NMS Q&A Family Medicine

296 NMS Q&A Family Medicine(D) D-cycloserine (DCS, an antituberculous drug)(E) Atenolol (Tenormin)7 Which of the following statements regarding anxietyand depression is true?(A) They usually (i.e., in the majority of cases)occur as clearly defined entities, easily separatedfrom each other.(B) Anxiety disorders are seldom confounded withmedical conditions.(C) Mixed anxiety and depression is less disablingthan pure cases of anxiety or depression.(D) One important aid in managing mixed anxietyand depression is to delay diagnostic closureand disposition while observing the patientthrough several visits.(E) Clear diagnosis of anxiety or depression usuallyobviates the need to further evaluate for organicdisease.8 A 52-year-old woman complains to her family physicianof bouts of anxiety and depression, the latter oftenvery deep but short lived (i.e., lasting 24 hours).Between such bouts, she often feels “like I’m going tojump out of my skin.” Her periods have changed withinthe past 6 months, becoming much less frequent butoften heavy when they do occur. She denies suicidalideation. She has difficulty sleeping through the night.Which of the following would be the most reasonableinitial approach to this patient?(A) Refer the patient to a psychiatrist(B) Start a SSRI for panic disorder(C) Start a tricyclic antidepressant (TCA)(D) Draw a follicle-stimulating hormone level andstart an estrogenic agent(E) Perform thyroid function studies9 A 30-year-old woman complains of irritability, apprehension,anxiety, difficulty concentrating, and varioussomatic complaints that differ with each visit to thedoctor. She has had difficulty falling off to sleep for thepast 8 months, although once she is asleep she generallyremains so for the night. Vital signs are within normallimits; menstrual periods are regular and unchangedfor the past 10 years. Although she has between 1 and 3“good days” per week, she notes the foregoing moreoften than not. She has not changed her patterns of living,remaining in her stable marriage and her job as areceptionist for a small business, neither of whichappears to be a focus of difficulty. Which of the followingis the presumptive diagnosis?(A) Panic disorder(B) Phobic reaction(C) Chronic depression(D) Generalized anxiety(E) Adjustment disorder10 Which of the following could logically constitute themainstay for therapy for the patient described inQuestion 8?(A) Paroxetine (Paxil)(B) Chloral hydrate (Noctec)(C) Zolpidem (Ambien)(D) Temazepam (Restoril)(E) Diazepam (Valium)11 A returning American soldier has recurring memoriesof scenes of his fellow soldiers being killed. Heexhibits extreme reactions to sudden sounds, as wellas insomnia, irritability, and avoidance of sights andsounds reminiscent of the precipitating event(s).Which of the following treatments have been shownto be of benefit to this condition?(A) Antipsychotic agents(B) Sedative–hypnotics(C) SSRIs(D) TCAs(E) Major tranquilizers12 What is the mean duration of posttraumatic stressdisorder (PTSD) symptoms without treatment?(A) Lifelong(B) 10 years(C) 64 months(D) 32 months(E) 24 months13 Of the following benzodiazepine medications, whichhas the shortest half-life?(A) Chlordiazepoxide (Librium)(B) Diazepam (Valium)(C) Clonazepam (Klonopin)(D) Alprazolam (Xanax)(E) Triazolam