Functional impairment assessment US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Functional impairment assessment. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Functional impairment assessment US Medical PG Question 1: A researcher is investigating whether there is an association between the use of social media in teenagers and bipolar disorder. In order to study this potential relationship, she collects data from people who have bipolar disorder and matched controls without the disorder. She then asks how much on average these individuals used social media in the 3 years prior to their diagnosis. This continuous data is divided into 2 groups: those who used more than 2 hours per day and those who used less than 2 hours per day. She finds that out of 1000 subjects, 500 had bipolar disorder of which 300 used social media more than 2 hours per day. She also finds that 400 subjects who did not have the disorder also did not use social media more than 2 hours per day. Which of the following is the odds ratio for development of bipolar disorder after being exposed to more social media?
- A. 1.5
- B. 6 (Correct Answer)
- C. 0.17
- D. 0.67
Functional impairment assessment Explanation: ***6***
- To calculate the odds ratio, we first construct a 2x2 table [1]:
- Bipolar Disorder (Cases): 500
- No Bipolar Disorder (Controls): 500 (1000 total subjects - 500 cases)
- Cases exposed to more social media (>2 hrs/day): 300
- Cases not exposed to more social media (≤2 hrs/day): 200 (500 - 300)
- Controls not exposed to more social media (≤2 hrs/day): 400
- Controls exposed to more social media (>2 hrs/day): 100 (500 - 400)
- The odds ratio (OR) is calculated as (odds of exposure in cases) / (odds of exposure in controls) = (300/200) / (100/400) = 1.5 / 0.25 = **6** [1].
*1.5*
- This value represents the **odds of exposure** (more than 2 hours of social media) in individuals with bipolar disorder (300 cases exposed / 200 cases unexposed = 1.5).
- It is not the odds ratio, which compares these odds to the odds of exposure in the control group.
*0.17*
- This value is close to the reciprocal of 6 (1/6 ≈ 0.166), suggesting a potential miscalculation or an inverted odds ratio.
- An odds ratio of 0.17 would imply a protective effect (lower odds of bipolar disorder with more social media), which is contrary to the calculation and typical interpretation in this context.
*0.67*
- This value is the reciprocal of 1.5 (1/1.5 ≈ 0.67) which represents the odds of *not* being exposed in cases (200/300).
- It does not represent the correct odds ratio, which compares the odds of exposure in cases to the odds of exposure in controls.
Functional impairment assessment US Medical PG Question 2: A 28-year-old woman presents with depressed mood lasting for most days of the week for the past month. She also mentions that she has lost her appetite for the past 3 weeks. She adds that her job performance has significantly deteriorated because of these symptoms, and she feels like she will have to quit her job soon. Upon asking about her hobbies, she says that she used to enjoy dancing and music but does not have any desire to do them anymore. The patient’s husband says that she has had many sleepless nights last month. The patient denies any history of smoking, alcohol intake, or use of illicit substances. No significant past medical history. Physical examination is unremarkable. Routine laboratory tests are all within normal limits. Which of the following clinical features must be present, in addition to this patient’s current symptoms, to confirm the diagnosis of a major depressive episode?
- A. Intense fear of losing control
- B. Lack of concentration (Correct Answer)
- C. Weight loss
- D. Anterograde amnesia
- E. Nightmares
Functional impairment assessment Explanation: ***Lack of concentration***
- The diagnostic criteria for a **major depressive episode** (DSM-5) require at least **5 out of 9 cardinal symptoms** present for at least 2 weeks, with at least one being either **depressed mood** or **anhedonia**.
- This patient currently has **4 symptoms**: (1) depressed mood, (2) anhedonia (loss of interest in dancing/music), (3) appetite disturbance (loss of appetite), and (4) sleep disturbance (insomnia).
- To meet diagnostic criteria, she needs **one more symptom** from the remaining options: fatigue, feelings of worthlessness/guilt, **diminished ability to concentrate or indecisiveness**, psychomotor changes, or suicidal ideation.
- **Lack of concentration** is one of the DSM-5 diagnostic criteria and would bring her total to 5 symptoms, confirming the diagnosis.
*Intense fear of losing control*
- This symptom is characteristic of **panic disorder** or anxiety disorders, where individuals experience sudden, intense episodes of fear with accompanying physical and cognitive symptoms.
- While anxiety can co-occur with depression, intense fear of losing control is **not a DSM-5 diagnostic criterion** for major depressive episode.
*Weight loss*
- The patient already has **loss of appetite**, which satisfies the weight/appetite criterion for major depressive episode.
