Psych Flashcards
Eisler is one mechanism of action for prolactinemia
A) Dopamine blockade
B) THR
A) Dopamine blockade
Blockade of dopamine D2 receptors by typical antipsychotics and risperidone can cause hyperprolactinemia in males and females.
Teenager who had fainting episode after influenza immunization. Presents to ED with right arm stiffening and clinic movements of one limb for 5 min. Period of sleepiness after, but able to preserve protective reflexes. Normal neurological exam. Kid doesn’t seem troubled by this.
A. Somatization
B. Post concussion seizure
C. Conversion disorder
C. Conversion disorder
14 year old male presents to ED with right-sided arm movement, left sided leg twitches. Refuses to weight beat. No focal findings on abdomen. Protecting reflexes. Patient himself is not concerned with findings. What is the diagnosis ?
A. Somatization
B. Seizure
C. Conversion disorder
C. Conversion disorder
12 y.o boy breaking things at home, not listening to instructions, and skipping school. He seems angry. What is the next BEST step ?
A) parent training
B) start an atypical antipsychotic
C) start an SSRI
A) parent training
Management of ODD
Treatment usually consists of a combination of:
-parent-management training programs and family therapy
-cognitive problem-solving skills training
-social-skills programs and school-based programs
- medication
What makes you worried about starting fluoxetine on a teenager with depression:
A) History of cardiac surgery
B) History of anxiety
C) family history of bipolar disorder
D) family history of suicide
C) family history of bipolar disorder
16 year old boy with history of ADHD on Vyvanse. His mother notes him becoming more withdrawn and secretive over the past year, wanting to spend all his time in his room and away from friends and family, in his computer. She has also noted money missing from her purse and strange charges on her credit card from an unknown source. What should she do ?
A) increase his medication dosage
B) assess him for gambling problems
C) add a mood stabilizer
D) reassure
B) assess him for gambling problems
Evidence suggests that a considerable subset of problem gamblers have ADHD with characteristic features of impulsivity and sustaining attention. Two disorders interact on various levels. Ie; gambling impulses are poorly controlled and ADHD symptoms such as chronic boredom, depression and low self esteem are relieved by the stimulus and reward of gambling.
Boy with stable ADHD has been on a stable dose of stimulant for the last two years. Had started to become very aggressive when spoken to and gets easily frustrated when he doesn’t get what he wants. You’ve already ruled out psychosocial stressors. What do you want to do as your next step:
A) Benzo PRN
B) increase psychostimulant
C) Add SSRI
D) add atypical antipsychotic
B) increase psychostimulant
???? Need a resource
A 9 y.o boy has been refusing to go to school for the last 3 months. He becomes upset when discussing attending school and says he wants to be homeschooled.
A) Allow him to be homeschooled this year. Return to school next year.
B) Return to school immediately following gradual protocol and desensitization
C) Start Citalopram
D) Start Fluoxetine
B. Return to school immediately following gradual protocol and desensitization.
The parents of a 16 y.o boy found him threatening to kill himself with a knife. He has recently had a significant decline in school performance. He complains of hearing voices. Feels weird for minutes to hours. Family history of of depression and suicide. Likely diagnosis ?
A. Drug abuse
B. Depression
C. Schizophrenia
D. Brain tumor
C. Schizophrenia
- no indication that pt is presenting sx of depression
- almost any other psych disorder among first degree relatives increases the individuals risk of schizophrenia
16 year old girl. Failing in school, used to be straight A student. Decreased need for sleep. Recently buying clothes. Family hx of suicide and depression. How do you treat?
A.Lithium
B. Fluoxetine
C. Clonidine
Answer A - but an atypical antipsychotic would be better answer
Bipolar disorder
A 16 y.o boy admits to recently having repetitive thoughts of violence. He has impulses to act on these, but is able to hold off doing so. What diagnosis is most likely ?
