第四章精神障碍的检查和诊断 一、单项选择题 1.精神检查的技巧哪项不对 A.学会观察病人的言行、表情及对外界刺激的反应 B.耐心倾听病人的表述 C.有针对性的开放式和封闭式提问 D.对有妄想的病人及时予以纠正，以免妄想进一步加重 E.要寻找病人感兴趣的话题作为检查性交谈的切入点 2.下列关于面谈的情况是错误的是 A.抑郁症患者很多时候没有意识到早醒是抑郁症的一个症状。 B.有暴力倾向的患者面谈时应该被约束，并且至少有一个其他人在场。 C.和家庭成员面谈时要注意保持良好的医患关系。 D.对抑郁症患者要详细询问其想法和计划以来评估其有无自杀的危险。 E.有妄想的患者应该问这样一些问题如：“你曾经觉得有人反对你吗？”或者“你有特 殊的能力吗？” 3.下列哪项不是精神检查的内容 A.外表与行为 B.言谈与思维 C.情绪状态 D.感知觉 E.对性方面的态度 4.在精神病学面谈中 A.精神科医生也许不得不先对有暴力行为的病人进行药物治疗 B.有暴力行为的病人最好单独和医生面谈以建立良好的医患关系 C.首先问妄想的内容 D.精神科医生不应该询问抑郁症患者有无自杀想法 E.精神科医生的位置比病人的要高 5.在面谈中建立良好的医患关系哪项最重要 A.做记录
第四章 精神障碍的检查和诊断 一、单项选择题 1. 精神检查的技巧哪项不对 A．学会观察病人的言行、表情及对外界刺激的反应 B．耐心倾听病人的表述 C．有针对性的开放式和封闭式提问 D．对有妄想的病人及时予以纠正，以免妄想进一步加重 E．要寻找病人感兴趣的话题作为检查性交谈的切入点 2.下列关于面谈的情况是错误的是 A．抑郁症患者很多时候没有意识到早醒是抑郁症的一个症状。 B．有暴力倾向的患者面谈时应该被约束，并且至少有一个其他人在场。 C．和家庭成员面谈时要注意保持良好的医患关系。 D．对抑郁症患者要详细询问其想法和计划以来评估其有无自杀的危险。 E．有妄想的患者应该问这样一些问题如：“你曾经觉得有人反对你吗？”或者“你有特 殊的能力吗？” 3.下列哪项不是精神检查的内容 A．外表与行为 B．言谈与思维 C．情绪状态 D．感知觉 E．对性方面的态度 4.在精神病学面谈中 A．精神科医生也许不得不先对有暴力行为的病人进行药物治疗 B．有暴力行为的病人最好单独和医生面谈以建立良好的医患关系 C．首先问妄想的内容 D．精神科医生不应该询问抑郁症患者有无自杀想法 E．精神科医生的位置比病人的要高 5. 在面谈中建立良好的医患关系哪项最重要 A．做记录
B.用一间私人办公室面谈 C.保持眼神的交流 E.不打断病人的谈话 F.关注病人所关心的问题并对其有所反应 6.在面谈刚开始时，病人想讨论她为什么感觉病了，而医生想了解她得病后的症状， 这时医生应该 A.让病人先讨论 B.礼貌地打断病人的谈话并继续进行封闭式提问 C.告诉她时间是重要的 D.告诉她如果面谈需要更多的时间要另外收费 E.立即讨论她的感觉会多么地影响依从性 7.诊断精神障碍最好的办法是 A.实验室检查 B.心理测验 C.既往病史资料 D.现症精神状况检查 E.横向的现症精神状况结合纵向的病史材料 二、多项选择题 1.精神检查的日的包括 A.获取必要信息以便确立诊断 B.从完整的人的角度了解患者 C.了解患者所处的环境 D.建立初步的良好医患治疗关系 E.向患者进行初步的精神卫生知识宣教，让病人了解自己的病情 2.完整的精神状况检查应涉及那几个方面 A.一般表现：包括仪态、个人生活自理情况、意识状态、日常活动等 B.认识活动：包括感知觉、思维活动、注意记忆、智能等 C.情感活动：包括一般的面部表情，情绪的稳定性、协调性、有无病理优势情感等 D.意志和行为：有无意志活动的增强与减退，有无行为异常等 E.自知力：病人对自身疾病的认识、判断能力
B．用一间私人办公室面谈 C．保持眼神的交流 E．不打断病人的谈话 F．关注病人所关心的问题并对其有所反应 6. 在面谈刚开始时，病人想讨论她为什么感觉病了，而医生想了解她得病后的症状， 这时医生应该 A．让病人先讨论 B．礼貌地打断病人的谈话并继续进行封闭式提问 C．告诉她时间是重要的 D．告诉她如果面谈需要更多的时间要另外收费 E．立即讨论她的感觉会多么地影响依从性 7.诊断精神障碍最好的办法是 A． 实验室检查 B． 心理测验 C． 既往病史资料 D．现症精神状况检查 E． 横向的现症精神状况结合纵向的病史材料 二、多项选择题 1．精神检查的目的包括 A． 获取必要信息以便确立诊断 B． 从完整的人的角度了解患者 C． 了解患者所处的环境 D． 建立初步的良好医患治疗关系 E． 向患者进行初步的精神卫生知识宣教，让病人了解自己的病情 2． 完整的精神状况检查应涉及那几个方面 A． 一般表现：包括仪态、个人生活自理情况、意识状态、日常活动等 B． 认识活动：包括感知觉、思维活动、注意记忆、智能等 C． 情感活动：包括一般的面部表情，情绪的稳定性、协调性、有无病理优势情感等 D．意志和行为：有无意志活动的增强与减退，有无行为异常等 E． 自知力：病人对自身疾病的认识、判断能力
3.当发现病人有某一精神症状时，你应该继续询问以下哪些情况 A.症状出现的时间、频度、持续时间和内容，最好让病人举一实例 B.症状出现时病人的意识状态，能否认识自身及周围环境 C.要求病人解释症状产生的原因 D.症状出现有无昼轻夜重之特点 E.症状出现时病人的情绪与行为反应 4.如发现病人有幻觉，还需进一步询问以下哪些情况 A.幻觉的种类、出现的频度、出现的时间、持续的时间、具体内容 B.幻觉是来自体内还是体外 C.幻觉的清晰程度如何 D.要求患者解释是真性幻觉还是假性幻觉 E.病人对幻觉的情绪反应，幻觉出现时有无意识障碍 5.为了保证病史的客观真实，应注意以下哪些问题 A.从不同的知情者处了解情况，收集病人的日记、信件等了解病情 B.事先应向供病史者说明病史准确与否对诊、治结果的重要性 C.排除病史提供者因种种原因有意无意地隐瞒或夸大病情 D.一定要让供病史者了解问话的真正含意，避免信口作答 E.如供病史者之间出现严重分歧，则应分别询问，了解分歧的原因 6.以下哪些因素是精神病人出现攻击行为的高危因素 A.男性 B.精神分裂症病人 C.有命令性幻听或被害妄想者 D.既往有攻击行为发生史 E.有强迫行为的病人 三、简答题 1.在面谈检查中，检查者应具有哪些个人条件和态度？ 2.病史采集、精神检查应包括哪些内容？ 3.精神科诊断过程中要考虑哪些因素？ 选择题答案： 一、单项选择题
3． 当发现病人有某一精神症状时，你应该继续询问以下哪些情况 A． 症状出现的时间、频度、持续时间和内容，最好让病人举一实例 B． 症状出现时病人的意识状态，能否认识自身及周围环境 C． 要求病人解释症状产生的原因 D．症状出现有无昼轻夜重之特点 E． 症状出现时病人的情绪与行为反应 4． 如发现病人有幻觉，还需进一步询问以下哪些情况 A． 幻觉的种类、出现的频度、出现的时间、持续的时间、具体内容 B． 幻觉是来自体内还是体外 C． 幻觉的清晰程度如何 D．要求患者解释是真性幻觉还是假性幻觉 E． 病人对幻觉的情绪反应，幻觉出现时有无意识障碍 5． 为了保证病史的客观真实，应注意以下哪些问题 A． 从不同的知情者处了解情况，收集病人的日记、信件等了解病情 B． 事先应向供病史者说明病史准确与否对诊、治结果的重要性 C． 排除病史提供者因种种原因有意无意地隐瞒或夸大病情 D．一定要让供病史者了解问话的真正含意，避免信口作答 E． 如供病史者之间出现严重分歧，则应分别询问，了解分歧的原因 6． 以下哪些因素是精神病人出现攻击行为的高危因素 A． 男性 B． 精神分裂症病人 C． 有命令性幻听或被害妄想者 D．既往有攻击行为发生史 E． 有强迫行为的病人 三、简答题 1. 在面谈检查中，检查者应具有哪些个人条件和态度？ 2. 病史采集、精神检查应包括哪些内容？ 3. 精神科诊断过程中要考虑哪些因素？ 选择题答案： 一、单项选择题
