Exam 2: Behavioral Sciences

A 35-year-old woman arrives at the office for an anxiety exam. The patient is a mechanical engineer who recently turned down a promotion to project manager. Despite the fact that her pay would have improved greatly, she believed that supervising other staff and holding team meetings would be too stressful. She states, "If something went wrong, everyone would point the finger at me. I have no idea why they offered me this post." The patient likes her job, but she prefers to eat lunch alone since she believes her coworkers dislike her appearance or sense of humor. She has never had a long-term love partner, although she dreams of marrying eventually.   The patient lives alone, rarely socializes with friends, and is close with her mother, whom she describes as "the person I can always rely on no matter what."  Which of the following is the most likely diagnosis?

His roommate brings a 20-year-old college student to the emergency department. The patient is terrified and thinks that campus police are tailing him and plotting his death. His roommate claims that the patient appeared "completely normal" until a few days ago, when he began staying up all night studying for final exams. Although the patient has no documented medical or mental background, his father suffers from schizophrenia. The blood pressure is 150/95 mm Hg, and the pulse rate is 110 bpm. The examination reveals clean lungs and tachycardia with normal S1 and S2 rhythms. The abdomen is nontender and soft. The pupils are dilated and the extraocular motions remain intact. The patient is sweating profusely. He seems hypervigilant, paces during the test, and speaks with a slight strain. Which of the following is the most likely diagnosis in this patient?

A 46-year-old man has been admitted to the hospital with diabetic ketoacidosis. He is given intravenous fluids and an insulin drip, and lab tests are scheduled. The on-call physician transfers the patient to the day shift physician in the morning, who comes an hour late owing to an emergency at his overnight moonlighting job. The patient's state and instructions to monitor electrolytes and compute his anion gap are included in the handoff information. The doctor does inpatient rounds and then his typical clinic outpatients in the afternoon, but he forgets to check the patient's anion gap. The patient's acidity worsens, necessitating intubation for respiratory distress. Which of the following is the most likely reason for this unfortunate outcome?

A 48-year-old man walks in with his wife for a check-up on his serious depressive condition. The patient had been on sertraline for two years before beginning bupropion and weekly cognitive behavioral therapy three weeks ago owing to a relapse of depression. Since then, his energy level has improved, and he is working on communicating more with his wife about his emotions. The patient has no suicidal ideation and is hopeful that he will feel better with continued treatment. A week later, his wife calls the office and states that her husband died by suicide a few days ago. She is tearful on the phone and says, "I thought that he was doing better. I don't understand how this happened." Which of the following is the most appropriate response?

Suicidal thoughts has landed a 22-year-old lady in the hospital. Following the breakdown of her month-long love relationship, the patient experiences emotions of great sadness, emptiness, and despair for the last week. She has had trouble sleeping and staying asleep for the past week, but there has been no change in her appetite, activity level, or concentration. She is angry at her parents for turning against her and feels betrayed by her partner. The patient has been going to bars, participating in hazardous sex, and drinking excessively since the split. She has had severe mood swings since youth and has had two suicide attempts with an overdose of sleeping tablets. Which of the following diagnoses is more likely?

A 38-year-old recently homeless woman and her 35-year-old boyfriend visit a neighborhood clinic for prenatal care at 27 weeks. She also sends her 19-year-old son, who has cerebral palsy and has received inconsistent medical attention. The patient informs the social worker that her family was just evicted from their flat due to nonpayment of rent after her partner lost his job. Which of these people is a candidate for Medicare?

A 56-year-old man visits the office for a check-up on his type 2 diabetes mellitus. He has a long family history of difficult type 2 diabetes, and several family members have had to have lower extremity amputations due to nonhealing ulcers. The patient has tried many oral drugs, and his most recent hemoglobin A1c level is 9.6%. Basal insulin treatment is currently being investigated for him. After a lengthy discussion on injection technique, the patient informs the clinician that he does not wish to begin insulin administration. He claims, "My diabetes is all my responsibility. My mother constantly thought I was too heavy and would develop diabetes like my father. Maybe if I cut back on my eating, I won't have to spend your time giving me insulin." Which of the following is the most appropriate response to this patient's statement?

A 55-year-old woman with advanced metastatic breast cancer arrives at the emergency room with dyspnea and tachycardia. After evaluating the patient, the resident orders an echocardiography, which confirms the existence of a pericardial effusion. The surgical team is called in, and the surgical attending informs the patient that a pericardiocentesis is required. After receiving an urgent page, the attending surgeon instructs the resident to acquire informed permission for the treatment. Although the surgical resident has never seen or done a pericardiocentesis, he has recently read an article regarding malignant pericardial effusions. Which of the following is the best plan of action for the resident?

A 30-year-old woman arrives to the office in a melancholy state. Since being turned over for promotion three weeks ago, the patient has been "disappointed and despondent." She has difficulty going asleep since she is preoccupied with what she could have done differently at work. The patient's appetite, energy, and concentration are not affected, and she still enjoys going out with friends and attending choir group. She has no substantial medical or mental health history. The vital signs and physical examination are normal. A course of psychotherapy is recommended, to which she responds, "Have you ever had depression or been in therapy, doctor?" Which of the following is the best response to this patient?

A 23-year-old lady, 8 weeks pregnant, arrives at the office for her first prenatal checkup. There is no vaginal bleeding or pelvic discomfort in the patient. On inspection, bruising in various stages of healing can be visible on the chest and belly. When questioned about the marks, the woman claims that her lover used to punch her during disagreements and was originally enraged by the pregnancy. He has been more helpful in the last three weeks, purchasing pregnancy vitamins and providing massages. An ultrasound reveals an 8-week intrauterine pregnancy and a normal fetal heart rate. Which of the following is the most suitable next step in this patient's care?

