Conditions

Question 1

ADHD

Answer 1

Inattention: Exhibits a poor/short attention span in schoolwork/play; displays poor attention to detail or careless mistakes; has difficulty following instructions or finishing tasks; is forgetful and easily distracted.

Hyperactivity/impulsivity: Fidgets; leaves seat in classroom; runs around inappropriately; cannot play quietly; talks excessively; does not wait for his or her turn; interrupts others.

Question 2

Autism spectrum disorder

Answer 2

• Deficits in social interaction and communication: Reduced interest in socialization, reduced empathy, inability to form relationships, impaired language development, inability to understand social cues, poor eye contact.
  - Prognosis is best determined by language development.
• Restricted/repetitive patterns of behavior, interests, or activities: Highly fixated or restricted interests, inflexibility to change, hand flapping, increased/decreased response to sensory input

Question 3

Oppositional defiant Disorder

Answer 3

negative, defiant, disobedient, and hostile behavior toward authority figures

Question 4

Conduct disorder

Answer 4

violating the basic rights of others or age-appropriate societal norms/rules

Question 5

Disruptive mode disregulation disorder

Answer 5

outbursts that are out of proportion to the situation and a persistently irritable or angry mood between outbursts;

Question 6

Cause for intellectual developmental disorders

Answer 6

Down syndrome (Trisomy 21)

Fetal alcohol syndrome (FAS)

Fragile X syndrome

Question 7

Tourette syndrome

Answer 7

Multiple motor tics (eg, blinking, grimacing).

■ One or more vocal tics (eg, grunting, coprolalia, echolalia, throat clearing, coughing).

Question 8

Schizophrenia

Answer 8

positive symptoms (hallucinations, delusions, disorganized thought/behavior) and negative symptoms (flat affect, social withdrawal, apathy).

Hallucinations (most often auditory).
■ Delusions.
■ Disorganized speech.
■ Disorganized or catatonic behavior.
■ Negative symptoms: Flattened affect, social withdrawal, anhedonia, apathy, ↓ emotion. May mimic depression.
■ 5A’s: Affect (flat), avolition, asociality, anhedonia, apathy. See Table 2.14-1 for the differential diagnosis of psychosis.

Catatonia is a neurobehavioral syndrome marked by the inability to move or speak (stuporous subtype) or the inability to stop moving or speaking repetitively (excited subtype) that typically arises from an exacerbation of a psychiatric disorder such as bipolar disorder or schizophrenia. Patients with the stuporous subtype of catatonia typically present with immobility, mutism, muscle rigidity, waxy flexibility (maintaining limb position after the limb is moved by the examiner), negativism (resistance to instruction), staring, and/or posturing. Patients with the excited subtype typically demonstrate hyperactivity, purposeless movements, verbigeration (repetition of words/phrases), and echolalia (repetition of other people’s words).

Question 9

Schizophreniform disorder

Answer 9

Schizophreniform disorder: 1–6 months

Question 10

Schizoaffective disorder

Answer 10

Schizoaffective disorder: Psychosis + mood disorder (mania or depression)

Question 11

Dissociative identity disorder (multiple personality disorder)

Answer 11

≥ 2 distinct personalities

Associated with history of trauma and child abuse

Question 12

Depersonalization/ derealization disorder (DDD)

Answer 12

Feeling of detachment from one’s self; may feel like an outside observer

Derealization: Experiencing one’s surroundings as unreal

Question 13

Dissociative amnesia

Answer 13

Inability to recall memories or important personal information, usually after a traumatic or stressful event

Characterized by sudden, unexpected travel in a dissociated state and subsequent amnesia of the travel

Question 14

GAD

Answer 14

Excessive anxiety or worry about multiple activities, occurring on most days for ≥ 6 months.

Symptoms cause a clinically significant impairment (eg, social, occupational).

Question 15

Panic disorder

Answer 15

recurrent, unexpected periods of intense fear that last for several minutes and causes excessive worry about having another panic attack.

History/PE ■ Recurrent episodes of intense fear and discomfort; symptoms usually last ≤ 30 minutes. ■ May lead to agoraphobia in 30–50% of cases (fear/anxiety of developing paniclike symptoms in situations where it may be difficult to escape or get help, resulting in avoidance of those situations).

