Archive for May 2017

Which statement best describes the onset of OCD?

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Which statement best describes the onset of OCD?



a) Insidious onset after recurring traumatic and anxiety provoking events
b) Abrupt onset usually after an event
c) Pace of onset varies significantly from one patient to the next



Answer: B

Which of the following is NOT an OCD symptom pattern?

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Which of the following is NOT an OCD symptom pattern?


a) Contamination--> Excessive handwashing
b) Pathological doubt followed by a compulsion of checking
c) Intrusive thoughts without compulsion of a sexually aggressive act that the patient finds repulsive
d) Asymmetry





Answer: D

15 year old female presents to your office with the complaint of stage fright. She is an incredible ballerina when practicing one-on-one with her dance instructor, but experiences a panic attack every time she attempts to go on stage to perform in front of a large crowd of unfamiliar people. As a result she usually doesn't make it on stage and has recently begun to avoid dancing altogether. She knows her fear is excessive since it's now interfered with her doing what she loves. These symptoms have been going on for the past 8 months. What's your DDx?

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15 year old female presents to your office with the complaint of stage fright. She is an incredible ballerina when practicing one-on-one with her dance instructor, but experiences a panic attack every time she attempts to go on stage to perform in front of a large crowd of unfamiliar people. As a result she usually doesn't make it on stage and has recently begun to avoid dancing altogether. She knows her fear is excessive since it's now interfered with her doing what she loves. These symptoms have been going on for the past 8 months. What's your DDx?



a) PTSD
b) Panic disorder
c) Social phobia
d) Specific phobia





Answer: C

A 16 year old presents to your office and states that he is excessively fearful of dogs. Even seeing a dog across the street or hearing one bark on TV illicits a panic attack. For that reason he only watches Netflix, which has no commercials, and stays indoors as often as possible. He began to recognize that his fear was unreasonable after his girlfriend broke up with him because he wouldn't go to her house due to her dogs. This has been going on for about 7 months and he has no other mental disorders. What's your DDx?

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A 16 year old presents to your office and states that he is excessively fearful of dogs. Even seeing a dog across the street or hearing one bark on TV illicits a panic attack. For that reason he only watches Netflix, which has no commercials, and stays indoors as often as possible. He began to recognize that his fear was unreasonable after his girlfriend broke up with him because he wouldn't go to her house due to her dogs. This has been going on for about 7 months and he has no other mental disorders. What's your DDx?




a) Panic disorder
b) PTSD
c) Specific phobia
d) Social phobia





Answer: C

A patient has an excessive fear of using public restrooms at work because he's afraid his co-workers will see him and make fun of him which will cause him severe embarrassment. What's your DDx?

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A patient has an excessive fear of using public restrooms at work because he's afraid his co-workers will see him and make fun of him which will cause him severe embarrassment. What's your DDx?



a) Specific phobia
b) Social phobia
c) Agoraphobia
d) PTSD




Answer: B

While treating a patient with panic disorder, you remind him that he has control over his anxiety. You teach him techniques to control his anxiety using calming images and muscle relaxation. What type of therapy is this?

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While treating a patient with panic disorder, you remind him that he has control over his anxiety. You teach him techniques to control his anxiety using calming images and muscle relaxation. What type of therapy is this?



a) Cognitive therapy
b) Applied relaxation
c) Respiratory training
d) In vivo exposure





Answer: B

Which of the following is NOT one of the two major foci of cognitive therapy for panic disorder?

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Which of the following is NOT one of the two major foci of cognitive therapy for panic disorder?



a) Teaching the patient not to misinterpret normal physiologic responses as a panic attack prodrome
b) Teaching the patients that panic attacks are NOT life threatening
c) Teaching the patients about the potential sequelae of panic attacks




Answer: C

Patient presents with newly diagnosed panic disorder. He has been on Paxil for the past month and states that he finally feels like he's getting his symptoms under control. In regards to his treatment, what's the most appropriate next step?

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Patient presents with newly diagnosed panic disorder. He has been on Paxil for the past month and states that he finally feels like he's getting his symptoms under control. In regards to his treatment, what's the most appropriate next step?




a) Lower the dose of his SSRI
b) Taper him off of Benzodiazepines
c) Titrate his SSRI very slowly
d) Nothing-he seems to be doing great




Answer: B

A patient states that he has significant anxiety about going to concerts and festivals because they are very crowded and he feels like he won't be able to escape in the event of a panic attack. What's your DDx?

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A patient states that he has significant anxiety about going to concerts and festivals because they are very crowded and he feels like he won't be able to escape in the event of a panic attack. What's your DDx?



a) Social phobia
b) Agoraphobia
c) Specific phobia of festivals and concerts
d) PTSD





Answer: B

In addition to the panic attack not having an obvious precipitant, DSM-TV requires the presence of at least one symptom of worry about a subsequent attack for a minimum of one month. Which of the below is NOT a symptom related to worry about a subsequent attack?

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In addition to the panic attack not having an obvious precipitant, DSM-TV requires the presence of at least one symptom of worry about a subsequent attack for a minimum of one month. Which of the below is NOT a symptom related to worry about a subsequent attack?



a) Persistent concern about having additional attacks
b) Worry about the implications of the attack--Am I out of control?
c) Worry about their ability to keep attacks secret from those close to them
d) A significant change in behavior related to the attacks/ avoid situations that may provoke attacks





Answer: C

What does Research Diagnostic Criteria require in order to diagnose someone with panic disorder?

