Diagnoses - Part 3 of 4 Flashcards
What is part of routine workup of child with mental retardation but without dysmorphic features or neurological findings?
CHROMOSOMAL ANALYSIS
Pattern of inheritance in Wilson’s disease
AUTOSOMAL RECESSIVE
Pattern of inheritance in Huntington’s disease
AUTOSOMAL DOMINANT
Polymerase chain reaction (PCR) used in genetic linkage studies involves:
AMPLIFICATION OF MICROSATELLITE MARKERS
What conditions associated w MR have an autosomal recessive inheritance pattern?
ADRENOGENITAL SYNDROME, HURLER’S, TAY- SACHS, PHENYLKETONURIA
4 y/o does not run/climb, falls, has iliopsoas/quadriceps/gluteal weakness, enlargement of calves with firm, “rubbery” consistency, decreased DTRs and normal sensation. Wide based stance and walks waddling. When rising from the ground, uses a four-point position through full extension of all four extremities. Has family h/o similar sx in males. 1) EMG reveals? 2) Genetic mutation in what protein?
1) SMALL, SHORT-LASTING MOTOR UNIT POTENTIALS WITH INCREASED RECRUITMENT 2) DYSTROPHIN
14 y/o girl presents with delayed onset of puberty, short status, and a history of cardiac abnormalities and hypertension. She has poor social skills. Psychological assessment reveals a normal verbal IQ and a below-normal performance IQ. Which of the following is the most likely dx?
TURNER SYNDROME
The Sural nerve biopsy of a pt w charcot-marie-tooth type 1 is shown (image), exam shows diminished LE DTRs and deformities of feet BL. These deformities are typical of which molecular abnormality?
DUPLICATION OF THE PERIPHERAL MYELIN PROTEIN GENE
Increase risk for psychopathology in offspring?
HAVING BIO-RELATIVES WITH PSYCHIATRIC ILLNESS
15 y/o pt w/ hx of atypical seizures that include psychomotor attacks and generalized motor episodes. Pt does poorly in school. Exam reveals skin lesion, no other abnormalities. A mutation of which gene?
TSC-1 (TUBEROUS SCLEROSIS GENE 1)
Epigenetic change with fragile X mental retardation 1 gene in fragile x syndrome?
METHYLATION OF THE CPG SITES OF THE PROMOTER REGION
What are splice variants?
DIFFERENT PROTEINS ENCODED BY THE SAME GENE
Which of the following occurs in epigenetic histone protein amino acid residue modification: There is little or no effect on chromatin remodeling, Acetylation is generally rapid and reversible, there is an increase in the positive charge on histones, there is an increase in the interaction with phosphates of the DNA, DNA methylation predominantly activated gene transcription
Acetylation is generally rapid and reversible
Genetic method for analysis of rare variations?
NEXT GENERATION SEQUENCING
Where are DNA methylation regulatory enzymes and proteins found?
MITOCHONDRIA
Small insertions and deletions in DNA sequence referred to as
INDELS
The most serious limitation of the candidate gene approach in identifying genetic disorder
HIGH PROBABILITY OF FALSE POSITIVE FINDINGS
Genetic mechanism in velocardiofacial syndrome
GENETIC DELETION
A young girl has developmental regression, loss of motor and language, stereotyped hand movements, muscle hypotonia, autonomic dysfunctions, and severe cognitive impairment. What genes are involved?
MECP2 CODING FOR METHYL CPG-BINDING PROTEIN 2
what genetic mechanism accounts for schizophrenia, autism, intellectual disability despite association with decreased facility?
DE NOVO MUTATIONS
This involves genetic control by factors other than DNA sequence
EPIGENETICS
Proportion of the genome composed of the “exome”
2%
What CYP450 polymorphism can lead to lower than expected lower than normal risperidone blood levels?
MULTIPLE COPIES OF WILD-TYPE ALLELES
Genetic copy number variations in individuals with severe neurodevelopmental disorders display what difference when compared to controls?
INCREASE IN BURDEN OF CNVS
Disorder caused by autosomal microdeletion
WILLIAM’S SYNDROME
Detection of single nucleotide variants in rare genetic diseases is most likely to occur with which genetic study
EXOME SEQUENCING
You suspect that a pt is a poor metabolizer due to excess side effects on low doses antidepressants, which method identifies CYP enzyme DNA sequence variants to explain intolerance
MICRO ARRAY ASSAYS
End stage AIDS with worsening fine motor movement, fluency, and visual spatial coordination, Dx? (2x)
AIDS DEMENTIA COMPLEX
HIV seropositive pt w/ psychotic symptoms has an absolute neutrophil count of 950 cells/mm3. Pt is on zidovudine, lamivudine, and ritonavir. What antipsychotic would be contraindicated? (2x)
CLOZAPINE
A 43 y/o patient with newly diagnosed AIDS has increased irritability, can’t remember phone numbers. Mild right hemiparesis, left ataxia and visual field defects apparent. LP is normal. MRI above. What is diagnosis?
PROGRESSIVE MULTIFOCAL LEUKOENCEPHALITIS
70 y/o +HIV heroin abuser is treated with Lopinavir and Ritonavir and fluoxetine for MDD. Hep C was dx and treated 2 months ago. Since then pt is more irritable, insomnia, and diarrhea. Why?
DRUG-DRUG INTERACTION
When is a psychiatrist permitted to notify a 3rd party identified to be at risk for contracting HIV from a patient
WHEN PATIENT W AIDS UNWILLING/UNABLE TO TAKE AUTONOMY-PRESERVING PRECAUTIONS LIKE ABSTINENCE
AIDS patient with memory problems, R hemiparesis, L limb ataxia, BL visual field deficits, and normal CSF. MRI T2 scan showed.
PROGRESSIVE MULTIFOCAL LEUKOENCEPHALITIS
AIDS and progressive hemiparesis and R homonymous visual field deficit assoc w patchy white matter lesions on MRI with normal routine CSF.
