psych rosh/ smarty pance befor eoc
What are the most effective agents in treating somatoform spectrum pain disorder?
Antidepressants Antidepressant medications often help with both the pain and the worry surrounding the pain.
Which of the following is the most appropriate intervention in suspected child abuse?
Assure the safety of the child, with hospitalization if necessary
A patient tells you that he is receiving special messages from the TV every night at 7:00 pm. This is an example of which of the following?
Ideas of reference are fixed beliefs that people are referring to you and about you through media
A 25 year-old male on a behavioral medicine unit is given haloperidol (Haldol) IM for a violent psychotic outburst. Initially he quiets down, but about an hour later develops confusion, an inability to open his mouth, and a temperature of 40 degrees C. Initial treatment should consist of which of the following? A Additional Haldol B Corticosteroid C Benzodiazepine D Dantrolene
In addition to supportive treatment, the most commonly used medications for neuroleptic malignant syndrome are dantrolene (Dantrium) and bromocriptine (Parlodel). What is the typical finding on electroencephalography in patients with this ? Answer: Generalized slow-wave activity.
A patient with known drug dependence mentions that he commonly sees sounds and hears colors. What is his drug of choice?
Lysergic acid diethylamide( LSD ) hallucinogen
A patient with advanced AIDS complicated by toxoplasmosis presents with altered mental status, recent onset of seizures, and focal neurologic deficits. Which of the following diagnostic studies is most helpful?***
MRI of brain multiple isodense or hypodense ring-enhancing mass lesions is the most useful test f
A 9-year-old male is brought in by his mother who reports the patient has exhibited an extremely negative attitude for the past year. He seems angry much of the time and frequently loses his temper. Arguing over even trivial details is commonplace and he seems to take delight in annoying his family. His grades and conduct at school remain excellent. He has few friends, though he has never been seen bullying or destroying others' property. What is the most likely diagnosis?
Oppositional defiant disorder ODD do drift into conduct disorders over time. His good grades and conduct at school lessen the probability of untreated ADD. Personality disorders (i.e. antisocial personality disorder) can not be diagnosed at this early an age. ifferentiated from conduct disorder by the lack of bullying and the lack of destruction of property.
A 2-year-old girl is admitted to the hospital for recurrent seizures. Her mother reports that the seizures were occurring daily prior to admission, but the patient has not had any seizures in the 3 days since being admitted to the hospital. On exam, the patient appears healthy without any neurologic abnormalities. The patient has had an MRI of the brain and an electroencephalogram, both of which were unremarkable. The mother reports that the patient has an older sibling who also had seizures prior to dying of an unknown medical illness at 6 years of age. Which of the following is a common finding in the suspected diagnosis?
Repeat visits for similar symptoms in the absence of objective abnormal findings dx:Medical child abuse (formerly known as Munchausen syndrome by proxy) is defined as a child receiving unnecessaryand harmful or potentially harmful medical care because of the overt actions of a caregiver, which may include exaggerating symptoms, fabricating symptoms or exam findings, and intentionally inducing illness in a child.)
A 25 year-old female presents with signs and symptoms of depression. She does not have any other known medical problems. What diagnostic study is indicated in the initial evaluation of this patient?
Thyroid stimulating hormone (TSH)
Which of the following classes of antidepressants is associated with anticholinergic side effects, including cardiac dysrhythmias, dry mouth, sedation, and orthostatic hypotension?
Tricyclic antidepressant
Which of the following dietary substances interact with monoamine oxidase-inhibitor antidepressant drugs [like phenelzine (Nardil)]?
Tyramine Tyramine is a precursor to norepinephrine. Some foods high in tyramine include: Aged cheeses, such as aged cheddar and Swiss; blue cheeses such as Stilton and Gorgonzola; and Camembert. Cheeses made from pasteurized milk are less likely to contain high levels of tyramine American cheese, cottage cheese, ricotta, farm cheese and cream cheese. Cured meats, which are meats treated with salt and nitrate or nitrite, such as dry-type summer sausages, pepperoni and salami. Fermented cabbage, such as sauerkraut and kimchee. Soy sauce, fish sauce and shrimp sauce. Yeast-extract spreads, such as Marmite. Improperly stored foods or spoiled foods. Broad bean pods, such as fava beans.
stuff I need to review
1)opined tx ? 2)Patient Health Questionnaire-9 = major depressive disorder 3)schizoid personality disorder rarely seek treatment and typically only do so at the request of family members. No pharmacologic treatment has proven efficacy. Group and family therapy psychotherapies can be effective in helping individuals with schizoid personality disorder develop social skills. 4) Medical child abuse (formerly known as Munchausen syndrome by proxy) 5)alcohol withdrawal symptoms based on hour 6)Neuroleptic malignant syndrome vs Serotonin syndrome 7)amphetamin , cocain , drugs 8)Fetal alcohol syndrome 9)Motor vehicle injuries are the leading cause of death in children 10)treatment of choice for benzodiazepine intoxication= Flumazenil (Romazicon) its clinical usefulness is not well-defined because most people who overdose on benzodiazepines recover with only supportive care, and occasionally flumazenil precipitates seizures. 11)Patients who are bipolar will often have worsening of their manic symptoms with the use of SSRIs. 12) 13) 14) 15) 16) 17) 18) 19) 20)
A 22-year-old man presents to the emergency department in a catatonic state. He was found at home with a few white tablets in his hand. Vital signs show tachypnea, tachycardia, hyperpyrexia, and hypertension. Physical exam shows vertical nystagmus and hyperreflexia. Laboratory results show elevated creatine kinase. Which of the following substances did this patient most likely ingest? A3-Methoxyphencyclidine BHeroin CLysergic acid diethylamide DTetrahydrocannabinol
3-Methoxyphencyclidine Phencyclidine= a dissociative anesthetic hallucinations, psychosis, catatonia, coma, agitation, hyperreflexia, hyperpyrexia, tachycardia, elevated blood pressure, disorientation, seizures, and nystagmus (horizontal, vertical, or rotatory). Common laboratory abnormalities associated with phencyclidine intoxication include elevated creatine kinase Treatment for acute intoxication with phencyclidine and its derivatives is supportive care, with airway protection and benzodiazepines for agitation or seizures. What is a dissociative anesthetic currently in medical use that is related to phencyclidine? Answer: Ketamine.