Panic attacks feature acute fear or anxiety that peaks within minutes and is associated with four additional physical symptoms or associated mental states. These additional symptoms may include heart palpitations or tachycardia, shortness of breath, chest pain, dizziness, the sensation of choking, gastrointestinal distress, paresthesias, sweating, chills, trembling, derealization, the fear of dying, or the fear of losing control. These episodes may occur during calm or anxious states, in the daytime or nighttime. The pathogenesis involves genetic factors, an anxious temperament, and stressful life events. In patients with an initial episode of panic symptoms, a thorough history and physical examination along with a basic laboratory workup and a potential ECG should be performed. Panic disorder is a relatively common psychiatric disorder characterized by recurrent panic attacks that are unexpected and associated with worry about future panic attacks or avoidance of panic attack triggers. Treatment of panic disorder typically includes antidepressant medication and/or cognitive behavioral therapy (CBT) with a focus on graded exposure to the feared situation.

Question 16

Social phobia

Answer 16

Social phobia (social anxiety disorder): Presents with excessive fear of criticism, humiliation, and embarrassment in multiple situations requiring social interaction.

Question 17

Specific phobia

Question 18

OCD

Answer 18

Obsessions: Persistent, unwanted, and intrusive ideas, thoughts, impulses, or images that lead to marked anxiety or distress (eg, fear of contamination, fear of harming oneself or loved ones). ■

Compulsions (or rituals): Repeated mental acts or behaviors that neutralize anxiety from obsessions (eg, handwashing, elaborate rituals for ordinary tasks, counting, excessive checking).

Obsessive-compulsive disorder (OCD) is an anxiety disorder typically characterized by obsessions that the patient attempts to neutralize with compulsions. Obsessions are unwanted, intrusive thoughts (eg, thoughts related to violence, sex, or contamination) or urges (eg, to commit violence) that increase anxiety. Compulsions are rigidly applied repetitive behaviors (eg, checking, washing) or mental activities (eg, counting, repeating words) that relieve anxiety related to obsessions. By definition, the compulsions are excessive or do not realistically address the obsessive fears, and patients commonly recognize the irrationality of their compulsions

Question 19

OCPD

Answer 19

Patients do not recognize their behavior as problematic (ego syntonic)

Question 20

PTSD

Answer 20

Patients experience severe psychological distress when exposed to stimuli that remind them of the event, resulting in avoidance of situations where exposure to triggers is possible.

Intrusive symptoms: Re-experiencing the event through nightmares, flashbacks, intrusive memories.

■ Avoidance of stimuli associated with the trauma.

■ Negative alterations in mood and cognition: Numbed responsiveness (eg, detachment, anhedonia), guilt, self-blame.

■ Changes in arousal and reactivity: ↑ Arousal (eg, hypervigilance, exaggerated startle response), sleep disturbances, aggression/irritability, and poor concentration.
■ Symptoms lead to significant distress or impairment in functioning. ■ Symptoms must persist for > 1 month. ■ Acute stress disorder

Question 21

Body dysmorphic disorder

Question 22

Hoarding disorder

Answer 22

Difficulty discarding possessions,

Question 23

Excoriation disorder

Answer 23

Skin picking

Question 24

Trichotillomania

Answer 24

Trichotillomania (hair pulling disorder)

Question 25

Common cause for dementia

Answer 25

Alzheimer’s
Vascular dementia
DEMENTIASS

Degenerative diseases (Parkinson, Huntington, dementia with Lewy bodies [DLB]) Endocrine (thyroid, parathyroid, pituitary, adrenal) Metabolic (alcohol, electrolytes, vitamin B12 deficiency, glucose, hepatic, renal, Wilson disease) Exogenous (heavy metals, carbon monoxide, drugs) Neoplasia Trauma (subdural hematoma) Infection (meningitis, encephalitis, endocarditis, syphilis, HIV, prion diseases, Lyme disease) Affective disorders (pseudodementia) Stroke/Structure (vascular dementia, ischemia, vasculitis, normal-pressure hydrocephalus)

Question 26

Dementia

Answer 26

memory loss, impaired executive function, impaired function at home, but can maintain most chores. Personal hygiene may need prompting. ■ Moderate: Severe memory loss, inability to recognize friends (agnosia), impaired social judgement, requires assistance with dressing and personal hygiene.

Personality, mood, and behavior changes are common (eg, wandering and aggression).

Question 27

Delirium

Answer 27

waxing and waning consciousness with lucid intervals and perceptual disturbances (hallucinations, illusions, delusions). ■ Patients may be combative, anxious, paranoid, or stuporous. ■ Patients have ↓ attention span and short-term memory, a reversed sleepwake

Question 28

Definition and Cause for delirium

Answer 28

acute disturbance of consciousness with altered cognition that develops over a short period (usually hours to days). Children, the elderly, and hospitalized patients (eg, ICU psychosis) are particularly susceptible. Major causes are outlined in the mnemonic I WATCH DEATH.

