Psych Bootcamp Flashcards
58 yo old woman with symptoms of depression, including hopelessness and anxious feeling since she lost her husband 12 months ago. physical exam and labs are normal. Which one of the following is a reasonable choice for her? -olanzapine (Zyprexa) -risperidone (Risperdol) -quetiapine (Seroquel) -clonazepam (Rivotril) - venlafaxine (Effexor)
Venlafaxine
SSRI First Line
SNRI and NDRI also good
Olanzapine atypical antipsychotic
Risperidone antipsyhotic
Patients with gender identity disorders often have a history of -cross-dressing in childhood -child abuse -chromosomal anomalies -previous homosexual behavior. - late onset of puberty.
Cross dressing in childhood
The basic mechanism of defense in phobic reactions is
-displacement.
-sublimation.
-splitting
-isolation.
-projection
Displacement
38 yo old man washes his hands 60 times a day. He checks the doors, windows, and stove at least a dozen times before retiring for the night.He is requesting help with medication to stop the urge. Which one of the following is the most likely diagnosis?
-obsessive-compulsive personality disorder
-obsessive-compulsive disorder
-schizotypal personality disorder
-social anxiety disorder
paranoid disorder
OCD
with personality disorder, no insight. Also impairment in function
26 yo-old female with depression presents with restlessness, agitation and nausea. She was recently switched from escitalopram (SSRI) to phenelzine (MAOI). Her bp is 140/90 mmHg and she is tachycardic and febrile(t-38). Her neurological examination is normal except hyperreflexia and myoclonous. What is the most likely diagnosis? - akathisia - Serotonin withdrawal - hypertensive crisis - neuroleptic malignant syndrome - serotonin syndrome
Serotonin syndrome (myoclonus)
Serotonin also loves the GI tract
What class of drug is phenelzine
MAOI
In which one of the following situations would it be unethical for the psychiatrist to break confidentiality and notify the authorities?
- The psychiatrist believes that the patient is actively suicidal.
- The patient has aggressive fantasies.
- The patient has severely impaired judgement and is in a responsible position, e.g. an airline pilot.
- The patient has taken a significant overdose.
- The psychiatrist believes that the patient will probably commit murder.
Aggressive fantasies
37-yo old man has been preoccupied with back pain for the past year. He mentioned it as severe and incapacitating. There is a history of minor injury 18 months ago. The patient has visited many doctors, constantly requesting medication; no abnormal physical findings have emerged. The most likely diagnosis is
-posttraumatic stress disorder.
-somatoform pain disorder.
-delusional disorder.
-hypochondria.
-dysthymia.
somatoform pain disorder
no dysthmymia is now persistent depressive disorder.
A major distinguishing factor between schizophrenia and acute organic brain syndrome (delirium) is
-difficulty in maintaining attention.
-inappropriate affect.
-fluctuation of consciousness.
-concrete interpretation of proverbs.
-hallucinations.
Fluctuation of consciousness`
A man is indignant when his graduate school thesis committee refuses to approve his project. "They're just jealous of me because they know I'll be the most brilliant anthropologist in history," he remarks. He has had this attitude all of his life. Which one of the following is the most likely diagnosis? -antisocial personality disorder -borderline personality disorder -schizophrenia -bipolar disorder -narcissistic personality disorder
Narcissistic
Korsakoff psychosis is characterized by which one of the following?
visual hallucinations and memory impairment
confabulation and altered levels of consciousness
auditory hallucinations and altered levels of consciousness
confabulation and memory impairment
visual hallucinations and altered levels of consciousness
Confabulation and memory impairment
Medical complications of bulimia nervosa include all of the following, EXCEPT esophagitis. hypokalemia. dental abnormalities. parotid gland enlargement. metabolic acidosis.
Metabolic acidosis
Which one of the following is the most effective method of treatment for patients with pathological gambling disorders? -self-help group therapy -Psychodrama -family therapy -individual therapy -activity group therapy
Individual therapy
28 year-old man presents with bizarre delusions, a blunted affect, and tangential thought processes. Which one of the following characteristics indicates a poor prognosis?
- a family history of schizophrenia
- magnetic resonance imaging (MRI) that shows no significant changes in brain morphology
- a sudden onset of symptomatology
- catatonic symptomatology
- an extensive premorbid history of social withdrawal
premorbid history of social withdrawal
25 year-old unconcious man is brought into the emergency room with pinpoint pupils, depressed respiration, and no sign of physical trauma. Laboratory results are pending. He receives intravenous glucose without response. Which of the following is the most appropriate drug to administer next?
Amphetamine diazepam physostigmine naloxone atropine
naloxone
Pinpoint pupils; OPiods (reverse with naloxone), cholinergic toxidrome (organophosphates)
Antidote for cholinergic = atropine or 2PAM
60 year-old man 3 days following cardiac bypass surgery. He appears confused, seems to think he is on a cruise ship and describes seeing a burglar is trying to get in through the window of his room. He describes the appearance of this person in vivid details. Which one of the following is this patient experiencing? -compulsions -flight of ideas -hallucinations -delusions -obsessional thoughts
hallucinations
Day three very common to get delirium tremens.
DT doesn’t occur until after 48h of last drink.
Hallucinations can be delirium tremendous.
