PRACTICE QUESTIONS IN CLASS

Question 1

Neurodegnerative diseases include:

Answer 1

Alzheimer’s disease
Dementia with Lewy body
Parkinson’s disease with dementia
Frontotemporal dementia
Huntington disease
Chronic traumatic encephalopathy
Corticobasal degeneration (CBD)
Progressive supra nuclear palsy (PSP)

Question 2

True or false dementia can be Alzheimers disease

Answer 2

True

Question 3

True or false there are many forms of dementia

Answer 3

True

Question 4

What are the types of non- neurodegenrative diseases?

Answer 4

vascular dementia
alcohol-related dementia
normal pressure hydrocephalus
chronic subdural hematoma
neurosyphilis
HIV associated dementia
Creutzfeldt-Jakob (CJD)

Question 5

Neurodegenerative you cannot correct

Answer 5

You cannot correct the brain

Question 6

Nonneurodegenerative disease

Answer 6

You can correct like vascular dementia- correct hypertension and high cholesterol

Question 7

Most dementias are considered neurodegenerative caused by the progression of neuron loss over time

Question 8

The most common type of dementia is?

Answer 8

Alzheimer’s disease (neurodegenerative disease)

Question 9

Dementias invariably process over time

Question 10

Nonneurodegenerative dementias may be reversible or their progression slowed if the underlying cause is identified

Question 11

What is the most common non- neurodegenerative dementia?

Answer 11

vascular dementia- caused by a stroke or cerebral small vessel disease (think baba)

Question 12

People with depression have a higher risk for developing headaches

Answer 12

Anyone with chronic pain is at higher risk for developing depression (think Stella)

Question 13

If a patient has extrapyramidal symptoms (EPS) with bipolar I how do we fix it?

Answer 13

EPS can happen with any antipsychotic medication

Question 14

If a patient has extrapyramidal symptoms (EPS) with bipolar I how do we fix it?

Answer 14

Treatment is either gradual dose reduction or D/C causative agent then trial anticholinergics, benzos, beta blockers, muscle relaxants based on the symptoms

Question 15

What is a new drug that treats Tardive Dyskinesia

Answer 15

Ingrezza (valbenazine)

Question 16

For bipolar I do we change medication depending on depression or mania?

Answer 16

We add on the regimen in a stepwise approach- drug of choice depends on symptoms

Question 17

Bipolar I if the patient is manic we?

Answer 17

start the patient on a mood stabilizer

Question 18

In bipolar I if the symptoms are no controlled?

Answer 18

add a antipsychotic

Question 19

In bipolar I if the patient has depression?

Answer 19

start antipsychotic

Question 20

What is the difference between bipolar I disorder versus bipolar 2 disorder

Answer 20

Many patients can be on a mood stabilizer or antipsychotic.

Type I- more severe form- true manic episodes
Type II- less severe hypomanic- not as much highs as in mania

Question 21

A 27 year old patient c/o 3 year h/o depressed mood, loss of interest in hobbies, & low energy levels. The MD prescribes fluoxetine to help improve mood. After 2 weeks she returns saying does not feel better

A. add sertraline
B. Do nothing
C. Increase the dose
D. stop the drug
E. switch to another drug

Answer 21

B. do nothing - wait 2-4 weeks with SSRI medications

SEVERE SYMPTOMS- INCREASE SOONER

The patient is a 27-year-old woman with a 3-year history of depressive symptoms who was prescribed fluoxetine (an SSRI antidepressant). Key points to consider:

Antidepressant medications, including SSRIs like fluoxetine, typically require 4-6 weeks to achieve full therapeutic effect

2 weeks is too early to evaluate the efficacy of the medication

No side effects or adverse reactions were mentioned in the case

Evaluation of Options

(A) Add sertraline - Adding another SSRI would be inappropriate and potentially dangerous (serotonin syndrome risk)

(B) Do nothing - This is the correct approach as more time is needed to evaluate efficacy

(C) Increase the dose - Premature dose adjustment before allowing adequate time for the initial dose to work

(D) Stop the drug - Discontinuation is not warranted as the medication hasn’t had sufficient time to work

(E) Switch to another drug - Switching medications before allowing adequate trial period is not recommended

Correct Answer

(B) Do nothing

The physician should explain to the patient that antidepressants typically take 4-6 weeks to show full therapeutic effect, and encourage the patient to continue the current treatment while monitoring for improvement or side effects.

These medications take several weeks to reach maximum therapeutic effect. Continue to take it for two more weeks before you decide it isn’t helping.”

Question 22

EPS

Answer 22

gradual dose reduction to see if it stops or d/c if they can tolerate.

