A hemorrhagic stroke compressing the brainstem can lead to:

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A 32-year-old woman presents with nightmares that happen when she is asleep and sometimes when she is awake. The episodes have been happening for at least 3 weeks now. She states that when it happens she feels “outside of her body,” like she’s “watching myself.” She also reports some chronic fatigue. The patient denies headaches, vision changes, dizziness, or loss of sensation or motor function. She has no notable medical or surgical history. She takes a multivitamin every day. She smokes 1 pack of cigarettes a day but denies alcohol or illicit drug use. The patient appears slightly anxious but is in no acute distress. Vital signs include T 98.6°F, BP 120/74 mmHg, HR 88/min, and RR 13/min with an oxygen saturation of 98% on room air. A physical and neurological exam is normal. She denies suicidal or homicidal ideation. Which of the following is the most likely diagnosis for the patient’s symptoms?

A 60-year-old woman is referred to you for a bizarre fixation. She has become preoccupied with the issue of having breasts that are too small, and she has been shopping for plastic surgeons to fix the problem. She has become so fixated on her problem that she stays in the house, does not socialize with others, and tries to constantly hide the perceived problem by wearing clothes that enhance her breasts; sometimes, she even wears prosthetic breasts. She has become paranoid about what people are saying about her appearance. What is the most likely diagnosis?

A 49-year-old female presents for a consultation 1 month after her 22-year-old son was killed in a fall at a construction site near her home. The patient is upset, restless, and reports feeling lonely. She lies awake at night. She does not feel like eating. She cries easily when she looks at their family pictures around the house. She wishes she could talk to him again, and she reports she sometimes thinks she sees him walking just outside their home. She says she wishes she would have died instead of him, but she denies any thoughts or plan of harming herself. Which of the following conditions is the most likely diagnosis for this patient?

A 22-year-old woman presents for psychiatric follow-up. During the visit, she begins to reveal what appear to be distinct personalities. Identities appear to repeatedly take control of the patient’s behavior and affect. You know she is an incest survivor. She denies any drug or alcohol use. You have tentatively diagnosed her with a post-traumatic stress disorder, but what other condition might she have?

A 28-year-old medical student presents to the student health center with the complaint being unable to sleep. Although he is a very successful student, over the past few months he has become increasingly preoccupied with failing. The patient states that he wakes up 10-15 times per night to check his textbooks for factual recall. He has tried unsuccessfully to suppress these thoughts and actions, and he has become extremely anxious and sleep-deprived. He has no past medical history and family history is significant for a parent with Tourette’s syndrome. He is started on cognitive behavioral therapy. He is also started on a first-line medication for his disorder, but after eight weeks of use, it is still ineffective.  Which of the following medications, if added to his current regimen, may help improve his symptoms?

A 35-year-old male patient presents with excessive daytime sleepiness for 6 months. He reports occasional episodes of sudden sleepiness occurring at any time without warning. Over the past 6 months, on at least 8 occasions, he has suddenly fallen on the floor without losing wakefulness; these episodes usually occur after fits of laughter. Multiple sleep latency tests reveal a mean sleep-onset latency of 7 minutes and 3 sleep-onset random eye movement episodes during the naps. Based on the most likely diagnosis, pharmacotherapy is initiated and daytime sleepiness improves, but he still has episodes where he loses muscle control and collapses after highly emotional events. What additional treatment is most likely to be helpful?

A 21-year-old woman is markedly thin, and she describes being worried she is going to fail her college finals and not graduate. She presents because she cannot eat or sleep; she feels like she would be better off dead. She was doing well in classes until after a spring break trip to Europe. When queried about previous psychiatric treatment, she tells you that she went “a little nuts” when she was a freshman; it was her first semester and the first time she had lived so far from home. She stayed up for a week trying to write a novel, and during that time she bought two computers and a whole new wardrobe with her father’s credit card. What is the most likely diagnosis?

A 7-year-old boy presents because he is fidgety, impulsive, and unable to sit still. The patient is observed running around. There is no evidence of any hallucinations or delusions. The mother notes that the child speaks excessively and loudly, makes simple arithmetic errors, and has short-term memory deficiencies. He finds it difficult to wait in lines or wait his turn in games or group situations. What is correct regarding this patient’s condition?