Differential Diagnosis and Management Questions Flashcards
An acute dystonic reaction in which there is a spasm of the muscles of extraocular motion
Oculogyric crisis
Muscle spasm that cause abnormal positioning of the head; abnormal, asymmetrical head or neck position, which may be due to a variety of causes
Torticollis
Spasmodic torticollis in which the head is drawn back
Retrocollis
Spasm of the jaw muscles
Trismus
Pt complains that she cannot stop looking up and eyes are deviated upward bilaterally on exam.
Oculogyric crisis
What should you use to treat symptoms of a patient with schizoaffective disorder with depressive sx?
Antipsychotic + Antidepressant
What should you use to treat postpartum depression with psychotic features?
Antidepressant (such as SSRI) and antipsychotic
What is a common psychotic symptom of postpartum depression?
Hearing a child crying
Bilateral abducens nerve palsy, horizontal nystagmus, ataxia, and global confusion + apathy
Wernicke encephalopathy
What causes Wernicke encephalopathy?
Thiamine – B1 – deficiency
Unstable vital signs, tremulousness, agitation
Alcohol withdrawal
Diarrhea, cheilosis, glossitis, but no neurological abnormalities
Folic acid deficiency
Dementia, Incontinence, Gait disturbance (Classic triad)
Normal pressure hydrocephalus
What should you do if you suspect Wernicke syndrome
Administer IV thiamine! - many sequelae of thiamine deficiency are reversible with this treatment
Is mistakenly administrating thiamine harmful?
Normal pressure hydrocephalus
Should a patient with Wernicke encephalopathy be given glucose?
No! Giving patient glucose prior to administering thiamine can worsen the Wernicke encephalopathy
Are the delusions in delusional disorder typically bizarre or non-bizarre?
Non-bizarre
How are delusional disorders typically treated?
Give an antipsychotic
What is tegretol?
Anti-epileptic used to treat bipolar disorder
What causes malignant hyperthermia?
Resembles NMS but follows administration of inhaled anesthetic agents.
Are command auditory hallucinations a psychiatric emergency?
Yes
What do you do if you have a patient with command auditory hallucinations
Start on a neuroleptic
What is a neuroleptic?
Antipsychotic
If a patient has bipolar disorder and is in a manic state but is disrupted and agitated what should you administer?
First give an antipsychotic and benzodiazepine; then give a mood stabilizer
How long does it take for mood stabilizers like carbemazepine or lithium to work?
At least a week
What are therapeutic lithium levels?
0.8 – 1.2 mEq/L
Can haldol cause muscle stiffness?
Yes, it can be a parkinsonian side effect
How do you treat the muscle stiffness caused by haldol?
Either lower the haldol or give an anticholinergic medication
What is baclofen?
A muscle relaxant
A reaction that may occur in a patient who witnesses or experiences a traumatic event (which must involve death, threatened death, or serious injury). Sx – hyperarousal states, dissociative states, and intrusive re-experiencing of events.
Acute stress disorder
PTSD-like symptoms for x weeks or less is acute stress disorder. What is x?
4 weeks / 1 month
Desire to rub one’s genitals against a nonconsenting person?
Frotteurism
The desire to watch people undress without their consent.
Voyeurism
Having intense fantasies or urges toward nonhuman objects that involve humiliation or pain, or toward nonconsenting persons
Paraphilias
Desire to expose one’s genitals to a nonconsenting person
Exhibitionism
Maladaptive behavioral or emotional symptoms after a stressful life event – sx begin within 3 months and end within 6 months and cause significant impairment in daily function or interpersonal relationships.
Adjustment disorder
Can an adjustment disorder diagnosis be made when a diagnosis of MDD be made?
Noooo
Do anxiety disorders ever result in unconsciousness?
No
How long is schizophreniform disorder?
1 month to 6 months
How long is brief psychotic disorder?
< 1 month
How long is schizophrenia?
> 6 months
Agitation, pacing, psychosis, tachycardia / vital sign instability, tics and spasms, vertical nystagmus
PCP intoxication
Pinpoint pupils –> diffuse crampy abdominal pain, flu-like syndromes → yawning, dilated pupils, fever, tachy, high blood pressure
Opiate withdrawal
Yawning, rhinorrhea, muscle aches, diarrhea, lacrimation, and fever
Opiate withdrawal
How do you manage opiate withdrawal?
Clonidine (a centrally acting alpha 2 agonist) or methadone (a synthetic long-acting opiate), lorazepam (to treat vital signs), loperamide (diarrhea)
Can TCAs or neurolpetics cause life-threatening withdrawal symptoms?
No
Tremors, anxiety, auditory / visual / tactile hallucinations, autonomic hyperactivity, seizures
Withdrawal of benzos or barbiturates
How long do some of the common side effects (diarrhea, constipation, nausea, headache) of SSRIs usually last?
Several days
Onset of emotional or behavioral disturbances within 3 months of a significant life event that may manifest as marked change in an individual’s ability to function in school, work, or interpersonal relationships. Less than 6 months I think.
Adjustment disorder
Difference between normal bereavement and MDD
MDE – if depressive sx last longer than 2 months after the person died, if the survivor has guilt surrounding anything other than actions they should have taken to prevent the death, if the survivor has prominent hallucinations, psychomotor retardation, or thoughts of wanting to end their life.
Best treatment for PCP intoxication
A dark, quiet room with minimal stimulation
What are three FDA approved medications for bipolar depression?
Seroquel, Latuda, and Zyprexa
Seroquel
Quetiapine
Lamotrigine
Lamictal
Quetiapine
Seroquel
Lamictal
Lamotrigine
Most appropriate treatment for patient with MDD with psychotic features?
ECT or antidepressant + antipsychotic
How do you tell if an elderly patient has dementia versus depression?
Patients with dementia confabulate when they don’t know an answer; patients with depression just say they don’t know.
Social anxiety disorder treatments?
1st line – behavioral (CBT), Short term – benzos. Long-term: Sertraline and fluoxetine, SNRI (venlafaxine)
