Behavioral Science
Review
Case 1
• You are asked to examine a 27 year old female patient in the
ER. She is accompanied by her parents. She has been hearing
voices telling her that she is worthless and will never amount
to anything. When trying to investigate further you encounter
difficulty as she begins to answer questions but then tails off
into seemingly random tangents unrelated to what you asked.
Her parents tell you this has been going on for about 2
months. They say that she has never had any problems with
her mood.
Case 1
• What is the most likely diagnosis?
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A. Schizophrenia
B. Schizoaffective disorder
C. Schizoid personality disorder
D. Schizotypal personality disorder
E. Schizophreniform disorder
Case 1
• What is the most likely diagnosis?
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A. Schizophrenia
B. Schizoaffective disorder
C. Schizoid personality disorder
D. Schizotypal personality disorder
E. Schizophreniform disorder
Case 2
• A 22 year old male is brought to the ED by his roommates for
7 months of unusual behavior. They described increased
isolation and lack of interest in personal hygiene. When asked
this he states that he’s “hiding from the FBI. They’ve placed
cameras in all the mailboxes and they’re watching me.” On
exam he has poor posture, flat affect, and appears to be
talking to someone in the empty corner of the room.
Case 2
• What neurotransmitter alteration do you expect in this
patient?
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A. Increased acetylcholine
B. Decreased acetylcholine
C. Increased dopamine
D. Decreased dopamine
E. Increased norepinephrine with decreased dopamine
Case 2
• What neurotransmitter alteration do you expect in this
patient?
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A. Increased acetylcholine
B. Decreased acetylcholine
C. Increased dopamine
D. Decreased dopamine
E. Increased norepinephrine
Case 2
• What anatomical changes can be seen in this condition?
• A. Increased size of ventricles
• B. Increased volume of hippocampus, amygdala and
parahippocampal gyrus
• C. Increased cerebral asymmetry
• D. Increased cranial nerve nuclei mass
Case 2
• What anatomical changes can be seen in this condition?
• A. Increased size of ventricles
• B. Increased volume of hippocampus, amygdala and
parahippocampal gyrus
• C. Increased cerebral asymmetry
• D. Increased cranial nerve nuclei mass
Case 2
• In addition to CBT, what is the best treatment for this patient?
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SSRIs
First gen antipsychotics
Second gen antipsychotics
TCAs
No pharmacologic therapy necessary
Case 2
• In addition to CBT, what is the best treatment for this patient?
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SSRIs
First gen antipsychotics
Second gen antipsychotics
TCAs
No pharmacologic therapy necessary
• Which of these are necessary to diagnose ADHD?
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A. Symptoms present before the age of 16
B. Noticed in at least two settings
C. Presence of at least 5 hyperactive/inattentive symptoms
D. Does not impact quality of life
E. Must be present for at least 4 months
• Which of these are necessary to diagnose ADHD?
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A. Symptoms present before the age of 16
B. Noticed in at least two settings
C. Presence of at least 5 hyperactive/inattentive symptoms
D. Does not impact quality of life
E. Must be present for at least 4 months
• First line treatment for ADHD in children, adolescents and
adults?
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A. Benzodiazepines
B. Anticonvulsants
C. Mycophenolate
D. Stimulants
E. Binge watching Scrubs on Netflix
• First line treatment for ADHD in children, adolescents and
adults?
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A. Benzodiazepines
B. Anticonvulsants
C. Mycophenolate
D. Stimulants
E. Binge watching Scrubs on Netflix
• A concerned mother brings her 18 month old son to your
office for an evaluation. She says he has not begun speaking
yet despite the fact his older sister was saying 1-2 word
sentences by this time. He does not interact with his family or
react when they call his name but he does throw tantrums if
they do not feed him his favorite breakfast cereal each
morning. He is generally content when left to play by himself.
What is the most likely diagnosis?
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A. Normal childhood development
B. Congenital hearing loss
C. Autism Spectrum Disorder
D. Oppositional Defiant Disorder
E. Intellectual Disability
• A concerned mother brings her 18 month old son to your
office for an evaluation. She says he has not begun speaking
yet despite the fact his older sister was saying 1-2 word
sentences by this time. He does not interact with his family or
react when they call his name but he does throw tantrums if
they do not feed him his favorite breakfast cereal each
morning. He is generally content when left to play by himself.
What is the most likely diagnosis?
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A. Normal childhood development
B. Congenital hearing loss
C. Autism Spectrum Disorder
D. Oppositional Defiant Disorder
E. Intellectual Disability
• Parents bring their 7 year old daughter in for an evaluation.
For as long as they can remember she has had a short fuse
and is quick to anger. She never performs her chores at home
and prefers to spend her time annoying her younger sister.
They became more concerned when her behavior started to
worsen at school. She won’t sit in her assigned seat in class
and blames her classmates when she doesn’t finish her work
on time. What is the most likely diagnosis?
• A. Conduct Disorder
• B. ADHD
• C. Antisocial Personality Disorder
• D. Intermittent Explosive Disorder
• E. Oppositional Defiant Disorder
• Parents bring their 7 year old daughter in for an evaluation.
