QUIZ: 1> Does the patient know anything about:a= architecture
b= art history
c= basic science
d= engineering
e= foreign languages
f= history
g= literature
h= Answer: We don't get that in med school. None of these is relevant to the diagnosis or treatment. The patient is assumed to have no past and no future unless we prescribe it for her. 2> Falsifying medical records:
a= is likely never to be detected
b= ensures appropriate placement of the mentally ill
c= is a career move
d= will not lead to repurcussions
e= is the usual and customary course of business
f= The ends always justify the means.
g= Answer: All of the above. The patient can always depend on Social Security Disability or Social Security Supplemental Insurance. Depending on circumstances, the patient will also be eligible for Medicare, Medicaid or Medical Assistance. This is all dependent on the right social worker. 3> What is meant by "ethics"?
a= When you do what you're not supposed to do.
b= Toadying up to the attending. Fuck the patient.
c= Not getting caught.
d= Answer: The patient is making unreasonable demands which is consistent with her diagnosis of bipolar mental disorder. She belongs in supervised housing if not the State hospital system. 4> Is there any part of the med school curriculum dealing with the field
of ethics?
a= Answer: We only get that when there is a federal investigation going on. Med school is not a place to learn ethics. 5> Health Care Economics: How is your salary being paid?
a= I don't know and I don't care.
b= The billing department handles all those details.
c= We don't know from nothing about private insurance or HMOs.
d= Answer: It's one thing you learn in med school and residency. Other people handle billing details. We just collect. That way, you never have to dirty your hands with billing and payment options. 6> Has she shown any achievement or accomplishment?
a= Deng: Goop. Glomp. Yang. Yin. Gondwallah. Gook. Yuk. Dim. Sung. Foom. Glop. Goo-goo. Wang. Wang.
b= Mary Ann Nichols: I never bothered to think. I'm not supposed to think. Her mini-mental exam indicates she has no insight and no judgment. According to the mini-mental exam (which is all I know to do), she is incapable of higher order thought.
c= Joseph Mullen: Not if it interferes with my own preconceived notions or ego. That's why almost all of her website can be disregarded.
d= Jennifer Oldham: I don't know and I don't care. She belongs in the State hospital system.
e= Udebiuwa: If the first year resident does not report it, it does not exist. 7> To Mary Ann Nichols:
a= Plato
b= Aristotle
c= Answer: The patient has no insight and no judgment. The attending agrees with me. This sounds like Western Civ. Black people like me don't have to know anything about European history to get in or out of med school. 8> To Joseph Mullen:
a= Immanuel Kant
b= Frederick Nietzche
c= David Hume
d= John Jacques Rousseau
e= Answer: The patient is obsessed with the Department of Defense. She is psychotic and the attending agrees with me. This doesn't have to do with the Department of Defense. The patient is psychotic and the attending agrees with me. 9> To Jennifer Oldham:
a= John Locke
b= Jeremy Bentham
c= Hegel
d= John Stuart Mill
e= John Dewey
f= Cardozo
g= Roscoe Pound
h= Answer: None of these agree with Lesbian thinking. In fact, I never heard of any of them. This has to do with Western Civ which is a bunch of shit. The patient is having a flight of fancy and is psychotic. The attending agrees with me. 10> Who does not belong:
a= Carl Gustav Jung
b= R.D. Laing
c= Sigmund Freud
d= Victor Frenkl
e= Hank Aaron
f= Emil Kraepelin
g= Answer: Hank Aaron is black. I don't know about the rest of them. 11> Who does not belong:
a= Carl Gustav Jung
b= R.D. Laing
c= Sigmund Freud
d= Victor Frenkl
e= Yogi Berra
f= Emil Kraepelin
g= Answer: Yogi Berra was a baseball player. I'm not sure about the rest of them. 12> This is a test - just a test:
a= Handel Messiah
b= Brahms Ein Deutches Requiem
c= Bach St. Matthew Passion
d= Beethoven Missa Solemnis
e= Dvorak Stabat Mater
f= Answer: The patient is hearing voices. The patient has a messianic complex and aberrant religious ideation. The patient warrants close supervision by third year students of the School of Social Work. 13> Testing further:
a= Kyrie eleison
b= Dominus vobiscum (ora pro nobis)
c= Gloria
d= Credo
e= Pater noster
f= Sanctus
g= Agnus Dei
h= peccata mundi
i= Dies irae
j= Consecration
k= Answer: The patient is speaking in nonsense syllables except she uses a common first name for a girl. She is probably also experiencing auditory hallucinations and practicing ritual sacrifice. The best placement for her is in a State hospital supervised by School of Social Work graduate students. 14> Explain what is meant by:
a= amino acid
b= polypeptide
c= protein
d= enzyme
e= Answer: This requires referral to a specialty clinic. A social worker will fill out the forms. Intake is a minimum of $180 depending on complications. Medicare and Medicaid are offering only partial coverage. 15> How is she with computer software?