PROGRESSIVE MULTIFOCAL LEUCOENCEPHALOPATHY
Gay couple seeks therapy. One has HIV, one is negative. HIV negative feels betrayed and believes HIV positive partner was unfaithful. What should therapist say?
MEDIAN DURATION OF ASYMPTOMATIC STAGES OF HIV INFECTION IN THE US IS 10 YEARS
Most frequent route for HIV transmission in teenage girls
HETEROSEXUAL CONTACT
What is a poor prognostic sign for HIV?
DEMENTIA
AIDS pt, progressive weakness of extremities over weeks. Distal sensory deficit for pinprick and vibration. Slow nerve conduction, but EMG shows no denervation
CHRONIC INFLAMMATORY DEMYELINATING POLYRADICULONEUROPATHY
In considering safe sex practices for avoiding HIV infection, oral sex is best characterized by:
CAN RARELY TRANSMIT VIRUS
Prevalence of AIDS increased after discovery of AZT, best explanation?
MORE PATIENTS WERE LIVING LONGER
What has demonstrated efficacy for Irritable bowel syndrome? (4x)
HYPNOSIS
Mild confusion, lethargy, thirst, polydipsia: (3x)
HYPONATREMIA
70 y/o with mild Alzheimer’s lives with family and prescribed SSRI for depression. Also has HTN, adult onset DM, and RA, which are stable. The pt develops acute confusion but no other med or psych symptoms which test should be ordered first? (2x)
ELECTROLYTES
In ER, which symptoms most strongly suggest a general medical condition? (2x)
CLOUDED SENSORIUM
Which of the following is the most accurate information on the use of biofeedback for hypertension?
IT IS EFFECTIVE FOR HYPERTENSION, HOWEVER, IT IS LESS EFFECTIVE THAN MEDICATION
75 YOM getting into several car accidents. Good physical health, no disease, no meds, most likely cause of accidents?
SLOWER VISUAL PROCESSING
Which metabolic changes is characteristic of normal aging?
CREATININE CLEARANCE DECLINES
Pt who was admitted to the ER after a MVA receives IV dextrose 5% to provide access for administration of parenteral meds. Later, pt experiences confusion, oculomotor paralysis, and dysarthria. Symptoms were likely caused by:
WERNICKE’S ENCEPHALOPATHY
A 34 yo patient is being treated for malaria after returning from a trip to Kenya. The patient has a history of schizoaffective disorder which has been well controlled for more than a decade with a combo of Risperdal and Lithium. The pt is given a single dose of mefloquine, however after 1 week the patient reports feeling anxious. This escalates over the next week to PMA and persecutory delusions. The most likely cause of the pt’s psychotic symptoms is:
UNCOMMON SE OF THE ANTIMALARIAL TREATMENT
A consult is requested for a patient on a medical ward who is agitated and hallucinating. Pt appears to be flushed and hot with dry skin, mydriasis, a rapid pulse and diminished bowel sounds. What is your first recommendation?
D/C ANTICHOLINERGIC DRUGS
Free RBCs protoporphyrin test in the screening for intoxication with:
LEAD
What is the most common biological cause of prenatal neurotoxicity linked to the development of intellectual disability (mental retardation)?
ALCOHOL EXPOSURE
What causes of decreased vision in older adults is characterized by an inability to focus on an object as a result of retinal damage
MACULAR DEGENERATION
Which of the following is the most powerful predictor of falling in older adults?
USE OF SEDATIVE MEDICATIONS
Pt has partial resection of bowel. Has not resumed ambulation despite encouragement. Pt has low mood, poor sleep, and anhedonia. Dx?
PSYCHOLOGICAL FACTORS AFFECTING GENERAL MEDICAL CONDITION
42 y/o pt has had chronic abdominal pain, constipation and nausea for the past 14 months. Extensive medical work-up has revealed no organic cause, but the pt insists that these are symptoms of a serious disease. Most likely diagnosis:
HYPOCHONDRIASIS WITH POOR INSIGHT
Terminally ill cancer patients who experience concerns about bad death are most typically worried about dying with what?
PAIN
A genetic susceptibility for OCD is suggested by evidence that there is a familial link with (4x)
TIC DISORDERS
Principal behavioral technique for OCD (4x)
EXPOSURE & RESPONSE PREVENTION
What is the most common pattern of obsessions in pts with OCD? (x2)
CONTAMINATION
25 y/o with OCD diagnosed 2 years ago is likely to benefit from what medicine (in addition to psychotherapy)? (2x)
CLOMIPRAMINE
A 20 year old male pt presents to his physician for a physical examination because he is worried that he may have contracted an infectious disease. He states that his worry is interfering with his ability to complete work assignments. He states that he counts to 100 repetitively in order to distract himself from this worry. He has no prior medical or psychiatric history. He does not abuse substances and is not involved in any relationships. Which of the following regions of the pt’s brain is most likely to show increased activity on PET scan? (2x)
CAUDATE
Name for tics comprised of obscene gestures (2x)
COPROPRAXIA
Neurosurgical approach that treats refractor OCD targets what structure?
CORTICO-STRIATAL-THALAMO-CORTICO- CIRCUITRY
Difference between childhood onset OCD differs and adult onset
PSYCHIATRIC COMORBIDITY BURDEN IS GREATER
Pt with OCD resistant to entering treatment is a candidate for:
MOTIVATIONAL INTERVIEWING
According to DSM-IV-TR, compulsive skin picking would be:
IMPULSE CONTROL D/O NOS
Episodic OCD with variable severity of Sxs, independent of Tx, is more common in:
BIPOLAR MOOD DISORDER
Which TCA has consistently been found to be useful in long term treatment and relapse prevention of OCD?
CLOMIPRAMINE
Repetitive behaviors that the pt feels compelled to perform ritualistically, while recognizing the irrationality and absurdity of the behaviors, describes:
COMPULSIONS
Persistently intrusive inappropriate idea, thought, impulse, or image that causes marked distress is
OBSESSION
Pt w OCD started on 100mg sertraline, at 4 week f/u increased to 150mg b/o no response. Week 10, pt reported no improvement. Next step?
