Psychiatry

Question 1

quid of alternative treatment(2)

Answer 1

yoga

acupuncture

Question 2

what to do if a patient is intereted in alternative treatment

Answer 2

physician should inquire as to why

Question 3

how to dx major depressive episode(8)

Answer 3

Sleep proble
Interest low
Guilt
Energu is low
Concentration
Appetite is low
Psychomotor ...
Suicidability

Question 4

First line treatment of schizophrenia(8)

Answer 4

Aripiprzole
Asenapine
iloperidone
olanzapine
quetiapine
paliperidone
risperidone
ziprasidone

Question 5

best btolerated drug in patient with psychosis

Answer 5

Olanzapine

Question 6

when using injectable products in schizophrenia

Answer 6

non compliant patient to oral medication

Question 7

what injectable medication can be used in schizophrenia(4)

Answer 7

haloperidol decanoate
fluphenazine decanoate
risperidone depot
paliperidone

Question 8

posologie of haloperidol injectable in the rx of schizophrenia

Answer 8

once a month

Question 9

posologie of fluphenazine injectable in the rx of schizophrenia

Answer 9

twice a month

Question 10

posologie of risperidone injectable in the rx of schizophrenia

Answer 10

twice a month

Question 11

posologie of paliperidone injectable in the rx of schizophrenia

Answer 11

1 a 2 fois par mois

Question 12

best long term rx of schizophrenia

Answer 12

paliperidone

Question 13

quid of bipolar(2)

Answer 13

lot of energy

megalomaniac

Question 14

do you need depression to DX bipolar

Answer 14

no

Question 15

rx of bipolar (3)

Answer 15

mood stabiliser
plus
atypical antipsychotics
atipical antipsychotics as montherapy

Question 16

quid of mood stabiliser(3)

Answer 16

lithium
lamotrigine
acid valproic

Question 17

quid of atypical antipsychotics used in bipolar(5)

Answer 17

risperidone
olanzapine
quetiapine
aripiprazole
ziprasidone

Question 18

first line regimen for mild to moderate bipolar

Answer 18

atypical antipsychotics

Question 19

rx of severe episodes of bipolar

Answer 19

mood stabiliser plus atypical anti psychotics

Question 20

patient presenting with many symptoms has seen many doctors asking for CT even if the prior CT was normal

Answer 20

somatisation

Question 21

what to do in patient with somatisation

Answer 21

scheduled appointment intended to reduce underlying psychological distress

Question 22

in vignette patietn patietn with thought of being poisonned depuis 3 mois

Answer 22

delusionnal disorder

Question 23

type of delusion(5)

Answer 23

persecutory
erotomanic
grandiose
jealous
somatic

Question 24

erotomanic delusion

Answer 24

you think someone of higher status is in love with you

Question 25

grandiose delusion

Answer 25

belief of great talent insights or achievements

Question 26

Jealous delusion

Answer 26

unfaithful partners

Question 27

somatic delusion

Answer 27

belief of bodily functions and sensation

Question 28

how to differentiate delusion from schizophrenia(2)

Answer 28

you need symptoms for at least 6 months to dx schizophrenia | additional psychotic symptom in schizophrenia

Question 29

psychotic symptom in schizophrenia(3)

Answer 29

hallucinations disorganisation negative symptom

Question 30

clue for delusion

Answer 30

patient is highly functionnal

Question 31

rx of obsessive compulsive disrder will target which substance

Answer 31

serotonin

Question 32

drugs used in OCD(5)

Answer 32

``` clomipramine fluoxetine fluvoxamine paroxetine sertraline ```

Question 33

class of drug for clomipramine

Answer 33

TCA

Question 34

RX of choice of OCD

Answer 34

paroxetine

Question 35

which neurotransmetter has altered level in OCD

Answer 35

serotonin

Question 36

quid of bereavment

Answer 36

normal reaction to the loss of loved one

Question 37

persistent complex bereavement syndrome

Answer 37

persistence of symptom at leats one year after the loss of loved one

Question 38

dx of major depression(2)

Answer 38

4 symptoms in SIGECAPs plus mood depressed or loss of interest

Question 39

cancer patient is at risk of what psychiatric disease

Answer 39

major depression

Question 40

rx of patient with cancer and major depression

Answer 40

SSRI

Question 41

can you have bereavement from cancer

Answer 41

yes you can

Question 42

how a patient with bipolar will take lithium

Answer 42

it depends on the number of relapses

Question 43

first episosde of bipolar rx duration

Answer 43

lithium for at least one year

Question 44

second episode of bipolar

Answer 44

lithium for years

Question 45

indication of lithium for many years(3)

Answer 45

2 episodes severe episode family history

Question 46

rx of more than 3 episodes of bipolar

Answer 46

lithium for lifetime

Question 47

patient taking fluoxatine for depression after 2 weeks he comes back to say there's no improvement what to do?

Answer 47

continue fluoxatine at the same dose

Question 48

when a patient taking SSRI will start having improvement

Answer 48

in 4 -6 weeks

Question 49

mechanism of action of risperidone

Answer 49

blocking dopamine D2 receptor

Question 50

what a clinician should do in case of mistake(2)

Answer 50

facts should be clarified | truth told to the patient

Question 51

patient leaves home to live on university campus weeks later develops anxiety that someone is going to break the house dx

Answer 51

adjustment disorder with anxiety

Question 52

quid of adjustment diosorder with anxiety

Answer 52

development of emotionnal or behavioral symptom in response to an identifiable stressor within 3 months of the onset of the stressor

Question 53

quid of acute stress disorder

Answer 53

anxiety developing after experiencing or whitnessing an event

Question 54

acute stress disorder and PTSD

Answer 54

PTSD last more than one month

Question 55

generalized anxiety disorder GAD

Answer 55

excessive worry on many aspects of life including work,family, finance etc...

Question 56

patient starting new job worry in asking if children are safe at school, has difficulty sleeping etc...

Answer 56

GAD

Question 57

what's the most important factor to determine a psychiatric disorder

Answer 57

the level of functionning at work

Question 58

patient with lot of stress at work because colleague quit and has more workload,sleep poorly but keep on doing well in his job dx

Answer 58

normal human experience

Question 59

immature mechanism of defense in which individual expresses his aggresion toward another person with repeated passive failure to meet the other person

Answer 59

passive agressive behavior

Question 60

patient after having a warm argumetn with the receptionnist called the physicyan office for a new appointment.Everytime patient calls up receptionnist says i am sorry the appointment is full what type od mechanism of defense is used by the receptionnist

Answer 60

passive agressive behavior

Question 61

patient develops tonic clonic seizures , she used to take a drug for anxiety but stops taking it and suddenly develops seizure what drug she was taking

Answer 61

alprazolam

Question 62

abrupt cessation of this drug cause seizure

Answer 62

alprazolam

Question 63

example of catatony

Answer 63

patient repeats only with monosyllables and refused to make eye contact

Question 64

symptoms of schizophrenia(5)

Answer 64

