Psychiatry

Question 1

First line management of an acute panic attack

Answer 1

Benzos like alprazolam after other life threatening conditions have been ruled out

Question 2

First line management of panic disorder

Answer 2

SSRI like sertraline, citalopram, fluoxetine, adding cognitive behavioral therapy to this is most effective

Question 3

Agoraphobia definition

Answer 3

Intense fear or anxiety about being in places or situations from which escape or obtaining help may be difficult and causing significant social or occupational dysfunction, managed best with CBT and SSRIs

Question 4

Adjunctive medication for generalized anxiety disorder

Answer 4

Buspirone is ann adjunct to SSRI’s and does not cause sedation

Question 5

Management of specific phobias

Answer 5

Exposure and desensitization therapy

Question 6

Only antidepressant approved for treatment of bulimia

Answer 6

Fluoxetine

Question 7

Buproprion function

Answer 7

Major depressive disorder and smoking cessation aid, has less sexual dysfunction and weight gain compared to SSRI’s

Question 8

Seratonin syndrome treatment (mild vs moderate)

Answer 8

Mild is supportive care, moderate is cyproheptadine (serotonin antagonist)

Question 9

Greatest risk factor for bipolar i disorder

Answer 9

Family history

Question 10

Acute mania most effective treatment

Answer 10

Antipsychotics like risperidone or olanzapine OR mood stabilizers like lithium and valproic acid

Question 11

Is lithium contrainidcated in pregnancy?

Answer 11

YES, and it should be used with caution in renal disease alongside nsaid or diuretic use

Question 12

Hypomania (characteristic of bipolar ii alongside major depressive disorders) differs from mania of bipolar i how so?

Answer 12

It doesn’t require hospitalization, is not associated with marked social/occupational function or psychotic features

Question 13

Cyclothymic disorder definition

Answer 13

Similar to bipolar II but less severe, approximately 1/3 will eventually develop bipolar disorder

Question 14

Highest risk for suicide in the US

Answer 14

Elderly white men

Question 15

Oppositional defiant disorder vs disruptive mood dysregulation disorder

Answer 15

-ODD is associated with intent behind behavior, while children with DMDD do not do it on purpose and may feel remorse after outburst

Question 16

Management of conduct disorder, oppositional defiance disorder, disruptive mood dysregulation disorder

Answer 16

Behavioral modification, community and family involvement, parental training

Question 17

Oppositional defiant disorder vs conduct disorder

Answer 17

-Oppositional defiant disorder sees children generally defiant to authority but is NOT associated with physical aggression, violating other’s basic rights, or breaking laws

Question 18

Dissociative identity disorder

Answer 18

Presence of 2 or greater distinct identities or state of personalities that take control of behavior, gaps in recall of events may occur throughout daily events, may be associated with history of sexuala buse

Question 19

Binge eating disorder differs from bulimia in that…

Answer 19

…it lacks compensatory behaviors like purging or restriction

Question 20

Weight of bulimia vs anorexia patients

Answer 20

Bulimic patients can usually maintain a normal weight or are overweight while anorexia is failure to maintain a normal body weight

Question 21

Highest mortality of any psychiatric condition

Answer 21

Anorexia nervos

Question 22

Difference between OCD and OCPD

Answer 22

OCD is ego dystonic (causes distress to patient and their worldview) while OCPD is ego syntonic (the patient doesn’t see anything wrong with their behaviors, OCPD is preoccupation with order, details, perfectionism without obsessions or compulsions

Question 23

OCD treatment

Answer 23

CBT and SSRI first line pharmacotherapy (paxil is best maybe?)

Question 24

Trichotillomania treatment

Answer 24

CBT habit reversal therapy

Question 25

ADD is highly associated with what other comorbid condition?

Answer 25

Conduct and oppositional defiant disorders

Question 26

Diagnostic criteria for ADD

Answer 26

-symptom onset before 12 years of age and present for at least 6 months, musc occur in 2 settings (home and school), must have at least 6 inattentive and 6 hyperactive/impulsive symptoms

Question 27

Management of ADD (3)

Answer 27

- First line is stimulants (methylphenidate, amphetamine) - nonstimulants like atomoxetine (norepi reuptake inhibitor) has similar efficacy and adverse profile and is good alternative - alpha agonists like guanfacine and clonidine are options as adjuncts

Question 28

Symptoms of autism spectrum disorder

Answer 28

Symptoms recognized between 12-24 months, social interaction difficulties, impaired communication, restricted, repetitive, stereotyped behaviors

Question 29

Schizoid personality disorder definition

Answer 29

Lifelong pattern of voluntary social withdrawal and anhedonic introversion, loner introverted hermit like behavior managed with psychotherapy first line

