Download Chemistry Problem Solving Drill

USMLE Step 1 - Problem Drill 5 : Psychiatry
Question No. 1 of 10
Instructions: (1) Read the problem statement and answer choices carefully, (2) Work the problems
on paper as needed, (3) Pick the answer, and (4) Review the core concept tutorial as needed.
1. You are making rounds at a nursing home and have one last patient to see. The
patient is new and his chart is currently being assembled by the office staff. You
start your exam by introducing yourself and asking a couple of questions. You
notice that the gentleman is alert and oriented to person, place, and time. He is
pleasant and seems to have good hearing and language skills. As you work through
the exam, you ask him to open his mouth so you can look inside and he does not
cooperate. You think it is odd that he does not follow this direction. You move on
with the plan of coming back to this part of the assessment in a few minutes. You
then ask him to raise his left leg up onto the bed so you can remove his sock and
examine his foot. He again does not follow the instructions you gave him regarding
doing something with a specific body part. His nurse enters the room reporting the
chart is ready now and you ask her if the resident has a history of _____. She
Question #01 reports that he indeed does and has ever since a CVA 5 years ago.
(A) Agnosia
(B) Anosognosia
(C) Anaphia
(D) Anosmia
(E) Autopagnosia
A. Incorrect!
Agnosia is the inability to recognize people or familiar things through sensory
stimuli.
B. Incorrect!
Anosognosia is the patient’s lack of awareness that they are patient ill.
C. Incorrect!
Anaphia is the inability to feel tactile stimulation.
Feedback
D. Incorrect!
Anosmia is a diminished or missing sense of smell.
E. Correct!
Autotopagnosia is a severe loss of the ability to identify and/or locate one’s own
body parts.
Orientation is essentially self-awareness. It refers to the patient’s ability to
understand who they are, where they are, and the time period in which they are
living. A specific type of orientation disorder is autotopagnosia: which is a severe
loss of the ability to identify and/or locate your own body parts. It is associated
with lesions of the dominant hemisphere and may follow a CVA.
Solution
E) Autopagnosia
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Question No. 2 of 10
Instructions: (1) Read the problem statement and answer choices carefully, (2) Work the problems
on paper as needed, (3) Pick the answer, and (4) Review the core concept tutorial as needed.
2. As a pediatrician, you often develop long-term relationships with your patients.
Tim, a teenage boy that has been one of your patients since he was a baby, was in
a bicycle accident and suffered a head injury while you were on vacation. Upon
your return, you hear of his accident. You decide to make a visit to the hospital to
check on him. As you are about to enter his room one of his friends is just leaving.
Tim is awake and is happy to see you. You ask him what happened and he tells you
in detail the events that led up to the accident. You see an empty meal tray in his
room and comment that lunch must have been good. You ask Tim what he had to
eat and he cannot seem to remember to answer you. Then as you are getting ready
to go, you comment that you do not want to overtire him as his friend had just left
as you were coming in and Tim says he must be tired, as he does not remember
having another visitor. It is apparent to you that because of the head injury Tim
Question #02
received in the accident he is suffering from _____.
(A) Retrograde amnesia
(B) Anterograde amnesia
(C) Amnesic apahsia
(D) Amnesic apraxia
(E) Post-traumatic amnesia
A. Incorrect!
Retrograde amnesia is when the patient cannot recall information before the injury.
B. Correct!
Anterograde amnesia is when the patient cannot remember life events after the
injury.
C. Incorrect!
Amnesic aphasia is when the patient cannot remember spoken words or is unable
to use words for names of objects, circumstances, of characteristics.
Feedback
D. Incorrect!
Amnesic apraxia is when the patient cannot follow instructions to perform a specific
physical movement because they are unable to remember the request.
E. Incorrect!
Post-traumatic amnesia a period of memory loss from the time of the injury until
the point at which functions concerned with memory return.
Solution
Amnesia is a disruption of memory. Amnesia may include either the process of
remembering newly learned information, and/or the process of referencing stored
memories. The two most common types of amnesia are named for whether they
affect information before or after a CNS injury: if the patient cannot recall
information before the injury, the amnesia is retrograde; if they cannot remember
life events after the injury, it is anterograde. You can remember the difference by
associating the first letters of “anterograde” and “after”, and by remembering that
the word retro often refers to something in the past.
(B) Anterograde amnesia
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Question No. 3 of 10
Instructions: (1) Read the problem statement and answer choices carefully, (2) Work the problems
on paper as needed, (3) Pick the answer, and (4) Review the core concept tutorial as needed.