For as long as they can remember she has had a short fuse
and is quick to anger. She never performs her chores at home
and prefers to spend her time annoying her younger sister.
They became more concerned when her behavior started to
worsen at school. She won’t sit in her assigned seat in class
and blames her classmates when she doesn’t finish her work
on time. What is the most likely diagnosis?
• A. Conduct Disorder
• B. ADHD
• C. Antisocial Personality Disorder
• D. Intermittent Explosive Disorder
• E. Oppositional Defiant Disorder
• A 13 year old patient is being seen in the ED for burn treatments.
You are called to see him because it is revealed that he caused the
fire in his neighbors car that burned him. He does not care that his
actions almost hurt his neighbor, instead he replies that “he had it
coming to him.” His parents say that he is getting out of control. Just
this past year alone he was brought home by the cops after he
discovered wandering the town at 1am. Two months after that he
was found to be playing a handheld video game system that he stole
out of a fellow student’s backpack. What is the best treatment for
this patient?
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A. Multisystemic therapy (MST)
B. SSRIs
C. Cognitive Behavioral Therapy (CBT)
D. Stimulants
E. Dialectical behavior therapy (DBT)
• A 13 year old patient is being seen in the ED for burn treatments.
You are called to see him because it is revealed that he caused the
fire in his neighbors car that burned him. He does not care that his
actions almost hurt his neighbor, instead he replies that “he had it
coming to him.” His parents say that he is getting out of control. Just
this past year alone he was brought home by the cops after he
discovered wandering the town at 1am. Two months after that he
was found to be playing a handheld video game system that he stole
out of a fellow student’s backpack. What is the best treatment for
this patient?
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A. Multisystemic therapy (MST)
B. SSRIs
C. Cognitive Behavioral Therapy (CBT)
D. Stimulants
E. Dialectical behavior therapy (DBT)
• A 47 year old Irish Catholic female comes in for evaluation of major
depression. She is a psychiatrist with her own private practice. She
has been working over 80 hours a week in order to keep her practice
open. She is divorced and has no children. She has been feeling
especially sad this year, as her mother committed suicide at 47 due
to the difficulty of breast cancer and its treatments. She has been
losing weight recently and fears she also has breast cancer. To deal
with the stress she has been drinking 4-5 glasses of wine daily after
work. Which of the following factors is protective against her risk of
suicide?
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A. She’s a physician
B. Her mother committed suicide so she knows how to cope
C. Her religion
D. She doesn’t have a family to worry about
E. She’s using alcohol to reduce her stress
• A 47 year old Irish Catholic female comes in for evaluation of major
depression. She is a psychiatrist with her own private practice. She
has been working over 80 hours a week in order to keep her practice
open. She is divorced and has no children. She has been feeling
especially sad this year, as her mother committed suicide at 47 due
to the difficulty of breast cancer and its treatments. She has been
losing weight recently and fears she also has breast cancer. To deal
with the stress she has been drinking 4-5 glasses of wine daily after
work. Which of the following factors is protective against her risk of
suicide?
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A. She’s a physician
B. Her mother committed suicide so she knows how to cope
C. Her religion
D. She doesn’t have a family to worry about
E. She’s using alcohol to reduce her stress
Risk Factors for Suicide Completion
Factor
Decreased Risk
Increased Risk
History
No previous suicidal behavior
Serious earlier attempt
Age
Younger adults
Older Adults
Substance Use
Little/none
Substance abuse/dependence
Behavior
Not impulsive or violent
Hx of rage and violent behavior
Sex
Female
Male
Race
African American
White
Social Status
Married
Socially Isolated
Family History
No family hx suicide
Parent/close relative committed suicide
Religion
Catholic or Muslim
Jewish or Protestant
Psychotic Symptoms
None
Present
Health
Good health
Chronic Illness
Occupation
Non-professional
Professional
Economic Conditions
Strong Economy
Recession or Depression
Employment
Job Satisfaction
Low Job Satisfaction
• A 35 year old male with a 15 year hx of bipolar disorder presents to
the ED. He has been working nonstop for the last week, with almost
no sleep, on his new quick million scheme. He assures everyone
around him that this time he’s destined to succeed. He has had
episodes of depression to which a psychiatrist had recently
increased his dose of SSRI to treat. He doesn’t drink regularly but
has consumed two beers tonight to celebrate his new plan to get
rich. His wife and kids have been away visiting the in-laws over this
time, but are normally supportive of his condition. Which places him
at greatest risk of suicide?
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A. His alcohol consumption
B. His family is out of town
C. His acute mania
D. His recent increase in SSRI dosage
E. His age
• A 35 year old male with a 15 year hx of bipolar disorder presents to
the ED. He has been working nonstop for the last week, with almost
no sleep, on his new quick million scheme. He assures everyone
around him that this time he’s destined to succeed. He has had
episodes of depression to which a psychiatrist had recently
increased his dose of SSRI to treat. He doesn’t drink regularly but
has consumed two beers tonight to celebrate his new plan to get
rich. His wife and kids have been away visiting the in-laws over this
time, but are normally supportive of his condition. Which places him
at greatest risk of suicide?