``` delusions hallucinations disorganised speech catatony negative symptom ```

Question 65

patietn presenting with all symptoms of schizophrenia but depuis moins de 6 mois dx

Answer 65

schizophreniform disorder

Question 66

quid of brief psychotic disorder

Answer 66

symptom lasting more than 1 day but less than 1 month

Question 67

qid of chizoaffective disorder

Answer 67

mood disorder with active symptom of schizophrenia lasting at least 2 weeks

Question 68

quid of delusionnal disorder(3)

Answer 68

delusions lasting more than 1 month normal functionning no psychotic symptom

Question 69

person who is splitting people as good or bad

Answer 69

bordeline personnality disorder type B

Question 70

risk of boderline personality disorder

Answer 70

risk of suicide | angry outburst

Question 71

disorganized speech in schizophrenia ,quid of of circumstantiality(3)

Answer 71

stand around you give detailed to a specific question but irrelevat responses patietn deviates from the original subject but eventually return to it

Question 72

tangential thought

Answer 72

patietn druft away from the subject but never return to it

Question 73

quid of conficdentiality in medical sciences

Answer 73

don't discuss thing about a patient with somebody or physician directly relaled to his care

Question 74

what to monitor in patietn taking olanzapine and clozapine(2)

Answer 74

fasting glucose | lipids

Question 75

pathologic gambling

Answer 75

pathologic history of gambling and inability to stop

Question 76

how to deal with angry patient

Answer 76

start a discussion with open ended question and let the patietn talk about the emotion and problem

Question 77

different classes of antidepressant drugs(4)

Answer 77

SSRI=selective serotonin reuptake inhibitor SNRI=serotonin norepinephrine reuptake inhibitor TCA=tricyclic antidepressant MAOI=mono amine oxydase inhibitor atypical antidepressant

Question 78

name atypical antidepressant(3)

Answer 78

bupropion mirtazapine trazodone

Question 79

TCA(4)

Answer 79

amitryptiline clomipramine doxepin nortryptiline

Question 80

name SNRI(3)

Answer 80

duloxetin venlafaxine Pesvenlafaxine

Question 81

Name MAOI (2)

Answer 81

phenelzine | tranylcipromine

Question 82

when to change class of anti depressor during rx

Answer 82

when two trials of SSRI are inneficient

Question 83

first line rx of GAD(2)

Answer 83

cognitive behavioral therapy | SSRI or SNRI

Question 84

second line of GAD(2)

Answer 84

benzodiapine | buspirone

Question 85

quid of GAD(6)

Answer 85

``` multiple wory or anxiety > ou egal a 6 months plus 3 or more of this restlessness fatigue difficulty concentrating irritability Mx tension sleep disturbance ```

Question 86

quid of folie a deux

Answer 86

psychaitric disorder a delusion or set of delusion is shared simultaneously by individuals who dshared a close relationship

Question 87

what to do in case folie a deux interview(2)

Answer 87

interview the two people separately | rx the one who first has the delusion

Question 88

person always alone ,demonstrate interst in magical thing

Answer 88

schysotypal personality disorder

Question 89

shizoid personality disorder

Answer 89

they don't have friends

Question 90

avoidant personality disorder

Answer 90

they want friends but fear ridicule

Question 91

patient major with paranoid schizphrenia compliant to meds come to the emergency with dx of ruptured ectopic pregnancy.patient is conscious ,whi can give the consent for her

Answer 91

the patietn as long as her jugment and decision making ability are not affected

Question 92

who can give consent for intervention surgical in minor

Answer 92

patient's parent

Question 93

minor less than 18 ans who don't require parental consent(5)

Answer 93

``` homeless live alone financially independent married military ```

Question 94

minor wo dont dont need consent (6)

Answer 94

emergent care

Question 95

jehovah witnesses with no advanced directives on him and requires blod transfusion but unconscious

Answer 95

transfusion can be done

Question 96

quid of advance directive or card

Answer 96

instruction saying you want something or not during critical care

Question 97

if the jehovah witness is conscious what can be done

Answer 97

he can refuse or accept the blod transfusion

Question 98

patient found in airport or terminal bus with dissociation forgetfulness of name and adress

Answer 98

dissociative fugue

Question 99

what 's the best answer to give to the parent of a kid with kleptomania

Answer 99

it's a mental disorder that can be treated with psychotherapy

Question 100

rx of kleptomania

Answer 100

cognitive behavioral therapy

Question 101

quid of kleptomania

Answer 101

impulsive control disorder

Question 102

dx differential of kleptomania(4)

Answer 102

shoplifting antisocial behavior disorder bipolar manic episode(impaired jugment) psychotic disorder vol because of hallucinations

Question 103

kid with ALL but parent refuse chimio next step

Answer 103

obtain a court order for chemo

Question 104

why you should obtain a court order for chemo in patient with ALL but parent refusing rx

