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Flashcards in Psychiatry Deck (23):
1

Gabriel is a healthy 2-year-old boy whose parents have taken him to the pediatrician. His problems started at 18 months of age, when he did not speak much. He does not have much attachment to his parents and seems aggressive toward other children.

What is the most likely diagnosis?

a. Deafness
b. Schizophrenia, childhood onset
c. Rett disorder
d. Autism spectrum disorder
e. Learning deficit

D. Autism spectrum disorder is seen more frequently in boys and usually starts by the age of 3. Children with autism tend to have problems with language and aggression, lack separation anxiety, and are withdrawn. Deafness should be ruled out if parents report that a child does not respond when his or her name is called.

2

What is the first line treatment of ADHD?

Methylphenidate and Dextroamphetamine

3

What are the side effects of Methylphenidate and Dextroamphetamine in the treatment of ADHD?

Insomnia, decreased appetite, GI disturbances, increased anxiety, and headache

4

ADHD is associated with lower/higher levels of dopamine

lower

5

A 10-year-old boy was seen by a school counselor after the teachers complained of his behavior in school. He frequently becomes angry towards others and loses his temper in class. His parents report that at home, he refuses to comply with house rules, often stays up later than he is supposed to, and frequently talks back to them.

What is the most likely diagnosis?

a. Conduct disorder
b. Tourette disorder
c. Adjustment disorder
d. Oppositional defiant disorder
e. Leaning disorder, not otherwise specified

D. Children with oppositional defiant disorder usually have problems with authority figures such as parents and teachers. Unlike children with conduct disorders, they do not break rules of society and do not commit crimes

6

You are asked to evaluate a 9-year-old boy who is having problems at home and school. His teachers report frequent temper tantrums in which he becomes physically aggressive toward his peers (biting and kicking). These usually occur after minor incidents, such as another child cutting in front of him in the cafeteria line. These outbursts have been occurring almost daily since the age of 8 and have worsened since school started 4 months ago, resulting in several weeks of disciplinary suspencion. His parents report the same problems at home (e.g. attacking his older brother when told he could not play outside). His general mood is irritable and angry, though his family noticed a slight improvement in his behavior during the summer months.

What is the most likely diagnosis?

a. Intermittent explosive disorder
b. Adjustment disorder with disturbances of conduct
c. Disruptive mood dysregulation disorder
d. Bipolar disorder
e. Oppositional defiant disorder

C. Disruptive mood dysregulation disorder. Children with intermittent explosive disorder are not aggressive on such a continuous basis; they have extended periods of good behavior. There is no mention of a stressor, ruling out diagnosis of bipolar disorder. There is no evidence of mood swings, ruling out diagnosis of biploar disorder. Children with oppositional defiant disorder mostly have problems with authority figures, not their peers.

7

This is characterized by the onset of multiple tics, lasting more than one year, and is seen before the age of 18. The motor tics most commonly involve the muscles of the face and neck, such as head shaking and blinking.

Tourette Disorder

8

What is the first line of treatment for Major Depressive Disorder?

SSRI (Fluoxetine, Paroxetine, Sertraline, Citalopram, or Escitalopram)

9

A 45-year-old woman was recently seen by her primary care physician due to complaints of depressed mood, lack of pleasure, sleep problems, decreased appetite and weight, decreased energy, and problems with concentration. She states that these symptoms started when she was fired from her job about 4 weeks ago, and that since then, she has been unable to function.

What is the most indicated treatment at this time?

a. Alprazolam
b. Paroxetine
c. Bupropion
d. Venlafaxine
e. Trazodone
f. Electroconvulsive therapy

B. She has a diagnosis of major depression and the first-line treatment is the use of an SSRI medication because of a better side-effect profile compared to the other therapies. All others, except alprazolam and electroconvulsive therapy, would be useful but usually are not based on side effect profile. Alprazolam is simply a benzodiazepine and acts as an anxiolytic, not an antidepressant. Electroconvulsive therapy might be useful if initial therapy did not work or the depression was far more severe and was associated with psychotic features.

10

You saw a 55-year-old male in your office today complaining of depressed mood for over 2 months, along with lack of energy, decreased appetite, inability to concentrate, and poor sleep. He stated that his sleep problems and inability to focus in the morning are impairing his work.

