step 3 6

Question 1

new name for hypochondriasis

Answer 1

illness anxiety disorder

Question 2

anorexia mgmt

Answer 2

olanzapine

SSRIs + psychotherapy

Question 3

intermittent explosive disorder vs disruptive mood dysregulation disorder

Answer 3

with intermittent they return to normal mood, in disruptive, patients do not

Question 4

treatment of pathologic gambling

Answer 4

group psychotherapy (gambling anonymous)

Question 5

workup for any signs of drug use

Answer 5

HIV
Hep B and C
PPD

Question 6

answer to question describing a patient with alcohol abuse

Answer 6

UDS

Check LDH, GGTP, AST/ALT

Question 7

wernicke-korsakoff management

Answer 7

Thiamine IV
B12
Folate
magnesium

Question 8

alcohol withdrawal management

Answer 8

CIWA protocol for benzos PO or IV
diazepam 5-10 mg IV repeat q5-10 minutes until symptoms controlled, goal to sedate until patient is calm but alert.
If cirrhotic or alcoholic hepatitis —> use ativan or oxazepam (serax)
when benzodiazepine doses reach 15-20 mg lorazepam IV per hour –> consider adjunctive therapy with clonidine 0.3 mg po q6h or haldol 0.5 – 1.0 mg IV q4h if delirium and psychotic features are present
qAM BMP
mag
phos
Ativan 2 mg PRN for seizure lasting longer than 5 minutes
IV access
IVF
Thiamine 100 mg daily IV
Folate 1 mg daily
MVI 1 tab/day either PO or IV starting immediately on admission and continuing for the length of their stay
Put in quiet, protective environment
IF severe liver disease → use short acting benzo, lorazepam or oxazepam

Question 9

alcohol dependency management

Answer 9

Refer to inpatient rehabilitation or outpatient group therapy (AA)
If receiving psychotherapy, give Naloxone or acamprosate .

Question 10

delirium tremens window

Answer 10

48-96 hours after last drink

Question 11

cannabis withdrawal presentation

Answer 11

irritability, difficulty sleeping, depression, fevers, nausea, vomiting

Question 12

paraphilia treatment

Answer 12

psychotherapy + aversive conditioning

Question 13

voyeurism

Answer 13

watching UNSUSPECTING person having sex or naked

Question 14

frotteurism

Answer 14

recurrent urge or behavior involving touching or rubbing against a nonconsenting partner

Question 15

PMS treatment

Answer 15

CBT + SSRI

Question 16

AMS in ED orders

Answer 16

Standard lab orders below → naloxone + thiamine + dextrose + O2/NS → UDS

Question 17

benzo management

Answer 17

verify but don’t give flumazenil, may precipitate a seizure

Question 18

management of digoxin OD

Answer 18

digoxin-binding antibodies

Question 19

organophosphate antidote

Answer 19

atropine, pralidoxime

Question 20

ASA overdose labs

Answer 20

CBC
chemistry panel
ABG
PT/INR/PTT
Salicylate level

Question 21

ASA overdose treatment

Answer 21

sodium bicarbonate

charcoal

Question 22

diagnostic labs for generic overdose

Answer 22

UDS
CBC, chem-7, UA
ASA level
Acetaminophen level
ETOH level

Question 23

digoxin toxicity

Answer 23

halos around objects and blurred vision
GI disturbance
encephalopathy

Question 24

causes of methemoglobinemia

Answer 24

nitroglycerin, anesthetics, dapsone, drugs ending in caine (lidocaine, benzocaine, bupivicaine)

Question 25

cause of NMS

Answer 25

Any medications within the family of neuroleptics can cause the condition, though typical antipsychotics appear to have a higher risk than atypicals

Question 26

settings of organophosphate poisoning

Answer 26

crop duster/insecticides | nerve-gas

Question 27

organophosphate poisoning treatment

Answer 27

atropine pralidoxime remove clothes and wash rest off the patient

Question 28

first step in TCA overdose

Answer 28

EKG

Question 29

black widow spider bite presentation

Answer 29

severe abdominal pain, rigidity, hypocalcemia, no tenderness

Question 30

brown recluse bite

Answer 30

necrotic, bullae, dark lesions

Question 31

brown recluse bite treatment

Answer 31

debride the wound

Question 32

rabies treatment

Answer 32

immune globulin + vaccine

Question 33

signs of respiratory injury in burns

Answer 33

hoarseness wheezing stridor

Question 34

burn management

Answer 34

assess for respiratory compromise → intubate → if no respiratory compromise give fluids at 4 mL of LR or NS for each kg

Question 35

first step in hypothermia mgmt

Answer 35

EKG

Question 36

first step in acute angle closure glaucoma mgmt

Answer 36

pilocarpine drops

Question 37

retinal detachment management

Answer 37

consult opthalmology, dilated retinal exam

Question 38

uveitis treatment

Answer 38

steroids

Question 39

uveitis presentation

Answer 39

photophobia

Question 40

first step in managing mentally intact patient refusing treatment

Answer 40

try to discuss it with patient

Question 41

emancipated minor

Answer 41

living independently, self-supporting, married, in the military

Question 42

partial emancipation

Answer 42

sex reproductive health substance abuse

Question 43

cases in which minors can make decisions

Answer 43

sex, reproductive health, HIV, prenatal care, STDs

Question 44

requirements of informed consent

Answer 44

benefits, risks, alternatives, intelligible language, specific to procedure

Question 45

consent in emergencies?

Answer 45

assumed unless prior wishes are known

Question 46

when you can break patient confidentiality

Answer 46

someone else is at risk (transmissible disease (TB, HIV, syphilis, gonorrhea) - psych patient trying to hurt someone

Question 47

health care proxy meaning

Answer 47

both an appointed agent AND a document

Question 48

living will utility

Answer 48

useless unless it specifically states interventions patient does not want

Question 49

when to consult ethics committee

Answer 49

1) no capacity and no clearly stated wishes on the part of the patient 2) family is split on nature of care

Question 50

response to patient requesting futile care

Answer 50

you can deny it, you are under no obligation to provide futile care

Question 51

abortion minutiae

Answer 51

unrestricted in first trimester, grey area in second, illegal in third

Question 52

gifts are fine when

Answer 52

small and not tied to specific treatments and tests

Question 53

sexual contact

Answer 53

illegal between psychiatrists and patients, must end doctor-patient relationship for others

Question 54

who to report impaired faculty to

Answer 54

department chair or dean of medical school

Question 55

who to report impaired physicians too

Answer 55

state medical board of office of professional medical conduct

Question 56

when to report physicians

Answer 56

only when patients are at risk of harm

Question 57

GERD management

Answer 57

Start with H2/RA If uncontrolled → PPI lowest effective dose, try to wean back to H2/RA, with goal to wean entirely off PPI IF RF’s (men, smoker, obesity, age greater than 50) Symptoms >5-10 years = surveillance endoscopy for barrett esophagus