C & L Flashcards
What is the most common cause of hyperthyroidism? A. Hashimoto's thyroiditis B. Grave's disease C. Administration of exogenous thyroid D. TSH-secreting pituitary adenoma E. Hydatidiform mole
B. Grave’s disease
Hyperthyroidism is the condition resulting from the effect of excessive amounts of thyroid hormone on body tissues. Grave’s disease is the most common cause of hyperthyroidism. Hashimoto’s thyroiditis causes hypothyroidism. Excess ingestion of thyroid hormone is relatively common when patients are given higher doses than that necessary to maintain a euthyroid state. TSH-secreting pituitary adenoma is very rare.
Which of the following is not the role of the psychiatry liaison consultant?
A. Comprehensive assessment of the patient
B. Accurate note keeping
C. Detailed psychodynamic formulation
D. Documentation of plans for follow-up
C. Detailed psychodynamic formulation
Which of the following is true regarding mental disorders in patients with epilepsy?
A. Ictal psychosis is more common than interictal psychosis.
B. Violence is common during a seizure.
C. Rates of attempted suicide are increased in people with epilepsy.
D. Mood symptoms are more common than schizophrenia-like symptoms.
C. Rates of attempted suicide are increased in people with epilepsy.
Interictal psychotic states are more common than ictal psychosis. An estimated 10-30% of all patients with complex partial epilepsy have psychotic symptoms. Risk factors are female gender, lefthandedness, onset of seizures during puberty, and a left-sided lesion. Mood symptoms like depression and mania are seen less often than schizophrenia-like symptoms. There is an increased incidence of attempted suicide in patients with epilepsy.
In which of the following regions of the brain is a tumor most likely to cause psychiatric symptoms? A. Frontal B. Parietal C. Temporal D. Occipital
A. Frontal
Approximately 50% of patients with brain tumors experience psychiatric symptoms. In approximately 80%, the tumors are located in the frontal or limbic region. Meningiomas are likely to cause focal symptoms by compressing a limited region of the cortex, whereas gliomas are likely to cause diffuse symptoms.
What is the most common reason for psychiatric consultation in rehabilitation medicine? A. Anxiety B. Pain C. Depression D. Psychosis
C. Depression
Depression is the most frequent reason for psychiatric consultation in rehabilitation medicine. It is associated with longer duration of inpatient rehabilitation, deficient self-care, and delay in resumption of premorbid social activities.
What is the most common psychiatric manifestation of Cushing syndrome? A. Mania B. Psychosis C. Depression D. Panic attacks E. Anxiet
C. Depression
The most common psychiatric manifestation of Cushing syndrome is depression. Cushing syndrome refers to a diverse symptom complex due to excess steroid hormone production by the adrenal cortex or sustained administration of glucocorticoids. The depressive symptoms are moderate to severe in 50% of patients. Many patients also experience psychotic features. In patients who demonstrate depression, it may be necessary to institute therapy for the depression itself while awaiting the eventual resolution of the manifestation of Cushing syndrome.
With which of the following is exogenous administration of steroids most commonly associated? A. Mania B. Psychosis C. Depression D. Panic attacks E. Anxiety
A. Mania
Exogenous administration of steroids is most commonly associated with mania. It can also cause psychosis, depression, panic attacks, or anxiety.
What is the most common psychiatric condition seen in patients with hyperparathyroidism? A. Mania B. Depression C. Psychosis D. Anxiety E. Panic attacks
B. Depression
Depression is common in patients with hypercalcemia. The severity of symptoms intensifies as the level of hypercalcemia increases. Delirium, psychosis, and cognitive impairment are more commonly seen in patients who have calcium levels more than 50 mg per dl. Depressive symptoms, but not cognitive symptoms, tend to resolve with treatment. Cognitive symptoms may improve; however, residual symptoms may remain.
Which of the following is NOT true regarding diabetes mellitus?
A. Dementia is less common.
B. There is a negative correlation between depression and good diabetic control.
C. In ketoacidotic coma, the level of consciousness correlates with plasma osmolality.
D. MAOIs potentiate the effect of oral hypoglycemic drugs.
A. Dementia is less common.
Dementia is more common in persons with diabetes mellitus. There is a negative correlation between emotional symptoms and diabetic control. Patients exhibiting persistent psychiatric symptoms who receive psychiatric intervention may have less disease morbidity. Between one-third and two-third of patients with diabetes mellitus have some kind of psychiatric disorder, ranging from anxiety and depression to substance abuse.
Which of the following is not a psychiatric manifestation of hyperthyroidism? A. Depression B. Anxiety C. Schizophrenia-like symptoms D. Opiate dependence E. Cognitive impairment
D. Opiate dependence
Hyperthyroidism is associated with a variety of psychiatric manifestations including anxiety, depression, psychosis, and cognitive impairment. More than 90% of patients presenting with depression and anxiety who do not have a preexisting psychiatric condition will experience resolution of the symptoms during the course of treatment for hyperthyroidism. Opiate dependence is not known to be associated with hyperthyroidism.