Answer 104

50% des cas ALL is treated with chemo

Question 105

straight A student 16 yo become suddenly to develop odd bahavior missed class failing in math ,what the best next thing to do

Answer 105

obtain urine toxicolog screening

Question 106

any changes in adolecent behavior what to check(5)

Answer 106

``` check drug use partner violence date rape pregnancy sexual or physical abuse ```

Question 107

patient on antipsychotics develops milky discharge in nipple cause?

Answer 107

risperidone

Question 108

clue for prolactinoma

Answer 108

prolactinemia > 200 ng /ml

Question 109

clue ofr dependent personnality disorder(3)

Answer 109

partner physically abusive but wife can leave him avoid arguments whenever possible to be pleasant to others fear of being alone

Question 110

clue for bulimia nervosa(3)

Answer 110

patient eats a lot and sometime vomit(throw up) tends to fast or exercicie to compensate BMI is normal or slighlty above

Question 111

clue for anorexia nervosa(2)

Answer 111

patient with low BMI | amenorrheic

Question 112

BMI in bulimia nervosa(2)

Answer 112

normal or slightly elevated

Question 113

clue for persistent depressive disorder

Answer 113

dysthimia ,chronic low grade depression that last 2 years or more

Question 114

how to differentiate major depressive disorder and persistent depressive disorder

Answer 114

you don't have all 5 crtieria in SIGECAP in persistent depressive disorder

Question 115

symptom in persistent depressive disorder(2)

Answer 115

sadness | low energy for years

Question 116

pain during sexual intercourse or when attempting penetration

Answer 116

genito pelvic pain penetration disorder

Question 117

quid of alcohol hallucinosis

Answer 117

alcohol withdrawal syndrome occurring 12-24 h after the last drink and resolves within 24-48 h

Question 118

patient with history of 6-8 beers /day develops auditory hallucination after an accident

Answer 118

alcohol hallucinosis

Question 119

quid of delirium tremens

Answer 119

fever HTA tachycardia occuring 48-96 hr after stopping alcohol

Question 120

quid of withdrawal seizures

Answer 120

alcohol withdrawal causing seizures

Question 121

quid of mild withdrawal alcohol(2)

Answer 121

palpitation or tremulation

Question 122

complication of mild withdrawal or alcohol withdrawal seizures

Answer 122

Delirium tremens

Question 123

differentiate alcohol hallucinosis and DT

Answer 123

vitals are normal in alcohol hallucinosis

Question 124

quid of pyromania

Answer 124

intentionnal and repeated fire setting with no obvious motive

Question 125

immature mechanism of defense in which individuals displace negative feelings associated with an unacceptable object or situation ob a safer object or situation

Answer 125

displacement | dan pouri gen fos sou bannann mu

Question 126

side effct most commonly seen with olanzapine

Answer 126

weight gain

Question 127

cause of acute dystonic reaction(2)

Answer 127

haloperidol | metochlopramine

Question 128

rx of acute dystonic reaction

Answer 128

benztropine or antihistaminics(diphenidramine)

Question 129

quid of bereavment

Answer 129

sadness after a bad event

Question 130

patietn with cancer can develop what disease

Answer 130

major depression

Question 131

rx of bereavment

Answer 131

SSRI

Question 132

drug used in NMS

Answer 132

dantrolene

Question 133

after a dx of cancer patient goes on internet to search for data on his disease waht mechanism of defense used by the patient(2)

Answer 133

intellectualisation | an immature mechanism of defense

Question 134

difference between boulimia nervosa and binge eating disorder

Answer 134

in binge eating disorger no compensatory behavior

Question 135

rx of binge eating disorder(2)

Answer 135

SSRI and CBT

Question 136

first line rx in boulimia nervosa and anorexia nervosa

Answer 136

CBT | nutritionnal rehab

Question 137

when use pharmacologic rx in boulimia nervosa and anorexia nervosa

Answer 137

when first line regimen fails

Question 138

clue for inducing vomiting(surreptitious vomiting)(4)

Answer 138

parotid gland hypertrophy dental caries halithosis scars and calluses over hand

Question 139

quid of hoarding disorder

Answer 139

difficulty discarding possessions regardless of their actual values

Question 140

first line rx of hoarding disorder(2)

Answer 140

CBT | SSRI

Question 141

patient with history of dependence of opiod develops false symptom of back pain to get morphine dx

Answer 141

malingering

Question 142

what's the deadline for a physician to give a copy of medical record on patient's request

Answer 142

30 jours

Question 143

what to do if relatives or patient want to get a copy of dossier

Answer 143

patient must request a copy of medical record

Question 144

pregnant woman with clear indication of CS refuses it what to do

Answer 144

respect the patient decision and proceed with vaginal delivery

Question 145

why respect the patient decision and proceed with vaginal delivery in case of refusal of CS

Answer 145

pregnant women have the right to refuse rx even if it places her unborn child at risk

Question 146

mother refuses to vaccinate children next step

Answer 146

document in the medical chart that the risks and benefits of vaccination have been explained

Question 147

quid of advance directives

Answer 147

document completed while patietn have decision making capacity to ensure that decisions are made according to his wishes in the event that they lose decision making capacity

Question 148

what to do if patient's healthcare proxy disagrees with a living will and demands care that contradicts the patietn written wishes

Answer 148

discuss the matter with the proxy and other family member

Question 149

what if the family members fails to resolve the problem

Answer 149

the hospital ethics commmitee shold be consulted

Question 150

why you shoul not give bupropion to patient with eating disorder

Answer 150

risk for seizures

Question 151

why can you have seizures with bupropion in patient with eating disorder

Answer 151

electrolytes disturbance

Question 152

why bupropion is contrindicated in epilepsy

Answer 152

it's decreases the tresholf of seizure

Question 153

why patient snorting cocaine tends to lose weight

Answer 153

because they have decreased appetite

Question 154

when using haloperidol in patient with manic episodes

Answer 154

extreme agitation

Question 155

some clue for manic episode(7)

Answer 155

inflated self esteem or grandiosity decreaased need for sleep increase talktiveness or pressured speech flight of ideas distractibility or irritability increase goal directed activity or psychomotor agiatation increasse involvement in pleasurable activities (sex,gambling,purchasing)

Question 156

patient with presenting with mx pain diarrhea abdominal cramps sweating and HTA abd dilated pupils what drugs can cause that

Answer 156

heroin withdrawal

Question 157

action of heroin

Answer 157

everything is high

Question 158

1 cause of NMS

Answer 158

haloperidol

Question 159

clue for major depression with psychotic symptom(2)

Answer 159

when the patient is depressed psychotic event occurs | when the patietn is euthymic no psychotic symptom

Question 160

quid of schizoaffective disorder

Answer 160

at least > ou egal a 2 weeks of delusions or hallucinations in absence of mood depression and than mood depression occurs with psychotic symptom

Question 161

bipolar with psychotic features(2)

Answer 161

when the patient is manic ,psychotic features occur | when the patient is ok no psychotic features

Question 162

quid of autism(3)

Answer 162

children perform stereotyped behavior no emotionnla bonds with others participation in restricted activities

Question 163

age of onset of autism

Answer 163

before 3 yo

Question 164

patient thinking he has special power

Answer 164

grandiose delusion

Question 165

dx of bipolar

Answer 165

elevated or irritable mood with 3 or more of this | DIGFAST

Question 166

quid of DIGFAST in bipolar disorder

Answer 166

