Psych

Question 1

What will an isolated benzodiazepine overdose present with?

Answer 1

A patient who has normal vital signs and is arousable. Bradycardia, respiratory depression, ect suggests involvement of another CNS depressant.

Question 2

What are PTSD symptoms less than 1 month but greater than 3 days referred to as?

Answer 2

Acute stress disorder.

Question 3

What triad defines serotonin syndrome?

Answer 3

Mental status changes, autonomic dysregulation, and neuromuscular hyperactivity. A tyramine induced HTN crisis would have just hypertension, not hyperreflexia or mydriasis, ect.

Question 4

What agent other than dantrolene can be used in the treatment of neuroleptic malignant syndrome?

Answer 4

Bromocriptine (after stopping the antipsychotics of course).

Question 5

What would SIG E CAPS symptoms in someone who’s wife died 7 months ago be classified as?

Answer 5

Major depressive disorder. MDD is diagnosed regardless of an existing precipitant. Thus the most appropriate next step would be anti-depressant therapy.

Question 6

Can anorexia present initially as edema?

Answer 6

Yes, it can cause edema due to nutritional deficiencies. Initially put hypothyroidism but I should have noticed that her BMI was 17; hypothyroidism would have caused weight gain.

Question 7

What is the first line medication for OCD?

Answer 7

SSRIs. Can also use the TCA clomipramine.

Question 8

What is premenstrual syndrome/PMS?

Answer 8

Bloating, fatigue, headaches, mood swings, anxiety, ect that begin 1 week before menses and resolve a few days into menses.

Question 9

What is the most appropriate next step for suspected premenstrual syndrome/PMS?

Answer 9

A menstrual diary to rule out a primary mood disorder (if symptoms not consistently tied to menstrual cycle it may not be PMS).

Question 10

What is the difference between separation anxiety disorder and normal development in a pre-schooler?

Answer 10

It is normal for a child to initially protest and cling to their parent on the first day of school if they then settle down, play with other children, engage in school activities, ect.

Question 11

What is the greatest risk factor for committing homicide?

Answer 11

Access to firearms.

Question 12

What agents are used in the management of PCP intoxication?

Answer 12

Benzodiazepines.

Question 13

What is the best initial approach to a patient with acute stress disorder?

Answer 13

Educate them on the range of reactions to trauma to normalize their experience.

Question 14

What do individuals with alcohol use disorder commonly present to the PCP with?

Answer 14

Sleep disturbance and/or mild anxiety symptoms due to mild withdrawal.

Question 15

How is a grief reaction differentiated from MDD?

Answer 15

Grief involves sadness that is specific to the person with “waves” of grief at reminders. Feelings of worthlessness and guilt are less likely than MDD.

Question 16

What is the best next step for a single episode of major depressive disorder that has gone into remission following anti-depressant therapy?

Answer 16

Continue the anti-depressant(s) for 6 additional months to reduce risk of relapse.

Question 17

What is the first line non-stimulant option for management of adult ADHD?

Answer 17

Atomoxetine (a NE re-uptake inhibitor).

Question 18

What mood stabilizer is associated with hepatotoxicity?

Answer 18

Valproate. Those on it should receive regular LFTs.

Question 19

What is the best management for tardive dyskinesia if anti-psychotic dose reduction isn’t possible?

Answer 19

Switch to clozapine as it is the least likely anti-psychotic to produce extrapyramidal symptoms.

Question 20

What is valbenzine?

Answer 20

A VMAT2 inhibitor that is FDA approved for tardive dyskinesia.

Question 21

How do you tell adjustment disorder from a normal stress reaction?

Answer 21

In adjustment disorder there is a functional impairment, while with a normal stress reaction there is no functional impairment (ex stressed out due to changes at work but is still getting work done, ect.).

Question 22

Can a 15 year old have oppositional defiant disorder?

Answer 22

Yes. A teenager who is defiant in multiple situations resulting in impairment (school suspension, ect) and who blames failings on others has ODD.

Question 23

What is REM sleep behavior disorder?

Answer 23

Motor movement/dream enactment that occurs during REM sleep if muscle atonia is absent. Patients can be awakened and become fully alert and remember the dream (contrast to non-REM disorders like sleepwalking or night terrors).

Question 24

What is nightmare disorder?

Answer 24

Recurrent awakenings from REM sleep associated with full alertness and dream recall. Contrasted from REM sleep behavior disorder in that there is no sleep motor movement, and from non -REM disorders like sleep terror and sleep walking where patients lack dream content and are slow to awaken.

Question 25

What symptoms characterize the early course of HIV-associated dementia?

Answer 25

Subcortical (basal ganglia). I.e. movement/gait disorder would be seen with HIV-associated dementia. Suspect in a patient with HIV, a CD4 count close to 200, and difficulty with smooth limb movement.

Question 26

What is the treatment of catatonia?

Answer 26

Benzodiazepines or electroconvulsive therapy.

Question 27

A patient who is immobile and mute whose arm stays in the same position (posturing) is suggestive of what?

Answer 27

Catatonia.

Question 28

What is the best next step for management of an acute manic episode with psychosis or escalating agitation (banging on door, ect)?

Answer 28

Administer an anti-psychotic.

Question 29

What is the best response to a gift given by a patient who has come in for psychiatric reasons?

Answer 29

Politely decline the gift (patient could have an unstable mental illness affecting their judgement, like a hypomanic episode in a patient who’s bipolar).

Question 30

What are the indications for hospitalization of a patient with anorexia nervosa?

Answer 30

Unstable vital signs (hypotension, bradycardia, ect), cardiac dysrhythmias, electrolyte derangement, and severely low body weight.

Question 31

How can parkinson disease dementia be differentiated from dementia with lewy bodies?

Answer 31

In parkinson disease dementia, parkinsonian/motor symptoms predate dementia symptoms by at least one year.

Question 32

What is the treatment of choice for adjustment disorder?

Answer 32

Psychotherapy.

Question 33

What is the first line therapy for anorexia nervosa?

Answer 33

Nutritional rehabilitation and CBT.

Question 34

Why should OTC cold medicines be avoided in very young children (ex. 4 years old)?

Answer 34

They can potentially cause confusion and hallucinations (1st generation anti-histamines, ect).

Question 35

What is a potential risk of anti-psychotic use for dementia with lewy body patients?

Answer 35

Extreme anti-psychotic hypersensitivity. Can present as confusion, worsening parkinsonism (rigidity, ect) and autonomic dysfunction (orthostatic hypotension, ect).

Question 36

In addition to causing serotonin syndrome, what electrolyte abnormality can be seen with MDMA intoxication?

Answer 36

Hyponatremia. Bath salts can also cause serotonin syndrome but are less likely than MDMA to cause hyponatremia.

Question 37

Does MDMA or bath salts show up on urine toxicology screening?

Answer 37

Both MDMA and bath salts may or may not be detected as amphetamines by urine toxicology screening.

Question 38

What psychiatric condition can high dose glucocorticoids precipitate?

Answer 38

Glucocorticoid induced psychosis.

Question 39

Which atypical anti-psychotics have the lowest low metabolic risk profile ? (i.e. safe for use in diabetics, ect).

Answer 39

Ziprasidone, aripiprazole, and lurasidone.

Question 40

What is the management of sleep terrors?

Answer 40

Reassurance, as they usually resolve within 1-2 years.

Question 41

What is consuming the same meal daily in a demented patient a possible sign of?

Answer 41

Compulsive behavior, which suggests the behavioral variant of frontotemporal dementia.

Question 42

Are long-acting injectable anti-psychotics appropriate first line agents for acute psychosis?

Answer 42

No. Oral anti-psychotics (preferably 2nd generation but 1st could be used) are indicated for cooperative patients. Injectables should only be considered if a pattern of non-compliance occurs afterwards.