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- 1. Open Ended45-year-old man with a history of schizophrenia and Type 2 Diabetes (T2DM) presents to the emergency department after drinking alcohol and snorting cocaine. He states that he feels anxious and "just can't calm down". He is diaphoretic and tremulous. Which test should be ordered STAT?
- 2. Open Ended28-year-old female medical student is brought to the physician by her boyfriend because of unremitting headaches and always "worrying about everything." The patient admits that she has been even more "stressed out" than usual over the last year about interview season, the couples match for residency, getting married, moving out of state, and student loans. Her headaches have increased in frequency and intensity. She reports difficulty sleeping through the night and constant fatigue. The patient's boyfriend complains that lately, "she freaks out about every little thing - I can't deal with it anymore. I don't even know if matching together is still a good idea." What is the most likely diagnosis?
- 3. Open Ended10-year-old boy presents with episodes of somatic complaints, anxiety, and crying at school , which resolves when he is sent home. He won't go anywhere without his mother. Which intervention would be an appropriate part of the plan of treatment?
- 4. Open EndedDespite a course of psychotherapy, a patient with PTSD continues to suffer from recurrent nightmares, flashbacks, hypervigilance, and emotional numbing. This patient also has a history of substance abuse. Which medication should NOT be used in this patient?
- 5. Open Ended23-year-old male physician assistant (PA) student with a history of hypothyroidism presents to his primary care provider for an annual examination. He has been studying intensely for his summative examination and trying new methods to stay focused. He started drinking an herbal tea that claims to "boost intelligence" several times a day over the past month. He reports feeling more anxious and jittery than ever, but has been able to study for longer hours. He has had heart palpitations after he drinks the tea and has had more difficulty sleeping. His hypothyroidism has been well controlled on a consistent medication regimen over the last year. What is the most likely diagnosis?
- 6. Open Ended36-year-old woman with a history of generalized anxiety disorder (GAD) is brought to the emergency department by her husband due to sudden onset of dyspnea, heart palpitations, and intense anxiety. She pants, "I feel like I am going to die." She has no significant additional past medical history or family history. Her only medications are oral contraceptives and venlafaxine (Effexor, an SNRI). She smokes 1 pack of cigarettes daily. On examination, she appears to be in acute distress. Vitals: HR 160 bpm, BP 84/44 mmHg, RR 32/min. ECG shows sinus tachycardia. After initial stabilization of the patient, what is the most appropriate next step?
- 7. Open EndedWhen starting an SSRI such as fluoxetine (Prozac) in an adolescent patient with separation anxiety disorder, the Food and Drug Administration (FDA) recommends the clinician monitor closely for which of the following?
- 8. Open Ended27-year-old married woman arrives at a community mental health clinic with her husband. She is initially embarrassed and reluctant, but eventually discloses that she has an intense fear of bridges, which has been present since adolescence. While she has rarely needed to drive over bridges, a recent promotion has required her to commute to the corporate headquarters, which are located across the bay past a long bridge. She has only been able to drive with resultant, severe panic, and she has already called in sick and missed work because of her fears. She is now worried about losing her job and wishes to get help "any way I can". What treatment would be the most appropriate for her condition?
- 9. Open EndedAcute stress disorder (ASD) is diagnosed in a 32-year-old woman who witnessed her fiance being shot to death in a robbery attempt. She has difficulty sleeping and feels that she is not emotionally attached to anything around her. She also has repetitive flashbacks of the event and avoids going near the location where the incident occurred. Which medication might be helpful to this patient over the short term?
- 10. Open Ended33-year-old divorced man has the chief complaint of "I'm going to have a heart attack like my father." He explains that his father died of a myocardial infarction at 45 years of age. He is convinced that he is experiencing angina attacks, consisting of nervousness, sweating, shortness of breath, palpitations, flushing, and numbness in his hands, each lasting for several minutes. He is anxious about having these symptoms, and despite negative results from a cardiology workup, he remains certain that he will suffer a heart attack. His behavior and lifestyle have not been otherwise affected. What is the most likely diagnosis?
- 11. Open EndedSSRIs are a first-line medication for treating generalized anxiety disorder (GAD). Which side effect is the most common with long-term treatment and often results in nonadherence?
- 12. Open Ended11-year-old develops OCD & begins a course of treatment with combination psychotherapy & SSRIs. The parents inform you that the child had an episode of post-streptococcal glomerulonephritis (PSGN) treated with antibiotics several weeks ago prior to developing the OCD symptoms. What other possible issue might be related to the patient's current symptoms?
