Mental health screening US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Mental health screening. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Mental health screening US Medical PG Question 1: A 25-year-old woman comes to the physician because of sadness that started 3 weeks after her daughter was born. Her daughter is now 9 months old and usually sleeps through the night, but the patient still has difficulty staying asleep. She has not returned to work since the birth. She is easily distracted from normal daily tasks. She used to enjoy cooking, but only orders delivery or take-out now. She says that she always feels too exhausted to do so and does not feel hungry much anyway. The pregnancy of the patient's child was complicated by gestational diabetes. The child was born at 36-weeks' gestation and has had no medical issues. The patient has no contact with the child's father. She is not sexually active. She does not smoke, drink alcohol, or use illicit drugs. She is 157 cm (5 ft 1 in) tall and weighs 47 kg (105 lb); BMI is 20 kg/m2. Vital signs are within normal limits. She is alert and cooperative but makes little eye contact. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis?
- A. Adjustment disorder
- B. Major depressive disorder
- C. Normal behavior
- D. Disruptive mood dysregulation disorder
- E. Depression with peripartum-onset (Correct Answer)
Mental health screening Explanation: ***Depression with peripartum-onset***
- The patient exhibits classic symptoms of **major depressive disorder**, including **anhedonia** (loss of enjoyment in cooking), **fatigue**, **insomnia**, and **changes in appetite/weight**, all appearing within 3 weeks post-childbirth and persisting for 9 months.
- According to **DSM-5-TR**, the **peripartum onset specifier** is applied when a major depressive episode begins during pregnancy or **within 4 weeks after delivery**.
- This patient's symptoms began at 3 weeks postpartum, meeting criteria for the peripartum onset specifier, which is clinically important for risk assessment (including infanticide risk) and treatment planning.
- The severity and duration of symptoms (persistent anhedonia, significant fatigue, insomnia despite adequate opportunity for sleep, appetite changes, functional impairment lasting months) clearly meet criteria for a **major depressive episode**.
*Adjustment disorder*
- This diagnosis involves emotional or behavioral symptoms in response to an identifiable stressor that do **not meet criteria for a major depressive episode**.
- The severity, number, and duration of symptoms (anhedonia, significant fatigue, insomnia, appetite changes, functional impairment lasting 9 months) exceed what is seen in adjustment disorder and meet full criteria for **major depressive disorder**.
*Major depressive disorder*
- While this patient's symptoms fully meet criteria for **Major Depressive Disorder (MDD)**, the onset within 4 weeks postpartum requires the addition of the **"with peripartum onset" specifier** per DSM-5-TR.
- Using the peripartum onset specifier is essential for clinical management, as it alerts clinicians to specific risks (including thoughts of harming the infant) and may influence treatment selection (e.g., considerations for breastfeeding-compatible medications).
*Normal behavior*
- The patient's symptoms—including **persistent sadness lasting 9 months**, **anhedonia**, **insomnia despite adequate sleep opportunity**, **significant fatigue**, **appetite loss**, and **inability to return to work**—represent severe functional impairment.
- These symptoms far exceed normal postpartum adjustment or transient "baby blues" (which typically resolve within 2 weeks postpartum) and indicate a serious mood disorder requiring treatment.
*Disruptive mood dysregulation disorder*
- This disorder is diagnosed **only in children and adolescents aged 6-18 years** and is characterized by persistent irritability and frequent, severe temper outbursts disproportionate to the situation.
- It is **not applicable to adults** and does not describe this patient's presentation of persistent depressed mood and neurovegetative symptoms.
Mental health screening US Medical PG Question 2: A mother presents to the family physician with her 16-year-old son. She explains, "There's something wrong with him doc. His grades are getting worse, he's cutting class, he's gaining weight, and his eyes are often bloodshot." Upon interviewing the patient apart from his mother, he seems withdrawn and angry at times when probed about his social history. The patient denies abuse and sexual history. What initial test should be sent to rule out the most likely culprit of this patient's behavior?
- A. Complete blood count
- B. Sexually transmitted infection (STI) testing
- C. Blood culture
- D. Urine toxicology screen (Correct Answer)
- E. Slit lamp examination
Mental health screening Explanation: ***Urine toxicology screen***
- The patient's presentation with **declining grades**, **cutting class**, **weight gain**, **bloodshot eyes**, and **irritability** are classic signs of **substance abuse** in an adolescent.