- **Weight loss and appetite changes are part of the same diagnostic criterion**, not separate ones. Therefore, weight loss would not add an additional criterion to reach the required 5 symptoms.
- While clinically significant weight loss can occur in depression, it would not provide the "additional" criterion needed in this case.
*Anterograde amnesia*
- **Anterograde amnesia** (inability to form new memories) is associated with neurological conditions such as **hippocampal damage**, **Korsakoff syndrome**, or **traumatic brain injury**.
- It is **not a DSM-5 diagnostic criterion** for major depressive episode, though some cognitive impairment (concentration difficulties) may occur.
*Nightmares*
- The patient already has **insomnia** (sleep disturbance), which is one of the DSM-5 diagnostic criteria.
- While nightmares may occur in depression, they are not a separate diagnostic criterion and would not add to the symptom count since sleep disturbance is already present.
Functional impairment assessment US Medical PG Question 3: A mental health volunteer is interviewing locals as part of a community outreach program. A 46-year-old man discloses that he has felt sad for as long as he can remember. He feels as though his life is cursed and if something terrible can happen to him, it usually will. He has difficulty making decisions and feels hopeless. He also feels that he has had worsening suicidal ideations, guilt from past problems, decreased energy, and poor concentration over the past 2 weeks. He is otherwise getting enough sleep and able to hold a job. Which of the following statement best describes this patient's condition?
- A. The patient may have symptoms of mania or psychosis.
- B. The patient is likely to show anhedonia.
- C. The patient likely has paranoid personality disorder.
- D. The patient has double depression. (Correct Answer)
- E. The patient should be started on an SSRI.
Functional impairment assessment Explanation: ***The patient has double depression.***
- The patient describes **chronic low-grade depressive symptoms** ("felt sad for as long as he can remember," "life is cursed," "difficulty making decisions," "hopeless") consistent with **persistent depressive disorder (dysthymia)**, which requires at least 2 years of symptoms.
- The recent worsening of symptoms over the past two weeks, including "worsening suicidal ideations, guilt from past problems, decreased energy, and poor concentration," indicates an additional **major depressive episode (MDE) superimposed on dysthymia**, a condition known as **double depression**.
- This patient currently meets criteria for both conditions simultaneously, not just at risk for developing them.
*The patient may have symptoms of mania or psychosis.*
- There are no symptoms mentioned that suggest **mania**, such as elevated mood, increased energy, decreased need for sleep, grandiosity, or racing thoughts.
- While suicidal ideation is present, there is no evidence of **psychotic features** like hallucinations or delusions.
*The patient is likely to show anhedonia.*
- **Anhedonia** (inability to feel pleasure) is a common symptom of depression and may well be present in this patient.
- However, the patient's presentation specifically highlights the pattern of **chronic dysthymia with a superimposed major depressive episode**, making **double depression** a more precise, comprehensive, and diagnostically specific description of his current condition.
- While anhedonia might be present, it is a symptom rather than a diagnostic formulation.
*The patient likely has paranoid personality disorder.*
- **Paranoid personality disorder** is characterized by pervasive distrust and suspicion of others, interpreting their motives as malevolent, without sufficient basis.
- The patient's feelings of being "cursed" and that "something terrible can happen" reflect **depressive pessimism and negative cognitive distortions**, not paranoid ideation about others' intentions.
- This is consistent with the hopelessness seen in depression.
*The patient should be started on an SSRI.*
- While an **SSRI (selective serotonin reuptake inhibitor)** combined with psychotherapy would likely be appropriate treatment for double depression, making a specific treatment recommendation is premature without comprehensive clinical assessment.
- The question asks for the **best statement describing the patient's condition** (diagnosis), not for treatment recommendations.
Functional impairment assessment US Medical PG Question 4: Two dizygotic twins present to the university clinic because they believe they are being poisoned through the school's cafeteria food. They have brought these concerns up in the past, but no other students or cafeteria staff support this belief. Both of them are average students with strong and weak subject areas as demonstrated by their course grade-books. They have no known medical conditions and are not known to abuse illicit substances. Which statement best describes the condition these patients have?
- A. A trial separation is likely to worsen symptoms.
- B. The disorder is its own disease entity in DSM-5.
- C. Antipsychotic medications are rarely beneficial.
- D. Can affect two or more closely related individuals. (Correct Answer)
- E. Cognitive behavioral therapy is a good first-line.
Functional impairment assessment Explanation: ***Can affect two or more closely related individuals.***
- The shared delusional belief in **folie à deux**, also known as **shared psychotic disorder**, typically occurs in two or more people who are closely associated.
