Depression — MCQs

A 32-year-old man comes to the physician because of recurrent episodes of palpitations, chest pain, shortness of breath, sweating, and dizziness over the past 4 months. These episodes are accompanied by intense fear of “losing control” over himself. Most of the episodes have occurred at work in situations when it would have been unacceptable to leave, such as during team meetings. The last episode occurred at home right before this visit, after he noticed that he was running late. He has been otherwise healthy. He occasionally drinks a beer or a glass of wine. Vital signs are within normal limits. Cardiopulmonary examination shows no abnormalities. Thyroid function studies and an ECG show no abnormalities. Given his symptoms, this patient is at greatest risk of developing which of the following?

An 18-year-old female presents to general medical clinic with the report of a rape on her college campus. The patient was visiting a local fraternity, and after having a few drinks, awakened to find another student having intercourse with her. Aside from the risk of unintended pregnancy and sexually transmitted infections, this patient is also at higher risk of developing which of the following?

A previously healthy 56-year-old woman comes to the family physician for a 1-month history of sleep disturbance and sadness. The symptoms have been occurring since her husband died in a car accident. Before eventually falling asleep, she stays awake for multiple hours and has crying spells. Several times she has been woken up by the sound of her husband calling her name. She has lost 3 kg (6.6 lb) over the past month. She has 3 children with whom she still keeps regular contact and regularly attends church services with her friends. She expresses feeling a great feeling of loss over the death of her husband. She has no suicidal ideation. She is alert and oriented. Neurological exam shows no abnormalities. Which of the following is the most likely diagnosis for this patient's symptoms?

A 32-year-old man comes to the physician because of a 2 month history of difficulty sleeping and worsening fatigue. During this time, he has also had difficulty concentrating and remembering tasks at work as well as diminished interest in his hobbies. He has no suicidal or homicidal ideation. He does not have auditory or visual hallucinations. Vital signs are normal. Physical examination shows no abnormalities. Mental status examination shows a depressed mood and flat affect with slowed thinking and speech. The physician prescribes sertraline. Three weeks later, the patient comes to the physician again with only minor improvements in his symptoms. Which of the following is the most appropriate next step in management?

A 27-year old gentleman presents to the primary care physician with the chief complaint of "feeling down" for the last 6 weeks. He describes trouble falling asleep at night, decreased appetite, and recent feelings of intense guilt regarding the state of his personal relationships. He says that everything "feels slower" than it used to. He endorses having a similar four-week period of feeling this way last year. He denies thoughts of self-harm or harm of others. He also denies racing thoughts or delusions of grandeur. Which of the following would be an INAPPROPRIATE first line treatment for him?

A 38-year-old man presents with fatigue and weight loss for the past 4 months. He feels tired all the time. He also no longer feels interested in his work. He says he has lost weight and says, "I just don’t want to eat." No significant past medical history. No current medications. Physical examination is unremarkable. The patient is started on sertraline. He returns for follow-up after 2 weeks and says that he has been compliant with his medications. He says that he is now getting a full night’s sleep with no early morning awakenings. Despite regaining his appetite, he hasn’t regained any lost weight, and he still feels fatigued. He believes that the medication is not working well and asks to be started on something else. Which of the following is the most appropriate next step in the management of this patient?

A 54-year-old man presents with feelings of sadness and low mood on most days of the week for the past month. He reports an inability to concentrate and also finds it hard to develop an interest in his daily activities. He goes on to tell his physician that he struggles to get sleep at night, and, in the morning, he doesn’t have the energy to get out of bed. He says he feels like a loser since he hasn’t accomplished all that he had set out to do and feels guilty for being unable to provide for his family. He says he doesn’t have the will to live anymore but denies any plans to commit suicide. Past medical history is significant for erectile dysfunction which was diagnosed about a year ago. Which of the following medications should be avoided in the treatment of this patient’s depression?

A 17-year-old boy is being seen by student health for a sports physical. He denies any recent injuries. He reports that he is doing well in his classes. He fractured his left collar bone 3 years ago, which required open reduction and internal fixation. He has not had any other surgeries. He takes no medications. His father and his paternal grandfather have hypertension. When asked about his mother, the patient tears up and he quickly begins talking about how excited he is for baseball tryouts. He has a chance this year to be in the starting lineup if, "I just stay focused." From previous records, the patient's mother died of ovarian cancer 6 months ago. Which of the following defense mechanisms is the patient exhibiting?

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 22-year-old man comes to the physician because of generalized fatigue for the past 3 months. During this time, his grades have declined in his college courses because he has had difficulty focusing on assignments and sometimes sleeps in class. He no longer plays the drums for his band and has stopped attending family events. His temperature is 37°C (98.6°F), pulse is 60/min, and blood pressure is 130/80 mm Hg. Physical examination shows no abnormalities. On mental status examination, he describes his mood as “ok.” He has a flat affect. There is no evidence of suicidal ideation. His speech is slow in rate and monotone in rhythm, and his thought process is organized. He has no delusions or hallucinations. Which of the following is the most appropriate next step in treatment?