- A **urine toxicology screen** is the most appropriate initial test to detect common illicit substances, especially given the clear signs pointing towards drug use.
*Slit lamp examination*
- This test is used to examine the **anterior segment of the eye**, including the conjunctiva, cornea, iris, and lens.
- While the patient has **bloodshot eyes**, this specific test would be more relevant for ruling out ocular infections or injuries, not for diagnosing the underlying cause of systemic behavioral changes.
*Complete blood count*
- A **complete blood count (CBC)** measures different components of the blood, such as red blood cells, white blood cells, and platelets.
- A CBC is a general health indicator and while it can detect infections or anemia, it is not specific or sensitive enough to identify the cause of the behavioral changes described.
*Sexually transmitted infection (STI) testing*
- Although the patient denies sexual history, all adolescents presenting with certain risk factors or symptoms may warrant STI testing in a broader health assessment.
- However, in this scenario, the primary cluster of symptoms (poor grades, cutting class, bloodshot eyes, irritability) points more directly to substance abuse than to an STI.
*Blood culture*
- A **blood culture** is used to detect the presence of bacteria or other microorganisms in the bloodstream, indicating a systemic infection (sepsis).
- The patient's symptoms are not indicative of an acute bacterial bloodstream infection, and a blood culture would not be the initial test for the presented behavioral changes.
Mental health screening US Medical PG Question 3: A 25-year-old woman presents to her college campus clinic with the complaint of being unable to get up for her morning classes. She says that, because of this, her grades are being affected. For the past 6 weeks, she says she has been feeling depressed because her boyfriend dumped her. She finds herself very sleepy, sleeping in most mornings, eating more snacks and fast foods, and feeling drained of energy. She is comforted by her friend’s efforts to cheer her up but still feels guarded around any other boy that shows interest in her. The patient says she had similar symptoms 7 years ago for which she was prescribed several selective serotonin reuptake inhibitors (SSRIs) and a tricyclic antidepressant (TCA). However, none of the medications provided any long-term relief. She has prescribed a trial of Phenelzine to treat her symptoms. Past medical history is significant for a long-standing seizure disorder well managed with phenytoin. Which of the following statements would most likely be relevant to this patient’s new medication?
- A. “This medication is known to cause anorgasmia during treatment.”
- B. “You will have a risk for cardiotoxicity from this medication.”
- C. “A common side effect of this medication is sedation.”
- D. “While taking this medication, you should avoid drinking red wine.” (Correct Answer)
- E. “While on this medication, you may have a decreased seizure threshold.”
Mental health screening Explanation: ***"While taking this medication, you should avoid drinking red wine."***
- Phenelzine is a **monoamine oxidase inhibitor (MAOI)**. MAOIs inhibit the breakdown of **tyramine**, an amine found in fermented foods like red wine, aged cheeses, cured meats, and pickled foods.
- Consuming tyramine-rich foods with an MAOI can lead to a **hypertensive crisis**, characterized by a sudden, severe increase in blood pressure which can cause headaches, palpitations, and potentially stroke.
- This dietary counseling is **essential and immediately actionable** patient education when starting an MAOI.
*"This medication is known to cause anorgasmia during treatment."*
- While sexual dysfunction can occur with many antidepressants, **anorgasmia** is much more common and severe with **SSRIs (Selective Serotonin Reuptake Inhibitors)** than with MAOIs.
- MAOIs like phenelzine have a different mechanism of action and generally have a lower incidence of sexual side effects compared to SSRIs.
*"You will have a risk for cardiotoxicity from this medication."*
- **Cardiotoxicity** is a significant concern with **tricyclic antidepressants (TCAs)**, especially in overdose, due to their effects on cardiac sodium channels and potential for arrhythmias.
- While MAOIs can cause **orthostatic hypotension**, direct cardiotoxicity is not a primary concern with phenelzine.
*"A common side effect of this medication is sedation."*
- Phenelzine is generally considered **activating** rather than sedating, and can sometimes lead to insomnia or agitation.