Question 23

EPS can also treat the symptoms- these symptoms can be mild to life threatening

Answer 23

mild symptoms:
-anticholinergics
-benzos
-beta blockers
-muscle relaxers

**this depends on what symptoms they are actually having!!!

serious symptoms- send them to the emergency department

Question 24

Cyclothymic Disorder

Answer 24

Presence of hypomanic & depressive symptoms that do not meet the full criteria of hypomania episode or a depressive episode. They must occur over 2 years patients may not have symptom free periods for more than 2 months.

Watch patient for to see if they develop bipolar 2 and even bipolar I category

Question 25

You diagnose a 31 year old patient with otitis externa and tympanic membrane perforation. Which of the following is appropriate for this patient and will offer analgesic effect? a. ciprofloxacin/dexamethason b. OTC swimmers ear drops - not safe to go in the middle ear c. neomycin/polymixin - not safe to go in the middle ear d. acetic acid/propylen glycol/hydrocortisone- not safe to go in the ear

Answer 25

ans. a. ciprofloxacin/dexamethasone This is the only option that is both safe and effective for otitis externa with tympanic membrane perforation, as it provides antimicrobial coverage and anti-inflammatory effects without risking ototoxicity. Ciprofloxacin/dexamethasone: Ciprofloxacin is a fluoroquinolone antibiotic that is non-ototoxic Dexamethasone is a corticosteroid that reduces inflammation This combination is specifically formulated to be safe for use with tympanic membrane perforations OTC swimmers ear drops: Often contain alcohol or other potentially ototoxic ingredients Not safe for use with tympanic membrane perforations as they can cause damage if they enter the middle ear Neomycin/polymyxin: Neomycin is an aminoglycoside antibiotic with known ototoxicity Can cause permanent hearing loss if it enters the middle ear Contraindicated in patients with tympanic membrane perforations Acetic acid/propylene glycol/hydrocortisone: Acetic acid can be irritating and potentially ototoxic Not safe for use with tympanic membrane perforations externa- infection TM perforation- the med safe to go into the inner ear

Question 26

A 30 year old patient presents to the office after starting sertraline for 2 weeks he reports his depression is severe what should you do? 1. Keep the scheduled dose 2. Increase the dose 3. Change the medication 4. What the fuck

Answer 26

Increase the dose- because the patient has severe symptoms

Question 27

What medications are unsafe to go into the middle ear?

Answer 27

OTC swimmers ear drops: Often contain alcohol or other potentially ototoxic ingredients Not safe for use with tympanic membrane perforations as they can cause damage if they enter the middle ear Neomycin/polymyxin: Neomycin is an aminoglycoside antibiotic with known ototoxicity Can cause permanent hearing loss if it enters the middle ear Contraindicated in patients with tympanic membrane perforations Acetic acid/propylene glycol/hydrocortisone: Acetic acid can be irritating and potentially ototoxic Not safe for use with tympanic membrane perforations

Question 28

What medication would be safe to go into the middle ear?

Answer 28

ciprofloxacin/dexamethasone This is the only option that is both safe and effective for otitis externa with tympanic membrane perforation, as it provides antimicrobial coverage and anti-inflammatory effects without risking ototoxicity.

Question 29

You have an 80 year old female patient who complains of a headache. Which of the following is not included within the differential? A. brain tumor B. subarachnoid hemorrhage C. ischemic stroke D. all are within the differential

Answer 29

D. all are within the differential

Question 30

You have a 30 year old patient with skin infections secondary to MRSA. The patient has no chronic medical conditions, denies smoking, or alcohol use. She does have allergies to sulfa and penicillin. Which of the following is most appropriate for this patient? A. Dicloxacillin B. Doxycycline C. Ciprofloxacin D. Trimethoprim/sulfamethoxazole

Answer 30

ans. B doxycycline

Question 31

Treatment for MRSA some of the best choices would be for a patient who is allergic to sulfa and penicillin? A. Dicloxacillin B. Doxycyline C. Ciprofloxacin D. Trimethoprim/sulfamethozazole

Answer 31

Doxycycline or Bactrim- TMP/SMX BUT patients who are allergic to sulfa cannot take Bactrim!!!

Question 32

For less severe MRSA skin infections

Answer 32

- Trimethoprim-sulfa- methoxazole (Bactrim) - Clindamycin - Doxycycline or minocycline

Question 33

Decolonization protocols - To eliminate MRSA carriage:

Answer 33

Mupirocin nasal ointment Chlorhexidine body washes Sometimes oral antibiotics

Question 34

Which of the following provides coverage against beta hemolytic strep & MRSA? A. Amoxicillin B. Trimethoprim/sulfamethoxazole C. Nitrofurantoin D. Cephalexin

Answer 34

answer- D. Cephalexin A.- Amoxicillin-Effective against beta hemolytic streptococci. Not effective against MRSA (MRSA is resistant to beta-lactam antibiotics) B. Trimethoprim/sulfamethoxazole (TMP-SMX) Limited activity against beta hemolytic streptococci (not reliable) Effective against many MRSA strains (commonly used for community-acquired MRS C. NitrofurantoinLimited activity against beta hemolytic streptococci Not effective against MRSA Primarily used for urinary tract infections only D.Effective against beta hemolytic streptococci

Question 35

Crying spells we want to assess the patients neuro and psychiatric history What screening tools would we use for her psych?

