General Internal Medicine

Question 1

US preventative services task force recommends two question survey for depression

Answer 1

1. Over the past two weeks have you felt down depressed or hopeless?
2. Over the past two weeks have you felt a little interest or pleasure in doing things?
   Positive response to either question warrens further evaluation

Question 2

What medication can you use for depression in hospice patients?

Answer 2

methylphenidate

Question 3

What are some non-psychiatric conditions that mimic depression?

Answer 3

Chronic infectious disease such as HIV, endocrine disease, such as thyroid and adrenal gland, androgen deficiency, menopause, cancer, heart failure, neurologic disease, like Parkinson, or multiple sclerosis, sleep apnea

Question 4

Major depressive disorder, diagnostic criteria

Answer 4

DSM five by the presence of five of the following symptoms during the same two-week period, at least one of which is depressed mood, or loss of interest or pleasure
1. Depressed mood.
2. Markedly diminished interest or pleasure in all or almost all activities, most of the day nearly every day.
3. Significant weight loss, when not dieting or weight gain or decreased or increased appetite
4. Insomnia, or hypersomnia.
5. Psycho, motor agitation or retardation nearly every day.
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive inappropriate guilt,
8. Diminished ability to think or concentrate nearly every day
9. Recurrent thoughts of death, recurrent suicidal ideation, with or without a specific plan, suicide attempt.

Question 5

Persistent depressive disorder, diagnostic criteria

Answer 5

1. Depressed mood most of the day, more days not for at least two years.
2. Depressants, while depressed of two or more of the following symptoms : poor appetite, or over, eating, insomnia, or hypersomnia, low energy or fatigue, Lu, self-esteem, poor concentration, difficulty making decision, feelings of hopelessness. symptoms do not a bit for more than two months

Question 6

Diagnostic criteria for seasonal affective disorder

Answer 6

Subtype of major depressive disorder, characterized by Johndrow symptoms during autumn or winter, which result during subsequent spring. Diagnosis requires three consecutive years of symptoms. 

Question 7

Peripartum, depression

Answer 7

Affects women within six months of giving birth, single and poor mothers at greater risk. Major depressive disorder that occurs during pregnancy or within four weeks following delivery, although clinical symptoms may not be recognized until after this. …? Unclear

Question 8

Persistent complex bereavement disorder

Answer 8

Normal grieving, occurs and fits and starts, but gradually becomes less intense over time. Weaving that lasts more than 12 months or six months in children is associated with persistent yearning, sorrow, we occupation with the deceased. Districts, normal function, or social relationships, and is out of proportion to cultural norms. 

Question 9

Management for depression 

Answer 9

1. psychotherapy, cognitive, behavioral therapy, psychodynamic therapy, interpersonal therapy.
2. Psychopharmacology. 

Question 10

Classes of anti-depressant drugs

Answer 10

1. SSRI.
2. SNRI
3. tricyclic antidepressants.
4. Other agents: bupropion, mirtazapine, trazodone

Question 11

Pharmacotherapy for depression

Answer 11

Patients who do not respond to photos antidepressant monotherapy for six weeks me respond to a different antidepressant drug are there from the same or different class or the addition of the second antidepressant drug. You can also add antipsychotic drug. 

Question 12

Antipsychotic drugs for depression to use in combination

Answer 12

1. Aripiprazole with any antidepressant
2. Quetiapine extended release with any anti-depressant
3. Olanzapine with fluoxetine

Question 13

Anti-depressant contraindicated in seizure disorder

Answer 13

Bupropion

Question 14

Serotonin syndrome

Answer 14

SNRI and MAOIs.
Characterized by altered mental status, autonomic, instability, neuromuscular, hyperactivity, that is potentially lethal

Question 15

Treatment of seasonal affective disorder

Answer 15

Involves daily therapeutic exposure of 30 to 60 minute of 10,000 Luxor visible light. Antidepressant drugs and cognitive behavioral therapy are also used.

Question 16

Bipolar II disorder

Answer 16

Major depression, and hypomania. is present for at least four days.

Question 17

Bipolar I disorder

Answer 17

One or more manic episodes
A manic episode is characterized by at least seven days of severe, abnormally, expansive, euphoric, or irritable mood associated with three of the following symptoms. Grandiosity or inflated self-esteem, pressured speech, flight of ideas, distractibility, increase, goal, directed activity or psychomotor agitation, excessive involvement and pleasurable activities with high potential for adverse consequences, such as pending spree’s or sexual encounters, lessened need for sleep.

Question 18

Management of bipolar disorder

Answer 18

Psychiatrist involvement. Pharmacotherapy involves mood, stabilizer, such as lithium, valproic acid, and carbamazepine, or lamotrigine

Question 19

Treatment of acute manic episodes

Answer 19

Lithium or valproic acid and an atypical, antipsychotic drug such as olanzapine, quetiapine or aripiprazole

Question 20

Diagnostic criteria for generalized anxiety

Answer 20

1. Excessive anxiety or worry about a number of events or activities for example school or work occurring more days than not for six months or longer.
2. The patient recognizes it is difficult to control the worry
3. The anxiety or worry is associated with three or more of the following symptoms. Restlessness, easy, fatigability, difficulty, concentrating, irritability, muscle tension, sleep disturbance.
4. The anxiety, worry or symptoms, cause an impairment at school, work or other setting, and cannot be attributable to medical or other psychiatric conditions, medication, or substance abuse.