3. Your patient is a 42-year-old man that has been seeing you for 8 months now.
His mental impairment has been progressively worsening and his level of
independence is continuing to deteriorate. In addition to suffering from delusions
and hallucinations, you have noticed that his behavior cycles between periods of
extreme withdrawal and periods of extreme excitement. You are diagnosing him as
having ______.
Question #03
(A) Disorganized Schizophrenia
(B) Catatonic Schizophrenia
(C) Paranoid Schizophrenia
(D) Undifferentiated Schizophrenia
(E) Residue Schizophrenia
A. Incorrect!
Disorganized Schizophrenia is characterized by an earlier age of onset and a more
severe disintegration of the personality.
B. Correct!
Catatonic Schizophrenia is characterized by alternating periods of extreme
withdrawal and extreme excitement.
C. Incorrect!
Paranoid Schizophrenia is characterized by a continuous preoccupation with
illogical, absurd, and changeable delusions accompanied by related hallucinations.
Feedback
D. Incorrect!
Undifferentiated Schizophrenia is characterized by a sudden onset of personality
disorganization with symptoms that include mood, thought, and behavior
disturbances.
E. Incorrect!
Residue Schizophrenia is characterized by the presence of residual symptoms
without delusions hallucination, incoherence, or gross disorganization.
Solution
Schizophrenia is diagnosed when there is are periods of psychosis and disturbed
behavior combined with declined functioning over a period greater than 6 months.
If such an episode lasts less than 1 month, it is considered to be a brief psychotic
disorder, often stress related. Although it presents earlier in men, there is no
difference in the lifetime prevalence between men and women, and between
Caucasians and African-Americans. Diagnosis of schizophrenia requires the
presence of at least 2 symptoms. The symptoms of schizophrenia are divided into
those that are “positive” and those that are “negative”. Positive symptoms include
1) delusions 2) hallucinations 3) loose association 4) disorganized or catatonic
behavior, and negative symptoms include 1) flat affect 2) social withdrawal 3) lack
of motivation, speech and/or thought. There are five types of schizophrenia you
need to remember: Disorganized, Catatonic, Paranoid, Undifferentiated, and
Residual. Keep in mind that the five types are not necessarily exclusive of other
disorders; for example, in schizoaffective disorder, there is schizophrenia plus a
major depressive or manic disorder, or both, resulting in schizoaffective disorders
that are either bipolar or depressive, depending on the accompanying symptoms.
(B) Catatonic Schizophrenia
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Question No. 4 of 10
Instructions: (1) Read the problem statement and answer choices carefully, (2) Work the problems
on paper as needed, (3) Pick the answer, and (4) Review the core concept tutorial as needed.
4. A patient suffers from ____. She will be traveling to Paris and does not want her
fear of heights to prevent her from going to the top of the Eiffel tower with the tour
group. She is seeking systematic desensitization therapy to reduce the anxiety that
her phobia causes so that she will be able to enjoy all aspects of this once in a
lifetime trip.
Question #04
(A)
(B)
(C)
(D)
(E)
Arachnophobia
Anginophobia
Amathophobia
Acrophobia
Agoraphobia
A. Incorrect!
Arachnophobia is a fear of spiders.
B. Incorrect!
Anginophobia is a fear of choking.
C. Incorrect!
Amathophobia is a fear of dust.
Feedback
D. Correct!
Acrophobia is a fear of heights.
E. Incorrect!
Agoraphobia is a fear of being in public places.
A phobia is an intense, persistent fear of certain situation, objects or people. While
the patient often recognizes that the fear is unreasonable, they cannot control the
anxiety response when cued by the presence or anticipation of the triggering object
or situation. Phobias can sometimes be treated using systematic desensitization.
Acrophobia is a fear of heights.
(D) Acrophobia
Solution
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Question No. 5 of 10
Instructions: (1) Read the problem statement and answer choices carefully, (2) Work the problems
on paper as needed, (3) Pick the answer, and (4) Review the core concept tutorial as needed.
5. Your patient is back at your office for the 6 th time in a two month period. She is
certain that she has a brain tumor. She is in overall good health, and you have
reassured her repeatedly that nothing is wrong. All of her diagnostic exams have
had normal results. You are starting to suspect that this patient should be referred
to a psychiatrist as she may have _____.
Question #05
(A)
(B)
(C)
(D)
(E)
Hypochondriasis
Body dysmorphic disorder
Conversion
Pseudocyesis
Pain disorder
A. Correct!
Hypochondriasis is an overwhelming fear of having a specific disease despite medical
reassurance that the disease is not present.
B. Incorrect!
Body dysmorphic disorder is a preoccupation with an imagined defect in appearance.
C. Incorrect!
Conversion is motor or sensory symptoms that suggest a disorder, in the absence of
evidence under examination by a physician.