1.D2.B3.E4.A5.F6.A7.E 二、多项选择题 1.ABCDE 2.ABCDE 3.ABDE 4.ABCE 5.ABCDE 6.ABCD 英文题 Select the single best response for each question. 1 Regarding the physical layout of an interview room,the psychiatrist should attend to all of the following except A.Chairs for patient and physician should be of equal height. B.There should be a desk between patient and physician for appropriate therapeutic distance. C.A playroom is advised for interactions with children. D.In the emergency room,the physician should have quick access to the door. E.Extraneous noise should be minimized or avoided. 2 Regarding physician contacts with the patient's relatives or friends,the physician should generally A.Talk to family and friends first for collateral history. B.Agree to withhold from the patient information gained from collateral sources C.Suspend the usual practice of physician-patient confidentiality when imminent dangerousness is present. D.Withhold from the patient information learned from collateral sources. E.Disclose the content of the interview to concerned family members,even in the absence of an emergency. 3 The behavior of a patient who remains silent during an interview illustrates which type of resistance? A.Conscious. B.Ego. C.Id. D.Superego
1.Ｄ 2.B 3.E 4.A 5.F 6.A 7.E 二、多项选择题 1．ABCDE 2．ABCDE 3．ABDE 4．ABCE 5．ABCDE 6．ABCD 英文题 Select the single best response for each question. 1 Regarding the physical layout of an interview room, the psychiatrist should attend to all of the following except A. Chairs for patient and physician should be of equal height. B. There should be a desk between patient and physician for appropriate therapeutic distance. C. A playroom is advised for interactions with children. D. In the emergency room, the physician should have quick access to the door. E. Extraneous noise should be minimized or avoided. 2 Regarding physician contacts with the patient’s relatives or friends, the physician should generally A. Talk to family and friends first for collateral history. B. Agree to withhold from the patient information gained from collateral sources. C. Suspend the usual practice of physician–patient confidentiality when imminent dangerousness is present. D. Withhold from the patient information learned from collateral sources. E. Disclose the content of the interview to concerned family members, even in the absence of an emergency. 3 The behavior of a patient who remains silent during an interview illustrates which type of resistance? A. Conscious. B. Ego. C. Id. D. Superego
