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Self-Assessment Questions

Psychiatry

Posttraumatic Stress Disorder: Review Questions

M. Amjad U. Khan, MD, Frank L. Giordano, MD, and Dan I. Blunk, MD

Dr. Khan is chief resident, Dr. Giordano is an associate professor of psychiatry, and Dr. Blunk is an associate professor of psychiatry;
all are at the Department of Neuropsychiatry, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX.




Choose the single best answer for each question.

Questions 1 to 4 refer to the following case.
A 47-year-old pawn shop worker was shot while at work 1 year ago. He was severely wounded and was left bleeding by the assailant. The patient reports to his physician that he has had high levels of anxiety since his attack. He has nightmares about the event and feels as if he is reliving the experience. He gets very anxious when he talks about the shooting. He feels fearful and is reluctant to leave his home, especially at night. He has stopped working. The physician suspects posttraumatic stress disorder (PTSD).


1. To meet diagnostic criteria for PTSD, which additional symptom must be present in this patient?

  1. Avolition
  2. Crying spells
  3. Increased arousal
  4. Loss of appetite
Click here to compare your answer.


2. Which of the following would be considered first-line treatment for this patient’s symptoms if the diagnosis of PTSD is confirmed?

  1. Alprazolam
  2. Amitriptyline
  3. Divalproex
  4. Risperidone
  5. Sertraline
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3. The patient meets criteria for PTSD and begins first-line treatment. If psychotherapy is also considered, which of the following would most likely benefit this patient?

  1. Brief counseling for trauma
  2. Cognitive behavioral therapy
  3. Psychological debriefing
  4. Trauma-focused psychodynamic therapy
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4. Six months after treatment and psychotherapy, the patient continues to have nightmares. He often wakes up at night in cold sweats and has difficulty falling to sleep. What is the next best step in the management of this patient?
  1. Add a ß blocker to the treatment regimen
  2. Add prazosin or clonidine to the treatment regimen
  3. Increase the dose of the current medication
  4. Increase the frequency of therapy sessions from once every 2 weeks to once weekly
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5. A 23-year-old man returned home about 3 weeks ago after being in a war zone for 6 months. During combat, he witnessed the death of one of his best friends. He is unable to recall specific details of how his friend died. Since returning home, he complains of poor sleep, both in quality and quantity. He also has lost his appetite, feels restless, becomes anxious easily, and is startled at the slightest noise. He reports a long history of feeling uncomfortable in new environments. Prior to being in combat, the patient states that he felt anxious when meeting new people and would isolate himself most of the time. Which of the following is the most likely diagnosis?

  1. Acute stress disorder
  2. Generalized anxiety disorder
  3. PTSD
  4. Social anxiety disorder
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6. Which of the following is most likely to be comorbid with PTSD?

  1. Depressive disorder
  2. Obsessive compulsive disorder
  3. Schizophrenia
  4. Substance abuse disorder
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