This page is dedicated to organizing various examples of standardized exam questions whose answer is major depressive disorder. While this may seem a odd practice, it is useful to see multiple examples of how major depressive disorder will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
Question # 1
A 69-year old man with Parkinson disease is brought to the physician by his husband for a routine examination. His husband remarks that he has become increasingly withdrawn and tearful during the past month. He has had poor energy and decreased sleep for 2 months. Current medications include carbidopa-levodopa and pramipexole. He has had a 17 lb weight loss compared to his visit 3 months ago (his current BMI is 18). His temperature is 38°C, pulse is 66, respirations are 19/min, and blood pressure is 130/80 mm Hg. Physical exam reveals the presence of a resting tremor of the hands and bradykinesia. On mental status exam he has a flat affect and a downcast gaze. His speech is slow and soft. When asked about his his crying he responds by saying, “Who wouldn’t be sad with this f*cking disease I have?” He does not leave the house anymore because he doesn’t want anyone to people to see him with his tremor. What is the best diagnosis for this patient?
Question # 2
A 25 year old male comes to the physician because of a 2 month history of crying spells, difficulty concentrating, fatigue, and difficulty getting out of bed. He explains that he needs at least 12 hours of sleep every day, and has lost interest in reading his favorite series (Harry Potter). He recently broke up with his girlfriend of 10 months, and since the breakup his boss has noticed that his work performance has declined. He explains that he has been eating more ice cream as of late, and has gained 20 lbs over the past 2 months. His physical exam is unremarkable. His mental status exam shows a sad mood and a restricted affect. What is the most likely diagnosis?
Question # 3
A 34 year old woman comes to the clinic because of a 7- week history of issues falling asleep and difficulty staying asleep in the mornings. She says she is very fatigued thought the day, and has become more irritable with her close friends. Working is difficult for this patient given her sleep disturbances and fatigue. Per her doctor’s advice, she has stopped drinking coffee past noon but this has not helped with her sleep issues. She no longer enjoys working in her garden or teaching her children how to paint. She feels guilty that her sleep issues are affecting her family and friends. She no longer enjoys eating her favorite foods, and has lost 10 lbs in the past 7 weeks. She has no history of any mental illness. She does not take any medications. She denies any substance use. In the clinic she appears tired and her vitals are as follows: temperature 37°C (98.6°F), pulse is 70, blood pressure is 117/71. Physical examination is unremarkable. Mental status exam shows a sad affect. She become tearful during the interview and says that she has been very sad every since her mother was diagnosed with breast cancer 5 months ago. She says, “I have thought about killing myself, but I would never hurt anyone else.” What diagnosis does this patient most likely have?
Question # 4
A 25 year old woman comes to the office saying she “is feeling off”. This feeling soon began after her older sister passed away from cancer 4 months ago. The patient is no longer interested in advancing in her career, or socializing with her friends over the weekends. She falls asleep easily at night, but awakens early in the morning (and then can no longer fall back asleep). She feels “very blue” especially when she first gets out of bed, and admits that this feeling gets slightly better as the day goes on. The patient often things about the time she spent with her sister growing up and how close they were. She feels guilty regarding her sister’s death, and thinks it was her fault for not keeping her sister’s “spirits up” when she was ill. Her work performance has suffered given her poor energy and concentration, and she has contemplated quitting work recently. She has been eating much less, and has lost 13 lbs in the one the past month. She denies thoughts of hurting her elf or others, and has no past psychiatric history. What si the most likely diagnosis?
Question # 5
A 32 year old man comes to the physician for a follow-up visit concerning his recent diagnosis of type 2 diabetes. He has started taking insulin since his last visit. His blood pressure is 120/80 mm Hg, fasting glucose is 132 omg/dL and BMI is 30.2 kg/m². The patient seems deflated and admits that he has “difficulty accepting” that he is indeed diabetic. He has tried to exercise, watch his diet, and quit smoking cigarettes in order to manage his disease, however he explains that he feels unmotivated and very “low energy”. The patient feels sad and guilty about his weight, but is unsure if he is going to be able to do anything about his condition. He has been sleeping much more then usual, and now spends most of his time in bed watching TV due to his lack of energy. He has stopped seeing friends and family, and has taken the last 2 weeks off of work because he did not feel like he could go. The patient admits that he has difficulty concentrating and paying attention to simply daily tasks. What is the most likely diagnosis?
Question # 6
A 76 year old man comes to the clinic due to worsening sadness and difficulty sleeping since his wife died 8 months ago. The patient experiences lethargy, and admits to having episodes of crying throughout the day. He does not wish o socialize anymore with his married friends. He has difficulty falling and staying asleep, and frequently lies awake at night thinking about his wife. He feels guilty about his wife’s passing, and believes that he should have done more for her during her final months. The patient experienced a more severe depression last week where he briefly thought about suicide, stating that “there was nothing left for him to love in this world”. With this in mind, he admits that he would never act on these thoughts. Physical exam reveals that this patient has lost 13 lbs since his wife’s death. What is the most likely diagnosis?
Page Updated: 09.10.2016