Psychiatry Flashcards
What medication class is first-line for post-traumatic stress disorder?
SSRI’s
A 36-year-old G1P0010 woman presents with 5 weeks of nightmares after she had a stillbirth. She reports vivid nightmares of the delivery that occur multiple times a week, and she has started avoiding the kitchen where she last felt the baby’s kicks. She feels she could have prevented it “if I had just eaten more organic vegetables.” She has been unable to return to work due to fears that her coworkers might blame her for the miscarriage. Her spouse reports she has been isolated since the incident and rarely sleeps more than a few hours at night. Which of the following disorders is likely causing her symptoms?
A) Acute stress disorder
B) Adjustment disorder
C) Post-traumatic stress disorder
D) Primary insomnia disorder
Post-traumatic stress disorder
What is the pathophysiology that causes hyperthermia in neuroleptic malignant syndrome?
Increased metabolic myocyte activity and hypothalamic thermoregulation dysfunction
What drugs are most commonly associated with serotonin syndrome?
- SSRI’s
- MAOI
- SNRI
- TCA
- Atypical antidepressants (trazadone and buproprion)
- Tramadol
A 17-year-old girl with a history of developmental delay and generalized anxiety disorder presents with crying, intermittent yelling, and retching. Her vital signs are significant for a heart rate of 114 bpm. She is inconsolable and unable to provide significant history due to agitation. She reports no pain but tells you her chest feels tight, and she cannot breathe. Her lungs are clear to auscultation. What is the most effective management?
A) PO olanzapine
B) IV lorazepam
C) PO gabapentin
D) PO fluoxetine
IV lorazepam
A 57-year-old man presents to the ED with a tremor, nausea, and vomiting. He states that he drinks 5–10 alcoholic beverages per day and smokes cigarettes. He has a history of depression. His BP is 157/108 mm Hg, HR is 115 bpm, RR is 26/min, and SpO2 is 99% on room air. Physical exam is notable for a tremor both at rest and with action and sweaty skin. Which of the following is the best treatment for this patient?
A) Lactulose and rifaximin
B) Levodopa and carbidopa
C) Lorazepam
D) Propranolol
Lorazepam
What is the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar)?
The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) is the most commonly used scoring system to assess the severity of alcohol withdrawal. The CIWA-Ar scale evaluates 10 symptoms, including nausea, tremor, sweating, anxiety, agitation, hallucinations, and headaches, to guide treatment decisions such as the need for benzodiazepine therapy.
An 18-year-old man presents to the emergency department after overdosing on medication. He is somnolent, only arousing to noxious stimuli. His vital signs are normal and his pupils are midposition and briskly reactive. You are unable to elicit nystagmus. He is not tremulous, his reflexes are normal, and he displays no clonus. Toxicity from which of the following agents is most likely responsible for his presentation?
A) Chlordiazepoxide
B) Lithium
C) Methadone
D) Quetiapine
Chlordiazepoxide
Coma or central nervous system depression with essentially normal vital signs and midposition pupils are characteristic findings in isolated benzodiazepine toxicity, making chlordiazepoxide the most likely culprit in this case. Similar findings would be expected with other benzodiazepines such as diazepam and lorazepam.
