Psychiatry Flashcards Preview

STEP 3 > Psychiatry > Flashcards

Flashcards in Psychiatry Deck (163):
1

A pt presents with flattened affect social withdrawal, anhedonia (loss of energy), apathy, poverty of thought and delusions/ disorganized speech or behavior/ hallucinations for more than 1 month but less than 6 months most likely suffers from ...

Schizophreniform

2

A pt presents with flattened affect, social withdrawal, anhedonia (loss of interest), apathy, poverty of thought, and delusions/ hallucinations/ disorganized speech or behavior for at least 1 month with significant impact on social/ occupational functioning for 6 months most likely suffers from...

Schizophrenia

3

A pt presents with flattened affect, social withdrawal, anhedonia (loss of energy), apathy, poverty of thought and delusions/ disorganized speech or behavior/ hallucinations following a stressful life event and symptoms last less than 1 month at which point the pt returns to baseline most likely suffers from...

Brief Psychotic Disorder

4

A pt presenting with non-bizarre delusions with no impairment of baseline functioning most likely suffers from ...

Delusional Disorder

(tx: psychotherapy)

5

What are the two indications to hospitalize a pt presenting with an acute psychiatric condition?

1. suicidal (risk to harm self)
2. homicidal (risk to harm others)

6

What is the best initial test for a patient presenting to the ER with psychosis?

drug screen

7

What medical conditions and associated testing should be performed in pt presenting with psychosis? (6)

1. thyroid disorder (TSH)
2. metabolic disorder (basic electrolytes and calcium
3. HIV (HIV serology)
4. syphilis (VDRL)
5. drug intoxication (drug screen)
6. temporal lobe epilepsy (auditory & olfactory hallucinations, feeling of deja vu, dissociation)

8

What is the greatest risk factor for progression to schizophrenia?

schizophreniform disorder (2/3 progress)

9

What are five indicators of poor prognosis in a schizophrenic?

1. early age of onset
2. negative symptoms
3. poor premorbid functioning
4. family history of schizophrenia
5. disorganized/ deficit subtype

10

What is the next best step in management for schizophrenia with bizarre or paranoid symptoms?

hospitalize

11

What is the best treatment for schizophrenia?

antipsychotics (for 6 months to prevent further episodes)
(long term treatment if have history of repeated episodes)

12

What is the best treatment for agitation in a schizophrenic?

benzodiazepines

13

Other than being used for psychotic disorders (schizophrenia, mania in bipolar, depression with psychotic features), what are two other indications for the use of antipsychotics?

1. sedation (if benzos contraindicated or as adjunct during anesthesia)
2. movement disorders (huntington's disease and tourette syndrome)

14

What are common side effects of low-potency antipsychotics (thioridazine, chlorpromazine)?

1. orthostatic hypotension (alpha blockade)
2. acute urinary retention
3. dry mouth
4. blurry vision
5. delirium

(swtich to atypical antipsychotic)

15

What is the common side effects of thioridazine?

1. prolonged QT and arrhythmia (obtain EKG)
2. abnormal retinal pigmentation (routine eye exams for chronic use)

16

What is the next best step in management of a pt presenting with chest pain, shortness of breath, and palpitations with a history of thioridazine use?

obtain EKG (likely prolonged QT or arrhythmia)

17

What is the most common reason for non-compliance with antipsychotic medication in males?

impotence and inhibition of ejaculation (due to alpha blockade)

18

What is the most common reason for non-compliance with antipsychotic medication in females?

weight gain (due to hyperprolactinemia along with galactorrhea and amenorrhea)

19

What is the most problematic complication associated with clonazpine use and what diagnostic test is used to detect this problem?

agranulocytosis; obtain CBC with diff (before initiating and weekly during therapy)
(also causes seizures)
(only used for treatment resistant patients)

20

What antipsychotic has the greatest weight gain?

olanzapine

21

What is the common side effect associated with high potency antipsychotics (fluphenazine, haloperidol)?

extrapyramidal symptoms (acute dystonia, bradykinesia, akathasia, tardive dyskinesia, neuroleptic malignant syndrome)

22

What is the best antipsychotic medication class to give intramuscularly in a pt who is unable or unwilling to take medication PO?

