Diagnoses - Part 1 of 4 Flashcards
1
Q
7 y/o child is brought in by parents who report he’s been hyperactive since age 4, talks constantly, interrupts, has trouble sitting still to do homework, will not play quietly outdoors. What else do you need to make the diagnosis of ADHD? (4x)
A
TEACHER REPORT
2
Q
Studies show effective intervention for children with ADHD is to involve their parents in what part of Tx? (4x)
A
BEHAVIORAL MANAGEMENT
3
Q
Child w ADHD ineffective Tx with methylphenidate. Next step in management: (4x)
A
DEXTROAMPHETAMINE
4
Q
Child w ADHD not respond to methylphenidate IR. What med to try next (4x)
A
MIXED AMPHETAMINE SALTS
5
Q
What aspect of ADHD is most likely to improve as children age? (3x)
A
HYPERACTIVITY
6
Q
Atomoxetine’s principal mechanism of action exerts a therapeutic action because it: (2x)
A
IS A SELECTIVE NOREPINEPHRINE REUPTAKE INHIBITOR.
7
Q
Atomoxetine is most likely to be considered as initial treatment in ADHD in adolescents with: (2x)
A
SUBSTANCE USE D/O
8
Q
The multimodal Tx study of children w/ ADHD examined the comparative responses over 14 months of children to medication and intense psychosocial interventions. What did the findings of the study reveal w/ respect to ADHD symptom changes? (2x)
A
MEDICATION MANAGEMENT IS SUPERIOR TO COMMUNITY CARE TREATMENT
9
Q
The component of ADHD that is most likely to remain in adulthood:(x2)
A
INATTENTION
10
Q
Which perinatal factor is specifically associated with development of ADHD?
A
MATERNAL TOBACCO USE PRENATALLY
11
Q
Which DSM-V diagnosis requires symptoms to be present in 2 or more settings?
A
ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD)
12
Q
Current thinking about relationship between ADHD in children and adults:
A
SIGNIFICANT NUMBER OF CHILDREN WILL GO ON TO BECOME ADULTS WITH ADHD
13
Q
8 y/o boy w/ ADHD, oppositional defiant disorder, and chronic motor tic disorder has worsening of his tics on a good dose of a stimulant that seems to control his ADHD. How do you manage this further in trying to improve the tics?
A
MONITOR THE TICS ONLY
14
Q
Which comorbid diagnosis of childhood ADHD worsens the prognosis into adolescence and adulthood to the greatest degree?
A
CONDUCT DISORDER
15
Q
32 y/o w/ ADHD mixed type as child. As adult still has Sx. Tx:
A
METHYLPHENIDATE
16
Q
Which med would you prescribe for 20 y/o college student being worried over his grades? He complains that he has not been able to focus on studying and that his mind wanders frequently during classes. His energy level is low. He sleeps well and his appetite is good. History indicates he was treated with stimulants since second grade.
A
METHYLPHENIDATE
17
Q
10yo w ADHD and aggressive outburst is started on a moderate dose of a stimulant. ADHD symptoms have improved, but aggression has not. In addition to behavioral intervention, what is the next best step to manage both the ADHD and aggression?
A
MAXIMIZE DOSAGE OF LONG ACTING STIMULANT
18
Q
Which psychiatric disorder is comorbid with ADHD?
A
DISRUPTIVE BEHAVIOR DISORDERS
19
Q
Which of the following side effects can result from stimulant medication treatment and warrants immediate discontinuation of the medication and a reassessment of the treatment plan?
A
HALLUCINATIONS
20
Q
Abnormal LFTs would be most commonly associated w/ what medication used to treat ADHD in children/adol?
A
PEMOLINE
21
Q
ADHD comorbid disorder
A
DEPRESSION
22
Q
These empirical non-stimulant meds have empirical support to treat ADHD:
A
CLONIDINE, BUPROPION, IMIPRAMINE, ATOMOXETINE
23
Q
What procedure is necessary to diagnose childhood ADHD?
A
CLINICAL INTERVIEW OF PARENTS AND CHILD
24
Q
Parents bring their 10 yo child for an eval due to concerns about child’s reported difficulty paying attention in a class and completing assignments in the expected time. Parents report that the child has trouble staying on task while doing homework and they are concerned that the child has an attention disorder. At the completion of the eval, the psychiatrist requests that both a parent and a teacher fill out a rating scale. The parent ratings fall into the clinical range but the teacher’s ratings do not meet criteria for a clinical problem. How should the psychiatrist account for the differences in observed ratings?
A
RATING DISCREPANCIES BY DIFFERENT OBSERVERS ARE COMMON IN CLINICAL PRACTICE.
25
Antidepressant for ADHD
BUPROPION
26
With respect to ADHD symptoms, the 1999 multimodal treatment study of children with ADHD was most notable for demonstrating which of the following?
THE EQUIVALENCE OF COMBINED METHYLPHENIDATE AND PSYCHOSOCIAL TREATMENT COMPARED TO MEDICATION ALONE
27
Which of the following instruments is most helpful in the assessment of children suspected of having ADHD?
CONNERS TEACHER RATING SCALE
28
What med used for ADHD has been associated with liver damage?
ATOMOXETINE (STRATTERA)
29
11 y/o with reading disability. Most likely comorbid dx:
ADHD
30
Describes the relationship of stimulant treatment of children with ADHD and the emergence and/or presence of tic d/o:
TREATMENT WITH STIMULANTS HAS BEEN SHOWN TO REDUCE TICS IN CHILDREN WITH COMORBID ADHD AND TIC D/O.
31
What DSM-IV-TR disorder requires symptoms to be present in two or more settings?
ADHD
32
12 yo comes in for worsening attention, impulsive, and hyperactive. He is snoring and hard to wake in the AM. Central adiposity, broad based neck and enlarged tonsils. exam is unremarkable. In child with ADHD and sleep problems, what is the most accurate about ADHD and sleep in this patient?
CORRECTING THE UNDERLYING SLEEP DISORDER CAN IMPROVE ADHD SYMPTOMS
33
5 y/o is evaluated for ADHD. Parents complain that the child has multiple symptoms of hyperactivity, impulsivity, inattention, and distractibility. Parents also bring teacher feedback reports that confirm these symptoms and state child is failing academically and having social problems. In psych MD office child is quiet, calm and cooperative, and very engaging . The difference in clinical presentation from parent and school reports is most likely because:
CHILDREN WITH ADHD CAN PRESENT WITH BRIEF PERIODS OF HEIGHTENED FOCUS AND CALM, ESPECIALLY IN A STRUCTURED SETTING.