a= Deng - Wang Wang Goo goo Gop Gop Feng Fang
b= Mary Ann Nichols - there is nothing in the mini-mental exam on that topic.
c= Joseph Mullen - Her website was intimidating and I refuse to be intimidated. I got to the point of a Table of Contents where there were incomplete sentences, they were out of order and they didn't make sense. That's all I needed to know. I skipped 15 years in the Department of Public Safety and anything autobiographical. I didn't ask about File Transfer Protocols (FTP) because it would have looked liked I was a jerk.
d= Jennifer Oldham - I refuse to read or look at anything you have done for any reason.
e= Udebiuwa: If the first year resident does not report it, it does not exist.
f= Nurses' Station: I clicked on the middle box on the top right and the screen got BIG. I had trouble clicking so that the screen would be small again. The patient is a computer hacker. The patient is not allowed near the computer again. The patient has no respect for and does not obey boundaries. 16> Turning to visual arts:
a= da Vinci
b= Titian
c= Giotto
d= Carvaggio
e= Monet
f= Manet
g= Picasso
h= Jackson Pollard
i= Andy Warhol
j= Answer: It is not possible to figure out what the patient is talking about. It is sure that the patient is experiencing some form of hallucination. The patient requires close supervision and monitoring by a clinical social worker at least as skilled as Sharon Lerner, LCSW-C if not placement in the State hospital system. 17> What about:
a= REITs
b= Money Markets
c= Mutual funds
d= T-bills
e= 401(k)
f= IRA
g= Dow
h= NASDAQ
i= Answer: I don't know what she's talking about. The patient is being grandiose and delusional and is having flights of fancy. She belongs in the State hospital system and qualifies for involuntary commitment. The social worker should take care of any of these needs. 18> What if I agree to go to a group home as Doris Balis, Clinical Review
Panel, envisioned:
a= Your house and all your belongings will be sold under the supervision of a University of Maryland Social Worker at least as competent as Sharon Lerner or Janis Raynor. The proceeds will inure to the University of Maryland.
b= Your dogs will be taken to the Animal Shelter where they will be euthanized.
c= You will be put on Social Security Disability where you will assign benefits to the shelter you are assigned to.
d= You will receive a stipend leftover, typically $50 a month, for your needs.
e= You will share space with junkies, schizophrenics and other mental defectives and learn to mingle with them as a group. You, by definition, will become permanently mentally defective. That will be your role, that will be your identity and and that will be your destiny.
f= You will not permitted to have a computer, printer or a fax machine.
g= Your only contact with the outside will be a payphone down the hall.
h= You will become a dependent of the University of Maryland.
i= You will have to deal with students of the School of Social Work.
j= Your medical care will be by students of the School of Medicine.
k= You cannot get out of the situation - your assets will be liquidated or assigned - students of the School of Social Work or Medical School will be making the decisions for you. The group home is your permanent placement. 19> "I influenced legislation for the past ten legislative sessions."
a= Government conspiracy
b= Grandiose
c= Delusional
d= Tangential
e= Loose Associations
f= Impaired reality testing
g= Psychotic
h= Answer: All of the above. Belongs in the State hospital system. Qualifies for involuntary commitment. 20> I voted in the last election.
I testified in front of House Judiciary Committee.
I testified in front of Senate Judicial Proceedings.
I passed paper to House Appropriations.
I faxed my findings to the Governor's Office.