A 19-year-old man presents to the emergency department in police custody with dog bites on his left arm. The police were called because the patient was attempting to stab pets in the neighborhood. The police indicate that the patient has a history of vandalism and setting public buildings on fire. You examine the patient, and he demonstrates no remorse for his actions. Which of the following is the most likely diagnosis? A 35-year-old man presents to the emergency department after getting in a bar fight with another patron. He has been in the emergency department multiple times due to injuries relating to the destruction of private property. He reports alcohol use and occasional marijuana use and has a difficult time retaining employment. On multiple occasions on this visit, he has tried to hit the nursing staff as they attempted to place an IV. Which of the following diagnoses did this patient most likely have during childhood and adolescence?
Antisocial personality disorder The treatment for antisocial personality disorder varies some based on the severity of symptoms and the patient's insight and motivation for improvement. a cluster B personality disorder along with borderline, histrionic, and narcissistic personality disorders. marked by dramatic, emotional, or erratic behavior. Antisocial personality disorder presents with a pervasive pattern of exploiting others, rule-breaking, violating the law, and deceitfulness. Individuals with antisocial personality disorder lack empathy or remorse for their actions. cannot be officially diagnosed until 18 years of age. Which childhood condition often precedes antisocial personality disorder? conduct disorder True or false: children under the age of 10 can be diagnosed with conduct disorder. Answer: True.
What class of medications has been found most beneficial in the treatment of alcoholism not associated with a concomitant psychiatric illness?
Benzodiazepines if there is psychiatric comorbid = then use SSRI # panic disorder
A 22-year-old woman with obesity presents to the clinic for episodes in which she eats abnormally large portions of food. She reports feeling a lack of control during these episodes and feels guilty afterward about her eating. The patient reports no self-induced vomiting and is not fasting, taking medications to lose weight, or participating in extreme exercise. These episodes have been occurring about five times per week for the past year. Which of the following is the most likely diagnosis?
Binge eating disorder Psychotherapy is the preferred first-line treatment. Behavioral weight loss therapy is recommended for patients who do not have access to psychotherapy, decline psychotherapy, or do not improve with psychotherapy.
A 52 year-old female complains of bouts of anxiety and depression, the latter very deep but short lived (<24 hours). She states "I often feel like I am going to jump out of my skin". Her periods have become less frequent over the past 6 months. She denies suicidal ideations. She is not sleeping through the night. Which of the following the most appropriate next step in this patient?
Check a follicle-stimulating hormone level patient to evaluate for menopause as a cause for her psychiatric symptoms
Which of the following antipsychotic medications is associated with significant agranulocytosis but not with extrapyramidal side effects? what's monitored biweekly for 6 months?
Clozapine is referred as an "atypical" antipsychotic agent. It can cause agranulocytosis and should be monitored with weekly CBC. CBC monitoring biweekly for 6 months according to rosh White blood cell counT Leukopenia, granulocytopenia and agranulocytosis
A 22-year-old man presents to the emergency department due to headache, myalgia, and chest pain. He is agitated, appears angry, and is difficult to restrain. Vital signs indicate blood pressure 180/100 mm Hg, pulse 130 beats per minute, and temperature 100.1°F. Physical exam reveals mydriasis, diaphoresis, and diffuse muscular tenderness to palpation. Which of the following is most likely found on this patient's urine toxicology screening?### What is crack lung? A 20 year-old male presents to the ED with complaints of palpitations and agitation, which developed suddenly while attending a party. On examination, the patient is moderately agitated and tremulous. Vital signs include a pulse of 110/minute and regular; respiratory rate 22/minute and blood pressure 160/92 mmHg. Skin is diaphoretic and pupils are dilated. Which of the following is the most likely diagnosis?
Cocaine Signs and symptoms of acute cocaine intoxication include hypertension, tachycardia, agitation, headache, hyperthermia, rhabdomyolysis, intracerebral hemorrhage, gastric ulcers, splenic or renal infarct, mydriasis, and diaphoresis. Cardiac ischemia and acute left ventricular dysfunction may also occur. Hyperthermia is a sign of significant intoxication and increases the odds of mortality. Lowering blood pressure can be accomplished with nitroprusside, nitroglycerin, or phentolamine. Beta-blocking agents should be avoided in acute cocaine intoxication to prevent unmitigated alpha-adrenergic stimulation. Diazepam is given in acute cocaine intoxication for treatment of psychomotor agitation. Immersion in ice may be necessary for severe hyperthermiaFIRST LINE BP What is crack lung? Answer: Hemorrhagic alveolitis from inhaled cocaine.
A 20 year-old male presents to the ED with complaints of palpitations and agitation, which developed suddenly while attending a party. On examination, the patient is moderately agitated and tremulous. Vital signs include a pulse of 110/minute and regular; respiratory rate 22/minute and blood pressure 160/92 mmHg. Skin is diaphoretic and pupils are dilated. Which of the following is the most likely diagnosis?