34
Failing grades, poor organization, spending sprees, spontaneous trips ditching class, fidgety, euthymic. No change in sleep, appetite, no anhedonia. Dx?
ADHD
35
When compared to the other subtypes of ADHD, children with the inattentive subtype have higher rates of anxiety and somatic complaints and
LEARNING DISORDERS
36
DSM 5 prior age of presentation ADHD symptoms
12 YEARS OLD
37
Increased rate of comorbidity with ADHD?
ANXIETY OR OPPOSITIONAL DEFIANT DISORDER
38
10yr old child, 3 yr hx of involuntary movements and vocalizations, symptoms wax and wane but never disappeared, child is aware of symptoms and only mildly distressed, academic performance is below average, what is the co-occurring disorder most likely causing this functional impairment at school?
ADHD
39
What distinguishes ADHD in children vs adults?
HYPERACTIVITY
40
What aspects of ADHD is likely to improve as children age?
HYPERACTIVITY
41
Best neuropsych test of sustained attention
CONNER’S CONTINUOUS PERFORMANCE TEST
42
A diagnostic feature of panic attack is: (2x)
DEREALIZATION
43
Respiratory illness is most clearly a risk factor for developing which anxiety disorder? (2x)
PANIC DISORDER
44
Differential diagnosis of pt presents at ED with panic d/o: (x2)
PULMONARY EMBOLISM
45
28 y/o pt presentes with one year history of agoraphobia. Pt is able to drive to the local drug store, but only with considerable pre-travel apprehension. Pt will venture alone no further than within approximately 5 miles of home. Personal hx of panic attacks or depression is denied, although family hx is positive for depression and alcoholism. Pt has had no previous treatment. The best initial treatment and one that offers the best long term prognosis is? (x2)
CBT INCLUDING EXPOSURE & SSRI AND BENZO
46
Repeat ED visits for CP, negative, most important
H/O OF PAIN ON EXERTION RELIEVED BY REST
47
Tx for med student w/ chronic anxiety and sense of inadequacy?
BRIEF PSYCHODYNAMIC THERAPY
48
When compared to younger adults, anxiety disorders in adults over age 65 have:
LESS COMORBIDITY WITH ALCOHOL ABUSE
49
Which of the following strategies exemplifies use of reciprocal inhibition by a patient to attenuate anxiety associated with a party?
REHEARSING MENTAL IMAGES OF PLEASURABLE EXPERIENCES WHILE ATTENDING THE PARTY
50
Best therapy for patient with illness anxiety disorder
CBT
51
The parent of a 43 y/o pt died 5 years ago from pancreatic cancer. 4 years ago patient began feeling full after eating large fatty meals, fearing it was pancreatic cancer. Constantly weighs himself so that he is not losing weight. Now avoids going to doctor to avoid being diagnosed with cancer. No other psychiatric symptoms. What is diagnosis?
ILLNESS ANXIETY DISORDER
52
Treatment for severe performance anxiety
PROPRANOLOL
53
36 y/o with several episodes of palpitations, sweating, trembling, SOB. Work suffering due to anxiety. Initial Tx regimen:
PAROXETINE AND CBT
54
Which of the following agents has been shown to augment the effects of CBT on anxiety disorders?
D-CYCLOSERINE
55
Weight loss, 3-month hx of anxiety, mild depression, & insomnia, thin, elevated HR, low BP, mild tremor
HYPERTHYROIDISM
56
Prevalence of separation anxiety d/o and GAD in children follows what pattern with regard to age?
GAD INCREASES WITH AGE WHILE SEPARATION ANXIETY DECREASES WITH AGE
57
What disorder is most likely to be comorbid in pts w trichotillomania?
MOOD DISORDER
58
In some Japanese and Korean cultures, rather than an intense fear of embarrassing oneself socially, social phobia symptoms may instead manifest with intense fear of what?
OFFENDING OTHERS
59
Which of the following is a common medical cause of anxiety in a pt dying of cancer?
POORLY CONTROLLED PAIN
60
18 y/o restless, feels mind going blank, poor concentration, irritability, insomnia, fatigue > 1 yr, used to be good student up until 2-3 yrs ago, no substance use
GAD
61
Core feature of GAD
EXCESSIVE WORRYING
62
35 y/o truck driver diagnosed w/ GAD. Does not want med that causes sleepiness:
BUSPAR
63
Psych MD was consulted for anxiety and depression. Pt reports severe pain and indicates that doctors refuse to prescribe enough medication to control pain. A factor important for psychiatrist to consider:
ACUTE PAIN IS OFTEN UNDERTREATED, AND POOR PAIN MANAGEMENT CAN CONTRIBUTE TO ANXIETY AND DEPRESSION.
64
Pt with leukemia underwent marrow transplant. Psych consulted. Pt more anxious and fearful about leaving hospital. Having trouble sleeping. MSE unremarkable. Dx? (x2)
ADJUSTMENT DISORDER WITH ANXIETY
65
A 45yr old pt, terminated treatment with previous PCP "because he didn’t take my concerns seriously." Pt believes he has dreaded illness and stomach cancer, denies all symptoms and labs are normal, diagnosis?
ILLNESS ANXIETY DISORDER
66
Generalized anxiety disorder is characterized by excessive worrying along with what combination of symptoms?
BEING EASILY FATIGUED AND FEELING KEYED UP
67
A 19-yo college student complains of “difficulty concentrating and my mind going blank when I try to study.” She feels restless, keyed up and worries excessively. Does not use substances.
GAD
68
55yr old Hispanic American brought to psychiatrist by family, spells of uncontrollable shouting, crying, trembling, insomnia, pt feels chest heat going up to head, pt and family believe pt is suffering ataque de nervios, pt meets criteria for?
ANXIETY DISORDER
69
What is the principle goal of the cognitive-behavioral therapy of panic d/o?
USING RESTRUCTURED INTERPRETATION OF DISTURBING SENSATIONS
70
Which clinical feature distinguishes panic disorder from pheochromocytoma?
ANTICIPATORY ANXIETY (in panic d/o)
71
Panic attack reaches peak in
A FEW MINUTES
72
Psych MD in the ED evaluates a 67 y/o pt w/ h/o depression who c/o panic attacks since the death of her spouse 1 month ago. Pt has frequent episodes of acute-onset palpitations, chest tightness, nausea, shortness of breath, and intense anxiety lasting several minutes, with no specific triggers. This morning it woke her up from her sleep. Exam: overweight, pale, anxious appearing, and mildly diaphoretic. Her BP is 140/90, pulse 106. Most appropriate next step in management?
