Mehl. Bullet depression + NBME 10 155, 55, 138, 9Q 03-21 (1) Flashcards
Mehl. depression lentele + dysthymia + cyclothymia.
M. Q might give guy who’s had weight loss + teary-eyed post-MI; Dx?
Depression due to a medical condition
M. Q might give guy who’s had weight loss + teary-eyed post-MI; Tx?
answer on an NBME form is just sertraline (an SSRI).
M. elderly male who’s a bit quiet + teary- eyed + who’s had weight loss. Dx?
just depression.
Students get confused because they don’t count 5/9, but as I said, USMLE doesn’t care.
It’s to my observation that weight loss is one of the most buzzy indicators in a psych vignette that MDD is likely the answer
M. The Q might say the patient is unable to draw a clockface, but when prompted, is able to finish it quickly. They might also say patient remembers 0 out of 3 objects after 5 minutes. Dx?
Pseudodementia.
NBME 10. 138Q.
62 y/o + sadness and difficulty sleeping since his wife of 35 years died of breast cancer 7 months ago. He began grieving for her before she died, but the grief has become more intense since her death. During this period, he has had loss of appetite and is no longer interested in golfing and having dinner with friends. He has started to believe that he will never feel better and sees himself as worthless. Physical examination shows no abnormalities. Mental status examination shows a depressed mood and sad affect. He says that life is no longer tolerable, but he has not thought about killing himself. Dx?
MDD
normal grieving < 6 months.
NBME 10. 155Q.
A 47-year-old woman comes to the physician because of difficulty sleeping for 2 months. During this period, she has been awakening at 3 AM and remaining awake worrying about work, even though she is tired. She has unstable angina pectoris and required placement of one coronary artery stent 6 months ago and a second stent 4 months ago. Her chest pain started to recur 1 month ago, and she now has it almost daily. Evaluation shows no organic cause for her recurring chest pain. She works as an attorney for a large firm and reports that she has been given more responsibility during the past year. For the past month, she has not enjoyed her work as much as she previously did. She forces herself to go to work and has difficulty paying attention while she is there. She is a gourmet cook but no longer prepares meals because she does not enjoy the taste of the food. Physical examination shows no abnormalities. On mental status examination, she has a sad and worried mood and a reactive affect. She is alert and oriented to person, place, and time. She states that she frequently becomes despondent, especially when she thinks about her heart disease. Which of the following is the most likely diagnosis?
MDD
As mehlman said, they can mention MI cancer
NBME 10. 55Q.
A 44-year-old man comes to the office with his girlfriend because she is concerned about his mood. He recently told her it would be a relief if he were hit by a truck and died. He reports frequent fatigue and says he has been persistently unhappy for 9 years. He has not had problems with sleep or appetite. He has
type 1 diabetes mellitus, chronic kidney disease, hypertension, and peripheral neuropathy. His medications are furosemide, gabapentin, insulin, metoprolol, and simvastatin. He lost joint custody of his two children 1 month ago, which he says is “a real downer.” He finds his work as a convenience store clerk tedious and uninteresting, but he enjoys playing poker and watching movies. He has used cocaine once monthly during the past 5 years. His pulse is 84/min, and blood pressure is 146/88 mm Hg. Physical examination shows retinal hemorrhages. On mental status examination, he has a dysphoric mood and sarcastic affect. There is evidence of interpersonal friction with his girlfriend. He reports no current suicidal ideation or intent. Which of the following is the most likely diagnosis?
Persistent depressive disorder (dysthymia)
72M + wife passed away 3 months ago + 5kg weight loss + cries + guilt; Dx?
MDD (weight loss/gain is huge indicator MDD in elderly).
72M + wife passed away 7 months ago + still grieves; Dx?
pathological grief (normal grief is <6 months).
Patient with MDD; which hormone is increased in serum?
Psych shelf answer = cortisol.
72M + wife passed away 5 months ago + sometimes hears her voice at night; Dx
normal bereavement.
60M + recovering from a recent MI; he is at high risk of which of the following?
MDD.
Its common following major adverse events (e.g., trauma, serious Dx); give sertraline for post-MI MDD.
60M + recent MI + asks when he can resume sexual intercourse; answer ?
as soon as he feels ready; wrong answer is “wait at least two weeks.”
The USMLE will tell you polysomnography shows a patient wakes up 19 times per night + he has low mood, and the answer Dx?
“mood disorder due to a medical condition.”
NBME 10. 9Q. A 15-year-old boy is brought to the physician by his parents for an examination prior to participating on the school basketball team. Five weeks ago, he had a 1-week history of fever, sore throat, and diffuse muscle aches. Since then, he has had decreased energy and needs at least 10 hours of sleep every night. While the patient’s parents are out of the room, the patient states that he does not want to play basketball, but his parents are forcing him to join the team. He is an honor student but failed an examination last week. He does not drink alcohol, but he smokes marijuana occasionally; he does not use any other illicit drugs. He has been sad and angry since his girlfriend broke up with him 3 weeks ago after she told him that he was “too moody and not fun to be around anymore.” His pulse is 88/min, and blood pressure is 120/72 mm Hg. Physical examination shows no abnormalities. On mental status examination, he has a sad mood and a full range of affect. Which of the following is the most appropriate next step in management?
Assessment for suicide risk
Mehl. What is cyclothymia vs dysthymia. cyclothymia definition?
cyclothymia is >2 years of swinging low + elevated moods, but never meets the thresholds for bipolar + never has true depressive episode.
Mehl. What is cyclothymia vs dysthymia. Dysthymia definition?
Dysthymia is >2 years of low moods not ever meeting thresholds for MDD
Mehl. 56M + depressed mood + sleep apnea; Dx?
mood disorder due to a general medical
condition.
Mehl. 22F + hyperphagia + hypersomnolence + improved mood with pleasurable events; Dx + Tx?
Dx = atypical depression;
Tx = SSRI, not MAOi;
MAOi (e.g., phenelzine) are considered highly efficacious but
carry dangerous side-effects, so SSRIs remain first-line.
Mehl. Patient eats aged cheese + red wine + slice of pepperoni pizza (fuck now I want pizza) + takes
phenelzine for atypical depression + gets BP of 220/100; Dx?
tyramine crisis; MAOi prevent the breakdown of tyramine, a naturally occurring catecholamine in some foods; tyramine prevents the reuptake of endogenous catecholamines;
Mehl. Patient eats aged cheese + red wine + slice of pepperoni pizza (fuck now I want pizza) + takes
phenelzine for atypical depression + gets BP of 220/100; Tx?
Tx for tyramine crisis on Psych shelf = alpha-1 blocker (phentolamine).
Mehl. 59F + metastatic cancer + in pain + crying + “wants to die”; Dx?
Q asks most likely reason for wanting to die; answer = “inadequate pain control”;
“major depression” is wrong answer; must address pain management in cancer patients.
Mehl. 35F + chronic pain in arm since MVA last year + says to physician “I’m realizing I’ll be like this forever.” Question wants most appropriate response. What to ask, what to do?
“have you been feeling like just giving up?” -> must assess suicide ris
