 degrees F, pulse 100,
respirations 18, BP 98/60. EKG shows sinus tachycardia.
Laboratory findings include Na 138 mEq/L, K 2.8 mEq/L, Cl 91