- The patient's current hypersomnia is a symptom of her **atypical depression**, not a predicted side effect of phenelzine. In fact, phenelzine may help improve this symptom.
*"While on this medication, you may have a decreased seizure threshold."*
- This statement is actually **medically accurate** - MAOIs including phenelzine can lower (decrease) the seizure threshold, meaning they increase seizure risk.
- This is relevant given the patient's seizure disorder managed with phenytoin and warrants monitoring.
- However, the **dietary tyramine restriction** is the more critical and immediately actionable counseling point when initiating MAOI therapy, as hypertensive crisis can occur with the very first exposure to tyramine-rich foods.
Mental health screening US Medical PG Question 4: A 24-year-old woman visits her psychiatrist a week after she delivered a baby. She is holding her baby and crying as she waits for her appointment. She tells her physician that a day or so after her delivery, she has been finding it difficult to contain her feelings. She is often sad and unable to contain her tears. She is embarrassed and often starts crying without any reason in front of people. She is also anxious that she will not be a good mother and will make mistakes. She hasn’t slept much since the delivery and is often stressed about her baby getting hurt. She makes excessive attempts to keep the baby safe and avoid any mishaps. She does not report any loss of interest in her activities and denies any suicidal tendencies. Which of the following is best course of management for this patient?
- A. Get admitted immediately
- B. Come back for a follow-up in 2 weeks (Correct Answer)
- C. Start on a small dose of fluoxetine daily
- D. Give her child to child protective services
- E. Schedule an appointment for electroconvulsive therapy
Mental health screening Explanation: ***Come back for a follow-up in 2 weeks***
- This patient presents with symptoms highly suggestive of **postpartum blues**, which typically resolve spontaneously within two weeks after delivery.
- Reassurance, emotional support, and monitoring her symptoms with a follow-up appointment are the most appropriate initial steps.
*Get admitted immediately*
- Immediate admission is generally reserved for more severe conditions like **postpartum psychosis**, characterized by delusions, hallucinations, or severe disorganization, which are not described here.
- Her symptoms, though distressing, do not indicate a level of impairment or danger requiring urgent inpatient care.
*Start on a small dose of fluoxetine daily*
- **Antidepressant medication** like fluoxetine is typically considered for **postpartum depression** if symptoms persist beyond two weeks or are severe from the outset.
- Given the transient nature of postpartum blues, medication is not the first-line treatment.
*Give her child to child protective services*
- This action is extreme and entirely unwarranted, as there is no indication of **child abuse, neglect, or harm** from the mother.
- Her increased anxiety about the baby's safety indicates concern, not a risk to the child's well-being.
*Schedule an appointment for electroconvulsive therapy*
- **Electroconvulsive therapy (ECT)** is a highly effective, but usually last-resort, treatment reserved for severe, treatment-refractory depression or psychosis, especially when rapid response is critical.
- Her symptoms do not currently warrant such an intensive intervention.
Mental health screening US Medical PG Question 5: A study is being conducted on depression using the Patient Health questionnaire (PHQ-9) survey data embedded within a popular social media network with a response size of 500,000 participants. The sample population of this study is approximately normal. The mean PHQ-9 score is 14, and the standard deviation is 4. How many participants have scores greater than 22?
- A. 175,000
- B. 17,500
- C. 160,000
- D. 12,500 (Correct Answer)
- E. 25,000
Mental health screening Explanation: ***12,500***
- To find the number of participants with scores greater than 22, first calculate the **z-score** for a score of 22: $Z = \frac{(X - \mu)}{\sigma} = \frac{(22 - 14)}{4} = 2$.
- A z-score of 2 means the score is **2 standard deviations above the mean**. Using the **empirical rule** for a normal distribution, approximately **2.5%** of the data falls beyond 2 standard deviations above the mean (5% total in both tails, so 2.5% in each tail).
- Therefore, $2.5\%$ of the total 500,000 participants is $0.025 \times 500,000 = 12,500$.
*175,000*
- This option would imply a much larger proportion of the population scoring above 22, inconsistent with the **normal distribution's properties** and the calculated z-score.
- It would correspond to a z-score closer to 0, indicating a score closer to the mean, not two standard deviations above it.