E.Countertransference. 4 After listening to several examples of similar behavior in the patient's life story,the psychiatrist offers the observation "When you can't perform up to your own high standards,you appear to act to try to please someone else."This response by the psychiatrist is an example of A.Reflection. B.Interpretation. C.Transition. D.Self-disclosure. E.Facilitation. 5 After fully exploring the patient's personal history,the psychiatrist proceeds to the next history item by asking,"Is there a family history of psychiatric illness,for example,suicidal behavior,mental retardation,or anxiety, mood,psychotic,substance abuse,or personality disorder?"This would be an example of A.Excessive direct questions. B.Preemptive topic shift. C.Run-on questioning. D.Put-down. E.Checklist questioning. 6 When interviewing a depressed or suicidal patient,the psychiatrist is advised to do all of the following except A.Begin with assessment of physical appearance and motor behavior. B.Thoroughly explore neurovegetative signs or symptoms and their effect on patient function. C.Be attentive to recent psychosocial stressors (especially losses)and recent anniversaries of significant past losses. D.Allow the patient to set the pace of the interview,avoid excessive engagement, and tolerate long silences. E.Assess both suicidal cognitions and the patient's ability to control
E. Countertransference. 4 After listening to several examples of similar behavior in the patient’s life story, the psychiatrist offers the observation “When you can’t perform up to your own high standards, you appear to act to try to please someone else.” This response by the psychiatrist is an example of A. Reflection. B. Interpretation. C. Transition. D. Self-disclosure. E. Facilitation. 5 After fully exploring the patient’s personal history, the psychiatrist proceeds to the next history item by asking, “Is there a family history of psychiatric illness, for example, suicidal behavior, mental retardation, or anxiety, mood, psychotic, substance abuse, or personality disorder?” This would be an example of A. Excessive direct questions. B. Preemptive topic shift. C. Run-on questioning. D. Put-down. E. Checklist questioning. 6 When interviewing a depressed or suicidal patient, the psychiatrist is advised to do all of the following except A. Begin with assessment of physical appearance and motor behavior. B. Thoroughly explore neurovegetative signs or symptoms and their effect on patient function. C. Be attentive to recent psychosocial stressors (especially losses) and recent anniversaries of significant past losses. D. Allow the patient to set the pace of the interview, avoid excessive engagement, and tolerate long silences. E. Assess both suicidal cognitions and the patient’s ability to control
self-destructive impulses. 7 On mental status examination,the patient's stream of thought reveals a lack of goal directedness,excessive details,and difficulty with closure.This thought pattern is called A.Circumstantiality. B.Tangentiality. C.Thought blocking. D.Perseveration. E.Neologism. 8 Delusions that cannot be understood by other psychological processes are referred to as primary delusions.Which of the following is an example of this type of delusion? A.Poverty. B.Nihilism. C.Thought insertion. D.Persecution. E.Guilt. 9 Which of the following is not considered a perceptual disturbance? A.Derealization. B.Illusion. C.Depersonalization. D.Delusion. E.Hallucination. 10 Psychometric testing instruments notable for their value in assessment of a wide variety of symptom patterns include all of the following except A.Minnesota Multiphasic Personality Inventory-2 (MMPI-2). B.Symptom Checklist-90-Revised(SCL-90-R). C.Brief Psychiatric Rating Scale (BPRS). D.Hamilton Rating Scale for Depression(HRSD)
