Psychiatry

Question 1

“False pregnancy”

Answer 1

Pseudocyesis

Question 2

When do anorexics require hospitalization?

Answer 2

1. Unstable vitals
2. Cardiac dysrhythmias (e.g. severe bradycardia, e.g. <50 bpm)
3. Electrolyte disturbances
4. Extremely low body weight (<70% expected)

Question 3

How long does it take do diagnose GAD?

Answer 3

6 months

Question 4

Treatment for SAD?

Answer 4

CBT and SSRI/SNRI (similar to GAD)

Question 5

What is the first step in patients with body dysmorphic disorder requesting surgery?

Answer 5

Acknowledge their distress and educate about nonsurgical treatments (CBT, SSRIs)

Question 6

Treatments for Tourette syndrome

Answer 6

1. Habit reversal therapy
2. Alpha2 agonists like clonidine and guanficine are first-line
3. Antipsychotics (risperidone, haloperidol) are for severe or refractory symptoms

Question 7

Episodic psychatric symptoms with abdominal pain and neuropathies?

Answer 7

Acute intermittent porphyria - look for elevated urinary porphyrinobilogen

Question 8

Imaging finding in schizophrenia

Answer 8

Enlargement of lateral cerebral ventricles

Question 9

Treatment for catatonia

Answer 9

Benzos or ECT

Lorazepam challenge can be part of diagnosis

Question 10

Treatment options for NMS that does not improve with cessation of medication and supportive care?

Answer 10

Dopamine agonists (e.g. bromocriptine) and/or dantroline

Question 11

Treatment for acute dystonia EPS?

Answer 11

Anticholinergics: Benztropine or diphenhydramine

Question 12

Treatment for parkinsonism EPS?

Answer 12

Benztropine or amantidine (both can be used for PD as well)

Question 13

Treatment for akathisia EPS?

Answer 13

Propanolol or benzos

Question 14

Neuromuscular irritability, GI symptoms like diarrhea, and fever in a psych patient

Answer 14

Consider serotonin syndrome

Question 15

Side effects of lithium long-term (even with correct levels)

Answer 15

1. Nephrogenic DI (monitor renal function)
2. Thyroid dysfunction (monitor TSH)
3. Hyperparathyroidism (monitor calcium)

Question 16

Acute lithium toxicity

Answer 16

GI symptoms (N/V/D)
If severe, neurological irritation signs (AMS, ataxia, tremor, hyperreflexia, seizures)
(Chronic lithium toxicity has just the neuro symptoms)

Question 17

Chronic lithium toxicity

Answer 17

Neurological irritation signs: AMS, ataxia, tremor, hyperreflexia, seizres

Question 18

What can lead to a rise in lithium levels?

Answer 18

1. Volume depletion

2. Meds: diuretics (thiazides, ACEIs), NSAIDs (other than aspirin), tetracycline, metronidazole

Question 19

What medication can be used to help alcoholics quit if they are actively drinking?
What is another medication to help alcoholics quit that requires they are already abstinent?

Answer 19

Naltrexone (reduces craving) can be used if still drinking.

Acamprosate can only be used if already abstinent.