All of the following are associated with psychiatric illness with steroid treatment except A. Male sex B. Higher dose C. Longer duration of therapy D. Previous psychiatric illness E. Depressed mood
A. Male sex
Psychiatric illness with steroid use is associated with female sex, high doses of steroids, longer duration of treatment, previous history of psychiatric illness, and depressed mood.
Which of the following is true regarding SSRIs used in treatment of premenstrual dysphoric disorder?
A. They cannot be combined with hormonal treatments.
B. They are poorly tolerated.
C. They inhibit ovulation.
D. They can be used exclusively in the luteal phase.
E. They have few side effects.
D. They can be used exclusively in the luteal phase.
Most serotonin-enhancing antidepressants have been shown to be effective in the treatment of premenstrual dysphoric disorder in comparison with placebo. Some SSRIs given in the latter half of the cycle can be as effective as continuous daily doses. In the case of citalopram, half-cycle dosing was found to be better than daily dosing. It has been postulated that some woman may have reduced serotonergic activity across the menstrual cycle as a trait, and during the luteal phase, further abnormalities of serotonergic function may occur. The beneficial effects of SSRIs on dysphoric symptoms are evident soon after initiation of treatment. They are generally well tolerated and do not interfere with ovulation.
Which of the following is true regarding pituitary disease?
A. There is an increased rate of mania in hypopituitarism.
B. Libido is increased in acromegaly.
C. Psychosis is common in acromegaly.
D. Increased energy and activity are seen in hypopituitarism.
E. Symptoms of hypopituitarism fully resolve with treatment.
E. Symptoms of hypopituitarism fully resolve with treatment.
Symptoms of hypopituitarism generally fully resolve with treatment. There is an increased rate of lethargy and depression in hypopituitarism. Libido is reduced in acromegaly, and psychosis is not common.
All of the following are associated with vitamin B12 deficiency EXCEPT: A. Macrocytic anemia B. Depression C. Polyneuropathy D. Dementia E. Memory impairment
B. Depression
Vitamin B12 deficiency can cause macrocytosis, polyneuropathy, dementia, and memory impairment. Its association with depression is not established.
All of the following are symptoms of Wilson's disease except A. Cognitive impairment B. Visual symptoms C. Epilepsy D. Changes in personality E. Rigidity and dystonia
B. Visual symptoms
Wilson’s disease is a rare autosomal recessive disorder that occurs between the first and third decades of life. It is characterized by the excess deposition of copper in the liver and brain. It tends to present as liver disease in adolescence and neuropsychiatric disease in young adults. The neurologic manifestations are related to basal ganglia dysfunction and include resting, postural, or kinetic tremor; rigidity; and dystonia of the bulbar musculature with dysarthria and dysphagia. Psychiatric features include behavioral and personality changes and emotional lability. The pathognomonic sign is the brownish Kayser-Fleischer ring in the cornea
All of the following are symptoms of premenstrual dysphoric disorder except
A. Pelvic discomfort
B. Irritability
C. Occurrence of the disorder soon after menstruation
D. Carbohydrate craving
E. Occurrence of the disorder for 2 consecutive months
C. Occurrence of the disorder soon after menstruation
The essential features required for a diagnosis of premenstrual dysphoric disorder (PMDD) are symptoms of marked and persistent anger or irritability, depressed mood, anxiety, and affective lability that have occurred regularly during the last week of luteal phase in most menstrual cycles during the last year. Premenstrual dysphoric disorder diagnosis requires that symptoms be present for a minimum of 2 consecutive months. PMDD must also be differentiated from premenstrual exacerbation or magnification of other conditions.
Which of the following is true about premenstrual dysphoric disorder?
A. It is seen in 10% to 20% of women.
B. It indicates abnormal ovarian function.
C. Symptoms are more severe in a middle-aged woman.
D. It is linked to abnormal central serotonergic function.
E. It is not associated with sexual abuse.
D. It is linked to abnormal central serotonergic function.
A number of studies have consistently demonstrated an important role for serotonin in the pathophysiology of PMDD. Patients have lower whole-blood serotonin levels and lower platelet serotonin uptake during the premenstrual phase. Estimates of prevalence vary with severe symptoms reported in 4-7% of women. The presence of PMDD does not indicate abnormal ovarian function, and women with PMDD show no consistent differences in basal levels of ovarian hormones. Younger age has been associated with more severe symptoms. It is also associated with low levels of education. Past sexual abuse is reported by a significant proportion of women seeking treatment for PMDD.
All of the following are true of porphyria except
A. Peripheral neuropathy may be seen.
B. Elevated ceruloplasmin is seen.
C. Benzodiazepines may be used.
D. Symptoms may resemble schizophrenia.
E. Acute intermittent porphyria is the most common form.
B. Elevated ceruloplasmin is seen.
Acute intermittent porphyria is the most common form of porphyria. It is an autosomal dominant condition. Clinical illness usually develops in women. Many drugs may precipitate attacks including alcohol, barbiturates, carbamazepine, tricyclic antidepressants, phenytoin, and valproic acid. Patients present with abdominal pain, autonomic and peripheral neuropathy, seizures, psychosis, and abnormalities of the basal ganglia. Benzodiazepines are generally considered to be safe for use in porphyria.