I went on talk radio to help defeat Kathleen Kennedy Townsend.
a= Answer: Government conspiracy. Bipolar Affective Disorder I (BADI). Belongs in a supervised setting if not the State hospital system. No sense of boundaries. 21> What impressed you most about the pharmaceutical reps (Risperdal and Seroquel) who showed up once a week and took over the conference room:
a= the freebee pizza and Pepsis
b= the charts and graphs that I could not understand, analyze or question
c= the professionally narrated slide show
d= the endorsement of a senior member of the faculty
e= the street costs of the drugs they were peddling
f= No sense of boundaries.
g= Answer: Patient well-being is our first prerogative. Costs are secondary. 22> What use do you have for:
a= arithmetic
b= algebra
c= geometry
d= calculus
e= Answer: Not much. We had to get that stuff to get into med school but we did not need it to get out of med school. There is no use for that in modern medicine. Any patient who exhibits mastery in any of these is psychotic and belongs in the State hospital system. 23> Is there a hospital scale on the ward and do you use it?
a= Yes, in the social worker office. No. As for converting kilograms to pounds to figure out dosages, we rely on the recommendations of the pharmaceutical reps. 24> What does the loss of three pounds over one month signify?
a= Answer: Nothing, except that in a patient, it is a sure sign of anorexia, bulemia and refusing food. Otherwise, three pounds is negligible. 25> What does the word "calibration" mean to you?
a= Answer: The patient is experiencing delusions consistent with her affective disorder. The three pounds lost between a hospital scale and an ordinary uncalibrated bathroom scale is indicative for the need for involuntary commitment. Otherwise, three pounds is negligible. 26> What is a sure sign of the onset of the menstrual period?
a= Answer: I don't know. We don't have any background in gynecology. We only specialize in psychiatry. Weight loss, possibly. Three pounds is negligible. 27> What doctor shows make you feel most inadequate as a clinician?
a= Ben Casey
b= Dr. Kildare
c= Marcus Welby
d= St. Elsewhere
e= Chicago Hope
f= Presidio Med
g= Answer: All of the above. The patient has unreal expectations that we are competent, reliable, trustable and in control of our basal instincts. 28> Why did you choose psychiatry as a specialty?
a= It was the best way out of the med school jungle.
b= I didn't have the intellect or ambition for anything else.
c= I like judging people and giving them drugs accordingly.
d= I thought I was following in my father's footsteps but a lot has changed since he was an eminent member of the Department.
e= I wanted to have a baby while I was still in my 20s.
f= I wanted to preserve my relationship with my significant other.
g= Student loans. 29> What about place names:
a= Ottawa
b= London
c= Baghdad
d= Caracas
e= Tehran
f= Islamabad
g= Seoul
h= Seattle
i= Answer: We don't get that in med school so that it is therefore irrelevant. The patient has impaired reality testing and belongs in the State hospital system. 30> Have you ever heard about:
a= protons
b= neutrons
c= electrons
d= the periodic table
e= Carbon-12 dating
f= Uranium-235
g= Answer: The patient has a fixation on exploding a nuclear bomb. She belongs in supervised housing if not the State hospital system. Supervision by a social worker at least as competent as Sharon Lerner, LCSW-C is indicated. Harbor City Unlimited flex counselors is an option. 31> What about:
a= Microsoft
b= Intel
c= Dell
d= Gateway
e= Hewlett-Packard
f= Answer: We get our computers from the Office of Procurement. The patient has nothing to say about it. In fact, we have nothing to do with it either. The patient is having gradiose delusions and belongs in the State hospital system. 32> Messages from the TV:
a= An earthquake of 7.2 on the Richter scale threatened Microsoft corporate headquarters.
b= Two planes hit the World Trade Center in New York.
c= A train carrying toxic gas derailed in the Howard Street tunnel.
d= There is now a Republican Governor of Maryland.
e= There is a potential war going on with Iraq and North Korea.
f= Answer: This only goes to show you the patient's paranoia, flights of fancy and psychosis. She belongs in the State hospital system. She doesn't have an appreciation of reality. 33> Appreciation of television commercials:
a= producing
b= directing
c= acting
d= incidental music and sound effects
e= presentation of trademark and other identifying criteria
f= Answer: The patient is still receiving messages from the TV. This is cause to increase her neuroleptic and antipsycotic. 34> Have you ever offered a prize or inducement for a patient to take a particular drug?
a= No, not really.
b= Yes, sort of.
c= The initial dose of Seroquel comes with a white plastic pill box which many patients find desirable. 35> What is the retail price of Seroquel?