Infection Withdrawal Acute metabolic/substance Abuse Trauma CNS pathology Hypoxia Deficiencies Endocrine Acute vascular/MI Toxins/drugs Heavy metals

Question 29

Alcohol withdrawal

Answer 29

Tremor, tachycardia, hypertension, malaise, nausea, seizures, delirium tremens (DTs), agitation

Question 30

Opioid withdrawal

Answer 30

lacrimation, diaphoresis, dilated pupils, rhinorrhea, piloerection, nausea, vomiting, stomach cramps, diarrhea, yawning Opioid withdrawal is not life-threatening, “hurts all over,”

Question 31

Amphetamine intoxication

Answer 31

Psychomotor agitation, impaired judgment, hypertension, pupillary dilation, tachycardia, fever, diaphoresis, anxiety, angina, euphoria, prolonged wakefulness/attention, arrhythmias, delusions, seizures, hallucinations MDMA (“ecstasy”) is an amphetamine with hallucinogenic properties; popular at dance parties or “raves.” Intoxication: As above, plus hyperthermia, heat exhaustion,

Question 32

Cocaine intoxication

Answer 32

Psychomotor agitation, euphoria, impaired judgment, tachycardia, pupillary dilation, hypertension, paranoia, hallucinations, “cocaine bugs” (the feeling of bugs crawling under one’s skin), sudden death Chronic use causes weight loss, erythema of the nasal turbinates and septum, and behavioral changes ECG changes from ischemia

Question 33

PCP intoxication

Answer 33

Assaultive/combative, belligerence, psychosis, violence, impulsiveness, psychomotor agitation, fever, tachycardia, vertical/horizontal nystagmus, hypertension, impaired judgment, ataxia, seizures, delirium

Question 34

LSD intoxication

Answer 34

Marked anxiety or depression, delusions, visual hallucinations, flashbacks, pupillary dilation, impaired judgment, diaphoresis, tachycardia, hypertension, heightened senses (eg, colors become more intense)

Question 35

Marijuana intoxication

Answer 35

Euphoria, laughter, slowed sense of time, impaired judgment, social withdrawal, ↑ appetite, dry mouth, conjunctival injection, hallucinations, anxiety, paranoia, ↓ motivation

Question 36

Barbiturates intoxication

Answer 36

respiratory depression

Question 37

Benzodiazepines intoxication

Answer 37

Interactions with alcohol, amnesia, ataxia, somnolence, mild respiratory depression

Question 38

Caffeine intoxication

Answer 38

Restlessness, insomnia, diuresis, muscle twitching, arrhythmias, tachycardia, flushed face, psychomotor agitation

Question 39

Nicotine withdrawal

Answer 39

Irritability, headache, anxiety, weight gain, craving, bradycardia, difficulty concentrating, insomnia

Question 40

Synthetic opioid intoxication

Answer 40

Parkinson-like disorder and loss of pigmented neurons in the substantia nigra

Question 41

Bath salt intoxication

Answer 41

Stimulant drug that causes agitation, combativeness, delirium, and psychosis that may last for weeks

Question 42

MDD criteria

Answer 42

Diagnosis requires depressed mood or anhedonia (loss of interest/pleasure) and ≥ 5 signs/symptoms from the SIG E CAPS mnemonic for ≥ 2 weeks.

Sleep (hypersomnia or insomnia) Interest (loss of interest or pleasure in activities) Guilt (feelings of worthlessness or inappropriate guilt) Energy (↓) or fatigue Concentration (↓) Appetite (↑ or ↓) or weight (↑ or ↓) Psychomotor agitation or retardation Suicidal ideation

Question 43

Mood disorder caused by a medical condition

Answer 43

Hypothyroidism, Parkinson disease, CNS neoplasm, other neoplasms (eg, pancreatic cancer), stroke (especially anterior cerebral artery stroke), dementias, parathyroid disorders

Question 44

Substance-induced mood disorder

Answer 44

Illicit drugs, alcohol, antihypertensives, corticosteroids, OCPs

Question 45

Adjustment disorder with depressed mood

Answer 45

resemble an MDE but does not meet the criteria for MDE Occurs within 3 months of an identifiable stressor