EKG
73
Pt w panic disorder failed 2 SSRI trials. Which med should be used next?
IMIPRAMINE
74
32yo h/o panic disorder, phobias, numerous failed trials of antidepressants. On clonazepam 0.5mg bid with good response. 1mo later response still good but not as good. Dose increased to 1mg bid, on 3rd visit pt reports some loss of benefit again. What is the appropriate course of action?
INCREASE TO 1.5MG PER DAY
75
Compared to pharmacotherapy, advantage of CBT in tx of panic disorder is
LOWER RATE OF RELAPSE FOLLOWING D/C OF TREATMENT
76
Once it becomes effective, pharmacological tx of pts with panic d/o should generally continue for what length of time?
8-12 MONTHS
77
This statement best characterizes current information on the recommended initial treatment of psychotherapy or pharmacotherapy for a pt with panic disorder:
THERE IS INSUFFICIENT DATA TO CHOOSE ONE TREATMENT OVER ANOTHER, OR COMBINATION OVER MONOTHERAPY
78
42 y/o surgeon experienced intense stomach cramps and palpitations when unable to immediately find the right instrument when performing an appendectomy. The surgeon was extremely alarmed by this and began to worry about the symptoms recurring. The surgeon then traded all ED calls so as to avoid these situations, began to avoid other crowded and noisy environments, and avoided a variety of social and professional settings. Likely diagnosis:
AGORAPHOBIA WITHOUT PANIC
79
A diagnosis of panic d/o requires which of the following?
AT LEAST SOME ANXIETY ATTACKS THAT ARE UNPROVOKED
80
First-line treatment of panic disorder?
FLUOXETINE
81
Using cash only due to substantial discomfort while writing checks or signing credit card receipts in the presence of others (because of messy handwriting)?
SOCIAL ANXIETY DISORDER
82
Boys with ___are most likely to delay first sexual intercourse until after 18 yo.
ANXIETY SYMPTOMS
83
College student feels embarrassed with public speaking or choosing seat in cafeteria and experiences blushing, muscle twitching, and shame. Endorses sadness about not having friends. What is dx?
SOCIAL ANXIETY DISORDER
84
Patient with self reported concerns of brain tumor; no symptoms suggestive of brain tumor, but states he has a cousin who died of brain tumor. PE unremarkable. Neuroimaging negative, patient repeatedly requests MRI, still concerned about tumor. Dx?
ILLNESS ANXIETY D/O
85
62 y/o requests antidepressant. Spouse died 6 wks ago. Crying spells, decreased appetite, poor sleep. Continues to see friends, no SI. Fam Hx of depression, no prior depressive episodes (3x)
BEREAVEMENT; ASSURE PATIENT OF NO PATHOLOGY
86
Which of the following factors has the most evidence to support its protective effect in bereavement following the loss of a spouse? (x2)
QUALITY OF SOCIAL SUPPORT OF THE BEREAVED
87
Most likely to increase risk of impairment after bereavement in 80 y/o (X2)
SIGNIFICANT DEPRESSIVE SXS SHORTLY AFTER THE LOSS
88
Normal bereavement in prepubertal children
WISH TO UNITE W/ DEAD LOVED ONE
89
Most common fear expressed by adults leaving home to go to hospice?
SEPARATION FROM LOVED ONES
90
5 y/o child several month after that he lost his mother in a MVA reports that his mother is watching him from sky every day is and example of:
NORMAL GRIEF
91
8yo w/ no hx of emotional disturbance p/w separation anxiety & over-concern for health of surviving parent.
AGE-TYPICAL PRESENTATION OF NORMAL BEREAVEMENT
92
For adult, death of loved one by violent means affects grieving process in what way?
EARLY BEREAVEMENT IS SIMILAR, HOWEVER, DYSPHORIA PERSISTS FOR PROLONGED PERIOD
93
A father wants to know if he should allow his 5 y/o child to attend the funeral of her mother. The child expresses a desire to go. To help the child through the funeral, it will be important to do which of the following?
HAVE SOMEONE FAMILIAR ACCOMPANY THE CHILD
94
62 y/o pt presents to psychiatrist requesting med for depression. Detailed hx reveals pt’s spouse of 35 years died suddenly 6 wks ago. Since then, pt complains of frequent crying spells, decreased appetite without weight loss, and poor sleep due to middle of the night awakening. Pt continues to attend social engagements with friends and denies SI. Pt has family hx of depression, no hx of depressive episode in past. Dx:
BEREAVEMENT
95
What factor is necessary to consider when deciding if a patient’s grief is defined as normal or abnormal?
CROSS-CULTURAL GRIEF PRACTICES
96
What symptom best differentiate chronic traumatic grief from uncomplicated bereavement?
PERSISTENT AVOIDANCE OF DEATH REMINDERS
97
Pt is engaged in interpersonal psychotherapy for depression. In the first several sessions, the patient and therapist identify unresolved grief after the death of the patient’s mother as the problem area, and relate these feelings to the patient’s current depression. Which of the following will be the focus of the middle phase of treatment?
FINDING NEW ACTIVITIES AND RELATIONSHIPS TO OFFSET THE PATIENT’S LOSS
98
5 y/o has been enuretic after mother died in an MVA 4 days ago and keeps saying, "Mommy will come home soon." The father wonders if the children should attend the funeral. What is your recommendation?
THE CHILD AND SIBLING SHOULD BOTH BE ALLOWED TO ATTEND IF THEY WANT TO GO.
99
Which symptom would indicate MDD rather than just bereavement: Poor appetite and sleep, hearing the voice of the loved one, feelings of guilt or thoughts of suicide?
THOUGHTS OF SUICIDE
100
30 y/o pt recently Dx w/ Hodgkin’s dz constantly states, “Why me?” According to Elizabeth Kubler-Ross, the patient’s reaction is consistent with what phases?
SHOCK AND DENIAL
101
What is a symptom of normal bereavement in a <5 y/o child after the death of a parent?
REGRESSION IN BOWEL AND BLADDER CONTROL
102
4 months ago the wife of a pt died and pt blames himself for her death. Next step:
REASSURANCE
103
60 y/o lost spouse 2 wks ago – sadness comes and goes
NORMAL GRIEF
104
65 y/o pt initially diagnosed w bereavement. Duration of sx to dx MDD?
2 MONTHS
105
58 y/o have week’s h/o intense feelings of sorrow and bitterness only 6 mos after wife’s death. “We would have been married 30 yrs this month.” His daughter confirmed his level of functioning only took a dip a week ago. Moderate diff sleeping and poor appetite only assoc Sxs. No SI. Physical exam normal. Dx:
DELAYED GRIEF
106
1-month post death of loved one. What would suggest a pathological grief rxn?
