Archive for July 2017

Patient is convinced that he is somehow related to the Kardashians. He believes it's the only way to explain his good looks, power and knowledge. Although he told you that he's "practically the CEO of a startup company", you decide to investigate and find that he's just a mid level office worker. How would you classify his delusional disorder?

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Patient is convinced that he is somehow related to the Kardashians. He believes it's the only way to explain his good looks, power and knowledge. Although he told you that he's "practically the CEO of a startup company", you decide to investigate and find that he's just a mid level office worker. How would you classify his delusional disorder?




a) Somatic
b) Persecutory
c) Grandiose
d) Erotomanic
e) Jealous





Answer: C

Patient's mother is in the best nursing home that money can buy. Every time she goes to visit her mother, her mother seems extremely happy, but the patient is convinced this is a facade and that the nursing home staff are actually neglecting her mother and treating her poorly. How would you classify her delusional disorder?

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Patient's mother is in the best nursing home that money can buy. Every time she goes to visit her mother, her mother seems extremely happy, but the patient is convinced this is a facade and that the nursing home staff are actually neglecting her mother and treating her poorly. How would you classify her delusional disorder?



a) Somatic
b) Persecutory
c) Grandiose
d) Erotomanic
e) Jealous





Answer: B

Patient states that she's convinced her husband is cheating on her. Even though they're together every night, she's convinced that his infidelities occur at some point during his work hours. She recently put a tracking device on his phone so that she can see if he leaves his office. How would you classify her delusional disorder?

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Patient states that she's convinced her husband is cheating on her. Even though they're together every night, she's convinced that his infidelities occur at some point during his work hours. She recently put a tracking device on his phone so that she can see if he leaves his office. How would you classify her delusional disorder?



a) Somatic
b) Persecutory
c) Grandiose
d) Erotomanic
e) Jealous





Answer: E

Patient states that he believes he has cancer in spite of the fact that no blood test, CT scan or other diagnostic studies have demonstrated that he's anything but healthy. How would you classify his delusional disorder?

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Patient states that he believes he has cancer in spite of the fact that no blood test, CT scan or other diagnostic studies have demonstrated that he's anything but healthy. How would you classify his delusional disorder?



a) Somatic
b) Persecutory
c) Grandiose
d) Erotomanic
e) Jealous




Answer: A

Seemingly normal patient presents to your office with the chief complaint of "I think my ex boyfriend is stalking me". She said she's been thinking this for the last 2 months after he liked one of her most recent Facebook photos. A substance being the source of her thoughts has been ruled out. What's your DDx?

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Seemingly normal patient presents to your office with the chief complaint of "I think my ex boyfriend is stalking me". She said she's been thinking this for the last 2 months after he liked one of her most recent Facebook photos. A substance being the source of her thoughts has been ruled out. What's your DDx?




a) Schizophreniform
b) Schizoaffective
c) Delusional disorder
d) Brief psychotic disorder






Answer: C

Patient states that she was hearing voices for 4 days last week, but they have since disappeared. Her symptoms cannot be better explained by a mood disorder with psychotic features or substances. What's your DDx?

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Patient states that she was hearing voices for 4 days last week, but they have since disappeared. Her symptoms cannot be better explained by a mood disorder with psychotic features or substances. What's your DDx?



a) Schizophreniform
b) Schizoaffective
c) Delusional disorder
d) Brief psychotic disorder





Answer: D

Patient presents with complaints of hyperactivity characterized by beginning a number of household and work projects that she never finishes for the last 4 weeks. She states that two weeks prior to this she was "seeing ghosts" in her house. What's the most appropriate treatment for this patient?

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Patient presents with complaints of hyperactivity characterized by beginning a number of household and work projects that she never finishes for the last 4 weeks. She states that two weeks prior to this she was "seeing ghosts" in her house. What's the most appropriate treatment for this patient?



a) Mood stabilizer, antidepressants, antipsychotics and psychotherapy
b) Mood stabilizer + antidepressant
c) Mood stabilizer+ Antipsychotic





Answer: A

Patient presents with complaints of hyperactivity characterized by beginning a number of household and work projects that aren't finished for the last 4 weeks. She states that two weeks prior to this she was "seeing ghosts" in her house. Her labs come back negative for psychotropic drug use. What's your DDx?

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Patient presents with complaints of hyperactivity characterized by beginning a number of household and work projects that aren't finished for the last 4 weeks. She states that two weeks prior to this she was "seeing ghosts" in her house. Her labs come back negative for psychotropic drug use. What's your DDx?



a) Schizophreniform
b) Schizoaffective
c) Delusional disorder
d) Brief psychotic disorder





Answer: B

An extremely confused Schizophreniform patient presents with hallucinations, catatonic behavior and disorganized speech. She states that these began about 4 weeks after she noticed a change in her behavior. She was a college professor prior to the onset of these symptoms and does not have a blunted affect. How would you describe her prognosis?

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An extremely confused Schizophreniform patient presents with hallucinations, catatonic behavior and disorganized speech. She states that these began about 4 weeks after she noticed a change in her behavior. She was a college professor prior to the onset of these symptoms and does not have a blunted affect. How would you describe her prognosis?



a) Poor prognosis
b) Good prognosis
c) Prognosis can't be determined as recurrence is common






Answer: B

Patient presents with hallucinations and disorganized speech that were present for a month, but have not recurred since. Schizoaffective mood disorder and the effects of a substance have been ruled out as causes of their symptoms. What would be the MOST appropriate treatment for this patient?

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Patient presents with hallucinations and disorganized speech that were present for a month, but have not recurred since. Schizoaffective mood disorder and the effects of a substance have been ruled out as causes of their symptoms. What would be the MOST appropriate treatment for this patient?




a) 3-6 month course of Antipsychotic medication
b) Lithium prophylaxis
c) Hospitalization





Answer: A

Patient presents with hallucinations and disorganized speech that were present for a month, but have not recurred since. Schizoaffective mood disorder and the effects of a substance have been ruled out as causes of their symptoms. What's your DDx?

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Patient presents with hallucinations and disorganized speech that were present for a month, but have not recurred since. Schizoaffective mood disorder and the effects of a substance have been ruled out as causes of their symptoms. What's your DDx?



a) Delusional disorder
b) Schizoid disorder
c) Schizophreniform disorder
d) Brief psychotic disorder





Answer: C

Which of the following best describes 2nd generation/atypical anti-psychotics?

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Which of the following best describes 2nd generation/atypical anti-psychotics?




a) They are dopamine antagonists with representative agents of Respirdal, Zyprexa, Seroquel, Clozaril, Geodon and Abilify and metabolic side effects
b) They are serotonin-dopamine antagonists with representative agents of Respirdal, Zyprexa, Seroquel, Clozaril, Geodon and Abilify and metabolic side effects
c) They are dopamine antagonists with representative agents of Respirdal, Zyprexa, Seroquel, Clozaril, Geodon and Abilify and extrapyramidal side effects
d) They are serotonin-dopamine antagonists with representative agents of Respirdal, Zyprexa, Seroquel, Clozaril, Geodon and Abilify and extrapyramidal side effects




Answer: B

Schizophrenic patient admits to hallucinations and ambivalence/mixed feelings or contradictory ideas about something for the past 3 months, but denies hallucinations or delusions. There is an absence of disorganized thoughts or behavior and no echolalia, extreme negativism, stupor or excess motor activity. How would you classify their Schizophrenia?

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Schizophrenic patient admits to hallucinations and ambivalence/mixed feelings or contradictory ideas about something for the past 3 months, but denies hallucinations or delusions. There is an absence of disorganized thoughts or behavior and no echolalia, extreme negativism, stupor or excess motor activity. How would you classify their Schizophrenia?




a) Paranoid
b) Disorganized
c) Catatonic
d) Undifferentiated
e) Residual




Answer: D

Schizophrenic patient presents to your office. She denies seeing or hearing things that aren't there. Although her affect is flat, her speech is fluid and organized and her behavior is not catatonic or unorganized. She states that she continuously lacks motivation, is socially detached and doesn't feel pleasure. How would you classify her Schizophrenia?

