A 20-year-old man comes to the university physician as per the suggestion of his roommate, who has noticed that for the past month he has been staying up all night, acting sometimes quite agitated and not being himself. He has also been mumbling to himself for the past 6 weeks. He does not smoke, drink, or use drugs. His vitals are normal. His girlfriend broke up with him about 3 months ago. He has been attending classes regularly. He works a part-time job at a convenience store. Which of the following is the most likely diagnosis?

A) Adjustment disorder with anxious mood
B) Bipolar with psychotic features
C) Depression with psychotic features
D) Schizoaffective disorder
E) Schizophreniform disorder

A 40-year-old woman comes to the physician because of poor concentration, feelings of guilt, and suicidal thoughts. She cannot recall when her symptoms specifically began. Her mother and brother have similar symptoms. She has intermittent abdominal pain. She does not drink alcohol because it can trigger her abdominal pain. Physical examination shows no abnormalities. Neurologic examination shows positive Romberg sign. Which of the following is the most likely explanation for this patient’s findings?

A 69-year-old man is brought to the physician by his wife for a follow-up appointment. Physical examination shows shuffling gait, a resting tremor of the left hand, and increased muscular rigidity. He has history of post-traumatic stress disorder managed with sertraline. Which of the following agents is most appropriate to avoid in this patient?

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A 40-year-old man is brought to emergency by his wife 20 minutes after several episodes of staring and blinking. He has type II diabetes mellitus and bipolar disorder. Current medications are metformin, glyburide, bupropion, and lithium. Two weeks ago, he started taking terbinafine for onychomycosis. Vitals are within normal limits. Neurologic examination shows no abnormalities. Which of the following is the most likely explanation for this patient’s symptoms?

A previously healthy 9-year-old girl is brought to the physician because of a rash on her left arm for the past 7 days. Blood pressure is 150/95. Examination shows a yellow crusted rash with excoriations on the dorsal aspect of the left forearm. The remainder of the physical examination shows no abnormalities apart from a repetitive leftward movement of the upper lip. Urinalysis shows 2+ protein, 30 RBC/hpf, and 10 WBC/hpf. Which of the following is the most likely diagnosis?

A 25-year-old man comes to the physician for a health maintenance examination. He has a 1-year history of worsening auditory hallucinations and has recently been started on aripiprazole. Which of the following sets of molecular findings is most likely to be seen in this patient?

A 49-year-old man is brought to the physician by his wife for a 4-month history of “hearing voices.” He is commenced on risperidone. 48 hours later he develops muscle rigidity and abnormal eye movements. Temperature is 98.6 F. The most appropriate pharmacologic treatment for this patient’s condition has which of the following mechanisms of action?

A 19-year-old woman with a 2-year history of auditory hallucinations and social seclusion is commenced on risperidone. 10 days later, she develops severe muscle rigidity and abnormal eye movements. Temperature is 98.9 F. Which of the following is the most appropriate pharmacologic therapy for this patient?

A 54-year-old woman comes to the physician for a one-year history of generalized muscle pain. The pain is worse during stress but is always present. Vitals are within normal limits. Physical examination is unremarkable apart from 12 areas of muscle point tenderness. In addition to recommending aerobic exercise, which of the following is the most appropriate pharmacologic therapy for this patient?