Clerkships: PSYCHIATRY

Question 1

Define universalization vs group cohesion vs validation vs

Answer 1

?

Question 2

optimal treatment for panic disorder

Answer 2

SSRI (paroxetine) + benzodiazepine (alprazolam)

Question 3

In parkinsons, antipsychotic of choice? Why

Answer 3

Clozapine (atypical?)

Spares nigrostriatal pathway and is anticholinergic

Question 4

Grand mal seizures are followed by a spike in…?

Answer 4

Prolactin

Question 5

Drug of choice for ECT sedation/anesthesia?

Answer 5

Methohexital (barbiturate)

Question 6

What are alternative names for AST and ALT?

Answer 6

AST = SGOT (serum glutamic oxaloacetic transaminase)
ALT = SGPT (serum glutamic pyruvic transaminase)

Question 7

MOA:

amphetamine
cocaine
benzo/barb
PCP
antipsychotics

Answer 7

increased catecholamine RELEASE

decreased catecholamine REUPTAKE

potentiates gaba by increasing affinity for GABA receptors

NMDA aspartate receptor activation

dopamine receptor BLOCK

Question 8

Supportive therapy hallmark

Answer 8

ABSENCE of interpretations

Question 9

tx for neuroleptic malignant syndrome (NMS)

Answer 9

Bromocriptine + dantrolene

Question 10

What’s responsible for cocaine’s addictiveness?

Answer 10

DOPAMINE (even though MOA is E/NE)

Question 11

Why is naloxone useful?

Answer 11

Not orally bioavailable, therefore lower abuse potential

Question 12

Digoxin overdose psych manifestation?

Answer 12

Yellow-blue visual hallucinations (Gogh vision)

Question 13

Schizophrenic well controlled on clozapine but then experiences seizures. What do you do?

Answer 13

Stop clozapine temporarily, start PHENOBARBITAL, then restart clozapine at 50% original dose and titrate up

Question 14

In someone with suicidal ideation, what is probably diminished in the CSF?

Answer 14

5-HIAA (serotonin metabolite)

Question 15

Neuroimaging seen in depression? What sleep changes would you see?

Answer 15

decreased frontal lobe perfusion and metabolism on PET scan.

Depressed patients show DECREASED REM latency (time it takes between falling asleep and entering REM)

Question 16

Temporal Lobe Epilepsy

Answer 16

Doesn’t need jerky movements; characterized by hypOsexuality, perseverative approach to interactions (viscosity), emotional intensity

Question 17

a) Planning, monitoring, flexibility, motivation.
b) Schizophrenia
c) Tourrette’s
d) OCD***
e) PTSD
f) Panic Attack
g) depersonalization
h) shadow following behind
i) “docile, dirty, and dim” (apathy, poor grooming, decreased attention)
j) “explode into orbit” (withdrawl, fear, explosive mood)
k) language, motion, memory
l) recall of proper names
m) “happy psychotic” (euphoria + primary psychosis, hallucinations, etc. )
n) dysphoria, loss of artistic sense, irritability
o) verbal processing
P) visuospatial processing (lesion: anosognosia)

Which region of the brain?

[postcardiotomy delirium]
[specific learning disorder]

Answer 17

a) Dorsolateral frontal lobe
b) enlarged ventricles
c) caudate nucleus atrophy; decreased frontal lobe mass
d) caudate nucleus hypertrophy; increased? frontal lobe metabolism
e) decreased hippocampal volume
f) decreased amygdala volume, dysfunction of the locus ceruleus (NE)
g) right angular gyrus stimulation
h) left angular gyrus stimulation
i) dorsal prefrontal cortex
j) orbitomedial frontal cortex
k) temporal lobe
l) rostral (left) temporal lobe
m) DOMINANT temporal lobe
n) NON-dominant temporal lobe
o) DOMINANT parietal
p) NON-dominant parietal

Question 18

Classic Picture of Meperidine Toxicity (pupils)

Answer 18

Meperidine usually doesn’t constrict pupils, but eventually they will constrict if toxic levels are reached:

1) respiratory suppression leads to

Question 19

Most common ADR of ECT?

Answer 19

headache

Question 20

What is the most effective HDL-raising drug? What is a common side effect of this drug and the MoA behind the reaction? How would you combat this?

Answer 20

Niacin, flushing, prostacyclin, take aspirin before

Question 21

Methadone length of duration. Single dose? Multiple dose?

Answer 21

4-6 hours, 22-48 hours

Question 22

Which ATYPICAL antipsychotic is most likely to give EPS

Answer 22

risperidone

Question 23

tx MDD w/ psychotic features

Answer 23

BOTH SSRI+antipsychotic

Question 24

Which cerebrovascular disease causes symptoms of depression? Mania?

Answer 24

Left-MCA stroke

Right-MCA stroke