INCREASE SERTRALINE TO 200MG
Hx of OCD, Zoloft only partially effective. Next:
TRY ANOTHER SSRI
What is an effective treatment for obsessive compulsive disorder?
ESCITALOPRAM
Anterior capsulotomy and/or cingulotomy are indicated and demonstrated effective for pts with what severe incapacitating disorder?
OCD
Pt is hoarding, home filled with filth, acknowledges is she is keep a lot of things (hoarding)
HOARDING DISORDER
Which condition is least likely to respond to hypnosis?
OCD
40 y/o pt complains of repetitive, continuous hand-washing throughout day to the point of chafing skin. Pt denies fear of germs or any obsessive thoughts, cannot explain continuous washing. Dx?
OCD
Psych MD asks a patient, “are there things you must do in a particular way or order?”which this question, psych MD is trying to elicit?
COMPULSIONS
Man obsesses about killing his g/f. Instead of killing, picks his face w/ a pin. Medication:
FLUVOXAMINE
Pt with contamination fears and hand washing rituals is treated with response prevention combined with:
EXPOSURE THERAPY
35 M w/ severe OCD, failed multiple meds, CBT and ECT, what next?
CINGULOTOMY
What condition is frequently associated with OCD?
TOURETTE SYNDROME
What statement reflects current thinking about neurological procedures for intractable OCD?
AT PRESENT, THERE IS LITTLE EVIDENCE TO SUGGEST THAT ANY ONE PROCEDURE IS SUPERIOR TO ANOTHER.
Group of disorders associated with disruption in cortico-striato-thalamo-cortical circuit function
OBSESSIVE-COMPULSIVE
OCD is commonly comorbid with
ANXIETY DISORDERS
Personality d/o w chronic feelings of emptiness, transient psychotic sx, mood swings, tumultuous relationships, self-mutilation, poor self-image, impulsivity? (7x)
BORDERLINE
Which disorder has greatest co-incidence of alcohol abuse and dependence? (3x)
ANTISOCIAL PERSONALITY DISORDER
What personality disorder results in displays of rapidly shifting and shallow expression of emotions in patients? (3x)
HISTRIONIC
What personality d/o is associated with transient psychotic symptoms (2x)
BORDERLINE
Personality d/o should be considered in ddx of cyclothymic d/o? (2x)
HISTRIONIC
Pts with which personality d/o sees themselves socially inept, personally unappealing, or inferior to others? (2x)
AVOIDANT
Pts with which personality d/o sees themselves socially inept, personally unappealing, or inferior to others? (2x)
OBSESSIVE-COMPULSIVE
Another psychiatrist refers to a pt by saying this pt is “special” and need really good treatment. You need to be careful with the pt to: (2x)
ANTICIPATE THE POTENTIAL FOR SPLITTING BETWEEN THE REFERRING MD AND YOURSELF.
Avoidant PD differs from Schizoid PD by: (2x)
DESIRE FOR SOCIAL RELATIONS
Interpersonal exploitativeness is a diagnostic feature of (2x):
NARCISSISTIC PERSONALITY DISORDER
40 y/o hand surgeon has come into conflict with the hospital admin. Though the hospital went out of its way to recruit this surgeon, he has felt consistently betrayed and has accused the administration of trying to exploit him by expecting that he should take more calls, though this has never been stated. The doctor-hospital relationship deteriorated further when peer review raised a question about one of the surgeon’s cases. The surgeon believes that none of his complaints have been satisfactorily resolved. He has become more unforgiving and isolated: (2x)
PARANOID PERSONALITY DISORDER
Borderline patient pulling away from a relationship due to growing up in abusive household is stuck in which stage
RAPPROCHEMENT
30 yo is pushed by family to get help for isolation she is uncomfortable around others and have problems making friends unless convinced they will accept her. She thinks others are highly critical of her and only has 2 close friends from childhood and has never dated. Fears of embarrassment interfere with job seeking as well. What is this dx?
AVOIDANT PERSONALITY DISORDER
29 y/o F w/ mood swings- mood changes very rapidly, sometimes without prompting, from elation to depression or intense anger. These moods last minutes to hours. Her history is significant for promiscuity, spending sprees, tumultuous relationships, unstable self-image, and occasional use of cocaine. Hx of a brief period of paranoia and AH? During and emotional break-up with her last boyfriend, which remitted after a 2-day admission to the psych unit. When asked about SI, she reports that it is always in her mind and that, whenever she is under stress, she cuts her arms with a sharp blade to relieve a strong feeling of emptiness. Most likely Dx?
BORDERLINE PERSONALITY D/O
Which personality d/o is most commonly found in pts w/ severe factitious d/o?
BORDERLINE PERSONALITY
Person with covert obstructionism, procrastination, stubbornness, and inefficiency may be classified as suffering from which personality d/o outside of current DSM classification?
PASSIVE-AGGRESSIVE
40 y/o M emotional detachment, little interest in sex, no close friends. Axis II Dx?
SCHIZOID PD
Common symptoms of paranoid personality disorder
PREOCCUPATION W/ UNJUSTIFIED DOUBTS OF LOYALTY/TRUSTWORTHINESS OF FRIENDS/ASSOCIATES
Underlying dynamic of much of the behavior of pts with paranoid personality d/o:
A DEVELOPMENTAL FAILURE TO ACHIEVE OBJECT CONSTANCY
20 y/o M with poor performance in college, before was very good student except for not being able to finish assigned projects at college. Classmates have described bizarre behavior, such as counting loudly or repeating words silently. He does not want to follow others rules but his owns, he believes nobody understands him and are against him.
OBSESSIVE COMPULSIVE PERSONALITY DISORDER
Pt with body dysmorphic d/o may have what personality d/o?
NARCISSISTIC
Which personality disorder is characterized by a style of speech that is excessively impressionistic and lacking in detail?