A 40-year-old lady suffering from serious depression visits the doctor for a check-up. For the last year, she has been taking paroxetine on a regular basis. The patient is doing well, although she is concerned that she has episodes of depression on occasion. "I know the package says once a day, but I normally take an additional tablet when I'm unhappy and skip it if I'm having a nice day," she replies when asked how she takes the drug. The vital indicators are within normal ranges. A physical examination reveals no anomalies. Which of the following management steps is the most appropriate next step?

A 38-year-old woman is taken to the emergency room after raising a commotion in a retail shop. The patient claims that the government was spewing deadly gas via the store's air vents and that red clothing was a warning to escape. She was arrested for a similar offense a year earlier. At the age of 20, the patient dropped out of college. She has never worked and lives with her parents. She smokes a carton of cigarettes every day but does not drink or take drugs. The physical exam is ordinary. The patient seems preoccupied and afraid during a mental status examination. She claims to have heard the voices of two men who have been criticizing her activities for years. Which of the following abnormalities is most likely associated with this patient's symptoms?

A 19-year-old college student arrives at the office complaining of new-onset fatigue. The patient has been having difficulties getting out of bed in the morning for the previous week and claims that if his schedule permitted, he would sleep 10-12 hours. He also has vivid dreams. The patient was diagnosed with attention deficit hyperactivity disorder at the age of ten and has been on dextroamphetamine ever since. His medication, however, ran out lately after he raised the amount to assist him study during exams. Which of the following observations is most likely in this patient?

A 37-year-old woman arrives to the clinic with a history of recurrent severe depressive illness. Her father died last month after a protracted illness, and she fears her sadness will resurface. The patient has a low appetite, sleeps badly, and has difficulty concentrating on her teaching profession. She lately quit coming to the gym and hanging out with friends, both of which she used to like. She's been gathering pills from half-empty bottles of old medicine and contemplating taking them all at once. The patient has no history of suicidal ideation. Her mother committed suicide at the age of 40. Which of the following is the most essential element in determining this patient's risk of suicide?

A 36-year-old man is taken to the hospital after being discovered barefoot and yelling to himself in the streets. Despite the fact that he takes antipsychotic medicine on a regular basis, his parents are having problems controlling him at home. The patient feels he is fighting a conspiracy and that a gadget placed in his brain during a previous illness is directly controlling his thoughts. Previous studies with haloperidol, quetiapine, and risperidone yielded very minor improvements. He doesn't have any other medical issues. The patient is awake and restless on mental state evaluation, with poor grooming, unkempt attire, and a flat attitude. He refuses to answer most inquiries, accuses his parents of being involved in the plot, and mumbles incomprehensible gibberish.Which of the following medications would be most effective for this patient's illness?

A 65-year-old man from the Dominican Republic has been admitted to the hospital for surgery. He has multiple myeloma and a pathologic right humerus fracture. The operation went off without a hitch. Following that, the patient is aware and focused, but grimaces regularly and seems uneasy. He is given pain relief but respectfully rejects. When asked if he is in agony, the patient says, "It hurts a lot, but I can handle it and don't want to be a burden." Which of the following is the most suitable medical response?

A 28-year-old lady, gravida 2 para 1, arrives at the emergency center with vaginal bleeding. For the previous 24 hours, the patient has experienced vivid red spotting but no contractions or fluid leaking. She is 31 weeks pregnant as of her last menstrual cycle and has not had prenatal care this pregnancy. Her first pregnancy concluded in a simple spontaneous vaginal birth at term. The fetal heart rate and vital signs are normal. Physical examination reveals a nontender uterus that is the same size as at 31 weeks gestation. A full placenta previa is shown via a pelvic ultrasound. The findings are addressed with the patient, who expresses her desire for a vaginal birth.The physician says, "Unfortunately, the only safe option for delivery is a cesarean delivery."  The physician's statement is an example of which of the following ethical principles?

A 45-year-old lady with type 2 diabetes, obesity, and hypertension visits the doctor for a regular check-up. A sulfonylurea and an ACE inhibitor are among her meds. The patient attributes his weight reduction of 2.3 kg (5 lb) to a new energy and weight loss supplement. She bought the supplement via the Internet on the advice of a friend and claims it includes caffeine and numerous herbs that aid in weight reduction. The supplement has been well tolerated by the patient. The blood pressure is 140/90 mm Hg, and the pulse rate is 88 beats per minute. Which of the following is the most suitable medical response?

A mother brings her 18-year-old man to the clinic since he has been acting strangely for the previous two months. The patient is in his first semester at an out-of-state college and is struggling to acclimate to his new surroundings. He hasn't attended to class in a few weeks, and he hasn't socialized with his pals. Because he feels the cafeteria food is tainted, the patient spends much of his time alone in his dorm room and eats very little. He has no serious medical or mental background, and he does not drink or use illegal substances. The physical exam is ordinary. During a mental state test, he seems unkempt with unclean hair, makes poor eye contact, and responds with "leave me alone." Which of the following is the most likely diagnosis in this patient?

A 2-year-old girl is brought to the office due to concerns about her development.  The girl says approximately 40 words and does not string words together.  She can jump, walk upstairs slowly, build a 6-block tower, and follow short commands.  She feeds and helps to dress herself.  The girl's mother says, "My daughter is such a happy child.  She loves playing with the other kids at day care.  She is affectionate and caring toward us and her dog.  I don't know why she won't speak.  Her sister was using sentences by age 2.  Is there something wrong with her?"  Which of the following is the most appropriate response by the physician?