Which of the following inborn errors of metabolism can not be treated by diet? A. Homocystinuria B. Lesch-Nyhan syndrome C. Phenylketonuria D. Galactosemia
B. Lesch-Nyhan syndrome
Lesch-Nyhan syndrome is an X-linked recessive condition that affects boys exclusively. Infants with Lesch-Nyhan syndrome develop attacks of hypertonia within a few weeks of birth. They also develop spasticity with ataxia and choreoathetosis. Most children have severe mental retardation and become wheelchair bound. They also show verbal and physical aggression and self-injurious behavior. The condition is not treated by dietary control. Treatment by dietary modification is a part of the treatment for homocystinuria, phenylketonuria, and galactosemia.
Which of the following is true about prion diseases?
A. It is more common in men.
B. Patients usually have a normal EEG.
C. There is a reduced risk with E4 apolipoprotein allele.
D. It is encoded on chromosome 10.
E. The familial form is autosomal recessive.
A. It is more common in men.
Prion diseases are called subacute spongiform encephalopathies. They are associated with the accumulation in the brain of abnormal partially protease-resistant glycoproteins known as prion proteins. The human prion diseases can be divided into inherited, sporadic, and acquired forms. CJD is a rapidly progressive multifocal dementia with myoclonus. Onset occurs between 45 and 75 years of age. The clinical progression is typically over weeks, progressing to akinetic mutism and death within 2 to 3 months. Patients with progressive dementia and two or more of the following signs in the setting of an EEG finding of pseudoperiodic sharp wave activity nearly always have CJD: myoclonus; cortical brightness; pyramidal, cerebellar, or extrapyramidal signs; or akinetic mutism. The familial form of prion disease, called Gerstmann-Sträussler-Scheinker syndrome, has an onset in the third and fourth decades of life and is characterized by cerebellar ataxia with pyramidal features and dementia. It is an autosomal dominant disorder.
Which of the following is NOT true regarding affective disorder in patients on renal dialysis?
A. Adjustment disorder can lead to behavioral problems.
B. Major depression is the most common psychiatric diagnosis.
C. Adjustment disorders can influence physical outcome.
D. Adjustment disorders may become chronic.
E. Lack of energy and insomnia are less indicative of depression than in patients who are not on dialysis.
B. Major depression is the most common psychiatric diagnosis.
The most common psychiatric diagnoses in patients on renal dialysis are adjustment disorders (30%), mood disorders (24%), and organic mental disorders. Symptoms useful in identifying major depressive disorders are low mood, reduced interest, feelings of worthlessness, excess guilt, anorexia, weight loss, and slow thoughts. Symptoms not useful in making a diagnosis are lack of energy, insomnia, and reduced libido, because these occur in end-stage renal disease. Behavioral problems such as self-neglect, social withdrawal, and noncompliance with treatment are common and can affect physical outcome.
Which of the following is NOT true regarding cognitive therapy in liaison settings?
A. It teaches techniques to deal with future problems.
B. It can modify negative automatic thoughts about physical illness.
C. It helps patients regain control of their illness.
D. It is supported by evidence in liaison settings.
E. It is directed by therapists’ perception of the patient’s problems.
D. It is supported by evidence in liaison settings.
Cognitive therapy can be used in the treatment of psychological problems related to physical illness. Patients’ attitude about their illness is of considerable importance to the outcome. The less control patients perceive themselves as having in a situation, the more depressed they are likely to be. Therapy involves the patient and therapist understanding the patient’s perception of problems. As well as assessing cognition, it is important to target physical symptoms and problems that can be assessed and baselines accorded to measure future change. Therapy should improve patients’ sense of control over their physical state and educate them in techniques they can use to deal with problems in the future.
Which of the following is true regarding denial in patients on renal dialysis?
A. It is rarely present.
B. It may cause problems with compliance.
C. It is always pathological.
D. If denial is low, less mood dysfunction occurs.
E. High denial results in rapid readjustment.
B. It may cause problems with compliance.
Denial is a defense mechanism often used by patients with end-stage illness. Some patients may use this more than others. Patients with low denial scores have been found to have greater interpersonal sensitivity and greater mood and sleep dysfunction than those with high denial scores. Automatic thoughts in patients with low denial tend to focus on their losses, leading to affective disturbance. Therefore, denial may be adaptive in complementing a patient’s ability to break the cycle of automatic thoughts that may lead to affective problems, allowing gradual adjustment to occur.
Which of the following is not useful in diagnosing depression in the patient on a medical inpatient unit? A. Hopelessness B. Morning depression C. Depressed mood D. Sleep disturbance E. Suicidal thoughts
D. Sleep disturbance
Depression is more difficult to diagnose in patients with physical illness. Depressed mood, hopelessness, and morning depression have been shown to be effective as differentiating symptoms to distinguish depression from the effects of physical illness. Sleep disturbance, anorexia, lethargy, and psychomotor retardation may be due to physical illness.
