Nov 1, 2019

Question 1

What are the clinical features of generalized anxiety disorder?

Answer 1

Excessive, uncontrolled worry about multiple issues for >=6mo that causes functional impairment

+ 3 or more of the following

Restlessness; feeling on edge

Fatigue

Difficulty Concentrating

Irritability

Muscle Tension

Sleep Disturbance

Question 2

How do you treat generalized anxiety disorder?

Answer 2

CBT

SSRI/SNRI

Buspirone

TCA’s

Question 3

What are frequent concomitant symptoms in Generalized Anxiety Disorder?

Answer 3

HA

Palpitations

Dizziness

Chest/Abd Pain

Question 4

If benzo’s are used in generalized anxiety disorder, how should they be used?

Answer 4

Short term while titrating up meds or starting CBT

<4-6 weeks

Question 5

Diagnosis of panic attack?

Answer 5

Suddent onset of extreme fear or anxiety

+ at least 4:

Fear of dying

fear of losing control

palpitations

diaphoresis

tremor

dyspnea

sensation of chocking

CP

nausea

dizziness

chills

heat sensations

paresthesia

derealization

Question 6

Diagnosis of panic disorder?

Answer 6

Recurrent unexpected panic attacks

at least 1 attack followed by 1+ months of persistent concern about additional attacks with maladaptive behavior changes

Question 7

Medical conditions to consider when diagnosing panic attacks?

Answer 7

Hyperthyroidism

Pheochromocytoma

Question 8

How do you treat panic disorder?

Answer 8

CBT

SSRI/SNRI

Benzo’s for short term control

Treat for at least 1 year after remission of symptoms

Question 9

Diagnosis of social anxiety disorder?

Answer 9

Excessive anxiety or fear of criticism or humiliation in social or performance situations

May experience palpitations, flushing, dyspnea, CP, panic attacks

Present for >=6 mo

Cause significant functional impairment

Question 10

How do you treat social anxiety disorder?

Answer 10

CBT

SSRI/SNRI

Question 11

What class of drugs is infliximab?

Answer 11

anti-TNF

Question 12

Vaccinations in anti-TNF patients?

Answer 12

Avoid live vaccines. Ideally administer prior to starting due to possible reduced response while on therapy.

If at risk for Hep B, give regardless of age.

Question 13

Treatment for major depression in terminally ill with short life expectancy?

Answer 13

Psychostimulants

Methylphenidate

dextroamphetamine

modafinil

Question 14

Mirtazapine?

Answer 14

Anti-depressant, Alpha-2 antagonist

Question 15

methylphenidate

Answer 15

CNS stimulant, blocks re-uptake of norepinephrine and dopamine

Question 16

dextroamphetamine

Answer 16

CNS stimulant - promote release of catecholamines (dopamine and norepinephrine)

Question 17

modafinil

Answer 17

CNS stimulant - increases dopamine

Question 18

Demographics of Fibromyalgia?

Answer 18

F:M of 3:1

Low socioeconomic/education level

Increases with age, peaks around 7th decade

Question 19

Diagnosis of Fibromyalgia?

Answer 19

Widespread pain by the Widespread Pain Index >=7 or >=3

Symptoms severity by the symptom severity scale >=5 or >=9

–Fatigue

–Non-restorative sleep

–Cognitive symptoms

Duration of symptoms >=3mo

No other disorder that would explain

Question 20

What are organic causes that should be considered when considering fibromyalgia?

Answer 20

Hypothyroidism

Hypoadrenalism

Depression