Depression — MCQs

A 52-year-old man presents with a 1-month history of a depressed mood. He says that he has been “feeling low” on most days of the week. He also says he has been having difficulty sleeping, feelings of being worthless, difficulty performing at work, and decreased interest in reading books (his hobby). He has no significant past medical history. The patient denies any history of smoking, alcohol use, or recreational drug use. A review of systems is significant for a 7% unintentional weight gain over the past month. The patient is afebrile and his vital signs are within normal limits. A physical examination is unremarkable. The patient is prescribed sertraline 50 mg daily. On follow-up 4 weeks later, the patient says he is slightly improved but is still not feeling 100%. Which of the following is the best next step in the management of this patient?

A 27-year-old man presents to his physician for a checkup. At presentation, he complains of anxiety and persistent mood changes. The patient's comorbidities include chronic gastritis treated with Helicobacter pylori eradication therapy, and chronic pyelonephritis with stage 1 chronic kidney disease. His grandfather who was a heavy smoker just passed away due to metastatic lung cancer. The patient has an 8-year-history of smoking, and he is concerned about consequences of his habit. He says that he tried to quit several times with nicotine patches, but he is unsuccessful because of the unpleasant symptoms and returning anxiety. Moreover, his tobacco use increased for the past 12 months due to increased anxiety due to his job and family problems, which could not be relieved by previous consumption levels. He still wants to stop smoking due to the health concerns. The patient's vital signs and physical examination are unremarkable. The physician considers prescribing the patient a partial nicotine agonist, and conducts a further testing to see whether the patient is eligible for this medication. Which of the following tests is required to be performed prior to prescribing this medication to the presented patient?

A 50-year-old woman presents to her family physician 6 months after the death of her husband, who died following a car accident. She is crying inconsolably and reports that she no longer enjoys doing the things she and her husband once did together. She feels guilty for the time she wasted arguing with him in the past. She finds herself sleeping on most mornings, but still lacks the energy and concentration needed at work. The physical examination is normal. Based on a well-known hypothesis, which of the following combinations of neurotransmitter abnormalities most likely exist in this patient?

A 43-year-old woman is brought to the physician by her daughter because she has been intermittently crying for 6 hours and does not want to get out of bed. Her symptoms started after she was fired yesterday from her job of 20 years. She says she feels sad and does not understand what she will do with her life now. She uses an over-the-counter inhaler as needed for exercise-induced asthma, and recently started oral isotretinoin for acne. She used to smoke a pack of cigarettes per day, but for the last year she has decreased to 2 cigarettes daily. She appears sad and very upset. Her temperature is 37°C (98.6°F), pulse is 110/min, respirations are 20/min, and blood pressure is 140/80 mm Hg. Physical examination shows no other abnormalities. On mental status examination, she is oriented to person, place, and time. She maintains eye contact and follows instructions. She denies suicidal ideation. Which of the following is the most likely explanation for this finding?

A 22-year-old female presents to your clinic for evaluation of "skin problems." She complains of severe acne and "spots" all over her face that have persisted for the last 8 years, despite innumerable creams and lotions. She reports spending several hours every morning using make-up just to go outside. She wishes to learn about cosmetic procedures or surgeries that could solve her problem. While you perceive her concern for her skin to be genuine, upon examination, you note a healthy-appearing, well-nourished female with a normal complexion, minimal acne and sparse freckles on the nasal bridge. You calculate her BMI to be 21. In addition to making a diagnosis, this patient should be screened for which other disorder?