Cocaine, as well as amphetamines, leads to a clinical picture of increased sympathetic stimulation and dilated pupils
A 45-year-old man presents to the clinic concerned that he may have brain cancer. He reports that since a coworker was diagnosed with brain cancer 5 years ago, he has spent more than 3 hours per day reading about brain cancer treatment in anticipation of being diagnosed himself. He has had 11 magnetic resonance images performed of his brain during the past 5 years. He reports no headaches or other neurologic symptoms. Which of the following is the first-line treatment for the suspected diagnosis?
Cognitive behavioral therapy dx:llness anxiety disorder most important clinical findings are the individual being preoccupied with having or developing a serious medical illness and no or minimal accompanying somatic symptoms. Alternative psychotherapies include mindfulness-based cognitive therapy and acceptance and commitment therapy. Pharmacotherapy is used in patients in whom psychotherapy is ineffective, unavailable, or declined; Selective serotonin reuptake inhibitors
A 24-year-old woman presents to the emergency department with right upper extremity weakness for the past 2 weeks. Physical examination reveals 2/5 strength in the right upper extremity and 5/5 strength in all other extremities. You review the patient's medical records and see that she has been to the emergency department four times in the past with similar symptoms, and diagnostic tests, including neuroimaging, have always been unremarkable. She has also been seen in a neurology outpatient clinic and had a normal nerve conduction study and a normal electromyography. You suspect a psychiatric condition marked by unintentional production of symptoms without clear secondary gain. Which of the following is the suspected diagnosis?
Conversion disorder What does the phrase La Belle indifference refer to? Answer: It refers to the situation in which patients are calm and unconcerned about symptoms that should cause distress.
A patient is evaluated for extreme fears of abandonment and an inability to care for himself throughout his adult life. He avoids disagreements and has difficulty initiating projects or acting on his own thoughts and ideas. Advice and reassurance are sought for even minor daily details. There are no reported suicidal tendencies or signs of self harm. What is the most likely personality disorder?
Dependent constantly seeking external support and will do even unpleasant things for others to gain approval and nurturing.
A 63 year-old retired engineer presents with one month of difficulty sleeping. He has a hard time staying asleep and says he is just restless. He also states that he has been more forgetful and can't pay attention very well. He lives with his wife. He denies fever, chills, recent trauma, or difficulty walking. When asked about the specifics of his symptoms, he repeatedly replies, "I don't know," without really trying. He states his wife thinks he just sits around the house all day since he retired. His neurological exam is unremarkable, except for some mild psychomotor retardation. Which of the following is the most likely diagnosis? A Dementia B Delirium C Depression D Dissociative disorder
Depression presents with difficulty thinking and concentrating, lessened sleep, and withdrawal from activities. firstline tx is ssri
A 25-year-old woman presents to a therapist due to persistent conflict in close relationships. She reports that one day it feels like her boyfriend is the love of her life, and the next day she wants to end their relationship. She also reports that she has had trouble maintaining a job because she will abruptly become upset with her boss and leave. She has attempted suicide twice in the past 6 months. Which of the following is the first-line treatment for the suspected personality disorder? A 26 year-old female has a long history of sexual promiscuity and substance abuse. She frequently expresses anger when she feels abandoned. She also has difficulty in controlling her anger at times. Her past relationships have been intense and short-lived. She has attempted suicide twice in the past 18 months. This patient exhibits which of the following disorders?
Dialectical behavioral therapy dx: Borderline personality disorder is one of the cluster B personality disorders. high risk for suicidal thoughts or attempts. core features include unstable moods, behaviors, and interpersonal relationships; fear of abandonment; intense attachment; Borderline personality disorder is characterized by instability of interpersonal relationships, marked impulsivity that is potentially self-damaging, inappropriate, intense anger or control of anger, recurrent suicidal attempts, gestures or threats, and identity disturbances. All of these are exhibited in this patient. Which defense mechanism is classically associated with borderline personality disorder? Answer: Splitting, which is the tendency to view individuals in dichotomous categories, such as entirely good or evil.
A 62-year-old man is admitted in stable condition following an uncomplicated total hip arthroplasty. His known medical history includes hypertension, peripheral vascular disease, and chronic tobacco use. After 10 hours, he reports nausea and appears anxious. The patient is diaphoretic, and a tremor is noted during intentional movement. Which of the following medications is best to initiate at this time? ACarbamazepine BDiazepam CNaltrexone DPhenobarbital
Diazepam dx:Alcohol withdrawal syndrome autonomic hyperactivity, tremors, insomnia, nausea and vomiting, transient hallucinations, psychomotor agitation, anxiety, and tonic-clonic seizures. These symptoms typically appear within 1 to 2 days of alcohol abstinence but may begin as early as 2 to 6 hours after reducing alcohol consumption. Symptom severity can range from mild to a severe and life-threatening presentation known as delirium tremens. Which vitamin is commonly deficient in individuals with chronic alcohol use disorder and can lead to Wernicke encephalopathy? Answer: Vitamin B1, also known as thiamine.
A 36 year-old patient presents requesting something to help him sleep. He reports that he has always had a problem sleeping, admits to feeling nervous most days for the last 2 years, and that he has always been "uptight" and a "worry wart." During the previous eight months he has frequently felt tense, shaky, sweaty, with palpitations and frequent headaches. He reports being irritable with his 5 year-old son. Which of the following is the best treatment option for this patient?
Escitalopram (Lexapro) SSRI
A patient presents within one hour of ingesting 30 tablets of diazepam (Valium). Which of the following is the most appropriate intervention?