CONTINUED FEELINGS OF WORTHLESSNESS
107
Risk factor that can adversely influence psych outcome of child after death of parent
CONFLICTUAL RELATIONSHIP W/ DECEASED PARENT
108
6 y/o girl hosp for surgery to repair fracture sustained in MVA in which mother was injured & brother died. She reports seeing her brother in her room since accident, MSE is nml. Receiving Vicodin & Benadryl. What explains pt seeing brother?
BEREAVEMENT
109
10 y/o M s/p MVA sustained burn and crush injuries to R foot 4 days ago, does not remember the accident but never lost consciousness, keeps asking for his mother who was killed in the accident and having nightmares crying out “Daddy help Mommy.” When should the child be told about his mother’s death?
ASAP
110
45 y/o still grieving for mother 3 years after her death. States she feels her mother hovering over her and sees mother at night. Friends are concerned. Patient has normal job function, cleans house, endorses anhedonia. Tx?
ANTIDEPRESSANT MEDICATION AND PSYCHOTHERAPY
111
Risks of complicated bereavement:
1) AMBIVALENT RELATIONSHIP TO DECEASED; 2) SIMULTANEOUS GRIEVING FOR MULTIPLE DEATHS;
3) PRE-EXISTING LOW SELF-ESTEEM & INSECURITY;
4) RECURRENT MAJOR DEPRESSION
112
65 y/o pt w MDD has died by suicide. Pt had received tx from same psychiatrist x 5 yrs. Psychiatrist contacts the pt's spouse. Best way to communicate this?
CONCENTRATE ON ADDRESSING THE FEELINGS OF THE SPOUSE
113
Which of the following is predictive of better adaptation in bereavement?
FINDING MEANING IN LOSS
114
Pt w/ h/o bipolar presents w immobility, posturing, echopraxia. First line tx? (5x)
LORAZEPAM
115
What predicts bipolarity in adolescent with depression? (2x)
PSYCHOTIC SYMPTOMS
116
What medication strategies is most effective and rapid in the treatment of severe bipolar illness, manic phase? (X2)
ANTIPSYCHOTIC MEDICATION + LITHIUM OR VALPROATE
117
40 y/o w/ 6 kids: insomnia, poor appetite, dizziness/nausea, thinks husband is poisoning her. Despite all classes of meds marked fluctuations from sadness to euphoria 5x during the year. Dx? (2x)
BIPOLAR W/ RAPID CYCLING
118
First line to treat bipolar depression
QUETIAPINE
119
What med can you add to lithium for tx resistant bipolar depression and is least likely to induce rapid cycling/mixed state?
BUPROPION
120
Pts > 65 years w bipolar disorder differ from younger pts w same dx—how?
MORE MIXED EPISODES
121
77 y/o pt w/ hx of BMD, stable w/ bupropion 300mg and valproic acid 1000 mg Qday. Pt reports feeling less motivated than usual at work, able to concentrate, but taking longer to finish tasks. Denied sadness. HTN is well controlled. MMSE score 26/30. Pt has master degree. The most appropriate workup:
B12 AND HOMOCYSTEINE LEVEL
122
24-year-old w/ 1 month increasing fatigue, difficulty falling asleep, poor motivation, and trouble paying attention in night school. No personal or family hx of depression. Rx Mirtazapine 15mg qhs. After two doses, pt becomes euphoric, hyperactive, talkative, and full of creative ideas. Pt stood on a chair at night school and offered hearty congratulations to teacher for contributing to pt’s certain future success. Most likely dx?
SUBSTANCE-INDUCED BIPOLAR DISORDER
123
28 y/o woman who is at 33 weeks gestation and has a history of bipolar disorder is brought to the emergency department by family members because she was running around the neighborhood loudly proclaiming, “I am the mother of Christ.” The pt is in restraints, yelling, spitting, disorganized, and tangential, with rapid speech. Family members report that the pt was stable on valproate, but discontinued the medication when she learned she was pregnant. Which medication to give acutely for this pt?
HALOPERIDOL
124
Which med is treatment of choice for bipolar with rapid cycling?
VALPROATE
125
Psychiatrist is treating pt with bipolar disorder whose condition is relatively stable, recently reports feeling depressed. The psychiatrist is considering adding lamotrigine, however is concerned it may interact with pts current meds. Which medication interaction is psychiatrist concerned about?
VALPROATE
126
Manic episode while on carbamazepine. Good response in 2 wks. 4 wks recurrence.
AUTOINDUCTION OF EPOXIDE PATHWAY
127
Bipolar pt w/ 2 hospitalizations for mania taking lithium
NEEDS LIFETIME LITHIUM TREATMENT
128
First-degree relatives of patient with BMD II have a higher incidence of what disorder?
MDD
129
What drug is good for acute mania?
LITHIUM
130
The natural course of an untreated manic episode lasts approximately what length of time?
3 MONTHS
131
The presence of adverse life events has been associated with precipitation of which of the following aspects of bipolar disorder?
DEPRESSIVE EPISODE
132
32 y/o w/ diarrhea x 2 wks, is anxious, and not oriented to date/time of day. Taking “some drug” for BMD and patient doubled her dose a month ago when she felt she wasn’t getting better fast enough. What med caused these Sx?
LITHIUM
133
42 y/o pt with episodes of feeling “sad and down” accompanied by decreased energy/interest in activities. Pt estimates these episodes occurred at least four times in his life, lasting 2-3 weeks at a time. During episodes, spends most of the time in bed. Most recent episode of sx ended 1 week ago. Since then, pt reports feeling energetic and “on top of the world.” He now sleeps only 1-2 hours a night, wakes feeling refreshed. Friends remark pt seems flighty, but pt notes no deleterious effect of the mood change and finds that his productivity at work is the best it has ever been. Most likely Dx:
BIPOLAR II DISORDER
134
27 y/o pt w/ BMD I, has been stabilized as an outpt one month following a hospitalization, and is now receiving weekly med management and supportive psychotherapy. Pt has been euthymic for the past 2 wks, but today does not show up for a scheduled appointment. The most appropriate response by the psychiatrist is?
CALL THE PT TO EXPRESS CONCERN AND FIND OUT WHY THE PT DID NOT MAKE THE APPOINTMENT
135
BMD II with rapid cycling have higher prevalence of what endocrinologic dysfunction?
HYPOTHYROIDISM
136
This is a risk factor for the rapid cycling form of bipolar disorder
FEMALE SEX
137
What symptoms are seen in a manic episode but not in MDE?