Feedback
D. Incorrect!
Pseudocyesis is the false belief one is pregnant and is associated with objective
physical signs of pregnancy.
E. Incorrect!
Pain disorder is prolonged or excessive pain not completely described by an illness.
Somatoform disorders are a mental condition where the patient experiences
symptoms that mimic physical disease or injury where there are no identifiable
causes. Unlike malingering and factitious disorders, which are conscious,
somatoform disorders are driven unconsciously, and are more common in women.
Hypochondriasis is an overwhelming fear of having a specific disease despite
medical reassurance the disease is not present.
(A) Hypochondriasis
Solution
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Question No. 6 of 10
Instructions: (1) Read the problem statement and answer choices carefully, (2) Work the problems
on paper as needed, (3) Pick the answer, and (4) Review the core concept tutorial as needed.
6. You are pleased that your patient is taking your advice and is starting a treatment
program for his alcoholism. He asks you want kind of withdrawal symptoms he
should expect to see. You inform him that ____ are the symptoms associated with
alcohol withdrawal.
Question #06
(A)
(B)
(C)
(D)
(E)
Anxiety, insomnia, and dilated pupils
Tremor, tachycardia, delirium tremens, agitation, and hallucinations
Irritability, anxiety, and difficulty sleeping
Depression, craving, and displeasure
Vomiting, diarrhea, and sweating
A. Incorrect!
Heroin withdrawal symptoms include anxiety, insomnia, and dilated pupils.
B. Correct!
Alcohol withdrawal symptoms include tremor, tachycardia, delirium tremens (which
is a life-threatening syndrome peaking 2-5 days after the last drink that is treated
with benzodiazepines), agitation, and hallucinations.
C. Incorrect!
Marijuana withdrawal symptoms include irritability, anxiety, and difficulty sleeping.
Feedback
D. Incorrect!
Cocaine withdrawal symptoms include depression, craving, and displeasure.
E. Incorrect!
Vicodin withdrawal symptoms include vomiting, diarrhea, and sweating.
When an abusive substance is withdrawn, there is a set of associated behavioral,
physiologic and cognitive state changes that take place. Symptoms are often
opposite those of intoxication, and are not attributable to another medical condition.
Alcohol intoxication is characterized by disinhibition, emotional lability, slurred
speech, ataxia and blackouts. Withdrawal symptoms include tremor, tachycardia,
delirium tremens (which is a life-threatening alcohol withdrawal syndrome peaking
2-5 days after the last drink that is treated with benzodiazepines), agitation, and
hallucinations. Disulfiram is a common treatment for alcoholism because it makes
the patient sick when they imbibe alcohol, thereby causing avoidance behavior.
(B) Tremor, tachycardia, delirium tremens, agitation, and hallucinations
Solution
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Question No. 7 of 10
Instructions: (1) Read the problem statement and answer choices carefully, (2) Work the problems
on paper as needed, (3) Pick the answer, and (4) Review the core concept tutorial as needed.
7. You are starting your patient on amitriptyline, a tricyclic antidepressant. To
ensure your patient is well informed you discuss with her that possible side effects
associated with this category of medication include _____.
Question #07
(A) Atypical depression, anxiety, anorexia, bulimia, hypochondria, and social
phobias
(B) Thrombocytopenia, arrhymia, stroke, MI, tachycardia, urinary retention, and
seizures
(C) Tremor, hypothyroidism, diabetes insipidus, and pregnancy issues
(D) Serotonin syndrome, insomnia, male reproductive dysfunction, and CNS
stimulation
(E) Dystonia, akathesia, tardive dyskinesia, and extrapyramidal symptoms
A. Incorrect!
Atypical depression, anxiety, anorexia, bulimia, hypochondria, and social phobias are
side effects associated with MAO inhibitors.
B. Correct!
Thrombocytopenia, arrhymia, stroke, MI, tachycardia, urinary retention, and
seizures are side effects associated with TCAs.
C. Incorrect!
Tremor, hypothyroidism, diabetes insipidus, and pregnancy issues are side effects
associated with Lithium.
Feedback
D. Incorrect!
Serotonin syndrome, insomnia, male reproductive dysfunction, and CNS stimulation
are side effects associated with SSRIs.
E. Incorrect!
Dystonia, akathesia, tardive dyskinesia, and extrapyramidal symptoms are side
effects associated with antipsychotics.
Tricyclic antidepressants block the reuptake of both norepinephrine and serotonin.
TCAs include the drugs imipramine and amitriptyline, and used clinically to treat
major depression, bed wetting and OCD. Side effects of TCAs can be remembered
using the abbreviation TCAs: Thrombocytopenia, Cardiac (arrhymia, MI, stroke),
Anticholinergic (tachycardia, urinary retention, etc), Seizures.
