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71 Cards in this Set
- Front
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1. A 55-year-old male patient is admitted to the hospital complaining of intense abdominal pain, nausea, and diarrhea. He states that over the past few days he has also been very "nervous" and depressed. When his urine is collected it appears purple in color. Testing of the urine is most likely to reveal high levels of
(A) histamine (B) 5-hydroxyindoleacetic acid (5-HIAA) (C) porphobilinogen (D) cortisol (E) vanillylmandelic acid (VMA |
This patient with abdominal pain, nausea, diarrhea, and purplish urine is most likely to have porphyria, which is associated with high levels of porphobilinogen in urine. Porphyria is a metabolic disorder in which toxic porphyrins accumulate in tissue and body fluids. Purplish urine is not seen in the serotonin syndrome (high 5-HIAA), Cushing disease (high cortisol) or pheochromocytoma (high VMA)
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5. To determine whether a 3-month-old infant is able to hear sounds, the most appropriate diagnostic technique is
(A) PET (B) CT (C) amobarbital sodium (Amytal) interview (D) EEG (E) evoked EEG (F) Glasgow Coma Scale (G) Folstein Mini-Mental State Examination |
5. The answer is E. The auditory evoked EEG can be used to assess whether this child can hear. Evoked EEGs measure electrical activity in the cortex in response to sensory stimulation.
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6. A 27-year-old female patient shows a sudden loss of sensory function below the waist that cannot be medically explained. To determine whether psychological factors are responsible, the most appropriate diagnostic technique is
(A) PET (B) CT (C) amobarbital sodium (Amytal) interview (D) EEG (E) evoked EEG (F) Glasgow Coma Scale (G) Folstein Mini-Mental State Examination |
the amobarbital sodium (Amytal) interview is used to determine whether psychological factors are responsible for symptoms in this patient who shows a non-medically explained loss of sensory function (conversion disorder—see
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7. To identify anatomical changes in the brain of an 80-year-old female patient with Alzheimer disease, the most appropriate diagnostic technique is
(A) PET (B) CT (C) amobarbital sodium (Amytal) interview (D) electroencephalogram (EEG) (E) EEG (F) Glasgow Coma Scale (G) Folstein Mini-Mental State Examination |
7. The answer is B. Computed tomography (CT) identifies organically based brain changes, such as enlarged ventricles. Thus, although not diagnostic, this test can be used to identify anatomical changes in the brain, such as enlarged ventricles in a patient with suspected dementia of the Alzheimer type.
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8. To differentiate delirium from dementia in a 75-year-old male patient, the most appropriate diagnostic technique is
P.49 (A) PET (B) CT (C) amobarbital sodium (Amytal) interview (D) EEG (E) evoked EEG (F) Glasgow Coma Scale (G) Folstein Mini-Mental State Examination |
8. The answer is D. Electroencephalogram (EEG) measures electrical activity in the cortex and can be useful in differentiating delirium (abnormal EEG) from dementia (usually normal EEG).
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9. A 40-year-old woman reports that she has little appetite, sleeps poorly, and has lost interest in her normal activities. Which of the following is the most likely laboratory finding in this woman?
(A) Positive dexamethasone suppression test (DST) (B) Normal growth hormone regulation (C) Increased 5-hydroxyindoleacetic acid (5-HIAA) levels (D) Normal melatonin levels (E) Hyperthyroidism |
9. The answer is A. Poor appetite, poor sleep, and lack of interest in normal activities characterize patients who have major depression (see Chapter 12). In this depressed woman, the dexamethasone suppression test is likely to be positive. A positive result is seen when the synthetic glucocorticoid dexamethasone fails to suppress the secretion of cortisol as it would in a normal patient. Also, in depression there may be abnormal growth hormone regulation and melatonin levels, and decreased 5-HIAA. Hypothyroidism may be associated with depression; hyperthyroidism is more commonly associated with the symptoms of anxiety.
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0. A 50-year-old man reports that over the past few months he has begun to experience intense anxiety and has lost 15 pounds. The patient also complains of "flushing, palpitations" and diarrhea. Which of the following is the most likely laboratory finding in this man?
(A) Positive DST (B) Normal growth hormone regulation (C) Increased 5-HIAA levels (D) Normal melatonin levels (E) Hyperthyroidism |
10. The answer is E. This man's symptoms (e.g., anxiety, fever, weight loss, diarrhea, and flushing) indicate that he has hyperthyroidism (and see answers to question 9). People commonly describe their perception of a rapid heartbeat as "palpitations."
