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CMS Psych Form 4 Questions - goatmilk
#1
4. A 47-year-old man is brought to the physician by his wife because of “unbearable” behaviour during the past 2 weeks. His wife reports that he has been talking about his various inventions constantly and recently bought a new recreational vehicle, even though they do not travel long distances. He repeatedly tells his wife that “the time to make and enjoy money has come.” He has been openly critical of their pastor’s prayers during church services. He claims that the pastor does not know what he is talking about because “God is talking to me, not him.” His wife says that he has had episodes of similar behaviour during the past 10 years that have been more tolerable. He has peptic ulcer disease treated with ranitidine and hypertension treated with triamterene. He does not smoke or drink alcohol. He is 170 cm (5 ft 7 in) tall and weighs 82 kg (180 lb); BMI is 28 kg/m2. His pulse is 80/min, and blood pressure is 150/95 mm Hg. Physical examination shows no other abnormalities. On mental status examination, he is relaxed and talkative, jumping from one topic to another. He claims that his wife does not understand him and that she has been plotting with the pastor against him. He denies any problem and says that he feels great and is capable of great things. Laboratory findings are within the reference range. Urine toxicology screening is positive for marijuana. Which of the following is the most likely diagnosis?
A) Bipolar disorder
B) Delusional disorder
C) Mood disorder due to a general medical condition
D) Schizoprenia
E) Substance induced mood disorder

6. A 26-year-old man comes to the physician because of increasing daytime sleepiness over the past 3 years. He has begun to unexpectedly fall asleep at work and is concerned that he will lose his job if he does not change his behaviour. He has stopped driving because of fear that he will fall asleep at the wheel. He generally sleeps well at night. He states that he avoids exercise and caffeine ingestion in the evening and does not read or watch television in bed. His wife states that he does not snore or have restless leg movements while sleeping. He has vivid dream-like images just before falling asleep and on awakening. He describes his mood as generally good despite his worry about his job security. Polysomnography is most likely to show which of the following?
A) Decreased REM density
B) Decreased REM latency
C) Decreased stage 1 sleep
D) Increased sleep efficiency
E) Increased sleep latency

12. A 72-year-old woman comes to the physician because of a 3-month history of fatigue and difficulty sleeping. She has had a 5.4-kg (12-lb) weight loss during this period because of decreased appetite. Her husband died 18 months ago. She has a 15-year history of hypertension treated with verapamil and a 3-month history of insomnia treated with zolpidem. Laboratory studies 1 week ago showed no abnormalities. She is 170 cm (5 ft 7 in) tall and weighs 60 kg (133 lb); BMI is 21 kg/m2. Her pulse is 74/min, and blood pressure is 131/84 mm Hg. Physical examination shows no abnormalities. Mental status examination shows an irritable and tearful mood. She expresses hopelessness about the future. Which of the following is the most likely finding in this patient?
A) Decreased hemoglobin concentration
B) Decreased serum vitamin B4 (thiamine) concentration
C) Increased percentage of bands on complete blood count
D) Increased serum cortisol concentration
E) Increased serum prolactin concentration

Please give your answers plus diagnosis with an explanation. Thank you!!
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#2
4. A 47-year-old man is brought to the physician by his wife because of “unbearable” behaviour during the past 2 weeks. His wife reports that he has been talking about his various inventions constantly and recently bought a new recreational vehicle, even though they do not travel long distances. He repeatedly tells his wife that “the time to make and enjoy money has come.” He has been openly critical of their pastor’s prayers during church services. He claims that the pastor does not know what he is talking about because “God is talking to me, not him.” His wife says that he has had episodes of similar behaviour during the past 10 years that have been more tolerable. He has peptic ulcer disease treated with ranitidine and hypertension treated with triamterene. He does not smoke or drink alcohol. He is 170 cm (5 ft 7 in) tall and weighs 82 kg (180 lb); BMI is 28 kg/m2. His pulse is 80/min, and blood pressure is 150/95 mm Hg. Physical examination shows no other abnormalities. On mental status examination, he is relaxed and talkative, jumping from one topic to another. He claims that his wife does not understand him and that she has been plotting with the pastor against him. He denies any problem and says that he feels great and is capable of great things. Laboratory findings are within the reference range. Urine toxicology screening is positive for marijuana. Which of the following is the most likely diagnosis?
A) Bipolar disorder
B) Delusional disorder
C) Mood disorder due to a general medical condition
D) Schizoprenia
E) Substance induced mood disorder (wrong answer)

