Behavioral Science

Practice Questions

Block 2
1. Patient is a 38 year-old Hispanic female who presents to the ED with her 9
year-old daughter. The mother has a superficial head wound and is clutching
her arm. Her daughter explains that her mother fell down the stairs, but will
not look at the physician when speaking. When asked where her father is, the
daughter mumbles, “hopefully he’s gone for good after this.” When attempts
are made to speak to the patient, she responds rapidly in Spanish. What is
the first thing the physician should do?

A.Ask the daughter to translate to patient to assess the extent of her injuries.
B.Call CPS and report the incident
C.Send patient for immediate CT scan
D.Call for a translator
E.Call the police
2. A 63 year old male patient is in your office for a check-up on his
hypertension. When reviewing his medications, he states “My wife takes care
of all of that.” What would be the best initial response from the physician:

A.“Why does your wife do that?

B.“How comfortable are you with your reading?”
C.“Can you tell me more about how your wife organizes this for you?”
D.“It’s really important that you understand your own medications.”
E.“Do you even know what you take your medications for?”
3. Patient is a 35 year-old Native American male presenting with concerns about
a recent infection. He reports that he has had “bad feelings” and believes this to
be the cause of his illness. He is hoping to meet with his tribe’s healer this
weekend, but his wife encouraged him to come see the physician. Which of the
following would be the most appropriate physician response?

A.“It is fine for you to see your healer so long as you know that the
treatment I prescribe is the real treatment.”
B.“You should be able to make the decision about treatments after I run
some tests.”
C.“I need you to tell me how a healer can help you more than I can with
an infection”
D.“I just want you to know that I won’t take any of your soul whenever I
take your blood for tests, as my culture does not believe that this is
possible.”
E.“Tell me more about your ‘bad feelings’ and what might be happening to
you.”
4. A 32 year-old Mexican-American male presents with symptoms of
intestinal pressure and pain and is accompanied by his daughter. He
did not want to be brought in to the physician’s office, stating, “This is
just a touch of Empacho. I just need some herbs and it will go away.”
Which of the following is the most appropriate initial response by the
physician?

a.“Some of the treatments for Empacho can be very harmful; have you
taken any yet?
b.“Let’s discuss your pain first, then you can tell me what you think is
causing it.”
c.“I’m not sure Empacho is the problem. How about you tell me more
about your symptoms?”
d.“I’d like to ask your daughter some information about what she has
been observing, and why she brought you in today.”
e.“Empacho? Can you tell me more about this?”
5. Patient is a 42 year-old male that is being seen by his primary care
doctor with his wife. She reports that two weeks ago patient began
talking about a new theory he had developed to make money in the
stock market. When she told him it did not make sense, he began
screaming, “I’m a genius! You don’t know what you’re talking about.
I’m going to make a fortune!” Patient reports that he “doesn’t need to
sleep”, and needs to focus on working on his investment theory. A few
days ago he began buying large amounts of stocks on margin. His
wife reports that he has had similar ideas in the past during which he
developed several “sure-fire” investment schemes. During one
episode he tried to corner the cotton futures market and the couple
ended up taking delivery on a railroad car full of cotton bales worth
$50,000. Which of the following is the best diagnosis:

A. Schizoaffective Disorder
B. Bipolar I Disorder, Most Recent Episode Mixed
C. Bipolar II Disorder, Most Recent Episode Hypomanic
D. Cyclothymic Disorder
E. Bipolar I Disorder, Most Recent Episode Manic
6. A 29 year-old female patient comes is being seen by her family
physician. She reports that for the past 3 weeks she has been
fatigued, has lost interest in her activities, sleeps too much,
eats too little and is unable to focus or concentrate on her
activities. She has stayed out of work for these 3 weeks and
says “I feel like an idiot. I am really worthless.” When
questioned, she says that over the last two years this has
happened a couple of times before, but her symptoms
resolved usually after a couple of weeks. Which of the
following is the most likely diagnosis for this patient:

A. Dysthymia
B. Major Depressive Disorder Recurrent
C. Avoidant Personality Disorder
D. Borderline Personality Disorder
E. Cyclothymia
7. A 41 year-old female presents for initial consultation as a new
patient. Upon exam, the patient denies any changes in mood
status, but states that she typically feels “somewhat
depressed” on most days. The patient states that she has felt
this way for “many years” following her divorce 6 years ago.
She states that she has a low self-esteem and feels hopeless
about her future at times. Which of the following is the best
diagnosis?