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11. A college-educated 72-year-old female patient has scored 15 on the Folstein Mini-Mental State Examination. From this score, the physician can conclude that this patient probably
(A) is normal (B) cannot calculate simple sums (C) is cognitively impaired (D) should be placed in an assisted living facility (E) has a lower-than-normal IQ |
1. The answer is C. Scores below 20 on the Folstein Mini-Mental State Examination indicate significant cognitive impairment. This test does not evaluate calculating ability or IQ. Although the patient is impaired, it is not clear what caused the problem or whether she needs to be placed in an assisted living facility.
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Four weeks after he begins to take a new medication, a 28-year-old male psychiatric patient develops a fever and a sore throat. He reports feeling tired, and blood studies reveal a white blood cell (WBC) count of less than 2,000. This patient is most likely to be taking which of the following agents?
(A) Amobarbital sodium (B) Clozapine (C) Lithium (D) Dexamethasone (E) Sodium lactate |
12. The answer is B. Agranulocytosis is seen particularly in patients taking clozapine, an antipsychotic, or carbamazepine, an anticonvulsant that is used to treat bipolar disorder (see Chapter 12). Lithium, amobarbital sodium, dexamethasone, and sodium lactate are not specifically associated with agranulocytosis.
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associated primarily with perception; it also is associated with spatial relations, body image, and musical and artistic ability.
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The right, or nondominant, hemisphere
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language function in about almost all right-handed people and most left-handed people.
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he left, or dominant, hemisphere is associated with language function in about almost all right-handed people and most left-handed people.
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Most serotonergic cell bodies in the brain are contained in the
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raphe
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Degeneration of cholinergic neurons is associated with
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ahlzheimers
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The nucleus basalis of Meynert is a brain area involved in
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production of Ach.
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a blocker of the N-methyl-d-aspartate (NMDA) receptor, a type of glutamate receptor, has been approved to treat Alzheimer disease and may prove useful also in the treatment of schizophrenia.
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memantine
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1. A 30-year-old man who has had many negative life experiences becomes upset when he sees photographs of himself taken during these times. The brain area most likely to be activated by these photographs is the
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1. The answer is E. The amygdala is an important brain area for the evaluation of sensory stimuli with emotional significance. Thus, the brain area most likely to be activated by these photos is the amygdala
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43-year-old man comes to the emergency department of a large hospital. He is very anxious and complains of abdominal cramps and diarrhea. The physician observes intense flushing of the man's skin. In this patient, a 24-hour urine study is most likely to reveal elevated levels o
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A 24-hour urine study is most likely to reveal elevated levels of vanillylmandelic acid (VMA), a metabolite of norepinephrine. Anxiety, abdominal cramps and diarrhea, and skin flushing are symptoms of pheochromocytoma, a norepinephrine-secreting adrenal tumor. This picture is not seen with elevated levels of other neurotransmitter metabolites.
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n a clinical experiment, a 48-year-old female patient with chronic pain who, in the past, has responded to placebos is given naloxone. Shortly thereafter the patient is given an inert substance that she believes is a painkiller. After the patient receives the inert substance, her pain is most likely to
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Since the placebo response is based in part on activation of the endogenous opioid system, it will be blocked by naloxone, and this patient's pain will be unchanged. This experiment will not necessarily affect her response to opioids in the future.
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hich of the following neuropeptides is most closely implicated in the psychopathology of physical and mental pain?
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Substance P has been implicated in physical and mental (e.g., depression) pain. Cholecystokinin (CCK) is implicated in schizophrenia and anxiety disorders; vasopressin, somatostatin, and vasoactive intestinal peptide have been implicated in mood disorders. Somatostatin has been implicated also in Huntington disease and Alzheimer disease.
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. Which of the following two structural entities connect the cerebral hemispheres?
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he corpus callosum and the hippocampal, habenular, and anterior commissures connect the two hemispheres of the brain. The basal ganglia, reticular system, and amygdala do not have this function.
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A 23-year-old patient shows side effects such as sedation, increased appetite, and weight gain while being treated with antipsychotic medication. Of the following, the mechanism most closely associated with these effects is
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Sedation, increased appetite, and weight gain are side effects of treatment with certain antipsychotic agents. The mechanism most closely associated with these side effects is blockade of histamine receptors since these antipsychotics are not specific for dopamine blockade. Blockade of dopamine receptors by these antipsychotic medications is associated with side effects such as Parkinsonism-like symptoms and elevated prolactin levels
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he autopsy of a 65-year-old man who was killed when he walked across the street without looking at the traffic light shows degeneration of cholinergic neurons in the hippocampus. In life, this man is most likely to have had which of the following disorders
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Degeneration of cholinergic neurons in the brain is seen in Alzheimer disease, movement disorders, and Down syndrome.