6. A 26-year-old man comes to the physician because of increasing daytime sleepiness over the past 3 years. He has begun to unexpectedly fall asleep at work and is concerned that he will lose his job if he does not change his behaviour. He has stopped driving because of fear that he will fall asleep at the wheel. He generally sleeps well at night. He states that he avoids exercise and caffeine ingestion in the evening and does not read or watch television in bed. His wife states that he does not snore or have restless leg movements while sleeping. He has vivid dream-like images just before falling asleep and on awakening. He describes his mood as generally good despite his worry about his job security. Polysomnography is most likely to show which of the following?
A) Decreased REM density (wrong answer)
B) Decreased REM latency
C) Decreased stage 1 sleep
D) Increased sleep efficiency
E) Increased sleep latency

12. A 72-year-old woman comes to the physician because of a 3-month history of fatigue and difficulty sleeping. She has had a 5.4-kg (12-lb) weight loss during this period because of decreased appetite. Her husband died 18 months ago. She has a 15-year history of hypertension treated with verapamil and a 3-month history of insomnia treated with zolpidem. Laboratory studies 1 week ago showed no abnormalities. She is 170 cm (5 ft 7 in) tall and weighs 60 kg (133 lb); BMI is 21 kg/m2. Her pulse is 74/min, and blood pressure is 131/84 mm Hg. Physical examination shows no abnormalities. Mental status examination shows an irritable and tearful mood. She expresses hopelessness about the future. Which of the following is the most likely finding in this patient?
A) Decreased hemoglobin concentration (wrong answer)
B) Decreased serum vitamin B4 (thiamine) concentration
C) Increased percentage of bands on complete blood count
D) Increased serum cortisol concentration
E) Increased serum prolactin concentration

Please give your answers plus diagnosis with an explanation. Thank you!!
Reply
#3
4-A Manic sx..(DIGFAST) Distractibility, Irresponsiblity/Erratic uninhibited behavior, Grandiosity, Flight of Ideas, Activity increased w weight loss and elevated libido, sleep is decreased, talkative.
No auditory or visual hallucinations (Claiming god talking to him is not a hallucination), therefore no psychosis, Bipolar disorder is best answer.

6-B Decreased REM Latency (Narcolepsy almost instantly going into REM stage sleep)

12-B Patient is clinically depressed. Low levels of Thiamine are associated with depression
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#4
17. A 32-year-old man is admitted to the hospital because of refusal to speak or move since he returned home after being robbed at gunpoint yesterday. His wife says that her husband was physically unharmed but seemed to be in acute emotional distress. He stopped talking, would not move from his chair, and began staring into space. His wife reports that he has no history of serious illness and takes no medications. The patient is sitting upright with his eyes closed. Vital signs are within normal limits. Physical examination shows no abnormalities. On mental status examination, he is mute, does not follow commands, and resists being moved. Which of the following is the most appropriate pharmacotherapy?
A) Buspirone
B) Dexamphetamine
C) Haloperidol
D) Lorazepam
E) Sertraline (wrong answer)

22. A 30-year-old woman has had frontal headaches, stomach upset, and poor appetite for 4 weeks; she has had a 2-kg (5-lb) weight loss during this period. She has pain in the left upper quadrant of the abdomen 1 to 3 hours after eating dinner. Over-the-counter antacids have been ineffective. She blames herself for not taking better care of her body. The headaches occur at night and awaken her. She feels fatigued in the morning and has difficulty getting up and going to work. Over the past month, her supervisor has complained about her recent errors, which she attributes to difficulty concentrating. She says that she is so tired when she comes home that she has stopped going out with her friends and just goes to sleep. Which of the following is the most likely diagnosis?
A) Adjustment disorder with depressed mood
B) Borderline personality disorder
C) Dysthymic disorder
D) Major depressive disorder
E) Somatization disorder (wrong answer)
F) Ulcerative colitis