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What does Research Diagnostic Criteria require in order to diagnose someone with panic disorder?



a) 3 panic attacks during a 3 week period
b) 6 panic attacks during a 6 week period
c) 4 panic attacks during a 4 week period
d) Does not specify a specific number but does require one attack followed by at least a month of concern about a subsequent attack





Answer: B and D.

Your friend has had bouts of chest pain, nausea and fears of losing control. She states that when these occur she also feels like someone is somthering her with a pillow because she can't seem to catch her breath. She has had 4 attacks in 4 weeks. According to ICD-9, how would you classify her panic disorder?

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Your friend has had bouts of chest pain, nausea and fears of losing control. She states that when these occur she also feels like someone is somthering her with a pillow because she can't seem to catch her breath. She has had 4 attacks in 4 weeks. According to ICD-9, how would you classify her panic disorder?



a) Intermittent
b) Moderate
c) Severe




Answer: C

The night before a Clin Med test your friend begins to sweat, feel dizzy and have palpitations. You take her pulse and determine her heart rate to be 120. She also complains of numbness in her fingers and toes. Thankfully for you, this peaked at 10 minutes. What do you think was going on with your friend?

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The night before a Clin Med test your friend begins to sweat, feel dizzy and have palpitations. You take her pulse and determine her heart rate to be 120. She also complains of numbness in her fingers and toes. Thankfully for you, this peaked at 10 minutes. What do you think was going on with your friend?




a) PTSD exacerbation
b) GAD
c) Clin Med specific phobia
d) Panic attack





Answer: D

Which anxiety disorder theory explains how a child being raised by an abusive father initially develops anxiety when she sees her father and through generalization she grows to distrust all men?

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Which anxiety disorder theory explains how a child being raised by an abusive father initially develops anxiety when she sees her father and through generalization she grows to distrust all men?


a) Psychoanalytic
b) Behavioral
c) Existential





Answer: B

Which anxiety disorder theory states that anxiety is the result of psychic conflict between unconscious sexual or aggressive wishes and corresponding threats from the superego or external reality?

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Which anxiety disorder theory states that anxiety is the result of psychic conflict between unconscious sexual or aggressive wishes and corresponding threats from the superego or external reality?



a) Psychoanalytic
b) Behavioral
c) Existential




Answer: A

What are the 2 components of anxiety?

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What are the 2 components of anxiety?




a) Awareness of the physiological sensation
b) Awareness of threat
c) Awareness of being nervous or frightened
d) a and b
e) b and c





Answer: E

Patient states that they've had a body wide unpleasant sense of apprehension accompanied by headache, sweating, palpitations, tightness in chest, stomach discomfort and restlessness. How would you document this symptom?

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Patient states that they've had a body wide unpleasant sense of apprehension accompanied by headache, sweating, palpitations, tightness in chest, stomach discomfort and restlessness. How would you document this symptom?



a) Depression
b) Fear
c) Anxiety
d) Phobia




Answer: C

Patient states that for the past 2 years she's had bouts of hyperactivity, talkativeness and inflated self esteem that cycle with feelings of hopelessness, fatigue, guilt and low self esteem. The hyperactivity lasts no more than 5 days. Her former psychologist told her that her depression is not severe enough to fulfill the MDD diagnosis and that her hypomanic symptoms do not fulfill the diagnostic criteria of mania. What's your DDx?

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Patient states that for the past 2 years she's had bouts of hyperactivity, talkativeness and inflated self esteem that cycle with feelings of hopelessness, fatigue, guilt and low self esteem. The hyperactivity lasts no more than 5 days. Her former psychologist told her that her depression is not severe enough to fulfill the MDD diagnosis and that her hypomanic symptoms do not fulfill the diagnostic criteria of mania. What's your DDx?




a) Dysthymic disorder
b) Cyclothymia disorder
c) Bipolar I
d) Bipolar II




Answer: B

Patient states that she has felt "down in the dumps" for the past 2 years, but her former psychologist told her that her symptoms weren't severe enough to fit the diagnosis of major depressive disorder. What's your DDx?

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Patient states that she has felt "down in the dumps" for the past 2 years, but her former psychologist told her that her symptoms weren't severe enough to fit the diagnosis of major depressive disorder. What's your DDx?



a) Dysthymic disorder
b) Cyclothymia disorder
c) GAD




Answer: A

Patient presents with feelings of fatigue, inability to concentrate and diminished interest in exercise which she used to love doing. She states that these symptoms cycle with hyperactivity, buying an obscene amount of books on amazon and attempting to finish all of them. She states that this cycle occurs almost daily and has been going on for at least a week. What's your differential?

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Patient presents with feelings of fatigue, inability to concentrate and diminished interest in exercise which she used to love doing. She states that these symptoms cycle with hyperactivity, buying an obscene amount of books on amazon and attempting to finish all of them. She states that this cycle occurs almost daily and has been going on for at least a week. What's your differential? 




a) Bipolar I
b) Mixed episode
c) Cyclothymia disorder
d) Bipolar II




Answer: B

You're interviewing a patient that complains of a recent decline in test scores. When inquiring about the events leading up to this, she states that after answering a question wrong in class, she couldn't stop telling herself how stupid she was. She noticed that the more she told herself she was stupid, the worse her grades got. What's this an example of?

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You're interviewing a patient that complains of a recent decline in test scores. When inquiring about the events leading up to this, she states that after answering a question wrong in class, she couldn't stop telling herself how stupid she was. She noticed that the more she told herself she was stupid, the worse her grades got. What's this an example of?



a) Depressed mood
b) Mixed episode
c) Learned helplessness
d) Cognitive disorientation





Answer: C
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