*17,500*
- This value represents **3.5%** of the total population ($17,500 / 500,000 = 0.035$).
- A proportion of 3.5% above the mean corresponds to a z-score that is not exactly 2, indicating an incorrect calculation or interpretation of the **normal distribution table**.
*160,000*
- This option represents a very large portion of the participants, roughly **32%** of the total population.
- This percentage would correspond to scores within one standard deviation of the mean, not scores 2 standard deviations above the mean as calculated.
*25,000*
- This value represents **5%** of the total population ($25,000 / 500,000 = 0.05$).
- A z-score greater than 2 corresponds to the far tail of the normal distribution, where only 2.5% of the data lies, not 5%. This would correspond to a z-score of approximately 1.65.
Mental health screening US Medical PG Question 6: A student health coordinator plans on leading a campus-wide HIV screening program that will be free for the entire undergraduate student body. The goal is to capture as many correct HIV diagnoses as possible with the fewest false positives. The coordinator consults with the hospital to see which tests are available to use for this program. Test A has a sensitivity of 0.92 and a specificity of 0.99. Test B has a sensitivity of 0.95 and a specificity of 0.96. Test C has a sensitivity of 0.98 and a specificity of 0.93. Which of the following testing schemes should the coordinator pursue?
- A. Test A on the entire student body followed by Test B on those who are positive
- B. Test A on the entire student body followed by Test C on those who are positive
- C. Test C on the entire student body followed by Test B on those who are positive
- D. Test C on the entire student body followed by Test A on those who are positive (Correct Answer)
- E. Test B on the entire student body followed by Test A on those who are positive
Mental health screening Explanation: ***Test C on the entire student body followed by Test A on those who are positive***
- To "capture as many correct HIV diagnoses as possible" (maximize true positives), the initial screening test should have the **highest sensitivity**. Test C has the highest sensitivity (0.98).
- To "capture as few false positives as possible" (maximize true negatives and confirm diagnoses), the confirmatory test should have the **highest specificity**. Test A has the highest specificity (0.99).
*Test A on the entire student body followed by Test B on those who are positive*
- Starting with Test A (sensitivity 0.92) would miss more true positive cases than starting with Test C (sensitivity 0.98), failing the goal of **capturing as many cases as possible**.
- Following with Test B (specificity 0.96) would result in more false positives than following with Test A (specificity 0.99).
*Test A on the entire student body followed by Test C on those who are positive*
- This scheme would miss many true positive cases initially due to Test A's lower sensitivity compared to Test C.
- Following with Test C would introduce more false positives than necessary, as it has a lower specificity (0.93) than Test A (0.99).
*Test C on the entire student body followed by Test B on those who are positive*
- While Test C is a good initial screen for its high sensitivity, following it with Test B (specificity 0.96) is less optimal than Test A (specificity 0.99) for minimizing false positives in the confirmation step.
- This combination would therefore yield more false positives in the confirmatory stage than using Test A.
*Test B on the entire student body followed by Test A on those who are positive*
- Test B has a sensitivity of 0.95, which is lower than Test C's sensitivity of 0.98, meaning it would miss more true positive cases at the initial screening stage.
- While Test A provides excellent specificity for confirmation, the initial screening step is suboptimal for the goal of capturing as many diagnoses as possible.
Mental health screening US Medical PG Question 7: A 65-year-old non-smoking woman with no symptoms comes to your clinic to establish care with a primary care provider. She hasn’t seen a doctor in 12 years and states that she feels very healthy. You realize that guidelines by the national cancer organization suggest that she is due for some cancer screening tests, including a mammogram for breast cancer, a colonoscopy for colon cancer, and a pap smear for cervical cancer. These three screening tests are most likely to be considered which of the following?
- A. Tertiary prevention
- B. Primary prevention
- C. Secondary prevention (Correct Answer)
- D. Cancer screening does not fit into these categories
- E. Quaternary prevention
Mental health screening Explanation: ***Secondary prevention***
- **Secondary prevention** aims to detect and treat a disease early, before symptoms appear, to prevent its progression or recurrence.
- **Cancer screening tests** such as mammograms, colonoscopies, and Pap smears fit this category perfectly as they are performed in asymptomatic individuals to identify early-stage cancer or pre-cancerous lesions.
