A 50-year-old woman complains of difficulty sleeping for the…

A 50-year-old woman complains of difficulty sleeping for the last 6 months. She states that when she gets in bed, she tosses and turns because she feels that “I just need to move.” She also reports that she sometimes feels like bugs are crawling on her skin, particularly her legs, which is alleviated by getting out of bed and walking around. She then gets back in bed, but the sensations return in about 30 minutes. She ends up staying awake almost all night two to three times a week. She notes that she is falling asleep at work because she is so tired. After further history and a physical examination, what lab test should be ordered?

An intoxicated patient presents to the emergency department…

An intoxicated patient presents to the emergency department with pupillary dilation, elevated blood pressure, psychomotor agitation, chest pain, and confusion. The patient appears quite thin. Which of the following substances is most likely the cause of these symptoms?

A 21-year-old man with a history of oppositional defiant dis…

A 21-year-old man with a history of oppositional defiant disorder presents with frequent impulsive behavioral outbursts that are grossly out of proportion to the stressor. He reports that he is unable to control himself and is worried that he might lose his job if his behavior continues. What is the most likely diagnosis?

A patient presents to your office reporting new-onset visual…

A patient presents to your office reporting new-onset visual and auditory hallucinations over the past 24 hours. On examination you observe a bilateral hand tremor and psychomotor agitation. Vitals are significant for tachycardia and hypertension. This patient is most likely experiencing withdrawal from which of the following substances?

Mr. S was a 45-year-old postal service employee who was eval…

Mr. S was a 45-year-old postal service employee who was evaluated at a clinic specializing in the treatment of depression. He claimed to have felt constantly depressed since the first grade without a period of normal mood for more than a few days at a time. His depression was accompanied by lethargy; little or no interest or pleasure in anything; trouble in concentrating; and feelings of inadequacy; pessimism, and resentfulness. His only periods of normal mood occurred when he was home alone, listening to music or watching TV. On further questioning, Mr. S revealed that he could never remember feeling comfortable socially. Even before kindergarten, if he was asked to speak in front of a group of family friends, his mind would go blank. He felt over overwhelming anxiety at children’s social functions, such as birthday parties, which he either avoided or attended in total silence. He could answer questions in class only if he wrote down the answers in advance; even then, he frequently mumbled and could not get the answer out. He met new children with his eyes lowered and embarrassed.  He was convinced that everyone around him though he was “dumb or a jerk.” The PMHNP would diagnose Mr. S with which of the following: