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Psychiatry Flashcards

1
Q
  1. 16 year old girl. Failing in school, used to be a straight A student. Decreased need for sleep. Recently buying clothes. Family hx of suicidal and depression. How do you treat
    a. Lithium
    b. Fluoxetine
    c. Clonidine
A

Lithium

Bipolar disorder

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2
Q
  1. 13 year old girl sleep less, distractible, irritated, wears provocative clothing, spends more money. Dad worried. Maternal history of suicide attempt. Brother has ADHD. What would you recommend?
    a. Lithium
    b. Fluoxetine
    c. Stimulant
    d. Substance abuse treatment program
A

Lithium

Meets criteria for Mania
A. Elevated, expansive or irrtiable mood AND increased goal-directed activity for >=7d, almost all day + every day
B. >=3/7 (4 if just irritable mood)
G
Sleep decreased
T
Pleasure + pain
A
I
Distractible
C. Marked impact on functioning , or need for hospitalization
D. Not due to another disorder
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3
Q
  1. Teen with a manic episode (from history). You treat with:
    a. Lithium
    b. SSRI
    —————–
    Girl who is shopping lots, irritable, decreased need for sleep and wearing provocative clothing. Family history of suicide. What’s the treatment?
    a. TCA
    b. paroxetine
    c. lithium
    d. fluoxetine
A

Lithium

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4
Q
  1. 11 y/o irritable and not sleeping (<5 hours/night), with mother who has mood disorder. Diagnosis? → not enough information…
    a. bipolar disorder
    b. substance abuse
    c. ADHD
    d. conduct disorder
A

?Bipolar

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5
Q
  1. Girl with family history of bipolar disorder. Now she is restless, irritable & only sleeping 5 hours a night. Most likely diagnosis?
    a. new onset ADHD
    b. bipolar disorder
    ————–
    11 yo female with agitation, personality changes, sleeping 5 hrs/night. Mom has Bipolar
    a. new onset ADHD
    b. marijuana abuse
    c. bipolar disorder
A

Bipolar disorder

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6
Q
  1. Describe a kid who has a change in behaviour over the last year. No longer gets A’s. Not interested in sports. Parents divorces 2 years ago. Picks on sister. Most likely dx?
    a. Adjustment d/o
    b. Major depressive d/o
    c. Substance abuse
    d. ADHD
A

Major depressive d/o vs substance abuse

Adjustment d/o:

  • development of emotional or behavioural Sx in response to identifiable stressor w/in 3mo of Sx onset
  • once stressor or its consequences have terminated, Sx do not persist for more than 6mo
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7
Q
  1. A 12 year old girl has been uninterested in activities she usually enjoys over the last 9 months. She has had less energy than usual and has had a decreased appetite. In addition to CBT, which of the following is the most appropriate treatment for her?
    a) Lithium
    b) Fluoxetine
    c) Amitryptiline
    d) Sertraline
A

Fluoxetine

M
S
Interest decreased
G
Energy decreased
C
Appetite decreased
P
S
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8
Q
  1. Depressive teen on medication. What is likelihood of recurrence of symptoms in the following 2 years?
    a) 5%
    b) 10%
    c) 40%
    d) 70%
A

40%

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9
Q
  1. Father comes to you regarding concern over 13 year old’s behaviour recently. Parents just separated. Brother has ADHD and mother has depression. Girl has declining school performance, buys provocative clothing and swears a lot. She is inattentive most days. You would most likely prescribe:
    a. Methylphenidate
    b. Fluoxetine
    c. Lithium
    d. CBT
A

CBT

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10
Q
  1. Parents, children and divorce – what is true?
    a. males respond better to divorce in the immediate post divorce period than females
    b. Children do better in a 1 parent custody setting without seeing the other parent
    c. The best predictor of the child’s response is post separation parental conflict and depression rather than custody issues
A

The best predictor of the child’s response is post separation parental conflict and depression rather than custody issues

Most important predictor is quality parenting, quality of parent-child relationships and minimizing exposure to hostile conflict

