Somatic Symptom Disorders

Question 1 of 26

1

Test 1 Question 11. You are talking to one of your colleagues from surgery. He tells you about a postoperative patient that he is covering who keeps complaining of pain. He tells you that the patient was originally on intramuscular meperidine and was switched to the same dose of oral meperidine just yesterday. The patient has been complaining constantly and is getting the nursing staff upset. What do you think is responsible for this situation?

Select one of the following:

The patient has low pain tolerance
The patient has borderline personality disorder and is splitting the staff
The patient has an intractable pain disorder
The analgesic potency of oral meperidine is less than that of intramuscular meperidine
The patient has a conversion disorder (functional neurological symptom disorder)

Explanation

Question 2 of 26

1

Test 1 Question 56. A patient comes into your practice after referral from his primary care physician. He is convinced that he has cancer. He thinks that it hasn’t been found yet, but is convinced that it is there. He remains convinced despite a full workup with negative results. Despite further reassurance by his doctors, he remains convinced that he has cancer. Which is the most appropriate diagnosis?

Select one of the following:

Conversion disorder (functional neurological symptom disorder
Illness anxiety disorder
Body dysmorphic disorder
Somatic symptom disorder
Briquet’s syndrome

Explanation

Question 3 of 26

1

Test 1 Question 81. Which one of the following is true regarding conversion disorder (functional neurological symptom disorder)?

Select one of the following:

It is intentionally produced
It consists of complaints in multiple organ systems
It involves neurologic symptoms
It can be limited to pain
It can be limited to sexual dysfunction

Explanation

Question 4 of 26

1

Test 1 Question 122. Which one of the following disorders presents with the patient being preoccupied with having a given illness based on misinterpretation of bodily sensations?

Select one of the following:

Pseudocyesis
Factitious disorder
Conversion disorder (functional neurological symptom disorder)
Somatic symptom disorder with predominant pain
Illness anxiety disorder

Explanation

Question 5 of 26

1

Test 1 Question 145. A 75-year-old woman is referred to your practice by an internist for depression. On initial examination you discover that the patient has recently recovered from a heart attack. Which one of the following medications would be the best choice for this patient?

Select one of the following:

Amitriptyline
Doxepin
Bupropion
Methylphenidate
Citalopram

Explanation

Question 6 of 26

1

Test 2 Question 19. Which of the following would fall under the heading of Other Specified Somatic Symptom and Related Disorders?

Select one of the following:

A patient with pain in one or more areas that is thought to be significantly mediated by psychological factors
A patient with a persistent belief that he or she has cancer despite reassurance by his or her physician that nothing is wrong
A patient who develops a motor deficit following significant psychological stressors
A patient who feels that she is pregnant and presents with amenorrhea, enlarged abdomen, and breast engorgement, but a negative pregnancy test
A patient with medical complaints involving pain, gastrointestinal complaints, neurological complaints, and sexual complaints, but no medical explanation can be found for these symptoms

Explanation

Question 7 of 26

1

Test 2 Question 134. Which one of the following is not an example of secondary gain?

Select one of the following:

Getting money
Getting medical help
Getting out of having to work
Getting out of family responsibilities
Getting drugs of abuse

Explanation

Question 8 of 26

1

Test 3 Question 82. A patient who is not malingering, but is believed to be producing the symptoms and signs of confusion or dementia involuntarily or unconsciously and believes that the symptoms are real, is thought to have which one of the following conditions?

Select one of the following:

Conversion disorder (functional neurological symptom disorder
Ganser’s syndrome
Capgras syndrome
Illness anxiety disorder
Folie-à-deux

Explanation

Question 9 of 26

1

Test 3 Question 109. A psychiatrist is consulted on a medical unit because there is a patient with a substance abuse history who is in need of pain control. Which one of the following answer choices would be the best way to treat this patient’s pain?

Select one of the following:

Large doses of opiates
A mixture of opiates and benzodiazepines
Patient-controlled analgesia
No opiates of any kind
PRN (as needed) buprenorphine

Explanation

Question 10 of 26

1

Test 3 Question 120. Which one of the following is not a feature of malingering?

Select one of the following:

Findings are compatible with self-inflicted injuries
Medical records may have been tampered with or altered
Family members are able to verify the consistency of symptoms
Symptoms are vague or ill defined
History and examination do not yield complaints or problems

Explanation

Question 11 of 26

1

Test 4 Question 23. A 29-year-old patient is admitted to the neurology unit for evaluation of seizures. Workup is negative and there has not been any seizure activity captured on electroencephalogram during his seizure episodes. Neurological examination is negative. The patient is noted to be very sad, and a psychiatric consult is called. Nurses have noted conflict between the patient and his wife during her visits. As the consultant, which one of the following would be the highest on your list of differential diagnoses?

Select one of the following:

Obsessive–compulsive disorder
Conversion disorder (functional neurological symptom disorder)
Somatic symptom disorder
Social phobia
Panic disorder

Explanation

Question 12 of 26

1

Test 4 Question 73. Of the following disorders, which one has the best prognosis?

