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34 Cards in this Set
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1. A 28 yo law student is admitted to the hospital for gallbladder problems. He is stubborn, rigid and expects staff to adhere to his exact ways of doing things. He refuses to stop working on school papers. He reports that his girlfriend has threatened to leave him unless he changes his inflexible ways and throws out some of the large collection of useless junk. Which diagnosis appears more appropriate?
a. Antisocial b. Avoidant c. Histroinic d. Obsessive-compulsive e. Schizotypal |
i. D) obsessive compulsive
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2. A 28 yo law student is admitted to the hospital for gallbladder problems. He is stubborn, rigid and expects staff to adhere to his exact ways of doing things. He refuses to stop working on school papers. He reports that his girlfriend has threatened to leave him unless he changes his inflexible ways and throws out some of the large collection of useless junk. You expect the pt may act out in which of the following fashions when under stress in the hospital?
a. Strange behavior may put off caregivers b. Sees hospitalization as a threat to his control c. Can be charming but in a manipulative fashion; resists rules d. Uses splitting, possibly dividing the staff, who might take sides e. Likely to be cooperative and do well with the attention |
i. B) Sees hospitalization as a threat to his control
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3. A 28 yo law student is admitted to the hospital for gallbladder problems. He is stubborn, rigid and expects staff to adhere to his exact ways of doing things. He refuses to stop working on school papers. He reports that his girlfriend has threatened to leave him unless he changes his inflexible ways and throws out some of the large collection of useless junk. You might recommend which of the following interventions to the staff regarding the pt?
a. Set firm limits; consider an antidepressant b. Set firm limits on pt and staff roles; remain noncritical c. Odd behavior may make staff uneasy, but avoid ridicule d. Similar pts generally do well, but avoid criticism e. Share control with the pt in as many ways as possible |
i. E) Share control with the pt in as many ways as possible
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4. Twin adoption studies demonstrate which of the following characteristics?
a. Genetic factors do not affect personality disorder b. Axis I comorbidity is common c. Personality is too complex to measure biologically d. Cluster C disorders are inherited e. Personality traits have a strong genetic component |
i. E) Personality traits have a strong genetic component
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5. When individuals with personality disorders are unable to see their role in the disturbances in their lives, the symptoms that develop are considered
a. Characterlogical b. Ego dystonic c. Ego syntonic d. Internal e. Self induced |
i. C) Ego syntonic; pts with personality disorders perceive their problem and express their sx differently from pts with other psychiatric illnesses. Pts with personality disorders often believe that the disturbance in their lives is caused by the outside world, rather than internally, the sx of which are called ego syntonic. Sx of a personality disorder are caused by the characterlogical style of the pt. Sx include feelings of anxiety, depression, and anger, but these sx do not meet the criteria for a specific Axis I disorder
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6. You are called to the ER to see a 24 year old woman who is waiting for stitches for a wrist laceration. She has been seen in the ER seven times previously for self-inflicted wrist lacerations. She reports rapid mood swings, impulsivity, chronic feeling of emptiness, and periods in which she feels paranoid when under stress. Which diagnosis appears most appropriate
a. Antisocial b. Borderline c. Obsessive compulsive d. Paranoid e. Schizoid |
i. B) borderline; some diagnostic criteria for borderline personality disorder include impulsivity, recurrent suicidal or self mutilating behavior, rapid mood swings, chronic feelings of emptiness and possible paranoia when under stress
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7. You are called to the ER to see a 24 year old woman who is waiting for stitches for a wrist laceration. She has been seen in the ER seven times previously for self-inflicted wrist lacerations. She reports rapid mood swings, impulsivity, chronic feeling of emptiness, and periods in which she feels paranoid when under stress You expect that this pt may act out in which fashion when under stress in the hospital
a. Strange behavior may put off caregivers b. Sees hospitalization as a threat to his control c. Can be charming but in a manipulative fashion; resists rules d. Uses splitting, possibly dividing the staff, who might take sides e. Likely to be cooperative and do well with the attention |
i. D) Uses splitting, possibly dividing the staff, who might take sides; this person is borderline
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8. You are called to the ER to see a 24 year old woman who is waiting for stitches for a wrist laceration. She has been seen in the ER seven times previously for self-inflicted wrist lacerations. She reports rapid mood swings, impulsivity, chronic feeling of emptiness, and periods in which she feels paranoid when under stress. For the pt, you might recommend which of the following interventions to the staff?
a. Be straightforward, explain everything, expect distrust b. Odd behavior may make staff uneasy, but avoid ridicule c. Set firm limits and consider an antidepressant d. Similar pts generally do well, but avoid criticism e. Share control with the pt in as many ways possible |
i. C) set firm limits and consider an antidepressant; tx of pts with borderline personality disorder, setting firm limits and providing structure can be therapeutic. Antidepressants can help some pts control impulsivity and self injury while supporting mood
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9. A 35 yo old man presents requesting psychotherapy for problems with reacting angrily to his coworkers. The pt reports persistent fear that he will lose his job “due to a system that has it out for me.” He reports distrust of others and a “look out for number one” philosophy. Which diagnosis appears most appropriate?
a. Antisocial b. Avoidant c. Narcissistic d. Obsessive-compulsive e. Paranoid |
i. E) Paranoid; some diagnostic criteria for paranoid personality disorder include suspicion of being exploited or deceived, doubts about the loyalty of others, reluctance to confide in others, perceiving threats or attacks in benign remarks and actions and angry reactions to perceived threats
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10. A 35 yo old man presents requesting psychotherapy for problems with reacting angrily to his coworkers. The pt reports persistent fear that he will lose his job “due to a system that has it out for me.” He reports distrust of others and a “look out for number one” philosophy. You might recommend which form of tx?
a. Start a MAO inhibitor antidepressant to reduce impulsivity b. Refer him straight to group therapy c. Start an antipsychotic and plan to explain tx for side effects only if the occur d. Cautiously begin individual psychotherapy e. Tell the pt there is no hope for tx and you will not take his money |
i. D) cautiously begin individual psychotherapy; psychotherapy is preferred to pharmacotherapy in paranoid pts
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11. Persons who experience others as either “all good” or “all bad” and cannot experience an ambivalent relationship are exhibiting which of the following mechanisms
a. Denial b. Identification c. Projection d. Regression e. Splitting |
i. E) splitting
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12. The defense mechanism whereby an individual attributes to another individual thought or feelings of their own that are unacceptable is called?
a. Dissociation b. Fantasy c. Isolation d. Projection e. Splitting |
i. D) projection
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13. Which of the following medications has been useful in decreasing self injury in pts with borderline personality disorder
a. Alprazolam b. Diazepam c. Diphenhydramine d. Fluoxetine e. Methylphenidate |
i. D) Fluoxetine; modern drugs such as fluoxetine and other serotonergic antidepressants have shown some efficacy in reducing behavioral impulsivity and self injury in borderline pts. Benzos should be avoided bc they may cause disinhibition or be abused. Antihistamines are sometimes used for sedation but do not effect self injury. Stimulants are contraindicated unless the pt has another condition for which stimulants would be appropriate
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14. Patients with which of the following personality disorders are most likely to handle the stress of hospitalization relatively well?
a. Antisocial b. Avoidant c. Borderline d. Dependent e. Schizotypal |
i. B) avoidant; undemanding and generally cooperative
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15. A 35 yo single man is admitted to the hospital for DVT. He has been inappropriately provocative and seductive toward female staff. Dramatic and suggestible, he appears obsessed with his attractiveness. He exaggerates his familiarity with some staff members and displays shallow, shifting emotions. Which dx appears most appropriate?
a. Antisocial b. Avoidant c. Histrionic d. Obsessive compulsive e. Paranoid |
i. C) Histrionic
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16. A 35 yo single man is admitted to the hospital for DVT. He has been inappropriately provocative and seductive toward female staff. Dramatic and suggestible, he appears obsessed with his attractiveness. He exaggerates his familiarity with some staff members and displays shallow, shifting emotions. You expect this pt may act out in which fashion when under stress in the hospital?
a. Aloof; may want to leave against medical advice b. Will likely be charming and fascinating; his sense of attractiveness may be threatened by illness c. Very guarded, suspicious and quarrelsome d. Will use splitting, possibly dividing the staff, who might take sides e. Will see hospitalization as a threat to his control |
i. B) charming and fascinating
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17. A 35 yo single man is admitted to the hospital for DVT. He has been inappropriately provocative and seductive toward female staff. Dramatic and suggestible, he appears obsessed with his attractiveness. He exaggerates his familiarity with some staff members and displays shallow, shifting emotions. You might recommend which of the following interventions to the staff
a. Be straightforward, explain everything, and expect distrust b. Set firm limits and consider an antidepressant c. Similar pts generally do well, but avoid criticism d. Share control with the pt in as many ways as possible e. Set firm limits on pt and staff roles; remain noncritical |
i. E) set firm limits, remain noncritical
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18. A 19 yo man with a 7 year history of legal charges is admitted for tx of phlebitis secondary to intravenous drug abuse. On the ward, he was initially quite charming to the staff but became irritable and aggressive when denied requests for more pain medication. He is demanding to be discharged. When changing his bed, staff found syringes and needles he had taken from the drug cart when a nurse was tending to another patient. When the nurse was reprimanded by her supervisor, the patient showed no remorse for the consequences of his action. Which diagnosis appears most appropriate?
a. Antisocial b. Narcissistic c. Paranoid d. Schizoid e. Schizotypal |
i. Antisocial; Some diagnostic criteria for antisocial personality disorder include evidence of conduct disorder with onset before age 15 years, a pattern of disregard for or violation of the rights of others, irritable and aggressive behavior, deceitfulness, recklessness, and lack of remorse
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19. A 19 yo man with a 7 year history of legal charges is admitted for tx of phlebitis secondary to intravenous drug abuse. On the ward, he was initially quite charming to the staff but became irritable and aggressive when denied requests for more pain medication. He is demanding to be discharged. When changing his bed, staff found syringes and needles he had taken from the drug cart when a nurse was tending to another patient. When the nurse was reprimanded by her supervisor, the patient showed no remorse for the consequences of his action. He may act out in which of the following fashions when under stress in the hospital?
a. Aloof; may want to leave against medical advice b. Strange behavior may put off caregivers c. Will likely be charming and fascinating; his sense of attractiveness may be threatened by illness d. Might suffer feelings of abandonment and helplessness e. Can be charming but in a manipulative fashion; resists rules |
i. E) can be charming but manipulative; antisocial personality disorder
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20. A 19 yo man with a 7 year history of legal charges is admitted for tx of phlebitis secondary to intravenous drug abuse. On the ward, he was initially quite charming to the staff but became irritable and aggressive when denied requests for more pain medication. He is demanding to be discharged. When changing his bed, staff found syringes and needles he had taken from the drug cart when a nurse was tending to another patient. When the nurse was reprimanded by her supervisor, the patient showed no remorse for the consequences of his action. You might recommend which of the following interventions to the staff for the pt?
a. Set firm limits and consider an antidepressant b. Odd behavior may make staff uneasy, but avoid ridicule c. Set firm limits; anticipate a demand for discharge against medical advice d. Be straightforward, explain everything, and expect distrust e. Share control with the pt in as many ways as possible |
i. C) set firm limits; anticipate a demand for discharge AMA; firm limits triggers demand for discharge
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21. A 19 yo man with a 7 year history of legal charges is admitted for tx of phlebitis secondary to intravenous drug abuse. On the ward, he was initially quite charming to the staff but became irritable and aggressive when denied requests for more pain medication. He is demanding to be discharged. When changing his bed, staff found syringes and needles he had taken from the drug cart when a nurse was tending to another patient. When the nurse was reprimanded by her supervisor, the patient showed no remorse for the consequences of his action. You would recommend which of the following courses of tx after discharge?
