Talking TomFollowing is a list of Psychiatry Questions for all students wishing to excel in the USMLE step 2 Exam. I collected and designed these myself. Hope they will of use to you all.
All the best!
1. After three weeks of taking fluoxetine, a college student was reported by her roommate to have been acting strangely for a week. She began staying up all night working on projects that were not required of her classes and despite getting only 2-3hours of sleep per night, feeling rested. She had been speaking excitedly and kept referring to a top secret study involving the ISI. She shifted from excited, agitated expressions to tearful exasperation. She reported never having felt this way before and said that she had been taking the fluoxetine as instructed. The diagnosis at this time is:
A. Schizoaffective disorder
B. Bipolar Disorder
C. Schizophrenia
D. Substance-induced mood disorder
Ans: D, Substance-induced mood disorder. Currently this presentation is of an apparent fluoxetine induced manic episode.
A is incorrect, the patient would have to have had an episode of psychotic symptoms in the absence of depressive or manic episode in order to be diagnosed with schizoaffective disorder
B is incorrect; this patient may later be diagnosed with bipolar disorder but not at this time
C is incorrect, while the psychotic symptoms that are present could be the onset of schizophrenia, the manic symptoms would generally not be present. Symptoms must also have been present for at least 6months to meet criteria for schizophrenia.
Chapter 10, Textbook of Clinical Psychiatry
2. A 33-year old male is referred for a substance abuse evaluation after he was arrested for driving while intoxicated. He is reluctant but realizes he has to cooperate with the authorities to avoid serious consequences. He states that alcohol is not really a problem for him and he can quit any time he wants to. He does admit to two prior drunken driving arrests. He reports that he was fired from two different jobs for “smelling like alcohol” but believes he was really fired because his bosses were ‘jerks’. He admits to have been having relationship problems because of his drinking habits. He reports that he doesn’t drink daily, only after work a few times a week or more heavily on weekends. He does not suffer from any symptoms of alcohol withdrawal and no prior attempts to reduce his level of intake. The most likely diagnosis is:
A. Narcissistic personality disorder
B. Alcohol dependence
C. Alcohol abuse
D. Alcohol intoxication
Ans: C, Alcohol abuse. A psychoactive substance abuse disorder is diagnosed when an individual has substance-produced impaired ability to fulfill major roles, social or interpersonal problems, use of substances in physically hazardous circumstances, and recurrent legal problems related to substance use.
A is incorrect, the history as obtained is insufficient to support a diagnosis of personality disorder
B is incorrect, an additional from a friend or family member would be critical in this patient’s case to verify that the history is accurate and to rule out alcohol dependence.
D is incorrect; there is no evidence during the interview t support a diagnosis of alcohol intoxication (i.e., odor of alcohol, slurred speech, in coordination, impaired judgment, and so on).
Chapter 9, Textbook of Clinical Psychiatry
3. A 30 year old man is brought to the psychiatric clinic by the authorities for getting arrested for drunken driving several times. He does not appear to be intoxicated. Long term alcohol abuse is apparent from his history. The most effective pharmacotherapeutic intervention would be:
A. Naltrexone
B. Fluoxetine
C. Clonidine
D. Disulfiram
Ans: A, Naltrexone. Naltrexone has the most empirical support of the listen agents for reduction of alcohol intake in alcohol abusers.
B is incorrect; Fluoxetine may be of use in individuals with co-morbid substance abuse and depression
C is incorrect; Clonidine has not been demonstrated to reduce alcohol abuse
D is incorrect, Disulfiram (ant abuse) has historically been the most widely employed pharmacotherapeutic treatment to prevent alcohol abuse but it has not been demonstrated to be as effective as naltrexone.