*Tertiary prevention*
- **Tertiary prevention** focuses on minimizing the impact of an established disease and improving quality of life through treatment and rehabilitation.
- This would involve managing existing cancer, not screening for it.
*Primary prevention*
- **Primary prevention** aims to prevent a disease from occurring in the first place, often through health promotion and risk reduction.
- Examples include vaccination, lifestyle modifications (e.g., healthy diet, exercise), or avoiding smoking.
*Cancer screening does not fit into these categories*
- This statement is incorrect as cancer screening is a well-established component of preventive healthcare.
- It clearly falls within the defined categories of prevention, specifically secondary prevention.
*Quaternary prevention*
- **Quaternary prevention** aims to protect patients from medical interventions that are likely to cause more harm than good, or to avoid over-medicalization.
- This concept is distinct from screening for diseases and focuses on ethical considerations in medical care.
Mental health screening US Medical PG Question 8: A 78-year-old woman is brought to the emergency ward by her son for lethargy and generalized weakness. The patient speaks in short utterances and does not make eye contact with the provider or her son throughout the interview and examination. You elicit that the patient lives with her son and daughter-in-law, and she reports vague weakness for the last couple days. The emergency room provider notices 3-4 healing bruises on the patient's upper extremities; otherwise, examination is not revealing. Routine chemistries and blood counts are unremarkable; non-contrast head CT demonstrates normal age-related changes. Which of the following is the most appropriate next step in management?
- A. Ask the patient's son to leave the room (Correct Answer)
- B. Question the patient's son regarding the home situation
- C. Call Adult Protective Services to report the patient's son
- D. Perform lumbar puncture
- E. Question the patient regarding abuse or neglect
Mental health screening Explanation: ***Ask the patient's son to leave the room***
- The patient's **lethargy**, **non-engagement**, and **healing bruises** raise strong suspicions for elder abuse or neglect. Removing the son allows for a private interview, which is crucial for her to feel safe enough to disclose information.
- In situations of suspected abuse, it is paramount to prioritize the **patient's safety and ability to speak freely** without the presence of the suspected abuser.
*Question the patient's son regarding the home situation*
- Questioning the son directly at this point may escalate the situation or make the patient even less likely to disclose abuse, as she is likely **frightened or coerced**.
- This step is premature and should only occur after a private interview with the patient, and potentially with the involvement of Protective Services.
*Call Adult Protective Services to report the patient's son*
- While reporting to **Adult Protective Services** is a critical step if abuse is confirmed, it is not the immediate first action until a private interview with the patient has been conducted to gather more information.
- Making a report without attempting to speak with the patient alone first can hinder the investigation and potentially jeopardize her safety if the abuser is alerted prematurely.
*Perform lumbar puncture*
- A lumbar puncture is an invasive procedure generally performed to diagnose **central nervous system infections** or **inflammatory conditions**.
- There are no clinical indications (e.g., fever, meningeal signs, focal neurological deficits) to suggest a need for a lumbar puncture, especially given the history and physical findings that point towards abuse.
*Question the patient regarding abuse or neglect*
- While it's important to question the patient about abuse, it must be done in a **safe and private environment** where she feels comfortable speaking freely.
- Questioning her while the suspected abuser (her son) is present would likely yield unhelpful responses due to fear or intimidation, as seen by her lack of eye contact and short utterances.
Mental health screening US Medical PG Question 9: A 24-year-old woman presents to her primary care physician for a wellness exam. She currently has no acute concerns but has been feeling hopeless, has a poor appetite, difficulty with concentration, and trouble with sleep. She says that she has poor self-esteem and that her symptoms have been occurring for the past 3 years. She has had moments where she felt better, but it lasted a few weeks out of the year. She currently lives alone and does not pursue romantic relationships because she feels she is not attractive. She has a past medical history of asthma. Her mother is alive and healthy. Her father committed suicide and suffered from major depressive disorder. On physical exam, the patient has a gloomy demeanor and appears restless and anxious. Which of the following is the most likely diagnosis?