``` D=distractibility I=impulsivity G=grandiosity F=flight of ideas A=activity S=sleep need decreased T=talktiveness or pressured speech ```

Question 167

quid of hypomanic episode(3)

Answer 167

less severe than bipolar symptoms > ou egal a 4 consecutives days no psychotic features

Question 168

can you have psychotic features in bipolar

Answer 168

yes

Question 169

quid of bipolar type 1

Answer 169

manic episode plus depressive episode

Question 170

do you require depressive episode in bipolar type 1

Answer 170

no

Question 171

quid of bipolar type 2(2)

Answer 171

hypomanic episodes | you must have 1 day or more of depressive episodes

Question 172

differenciate type 1 bipolar from type 2(2)

Answer 172

in type 1 no depressive episode is needed | in type 2 you need at one episode at major depression

Question 173

quid of cyclothymic disorder

Answer 173

2 years of fluctuating mild hypomanic and depressive symptom

Question 174

what to suspect in children with sudden behaviral changes

Answer 174

physical or sexual abuse

Question 175

risk factor of sexual abuse or physical abus(2)

Answer 175

parent with unstable economic backgrounds | parent with history of drugs or alcohol abuse

Question 176

quid of response during rx in psychiatry

Answer 176

50% reduction in the baseline level of severity

Question 177

quid of remission during rx in psychiatry

Answer 177

absence of Symptom or minimal symptom

Question 178

quid of sustained remission during rx in psychiatry

Answer 178

stabilisation of patient's symptom

Question 179

quid of recovery during rx in psychiatry

Answer 179

episode is over

Question 180

quid of reccurence during rx in psychiatry

Answer 180

after recovery symptom reappears

Question 181

quid of relapse during rx in psychiatry

Answer 181

during sustained remission symptoms reappears

Question 182

patient with schizophrenia says he is hearing voice telling her to do bad thing.he has a history of suicide attempt 10 years ago ,the patietn refuses to be hospitalised next step

Answer 182

hospitalise the patient involuntarily

Question 183

telling her to do bad thing.he has a history of suicide attempt 10 years ago ,the patietn refuses to be hospitalised ,why you should hospitalise this patient involuntarily

Answer 183

he is a danger for himself and other

Question 184

what medication ingestion contrindicated consumption of meat and aged cheese and why(2)

Answer 184

phenelzine | risk of icrease of blood presure

Question 185

quid of phenelzine

Answer 185

monoamine oxydase inhibitor

Question 186

patiet 16 yo with attempted suicide next step

Answer 186

hospitalisation

Question 187

anxiety restricted to social or performance situations

Answer 187

social anxiety

Question 188

young girl with no close friend during interview the patient says nobody wants to be friend of someone ugly and stupid like me dx

Answer 188

avoidant pesonality disorder

Question 189

quid of body dismorphic disorder

Answer 189

it's an obsessive compulsive disorder

Question 190

what to in case of body dismorphic disorder(4)

Answer 190

continue to meet regularly to discuss concerns of the patient psychoterapy SSRI referral to a psychiatrist

Question 191

Quid of body dismorphic disorder

Answer 191

preoccupation with at least one perceived physical detect

Question 192

quid of most likely cause of tardive dyskinesia

Answer 192

risperidone

Question 193

common manif of tardive dyskinesia(9)

Answer 193

``` face grimacing chewing biting tongue protrusion torticolis shoulder shruugging respiratory grunting noises rocking and swaying rotary hip movements ```

Question 194

limb abnormality in tardive dyskinesia(4)

Answer 194

limb twisting and spreading piano playing finger foot tapping dystonic extension of the toe

Question 195

next step in rx tardive dyskinesia

Answer 195

stop risperidone | begin clozapine

Question 196

side effect of clozapine

Answer 196

agranulocytoiss

Question 197

in cae of suicidability what patient should be hospitalised(2)

Answer 197

patient with ideation | intent and plan

Question 198

suicidability with no plan next step(3)

Answer 198

rx underlying depression family support reduce access to potential means

Question 199

rx of performance only social anxiety(2)SAD

Answer 199

Bblocker or benzodiapines

Question 200

rx used in Generalised social AD and SAD

Answer 200

CBT

Question 201

how to give propranolol in anxiety provoking situation

Answer 201

30-60 mn before the act

Question 202

quid of generalised social anxiety disorder

Answer 202

anxiety in meeting new people | initiating or maintaining conversation

Question 203

rx of generalised social anxiety disorder (2)

Answer 203

CBT | SSRI

Question 204

2 types of social anxiety

Answer 204

performance only | generalised

Question 205

indication of buspirone

Answer 205

generalised anxiety social disorder

Question 206

what about CBT in social anxiety compared to drug

Answer 206

equally efficace

Question 207

tetrad of alzheimer(5)

Answer 207

