Minicase - Loss of Vision and Depressed Mood

Question 1

Hx of retinal artery occlusion (6)

Answer 1

1. vision loss
2. acute
3. painless
4. no discharge, redness or photophobia
5. no assoc symptoms (no HA, weakness/numbness)
6. hx afib/emoblic events

Question 2

Retinal artery occlusion w/u (8)

Answer 2

1. fluorescein angiogram
2. ECHO
3. doppler US carotid
4. intraocular tonometry (acute closure glaucoma)
5. ESR (temporal arteritis)
6. CRP (temporal arteritis)
7. temporal artery biopsy
8. CBC

Question 3

Normal bereavement presentation (8)

Answer 3

1. Depressed mood
2. Hx of recent (~2mo) death
3. excessive sleep
4. crying spells
5. poor hygiene
6. wt loss (this sounds more like MDD or complicated grief to me…)
7. does not enjoy time with grandchildren
8. imagines wife

Question 4

Normal bereavement w/u (6)

Answer 4

1. TSH
2. CBC
3. Urine tox
4. Beck Depression Inventory
5. PHQ-9
6. QIDS-SR16

Question 5

MDD presentation (8)

Answer 5

1. depressed mood
2. excessive fatigue
3. insomnia
4. anhedonia
5. passive SI
6. prior episodes
7. hx of suicide attempts
8. increased substance use

Question 6

MDD w/u (7)

Answer 6

1. Beck depression inventory
2. PHQ-9
3. QIDS-SR16
4. Blood EtOH level
5. TSH
6. CBC
   7, Utox

Question 7

BP 1 presentation (7)

Answer 7

1. depressed mood
2. wt loss
3. decreased sleep (early-morning awakening)
4. excessive guilt
5. psychomotor retardation
6. no trigger
7. hx of mania (increased energy, sexual promiscuity, irresponsible spending, racing thoughts)

Question 8

BP1 w/u (4)

Answer 8

1. mood disorder questionnair
2. Utox
3. TSH
4. CBC

Question 9

Loss of vision exam (4)

Answer 9

1. head and neck
2. fundoscopic
3. neuro exam
4. cardiac exam

Question 10

Psychiatric documentation (mental status exam) (15)

Answer 10

1. appearance
2. behavior
3. attitude
4. level of consciousness
5. orientation
6. speech and language
7. mood
8. affect
9. though process
10. thought content
11. sucidality and homicidality
12. insight and judment
13. attention
14. memory
15. intellectual

Question 11

What is QIDS-SR16

Answer 11

Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR-16)