Board Vitals Psychiatry Flashcards
Is relapse of depression common after discontinuation of pharmacotherapy?
No
Do benefits of psychotherapy for depression persist after discontinuation?
Yes
What is the heart rate in patients with anorexia nervosa?
Bradycardia (< 60/min)
When feeding is started in a bradycardic anorexia nervosa patient, her heart rate returns to normal.
What is the next step?
Evaluation for refeeding syndrome and impending cardiac compromise (relative tachycardia).
What is the first electrolyte abnormality in anorexia nervosa patients with refeeding syndrome?
Hypophosphatemia
If patients with anorexia nervosa are in danger of developing refeeding syndrome then what should you do?
Reduce the calorie intake
What heart rate is concerning for refeeding syndrome with heart failure in anorexia nervosa patients?
> 70 beats/min
What is the minimum criteria to diagnose bipolar type II disorder?
- One hypomanic episode
- Depressive episode
What is the minimum criteria to diagnose bipolar type I disorder?
- One manic episode
- Depressive episode
An illness in Mexican, Central and South American cultures where it is believed that a frightening event can cause one’s soul to leave one’s body. Symptoms similar to post-traumatic stress disorder.
Terminology?
Susto
Entity in Southeast Asia characterized by symptoms of anxiety and depression occurring in the setting of somatic complaints attributed to semen loss.
Terminology?
Dhat syndrome
Belief that illness occurs because of destiny.
Terminology?
Fatalismo
Ongoing illness caused by challenging life circumstances, including depression, anxiety and somatoform features.
Terminology?
Nervios
Belief that illness is a result of long-term social struggle.
Terminology?
Coraje
What are residential services for psychiatric patients or those with substance abuse disorders?
Community-based treatments like halfway houses
What is the first line management for opioid use disorder?
Medication-assisted treatment (MAT)
Which opioid antagonist can prevent the effects of opioid intoxication, thereby reinforcing abstinence?
Naltrexone
Which drug is an acetyaldehyde dehydrogenase that is used to manage alcohol use disorder?
Disulfiram
Which drug is an acetaldehyde dehydrogenase that is used to manage alcohol use disorder?
Disulfiram
Which opioid antagonist is used to rapidly treat acute opioid overdose and should not be used to manage chronic opioid use disorder?
Naloxone
What is the mechanism of action of buprenorphine?
Partial mu-opioid agonist
Does disulfiram reduce alcohol cravings?
No
Is disulfiram a first line treatment for alcohol use disorder?
No
Which medication reduces cravings for alcohol?
Naltrexone
Which medication reduces cravings for nicotine?
Varenicline (Chantix)
What is the first line treatment (medication) for opioid use disorder in a patient who is still using and has withdrawal symptoms?
Buprenorphine
Which medications can increase serum lithium levels?
- Diuretics (especially thiazides)
- ACE inhibitors
- NSAIDs
Does fentanyl respond to naloxone?
Not unless very high doses are given.
Which drug is responsible for the most overdose deaths?
Fentanyl
Can ecstasy cause rhabdomyolysis?
Yes
What is benzolecgonine a metabolite of?
Cocaine
What is 3-morphine glucuronide a metabolite of?
Morphine
What is 6-(mono)acetylmorphine a metabolite of?
Heroin
What is 4-aniline-N-phenethyl-4-piperidinone a metabolite of?
Fentanyl analogs
What is codeine-6-glucuronide a metabolite of?
Codeine
What is the treatment of acute lithium toxicity?
Hemodialysis
What is the initial treatment of neuroleptic malignant syndrome?
ICU admission
Aggressive supportive care
What is the initial medical treatment of neuroleptic malignant syndrome?
Dantrolene
Which one involves secondary gain - malingering or factitious disorder?
Malingering
What should be tried first for hospital acquired delirium - conservative measures like reorientation or antipsychotics?
Conservative measures
What should you do in severe alcohol withdrawal not responding to benzodiazepines?
Use alternative agents:
- Phenobarbital
- Propofol
- Dexmedetomidine
Which medication is used to treat generalized anxiety disorder - buspirone or bupropion?
Buspirone
Which medication for generalized anxiety disorder does not have sedating or sexual dysfunction adverse effects?
Buspirone
Can lithium cause hypothyroidism?
Yes
Which medication can treat both opioid and alcohol use disorder?
Naltrexone
What adjunct behavioral therapy is useful in bipolar disorder?
Group psychoeducation
What is the mechanism of action of N-acetylcysteine (NAC)?
Increases glutathione levels
What is a non-stimulant medication for ADHD?
Atomoxetine
Should you prescribe stimulants to an ADHD patient who has previously abused stimulants?
No
Can phenytoin increase the clearance of methadone?
Yes
What is the ocular side effect of thioridazine?
Retinitis pigmentosa
What medication is the most common cause of cornea verticillata?
Amiodarone
What medication typically causes dyschromatopsia (decrease in color vision)?
Ethambutol
What medication typically causes xanthopsia (yellowing of vision)?
Digoxin (toxicity)
When a patient is malingering, should you determine motivations for behavior or confront the patient?
Determine motivations for behavior
What drugs are first-line for treating generalized anxiety disorder?
SSRIs or SNRIs
What class of medications is the best treatment of major depressive disorder with atypical features (depressive episode with emotional reactivity)?
Monoamine oxidase inhibitors