Question 46

Dysthymia (persistent depressive disorder)

Answer 46

Milder, chronic depression with depressed mood (≥ 2 depressive symptoms) present most of the time for ≥ 2 years; often resistant to treatment

Question 47

Postpartum subtype of depression

Answer 47

Postpartum: Occurs within 1 month postpartum;

Question 48

Psychotic subtype of depression

Answer 48

Psychotic features: Generally mood-congruent delusions/hallucinations. Psychosis

Question 49

Presentation of mania

Answer 49

DIG FAST outlines the clinical presentation of mania. ■ May report excessive engagement in pleasurable activities (eg, excessive spending or sexual activity), reckless behaviors,

DIG FAST Distractibility Insomnia (↓ need for sleep) Grandiosity (↑ self-esteem)/more Goal directed Flight of ideas (or racing thoughts) Activities/psychomotor Agitation Sexual indiscretions/other pleasurable activities Talkativeness/pressured speech

Question 50

Hypomanic

Answer 50

Less severe symptoms Symptoms present for ≥ 4 days. No hospitalization is required No significant impairment in social/occupational functioning No psychotic features

Question 51

Cyclothymia disorder

Answer 51

Alternating periods of the following symptoms for at least 2 years: ■ Hypomanic symptoms that do not meet criteria for hypomania. ■ Depressive symptoms that do not meet criteria for major depressive episode.

Question 52

Paranoid personality disorder

Answer 52

Distrustful, suspicious; interpret others’ motives as malevolent Note: These patients will use projection as a defense mechanism

Question 53

Schizoid personality disorder

Answer 53

Isolated, detached “loners” who prefer to be alone Restricted emotional expression

Question 54

Schizotypal personality disorder

Answer 54

Odd behavior, perceptions, and appearance Magical thinking; ideas of reference Note: Remember, in contrast to OCD, these patients do not feel their behavior is problematic (ego syntonic). They also do not have true obsessions and compulsions.

Schizotypal personality disorder is a cluster A personality disorder, the odd or eccentric cluster. The disorder is characterized by odd behavior and thinking and a constricted affect. Patients with schizotypal personality disorder may have strange, overly metaphorical or magical thinking, though they fluctuate in the degree of their conviction about these beliefs (which differentiates these beliefs from the fixed delusions of schizophrenia). The strange beliefs may also manifest as eccentric appearance as in this patient. Patients may experience somatosensory illusions or other abnormal perceptions. Patients with schizotypal personality disorder may appear to lack interest in cultivating relationships (eg, work graveyard shifts) and, because of an inability to interpret others’ motivations, may be deeply distrustful and anxious around others. Personality disorders are persistently maladaptive ways of relating to the self and to society that typically appear by early adulthood

Question 55

Borderline personality disorder

Answer 55

Unstable mood, relationships, and selfimage; feelings of emptiness Impulsive History of suicidal ideation or self-harm Note: These patients often employ splitting as a defense mechanism

Question 56

Histrionic personality disorders

Answer 56

Excessively emotional and attention seeking Sexually provocative; theatrical

Question 57

Narcissistic personality disorders

Answer 57

Grandiose; need admiration; have sense of entitlement Lack empathy

Question 58

Antisocial personality disorder

Answer 58

Violate rights of others, social norms, and laws; impulsive; lack remorse Must be > 18 years of age Evidence of conduct disorder before 15 years of age

Question 59

OCPD

Answer 59

Preoccupied with perfectionism, order, and control at the expense of efficiency Inflexible morals and values Note: Remember, in contrast to OCD, these patients do not feel their behavior is problematic (ego-syntonic). They also do not have true obsessions and compulsions

Question 60

Avoidant personality disorders

Answer 60

Socially inhibited; rejection sensitive Fear of being disliked or ridiculed, yet desires to have friends and social interactions

Question 61

Dependent personality disorder

Answer 61

Submissive, clingy; feel a need to be taken care of Have difficulty making decisions Feel helpless

Question 62

Substance use disorder criteria

Answer 62

Impaired control: ■ Consumption of greater amounts of the substance than intended. ■ Failed attempts to cut down use or abstain from the substance. Increased amount of time spent acquiring, using, or recovering from effects. ■ Craving. ■

Social impairment: ■ Failure to fulfill responsibilities at work, school, or home. ■ Continued substance use despite recurrent social or interpersonal problems 2° to the effects of such use (eg, frequent arguments with spouse over the substance use). ■ Isolation from life activities.

