MOC Exam#9

Question 1

Caveats regarding liver transplant and pts on methadone maintenance

Answer 1

• continue methadone
• outcomes are similar to pts no to methadone
• will need increased meds for post-op pain management

Question 2

Treatment of lithium induced hypothyroidism

Answer 2

• thyroid hormone replacement

- no need to stop Li if stable and effective

Question 3

Which treatment for opioid use disorder in pregnant women has lowest risk of neonatal abstinence syndrome for the newborn?

Answer 3

-BUPRENORPHINE

Question 4

Antipsychotics that are substrates for 1A2

Answer 4

• asenapine
• olanzapine
• clozapine
• phenothiazines
• cigarette smoke induces 1A2 and therefore these meds should be avoided in smokers

Question 5

Which benzodiazepine should not be prescribed with Valproic acid?

Answer 5

• Clonazepam

- can cause absence seizure

Question 6

Characteristics of frontotemporal dementia

Answer 6

• behavioral and personality changed
• onset before age 65
• hyperorality especially for carbohydrates
• TDP-43 proteinopathy on autopsy

Question 7

Synucleinopathy are found in which disorders

Answer 7

• Parkinson’s Disease
• Lewy Body Disease
• REM Sleep Behavior Disorder (RSBD)

Question 8

Synucleinopathies are characterized by

Answer 8

• signs of Parkinsonism
• cognitive decline significantly later after motor symptoms in Parkinson’s disease
• cognitive decline early or soon after development of motor symptoms in Lewy Body Disease

Question 9

Recommendation for the INITIAL assessment of thyroid function is to measure _______.

Answer 9

• ONLY SERUM TSH

- because 95% of hypothyroid cases are due to primary hypothyroidism

Question 10

When is it recommended to order fT4

Answer 10

• when secondary hypothyroidism is suspected (disease of the pituitary)
• low TSH which symptoms of hypothyroidism

Question 11

When would one order thyroid antibodies

Answer 11

• in a patient with hypothyroidism to establish the cause

- anti-thyroperoxidase and/or anti-thyroglobulin antibodies are detected in Hashimoto’s thyroiditis

Question 12

Characteristics of Psychological Factors Affecting Medical Condition

Answer 12

-the presence of psychological or behavioral factors that adversely affect a medical condition by increasing suffering, disability, or death

Question 13

Characteristics of anxiety illness disorder

Answer 13

-preoccupation with having or acquiring a serious illness in a case in which the patient does not suffer not from any prominent physical symptoms

Question 14

Characteristics of somatic symptom disorder

Answer 14

-for somatic symptom disorder a diagnosable medical illness does not need to be present; instead the focus is on the maladaptive thoughts, behaviors, and feelings associated with the somatic symptom.

Question 15

How does neuroleptic malignant syndrome happen?

Answer 15

• Neuroleptic malignant syndrome (NMS) appears to be induced by an acute hypodopaminergic state, either as a result of dopamine blockade via antipsychotic medications or as a result of withdrawal of dopaminergic effect, as in discontinuation of levodopa in patients with parkinsonism
• D2 receptor

Question 16

What is Pimavanserin?

Answer 16

• pimavanserin is an antipsychotic and won’t increase cholesterol or lipids.
• It’s the only FDA-approved medication for treatment of psychosis in Parkinson’s disease.

Question 17

The 1974 Tarasoff v. Regents of University of California case established

Answer 17

-that psychiatrists have a duty to warn potential victims against whom their patients have made threats, a duty which supersedes doctor-patient confidentiality

Question 18

What is the estimated prevalence of psychotic symptoms in neurocognitive disorder due to Alzheimer’s disease?

Answer 18

30% to 50%

Question 19

Which ethical or legal doctrine(s) are generally given as grounds for involuntary psychiatric treatment?

Answer 19

• Police power: responsibility to protect citizens from others and maintain order
• Parens patriae: responsibility to protect those who cannot care for themselves