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9. The major neurotransmitter implicated in both Alzheimer disease and schizophrenia is
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While acetylcholine (Ach) is the major neurotransmitter implicated in Alzheimer disease, abnormalities in glutamate are seen in both Alzheimer disease and schizophrenia.
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\what is metabolized by MHPG
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NE
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The neurotransmitter metabolized to 5-HIAA (5-hydroxyindoleacetic acid) is
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serotonin
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A 35-year-old female patient reports that she has difficulty sleeping ever since she sustained a concussion in a subway accident. The area of the brain most likely to be affected in this patient is (are) the
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Sleep-arousal mechanisms are affected by damage to the reticular system.
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A 55-year-old woman was diagnosed with schizophrenia at the age of 22. If this diagnosis was appropriate, the volume of the hippocampus, size of the cerebral ventricles, and glucose utilization in the frontal cortex of this patient are now most likely to be, respectivel
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Although neuroimaging cannot be used to diagnose psychiatric disorders, brains of patients with schizophrenia such as this woman are likely to show decreased volume of limbic structures such as the hippocampus; increased size of cerebral ventricles due, in part, to brain shrinkage; and decreased glucose utilization in the frontal cortex.
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An 80-year-old female patient has a resting tremor of her left hand, little expression in her face, and problems taking a first step when she has been standing still. The area of the brain most likely to be affected in this patient is
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his 80-year-old female patient is showing signs of Parkinson disease (e.g., a resting tremor, little facial expression, and problems initiating movement). This disorder is associated with abnormalities of the basal ganglia.
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A 69-year-old former bank president cannot tell you the name of the current president and has difficulty identifying the woman sitting next to him (his wife). He began having memory problems 3 years ago. The area of the brain most likely to be affected in this patient is (are) the
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his patient is showing evidence of Alzheimer disease. Of the listed brain areas the major one implicated in Alzheimer disease is the hippocampus.
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A 28-year-old male patient is brought to the emergency room after a fight in which he attacked a man who cut into his line at the supermarket checkout. In the emergency room he remains assaultive and combative. The body fluids of this patient are most likely to show
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Assaultive, impulsive, aggressive behavior like that seen in this 28-year-old male patient is associated with decreased levels of serotonin in the brain. Levels of 5-HIAA (5-hydroxyindoleacetic acid), the major metabolite of serotonin, have been shown to be decreased in the body fluids of violent, aggressive, impulsive individuals as well as depressed individuals. MHPG (3-methoxy-4-hydroxyphenylglycol), a metabolite of norepinephrine, is decreased in severe depression, while homovanillic acid (HVA), a metabolite of dopamine, is decreased in Parkinson disease and depression.
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A 30-year-old woman who is withdrawing from heroin shows intense anxiety, increased pulse, elevated blood pressure, and a hand tremor. Her symptoms improve when she is given clonidine, an α-2 adrenergic receptor agonist. The area of the brain most likely to be involved in the improvement in this patient's symptoms is (are) the
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The effectiveness of clonidine in treating withdrawal symptoms associated with use of opiates and sedatives is believed to be due to its action on alpha-2-adrenergic receptors, e.g., reducing the firing rate of noradrenergic neurons, most of which are located in the locus ceruleus.
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Analysis of the blood plasma of a 45-year-old male patient shows increased concentration of homovanillic acid (HVA). This elevation is most likely to be associated with which of the following conditions?
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ncreased body fluid level of homovanillic acid (HVA), a major metabolite of dopamine, is seen in schizophrenia. Decreased HVA is seen in Parkinson disease, depression, and in medicated schizophrenic patients. Increased vanillylmandelic acid (VMA), a metabolite of norepinephrine, is seen in pheochromocytoma. Decreased body fluid level of 5-HIAA, a metabolite of serotonin, is seen in depression and in bulimia.