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A. His alcohol consumption
B. His family is out of town
C. His acute mania
D. His recent increase in SSRI dosage
E. His age
• Your patient, Mr. White, was found wandering naked through a
supermarket. When questioned he is confused and unable to recall
any information about the date or where he is. The supermarket he
was found in is located very far from his home and Mr. White does
not know how he got there. You discover that he was recently
diagnosed with lung cancer and is distraught over his ability to pay
his medical bills on a high school chemistry teacher’s salary. This has
caused him significant personal stress. What is the most likely
diagnosis?
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A. Dissociate Amnesia with Fugue State
B. Malingering
C. Acute methamphetamine intoxication
D. Brain metastasis from lung cancer
E. Dissociative Identity Disorder
F. Yeah Science!
• Your patient, Mr. White, was found wandering naked through a
supermarket. When questioned he is confused and unable to recall
any information about the date or where he is. The supermarket he
was found in is located very far from his home and Mr. White does
not know how he got there. You discover that he was recently
diagnosed with lung cancer and is distraught over his ability to pay
his medical bills on a high school chemistry teacher’s salary. This has
caused him significant personal stress. What is the most likely
diagnosis?
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A. Dissociate Amnesia with Fugue State (Never saw Breaking Bad)
B. Malingering (Breaking Bad fans)
C. Acute methamphetamine intoxication
D. Brain metastasis from lung cancer
E. Dissociative Identity Disorder
F. Yeah Science!
• A 25 year old male is seen because he has been hearing voices
for the last 2 years. The voices have been getting more
frequent. He says that the mayor is planting these voices in his
head and that they transmit from the TV. He has a flat affect
and a hard time answering questions without getting
distracted and moving from idea to idea. His doctor prescribes
him risperidone. On follow up 3 months later his symptoms
have improved but he now complains of fluid discharge from
his nipples. Abnormalities in which dopamine pathways are
present in this patient and his treatment?
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A. Nigrostriatal
B. Mesolimbic and Nigrostriatal
C. Nigostriatal, Mesolimbic, Tuberoinfundibulum
D. Mesolimbic and Tuberoinfundibulum
E. Nigrostriatal, mesolimbic, mesocortical, tuberoinfundibulum
• A 25 year old male is seen because he has been hearing voices
for the last 2 years. The voices have been getting more
frequent. He says that the mayor is planting these voices in his
head and that they transmit from the TV. He has a flat affect
and a hard time answering questions without getting
distracted and moving from idea to idea. His doctor prescribes
risperidone. On follow up 3 months later his symptoms have
improved but he now complains of fluid discharge from his
nipples. Abnormalities in which dopamine pathways are
present in this patient and his treatment?
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A. Nigrostriatal
B. Mesolimbic and Nigrostriatal
C. Nigostriatal, Mesolimbic, Tuberoinfundibulum
D. Mesolimbic and Tuberoinfundibulum
E. Nigrostriatal, mesolimbic, mesocortical, tuberoinfundibulum
• A 63 year old female with a 30 year history of DM II, CAD and
PUD presents for an evaluation of foot pain. She says for the
last 3 months she has had constant burning pain in both of her
feet. Initially the pain was intermittent but has become
continuous over the last few months. She has tried ibuprofen,
which helped a little, but wants to know if there is anything
else she should be taking. What type of pain medication
would you recommend?
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A. Gabapentin (anticonvulsant)
B. Vicodin (opiate + acetaminophen)
C. Naproxen (NSAID)
D. Meloxicam
E. Acetaminophen
• A 63 year old female with a 30 year history of DM II, CAD and
PUD presents for an evaluation of foot pain. She says for the
last 3 months she has had constant burning pain in both of her
feet. Initially the pain was intermittent but has become
continuous over the last few months. She has tried ibuprofen,
which helped a little, but wants to know if there is anything
else she could be taking. What type of pain medication would
you recommend?
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A. Gabapentin (anticonvulsant)
B. Vicodin (opiate + acetaminophen)
C. Naproxen (NSAID)
D. Meloxicam
E. Acetaminophen
• A 32 year old female presents to the office complaining of 3
years of intermittent nausea and diarrhea. She was referred to
you by a friend because “you’re a good doctor, unlike all those
other quacks I’ve seen.” She is getting frustrated with his
symptoms and just wants an answer. She has seen several GI
specialists who ran multiple tests, including colonoscopy, and
cleared her. While obtaining a history she complains that the
other doctors didn’t listen to her and didn’t give him any
answers about the numbness in her left leg. She apologizes for
speaking ill of other doctors and says that he has been more
stressed than normal because of marital problems. She has
been unable to have sex because she has not had any interest
at all.
• What is the most likely diagnosis?
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A. Illness anxiety disorder
B. Malingering
C. Irritable Bowel Syndrome
D. Factitious Disorder
E. Somatic Symptom Disorder
• What is the most likely diagnosis?
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A. Illness anxiety disorder
B. Malingering
C. Irritable Bowel Syndrome
D. Factitious Disorder
E. Somatic Symptom Disorder
• What should you do to best treat this patient?