Chapter 9, Textbook of Clinical Psychiatry
4. A 27year old woman is brought to the emergency ward by her neighbors who reported her to be banging on their doors and screaming in the stairwell. Upon examining the patient’s apartment the police found the place to be filthy and malodorous, with rotting garbage and food in the kitchen. The curtains were closed and the windows were sealed with duct tape. The patient’s family reports that for the past year or so she has seemed increasingly odd, dissociating herself from family activities. She also gave up her well-paying job as a computer graphics designer. She had ended her 2year engagement 6months ago for no particular reason. On mental status examination the patient appears disheveled and her clothes appear to be dirty. She appears wary and guarded. Her speech is normal in rate, volume and production. She is conversant, and explains that she has been defending herself against aliens who want to use her as a specimen. She believes that she began picking up hidden transmissions in her email at work, revealing an alien conspiracy. On asking why she quit her job she states that she needs to stay hidden inside her home because they are after her. She ended her recent relationships because she believes that aliens would harm her loved ones. She denies substance use or any medical symptoms. She reports that she has been eating and sleeping well and that her mood is good. She denies hearing voices. Diagnostic testing, including drug screen, CBC, chemistry panel and brain MRI are all normal. The most likely diagnosis is :
A. Schizophrenia
B. Bipolar disorder
C. Major depression
D. Paranoid personality disorder
Ans: A, Schizophrenia. A diagnosis of schizophrenia requires a greater than 6-month period of positive and negative symptoms of psychosis combined with social and occupational deterioration.
B is incorrect; Bipolar disorder requires the presence of at least one episode of mania and usually consists of cycles of mania and depression. Psychosis is common in the manic phase of bipolar illness but this patient does not display symptoms of mania.
C is incorrect, Major depression may be associated with psychosis, but this patient does not provide evidence of having major depression.
D is incorrect, Paranoid personality disorder does not lead to the level of severe social and occupational dysfunction experienced by this patient.
Chapter 10, Textbook of Clinical Psychiatry
5. Which negative symptom of schizophrenia is most prominent in the above patient?
A. Affective flattening
B. Alogia
C. Asociality
D. Atrophy
Ans: C, Asociality. The patient’s termination of a relationship and her avoidance of interaction with others are symptoms of asociality.
A is incorrect, the mental status exam does not document affective flattening in this patient
B is incorrect; Alogia is not present in this conversant, articulate woman.
D is incorrect; Atrophy is a structural change in the brain statistically associated with Alzheimer’s dementia and is not a negative symptom.
Chapter 10, Textbook of Clinical Psychiatry
6. Which positive symptom is the most prominent in this patient?
A. Hallucinations
B. Delusions
C. Dishevelment
D. Anxiety
Ans: B, Delusions. Delusions are defined as fixed false beliefs. A belief is fixed when the individual cannot be dissuaded from believing in its veracity with contradictory evidence or arguments pointing out its implausibility. In this case the woman strongly believes that aliens are after her.
A is incorrect; there is no evidence of visual, auditory or olfactory hallucinations.
C Is incorrect, Dishevelment is perhaps a type of negative symptom and perhaps a function of the patient’s preoccupation with other activities (i.e., she’s too busy to shower or change clothes)
D is incorrect; Anxiety is not overt in this patient’s presentation.
Chapter 10, Textbook of Clinical Psychiatry
7. A 35year old man is brought to the casualty department because he was turning blue. On observation, he appears pale, with perioral cyanosis, periungual cyanosis and shall breathing of 3-5 per minute. He is unresponsive except that he moans to deep sternal rub. The patient’s brother says that he may have taken something to relax but he does not have any idea of what it could have been or how it had been ingested. No marks are visible on the patient’s body. The most likely drug the patient ingested was:
A. A Benzodiazepine
B. Cocaine
C. Ketamine
D. An opiate
Ans: D, An opiate. Overdoses of opiates commonly produce profound respiratory depression.
A is incorrect, Benzodiazepine alone is unlikely to produce this magnitude of respiratory depression but might do so if combined with other drugs
B is incorrect; Cocaine does not produce respiratory depression
C is incorrect; Ketamine is a dissociative anesthetic which produces little respiratory depression.
