Mood Disorders — MCQs

A 9-year-old boy is brought to a pediatric psychologist by his mother because of poor academic performance. The patient’s mother mentions that his academic performance was excellent in kindergarten and first grade, but his second and third-grade teachers complain that he is extremely talkative, does not complete schoolwork, and frequently makes careless mistakes. They also complain that he frequently looks at other students or outside the window during the class and is often lost during the lessons. At home, he is very talkative and disorganized. When the pediatrician asks the boy his name, he replies promptly. He was born at full term by spontaneous vaginal delivery. He is up-to-date on all vaccinations and has met all developmental milestones on time. A recent IQ test scored him at 95. His physical examination is completely normal. When he is asked to read from an age-appropriate children’s book, he reads it fluently and correctly. Which of the following is the most likely diagnosis in this patient?

A 26-year-old woman presents to the clinic complaining of a headache, runny nose, and malaise. A few minutes into the interview, she mentions that she recently started her job and is glad to work long hours despite the toll on her health. However, she admits that she is finding it difficult to keep up with the workload. She has numerous pending papers to correct. When advised to seek help from other teachers, she exclaims that it needs to be done in a particular way, and only she can do it the right way. This is causing her to perform poorly at work, and she is at risk of being asked to quit her very first job. Which of the following is the most likely diagnosis in this patient?

A 24-year-old woman comes to the physician because she feels sad and has had frequent, brief episodes of crying for the last month. During this period, she sleeps in every morning and spends most of her time in bed playing video games or reading. She has not been spending time with friends but still attends a weekly book club and continues to plan her annual family reunion. She stopped going to the gym, eats more, and has gained 4 kg (8.8 lb) over the past 4 weeks. Three weeks ago, she also started to smoke marijuana a few times a week. She drinks one glass of wine daily and does not smoke cigarettes. She is currently unemployed; she lost her job as a physical therapist 3 months ago. Her vital signs are within normal limits. On mental status examination, she is calm, alert, and oriented to person, place, and time. Her mood is depressed; her speech is organized, logical, and coherent. She denies suicidal thoughts. Which of the following is the most likely diagnosis?

A 77-year-old Caucasian woman presents to her primary care provider for a general checkup. The patient is with her daughter who brought her to this appointment. The patient states that she is doing well and has some minor joint pain in both hips. She states that sometimes she is sad because her husband recently died. She lives alone and follows a vegan diet. The patient's daughter states that she has noticed her mother struggling with day to day life. It started 2 years ago with her forgetting simple instructions or having difficulty running errands. Now the patient has gotten to the point where she can no longer pay her bills. Sometimes the patient forgets how to get home. The patient has a past medical history of obesity, hypertension, gastroesophageal reflux disease (GERD) controlled with pantoprazole, and diabetes mellitus. Her temperature is 99.5°F (37.5°C), blood pressure is 158/108 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Which of the following will most likely help with this patient's presentation?

A 4-year-old girl is brought to the pediatrician by her parents after her mother recently noticed that other girls of similar age talk much more than her daughter. Her mother reports that her language development has been abnormal and she was able to use only 5–6 words at the age of 2 years. Detailed history reveals that she has never used her index finger to indicate her interest in something. She does not enjoy going to birthday parties and does not play with other children in her neighborhood. The mother reports that her favorite “game” is to repetitively flex and extend the neck of a doll, which she always keeps with her. She is sensitive to loud sounds and starts screaming excessively when exposed to them. There is no history of delayed motor development, seizures, or any other major illness; perinatal history is normal. When she enters the doctor’s office, the doctor observes that she does not look at him. When he gently calls her by her name, she does not respond to him and continues to look at her doll. When the doctor asks her to look at a toy on his table by pointing a finger at the toy, she looks at neither his finger nor the toy. The doctor also notes that she keeps rocking her body while in the office. Which of the following is an epidemiological characteristic of the condition the girl is suffering from?