Use benzo’s (they inhibit GABA
55 year-old man with history of alcohol abuse comes to the emergency room of a general hospital. He is confused and on examination is noted to have palsies of conjugate gaze, horizontal nystagmus, and ataxia. Which one of the following is the most likely diagnosis? alcohol intoxication delirium tremens alcohol hallucinosis Wernicke's encephalopathy conversion reaction
Wernickes Encephalopathy
Prevented with thiamine (B1)- usually needs 2 weeks of thiamine dosing.
for prevention of werknickes 3d of thiamine.
Which one of the following populations is at greatest risk of completed suicide? females over 45 years of age females age 14 to 18 females under 14 years of age males age 14 to 18 males over 45 years of age
Males over 45
A 22-yo-old university student is brought to the emergency room after trying to smash a computer at university lab. He says the computer is being used to control his thoughts and Canadian Security Intelligence Service is behind this. This patient is exhibiting which one of the following? - delusions -Obsessions -visual hallucinations -Ruminations -auditory hallucinations
Delusions
23 year-old man is brought to the emergency room after being found unresponsive in park. Physical examination reveals pinpoint pupils unresponsive to light and a respiratory rate of 7 breaths per minute. Which one of the following is the most likely cause? hydromorphine overdose lead intoxication arsenic poisoning alcohol intoxication tricyclic antidepressant overdose
hydromorphone overdose
30 year-old woman reports episodic feelings of sadness since adolescence.Occasionally she feels good, but these periods seldom last more than 2 weeks. She is able to work but thinks she is not doing as well as she should.she seems to focus more on repeated disappointments in her life and her low opinion of herself than on discrete depressive symptoms. In your differential diagnosis at this point, which one of the following is the most likely diagnosis? -adjustment disorder with depressed mood -childhood depression -cyclothymia -dysthymia -major depression with melancholia
dysthymia
for major depressive episode have to have at least 5 sx of SIGECAPS
Therapy; SSRI and psychotherapy
27-year-old woman with depression repeatedly talks about irrelevant topics when being interviewed by a psychiatrist. Which one of the following symptoms is the patient demonstrating? denial Resistance introjection Repression suppression
repression
38 year-old man mentions he is feeling somewhat down and in conflict with his wife. And he has always been rigid; he is a conscientious hard worker at his employment. he is dressed very neatly , he rambles and provides details personal history. The most likely personality type is narcissistic. dependent. obsessive-compulsive. self-defeating (masochistic). passive-aggressive.
oCPD
38 year-old man mentions he is feeling somewhat down and in conflict with his wife. And he has always been rigid; he is a conscientious hard worker at his employment. he is dressed very neatly , he rambles and provides details personal history. The most likely personality type is narcissistic. dependent. obsessive-compulsive. self-defeating (masochistic). passive-aggressive.
oCPD
19 year old man has withdrawn to the basement of his house because he believes he is the subject of a conspiracy to kill him and that the home is under surveillance by mafia. Which of the following is the most likely diagnosis?
Antisocial personally disorder Obsessive- compulsive disorder Schizophrenia Delirium Bipolar disorder- manic phase
schizophrenia
36 year old woman she has been experiencing palpitations, dizziness, shortness of breath, a feeling of impending doom and a fear of dying for 3 to 4 months. Which of the following would be the most appropriate initial step in managing this patient?
Prescribe benzodiazepines Refer the patient to a psychiatrist Perform a physical examination Teach relaxation techniques Offer psychotherapy
pe
A depressed patient is mostly likely to commit suicide when
The patient is staring to recover from the depression
The patient becomes physically ill
The patient receives bad news or disappointment
The patient has completed a course of electroconvulsive treatments
The depression is most profound
starting to recover
47 year old man complains of the several months history of worrying about his health, increased desire to sleep, demoralization, and difficulty focussing attention on tasks. Which one of the following is the most likely diagnosis?
Somatization disorder Depression Generalized anxiety disorder Chronic fatigue syndrome Schizoid personality disorder
depression/? GAD
28 yo old man is very angry with his co-workers and describe fantasies of driving to work and punching them up. Which one of the following is the most warning sign that he may take action?
The presence of temporal lobe epilepsy The presence of the persecutory delusions A history of alcohol abuse A history of violence A lack of anxiety
A history of violence
25 yo old woman comes 10 days after the death of her father describes many memories of her father and says that she is tearful occasionally and having some trouble falling asleep. She returned to work 4 days after her father’s death. Proper treatment for this patient should consist of which of the following?
- Long term psychotherapy
- A longer period of time away from work
- Referral for further psychiatric evaluation
- Conservative, supportive treatment
- Administration of antidepressant agents
Conservative, supportive tx
27 yo old man is hospitalized after weeks of the worsening psychosis. He is given thiothixene, an antipsychotic medication. Five days later, he develops a fever of 39.8 C, become delirious and lies stiffy in his bed. His family reports that he had been physically well before his admission. Which one of the following diagnosis is most immediate concern?
- Viral meningitis
- Ruptured cerebral aneurysm
- Neuroleptic malignant syndrome
- Unsuspected opioid dependence
- Tardive dyskinesia
neuroleptic malignant syndrome; complete dopamine blockade
20 year old college student broke up with her boyfriend 3 days ago. She now complains of depressed mood, anxiety , difficulty concentrating on studies, and preoccupation with “mistakes” she made in the relationship. Which one of the following is the most appropriate treatment at this time
- Diazepam
- Psychotherapy
- Phenelzine
- Thioridazine
- Desipramine
psychotherapy.
adjustment disorder is the cause.
does not require medication.