Gastric lavage, along with the administration of activated charcoal and monitoring of vital signs and CNS status is the mainstay of therapy in the person who has overdosed on benzodiazepines. Vomiting should be induced in the person who is not comatose. Flumazenil (Romazicon), a specific benzodiazepine antagonist, might be used with caution in certain patients -------------------------------------------------------------- Alkalinization of the urine may be useful in the management of a barbiturate overdose, but not a benzodiazepine overdose.
A 32 year-old female presents to the office with the complaint of worry which she can not control for the last six months. She tells you that she has symptoms at least four times per week consisting of sleep disturbances, difficulty concentrating and irritability. What is the most likely diagnosis?
Generalized anxiety disorder A patient needs to have symptoms for more days than not for six months or more, need 3 of 6 symptoms to diagnose generalized anxiety disorder. ================================================ obsessive-compulsive disorder patients have symptoms of intrusive thoughts, rituals, preoccupations, and compulsions.
A 24 year-old female presents to your office for a physical examination. She is dressed in a low cut blouse and a short skirt. She is dramatic, emotional and sexually provocative. She complains of difficulty being intimate with men. On further questioning, she seems to overemphasize the severity of her current cold. After a full history and physical examination you suspect what personality disorder?
Histrionic are attention seekers, and exaggerate their thoughts and feelings, they are often sexually provocative. Using physical appearance to draw attention is more typical of histrionic disorder. ===================================================== Narcissistic patients are grandiose, envious, and have a sense of special entitlement. They lack empathy. Antisocial patients are unwilling to conform to social norms and do not learn from prior experiences. Schizotypal personalities have this along with magical thinking and ideas of reference. They may become withdrawn due to the lack of acceptance. What behavior would be most typical for a patient diagnosed with schizoid personality disorder? very withdrawn and do not seek or enjoy relationships and are indifferent to praise or criticism. They generally appear cold and unfeeling to others.Chooses solitary activities
A 35 year-old male patient comes back to the office for a follow-up visit. He remarks that after 5 weeks on fluoxetine (Prozac) 20 mg per day, he still feels depressed but he denies suicidal ideations. What should you do to help this patient?
Increase the dose of fluoxetine antidepressant should be raised to the recommended level and maintained at that level for 4-5 weeks, this patient was on too low of a dose.
A 22-year-old man is admitted to the psychiatric hospital for a condition marked by recurrent psychosis. You examine him and note that he has a flat affect and is apathetic. In addition, he will maintain unnatural postures that he is put into. He was initially admitted after he attempted to break into the White House because he thought he was the president. Which of the following accurately describes the epidemiology of this condition?
Individuals born in March are at increased risk dx:Schizophrenia . Risk factors include birth during the late winter or spring, living further from the equator, living in an urban area, immigration, advanced paternal age at conception, perinatal obstetric complications, childhood trauma or central nervous system infections, and cannabis use during adolescence. Birth during the late winter or spring is thought to be a risk factor because of an increased risk of maternal exposure to viruses during pregnancy. clinical manifestations of schizophrenia include hallucinations, delusions, disorganized speech, disorganized behavior, and negative symptoms. Examples of negative symptoms are flat affect, blunted facial expressions, anhedonia, apathy, lack of energy, and social isolation. The diagnosis is made according to criteria from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The treatment consists of antipsychoticmedications. Which type of hallucination is most common in schizophrenia? Answer: Auditory.
A 26-year-old female arrives in the emergency department with friends who say she was standing in front of her church, dressed in a white bathrobe, claiming to be the Virgin Mary and handing out $100 bills to all passers-by. Her friends noted that she had been depressed lately but now seems completely euphoric. She had a similar episode two years ago. Which of the following is the most appropriate treatment? ****
Inpatient olanzapine (Zyprexa) therapy Treatment of the manic phase is usually done in the hospital to protect patients from behaviors associated with grandiosity (spending inordinate amounts of money, making embarrassing speeches, etc.). Lithium, valproate, and olanzapine are considered effective in the manic stage; the depressive stage is treated monotherapy using quetiapine or lurasidone. If quetiapine monotherapy and lurasidone monotherapy are each ineffective or intolerable, next-step treatment options may include an SSRI as combination therapy (olanzapine plus fluoxetine).
A 25 year-old female presents to the emergency department after she collapsed at work. Medical history is significant for a mood disorder that causes her to have "wild mood swings and reckless behavior" according to her husband. She was diagnosed a year ago and since has been treated with several medications. Her symptoms today consist of nausea, vomiting, fatigue, tremor, and hyperreflexia. Lab results show an elevated BUN and creatinine, low sodium and elevated drug levels. All other results are normal. Which of the following medications is most likely the cause of her symptoms? A Lithium (Lithobid) B Lorazepam (Ativan) C Carbamazepine (Tegretol) D Risperidone (Risperdal) What laboratory test should be followed routinely every six to twelve months in patients taking this medication ? A Complete blood count B Calcium C Potassium D Thyroid stimulating hormone
Lithium (Lithobid Any sodium loss results in increased lithium levels. Signs and symptoms include vomiting and diarrhea which exacerbate the problem. Tremors, muscle weakness, confusion, vertigo, ataxia, hyperreflexia, rigidity, seizures, and coma may also be present. Lithium induces hypothyroidism because of the decrease in concentration of circulating thyroid hormones
A patient is evaluated for an overblown sense of self-importance and sense of entitlement. He is described as being arrogant, envious, exploitative and lacking in empathy. He is prone to mood swings and though he has a productive career in business he has few meaningful personal relationships. Which of the following is the most appropriate management for this patient?***
Lithium (Lithobid) dx:narcissistic personality disorder Lithium can be used with this diagnosis if mood swings are prominent along with antidepressants to address the frequent co-morbid depression.