A 73-year-old woman is brought to the physician by her son because of increasing forgetfulness over the past 2 years. Initially, she used to misplace keys and forget her dog's name or her phone number. Now, she often forgets about what she has seen on television or read about the day before. She used to go for a walk every morning but stopped one month ago after she became lost on her way back home. Her son has prevented her from cooking because she has had episodes of leaving the gas stove on after making a meal. She becomes agitated when asked questions directly but is unconcerned when her son reports her history and says he is overprotective of her. She has hypertension, coronary artery disease, and hypercholesterolemia. Current medications include aspirin, enalapril, carvedilol, and atorvastatin. She is alert and oriented to place and person but not to time. Vital signs are within normal limits. Short- and long-term memory deficits are present. Her speech rhythm is normal but is frequently interrupted as she thinks of words to frame her sentences. She makes multiple errors while performing serial sevens. Her clock drawing is impaired and she draws 14 numbers. Which of the following is the most likely diagnosis?

An 84-year-old woman with Alzheimer's disease is brought to the physician by her son for a follow-up examination. The patient lives with her son, who is her primary caregiver. He reports that it is becoming gradually more difficult to care for her. She occasionally has tantrums and there are times when she does not recognize him. She sleeps 6–8 hours throughout the day and is increasingly agitated and confused at night. When the phone, television, or oven beeps she thinks she is at the dentist's office and becomes very anxious. She eats 2–3 meals a day and has a good appetite. She has not fallen. She has not left the home in weeks except for short walks. She has a history of hypertension, hyperlipidemia, atrial fibrillation, and hypothyroidism. She takes levothyroxine, aspirin, warfarin, donepezil, verapamil, lisinopril, atorvastatin, and a multivitamin daily. Her temperature is 37°C (98.4°F), pulse is 66/min, respirations are 13/min, and blood pressure is 126/82 mm Hg. Physical examination shows no abnormalities. It is important to the family that the patient continues her care in the home. Which of the following recommendations is most appropriate at this time?

A 15-year-old boy is brought to the physician by his mother because of 4 months of strange behavior. She says that during this period, he has had episodic mood swings. She has sometimes found him in his room “seemingly drunk” and with slurred speech. These episodes usually last for approximately 15 minutes, after which he becomes irritable. He has had decreased appetite, and his eyes occasionally appear red. He has trouble keeping up with his schoolwork, and his grades have worsened. Physical examination shows an eczematous rash between the upper lip and nostrils. Neurologic examination shows a delay in performing alternating palm movements. Use of which of the following is the most likely cause of this patient's condition?

A 68-year-old man seeks evaluation by a physician with complaints of worsening forgetfulness and confusion for 1 year. According to his wife, he has always been in good health and is generally very happy; however, he has started to forget important things. He recently had his driving license revoked because of multiple tickets, but he cannot recall having done anything wrong. This morning, he neglected to put on his socks and was quite agitated when she pointed this out to him. He denies having a depressed mood, sleep problems, or loss of interest. He occasionally has a glass of wine with dinner and has never smoked or used recreational drugs. His medical history and family medical history are unremarkable. His pulse is 68/min, respirations are 14/min, and blood pressure is 130/84 mm Hg. Except for a mini-mental state examination (MMSE) score of 20/30, the remainder of the physical examination is unremarkable. Imaging studies, including a chest X-ray and CT of the brain, reveal no pathologic findings. An electrocardiogram (ECG) is also normal. Laboratory testing showed the following: Serum glucose (fasting) 76 mg/dL Serum electrolytes: Sodium 140 mEq/L Potassium 4.1 mEq/L Chloride 100 mEq/L Serum creatinine 0.9 mg/dL Blood urea nitrogen 11 mg/dL Cholesterol, total: 180 mg/dL HDL-cholesterol 45 mg/dL LDL-cholesterol 75 mg/dL Triglycerides 135 mg/dL Hemoglobin (Hb%) 16 g/dL Mean corpuscular volume (MCV) 85 fL Reticulocyte count 0.9% Erythrocyte count 5 million/mm³ Thyroid-stimulating hormone 3.5 µU/mL Urinalysis Glucose Negative Ketones Negative Leucocytes Negative Nitrite Negative RBCs Negative Casts Negative Which of the following is the most likely diagnosis?

An 8-year-old boy is brought to the clinic by his father for an annual well-check. His dad reports that he has been "difficult to handle" as he would not listen and follow instructions at home. "Telling him to sit still and do something is just so hard," the father says. His teacher also reports difficulties in the classroom where the child would talk out of turn and interrupt the class intermittently by doing something else. His grades have been suffering as a result. Otherwise, the patient has been healthy and up to date on his immunizations. What is the best course of management for this patient?