psych

Question 1

How should you confirm positive urine drug screens?

Answer 1

Gas chromatography and mass spectrometry

Question 2

What is the most common fatal complication with use of inhalants in teenagers ?

Answer 2

Cardiac arrhythmias

Question 3

What diagnosis should you consider in a patient with agitation and ataxia who has hydrocarbon smell on breath, but urine tox screen is negative?

Answer 3

Inhalant use

Question 4

What can occur with chronic use of inhalants?

Answer 4

Encephalopathy

Question 5

What type of drug use should you consider in a patient who is combative with muscle rigidity, vertical & horizontal nystagmus? What would you expect the pupils to be like?

Answer 5

PCP - normal pupils

Question 6

What type of drug use should you expect in a combative patient with tachycardia, tremors, HTN and dilated pupils? (2 answers)

Answer 6

Cocaine

Amphetamines

Question 7

What type of drug use should you consider in a combative and agitated patient without tremors and with a normal heart rate? (2 answers)

Answer 7

Opiates

Alcohol

Question 8

What are 4 psychological consequences with marijuana use?

Answer 8

Learning problems
Poor problem solving skills
Memory impairment
Worsening anxiety/depression

Question 9

what are 4 acute physical signs of marijuana use?

Answer 9

Dry mouth
Dilated pupils
Drowsiness
Distortion of time

Question 10

What are 3 chronic effects of marijuana use?

Answer 10

Pulmonary compromise
Tachycardia
Gynecomastia

Question 11

What are 4 additional signs you may find in a teenage patient who presents with ataxia, slurred speech, visual disturbance and vomiting ? What is the likely diagnosis ?

Answer 11

Sluggish pupils
Excessive sweating
Flushed skin
Hypoglycemia 
*alcohol toxicity*

Question 12

What symptoms occur with opiate overdose in regards to 1. Breathing, 2. Blood pressure, 3. Temperature, 4. Stooling/urination, 5. Pupils?

Answer 12

1. Respiration depression/arrest
2. Hypotension
3. Hypothermia
4. Constipation/urinary retention
5. Miosis

Question 13

What are the possible causes of death in patients with severe opioid overdose? (3 answers)

Answer 13

Respiratory arrest
Circulatory collapse
Seizures

Question 14

What should you suspect in a patient with anxiety, rhinorrhea, insomnia and stomach cramps?

Answer 14

Opioid withdrawal

Question 15

What are the signs of amphetamine abuse in regards to vitals and pupils? What psych finding is specific to amphetamine use?

Answer 15

Tachycardia 
Hypertension 
Hyperthermia
Sluggish dilated pupils 
*feeling insects crawling on skin

Question 16

What are the signs of barbituate overdose in regards to vital signs, bowel sounds and pupils?

Answer 16

Bradycardia
Bradypnea 
Hypotension 
Hypothermia 
Hypoactive bowel sounds 
Normal pupils with slow pupillary reflex

Question 17

What drug would you expect to be the cause of paranoia, agitation, hallucinations and distorted body image?

Answer 17

Pcp

Question 18

What are the affects on HR, BP, reflexes and the pupils in a patient using PCP?

Answer 18

Tachycardia
HTN
Increased reflexes
Miosis

Question 19

What are two things that should not be done in a patient suspected of PCP intoxication and why?

Answer 19

Do not acidify urine (precipitates myoglobin)

Do not use restraints (rhabdomyolysis)

Question 20

What happens to HR and BP in patients using cocaine and how would you treat these patients ?

Answer 20

Hypertension & tachycardia - nitroprusside

Question 21

What are 4 serious complications of cocaine abuse ?

Answer 21

Myocardial infarction
Stroke
Rhabdomyolysis
Renal failure

Question 22

What is a sign of chronic cocaine abuse?

Answer 22

Choreoathetotic movements due to dopamine depletion

Question 23

What are 5 organic causes of enuresis ?

Answer 23

Sickle cell trait 
UTI
Diabetes
Seizure 
Sacral simple? (tethered cord)

Question 24

What is the appropriate short term treatment for nocturnal enuresis? Why is imipramine no longer used?

Answer 24

Intranasal desmopressin

*imipramine associated with overdose

Question 25

What are 4 possible organic causes of daytime enuresis after age 3?

Answer 25

UTI
Diabetes mellitus
Diabetes insipidus
Kidney disease

Question 26

What is the condition in with symptoms are not compatible with any medical cause but symptoms are not faked ?

Answer 26

Conversion disorder

Question 27

What is the belief that something is wrong with oneself but takes on psychotic dimensions (such as “my pancreas has wings”)?

Answer 27

Somatic delusions

Question 28

By what age should infants be able to sleep through the night?

Answer 28

4 months

Question 29

What condition causes children to awaken during the first 1/3 of the night with sweating, tachycardia and tachyons but they are disoriented and don’t recall what occurred? What should be done in this situation ?

Answer 29

Night terrors - do not intervene. Make sure the environment if safe to prevent injury to self. Benzodiazepines may be used to decrease slow wave sleep frequency

Question 30

What are some things a pediatrician must do after an international adoption?

Answer 30

Verify vaccines
TB screening 
CBC, lead
?hep B, HIV, syphilis, hep C
Vision/hearing screen
Developmental assessment Q3 months

Question 31

How would you monitor for discontinuation of marijuana use ?

Answer 31

Serial urine THC:creatinine ratio