■ Risky use: ■ Use of substances in physically hazardous situations (eg, driving while intoxicated). ■ Continued substance abuse despite recurrent physical or psychological problems 2° to the effect of the substance use. ■

Pharmacologic: ■ Tolerance and use of progressively larger amounts to obtain the same desired effect. ■ Withdrawal symptoms when not taking the substance.

Question 63

AUD

Answer 63

CAGE questionnaire. Monitor vital signs for evidence of withdrawal. ■ Labs may reveal ↑ LFTs (classically AST:ALT ratio > 2∶1), ↑ LDH, ↑ carbohydrate-deficient transferrin, and ↑ mean corpuscular volume.

Look for palmar erythema or telangiectasias and for other signs and symptoms of endorgan complications.

1. Have you ever felt the need to Cut down on your drinking? 2. Have you ever felt Annoyed by criticism of your drinking? 3. Have you ever felt Guilty about drinking? 4. Have you ever had to take a morning Eye opener?

Question 64

Complications forAUD

Answer 64

Gastritis (GI bleeds, ulcers), varices, or Mallory-Weiss tears. ■ Pancreatitis, liver disease, DTs, alcoholic hallucinosis (see Table 2.14-17), peripheral neuropathy, Wernicke encephalopathy, Korsakoff psychosis, fetal alcohol syndrome, cardiomyopathy, anemia, aspiration pneumonia, ↑ risk for sustaining trauma (eg, subdural hematoma).

Question 65

Alcoholic hallucinosis vs. delirium tremen

Answer 65

12–24 hours since last drink Visual, auditory, and tactile hallucinations

48–96 hours since last drink Autonomic instability (hyperadrenergic state; ↑ BP, ↑ HR) Disorientation, agitation Hallucinations

Question 66

Anorexia nervosa

Answer 66

Persistent restriction of caloric intake resulting in low body weight, an intense fear of gaining weight, and a distorted body image (patients perceive themselves as fat)

BMI<18.5

Patients are typically not distressed by their illness and may thus be resistant to treatment

Anorexia nervosa is characterized by an intense fear of gaining weight, decreased self-worth related to body weight, and consequent restricting (eg, fasting, exercising) or binge eating/purging behavior (eg, vomiting, laxative or diuretic misuse) leading to insufficient nutrition. Patients with anorexia nervosa often have a BMI less than 17 kg/m2, though patients with mild anorexia may demonstrate a BMI greater than 17 kg/m2(normal BMI is 18.5 to 24.9 kg/m2). Amenorrhea is common and reflects insufficient nutrition. Alternatively, patients with bulimia nervosa do not typically demonstrate severe malnutrition that leads to amenorrhea or a low BMI. Physical examination of patients with anorexia nervosa can show dry, scaly skin and fine hair or hair loss caused by decreased protein stores. Patients who vomit to purge can demonstrate parotid gland enlargement from salivary gland overstimulation, dental caries from gastric hydrochloric acid erosion of enamel, and scars on the knuckles secondary to abrasions from the incisors when inducing vomiting. The loss of gastric hydrochloric acid leads to hypochloremia and metabolic alkalosis. In severe cases, signs of hypovolemia such as tachycardia and hypotension may be present.

Question 67

Bulimia nervosa

Answer 67

Episodes of binge eating followed by compensatory behaviors (eg, purging, fasting, excessive exercise)

Patients are of normal weight or are overweight (BMI > 18.5 kg/m2)

Patients are typically distressed about their symptoms and are thus easier to treat

Dental enamel erosion, enlarged parotid glands, scars on the dorsal hand surfaces (if there is a history of repeated induced vomiting), and BMI > 18.5 kg/m2.

Obsessive-compulsive disorder (OCD) is an anxiety disorder typically characterized by obsessions (unwanted, intrusive thoughts that produce anxiety) that the patient attempts to neutralize with compulsions (repetitive behaviors). By definition, the compulsions are excessive or do not realistically address the obsessive fears, and patients commonly recognize the irrationality of their compulsions. This patient’s worry about contamination represents an obsession, while her repeated hand washing represents a compulsion. Treatment includes high doses of selective serotonin reuptake inhibitors (SSRIs, eg, fluoxetine) or cognitive behavioral therapy (CBT) with a focus on exposure to the discomfort of suppressing the compulsion after experiencing the obsession. SSRIs have the lowest side effect burden of antidepressant medications. Clomipramine (a tricyclic antidepressant) and venlafaxine (a selective serotonin-norepinephrine reuptake inhibitor antidepressant) are effective second-line agents.