A. Persistent Depressive Disorder, late onset

B. Adjustment Disorder with Depression
C. Bipolar II disorder, Depressed
D. Major Depressive Disorder, Mild, Recurrent
E. Dependent Personality Disorder
8. A 32 year-old male patient presents to his primary care physician.
He reports that over the past six weeks he has been “pretty down.” He
was enrolled in a graduate program, but two months ago he was asked
to leave the program. He reports that in addition to feeling down, he
has been feeling “really anxious,” with excessive rumination that has
impaired his ability to fall asleep. Patient has no history of mental health
problems but acknowledges that his current symptoms are affecting his
ability to look for a new job. He has been wanting to maintain normal
social interaction, but conveys that at times it has been “tough.” Which
of the following is the most likely diagnosis:

A.Dysthymia
B.Bipolar I Disorder
C.Rumination Disorder
D.Adjustment Disorder with Mixed Anxiety and Depressed Mood
E.Major Depressive Disorder
9. A 40 year-old female presents with increased back pain for the
past 6 months. She ended an abusive relationship with her
partner 7 months ago. The physician has ruled out most
causes for her back pain, but needs to continue building an
alliance with the patient in order to help her address what may
be a Somatic Symptom Disorder. Which of the following is the
best initial physician response?

A. “I need you to be patient. I’m doing my best to help you.”

B. “Do you think this might be all in your head?”
C. “The pain sounds very difficult for you to handle.”
D. “We have run lots of tests, what would you like to try next?”
E. “I think I should refer you to a psychiatrist since I can’t find
anything wrong.”
10. A 19 year-old male is a freshman in college. His parents were
blue-collar workers and he is the first person in his family to
attend college. He does not want to eat in front of his friends
because he fears that he has not been taught proper table
manners and that he will do something while eating that will be
offensive and/or embarrassing. He experiences a great deal
of distress at having to constantly make up excuses to his
friends as to why he won’t eat with them. Which of the
following is the most likely diagnosis:

A. Generalized Anxiety Disorder

B. Specific Phobia, Situational type
C. Obsessive-Compulsive Disorder
D. Social Anxiety Disorder
E. Anxiety Disorder due to a substance
11. A 28 year-old woman reports that for the past 6 months she
has had recurrent but brief episodes of heart palpations,
sweaty palms, and shortness of breath. She reports that she
is afraid of having another attack and has not left her house
on her own, and has not been able to go grocery shopping
because she is afraid that she might have one of these
episodes and that there might not be anyone to help her. She
denies any history of substance abuse and has no previous
psychiatric history. Results from various tests have ruled out
any medical conditions contributing to her symptoms. Which
of the following is the best diagnosis:

A. Specific Phobia, Environmental Type

B. Panic Disorder
C. Agoraphobia
D. Panic Disorder with Agoraphobia
E. Acute Stress Disorder
12. A 25 year-old male was involved in an auto accident 6
weeks ago where a passenger in another vehicle was killed. He
immediately developed symptoms of hypervigilance,
nightmares, flashbacks, and episodes of depersonalization. He
returned to work a week ago and today tells you he was fired for
assaulting another employee. These behaviors are very different
from his normal behavior and he reports that his symptoms have
become worse instead of better and that he is “angry all the
time.” Which of the following is the best diagnosis:

A. Acute Stress Disorder

B. Post-traumatic Stress Disorder
C. Adjustment Disorder with anxious mood
D. Generalized Anxiety Disorder
E. Depersonalization Disorder
13. A 22 year-old female lives with her parents and has
worry about leaving her home. When asked what is difficult
about leaving home, she states “Everyone will notice that I
have a huge forehead. I just don’t want them to laugh at
me.” She has several scars on her forehead, but conveyed
she “doesn’t want to talk about that” when asked. Which of
the following is the most likely diagnosis:

A. Delusional Disorder
B. Major Depressive Disorder
C. Panic Disorder
D. Body Dysmorphic Disorder
E. Social Anxiety Disorder
14. A 17 year-old female is referred for evaluation of a
possible eating disorder as she is pre-occupied with her
weight which is in the normal range. She has several
scabs on her forearm, as well as on her face. When
asked, she explains, “ I just can’t help it. I like to pick at
my scabs because it feels so much better afterwards.”
Which of the following is the best treatment for this
disorder?

