Archive for April 2017

18 year old patient presents with complaints of bouts of a hyperactive state in which she feels like she has a grandiose sense of self and is better than others and doesn't sleep because she's either too busy cooking recipes she found on pinterest or has racing thoughts pertaining to what her next project will be that cycles with mild depressive symptoms. When these bouts occur they typically last about 4 days. She states that she has been experiencing these symptoms since she was 15 and that she's never been symptom free for greater than 2 months. What's your DDx?

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18 year old patient presents with complaints of bouts of a hyperactive state in which she feels like she has a grandiose sense of self and is better than others and doesn't sleep because she's either too busy cooking recipes she found on pinterest or has racing thoughts pertaining to what her next project will be that cycles with mild depressive symptoms. When these bouts occur they typically last about 4 days. She states that she has been experiencing these symptoms since she was 15 and that she's never been symptom free for greater than 2 months. What's your DDx?



a) Bipolar II disorder
b) Cyclothymic disorder
c) Dysthymia disorder
d) Bipolar I disorder





Answer: B

In order to fulfill the diagnostic criteria of dysthymia disorder, patients must have at least 2 of the below symptoms for the majority of the time for the last 2 years without a symptom-free period lasting longer than two months. Which of these symptoms is NOT part of the dysthymia diagnostic criteria?

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In order to fulfill the diagnostic criteria of dysthymia disorder, patients must have at least 2 of the below symptoms for the majority of the time for the last 2 years without a symptom-free period lasting longer than two months. Which of these symptoms is NOT part of the dysthymia diagnostic criteria? 



a) Feelings of hopelessness
b) Inflated self-esteem
c) Change in appetite or sleep
d) Decreased energy
e) Poor concentration





Answer: B

20 year old patient presents with complaints of her grades dropping in school, which she attributes to her inability to concentrate in class and at study sessions. Patient admits to feelings of hopelessness and decreased self esteem. PE reveals a weight reduction. When you ask the patient about it, she states that she doesn't have much of an appetite. These symptoms have persisted for the majority of the past three years and she's never gone more than 2 months without experiencing them. What's your DDx?

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20 year old patient presents with complaints of her grades dropping in school, which she attributes to her inability to concentrate in class and at study sessions. Patient admits to feelings of hopelessness and decreased self esteem. PE reveals a weight reduction. When you ask the patient about it, she states that she doesn't have much of an appetite. These symptoms have persisted for the majority of the past three years and she's never gone more than 2 months without experiencing them. What's your DDx?




a) Bipolar I
b) MDD
c) Cyclothymia disorder
d) Dysthymia disorder




Answer: D

Which of the following is FALSE regarding Dysthymia disorder?

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Which of the following is FALSE regarding Dysthymia disorder?



a) Lifetime prevalence is 6%
b) 20% of these patients will develop MDD and 15% will develop Bipolar II disorder
c) Adults and teens must have depressed mood for the majority of the time for at least 2 years to fulfill diagnostic criteria
d) Children must have depressed mood for the majority of the time for at least 2 years to fulfill diagnostic criteria





Answer: D

Which of the following is NOT true of Bipolar II disorder?

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Which of the following is NOT true of Bipolar II disorder?



a) Onset before age 30
b) Lifetime prevalence is 0.5%
c) Firm evidence suggests the progression of Bipolar II to Bipolar I disorder
d) Has a history of ONE or more major depressive episodes and at least one HYPOMANIC episode with hypomanic episode lasting at least 4 days





Answer: C

28 year old female presents with long-standing bouts of increased productivity, decreased sleep, excessive chattiness and distractibility. These bouts are typically one week in duration. Which of the following would NOT be an appropriate maintenance treatment for this patient?

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28 year old female presents with long-standing bouts of increased productivity, decreased sleep, excessive chattiness and distractibility. These bouts are typically one week in duration. Which of the following would NOT be an appropriate maintenance treatment for this patient?




a) Lamotrigine/Lamictal
b) Lithium
c) Anti-depressant alone
d) Carbamazepine
e) Valproic acid






Answer: C

Which of the following is NOT one of the manic diagnostic criteria symptoms that a patient must have 3 or more of?

