#Psychiatry#Loctorio

A 34-year-old woman seeks the advice of her primary care provider because she has struggled with her weight through adulthood. She explains that over the past 10 years, it has become routine for her to eat large amounts of food at a time, and she feels she cannot control her intake. This has led to a weight gain of 45.4 kg (100 lb). The patient has not been successful in maintaining any weight loss she has achieved through diet and exercise. She denies any underlying cardiac issues, history of manic behavior, or substance abuse. Which medication is approved for the treatment of her condition as well as for attention-deficit hyperactivity disorder?

After a shooting at his school, a 26-year-old teacher begins to experience increased anxiety when he thinks about the event, vivid dreams about this trauma, and flashbacks. This has been going on for 2 months. He denies a history of mental illness before this. He seeks the help of his school counselor, who is able to work with him weekly to address these symptoms. In addition to counseling, which medication is most appropriate for this patient to start to help manage these symptoms?

A 24-year-old woman consults with her primary care provider due to fatigue, marked mood swings and irritability, anxiety, difficulty concentrating, and a feeling of bloating almost every month around the same time for a week before her menses. The symptoms resolve a few days after her menses, and she is asymptomatic for at least 2 weeks afterward. She feels frustrated because these symptoms have impacted her ability to be effective at work, and have caused conflict in her personal relationships. She denies a history of mood disorder, trauma, or substance abuse. She takes no medication. Based on the suspected diagnosis, which of the following medications is an appropriate option to help manage her psychological complaints?

A 19-year-old man is seen in the primary care setting for mental health complaints. He reports feeling down, with a loss of interest in activities he used to enjoy on a daily basis, since starting university classes 4 months ago. The patient states his mood is impacting his ability to focus and eagerness to engage with others. He also feels more fatigued, but denies restlessness or excessive worry. He denies a history of substance abuse. The patient has no medication allergies or other underlying medical conditions. After a thorough history, an examination, and lab testing, the provider determines the patient would benefit from therapy as well as medication. First-line pharmaceutical therapy for his condition is aimed at raising levels of which of the following?

A 2-year-old boy is referred for further evaluation for language delays and abnormal behavioral patterns observed over the past year. He does not speak or make direct eye contact. He is not affectionate and is distressed when he is touched or hugged. His parents report observing him banging his head on objects repeatedly at times when he is stressed. An electroencephalogram and auditory studies have already been conducted and are unremarkable. What is the child's most likely diagnosis?

A33-year-old man returns for a follow-up visit in the primary care settling As part of the intake, a depression screening questionnaire is administered, indicating the patient has suicidal thoughts He has been taking sertraline for depression for the past 6 months. In addition to depression, which of the following risk factors is most highly correlated with attempted surade?

A 38-year-old man has been arrested for threatening to take his spouse's life by means of a firearm. He undergoes a psychiatric assessment during the intake process. He reports that his spouse has been following him and that she deserves to be killed for not trusting him. Furthermore, he is oriented to person, place, and time, but appears agitated, is sweating, and his speech is disorganized. His past medical history is negative for significant illness. His assessment also includes drug testing, which is positive for methamphetamine, Which of the following is the most likely contributing cause to his behavior?

A 33-year-old woman complains of intense mood swings, increased appetite, irritability, a feeling of bloating, social withdrawal, and poor concentration occurring 1-2 weeks prior to her period almost every month over the past 3 years. Which strategy can she apply on her own to help improve these symptoms?

A 36-year-old woman with no significant past medical history presents to the clinic with a 2-month history of poor sleep, fatigue, emotional lability, and depressed mood which all occurred after her mother's unexpected death. She also reports a suboptimal performance review at work, which cited difficulty concentrating and failure to meet deadlines. She expresses feelings of worthlessness and has to force herself to stay engaged in her children's activities and events that she usually enjoys. She denies any history of mania, hypomania, psychosis, or hospitalization. Vital signs, physical examination, and routine blood work are within normal limits. You diagnose the patient with major depressive disorder and choose to start her on fluoxetine. Which of the following is the most likely adverse effect the patient would experience with this medication?

Women with premenstrual dysphoric disorder (PMDD) are most likely to experience symptoms during which part of their menstrual cycle?

A 16-year-old girl is seen in the pediatric outpatient setting for a routine wellness examination. She tells her provider that she is participating on the gymnastics team and continues to do well in school. In contrast to her history and examination 2 years ago, she reports missing her periods. A weight loss of 4.5 kg (10.0 lb) is noted, resulting in a body mass index of 17. The patient has no known underlying medica) cause for this weight loss, and her mother expresses concern about her daughter's obsession with eating low-fat and low-calorie foods and refusing to eat anything that she did not prepare horsell. What is a potential complication of this patient's condition if left untreated?