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A. Anticonvulsants
B. Schedule regular follow up appointments
C. Immediate inpatient psychiatry
D. Referral to outpatient psychiatry
E. SSRIs
• What should you do to best treat this patient?
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A. Anticonvulsants
B. Schedule regular follow up appointments
C. Immediate inpatient psychiatry
D. Referral to outpatient psychiatry
E. MAOi
• A 35 year old male FedEX driver with a history of MDD is brought to
the ED by his friends due to problems with his vision. They say he
has been “blind as a bat” for the last two weeks and tripping over
everything. When asked about these symptoms he replies
“whatever” and does not seem very upset. He has been taking
sertraline for MDD for the past 3 months. He began feeling
depressed when he started to suspect his wife was cheating on him,
which culminated in him walking in on his wife in bed with the UPS
man 15 days ago. Physical exam is mostly normal with the exception
of appreciable loss of vision. What is this patient’s most likely
prognosis?
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A. Recovery within 1 month.
B. Progressive loss of vision until complete blindness
C. No change because he’s malingering
D. Return of vision with corneal transplant
E. Return of vision after discontinuing Sertraline
• A 35 year old male FedEX driver with a history of MDD is brought to
the ED by his friends due to problems with his vision. They say he
has been “blind as a bat” for the last two weeks and tripping over
everything. When asked about these symptoms he replies
“whatever” and does not seem very upset. He has been taking
sertraline for MDD for the past 3 months. He began feeling
depressed when he started to suspect his wife was cheating on him,
which culminated in him walking in on his wife in bed with the UPS
man 15 days ago. Physical exam is mostly normal with the exception
of appreciable loss of vision. What is this patient’s most likely
prognosis?
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A. Recovery within 1 month.
B. Progressive loss of vision until complete blindness
C. No change because he’s malingering
D. Return of vision with corneal transplant
E. Return of vision after discontinuing Sertraline
• A 16 year old girl is being evaluated in the emergency
department due to a seizure. Psychiatry was was called
because of concern over an eating disorder. You find that the
patient regularly vomits after meals because “she is a fat pig.”
She has also recently starting abusing laxatives to further
reduce any weight gain. On physical exam she is thin and fine
white hair is observed on her body. There is scarring and
callous on her knuckles. She has poor dentition and halitosis.
Her BMI is 16.5. CMP reveals a sodium of 126 mEq/L. What is
the most likely disorder?
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A. Binge Eating Disorder
B. Bulimia Nervosa
C. Anorexia Nervosa
D. Malingering
E. Normal development
• A 16 year old girl is being evaluated in the emergency
department due to a seizure. Psychiatry was was called
because of concern over an eating disorder. You find that the
patient regularly vomits after meals because “she is a fat pig.”
She has also recently starting abusing laxatives to further
reduce any weight gain. On physical exam she is thin and fine
white hair is observed on her body. There is scarring and
callous on her knuckles. She has poor dentition and halitosis.
Her BMI is 16.5. CMP reveals a sodium of 126 mEq/L. What is
the most likely disorder?
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A. Binge Eating Disorder
B. Bulimia Nervosa
C. Anorexia Nervosa
D. Malingering
E. Normal development
• What’s the next best step for this patient?
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A. Hospitalization
B. CBT
C. Psychodynamic Therapy
D. SSRI
E. Food journal with regular follow up and close family support
• What’s the next best step for this patient?
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A. Hospitalization
B. CBT
C. Psychodynamic Therapy
D. SSRI
E. Food journal with regular follow up and close family support
BONUS PHARM QUESTION
• You discover the patient also has major depression. What
medication is contraindicated in this patient?
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A. Sertraline
B. Escitalopram
C. Mirtazapine
D. Amitriptyline
E. Bupropion
BONUS PHARM QUESTION
• You discover the patient also has major depression. What
medication is contraindicated in this patient?
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A. Sertraline
B. Escitalopram
C. Mirtazapine
D. Amitriptyline
E. Bupropion
• A 36 year old male presents to the ED with acute diarrhea. He says
he has also had increased flatulence but denies any other
symptoms. He has no significant medical history except obesity since
childhood. His doctor recently started him on a new medication to
help with this. He does not take any other medications. He was at a
friends house earlier to watch a football game. He ate plenty of pizza
and wings but denies consuming any beer/alcohol. He has no
problems with anxiety, palpitations, insomnia, or decreased
appetitive. Physical exam shows increased bowel sounds. What
medication did his physician start him on?
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A. Amphetamines
B. Orlistat (lipase inhibitor)
C. Topiramate/Phentermine combo
D. Naltrexone/Bupropion combo
E. Lorcaserin
• A 36 year old male presents to the ED with acute diarrhea. He says
he has also had increased flatulence but denies any other
symptoms. He has no significant medical history except obesity since
childhood. His doctor recently started him on a new medication to
help with this. He does not take any other medications. He was at a
friends house earlier to watch a football game. He ate plenty of pizza
and wings but denies consuming any beer/alcohol. He has no
problems with anxiety, palpitations, insomnia, or decreased
appetitive. Physical exam shows increased bowel sounds. What
medication did his physician start him on?