A 25-year-old man presents to the emergency department, brought by emergency medical services, after getting into an altercation at a nightclub. He is agitated and yelling at the staff in the emergency department. His vital signs are notable for a HR of 135 bpm and blood pressure of 208/115 mm Hg. On exam, you notice that he is diaphoretic and has dilated pupils. You are able to obtain further information from his roommate who reports he is likely intoxicated with a substance made from pseudoephedrine in a home laboratory. Which of the following medications is considered first-line treatment for his elevated blood pressure?##
Lorazepam AVOID USE OF BETA BLOCKER dx:Amphetamine intoxication causes increased levels of central nervous system norepinephrine, dopamine, and serotonin. sympathomimetic findings, including tachycardia, hypertension, diaphoresis, and mydriasis. Amphetamine intoxication may also cause paranoia, anxiety, agitation, confusion, and hallucinations.
A 10-year-old boy presents to the clinic for evaluation after his teacher voiced concerns about his behavior in school. She reports the patient has difficulty remaining seated during class, talks excessively, interrupts others, and blurts out answers too quickly. His parents state that, since he was 4 years old, the patient gets angry when waiting for his turn and enjoys boisterous play. His family voices concerns about the first-line medication and would like to try an alternative agent. Which of the following side effects is most likely with this alternative medication?
Nausea Atomoxetine is the primary alternative nonstimulant medication ide effects for this agent include nausea, vomiting, weight loss, sleep problems, hepatotoxicity, xerostomia, insomnia, drowsiness, hyperhidrosis, erectile dysfunction, priapism, and psychosis with aggressive behavior. Additionally, cardiovascular effects include QT prolongation, hypertension, tachycardia, and cardiovascular collapse. The black box warning associated with atomoxetine includes increased suicidal ideation, dx:Attention-deficit/hyperactivity disorder Stimulants arefirst-line agents used to treat this condition in children, and common agents include methylphenidate, dexmethylphenidate, dextroamphetamine, and amphetamine-dextroamphetamine. Common side effects of stimulant medications include appetite suppression, insomnia, and weight loss. This class of medications may also result in growth suppression or the development of tics . Behavioral interventions are preferred to pharmacotherapy in preschool-aged children, but this approach is not recommended as a lone therapy in school-aged children or adolescents.
A 25-year-old man presents to the emergency department with altered mental status. Vital signs are significant for a temperature of 102.5°F, heart rate of 135 bpm, and blood pressure of 195/122 mm Hg. You examine him and find a stuporous man with profuse diaphoresis, rigidity in his extremities through all ranges of movement. You discuss his presentation with his mother, who notes he recently started taking risperidone for an unknown psychiatric condition. CT scan of his head is negative, and lumbar puncture reveals cerebrospinal fluid of 5 white blood cells/µL. Which of the following diagnoses is suspected? What is the typical finding on electroencephalography in patients with this?
Neuroleptic malignant syndrome The hallmark clinical tetrad of neuroleptic malignant syndrome is mental status changes, rigidity, fever, and dysautonomia. Dysautonomia consists of tachycardia, labile or high blood pressure, tachypnea, and diaphoresis. Lead-pipe rigidity is a classic exam finding and is defined by rigidity that produces smooth and steady resistance to passive movement of the limbs. What is the typical finding on electroencephalography in patients with neuroleptic malignant syndrome? Answer: Generalized slow-wave activity. Stopping the causative agent is the most important intervention. Otherwise, supportive care is the mainstay of treatment. Supportive care includes maintaining a euvolemic state via intravenous fluids, treating hyperthermia with cooling blankets, lowering blood pressure when it is markedly elevated, preventing venous thromboembolism with anticoagulation, and treating agitation with benzodiazepines. Some medications (including dantrolene, bromocriptine, and amantadine) are possibly effective in moderate or severe cases. In addition to supportive treatment, the most commonly used medications for neuroleptic malignant syndrome are dantrolene (Dantrium) and bromocriptine (Parlodel). ===================================================== Serotonin syndrome (D) occurs in individuals who are taking serotonergic agents, such as selective serotonin reuptake inhibitors. It also causes similar symptoms to neuroleptic malignant syndrome. However, nausea, vomiting, and diarrhea are more common in serotonin syndrome. Typically patients with serotonin syndrome have hyperreflexia while neuroleptic malignant syndrome rarely has hyperreflexia.
Which of the following drugs is first-line therapy for schizophrenia?*** A Chlorpromazine (Thorazine) B Clozapine (Clozaril) C Haloperidol (Haldol) D Olanzapine (Zyprexa)
Olanzapine (Zyprexa) One of the newer, "atypical" antipsychotic drugs, such as olanzapine, risperidone, quetiapine, etc. because their side effect profile is significantly better than the older drugs, and they may be more effective for negative psychotic symptoms. ----------------------------------------------------------- older, traditional antipsychotic agents, such as haloperidol and chlorpromazine have higher risk of side effects, including acute motor system side effects a long-term risk of tardive dyskinesias Clozapine should not be considered a first-line therapy because of its hematopoietic and hepatic side effects.
A 56 year-old man is admitted to a hospital unit for evaluation of rectal bleeding and weight loss. He has a strong family history of cancer. Soon after admission, a barium enema is scheduled. The patient refuses the "prep" because he fears x-ray radiation. He states he has had previous x-rays, but becomes frightened at the thought of an x-ray and "can't face it." The most likely diagnosis is
Phobic neurosis is a phobic ideation of displacement where the patient transfers feelings of anxiety from the object to one that can be avoided.