``` memory impairment apraxia aphasia or language dysfunction agnosia you can have 2 of them ```

Question 208

quid of agnosia

Answer 208

difficulty recognizing object

Question 209

quid of apraxia

Answer 209

difficulty carrying out activities

Question 210

what should be done before making the dx of alzheimer

Answer 210

rule out any medical causes of cognitive decline

Question 211

the best way to break bad news(2)

Answer 211

use a symptom to ask the question | what do you think is going on with your back pain for example

Question 212

steps to prepare meeting with family to break bad news

Answer 212

SPIKES

Question 213

quid of SPIKES(6)

Answer 213

``` S=set up situation P=perception of the family is assessed I=obtain family Invitation,how much info they need to know K=give knowledge and information E=use empathic statements S=staregy and summary ```

Question 214

clue for panic attack(4)

Answer 214

suddeny you have a patient with palpitation chest pain and diaphoresis

Question 215

first thing to do in patient with palpitation chest pain and diaphoresis(2)

Answer 215

EKG | drug screening

Question 216

acute rx of panic attack

Answer 216

benzodiazepine

Question 217

long term rx of panic attack

Answer 217

SSRI

Question 218

gender involved in panic attack

Answer 218

woman

Question 219

you receive le fils d'une femme avec dx of de cancer .Le fils vous demande to withhold the dx to his mother what to do

Answer 219

is there a specific reason you don't want your mother to know the DX

Question 220

quid of trichotillomania

Answer 220

it's an OCD

Question 221

rx of trichotillomania

Answer 221

CBT

Question 222

reaction of pain ,distress after the loss of a close relationship pendant

Answer 222

greaf of bereavement

Question 223

normal laps of time to speak of greaf bereavment

Answer 223

about 6 months

Question 224

complication of greaf bereavment

Answer 224

major depression

Question 225

rx of greaf bereavment(2)

Answer 225

SSRI plus psychoterapy

Question 226

first line rx of OCD(2)

Answer 226

SSRI or clomipramine

Question 227

patient with bruises on body come to clinic when physicians saks on bruises patient start crying dx and next step(2)

Answer 227

tell me more about the bruises on your body | physical abuse

Question 228

rx of withdrawal alcohol seizures

Answer 228

long acting benzodiapines

Question 229

quid of long acting benzodiapines(3)

Answer 229

diazepam lorazepam chlordiazepoxide

Question 230

action of long acting benzodiazepines in rx withdrawal seizures

Answer 230

stimulate gamma aminobutyric acid receptor causing sedation

Question 231

quid of alcoholic in USMLE

Answer 231

6-10 beers /day

Question 232

indication of disulfuram (antabuse)

Answer 232

to maintem long term abstinenece in alcoholic patients

Question 233

rx of alzheimer dementia

Answer 233

initiate cholinesterase inhibitor

Question 234

example of cholinesterase inhibitor(3)

Answer 234

donepezil galantamine rivastigmine

Question 235

children with motor tick =grimacing,blinking shouldeer shrugging vocal tick barking grunting coughing and throat clearance dx

Answer 235

tourette syndrome

Question 236

complication of tourette(2)

Answer 236

hyperactivity disorder | OCD

Question 237

patient with insomnia and use of caffeine alcohol and nicotine especially at the period preceding sleep,engaging to activities too close to bed time ,use of the bed for other activities cause of imsomnia

Answer 237

poor sleep hygiene

Question 238

risk for survivor of sexual assault(3)

Answer 238

PTSD depression suicidability

Question 239

quid of narcolepsy(2)

Answer 239

daytime drowsiness plus cataplexy

Question 240

quid of cataplexy

Answer 240

sudden loss of mx tone triggered by strong emotions

Question 241

rx of narcolepsy

Answer 241

modafinil or amphetamine stimulants

Question 242

preferred drug in narcoplepsy

Answer 242

modafinil also called provigil

Question 243

measure in narcolepsy(3)

Answer 243

avoid alcohol maintain proper sleep schedules avoid drugs causing drowsiness

Question 244

what to do if an employer asks to hospital information on hospitalised patient what you need to do that

Answer 244

verbal or written autorization from patient

Question 245

what to do if an employer asks to hospital information on hospitalised patient with patient's autorization(2)

Answer 245

disclose only minimal necessary information | i can confirm the patietn is hospitalised and i anticipate he will be able to return to work

Question 246

indication of methylphenidate

Answer 246

hyperactivity disorder

Question 247

side effect # 1 of methylphenidate

Answer 247

decreased appetite

Question 248

contrindication of methylphenidate

Answer 248

children less than 6 years

Question 249

common side effect of methylphenidate(3)

Answer 249

abdominal pain insomnia nervousness

Question 250

quid of dysthimia

Answer 250

depressed mood for at least 2 years

Question 251

differenciation between dysthimia and major depression

Answer 251

in dysthimia you have the same symptom than major depression but less severe and longer duration

Question 252

patient rx with sertraline for major depression accuses improvement next step?

Answer 252

continue medication for 6 months

Question 253

rx of simple episode of depression duration

Answer 253

6 mois rx

Question 254

in multiple episode of major depression duration of rx

Answer 254

continue maintenance rx for a long time

Question 255

patient with manic episode has been on rx for 6 months for a prior manic episode develops manic episode next step(2)

Answer 255

initiate antipsychotic | recommend hospitalisation

Question 256

any patient on lithium and develops manic episode next step(4)

Answer 256

hospitalisation antipsychotic plus moodstabilizer urine toxicology mood stabilizer drug levels

Question 257

patient 60 ans with colon cancer refuses rx next step

Answer 257

ask the patient why he doesn't want rx and intervention of any kind

Question 258

what to do if a patient refuses rx

Answer 258

it's important to fully discuss the specific reasons for the decision before honoring it

Question 259

patient has seen many doctors for symptoms but all tests are negative ,she comes to you and asks for CT abdominal scan what to answer ?

Answer 259

i would like to see you at a follow up visit to evaluate your symptom again before deciding the ct scan

Question 260

why patient with somatisation should be seen at follow up visit for further evaluation

Answer 260

because they have to be seen in regular scheduled visits that focus on psychological distress associated with their symptoms

Question 261

patient comes to the hospital for severe haeadache despite of extensive follow up he is sure he has cerebral hemmorrage dx

Answer 261

hypochondriasis

Question 262

next step after dx hypochondriasis

Answer 262

initiate discussion about current emotionnal stressors

Question 263

why you shoud initiate discussion about current emotionnal stressors in case of hypochondriasis

Answer 263

because the symptom will develop in stressfull period

Question 264

rx of hypochondriasis

Answer 264

brief psychotherapy

Question 265

clue for amphetamine intox(8)

Answer 265