Select one of the following:

Somatic symptom disorder
Body dysmorphic disorder
Somatic symptom disorder with predominant pain
Illness anxiety disorder
Conversion disorder (functional neurological symptom disorder)

Explanation

Question 13 of 26

1

Test 5 Question 5. Which of the following must be present to meet Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM 5), criteria for somatic symptom disorder?

Select one of the following:

Preoccupation with acquiring a serious illness
Two sexual symptoms
Three pseudoneurological symptoms
Maladaptive thoughts, feelings, or behaviors in response to the symptoms
The illness must begin after age 30

Explanation

Question 14 of 26

1

Test 5 Question 49. A depressed patient comes to you with brittle hair, weight gain, muscle weakness, dry skin, constipation, and cold intolerance. Which is the most appropriate next step in management?

Select one of the following:

Start sertraline
Refer the patient for a head CT
Check thyroid-stimulating hormone (TSH) level
Check serum glucose
Prescribe sertraline plus Colace

Explanation

Question 15 of 26

1

Test 5 Question 97. Which of the following choices is a risk factor for developing conversion disorder (functional neurological symptom disorder)?

Select one of the following:

High socioeconomic status
Little education
High intelligence
Urban setting
Lack of military service

Explanation

Question 16 of 26

1

Test 5 Question 104. Which of the following is not one of the psychiatric symptoms that can result from adrenal insufficiency?

Select one of the following:

Delirium
Psychosis
Mania
Depression
Irritability

Explanation

Question 17 of 26

1

Test 5 Question 139. A new patient comes to you asking for help with depression. She states that she has had a very low mood recently and has been feeling overwhelmed. She has a 2-month-old daughter at home and keeping up with a new baby has been hard for her. She reports constant fatigue, listlessness, and weight loss. She states that her libido is down and she is very upset because she could not breastfeed her baby owing to lack of milk production. Her concentration is normal. She bursts into tears and states that she doesn’t think she can be a good mother. Which of the following would be the most appropriate next step in the management of this case?

Select one of the following:

Start psychotherapy only
Start an antidepressant
Start a benzodiazepine
Send patient for endocrine blood work
Report the case to child protective services

Explanation

Question 18 of 26

1

Test 5 Question 141. Which one of the following is not a possible psychiatric manifestation of acute intermittent porphyria?

Select one of the following:

Anxiety
Dementia
Depression
Psychosis
Delirium

Explanation

Question 19 of 26

1

Test 6 Question 41. Which of the following is the most important factor in distinguishing somatic symptom disorder with predominant pain from chronic pain syndromes?

Select one of the following:

The pain is severe enough to warrant clinical attention
The patient suffers disability from the pain
No physical lesion is found on imaging studies
Substance abuse and character pathology may complicate the picture
The pain is attributed to psychological factors

Explanation

Question 20 of 26

1

Test 6 Question 49. A man in his 30s is convinced that he has Lou Gehrig’s disease. Despite negative evaluations by several physicians he is still convinced that he has it. He comes to you convinced that the proper diagnosis has been missed. Your workup is negative but he remains convinced that he has the disease despite your efforts at reassurance. What is the most appropriate diagnosis?

Select one of the following:

Somatic symptom disorder
Factitious disorder
Malingering
Illness anxiety disorder
Lou Gehrig’s disease

Explanation

Question 21 of 26

1

Test 6 Question 144. Which of the following medical conditions can present with panic attacks, elevated blood pressure, flushing, and tremulousness?

Select one of the following:

Crohn’s disease
Raynaud’s phenomenon
Hypothyroidism
Hyperparathyroidism
Pheochromocytoma

Explanation

Question 22 of 26

1

1. Which of the following symptoms would push your differential diagnosis away from a conversion disorder (functional neurological symptom disorder) in Grace’s case? (Pick three of seven)

Select one or more of the following:

Backaches
Headaches
Anorgasmia
Dizziness
Constipation
Gastrointestinal discomfort
Arm and leg pain

Explanation

Question 23 of 26

1

2. Which of the following etiological theories are believed to be possible contributors to Grace’s primary problem? (Pick three
of six)

Select one or more of the following:

Abnormal regulation of the cytokine system
Only personality disordered patients have Grace’s disorder
Decreased metabolism in the frontal lobes and nondominant hemisphere
Apoptosis and gliosis of brain-stem neurons
Catecholaminergic deficits or imbalance in the CNS
Genetic predisposition of the disorder in first-degree female relatives of probands of patients with Grace’s disorder

Explanation

Question 24 of 26

1

Vignette 19 Question 3. Which of the following statements about the epidemiology of Grace’s primary disorder are not true? (Pick three of six)

Select one or more of the following:

