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A 25-year-old female presents with altered mental status. History provided by her family reveals she has been depressed lately but she is relatively healthy. Vital signs are BP: 98/42 mmHg (right arm, supine); pulse: 114 beats/min (regular); respirations: 8 breaths/min (nonlabored); temp: 97.2 degrees F (oral). Physical examination reveals that she is obtunded with slurred speech. Pupils are 3mm with a sluggish light reaction. Deep tendon reflexes are absent in all extremities. Which of the following is the most likely diagnosis?
A 20-year-old was brought in after competing in a “beer chugging” contest. The patient is belligerent and combative. There is no history of head trauma; vital signs are stable. After an IV access is established, what would be the most effective chemical restraint for this patient?
A 63-year-old retired engineer presents with one month of difficulty sleeping. He has a hard time staying asleep and says he is just restless. He also states that he has been more forgetful and can’t pay attention very well. He lives with his wife. He denies fever, chills, recent trauma, or difficulty walking. When asked about the specifics of his symptoms, he repeatedly replies, “I don’t know,” without really trying. He states his wife thinks he just sits around the house all day since he retired. His neurological exam is unremarkable, except for some mild psychomotor retardation. Which of the following is the most likely diagnosis?
A 54 year old had had declining performance at work over the last 2 months. He spends less time with friends, has lost interest in his hobbies and spends much of his free time sleeping. His neurological exam is unremarkable. Which of the following is the most likely diagnosis?
A 33-year-old woman has panic-agoraphobia. She is most likely to also have which of the following disorders?
An 18-year-old female is seeing you for a routine pre-college examination. She has no complaints and review of systems is negative. Vital signs including height and weight are within normal limits. Physical exam is normal except for the oropharynx which appears injected without areas of erosion, and the loss of enamel on the front teeth. Which of the following diagnoses do you suspect from these findings?
A 54-year-old woman is in a hypomanic state characterized by irritable mood, decreased need for sleep, and flight of ideas. Which of the following is the most likely underlying disorder?
A 5-year-old boy exhibits a lack of social interaction manifested by a lack of facial expression and eye-to-eye gaze. He will not play with other children. Which of the following is the most likely diagnosis?
A 45-year-old male stumbles in to the office. He has difficulty relating a history and is agitated. He does admit to insomnia the past two nights because he thinks a ghost is in his bedroom. He has a history of alcohol abuse since 15 years of age, but had not consumed any alcohol in 3 days according to his girlfriend. His blood pressure is 174/96 mmHg, pulse is 110/bpm, and he is diaphoretic. Which of the following is the most likely diagnosis?
A patient presents to the office with suspected obsessive compulsive disorder; they would most likely have which of the following findings?
Which of the following is not effective in the treatment of bipolar I disorder?
A 67-year-old woman arrives at the office complaining of trouble sleeping, decreased appetite, trouble concentrating, feeling sad, and daily crying episodes. The patient reports that her husband died 2 weeks ago unexpectedly. The most likely diagnosis for this woman is:
In considering pharmacotherapy for your patient with Bipolar I Disorder, which of the following statements is most true in regard to lithium pharmacotherapy?
Which of the following medications is best indicated for the management of paranoid schizophrenia?
You have been evaluating a 24-year-old male patient over several office visits. You appreciated that the patient exhibits excessive emotionality with attention-seeking behavior and a fair amount of dramatics. The patient appears to be uncomfortable in situations in which he is not the center of attention and displays a shallow expression of emotions and rapidly shifts emotions. You also appreciate that the patient appears to dress in a manner that draws attention to him. Which of the following diagnosis would be most appropriate for this patient?
For which of the following conditions would an antidepressant be least effective?
An 88-year-old woman who had a total hip arthroplasty 3 days ago has been experiencing memory problems, somnolence, cough, and confusion over the last 6 hours. She is afebrile. Which of the following is the most likely diagnosis?
A 76-year-old woman is seen for follow-up of her major depressive disorder that is failing to improve following 6 months of fluoxetine 60 mg per day pharmacotherapy. She now expresses suicidal ideation and has stopped eating. Which of the following is the best course of action at this time?
Which of the following diagnostic studies is indicated in the initial evaluation of a patient with psychosis?
A 27-year-old woman is brought to the clinic by her husband. He reports that she has not slept for more than 3 hours in the past 3 days. Her speech is rapid and pressured. She moves continuously about the room and is irritable. She has been jumping from one activity to another for the past 48 hours, never completing anything. She has no prior mental health history and had been fine until about 10 days ago when she started experiencing this burst of energy and progressively decreasing need for sleep. Which of the following is the most likely diagnosis?
Which of the following medications is contraindicated for treatment of anorexia nervosa?
A 27-year-old female presents with periodic episodes of moody, erratic, impulsive, and violent behavior. The patients states these episodes have been occurring for the past several years with associated symptom-free periods that last greater than two months. Based on the patient’s history, which of the following is the most appropriate diagnosis?
Which of the following types of medication is commonly used for treatment of binge eating and obesity?
A patient currently taking an antidepressant complains of diminished sex drive and expresses an interest in switching or adding an antidepressant that will not cause this side effect. Which of the following types of antidepressant is least likely to cause diminished sexual function?
A 35-year-old male patient complains of intrusive thoughts of a graphic and disturbing nature. He is bothered by these thoughts, but cannot seem to eliminate them. He complains that the thoughts and images occur repeatedly and often distract him from accomplishing daily tasks. The thoughts are not memories of an event or scene, and were not triggered by a precipitating event. The most likely diagnosis for this patient is
A 16-year-old male presents with maladaptive behavioral and emotional problems that have occurred since his parents divorced two months previously. Based on this history, which of the following is the most appropriate diagnosis?
A 25-year-old male presents with a history of several manic episodes alternating with several depressive episodes. You diagnose this patient with bipolar disorder. Which of the following medications would you prescribe for treatment of this disorder?
A 31-year-old female presents with persistent mild depression with symptoms including loss of interest, social withdrawal, overeating, over-sleeping, and lack of self-esteem for over 2 years. The patient denies any psychotic, manic, or hypo-manic episodes. Based on the patient’s history, which of the following is the most appropriate diagnosis?
Which of the following medications is an alcohol deterrent medication that causes nausea when alcohol is consumed?
A 22-year-old female presents with history of feigning signs and symptoms of several disease processes and attempting to gain hospital admission for these diseases by assuming several different names. Full work-up, including blood work and radiographic study, fail to find any clinical explanation for the symptoms she is feigning. Based on the patient’s presentation and work-up, which of the following is the most appropriate diagnosis?