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11
Q

Parents are divorcing and would like you to give them guidance:

a. joint custody decision at this time is most important
b. sole parental custody is best
c. boys fare better than girls in their psychological adjustment
d. parental emotions discordance can have big impact

A

d. parental emotions discordance can have big impact

Most important predictor is quality parenting, quality of parent-child relationships and minimizing exposure to hostile conflict

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12
Q
  1. A 13 year old boy with Type 1 diabetes tells his parents that he hopes his diabetes kills him because he doesn’t want to live anymore. He’s had a lower appetite the last few months (?also said sleeping more). Psychiatry has assessed him and feels he is not at an acute risk of self harm. What is the best thing to do now to ensure his safety?
    a. Start fluoxetine
    b. Admit him
    c. Parents to provide constant supervision
    d. Parents to take over control of his insulin injections
A

Parents to take over control of insulin injections

  • Fluoxetine takes 4-6 weeks for mood effects
  • No acute SI to warrant immediate admission
  • For safety NOW, best thing for parents to control insulin injections
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13
Q
  1. An adolescent female presents to the ER because her mother found out that she has been making superficial cuts on her arms. What would reassure you that she is not suicidal (i.e. make you the LEAST worried about suicide)?
    a) She was cutting to get relief of sx
    b) Sleeping x 2 weeks
    c) Using marijuana
    d) Boyfriend just broke up w her
A

Cutting for relief

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14
Q
  1. What is the greatest risk factor for suicide attempt?
    a. Living alone
    b. Prior spontaneous suicide attempt
A

Prior spontaneous suicide attempt

6 RFs for suicide

  1. Previous attempt
  2. Mental illness
  3. Impulsivity
  4. Precipitating factors/stress
  5. Family factors
  6. Lack of access to psychosocial support
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15
Q
  1. Who has the highest risk of suicide completion?
    a. cerebral palsy
    b. homosexual
    c. child who’s just been through parental divorce
    —————–
    Teen after suicide attempt. Which is the strongest risk factor that he is going to complete suicide in the next 24 hours:
    a. homosexuality
    b. wrist slashing
    —————–
    Who’s at greatest risk for suicide?
    a. recent breakup with boyfriend
    b. teen with a history of superficial cutting
    c. homosexual teenager
A

The point may be homosexual youth have higher rates of suicide

CPS statement on adolescent sexual orientation:

  • High school students who say they are gay, lesbian, bisexual, attracted to same sex, or have sex with same sex are 2-7X more likely to attempt suicide
  • Highest risk when:
    1) teen acquires gay identity at young age
    2) teen is conflicted about orientation
    3) teen has not been able to disclose orientation to anyone
    4) family conflict
    5) teen has run away or been thrown out of house
  • Data is not as strong on completed suicides, but evidence that a disproportionate number of suicides are among homosexuals

Precipitating factors

  1. Breakup
  2. Bullying
  3. Conflict with parents or peers
  4. Revealing LGBTQ identity
  5. Legal involvement or impending court proceedings
  6. Academic challenges
  7. Situation or interaction triggering memories of prior abuse
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16
Q
  1. 12 year old adolescent took 10 regular strength Tylenol. What does this act signify?
    a. plan to die
    b. Unconscious desire to hurt her parents
    c. Conscious desire to change something in her life
    - ————-
  2. Teenage girl comes in to emerg takes 10 tylenol. What does this signify?
    a. Suicide attempt
    b. Conscious attempt to change life situation
A

Conscious attempt to change life situation

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17
Q
  1. 9 year old boy presents with suicidal ideation; what conditions could be associated with this behaviour?
    a. Parental divorce
    b. Bullying
    c. Impulsive behaviour
    d. depression
    ——————
    9 year old boy with depression & suicidal ideation. What could be a reason:
    a. parental divorce
    b. poverty
    c. bullying at school
A

Any of them….