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Which of the following is NOT one of the manic diagnostic criteria symptoms that a patient must have 3 or more of?



a) Poor self esteem
b) Decreased need for sleep
c) Talkative more than normal/pressured speech
d) Flight of ideas or racing thoughts
e) Distractible
f) Increase in goal-directed activity
g) Excessive involvement in pleasurable activities that have severe consequences




Answer: A

In addition to the presence of a distinct period of abnormally and persistently elevated, expansive or irritable mood with abnormally and persistent increased goal-directed activity lasting at least one week and 3 or more of the diagnostic manic symptoms. A patient must also have all of the following EXCEPT what?

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In addition to the presence of a distinct period of abnormally and persistently elevated, expansive or irritable mood with abnormally and persistent increased goal-directed activity lasting at least one week and 3 or more of the diagnostic manic symptoms. A patient must also have all of the following EXCEPT what?



a) Mood disturbance causes marked impairment in social or occupational functioning and/or necessitate hospitalization
b) The episode is NOT attributable to the psychologic effects of a substance or there are psychotic features
c) The patient must have a previous diagnosis of depression





Answer: C

Patient reports that they were much more talkative last week and his friends complained that he wasn't giving them any time to answer his questions or participate in the conversation. During this consecutive five day period, patient also states that he went sky diving, which was odd for him because he's normally terrified of heights. He also stayed up all night working on miscellaneous projects, and was considerably more productive at work. Patient reports feeling overly confident during this period. How would you define this episode?

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Patient reports that they were much more talkative last week and his friends complained that he wasn't giving them any time to answer his questions or participate in the conversation. During this consecutive five day period, patient also states that he went sky diving, which was odd for him because he's normally terrified of heights. He also stayed up all night working on miscellaneous projects, and was considerably more productive at work. Patient reports feeling overly confident during this period. How would you define this episode?







a) Mania
b) Hypomania
c) Psychotic break





Answer: A

In order to meet the diagnostic criteria, how long should the abnormally and persistently elevated, expansive or irritable mood with abnormally and persistently increased goal-directed activity or energy last to be classified as mania?

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In order to meet the diagnostic criteria, how long should the abnormally and persistently elevated, expansive or irritable mood with abnormally and persistently increased goal-directed activity or energy last to be classified as mania?



a) At least 4 consecutive days
b) At least 1 week
c) At least 1 month




Answer: B

In addition to the presence of 5 or more symptoms, one of which being depressed mood or anhedonia, being present during the same two week period, all of the following are required to meet the diagnostic criteria of MDD except what?

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In addition to the presence of 5 or more symptoms, one of which being depressed mood or anhedonia, being present during the same two week period, all of the following are required to meet the diagnostic criteria of MDD except what?




a) Symptoms cause clinically significant distress or impairment
b) The episode is substance-induced
c) Patient's symptoms are not explained by Schizophrenia or other psychotic disorder
d) There has NEVER been a manic or hypomanic episode






Answer: B

Aside from anhedonia and depressed mood, a patient must possess at least 4 or more of these during the same two week period. Which of the following is NOT a symptom included in the diagnostic criteria of MDD?

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Aside from anhedonia and depressed mood, a patient must possess at least 4 or more of these during the same two week period. Which of the following is NOT a symptom included in the diagnostic criteria of MDD?





a) Weight or sleep changes
b) Psychomotor agitation/retardation
c) Boosted energy
d) Impaired concentration
e) Thoughts of death





Answer: C

40 year old female presents to your office with a stooped posture and a chief complaint of difficulty concentrating at work and states that they missed their previously scheduled appointment with you because they forgot they had scheduled it. During your interview, the patient rarely makes eye contact with you and patient reveals that they've contemplated suicide. What's your DDx?

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40 year old female presents to your office with a stooped posture and a chief complaint of difficulty concentrating at work and states that they missed their previously scheduled appointment with you because they forgot they had scheduled it. During your interview, the patient rarely makes eye contact with you and patient reveals that they've contemplated suicide. What's your DDx?




a) MDD
b) Bipolar I disorder
c) Bipolar II disorder
d) Cyclothymic disorder





Answer: A
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