A. Alprazolam
B. Behavioral Therapy
C. Aripiprazole
D. Trazodone
E. Mirtazapine
15. A 31 year-old male drives to work and recently
began having increased fear about crossing the
bridge on his commute. This morning, he
experienced shortness of breath, palpitations,
dizziness, and trembling while in the elevator. An
examination in the ED ruled out any physiologic
basis for these symptoms. Which of the following
is the most likely diagnosis:

A. Dissociative Disorder
B. Specific Phobia, Situational Type
C. Specific Phobia, Environmental Type
D. Somatic Symptom Disorder
E. Agoraphobia
16. A 48 year-old female arrives at the ED reporting that
she has been having “severe anxiety” in which she feels
that she can’t breathe, has the “shakes,” and hasn’t slept
for the past 24 hours. She reported that she has been
experiencing these symptoms all day, and these episodes
have happened “numerous times” over the past 2 years,
but today she feels is “the worst.” She now doesn’t want to
go to work. All tests reveal no physiologic basis for
symptoms. Which of the following is the best diagnosis:

A. Panic Disorder
B. Agoraphobia
C. Generalized Anxiety Disorder
D. Bipolar I Disorder
E. Obsessive Compulsive Disorder
17. A 29 year-old female presents to the prison physician
with complaints of extreme weakness in her left leg and
arm, neck pain, and visual problems that “come and go.”
She reports that she has been experiencing these
symptoms for the past 2 weeks, and the officer escorting
her indicates that as a result of these symptoms she has
been unable to do her work duty, and has been staying in
the medical center, which patient conveys has “really good
food.” Labs, imaging, and neurologic findings are all
negative. Which of the following is the most likely
diagnosis:
A. Illness Anxiety Disorder
B. Malingering
C. Factitious Disorder
D. Generalized Anxiety Disorder
E. Somatic Symptom Disorder
 18. A 35 year-old female presents to her primary care
physician with a cold. During the interview, patient
states her boss is “out to get her,” and he has been
hacking in to her emails. She reports concerns that
he has been driving by her house frequently. Which
of the following is the most likely diagnosis?

a. Delusional Disorder, Erotomanic subtype

b. Bipolar II Disorder
c. Delusional Disorder, Persecutory subtype
d. Delusional Disorder, Jealous subtype
e. Major Depressive Disorder, with psychosis
19. A 31 year-old male is being seen in the ED for a
laceration on his head. He reports for the past 3 months he
has been hearing voices telling him that he is “evil” and
should kill himself. The voices continually comment on his
behavior. At times he talks back to the voices. He believes
that God is out to get him and that if he kills himself, he will
be forgiven. He does not sleep much during these periods,
seems to be unable to complete his work. He spends most
of the day walking around his neighborhood. Which of the
following is the best initial diagnosis:

A.Schizophrenia
B.Major Depressive Disorder with psychotic features
C.Delusional Disorder, Paranoid subtype
D.Schizophreniform Disorder
E.Schizoaffective Disorder
20. A 47 year-old male is being treated for symptoms of depression
with Cognitive Behavioral Therapy. After 3 weeks, his counselor
reports that patient began talking about the FBI monitoring him through
his microwave, and he was convinced his neighbor was spying on him.
The counselor also observed that at times patient appeared to be
mumbling quietly to himself. Patient is treated with an antipsychotic
agent and an SSRI. After 2 weeks, he stopped talking about the FBI
and neighbor, yet continued to endorse low mood. He is maintained on
a treatment regime of antidepressant medication and the antipsychotic
is discontinued. Which of the following is the best diagnosis:

A. Schizophrenia
B. Bipolar I Disorder
C. Major Depressive Disorder with Psychotic Features
D. Schizophreniform Disorder
E. Schizoaffective Disorder
 21. A 58 year-old female is being seen by her primary care.
Her son is bringing her with concerns that she has been
losing weight and not eating. Patient has been unemployed
all her life, supporting herself through social security
disability checks. She is dependent on her son to shop and
take care of household responsibilities such as paying bills.
Her son reported that for the past seven months, she has
talked about seeing “dead people.” When asked, patient
reported she is not eating because the food has been
“poisoned.” Which of the following would be the best
diagnosis?