high potency antipsychotics (fluphenazine, haloperidol)

23

What is the best antipsychotic medication class to give as depot injections for noncompliant patients?

high potency antipsychotics (fluphenazine, haloperidol)

24

What is the best initial medication for psychosis?

atypical antipsychotics (risperidone, olanzapine, quetiapine, clozapine)

(greater effect on negative symptoms)

25

What is the antipsychotic medication of choice for treatment of schizophrenia when sedation is a problem (impacting social/ occupational functioning)?

risperidone

26

What is the antipsychotic medication of choice for treatment of schizophrenia when insomnia is a problem? (4)

1. olanzapine
2. quetiapine
3. ziprasidone
4. aripiprazole

27

A pt (likely young man) develops muscle spasms specifically in the neck resulting in difficulty swallowing about 1 week after starting an antipsychotic most likely suffers from ...

Acute Dystonia (torticollis)

28

What is the best management for a pt who develops acute dystonia while on an antipsychotic?

1. reduce dose of antipsychotic
2. give anticholinergic (benztropine, diphenhydramine, trihexyphenidyl)

29

A pt (likely elderly) develops bradykinesia, tremors, and rigidity weeks after starting an antipsychotic most likely suffers from..

medication induced parkinsonism

30

What is the best management for a pt who develops medication induced parkinsonism while on an antipsychotic?

1. reduce dose of antipsychotic
2. give anticholinergic (benztropine, diphenhydramine, trihexyphenidyl)

31

A pt develops motor restlessness after being on a antipsychotics for weeks/ chronically most likely suffers from ...

Akathisia

32

What is the best management for a pt who develops akathisia while on an antipsychotic?

1. reduce dose of antipsychotic
2. add benzo or beta-blocker
3. switch to newer antipsychotics

33

A pt develops choreoathetosis (dance-like movements) and other involuntary movements after chronic use (months to years) with an antipsychotic most likely suffers from ...

Tardive Dyskinesia

(usually irreversible; symptoms worsen after med discontinuation)

34

What is the best management for a pt who develops tardive dyskinesia while on an antipsychotic?

1. stop older antipsychotic
2. switch to newer antipsychotic (clozapine)
3. can use benztropine

35

A pt develops muscle rigidity, hyperthermia, volatile vital signs (autonomic instability), altered level of consciousness, leukocytosis, and elevated creatine kinase while on an antipsychotic most likely suffers from...

Neuroleptic Malignant Syndrome

36

What is the best management for a pt who develops neuroleptic malignant syndrome while on an antipsychotic?

1. stop antipsychotic
2. transfer to ICU for monitoring

37

What is the pathophysiology responsible for dystonic reactions while using antipsychotic medications?

nigrostriatal dopamine D2 receptor blockade leading to striatal cholinergic output
(use anticholinergics to treat)

38

What medications can result in tardive dyskinesia other than antipsychotics?

dopamine antagonist like antiemetics (metoclopramide, prochlorperazine)

(stop offending agent)

39

What medical conditions can result in anxiety that interferes with daytime functioning?

1. hyperthyroidism
2. pheochromocytoma
3. excess cortisol
4. heart failure
5. arrhythmia
6. asthma
7. COPD

40

What drugs can result in anxiety that interferes with daytime functioning?

1. corticosteroids
2. cocaine
3. amphetamines
4. caffeine
5. alcohol/ sedatives withdrawal

41

A pt develops anxiety, depression and/or irritability shortly after a profound change in their life (divorce, migration, birth of handicapped child) most likely suffers from...

Adjustment Disorder

(tx: counseling/ brief psychotherapy with benzos)

42

A pt presents with history of brief attacks of intense anxiety with associated tachycardia, hyperventilation, dizziness, and/or sweating that occur regularly and are associated with a precipitant most likely suffers from ...

Panic Disorder

(meds used are SSRIs, benzos, imipramine, MAOIs)

43

What is the best initial therapy for Panic Disorder?

Cognitive behavioral therapy (CBT) and/or relaxation training and desensitization (especially if agoraphobic)

44

A pt presenting with a persistent, unreasonable, intense fear and avoidance of situations/ circumstances/ objects without a known eliciting event most likely suffers from ...

Social Anxiety Disorder

45

A pt who fears and avoids public places due to the anxiety about not being able to escape most likely suffers from ...

Agoraphobia

(public places, being outside, public transportation, crowds)

46

What is the best treatment for social anxiety disorder?

exposure therapy (increasing exposure to stimulus) using benzos and beta-blockers prior to exposure

47

A pt presents with excessive, poorly controlled anxiety occurring for more than 6 months in which they worry about multiple circumstances of life and there is no single event/ focus most likely suffers from ...

generalized anxiety disorder (GAD)

48

What is the best treatment for generalized anxiety disorder?

1. supportive therapy
2. SSRIs, venlafaxine, buspirone, benzos

49

What are the three major benzodiazepines in order from shortest to longest half-life?

alprazolam (xanax)

50

What is the best anxiolytic medication for patients with occupations where driving or using machinery is involved?

buspirone (no sedative effect and no withdrawal syndrome)
(5-HT1A receptor partial agonist)

51

A pt presents with recurrent anxiety provoking, intrusive thoughts about contamination/ doubt/ guilt/ agression/ sex, perform peculiar behaviors that reduce this anxiety (such as hand washing, organizing, counting, checking, praying) and recognizes that this behavior is unreasonable and excessive most likely suffers from ...

Obsessive-Compulsive Disorder (OCD)

52

What is the best treatment for obsessive-compulsive disorder?

1. behavioral psychotherapy
2. SSRIs or clomipramine

53

A pt develops intense dreams/ flashbacks/ intrusive recollections of a traumatic event, avoidance of stimuli associated with the trauma or numbing of general responsiveness and hyperarousal (anxiety, sleep disturbance, hypervigilance, emotional lability, impulsiveness) within 1 month of a near-death traumatic experience and symptoms resolve within 1 month most likely suffers from ...

Acute Stress Disorder

(benzos for acute anxiety; SSRIs for long term therapy)

54

A pt develops intense dreams/ flashbacks/ intrusive recollections of a traumatic event, avoidance of stimuli associated with the trauma or numbing of general responsiveness and hyperarousal (anxiety, sleep disturbance, hypervigilance, emotional lability, impulsiveness) after a near-death traumatic experience and symptoms last longer than 1 month most likely suffers from ...

Post-traumatic stress disorder (PTSD)

(benzos for acute anxiety; SSRIs for long term therapy)

55

What is the most effective therapy to prevent post-traumatic stress disorder after a life-threatening traumatic event occurs?

group therapy

56

A pt presents with depressed mood and at least five of the following (changes in sleep, loss of interest/pleasure, guilt or feelings of worthlessness, loss of energy, trouble concentrating, changes in appetite or weight, psychomotor changes, and suicidal ideation) lasting more than 2 weeks most likely suffers from...

Major Depressive Disorder
(SMIGECAPS)

57

What are medical causes that can result in depression? (4)

1. hypothryoidism (check TSH and give levothyroxine)
2. Parkinson's disease (anti-parkinsons meds)
3. medications (steroids, beta blockers, antipsychotics, resperine)
4. substance use (alcohol, amphetamines)

58

What is the best initial therapy for major depressive disorder?

SSRIs (admit if suicidal or homicidal)

(use benzos for agitation)

59

What is the best therapy for a major depressive disorder pt who is acutely suicidal or for pts worried about side effects from medication?

electroconvulsive therapy (ECT)

60

A pt who has depressive symptoms (however less than 5 of SIGECAPS) that are present on most days for at least 2 years most likely suffers from...

Dysthymic Disorder

61

What is the best treatment for dysthymic disorder?

Long-term individual, insight oriented psychotherapy

62

A pt who has depressive symptoms (SMIGECAPS) in the winter but no symptoms in the summer most likely suffers from ...

Seasonal Affective Disorder

63

What is the best treatment for seasonal affective disorder?

phototherapy or sleep deprivation

64

A pt presents with at least 4 of the following (grandiosity, less need for sleep, excessive talking/ pressured speech, racing thoughts/ flight of ideas, distractibility, goal- focused activity at home/ work, sexual promiscuity) for at least 1 week as well as a time period of depression with periods of normalcy in between most likely suffers from ....

bipolar disorder

(DIGFAST)

65

A pt that has more than 4 episodes of mania in a year most likely suffers from ...