Question 68

Sexual Changes with Aging

Answer 68

Men usually require ↑ stimulation of the genitalia for longer periods of time to reach orgasm; intensity of orgasm ↓, and the length of the refractory period before the next orgasm ↑. ■ In women, estrogen levels ↓ after menopause, leading to vaginal dryness and thinning, which may result in discomfort during coitus.

Question 69

Paraphilic disorder

Answer 69

Preoccupation with or engagement in unusual sexual fantasies, urges, or behaviors for > 6 months with clinically significant impairment in one’s life. There are eight classified disorders, characterized by disordered courtship (voyeurism, exhibitionism, and frotteurism), disordered preferences (pedophilia, transvestic fetishism, fetishism), and pleasure in inflicting/ receiving pain (sadism, masochism).

Question 70

Gender dysphasia

Answer 70

dressing like the opposite sex, taking sex hormones, or pursuing surgeries to reassign their sex.

Question 71

Primary insomnia

Answer 71

nonrestorative sleep or difficulty initiating or maintaining sleep that is present at least three times per week for 1 month.

Question 72

Primary hypersomnia

Answer 72

of excessive daytime sleepiness or nighttime sleep that occurs for > 1 month.

Question 73

Narcolepsy

Answer 73

excessive daytime somnolence and ↓ REM sleep latency daily for at least 3 months. Sleep attacks are the classic symptom; patients cannot avoid falling asleep. ■ Characteristic excessive sleepiness may be associated with the following: ■ Cataplexy: Sudden loss of muscle tone that leads to collapse. ■ Hypnagogic hallucinations: Occur as the patient is falling asleep. ■ Hypnopompic hallucinations: Occur as the patient awakens. ■ Sleep paralysis: Brief paralysis upon awakening.

Question 74

Central sleep apnea

Answer 74

airflow and respiratory effort cease. CSA is linked to morning headaches, mood changes, and repeated awakenings during the night.

Question 75

OSA

Answer 75

obstruction along the respiratory passages. OSA is strongly associated with snoring. ■ Risk factors: Male gender, obesity,

Question 76

Complication of OSA

Answer 76

headaches, depression, ↑ systolic BP, and pulmonary hypertension.

Question 77

Circadian Rhythm Sleep Disorder

Question 78

Somatic symptom disorder

Answer 78

excessive thoughts, anxiety, and behaviors driven by the presence of somatic symptoms that is distressing and negatively affects daily life. This may occur with or without any medical illness present. High health care utilization is often present.

Question 79

Conversion disorder

Answer 79

deficits of voluntary motor or sensory function (eg, blindness, seizurelike movements, paralysis) incompatible with medical processes.

Symptoms unexplained by other medical or neurologic causes. ■ Physical exam signs suggesting nonorganic cause of symptoms: ■ Presence of Hoover sign (extension of affected leg when asked to raise the unaffected contralateral leg) when attempting to rule out leg paralysis.

Eyes closed and resistant to opening during seizure; negative simultaneous EEG. ■ Tremor disappears with distraction. ■ La belle indifference: Patients are strangely indifferent to their symptoms.

Question 80

Fictitious disorder

Answer 80

fabrication of symptoms or selfinjury to assume the sick role (primary gain). ■ Factitious disorder imposed on another (formerly Munchausen by proxy): Caregiver exaggerates or falsifies medical/psychiatric symptoms or intentionally induces illness in someone else to receive benefit by taking on the role of concerned caregiver.

Question 81

Malingering

Answer 81

Malingering: Patients intentionally cause or feign symptoms for secondary gain (eg, financial, housing, legal).

Question 82

Sexual and physical abuse

Answer 82

Patients typically have multiple somatic complaints, frequent emergency department visits, and unexplained injuries with delayed medical treatment. They may also avoid eye contact or act afraid or hostile. ■ Children may exhibit precocious sexual behavior, genital or anal trauma, STDs, UTIs, and psychiatric/behavioral problems. ■ Other clues include a partner who answers questions for the patient or refuses to leave the exam room.

Question 83

Risk factors for suicidality

Answer 83

SAD PERSONS). ■ Women are more likely to attempt suicide. Men use more lethal methods (eg, firearms) and are more likely to complete suicide.

Sex (male) Age (older) Depression Previous attempt Ethanol/substance abuse Rational thinking loss Sickness (chronic illness) Organized plan/access to weapons No spouse Social support lacking