Men outnumber women with the disorder by about 5 to 20 times
The lifetime prevalence of somatic symptom disorder among women is about 1% to 2%
The disorder occurs more frequently in patients of upper class and higher socioeconomic status
The disorder usually begins in adulthood after the age of 30
Concomitant personality traits associated with somatic symptom disorder include obsessive–compulsive, paranoid, and avoidant features
Bipolar I disorder and substance abuse occur no more frequently in somatic symptom disorder patients than in the general population at large

Explanation

Question 25 of 26

1

Vignette 19 Question 4. Which of the following facts are true about the course and prognosis of Grace’s primary disorder? (Pick three of six)

Select one or more of the following:

The course of the disorder is typically acute and static in its presentation
Patients with the disorder have a 20% chance of being diagnosed with this disorder 5 years later
Patients with the disorder are no more likely to develop another medical illness in the next 20 years than people without the disorder
The disease rarely remits completely
It is unusual for a patient with the disorder to be free of symptoms for greater than 1 year
The overall prognosis of the disorder is good to excellent in most cases

Explanation

Question 26 of 26

1

5. The only treatment maneuver for Grace’s primary disorder that seems to be able to decrease personal health care expenditure
by about 50% is:

Select one or more of the following:

Atypical antipsychotics
Antidepressant medications
Electroshock therapy
Group and individual psychotherapy
Mood stabilizers like lithium and divalproex sodium
Opioid antagonists like naltrexone

	Created by Eleanor garvey over 4 years ago

Test I: 11, 56, 81, 122, 145 Test II: 19, 134 Test III: 82, 109, 120 Test IV: 23, 73 Test V: 5, 49, 97, 104, 139, 141 Test VI: 41, 49, 144 Vignette 19

Somatic Symptom Disorders

Somatic Symptom Disorders

Question 1 of 26

Select one of the following:

Explanation

Question 2 of 26

Select one of the following:

Explanation

Question 3 of 26

Test 1 Question 81. Which one of the following is true regarding conversion disorder (functional neurological symptom disorder)?

Select one of the following:

Explanation

Question 4 of 26

Test 1 Question 122. Which one of the following disorders presents with the patient being preoccupied with having a given illness based on misinterpretation of bodily sensations?

Select one of the following:

Explanation

Question 5 of 26

Test 1 Question 145. A 75-year-old woman is referred to your practice by an internist for depression. On initial examination you discover that the patient has recently recovered from a heart attack. Which one of the following medications would be the best choice for this patient?

Select one of the following:

Explanation

Question 6 of 26

Test 2 Question 19. Which of the following would fall under the heading of Other Specified Somatic Symptom and Related Disorders?

Select one of the following:

Explanation

Question 7 of 26

Test 2 Question 134. Which one of the following is not an example of secondary gain?

Select one of the following:

Explanation

Question 8 of 26

Test 3 Question 82. A patient who is not malingering, but is believed to be producing the symptoms and signs of confusion or dementia involuntarily or unconsciously and believes that the symptoms are real, is thought to have which one of the following conditions?

Select one of the following:

Explanation

Question 9 of 26

Test 3 Question 109. A psychiatrist is consulted on a medical unit because there is a patient with a substance abuse history who is in need of pain control. Which one of the following answer choices would be the best way to treat this patient’s pain?

Select one of the following:

Explanation

Question 10 of 26

Test 3 Question 120. Which one of the following is not a feature of malingering?

Select one of the following:

Explanation

Question 11 of 26

Select one of the following:

Explanation

Question 12 of 26

Test 4 Question 73. Of the following disorders, which one has the best prognosis?

Select one of the following:

Explanation

Question 13 of 26

Test 5 Question 5. Which of the following must be present to meet Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM 5), criteria for somatic symptom disorder?

Select one of the following:

Explanation

Question 14 of 26

Test 5 Question 49. A depressed patient comes to you with brittle hair, weight gain, muscle weakness, dry skin, constipation, and cold intolerance. Which is the most appropriate next step in management?

Select one of the following:

Explanation

Question 15 of 26

Test 5 Question 97. Which of the following choices is a risk factor for developing conversion disorder (functional neurological symptom disorder)?

Select one of the following:

Explanation

Question 16 of 26

Test 5 Question 104. Which of the following is not one of the psychiatric symptoms that can result from adrenal insufficiency?

Select one of the following:

Explanation

Question 17 of 26

Select one of the following:

Explanation

Question 18 of 26

Test 5 Question 141. Which one of the following is not a possible psychiatric manifestation of acute intermittent porphyria?

Select one of the following:

Explanation

Question 19 of 26

Test 6 Question 41. Which of the following is the most important factor in distinguishing somatic symptom disorder with predominant pain from chronic pain syndromes?

Select one of the following:

Explanation

Question 20 of 26

Select one of the following:

Explanation

Question 21 of 26

Test 6 Question 144. Which of the following medical conditions can present with panic attacks, elevated blood pressure, flushing, and tremulousness?

2. Which of the following etiological theories are believed to be possible contributors to Grace’s primary problem? (Pick three
of six)

5. The only treatment maneuver for Grace’s primary disorder that seems to be able to decrease personal health care expenditure
by about 50% is: