Psych Uworld

Question 1

adjustment disorder vs GAD timeline

Answer 1

adjustment disorder occurs within 3 months of a stressor

GAD for greater than 6 months

Question 2

acute stress disorder vs PTSD

Answer 2

ASD: more than 3 days less than 1 month
PTSD: longer than 1 month

Question 3

pt on antipsychotic develops restlessness, consider ?

how to treat?

Answer 3

akathisia

reduce antipsychotic dose and give B-blocker, benztropine, or a benzo

Question 4

differentiating feature between normal aging and dementia

Answer 4

loses ability to perform ADLs, loses social interest, may get lost in familiar territory

Question 5

neuropathic abdominal pain, +/- vomiting, +/- constipation, sensory/motor neuropathies, anxiety, mood changes think ?
how to dx?

Answer 5

acute intermittent porphyria (AIP)

dx: urinary porphobilinogen

Question 6

shizo timeline

Answer 6

brief psychotic disorder: more than 1 day-1 month

shizophreniform: 1 month to 6 months
schizophrenia: more than 6 months

Question 7

what is acute dystonia?

how to treat?

Answer 7

sudden, sustained contraction of neck, mouth, tongue, eye muscles
tx: benztropine or diphenhydramine

Question 8

what is akathisia?

how to treat?

Answer 8

subjective restlessness

tx: B-blocker (propranolol) or benzo (lorazepam)

Question 9

what is parkinsonism?

how to treat?

Answer 9

gradual onset tremor, rigidity, bradykinesia

tx: benztropine or amantadine

Question 10

what is tardive dyskinesia?

how to treat?

Answer 10

dyskinesia of mouth, face, trunk, extremities
gradual onset after prolonged therapy (6+ mos)
tx: no definitive tx, but switching to clozapine may help

Question 11

test to get before lithium treatment

Answer 11

creatinine, thyroid function test

causes: nephrogenic diabetes insipidus, nephrotoxicity, hyperparathyroidism with hypercalcium, thyroid dysfunction

Question 12

NMS s/s

Answer 12

severe muscle rigidity, AMS, autonomic instability, high fever, elevated CK, leukocytosis

Question 13

paranoid delusions and auditory, visual and tactile hallucinations, weight loss, tooth decay, excoriations think ?

Answer 13

methamphetamine abuse

Question 14

bipolar disorder: can you discontinue lithium?

Answer 14

not typically, as BP requires long-term maintenance as it has high recurrence

Question 15

hallucinations, euphoria, increased sexual desire, HTN, tachy, hyperthermia, serotonin syndrome, hyponatremia, think?

Answer 15

ecstasy (MDMA) intoxication

synthetic amphetamine

Question 16

how long to continue SSRI?

Answer 16

if single episode of MDD: additional 4-9 months rolling acute response
recurrent, chronic, severe episodes: 1-3 yrs or indefinitely

Question 17

second gen antipsychotic with higher risk increased PRL

Answer 17

risperidone

Question 18

1st line for alcohol use disorder

Answer 18

naltrexone: mu-opioid receptor antagonist
contraindicated in pts taking opioids and pts with acute hepatitis or liver failure
decreases craving and heavy drinking

acamprosate: glutamate modulator; only used once pt is abstinent to maintain abstinence

Question 19

indicator of TCA intoxication severity

Answer 19

QRS duration greater than 100 msec

Question 20

meds for treatment of acute bipolar depression

Answer 20

quetiapine and lurasidone (2nd gen antispsychotics)
also: lithium, valproate, combo of olanzapine and fluoxetine
avoid antidepressants alone

Question 21

syndrome seen in severe psych and medical illness characterized by immobility, mutism, posturing
how to treat?

Answer 21

catatonia

benzos and ECT