2 Qs, NBME clinical mastery form 3 PSYCH, help! - iamzining

[ArchivalUser]

Just did it online, got 2 questions wrong, need help please!
BTW, if someone need correct answers for other 48 questions, please post here and and I will tell you the right answer according to my choice

1. A 28 year-old man is brought to the emergency department because of flu-like symptoms and cough productive of clear sputum for 24 hours. He has been hospitalized eight times over the past 5 years because of bizarre delusions and hallucinations during which a voice tells him what to do. He has a 9-year history of type 1 diabetes mellitus. In addition to insulin, he is receiving clozapine theraphy(400mg daily) for his psychotic condition. During mental status examination, he is hallucinating and says that he is being pursued by special agents of the government. Leukocyte count is 2750/mm3, and serum glucose concentraion is 140mg/dL. Urinalysis is within normal limits. Which of the following is the most appropriate next step in managment?
A.add lithium carbonate therapy
B.add penicillin therapy
C.decrease the dose of clozapine
D.discontinue clozapine therapy
E. increase the dose of clozapine

2.A 25-year-old woman comes to the physician at her husband's request because of increasing irritability and tense mood over the past year. Her husband would like to start a family, and he is concerned about her ability to handle the added responsibility. She says that she worries about their finances despite the fact that they have no debt and she and her husband have jobs that pay well. Her pulse is 84/min, and blood pressure is 120/70mmHg. Physical examination shows no abnormalities except for sweaty palms. Mental status examination shows tension and anxiety. She admits to occasional difficulty sleeping and periods of mild depression but does not think that this is our of the ordinary. Laboratory studies show:
Hematocrit 38%
Erythrocyte count 4 million/mm3
Leukocyte count 5500/mm3
Serum
Thyroid-stimulating hormone 0.5 uU/mL
Thyroxine(T4) 12 ug/dL
Toxicology screening is negative. Which of the following is the most appropriate pharmacotherapy for this patient?
A. Bupropion
B. Buspirone
C. Levothyroxine
D. Methimazole
E. Quetiapine

[ArchivalUser]

E - clozapine is the most effective antipsychitoc and his blood work allows the increase of dosage

B - general anxiety disorder, first line is SSRI but buspirone/ clomipramine is 2nd line

[ArchivalUser]

agree

[ArchivalUser]

1.D; flu-like symptoms and cough productive of clear sputum for 24 hours, WBC is low. clozapine --> agranulocytosis (confirmed answer)
2.B; (confrimed)

if you don't mind, can you please let me know the answers for these questions? thx!

4. A 5-year-old boy has had temperatures to 38.9°C (102°F), cough, and coryza for 2 days and visual hallucinations of animals and people for 2 hours. His mother has been giving him an over-the-counter cold medicine for 24 hours, but it has not relieved his symptoms. His temperature is 38.8°C (101.8°F). Examination shows a clear nasal discharge. Which of the following is the most likely reason for the child's hallucinations?
A) Behavioral abnormalities
B) Drug toxicity
C) Hyperpyrexia
D) Increased intracranial pressure
WRONG E) Neuronal inflammation

9. A previously healthy 27-year-old woman comes to the physician because of a 2-month history of crying spells, poor concentration, fatigue, and lethargy. She says that she sleeps at least 12 hours daily and is no longer interested in socializing. She recently broke up with her boyfriend of 10 months, and her work performance has begun to decline; she is afraid that she will lose her job if it does not improve. She does not drink alcohol or use illicit drugs. Menses occur at regular 28- to 30-day intervals. Her last menstrual period was 2 weeks ago. She has had a 9-kg (20-lb) weight gain over the past 9 months. She is 168 cm (5 ft 6 in) tall and weighs 66 kg (145 lb); BMI is 23 kg/m2. Physical examination shows no abnormalities. Mental status examination shows a sad mood and restricted affect. Which of the following is the most likely diagnosis?
WRONG A) Adjustment disorder with depressed mood
B) Dysthymic disorder
C) Generalized anxiety disorder
D) Major depressive disorder
E) Premenstrual dysphoric disorder