HISTRIONIC
Pt becomes panicky and distressed every time psychiatrist goes on vacation, this pattern is most likely a characteristic of:
DEPENDENT PERSONALITY
Pt with histrionic personality d/o storms in his psychodynamic session and a few minutes late, clearly in rage. He expresses hopelessness and declares vehemently that he must divorce his wife. Next best intervention:
ENCOURAGE THE PT TO REFLECT MORE ON WHAT HAS HAPPENED TO TRIGGER SUCH PAINFUL FEELINGS.
22 y/o borderline splitting inpatient staff. You should:
EDUCATE STAFF ABOUT SPLITTING
DDx of histrionic personality disorder includes what other personality d/o?
DEPENDENT PERSONALITY DISORDER
Which personality d/o should be in the dif dx of agoraphobia:
DEPENDENT PERSONALITY DISORDER
23 y/o M w/ Borderline. Had fight w/ g/f now psychotic, cutting, AH w/ command to harm self. What level of care:
BRIEF INPATIENT HOSPITALIZATION
Pts w/ this personality d/o most likely to have 1st degree relatives with depression
BORDERLINE
According to DSM-IV-TR, what personality disorder in adults requires evidence of another specific psychiatric diagnosis prior to age 15?
ANTISOCIAL
Pt repeatedly becomes distressed after what seems, even to the pt, to be minor disappointments. Pt also seems to suffer from extreme narcissistic vulnerability. A therapist utilizing self-psychology would be most likely to interpret this as due to?
A LACK OF DEVELOPMENTALLY APPROPRIATE EMPATHIC CAREGIVERS.
DBT has been shown to be effective in the treatment of what personality disorder?
BORDERLINE
What personality disorders should be the main consideration in differential dx of schizotypal personality disorder?
AVOIDANT
16-year-old adolescent is being evaluated for possible schizophrenia. A family history of which of the following personality d/o is most strongly associated with this dx?
SCHIZOTYPAL
25 y/o hospitalized for appy. Pt reports being “bothered by surgeon’s aura”. Lives alone, no close friends, gets on websites about auras and crystal work. Pt’s mother affirms he’s “always been this way.” Which personality disorder?
SCHIZOTYPAL
There is increased risk of schizophrenia with this personality disorder
SCHIZOTYPAL
Which intervention is helpful in dealing with a borderline pt on a medical ward?
SETTING LIMITS WITH THE PT ON THE STRUCTURE OF THE MEDICAL CARE
Extremely demanding patient repeatedly calls psychiatrist’s office and berates staff in offensive terms. Which step should the psychiatrist take first?
SET LIMITS WITH THE PATIENT
Useful info to confirm diagnosis of antisocial personality d/o (APD) in 20 y/o patient?
SCHOOL COUNSELING RECORDS
Pts that “cut” as a form of self-mutilation typically:
CLAIM TO FEEL NO PAIN
Which test to confirm personality disorder?
MILLON CLINICAL MULTIAXIAL INVENTORY (MCMI-III)
Med student is struggling with time management and peer to peer interactions on rotations. Has gotten feedback that she spends too much time organizing and highlighting her notes. She also violates duty hours due to inability to finish work during the day. If given a group assignment she completes it on her own saying it’s easier to do it myself. Which of the following personality disorders does she likely have?
Obsessive-compulsive Personality Disorder
Man convinced wife is cheating. Monitors emails, texts, phone calls. No changes in sleep, appetite, energy. Diagnosis?
PARANOID PERSONALITY DISORDER
Personality disorder with pervasive and excessive emotionality and attention seeking behaviour
HISTRIONIC
The key distinction in the differential diagnosis of social phobia versus agoraphobia is: (2x)
NATURE OF THE FEARED OBJECT
The parents of an 18 y/o adol who is overweight notice that their child is avoiding high caloric foods, such as meat and pasta. When the parents inquire about this, the teen says, “I am afraid of eating.” The evaluating psychiatrist asks when the eating behavior changed, and the teen reports having had an episode of panic which occurred while eating and was accompanied by choking feelings. A fear of choking while eating and a wish to avoid foods that might cause choking developed. The teen denies other episodes of panic. Dx? (2x)
SPECIFIC PHOBIA
Take agoraphobic to crowded place and stay there until anxiety dissipates
FLOODING
Which psychotherapeutic technique is most clearly indicated for treatment of simple phobia?
EXPOSURE THERAPY
Pt presents with chapped and reddened hands. Upon questioning, pt admits to washing the hands many times a day because “I work in a hospital cafeteria and am intensely afraid of contracting a flesh-eating bacterial infection.” The most likely Dx:
SPECIFIC PHOBIA
Pts with blood phobia have 2 stage response when exposed to stimulus. First is increased anxiety and elevated BP. 2nd response?
HYPOTENSION
Pt reports having a fear of driving and experiences feeling of panic, SOB, heart racing, sweating, and clamminess when anticipating a drive down street roads. Pt acknowledges going out of the way to avoid this situation. Pt denied similar Sx in other settings. Dx:
SPECIFIC PHOBIA
Avoids interpersonal situations due to anxiety and panic attacks
SOCIAL PHOBIA
28 y/o M episodic anxiety, palpitations, flushing, shaking, chest tightness. Mostly at work or w/ group of friends. Embarrassed, afraid to go to work, avoiding people:
SOCIAL PHOBIA
Most effective approach in behavioral treatment of phobias:
IN-VIVO EXPOSURE
This medication is commonly used in social phobia associated with performance situations, shortly before exposure to a phobic stimulus?