``` agitation excitability delirium paranoia tachycardia hta mydriasis diaphoresis ```

Question 266

complication of amphetamine intox(4)

Answer 266

cardiac arythmia seizures hyper thermia intracerebral hemorrage

Question 267

what differentiate amphetamine intox from anticholinergic poisonning intox(5)

Answer 267

``` same symptom sauf dry skin and mucous membranes ileus retention d'urine tremor and myoclonic jerk favors anticholinergic ```

Question 268

patient with low mood but no impairement of daily functionning dx

Answer 268

normal stress response

Question 269

conversion disorder quid

Answer 269

neurologic symptom after a stressor event

Question 270

most common presentation of conversion(4)

Answer 270

weakness paralysis seizures but normal neurologic exam

Question 271

first line rx in conversion

Answer 271

education

Question 272

second line rx in conversion

Answer 272

CBT

Question 273

2 ways of presentation of conversion

Answer 273

hysterical | indifferent

Question 274

sleep pattern in older people

Answer 274

they tend to frequently awaken from sleep and spend less time sleeping overall

Question 275

persistent complex bereavment syndrome

Answer 275

symptom last more than 12 months followiing the loss

Question 276

In USMLE anytime you see death what to rule out

Answer 276

breavement syndrome

Question 277

exposure to lithium during first trimester of pregnancy

Answer 277

cardiac malformation

Question 278

what are the 2 cardiac abnormalities seen in litium during pregnancy(2)

Answer 278

septal defect | ebstein anomaly

Question 279

quid of ebstein anomaly

Answer 279

malformed and inferiorly atached tricuspid valve causing a part of the right ventricle to become part of the right atrium

Question 280

Ebstein

Answer 280

atrialisation of the right ventricle

Question 281

complication of lithium on baby during 3 e trimestre de la grossesse(2)

Answer 281

goiter | transient neuromxar dysfunction

Question 282

rx of tourette(3)

Answer 282

first generation antipsychotics pimozide haloperidol fluphenazine

Question 283

second line rx of tourette(2)

Answer 283

atypical antipsychotics | risperidone

Question 284

quid of tourette syndrome

Answer 284

multiple motor and vocal ticks for 1 yaer

Question 285

should you have vocal ticks and motor ticks together for tourette

Answer 285

no you can them separately

Question 286

first rx for tourette

Answer 286

risperidone

Question 287

quid of narcistic personality disorder

Answer 287

exaggerated senseof self importance feelings and entitlement egocentrism and lack of empathy to others

Question 288

indication of electroconvulsive rx(5)

Answer 288

``` severe depression depression in pregnancy refractory mania NMS catatnic schizophrenia ```

Question 289

adverse effect of electroconvulsive rx(6)

Answer 289

``` prolonged seizures delirium skin burns amnesia headache nausea ```

Question 290

most common side effect of electroconvulsive rx

Answer 290

amnesia

Question 291

quid of factitious disorder

Answer 291

patient induces symptom to play the sick role

Question 292

example of factitious disorder

Answer 292

patient taking insulin

Question 293

munchausen syndrome

Answer 293

patient playing the sick role in order to get surgery

Question 294

complication in baby with mother suffering from anorexia nervosa

Answer 294

small of gestationnal age baby

Question 295

anomaly in anorexia nervosa in patient(6)

Answer 295

``` osteoporosis increase cholesterol and carotene levels cardiac arythmia euthyroid sick syndrome hyponatremia hypothalamic pituitary axis dysfunction ```

Question 296

cardiac arythmia seen in anorexia nervosa

Answer 296

prolonged QT syndrome

Question 297

anorexia nervosa and hypothalamic pituitary axis dysfunction(3)

Answer 297

amenorrhea anovulation estrogen deficiency

Question 298

why hyponatremia in anorexia nervosa

Answer 298

excess of water drinking

Question 299

why you can have many electrolytes disturbances in anorexia nervosa

Answer 299

because of purging behavior

Question 300

complication of pregnancy in anorexia nervosa(6)

