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* = what we think the answer might be

DIFFERENTIAL DIAGNOSIS
M patient comes in with criteria for MDD. Has extensive history of alcoholism, upset because
recently daughter called him a drunk and he is unable to quit drinking. His last drink was 36
hours ago. Neurotransmitter abnormality?
GABA
Endorphins
Dopamine
Ach
M brought in by girlfriend because he had 2 tonic-clonic seizures and has been acting strangely
in the past 24 hours. He keeps talking about the rapture and made sexual advances to
girlfriends friend, other racous behavior. He was diagnosed with seizure disorder 6 few years
ago and its well controlled- yesterday was the first seizure hes had in years. His speech is fast,
and he jumps from one idea to another. What does he have?
Bipolar DO, Manic Phase
Psychosis induced by General Medical Condition
Schizophrenia
adjustment disorder, conduct behavior
PSYCHOTIC DO
Male patient CC hearing voices the past week. Was fired from job last week, head voices tell
him hes no good, paranoid others were talking about him getting fired at the bar. These
symptoms resolved after 2 days. Diagnosis?
Brief Psychotic DO*
Delusional DO
Schizophreniform
MOOD DO
Female patient who has lupus and worsening symptoms. 6 weeks ago, her physician increased
the dose of corticosteroids to manage symptoms. Past 3 weeks, she is depressed, sad,
difficulty sleeping, gaining weight. Husband noticed her face and body have become more
round, out of proportion to her body. On exam she has truncal obesity. What do you plan to do
next?
Recommend group therapy for those with lupus
Revisit her need for corticosteroids
Female patient comes in for check-up, says shes had feelings of sadness ever since her
parents divorced 3 years ago. Sleep, appetite and concentration are fine. She enjoys going out
with friends because it helps her forget about her sadness, but becomes sad when at home
studying or trying to sleep. Gets good grades, no suicidal ideation.
Dysthymic DO*
MDD
F comes in with depressive symptoms even since she had her baby 6 weeks ago. Meets criteria
for MDD. What is this?
Baby Blues
Major Depression, Post-Partum Type
Normal

F who had a major depressive episode after her first child was born comes in wanting to have
another child. She is afraid of birth defects, but also of getting post partum depression. 8 weeks
into her 2nd pregnancy. Taking Sertraline + Antipsychotic. What do you do?
Continue medications
Switch Sertraline to Paxil - no
Discontinue Sertraline and Antipsychotic
Discontinue Sertraline
Discontinue Antipsychotic
M comes in with emotional instability- has 3-4 days of feeling high energy and high self esteem
followed by periods of low energy and mood. No impairment in functioning
Cyclothymic
28 YO African American F tried to kill herself with 8 ibuprofen pills. Took them when her
boyfriend left the apartment and thought he wouldnt be back for a while. Boyfriend came back
early unexpectedly and brought her to ER. Which increases risk for successful suicide attempt?
Age
Ethnicity
Lethality of Drug Dose
Anticipating not to be found by others
80 YO M has long history of medical problems, has depression and suicidal ideations. Recently
bought a firearm. What should the wife do?
Remove gun from home
BIPOLAR male patient tried to commit suicide by cutting himself. He was found by his mother
with a DNR form in his hand saying he did not want to be resuscitated. The DNR form was
signed and dated for today. He has a low BP and HR, low respiratory rate. What should you do?
Administer blood, fluids, etc as needed
Clarify with the mother if the wishes in his DNR are new desires or if they have been there for a
while
Start intubation and ventilation
ANXIETY DO
High school senior got palpitations, sweating, feeling like hes going to die, etc right after playing
tennis with friends 2 months ago. Have been increasing in frequency since then. No other
problems, says hes anxious because hes going to leave for college in 3 months. What does he
have?
Adjustment DO with anxiety
Panic DO
Female medical student is currently upset because one of her teachers told her she had poor
communication skills last week. She has difficulty talking on the phone- she is afraid of not being
able to obtain correct information, and when her attending asks her to call a patient, she freezes
and hangs up the phone. In addition, when she has to use the phone to call someone, she gets
anxious. She is afraid this may affect her. What do you treat the patient with?
SSRI
Woman with episodes of heart palpitations, sweating, and feeling very anxious for past 2
months. Patellar reflexes are increased bilaterally. Has lost 6 pounds over last 2 months. Labs:
TSH low. Diagnosis?
Hyperthyroid-induced Anxiety*
Panic DO
W with episodes of chest pain, palpitations, feeling as if shes going to die while reading the
newspaper this morning. She has had 2 episodes similar to this, but did not seek help because

