Exam 13: Psychiatry and Psychotherapy

A 45-year-old woman started psychotherapy due to depression affecting her productivity at her job as an accountant. Psychotherapy sessions made progress with her depression, and she feels now better. The patient has had an insight into her childhood, especially since her mother was not always available for her. Recently, she told her mom " I am really sad that I never found you beside me". Two days ago, the psychotherapist canceled the session due to an emergency in the hospital. In the following session, the patient says" I am not your priority, and you don't want to listen to me". Which of the following is the explanation for The patient's response to the physician?

While a resident was finishing his shift, he received a call saying that his patient in room 211 wants to leave. The patient was admitted today due to a high-grade fever. The physician started discussing with the patient the cause he is asking to leave for. The patient became agitated and said, " you are misbehaving with me, you are not a real doctor!". The situation reminded the resident of his father who has frequently doubted his achievements. He angrily informed the patient, "You won't leave this hospital, I am ordering anxiolytic to calm you down" Which of the following best explains the resident's response to the patient?

A 72-year-old man with known metastatic prostatic cancer presented to the office due to a depressed mood. The patient has been sad most of the time and cries often when thinking about his course of the disease. He has lost appetite with a 6 kg weight loss over the past month. He has difficulty sleeping with multiple awakenings. He has been withdrawn from his family and does not go for family visits. A mental examination shows depressed mood and affect. She has no suicidal ideation. Which of the following presentations is most indicative of major depressive disorder in this patient?

An 8-year-old girl presents to the psychiatrist to discuss the recent divorce of her parents. The girl explains that her mother is the most caring and loving mother anyone could ever have and that she will be spending the majority of her time with her mother. On the other hand, she exclaims that her father is an evil person and hates him. Which of the following is the most likely explanation for this patient's behavior?

A 42-year-old biochemist receives negative feedback from a senior associate on a recent project. He is placed on probation within the company and told that he must improve his performance on the next project to remain with the company. He is distraught and leaves his office early. When he gives an account of the episode to his wife, she says, "I'll always be proud of you no matter what because I know that you always try your best." Later that night, he tearfully accuses her of believing that he is a failure. Which of the following psychological defense mechanisms is he demonstrating?

A 48-year-old woman presented to the office complaining of sexual abnormalities in the last year. The patient does not feel the urge for sex and refuses sex with her husband. She is emotionally attracted to her husband and fears that this might affect their relationship. She does not have any abnormality with vaginal lubrication or orgasm, but her mind wanders during sex. She has been working intensively in her office for the last 3 months. The patient has a depressive episode, and she is on Bupropion right now. The patient has normal physical examination findings and normal laboratory studies. Which of the following is the most likely diagnosis?

A 14-year-old woman comes to the office due to discolored vaginal discharge with a bad smell. The patient is accompanied by her mother. She has noticed an increased amount of vaginal discharge for the last 3 days, but without vaginal bleeding. She does not complain of abdominal or pelvic pain. She has been sexually active with a new partner and uses condoms for contraception. Her last menstrual period was 10 days ago. The patient does not have prior medical or surgical history. Vital signs are normal. Physical examination shows normal abdominal examination. The patient refused the pelvic examination. Which of the following is the best action?

A 75-year-old man presented to the office for a follow-up appointment. Diabetes mellitus type 2, coronary artery disease, and hypertension are among the patient's medical conditions. The patient is on metformin, atorvastatin, lisinopril, and nitroglycerin. During the evaluation, the patient expressed his concern about not being able to get an erection and asked about the possibility of taking Sildenafil. Which of the following responses is the right response for the patient's question?

A 19-year-old man in a 3-month relationship with a woman experiences frequent sexual fantasies about male coworkers. He lives in a suburban town and has never knowingly been in contact with anyone who is not heterosexual. Two days ago, he joined a local group seeking to criminalize homosexual activity. Together with other members, he verbally and physically assaulted a same-sex couple on their way home from dinner. Which of the following psychological defense mechanisms is he demonstrating?

A 38-year-old man presented to the office due to decreased sexual interest. He has been in a new relationship for the last 6 months, and he is attracted to his partner. A 35-year-old man comes to the office due to a lack of sexual interest. When the patient is asked about sex, he admits that he usually has an orgasm in less than one minute, and this is causing him embarrassment. The patient has chronic insomnia and a history of major depressive disorder. He takes his medication Trazodone. He does not use illicit substances. Vital signs are within normal limits. Which of the following is the most likely diagnosis?