(B) Thrombocytopenia, arrhymia, stroke, MI, tachycardia, urinary
retention, and seizures
Solution
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Question No. 8 of 10
Instructions: (1) Read the problem statement and answer choices carefully, (2) Work the problems
on paper as needed, (3) Pick the answer, and (4) Review the core concept tutorial as needed.
8. A patient you have been treating has a psychiatric disorder. They are suffering
from _____. They refuse to let go of their false beliefs despite being presented with
evidence to the contrary.
Question #08
(A)
(B)
(C)
(D)
(E)
Delirium
Hallucinations
Delusions
Illusions
Loose associations
A. Incorrect!
Delirium is an acute state of confusion.
B. Incorrect!
Hallucinations take place in the absence of an external stimulus.
C. Correct!
Delusions are false beliefs that cannot be changed in the face of facts to the
contrary.
Feedback
D. Incorrect!
Illusions misinterpret a real, external stimulus, such as the visual appearance of an
object.
E. Incorrect!
Loose associations are issues with tying together associated thoughts in a coherent
fashion.
There are four psychiatric disorders with similar characteristics, namely
hallucination, illusion, delusion and loose association. Delusions are false beliefs
that cannot be changed in the face of facts to the contrary.
(C) Delusions
Solution
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Question No. 9 of 10
Instructions: (1) Read the problem statement and answer choices carefully, (2) Work the problems
on paper as needed, (3) Pick the answer, and (4) Review the core concept tutorial as needed.
9. You are treating an elderly man that has no evidence of psychosis. He is viewed
in the community as being weird as his behavior is eccentric. He is _____. You
understand that this is a Cluster A personality disorder.
Question #09
(A)
(B)
(C)
(D)
(E)
Antisocial
Histrionic
Obsessive-compulsive
Avoidant
Schizoid
A. Incorrect!
Antisocial is a Cluster B personality disorder.
B. Incorrect!
Histrionic is a Cluster B personality disorder.
C. Incorrect!
Obsessive-compulsive is a Cluster C personality disorder.
Feedback
D. Incorrect!
Avoidant is a Cluster C personality disorder.
E. Correct!
Schizoid is a Cluster A personality disorder.
Solution
Personality is a core trait which can occasionally undergo change during disease
processes. Personality traits are enduring patterns of perceiving, relating to, and
thinking about the environment and oneself that encompasses the wide range of
social and personal contexts in which personality is evident. Personality disorders
occur when these traits become maladaptive and inflexible, impairing social and/or
occupational functioning. Such disorders are usually diagnosed in children.
Personality disorders are often “clustered” into three categories that can be
remembered as follows: A: weird, B: wild, C: worried. Cluster A personality
disorders are often described as the patient being “weird.” Their behavior is
considered eccentric compared to social norms, yet there is no evidence of
psychosis. The three primary types of type A disorders are 1) paranoid 2) schizoid
and 3) schizotypal.
(E) Schizoid
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Question No. 10 of 10
Instructions: (1) Read the problem statement and answer choices carefully, (2) Work the problems
on paper as needed, (3) Pick the answer, and (4) Review the core concept tutorial as needed.
10. The study of psychology incorporates concepts from the structural theory of the
mind and the topographic theory of the mind. When considering these theories,
_____ is comprised of the basal, primal urges such as sex and aggression.
Question #10
(A)
(B)
(C)
(D)
(E)
Id
Ego
Superego
Preconscious
Conscious
A. Correct!
Id is comprised of the basal, primal urges such as sex and aggression.
B. Incorrect!
Ego is the mediator between the id and external world, resisting the urges of the Id.
C. Incorrect!
Superego is comprised of higher social behaviors, such as moral values and
conscience.
Feedback
D. Incorrect!
Preconscious is consciousness that requires focused effort, such as retrieving
previously memorized information.
E. Incorrect!
Conscious is what you are aware of.
Solution
Much of psychology is based in the structural theory of the mind, as first described
by Freud. According to Freud, there are 3 structures of the mind: Id: which
comprises the basal, primal urges such as sex and aggression. Think of Id as the
Instincts of what I want. Ego: the ego is the mediator between the id and external
world, resisting the urges of the Id. Superego: superego comprises higher social
behaviors, such as moral values and conscience. The topographic theory of the
mind is similar to Freud’s structural theory in its presumption of three layers of
consciousness. Conscious: what you are aware of Preconscious: consciousness that
requires focused effort, such as retrieving previously memorized information.
Unconscious: the portion of the mind you are not aware of, that may drive specific
behaviors.
(A) Id
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