A). Schizophrenia
B) Behavioural problem
C) OCD
D) Antisocial personality
Answer C- OCD - schizophrenia is usually egodystonic aka they don’t realize they have those thoughts or can suppress them
A 13 year old boy with type 1 diabetes tells his parents that he hopes his diabetes kills him because he doesn’t want to live anymore. He’s had a lower appetite the last few months (? Also said sleeping more). Psychiatry has assessed him and feels he is not at an acute risk of self harm. What is the best thing to do now to ensure his safety?
A. Fluoxetine
B. Admit him
C. Parents to prevent constant supervision
D. Parents to take over control of his insulin injections
D. Parents to take over his insulin injections
- fluoxetine will take 4-6 weeks to take effect
- no need for hospital admission if no acute/active suicidality and distress or functional impairment the paediatrician can schedule a f/u appt within 1-2weeks
- best thing to do NOW for safety is to control insulin injections
Teen is on Sertraline. She is experiencing unwanted side effects and would like to stop. What should you do ?
A. Stop cold turkey
B. Wean gradually to avoid withdrawal
C. Wean gradually to avoid serotonin syndrome
D. Switch to a benzo
B. Wean gradually to avoid withdrawal.
8 year old girl with hx of asthma. She has missed 10 days of school this spring as she wakes up with a “tight” chest in the am. She has been able to continue with no problems for extracurricular activities.
What is the diagnosis ?
A. Generalized anxiety disorder
B. Separation anxiety disorder
C. Chronic asthma
D. Chronic bronchitis
B. Separation anxiety disorder
- in this case unlikely to be GAD as sx only occur in the AM and do not seem to interfere with other activities; and unlikely to be asthma as sx in AM and no problems with activity
A 13 y.o boy has become more withdrawn over the last year and seems only interested in his friends and his computer. He has difficulty waking up in the morning and seems tired. He has difficulty waking up in the morning and seems tired. Which is the next step in management ?
A. TSH
B. Tox screen
C. Refer to psychology
Controversial: c. Refer to psychology vs reassure (not listed)
None of these - this is normal
Teenage behaviour. Key to knowing it’s normal is “interested in his friends”. If it said ‘ not interested in friends’ - that would be more concerning. Tired in the morning - not red flag for teenager. Answer likely remembered wrong is “reassurance” or “do nothing”
A 12 year old girl has been uninterested in activities she usually enjoys over the last 9 months. She has had less energy than usual and has had a decreased appetite. In addition to CBT, which of the following is the most appropriate treatment for her ?
A. Lithium
B. Fluoxetine
C. Amitryptiline
B. Fluoxetine
13y.o F in foster care has been losing weight, decreased appetite, and occasional emesis. On exam you see that she is pale and has patchy areas of hair loss. What is the most likely diagnosis ?
A. Trichobezoar
B. Anorexia nervosa
C. Celiac disease
D. Lead poisening
A. Trichobezoar
An adolescent female presents to the ER because her mother found out that she has been making superficial cuts on her arms. What would reassure you that she is not suicidal ?
A. The cutting makes her feel better
B. Her boyfriend just dumped her
Or
Teen who has tried cutting herself a lot - what would make you LEAST worried about suicide? A. She was cutting to get relief of sx B. Sleeping x 2 weeks C. Using marijuana D. Boyfriend just broke up with her
A. The cutting makes her feel better
13 year old boy with several episodes of irritability, swearing a lot, difficulty sleeping over the last 2 years. He has gotten into trouble at school because of them and has been suspended. What do you treat him with ?
A. Clonidine
B. Methylphenidate
C. Valproate
D. Fluoxetine
Controversial question - I am going with D) fluoxetine
- would be used for depression./anxiety
- sx of irritability and difficulty sleeping = depression or anxiety; less likely to be a/w searing
- sx of irritability and seating = disruptive mood dysregulation disorder but not sleeping difficulties
A. Clonidine - would be used for tax of : ADHD/aggression, disruptive behaviours in ODD
B. MPH= would be used for tax of ADHD, but sx not in keeping with this dx
C. Valproate = can be used for bipolar. First line is antipsychotics, then lithium, valproate would only be used as adjunctive tx. Sick kids worrying about bipolar dx.