- In this case, the **dizygotic twins** sharing the same delusional belief about being poisoned from cafeteria food fits this pattern.
*A trial separation is likely to worsen symptoms.*
- **Separating the individuals** involved in **folie à deux** is often a crucial step in treatment, as it can help break the cycle of shared delusion and allow for individual therapy.
- Separation typically IMPROVES rather than worsens symptoms by removing the reinforcement of the shared delusion.
*The disorder is its own disease entity in DSM-5.*
- In the **DSM-5**, **folie à deux** is no longer considered a separate diagnostic category.
- Instead, it is classified under **Other Specified Schizophrenia Spectrum and Other Psychotic Disorder** or **Unspecified Schizophrenia Spectrum and Other Psychotic Disorder**, with the specific context of shared delusion noted.
*Antipsychotic medications are rarely beneficial.*
- **Antipsychotics** are actually commonly used in treating folie à deux, particularly for the **primary individual** who initially developed the delusion.
- They can be an important component of treatment, often combined with separation and psychotherapy.
*Cognitive behavioral therapy is a good first-line.*
- **Cognitive Behavioral Therapy (CBT)** can be beneficial, particularly after separation, to help individuals challenge and reframe their delusional beliefs.
- However, the **first-line intervention** for shared psychotic disorder is **separation of the involved individuals**, followed by individual therapy (which may include CBT) and medication as needed.
Functional impairment assessment US Medical PG Question 5: A 24-year-old male comes into the psychiatric clinic complaining of consistent sadness. He endorses feelings of worthlessness, anxiety, and anhedonia for the past couple months but denies feeling suicidal. He further denies any past episodes of feeling overly energetic with racing thoughts. Confident of the diagnosis, you recommend frequent talk therapy along with a long-term prescription of a known first-line medication for this disorder. What is the drug and what are some of the most frequently encountered side effects?
- A. Selective serotonin reuptake inhibitor; hypomania, suicidal thoughts
- B. Tricyclic antidepressants; hypomania, suicidal thoughts
- C. Selective serotonin reuptake inhibitor; anorgasmia, insomnia (Correct Answer)
- D. Monoamine oxidase inhibitors; Orthostatic hypotension, weight gain
- E. Tricyclic antidepressants; Orthostatic hypotension, anticholinergic effects
Functional impairment assessment Explanation: ***Selective serotonin reuptake inhibitor; anorgasmia, insomnia***
- The patient presents with classic symptoms of **major depressive disorder**, including persistent sadness, worthlessness, anxiety, and anhedonia, without any history of manic or hypomanic episodes. **SSRIs** are considered first-line pharmacotherapy for this condition.
- Common side effects of SSRIs include **sexual dysfunction** (e.g., anorgasmia, decreased libido) and **insomnia** or agitation, especially during the initial weeks of treatment.
*Selective serotonin reuptake inhibitor; hypomania, suicidal thoughts*
- While SSRIs are the correct drug class, **hypomania** is not a frequent side effect in patients without bipolar disorder. For patients with bipolar disorder, antidepressant monotherapy can induce hypomania or mania, but this patient denies such episodes.
- **Suicidal thoughts** can occur, particularly in young adults, during the initial phase of antidepressant treatment, but it is less common to frame it as a *frequently encountered side effect* in the general population compared to sexual dysfunction or sleep disturbances.
*Tricyclic antidepressants; hypomania, suicidal thoughts*
- **Tricyclic antidepressants (TCAs)** are generally not first-line due to their less favorable side effect profile compared to SSRIs, including significant anticholinergic effects and cardiovascular risks.
- As with SSRIs, **hypomania** is not a typical frequent side effect in unipolar depression, and while **suicidal thoughts** are a concern with antidepressants, TCAs carry a higher risk of lethality in overdose, making them less preferred initially.
*Monoamine oxidase inhibitors; Orthostatic hypotension, weight gain*
- **Monoamine oxidase inhibitors (MAOIs)** are effective but are typically reserved for **refractory depression** due to their significant drug and food interactions (e.g., tyramine-induced hypertensive crisis).
- While **orthostatic hypotension** and **weight gain** are known side effects of MAOIs, this class is not considered a first-line treatment for major depressive disorder.
*Tricyclic antidepressants; Orthostatic hypotension, anticholinergic effects*
- **TCAs** are indeed associated with side effects such as **orthostatic hypotension** and prominent **anticholinergic effects** (e.g., dry mouth, constipation, blurred vision, urinary retention).
- However, because of these more burdensome side effects and higher toxicity in overdose, TCAs are not generally considered the first-line medication choice, especially when SSRIs are available and safer.