Chapter 9, Textbook of Clinical Psychiatry
8. You are asked to immediately resuscitate a patient who has been brought to the emergency room with opioid poisoning. He is in a state of profound respiratory distress. Which of the following drugs should you choose to administer to bring his breathing back to normal:
A. Flumazenil
B. Naloxone
C. Pentazocine
D. Amitryptiline
Ans: B, Naloxone. Naloxone is an opiate antagonist used to reverse opiate intoxication
A is incorrect, Flumazenil is a benzodiazepine antagonist
C is incorrect, Pentazocine is an analgesic
D is incorrect; Amitryptiline is a cyclic antidepressant that is lethal in overdose, primarily due to its cardiac effects.
Chapter 9, Textbook of Clinical Psychiatry
9. A young teenage boy is brought to the psychiatrist by his roommate who says that his behavior has been ‘upsetting of late’ and he has been talking and acting strange. On examination he has auditory hallucinations, agitation and rapid incoherent speech. The duration of symptoms is unknown. Substance abuse history is also unknown. The diagnosis could be all of the following except:
A. Schizophreniform Disorder
B. Schizoaffective disorder
C. Generalized Anxiety Disorder
D. Bipolar Disorder
E. Substance-induced psychotic disorder
Ans: C, Generalized Anxiety Disorder. Although patients with generalized anxiety disorder can present with restlessness or irritability, they are usually not agitated and do not have auditory hallucinations or thought disorder.
A is incorrect, this could be labeled as a schizophreniform disorder that could persist for 6-months to meet the criteria of schizophrenia
B and D are incorrect; this could be a manic episode with psychotic features in a patient with underlying bipolar or schizoaffective disorder
E is incorrect, the psychosis may also be substance induced (e.g., amphetamine-induced psychotic disorder)
Chapter 10, Textbook of Clinical Psychiatry
10. The most effective agent for treating the above condition would be:
A. Buspirone
B. Sertraline
C. Dextroamphetamine
D. Olanzapine
Ans: D, Olanzapine. Olanzapine is an atypical antipsychotic that is used to treat psychosis of any etiology.
A is incorrect, Buspirone is indicated for generalized anxiety disorder but is ineffective in psychosis
B is incorrect, Sertraline is an SSRI which is used to treat depression but might worsen a manic episode
C is incorrect; Dextroamphetamine is a psycho-stimulant that would exacerbate psychotic symptoms
Chapter 10, Textbook of Clinical Psychiatry
11. A 65 year old man visits his physician with the complaints of fatigue, inactivity, weight loss and abdominal discomfort. He appears to be depressed. Which of the following could be RULED OUT as a possible cause:
A. Hyperthyroidism
B. Aspirin abuse
C. Dementia
D. Pancreatic Cancer
Ans: A, Hyperthyroidism. It is associated with an elevation of mood and an increase in activity rather than depression
B is incorrect, aspirin abuse in patients because of somatization disorders who are preoccupied
With physical complaints often experience chronic depression
C is incorrect, Dementia presents with depressive symptoms in its early stages
D is incorrect, Patients with pancreatic cancer are most likely to be alcohol abusers, and both pancreatic cancer and alcohol abuse present with depression
Chapter 8, Textbook of Clinical Psychiatry
12. A 20 year old boy is brought to the emergency room at 04:00am in the morning by his friends after a night at the club. He is appears agitated and is euphoric. He has vomited a few times and is hyperactive. His respiration is slow and noisy. His heart rate is 120bpm. Which of the following drugs will you administer to restrain him:
A. Diazepam
B. Phenobarbital
C. Disulfiram
D. Haloperidol
Ans: D, Haloperidol. This is a probable case of alcohol intoxication and if he does not get restrained, a non sedating neuroleptic, such as haloperidol, may be administered if the patient continues to struggle.
A is incorrect, Diazepam is central nervous system depressant and is contraindicated since it may augment the CNS depression caused by alcohol
B is incorrect; Phenobarbital is also a Central Nervous system depressant
C is incorrect; Disulfiram produces severe nausea and vomiting when combined with alcohol
Chapter 10, Textbook of Clinical Psychiatry
13. A young boy was found on the streets smoking crack (cocaine) after which he was brought to the rehabilitation center. Which of the following symptoms will you least expect once his abstinence syndrome begins:
A. Increased Sleep
B. Increased Appetite
C. Severe Depression
D. Cardiovascular Collapse
Ans: D, Cardiovascular collapse. Cardiovascular collapse is a feature of withdrawal from barbiturates, benzodiazepines and related tranquilizers and not cocaine.