FLIGHT OF IDEAS
138
Suggest underlying bipolar in 27 y/o F who presents w/ first major depressive episode:
FAMILY HX OF BIPOLAR
139
Bipolar w/ 4+ manic episodes / yr for 3 yrs. Treatment of choice?
CARBAMAZEPINE, 1200 MG DAILY
140
DSM-IV defines h/o major depression plus hx of mixed manic and depressive episode as:
BIPOLAR DISORDER, TYPE I
141
Hx of MDD, irritable, restless, distractible, insomnia, poor appetite, guilt, impulsive spending
BIPOLAR D/O, MIXED
142
Male and female prevalence rates are comparable for which of the following disorders?
BIPOLAR DISORDER
143
bipolar disorder pt with multiple arrests for violences exhibits threatening behaviour and threatens to harm ex-gf. what is your legal responsibility
INFORM POLICE THAT PATIENT IS POTENTIAL DANGER
144
23 y/o in ER after a party. Dehydration, dilated pupils, HTN, elevated CPK. Which drug did he take? (7x)
MDMA
145
35 y/o pt in ED presents w hypoventilation, blue lips, pinpoint pupils, crackles on lung auscultation, mild arrhythmia on EKG. Most likely drug of abuse: (4x)
CODEINE
146
A state of general fatigue, hypersomnolence, and depression may be seen during a patient’s withdrawal from: (4x)
COCAINE
147
While intoxicated with a psychomimetic drug, a young man reports “seeing sounds” and “patterns of colors like fireworks or colored flames” associated with real auditory stimuli. What best describes this type of sensory experience? (3x)
SYNESTHESIA
148
After Cannabis ingestion (in chronic use) it can be detected in urine how long? (3x)
ONE MONTH
149
The large number of CB1 cannabinoid receptors found in the hippocampus best explains cannabis’ negative effects on: (2x)
SHORT TERM MEMORY
150
Acute caffeine withdrawal symptoms include: (2x)
HEADACHE
151
What is NOT likely to be an effective intervention for a physician with a substance abuse problem? (2x)
OBSERVING THE PATIENT UNTIL HE/SHE BECOMES MOTIVATED TO SEEK TREATMENT
152
Which drug causes euphoria, a feeling like “flying above the dance floor,” social withdrawal, nystagmus? (2x)
KETAMINE
153
What does the pentobarbital challenge test do? (2x)
ESTIMATES THE STARTING DOSE OF PENTOBARBITAL USED FOR BARBITURATE DETOXIFICATION
154
Person who smokes a pack of cig/day stops smoking and has need for cig after every meal. This is... (2x)
ENVIRONMENTAL TRIGGER
155
Motivational interviewing of patients with addictive disorders addresses what? (2x)
AMBIVALENCE ABOUT BECOMING DRUG FREE
156
Maximum duration of PCP in the urine: (2x)
8 DAYS
157
40 y/o dentist is referred for evaluation by staff members who are concerned about his erratic behavior, staying excessively late at the office and problems with dexterity in treating pts. He complains of numbness and weakness of limbs, loss of dexterity, and loss of balance. Which drugs is the dentist most likely abusing? (2x)
NITROUS OXIDE
158
Best describes the intervention goal associated with contemplation stage of substance abuse treatment using motivational enhancement therapy: (2x)
ACKNOWLEDGE AMBIVALENCE AND EVOKE REASONS TO CHANGE
159
Neurotoxicity associated with MDMA is associated with deficits in neurons that produce which of the following neurotransmitters? (2x)
SEROTONIN
160
18 y/o pt in ER w/ a clouded sensorium, agitation and hyperactivity, mild paranoia, pressured speech, and euphoric, though labile mood. On exam: HTN, tachycardia, and vertical nystagmus. The most likely used? (3x)
PHENCYCLIDINE (PCP)
161
17 y/o pt is brought to the ER by friends who report that he ingested a drug 2 hours earlier. Pt’s behavior after the drug ingestion as relaxed and tranquil but talkative. Soon after, the pt c/o drowsiness, dizziness, and nausea. On exam, pt has labile level of consciousness. The drug screen is negative for benzodiazepines, barbiturates, and opioids. Psych MD alerts ED to the possibility of imminent respiratory difficulty. What drug most likely caused this condition? (2x)
GAMMA-HYDROXYBUTYRATE (GHB)
162
Substance found in several over-the-counter symptom cold remedies and is abused to produce a dissociative feeling: (2x)
DEXTROMETHORPHAN
163
Psychotherapy for addiction utilizes a disease-model approach and emphasizes acceptance of the disease and surrender to help beyond oneself: (2x)
12-STEP FACILITATION
164
Drug of abuse associated with sxs of bruxism, anorexia, diaphoresis, decreased ability to orgasm, and hot flashes: (2x)
MDMA/ECSTASY
165
A muscular male patient presents to an outpatient psychiatric clinic complaining of discomfort in public places and excessive irritability. Though warm outside, the patient is dressed in heavy, baggy clothes, making him appear bigger than he is. The patient’s belief that he is shrinking greatly distresses him. Which of the following is the most likely diagnosis for the patient? (2x)
ANABOLIC-ANDROGENIC STEROID ABUSE
166
17 yo pt brought to ED after reporting recent cocaine use to teacher. In ED pt is agitated, hyperaroused, unable to concentrate on interview. Pt denies hallucinations, however appears very distractible, frightened. Physical exam shows HR 100, normal rhythm. What is most appropriate intervention to give? (x2)
LORAZEPAM 2 MG
167
The class of meds with greatest prevalence for prescription drug abuse (x2)
PAIN RELIEVERS
168
Which dx criteria helps to establish dx of substance dependence vs. abuse? (x2)
RECURRENT UNSUCCESSFUL EFFORTS TO CONTROL USE
169
Easiest biologic sampling to falsify when testing for drugs?
URINE
170
Which electrolyte abnormality is associated with MDMA use?
HYPONATREMIA
171
What is the most efficacious treatment of tobacco-use disorder?
VARENICLINE (CHANTIX)
172
What is a very common impulse control d/o NOS?
PATHOLOGIC GAMBLING
173
Pathological gambling is included in what grouping:
IMPULSE CONTROL D/O
174
Drug least effective as adjunctive tx of chronic violent behavior
DIAZEPAM
175
Heavy smoking will likely affect the dosing of which of the following medications?
OLANZAPINE
176
Guy drinks 12-15 cups of coffee a day, Has insomnia and headaches relieved by drinking coffee. Irritable and poor concentration if he doesn’t drink coffee. How to treat?