Boy writing out his sentences by going over the letters 3 times, what does he have ?
A. OCD
B. Anxiety
C. ADHD
A. OCD
Mother of 13 y.o boy comes to your office presenting with concerns about his behaviour. He stays in his room, not active in sports, and his school performance has declined. He likes working on his computer and being with his few friends. His physical exam is normal. He states he has smoked before, but denies alcohol use. What is the most appropriate management?
A. Reassure
B. Toxicology screen
C. TSH
D. Psychological assessment
Controversial: psychological assessment vs reassure
What is the greatest risk for suicide attempt?
A. Living alone
B. Prior spontaneous suicide attempt
B. Prior spontaneous suicide attempt
13 year old girl sleepless, distractible, irritated, wears provocative clothing, spends more money. Dad worried. Maternal history of suicide attempt. Brother has ADHD. What would you recommend?
A. Lithium
B. Fluoxetine
C. Stimulant
D. Substance abuse treatment program
A. Lithium - first line is atypical antipsychotic for bipolar.
Kid with ODD. What do you suggest for management ?
A. Start Risperidone
B. Start stimulant medication
C. Parent skills training
D. Put him in a “special Program” (don’t remember how they worded it )
Answer: C parent skills training
15 year old girl has a headache, then syncope at school for several minutes. She is brought to hospital. Can’t walk because of numbness in her legs. Exam is normal, plantar reflexes normal, DTR normal. Initial loss of sensation to L4, the next day she has sensation to S1. Able to walk leaning heavily on your hands, feet spaced 8cm apart. What is your next step in management?
A. EEG
B. MRI head and spine
C. Confrontation and explanation that her symptoms are not organic
D. Patient should be included in management
D. Patient should be included in management - conversion disorder
Child with complex medical history and all examination is normal. Complaints of abdo pain for 1 hour in the morning but resolved quickly. Is ok to play soccer. What do you tell the child to do ?
A. Go back to school, doesn’t matter about the pain
B. Home school
C. Get the needed school work and then go back when the pain is gone
D. Don’t need to go to school
A. Go back to school, doesn’t matter about the pain
Functional abdominal pain/separation anxiety.
Male bully, has used a knife, picks fights
A. Conduct disorder
B. ADHD
C. Antisocial personality disorder
A. Conduct disorder
5 year old girl with rapid onset episodes characterized by intense fear and discomfort lasting a few minutes to a few hours. Which of the following will help establish the diagnosis:
A. Episodes occur post specific anxiety provoking situations
B. Previous emotional trauma
C. Episodes occur unexpectedly and she would fear more of these episodes
D. Obsessions and compulsions
Answer C. Episodes occur unexpectedly and she would fear more of these episodes
Parents are divorcing and would like you to give them guidance
A. Joint custody decision at this time is most important
B. Sole parental custody is best
C. Boys fare better than girls in their psychological adjustment
D. Parental emotions discordance can have big impact
D. Parental emotions discordance can have big impact
7 y.o male, separation anxiety, spends time with mother, refuses to go to school. What to do ?
A. Send back to school immediately
B. Send back to school gradually, with mom going to school
C. Give SSRI and send back to school
Or
Child has history of separation anxiety and is having difficult time going to school.
A. Graded exposure, and gradually prolong parents leaving
Controversial question
A. Send back to school immediately - lecturer said depends how long it’s been going on
So maybe A or B depending on timeline
Gen says A - mom should not go to school with him
Parents, children and divorce - what is true ?
A. Males respond better to divorce in the immediate post divorce period than females
B. CHildren do better in a 1 parent custody setting without seeing the other parent
C. The best predictor of the child’s response is post separation parental conflict and depression rather than custody issues
A- AAP Divorce and Adjustment of
Children - meta analysis indicate few consistent effects of age at the time of the divorce and only scattered effects for sex
B. CPS statement of supporting mental health of children and youth separating parents:
Children whose parents effectively share joint custody tend to be better adjusted after separation or divorce
C. CPS statement: the three most significant factors that impact children’s well- being during the process of parental separation or divorce are: the quality of parenting; the quality of parent- child interaction; and the degree, frequency, intensity and duration of hostile conflict.
