Bates’ Guide to Physical Examination and History Taking, 12th Edition
Chapter 5 Behavior and Mental Status
1. A 19-year-old college student, Todd, is brought to your clinic by his mother. She
is concerned that there i
...
Bates’ Guide to Physical Examination and History Taking, 12th Edition
Chapter 5 Behavior and Mental Status
1. A 19-year-old college student, Todd, is brought to your clinic by his mother. She
is concerned that there is something seriously wrong with him. She states for the past
6 months his behavior has become peculiar and he has flunked out of college. Todd
denies any recent illness or injuries. His past medical history is remarkable only for a
broken foot. His parents are both healthy. He has a paternal
uncle who had similar symptoms in college. The patient admits to smoking cigarettes
and drinking alcohol. He also admits to marijuana use but none in the last week. He
denies using any other substances. He denies any feelings of depression or anxiety.
While speaking with Todd and his mother you do a complete physical examination,
which is essentially normal. When you question him on how he is feeling, he says that
he is very worried that Microsoft has stolen his software for creating a better browser.
He tells you he has seen a black van in his neighborhood at night and he is sure that
it is full of computer tech workers stealing his work through special gamma waves.
You ask him why he believes they are trying to steal his programs. He replies that the
technicians have been telepathing their intents directly into his head. He says he
hears these conversations at night so he knows this is happening. Todd's mother then
tells you, “See, I told you . . . he's crazy. What do I do about it?”
While arranging for a psychiatry consult, what psychotic disorder do you think Todd has?
A) Schizoaffective disorder
B) Psychotic disorder due to a medical illness
C) Substance-induced psychotic disorder
D) Schizophrenia
Ans: D
Chapter:
05
Feedback: Schizophrenia generally occurs in the late teens to early 20s. It often is seen in
other family members, as in this case. Symptoms must be present for at least 6 months and
must have at least two features of (1) delusions (e.g., Microsoft is after his programs), (2)
hallucinations (e.g., technicians sending telepathic signals), (3) disorganized speech, (4)
disorganized behavior, and (5) negative symptoms such as a flat affect.
2. A 24-year-old secretary comes to your clinic, complaining of difficulty sleeping,
severe nightmares, and irritability. She states it all began 6 months ago when she
went to a fast food restaurant at midnight. While she was waiting in her car a man
entered through the passenger door and put a gun to her head. He had her drive to a
remote area, where he took her money and threatened to kill her. When the gun
jammed he panicked and ran off. Ever since this occurred the patient has been having
these symptoms. She states she jumps at every noise and refuses to drive at night.
She states her anxiety has had such a marked influence on her job performance she
is afraid she will be fired. She denies any recent illnesses or injuries. Her past medical
history is unremarkable. On examination you find a nervous woman appearing her
stated age. Her physical examination is unremarkable. You recommend medication
and counseling.
What anxiety disorder to you think this young woman has?
A) Specific phobia
B) Acute stress disorder
C) Post-traumatic stress disorder
D) Generalized anxiety disorder
Ans: C
Chapter:
05
Feedback: Post-traumatic stress disorder is the fearful response (nightmares, avoidance
of areas, irritability) to an event that occurred at least 1 month prior to presentation. The
patient's fears and reactions cause marked distress and impair social and occupational
functions.
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