Psych

Question 1

clozaril SE’s

Answer 1

• weight gain/metabolic syndrome

- moderate risk of prolonged QTc

Question 2

second generation antipsychotic least associated with weight gain

Answer 2

• Abilify

Question 3

Second generation antipsychotics vs first generation antipsychotics

Answer 3

Less risk of EPS

Question 4

EPS is

Answer 4

dystonia, akathisia, parkinsonism (dopamine deficiency)

Question 5

Management of social anxiety disorder (social phobia)

Answer 5

• SSRI

- CBT

Question 6

What is an adequate trial of an SSRI

Answer 6

6 weeks

Question 7

Management of SSRI non responder

Answer 7

Stop SSRI, switch to another antidepressant

Question 8

Management of patient who partially responds to an SSRI

Answer 8

Continue SSRI + Augment with a second agent

Question 9

first line for borderline personality disorder

Answer 9

• psychotherapy (dialectical behavioral therapy)

Question 10

Borderline personality disorder features

Answer 10

• unstable relationships
• mood instability (mood swings and mood reactivity)
• recurrent suicidal behaviors
• self mutilation and threats of self mutilation
• chronic feelings of emptiness
• transient paranoia

Question 11

First line treatments for bipolar 1 disorder

Answer 11

• quetiapine
• lurasidone
• olanzapine + fluoxetine
• lithium
• lamictal
• valproate

Question 12

Management of tardive dyskinesia

Answer 12

• discontinue causative medication if feasible
• *IF continued antipsychotic is required –> switch to second-generation antipsychotic
• treatment = valebnazine or deutetrabenazine

Question 13

sporotrichosis clinical features + biopsy features

Answer 13

• nodule forms, which typically ulcerates or can remain nodular, then more proximal lesions develop in a lymphatic chain
• clear fluid drained
• no adenopathy or other signs of infection
• granulomatous inflammation

Question 14

tularemia clinical features

Answer 14

• single erythematous ulcerative lesion with a central eschar + tender regional LAD

Question 15

PFTs in primary pulmonary hypertension

Answer 15

• typically normal but decreased diffusion capacity

Question 16

physical exam + clinical features of pulmonary HTN

Answer 16

• left parasternal lift, right ventricular heave
• loud P2, right-sided S3
• pan systolic murmur of TR
• **JVD, ascites, peripheral edema, hepatomegaly

Question 17

Presentation + labs for APAP toxicity

Answer 17

• markedly elevated liver enzymes or acute liver failure
• may say concurrent intake of CYP450 meds (phenytoin or bactrim) or chronic alcoholic (additional RF)
• subtle at first (asymptomatic or mildly altered with nausea and vomiting, then become progressively lethargic)

Question 18

Presentation + labs for liver abscess

Answer 18

• fever + RUQ pain

- elevated liver enzymes but not in thousands

Question 19

acute hep c presentation

Answer 19

• often asymptomatic

- rarely causes liver failure

Question 20

Management of SSRI withdrawal syndrome

Answer 20

• restart SSRI and then gradually taper
  OR
  substitute an equivalent dose of long-acting fluoxetine

Question 21

Diagnosis of depression in cancer patients

Answer 21

• non somatic symptoms (loss of interest, worthlessness, suicidality)
• guilt over being a burden to family, thinking about death are not reliable because they are common among cancer patients
• Depression in cancer patients is under-recognized and underrated

Question 22

Acute stress disorder presentation + feature differentiating it from PTSD

Answer 22

• within 4 weeks of a traumatic event (PTSD is over 1 month)

- similar to PTSD: re-experiencing of event + hyperarousal + avoidance behaviors + nightmares

Question 23

Management of elderly male with depression

Answer 23

IF RF’s for suicide (widowed, living alone, hopelessness, access to firearms) –> psych hospitalization

Question 24

Suicide risk from beta blockers

Answer 24

• association with depression hasn’t been supported by research

Question 25

First and second line treatment of anorexia

Answer 25

First line: CBT + nutritional rehabilitation | Second line: olanzapine

Question 26

Bulimia vs binge-eating disorder

Answer 26

- bulimia = inappropriate compensatory behavior

Question 27

When pharmacotherapy is indicated for anorexia

Answer 27

- only when people don't respond to nutritional rehab and psychotherapy

Question 28

Postpartum depression vs blues

Answer 28

postpartum depression = 2 or more weeks + meeting SIGECAPS criteria

Question 29

MMSE scoring + caveat

Answer 29

less than 24 = dementia | *highly educated patients can have normal scores

Question 30

First line treatment of PTSD

Answer 30

- trauma focused CBT - SSRIs or SNRIs * not atypical antidepressants or wellbutrin

Question 31

Treatment of akathisia

Answer 31

- Dose reduce antipsychotic if possible | - beta blockers or benzos

Question 32

Indications for hospitalization with diverticulitis

Answer 32

- high fever or high white count - poor oral intake * significant comoborbidities - immunosuppressed

Question 33

Options for inpatient diverticulitis antibiotic treatmnet

Answer 33

zosyn CTX + flagyl quinolone + flagyl

Question 34

Other features of PTSD

Answer 34

- dissociative symptoms (don't confuse with depersonalization-derealization disorder)

Question 35

antidepressants that don't effect sexual function

Answer 35

- bupropion | - mirtazapine

Question 36

Features of transient global amnesia vs. dissociative amnesia

Answer 36

- transient global amnesia = transient impaired anterograde memory (can't form any new memories) - dissociative amnesia = loss of autobiographical memory (no ability to remember details about self or family)

Question 37

treatment of pelvic organ prolapse

Answer 37

- vaginal pessary | - pelvic floor muscle exercises

Question 38

Panic disorder management

Answer 38

- acute: benzos | - maintenance: SSRI + CBT