ATENOLOL
Pt is nonsensical but is rhyming. What is this called? (4x)
CLANG ASSOCIATION
A person’s inability or difficulty to describe or be aware of emotions or mood is called: (4x)
ALEXITHYMIA
Schneiderian first-rank symptom of schizophrenia: (3x)
HEARING VOICES AND ARGUING ABOUT ONESELF
What factor is a good prognostic indicator in schizophrenia? (2x)
FEMALE GENDER
Successful psychosocial interventions in schizophrenics: (2x)
ASSERTIVE COMMUNITY TREATMENT
Which term describes state of immobility that is constantly maintained? (Ability of a catatonic pt to hold the same position) (2x)
CATALEPSY
19 y/o pt reported hearing a voice that talked about what pt was thinking. The pt’s speech has a normal rate and rhythm, but says things such as, “It is white, very white. I know. Things are that way. They are. I am.” (Poverty of speech and content) This speech is an example of: (2x)
ALOGIA
Subtype of schizophrenia less severe and starts older: (2x)
PARANOID
Late-onset schizophrenia is more common in men or women? (2x)
WOMEN
Schizophrenic with poor response to 3 trials of antipsychotic meds, next step? (2x)
CROSSOVER TO CLOZAPINE
Dysprosody is an abnormality of (2x)
SPEECH
Pt with CPS hospitalized 6x in the past year, hx of non-adherence to treatment, difficulty maintaining housing, and multiple med probs – which treatment most appropriate for this patient? (3x)
ASSERTIVE COMMUNITY TREATMENT
The most important risk factor for developing postpartum psychosis: (x2)
PREVIOUS POSTPARTUM PSYCHOSIS
Which of the following antipsychotic meds is most likely to be effective in pts with refractory schizophrenia who have failed to improve with other antipsychotics? (2x)
CLOZAPINE
Postpartum psychosis is often associated with which of the following disorders? (2x)
BIPOLAR
Most commonly abused substance among patients with schizophrenia? (2x)
NICOTINE
No additional criterion A symptoms are required for the dx of schizophrenia if the pt has which of the following symptoms: (2x)
PRESENCE OF PSYCHOTIC SYMPTOMS FOR AT LEAST 2 WEEKS IN THE ABSENCE OF MOOD SYMPTOMS
Educate fam of schizophrenia pt to?
ENCOURAGE ADHERENCE TO MEDS
Neuronal cell density in schizophrenia characterized by
NO CHANGE
Longer duration of psychosis is associated w/
FIRST GENERATION IMMIGRANT
What is the risk of developing schizophrenia when sibling has it but parents don’t?
10%
Reduces the suicide rate in adults with schizophrenia:
CLOZAPINE
“When I hear the news, the newscaster is talking about me.” This represents?
IDEAS OF REFERENCE
75 y/o male brought in by family for psych eval, family reports no past psych history, has gotten suspicious, withdrawn, hostile. Talks to self, talks about being controlled by aliens, believes aliens are putting thoughts in his head. 28/30 on MOCA, MRI shows age-related changes. Diagnosis?
SCHIZOPHRENIA
Poverty of speech and poverty of content are aspects of which of the following conditions?
ALOGIA
Only one criterion is necessary for Dx of schizophrenia if the reported delusion is:
BIZARRE
23 y/o pt w/ no previous psych hx BIB family. Parents reports that pt has stopped seeing friends for the last 6 months, is afraid when cars pass by on the street, seems to be talking to self and television. Pt also has unusual movements of arms at times, flap and wave on their own accord. What is the diagnosis?
SCHIZOPHRENIA
Most common cause of organic paranoid symptom
STIMULANT ABUSE
Which of the following is a non-DSM term for the category of schizophrenia when the dx is based solely on deficit or negative symptoms?
SIMPLE SCHIZOPHRENIA
Which of the following statements characterizes late-onset schizophrenia?
OCCURS MORE FREQUENTLY IN WOMEN THAN MEN
Assessing whether a schizophrenic criminal defendant may meet standard for insanity defense, what do you ask?
“WHAT WERE THE VOICES SAYING TO YOU AT THE TIME OF THE CRIME?”
Which differentiates deteriorative d/o from schizophrenia?
ABSENCE OF PROMINENT POSITIVE SYMPTOMS
Though recent research has demonstrated that the blunted emotional expression in schizophrenia does not imply that a patient is anhedonic, individuals with schizophrenia do experience loss of interest or pleasure associated with?
SOCIAL INTERACTIONS
Focus for outpatient psychotherapeutic groups for schizophrenia?
SOCIAL SKILLS DEVELOPMENT
44 y/o pt with schizophrenia is admitted to an inpatient psychiatric unit. After several days pt has muscle tremor, ataxia, twitching, diarrhea, restlessness, vomiting, polyuria, and stupor. Dx?
WATER INTOXICATION
What is a negative sx of schizophrenia?
SOCIAL INATTENTIVENESS
20 y/o avoids everyone but parents. Stopped going to school. Feels everyone watching him. Always quiet, sits at home doing nothing, mumbles to self, some bizarre movements, flat affect. Denies depression or substance use.
SCHIZOPHRENIFORM
Characterizes schizophrenics that smoke
REQUIRE MORE NEUROLEPTIC MEDS
Most closely correlates w/ social fx in schizophrenics:
NEGATIVE SYMPTOMS
Healthy 37 y/o F business exec learns that her brother is killed in a MVA. 3 days after the funeral, she spots a man driving a car just like her brothers and is now convinced he is not dead. She believes she is the victim of a conspiracy in which others are manipulating her into losing her mind on order to take over her business. She hears a buzzing noise on her phone at work, believes her line is tapped. At home, light in her neighbor’s window is a sign that she is under surveillance. She calls the police. 1 month after treatment, her symptoms are gone and within 3 months she is nml. Dx?
BRIEF PSYCHOTIC DISORDER
45 y/o F pt with vague complaints of “not feeling good,” not sleeping well X 1 month. Pt discloses fear/anxiety over “weird things happening to me,” believes that some personal possessions are mysteriously missing or altered. Pt aware “this all sounds crazy,” frightened that “someone is messing with my mind, maybe my ex-husband.” Pt called police several times. Pt had been a successful insurance agent, and expresses worry that his distress is distracting and may negatively affect work performance, which could result in job loss. No past psychiatric hx, except for feeling depressed for several months after the divorce a few years ago = resolved without treatment. Which course of action would best clarify the diagnosis?
OBTAIN A GENERAL MEDICAL/ NEUROLOGICAL WORKUP
Which medical condition is likely to include psychosis in the symptom complex?