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A depressed 14-year-old girl with no history of conduct disorder has sexual encounters with multiple partners after her parents' divorce
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Acting out Avoiding personally unacceptable emotions by behaving in an attention-getting, often socially inappropriate manner
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Assisting others to avoid negative personal feelings
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Altruisms
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An alcoholic insists that he is only a social drinker
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Denial
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A surgeon with unacknowledged anger toward his
mother is abrasive to the female residents on his service |
displacement
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Although he was not injured, a teenager has no memory
of a car accident in which he was driving and his girlfriend was killed |
Dissasociation - Mentally separating part of one's consciousness from real life events or mentally distancing oneself from others
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A man who is concerned about his erectile problems makes jokes about Viagra
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Humora
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Identification
(introjection) is? |
Unconsciously patterning one's behavior after that of someone more powerful (can be either positive or negative)
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A man who was terrorized by his gym teacher as a child
becomes a punitive, critical gym teacher (identification with the aggressor) |
introjection (ID)
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A sailor whose boat is about to sink calmly explains the
technical aspects of the hull damage in great detail to the other crew member |
Intellectualization
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Using the mind's higher functions to avoid
experiencing emotion |
Intellectualization
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Without showing any emotion, a woman tells her family
the results of tests that indicate her lung cancer has metastasized |
solation of affect - ailing to experience the feelings associated
with a stressful life event, although logically understanding the significance of the event |
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A man who loses an arm in an accident says the loss of
his arm was good because it kept him from getting in trouble with the law |
Rationalization - Distorting one's perception of an event so that
its negative outcome seems reasonable |
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Adopting opposite attitudes to avoid personally unacceptable emotions, i.e., unconscious
hypocris |
Reaction
formation |
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A woman who unconsciously is resentful of the
responsibilities of child rearing overspends on expensive gifts and clothing for her children |
RXN formation
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Categorizing people or situations into
categories of either "fabulous" or "dreadful" because of intolerance of ambiguity Seen in patients |
spltting seen in patients with Categorizing people or situations into
categories of either "fabulous" or "dreadful" because of intolerance of ambiguity Seen in patients with borderline personality disorder |
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A patient tells the doctor that while all of the doctors in
the group practice are wonderful, all of the nurses and office help are unfriendly and curt |
Splitting
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Deliberately pushing personally unacceptable
emotions out of conscious awareness (the only defense mechanism that includes some aspect of consciousness) |
suppresion
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A medical student taking a review course for the United
States Medical Licensing Examination, mentally changes the subject when her mind wanders to the exam during a lectur |
suppression
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Believing that one can magically reverse past
events caused by "incorrect" behavior by now adopting "correct" behavior |
undoing
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basic defense mechanism on which all others are based.
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repression
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the patient has confidence in the doctor. If intense, the patient may over-idealize the doctor or develop sexual feelings toward the doctor.
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positive transferance
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feelings about a patient who reminds the doctor of a close friend or relative can interfere with the doctor's medical judgment.
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countertransferance
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When a 27-year-old patient who had a contentious relationship with his father joins a new health insurance plan, he must change from his primary care physician, a young man, to a new physician, a middle-aged man. On his first visit to the new doctor, the patient seems annoyed with everything the doctor says and states, "You are an old man with old-fashioned ideas; you just want to control my life." This patient's behavior is most closely related to which of the following?
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negative transferance - The patient who becomes very angry at his new doctor is showing a negative transference reaction. This emotional demonstration is likely to be a result of reexperiencing negative feelings about his relationship with his father in his relationship with the middle-aged doctor. In negative transference, patients become resentful or angry toward the doctor if their desires and expectations are not realized. This may lead to noncompliance with medical advice. In positive transference, patients have a high level of confidence in the doctor. Patients may also over-idealize or develop sexual feelings toward the doctor. This patient's reaction to the new doctor is less likely to be related to dislike or fear of the doctor.
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A physician becomes very angry with a patient when the patient does not take his medication. The patient reminds the doctor of her rebellious son. This physician's intense reaction to the patient's behavior is most likely to be a result of
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countertransferance - The doctor who becomes very angry at her patient for not taking his medication is showing a countertransference reaction. This excessive show of emotion is a result of reexperiencing feelings about her son's behavior in her relationship with the noncompliant patient. It is important for the doctor to identify this reaction because it can interfere with her medical judgment (see also answer to question 1). This doctor's reaction to the patient is less likely to be related to dislike or fear of the patient.
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Which of the following structures of the mind work on an unconscious level?
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In Freud's structural theory, the mind is divided into the id, ego, and superego. The id operates completely on an unconscious level, while the ego and superego operate partly on an unconscious and partly on preconscious and conscious levels.
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Which of the following structures of the mind are developed in a normal 4-year-old child?
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the id is present at birth, the ego begins to develop immediately after birth, and the superego begins to develop at about age 6 years.
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A primary care physician notices that many of her patients use statements like "I can't stop smoking because I'll gain weight," or "when I'm sick, I only want to eat junk food." Statements like these
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Statements such as "I can't stop smoking because I'll gain weight," or "when I'm sick, I only want to eat junk food" are examples of the defense mechanisms of rationalization and regression, respectively. In rationalization, a person distorts her perception of an event so that its negative outcome seems reasonable, e.g., because she feels unable to stop smoking, this patient claims (and so she reasonably feels) that gaining weight is worse than smoking, a life-threatening habit. In regression, ill patients revert to behavior patterns like those seen in someone of a younger age (e.g., eating junk food, crying). Defense mechanisms such as these are unconscious mental techniques that decrease anxiety and help people to maintain a sense of equilibrium and self-esteem.