a= Answer: Patient well-being is our first prerogative. Costs are secondary. Most of our patients are Medicaid or Medical Assistance anyway. [Commentary: My (private) doctor decreased the dose of Seroquel from 200 mg d to 100 mg d on our first visit. When I complained that the cost of Seroquel was still $188/month, he substituted loxapine 5 mg bid and nortriptyline 25 mg qhs. The loxapine 5 mg has since gone to qhs. Over the Internet, 3 months of nortriptyline recently came in at $18.97 - 2 months of loxapine 5 mg $41.50. This (successful) regimen has been going on since August 2001. Compare with the Outpatient Department of UMMS during 2000.] 36> Identify the following people:
a= Dean Rusk
b= Henry Kissinger
c= Madeleine Albright
d= Colin Powell
e= Answer: I never heard of any of these people so it's grandiose and delusional. It IS however tangential with impaired reality features. Government conspiracy. Psychotic - belongs in the State hospital system. Qualifies for involuntary commitment. 37> The patient has an Internet website: Have you seen it:
a= Deng: Goop. Glomp. Yang. Yin. Gondwallah. Gook. Yump. Dim. Sung. Foom. Glop. Wang! Wang!
b= Joseph Mullen: It was incomplete sentences. It was all out of order and it didn't make any sense. I chose to disregard 15 years with the Division of Correction and anything autobiographical.
c= Jennifer Oldham: No, nothing she does or shows me is relevant. "Bipolar Realities" is all I needed to know to cripple her with massive doses of a neuroleptic.
d= Udebuiwa: No. My first year residents tell me everything. 38> What's the difference between:
a= loxapine and Loxitane
b= nortriptyline and Pamelor
c= Lasix and furosemide
d= lithium carbonate and calcium carbonate
e= Answer: No difference at all. It's all up to the medical transcriptionist. The medical transcriptionist has judgment and discretion. We just sign whatever comes back up. 39> Has the patient ever indicated what word processing software she is
adept at?
a= Deng - Wang! Wang!
b= Nichols - No, the mini-mental exam doesn't have to do with that. All it does is tell you that the patient has no insight and no judgment.
c= Mullen - Now that you think of it, it says in small print on the bottom of her website that it was done in PC-Outline 1.08B and Word Perfect 5.1. [She only could have done that with a knowledge of HTML. I haven't the slightest idea what HTML is.] But the patient is unreliable because she is grandiose, delusional and psychotic. I know mental illness when I see it. I personally have not gotten past Windows 95 and the command line of Internet Explorer where it says, "GO".
d= Oldham - Whatever she does or says is irrelevant. I don't read anything she has done. I don't have to to be told she belongs in the State hospital system. [I can't tell software from hardware. I can't navigate a computer keyboard.]
e= Udebiuwa: If the first year resident does not report it, it does not exist. However, it has since been brought to my attention over her fax machine that she is pretty good with Microsoft Word. 40> UMMC - The patient sits by herself, smiling to herself. We don't bother ourselves with verbal cues.
a= UMMS Answer: The patient is psychotic. She is hearing voices. 41> Spring Grove: The patient sits by herself, smiling to herself. She does not respond to verbal cues.
a= Spring Grove Answer: She is plugged into a transistor radio all or most of the time. Her hearing needs to be checked. 42> What are the criteria for assignment to the State hospital system?
What patient criteria count for nothing?
a= imagination
b= creativity
c= initiative
d= predetermined as taught by the attending
e= Black English
f= Answer: All of the above 43> Historical perspective: What came first - the telegraph or the
telephone?
a= I don't know.
b= I never really thought about it.
c= Answer: The patient's mind is disordered and cannot distinguish time or place. Her thinking is tangential. She belongs in a supervised setting such as a State hospital. 44> Who invented the telephone?
a= Alexander Graham Bell
b= Thomas Alva Edison
c= Enrico Marconi
d= Answer: This is a tough one to answer. I hate multiple choice tests. The patient is being obstructive and has no consciousness of the consequences of her actions. She belongs either in supervised housing or the State hospital system. 45> What court has jurisdiction over persons involuntarily committed?
