Psychiatry

Question 0

Anorexia

Answer 0

Starts at teens
Preoccupation with food
Bradycardia, anaemia, hypoalbinemia

Question 1

Bulimia

Answer 1

Young women (20-30)
Dental erosions
HypoK, hypoCl, decrease urine Cl,
Mallory-Weiss tear

Question 2

Panic d/o Tx

Answer 2

SSRIs and cogn Tx

Question 3

Panic d/o

Answer 3

Family Hx
Cocaine may be a ppt
Major depression in 50%

Question 4

Manic spells clinical presentation

Answer 4

• Paranoid thoughts
• can have delusions and hallucinations too
• little sleep but feeling energized

Question 5

Bipolar Tx

Answer 5

Mood stabilizers: Li, Valproate, carbamazepine and anti-psychotic in mania stage

Question 6

Tx for acute mania

Answer 6

Li or

Anticonvulsant (Valproate or carbazepine) and antipsychotic

Question 7

Metabolic changes w anti-psychotic

- biggest risk w?

Answer 7

Wt gain, increase in insulin-resistance, hyperglycaemia

- biggest risk w: olanzapine, clozapine and risperidone

Question 8

Obsessions in OCD - are there certain thoughts that go through your mind and can’t get rid of?

Answer 8

Fear of germs
Fear of contamination
Fear of harming other/self
Distressing sexual ideas

Question 9

Compulsions in OCD - are there habits you feel the need to repeat again and again a lot?

Answer 9

Hoarding
Exactness
Repetitive checking
Repetitive counting

Question 10

OCD Tx

Answer 10

High doses of SSRIs

Question 11

Dysthymic d/o clinical presentation and Tx

Answer 11

• Depressive syx + physical syx
• unhappy for a long time (eg since high school)
• Tx: cogn behavioural Tx (doesn’t respond to antidepressants well)

Question 12

Conditions ass w depression

Answer 12

• panic d/o
• stroke, CAD, hypothyroidism
• fibromyalgia/chr fatigue sy
• corticosteroid use

Question 13

Major depression 5/8

Answer 13

• depressed mood, esp in the am
• anhedonia
• wt changes
• sleep changes
• fatigue
• feeling of worthlessness/guilt
• decreased concentration
• thoughts of death/suicide

Question 14

TSH/metabolic problems in depression

Answer 14

• ppl w subclinical hypothyroidism do not respond to antidepressant Tx well
• thyroid hormone replacement suggested as augmentation of Tx in refractory depression
• ?B12 deficiency may contribute

Question 15

SSRIs - sexual side effects

Answer 15

• delayed ejaculation
• delayed orgasm (30-50%)
• in fact they are approved for Tx for premature ejaculation

Question 16

Least sexual s/e - SSRI

Answer 16

Bupropion, ?Venlafaxine

Question 17

Worst anticholinergic s/e and weight gain

Answer 17

Paroxetine

Question 18

Best SSRI when wt gain

Answer 18

Venlafaxine

Question 19

These meds can cause wt gain

Answer 19

MAOI
TCA
Paroxetine
Mirtazapine

Question 20

No wt gain

Answer 20

Bupropion
Nefazodone
Venlafaxine
sSRIs (other than Paroxetine)

Question 21

Contraindications for TCAs (amitryptiline, nortryptiline)

Answer 21

• BPH (can cause urinary retention/obstruction)
• recent MI
• known cardiac arrhythmia
• (elderly, falls, confusion)

Question 22

Bupropion - mechanism of action and CNS side effect/contraindications

Answer 22

• Norepinephrine & dopamine repuptake inhibitor (NDRI)
• lowers Sz-treshold
• Sz disorder, eating d/o, alcoholism

Question 23

Augmentation options for refractory depression

Answer 23

• add thyroid hormone (least side effects)
• add Li
• add bupropion

Question 24

Serotoninergic syndrome symptoms

Answer 24

Confusion, sweating, agitation, anxiety, vomiting, diarrhea

Question 25

Serotoninergic Sy - signs

Answer 25

Increased HR& BP, fever, muscle rigidity, hyperteflexia, tremor

Question 26

Serotoninergic drugs

Answer 26

SSRI, Tramadol, linezolid, meperidine, dextrometorphan, TCAs, MAOIs, buspirone, trazadone

Question 27

Psych side effects of fuorokinolones

Answer 27

Insomnia, delirium, nightmares, psychosis/ hallucinations