MD#26 QuiZz

A 17-year-old girl is brought to the office by her parents due to recurrent episodes where "she seems to be lost in her own world." The parents say that the episodes began about 2 years ago, but seem to be occurring more frequently since a difficult breakup with her boyfriend several months ago. The patient acknowledges that she seems to "space out" easily. She says, "I often feel numb, like I'm in a fog or a dream. Sometimes, I feel as if I'm not myself, as if things are happening to someone else." The patient uses nonsteroidal anti-inflammatory drugs for menstrual cramps. She has no other medical conditions. She smokes cigarettes but does not use alcohol or illicit drugs. Physical and neurologic examinations are normal. On mental status examination, the patient is cooperative with a mildly anxious mood and flat affect. Which of the following is the most likely diagnosis?

A 19-year-old man is referred to a prison psychiatrist. He is incarcerated while awaiting trial for theft. He reports a history of harming animals and lighting fires as a child. He has been incarcerated previously for theft and violent assault. He does not seem to care that he is facing a long jail sentence. He denies any depressive mood symptoms. This man’s behavior is consistent with which of the following?

A 28-year-old man brings his wife to the office due to concerns of extreme jealousy. He explains that she will not allow him to socialize with coworkers outside of work and that she doesn’t trust his family members. She has cut off most of her own relationships, stating that people she has known have been “backstabbers”. Throughout the appointment, she glares at her husband and refuses to answer the doctor’s questions, stating, “You’re just like everybody else and will use this information against me.” This woman’s behavior is consistent with which of the following?

A 20-year-old woman is brought for evaluation by her mother. She is dressed completely in black though it is a warm summer day. She has few friends and rarely socializes. Her mother reports a long history of odd thinking, including superstitious beliefs about walking under ladders and on sidewalk cracks. The patient likes to spend her weekends investigating haunted houses. She denies hallucinations or depressed mood symptoms. She is doing well in school but prefers to keep to herself and socialize primarily with family members. This woman’s behavior is consistent with which of the following?

A 40-year-old woman comes to the clinic to discuss her relationship difficulties. She is wearing bright makeup, a short tight dress and stiletto heels. She spends most of the appointment crying or laughing and frequently uses her hands as she talks. At the end of the appointment, she asks the doctor if he would like to take her for dinner as she feels “very close” to him. When he declines, the woman says that she feels “shunned.” This woman’s behavior is consistent with which of the following?

A 45-year-old stockbroker is evaluated after being fired from his job. He says that he doesn’t know why he was fired because he was “the best” in the office and that all of his coworkers are jealous of him. He spends most of the appointment talking about exotic vacations he has taken throughout his life. He is not married, as he cannot seem to find someone who is worthy of his time. When the doctor interrupts him to end the appointment, he yells at the doctor, “don’t you know who I am?” This man’s behavior is consistent with which of the following?

A 32-year-old man presents with his wife for couples counseling. He is a successful attorney who works long hours. His wife says she can no longer tolerate his inflexible rules about cleaning their home and completing a “to do” list every day. He describes himself as being very “detail-oriented” at work and says that he often works up to 100 hours per week. This man’s behavior is most consistent with which of the following?

A 21-year-old woman is referred for psychiatric evaluation by her employer as a condition of continued employment. She comes to work unkempt, struggles to make decisions on her own and is excessively passive in her interactions with colleagues. She does not participate in meetings and is hesitant to give her opinion, even when asked. She speaks very quietly and often looks at the floor when speaking. Her colleagues have complained that she is clingy and is always asking them what to do. The psychiatrist notices bruises on her upper arms. This woman’s behavior is consistent with which of the following?

A 25-year-old man is brought for evaluation by his parents who are concerned that “he has no social life.” He works as an engineer. When at work, he prefers to wear headphones and eat lunch alone at his desk. He has no interest in romantic relationships and is satisfied with spending time alone on the weekends in his apartment. This man’s behavior is consistent with which of the following?

A 23-year-old woman is admitted to the hospital after her fourth suicide attempt. She reports having multiple sexual partners and a history of burning herself with cigarettes. When her doctor is called away for an emergency, the patient threatens suicide. When her doctor returns, she accuses her of abandoning her and states that the other hospital doctors are much better physicians. This woman’s behavior is consistent with which of the following?