A. Schizophrenia
B. Schizophreniform Disorder
C. Schizoaffective Disorder
D. Delusional Disorder
E. Psychotic Disorder NOS
22. A 7 year-old male awakens during the night and cries
for his parents. He relates to them a frightening dream in
which he was attacked by monsters. During this
disturbance, the EEG would be primarily characterized by:

A. Sawtooth Waves
B. Theta waves
C. K spindles
D. Alpha Waves
E. Delta Waves
23. A 20 year-old female is being seen for concerns of
fatigue. Patient is a student, and reports that for the past 2
weeks she has been studying late and then has difficulty
falling asleep. Which of the following is the best treatment
recommendation:

A. A. Short acting benzodiazepine at bedtime

B. B. Exercise before bedtime
C. C. Eating a large meal prior to going to sleep
D. D. A warm glass of milk
E. E. Fixed wake-up and bedtime schedule
24. A 34 year-old female came to the clinic on her
husband’s urging. She was shopping at the grocery store
when she felt like the aisles got blurry and colors became
distorted. She laughed and said, “Maybe it was déjà vu”
but her husband insisted that she come see the physician.
Which of the following is her most likely diagnosis:

A. Dissociative Identity Disorder

B. Depersonalization Disorder
C. Derealization Disorder
D. Dissociative Amnesia
E. Traumatic Brain Injury
25. A 9 year-old boy with normal intelligence has a
history of fighting with other children and catching and
torturing young animals. When asked about these
behaviors he says, “I don’t know, it’s just fun.” Which
of the following is the most likely diagnosis:

A. No diagnosis
B. ADHD
C. Schizophrenia
D. Conduct Disorder
E. Antisocial Personality Disorder
26. An 8 year-old female is brought to the pediatrician for an
evaluation after she threw a chair at school. According to the
principal in a letter from the school, she was “wildly out of
control.” Seven months ago she tackled a child on the
playground, hitting him so hard he had to get stitches. When
asked why she did these things, she said, “ I don’t know. I just
did it.” She sounded remorseful and had tears in her eyes
when her parents were describing the incident. Which of the
following is the most likely diagnosis:

A.Intermittent Explosive Disorder

B.Disruptive Mood Dysregulation Disorder
C.Oppositional Defiant Disorder
D.Conduct Disorder
E.Attention Deficit Disorder-Combined Type
BONUS QUESTIONS
Bonus 1. A 32 year-old female was hospitalized after telling people that
she had been abducted from her home by aliens who ran medical tests
on her. She reported a history of 3 previous psychiatric hospitalizations,
beginning at age 27. After her legal hold expired, she consented to
remain in the hospital until she felt better. She revealed to the staff that
she had been abducted 10 times over the last year and that she
thought the aliens had transplanted her stomach with an alien stomach
the last time she was taken. While discussing these abductions in
group therapy, she grew tearful about it for the first time, stating that
finally opening up about these awful experiences made her realize how
sad it all was. She reported lying in bed at night for hours before falling
asleep, thinking about the loss of her own stomach. She refused to eat
most foods due to having an alien stomach, and had begun losing
weight. Staff reported that she spent most of her time watching TV and
complained frequently about feeling tired. Which of the following would
be the best diagnosis:

A. Post-traumatic Stress Disorder

B. Acute stress disorder
C. Delusional Disorder, Persecutory subtype
D. Schizophrenia
E. Schizoaffective Disorder
Bonus 2. Patient is 23 year-old homeless female who is
brought to the ED after attacking a pedestrian on the
street. During the attack, the patient sustained a minor
head injury that requires stitches. Patient stated, “They
told me to kill all of the aliens,” and she needed to be
restrained by the paramedics due to safety issues.
Medical records indicate a previous hospitalization 7
months ago for a psychotic episode. Which of the
following is the best treatment:

A. Olanzapine
B. Clonazepam
C. Clozapine
D. Trazadone
E. Lithium
Bonus 3. Patient is 27 year-old male who presents to the
physician with symptoms of fatigue and difficulties
concentrating. He reports that he has been feeling this way
for over 3 months, and in the past 2 weeks it has worsened.
He reports he is unable to engage in activities that he
enjoys. When assessed for suicide, patient denies thoughts
of self-harm, but indicates there is “no real reason to go on
anymore.” Which of the following neurotransmitters would
be most involved in producing these symptoms?

A. Dopamine
B. Norepinephrine
C. Serotonin
D. Histamine
E. Acetylcholine
Bonus 4. A 16 year-old female patient presents to Urgent Care with a
laceration on her wrist after she attempted to jump out of a 2nd floor
window. She stated that she wanted to show her girlfriend that she can
fly. Patient’s speech was rapid, and she paced in the waiting room
loudly declaring she needed to get fixed up before the media crew
arrived to film her next attempt. She reported that she has not “really
been sleeping” for over a week. Her parents reported that patient was
“pretty depressed” last month, and she was doing okay until this past
week. The patient has been on traditional medication for this disorder.
Which of the following would be one of the main side effects for the
medication:

A. Hypertension
B. Hypotension
C. Pyretic Syndrome
D. Weight Gain
E. Serotonin Syndrome