CUT CAFFEINE BY 25% WEEKLY
177
Smoking cessation strategy with highest success rate
BUPROPION PLUS GROUP THERAPY
178
Other than nicotine replacement therapies, evidence most strongly supports the use of which of the following agents for smoking cessation?
VARENICLINE (CHANTIX)
179
19yo college student at ED ate postage stamp sized LSD, now distressed, begging for help, says things aren't right. What is the treatment?
ADMINISTRATION OF 20 MG DIAZEPAM
180
A 24 yo pt who is intoxicated with PCP presents to the ED. The pt is verbally aggressive, threatening to staff, and actively hallucinating. Pt’s behavior has escalated despite redirection and placement in a quiet seclusion room. Which of the following is the best treatment for managing this patient’s acute presentation?
ADMINISTER HALDOL 5MG IM
181
23 y/o pt is admitted to the hospital with rhabdomyolysis and renal failure. On examination, pt is noted to have ataxia and peripheral neuropathy. Following treatment of the pt’s acute medical problems, it becomes apparent that the pt has dementia. MRI: cerebellar atrophy and diffuse white matter changes. Which long standing substance of abuse:
TOLUENE
182
Which of the following subjective effects is the basis of the appeal of MDMA?
CONNECTEDNESS TO OTHERS
183
20 y/o male college student who is a weight lifter and star player on the football team, is brought to the ED by roommates because of their concern regarding the pt’s increased irritability and aggressiveness over the last several weeks, including threats to harm particular classmates. The roommates report that the patient has been exercising in the gym more frequently than usual. They do not think he has been drinking alcohol excessively, using cannabis or other illicit substances and he has never done so in the past.
ANABOLIC STEROID USE
184
What is perceptual abnormality in which hallucinogenic drugs cause moving objects to appear as a series of discrete and discontinuous images?
TRAILING
185
Medical specialty with highest rate of substance use d/o:
EMERGENCY MEDICINE
186
Most often abused hallucinogens associated with:
TOLERANCE TO EUPHORIC EFFECTS
187
What technique may be dangerous in managing patient with PCP intoxication?
TALKING THE PATIENT DOWN
188
For polysubstance dependence need criteria for:
SUBSTANCES AS A GROUP, BUT NOT FOR ANY PARTICULAR SUBSTANCE
189
Ataxia, nystagmus, muscular rigidity, normal or small pupils suggests intoxication with what?
PCP
190
UDS performed on pt who eats poppy seed bagels may yield false (+) for?
OPIATES
191
At what receptors does phencyclidine’s major action occur?
N-METHYL-D-ASPARTATE ACID (NMDA)
192
Causes long-term inhibition of new serotonin synthesis and decrease in serotonin terminal density:
METHYLENEDIOXYMETHAMPHETAMINE (MDMA)
193
Dissociative compound, sense of fragmentation and detachment during intoxication
KETAMINE
194
What is the mechanism of action of varenicline in the treatment of tobacco use disorders?
BLOCKS REINFORCING EFFECT OF NICOTINE
195
Molecular mechanism of ketamine?
ANTAGONIST AT NMDA RECEPTORS
196
A 25 year old body-builder comes to ed with euphoria, peripheral vision loss and hallucinations. Pt states these occurred after ingesting a liquid nutritional supplement an hour ago. UDS and BAL are negative. What did he ingest?
GHB
197
What should lead a provider to increase concern for patient having a substance use disorder?
HISTORY OF MISUSING OTHER DRUGS OR ALCOHOL
198
Caffeine results in dopaminergic activity, where?
ADENOSINE RECEPTOR
199
Drug of abuse that does not depend on specific neuronal membrane binding sites:
ALCOHOL
200
Pt presents highly anxious with seizures, has emotional lability, irritability, dizziness, and confusion. MRI reveals multiple subcortical demyelinating lesions. The most likely sx is exposure to which of the following substances?
TOLUENE
201
Apathetic and nervous, sees halos, flashes of color, recent ETOH and LSD, unemployed, never hospitalized. Dx?
HALLUCINOGEN PERSISTING PERCEPTION D/O
202
What substance is only detected in urine for 7-12 hours after ingestion?
ETOH
203
A 32 yo pt presents to ED with acute onset paranoia, AH and hypervigilance. On exam pt is tachycardic, HTN and has PMA and anxiety. No past psych hx or PMH. ROS is + intermittent substernal CP. Which test is most helpful in developing a DDX?
URINE TOXICOLOGY
204
Not pregnant premenopausal pt in ED has galactorrhea, elevated prolactin level, pt denies seizures or antipsychotic meds. What condition could explain this?
COCAINE WITHDRAWAL
205
Pt who is dependent on cannabis had a period of cancelling appts frequently but is now showing up consistently and acknowledges that the negative costs of marijuana outweigh the anxiolytic effect and is committing to altering his use. Pt is at which stage of change?
CONTEMPLATION
206
Dose for 2ppd smoker?
42mg/day.
207
At a minimum, state physician health programs provide which services to impaired physician?
STRUCTURED MONITORING PROGRAM
208
Core principle of motivational interviewing when used to treat addictive disorder:
DEVELOP DISCREPANCY
209
Withdrawal from which sub can constitute a life-threatening medical emergency?
SEDATIVE-HYPNOTICS
210
Which of the following is usually the first step in treating adolescents with substance abuse disorders?
ENGAGING THE PT AND FAMILY IN STEPS TO DIMINISH DRUG-SEEKING BEHAVIOR
211
A person who smokes a pack of cigarettes per day stops smoking and experiences the need for a cigarette after every meal. Example of:
AN ENVIRONMENTAL TRIGGER
212
Most effective initial treatment for pts with PCP intoxication:
URINE ACIDIFICATION
213
21 y/o pt presents to the ED after using marijuana for the first time. The pt reports pounding heart, sweating, fear of dying and shaking. The most appropriate next step to administer:
LORAZEPAM
214
Pt recently emigrated from East Africa presents to establish care at a health center. Pt denies use of alcohol, tobacco, or common street drugs, however notes that, prior to immigrating, he routinely chewed leaves of a local plant to improve concentration and help him stay awake while working long hours. Which plant did pt most likely use?
KHAT
215
In nicotine dependence, neurotransmitter most associated w/ reward and reinforcement is:
DOPAMINE
216
Abrupt withdrawal of nicotine is followed by what symptom?
INSOMNIA
217
What substance can cause dementia w/ long-term use?
INHALANTS
218
What substance is a common cause of flashbacks?
CANNABIS
219
Use of which substance in adolescence is associated with development of schizophrenia?