A, B and C all are symptoms of cocaine withdrawal.
Chapter 9, Textbook of Clinical Psychiatry
14. An 85 year old mathematics professor is brought in by her son for a routine visit to the physician. He reports that she is progressively more forgetful and is now somewhat paranoid, accusing him of stealing her money and planning to send her away to a nursing home. She has no prior history of cerebrovascular or cardio-vascular illness. There is a family history of dementia in an older sibling. On examination, the patient is alert and pleasant. She does not know anything about current politics but can recite names of leaders and events of 20 years back. Neurological exam is non focal. Head CT scan with and without contrast shows mild cortical atrophy. HIV test is negative. Thiamine, folate, vitamin B12, and niacin levels are normal. Serum RPR is negative. The most likely diagnosis is:
A. Vascular Dementia
B. Tertiary neurosyphilis
C. Alzheimer’s dementia
D. Psychotic disorder
Ans: C, Alzheimer’s Dementia. The Patient displays symptoms consistent with early dementia, including recent memory loss, anomia and paranoia. Risk factors for Alzheimer’s dementia (the most common cause of dementia) include advanced age, family history of dementia, Down’s syndrome and prior head trauma. The patient has risk factor of advanced age and family history of dementia. HIV dementia is ruled out.
A is incorrect, a non focal neurological examination, no prior history of cardiovascular or cerebro-vascular illness and no CT evidence of infarction rule out vascular dementia.
B is incorrect, potentially treatable causes of dementia such as vitamin deficiency, neuro-syphilis and normal pressure hydrocephalus are ruled out using the appropriate tests
D is incorrect, the patient’s worries about her son appear to be paranoia, but psychosis, including paranoia, hallucinations and delusions, is common in dementia
Chapter 8, Textbook of Clinical Psychiatry
15. A 75 year old female with a history of mild Alzheimer’s dementia is evaluated in the psychiatric ward for confusion. Her family reports that she was on her baseline until this morning when she became increasingly disoriented, losing recognition of family members and repeatedly complaining of hearing voices down the hall. On examination, she is initially alert. She is oriented to person but is convinced that she is in an army barracks and you and the other medical staff is military police. She can spell the word table forward but not backwards. Later in the interview she see seems distracted and doses off. Laboratory results reveal normal findings except for a mild anemia, increased WBC with increased PMNs and band forms. Urinalysis reveals no blood, 50-100 WBCs per HPF, gross bacturia. The most likely diagnosis is:
A. Worsening dementia
B. Delirium
C. Major Depressive disorder
D. Meningitis
Ans: B, Delirium. Dementia is a risk factor for delirium. This patient has a newly developed delirium. The time course of delirium is abrupt in onset (hours to days) and is characterized by altered cognition, including disturbances in perception (hearing voices, misperceiving medical personnel), altered attention (inability to spell table backwards) and altered level of arousal (alert to dozing in a brief time period).
A is incorrect, a worsening dementia would not present with all the above mentioned symptoms of delirium
C is incorrect, Major depression alone would not account for the patient’s disturbed sensorium and cognitive clouding, particularly with such an acute time course.
D is incorrect, The clinical picture; absence of headache, nuchal rigidity, photophobia or other localizing signs, does not support the diagnosis of meningitis in this individual.
Chapter 8, Textbook of Clinical Psychiatry
16. The most likely cause of this condition is:
A. Dementia
B. Anemia
C. Urinary tract Infection
D. Multifactorial
Ans: D, Multifactorial. The diagnosis of delirium requires a medical or substance-related precipitant. In this case there is no history of drug withdrawal or intoxication. However the present dementia, anemia and urinary tract infection all can jointly predispose her to develop delirium.