Which of the following is most indicated at this time?

a. Imipramine
b. Venlafaxine
c. Bupropion
d. Zolpidem
e. Mirtazapine

E. Although any antidepressant can be used, mirtazapine is preferable in this patient for both its antidepressant and sedative effects. Imipramine would have too many side effects and is not a first-line agent. Venlafaxine might be considered if the patient had depression alone; since insomnia is a major concern, mirtazapine is the better option. Bupropion tends to cause problems with sleep, so is not indicated. Zolpidem would help this patient sleep but would not treat his depression.

11

A 21-year-old college student is taken to the emergency department and admitted after she was noted to be acting bizarrely in class. She is talking fast and giggling, and she reports that she has not slept for over 4 days. She appears to be paying little attention to her surroundings. Her roommate reports that she has been drinking alcohol excessively over the last few days and has had many sexual contacts with unknown men.

What is the most likely diagnosis?

a. Alcohol-induced mood disorder
b. Biploar disorder type I
c. Bipolar disorder type II
d. Major depression with psychosis
e. Cyclothymia

B. The patient is exhibiting mania, as shown by her pressured speech, decreased sleep, increased libido, and inappropriate behavior. The symptoms are severe enough that her level of functioning is affected. Bipolar disorder occurs more frequently in young individuals.

12

A 33-year-old man was taken to the emergency room by the police after neighbors complained about his behavior. His family informed the doctor that he has been diagnosed with biploar disorder and was recently started on lithium. While in the emergency room, he became combative and punched a nurse on the mouth.

What is the next step in the management of this patient?

a. Obtain lithium level
b. Admit to psychiatric unit
c. Refer to psychiatry
d. Add valproic acid
e. Olanzapine

E. The patient is exhibiting mania and you do not need to verify the lithium level given that his symptoms are acute. He apparently has been noncompliant with medications and obtaining a level is not the correct answer. He needs to be medicated and antipsychotics are considered first-line treatment for bipolar patients presenting with acute mania. Admitting an agitated patient to the psychiatric unit is not as important as administering adequate treatment.

13

A 65-year-old man was brought to the office by his daughter after she became concerned about him. He has been hopeless and helpless since his wife died 3 months ago. His daughter is worried about his isolative behavior and lack of appetite, and he expresses feelings of worthlessness. He has lost over 30 pounds. He does not seem interested in getting better and believes he should have died with his wife.

What is the most likely diagnosis?

a. Bereavement
b. Persistent depressive disorder
c. Major depressive disorder
d. Adjustment disorder
e. Bipolar disorder

C. Although it has been less than 6 months since his wife died, his symptoms are severe enough to warrant a diagnosis of major depression. He has no interest in things, has lost weight, feels hopeless and helpless, and believes he should have died as well. He needs to be treated with antidepressants, and you must ensure that he is not suicidal since he is at high risk.

14

What is the single most effective treatment for depression?

a. Electroconvulsive therapy
b. Fluoxetine
c. Venlafaxine
d. Imipramine
e. Phenelzine

A. Although electroconvulsive therapy (ECT) is usually used for suicidal patients or those who do not respond to treatment, it is considered the best treatment for depression. All others are equally efficacious, but the SSRIs are used more frequently due to side-effect profiles

15

A 22-year-old woman was recently diagnosed with schizophrenia. She is 30 pounds overweight and suffers from type 2 diabetes. She is concerned about her medications and asks for your advice.

Which of the following would be most indicated in this patient?

a. Aripiprazole
b. Olanzapine
c. Quetiapine
d. Clozapine
e. Risperidone

A. Aripiprazole and ziprasidone are the least likely to cause weight gain, diabetes, and metabolic syndrome. Olanzapine and clozapine have the highest risk of metabolic abnormalities. Quetiapine and risperidone have medium risk.

16

You have recently diagnosed a 23-year-old man with schizophrenia and started him on haloperidol. Within a few hours he develops muscle stiffness, and his eyes roll upward and he cannot move them down.

What is the most likely diagnosis?

a. Tardive dyskinesia
b. Neuroleptic malignant syndrome
c. Akathisia
d. Serotonin syndrome
e. Acute dystonia

E. Acute dystonia develops within hours of the use of medications. This side effect is typical for haloperidol. The treatment of choice is benztropine or diphenhydramine, which can be given with the haloperidol or after should side effects occur.

