Psychotic Disorders — MCQs

A 40-year-old sexually active woman with type 2 diabetes mellitus is admitted to a hospital 2 weeks after an uncomplicated cholecystectomy for pain, itching, and erythema at the incision site. Labs show a hemoglobin A1c of 6.5%, and wound cultures reveal mixed enteric bacteria. She is treated with appropriate antibiotics and discharged after her symptoms resolve. One week later, she is re-admitted with identical signs and symptoms. While in the hospital, the patient eats very little but is social and enjoys spending time with the staff. She repeatedly checks her own temperature and alerts the nursing staff when it is elevated. One morning, you notice her placing the thermometer in hot tea before doing so. What is the most likely cause of this patient’s recurrent infection and/or poor wound healing?

A 45-year-old male presents to your office following a diagnosis of an autosomal dominant disease. He has started therapy and has a strong family support system. He endorses a decrease in appetite over the last two weeks that he attributes to sadness surrounding his diagnosis and a depressed mood but denies any suicidal ideation. He continues to enjoy working in the yard and playing with his children. On physical examination you notice involuntary quick jerky movements of his hands and feet. Which of the following would you expect to see in this patient?

A 5-year-old girl is brought to the physician by her parents because of difficulty at school. She does not listen to her teachers or complete assignments as requested. She does not play or interact with her peers. The girl also ignores her parents. Throughout the visit, she draws circles repeatedly and avoids eye contact. Physical and neurological examination shows no abnormalities. Which of the following is the most likely diagnosis?

A 68-year-old man, accompanied by his wife, presents to his physician with cognitive decline and hallucinations. The patient’s wife tells that his cognitive impairment progressed gradually over the past 6 years, and first began with problems counting and attention. The hallucinations began approximately a year ago. The patient describes them as realistic and non-frightening; most often, he sees his cat accompanying him everywhere he goes. The patient’s wife also notes frequent episodes of staring spells in her husband and prolonged daytime napping. The blood pressure is 130/80 mm Hg with the orthostatic change to 110/60 mm Hg, heart rate is 75/min, respiratory rate is 13/min, and the temperature is 36.6°C (97.8°F). The patient is alert and responsive, but he is disoriented to time and place. He is pale and hypomimic. The cardiac, lung, and abdominal examinations are within normal limits for the patient’s age. The neurological examination is significant for a bilateral symmetrical cogwheel rigidity in the upper extremities. What would you most likely see on additional radiological investigations?

A 24-year-old woman presents to the emergency department when she was found yelling and screaming outside a bowling alley. The patient was found smoking marijuana and eating pizza while stating “if I'm going to die I'm going to die happy.” She was brought in by police and has been compliant since her arrival. Upon questioning, the patient states that she has had technology implanted in her for quite a while now, and she knows she will die soon. Any attempts to obtain further history are not helpful. The patient’s parents are contacted who provide additional history. They state that the patient recently started college 3 months ago. Two months ago, the patient began complaining about “technology” and seemed at times to converse with inanimate objects. On physical exam, you note a healthy young woman whose neurological exam is within normal limits. The patient is fixated on her original story and does not offer any information about her past medical history or current medications. Which of the following is the most likely diagnosis?