Psychiatry (PACKRAT 9, 11, 12, 13, 14, 15) Test 2

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Psychiatry (PACKRAT 9, 11, 12, 13, 14, 15) Test 2 History & Physical/Psychiatry/Behavioral Medicine A patient with obsessive-compulsive disorder would most likely have which of the following findi... ngs? Answers A. Raw, red hands B. Priapism C. Memory impairment D. Abdominal pain - ANS - Explanations (c) A. Common manifestations of obsessive-compulsive disorder include phobias of germ and contaminants, which results in frequent hand washing leading to chafe and reddened hands. The other answers are inconsistent with obsessive-compulsive disorder. (u) B. See A for explanation. (u) C. See A for explanation. (u) D. See A for explanation. Diagnostic Studies/Psychiatry/Behavioral Medicine A 19 year-old female presents with complaints of intermittent abdominal pain associated with recent, frequent episodes of regurgitation of food for the past several months and worsening over the past 12 hours. She maintains a normal weight for her height however she seems obsessed with losing weight. On examination the physician assistant notes multiple dental caries, bilateral tenderness of the parotid glands and mild epigastric tenderness. Which of the following findings would you expect to find on laboratory tests to support your suspected diagnosis? Answers A. hypokalemia B. hypocalcemia C. hyperchloremia D. hypermagnesemia - ANS - Explanations (c) A. This patient most likely has bulimia nervosa - purging type. Self-induced vomiting is the most common method of purging and this is supported by the physical examination findings noted in this patient. Laboratory findings to support this diagnosis include hypochloremia with subsequent hypokalemia due to renal compensatory mechanisms, hypomagnesemia and metabolic alkalosis. (u) B. See A for explanation. (u) C. See A for explanation. (u) D. See A for explanation. Diagnostic Studies/Psychiatry/Behavioral Medicine A divorced female patient presents for an employment physical. She states she has had a "run of bad luck" with jobs and has not been able to hold any job for longer than 2-3 months. She also states she has been arrested several times for getting into fights when she is out with the girls. She states she drinks an occasional beer, but denies any significant problems with alcohol. Which of the following laboratory findings would support your suspected diagnosis? Answers A. decreased triglycerides B. decreased serum uric acid C. increased LDL cholesterol D. increased mean corpuscular volume - ANS - Explanations (u) A. See D for explanation. (u) B. See D for explanation. (u) C. The primary lipid abnormalities demonstrated with alcoholism are increased triglycerides and increased HDL cholesterol, not LDL cholesterol. (c) D. This patient most likely has alcohol abuse as evidence by her social, occupational and legal issues. Laboratory tests will reveal the presence of an elevated mean corpuscular volume, triglycerides, serum uric acid and liver function tests. Diagnosis/Psychiatry/Behavioral Medicine A 20 year-old male presents to the ED with complaints of palpitations and agitation, which developed suddenly while attending a party. On examination, the patient is moderately agitated and tremulous. Vital signs include a pulse of 110/minute and regular; respiratory rate 22/minute and blood pressure 160/92 mmHg. Skin is diaphoretic and pupils are dilated. Which of the following is the most likely diagnosis? Answers A. Heroin use B. Cocaine use C. Scombroid ingestion D. Alcohol intoxication - ANS - Explanations (u) A. Opioids, such as heroin produce euphoria, drowsiness and constricted pupils. Severe intoxication causes bradycardia, respiratory arrest, and hypotension. (c) B. Cocaine, as well as amphetamines, leads to a clinical picture of increased sympathetic stimulation and dilated pupils. (u) C. Clinical findings of scombroid include flushing, reversal of hot and cold sensations and hives. (u) D. Alcohol, as well as barbiturates and sedative-hypnotic agents, cause central nervous system depression, leading to bradycardia and hypotension. Diagnosis/Psychiatry/Behavioral Medicine A 53 year-old man with a history of hypertension is being treated with atenolol (Tenormin). He currently presents complaining of chronic fatigue, insomnia, decreased appetite, and difficulty concentrating for the past 3 weeks. His wife also notes that he no longer goes bowling with his friends and has lost interest in any sexual intimacy. Physical examination is unremarkable. Which of the following is the most likely diagnosis? Answers A. major depression B. dysthymic disorder C. atypical depression D. drug-induced depression - ANS - Explanations (c) A. Diagnostic criteria for a major depressive disorder include a loss of pleasure in usual activities, vegetative or physical changes (poor appetite, loss of energy), and cognitive changes such as difficulty in concentrating. (u) B. A dysthymic disorder is a chronic depressive disorder whose symptoms are milder, but longer lasting (> 2 years) than those in a major depressive episode. (u) C. Atypical depression is characterized by hypersomnia, overeating, lethargy, and rejection sensitivity, which are not present in this case. (u) D. While beta-blockers may cause fatigue and sleep disturbances, they do not cause a depressive disorder. Diagnosis/Psychiatry/Behavioral Medicine A 56 year-old man is admitted to a hospital unit for evaluation of rectal bleeding and weight loss. He has a strong family history of cancer. Soon after admission, a barium enema is scheduled. The patient refuses the "prep" because he f [Show More]

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