(asked of Jennifer Oldham, first year resident, upon filing of
Petition of Writ of Habeas Corpus)
a= I don't recognize court
b= I don't recognize jurisdiction
c= I don't understand the concept of habeas corpus
d= I don't use the word "nigger" to describe you because I'm a "professional" - I use the word "patient" instead
e= I never heard the word "cognizable"
f= I'm a Lesbian
g= You belong in the State Hospital System
h= nothing you tell me is cognizable by me
i= patients are second or third class citizens
j= [Comment: When I was her age, I was reading Strickland v. Washington, Gideon v. Wainwright, and Miranda v. Arizona not to mention Bates v. O'Steen] 46> What do the following people have in common:
a= Isaac Newton
b= Renee Descartes
c= Georg Frederick Handel
d= Abraham Lincoln
e= Answer: All their social security numbers were rejected by the computer. By reference, their patient numbers are invalid. Maryland Health Partners authorization could not be obtained. 47> Bureaucritazation - Abdication of Responsibility: What do you do when you know for a fact that the social worker is mentally insufficient or defective?
a= A professional is a professional is a professional.
b= A job is a job is a job.
c= Answer: Rely on the person as if she were reliable. Meanwhile, the patient qualifies for involuntary commitment. 48> Who is stupider?
a= Sharon Lerner, LCSW-C
b= Janis Raynor, MSW
c= Answer: This is an unfair question. Both of these females is stupid. But both of these females have advanced degrees which obviate the question. In the case of Janis Raynor, it it more a matter of ignorance and malignancy. Fuck the patient. 49> What government entity has the MOST to do with the practice of
psychiatry?
a= FTC
b= FDA
c= SEC
d= Answer: Government conspiracy. Grandiose. Delusional. Impaired reality testing. Advanced psychoses. Destined for the State hospital system. Qualifies for involuntary commitment. No sense of boundaries. I don't know what any of those letter combinations means. 50> What television did she watch while a patient on the ward:
a= News and information
b= Jerry Springer
c= Maury Povich
d= NCAA basketball
e= Professional basketball
f= Eclectic basketball
g= Harlem Globetrotters
h= Answer: I don't know and I don't care. 51> What's the difference between the Parthenon and the Pantheon?
a= I'm a Lesbian and my opinions mean something.
b= This shows definitely schizo-affective disorder. The patient belongs in the State hospital system. 52> What's the difference between:
a= 1776
b= 1876
c= 1976
d= Answer: Paranoid delusions. Impaired reality testing. Loose associations. Belongs in the State hospital system. 53> Where do black patients belong?
a= If they speak Black English, they are schizophrenic.
b= Schizophrenics belong in group homes or in the State hospital system.
c= There is no cure or treatment for schizophrenia except Zyprexa.
d= The determination of a first year resident is definative. 54> What parts of the Bill of Rights of the U.S. Constitution are
abridged by voluntary or involuntary commitment?
a= 1st
b= 4th
c= 5th
d= 6th
e= 8th
f= 14th
g= Answer: We don't get the U.S. Constitution in med school. We only do what we feel we should do. We don't know the word "abridge". If we wanted to know this stuff, we would have gone to the Law School, if we could get in. 55> What does the emergency room have to do with the eventual destination of the patient?
a= Answer: Not a whole lot. We use the labs to justify detention. As long as we have a commitment order, we can disregard any findings down there. What we decide upstairs is entirely up to us at our discretion. We rely heavily on authoritative informants like Sharon Lerner, LCSW-C. No sense of boundaries. 56> Which preference is most indicative of recovery from three months in a mental hospital?
a= Bartok
b= Borodin
c= Prokofiev
d= Rachmaninov
e= Rimsky-Korsakov
f= Moussorgsky
g= Kabalevsky
h= Shostakovich
i= Tchaikovsky
j= Answer: The patient continues to speak gibberish. This is indicative of her continuing psychoses and alienation from reality. She requires continuing monitoring and close aftercare. Supervision by Harbor City Unlimited is recommended. [Comment: Bartok wasn't Russian, he was Hungarian.] 57> Outside their vocabulary:
a= affective
b= appraise
c= attention span
d= curiosity
e= discrimination
f= doubt
g= empirical
h= equanimity
i= eye-hand coordination
j= insight
k= judgment
l= levity
m= mirth
n= mood
o= ordinance
p= perjury
q= petition
r= redress
s= regulation
t= sarcasm
u= sophisticate
v= sophistication
w= spatial relationships
x= spirituality
y= spontaneity
z= statute
aa= tact
ab= uncertainty