A is incorrect, the pre-existing dementia is a cause but not the only one in this case
B is incorrect, Anemia may also predispose a patient to delirium but once again it is not the only factor
C is incorrect, she has a urinary tract infection, a frequent cause of delirium in the elderly but the other causes cannot be ruled out in this case
Chapter 8, Textbook of Clinical Psychiatry
17. A 55 year old man is brought to casualty department by the police. He was confused, disheveled and agitated and was found wandering on the roads. On physical examination his BP is 200/110, heart rate of 130bpm, respiratory rate of 22 per minute and a temperature of 101˚F. He has prominent dilated pupils, symmetrical hyperreflexia, acne rosacea, palmar erythema and tender hepatomegaly. On mental status examination he is oriented only to person. He focuses at times and at other times talks about bugs crawling on the walls. He cannot provide any useful history. He has intermittent episodes of out of control behavior required restraint from the staff. Laboratory exams show mild pancytopenia on CBC with an increased MCV; electrolytes are normal with exception of reduced magnesium; liver functions show increased liver enzymes with decreased albumin. Urine and serum toxicology are normal. Head CT is negative. LP is normal. The most likely diagnosis is:
A. Alcohol withdrawal
B. Cocaine withdrawal
C. Opiate withdrawal
D. Dementia
Ans: A, Alcohol withdrawal. The clinical evidence points to a history of chronic heavy alcohol use in this patient. They physical exam finding of palmar erythema and acne rosacea suggest long-standing alcohol ingestion; enlarged tender liver suggests an alcohol-induced fatty or cirrhotic liver. The elevated vital signs, hyperreflexia, and dilated pupils all point to autonomic arousal produced by alcohol withdrawal. The CBC reveals evidence of alcohol induced bone marrow suppression with a megaloblastic anemia due to folate deficiency. Additional metabolic findings common in alcohol-dependent individuals include hypomagnesemia. This individual is delirious and has visual hallucinations, the most serious complications of alcohol withdrawal.
B is incorrect, Cocaine withdrawal is characterized by lassitude, fatigue, depression and increased sleep etc.
C is incorrect, although opiate withdrawal may present with dilated pupils and tachycardia but the lab results present in this case point towards alcohol withdrawal.
D is incorrect, in presence of dementia only there would be no hepatic and serum findings. Also hyperreflexia and dilated pupils would not be present.
Chapter 9, Textbook of Clinical Psychiatry
18. A 25year old university student presented with a history of a ‘schizophrenic episode’ following a few months of social withdrawal, symptoms of paranoia and auditory hallucinations. She was given a drug which she used for a year and a half. Her thought disorder improved but according to her mother she developed strange slow movements of mouth and upper body. Of the following antipsychotics, which has the highest risk of causing this condition:
A. Risperidone
B. Haloperidol
C. Clozapine
D. Olanzapine
Ans: B, Haloperidol. Haloperidol is the only neuroleptic in this list. Neuroleptics carry the highest risk for causing tardive dyskinesia.
A is incorrect, Risperidone is an atypical neuroleptic with a much lower risk of tardive dyskinesia
C is incorrect; Clozapine is not seen to have been associated with these side effects
D is incorrect, similar to risperidone
Chapter 10, Textbook of Clinical Psychiatry
19. A 60 year old man is admitted to the ICU with symptoms of severe alcohol withdrawal. He is agitated and disoriented. His vitals are; BP: 180/100, HR: 125 per minute and shallow and noisy breathing. His pupils are dilated and he has bilateral hyper-reflexia. On mental status exam, he is in a state of delirium and does not appear to focus. He is delirious and also has visual hallucinations. After appropriate treatment, the medical staff report that he is still ‘acting strange’ and has nystagmus, ataxia and anterograde amnesia. The most likely diagnosis for this patient is:
A. Wernicke’s encephalopathy
B. Korsakoff’s psychosis
C. Wernicke-Korsakoff syndrome
D. Subdural hematoma
Ans: C, Wernicke-Korsakoff syndrome. Wernicke-Korsakoff syndrome is a serious and usually irreversible complication of heavy alcohol use caused by thiamine deficiency, with associated hemorrhagic infarction in the mammilary bodies.