A3-year-old boy presents to the pediatric cutpatient setting for an annual examination. Multiple bruises are noted to his body at different stages of healing. Bruising to which of the following body pans should raise suspicion for abuse?

A mother presents with ner 9-month-old daughter to the emergency department. The mother states that when she arrived home aller work, she found her baby in the crib acting lethargic after having had a vorniting episode. Her chid had been home with a new babysitter for the day and had been perfectly fine in the maming. The babysitter denied noting any issues. The child's vital signs are within normal limits. On examination, the baby is alert and responsive to voice, but is lethargic. The patient is afebrile and has normal signs. Which of the following life-threatening conditions should be considered in the differential cagnosis?

A 34-year-old woman presents to her primary care provider seeking a mental health consultation. She reports frequent feelings of guilt, decreased energy, poor concentration, a decrease in appetite, and increased somnolence, all of which are affecting her ability to function at the capacity she was able to a few months ago. She denies impulsive or irrational behaviors. Furthermore, she is otherwise healthy, takes no medications other than a daily vitamin, and has no history of substance abuse. Which of the following symptoms is part of the diagnostic criteria used to classify her condition as major depressive disorder (MDD)?

Parents of an 18-month-old toddler return to their healthcare provider for a follow-up visit. At 14 months, the boy was not responding to his name, making facial gestures, or making eye contact with others, these signs have continued. To date, he does not speak. He is ambulatory and can leed himself, but when sitting still, he taps his hands on his ap. The boy is also extremely sensitive to loud noises He was born at term without any complications during pregnancy or delivery. The parents deny any history of seizures, abuse, or trauma. Other than the behavioral issues mentioned previously, the boy's physical examination is within normal limits. What is his most likely diagnosis?

A 17-year-old girl with anorexia is being treated in the inpatient setting due to the severity of her condition. In addition to talk therapy, part of her rehabilitation involves increasing her caloric intake. What potentially serious complication can occur if too much food is introduced in the initial days after the patient has been starving herself?

A 35-year-old woman has recently been diagnosed with major depressive disorder (MDD) based on history, lab results, and her PHQ-9 results. Her provider has recommended cognitive behavioral therapy (CBT). Which of the following best describes this treatment approach?

A 17-year-old girl is referred to her school-based health center after she was found for the second time vomiting in the women's bathroom after lunch. The student is defensive and says she had a stomach ache, but after further discussion, she reports this becoming a routine behavior after eating "loo much". Her vital signs are within normal limits; however, in comparison to her last visit 6 months ago, her weight is 8 lb (3.6 kg) lower. On examination, her face appears to be bloated yet her body appears underweight with a BMI of 18. Her breath smells slightly acidic, but her dentition is within normal limits. The rest of her examination is unremarkable. The provider explains that in addition to getting a more thorough history, it is helpful to perform some lab work to help assess her health. With a parent's permission, labs are performed. Which of the following levels is likely to be lower than normal?

A 33-year-old woman with a history of major depressive disorder tells her primary care provider that she feels lite is no longer worth living. The patient denies having a plan to harm herself and has no history of substance abuse. She has been taking sertraline 100 mg daily for the past year to manage her condition. Before discharging the patient, the provider asks about home safety. The patient lives alone and reports having access to firearms in the home. What step should be taken to reduce the patient's risk of harming herself?

4-year-old boy with developmental delays, who was recently transferred to foster care due to Violence and instability at home, is brought to the pediatric clinic by his new foster parents. They have observed that about 30 minutes after almost every meal, he appears to regurgitate his food, chew it, and swallow it again. Occasionally, he spits it out. He also has occasional constipation but no diarrhea. His vital signs are normal, and he is not underweight according to his body mass index. On examination, poor dentition is noted. The boy's abdominal examination is negative for tenderness or masses. His skin is free of bruising other than to his right knee. The child is referred for a swallowing study and ultrasound scan, both of which came back normal. What is the patient's diagnosis?

In the outpatient pediatric clinic, a 3-year-old boy on the examination table before his exam cries that he is "afraid of the doctor." The patient's mother firmly grabs him on the wrist and yanks his arm while shouting "stop crying!" What is the best way for the clinician to react to this situation?

A 27-year-old man presents to his primary care provider with a complaint of feeling helpless and depressed. He states the symptoms have worsened over the past 3 months, and he is not sure what to do. He denies substance or alcohol abuse, and denies suicidal thoughts. Which of the following patient questionnaires can be used to help screen for major depression and psychosocial impairment?