Answer 35

Screening tools for this patient: -Geriatric depression scale -PHQ-9 -Check cognition -MOCHA okay but you have to be certified to do MOCHA - Mini- mental status exam

Question 36

If we are concerned about anxiety symptoms what screening tool would we use?

Answer 36

GAD-2 versus GAD-7

Question 37

The patient has post-nasal drip and congestion

Answer 37

allergic rhinitis

Question 38

Anytime the patient is on medication- there needs to be a matching diagnosis.

Question 39

How would you treat her allergic rhinitis?

Answer 39

Restart Flonase because it has been working for the patient

Question 40

The loratadine is not helping what other antihistamine would we consider prescribing?

Answer 40

- Allegra- Dr. Clabo likes this drug - It does not cross the blood brain barrier so it does not make you sleepy Zyrtec- not great to use because of drowsiness

Question 41

Claritin (loratadine) is a non-drowsy antihistamine that treats allergy symptoms. It can relieve sneezing, runny nose, itchy and watery eyes, and itchy throat or nose. Claritin can be taken by adults and children ages 6 and up.

Question 42

Fexofenadine (oral route) (Allegra) to treat allergic rhinitis

Answer 42

Fexofenadine is an antihistamine. It is used to relieve the symptoms of hay fever (seasonal allergic rhinitis) and hives of the skin (chronic idiopathic urticaria) . This 1 is a great 1 because it does not cross the blood brain barrier However, elderly patients are more likely to have age-related kidney problems, which may require an adjustment in the dose for patients receiving fexofenadine .

Question 43

Montelokast

Answer 43

not same class as antihistamine- this can cause very bad nightmares + some psychiatric side effects

Question 44

Nondrowsy antihistamine

Question 45

GAD-7 what does a score of 12 mean? mild, moderate, severe

Answer 45

moderate anxiety

Question 46

PH-9= + at 17 points- Is this mild, moderate, etc.

Answer 46

moderately severe

Question 47

Remeron

Question 48

Buspar

Answer 48

Buspirone is a non-benzodiazepine anxiolytic medication primarily used to treat anxiety disorders. It is a partial agonist of the serotonin 5-HT1A receptor, which means it can both stimulate and inhibit the activity of this receptor. The 5-HT1A receptor is a type of serotonin receptor found throughout the central nervous system, including the hippocampus, amygdala, and septal nuclei. These areas are involved in emotion regulation, stress response, and anxiety. By partially activating the 5-HT1A receptor, buspirone helps to modulate the release of neurotransmitters such as serotonin, dopamine, and norepinephrine, thereby reducing anxiety symptoms. Buspirone has several advantages over benzodiazepines, which are also used to treat anxiety disorders. Unlike benzodiazepines, buspirone is not associated with sedation, muscle relaxation, or amnesia. It also has a lower potential for abuse and dependence. However, buspirone has a slower onset of action compared to benzodiazepines and may take several weeks to achieve its full therapeutic effect. Final answer: Buspirone is a non-benzodiazepine anxiolytic medication that acts as a partial agonist of the serotonin 5-HT1A receptor, reducing anxiety symptoms by modulating the release of neurotransmitters such as serotonin, dopamine, and norepinephrine. It has several advantages over benzodiazepines, including a lower potential for abuse and dependence, but has a slower onset of action and may take several weeks to achieve its full therapeutic effect.

Question 49

Alprazolam

Question 50

You are seeing a 42 year old female for the first time. She is not taking any medication at this time. She has a history of severe depression with past suicide attempts. Upon assessment and through shared decision making, you and the patient decide it is best to treat her depression with medication and therapy. Which of the following medications should be avoided?

Answer 50

Paroxetine (Paxil) - This is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat depression. It is generally safe and effective, but like all medications, it can have side effects. Duloxetine (Cymbalta) - This is a serotonin and norepinephrine reuptake inhibitor (SNRI) used to treat depression and anxiety. It is generally safe and effective, but like all medications, it can have side effects. Desipramine (Norpramin) - This is a tricyclic antidepressant (TCA). TCAs are older medications that are not typically first-line treatments for depression due to their side effect profiles and potential for toxicity in overdose. They can be lethal in overdose, which could be a concern in a patient with a history of suicide attempts. Sertraline (Zoloft) - This is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat depression. It is generally safe and effective, but like all medications, it can have side effects. Mirtazapine (Remeron) - This is an atypical antidepressant that is often used to treat depression. It is generally safe and effective, but like all medications, it can have side effects. The medication that should be avoided in this case is Desipramine (Norpramin) due to its potential for toxicity in overdose, which could be a concern in a patient with a history of suicide attempts.