SYSTEMIC LUPUS ERYTHEMATOSUS
21 y/o recently diagnosed with schizophrenia becomes largely mute and occasionally repeats words in a parrot-like manner. This is a subtype of schizophrenia called:
CATATONIC
Positive Sxs of schizophrenia:
PARANOIA, AH, THOUGHT INSERTION, DELUSIONS
A negative Sx of schizophrenia:
BLUNTED AFFECT
28 F pt mute, rigid, catatonic. Not on meds. What Tx?
LORAZEPAM
What condition in patients with schizophrenic or schizophreniform psychosis is associated with poor prognosis?
INITIAL ONSET DURING ADOLESCENCE
Most common eye tracking movement abnormality in pts with schizophrenia?
INAPPROPRIATE SACCADES (SACCADIC INTRUSIONS)
What is the term for senseless repetition in schizophrenics?
ECHOLALIA
What is associated with poor prognosis in schizophrenics?
EARLY AGE OF ONSET, NEGATIVE SYMPTOMS, LACK OF PRECIPITATING FACTORS
Schizophreniform disorder differs from schizophrenia primarily in
DURATION
Schizophrenic on haldol 10 develops acute EPS. Cause?
CESSATION OF SMOKING
Schizophrenic stabilized on haldol 10. Return of psychotic Sx’s after starting med for another condition. Cause?
CARBAMAZEPINE
Schizophrenic with VH, restlessness, marked thirst, agitation, elevated temperature, dilated pupils, dry skin. Dx?
ANTICHOLINERGIC INTOXICATION
What factor is associated with a better long-term prognosis in pts w schizophrenia?
ONSET AFTER 35 YEARS OF AGE
Good prognostic feature in schizophrenia
ACUTE ONSET
Schizophrenic stops taking antipsychotic. States that nothing is wrong. What is this behavior?
POOR INSIGHT
A 22 y/o pt is brought to the ED by family members who report unusual behavior that has worsened over a few weeks. Disorganized and difficult to interview – stating “The world is ending! You must repent now!” Patient is actively responding to unseen others and accuses family of being “devils”. No family history and no prior psych history for pt. Behavior began two months ago follow grad from college. What is dx
SCHIZOPHRENIFORM DISORDER
Schizophrenic patient becoming catatonic with waxy flexibility. Which is the most appropriate medication?
LORAZEPAM
A profound breakdown in both the logical connection between ideas and the overall sense of goal-directedness of speech is called:
DERAILMENT
Which of the following is more common in patients experiencing a first episode psychotic depression at old age compared to younger age?
NIHILISTIC DELUSIONS
An 80 year old has depressed mood and cognitive decline. They respond with brief one word responses and rare spontaneous elaboration. This is an example of?
POVERTY OF SPEECH
Patient describes hearing his name when the wind rustles leaves outside in the morning. Phenomenon?
ILLUSION
16 yr old has degrading and masochistic fantasies, accompanied by excitement and anxiety. Represent what?
NORMAL SEXUAL BEHAVIOR DEVELOPMENT
Initial psychiatric intervention for 50-year-old married man with ED during sex but normal masturbatory ability, otherwise good marriage, and normal evaluation by PCP?
ASK PT TO BRING WIFE TO DISCUSS BEHAVIORAL EXERCISES
Best treatment for genito-pelvic pain/penetration disorder
DILATION WITH GRADUATED SIZED VAGINAL DILATORS
Male sexuality in the seventh decade is characterized by which of the following?
NO CHANGE IN SEX DRIVE
29 y/o recent immigrant from China believes his penis is shrinking; concerned he might die once his penis retracts into his abdomen. 1) What type of d/o is this? 2) What is best treatment?
1) CULTURE-BOUND SYNDROME 2) SUPPORTIVE THERAPY
Psych MD is asked to evaluate a 37 y/o F who complains of chronic vulvar pain. This pain is accompanied by a burning sensation which is localized to the vestibular region. Pt’s husband reports a 12-month lack of any sexual intercourse with pt. on psychiatric eval, the pt expresses ambivalence about the lack of intimacy with her husband, and appears somewhat annoyed at him for not understanding how painful sex has become. Pt denies depression or anxiety, but admits to frustration about the pain. The gynecologist reports that a full physical and laboratory workup is remarkable except for pain in the vestibule which can be elicited with touch. Which would be the most reasonable intervention?
INITIATE NORTRIPTYLINE AND SLOWLY TITRATE.
35 y/o F pt presents to the physician complaining of decreased interest in sexual activity and difficulty becoming aroused by her spouse over the last 3 months. Upon further questioning, the patient also reports anhedonia, difficulty sleeping, fatigue, and decreased appetite over the same time period. Medical history and workup are otherwise unremarkable, and pt is not currently taking any medications. According to the DSM-IV-TR, pt’s decreased interest in sex is most likely assoc w which?
SYMPTOM OF A MAJOR DEPRESSIVE EPISODE
Disorder associated with decreased sex steroid secretion and loss of fast-conducting peripheral sensory nerves with aging?
DELAYED EJACULATION
Man sexually aroused by crossdressing. Diagnosis?
TRANSVESTIC DISORDER
A young adult woman has difficulty with sexual intercourse. She is very embarrassed about giving information about it. She experiences “vaginal spasms” at her last encounter and thus she feels anxious thinking about having sex. She has a normal gynecological exam without discomfort. What is the most likely diagnosis?
GENITO-PELVIC PAIN/PENETRATION DISORDER
32y/o cannot move the right leg. Exam does not find a cause. Dx is likely to be conversion d/o if which of the following is found? (6x)
SYMPTOMS NOT INTENTIONALLY PRODUCED
Preoccupation and fear of having contracted serious disease based on misinterpretation of bodily sxs despite medical eval and reassurance. (3x)
HYPOCHONDRIASIS
Psych consulted re: 43 y/o who c/o “lump in throat,” headaches, bloating, back pain, diarrhea, chest pain, painful urination, sexual indifference; complaints do NOT match objective findings from dx workup. What should be recommended to pt’s PCP? (2X)
SCHEDULE REGULAR VISITS WITH A PHYSICAL EXAM
25 y/o referred by plastic surgeon, claims that part of her face is swollen. (2x)
BODY DYSMORPHIC DISORDER
When compared to patients with somatic sx disorder, patients with illness anxiety disorder are less likely to:
HAVE MULTIPLE PHYSICAL COMPLAINTS
psychogenic blindness
OCULAR JERK MOVEMENTS WITH OPTOKINETIC DRUM
Adolescent on neurology service for loss of vision with all negative testing. Walks around garbage can. Dx?
