html xmlns=”http://www.w3.org/1999/xhtml” xmlns:mml=”http://www.w3.org/1998/Math/MathML” xmlns:epub=”http://www.idpf.org/2007/ops”>
Question One
A 35-year-old female presents to your office and begins to divulge her frequent worries: ever since she was young she was worried someone close to her would die in a freak accident. As she grew older, this worry was exacerbated by the fear that she would pass away without telling her friends and family how important they are to her. Additionally, once she had children, she became so worried for their safety that she rarely lets them leave the house. Furthermore, she has constant worries about how things will work out for her in the future, and recently experienced a panic attack. How might you currently diagnose this patient?
A. Posttraumatic stress disorder
B. Panic disorder
C. Social anxiety disorder
D. Generalized anxiety disorder
The correct answer is D.
| Choice | Peer answers |
|---|---|
| A. Posttraumatic stress disorder | 1% |
| B. Panic disorder | 1% |
| C. Social anxiety disorder | 1% |
| D. Generalized anxiety disorder | 97% |
A Incorrect. Posttraumatic stress disorder generally originates after a traumatic event; it does not appear that this patient has ever actually experienced a traumatic death experience. She just appears to have excessive worry.
B Incorrect. Panic disorder is characterized by the presence of spontaneous panic attacks, which this patient does not report having.
C Incorrect. Worry in social anxiety disorder is tied to embarrassment, whereas this patient’s worry is related to a fear of dying.
D Correct. This patient is displaying core symptoms of generalized anxiety disorder via generalized anxiety and worry. Although she did have a panic attack, a single panic attack is insufficient for a diagnosis of either panic disorder or social anxiety disorder.
References
Question Two
A 35-year-old male Army veteran has been experiencing anxiety attacks during which he has difficulty breathing and increased heart rate. His symptom of difficulty breathing is hypothetically related to activation in the:
A. Hippocampus
B. Hypothalamus
C. Parabrachial nucleus
D. Periaqueductal gray
The correct answer is C.
| Choice | Peer answers |
|---|---|
| A. Hippocampus | 19% |
| B. Hypothalamus | 25% |
| C. Parabrachial nucleus | 46% |
| D. Periaqueductal gray | 10% |
A Incorrect. The hippocampus is involved in a reciprocal relationship with the amygdala when re-experiencing occurs, a phenomenon often associated with PTSD.
B Incorrect. The hypothalamus regulates endocrine output of fear, which can increase cortisol output, in turn increasing risk of coronary artery disease, type 2 diabetes, and stroke if prolonged activation of hypothalamic pituitary adrenal (HPA) axis is present.
C Correct. The parabrachial nucleus (PBN) regulates changes in respiration, which can occur during fear response. This regulation is activated by the amygdala. Excessive activation of the PBN can lead to an increased rate of respiration and symptoms such as shortness of breath or sense of being smothered.
References
Question Three
A 46-year-old female patient has been experiencing several anxiety-based symptoms for many years, and was previously diagnosed with generalized anxiety disorder. She describes difficulty concentrating in addition to difficulty falling asleep. Her family has recently told her that she seems to be displaying heightened anger responses toward them over minor details. Oftentimes she will cry for extended periods of time and become irritable and distant. Based on the above patient’s revelations, if she were to continue to experience these stressful reactions to stimuli (i.e., excessive crying, fatigue, problems concentrating, tension, irritability), what could potentially occur?
The correct answer is E.
| Choice | Peer answers |
|---|---|
| A. Increased hippocampal volume | 1% |
| B. Reduced BDNF production | 3% |
| C. Reduced reactivity to stress | 1% |
| D. Decreased hippocampal volume | 5% |
| E. B and D | 89% |
| F. A and C | 2% |
A and C Incorrect. Hippocampal volume in chronic stress is actually theorized to decrease, not increase. Reduced reactivity to stress may occur in patients who experience mild stressors while growing up, which may result in an improved adaptability when dealing with adult stressors. However, severe or persistent stress, such as this adult is experiencing, does not lead to reduced reactivity to stress.
B and D Correct. Reduced BDNF production can occur in patients who experience chronic stress, leading to a decreased ability to create and maintain neurons and neuronal connections. Decreased hippocampal volume, perhaps related to decreased expression of BDNF, has been reported in some chronic stress conditions such as major depression and certain anxiety disorders. A major treatment strategy for stress-related disorders is the use of selective serotonin reuptake inhibitors (SSRIs), which can increase BDNF levels because serotonin initiates signal transduction cascades that lead to BDNF release.
E Correct; as both B and D are correct answers.
F Incorrect; as both A and C are incorrect answers.
References
Question Four
A 51-year-old male veteran with chronic PTSD has agreed to begin pharmacotherapy for his debilitating symptoms of arousal and anxiety associated with his experiences in Iraq 2 years ago. Which of the following would be appropriate as first-line treatment?
The correct answer is A.
| Choice | Peer answers |
|---|---|
| A. Paroxetine | 94% |
| B. Paroxetine or diazepam | 4% |
| C. Paroxetine, diazepam, or D-cycloserine | 2% |
| D. Paroxetine, diazepam, D-cycloserine, or quetiapine | 1% |
A Correct. Paroxetine, a selective serotonin-norepinephrine reuptake inhibitor, is approved for use in PTSD.
B Incorrect. Diazepam is a benzodiazepine. Benzodiazepines do not have evidence of efficacy in PTSD and are not generally recommended for first-line use in PTSD.
C Incorrect. D-cycloserine, an NMDA agonist, has been theorized to be useful in facilitating fear extinction, and may be useful in conjunction with exposure therapy. However, it is not a first-line choice.
D Incorrect. Quetiapine, an atypical antipsychotic, is not approved as first-line treatment for PTSD, but may be useful in selected cases as a third-line treatment, specifically for sleep and possible reduction of nightmares.
References
Question Five
A 45-year-old female presents with a hand-washing compulsion and an obsession with air fresheners. Based on these symptoms, which of the following is most likely to be true?
A. She may have been born with the catechol-O-methyltransferase (COMT) Met genotype, leading to an increased risk of susceptibility to worry and anxiety disorders.
B. She may have been born with the COMT Val genotype, leading to an increased risk of susceptibility to worry and anxiety disorders.
C. She may have been born with the l variant of the gene for the serotonin transporter (SERT), leading to an increased risk of developing a mood or anxiety disorder.
D. She may have been born with the s variant of the gene for SERT, leading to an increased risk of developing a mood or anxiety disorder.
E. A and D
F. B and C
The correct answer is E.
| Choice | Peer answers |
|---|---|
| A. She may have been born with the catechol-O-methyltransferase (COMT) Met genotype, leading to an increased risk of susceptibility to worry and anxiety disorders | 9% |
| B. She may have been born with the COMT Val genotype, leading to an increased risk of susceptibility to worry and anxiety disorders | 7% |
| C. She may have been born with the l variant of the gene for the serotonin transporter (SERT), leading to an increased risk of developing a mood or anxiety disorder | 6% |
| D. She may have been born with the s variant of the gene for SERT, leading to an increased risk of developing a mood or anxiety disorder | 7% |
| E. A and D | 51% |
| F. B and C | 21% |
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