self-destructive impulses. 7 On mental status examination, the patient’s stream of thought reveals a lack of goal directedness, excessive details, and difficulty with closure. This thought pattern is called A. Circumstantiality. B. Tangentiality. C. Thought blocking. D. Perseveration. E. Neologism. 8 Delusions that cannot be understood by other psychological processes are referred to as primary delusions. Which of the following is an example of this type of delusion? A. Poverty. B. Nihilism. C. Thought insertion. D. Persecution. E. Guilt. 9 Which of the following is not considered a perceptual disturbance? A. Derealization. B. Illusion. C. Depersonalization. D. Delusion. E. Hallucination. 10 Psychometric testing instruments notable for their value in assessment of a wide variety of symptom patterns include all of the following except A. Minnesota Multiphasic Personality Inventory-2 (MMPI-2). B. Symptom Checklist-90-Revised(SCL-90-R). C. Brief Psychiatric Rating Scale (BPRS). D. Hamilton Rating Scale for Depression(HRSD)
E.Millon Clinical Multiaxial Inventory-III(MCMI-III). 11 Clinical scales on the Minnesota Multiphasic Personality Inventory-2 include all of the following except A.Hypochondriasis. B.Hysteria. C.Lie. D.Psychopathic deviance. E.Psychasthenia. 12 Regarding the Hamilton Rating Scale for Depression (HRSD),all of the following are true except A.It contains 17-24 items. B.It has 3-to 5-point severity scales for each item. C.It is weighted toward the neurovegetative rather the cognitive symptoms of depression. D.It is often used in conjunction with the Beck Depression Inventory (BDI). E.It is self-administered. 13 Regarding the Wisconsin Card Sorting Test (WCST),all of the following are true except A.It is a test of conceptualization. B.It requires the subject to match cards on the dimensions of color,number, or form. C.It requires the subject to derive "rules"based on interpretations of patterned visual stimuli. D.The examiner changes the "rule"after 10 correct sorts. E.The examiner prompts the subject that the rule change is imminent. 14 Screening instruments that may be administered rapidly for prompt and efficient assessment of personality in a managed care system include all of the following except A.International Personality Disorder Examination Screen (IPDE-S)
