Psych

Question 1

Tx for depressed patient that has diabetic neuropathy sxs

Answer 1

Duloxetine (SNRI have analgesic properties for painful diabetic neuropathy)

Question 2

Work up for SSRI overdose where patient has AMS

Answer 2

• Analyze for contestants (salicylates, ethanol) because SSRI overdose alone is typically asymptomatic or has moderate CNS depression

Question 3

Tx acute bipolar depression

Answer 3

quetiapine or lurasidone

Question 4

Low 5-hydroxyindolacetic acid (5-HIAA) is associated with?

Answer 4

Suicide (low amount of serotonin metabolite –> increase risk suicide)

Question 5

Lithium side effects

Answer 5

Lithium-induced hypothyroidism- fatigue, constipation, myalgia (those on lithium should get TSH checked every 6-12 months), hyperthyroidism, hypercalcemia
- diabetes insipidus, tremor, weight gain, nausea, vomiting, thirst, polyuria

Question 6

Lithium toxicity

Answer 6

ataxia, dysarthria, delirium, acute renal failure

Question 7

Reversal of benzodiazepine sedation

Answer 7

Flumazenil

Question 8

Tx for adult ADHD

Answer 8

Methylphenidate (atomoxetine in those with hx of substance use)

Question 9

HIV patient noncompliant with tx presenting with fever, confusion, double vision, headaches, nausea, vomiting,, lateral gaze palsy, umbilicated lesions with erythema?

Answer 9

Cryptococcal meningoencephalitis (yeast clog arachnoid villi- CSF outflow obstruction causes ICP)
dx with LP/india ink stain 

**elevated ICP causes compression of 6th cranial nerve- gaze palsy, headache, nausea, vomiting, CT scan with ventriculomegaly