?Bullying

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18
Q

A 9 year old boy has been refusing to go to school for the last 3 months. He becomes upset when discussing attending school and says he wants to be homeschooled.

a) Allow him to be homeschooled this year. Return to school next year.
b) Return to school immediately following gradual protocol and desensitization
c) Start Citalopram
d) Start Fluoxetine

A

Return to school immediately following gradual protocol + desensitization

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19
Q
  1. Child with complex medical history and all examination is normal. Complaints of abdo pain for 1 hour in the morning but resolves quickly. Is ok to play soccer. What do you tell the child to do?
    a. Go back to school, doesn’t matter about the pain → but less rude…
    b. Home school
    c. Get the needed school work and then go back when the pain is gone
    d. Don’t need to go to school
    - ——————–
  2. A 7 year old had a renal transplant 3 months ago. She had quite a few complications including pneumonia and a possible rejection. As a result she has missed a lot of school. She now complains of non-specific abdominal pain in the morning time. What would be the best management strategy?
    a. Tell teacher to give you her homework and keep her home until she no longer has abdominal pain
    b. Go back to school despite the abdominal pain
    c. Refer her to nephrology
A

Go back to school

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20
Q
  1. 10 year old boy presents with school absenteeism and recurrent abdominal pain. Has missed 40% of classes but still able to get A’s. Growth plotted on growth chart and is normal, with physical exam likewise unremarkable. Now has headache consistently in the afternoons which have not changed in severity over the past 12 weeks. What is the likely diagnosis?
    a. Cow’s milk protein allergy
    b. Inflammatory bowel disease
    c. CNS neoplasm
    d. Anxiety
    —————
    Kid with daily headaches for weeks & lots of abdominal pain. Misses lots of school but still has A+ average. Diagnosis or management
    a. anxiety
    b. cow’s milk protein intolerance
A

Anxiety

  • CMPA resolves usually by 1yo
  • IBD less likely b/c growth normal, no other Sx
  • CNS neoplasm - reassuring that H/A hasn’t changed and still doing well in class
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21
Q 
7.  8 years old girl with hx of asthma. She has missed 10 days of school this spring as she wakes up with a "tight" chest in am. She has been able to continue with no problems for extracurricular activities.  What is the diagnosis?
A. Generalized anxiety disorder 
B. Separation anxiety disorder
C. Chronic asthma 
D. Chronic bronchitis
------------------
15. Kid with asthma, but only tight in the AM before school, doesn’t stop other activities. What is the diagnosis?
a) GAD
b) Separation anxiety
c) Uncontrolled asthma
A

Separation anxiety disorder

GAD would limit other activities
Uncontrolled asthma wouldn’t be just in the morning, wouldn’t be able to do other activities

22
Q
  1. 7 yo male, separation anxiety, spends time with mother, refuses to go to school. What to do?
    a. Send back to school immediately
    b. Send back to school gradually, with mom going to school
    c. Give SSRI and send back to school
    ——————————
  2. 7 y.o. boy, known to have separation anxiety, with no other conditions according to parents and school. What would be the best treatment:
    a. immediate return to school
    b. gradual return to school accompanied by parents, with gradual withdrawal of parents
    c. return to school with SSRI treatment
    d. return to school with benzodiazepine treatment
    ————-
    Kid with known separation anxiety. Management of school phobia?
    a. Return to school immediately
    b. Return gradually with parents leaving gradually
    c. Give SSRI
    d. Give benzo
A

Return to school immediately

23
Q
  1. A 10 year old boy has anxiety. Which of the following would make you most concerned to start him on fluoxetine?
    a) His age
    b) His gender
    c) Family history of suicide
    d) Family history of bipolar disorder
A

FHx of suicide

CPS Statement: Use of SSRIs for Tx of child & adolescent mental illness
A. What should I do before starting SSRI?
- Explore & document presence of physical (somatic) Sx of anxiety - so these don’t become attributed as a SE of the med
- Screen for personal & FHx of bipolar d/o - if present, refer for psych consult before starting SSRI for depressive or anxiety d/o (can induce/reveal mania)
B. Cautions about worsening suicidality associated with SSRI treatment in depression
- not with anxiety as primary treatment target
- Still prudent to monitor for suicidality