E. Millon Clinical Multiaxial Inventory-III(MCMI-III). 11 Clinical scales on the Minnesota Multiphasic Personality Inventory-2 include all of the following except A. Hypochondriasis. B. Hysteria. C. Lie. D. Psychopathic deviance. E. Psychasthenia. 12 Regarding the Hamilton Rating Scale for Depression (HRSD), all of the following are true except A. It contains 17-24 items. B. It has 3- to 5-point severity scales for each item. C. It is weighted toward the neurovegetative rather the cognitive symptoms of depression. D. It is often used in conjunction with the Beck Depression Inventory (BDI). E. It is self-administered. 13 Regarding the Wisconsin Card Sorting Test (WCST), all of the following are true except A. It is a test of conceptualization. B. It requires the subject to match cards on the dimensions of color, number, or form. C. It requires the subject to derive “rules” based on interpretations of patterned visual stimuli. D. The examiner changes the “rule” after 10 correct sorts. E. The examiner prompts the subject that the rule change is imminent. 14 Screening instruments that may be administered rapidly for prompt and efficient assessment of personality in a managed care system include all of the following except A. International Personality Disorder Examination Screen (IPDE-S)
B.Iowa Personality Disorder Screen. C.Self-directedness subscale from the Temperament and Character Inventory. D.Screen for personality disorders developed from the Inventory of Interpersonal Problems. E.Minnesota Multiphasic Personality Inventory-2 (MMPI-2). 15 Instruments used for the assessment of psychodynamics and patient enabling factors include all of the following except A.Rorschach. B.Thematic Apperception Test (TAT). C.Minnesota Multiphasic Personality Inventory-2 (MMPI-2). D.Social Adjustment Scale-Self-Report(SAS-SR). E.Millon Clinical Multiaxial Inventory-III(MCMI-III). 16 A supplemental laboratory/diagnostic test recommended for evaluating physical conditions in nondemented,mood-disordered patients is A.Chest X ray. B.Electrocardiogram. C.Complete blood count. D.Magnetic resonance imaging scan. E.Serum vitamin B 12 and folate levels. 17 A single,53-year-old man is found lying on the floor in his apartment, having apparently lost consciousness.In the emergency room,he is alert,appears oriented,and reports no complaints;however,he has a large bruise on the left side of his head above the ear.He is admitted overnight for observation and in the morning is noted to be lethargic and disoriented,despite having taken no medications.Which of the following tests would be contraindicated? A.Carotid ultrasound. B.Computed tomography. C.Electroencephalogram. D.Lumbar puncture. E.Magnetic resonance imaging
B. Iowa Personality Disorder Screen. C. Self-directedness subscale from the Temperament and Character Inventory. D. Screen for personality disorders developed from the Inventory of Interpersonal Problems. E. Minnesota Multiphasic Personality Inventory-2 (MMPI-2). 15 Instruments used for the assessment of psychodynamics and patient enabling factors include all of the following except A. Rorschach. B. Thematic Apperception Test (TAT). C. Minnesota Multiphasic Personality Inventory-2 (MMPI-2). D. Social Adjustment Scale-Self-Report(SAS-SR). E. Millon Clinical Multiaxial Inventory-III(MCMI-III). 