March 23 - Behavioral Science

Question 1

Alcohol withdrawal: four stages

Answer 1

Mild withdrawal: 6-24 hours; anxiety, insomnia, tremors, sweating, palpitations, GI upset, in tact orientation

Seizures: 12-48 hours
Alcoholic hallucinosis: 12-48 hours

Delirium tremens: 48-96 hours; confusion, agitation, fever, tachycardia, HTN, diaphoresis

Question 2

Mania vs hypomania

Answer 2

Mania: more severe symptms, last at least 1 wk or require hospitalization; impair function (usually can’t work); +/- psychotic features

Hypomania: less severe, lasts at least 4 days, doesn’t cause marked impairment or require hospitalization, no psychotic features

Question 3

Bipolar I vs bipolar II vs cyclothymic

Answer 3

Bipolar I: manic episode +/- depressive episodes
Bipolar II: hypomanic episode + major depressive episode
Cyclothymic: 2 yrs fluctuating mild hypomanis and depressive symptoms

Question 4

Acute alcohol intoxication and medical decision making

Answer 4

Lack decision making capacity. Should reassess capacity once sober

Question 5

Schizoid vs schizotypal

Answer 5

Schizoid: prefer to be loner, detached, unemotional
Shizotypal: eccentric, odd thoughts, perceptions, and behavior but no frank delusions or hallucinations, rarely have close interpersonal relationships because of social anxiety that doesn’t decrease with familiarity

Question 6

Informed consent

Answer 6

Accurate description of intervention.
Alternative treatments, risks, and benefits
Assessment of patient’s understanding and preference
Need to have adequate knowledge of procedure in order to consent

Question 7

OD deaths

Answer 7

Most common cause is opioids (prescription and heroin)

Question 8

Stimulant intoxication symptoms

Answer 8

Paranoia, restlessness, hypervigilence, tachycardia, HTN, diaphoresis. Can get transient paranoid psychosis

Question 9

Differentiating stimulant-induced psychosis from mania/psychotic disorder

Answer 9

Prominent physical signs, lack of psych history

Question 10

Brief psychotic disorder

Answer 10

Diagnosis of exclusion - have to rule out substance abuse and medical conditions. Acute onset of over 1 psychotic symptom. Lasts 1 day to 1 month with complete resolution.

Question 11

Delusional disorder

Answer 11

Over 1 delusion lasting at least a month.

Question 12

Olanzapine

Answer 12

2nd generation antipsychotic with high risk of metabolic side effects

Question 13

Lithium monitoring

Answer 13

Routine monitoring of BUN/Cr and thyroid function due to risk of impaired renal function and hypothyroidism

Question 14

Risperidone

Answer 14

2nd gen antipsychotic with highest risk of increase prolactin

Question 15

Acute stress disorder vs PTSD

Answer 15

Acute stress disorder lasts 3 days to 1 month

PTSD lasts longer than 1 month

Question 16

Adjustment disorder with depressed mood

Answer 16

Diagnosed if don’t meet full criteria for ME=DE

Question 17

Somatic symptom disorder

Answer 17

Preoccupation with unexplained medical symptoms and excessive healthcare use. Manage with regular visits to same provider and avoidance of unnecessary diagnostic testing and specialist visits. Refer to mental health provider only once physican-patient relationship well established

Question 18

Treatment of drug-induced parkinsonism

Answer 18

Benztropine or trihexyphenidyl (centrally-acting anticholinergics_

Question 19

PCP vs cocaine vs methamphetamine intoxication

Answer 19

PCP: violence, hallucinations, dissociation, amnesia, nystagmus, ataxia

Cocaine: chest pain and seizures

Methamphetamine: violence, psychosis, diaphoresis, choreiform movements, tooth decay

Question 20

Different mood stabilizers and their side effects

Answer 20

Lithium

• treats both mania and depression
• can cause hypothyroidism, tremor, diabetes insipidus

Valproate

• hepatotoxicity, NTDs
• treats mania, seizures

Carbamazepine

• causes agranulocytosis, SIADH/hyponatremia, NTDs
• treats mania, seizures

Lamotrigine

• causes rash and SJS
• treats depressive episodes, focal seizures

Question 21

Citalopram

Answer 21

SSRI

Question 22

Trazodone MOA and side effects

Answer 22

MOA: serotonin modulator. Antagonizes serotonin receptors, inhibits serotonin reuptake.

Side effects: blocks alpha1 receptors caushing othostatin hypotension. blocks H1 receptors causing sedation. Most serious side effect is priapism (painful erection)- drug should be avoided in sickle cell disease and multiple myeloma which predispose to priapism

Question 23

Paranoid personality disorder vs delusional disorder

Answer 23

Paranoid personality is pattern of suspiciousness without clear delusions
Delusional disorder is delusions over 1 month without other psychotic symptoms or otherwise bizarre behavior that impairs function

Question 24

Addressing a possible opioid use disorder

Answer 24

1. validate patient’s concern about pain control
2. engage in discussion about how patient is using the med
3. Explore reasons for escalting use

Question 25

Reducing prescription transcription errors

Answer 25

Avoid abbreviations and trailing zeros

Question 26

Imipramine

Answer 26

TCAD

Question 27

Climipramine

Answer 27

TCAD

Question 28

Duloxetine

Answer 28

SNRI

Question 29

Fluvoxamine

Answer 29

SSRI

Question 30

Paraxetine

Answer 30

SSRI

Question 31

R vs L frontal lobe damag

Answer 31

L frontal lobe: apathy and depression | R frontal lobe: disinhibited behavior

Question 32

Clozapine use

Answer 32

Superior in treating resistance schizophrenia

Question 33

Hospice criteria

Answer 33

Provided to terminally ill with less than 6 mos to live when aggressive, curative treatments no longer beneficial or desired

Question 34

Relationships between doctors and patients

Answer 34

Never ethical. Shouldn't suggest that a relationship could exist if patient found a different doctor becuase would encourage them to stop seeing you

Question 35

Effective discharge

Answer 35

Collaboration between social work, nurse, and physician to talk about meds, follow up, functional status Discharge checklist with dtailed med instructions, follow up appts, pending labs, emergency contact number

Question 36

Declining a gift of vale

Answer 36

Express gratitude, explain why can't accept, avoid any implication that gift was given to gain preferential treatment

Question 37

Provide discharge checklist to help prevent readmission

Answer 37

Detailed med instructions, follow up appointments, pending lab tests, emergency contact number

Question 38

Capitation

Answer 38

Payor pays fixed, pretermined fee to over all med services. Payment structure of HMO

Question 39

Global payment

Answer 39

Insurer pays single payment to cover all expenses associated with an incidence. Common for elective surgeries.

Question 40

Point of service

Answer 40

PCP required, need referral for specialty consults. Allowed to see provider outside network but at higher cost (distinguishes from HMO)

Question 41

Treatment of friends

Answer 41

Should be limited to emergencies when no other physician available

Question 42

Suspected IPV

Answer 42

ensure privacy, nonjudgemental, empathic, open-ended questioning. No pressure to disclose, report, or leave partner. Assess safety and ask about emergency safety plan.

Question 43

Schizoaffective disorder

Answer 43

MDE or manic episode concurrent with schizophrenia symptoms. Distinguished from depression/bipolar with psychotic features by lifetime history of delusions or hallucinations over 2wks without depression or mania (in depression/bipoarl with psychotic features, psychotic symptoms only occur during mood episodes)