Rapid cycling bipolar disorder

66

What is the best management for a patient presenting with bipolar disoder?

1. hospitalization
2. mood stabilizer (lithium takes 1 week)
3. antipsychotics for acute mania (risperidone)
4. antidepressants (for pts with recurrent episodes of depression)

67

What is the best treatment for noncompliant, severely maniac bipolar patients?

intramuscular depot phenothiazine

68

What is the most common cause of progression of bipolar disorder to rapid cycling bipolar disorder?

use of antidepressants
(tx: gradually stop antidepressant, stimulant, caffeine, benzo and alcohol use)

69

What medication has been shown to prevent suicidal ideation in a bipolar disorder?

lithium

70

What is the next best step in management of a bipolar disorder pt who becomes pregnant?

discontinue lithium and perform ECT (or give lamotrigine if 2nd or 3rd trimester)

71

What are the two most problematic side effects of lithium use?

1. Ebstein's anomaly (cardiac defect in neonate with maternal use)
2. nephrogenic diabetes insipidus

72

A pt presenting with recurrent episodes of depressed mood and hypomaniac mood for at least 2 years most likely suffers from ...

Cyclothymia

73

What is the best initial treatment for cyclothymia?

psychotherapy

74

What is the best medical treatment for cyclothymia and when is its use indicated?

divalproex; impaired functioning for mood swings

75

A pt presenting with symptoms of sadness, tearfulness, decreased sleep, decreased appetite, and decreased interest in the world that wax and wane lasting up to 1-2 years but pt usually returns to baseline level of functioning within 2 months especially following death/ loss of loved one (may have auditory hallucinations of dead loved one) most likely suffers from ...

Normal Grief reaction

(tx: supportive therapy)

76

What is the best initial treatment for a pt presenting with both depressive and psychotic symptoms?

anti-psychotic medications (treat worse symptoms first which is psychosis)

77

A mother presents with mild depressive symptoms after giving birth to a child but continues to demonstrate the feeling of caring for the child most likely suffers from ...

Postpartum Blues (Baby Blues)

(no tx needed)

78

A mother presents with severe depression after giving birth to a child (usually a second child) and has thoughts about hurting the baby most likely suffers from ...

Postpartum Depression

(tx: antidepressants)

79

A mother presents with severe depression and psychotic symptoms after giving birth to a child and has thoughts about hurting the baby most likely suffers from ...

Postpartum Psychosis

(tx: mood stabilizers/ antipsychotic and antidepressants)
(use ECT if pt is breastfeeding)

80

What are the risk factors for suicide attempt in a suicidal patient? (10)

1. history of prior attempt
2. family history of suicide
3. perceived hopelessness (demoralization)
4. schizophrenia/ borderline or antisocial personality disorder
5. drug use (alcohol)
6. males
7. age > 65
8. social isolation/ recently divorced or widowed
9. chronic physical illness
10. low job satisfaction or unemployment

81

What is the treatment of choice for a suicidal patient?

psychotherapy with SSRI (or other antidepressant)
(use ECT if acute, severe risk of self harm)

82

What are the four indications for the use of electroconvulsive therapy (ECT)?

1. major depressive disorder unresponsive to meds
2. high risk for immediate suicide
3. contraindications to antidepressants meds
4. good response to ECT in past

83

In which patients should electroconvulsive therapy (ECT) be avoided?

pts with space-occupying lesions (tumors) because causes transient elevated intracranial pressure

84

What is the major complication of electroconvulsive therapy (ECT)?

transient memory loss

(safe in pregnancy)

85

What are the two indications for switching to another antidepressant medication?

1. dont respond to initial med after 8 weeks
2. dont tolerate side effects

86

How long should a pt be treated for initial episode of major depression disorder?