CANNABIS
220
Acute anxiety, restless, flushed, irritable, nauseous, wo insomnia –attributes everything to stress at work
CAFFEINE INTOXICATION
221
Has intoxication syndrome but not a substance of abuse
CAFFEINE
222
LSD and mescaline show agonist at which of the receptors?
5HT2A
223
he most common mood altering substance worldwide:
CAFFEINE
224
35 y/o ED physician is referred for psychiatric evaluation by ED medical director who has noted recent changes in the physician including rambling speech, psychomotor agitation, a flushed and excited appearance, and restless demeanor. On eval, physician complains of having to work excessive and different shifts due to several members of the group being out on vacation or sick. Physician also complains of palpitations. The physician admits to using alcohol to initiate sleep and more caffeine to stay alert. Dx?
CAFFEINE INTOXICATION
225
16 y/o adolescent with burns to the face 2/2 playing with a spray paint can that ignited. Grades dropped from A’s to F’s. The mother is concerned about hearing problems. No other health problems. Dx?
INHALANT ABUSE
226
15 year-old pt is brought to ER by friends due to aggression and impaired judgment while intoxicated. On exam the pt has a mild tremor, nystagmus, slurred speech, unsteady gait and hypoactive deep tendon reflexes. The pt complains of dizziness and appears uncoordinated. Which of the following substances did the pt use?
INHALANTS
227
13yo pt is reported by parents to be sleepy during the day, out of it, dazed, decreased appetite, nauseated, red eyes, runny nose, red sores around mouth.Which substance is playing a role?
AEROSOL INHALANTS
228
21 year old has episode of nausea, sweating and hematemesis. Pt reports having recent severe headaches and numbness in extremities. CT shows generalized brain atrophy and labs show renal tubular acidosis and CPK of 3120 mcg/L. This is likely due to chronic use of what?
INHALANTS
229
What symptoms of nicotine withdrawal may persist in a patient for up to 6 mos?
INCREASED APPETITE
230
In treatment of recovering addict, rehearsal strategies help with what?
IDENTIFYING INTERNAL HIGH-RISK RELAPSE FACTORS
231
What drugs make up the street drug named Speedball?
HEROIN AND COCAINE
232
20 y/o pt w/ acute onset belligerence, distortion of body image, depersonalization, and cloudy sensorium following ingestion of a street drug. Horizontal nystagmus, ataxia, and slurred speech, pupils not dilated. Management:
ADMINISTER AMMONIUM CHLORIDE
233
What is a characteristic of hallucinogens?
ADDICTIVE CRAVING IS MINIMAL
234
Conjunctival injection in a patient with a substance use disorder is most suggestive of:
CANNABIS INTOXICATION
235
Drug of abuse that exerts it ffects primarily though serotonin release and reuptake inhibition:
METHYLENEDIOXYMETHAMPHETAMINE (MDMA)
236
Developing a plan for managing a future lapse or relapse of addictive illness is most likely to:
HELP LIMIT THE EXTENT AND LENGTH OF DRUG USE
237
Phenomena is most typical of hallucinogen use?
ILLUSIONS
238
The most common acute effect of recreational ketamine use:
DISSOCIATION
239
In relapse prevention therapy, teaching a recovering pt w/ an addiction that relapse is a process rather than an event conveys what?
WARNING SIGNS PRECEDE SUBSTANCE USE
240
Due to the increased risk of stroke and sudden death, the U.S. FDA has determined that what substance is unsafe when used in combination with ephedra?
CAFFEINE
241
Reducing the intensity of an addict’s reaction to environmental reminders of drug use is a goal of what intervention?
CUE EXPOSURE TREATMENT
242
Follow-up studies on the Drug Abuse Resistance Education (DARE) program for elementary students have reported what finding?
SMALL TO NON-MEASURABLE DECREASES IN SUBSTANCE USE BY PARTICIPANTS
243
Emergency management of pt w phencyclidine (PCP) toxicity should include?
HALDOL, BENZODIAZEPINES, CLOSE SUPERVISION AND RELATIVELY DARK, QUIET SURROUNDINGS.
244
Formication, agitation, stereotypical oral movements and paranoia are sx of intoxication with which of the following substances?In the reward pathways implicated in the neurobiology of addiction, dopaminergic neurons project to the nucleus accumbens. The cell bodies of these neurons reside in what area of brain?
VENTRAL TEGMENTAL AREA
245
An 18 y/o pt presents to the Emergency Dept with a clouded sensorium, agitation, hyperactivity, mild paranoia, pressured speech and euphoric though labile mood. Physical exam notable for HTN, tachycardia and vertical nystagmus. Cause?
PCP
246
Pt arrested for possession of cocaine, spends 2 days in jail, after missing apps with subs abuse counselor. Intervention is referred to as...?
DRUG COURT
247
Pt with addiction and social anxiety d/o discusses their painful experience of anxiety during their first AA meeting. What reply is consistent with 12-step facilitation therapy? (7x)
“YOU DID THE MOST IMPORTANT THING, YOU WENT TO THE MEETING. IT WILL GET EASIER.”
248
What does CAGE stand for? (7x)
CUT DOWN, ANNOYED, GUILTY, EYE OPENER
249
Eval of which lab test is most specific for chronic heavy alcohol consumption? (7x)
% CDT (PERCENT CARBOHYDRATE DEFICIENT TRANSFERRIN)
250
50 y/o with alcohol dep at ED for confusion, oculomotor disturbances, ataxia, and dysarthria. Give which med first? (5x)
THIAMINE
251
Alcoholic hallucinosis versus DT: alcoholic hallucinosis includes what? (3x)
A CLEAR SENSORIUM
252
Alcoholic on disulfiram reports EtOH cravings. What drug will likely decrease these? (4x)
NALTREXONE
253
What is a SE common to both naltrexone and disulfiram? (3x)
ELEVATED LIVER ENZYMES
254
What is the function of Al-anon? (2x)
HELPS RELATIVES COPE WITH ALCOHOLICS DRINKING
255
Evidence that alcoholism is hereditary? (2x)
ADOPTED SIBLINGS
256
Lab parameter often elevated in patients with alcohol dependence? (2x)
MEAN CORPUSCULAR VOLUME
257
The best way to ask adolescent about alcohol abuse? (2x)
HAVE YOU EVER RIDDEN IN A CAR DRIVEN BY SOMEONE INCLUDING YOURSELF, WHO WAS HIGH OR HAD BEEN USING ALCOHOL OR DRUGS?