Answer 300

``` miscarriage intrauterine growth retardation hyperemesis premature birth cesarean section post partum depression ```

Question 301

quid of antisocial personnality disorder

Answer 301

patient 18 ou plus engages in illegal activities and disregard rights of others

Question 302

what to monitor in all patietns taking clozapine

Answer 302

WBC

Question 303

why monitor WBC in patient taking clozapine

Answer 303

to rule out agranulocytosis

Question 304

other side effect of clozapine

Answer 304

lower seizure treshold

Question 305

rs of alcohol withdrawal syndrome

Answer 305

diazepam

Question 306

patietn asking to see doctor after time of closing office for sore in the mouth what to do(2)

Answer 306

politely and firmly refuses to see the patient and schedules her for tomorrow although i undestood your concern we should address the issue tomorrow because it's not an emergency

Question 307

quid of somatisation

Answer 307

symptom more than 6 months with disruption of daily life

Question 308

quid of illness anxiety disorder

Answer 308

prolonged fear and concern about getting or having a disease but with minimal or no actual physical symptom

Question 309

children verbal and talkative at home but refuses to speak in specific settings generally at school dx

Answer 309

selective mutism

Question 310

patient presenting with sudden palpitations sweating trembling or shaking shortness of breath and hot and cold sensations dx

Answer 310

panic disorder

Question 311

disease associated with panic disorder(4)

Answer 311

major depression agoraphobia bipolar substance abuse

Question 312

risk in patient with panic attack

Answer 312

suicide

Question 313

abnormal imaging associated with schizophrenia

Answer 313

enlargement of cerebral ventricles

Question 314

abnormal imaging associated with autism

Answer 314

increase total brain volume

Question 315

abnormal imaging associated with OCD

Answer 315

abnormalities in orbitofrontal cortex and striatum

Question 316

abnormal imaging associated with PTSD

Answer 316

decrease volume of amygdala

Question 317

which ventricle is enlarged in schizophrenia

Answer 317

lateral ventricle

Question 318

hiv positive woman is terrified by her lab result she has trouble telling that to her husband what to say

Answer 318

encourage the patient to tell her husband but tell her you to inform the local health department

Question 319

what will do the local health department in hiv case

Answer 319

departement health will call the husband to him he is at risk of hiv without telling him about the person who placed him at risk

Question 320

patietn with caught his girlfriend cheating on him he develops worthless,sleep problem all began 2 months after the rupture dx(2)

Answer 320

adjustement disorder | it's not depression

Question 321

rx of adjustment disorder(2)

Answer 321

psychodynamic psychotherapy | brief cognitive psychotherapy

Question 322

quid of adjustment disorder

Answer 322

emotionnal or behavioral symptom that develops within 3 months of exposure to an identifiable stressor

Question 323

quid of rationalisation

Answer 323

an immatire defense mechanism characterised by excusing an unacceptable behavior in a false but logical way to avoid the true reasons for the behavior

Question 324

a woman noticed a mass in a breast but resolved not to see a doctor.when asked why she made this decision she replies:i didn't want to have a bunch of appointment when i should be helping my children with homeworkwhat mechanism is used to explain why she didn't come to see doctors

Answer 324

rationalisation

Question 325

clue for EPS type parkinsonian(4)

Answer 325

walk much slower not swinging arms facial expressions flat ,unchanged micrographia

Question 326

rx for EPS

Answer 326

benztropine

Question 327

indication of CBT(3)

Answer 327

overgeneralisation of negative events catastrophising maximizing negative events

Question 328

when CBT can be used(5)

Answer 328

``` anxiety mood problem personality problem somatic symptom eating disorder ```

Question 329

how many sessions of CBT is recommnaded

Answer 329

12

Question 330

indication to place a patient in a hospice care

Answer 330

patient with prognosis less than 6 months

Question 331

what are the focus in hospice care(5)

Answer 331

``` symptom control quality of life psychosocial spiritual bereavment care ```

Question 332

rx of meningococcemia(3)

Answer 332

isolation IV antibiotics supportive care

Question 333

can a patient refuse the rx of meningococcemiaand why(2)

Answer 333

no | because he could be pose a threat to the health and welfare of others

Question 334

patient comes in hospital for symptom she has last week and asked to see the same doctor in private without the nurse,she comes with no appointment what to do

Answer 334

ask the receptionnist instruct the patient to shedule an appointment during normal office hours

Question 335

rx of specific phobia first line

Answer 335

CBT

Question 336

second line rx of specific phobia

Answer 336

benzodiazepines

Question 337

what they do during CBT

Answer 337

exposure technique

Question 338

quid of phobia

Answer 338

fear of specific object or situation

Question 339

strongest indication for a future suicide in patient with psychiatric disorder

Answer 339

previous suicide attempt

Question 340

indication for suicide(8)

Answer 340

``` preexisting psychiatric disorder hopelessness impulsivity never married elderly white men unemployed or unskilled physical illness family history or genetics family discord ```

Question 341

protective fgactors against suicide(4)

Answer 341

social support/family connectedness pregnancy parenthood religion and participation in religious activities

Question 342

the greatest risk to attempt suicide in future

Answer 342

past history of suicide attempt

Question 343

what must be present for the dx of major depression(2)

Answer 343

low mood or anhedonia plus SIGECAPS

Question 344

duration of symptom to dx major depression

Answer 344

two weeks or more

Question 345

what the most important element to dx grief(2)

Answer 345

loss | emptyness

Question 346

dx depression

Answer 346

5 on 9 depressive symptoms which at least 2 weeks | at least one is depressed mood or looss of interest/pleasure

Question 347

reaction formation

Answer 347

transformation of an unwanted thought or feeling into it's opposite

Question 348

woman is angry because of increasing number of immigrants asking for job,he volunteers to help immigrant families by offering vocationnal guidance to find job DX

Answer 348

reaction formation

Question 349

patient with creat 1,9 and bipolar what medication can be given in long term rx (as mood stabiliser )of the patient

Answer 349

acid valproic

Question 350

bipolar and renal failure

Answer 350

no lithium

Question 351

in major depression evaluation what should be screened

Answer 351

suicidal ideation

Question 352

if suicidal ideation is present during major depression evaluation what should be done