6 months then start tapering off

(long term treatment if recurrent episodes)

87

What is the best initial treatment for a pt with major depressive disorder who is concerned about weight gain and/or sexual side effects?

bupropion

(lowers seizure threshold)

88

What is a major contraindication for the use of bupropion?

pt with seizure disorder or anorexic
(lowers seizures threshold)

89

What is the best initial treatment for a pt with major depressive disorder who has poor appetite, loss of weight or insomnia?

mirtazapine

(causes weight gain)

90

What antidepressant medication is used to treat chronic pain?

amitriptyline

91

What antidepressant medication is used for enuresis (inability to control urination)?

imipramine

92

What antidepressant medication is used for depressed patients who have severe insomnia?

trazadone

(strongly sedating, priapism- prolonged erection)

93

What antidepressant medication is not safe in pregnancy?

paroxetine (paxil)

94

What is the best medication for pt with depression and agitation?

doxepin and trazadone (antidepressants with sedative properties)

95

A pt presenting with confusion, disorientation, hypotension, tachycardia, signs of peripheral vasodilation (flushing) and dilated pupils after overdose most likely is intoxicated with ...

Tricyclic Antidepressants (TCAs)

96

What is the most important test to determine severity and prognosis in a tricyclic antidepressant overdose?

EKG (assess for prolonged QRS/ QT/ PR interval)

97

What is the next best step in management of a pt with tricyclic antidepressant overdose found to have prolonged QRS/QT/PR interval on EKG?

give sodium bicarbonate (alkalinizes blood to uncouple TCA from myocardial sodium channels)

98

What are the complications associated with lithium? (8)

1. acne (most common)
2. weight gain (most common)
3. tremors (dose related)
4. GI distress (dose related)
5. headaches (dose related)
6. hypothyroidism
7. nephrogenic diabetes insipidus
8. cardiac defects in neonate

99

When is divalproex the best initial therapy? (2)

1. rapid cycling bipolar disorder
2. when lithium is ineffective/ impractical/ contraindicated

100

What are the side effects of carbamazepine?

1. agranulocytosis
2. sedation

101

What is the next best step in management for a pt with bipolar disorder in which lithium and divalproex are ineffective or contraindicated?

carbamazepine

(CYP450 inducer increasing clearance of warfarin/ phenytoin/ theophylline/ valproic acid)

102

An elderly pt presents with nausea, vomiting, acute disorientation, polyuria, tremors, increased deep tendon reflexes, seizures in the setting of renal failure/ hyponatremia and bipolar disorder most likely suffers from ...

lithium toxicty

103

A pt recently started on antipsychotic or parkison's pt who recently stopped levodopa presents with high fever, tachycardia, muscle rigidity, altered consciousness, elevated CPK, and autonomic instability most likely suffers from ..

neuroleptic malignant syndrome

(due to D2 receptor blockade in hypothalamus, nigrostriatal, and spinal cord)

104

What is the best management for a patient with neuroleptic malignant syndrome?

1. transfer to ICU
2. discontinue antipsychotic
3. give bromocriptine (overcome D2 blockade)
4. give dantrolene or diazepam (muscle relaxant)

105

A pt with major depression and migraines develops agitation, hyperreflexia, hyperthermia, muscle rigidity and volume contraction (sweating, insensible fluid loss) most likely suffers from ...

Serotonin Syndrome

(SSRI use with triptans or MAOIs)

106

What is the best management for Serotonin Syndrome?

1. IV fluids
2. Cyproheptadine (decreases serotonin production)
3. benzos (reduce muscle rigidity)

107

A pt with major depression and allergies develops acute hypertension after consumption of cheeses or pickled foods most likely suffers from ...

MAOI induced Hypertensive Crisis

(MAOIs with antihistamines/ nasal decongestant/ consumption of tyramine rich foods)

108

What is the best initial step in management of a depressive patient?

assess for suicidal ideation

(if suicidal, ECT; antidepressants can worse in first 2 weeks)

109

What is the best initial step in management of a pt with somatic disorder (multiple physical symptoms without medical explanation that interferes with pt's ability to function)?

1. maintain single physician
2. schedule brief monthly visits
3. avoid diagnostic tests/therapies
4. individual psychotherapy
5. do not hospitalize

110

A pt presents with one or more neurologic symptoms (mutism, blindness, paralysis, anesthesia, paresthesia) that can not be explained by any medical or neurological disorder and the pt has no concern about their impairment most likely suffers from ...