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A. Amphetamines
B. Orlistat (lipase inhibitor)
C. Topiramate/Phentermine combo
D. Naltrexone/Bupropion combo
E. Lorcaserin
Rapid Fire Personality
Disorders
• A 22 year old female who is always in and out of relationships.
She has had multiple suicide attempts in the past, including
taking 6 Tylenol at once, and slashing the top of her forearms.
She loves the nurse that saw her today, stating “she is so
wonderful! Every other nurse I’ve seen is awful. They are
literally the worst people ever.”
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A. Narcissistic
B. Schizotypal
C. Borderline
D. Dependent
E. Obsessive Compulsive
• A 22 year old female who is always in and out of relationships.
She has had multiple suicide attempts in the past, including
taking 6 Tylenol at once, and slashing the top of her forearms.
She loves the nurse that saw her today, stating “she is so
wonderful! Every other nurse I’ve seen is awful. They are
literally the worst people ever.” When you leave the room
after the exam she screams “You’re just leaving me like
everyone else!”
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A. Narcissistic
B. Schizotypal
C. Borderline
D. Dependent
E. Obsessive Compulsive
• A 50 year old software engineer doesn’t go to his companies
Christmas party. His co-workers aren’t surprised as he doesn’t
usually go to work functions. He is polite but quiet. He prefers
to keep to himself and enjoys reading and painting in his spare
time. He denies hearing any voices. His train of thought is
logical and he answers questions without drifting off on
tangents.
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A. Narcissistic
B. Schizoid
C. Borderline
D. Dependent
E. Obsessive Compulsive
• A 50 year old software engineer doesn’t go to his companies
Christmas party. His co-workers aren’t surprised as he doesn’t
usually go to work functions. He is polite but quiet. He prefers
to keep to himself and enjoys reading and painting in his spare
time. He denies hearing any voices. His train of thought is
logical and he answers questions without drifting off on
tangents. His responses are monotone.
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A. Narcissistic
B. Schizoid
C. Borderline
D. Dependent
E. Obsessive Compulsive
http://itsalwayssunny.wikia.com/wiki/Dennis_Reynolds
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A. Narcissistic
B. Schizoid
C. Borderline
D. Dependent
E. Obsessive Compulsive
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A. Narcissistic
B. Schizoid
C. Borderline
D. Dependent
E. Obsessive Compulsive
• An 18 year old college freshmen has been under increased stress
lately. She is visibly annoyed that you are 2 minutes late for the
appointment. She is failing her classes despite sticking with the
same routine that made her valedictorian of her high school class.
She records each of her lectures, watches them twice each. She then
writes down an exact transcription of what her professors say which
is color coded depending on the type of material. She is unable go
through her routine in time for her next class and has recently
missed her last two calculus classes because she was still
transcribing previous lectures and insists on finishing them before
going to the next lecture.
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A. Narcissistic
B. Schizoid
C. Borderline
D. Dependent
E. Obsessive Compulsive
• An 18 year old college freshmen has been under increased stress
lately. She is visibly annoyed that you are 2 minutes late for the
appointment. She is failing her classes despite sticking with the
same routine that made her valedictorian of her high school class.
She records each of her lectures, watches them twice each. She then
writes down an exact transcription of what her professors say which
is color coded depending on the type of material. She is unable go
through her routine in time for her next class and has recently
missed her last two calculus classes because she was still
transcribing previous lectures and insists on finishing them before
going to the next lecture.
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A. Narcissistic
B. Schizoid
C. Borderline
D. Dependent
E. Obsessive Compulsive
• A successful chef and restaurant owner feels guilty because
her drive home takes her through a less well off part of town
that has a large homeless population. To combat this guilt she
decides to open up and fund a soup kitchen in that part of
town. She personally cooks there one night a week. After
doing this for several months she notices that she feels happy
cooking for less fortunate. What defense mechanism is this?
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A. Altruism
B. Reaction Formation
C. Sublimation
D. Displacement
E. Projection
• A successful chef and restaurant owner feels guilty because
her drive home takes her through a less well off part of town
that has a large homeless population. To combat this guilt she
decides to open up and fund a soup kitchen in that part of
town. She personally cooks there one night a week. After
doing this for several months she notices that she feels happy
cooking for less fortunate. What defense mechanism is this?
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A. Altruism
B. Reaction Formation
C. Sublimation
D. Displacement
E. Projection
• Your friend Lloyd is nervous because he recently moved to
Aspen and will be attending a social event with new people.
These people are from a higher SES than he is and he’s
worried that they won’t be accepting of him. You’re late to the
party because you spent the day skiing. You walk in on the end
of his joke “so he says ‘do you love me?’ and she goes ‘No, but
that’s a real nice ski mask!’”. The people laugh and he
proceeds to sit down on the couch and throw peanuts in his
face which causes even more laughter. What defense
mechanism did he use to help with his nerves?
•
•
•
•
•
A. Acting out
B. Regression
C. Humor
D. Isolation
E. Splitting
• Your friend Lloyd is nervous because he recently moved to
Aspen and will be attending a social event with new people.
