Alternative treatments for anxiety — MCQs

A 75-year-old female patient comes to the emergency department with altered mental status. She is brought in by her daughter with whom the patient lives. The patient’s daughter said they were watching TV when her mother became unresponsive. On exam the patient withdraws to pain but does not open her eyes or speak. An emergent head CT is done and shows an intracranial bleed. The patient is moved to the ICU and intubated. Further history is obtained from the daughter. The patient has a past medical history of diabetes and a previous stroke. Her medications are metformin and warfarin. The patient is compliant with all of her medications. The daughter says that the patient changed her diet about 1 month ago in response to a diet she saw on a talk show. Which of the following foods is most likely to cause the pathology seen in this patient?

A professional golfer tees off on the first day of a tournament. On the first hole, his drive slices to the right and drops in the water. He yells at his caddy, then takes his driver and throws it at his feet, blaming it for his poor swing. Notably, the golfer had had a long fight with his wife last night over problems with family finances. The golfer's actions on the course represent which type of defense mechanism?

Please refer to the summary above to answer this question Which of the following is the most appropriate pharmacotherapy? Patient Information Age: 30 years Gender: F, self-identified Ethnicity: unspecified Site of Care: office History Reason for Visit/Chief Concern: "I'm so anxious about work." History of Present Illness: 7-month history of sensation that her heart is racing whenever she gives oral presentations at work she has also had moderate axillary sweating during these presentations and feels more anxious and embarrassed when this happens feels otherwise fine when she is interacting with her colleagues more casually around the workplace Past Medical History: alcohol use disorder, now abstinent for the past 2 years acute appendicitis, treated with appendectomy 5 years ago verrucae planae Medications: disulfiram, folic acid, topical salicylic acid Allergies: no known drug allergies Psychosocial History: does not smoke, drink alcohol, or use illicit drugs Physical Examination Temp Pulse Resp BP O2 Sat Ht Wt BMI 36.7°C (98°F) 82/min 18/min 115/72 mm Hg – 171 cm (5 ft 7 in) 58 kg (128 lb) 20 kg/m2 Appearance: no acute distress Pulmonary: clear to auscultation Cardiac: regular rate and rhythm; normal S1 and S2; no murmurs Abdominal: has well-healed laparotomy port scars; no tenderness, guarding, masses, bruits, or hepatosplenomegaly Extremities: no tenderness to palpation, stiffness, or swelling of the joints; no edema Skin: warm and dry; there are several skin-colored, flat-topped papules on the dorsal bilateral hands Neurologic: alert and oriented; cranial nerves grossly intact; no focal neurologic deficits Psychiatric: describes her mood as "okay"; speech has a rapid rate but normal rhythm; thought process is organized

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 26-year-old woman presents with an 8-month history of insomnia and anxiety. She says that she has difficulty sleeping and has feelings of impending doom linked to her difficult financial situation. No significant family history and no current medications. The patient was prescribed an 8-week supply of medication. She follows up 4 weeks later saying that she has increased anxiety and needs a refill. She says that over the past month, due to increasing anxiety levels, she started taking extra doses of her medication to achieve an anxiolytic effect. Which of the following medications was most likely prescribed to this patient?

A 35-year-old man comes to the Veterans Affairs hospital because of a 2-month history of anxiety. He recently returned from his third deployment to Iraq, where he served as a combat medic. He has had difficulty readjusting to civilian life. He works as a taxi driver but had to take a leave of absence because of difficulties with driving. Last week, he hit a stop sign because he swerved out of the way of a grocery bag that was in the street. He has difficulty sleeping because of nightmares about the deaths of some of the other soldiers in his unit and states, “it's my fault, I could have saved them. Please help me.” Mental status examination shows a depressed mood and a restricted affect. There is no evidence of suicidal ideation. Which of the following is the most appropriate initial step in treatment?

A 33-year-old man visits his psychiatrist with feelings of sadness on most days of the week for the past 4 weeks. He says that he is unable to participate in his daily activities and finds it hard to get out of bed on most days. If he has nothing scheduled for the day, he sometimes sleeps for 10–12 hours at a stretch. He has also noticed that on certain days, his legs feel heavy and he finds it difficult to walk, as though there are bricks tied to his feet. However, he is still able to attend social events and also enjoys playing with his children when he comes home from work. Other than these simple pleasures, he has lost interest in most of the activities he previously enjoyed. Another troubling fact is that he had gained weight over the past month, mainly because he eats so much when overcome by these feelings of depression. His is prescribed a medication to treat his symptoms. Which of the following is the mechanism of action of the drug he was most likely prescribed?

A 65-year-old woman presents with memory problems for the past few weeks. Patient vividly describes how she forgot where she put her car keys this morning and did not remember to wish her grandson a happy birthday last week. Patient denies any cognitive problems, bowel/bladder incontinence, tremors, gait problems, or focal neurologic signs. Patient mentions she wants to take Ginkgo because her friend told her that it can help improve her brain function and prevent memory loss. Past medical history is significant for an acute cardiac event several years ago. Current medications are aspirin, carvedilol, and captopril. Patient denies any history of smoking, alcohol or recreational drug use. Patient is a widow, lives alone, and is able to perform all activities of daily living (ADLs) easily. No significant family history. Patient is afebrile and vital signs are within normal limits. Physical examination is unremarkable. Which of the following would be the most appropriate response to this patient’s request to take Ginkgo?

A 42-year-old female complains of feeling anxious and worrying about nearly every aspect of her daily life. She cannot identify a specific cause for these symptoms and admits that this tension is accompanied by tiredness and difficulty falling asleep. To treat this problem, the patient is prescribed sertraline. She endorses a mild improvement with this medication, and over the next several months, her dose is increased to the maximum allowed dose with modest improvement. Her psychiatrist adds an adjunctive treatment, a medication which notably lacks any anticonvulsant or muscle relaxant properties. This drug most likely acts at which of the following receptors?

A goalkeeper of a famous soccer team gives an interview with a health agency regarding his childhood. He describes how when he was a child, he would constantly clear his throat in class and the teachers would write a note to his mother with advice to go see an ENT doctor. He complained of being restless, fidgety, and sometimes hyperactive in class, disrupting the environment and causing him many social problems. He would blurt out the answer at times and keep repeating it without any control, leading to some embarrassing timeouts. But he was always nice to his teachers, so he calls it a “benign frustration” rather than aggressively causing distress. He also talked about how his symptoms were dramatically improved with medication. Which of the following is an FDA approved drug for this patient’s most likely condition?