Anxiety ***

Question 1

RF for anxiety

Answer 1

Fam hx, childhood anxiety, stress, abuse

Question 2

Sx

Answer 2

Restlessness
Palpitations
SOB
Hyperventilation
CP
Sweating
Dyspepsia
Fatigue
Insomnia
Dizziness
Abdo pain

Question 3

GAD

Answer 3

Excessive + difficult to control anxiety + worry
Restlessness, feeling on edge or muscular tension

Question 4

panic disorder

Answer 4

Recurrent, unexpected attacks in absence of triggers
Concern about future attacks
Sweating, trembling, derealisation, palpitations, nausea, tingling

Question 5

PTSD

Answer 5

Exposure to actual or threatened death
Flashbacks
Nightmares
Hypervigilance or irritability
Avoidance of stimuli
Negative alterations in cognition and mood

Question 6

OCD

Answer 6

Obsessions - recurrent, persistent thoughts, causes anxiety
Compulsions - behaviours that pt must do to help anxiety

Question 7

agoraphobia

Answer 7

Fear about situation
Avoidance of situation due to fear that it would be difficult to escape from

Question 8

phobias

Answer 8

Fear about certain object - restricting lifestyle
Exposure almost always causes reaction
Avoidance of situation

Question 9

social anxiety

Answer 9

Fear of social situations in which there is a possibility of scrutiny
Avoidance of social situations because of this
Can use Liebowitz social anxiety

Question 10

Substances that can cause anxiety

Answer 10

Amphetamines
Cocaine
Withdrawal from alcohol
New use of marijuana

Question 11

GAD score thresholds

Answer 11

5-9 = mild anxiety
10-15 = moderate
15+ = severe

Question 12

What to ask in anxiety history, other conditions to r/o

Answer 12

Other psychiatric conditions (other anxiety disorders, MDD)
Functional screen - MOAP
Mood (depression, mania)
Organic causes (substance use, delirium)
Anxiety (obsessions, compulsions, panic)
Psychosis (hallucinations, delusions)
Suicide
Hyperthyroidism
Pheochromocytoma
Cardiac/ pulmonary disease
Central structural pathology
Hypoglycemia
Substance use

Question 13

Labs for new anxiety presentation

Answer 13

CBC
Fasting lipids
Fasting glucose
TSH
Liver enzymes
Electrolytes
Urine tox

Question 14

Rx for anxiety (not inc pharmacotherapy)

Answer 14

Self management - BounceBack or apps
Community resources - support groups
Regular FU in office
Refer to psychiatry or psychology
Counselling
Exposure
Safety response inhibition
Corrective strategies
Arousal management
Surrender of safety signals
Pharmacotherapy

Question 15

Rumination disorder + rx

Answer 15

repeated regurgitation of food, rx w/ habit reversal and breathing exercises

Question 16

Risks of benzo use

Answer 16

physical dependence, psychological dependence, falls risk

Question 17

What is azaprione and when do you use it?

Answer 17

Buspirone - used as an adjunct in anxiety

Question 18

Best tolerated, most effective meds for GAD

Answer 18

duloxetine, pregabalin, venlafaxine, escitalopram. Also effective: sertraline

Question 19

Rules for prescribing benzos

Answer 19

avoid in elderly, avoid high doses, address fear, consider dependence, don’t combine w/ opioids

Question 20

Rx for tourette’s

Answer 20

tetrabenazine or risperidone (dopamine blockers), botox, habit reversal training

Question 21

Pica causes

Answer 21

behavioural/ delusional e.g. schizophrenia, autism or anemia, malnourishment

Question 22

Pica Rx if behavioural

Answer 22

methylphenidate (CNS stimulant), olanzapine

Question 23

Complication of pica

Answer 23

FB, obstruction, bezoar - need XR

Question 24

Sx of panic attack

Answer 24

sweating, hot flashes, nausea, tachycardia, SOB, tingling, fear of dying, CP, choking

Question 25

Other forms of anxiety disorder

Answer 25

specific phobia, social anxiety disorder, panic disorder, agoraphobia, unspecified anxiety disorder