These people are from a higher SES than he is and he’s
worried that they won’t be accepting of him. You’re late to the
party because you spent the day skiing. You walk in on the end
of his joke “so he says ‘do you love me?’ and she goes ‘No, but
that’s a real nice ski mask!’”. The people laugh and he
proceeds to sit down on the couch and throw peanuts in his
face which causes even more laughter. What defense
mechanism did he use to help with his nerves?
•
•
•
•
•
A. Acting out
B. Regression
C. Humor
D. Isolation
E. Splitting
• A patient presents to the ED with dry cough and severe SOB. A
work up reveals pneumocystic pneumonia. When you explain
that this is an AIDS defining illness he responds “My last
doctor told me I have HIV, but that’s not right. I’m sure this is
just a simple cold.” The patient has lost 15 pounds in the last
two months which he says is due to not eating as much. There
are purple lesions located over his extremities which he says
are “bruises because I’m clumsy”, despite being there for long
periods of time. What defense mechanism is this?
•
•
•
•
•
A. Acting out
B. Denial
C. Isolation
D. Repression
E. Supression
• A patient presents to the ED with dry cough and severe SOB. A
work up reveals pneumocystic pneumonia. When you explain
that this is an AIDS defining illness he responds “My last
doctor told me I have HIV, but that’s not right. I’m sure this is
just a simple cold.” The patient has lost 15 pounds in the last
two months which he says is due to not eating as much. There
are purple lesions located over his extremities which he says
are “bruises because I’m clumsy”, despite being there for long
periods of time. What defense mechanism is this?
•
•
•
•
•
A. Acting out
B. Denial
C. Isolation
D. Repression
E. Supression
• A 12 year old male is sitting in class taking a quiz when his
classmate sitting next to him drops a cheat sheet. His teacher
blames him for it and yells at him in front of the whole class.
Later in the day while playing Monopoly with his younger
brother, he accuses his younger brother of cheating and
punches him in the face. What defense mechanism did he
use?
•
•
•
•
•
A. Displacement
B. Projection
C. Acting out
D. Suppression
E. Normal behavior. Never cheat in Monopoly.
• A 12 year old male is sitting in class taking a quiz when his
classmate sitting next to him drops a cheat sheet. His teacher
blames him for it and yells at him in front of the whole class.
Later in the day while playing Monopoly with his younger
brother, he accuses his younger brother of cheating and
punches him in the face. What defense mechanism did he
use?
•
•
•
•
•
A. Displacement
B. Projection
C. Acting out
D. Suppression
E. Normal behavior. Never cheat in Monopoly.
• What are important components of CBT?
•
•
•
•
•
A. Homework do be done outside of the session
B. Identification/correction of errors in logic
C. Teaching of coping skills
D. Focus on dealing with future experiences
E. All of the above
• What are important components of CBT?
•
•
•
•
•
A. Homework do be done outside of the session
B. Identification/correction of errors in logic
C. Teaching of coping skills
D. Focus on dealing with future experiences
E. All of the above
• What are the limitations to psychodynamic therapy?
•
•
•
•
•
A. Very limited scope. Can only treat certain personality disorders
B. Cannot help deal with deeply repressed issues
C. Very time and resource consuming
D. Requires intense pharmacologic co-therapy
E. Not patient focused
• What are the limitations to psychodynamic therapy?
•
•
•
•
•
A. Very limited scope. Can only treat certain personality disorders
B. Cannot help deal with deeply repressed issues
C. Very time and resource consuming
D. Requires intense pharmacologic co-therapy
E. Not patient focused
• An 18 year old male presents to the clinic for a month increased
stress. He started college 2 months ago. It is the first time that he’s
been away from home. He says that he has been pretty sad because
he misses his family and is getting overwhelmed with work. He has
decreased appetite and he is awake most of the night worried about
doing well in classes. He looks forward to hanging out with his
friends on the weekend and admits that sometimes they go to
parties that serve alcohol. He denies feeling excess guilt, decreased
energy, problems concentrating in class, or suicidal ideation. What is
the most likely diagnosis?
•
•
•
•
•
A. Major Depressive Disorder
B. Dysthymic disorder
C. Adjustment disorder
D. Bipolar II
E. Substance Use Disorder
• An 18 year old male presents to the clinic for a month increased
stress. He started college 2 months ago. It is the first time that he’s
been away from home. He says that he has been pretty sad because
he misses his family and is getting overwhelmed with work. He has
decreased appetite and he is awake most of the night worried about
doing well in classes. He looks forward to hanging out with his
friends on the weekend and admits that sometimes they go to
parties that serve alcohol. He denies feeling excess guilt, decreased
energy, problems concentrating in class, or suicidal ideation. What is
the most likely diagnosis?
•
•
•
•
•
A. Major Depressive Disorder
B. Dysthymic disorder
C. Adjustment disorder
D. Bipolar II
E. Substance Use Disorder
• A 40 year old woman presents to the clinic because she “can’t
stop feeling worthless.” She says she has felt this way the last
few months. Over this time period she has stopped going to
her weekly improv comedy club meetings because she doesn’t
see the point of going anymore. She has slept poorly and lost
5 pounds unintentionally. Her performance at work as a data
analyst is falling because she feels she can no longer
concentrate. What is the most important next step in your
evaluation of this patient?