24
Q
  1. 15 year old girl with rapid onset episodes characterized by intense fear and discomfort lasting few minutes to few hours. Which of the following will help establish the diagnosis:
    a. episodes occur post specific anxiety provoking situation
    b. previous emotional trauma -
    c. episodes occur unexpectedly and she would fear more of these episodes
    d. obsessions and compulsions
    - ———————–
  2. 15 y/o girl with a history of sudden-onset episodes of intense fear and anxiety, lasting minutes to hours. What on history would confirm your diagnosis:
    a. episodes are triggered by emotion
    b. unexpected attacks and concern of future attacks
    c. family history of OCD
    d. history of emotional trauma
    - ———————–
  3. A patient with a description of panic attacks. Which of the following are needed to make the diagnosis?
    a. Hypervigilance
    b. Attacks occur when put into an anxiety provoking situation
    c. Unexpected attacks with a fear of future events
A

Episodes occur unexpectedly and she would fear more of these episodes

25
52. Girl who is having sudden onset episodes of fear and panic, lasting minutes to hours. What else would you elicit on history that would confirm your diagnosis? a. Unexpected episodes, and fear of attacks b. Clear precipitating factors prior to each episode c. History of emotional trauma ------------- Girl with panic attack symptoms vs. PTSD symptoms. What need to confirm diagnosis? a. Attacks triggered by anxiety-provoking event b. Attacks out of the blue and fear to have them again c. History of traumatic emotional event ---------------------- 67. 15 year old girl with rapid onset episodes characterized by intense fear and discomfort lasting few minutes to few hours. Which of the following will help establish the diagnosis: a) episodes occur post specific anxiety provoking situation b) previous emotional trauma c) episodes occur unexpectedly and she would fear more of these episodes d) obsessions and compulsions
Unexpected episodes, and fear of attacks
26
57. Child presents with recurrent episodes of tachypnea, tachycardia, diaphoresis, nausea and vomiting. This occurs 2x weekly, never at school, for six months. What is the cause? a. Panic attack b. Social phobia c. Arrhythmia
Panic disorder
27
29. Teachers are worried about a child who is shy, has no friends, does not generate conversation spontaneously, does not make eye contact with teacher, and plays on his own. At home, mother is not as concerned, as he speaks to both his parents all right. Diagnosis a. selective mutism b. autism c. language delay
Selective mutism - present for >=1mo - Hx of normal speech in at least 1 setting to r/o any communication d/o, neuro d/o ASD, or schizophrenia - Sx of underlying anxiety d/o (chronic pattern, not single tranumatic event) - Tx: fluoxetine + CBT
28
4. A 16 year old boy admits to recently having repetitive thoughts of violence. He has impulses to act on these, but is able to hold off doing so. What diagnosis is most likely? a. Schizophrenia b. Behavioural problem c. OCD d. Antisocial personality -------------------- 37. Parents found a boy trying to hang himself and they have brought him in for an assessment. This is a young man troubled by violent thoughts and thoughts of hurting others. Has been able to deal with them for now but isn’t sure if he can do so in the future. What does he have? a. anxiety b. antisocial personality disorder c. schizophrenia d. depression ----------------------------- 46. A teenage boy admits to having violent thoughts that overwhelm him. He says the thoughts are frequent and that he has not hurt anyone yet but fears he will soon. What diagnosis is most likely? a. Behavioural problem b. OCD c. Schizophrenia d. Antisocial personality
OCD
29
14. Boy writing out his sentences by going over the letters 3 times, what does he have? a) OCD b) Anxiety c) ADHD - ------------------- 53. Child at school is very slow because he is going over every letter three times. What is his problem? a. OCD b. ADHD c. Learning disability d. Anxiety
OCD - Schizophrenia: does not meet criteria (no delusions, hallucinations, disorganized speech, disorganized/catatonic behaviour) - Antisocial personality disorder: cannot diagnose until >18yo
30