Which of the following underlying conditions is known to cause symptoms that mimic major depressive disorder (MDD)?

A 44-year-old single woman presenting for her annual wellness visit has a review of symptoms positive for psychiatric symptoms of decreased self-esteem, hopelessness, and difficulty sleeping. She reports having experienced these symptoms nearly every day for the past 2 years. She sought the support of a therapist three months ago, but feels she may need to start medication. She denies impulsive or irrational behaviors. Otherwise, she is healthy and denies substance abuse. What is her most likely diagnosis?

Patients with persistent depressive disorder (dysthymia) can experience symptoms of apathy and depression. Which of the following is considered a symptom of apathy?

Before menses, some women experience several symptoms related to hormonal fluctuations during the luteal phase, including markedly depressed mood, feelings of hopelessness or self-deprecating thoughts, irritability, anxiety, sleep, appetite changes, change in concentration, as well as physical symptoms like bloating and breast and joint discomfort. The symptoms start to improve a few days after menses. Approximately what percentage of these patients attempt suicide?

Patients presenting with post-traumatic stress disorder (PTSD) often have another underlying mental illness. Which Axis II disorder is most commonly associated with PTSD?

When a physician associate is evaluating a patient with an eating disorder, which determinant on its own warrants inpatient management?

A 23-year-old woman is seen in the primary care setting for an annual wellness examination. A review of symptoms reports increased fatigue and loss of interest in previously pleasurable activities. Upon further questioning by the provider, the patient reveals thoughts of hopelessness and of ending her life. It is established that the patient does not have a plan in place to end her life. Her family history is positive for depression (in a sibling). Her medical history and social history are negative for chronic illnesses or substance abuse. Her physical examination is within normal limits, with no evidence of self-harm. What is the best next step in managing this patient?

In the outpatient primary care setting, a provider is reviewing the medical and social history of a 23-year-old man who reports decreased ability to concentrate as well as increased anxiety, particularly regarding his eating habils. The patient reports that over the past year, he has become stricter about the types of foods he eats and has eliminated foods from his diet that he feels could be unhealthy such as processed foods, meats, and cheese. He denies counting calories, but he eats his meals at the same time each day and measures the portions. His body mass index is currently within a healthy weight range, and he denies any gastrointestinal changes. Routine laboratory tests are performed and reveal a low vitamin B12 level and mild iron-deficiency anemia. What is the patient's most likely diagnosis?

A 4-year-old child is seen in the pediatric setting for a routine wellness examination. He has been in and out of foster care as a result of living in a household where he was subjected to neglect. His current caregiver reports that the child grows anxious around mealtime and refuses to finish what he is served. His guardian also reports that in the child's prior home setting, meals were not regularly scheduled and lacked nutritional value. At this visit, the patient's weight is noted to have fallen from the 25th percentile to the 5th percentile. His physical examination and labor results are not indicative of an underlying medical issue, and he demonstrates no developmental delays. What is an appropriate strategy for improving the child's daily consumption to support weight gain?

A 43-year-old woman presents to her primary care provider for a mental health consultation. The patient reports frequent feelings of guilt, decreased energy, poor concentration, a decrease in appetite, and increased somnolence, all of which affect her ability to function at the capacity she was able to a few months ago. She denies impulsive or irrational behaviors. She reports that her sister and mother both suffer from major depression. She is otherwise healthy, does not take any medications other than a daily vitamin, and has no history of substance abuse. To what degree does this family history increase her risk of having depression as well?

Major depressive disorder (MDD) is known to be significantly more common among which of the following patient populations?

In the primary care outpatient setting, a 16-year-old girl accompanied by her father is being evaluated because she has had missed periods over the past 4 months. She is a cross-country runner for her high school and runs almost every day. Her father is also concerned about a notable weight loss over the past year and decreased food intake. The patient's pulse rate is 56/min and her blood pressure is 98/64 mm Hg. She reports decreased stamina when exercising. The provider orders fasting lab tests including thyroid function testing, a complete blood count, a metabolic panel, prolactin, luteinizing hormone, and follicle-stimulating hormone levels. All the results are within normal limits, and the patient's urine pregnancy test is negative. Which test would determine if the patient meets the criteria for the female triad?

Paramedics bring a 6-month-old boy into the emergency department after receiving a call from his mother. The mother states she was frantic after losing her temper and shook the crying baby, who appeared to subsequently lose consciousness and then vomited. In the emergency department, the infant's neurological examination is within normal limits. However, retinal hemorrhages are noted on ophthalmological examination. What is the best study in order to definitively rule out a head injury in this child?

Psychiatry