11. A 67-year-old woman, whose husband died 18 months ago, is admitted to the hospital because of severe headaches for 4 weeks. She is quiet and seems sad. She believes that she has brain cancer, deserves to be punished for her sins, and is being punished by God for past misdeeds. She has had fatigue and a 6.8-kg (15-lb) weight loss over the past 4 months. Physical and neurologic examinations show no abnormalities. Which of the following is the most likely diagnosis?
A) Adjustment disorder with mixed disturbance of emotions and conduct
WRONG B) Delusional disorder
C) Major depressive disorder
D) Schizophrenia
E) Somatization disorder
14. A 27-year-old man comes to student health services because of a 6-week history of increasingly severe insomnia and persistent fatigue. During this time, he also has had feelings of guilt, emptiness, hopelessness, and profound sadness. He is a graduate student and has withdrawn from most social activity. He says that during the past 4 years he has heard "Sauron" from a fantasy novel instructing him to renounce his family and forswear all sexual activity. He notes that he has had two episodes of depressed mood during the past 2 years. He began sertraline therapy during the second episode and had improvement in his mood; he discontinued the therapy 6 months ago because he was feeling well apart from intermittent hallucinations. He has no other history of serious illness and currently takes no medications. Physical examination shows no abnormalities. On mental status examination, he has a depressed mood and restricted affect. His thought processes are mildly tangential. He does not appear to be responding to internal stimuli. He has not had suicidal ideation. Which of the following is the most likely diagnosis?
A) Dysthymic disorder
WRONG B) Major depressive disorder with psychotic features
C) Schizoaffective disorder
D) Schizophrenia
E) Schizotypal personality disorder

15. A 16-year-old boy comes to the physician because of a 1-year history of progressive headaches that have caused him to miss several days of school. They now occur daily and are always present on awakening in the morning. He describes the headaches as a diffuse, constant pressure that occasionally throbs. He feels better after taking acetaminophen and resting in front of the television for 10 to 20 minutes. He has not noticed any particular events that cause the headaches, and he says that they are not exacerbated by light, sound, coughing, or straining. He has not had nausea or vomiting. Two months ago, he sustained a whiplash injury in a motor vehicle collision. His parents say that he snores loudly. His mother and maternal aunt have migraines, and his father has major depressive disorder. The patient is 168 cm (5 ft 6 in) tall and weighs 86 kg (189 lb); BMI is 31 kg/m2. He breathes through his mouth. Respirations are 20/min. Examination shows 3 to 5 beats of jerk nystagmus with far lateral gaze bilaterally. Which of the following is the most likely cause of this patient's headaches?
A) Hydrocephalus
WRONG B) Idiopathic intracranial hypertension
C) Major depressive disorder
D) Migraine
E) School-related anxiety
F) Sleep-related hypoventilation

18. A 47-year-old woman comes to the physician because she has had difficulty sleeping at night since her youngest daughter left for college 2 months ago. During the past week, she has been struggling to stay awake at work. She drinks two to three cocktails to help her fall asleep and 3 to 4 oz of vodka in the morning to help calm her nerves. She is often anxious and has frequent heartburn. She was told by her physician that the heartburn is likely caused by her alcohol consumption. She does not want to alter her routine because she has become increasingly anxious and irritable when she has tried to do so. Her temperature is 37.2°C (99°F), pulse is 90/min, respirations are 12/min, and blood pressure is 150/90 mm Hg. Physical examination shows no other abnormalities. On mental status examination, she is mildly anxious but polite and friendly. She says that she is not depressed but that it was difficult for her to adjust when her daughter first left for college. Laboratory studies show:

Erythrocyte count 3500/mm3
Mean corpuscular volume 102 μm3
Leukocyte count 4500/mm3
Serum
Mg2+ 1.5 mEq/L
Thyroid-stimulating hormone 3.5 μU/mL
AST 40 U/L
ALT 25 U/L

An ECG shows a normal sinus rhythm. Which of the following is the most likely diagnosis?
WRONG A) Adjustment disorder
B) Alcohol dependence
C) Circadian rhythm sleep disorder
0) Generalized anxiety disorder
E) Major depressive disorder
F) Primary insomnia

24. A 29-year-old man comes to the physician because of the inability to maintain an erection through completion of sexual activity. He has been married for 3 months and has not been able to complete coitus over the past 2 months. He is usually able to attain an erection by direct penile stimulation and is often aware of nocturnal erections when waking during the night. For the past month, he and his wife have attempted to have intercourse about twice a week. He drinks several alcoholic beverages before engaging in sexual activity in an effort to relax. He has had two major depressive episodes over the past 4 years and was successfully treated with desipramine; he has not taken the medication since his marriage. He has borderline hypertension but takes no medications for it. He has a strong family history of type 2 diabetes mellitus. He takes ranitidine for stomach problems. His vital signs are normal. Cranial nerve function appears normal. He walks normally. Laboratory studies show:
Hemoglobin11 g/dl
Platelet count 178,000/mm3

Serum
Fasting glucose 86 mg/dl
y-Glutamyltransferase 70 U/L (N=5-50)