25. Boy with ++ worries about his mom, then walks to school and steps over cracks but if he doesn't he has to walk around a car three times. what would be most helpful for him: a. desensitization b. fluoxetine ----------------- Young boy who constantly worries about his mother’s safety, and always late for school because he worries about his mother. Other features of OCD like taking long route home to avoid a dog etc. etc. Management? a. Fluoxetine b. Family therapy c. Desensitization
Fluoxetine Desensitization is for specific phobias If exposure therapy was an option, then choose this one
31
39. A teenage boy is having difficulties functioning because he constantly has to watch his hands and has obsessive thoughts. Which of the following medications may help him? a. Amitryptiline b. Clonazepam c. Clozapine d. Fluoxetine
Fluoxetine
32
63. 6 y.o. boy with 2 weeks of sudden onset of OCD behaviors. Which infectious agent would you be concerned about? a) Strep pneumonia b) Group A strep c) E.Coli d) H. Influenzae e) Echovirus
GAS PANDAS
33
64. 10 y.o. female with long history of handwashing 10-12 times per day. Now handwashing 100 times per day. She also has new onset eye blinking and throat clearing. She had a sore throat 2 weeks ago. What should she be treated with? a) Risperidol b) Clonidine c) Penicillin d) Dexedrine
Penicillin PANDAS
34
11. 13 yo F in foster care has been losing weight, decreased appetite, and occasional emesis. On exam you see that she is pale and has patchy areas of hair loss. What is the most likely diagnosis? a) Trichobezoar b) Anorexia nervosa c) Celiac disease d) Lead poisoning
Tichobezoar Bezoar is an accumulation of exogenous material in stomach or intestine Trichobezoar = pt's own hair, usually as a complication of trichotillomania - peaks in teen girls - N/V, abdo pain + distention b/c gastric outlet or partial intestinal obstruction - pale b/c iron deficiency anemia - Confirm on U/S or CT (non-homogenous, non-enhancing mass) - Remove endoscopically or surgically if unsuccesful
35
66. Trichotillomania, which is true? a) is associated with OCD in older kids b) is usually self-limiting c) is rare
Assoc'd with OCD in older kids - onset coincides with puberty - recurrent pulling of one's hair leading to hair loss (scalp, eyebrows, eyelids) - triggered by anxiety/boredom or lead to gratification + sense of relief - repeat attempts to decrease or stop hair pulling - causes significant distress or impairment - closely related to OCD -> Tx with SSRI + CBT Tx - clomipramine or fluoxetine Complications - trichobezoars - irreversible damage to hair - MDD
36
13. 13 year old boy with several episodes of irritability, swearing a lot, difficulty sleeping over the last 2 years. He has gotten into trouble at school because of them and has been suspended. What do you treat him with? a) clonidine b) methylphenidate c) valproate d) fluoxetine
Clonidine for ODD/ADHD?? vs fluoxetine for depression??
37
55. A 10 year old boy comes in with a history of resistance to following instruction, arguing with parents and teachers, and often gets into fights. What is his likely diagnosis? a. Oppositional Defiant Disorder b. ADHD c. Conduct Disorder d. Depression
ODD
38
18. Kid with ODD. What do you suggest for management a. Start Risperidone b. Start stimulant medication c. Parent skills training d. Put him in a “special Program” (don’t remember how they worded it)
Parent skills training
39
21. Male bully, has used a knife, picks fights a. CD b. ADHD c. Antisocial personality disorder ---------------- 32. 10 yr old boy knifes cars, doesn’t listen to parents, very disruptive in classroom and has been in trouble legally. Most likely diagnosis: a. anxiety b. depression c. oppositional defiant d. conduct disorder ----------------- Some kid is getting in fights starting at 8 years of age. Now carrying a knife around. Has been charged for stealing and arson. (but he isn’t killing cats). a. oppositional-defiance disorder b. ADHD c. Conduct disorder d. behaviour disorder
Conduct disorder
40
43. 10 y/o causing trouble, including fire setting, killed family cat (repeat) a. conduct disorder b. ADHD c. ODD doesn’t include aggression towards animals or property - ----------- 56. A 13 year old boy comes in with a history of fire setting, cruelty to animals, aggression toward classmates and teachers including threats with a knife. What is his likely diagnosis? a. Oppositional Defiant Disorder b. ADHD c. Conduct Disorder - --------- 51. It’s the bad kid again who is doing lots of horrible things, including torturing and KILLING the family cat. What is his likely diagnosis? a. Oppositional defiant disorder b. Conduct disorder c. generalized anxiety c. ADHD
