United State Medical Licensing Examination (Step 2) Set 17

A 40-year old man has been treated for chronic paranoid schizophrenia for many years with a typical neuroleptic. To decrease his risk for tardive dyskinesia, his psychiatrist wants to change his medication to an atypical antipsychotic. Which of the following atypical antipsychotics is limited in its use by the risk of agranulocytosis, which occurs in 12% of all patients treated?

A 45-year-old homeless schizophrenic patient presents to you with suicidal ideation. You interview him and find out he is a divorced Roman Catholic. He recently lost his job after being caught a second time drinking on the job. He had attempted suicide impulsively 5 years previous by overdosing. He is not currently psychotic. He bought a handgun and ammunition recently and has been thinking about shooting himself in the head. He has gotten as close to acting on it as having loaded the gun and held it up to his head this morning. Someone walking by stopped him and convinced him to come and see you. He is ambivalent about seeking help. Which of the following is not associated with an increased suicide risk?

A 45-year-old homeless schizophrenic patient presents to you with suicidal ideation. You interview him and find out he is a divorced Roman Catholic. He recently lost his job after being caught a second time drinking on the job. He had attempted suicide impulsively 5 years previous by overdosing. He is not currently psychotic. He bought a handgun and ammunition recently and has been thinking about shooting himself in the head. He has gotten as close to acting on it as having loaded the gun and held it up to his head this morning. Someone walking by stopped him and convinced him to come and see you. He is ambivalent about seeking help Which of the following is the most appropriate immediate treatment recommendation?

A45-year-old woman, seen by her medical internist, has been experiencing fears that she may have a serious illness. She complains that after eating she experiences "a lot of gas" and abdominal pain, followed by diarrhea on occasion. Her heart at times seems to be beating rapidly, and she feels faint at times, has chest "discomfort," and wonders if she is having a heart attack. Multiple tests have identified only a mild irritable bowel syndrome. The woman's fears are not allayed by this. She makes repeated calls to be seen by her doctors as well as seeking consultation from other specialists. She insists that "there's something there" and believes the doctors are not taking her seriously. Which of the following is the most likely diagnosis?

A45-year-old woman, seen by her medical internist, has been experiencing fears that she may have a serious illness. She complains that after eating she experiences "a lot of gas" and abdominal pain, followed by diarrhea on occasion. Her heart at times seems to be beating rapidly, and she feels faint at times, has chest "discomfort," and wonders if she is having a heart attack. Multiple tests have identified only a mild irritable bowel syndrome. The woman's fears are not allayed by this. She makes repeated calls to be seen by her doctors as well as seeking consultation from other specialists. She insists that "there's something there" and believes the doctors are not taking her seriously. Which of the following is the most effective long-term management of this patient?

A45-year-old woman, seen by her medical internist, has been experiencing fears that she may have a serious illness. She complains that after eating she experiences "a lot of gas" and abdominal pain, followed by diarrhea on occasion. Her heart at times seems to be beating rapidly, and she feels faint at times, has chest "discomfort," and wonders if she is having a heart attack. Multiple tests have identified only a mild irritable bowel syndrome. The woman's fears are not allayed by this. She makes repeated calls to be seen by her doctors as well as seeking consultation from other specialists. She insists that "there's something there" and believes the doctors are not taking her seriously. Which of the following most appropriately describes this woman's disorder?

During the course of psychotherapy with a woman who has a severe phobia of cars, it is discovered that her first sexual experience, which was a humiliating one for her, took place in an automobile. What is the defense mechanism illustrated by this phobia called?

A 30-year-old woman complains that she has had sleep disturbances since the start of her depression 2 months ago. Which of the following is an accurate description of typical sleep abnormalities in depression?

A25-year-old man presents in the emergency department for a 2-week problem of worsening urinary hesitancy. He has had problems getting his urine stream started and has noted a decrease in the force of the stream. Now it seems to just "dribble out." He denies any pain or burning, any medical problems, and any exposure to sexually transmitted diseases. For approximately 1 month, he has been taking thioridazine, 200 mg bid, and benztropine, 2 mg qid, and "sometimes one or two benztropine" prn.Given the above information, which of the following is the most likely cause of this man's problem?

A25-year-old man presents in the emergency department for a 2-week problem of worsening urinary hesitancy. He has had problems getting his urine stream started and has noted a decrease in the force of the stream. Now it seems to just "dribble out." He denies any pain or burning, any medical problems, and any exposure to sexually transmitted diseases. For approximately 1 month, he has been taking thioridazine, 200 mg bid, and benztropine, 2 mg qid, and "sometimes one or two benztropine" prn.Given the above information, which of the following is the most likely cause of this man's problem? Which of the following is a safer choice of medication for this man?