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When having a manic episode, a 53-year-old patient with bipolar disorder shows primary process thinking. This type of thinking
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Primary process thinking is associated with pleasure seeking, disregards logic and reality, has no concept of time, and is not accessible to the conscious mind. Secondary process thinking is logical and is associated with reality.
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About 1 week after her final examination for a biochemistry course, a medical student's knowledge of the details of the Krebs cycle is most likely to reside in her
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Memory of the details of the Krebs cycle, while no longer in the forefront of the medical student's mind, can be recalled relatively easily 1 week after the examination. This memory therefore resides in the preconscious mind. The unconscious mind
P.59 contains repressed thoughts and feelings, which are not available to the conscious mind. The conscious mind contains thoughts that a person is currently aware of. The id contains instinctive sexual and aggressive drives and is not influenced by external reality. The ego also controls the expression of the id, sustains satisfying interpersonal relationships, and, through reality testing, maintains a sense of reality about the body and the external world (see also answer to question 9). |
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15-year-old steals from family members and friends. When no one is watching, he also tortures the family cat. Which aspect of the mind is deficient in this teenager?
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The superego is associated with moral values and conscience, and controls impulses of the id. This teenager who steals from family members and friends and tortures the family cat is showing deficiencies in his superego. Children and adolescents under age 18 years who have poor superego development may be diagnosed with conduct disorde
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A 28-year-old medical resident is assigned to tell a patient that her illness is terminal. Prior to seeing the patient, the resident conducts extensive library research on the details and statistics of length of survival of people with this illness. When he speaks to the patient, he cites the journal articles that he has read, including a detailed explanation of the theories of the etiology of her condition. Later that day, the resident tells the attending physician that the patient did not seem to understand what he told her.
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he resident's behavior in dealing with this patient reflects his use of the defense mechanism of intellectualization. The resident has used his technical knowledge to avoid experiencing the emotion associated with telling the patient that she is dying.
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40-year-old man who is angry at his wife, but does not consciously acknowledge that anger, shouts at his children as soon as he returns home from work.
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In displacement, the man's personally unacceptable angry feelings toward his wife are taken out on his children.
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A 26-year-old medical student who has unconscious angry, violent feelings chooses to do a surgery residency.
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n sublimation, the surgeon reroutes his unconscious, unacceptable wish for committing a violent act to a socially acceptable route (cutting people during surgery).
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A 32-year-old man who is unconsciously attracted to his wife's sister becomes extremely jealous whenever his wife speaks to another man.
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Using projection, the husband attributes his own unconscious, unacceptable sexual feelings toward another woman to his wife.
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A 45-year-old man who is unconsciously afraid of flying repeatedly states his love of airplanes.
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In reaction formation, the man denies his unconscious fear of flying and embraces the opposite idea by stating that he loves airplanes.
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A 52-year-old man receives a letter from his physician informing him that his level of prostate-specific antigen (PSA) was abnormally high during his last visit. When the man appears at his physician's office for a follow-up visit, he complains about a headache but does not mention or seem to remember receiving the letter about his PSA test.
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Using denial, this patient seemingly has forgotten an aspect of external reality, i.e., the letter about his problematic PSA test.
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A 34-year-old woman relates that she wakes up fully dressed at least twice a week but then is tired all day. She also notes that she frequently receives phone calls from men who say they met her in a bar but whom she does not remember meeting.
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his patient who relates that she wakes up fully dressed at least twice a week and receives phone calls from men whom she does not remember meeting is exhibiting dissociative identity disorder (multiple personality disorder). Dissociation, separating part of one's consciousness from real life events, is the defense mechanism used by individuals with this disorder. It is likely that this patient met the men who have her phone number but does not remember meeting them because at that time she was showing another personality (see also Cha
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A 35-year-old lawyer scheduled for surgery the next day insists that her mother stay overnight in the hospital with her.
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Regression, going back to a less mature way of behaving, is the defense mechanism used by this woman scheduled for surgery the next day who insists that her mother stay overnight in the hospital with her.
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A woman, whose parents and teachers complained about how messy she was as a child, grows up to become a famous abstract painter. Her technique involves throwing paint and small objects at large canvases and then using her fingers to mix the colors and textures.
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useful employment in her abstract art of this woman's "messy" tendencies is an example of the defense mechanism of sublimation.
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