17

Which is considered to be the first-line treatment for panic disorder?

a. Alprazolam
b. Buspirone
c. Sertraline
d. Imipramine
e. Fluvoxamine

C. SSRIs are considered to be the first-line treatment for panic disorder. If the question is panic attack, then alprazolam is the correct answer; if a single panic attack, then alprazolam is the correct answer. If a single panic attack is the diagnosis, a benzodiazepine is the treatment.

18

A 40-year-old man was referred to a psychiatrist by his physician because he is "too shy". He has problems going to parties, feel anxious about getting close to others, and stays at home in fear that others would laugh at him. When confronted by others, he develops severe anxiety as well as hyperventilation and increased sweating.

Which is the most likely diagnosis?

a Panic disorder
b. Social anxiety
c. Generalized anxiety disorder
d. Specific phobia
e. Acute stress disorder

B. Social anxiety is characterized by fear of embarrassment in social situations. These patients have problems going out in fear that others will laugh at them.

19

A 35-year-old woman reports palpitations, dizziness, and increased sweating for at least 8 months. She has visited numerous physicians and none have been helpful. Her husband is concerned because she cannot relax and worries about everything. She worries about her parent' health even though they are healthy. She worries about her finances, although her husband assures her they are financially secure.

What is the most likely diagnosis?

a. Generalized anxiety disorder
b. Phobias
c. Panic disorder
d. Adjustment disorder
e. Social anxiety

A. The main feature of generalized anxiety disorder is chronic worrying about things that do not merit concern. It is also accompanied by other symptoms of anxiety, as well as sleep and concentration problems.

20

A 65-year-old engineer is taken to the emergency room after being involved in a motor vehicle accident. He suffered a fracture of the femur and some cuts and bruises. He is admitted to the medicine floor and started on oxycodone. The day after admission, he appears confused and has observable tremors in both extremities. He becomes concerned about "bugs on the walls" in his room and asks for your help.

What is the most likely explanation for his symptoms?

a. Brain concussion
b. Alcohol withdrawal
c. Oxycodone intoxication
d. Brief psychotic disorder
e. Schizophrenia

B. Most withdrawal questions are asked in a hospital setting on the next day after admission. The patient presents with uncomplicated alcohol withdrawal, characterized by visual hallucinations and tremors.

21

A 35-year-old married woman with 3 children was taken to the doctor's office after daily complaints of dizziness, nausea, and headaches for the last 6 months. She is intensely bothered by her symptoms to the point that she now stays home and avoids both going to work and caring for her children. She has been tried on numerous medications but none has proven to be beneficial. A neurological examination finds some abnormalities. Which of the following would be most indicated in this patient?

a. Lorazepam
b. Sertraline
c. Individual psychotherapy
d. Lithium
e. Risperidone

C. This patient has somatic symptom disorder, which is treated with individual psychotherapy given that psychological issues are the cause of her symptoms. She should have one primary caretaker and not be sent to specialists. Lorazepam, a benzodiazepine, treats anxiety disorder. SSRIs such as sertraline treat fibromyalgia and depression. Lithium treats bipolar disorder. Risperidone is for psychosis.

22

Which of the following personality disorders has been associated with positive psychotic symptoms?

a. Borderline
b. Histrionic
c. Schizoid
d. Paranoid
e. Antisocial

A. Borderline and schizotypal personality disorders may have short-lived psychotic episodes that are brief and usually occur after stressful situations.

23

A 15-year-old girl is brought to the clinic by her mother, who found her vomiting in the bathroom. Her mother reports that the girl vomits daily after each meal. She is sometimes observed exercising excessively. She has numerous calluses on her hands as well as cavities. She is 5'5' and weighs 90 pounds.

What is her most likely diagnosis?

a. Bulimia nervosa
b. Anorexia nervosa
c. Eating disorder not otherwise specified
d. Obesity
e. Atypical depression

B. The main focus of this question is the height and weight. She should weigh about 110 pounds but weighs only 90 pounds. This is indicative of the weight loss seen in anorexia nervosa. She obviously purges and as a result has calluses and cavities. Amenorrhea, significant weight loss, and abnormal preoccupation with body image are the key to the diagnosis of anorexia.