CONVERSION DISORDER
Personality trait that is independent risk factor for somatic symptoms?
NEUROTICISM
18 y.o. With skin picking, one hour washing face every day
BODY DYSMORPHIC DISORDER
Risk factors for somatic symptoms disorder
CHRONIC PHYSICAL ILLNESS
In a patient with right hemiparesis, lifting the patient’s right hand above the face and letting it drop “face-hand test” assesses for what?
PSYCHOGENIC PATHOLOGY
What is commonly associated with conversion d/o?
LOW INTELLIGENCE
40-year-old cannot speak after a screaming argument with spouse. Patient writes, “I have been trying to speak, but cannot make a single sound.” Throat exam is normal. There is an occasional loud cough. Diagnosis?
CONVERSION DISORDER
Somatic sx/complaint, negative medical workup, negative psych eval
LOOK AGAIN FOR ORGANIC ETIOLOGY
Main clinical factor of hypochondriasis vs. somatization d/o?
FEAR OF HAVING A DISEASE
Hallucinations in pt with conversion d/o are characterized as:
HAVING CHILDISH, FANTASTIC QUALITY
Primary focus of pt with hypochondriasis:
DISEASE
The presence of which of the following would suggest that a patient has somatization disorder rather than a general medical condition?
COMPLAINTS INVOLVING MULTIPLE ORGAN SYSTEMS
Characterized mainly by cognitive rather than perceptual preoccupation
HYPOCHONDRIASIS
A patient has periodic pelvic pain for past two years. Had laparoscopy, diagnosed with endometriosis, started oral contraceptives and analgesics with some relief, still has symptoms. The patient reports worry that she will quit job due to pain. Calls doctor every few days to ask whether new tx should be considered or she may have cancer?. What is diagnosis:
SOMATIC SYMPTOMS DISORDER
50yo referred to psych following negative medical workup of abd pain. Pt appears depressed and in constant pain. What is the preferred psych intervention?
START LOW DOSE IMIPRAMINE
Biological consequences of psychological stress affect which mechanism?
NEURO-IMMUNO-ENDOCRINE FUNCTION
The first-line treatment for retentive encopresis:
BIOFEEDBACK
Which of the following is an effective treatment for mild-to-moderately severe idiopathic Raynaud’s disease?
THERMAL BIOFEEDBACK
Pt recurrently goes to ED because of severe chest pain. Has been w/u for everything and all test are normal. He states that something needs to be done to “fix” his pain. Psych consult is placed. MSE and neuro is normal. Past hx reveals his father died of lung CA. Next intervention as psychiatrist is:
EXPLORE PT’S FEELINGS ABOUT FATHER’S DEATH
Which disease is most likely to present as pain disorder?
DEPRESSION
18 y/o pt presents with an acute onset of blindness after witnessing the murder of a close friend. Neurological examination is inconsistent with loss of vision but otherwise unremarkable. What is most probable outcome for this pt?
SYMPTOMS WILL FULLY RESOLVE IN A MATTER OF DAYS OR WEEKS.
Neurasthenia, an accepted condition in Europe and Asia, corresponds to which of the following in DSM-IV-TR?
UNDIFFERENTIATED SOMATOFORM DISORDER
Pt presents with sudden right leg paralysis with normal reflexes, doctor feels increased pressure under affected leg when patient lifts unaffected leg. Diagnosis is:
CONVERSION DISORDER
Which d/o is the most common among pts who complete suicide: (4x)
MOOD
No harm contract between patients and clinicians are? (2x)
UNHELPFUL IN MAKING DECISIONS
Rate of completed suicide highest for adult males when? (2x)
OLDER THAN 65
Consistent predictor of future suicidal behavior (2x)
PRIOR ATTEMPTS
Most common method for completed suicides in adolescents (2x)
FIREARMS
Suicide risk for adopted child whose bio mother died by suicide
ELEVATED RELATIVE TO OTHER ADOPTEES
physician suicide is different than the rest of the pop
LESS LIKELY TO BE TAKING ANTIDEPRESSANT
Based upon longitudinal studies, which risk factors correlated w/ suicide more than one year after initial assessment?
HISTORY OF PRIOR ATTEMPTS AND HOPELESSNESS
In the cognitive therapy model, which of the following is most associated with suicide risk?
HOPELESSNESS
Which is a consistently identified risk factor for suicide that is unique to adults with schizophrenia compared to the general population?
AGE LESS THAN 35 YEARS
Which of the following factors carries the highest standardized mortality ration for suicide
HISTORY OF PRIOR SUICIDE ATTEMPTS
Highest rate of suicide associated with
HAVING READY ACCESS TO FIREARMS
Based on epidemiological studies from 1994-2004, which groups has highest suicide completion rate?
CAUCASIAN AMERICAN MEN IN THEIR 60S
In documenting suicide risk-assessment, key risk management strategy is to discuss what factors in the record?
WHY THE PSYCHIATRIST REJECTED ALTERNATIVE WAYS OF RESPONDING
Pt with which medical condition most likely to commit suicide?
SYMPTOMATIC HIV INFECTION
The leading cause of death among gun buyers in the first year after the weapon was purchased is:
SUICIDE
Along w/ depression most common comorbid disorder in physician suicide is
SUBSTANCE DEPENDENCE
Preventing adolescent suicide:
REMOVE FIREARMS
23 y/o pt presents to ED by ambulance for SI. Pt has alcohol odor and slurred speech. He endorses SI but his plan is incomprehensible. Next step:
OBSERVE AND EVALUATE WHEN HE IS SOBER.