16 A supplemental laboratory/diagnostic test recommended for evaluating physical conditions in nondemented, mood-disordered patients is A. Chest X ray. B. Electrocardiogram. C. Complete blood count. D. Magnetic resonance imaging scan. E. Serum vitamin B 12 and folate levels. 17 A single, 53-year-old man is found lying on the floor in his apartment, having apparently lost consciousness. In the emergency room, he is alert, appears oriented, and reports no complaints; however, he has a large bruise on the left side of his head above the ear. He is admitted overnight for observation and in the morning is noted to be lethargic and disoriented, despite having taken no medications. Which of the following tests would be contraindicated? A. Carotid ultrasound. B. Computed tomography. C. Electroencephalogram. D. Lumbar puncture. E. Magnetic resonance imaging
18 An advantage of magnetic resonance imaging (MRI)over computed tomography (CT)is that MRI A.Provides better detection of calcified brain lesions. B.Is less anxiety provoking. C.Is less expensive. D.Provides better visualization of lesions in the brain stem. E.Requires a shorter period of patient cooperation. 19 Prior to starting a patient on lithium carbonate,the psychiatrist should order which of the following tests? A.Reticulocyte count. B.Platelet count. C.Erythrocyte sedimentation rate. D.Liver function tests. E.Thyroid function tests. 20 Research advantages of functional magnetic resonance imaging (fMRI)over positron emission tomography (PET),single photon emission computed tomography (SPECT),and regional cortical blood flow(rCBF)studies include all of the following except A.fMRI offers superior spatial/temporal resolution. B.fMRI avoids exposure to ionizing radiation. C.fMRI does not need a source of radiopharmaceuticals. D.fMRI does not have the same degree of limitations on multiple studies. E.fMRI can be used by patients with pacemakers. 参考答案 1.B2.C3.A4.B5.C6.D7.A8.C 9.D 10.D 11.C12.E13.E14.E15.D16.D17.D18.D19.E20.E
18 An advantage of magnetic resonance imaging (MRI) over computed tomography (CT) is that MRI A. Provides better detection of calcified brain lesions. B. Is less anxiety provoking. C. Is less expensive. D. Provides better visualization of lesions in the brain stem. E. Requires a shorter period of patient cooperation. 19 Prior to starting a patient on lithium carbonate, the psychiatrist should order which of the following tests? A. Reticulocyte count. B. Platelet count. C. Erythrocyte sedimentation rate. D. Liver function tests. E. Thyroid function tests. 20 Research advantages of functional magnetic resonance imaging (fMRI) over positron emission tomography (PET), single photon emission computed tomography (SPECT), and regional cortical blood flow (rCBF) studies include all of the following except A. fMRI offers superior spatial/temporal resolution. B. fMRI avoids exposure to ionizing radiation. C. fMRI does not need a source of radiopharmaceuticals. D. fMRI does not have the same degree of limitations on multiple studies. E. fMRI can be used by patients with pacemakers. 参考答案 1. B 2.C 3.A 4.B 5.C 6.D 7.A 8.C 9.D 10.D 11. C 12.E 13.E 14.E 15.D 16.D 17.D 18.D 19.E 20.E