23. An 18-year-old man is brought to the emergency department by friends 1 hour after they found him on the couch at a party unable to move. Earlier that evening, he had been using synthetic heroin. On arrival, his pulse is 85/min, respirations are 18/min, and blood pressure is 130/80 mm Hg. Examination shows stiffness in all extremities, drooling, and slow response to questions. Which of the following brain region is most likely affected?
A) Cerebellar vermis
B) Globus pallidus
C) Locus ceruleus
D) Mammillary bodies
E) Nucleus accumbens (wrong answer)
F) Substantia nigra
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#5
17. D- Treatment for Catatonia is Benzodiazepines.
22. D- Has all classic features of clinical depression; Depressed mood + majority of SIGECAPS (Sleep changes, Interest in activities decreased, Guilt/Blame, Low Energy, Concentration Difficulty, Appetite decreased, Psychomotor agitation, Suicidal Ideation)
23. F- akinesia, rigidity, Parkinsonian features = Substantia Nigra
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#6
Doc2530, shouldnt Q23 be related to heroin use and what part of the brain it affects?
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#7
25. A 37-year-old woman comes to the physician with her husband because of a 1-year history of fatigue, intermittently blurred vision and numbness of her legs that is exacerbated by walking long distances. Her husband adds that she has begun to have difficulty remembering where she put things around the house and says that when he points out her memory problem to her, she does not seem to care. She states that she does the best she can but does not have the energy to devote to his concerns. Cardiopulmonary examination shows no abnormalities. Sensation to pinprick is decreased over the low extremities. Muscle strength in the upper and lower extremities is 3/5. On mental status examination, her mood and affect are incongruously bright. She is oriented to person, place, and time. She recalls two of three objects after 5 minutes. Which of the following abnormalities is most likely to be present in this patient on imaging studies?
A) Arteriovenous malformation
B) Edema of the right cerebral hemisphere
C) Enlarged cortical sulci (wrong answer)
D) Focal white matter lesions
E) Left cerebellar atrophy

29. A 52-year-old man with schizophrenia comes to the physician for a follow-up examination. At his last examination 1 week ago, the physician noticed that the patient’s tongue occasionally protruded. When asked, the patient was unaware of this movement, but was able to voluntarily prevent it. At that time, physical examination showed normal muscle strength. He had been taking risperidone for 5 years; treatment was discontinued to stop his tongue movements. Today, examination shows worsening tongue movements and writhing choreoathetoid movements of the upper extremities. Which of the following is the most likely underlying cause of this patient’s symptoms?
A) Atrophy of the caudate nucleus (wrong answer)
B) Increased acetylcholine
C) Increased sensitivity of the dopamine receptors
D) Loss of volume in the basal ganglia
E) Vascular changes in the small vessels

38. A 37-year-old woman is brought to the emergency department 30 minutes after the onset of a severe occipital headache, palpitations, and tremulousness. Shortly before this episode, she ate several slices of pepperoni pizza. She has a 2-mont history of atypical major depressive disorder treated with phenelzine. She is otherwise healthy. She appears anxious and tremulous. Her temperature is 37.8°C (100°F), pulse is 94/min, respirations are 20/min, and blood pressure is 210/110 mm Hg. Physical examination shows no other abnormalities. The most appropriate next step is administration of which of the following?
A) Bromocripitine
B) Diazepam (wrong answer)
C) Diphenhydramine
D) Fluvoxamine
E) Haloperidol
F) Naloxone
G) Phentolamine
H) Physostigmine
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#8
@goatmilk Synthetic Heroin (MPTP) induces Parkinsonism features through its effect in the Substantia nigra

25 D- Multiple Sclerosis
29 C- Tardive Dyskinesia
38 G - Tyramine Crisis is treated with alpha blocker Phentolamine
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#9
39. A previously healthy 37-year-old man comes to the physician because of a 6-month history of depressed mood, fatigue, poor concentration, and difficulty sleeping. He works as an accountant and has had difficulty staying awake at work, particularly in the afternoon. He says that his wife sleeps in a separate room because of his loud snoring He drinks alcohol at social functions only. He is 175 cm (5 ft 9 in) tall and weighs109 kg (240 lb); BMI is 35 kg/m2. Physical examination shows no other abnormalities. Mental status examination shows a mildly depressed mood.
For each patient with depressed mood, select the most likely diagnosis.
A) Adjustment disorder with depressed mood
B) Bereavement
C) Bipolar disorder, depressed
D) Cyclothymic disorder
E) Dysthhymic disorder
F) Major depressive disorder (wrong answer)
G) Mood disorder due to a general medical condition
H) Substance-induced mood disorder

43. A 47-year-old man comes to the physician because of a 2-day history of intense anxiety. He has been receiving chemotherapy for hepatoma for 5 days. His nausea is well controlled with prochlorperazine. He has no history of similar symptoms or psychiatric illness. His pulse is 104/min, and blood pressure is 142/86 mm Hg. Mental status examination shows anxious affect. He paces, wrings his hands, and says, “I feel as though I am going to jump out of my skin!” Which of the following is the most likely cause of this patient’s symptoms?
A) Acute stress disorder
B) Adjustment disorder with anxiety
C) Adverse effect of prochlorperazine
D) Anxiety disorder due to hepatoma (wrong answer)
E) Generalized anxiety disorder
F) Panic disorder
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#10
39 G- Obstructive Sleep Apnea
43- C- Extrapyramidal symptoms associated with typical antipsychotics
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