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Schizophrenic patient presents to your office. She denies seeing or hearing things that aren't there. Although her affect is flat, her speech is fluid and organized and her behavior is not catatonic or unorganized. She states that she continuously lacks motivation, is socially detached and doesn't feel pleasure. How would you classify her Schizophrenia?




a) Paranoid
b) Disorganized
c) Catatonic
d) Undifferentiated
e) Residual





Answer: E

Schizophrenic patient presents with complaints of transient losses of consciousness. You notice that he's continuously fidgeting in order to assume a bizarre posture. He repeats all questions you ask and is extremely resistant to all instructions. How would you classify their Schizophrenia?

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Schizophrenic patient presents with complaints of transient losses of consciousness. You notice that he's continuously fidgeting in order to assume a bizarre posture. He repeats all questions you ask and is extremely resistant to all instructions. How would you classify their Schizophrenia?




a) Paranoid
b) Disorganized
c) Catatonic
d) Undifferentiated
e) Residual









Answer: C

Schizophrenic patient states they hear voices several times a day that interfere with their thoughts. He articulates these symptoms well and at an appropriate pace. His affect is not flat and is appropriate for the situation. How would you classify their Schizophrenia?

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Schizophrenic patient states they hear voices several times a day that interfere with their thoughts. He articulates these symptoms well and at an appropriate pace. His affect is not flat and is appropriate for the situation. How would you classify their Schizophrenia?



a) Paranoid
b) Disorganized
c) Catatonic
d) Undifferentiated
e) Residual





Answer: A

Which of the following is FALSE concerning Schizophrenic patients?

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Which of the following is FALSE concerning Schizophrenic patients?




a) Memory is intact
b) Judgement and insight are poor
c) They are less reliable than other psychiatric patients
d) Cognitive impairment seems to be present when patients have first episode and remains stable over the course of their illness





Answer: C

You ask a Schizophrenic patient "What did you do last night?" and they reply "I went to dinner with my mom". You then proceed to say "That sounds fun, where did you and your mom go to eat?" and they reply "I went to dinner with my mom". What type of thought PROCESS is this?

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You ask a Schizophrenic patient "What did you do last night?" and they reply "I went to dinner with my mom". You then proceed to say "That sounds fun, where did you and your mom go to eat?" and they reply "I went to dinner with my mom". What type of thought PROCESS is this?




a) Perseveration
b) Thought blocking
c) Poor abstraction ability
d) Poverty of thought content






Answer: A

A Schizophrenic patient states "My favorite restaurant is Outback, I love their steaks. Yesterday I went to the mall with my mom. I had to iron my shirt this morning." What type of thought PROCESS is this?

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A Schizophrenic patient states "My favorite restaurant is Outback, I love their steaks. Yesterday I went to the mall with my mom. I had to iron my shirt this morning." What type of thought PROCESS is this?



a) Idiosyncratic/Clang association
b) Thought blocking
c) Over inclusion
d) Flight of ideas






Answer: D

While interviewing a Schizophrenic patient, they say "yesterday I went to the pool and right as I was about to jump off the diving board, last night I had a steak for dinner". What thought PROCESS is this?

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While interviewing a Schizophrenic patient, they say "yesterday I went to the pool and right as I was about to jump off the diving board, last night I had a steak for dinner". What thought PROCESS is this?




a) Perseveration
b) Thought blocking
c) Poor abstraction ability
d) Poverty of thought content




Answer: B

When asking about the event that precipitated the onset of your patient's Schizophrenia. They tell you that a huge red SUV with a family of 4 inside ran a red light at the intersection of South Blvd and Abercorn St at 8:00 AM on Saturday July, 29 and hit them. The patient proceeds to tell you that damage from the accident caused him to rip his favorite pair of blue jeans, but the white button down he was wearing survived. What FORM of thought is this?