Conversion Disorder

(tx: supportive physician patient relationship and psychotherapy)

111

A pt presenting with unexplained symptoms, has seen many doctors, visited many hospitals, has large amount of medical knowledge (health care worker), demands treatment and gets agitated/ threatens litigation if tests are negative most likely suffers from ...

Factitious Disorder

112

A pt presenting with unexplained symptoms that are faked by another person such as a mother making up symptoms for her child most likely suffers from ..

Factitious Disorder by proxy

113

A pt presenting with unexplained symptoms that are preoccupied with rewards/ gain (shelter/ medications/ disability insurance) instead of with alleviating presenting symptoms most likely suffers from ...

Malingering

114

What is the best treatment for Malingering and Factitious Disorder?

Supportive Psychotherapy and only provide minimal treatment and workup

(avoid confronting/ accusing pt)

115

A young female pt presents with amenorrhea, underweight, history of food restriction, history of excessive exercise, and possibly purging episodes most likely suffers from ...

Anorexia Nervosa

116

A young female pt presents with episodes of binge eating followed by guilt, anxiety, and self-induced vomiting/ laxative/ diuretics/ enema use and episodes occurs at least once a week, she has a normal BMI, painless parotid gland enlargment, dental enamel erosions and electrolyte disturbances most likely suffers from ...

Bulimia Nervosa

117

What is the best management for a pt with anorexia nervosa or bulimia nervosa?

1. hospitalize for IV hydration (if electrolyte disturbance)
2. olanzapine (for weigh gain in anorexia)
3. SSRI antidepressant (fluoxetine to prevent relapse)
4. behavioral psychotherapy

118

A young female pt presents with preoccupation with an imagined/ slight defect in appearance (not just body shape/ weight and not just sex characterisitics) which causes severe distress and impairs the ability to function in social/ occupational setting most likely suffers from ...

Body Dysmorphic Disorder

119

What is the best initial treatment for body dysmorphic disorder?

high dose SSRIs

120

A pt (> 6 y/o) presents with history of episodes of anxiety followed by aggression out of proportion to the stressor that occurs at least twice a week for 3 months or involving more destructive episodes (assault) 3 times within 12 month period and has not drug use history most likely suffers from ...

intermittent explosive disorder

(tx: SSRIs and mood stablizers)

121

A pt presents with episodes of severe anxiety followed by stealing items to relieve anxiety and may secretly replace the object after stealing it, and lack insight most likely suffers from ...

Kleptomania

122

A pt presents with episodes of severe anxiety followed by repeatedly lighting fires to relieve anxiety and not for personal gain (insurance money) or anger, and lack insight most likely suffers from ....

Pyromania

123

... is an obsession with gambling despite the consequences and is treated by....

Pathologic Gambling; psychotherapy (gambling anonymous)

124

What are the physician's role in the care of child abuse (including female circumcision)?

1. mandatory reporting up to age 18
2. protect child via separate from parents (consider admission)

125

What are the physician's role in the care of adult maltreatment/ elder abuse (neglect)?

1. mandatory reporting
2. protect pt from abuser (consider admission)

126

What are the physician's role in the care of spousal abuse (usually physical)?

1. reporting not indicated
2. provide info about local shelters and counseling

127

A pt who is mistrustful and suspicious of the motivations and actions of others, often secretive and isolated, emotionally cold and odd, take legal action against others and use projection as a defense mechanism most likely suffers from ...

Paranoid Personality Disorder

(tx: psychotherapy)

128

A pt who is emotionally distant, fears intimacy with others, absorbed in their own thoughts and feelings, disinterested in others and uses projection as a defense mechanism most likely suffers from ...

Schizoid Personality Disorder

(tx: psychotherapy)

129

A pt who is emotionally distant, fears intimacy with others, absorbed in their own thoughts and feelings, disinterested in others, have magical thinking/ clairvoyance/ ideas of reference/ paranoid ideation most likely suffers from ...

Schizotypal Personality Disorder

(tx: psychotherapy)

130

A pt who is colorful, exaggerated behavior, excitable and shallow expression of emotions, uses physical appearance to draw attention to self, sexually seductive, and uncomfortable in situations where they are not the center of attention most likely suffers from ...

