Pathology

Question 1

Bilateral lesion in the amygdala portion of the brain causes what?

Answer 1

Klüver-Bucy Syndrome - loss of fear response, become docile, extremely curious, hyper-orality, and hyper sexuality

Question 2

What are the 3 major criteria for Anorexia Nervosa?

Answer 2

• Distorted body image
• Intense fear of gaining weight
• Refusal to maintain normal body weight —> BMI <17

Question 3

What is the diagnostic criteria for Binge Eating Disorder?

Answer 3

At least 3/5:

• Eating faster
• Eating until uncomfortably full
• Eating large amounts when not hungry
• Eating alone
• Feeling badly about it

Marked distress or remorse, occurring at least 1x per week for at least 3 months, with no compensatory behavior

Question 4

What is the diagnosis of the following symptoms:

• Delirium
• Autonomic instability (tachycardia)
• Muscle rigidity
• Myoglobinuria
• Hyperpyrexia

Answer 4

Neuroleptic Malignant Syndrome

Question 5

Patient refers unexplained pain. What is the psychiatric diagnosis?

Answer 5

Somatic symptom disorder, with predominant pain

Question 6

Patient with normal anatomy is convinced a part of their anatomy is abnormal. What is the psychiatric diagnosis?

Answer 6

Body dysmorphic disorder

Question 7

Unexplained loss of sensory or motor function (tests and PE are negative). What is the psychiatric diagnosis?

Answer 7

Conversion disorder

Question 8

Unwavering belief by the patient that she has a specific disease (despite medical reassurance). What is the psychiatric diagnosis?

Answer 8

Illness anxiety disorder

Question 9

Unexplained complaint despite normal workup. What is the psychiatric diagnosis?

Answer 9

Somatic symptom disorder

Question 10

What is the triad for Wernicke encephalopathy? What about Korsakoff Syndrome?

Answer 10

W-Ophthalmoplegia, confusion, ataxia

K-Memory loss, confabulation, personality change

Question 11

What are the 3 main characteristics of Serotonin Syndrome?

Answer 11

1. Mental status changes (anxiety, disorientation, delirium)
2. Autonomic changes (fever diarrhea, flushing, diaphoresis, tachycardia that can lead to heart failure)
3. Neuromuscular changes (hyperreflexia, tremor, rigidity)

Question 12

What are the risk factors for suicide completion?

Answer 12

S - Sex - males more likely to complete 
A - Age - (young adult/teen and the elderly)
D - Depression
P - Previous attempt
E - Ethanol
R - Rational thinking
S - Sickness (medical or a lot of Rx meds)
O - Organized plan
N - No spouse or social support 
S - Stated future intent

Question 13

Disordered regulation of sleep-wake cycles characterized by excessive daytime sleepiness. What is the Dx and cause?

Answer 13

Narcolepsy

Cause: decreased hypocretin (orexin)

Question 14

Symptoms and motivation are Intentional. Patient consciously fakes, profoundly exaggerates to have a disorder to attain a specific secondary external gain (avoiding work, obtaining compensation). Poor compliance with treatment or follow-up of diagnostic tests. Complaints cease after gain. What pathology is at hand?

Answer 14

Malingering

Question 15

Symptoms are intentional but motive is unconscious. Patient consciously creates physical and/or psychological symptoms in order to assume “sick role” and to get medical attention and sympathy (1* internal gain).

Answer 15

Factitious Disorders (they don’t know why they do it).

Question 16

Chronic factitious disorder with predominantly physical signs and symptoms. Characterized by a history of multiple hospital admissions, and willingness to undergo signs and symptoms. Characterized by a history of multiple hospital admissions and willingness to undergo invasive procedures. MC in women and healthcare workers.

Answer 16

Factitious Disorder imposed on self

Aka Münchausen syndrome

Question 17

Illness in a child or elderly patient is caused or fabricated by the caregiver. Motivation is to assume a sick role by proxy. Form of child or elder abuse.

Answer 17

Factitious Disorder imposed on another

Aka Münchausen syndrome by proxy

Question 18

Binge eating with (inappropriate compensatory behaviors (self induced vomiting, laxatives, diuretics, fasting, or excessive exercise) and overvaluation of body image. They maintain a normal body weight. Associated with parotitis, enamel erosion, electrolyte disturbances and Russell sign. What pathology is at hand? what is the required timeframe? What electrolyte changes are seen?

Answer 18

Bulemia nervosa
Electrolyte changes: hypokalemia, hypochloremia, metabolic alkalosis
Weekly Episodes for the last 3 months

Bupropion contraindicated due to increased risk of seizures

Question 19

Anorexic patients are at risk for what?

Answer 19

Refeeding Syndrome - increased insulin leading to hypophosphatemia, hypokalemia, hypomagnesemia —> cardiac complications, rhabdomyolysis, and seizures.

Question 20

Recurrent episodes of binge eating without purging behaviors, at least weekly for the last 3 months. Increased risk for diabetes. MC eating disorder in adults. What is the Dx and treatment?

Answer 20

Binge eating disorder

Tx: Psychotherapy, SSRIs, lisdexamphetamine