Answer 352

hospitalisation

Question 353

helpful measure in schizophrenia

Answer 353

keep family stresses and conflicts to a minimum

Question 354

what about school during schizophrenia

Answer 354

gradual return with a reduced schedule would be more appropriate

Question 355

patient seen in clinics but refuses to speak,her husband is with her but replies to all the question during interview next step

Answer 355

ask the husband to step out the room and then try to speak to the patient

Question 356

what types of question patient can have difficulty to answer in front of family members(3)

Answer 356

question regarding drug use sexual history domestic violence

Question 357

clue for marijuana intox(3)

Answer 357

increased appetite impaired perception conjunctival injection

Question 358

clue for PCP intox

Answer 358

nystagmus

Question 359

type of drug PCP is

Answer 359

hallucinogen

Question 360

clue for LSD intox

Answer 360

visual halucinations

Question 361

complication of cocaine(2)

Answer 361

chest pain | seizures

Question 362

clue heroin intox(3)

Answer 362

deressed mental status miosis respiratory depression

Question 363

what type of drug is heroin

Answer 363

opioid

Question 364

type of drug is marijuana

Answer 364

psychoactive drugs

Question 365

gynecomastia in use of cannabis meaning?

Answer 365

chronic use

Question 366

what test shold be done before initiating lithium rx(2)

Answer 366

creatinine | thyroid function

Question 367

complication of lithium(3)

Answer 367

nephrogenic insipidus diabetes hypothyroidism ebstein anomaly in fetus

Question 368

neurologic action of lithium

Answer 368

inhibit inositol 1 phosphatase in neuron

Question 369

why headache is important in psychiatry

Answer 369

could be indicative of depression in elderly

Question 370

can you physical symptom in depression

Answer 370

sometimes patient with depression comes to see you with physical symptom

Question 371

drugs causing halluciantions and combative behavior

Answer 371

Phenylcyclidine

Question 372

drugs causing hallucinations and intensified perceptions

Answer 372

PCP and LSD

Question 373

what are the 3 A for negative symptoms(3)

Answer 373

asociability alogia affective flattening

Question 374

SIGECAPS

Answer 374

``` S=sleep I=interst G=guilt E=energy C=concentration A=appetite P=psychomotor S=suicidability ```

Question 375

teens you can rx without parents consent(4)

Answer 375

contraception prenatal care substance abuse STD

Question 376

drugs used in depression and smoking cessation

Answer 376

bupropion

Question 377

druds used to rx all forms of anxiety and fright disorder

Answer 377

SSRI

Question 378

if father ,or sibling or dizygotic tween or first degree relative twin has schizophrenia what's the probability to progeniture to have it

Answer 378

5 a 10 %

Question 379

twin monozygotic has schizophrenia what the probility of having it in other twin

Answer 379

70%

Question 380

a child with both parents schizophrenic what the probability for the child to have it

Answer 380

60%

Question 381

schizophrenia probability in the general population

Answer 381

1%

Question 382

the 3 manif of extra pyramidal syndrome

Answer 382

acute dystonic reaction akathisia parkinsonism

Question 383

symptom in acute dystonic reaction

Answer 383

neck rigidity

Question 384

symptom in acute akathisia

Answer 384

restlessness

Question 385

rx of akathisia

Answer 385

propranolol

Question 386

rx of parkinsonism(2)

Answer 386

amantadine or anticholinergic

Question 387

hallmark of NMS(3)

Answer 387

hyperthermia rigidity autonomic instability

Question 388

complication of NMS

Answer 388

rhabdomyolysis

Question 389

rx of NMS(3)

Answer 389

dantrolene or amantadine or/and dopamine agonist

Question 390

rx of anorexia nervosa

Answer 390

olanzapine

Question 391

rx of bulimia

Answer 391

SSRI

Question 392

quid of russel's sign(2)

Answer 392

cicatrices and calluses over the hand | seen in anorexia nervosa

Question 393

triad of anorexia nervosa(3)

Answer 393

low BMI

Question 394

first thing to do if child abuse is suspected

Answer 394

complete physical examination

Question 395

second thing to do if child abuse is suspected

Answer 395

skeletal survey

Question 396

third thing to do if child abuse is suspected

Answer 396

coagulation profile

Question 397

4e thing to do if child abuse is suspected

Answer 397

child protective services

Question 398

5e et 6 e thing to do if child abuse is suspected(2)

Answer 398

hospitalisation if necessary | consultation with a psychiatrist

Question 399

patient with depression develops HTA crisis while eating cheese what drug is he on

Answer 399

phenelzine

Question 400

substance containing tyramine and hta crisis during depression if patient is taking phenelzine(2)

Answer 400

meat | cheese

Question 401

indication of cl0zapine in hospiatalised patietn with schizophrenia(2)

Answer 401

treatment resistant schizophrenia | schizophrenia associated with suicidability

Question 402

adverses effect of clozapine(4)

Answer 402

agranulocytosis seizures myocarditis metabolic syndrome

Question 403

patient with delusion or hallucinations ask you if you believe him the best answer to give him

Answer 403

i know your experienc ehas been difficult for yo.Let's see what we can do to help u

Question 404

approach the patient with delusions(2)

Answer 404

acknowledge the patient distress | without endorsing specific delusions or halucinations

Question 405

first line regimen in psychosis

Answer 405

second generation anitpsyhotics

Question 406

patient foud by police wandering in the street .whe askin what she fels she answers"jingle jangle " doctor dx

Answer 406

psychosis

Question 407

patient hospitalised three months later for psychosis come to see you with erectile dysfunction and gynecomastia what cause that and physiopatho

Answer 407

hyperprolactinemia caused by antopsychotics | reason=decreased or blackade of dopamine activity in the tuberoinfundibular pathway

Question 408

kid 5 yo talking to herself.She says she has a friend called Mindy dx

Answer 408

imaginary friends

Question 409

what to do in case of imaginary friends(2)

Answer 409

nothing | imaginary friend is outgrown by the early elementary school years