A is incorrect; Wernicke’s encephalopathy is the early stage of this condition and consists of confusion, nystagmus and ataxia. But in this case the diagnosis is severe.
B is incorrect, Prompt treatment in this case may prevent a progression to Korsakoff’s psychosis (anterograde amnesia and confabulation)
D is incorrect, these signs and symptoms do not correlate well with subdural hematoma which would give a focal presentation with a history of trauma
Chapter 9, Textbook of Clinical Psychiatry
20. A 21 year old male college student is brought to the emergency room after ingesting a drug for the first time. He denies any loss of consciousness but states that he felt ‘unreal’ as though he were watching himself from the outside. He denies any hallucinations but does report feeling anxious that someone might be following him. He also recalls feeling very hungry and that the 10-minute drive to the hospital lasted ‘five hours’. On physical examination, he has heart rate of 105, dry mouth and injected conjunctive. Which of the following substances did he most likely ingest:
A. Opium
B. Heroin
C. Cocaine
D. Marijuana
Ans: D, Marijuana. Because he presents with symptoms of derealization, paranoid ideation, distorted time sense and increased appetite. Tachycardia and dry mouth also point towards marijuana intake.
A is incorrect, Opium intoxication would produce flushing and an intensely pleasurable, diffuse bodily sensation. The initial rush is followed by a sense of well being. Signs would include papillary constriction, slurred speech, hypotension, bradycardia and hypothermia.
B is incorrect; Heroin intoxication would produce analgesia, nausea and vomiting, apathy and lethargy, flushing, euphoria and constricted pupils
C is incorrect; Cocaine would produce euphoria or hyper vigilance, tactile hallucinations, papillary dilatation, confusion and respiratory depression.
Chapter 9, Textbook of Clinical Psychiatry
21. A 26year old police officer is brought to the ER by his colleagues, who are concerned about a recent change in his behavior. For two weeks he has been accusing them of trying to frame him. He thinks that they want to kick him off the force because they can read all his thoughts. His wife confirms this history and says that he has been insisting on keeping the blinds on the windows closed. She also says that he has been suspicious of his co-workers since having been passed up for a promotion less than a month ago. On mental status exam, patient acts bizarre and answers question in a loose and disorganized fashion. The most probable diagnosis in this case would be:
A. Schizophrenia
B. Brief psychotic disorder
C. Delusional Disorder
D. Adjustment Disorder
Ans: B, Brief psychotic disorder. Presents with change in behavior involving delusions and suspicions for less than a month. Loosening of associations like answering questions in a bizarre way is also prominent
A is incorrect, schizophrenia should be diagnosed when psychosis persists for > 6months
C is incorrect, delusional disorder has symptoms that are present for at least one month, but the patient does not have prominent psychotic symptoms but instead the patient has a fixed and well circumscribed delusion
D is incorrect; Adjustment disorder does not have psychotic features
Chapter 10, Textbook of Clinical Psychiatry
22. A 36 year old woman is brought to the emergency room by her husband in a confused disoriented state. She was diagnosed with major depression several months ago and has failed to respond to treatment with nortriptyline thus far. Her husband says that she had become increasingly hopeless over the last few days and felt that life isn’t worth living. On physical exam, she is found to have tachycardia, hypotension, low grade fever, dilated pupils and warm red skin. On ECG, prolonged QT interval. Which of the following would be elevated in her serum:
A. Tri-cyclic antidepressant
B. Benzodiazepine
C. Lithium
D. Mefenamic Acid
Ans: A, Tri-cyclic antidepressant. Complications of tricyclic overdose include dry mouth, warm skin, blurred vision, respiratory depression, hypotension and cardiac arrhythmias (QT prolongation)
B is incorrect; Benzodiazepine intoxication would produce euphoria, hyperalgesia, sedation or paradoxical excitement, respiratory depression and stupor.