A 27-year-old woman presents to the emergency department reporting dysphoria, muscle aches, yawning, diaphoresis, restlessness, rhinorrhea, lacrimation, nausea, vomiting, and diarrhea. Her symptoms began about 12 hours ago. On physical exam, she is tachycardic and hypotensive, with decreased skin turgor, increased bowel sounds, and several scabs and scars noted over both antecubital fossae. Which of the following signs and symptoms is consistent with the patient's most likely diagnosis? AAltered mental status BHyperpyrexia CMiosis DPiloerection
Piloerection dx:opioid withdrawal Opioid withdrawal symptoms usually begin within 12 to 24 hours of the last dose of the opioid, peak at day 3, and taper off by day 7. Classic opioid withdrawal signs and symptoms include piloerection, diaphoresis, yawning, restlessness, dysphoria, myalgia, arthralgia, rhinorrhea, lacrimation, nausea, vomiting, diarrhea, palpitations, mydriasis, insomnia, tremor, and irritability What is the role of clonidine in acute opioid withdrawal? Answer: Clonidine is an alpha-2 adrenergic agonist that counters the noradrenergic hyperactivity found in opioid withdrawal.
1)Which defense mechanism is classically associated with borderline personality disorder? Answer: Splitting, which is the tendency to view individuals in dichotomous categories, such as entirely good or evil. 2)Which antidepressant medication can cause a false positive for amphetamines on a urine drug assay? Answer: Bupropion. 3)What is the name of the condition in which a patient fabricates symptoms about themselves? Answer: Factitious disorder. 4)Which childhood condition often precedes antisocial personality disorder? conduct disorder 5)What is the role of clonidine in acute opioid withdrawal? Answer: Clonidine is an alpha-2 adrenergic agonist that counters the noradrenergic hyperactivity found in opioid withdrawal. 6)Which vitamin is commonly deficient in individuals with chronic alcohol use disorder and can lead to Wernicke encephalopathy? Answer: Vitamin B1, also known as thiamine. 7)What is a dissociative anesthetic currently in medical use that is related to phencyclidine? Answer: Ketamine. 8)Which type of hallucination is most common in schizophrenia? Answer: Auditory. 9)True or false: adrenarche typically occurs early in children with Prader-Willi syndrome. Answer: True. 10)True or false: children under the age of 10 can be diagnosed with conduct disorder. Answer: True. 11)What is the typical finding on electroencephalography in patients with neuroleptic malignant syndrome? Answer: Generalized slow-wave activity. 12)What does the phrase La Belle indifference refer to? Answer: It refers to the situation in which patients are calm and unconcerned about symptoms that should cause distress. 13)Which of the following electrolyte abnormalities is the primary cause of tissue hypoxia?Anorexia nervosa = Hypophosphatemia . The clinical and laboratory findings of refeeding syndrome can include peripheral edema, seizures, hypophosphatemia, hypokalemia, hypomagnesemia, hemolysis, and rhabdomyolysis (tissue hypoxia and myocardial dysfunction). 14)Higher doses of SSRIs are usually required in which of the following conditions?Obsessive Compulsive Disorde 15) 16) 17) 18) 19) 20)
Q/A part 1
1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) 17) 18) 19) 20
Q/A part 2
A patient with obsessive-compulsive disorder would most likely have which of the following findings?
Raw, red hands Common manifestations of obsessive-compulsive disorder include phobias of germ and contaminants,
Which of the following is the most appropriate management of acute psychosis in a patient with schizophrenia?
Risperidone (Risperdal) numerous options used in the management of acute psychosis including benzodiazepines and antipsychotics such as haloperidol (first generation - typical -antipsychotic), risperidone or aripiprazole (second Generation - atypical - antipsychotics)
Which of the following is effective in the long-term treatment of panic attacks? vs urgent treatment of panic disorders,
SSRI's, such as fluoxetine, are the initial drugs of choice for the long-term Lorazepam may be used for urgent treatment of panic disorders, but should not be used for long-term treatment.
A 24 year-old male presents to the emergency room via ambulance. He was found by the police walking naked on the highway. His speech is minimal but disorganized and he appears to be responding to auditory hallucinations. With further questioning, he is preoccupied with the delusion of the FBI listening in on his conversations. His mother tells you that he has been acting bizarre for two months now. What is the most likely diagnosis?
Schizophreniform disorder is characterized by the same features as schizophrenia except the total duration of the illness is at least one month and less than six months.
A 25-year-old woman who is 5 weeks postpartum and breastfeeding presents to the clinic with decreased interest in activities that are usually pleasurable for the past 3 weeks. She also reports excessive feelings of guilt, decreased concentration, dysphoria, and fatigue. You offer to refer the patient for psychotherapy, and she declines. She has no prior history of psychiatric conditions. Which of the following is the most appropriate pharmacologic treatment for the suspected diagnosis?
Sertraline dx:Postpartum depression first 12 months after delivery. feelings of depression or anhedonia lasting at least 2 weeks and at least five of the following symptoms: dysphoria, anhedonia, excessive guilt, impaired concentration, changes in sleep, changes in appetite, fatigue, or suicidal thoughts. The preferred first-line pharmacologic treatment is selective serotonin reuptake inhibitors, specifically sertraline or paroxetine. S
A 17 year-old patient presents to the emergency department with agitation and hallucinations, and has one seizure. He admits to using "some drugs" but does not know what they were. On physical examination, temperature is 103 degrees F, BP 140/90, pulse 120, respirations 20. Remainder of the examination is unremarkable. Which of the following diagnostic studies will be of most help in managing this patient?**** A Drug screen B Urine dipstick C Complete blood count D Serum creatinine kinase
Serum creatinine kinase most sensitive test to detect rhabdomyolysis, a serious complication of seizures and hyperthermia related to drug abuse
What patient demographic is at highest risk for the development of anorexia nervosa? A College aged swimmer B. High school football player C Married, 50 year old, heterosexual female D Single, 20 year old, homosexual male
Single, 20 year old, homosexual male due to the strong community desire for slimness. This is not the case in the lesbian community. Wrestlers are at the greatest risk group among athletes along with ballet dancers. Though anorexia nervosa is more common in the female population, its onset is far more typical in the teens to early 20's.