258
44 y/o pt w ETOH dependence/cirrhosis inquiring about med to stop drinking. Pt is disappointed in drinking behavior but otherwise shows little evidence of a mood D/O. Which meds has his most favorable risk/benefit profile for ETOH cessation? (2x)
ACAMPROSATE
259
Alcohol withdrawal symptoms peak in how long? (x2)
48 HOURS
260
Which med reduces acetaldehyde dehydrogenase function? (2x)
DISULFIRAM
261
Molecular mechanism of ethanol causes intoxication? (x2)
NMDA ANTAGONISM AND GABA AGONISM
262
Alcohol withdrawal symptoms peak in how long? (x2)
48 HOURS
263
Women differ from men in drinking behavior and in development and effects of alcohol use d/o, compared w/men, women: (X2)
HAVE A FASTER PROGRESSION FROM FIRST DRINK TO ALCOHOL DEP
264
Disadvantage of using shorter half-life benzodiazepines in the tx of EtOH withdrawal: (X2)
INCREASED LIKELIHOOD OF GRAND MAL SEIZURES
265
Can 65 yo patient with family history of dementia continue to drink the same amount of alcohol in their old age
CONTINUE THE ALCOHOL AS LONG AS PATTERN ON USE DOES NOT CHANGE
266
After gastric bypass surgery, continued abuse of what substance can be more life
threatening than before surgery?
ALCOHOL
267
Having a pt’s friend or spouse monitor disulfiram administration and report to the treating psych MD is an example of:
NETWORK THERAPY
268
Which diagnosis is associated with the highest risk of person to person violence?
ALCOHOL USE DISORDER
269
The psychiatrist asks pt w EtOH dependence to rate readiness to quit drinking on scale of 1- 10. When pt responds “3,” psychiatrist asks, “Why a 3 instead of a 1?” The psychiatrist is using which of the following modalities?
MOTIVATIONAL ENHANCEMENT THERAPY
270
Alcohol use is associated with what changes in sleep?
DECREASED REM SLEEP
271
Best characterizes the role of spirituality in abstinence in alcoholics who attend AA?
THERE IS LIMITED EVIDENCE SUPPORTING THE ROLE OF SPIRITUALITY IN ABSTINENCE
272
Most common substance of abuse in adolescents:
ALCOHOL
273
44 yo M found wandering aimlessly, brought into ED, BP is 200/132, HR 112 and regular. Pt is belligerent, picking his skin, feels like insects crawling on his skin. Oriented only to name, tremulous, is diaphoretic, dilated pupils, palmar erythema, and spider angiomata on chest. What explains his symptoms?
DELIRIUM TREMENS
274
40 yo female presents with new onset paranoid delusion as well as AH and VH, no SI. Denies hx of mania or MDD. Pt has previous hospital admission for MDD and anxiety symptoms and had taken citalopram, sertraline and quetiapine but was non- compliant. Hx reveals chronic alcohol use with heavy drinking one week ago. What is the most likely cause of her paranoia?
ALCOHOL-INDUCED MOOD DISORDER
275
55 y/o pt w/ hx of ETOH dependence reports hearing voices for the past 6 weeks. Pt reports that the last episode of ETOH intoxication was 1 month prior, with moderate drinking since that time. There is no prior hx of psychosis. On exam, pt is alert and oriented. On laboratory evaluation, pt has a GGT of 54, an MCV of 110, and an AST/ALT ratio of 2.1. the most likely cause of this pt’s hallucinations is:
ALCOHOL INDUCED PSYCHOTIC DISORDER
276
Pt who is 2 months sober on disulfiram, what lab studies should be done at baseline and
after 2 months of treatment?
TRANSAMINASES
277
72 y/o w chronic hepatitis in ED for treatment of ongoing alcohol withdrawal. Hospital protocol is to use chlordiazepoxide, but psych suggest lorazepam because
METABOLIZED THROUGH GLUCURONIDE CONJUGATION
278
Electrolyte imbalance common in chronic heavy EtOH use?
HYPOMAGNESEMIA AND HYPOPHOSPHATEMIA
279
Psychiatrist recommends AA to pt who abuses alcohol, but pt reluctant. Next step?
RECOMMEND PATIENT SPEAK TO A CURRENT AA MEMBER
280
Most clearly predictive of alcohol abstinence for alcoholics who attend AA meeting:
OBTAINING A SPONSOR
281
50 y/o pt w ETOH dependence admitted to ED for confusion, oculomotor deficits, ataxia, and dysarthria. The first step in acute management of this pt’s condition:
ADMINISTRATION OF THIAMINE
282
Can alcohol fumes at work (brewery) cause a pt on disulfiram headaches?
YES
283
Sixth cranial nerve palsy is associated with which alcohol-related syndrome?
WERNICKE’S ENCEPHALOPATHY
284
Tests for detecting excessive drinking
TRIGLYCERIDES, MCV, SGGT, SGOT
285
Pattern of drinking in women alcoholics (as opposed to males):
SOLITARY DRINKING
286
Non-specific hematological marker for heavy drinking
MCV
287
Complication of heavy EtOH likely to persist beyond first week of withdrawal?
SLEEP FRAGMENTATION
288
What is the principle problem with disulfiram in the treatment of alcoholics?
PT CAN STOP TAKING IT AND RESUME DRINKING
289
Verbally and physically aggressive after a small amount of ETOH. Dx?
PATHOLOGICAL INTOXICATION
290
Wernicke’s disease triad:
OPHTHALMOPLEGIA, ATAXIA, GLOBAL CONFUSION
291
Drinking ETOH while taking disulfiram most likely to produce what sx
NAUSEA AND VOMITING
292
Equal dose of alcohol corrected for body weight lead to higher BAL in woman than me. Why?
LOWER LEVELS OF ALCOHOL DEHYDROGENASE IN GASTRIC MUCOSA
293
Avoid which drug in a pt intoxicated with alcohol or a sedative drug?
LORAZEPAM
294
Characteristic of Cloninger’s type 1 alcoholism:
LATE ONSET
295
Most serious complication for a pt who ingests EtOH while on disulfiram
HYPOTENSION
296
Alcoholic, AH on & off alcohol, extreme agitation. During withdrawal give benzo and
HALDOL
297
What is decreased with heavy ETOH intake
GLUCOSE
298
41 y/o pt in ED w/ blood alcohol level of 0.425.Pt is stuporous, the pulse is 75, BP is 110/70. UDS is negative. What is the immediate concern?
RESPIRATORY FAILURE
299
RESPIRATORY FAILURE
FRAGMENTATION OF STAGE 4 SLEEP
300
60 y/o alcoholic with 4 day h/o unstructured, maligning AH and clear sensorium. Dx?
ETOH-INDUCED PSYCHOTIC D/O