Functional impairment assessment US Medical PG Question 6: 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
Functional impairment assessment 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.
Functional impairment assessment US Medical PG Question 7: A 42-year-old female presents to her primary care provider for an annual checkup. She reports feeling sad over the past few months for no apparent reason. She has lost interest in swimming, which she previously found enjoyable. Additionally, she has had trouble getting a full night’s sleep and has had trouble concentrating during the day. She has lost 15 pounds since her last visit one year prior. Which of the following sets of neurotransmitter levels is associated with this patient’s condition?
- A. Decreased acetylcholine, normal serotonin, normal dopamine
- B. Decreased norepinephrine, decreased serotonin, decreased dopamine (Correct Answer)
- C. Decreased GABA, decreased acetylcholine, increased dopamine
- D. Increased norepinephrine, decreased serotonin, decreased GABA
- E. Increased acetylcholine, increased serotonin, decreased dopamine
Functional impairment assessment Explanation: ***Decreased norepinephrine, decreased serotonin, decreased dopamine***
- The patient's symptoms of **sadness**, loss of interest (**anhedonia**), **insomnia**, **difficulty concentrating**, and **weight loss** are classic for **major depressive disorder**.
- **Depression** is strongly associated with deficiencies in **monoamine neurotransmitters**: **norepinephrine**, **serotonin**, and **dopamine**.
*Decreased acetylcholine, normal serotonin, normal dopamine*
- While **acetylcholine** is involved in mood regulation, its isolated decrease with normal serotonin and dopamine levels is not characteristic of generalized depression.
- More prominent roles for **acetylcholine dysfunction** are seen in conditions like **Alzheimer's disease** or **myasthenia gravis**.
*Decreased GABA, decreased acetylcholine, increased dopamine*
- **Decreased GABA** is often associated with **anxiety disorders** and seizures, not the primary presentation of depression here.
- **Increased dopamine** is more characteristic of conditions like **schizophrenia** or **mania**, which contrasts with the patient's depressive symptoms.
*Increased norepinephrine, decreased serotonin, decreased GABA*
- **Increased norepinephrine** is typically associated with **anxiety**, **stress**, or sometimes **mania**, which is inconsistent with this patient's depressive state.
- While **decreased serotonin** is correct for depression, the combination with increased norepinephrine and decreased GABA does not fit the typical neurotransmitter profile.
*Increased acetylcholine, increased serotonin, decreased dopamine*
- **Increased acetylcholine** is generally not associated with the full spectrum of depressive symptoms described.
- **Increased serotonin** is often the goal of antidepressant treatments (SSRIs), making an endogenous increase unlikely to cause depression.
Functional impairment assessment US Medical PG Question 8: A 38-year-old woman comes to the physician for the first time because of a 2-year history of lower back pain and fatigue. She also says that she occasionally feels out of breath. Her symptoms are not associated with physical activity. She has seen multiple physicians over the past year. Extensive workup including blood and urine tests, abdominal ultrasound, MRI of the back, and cardiac stress testing have shown no abnormalities. The patient asks for a medication to alleviate her symptoms. Which of the following is the most appropriate response by the physician?
- A. I would like to refer you to a psychiatric specialist to start behavioral psychotherapy.
- B. Your symptoms are suggestive of a condition called somatic symptom disorder.
- C. I would like to investigate your shortness of breath by performing coronary artery catheterization.
- D. Your desire for pain medication is suggestive of a medication dependence disorder.
- E. I would like to assess your symptoms causing you the most distress and schedule monthly follow-up appointments. (Correct Answer)
Functional impairment assessment Explanation: ***"I would like to assess your symptoms causing you the most distress and schedule monthly follow-up appointments."***
- This response demonstrates **empathy** and a commitment to ongoing care, which is crucial for patients with **somatic symptoms** who often feel dismissed.
- Establishing a consistent relationship with a primary care physician can help manage chronic, unexplained symptoms and build **trust**, potentially reducing the need for extensive, often fruitless, investigations.
*"Your desire for pain medication is suggestive of a medication dependence disorder."*
- This statement is **judgmental** and incorrect, as the patient has not shown any signs of drug-seeking behavior beyond requesting medication for pain.
- It would likely damage the **doctor-patient relationship** and discourage the patient from seeking further help from this physician.
*"I would like to refer you to a psychiatric specialist to start behavioral psychotherapy."*
- While psychotherapy may be beneficial, immediately referring to a **psychologist** without first validating the patient's physical symptoms can make them feel dismissed.
- It's often more effective to integrate mental health support after a continued period of medical evaluation and relationship building.