Histrionic Personality Disorder

(tx: psychotherapy, mood stabilizers, antidepressants)

131

A pt who has unstable affect, mood swings, marked impulsivity, unstable relationships, recurrent suicidal behaviors, chronic feelings of emptiness, identity disturbance, inappropriate anger, intense anger when feel abandoned and uses splitting as defense mechanism most likely suffers from ..

Borderline Personality Disorder

(tx: psychotherapy, mood stabilizers, antidepressants)

132

A pt who has criminal history, unable to conform to social rules, impulsive, disregards the rights of others, aggressive, lacks remorse and is deceitful most likely suffers from ...

Antisocial Personality Disorder

(tx: psychotherapy, mood stabilizers, antidepressants)

133

A pt who has a sense of self-importance, grandiosity, preoccupied with fantasies of success, believes he is special, requires excessive admiration, reacts with rage when criticized, lacks empathy, is envious of others, and is interpesonally exploitative most likely suffers from ...

narcissistic Personality Disorder

(tx: psychotherapy, mood stabilizers, antidepressants)

134

A pt who has social inhibition, feelings of inadequacy, hypersensitivity to criticism, shies away from starting new/ attending social gatherings for fear of failure/ rejection, desires affection and acceptance and is open about their isolation and inability to interact with others most likely suffers from ...

Avoidant Personality Disorder

(Tx: psychotherapy)

135

A pt who is submissive, clinging, need to be taken care of, worry about abandonment, feel inadequate, helpless, and avoid disagreements with others most likely suffers from ...

Dependent personality Disorder

(tx: psychotherapy)

136

A pt who is preoccupied with orderliness, perfectionism, controlling, consumed with details of everything, lose the sense of overall goals, strict, overconscientious, inflexible, and has difficulty with interpersonal relationships most likely suffers from ...

Obsessive-Compulsive Personality Disorder

(tx: psychotherapy)

137

What is the most accurate diagnostic test for alcohol abuse (alcohol use resulting in failure to fulfill obligations, craving/ strong urge to use substance, or exposure to physically dangerous situations)?

CAGE questions (cut down, annoyed by criticism, guilty, need eye-opener)

(2 or more yes is positive)

138

What is the most effective management of alcohol abuse or prevention of relapse?

Alcoholic Anonymous (AA)

139

What diagnostic tests should be performed if pt is found to be alcohol abuse?

toxicology (blood, breath and urine) to assess for other drugs

140

What diagnostic tests should be performed if pt is found to be IV drug user? (4)

1. HIV testing
2. hepatitis B
3. hepatitis C
4. PPD for TB

141

What is the best management for alcoholism in the acute inpatient cases?

1. assess for withdrawal symptoms
2. give thiamine, magnesium, B12 and folate (to prevent Wernicke- Korsakoff)
3. use chlordiazepoxide or diazepam for seizure and withdrawal symptoms
3b. use short acting benzo (lorazepam, oxazepam) if pt has liver disase)

142

An alcoholic develops insomnia, tremulousness, mild anxiety, headache, diaphoresis, and palpitations hours after last drink most likely suffers from ... and the next best step in management is ...

minor withdrawal symptoms; thiamine, folate, multivitamine and glucose

143

An alcoholic develops visual hallucinations along with auditory/tactile hallucinations 12-24 hours after last drink most likely suffers from .....

Alcoholic hallucinosis

(no altered mental status/ disorientation)

144

An alcoholic develops tonic-clonic seizures 48 hours after last drink most likely suffers from .... and the next best step in management is ....

Withdrawal Seizures; CT scan (to rule out structural or infectious causes)

145

An alcoholic pt develops hallucinations, disorientation, tachycardia, hyperetension, low grade fever, agitation and diaphoresis 48-96 hours after last drink most likely suffers from ....

Delirium Tremens

(2 or more days after last drink)
(tx: long term benzos)

146

An intoxicated pt presenting with euphoria, hypervigilence, autonomic hyperactivity, weight loss, pupil dilation, disturbed perception and possible stroke/ myocardial infarction most likely is intoxicated with ...