Question 21

Generalized anxiety treatment

Answer 21

1.Cognitive behavioral therapy/psychotherapy
2.SSRI, SNRI, tricyclic, antidepressants, and benzodiazepine for short term (6 wks)

Question 22

Panic disorder 

Answer 22

Panic disorders characterized by recurrent unexpected, an abrupt searches of extreme anxiety that peak within minutes and is a company by four or more of the following symptoms: palpitations, sweating, trembling, dyspnea, choking sensation, chest pain, nausea or abdominal pain, lightheadedness, chills, numbness, or tingling, feeling, detached, fear of losing control, or dying.

Diagnosis requires that an attack default by at least one month of worry by the patient that he, or she will experience a recurrent attack 

Question 23

Treatment of panic disorder

Answer 23

SSRI or SSRI in combination with CBT, you can consider a short course of a long acting benzodiazepine like clonazepam for the first few weeks as the anti-depressant is escalated

Question 24

Social anxiety disorder

Treatment

Answer 24

Characterized by severe, persistent, anxiety, or fear of social or performance situations like public speaking, meeting, unfamiliar people that last six months or longer.

SSRI or SNRI venlafaxine

Question 25

Post traumatic stress disorder

Answer 25

Occurs in response to directly experiencing or witnessing traumatic events, characterized at least one month of symptoms, including intrusive memories of the traumatic event, recurrent nightmares, or flashbacks, persistent, avoidance of reminders, persistent negative changes, and thought, and mood associated with the event and alteration in arousal and reactivity

Question 26

Anti-depressant, useful for insomnia and nightmares, used in PTSD

Answer 26

Trazodone

Question 27

Obsessive compulsive disorder

Answer 27

Characterized by obsessions, which are persistent and intrusive thoughts, images, or impulses that are associated with distress and compulsion, which are repetitive behavior, such as handwashing, counting and inspecting that are done in order to decrease distress, caused by the obsession 

Question 28

Tobacco abuse pharmacotherapy

Answer 28

Bupropion, varenicline

Bupropion is contraindicated in patients with seizures

varenicline is contraindicated in severe renal impairment

Both can cause, vivid dreams, and can increase suicidality

Question 29

Alcohol use disorder 

Answer 29

Problematic alcohol use, causing significant distress or impairment within a 12 month period.

It is the third leading preventable cause of death behind smoking in obesity

much of the mortality risk is related to an increased risk of accidental death including motor vehicle accidents, and drowning. Suicide rates are also higher among frequent alcohol users.

Question 30

Alcohol abuse, pharmacotherapy 

Answer 30

Naltrexone and acamprosate in combination with psychosocial treatment

Naltrexone is contraindicated in patients receiving or withdrawing from opiates or those with liver failure, or hepatitis

Acamprosate enhances abstinence, but is contraindicated in CKD

Question 31

Conversion disorder

Answer 31

Functional neurological symptom disorder involving one or more symptoms of abnormal sensation or motor function, such as limb weakness that are not explained by medical condition and are inconsistent with physical exam findings 

Question 32

Fictitious disorder

Answer 32

Deliberate, falsification of symptoms, or inflection of injury on oneself or another, even in the absence of clear external benefit.

Question 33

Binge eating disorder 

Answer 33

Reoccurring episodes on average more than one time a week for three months of eating significantly more food in a short period of time than most people would understand similar circumstances, while feeling lack of control

Question 34

Bulimia nervosa

Answer 34

Frequent episodes, more than once per week of binge eating, followed by inappropriate compensatory behaviors, like self induced, vomiting, or misuse of laxatives, diuretics, and enemas due to fear of weight gain. 

Question 35

Anorexia nervosa

Answer 35

Associated with high mortality
Persistent, caloric intake, restriction, leading to significantly low body weight, a distorted body image, intense fear of gaining weight, or becoming fat

Question 36

Pharmacotherapy for bulimia nervosa

Answer 36

Fluoxetine 

Question 37

Pharmacotherapy for anorexia nervosa

Answer 37

Olanzapine 

Question 38

Schizophrenia

Answer 38

Begins in late adolescence, and is characterized by at least two of the following symptoms:
Delusions, hallucinations, disorganized, or catatonic behavior, and negative symptoms
They must affect one or more major areas of functioning, and have been present for six months, including at least one month of active symptom 

Question 39

Clozapine

Answer 39

Antipsychotic

Requires routine blood monitoring because it can cause agranulocytosis

Question 40

Osteoporosis screening

Answer 40

Dual energy xray absorptiometry DEXA

Measurements of bone mineral density in women age 65 or older and younger women who have a fracture risk equal to or higher than a 65 yr old white woman (greater than 9.3%)

Question 41

Screening for lipid disorders

Answer 41

Every 5 yrs in all men 35 or older and women 45 or older

Question 42

Screening for diabetes

Answer 42

Every 3 yrs for adults older than 45 or younger than 45 with BMI more than 25 and one risk factor

Question 43

PAP smear

Answer 43

Women 30-65 yrs Every 3 yrs
Every 5 yrs with PAP and HPV testing

Question 44

Smoking cessation

Answer 44

Increased risk for cancer, heart disease stroke lung disease