a. Tx with benzos to reduce anxiety b. Individual therapy focusing on building strong pt-therapist relationship c. Tell the pt there is no hope for tx and you will not take his money d. Group therapy with a particular therapist and pts e. Volunteer work in a pain clinic to help develop more empathy |
i. D) group therapy
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22. For the following pt description, select the appropriate personality disorder
a. Antisocial b. Avoidant c. Dependent d. Histrionic e. Obsessive-compulsive f. Paranoid g. Schizotypal Pts tend to group themselves in esoteric religious and pseudoscientific groups |
F. Paranoid
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22. For the following pt description, select the appropriate personality disorder
a. Antisocial b. Avoidant c. Dependent d. Histrionic e. Obsessive-compulsive f. Paranoid g. Schizotypal ii. Pts exhibit clairvoyance and telepathy |
G. Schizotypal
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22. For the following pt description, select the appropriate personality disorder
a. Antisocial b. Avoidant c. Dependent d. Histrionic e. Obsessive-compulsive f. Paranoid g. Schizotypal iii. Pts display behavior similar to that precipitated by brain damage |
A. Antisocial
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22. For the following pt description, select the appropriate personality disorder
a. Antisocial b. Avoidant c. Dependent d. Histrionic e. Obsessive-compulsive f. Paranoid g. Schizotypal iv. Patients persistently bear grudges and are unforgiving of insults |
F. Paranoid
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22. For the following pt description, select the appropriate personality disorder
a. Antisocial b. Avoidant c. Dependent d. Histrionic e. Obsessive-compulsive f. Paranoid g. Schizotypal v. Pts believe that they are socially inept, personally unappealing, or inferior to others |
B. Avoidant
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22. For the following pt description, select the appropriate personality disorder
a. Antisocial b. Avoidant c. Dependent d. Histrionic e. Obsessive-compulsive f. Paranoid g. Schizotypal vi. Patients are easily influenced by other people or by circumstances |
D. Histrionic
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22. For the following pt description, select the appropriate personality disorder
a. Antisocial b. Avoidant c. Dependent d. Histrionic e. Obsessive-compulsive f. Paranoid g. Schizotypal vii. Patients have difficulty expressing disagreement with others because of fear of loss of support or approval |
C. Dependent
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22. For the following pt description, select the appropriate personality disorder
a. Antisocial b. Avoidant c. Dependent d. Histrionic e. Obsessive-compulsive f. Paranoid g. Schizotypal viii. Patients fear losing control |
E. Obsessive compulsive
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23. For each characteristic listed select the appropriate disorder
a. Antisocial b. Borderline c. Narcissistic d. Paranoid e. Schizoid i. Pts take offense quickly and question the loyalty of others |
D. Paranoid
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23. For each characteristic listed select the appropriate disorder
a. Antisocial b. Borderline c. Narcissistic d. Paranoid e. Schizoid ii. Patients have a defective capacity to form social relationships |
E. Schizoid
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23. For each characteristic listed select the appropriate disorder
a. Antisocial b. Borderline c. Narcissistic d. Paranoid e. Schizoid iii. Pts fail to plan ahead and are impulsive (e.g. may move without a job) |
A. Antisocial
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23. For each characteristic listed select the appropriate disorder
a. Antisocial b. Borderline c. Narcissistic d. Paranoid e. Schizoid iv. Pts form relationships that lack empathy; they idealize or devalue others |
B. Borderline
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23. For each characteristic listed select the appropriate disorder
a. Antisocial b. Borderline c. Narcissistic d. Paranoid e. Schizoid v. Pts exude a sense of entitlement with the expectation of special favors but without assuming reciprocal responsibilities |
C. Narcissistic
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