Most common time for pt w/ schizophrenia to attempt suicide is during
RECOVERY PHASE OF THE ILLNESS
What factors is most highly correlated with completed suicide in adolescent males?
PREVIOUS SUICIDE ATTEMPT
Which commonly precipitates suicide in the elderly?
LOSS
Most powerful statistical risk factor for completed and attempted suicide
HAVING A PSYCH ILLNESS
Most common method of committing suicide for women in the US is:
FIREARMS
15 y/o pt depressed + suicidal has an alcoholic father. Prior d/c from hospital the next step should be:
ENSURE THAT ANY LETHAL MEANS ARE UNAVAILABLE AT HOME
1993 – highest rate of suicide in 75-84 y/o age group:
CAUCASIAN-AMERICAN MALES
Pt with which dx are most likely to engage in parasuicidal behaviors?
BORDERLINE D/O
When is there highest risk of suicide in MDD patients recently dc’d from hospital?
0-3 MONTHS AFTER DC
In terminal cancer patients who ultimately die by suicide, which one of the following complaints is most frequently reported?
SEVERE UNCONTROLLED PAIN
Psych MD in the ER evaluates a 27 y/o pt with no past psychiatric history who presents with SI following an altercation w/ her boyfriend. The psych MD makes a diagnosis of adjustment disorder with mixed emotional features. What is initially most appropriate for the psych MD to recommend for this pt?
CRISIS INTERVENTION
What condition has been shown to increase the risk of suicide to the greatest degree in persons with depression?
PAIN SYNDROMES
What factor may be protective in assessing a pt’s risk for suicide?
STRICT RELIGIOUS FAITH
What diagnosis, considered in the absence of other comorbidities, is estimated to put one at highest lifetime risk for suicide?
BIPOLAR DISORDER
50 y/o pt presents to the ER voicing suicidal thoughts. The pt states the intent to kill himself with a gun in the woods behind his house. Best course of action is to:
ADMIT THE PT TO THE HOSPITAL FOR FURTHER ASSESSMENT AND CARE.
A Caucasian pt with what risk factors has the highest risk for completed suicide in the US?
AGE GREATER THAN 85 YEARS
Prevalence rate of suicide in general adolescent population?
10%
The best describes data on suicide risk from meta-analysis of clinical studies of depressed children and adol treated w. SSRI:
MORE YOUTH APPEAR TO FAVORABLY RESPOND TO MEDS THAN SPONTANEOUSLY REPORT SUICIDALITY
Pancreatic cancer patient just diagnosed, tells nurses he wishes he was dead. Distant with psychiatrist. Several month hx of depressive Sx’s, no support system. “The only family at home is my gun”
PLACE ON SUICIDE PRECAUTIONS
Suicidal thoughts, constant worrying, feels depressed, guilt, lacks energy, hypersomnia, feels ineffective at work. Tx?
CONSIDER TX W/ ANTIDEPRESSANT
In pts with self- injurious bx and SI, the decision to admit to the inpatient unit would be strongly supported by hx of:
RECENT ALCOHOL ABUSE
The most valid criticism of relying on a no-harm contract to determine a pt’s suicide potential:
IT LACKS ANY SIGNIFICANT EMPIRICAL EVIDENCE TO SUPPORT ITS US
During a visit, a borderline patient is very angry and begins kicking chairs, gurney, and walls. Staff are concerned pt will get hurt. What is the best initial response?
OFFER THE PATIENT THE OPTION OF GOING TO A QUIET ROOM OR TAKING A MEDICATION TO CALM DOWN
Way to decrease risk of suicidal events when prescribing antidepressants to adolescents and young adults:
SLOWLY TITRATING THE ANTIDEPRESSANT
what proportion of med students world wide have SI?
10%
12 y/o disclosed to counselor hx of sexual abuse by relative. Report made to authorities. During eval, pt reports anxiety/inability to concentrate due to thinking about event/irritability/sleep problems/crying frequently. Grades fell significantly after abuse began & relationships suffered. Dx? (5x)
PTSD
Pregnant women involved in a DV relationship get struck where most commonly? (5x)
ABDOMEN
32 y/o w/ no psychiatric history brought to ER with 2 days of memory loss, insomnia, poor appetite, and difficulty performing daily routines. Subjective sense of numbing, detachment, and anxiety. One week earlier pt witnessed her child being fatally injured in a motor vehicle accident. All labs and scans normal. Dx? (4x)
ACUTE STRESS DISORDER
40 y/o has hyperarousal after seeing bad MVA. Has nightmares, avoids freeways, isolating at home. Therapy only moderately helpful. Which medication? (3x)
SERTRALINE
Which type of child maltreatment is most prevalent? (3x)
NEGLECT
Pt has been sexually assaulted is in the ER immediately after the trauma. Initiation of which of the following is most likely to be helpful in preventing long-term psychiatric sequelae? (3x)
PSYCHOSOCIAL INTERVENTIONS TO ESTABLISH SAFETY FROM FURTHER TRAUMA
When evaluating a patient in the ED for risk of dangerousness to others, the best predictor of future violent behavior is (3x):
A HISTORY OF VIOLENT BEHAVIOR
Which of the following is the leading cause of child maltreatment fatalities? (x2)
HEAD INJURIES
23 y/o admitted in inpatient unit w/ Dx acute psychotic d/o after threatening to beat up his mother (with whom he lives). Agreed to voluntary admit, but 2 days later demands to sign out AMA. What justifies involuntary hospitalization in this pt? (2x)
IF THE PATIENT CONTINUES TO THREATEN HIS MOTHER
Which of the following caregiver characteristics is the strongest predictive factor for elder abuse? (2x)
ALCOHOL ABUSE
Occurrence of sexual abuse or inappropriate sexual exposure is indicated by? (2x)
PRETENDING TO HAVE INTERCOURSE WITH A STUFFED ANIMAL
PTSD. what predicts best long-term outcome?
RAPID ONSET OF SYMPTOMS
What event assoc. w/ highest rates of PTSD
EXPERIENCING SEXUAL VIOLENCE
