Applied behavior analysis — MCQs

A mother brings her 3-year-old son to the doctor because she is worried that he might be harming himself by constantly banging his head on the wall. He has been exhibiting this behavior for a few months. She is also worried because he has started to speak less than he used to and does not respond when his name is called. He seems aloof during playtime with other children and seems to have lost interest in most of his toys. What is the most likely diagnosis?

A 52-year-old man is on a week-long cruise vacation with his family to celebrate his mother's 80th birthday. He has a very important presentation at work to give in one month, which will in part determine whether he receives a promotion. He decides to focus on enjoying the vacation and not to worry about the presentation until the cruise is over. Which of the following psychological defense mechanisms is he demonstrating?

A 38-year-old project manager is told by her boss that her team will need to work on an additional project in the coming week for a very important client. This frustrates the woman, who already feels that she works too many hours. Instead of discussing her feelings directly with her boss, the woman leaves a voice message for her boss the next day and deceitfully says she cannot come to work for the next week because of a family emergency. Which of the following psychological defense mechanisms is this individual demonstrating?

A 14-year-old girl presents to the pediatrician for behavior issues. The girl has been having difficulty in school as a result. Every time the girl enters her classroom, she feels the urge to touch every wall before heading to her seat. When asked why she does this, she responds, "I'm not really sure. I just can't stop thinking about it until I have touched each wall." The parents have noticed this behavior occasionally at home but were not concerned. The girl is otherwise healthy, has many friends, eats a balanced diet, does not smoke, and is not sexually active. Her temperature is 98.2°F (36.8°C), blood pressure is 117/74 mmHg, pulse is 80/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for a healthy young girl. Neurologic exam is unremarkable. There is no observed abnormalities in behavior while the girl is in the office. Which of the following is the most appropriate initial step in management for this patient?

A 10-year-old child is sent to the school psychologist in May because he refuses to comply with the class rules. His teacher says this has been going on since school started back in August. He gets upset at the teacher regularly when he is told to complete a homework assignment in class. Sometimes he refuses to complete them altogether. Several of his teachers have reported that he intentionally creates noises in class to interrupt the class. He tells the psychologist that the teacher and his classmates are at fault. What is the most appropriate treatment?

A 3-year-old boy is brought to your pediatrics office by his parents for a well-child checkup. The parents are Amish and this is the first time their child has seen a doctor. His medical history is unknown, and he was born at 39 weeks gestation. His temperature is 98.3°F (36.8°C), blood pressure is 97/58 mmHg, pulse is 90/min, respirations are 23/min, and oxygen saturation is 99% on room air. The child is in the corner stacking blocks. He does not look the physician in the eye nor answer your questions. He continually tries to return to the blocks and becomes very upset when you move the blocks back to their storage space. The parents state that the child has not begun to speak and often exhibits similar behaviors with toy blocks he has at home. On occasion, they have observed him biting his elbows. Which of the following is the best next step in management?

A 47-year-old woman is upset with her neighbor for playing music too loudly late at night. Rather than confront her neighbor directly, the woman makes a habit of parking her car in a manner that makes it difficult for her neighbor to park in his spot. Which of the following defense mechanisms is this woman demonstrating?

A 15-year-old boy is referred to a child psychologist because of worsening behavior and constant disruption in class. He has received multiple reprimands in the past 6 months for not doing the homework his teacher assigned, and he refuses to listen to the classroom instructions. Additionally, his teachers say he is very argumentative and blames other children for not letting him do his work. He was previously well behaved and one of the top students in his class. He denies any recent major life events or changes at home. His past medical history is noncontributory. His vital signs are all within normal limits. Which of the following is the most likely diagnosis?

A 20-year-old man comes to the physician because of decreasing academic performance at his college for the past 6 months. He reports a persistent fear of “catching germs” from his fellow students and of contracting a deadly disease. He finds it increasingly difficult to attend classes. He avoids handshakes and close contact with other people. He states that when he tries to think of something else, the fears “keep returning” and that he has to wash himself for at least an hour when he returns home after going outside. Afterwards he cleans the shower and has to apply disinfectant to his body and to the bathroom. He does not drink alcohol. He used to smoke cannabis but stopped one year ago. His vital signs are within normal limits. He appears anxious. On mental status examination, he is oriented to person, place, and time. In addition to starting an SSRI, which of the following is the most appropriate next step in management?

A resident doctor was reprimanded by the attending physician for making medication errors during morning rounds. Later that day, when a medical student asked a simple question about drug dosages during the evening rounds, the resident responded with excessive criticism and harsh comments, making the student visibly uncomfortable and embarrassed. Which of the following ego defense mechanisms is the resident demonstrating?