- 13. Open EndedWhich area of the brain which appears to be most closely related to anxiety based on functional imaging studies?
- 14. Open EndedChildren or adolescents with separation anxiety disorder are at higher risk for which other psychiatric disorder?
- 15. Open EndedThere is well accepted evidence that which of the following treatments is effective in social anxiety disorder?
- 16. Open EndedA patient with OCD is started on sertraline (Zoloft, an SSRI). What is the most common side effect to this medication?
- 17. Open Ended37-year-old male college professor with a history of GAD and major depressive disorder (MDD) has been referred to psychiatry by his primary care physician. His symptoms have been relatively well controlled up until last semester when he received negative reviews from his students. Since this time, he has started to doubt his ability to teach, worry about his career, and ruminate on each lesson plan. He worries that his reputation among the students has been irrevocably damaged, which makes him feel despondent. The professor desperately wants to get help, but he is hesitant to try any medication that will impair his intellectual prowess. What is the most effective treatment approach?
- 18. Open Ended25-year-old single woman describes a lifelong history of being "scared of heights". She becomes uncomfortable when at an elevation higher than three stories, and whenever traveling or shopping, she becomes preoccupied with knowing the exact heights of buildings. Whenever finding herself at a significant distance from the ground, she has severe anxiety symptoms including trembling, lightheadedness, numbness and tingling, and a fear of dying. What is the most likely diagnosis?
- 19. Open Ended28-year-old business man describes a persistent fear of speaking in public. Although he does not have difficulty with one on one situations, when giving a lecture to a group he becomes extremely anxious, worrying that he will be humiliated. He relates one episode in which he was forced to speak at the last minute, which resulted in his experiencing panic, shaking, abdominal cramps, and a fear that he would defecate on himself. Because of this problem, he has been held back from promotion at his place of employment. What is the most likely diagnosis?
- 20. Open Ended17-year-old high school senior is referred to a psychiatrist by his counselor because of academic difficulty. Although he had always been an honors student, this past year his grades have dropped, especially in mathematics. When questioned, he reveals the new onset of superstitions involving numbers. When presented with certain numbers, he feels compelled to count forward and then backward to and from that number. He becomes anxious about not completing this task, although he is unable to state a particular consequence if he doesn't. If interrupted, he must begin all over again. He realizes that there is "no good reason" for this behavior, but is unable to stop it. Because of this, he not only feels "tortured" but he may need to repeat a year in school. He denies any past psychiatric history. You begin treating him with sertraline (Zoloft, an SSRI), and cognitive therapy to address the obsessions. He misses appointments with his therapist, feels therapy will not be helpful, and the parents believe he is not taking his medications regularly. What interventions should be considered next?
- 21. Open EndedWhat alpha-1 adrenergic antagonist medication that is typically used to treat men with benign prostatic hypertrophy (BPH) and hypertension (HTN) has been shown to be very effective in treating PTSD, especially for the "reexperiencing" and hyperarousal symptoms?
- 22. Open EndedWhich of the following symptoms might be considered of the somatovisceral type?
- 23. Open EndedA 36-year-old businessman who survived a serious car accident 4 months ago complains of "jitteriness" when driving to work and is currently using public transportation because of his anxiety. He has found himself "spacing out" for several minutes at a time and having difficulty concentrating on his job. He has felt "sad" much of the time, has trouble sleeping at night, has lost 4 lb because of decreased appetite, and admits that his job performance is slipping. What is the most likely diagnosis?
- 24. Open EndedA 36-year-old businessman who survived a serious car accident 4 months ago complains of "jitteriness" when driving to work and is currently using public transportation because of his anxiety. He has found himself "spacing out" for several minutes at a time and having difficulty concentrating on his job. He has felt "sad" much of the time, has trouble sleeping at night, has lost 4 lb because of decreased appetite, and admits that his job performance is slipping. What would your diagnosis be if the patient stated that the care accident was less than 1 week ago?
- 25. Open Ended38-year-old separated woman is sent to a psychiatrist by her OBGYN. She describes increasing difficulties leaving her home, which stemmed from having a severe panic attack 4 months prior while at the shopping mall. Since that time, although she has not had any further panic attacks, she is "deathly afraid" of having another one. At first, she avoided malls, but gradually she has limited her driving, and recently won't even leave her home. In fact, she was "forced" to come in by her sister, who has become very worried about her. During the car ride to the appointment, the patient suffered extreme anxiety, fearful she would have another panic attack while on the highway and be unable to obtain help. What is the most appropriate diagnosis?
- 26. Open EndedIn controlled studies, which of the following medications is ineffective for use in childhood anxiety disorders?
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