they were not as severe. Episodes occur spontaneously, without a trigger. Ambulance comesshe is given nitroglycerin which makes her feel better. Her best friend from childhood died from
cancer 3 months ago. Patients says her mood is frightened, which is congruent with her affect.
No depressive symptoms, suicidal ideations. Most likely diagnosis?
Adjustment DO
Panic DO
PERSONALITY DO
Treatment for borderline personality disorder?
Dialectical Behavioral Therapy
22 yo male patient has a history of conduct disorder. In the past year, he has gone to jail and
has typical antisocial behavior (hitting people, stealing, etc). however, the last line stated that
he felt sad about the path of his life. ddx:
Antisocial PD (most likely, but not sure because usually patients with antisocial PD dont show
any remorse)
conduct disorder
Patient who has antisocial personality disorder. Abnormality in what neurotransmitter?
serotonin*
ach
dopamine
gaba
Patient feels restless, fatigue, and irritable for the past 2 months since starting his new job at the
law firm. He spends a lot of time re-reading manuscripts (10x) before turning them in. His gfs in
the past of called him rigid, and mental status exam shows a very tense person.
obsessive compulsive personality disorder*
general anxiety disorder
Female patients comes in because she feels sad. Father says shes had a history of unstable,
intense relationships. History of self-mutilation and emotional lability.
Borderline PD
M that has no friends. Works graveyard shift- was offered daytime shift a few months back but
turned it down. Enjoys cutting out articles about animals from magazines and collecting them.
Dx?
Schizotypal PD*
Schizoid PD
Schizophrenia
Avoidant PD
SUBSTANCE ABUSE
Alcoholic with nystagmus, ataxia, delirium. What is deficient?
Thiamine*
B12
Folate
Old lady brought to ER by police after she called them saying people in her neighborhood were
trying to get her. Slurred speech. Blood alcohol level in the 200s. 4 hours later she says she
doesnt know how she got here and wants to go home. Diagnosis?
Alcohol intoxication
Alcohol-induced amnesia episode
Korsakoff Psychosis

Wernicke Encephalopathy
Hepatic Encephalopathy
Yawning, dilated pupils
Opioid withdrawal
F is agitated, hypertension, increased HR, stained teeth, some teeth missing.
Methamphetamine intoxication*
Methamphetamine withdrawal
F brought into ER by friends after strange behavior at a party 1 hour ago. She is anxious,
grinding her teeth. What did she take?
MDMA ecstasy* (what we chose, not sure though)
Cocaine
Opioids
High BP, dry mouth, injected conjunctiva, slow response, emphasizes words.
Cannabis intoxication
COGNITIVE DO
Normal Pressure Hydrocephalus: ataxia, urinary incontinence, memory problems
77 yo patient developed progressive memory problems and seizures in the past 2 months. what
organism is responsible?
prion*
virus
bacteria
fungi
Parkinsons patient has started having visual hallucinations. He knows theyre not real, but they
bother him. He is on Levodopa/carbidopa and Rivastigmine and has the same dose for the past
6 years. He is oriented, happy, no other symptoms. Management?
Tell him hallucinations are a normal part of Parkinsons
Decrease levodopa/carbidopa dose
Increase levodopa/Carbidopa dose
Give Haloperidol
70 YO with strange behavior the past 4 days. Wife says hell have episodes of saying
nonsensical things, then coming back to normal. Worried because now these episodes have
become longer, lasting 2-4 hours. Physical exam shows slightly tender abdomen. Labs:
Increased WBC, fever, Urine 3+
Delirium
77 YO previously healthy M had wrist fracture. He comes in to get his cast off. While physician
is taking his cast off, patient begins going into the accident that caused the fracture in great
detail. He is not able to be interrupted and continues. What is the cause?
Normal Aging
Alzheimers dementia
Fat Embolism
GERIATRIC DO
PEDIATRIC DO
Kid has autistic/aspergers-like symptoms- which is the most likely comorbid DO?
Mental Retardation*
Tourettes
2.5 YO kid only speaks a few words, sometimes not in full sentences. Preoccupied with
paperclip in office. May have also had some motor delay? Next best step?
Intensive social skills training
Do a complete developmental evaluation

3.5 YO was potty trained- wet diaper at night but dry during day. What do you tell parent?
Reassure this is normal behavior for the age*
Prescribe imipramine
Use bell and pad behavioral training
Long face, prominent ears, large forehead, epicanthal folds. learning and behavioral problems.
Fragile X
Trisomy 21
Kid scored lower than intelligence on reading test. Scored at expected level for math
Reading DO*
Mental Retardation
Aphasia
Mom brings unconscious child in stating she found him like that on his bed. his sibling died
unexpectedly. he has two older brothers who live in the house.Child with retinal hemorrhages,
green ecchymoses on chest
Child abuse
Child has a history of scratching her arms. Child with bruises on forearm resembling pinch
marks
Child abuse
Social worker cant find child foster care placement. Beats up younger kids. Has nightmares,
trouble sleeping, often found hiding under his bed. He had bruise marks on his knees.
PTSD*
Adjustment DO
conduct disorder
Kid that talks back to parents and teachers, stays out past curfew
ODD
17 YO mom comes in because her kid has bad behavior for the past 6 months, wont listen or
follow directions. She will no longer eat food that she used to eat. Mom looks
overwhelmed/stressed. Child appears active in the exam room. Next step?
Parental training
Check urine for amino acids
Check for some enzyme deficiency (galactokinase?)
F comes in, has been diagnosed with ADHD in the past. Wants to avoid using amphetamines
because her brother is addicted to methamphetamine and is in jail for it. What do you prescribe?
Atomexetine
Little girl (5 YO?) brought in because her teachers say she wont talk. She completes her
homework and follows directions fine. Parents say she is also shy at home and reluctant to talk.
Also wont talk while in the doctors appointment. What does she have?
Selective mutism
Separation Anxiety DO
12 yo girl who talks about to her parents, goes to her room when she gets home from school.
started dyeing her hair different colors. starting drinking alcohol and using marijuana. mj shows
up on urine tox screen. what is the next step ?
talk about the effects of substance use
reassure the parent this is normal behavior
inpatient substance use program
outpatient substance use program
DISSOCIATIVE DO