Boy with ++ worries about his mom, then walks to school and steps over cracks but if he doesn’t he has to walk around a car three times. What would be most helpful for him ?
A. Desensitization
B. Fluoxetine
Or
Young boy who constantly worries about his mother’s safety, and always late for school because he worries about his mother. Other features of OCD like taking long route home to avoid dog etc. Etc. Management ?
A. Fluoxetine
B. Family therapy
C. Desensitization
Answer: Desensitization
Debated question. His OCD sounds pretty bad so I don’t think starting meds would be wrong but some some sort of CBT would be best. So if that is what they mean by desensitization then ok.
11 year old with severe symptoms of separation anxiety. Very worried about something happening to his parents (and to him). Best treatment ?
A. Desensitization
B. SSRI
C. Parent therapy
Answer: desensitization
Controversial some say c or b as well.
CBT should be first
Describe a kid who has a change in behaviour over the last year. No longer gets As. Not interested in sports. Parents divorced 2 years ago. Picks on sister. Most likely diagnosis ?
A. Adjustment disorder
B. Major depressive disorder
C. Substance abuse
D. ADHD
Answer: ?
A. Adjustment disorder - has to be symptoms are < 6 months from stressor
B major depressive disorder - need > 5 more symptoms in a 2 week period but only 2 in question
- diminishes interest
- diminished concentration - bad grades
C. Substance abuse - maybe
Depressive teen on medication. What is likelihood of recurrence of symptoms in the following 2 years ?
A. 5%
B. 10%
C. 40%
D. 70 %
Answer: C - 40%
Depression has a high rate of recurrence, reaching 20-60% by 1-2years after remission and up to 70% after 5 years of remission.
Teachers are worried about a child who is shy, has no friends, does not generate conversation spontaneously, does not make eye contact with teacher, and plays on his own. At home, mother is not as concerned, as he speaks to both his parents all right. Diagnosis ?
A. Selective mutism
B. Autism
C. Language delay
A. Selective mutism
17 y.o girl who is very socially inhibited and gets very upset with criticism, and is very sensitive about herself. Her diagnosis is:
A. Avoidant personality disorder
B. Anxiety disorder
C. Schizophrenia
D. Specific phobia
Controversial:A. Avoidant personality disorder (MAC)
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts
But diagnosis can only be given if > 18 = looked it up
And you can diagnose avoidant personality disorder under 18 if traits are pervasive, persistent and unlikely limited to a particular developmental stage or an episode of an Axis 1 disorder. To dx you need to have features present for 1 year
Vs
B- anxiety disorder (CHEO)
Social anxiety (social phobia)
10 y.o boy knifes cars, doesn’t listen to parents, very disruptive in classroom and has been in trouble legally. Most likely diagnosis ?
A. Anxiety
B. Depression
C. Oppositional defiant disorder
D. Conduct disorder
D. Conduct disorder
Some kid is getting in fights starting at 8 years of age. Now carrying a knife around. Has been charged for stealing and arson (but he isn’t killing cats)
A. Oppositional- defiance disorder
B. ADHD
C. Conduct disorder
D. Behaviour disorder
C. Conduct disorder
Father comes to you regarding concern over 13 year old’s behaviour recently. Parents just separated. Brother has ADHD and mother has depression. Girl has declining school performance, buys provocative clothing and swears a lot. She is in attentive most days. You would most likely prescribe:
A. Methylphenidate
B. Fluoxetine
C. Lithium
D. CBT
C. Lithium (MAC answer)
Vs D - CBT (cheo answer)
-would need more information to be able to say wether or not this is bipolar disorder
Rebecca’s group felt that this was bipolar- don’t feel like this is enough information to diagnose mania