Question 30

Schizotypal personality disorder definition

Answer 30

Characterized by odd, eccentric, bizarre behavior and thought patterns suggestive of schizophrenia but without psychosis (no delusions or hallucinations), has magical thinking, distorted cognition and reasoning, first line management is psychotherapy

Question 31

Borderline personality disorder definition

Answer 31

Unstable unpredictable mood, self image, and relationships, has intense fear of abandonment, intense reactions disproportionate to event, impulsivity in self damaging behaviors, CBT is management

Question 32

Avoidant personality disorder definition

Answer 32

Social inhibition due to intense fear of rejection affecting daily lives, timid, shy, lacks confidence, unwilling to interact with others unless certain of being liked, inferiority or inadqueacy complex, averseness to participate in new activiites for fear of rejection or embarassment, psychotherapy is management

Question 33

Dependent personality disorder definition

Answer 33

Characterized by inability to assume responsitiblity, dependent or submissive behavior, fear of being alone and difficulty making day to day decisions, needing to be taken care of, clingy or needy behaviors, managed with psychotherapy

Question 34

Delusional disorder definition and how is it managed?

Answer 34

Fixed belief despite evidence to contrary, either bizarre or non bizarre (feasible but highly unlikely), without other psychotic symptoms or significant impairment in function Atypical 2nd generation antipsychotics first line medical management

Question 35

Schizophrenia vs schizophreniform vs schizoaffective disorder vs brief psychotic disorder

Answer 35

Schizophrenia is characterized by positive symptoms, negative symptoms, grossly disorganized or catatonic behavior for at least six months, schizophreniform is between 1-6 months, schizoaffective disorder is schizophrenia plus a mood disorder (major depressive or manic episode), brief psychotic disorder is 1 psychotic symptom with onset and remission <1 month!!!

Question 36

Most common hallucination in schizophrenia, most common delusion types

Answer 36

Auditory, persecutory or grandiose

Question 37

Imaging findings of schizophrenia (not diagnostic criteria)

Answer 37

Ventricular enlargement and decreased cortical volume and grey matter

Question 38

First and second line management of schizophrenia

Answer 38

Second gen antipsychotics like risperidone, olanzapine, quetiapine, aripiprazole, clozapine is not used first line but is the most effective for treatment resistant psychosis First generation antipsychotics like haloperidol can be used but increases risk of extrapyramidal symptoms or neuroleptic malignant syndrome

Question 39

Emergency medication for agitated acute psychosis

Answer 39

Haloperidol or IM olanzapine

Question 40

Management of acute dystonia reaction

Answer 40

Diphenhydramine or benztropine (cogentin, antitremor for parkinsons)

Question 41

Neuroleptic malignant syndrome management

Answer 41

Prompt discontinuation, supportive care, dopamine agonists or dantrolene (also used for malignant hyperthermia)

Question 42

Prazosin

Answer 42

Anti hypertensive and urinary retention medication alpha 1 blocker that also is sometimes used for nightmares in PTSD management

Question 43

Adjustment disorder definition

Answer 43

Maladaptive emotional or behavioral reaction to an identifiable stressor that causes disproprotionate reponse than would normally be expected within 3 months of the stressor and usually resolves within 6 months of the stressor, psychotherapy is initial management

Question 44

Somatic symptom disorder vs functional neurological disorder (conversion disorder) vs illness anxiety disorder vs factitious disorder vs malingering

Answer 44

Somatic symptom disorder - physical symptoms in at least 1 body symptom with no cause on workup plus no intentional falsification, often vague but disruptive to individuals daily life Functional neurlological disorder (conversion disorder) - neurologic synmptoms or deficits (sensory or motor) with no cause on work up often preceded by a traumatic event and has no intentional falsification Illness anxiety disorder - Preoccupation that one has an undiagnosed serious illness with no intentional falsification that can cause maladaptive behaviors for at least 6 months Factitious disorder - Intentional falsification of symtpoms for primary gain (desire to be sick or have sympathy) Malingering - Intentional falsification of symptoms for secondary external gain (money, shelter, etc)

Question 45

Varenicline use

Answer 45

Blocks nicotine receptor reducing nicotine activity, partial agonist that mimicks the effects of nicotine reducing reward effect and prevent withdrawal symptoms, therapy should begin 1 week prior to quitting smoking and be continued for 4 motnhs after, can see adverse effects like headache, nausea, increased suicidality or rage

Question 46

Management of alcohol withdrawal

Answer 46

IV benzodiazepines, hospitalization as can be fatal, iv fluids, thiamine

Question 47

First line therapy for narcolepsy

Answer 47

Modafinil (stimulant that promotes wakefulness early into evening)