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When asking about the event that precipitated the onset of your patient's Schizophrenia. They tell you that a huge red SUV with a family of 4 inside ran a red light at the intersection of South Blvd and Abercorn St at 8:00 AM on Saturday July, 29 and hit them. The patient proceeds to tell you that damage from the accident caused him to rip his favorite pair of blue jeans, but the white button down he was wearing survived. What FORM of thought is this?




a) Neologism
b) Tangentiality
c) Circumstantiality
d) Derailment





Answer: C

While asking a Schizophrenic patient if he's ever had hallucinations, he replies "my friend tells me that he constantly hears an evil woman's voice in his head that tells him he's disgusting". What FORM of thought is this?

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While asking a Schizophrenic patient if he's ever had hallucinations, he replies "my friend tells me that he constantly hears an evil woman's voice in his head that tells him he's disgusting". What FORM of thought is this?




a) Neologism
b) Tangentiality
c) Circumstantiality
d) Derailment





Answer: B

You're talking to a Schizophrenic patient about their initial diagnosis. In the middle of describing their age of onset and initial symptoms they begin telling you about a really good new restaurant in town. What FORM of thought is this?

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You're talking to a Schizophrenic patient about their initial diagnosis. In the middle of describing their age of onset and initial symptoms they begin telling you about a really good new restaurant in town. What FORM of thought is this?




a) Neologism
b) Tangentiality
c) Circumstantiality
d) Derailment




Answer: D

Patient states that every time he looks in the mirror his face looks distorted. He also states that his favorite song sounded jumbled on the radio the other day. How would you describe this symptom in his chart?

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Patient states that every time he looks in the mirror his face looks distorted. He also states that his favorite song sounded jumbled on the radio the other day. How would you describe this symptom in his chart?



a) Delusions
b) Hallucinations
c) Illusions




Answer: C

A patient complains of hearing voices that are threatening, obscene, accusatory and insulting. Occasionally he notes that he hears an additional voice that converses with the other voice. How would you describe this symptom in his chart?

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A patient complains of hearing voices that are threatening, obscene, accusatory and insulting. Occasionally he notes that he hears an additional voice that converses with the other voice. How would you describe this symptom in his chart?



a) Delusions
b) Hallucinations
c) Illusions





Answer: B

15 year old Schizophrenic male presents your office. Review of his history reveals that he was diagnosed with Schizophrenia at age 10. Prior to his diagnosis, he had to attend summer school almost every year due to failing grades. His father is also a Schizophrenic. He states that since his diagnosis he has lost pleasure in all activities. How would you rate his prognosis?

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15 year old Schizophrenic male presents your office. Review of his history reveals that he was diagnosed with Schizophrenia at age 10. Prior to his diagnosis, he had to attend summer school almost every year due to failing grades. His father is also a Schizophrenic. He states that since his diagnosis he has lost pleasure in all activities. How would you rate his prognosis?




a) Good prognosis
b) Poor prognosis
c) Cannot be determined because her symptoms will change with time
b) Poor prognosis




-Early age of onset
-Poor pre-illness functioning
-Family history of Schizophrenia
-Disorganized subtype with apathy, blunted affect and anhedonia

34 year old female was recently diagnosed with Schizophrenia. She is an engineer and has been able to keep her job, but occasionally reports hearing voices or seeing things that aren't there. Dependent mood disorder is the only significant family history she has. How would you rate her prognosis?