Amphetamines/ Cocaine

(tx: short term anti-psychotics, benzos, inderal, vitamin C)

147

An withdrawing pt presents with anxiety, tremors, headache, increased appetite, depression and increased risk of suicide most likely was intoxicated with...

Amphetamine/ Cocaine

(tx: antidepressants)

148

A pt presents with impaired motor coordination, impaired time perception, social withdrawal, increased appetite, dry mouth, tachycardia, and conjunctival redness most likely is intoxicated with ...

Cannabis

149

A pt presenting with ideas of reference, hallucinations, impaired judgment, dissociative symptoms, pupil dilation, panic, tremors and incoordination most likely is intoxicated with ...

Hallucinogens (LSD)

(tx: supportive counseling/ talking down, antipsychotics, benzos)

150

A pt presents with belligerence, apathy, assaultiveness, impaired judgment, blurred vision, stupor and coma most likely is intoxicated with...

Inhalants

(tx: antipsychotics if delirious or agitated)

151

A pt presents with apathy, dysphoria, constricted pupils, drowsiness, slurred speech, impaired memory, respiratory distress, coma and possibly death most likely is intoxicated with ...

Opiates

(tx: naloxone)

152

A pt develops fever, chills, lacrimation, rhinorrhea, abdominal cramps, muscle spasms, insomnia, and yawning most likely was intoxicated with

Opiate (withdrawal)

(tx: clonidine, methadone)

153

A pt presents with panic reactions, assaultiveness, agitation, nystagmus, hypertension, seizures, coma and hyperacusis most likely is intoxicated with....

PCP intoxication

(tx: talking down, benzos, antipsychotics, support respiratory function)

154

A pt presents with inappropriate sexual/ aggressive behavior, impaired memory and impaired concentration most likely is intoxicated with ....

Barbituates/ Benzo intoxication

(tx: flumazenil)

155

A pt presents with autonomic hyperactivity, tremors, insomnia, seizures and anxiety was most likely intoxicated with ...

Barbituates/ Benzo (withdrawal)

(tx: use chlordiazepoxide, phenobarbital)

156

A pt who is insists that he/she is the opposite gender and experiences intense discomfort about his/her sex most likely suffers from...

Gender Identity Disorder

157

A pt with recurrent urges to observe an unsuspecting person who is engaging in sexual activity/ disrobing and urges last at least 6 months and impairs the patient's level of functioning most likely suffers from ...

Voyeurism

(tx: individual psychotherapy and aversive conditioning)
(if severe, use antiandrogens or SSRIs)

158

A pt with recurrent urges/ arousal toward prepubescent children and urges last at least 6 months and impairs the patient's level of functioning most likely suffers from ...

Pedophilia

(tx: individual psychotherapy and aversive conditioning)
(if severe, use antiandrogens or SSRIs)

159

A pt with recurrent urge to expose oneself to strangers and urges last at least 6 months and impairs the patient's level of functioning most likely suffers from ...

Exhibitionism

(tx: individual psychotherapy and aversive conditioning)
(if severe, use antiandrogens or SSRIs)

160

A pt with recurrent urges that involves the use of nonliving objects that are usually associated with the human body and urges last at least 6 months and impairs the patient's level of functioning most likely suffers from ...

Fetishism

(tx: individual psychotherapy and aversive conditioning)
(if severe, use antiandrogens or SSRIs)

161

A pt with recurrent urge/ behavior involving touching/ rubbing against a nonconsenting partner and the urge lasts at least 6 months and impairs the patient's level of functioning most likely suffers from ...

Frotteurism

(tx: individual psychotherapy and aversive conditioning)
(if severe, use antiandrogens or SSRIs)

162

A pt with recurrent urge/ behavior involving the act of humiliation and the urge lasts at least 6 months and impairs the patient's level of functioning most likely suffers from ...

Masochism

(tx: individual psychotherapy and aversive conditioning)
(if severe, use antiandrogens or SSRIs)

163

A pt with recurrent urge/behavior involving acts in which physical/ psychological suffering of a victim is exciting to the patient and the urge lasts at least 6 months and impairs the patient's level of functioning most likely suffers from ...

Sadism

(tx: individual psychotherapy and aversive conditioning)
(if severe, use antiandrogens or SSRIs)