Behavioral Medicine and Substance Abuse

Question 1

What is the most likely complication of androgenic steroid use?

Answer 1

hepatic abnormalities (elevated liver enzymes, cholestatic jaundice, drug induced hepatitis)

Question 2

What substance is likely to cause patient to be unconscious, hyperthermic, decreased respiratory rate, hyponatremia, hyperkalemia, hypoglycemia and elevated creatinine kinase (rhabdomyolysis)?

Answer 2

MDMA (Ecstasy)

Question 3

…. is the phenomenon in which children of parents with disabilities or chronic illnesses are obligated to take on adult responsibilities to the detriment of their own development

Answer 3

Parentification

Question 4

What is the next step in management of a patient who is on stimulant for ADHD but develops worsening disruptive tics?

Answer 4

continue stimulant (if helping with ADHD symptoms) and started clonidine (alpha agonist)

Question 5

What is the treatment for trichotillomania (hair pulling excessively)?

Answer 5

behavior modification and SSRIs

Question 6

What is the most likely diagnosis for patient present with decreasing rates of cranial growth, regression in developmental milestones, hypotonia, expressive language dysfunction, stereotypic hand gestures and seizures starting around 6-18 months of age?

Answer 6

Rett syndrome

Question 7

What is the inheritance pattern for Rett syndrome?

Answer 7

X-linked dominant

males generally die at or before birth, so predominantly seen in females

Question 8

Which ADHD medication carries a warning regarding increased risk of suicidal ideation?

Answer 8

Atomoxetine

Question 9

What medication is usually used for aggressive behavior and irritability associated with Autism?

Answer 9

Risperidone

can also use Aripiprazole

Question 10

What is the most likely diagnosis for patient presenting with perioral and perinasal eczematous rash, nosebleeds, cough, wheezing, SOB, excessive lacrimation, rhinorrhea, salivation and benzene like odor?

Answer 10

Inhalant use

Question 11

What is the FDA warning for adolescents on SSRIs?

Answer 11

Suicidality

Question 12

What is a side effect of Risperidone?

Answer 12

Galactorrhea (elevated prolactin levels)

Question 13

… is characterized by multiple motor and vocal tics lasting more than 1 year.

Answer 13

Tourette Syndrome

Onset usually begins prior to 7 years old

Question 14

What is the most likely substance misuse associated with hypotension, generalized hypotonia, ataxia, nystagmus and respiratory depression in patient with family/ personal history of anxiety?

Answer 14

Benzodiazepine overdose

Question 15

What is the most likely diagnosis for patient presenting with sleep problems, nightmares that revolve around separation from family, decreased appetite, physical complaints and refusal to go to school?

Answer 15

Separation Anxiety Disorder

Question 16

What is the first step in management for adolescent found to be sexting?

Answer 16

alert authorities of any potentially unlawful behavior by the recipients of the patient’s photos/ videos
(criminal charges of child porn)

Question 17

What is the CRAFFT screening test used for?

Answer 17

assess drug and alcohol abuse

Question 18

What is a respiratory complication associated with Rett syndrome?

Answer 18

episodes of hyperventilaion followed by hypoventilation and periods of apnea during wakefulness

Question 19

What is the next best step in management for patient presenting with nonsuicidal self-injury (behaviors that harm without the intent to die)?

Answer 19

refer to mental health and reassess in 1 week

Question 20

What is the most likely diagnosis for child age 3-12 who has abrupt awakening from sleep with loud scream, appears agitated/ frightened/ confused, has facial flushing/ sweating/ tachycardia, does not respond to parental efforts at calming and does not recall the episode in the morning?

Answer 20

Night Terrors

usually during 1st 1/3 of sleep

Question 21

What is the best treatment for psychomotor agitation associated with Bath Salt ingestion?

Answer 21

Lorazepam (or diazepam)

Question 22

What is the first line medication treatment for OCD?

Answer 22

SSRI

Question 23

What substance is referred to as “downers”, “blue footballs”, “tranks”, “totem poles”?

Answer 23

Benzodiazepine

Question 24

What is a complication of benzodiazepine withdrawal?

Answer 24

Seizures

Question 25

What illici substance can result in gynecomastia?

Answer 25

Marijuana

Question 26

What is the most likely substance use for patient presenting with hyperreflexia, clonus, muscle rigidity, nystagmus, temperature instability, and psychosis features?

Answer 26

Phencyclidine (PCP)

Question 27

What is an orthopedic complication of stacking/ pyramiding androgenic steroids?

Answer 27

early epiphyseal closure (decrease in ultimate adult height)

Question 28

Ibuprofen use in last 24 hours can cause a false positive result for which illicit drug?

Answer 28

Phencyclidine (PCP)

Question 29

What is a potential complication of cocaine use (nose bleeds, clear chronic rhinorrhea, nasal septal perforation)?

Answer 29

vasoconstriction (cerebral hemorrhages, seizures, stroke, MI)

Question 30

What has been shown to increase prenatal risk for ADHD?

Answer 30

fetal exposure to alcohol

Question 31

What is the most likely diagnosis for patient presenting with episodes of loses temper, argues with authority figures, refuses to comply with adults’ request/ rules, deliberately annoys both adults and peers, blames others for mistakes/ misbehavior, easily annoyed by others, and angry/ resentful/ vindictive for more than 6 months?

Answer 31

Oppositional Defiant Disorder (ODD)

Question 32

What is a possible side effect of SSRIs when taken by patient with bipolar disorder?

Answer 32

Maniac Episode

Question 33

What is the etiology that causes increased sudden death in patient’s with Rett Syndrome?

Answer 33

Cardiac arrhythmia

Question 34

Who is the etiology behind seizures in the setting of MDMA (Ecstasy) use?

Answer 34

hypoglycemia (patients usually suck on candy to avoid risk)