High Yield Psych-MSE changes, drug abuse, MR, child

Question 1

Elderly woman w/ AMS and sundowning. Explain her lab workup; which meds to avoid

Answer 1

UA, glucose, Na, blood cultures, B12, RPR; benadryl, opiates, benzos

Question 2

Alzheimer: On MMSE, prompting does not increase ____. Due to global brain path with ___ plaques and ___ tangles

Answer 2

recall; ßamyloid; tau

Question 3

Frontotemporal dementia: tx w/ ___ for severe disinhibition

Answer 3

olanzepine

Question 4

Lewy Body Dementia: ____ inclusions in neocortex; give ______ [class of drugs]

Answer 4

∂synuclien; AChE inhibitors

Question 5

Creutzfeldt Jacob [myoclonus, startle response, seizures and recent corneal transplant]: EEG findings

Answer 5

triphasic bursts

Question 6

Normal pressure hydrocephalus: VP shunt improves cognitive fxn in ____ of patients

Answer 6

50-66%

Question 7

Alcoholism: seizures can occur ____ since last drink

Answer 7

12-24hrs

Question 8

Alcoholism: tactile hallucinations can occur _____, usually when DTs start

Answer 8

48-72hrs since last drink

Question 9

Alcohol is metabolized by _____ kinetics.

Answer 9

25mg/hr [if pt BAL 0.225 mg/ml, will take 9 hours to get rid of]

Question 10

Alcoholism w/dwl: ___ can mask the signs of autonomic hyperactivity, except for ____, which is used to dose benzos during withdrawal

Answer 10

ßblockers; hyperreflexia

Question 11

Alcoholism: best initial tx current tonic/clonic seizures from w/dwl; tx if liver disease

Answer 11

diazepam/clordiazepoxide (long half lives); lorazepam, oxazepam (glucuronidated prior to elimination)

Question 12

Most specific test for ETOH consumption in the past 10 days?

Answer 12

Carbohydrate-deficient transferrin. Less specific- elevated GGT and AST more than twice ALT

Question 13

Abuse/Wdwl: diagnose pt w/ confusion, ataxia and constricted pupils; tx

Answer 13

Wernicke Encephalopathy (thiamine def); give thiamine first then glucose

Question 14

Abuse/Wdwl diagnosis: apathy, anter/retrograde amnesia and confabulation, can see MB atrophy on MRI

Answer 14

Korsakoff’s syndrome (irreversible damage to mamillary bodies)

Question 15

Diagnose: ER pt is in a non- responsive state. His BP is 100/60, HR is 50, RR is 6. He has multiple track marks on his arm; what if pupils dilated?

Answer 15

opioid OD; same diagnosis (hypoxia secondary to respiratory depression can cause mydrasis)

Question 16

Opioid wdwl sxs

Answer 16

joint/muscle pain, photophobia, goodsebumps, diarrhea, tachycardia, HTN, GI cramps, dilated pupils, anxiety/depression

Question 17

Opioid OD: tx

Answer 17

IM/IV naloxone [full mu-opioid antagonist]

Question 18

Opioid wdwl tx short term; long-term dependence

Answer 18

Clonidine for autonomic sxs; methadone, buprenorphrine or naltrexone

Question 19

Diagnose drug/wdwl: Pt presents with horizontal nystagmus, dilated pupils, ataxia and acute psychosis

Answer 19

PCP

Question 20

Diagnose drug/wdwl: Pt presents s/p MVC with injected conjunctiva, sedation and is asking for Doritos (cool ranch plz)

Answer 20

MJ

Question 21

Diagnose drug/wdwl: Pt presents with SI, hypersomnia, depression and anergia

Answer 21

cocaine/amphetamine wdwl

Question 22

Diagnose drug/wdwl: Pt presents with dilated pupils, seizure, tachycardia and HTN

Answer 22

cocaine/amphetamine

Question 23

Cocaine/amphetamine intoxication w/ HTN and tachycardia, tx with ____

Answer 23

CCBs [ßblockers contraindicated]

Question 24

Diagnose: 11yo boy evaluated for developmental delay, poor school and social performance. IQ 50. He has a macrocephaly,
long face and macroorchidism

Answer 24

Fragile X [CGG repeats w/ anticipation; Cx = Seizures, MVP, dilation of the aorta, tremors, ataxia, ADHD-like behavior.
MC cause of INHERITED MR]

Question 25

MR: IQ of ___ is mild.

Answer 25

55-70

Question 26

MR: IQ of ___ is moderate.

Answer 26

40-55

Question 27

MR: IQ of ___ is severe.

Answer 27

25-40

Question 28

MR: IQ of ___ is profound.

Question 29

Average IQ is ___ with std of ___; MR is categorized under Axis ___

Answer 29

100; 15; Axis II

Question 30

MR: For pts w/ Down Syndrome, will most likely have _____ MR, speech and gross/fine motor skill delay

Answer 30

mild to moderate

Question 31

MR diagnoses: Café-au-lait spots, seizures large head. Autosomal dominant

Answer 31

NF 1

Question 32

MR diagnoses: Coarse facies, short stature, cloudy cornea. Autosomal recessive

Answer 32

Hurler syndrome

Question 33

MR diagnoses: Broad, square face, short stature, self- injurious behavior. Deletion on Chr17

Answer 33

Smith Magenis

Question 34

MR diagnoses: Hypotonia, hypogonadism, hyperphagia, skin picking, agression. Deletion on paternal Chr15.