*"Your symptoms are suggestive of a condition called somatic symptom disorder."*
- While the patient's symptoms are consistent with **somatic symptom disorder**, directly labeling the condition at the initial interaction might be perceived as diagnostic and **invalidating** to the patient, who believes their symptoms are purely physical.
- A more gradual approach, focusing on symptom management and observation, is usually preferred before introducing a psychiatric diagnosis.
*"I would like to investigate your shortness of breath by performing coronary artery catheterization."*
- The patient has already undergone an extensive cardiac stress test with **no abnormalities**, making an invasive procedure like catheterization unnecessary and potentially harmful.
- This approach ignores the previous negative workup and the chronic, unexplained nature of the symptoms, contributing to over-medicalization.
Functional impairment assessment US Medical PG Question 9: A patient with second-degree cervical prolapse complains of dribbling of urine when coughing. What is the most likely diagnosis?
- A. Cystitis
- B. Stress incontinence (Correct Answer)
- C. Overflow incontinence
- D. Functional incontinence
Functional impairment assessment Explanation: ***Stress incontinence***
- **Stress incontinence** is characterized by involuntary urine leakage due to increased intra-abdominal pressure (e.g., coughing, sneezing), which is common in association with **pelvic organ prolapse** like a second-degree cervical prolapse.
- The prolapse weakens the **pelvic floor muscles** and supporting structures around the urethra, diminishing its ability to maintain closure during sudden pressure changes.
*Cystitis*
- **Cystitis** is an inflammation of the bladder, typically presenting with symptoms like painful urination (dysuria), frequent urination, and urgency.
- While it can cause bladder irritation, it does not directly lead to urine dribbling with coughing in the absence of other typical infection symptoms.
*Overflow incontinence*
- **Overflow incontinence** occurs due to an **overfilled bladder** that can't empty completely, leading to constant dribbling or leakage.
- This typically results from a **bladder outlet obstruction** or an **underactive detrusor muscle**, not directly from increased abdominal pressure during coughing.
*Functional incontinence*
- **Functional incontinence** is when a person has control over their bladder but cannot reach the toilet in time due to **physical or cognitive impairments**.
- It does not involve a problem with the urinary tract itself but rather with the ability to respond to the urge to urinate.
Functional impairment assessment US Medical PG Question 10: A 38-year-old woman presents to her primary care physician for complaints of insomnia. She states that for the last 8 months, she has had difficulty falling asleep. Additionally, she awakens in the middle of the night or early morning and cannot fall back to sleep. When further questioned, she reports decreased appetite with a 12-lb. weight loss in the last 6 months. She was recently demoted at her work as a baker due to trouble focusing and coordinating orders and excess fatigue. She feels she is to blame for her family's current financial status given her demotion. She is given a prescription for fluoxetine at this visit with follow-up 2 weeks later. At the follow-up visit, she reports no improvement in her symptoms despite taking her medication consistently. What is the most appropriate next step in management?
- A. Increase dose of current medication
- B. Switch to bupropion
- C. Add lithium
- D. Switch to paroxetine
- E. Continue current medication (Correct Answer)
Functional impairment assessment Explanation: ***Continue current medication***
- It takes approximately **4-6 weeks** for an antidepressant, such as fluoxetine, to reach its full therapeutic effect and for patients to experience significant symptom improvement.
- Due to the **delayed onset of action**, continuing the medication for a longer period is necessary to assess its efficacy before making changes.
*Increase dose of current medication*
- Increasing the dose after only 2 weeks is premature as the medication has not had sufficient time to reach its **therapeutic plasma concentration** or demonstrate its full effect.
- Adjusting the dose too early could also increase the risk of **side effects** without a clear benefit.
*Switch to bupropion*
- Switching to a different antidepressant like bupropion after just 2 weeks is also premature, as the patient has not had an adequate trial of fluoxetine.
- Bupropion has a different mechanism of action and side effect profile but also requires a similar **onset period** for efficacy.
*Add lithium*
- Lithium is primarily used as a **mood stabilizer** in bipolar disorder or as an augmentation strategy for treatment-resistant depression.
- There is no indication of bipolar disorder, and it's too early to consider her depression as **treatment-resistant** given the short duration of fluoxetine use.
*Switch to paroxetine*
- Switching to another **SSRI** (selective serotonin reuptake inhibitor) like paroxetine after only 2 weeks is not appropriate because the initial SSRI has not been given sufficient time to work.
- The patient has not failed therapy with fluoxetine yet, and such a change would unnecessarily prolong the search for an effective treatment.
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