Which of the following is the most likely explanation for these findings?
A) Alcohol use
B) Desipramine therapy
C) Diabetes mellitus
D) Generalized anxiety disorder
E) Major depressive disorder
F) Marital conflict
WRONG G) Ranitidine therapy

25. A 7-year-old boy is brought to the physician by his adoptive parents because of ongoing concern about his behavior and academic performance. He is two grade levels behind his peers in reading and frequently has fights with other children. He has no history of serious illness and takes no medications. His biological mother abused multiple substances before and during pregnancy. On adoption at the age of 15 months, there was some evidence that she may have physically abused him. He is at the 10th percentile for height and 5th percentile for weight. His pulse is 82/min, and blood pressure is 116/78 mm Hg. Examination shows a flattened nasal bridge, a long philtrum, and prominent ears. During the interview, he is friendly but becomes frustrated and distracted and is unable to sit still. Which of the following is the most likely diagnosis?
A) Angelman syndrome
B) Fetal alcohol syndrome
WRONG C) Fragile X syndrome
D) Rett disorder
E) Shaken baby syndrome

28. A 37-year-old man comes to the physician because of increasing distress about his procrastination and indecision. He has been late for work often because he is easily distracted by any task; as a result, he has received poor job performance ratings. He arrived late for today's examination because he was awake late last night creating a new computer folder system and then had to refold the clothes in his closet several times this morning. He says he becomes nervous if he is unable to finish similar minor projects. He sometimes daydreams about projects and must complete them in his daydreams before attending to other tasks. He reports that his family is exasperated by his behavior. He has no history of serious illness and takes no medications. He appears fatigued. Physical examination shows no abnormalities. On mental status examination, he is fully oriented. He is cooperative but fidgets and has poor eye contact. He is able to repeat six digits forward, spell "world" backward, and perform serial sevens. He gives four interpretations of a proverb and is unable to decide on a final answer. Which of the following is the most likely diagnosis?

WRONG A) Attention-deficiUhyperactivity disorder
B) Delusional disorder
C) Generalized anxiety disorder
D) Obsessive-compulsive disorder
E) Schizotypal personality disorder

43. A 15-year-old boy is brought to the physician by his parents because "he does whatever he wants and comes and goes as he pleases." They report that he always has been challenging to manage and has not responded to disciplinary measures since he was 10 years of age. During the past 2 years, his behavior has become worse; he has been arrested twice in the past month, once for assault and once for vandalism. He is currently on probation. His parents state that they have found him intoxicated in his room on several occasions, and they recently found marijuana paraphernalia in his room. Today, the patient is sullen and minimally cooperative. He says he is frequently irritable and short tempered. His clothes smell of cigarette smoke. Physical examination shows several tattoos over the chest and upper extremities and several body piercings; no other abnormalities are noted. Mental status examination shows an irritable mood and poor eye contact. Which of the following is the most likely diagnosis?
A) Antisocial personality disorder
B) Bipolar disorder
C) Conduct disorder
WRONG D) Dysthymic disorder
E) Intermittent explosive disorder
F) Oppositional defiant disorder

[ArchivalUser]

1. patient is still hallucinating and if completely stopping will make his symptoms worse. Can we lower his dose choice C. correct me if i am wrong

[ArchivalUser]

4. answer is D Increased intracranial pressure
9. answer is B Dysthymic disorder
11. answer is A Adjustment disorder with mixed disturbance of emotions and conduct
14. answer is C Schizoaffective disorder
15. F Sleep-related hypoventilation
18. B Alcohol dependence
24. A Alcohol use
25. B Fetal alcohol syndrome
28. D Obsessive-compulsive disorder
43. A Antisocial personality disorder

[ArchivalUser]

4. B
9. D.
14. C) Schizoaffective disorder - Pt has both depression and hallucinations
15. F
18. B Alcohol dependence
24. A) Alcohol use
25. B Fetal alcohol syndrome
28. D) Obsessive-compulsive disorder
43. A

[ArchivalUser]

9. It cannot be D MDD. Bcoz pt is having symptoms for 2 months. According to definition MDD is within 2 weeks. Hope that helps

[ArchivalUser]

@coke170
what do you mean by confirmed, did you get these two right when doing online version?

I chose these answers for your posted questions and they did not appear on my final score report as wrong, so I am pretty sure it's right. I know some of them are pretty tricky.
4.B
9.D
11.C
14.C
15.F
18.B
24.A
25.B
28.D
43.A

[ArchivalUser]

@iamzining

11. Can you please explain how it is MDD bcoz pt has symptoms of weight loss, fatigue since 4 months. And for MDD the time period is 2 weeks.