Answer 34

Prader-Willi

Question 35

MR diagnoses: Seizures, strabismus, sociable w/ episodic laughter. Deletion on maternal Chr15

Answer 35

Angelman

Question 36

MR diagnoses: Elfin-appearance, friendly, increased empathy and verbal reasoning ability. Deletion on Chr7

Answer 36

Williams

Question 37

MR diagnoses: ADHD-like sxs, microcephaly, smooth philtrum. Most common cause of mental retardation

Answer 37

FAS

Question 38

MR diagnoses: Seizures, chorioretinitis, hearing impairments, periventricular calcifications, petechiae @ birth, hepatitis

Answer 38

congenital CMV infection

Question 39

MR diagnoses: Seizures, hearing impairments, cloudy cornea/retinitis, heart defects, low birth weight

Answer 39

congenital rubella syndrome

Question 40

MR diagnoses: Abnormal muscle tone, unsteady gait, seizures, mental retardation or learning disability

Answer 40

cerebral palsy from birth asphyxia

Question 41

MR diagnoses: IUGR, hypertonia, distinctive facies, limb malformation, self-injurious behavior, hyperactive

Answer 41

Cornelia de Lange

Question 42

MR diagnoses: Coloboma, heart defects, choanal | atresia, growth retardation, GU anomalies, ear deformity and deafness. Chr 8

Answer 42

CHARGE

Question 43

MR diagnoses: Autism spectrum sxs, heart disease, palate defects, hypopastic thymus, hypoCa. Chr 22 deletion

Answer 43

DiGeorge

Question 44

MR diagnoses: Vomiting, seizures, lethargy, coma. Acidosis w/ stress, illness. Causes neurological damage

Answer 44

Maple Syrup Urine dz

Question 45

MR diagnoses: Exclusively in girls, normal development for 6-8mo, then regression, handwringing, loss of speech and use of hands. X-linked dominant deletion of MECP2

Answer 45

Rett syndrome

Question 46

MR diagnoses: Normal development until age 2 then major loss of verbal, social skills w/ autistic like behavior.

Answer 46

Childhood disintegrative disorder

Question 47

MR diagnoses: Lack of mother-child eye contact, language delay/repetitive language, peroccupation w/ “parts of toys” before age 3

Answer 47

Autism

Question 48

MR diagnoses: Problems with social skills (usually recognized in preschool) w/ reserved verbal ability

Answer 48

Asperger

Question 49

ADHD: ___ heritability; low birth weight, ____ exposure

Answer 49

77%; AODA

Question 50

ADHD: comorbid ODD/CD in _____ cases

Answer 50

30-50%

Question 51

ADHD: tx

Answer 51

methylphenidate, amphetamine, atomoxetine, others [clonidine, guanfacine, SNRIs, TCAs, MAOIs]

Question 52

ADHD: major SEs for methylphenidate/amphetamine

Answer 52

dec appetite, nausea, HTN, tachycardia, stunted growth

Question 53

Methylphenidate blocks ___ where amphetamine blocks ____ and stimulates ____

Answer 53

dopamine reuptake; DA/NE reuptake; DA/NE release

Question 54

Diagnose: 14 yo boy stole his neighbor’s lawn mower and then set fire to his tool shed. He has a 5 year history of truancy from school and assaulted a 13 year old school mate

Answer 54

conduct disorder

Question 55

Conduct Disorder: sxs for at least ____; comorbidity _____; may progress to ____

Answer 55

6mo; substance abuse; anti-social PD

Question 56

Diagnose: 14 yo boy has been getting in trouble at school for being argumentative and disrespectful to his teachers (for over 1 yr); defies rules and often deliberately annoys her

Answer 56

Oppositional defiant disorder

Question 57

ODD: need sxs for at least ___

Answer 57

1 year

Question 58

Diagnose: 9 year old boy is sent to counseling b/c at least once a day he makes loud grunting noises and hand movements that are disruptive to the class

Answer 58

Tourette's

Question 59

Tourettes: tics must occur _____ for ____ in order to diagnose

Answer 59

at least once per day; 1 year

Question 60

Tourettes: comorbidity ____; tx first line ____ and most effective _____

Answer 60

clonidine/carbamazepine (b/c benign SE profile); haloperidol/pimozide

Question 61

Diagnose: 7 year old complains of frequent abdominal pain resulting in many missed school days. He never gets the pain on the weekends or in the summer

Answer 61

separation anxiety disorder

Question 62

Diagnose: 6 year old adopted child is brought in because she has not formed a relationship with her adoptive parents. She is inhibited and hyper vigilant

Answer 62

Reactive attachment disorder

Question 63

Diagnose: An 18mo old baby has recently been regurgitating and re-chewing her food. She had previously been eating normally

Answer 63

Rumination disorder [check lead levels!]

Question 64

Tx of 6y/o stools in her clothes once every 2 weeks w/ normal fecal retention

Answer 64

behavioral modification that only rewards

Question 65

Tx of 6 y/o urinates in her clothes once a day w/ normal UA/urine culture

Answer 65

(1) Alarm and pad for 6wks (2) imipramine/DDAVP, but relapse is common

Question 66

MC SEs of DDAVP for childhood urinary incontinence

Answer 66

headaches, nausea, hyponatremia