- A. Major depressive disorder
- B. Cyclothymia
- C. Persistent depressive disorder (Correct Answer)
- D. Seasonal affective disorder
- E. Disruptive mood dysregulation disorder
Mental health screening Explanation: ***Persistent depressive disorder***
- The patient exhibits chronic symptoms of depression (poor appetite, poor self-esteem, difficulty with concentration, trouble with sleep, hopelessness) lasting for at least **2 years**, with symptom-free periods lasting no more than **2 months**.
- Her long-standing symptoms (3 years) and the intermittent improvement, but never full resolution for extended periods, are characteristic of **persistent depressive disorder** (formerly dysthymia).
*Major depressive disorder*
- While the patient has many symptoms of depression, **major depressive disorder** is characterized by distinct episodes of at least 2 weeks, with significant functional impairment. The chronic, fluctuating course over 3 years is less typical.
- The presence of depressive symptoms for 3 years, with only brief periods of improvement, points away from episodic major depressive disorder alone and more towards a chronic form.
*Cyclothymia*
- **Cyclothymia** involves numerous periods of hypomanic symptoms and numerous periods of depressive symptoms for at least 2 years, with periods of stability lasting no more than 2 months. The patient describes only depressive symptoms, not hypomanic episodes.
- There is no mention of elevated mood, increased energy, or decreased need for sleep, which are characteristic of **hypomanic episodes** in cyclothymia.
*Seasonal affective disorder*
- **Seasonal affective disorder** is a type of depressive disorder that occurs during a specific season (most commonly winter) and resolves during other seasons; the patient's symptoms are year-round and chronic.
- The patient's symptoms are not described as tied to a particular season, making this diagnosis less likely.
*Disruptive mood dysregulation disorder*
- Predominantly diagnosed in **children and adolescents**, this disorder is characterized by severe recurrent temper outbursts and persistently irritable or angry mood between outbursts.
- The patient's age (24 years old) and the absence of temper outbursts make this diagnosis inappropriate.
Mental health screening US Medical PG Question 10: A 55-year-old man presents for physical and preventive health screening, specifically for prostate cancer. He has not been to the doctor in a long time. Past medical history is significant for hypertension that is well-managed. Current medication is hydrochlorothiazide. He has one uncle who died of prostate cancer. He drinks one or two alcoholic drinks on the weekends and does not smoke. Today his temperature is 37.0°C (98.6°F), blood pressure is 125/75 mm Hg, pulse is 82/min, respiratory rate is 15/min, and oxygen saturation is 99% on room air. There are no significant findings on physical examination. Which of the following would be the most appropriate recommendation for prostate cancer screening in this patient?
- A. Contrast CT of the abdomen and pelvis
- B. Serum PSA level (Correct Answer)
- C. Digital rectal examination
- D. No screening indicated at this time
- E. Transrectal ultrasound (TRUS)
Mental health screening Explanation: ***Serum PSA level***
- This patient is 55 years old and has a family history of prostate cancer (uncle), placing him at **average to increased risk** for prostate cancer.
- **Serum PSA (prostate-specific antigen) testing** is the primary screening tool for prostate cancer, often combined with shared decision-making with the patient.
*Contrast CT of the abdomen and pelvis*
- A CT scan is not a primary screening tool for prostate cancer but is used for **staging** once cancer is diagnosed or to investigate specific symptoms.
- It involves **radiation exposure** and **contrast dye risks** which are not justified for routine screening in an asymptomatic patient.
*Digital rectal examination*
- While DRE can detect prostate abnormalities, it has a **lower sensitivity and specificity** as a stand-alone screening test compared to PSA.
- Current guidelines often recommend DRE in conjunction with PSA, but **PSA remains the initial and most important screening test**.
*No screening indicated at this time*
- The patient's age (55) and family history (uncle with prostate cancer) warrant discussion about prostate cancer screening.
- The **American Cancer Society (ACS)** recommends starting discussions about screening at age 50 for average-risk men, and earlier for those with risk factors.
*Transrectal ultrasound (TRUS)*
- TRUS is not a screening test but is typically used to **guide prostate biopsies** if PSA levels are elevated or a DRE is abnormal.
- It is an **invasive procedure** and not appropriate for initial prostate cancer screening in asymptomatic individuals.
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