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34 year old female was recently diagnosed with Schizophrenia. She is an engineer and has been able to keep her job, but occasionally reports hearing voices or seeing things that aren't there. Dependent mood disorder is the only significant family history she has. How would you rate her prognosis?



a) Good prognosis
b) Poor prognosis
c) Cannot be determined because her symptoms will change with time
a) Good prognosis




-Late onset
-Female
-Good pre-illness functioning
-Minimal cognitive impairment
-Paranoid subtype with hallucinations/delusions
-Family history of mood disorders

15 year old boy presents to the psychologist's office with his father who states that his son has dropped out of chess club and lost his job at the local icecream shop. He has recently become enamored by the preachings a local cult leader and has begun saying weird phrases and standing in weird postures. What phase of Schizophrenia could this patient potentially be in?

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15 year old boy presents to the psychologist's office with his father who states that his son has dropped out of chess club and lost his job at the local icecream shop. He has recently become enamored by the preachings a local cult leader and has begun saying weird phrases and standing in weird postures. What phase of Schizophrenia could this patient potentially be in?





a) Prodromal phase
b) Premorbid phase
c) Active phase




Answer: A

An 18 year old presents to your office with his mother who is concerned about him leaving for college since he is extremely quiet and passive and would prefer to watch TV or play video games instead of attend social activities. Throughout his life he has had few friends and was diagnosed as Schizoid. What phase of Schizophrenia could this patient potentially be in?

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An 18 year old presents to your office with his mother who is concerned about him leaving for college since he is extremely quiet and passive and would prefer to watch TV or play video games instead of attend social activities. Throughout his life he has had few friends and was diagnosed as Schizoid. What phase of Schizophrenia could this patient potentially be in?




a) Prodromal phase
b) Premorbid phase
c) Active phase




Answer: B

If a patient has a history of Autism spectrum disorder, the diagnosis of Schizophrenia can only be made in the presence of what for at least 1 month?

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If a patient has a history of Autism spectrum disorder, the diagnosis of Schizophrenia can only be made in the presence of what for at least 1 month?



a) Prominent delusions OR hallucinations
b) Ambivalence OR disorganized thinking
c) Hostility OR hallucinations
d) Prominent delusions OR disorganized thinking





Answer: A

In order to fulfill the diagnostic criteria of Schizophrenia, patients must have at least 2 symptoms for a 1 month period. Which of the following is NOT a symptom that they are required to have ONE of in combination with the other symptoms on the list?

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In order to fulfill the diagnostic criteria of Schizophrenia, patients must have at least 2 symptoms for a 1 month period. Which of the following is NOT a symptom that they are required to have ONE of in combination with the other symptoms on the list?





a) Delusions
b) Hallucinations
c) Disorganized speech
d) Grossly disorganized or catatonic behavior



Answer: D

Which of the following is NOT a finding you'd see in a CT scan of a Schizophrenic patient's brain?

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Which of the following is NOT a finding you'd see in a CT scan of a Schizophrenic patient's brain?



a) Enlargement of the lateral and third ventricles
b) Reduced symmetry in the temporal, frontal, and occipital lobes
c) Increase in size of emotional control region of the Limbic System
d) Abnormalities in Prefrontal Cortex that causes lobotomy like symptoms




Answer: C

Patient appears withdrawn from reality, does NOT seem to be making logical connections, states that he often sees and hears aliens speaking to him. His PCP referred him to your office and noted that he had significant emotional and behavioral disturbances. What's your DDx?

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Patient appears withdrawn from reality, does NOT seem to be making logical connections, states that he often sees and hears aliens speaking to him. His PCP referred him to your office and noted that he had significant emotional and behavioral disturbances. What's your DDx?




a) Schizotypal personality disorder
b) Manic episode
c) Schizophrenia





Answer: C

A GAD patient presents to your office after being prescribed an SSRI by his PCP. He seems extremely agitated when you try to elicit history from him and he states that his anxiety has gotten significantly worse since he began taking the drug a few days ago. Without looking at his chart, what do you think his PCP prescribed him?

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A GAD patient presents to your office after being prescribed an SSRI by his PCP. He seems extremely agitated when you try to elicit history from him and he states that his anxiety has gotten significantly worse since he began taking the drug a few days ago. Without looking at his chart, what do you think his PCP prescribed him?



a) Prozac
b) Lexapro
c) Paxil





Answer: A

Which of the following is the MOST effective treatment for GAD?