•
•
•
•
•
A. Immediate inpatient psychiatric treatment
B. Prescribe SSRI
C. CBT
D. CBC, TSH and T4, and Vitamin Levels
E. Assess for Suicide Risk
• A 40 year old woman presents to the clinic because she “can’t
stop feeling worthless.” She says she has felt this way the last
few months. Over this time period she has stopped going to
her weekly improv comedy club meetings because she doesn’t
see the point of going anymore. She has slept poorly and lost
5 pounds unintentionally. Her performance at work as a data
analyst is falling because she feels she can no longer
concentrate. What is the most important next step in your
evaluation of this patient?
•
•
•
•
•
A. Immediate inpatient psychiatric treatment
B. Prescribe SSRI
C. CBT
D. CBC, TSH and T4, and Vitamin levels
E. Assess for Suicide Risk
• An 80 year old male is brought to your office by their
concerned daughter. She states that over the course of the last
year her father has become increasingly more forgetful. He
has forgotten his keys multiple times and has had to call his
daughter to let him into his house. He has trouble recognizing
his grandkids at times. Two months ago the police found him
confused and lost in a gas station 50 miles home. The patient
insists that he’s fine and he’s just had a couple brain farts here
and there. If you could perform a brain biopsy on this patient,
what would you expect to see?
•
•
•
•
•
A. Neurofibrillary tangles consisting of tau protein
B. Spherical tau protein aggregates
C. Lewy Bodies
D. Spongiform cortex
E. alpha-synuclein defects
• An 80 year old male is brought to your office by their
concerned daughter. She states that over the course of the last
year her father has become increasingly more forgetful. He
has forgotten his keys multiple times and has had to call his
daughter to let him into his house. He has trouble recognizing
his grandkids at times. Two months ago the police found him
confused and lost in a gas station 50 miles home. The patient
insists that he’s fine and he’s just had a couple brain farts here
and there. If you could perform a brain biopsy on this patient,
what would you expect to see?
•
•
•
•
•
A. Neurofibrillary tangles consisting of tau protein
B. Spherical tau protein aggregates
C. Lewy Bodies
D. Spongiform cortex
E. alpha-synuclein defects
• A 57 year old patient is brought to your clinic by his son. His
appointment is delayed by 15 minutes because the patient had to
urinate and decided to use the potted plant in your waiting room as
a toilet. His son states that his dad has been acting funny for the
past few months and over the last two weeks he has become
increasingly forgetful. The patient says “Doc, there’s nothing wrong
with me. In fact, what’s your nurses phone number? I’d like to take
her out. My wife won’t find out.” Prior to this recent behavior, the
patient was a quiet, stern retired military man. What is the most
likely diagnosis?
•
•
•
•
•
A. Alzheimer Disease
B. Creutsfeldt-Jakob Disease
C. Frontotemporal Dementia
D. Lewy Body Dementia
E. Vascular Dementia
• A 57 year old patient is brought to your clinic by his son. His
appointment is delayed by 15 minutes because the patient had to
urinate and decided to use the potted plant in your waiting room as
a toilet. His son states that his dad has been acting funny for the
past few months and over the last two weeks he has become
increasingly forgetful. The patient says “Doc, there’s nothing wrong
with me. In fact, what’s your nurses phone number? I’d like to take
her out. My wife won’t find out.” Prior to this recent behavior, the
patient was a quiet, stern retired military man. What is the most
likely diagnosis?
•
•
•
•
•
A. Alzheimer Disease
B. Creutsfeldt-Jakob Disease
C. Frontotemporal Dementia
D. Lewy Body Dementia
E. Vascular Dementia
• You are seeing a 21 year old college student. He scheduled an
appointment because he wants help dealing with anxiety. Public
speaking has always made him nervous and he is currently taking a
class that requires one oral presentation a week. When he tried to
present last week he noticed that his heart was racing, his heart was
racing, and his finger tips felt tingly. He broke out into a sweat while
presenting and was very embarrassed. He denies feeling nervous
outside of these presentations. He is normally a laid back person,
has an active social life, sleeps normally. Physical exam does not
reveal anything abnormal. What treatment is most appropriate at
this time?
•
•
•
•
•
A. Propranolol
B. Escitalopram
C. Alprazolam
D. Moderate ethanol intake prior to presentations
E. Amitriptyline
• You are seeing a 21 year old college student. He scheduled an
appointment because he wants help dealing with anxiety. Public
speaking has always made him nervous and he is currently taking a
class that requires one oral presentation a week. When he tried to
present last week he noticed that his heart was racing, his heart was
racing, and his finger tips felt tingly. He broke out into a sweat while
presenting and was very embarrassed. He denies feeling nervous
outside of these presentations. He is normally a laid back person,
has an active social life, sleeps normally. Physical exam does not
reveal anything abnormal. What treatment is most appropriate at
this time?
•
•
•
•
•
A. Propranolol
B. Escitalopram
C. Alprazolam
D. Moderate ethanol intake prior to presentations
E. Amitriptyline
• A patient presents because he wants treatment for his anxiety.