A 75-year-old man is brought to the emergency department due to suicidal thoughts. The patient is diagnosed with major depressive disorder. His family history is positive for bipolar disorder and completed suicide with his father. The patient has been admitted to the hospital twice due to suicidal attempts. The patient is recovering from alcohol use disorder and attends weekly Alcoholics Anonymous meetings at her church. The patient reports that he has a firearm hidden in the house. Which of the following is the strongest risk factor?

A 40-year-old man presented to the office complaining of insomnia for the last month. He lost his job 6 weeks ago and started feeling low mood, irritability, and guilt. He stays in bed most of the time. He has lost 4.5 kg over the last month. The patient noticed decreased concentration. Physical examination is normal. Which of the following is the most likely diagnosis in this patient?

An 80-year-old woman is brought to the office due to memory impairment. One month ago, the patient started having problems with her memory. She has been forgetting the place of her keys, has had difficulty remembering the time of her medications, and has neglected to feed her dog on multiple occasions. She has an interest in reading and playing with her grandchildren. She has decreased sleep time, diminished appetite, and low energy. The patient has hypertension and type 2 diabetes, for which she takes medications. The patient feels guilty and worthless. Temperature is 36.7 C (98.1 F), blood pressure is 121/80 mm Hg, the pulse is 76/min, and respirations are 16/min. Neurological examination reveals no focal deficits. Montreal Cognitive Assessment score is 22 (normal: more than or equal to 26/30). Which of the following is the most likely diagnosis?

A 73-year-old woman is admitted to the hospital due to pneumonia. The patient is known to have hypertension and diabetes mellitus type two. Physical examination shows decreased breath sound in the right lung, with crackles and wheezes. A right lung consolidation is confirmed by radiological imaging. The patient has been prescribed the proper antibiotics. On the first day of admission, the patient reports visual hallucinations of animals around her in the room. The patient started shouting accusing the hospital of giving her toxic materials in her blood, and then fell asleep suddenly. She became violent and needs restraints. Vital signs are normal. She has disorientation and can't cooperate with the medical examination. Which of the following is the most likely explanation for this patient's current behavior?

A 45-year-old woman started psychotherapy due to depression affecting her productivity at her job as an accountant. Psychotherapy sessions made progress with her depression, and she feels now better. The patient has had an insight into her childhood, especially since her mother was not always available for her. Recently, she told her mom " I am really sad that I never found you beside me". Two days ago, the psychotherapist canceled the session due to an emergency in the hospital. In the following session, the patient says" I am not your priority, and you don't want to listen to me". Which of the following is the explanation for The patient's response to the physician?

A 42-year-old woman is admitted to the hospital with suicidal thoughts. Since last month, the patient has become increasingly depressed. Her concentration on her work as an accountant has decreased. She has decreased appetite and difficulty sleeping. She has been absent from her work over the last week and refused to leave her house. The patient has no medical or psychiatric history. The evaluation shows a weight loss of 5 kg over the past period. Mental status examination shows a depressed mood. She feels guilty for all the evil found in the world and heard voices in her head telling her that she is the worst person in the world. Which of the following is the most suitable diagnosis for this patient?

A 25-year-old woman, G2P2, presented to the office 8-week postpartum for a regular postpartum checkup. The patient complains of fatigue and decreased energy for the last weeks. She has decreased appetite. The baby is healthy and in a good state, but the mother keeps saying that she is a bad mother for her child. The husband reports that she is always crying in the house. Physical examination is normal. The patient has no suicidal ideation or thoughts of harming the baby. Which of the following is the most likely diagnosis?

A 73-year-old woman is admitted to the hospital due to pneumonia. The patient is known to have hypertension and diabetes mellitus type two. Physical examination shows decreased breath sound in the right lung, with crackles and wheezes. A right lung consolidation is confirmed by radiological imaging. The patient has been prescribed the proper antibiotics. On the first day of admission, the patient reports visual hallucinations of animals around her in the room. Vital signs are normal. She has disorientation and can't cooperate with the medical examination. Which of the following interventions is most likely indicated to prevent further worsening of his condition?

A 30-year-old new pregnant woman visit her doctor for regular pregnancy follow up. She has a history of feeling anxious and sweats when she is in the examination room with her primary care physician. The patient sweats and feels her heart start to race during physical examination whenever she sees the stethoscope. This patient's response to her physician's stethoscope is an example of which of the following phenomena?

An 18-year-old man is brought to the clinic due to recent recurrent episodes of wandering in the street. The first episode was reported by the parents two years ago, but recently episodes occur more frequently after a street fight he had with his friend. The patient says that he spaces out easily. He says " I lose sensation to the world around me like I am dreaming, or I am watching the life of another person". He has no medical or surgical condition. Physical and neurologic examinations are normal. Mental examination shows anxious affect. Which of the following is the most likely diagnosis?