A 25 year-old female graduate student presents to the student health center for the eighth time in three weeks to be sure she does not have meningitis. She read that there was a student on campus who had meningitis last month, and now she has headaches and is requesting to be tested to make sure she does not have meningitis. She has been evaluated at each visit, and physical examination has been completely normal each time. Which of the following is the most likely diagnosis?
Somatic symptom disorder somatization disorder, undifferentiated somatoform disorder, hypochondriasis, and somatoform pain disorder—are now considered somatic symptom disorders. may or may not be associated with another medical problem; symptoms no longer have to be medically unexplained. Sometimes the symptoms are normal body sensations or discomfort that do not signify a serious disorder. Patients are commonly unaware of their underlying mental problem and believe that they have physical ailments, so they typically continue to pressure physicians for additional or repeated tests and treatments even after results of a thorough evaluation have been negative.
A 25-year-old woman presents to a therapist to discuss her anxiety. She states that she has missed out on opportunities for career advancement because she cannot fly on planes. She describes an intense fear at the thought of boarding planes and has to commute by car or train for all long-distance travel. She also experiences palpitations and nausea when she sees planes from a distance. Which of the following is the most likely diagnosis?
Specific phobia Behavioral therapy including exposure therapy utilizing systemic desensitization. Hypnosis, supportive therapy and family therapy may also be useful adjunct treatment.
A patient is started on a new antipsychotic medication for his disorder. Three days later he develops altered consciousness, lead-pipe rigidity, diaphoresis and catatonia. Vital signs reveal respiratory rate of 20, temperature of 105.6 degrees F, and pulse oximetry of 95% room air. Which of the following would be the most appropriate initial intervention in this patient?
Supportive care with fluids and antipyretics dx: Neuroleptic malignant syndrome is characterized by extrapyramidal signs, blood pressure changes, altered consciousness, hyperpyrexia, muscle rigidity, dysarthria, cardiovascular instability, fever, pulmonary congestion and diaphoresis. Controlling fever and fluid support are the best initial management. With a normal pulse oximetry mechanical ventilation is not indicated In addition to supportive treatment, the most commonly used medications for neuroleptic malignant syndrome are dantrolene (Dantrium) and bromocriptine (Parlodel).
A 65 year-old patient has a long history of schizophrenia that is treated with phenothiazines. On an unrelated clinic visit, the patient has difficulty sticking out her tongue, facial tics, increased blink frequency, and lip-smacking behavior. These involuntary movements are most suggestive of
Tardive dyskinesia is characterized by abnormal involuntary movements of the face, mouth, tongue, trunk, and limbs and may develop after months or years of treatment with neuroleptic drugs.
A 22 year-old female presents to the emergency department with rapid heart rate. She appears quite thin and dehydrated. She denies that she is thin, stating "I am so fat that I can hardly stand myself! That is why I exercise every day." She runs twelve to fifteen miles a day, and on weekends also bicycles forty to fifty miles. Her LMP was six months ago. On exam, she is 5' 6" tall and weighs 98 pounds. Temp 98 degrees F, pulse 100, respirations 18, BP 98/60. EKG shows sinus tachycardia. Laboratory findings include Na 138 mEq/L, K 2.8 mEq/L, Cl 91 mEq/L, BUN 35 mg/dL, Creatinine 1.1 mg/dL. Which of the following is the next most appropriate treatment? Which of the following electrolyte abnormalities is the primary cause of tissue hypoxia?
Weight restoration and family therapy anorexia side effects in image requires a comprehensive, multidisciplinary approach to treatment that integrates medical management, individual psychotherapy, and family therapy. Currently, the best results have been shown with weight restoration accompanied by family therapy for patients with adolescent-onset anorexia nervosa and individual therapy for patients with onset after 18 years of age. Inpatient treatment is often required. 3)Which of the following electrolyte abnormalities is the primary cause of tissue hypoxia?Anorexia nervosa = Hypophosphatemia . The clinical and laboratory findings of refeeding syndrome can include peripheral edema, seizures, hypophosphatemia, hypokalemia, hypomagnesemia, hemolysis, and rhabdomyolysis (tissue hypoxia and myocardial dysfunction).
A 48-year-old male with alcohol use disorder, whose last drink was 6 hours ago, presents to the clinic complaining of palpitations and intermittent abdominal pain. On physical examination, blood pressure is 170/110 mm Hg, pulse 124/min, respirations 22/min, and temperature 100.4 degrees F. The patient is agitated and excitable. Cardiovascular examination reveals tachycardia without murmurs, gallops, or rubs and is otherwise normal. Which of the following is the most appropriate intervention?
admit to the hospital for alcohol withdrawal This patient is exhibiting the signs and symptoms of alcoholic withdrawal characterized by delirium, autonomic hyperactivity, perceptual distortions, and fluctuating levels of psychomotor activity. Seizures are a common occurrence prior to DTs, but the delirium may occur without preceding seizures. This is a medical emergency,
Rates of alcohol use in the adolescent are reportedly higher in:
adopted children whose biological parents are alcohol dependents. -Alcoholism has been reported to be lower among Japanese familie -no correlation suggesting that mood disorders in a grandparent -
Early clues to impending delirium tremens include vs full blown symptoms
agitation and decreased cognition. =Anxiety, decreased cognition, tremulousness, increasing irritability, and hyperactivity are common early clues to impending delirium tremens. ------------------------------------------------------- Mental confusion, tremor, sensory hyperacuity, visual hallucinations, autonomic hyperactivity, diaphoresis, dehydration, electrolyte disturbances, seizures, and cardiovascular abnormalities are common signs and/or symptoms of full-blown delirium tremens.