C is incorrect, lithium is indicated for bipolar disorder and presents with nausea diarrhea vomiting and unsteady gait.
D is incorrect, mefenamic acid is a substance present in painkillers and it is unlikely that the woman reached this state because of this type of overdose.
Chapter 9, Textbook of Clinical Psychiatry
23. A 45year old male is evaluated in the ER because he is a little confused and has run out of his medications. His wife reports that he filled a prescription of amitryptiline a few days ago. He seems sedated and keeps smacking his lips as if he has a dry mouth. He says he may have taken a few extra pills to help him sleep better but strongly denies a suicidal attempt. Vital signs show pulse of 110, Blood pressure 140/80, respirations 13/min, and temperature 99˚F. He is discharged since he does not have a declining level of consciousness and is advised for follow up with his psychiatrist the next day. Two hours later he is brought in again after he collapsed at home and turned blue. The patient was brought to hospital after which he died. The most likely cause of death in this patient is:
A. Pulmonary embolism
B. Cardiac arrhythmia
C. Opiate overdose
D. Intracranial bleeding
Ans: B, Cardiac Arrhythmia. The patient displays clinical evidence of having ingested toxic level of a tricyclic antidepressant. He has taken much more medication than prescribed and shows evidence of anticholinergic toxicity. TCAs produce QT prolongation and can produce ventricular tachycardia. Seizure, hypotension and delirium are also common
A is incorrect, pulmonary embolism has no relation to the drugs he has taken. His vitals also point towards a cardiac problem rather than a pulmonary complication
C is incorrect; the patient has no history of opiate poisoning. His symptoms are also different.
D is incorrect, cannot be a diagnosis unless proved on CT.
Chapter 9, Textbook Of Clinical Psychiatry
24. A 23year old boy is brought to the psychiatrist by his brother. The brother believes that the patient has been hearing and seeing things that were not there, particularly visions of people. At times the patient also talks abnormally and blames himself for things that are not his fault. At other times he has delusions that his friends at the university are plotting against him. He is socially withdrawn. His speech is coherent and there are no gross behavioral abnormalities. Which of the following is the most likely diagnosis:
A. Catatonic Schizophrenia
B. Disorganized Schizophrenia
C. Paranoid Schizophrenia
D. Residual Schizophrenia
Ans: C, The hallmark of paranoid schizophrenia is the relative prominence of paranoid delusions and auditory hallucinations. The thought process of the patient involves suspicions and fears that others may harm him. Most importantly disorganized behavior or speech, catatonia, or flat or
Inappropriate affect precludes this diagnosis. Social and occupational functioning may be well preserved.
A incorrect, is characterized by catatonic stupor or mutism, rigidly, excitement or negativity which is apparently motiveless resistance to all instructions
B incorrect, involves incoherent speech and grossly disorganized behavior
D incorrect is characterized by at least one psychotic episode. Prominent delusions or hallucinations are absent at the time of evaluation. Minor social and thought disturbances may be present.
Chapter 10, Textbook of Clinical Psychiatry
25. A 45 year old woman who has been a known patient of depression for years is brought to the emergency room in a state of clouded consciousness. She was recently prescribed lorazepam by her physician. She is confused, distracted and has trouble conversing. She is agitated and is disoriented in space and time. According to the attendant, she was fine a few hours ago and has never suffered a similar episode. Which of the following is the most likely diagnosis:
A. Dementia
B. Delirium
C. Schizophrenia
D. Epilepsy
Ans: B, Delirium is characterized by a clouded state of consciousness and attention deficits. Disorientation and memory deficits are also a prominent feature. Delirium has a rapid onset following drugs such as lorazepam, furosemide, digoxin etc.
A is incorrect; dementia is a disorder that effects personality, intellect and cognition and is not acute in onset.
C is incorrect, Schizophrenia is characterized by hallucinations and delusions and the patient is usually well oriented in space and time
D is incorrect, epilepsy involves episode(s) of seizures and the patient may become unconscious
Chapter 8, Textbook of Clinical Psychiatry
Talking Tom 