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Which of the following is the MOST effective treatment for GAD?



a) Buspirone/BuSpar/A 5-HT1A partial receptor agonist + Benzodiazepines
b) Benzodiazepines + Psychotherapy emphasizing relaxation and biofeedback
c) Buspirone/BuSpar/ A 5-HT1A partial receptor agonist + Psychotherapy emphasizing relaxation and biofeedback






Answer: B

Patient states that he has been worried about his upcoming bar exam, current financial status and his girlfriend's fidelity for the past 7 months. Although he admits that he's been anxious for as long as he remembers, he feels like it has recently gotten worse. Every time he thinks about these things his neck muscles tense up. His worry makes him feel extremely irritable and has significantly disrupted his sleep. He was diagnosed with panic disorder 2 years ago. What's your DDx?

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Patient states that he has been worried about his upcoming bar exam, current financial status and his girlfriend's fidelity for the past 7 months. Although he admits that he's been anxious for as long as he remembers, he feels like it has recently gotten worse. Every time he thinks about these things his neck muscles tense up. His worry makes him feel extremely irritable and has significantly disrupted his sleep. He was diagnosed with panic disorder 2 years ago. What's your DDx?





a) Social phobia
b) GAD
c) Panic attack
d) MDD



Answer: B

Patient presents with suspected PTSD following a high school shooting 6 months ago. Symptoms began about a week after the event and persisted for about 5 months. He was extremely functional prior to the event with no history of psychiatric illness. Both his mom and dad came to the appointment to support him and are inquiring about his prognosis. What would you tell them?

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Patient presents with suspected PTSD following a high school shooting 6 months ago. Symptoms began about a week after the event and persisted for about 5 months. He was extremely functional prior to the event with no history of psychiatric illness. Both his mom and dad came to the appointment to support him and are inquiring about his prognosis. What would you tell them?



a) Good prognosis
b) Poor prognosis
c) Prognosis can't be predicted as PTSD patients' symptoms fluctuate in response to the types and degree of stresses experienced daily





Answer: A

A patient was involved in a horrific bus hijacking 3 months ago in which she was shot and numerous people around her were shot to death. She comes to your office complaining of dreams that wake her up in a cold sweat and cause her extreme distress to the point that she can't go back to sleep. You are the first person that she's discussed this with as she tries to avoid conversations of the event at all cost. She no longer rides the bus and states that she's distanced herself from those close to her. You accidentally dropped your pen during the interview and noticed that she became extremely startled. These symptoms have been going on for 2 months and continue to interfere with her performance at work. What's your DDx?

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A patient was involved in a horrific bus hijacking 3 months ago in which she was shot and numerous people around her were shot to death. She comes to your office complaining of dreams that wake her up in a cold sweat and cause her extreme distress to the point that she can't go back to sleep. You are the first person that she's discussed this with as she tries to avoid conversations of the event at all cost. She no longer rides the bus and states that she's distanced herself from those close to her. You accidentally dropped your pen during the interview and noticed that she became extremely startled. These symptoms have been going on for 2 months and continue to interfere with her performance at work. What's your DDx?




a) Chronic PTSD
b) Acute PTSD
c) Late-onset acute PTSD
d) Late-onset chronic PTSD




Answer: B

What 2 things must be present in the initial event in order to fulfill DSM-V-TR diagnostic criteria for PTSD?

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What 2 things must be present in the initial event in order to fulfill DSM-V-TR diagnostic criteria for PTSD?



a) The person's response involved intense fear, helplessness or horror
b) The person had to execute an act or be an accomplice to an act that involved actual or threatened death or serious injury or threat to physical integrity of self or others
c) The person experienced, witnessed, or was confronted with an event that involved actual or threatened death or serious injury or threat to physical integrity of self or others
d) a and b
e) a and c





Answer: E
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