Woman found in a different city than she lives, husband filed a missing persons report a few
days ago. States her name is Martha when its really not.
Dissociative Fugue
SOMATIZIATION DO
(2 questions like this) W who lost her voice after her husband told her he was having an affair 3
days ago. Normal physical exam
Conversion DO*
Adjustment DO
(2 questions like this) W with shakiness, tremors. Has happened 2 times before in past few
months, with glucose in 30s using her husbands glucose monitor. Her labs: Glucose low, insulin
high, C-peptide low, proinsulin low. Cause?
Exogenous insulin administration*
Insulinoma
Glucagonoma
IMPULSE DO
Girl with trichotillomania. Treatment?
Behavioral therapy
Psychodynamic psychotherapy
Drugs
EATING DO
Male patient with episodes of binge eating, during which he feels out of control. It distresses him
and he feels guilty afterwards. Treatment?
Young F brought in for muscle weakness and sensory loss past 4 days. Feels fatigued.
Constipated. Friends say theyve heard her in the bathroom throwing up for the past year.
Bradycardia, hypotension. Dry skin. Last menstrual period was 3 weeks ago. Bowel sounds
decreased. Best way to find out whats causing her muscle weakness and sensory loss?
Check serum electrolyte*
Check thyroid levels
Check b-hCG levels
Check LH/FSH levels
Check progesterone/estrogen levels
Anorexia most at risk for
Hyperkalemia
QT Prolongation
Binging and purging. treatment?
SSRI
SLEEP DO
M complaining of sleepiness. Snores. Wakes up in the morning with a headache that quickly
goes away once he gets up. Patient thinks he has seizures but isnt sure. Next best way to
diagnose him?
EEG
Polysomnogram*
M patient fell asleep while driving, falls asleep at desk at work. Wakes up sometimes and cant
move his body even though hes awake. Sometimes sees images of cats and dogs before he
goes to sleep. Probably has?
Sudden REM sleep onset

Kid wakes up screaming many times a week between 4-6 AM. He is able to be consoled. He
says monsters are chasing him in his dream and hes scared to go back to sleep. Dx?
Sleep terrors
Nightmare DO*
SEXUAL DO
24 YO M just got married. No previous sexual experience. Has low libido and cant attain an
erection. What is the cause?
Anxiety*
Ethics question: High school boy comes in for sports physical exam. He has a history of
depression successfully treated with fluoxetine one year ago. states that he is attracted to males
instead of females. Affect is anxious. What is your next question?
Can we talk about this with your parents?
Are you thinking of having sex with other men?
Do you think your depression is affecting your point of view?
Can we talk about your sexuality right now?
Why would you ever think men are more attractive than women?
Man left his wife 11 years ago because he felt he was more attracted to men than females. Now
in a relationship with a man for the past 7 years. Although he admits he is much happier now
than he was when he was with his wife, he is feeling some anxiety and has some doubts.
Recently, his daughter got engaged. The parents of the groom have asked him not to attend
their wedding. What does he have?
Transsexuality
Adjustment DO
Gender Identity DO
PSYCHOTHERAPY
PHARM
Patient with bipolar is on Lithium. Levels >3.0, increased creatinine. Treatment?
Dialysis
Patient wants to stop his Paroxetine all together. What will he experience if he does this?
Flu-like symptoms
Constipation
Girl tries to OD on her parents sleep pills- now has dry mouth, high temp, delirium
Catecholamine excess/blockade
Anticholinergic excess
Anticholinergic blockade*
Serotonin excess
Serotonin blockade
Patient with depression was prescribed an SSRI 6 weeks ago. Comes in saying that the meds
havent been that helpful, only her appetite has improved (she gained 7 lbs). Next step?
Add buproprion to SSRI
Add lithium to SSRI
Switch to AP
Switch to MAOI
Switch to duloxetine
Treatment for acute mania
Olanzapine
Man was given Haloperidol. Now his neck muscles are taut and wont relax. What NT is
responsible?
DA blockade*

DA excess
Ach excess
Ach blockade
FORENSIC PSYCH
NEURO
M patient has episodes when he smells ether, stares into space, and smacks his lips. Has a
history of head trauma. How do you treat?
Carbamazepine*
OTHER
W has really bad symptoms right before her menstrual period- cramps, fatigue, irritability,
bloated, etc. It gets better with OTC ibuprofen. Pelvic exam and everything is normal. Next
step?
Pelvic ultrasound
Have her journal her symptoms for next 2 menstrual cycles
Order TSH
Order CBC

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