Question 51

Which SSRI is considered the drug of choice for treating depression in elderlypatients due to its favorable side effect profile? Fluoxetine Sertraline Paroxetine Citalopram

Answer 51

Fluoxetine: This SSRI is effective for treating depression but is not typically the first choice for elderly patients due to its longer half-life and potential for drug interactions. Sertraline: This SSRI is often preferred for elderly patients because it has a favorable side effect profile and fewer drug interactions. Paroxetine: This SSRI is generally avoided in elderly patients due to its anticholinergic effects, which can cause confusion and other cognitive issues. Citalopram: This SSRI is also considered a good option for elderly patients due to its relatively mild side effect profile, but it can cause QT prolongation at higher doses.

Question 52

what drug would you give an older patient who has anxiety and depression with vascular dementia who is allergic to SSRIs

Answer 52

For an older patient with anxiety, depression, and vascular dementia who is allergic to SSRIs, mirtazapine would be an appropriate choice. Mirtazapine is a noradrenergic and specific serotonergic antidepressant (NaSSA) that can address both depression and anxiety symptoms while having a favorable side effect profile for elderly patients. It may help with sleep disturbances and has minimal anticholinergic effects, which is important in vascular dementia where cognitive function is already compromised. Other options might include SNRIs like duloxetine or venlafaxine, but these should be used cautiously with close monitoring for cardiovascular effects and potential drug interactions. Trazodone at lower doses could also be considered, particularly if sleep disturbances are prominent. Any medication choice should start at low doses with careful titration and regular monitoring for efficacy and adverse effects.

Question 53

First-line therapy for uncomplicated MRSA skin infections is typically TMP-SMX or doxycycline, with clindamycin as alternative when susceptible.

Question 54

Clindamycin: Lincosamide antibiotic that inhibits bacterial protein synthesis by binding to 50S ribosomal subunit TMP-SMX (Trimethoprim-Sulfamethoxazole): Sulfonamide combination that inhibits bacterial folate synthesis Doxycycline and Minocycline: Tetracycline antibiotics that inhibit protein synthesis by binding to 30S ribosomal subunit Linezolid: Oxazolidinone antibiotic that inhibits protein synthesis by binding to 23S rRNA of 50S ribosomal subunit Specific attributes of these MRSA antibiotics: All are effective against MRSA through mechanisms that bypass β-lactam resistance All are available in oral formulations, facilitating outpatient treatment Resistance patterns vary geographically, requiring local susceptibility monitoring Side effect profiles differ significantly (e.g., C. difficile risk with clindamycin, photosensitivity with tetracyclines)

Question 55

Cephalexin, dicloxacillin, and clindamycin are antibiotics that work by different mechanisms to treat bacterial infections. Cephalexin: First-generation cephalosporin antibiotic Mechanism: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins Spectrum: Effective against many gram-positive bacteria and some gram-negative bacteria MRSA effectiveness: Generally ineffective against MRSA (methicillin-resistant Staphylococcus aureus) Beta-hemolytic strep effectiveness: Highly effective against beta-hemolytic streptococci Notable attributes: Oral administration, relatively low cost, good tissue penetration Dicloxacillin: Penicillinase-resistant penicillin antibiotic Mechanism: Inhibits bacterial cell wall synthesis similar to other beta-lactams Spectrum: Narrow spectrum focused on gram-positive organisms MRSA effectiveness: Generally ineffective against MRSA Beta-hemolytic strep effectiveness: Effective against beta-hemolytic streptococci Notable attributes: Resistant to beta-lactamase enzymes produced by some bacteria, good oral absorption Clindamycin: Lincosamide antibiotic Mechanism: Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit Spectrum: Active against gram-positive aerobes and anaerobes, some gram-negative anaerobes MRSA effectiveness: Often effective against community-acquired MRSA strains Beta-hemolytic strep effectiveness: Highly effective against beta-hemolytic streptococci Notable attributes: Good penetration into bone and abscesses, alternative for penicillin-allergic patients, risk of Clostridioides difficile infection For MRSA infections, clindamycin may be effective against community-acquired strains but susceptibility testing is required. For beta-hemolytic streptococcal infections, all three can be effective, with penicillins typically being first-line therapy when the organism is susceptible.

Question 56

Meds to help with anxiety in an older adult?

Answer 56

Buspar Hydroxyzine

Question 57

Avoid Benadryl in the older adult!!

Question 58

Remeron can help with sleeping and eating