Everyday he has thoughts of people ridiculing him for his
choice of pants. He feels like he has to change his pants 4
times every day until he finds the right pair. Despite his
roommate assuring him that all his pants look the same, he
needs to change his pants 4 times or else he gets terrible
anxiety. He has been late to class many times because of this,
which is causing his grades to slip. This patient also has an
additional condition he sees a psychiatrist for. The other
condition is probably…
•
•
•
•
•
A. MDD
B. Tourette’s Syndrome
C. Obsessive compulsive personality disorder
D. Illness anxiety disorder
E.Bipolar Disorder
• A patient presents because he wants treatment for his anxiety.
Everyday he has thoughts of people ridiculing him for his
choice of pants. He feels like he has to change his pants 4
times every day until he finds the right pair. Despite his
roommate assuring him that all his pants look the same, he
needs to change his pants 4 times or else he gets terrible
anxiety. He has been late to class many times because of this,
which is causing his grades to slip. This patient also has an
additional condition he sees a psychiatrist for. The other
condition is probably…
•
•
•
•
•
A. MDD
B. Tourette’s Syndrome
C. Obsessive compulsive personality disorder
D. Illness anxiety disorder
E.Bipolar Disorder
• A patient comes to your clinic because of difficulty sleeping. He is
currently unemployed and spends most of his day sitting in bed
watching television. He has tried taking a shot of whiskey before bed
each night but finds that he doesn’t feel any better rested the next
morning. He doesn’t remember the last time he exercised. He has an
erratic schedule and goes to bed at different times each night. He is
consistent with his dinner each night, however, and always makes
sure to eat at 7pm daily with a Mountain Dew to wash it down. If he
can’t fall asleep right away he will surf the web on his phone for a
half hour or so waiting to get sleepy. What is the most important
initial treatment for this patients insomnia?
•
•
•
•
•
A. Increase his night cap to 2 shots daily
B. Benzos
C. 30 minutes of cardio prior to bed
D. Sleep hygiene education
E. Ambien or other Z-drugs
• A patient comes to your clinic because of difficulty sleeping. He is
currently unemployed and spends most of his day sitting in bed
watching television. He has tried taking a shot of whiskey before bed
each night but finds that he doesn’t feel any better rested the next
morning. He doesn’t remember the last time he exercised. He has an
erratic schedule and goes to bed at different times each night. He is
consistent with his dinner each night, however, and always makes
sure to eat at 7pm daily with a Mountain Dew to wash it down. If he
can’t fall asleep right away he will surf the web on his phone for a
half hour or so waiting to get sleepy. What is the most important
initial treatment for this patients insomnia?
•
•
•
•
•
A. Increase his night cap to 2 shots daily
B. Benzos
C. 30 minutes of cardio prior to bed
D. Sleep hygiene education
E. Ambien or other Z-drugs
• A 53 year old female comes to ED with acute onset RLQ pain.
Workup reveals acute appendicitis. She has a successful
laparoscopic appendectomy that night. Two days after her
surgery the patient complains that there are insects crawling
all over her skin. Her nurse denies ever seeing any bugs in her
room. When you go to examine the patient she appears to be
speaking to someone in the corner of her room that isn’t
there. While performing your physical exam she has a tonicclonic seizure. What is the most likely explanation for her
symptoms?
•
•
•
•
•
A. Alcohol intoxication
B. Alcohol withdrawal
C. Opioid withdrawal
D. Hallucinogen intoxication
E. PCP intoxication
• A 53 year old female comes to ED with acute onset RLQ pain.
Workup reveals acute appendicitis. She has a successful
laparoscopic appendectomy that night. Two days after her
surgery the patient complains that there are insects crawling
all over her skin. Her nurse denies ever seeing any bugs in her
room. When you go to examine the patient she appears to be
speaking to someone in the corner of her room that isn’t
there. While performing your physical exam she has a tonicclonic seizure. What is the most likely explanation for her
symptoms?
•
•
•
•
•
A. Alcohol intoxication
B. Alcohol withdrawal
C. Opioid withdrawal
D. Hallucinogen intoxication
E. PCP intoxication
• A 24 year old male patient comes to the clinic seeking
assistance for smoking cessation. He has made several
attempts to quit cold turkey but has been unable to do so. He
recently got promoted at his job but has not been performing
well because he has had difficulty concentrating. His inability
to quit smoking combined with his failings at work have him
feeling depressed and worthless. What treatment would be
best for this patient to assist his smoking cessation?
•
•
•
•
•
A. Continue to encourage quitting cold turkey
B. Varenicline
C. Sertraline (SSRI)
D. Switch to chewing tobacco
E. Bupropion
• A 24 year old male patient comes to the clinic seeking
assistance for smoking cessation. He has made several
attempts to quit cold turkey but has been unable to do so. He
recently got promoted at his job but has not been performing
well because he has had difficulty concentrating. His inability
to quit smoking combined with his failings at work have him
feeling depressed and worthless. What treatment would be
best for this patient to assist his smoking cessation?
•
•
•
•
•
A. Continue to encourage quitting cold turkey
B. Varenicline
C. Sertraline (SSRI)
D. Switch to chewing tobacco
E. Bupropion