A 54 year-old patient has acute onset of palpitations, tremulousness, profuse sweating, shortness of breath, and numbness and tingling of the extremities. Physical examination reveals a pulse of 104 beats/min and regular, respiratory rate of 30/min, blood pressure of 160/95 mm Hg. Arterial blood gases reveal a low pCO2. ECG shows no acute changes. The most likely diagnosis is
anxiety neurosis
The most important initial component of evaluating a patient with depressive illness is
assessment of suicidal risk
A 19 year-old female presents with complaints of intermittent abdominal pain associated with recent, frequent episodes of regurgitation of food for the past several months and worsening over the past 12 hours. She maintains a normal weight for her height however she seems obsessed with losing weight. On examination the physician assistant notes multiple dental caries, bilateral tenderness of the parotid glands and mild epigastric tenderness. Which of the following findings would you expect to find on laboratory tests to support your suspected diagnosis? A 20 year-old female presents with episodes of binge eating, overuse of laxatives, and periods of starvation. Which of the following is the best treatment option for this patient? Which of the following laboratory abnormalities is most commonly noted in bulimia nervosa?
bulimia nervosa - purging type uncomplicated =Start an antidepressant . Fluoxetine, a SSRI, is the drug of choice for the treatment of bulimia nervosa Electrolyte abnormalities hypochloremia with subsequent hypokalemia due to renal compensatory mechanisms, hypomagnesemia and metabolic alkalosis.
Which of the following medications used in the management of anxiety has a delayed onset of action?**** A buspirone (BuSpar) B diphenhydramine (Benadryl) C lorazepam (Ativan) D butalbital (Fiorinal)
buspirone (BuSpar) --------------------------------------------------------- diphenhydramine (Benadryl) works as a histamine blocker and will cause sedation immediately because of its anticholinergic effects.
Which of the following effects result from cigarette smoking and contributes to atherogenesis? A transient decrease in blood pressure B polycythemia with relative hyperoxemia C decreased blood viscosity D chronic inflammation
chronic inflammation ------------------------------------------------------------ polycythemia with relative hyperoxemia Smoking induces a hypoxic state, leading to polycythemia. However, because of increased carbon monoxide, there is still a relative hypoxemia rather than increased levels of oxygen. increased blood viscosity transient increase in blood pressure
Phenothiazines exert their antipsychotic effects by blocking
dopamine receptors. in the mesolimbic areas of the brain is responsible for the antipsychotic effects of the phenothiazines; blockage of the dopamine receptors in the nigrostriatal areas lead to the motor side effects, such as dystonia and akathisia.
A divorced female patient presents for an employment physical. She states she has had a "run of bad luck" with jobs and has not been able to hold any job for longer than 2-3 months. She also states she has been arrested several times for getting into fights when she is out with the girls. She states she drinks an occasional beer, but denies any significant problems with alcohol. Which of the following laboratory findings would support your suspected diagnosis?*** A decreased triglycerides B. decreased serum uric acid C increased LDL cholesterol D increased mean corpuscular volume
dx alcohol abuse The primary lipid abnormalities demonstrated with alcoholism are increased triglycerides and increased HDL cholesterol, not LDL cholesterol. Laboratory tests will reveal the presence of an elevated mean corpuscular volume, triglycerides, serum uric acid and liver function tests.
A 36 year-old woman admits that her husband has abused her for over ten years. You should inform the woman that she is at most risk for injury or death
just after leaving an abusive spouse
A 19 year-old woman has been consuming up to six beers daily since she was 16. She is now pregnant with her first child, has had little prenatal care, and is due to deliver in four weeks. Of the following, which neonatal problems should you anticipate?******
low birth weight dx:Fetal alcohol syndrome Poor coordination. Hyperactive behavior. Difficulty with attention. Poor memory. Difficulty in school (especially with math) Learning disabilities. Speech and language delays. Distinctive facial features, including small eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip. Deformities of joints, limbs and fingers. Slow physical growth before and after birth. Vision difficulties or hearing problems. ================================================ Kernicterus is typically due to ABO/Rh incompatibility
On performing a mental status examination you notice that the patient tends to repeat words and phrases out of context to your questions. This type of thought disorder is defined as which of the following?
perseveration is the persistent repetition of words or concepts in the process of speaking. This is often seen in cognitive disorders, schizophrenia, and other mental illness. ===================================================== flight of ideas, thoughts move from one topic to another with rapid speech. Circumstantiality includes much detail, but information is not relevant. Derailment is speech with loose associations and sentences that do not make sense.
A 28 year-old male patient is being treated for depression and has been taking paroxetine (Paxil) for the past two and a half months with a marked improvement in symptoms. The patient reports problems with sexual functioning which he believes is related to the medication. Which of the following is an immediate concern with abrupt discontinuation of the medication?
risk of drug withdrawal symptoms or withdrawal delirium which represents cholinergic rebound. short acting SSRIs relapse is not an immediate risk of abrupt discontinuation. Abrupt discontinuation of an SSRI in a patient who is relatively asymptomatic does not increase the risk of suicide
Formications are most commonly associated with which of the following?
sensation of insects crawling on the skin and is commonly associated with delirium tremens from alcohol withdrawal and cocaine addiction.