Conduct disorder
41
30. 17 year old girl who is very socially inhibited and gets very upset with criticism, and is very sensitive about herself. Has persistent issues with negative evaluation and fear of social situations. Her diagnosis most likely is: a. avoidant personality disorder b. anxiety disorder c. schizophrenia d. specific phobia --------------- 17 year old teen with persistent issues with negative evaluation, fear of social situations. What is the most likely? a. avoidant personality disorder b. anxiety disorder c. depression
Avoidant personality disorder - social inhibition, feeling of inadequacy + hypersensitivity to negative evaluation - Tx: CBT - Social anxiety disorder: excessive anxiety in social settings; however, not usually negative evaluation and sensitivity. Avoidance or escape from the situation usually dissipates anxiety - Personality disorder is persistent and pervasive, typical of individual’s long-term functioning, onset needs to be at least adolescence! Or early adulthood
42
19. 15 yr old girl has a headache, then syncope at school for several minutes. She is brought to hospital. Can’t walk because of numbness in her legs. Exam is normal, plantar reflexes normal, DTR normal. Initial loss of sensation to L4, the next day she has sensation to S1. Able to walk leaning heavily on your hands, feet spaced 8 cm apart. What is your next step in management? a. EEG b. MRI head and spine c. Confrontation and explanation that her symptoms are not organic d. PT should be included in management ---------------- 15 yr old girl lives in a group home, history of sexual assault by her father. She has a headache, then syncope at school for several minutes. She is brought to hospital. Can’t walk because of numbness in her legs. Exam is normal, plantar reflexes normal, DTR normal. Initial loss of sensation to L4, the next day she has sensation to her ankles. Able to walk without ataxia leaning heavily on your hands, feet spaced 8 cm apart. What is your next step in management? a. EEG b. MRI head and spine c. Confrontation and explanation that her symptoms are not organic d. PT should be included in management
PT should be included in management DSM-5 Criteria for Conversion Disorder A. >=1 Sx or deficits affecting voluntary motor or sensory function B. Sx not compatible with recognized neurologic or medical condition based on clinical findings C. Not explained better by another medical or mental disorder D. Causes significant distress or impairment in function or warrants medical evaluation Specify symptoms type - weakness/paralysis - abnormal movements - swallowing symptoms - speech symptoms, - attacks/seizures, - sensory loss, - visual/olfactory/hearing - mixed symptoms Tx - Do not tell them it is in their head, focus on mind-body connection - *Multidisciplinary approach - Shift focus from finding cause to improving function - CBT - Meds for comorbidities
43
2. The parents of a 16 year old boy found him threatening to kill himself with a knife. He has recently had a significant decline in school performance. He complains of hearing voices. Feels weird for minutes to hours. Family history of depression and suicide. Likely diagnosis? a. drug abuse b. depression c. schizophrenia d. brain tumor
Schizophrenia
44
36. A 16 year old boy. Suicidal, threatening with a knife. Poor school performance recently. Mother thinks he is hearing voices. Feels weird for minutes to hours. Family history of depression and suicide. Likely diagnosis? a. drug abuse b. depression c. schizophrenia d. brain tumor ----------------- Child with knife wants to kill himself. Decreased school performance and personal appearance for last 6 mo. Hearing voices which are upsetting to him when it occurs. Family hx of depression and suicide. Most likely diagnosis? a. depression b. schizophrenia c. substance abuse ----------------- 16 year old male with unusual behaviour. For the last few weeks has been neglecting his personal hygiene. Now stays in his room and has episodes lasting a few hours where he hears voices and appears to be talking to someone. He appears frightened during these episodes. What is his likely diagnosis? a. Depression b. Substance abuse c. Schizophrenia
Schizophrenia
45
6. Teen is on sertraline. She is experiencing unwanted side effects and would like to stop. What should you do? a) Stop cold turkey b) Wean gradually to avoid withdrawal c) Wean gradually to avoid serotonin syndrome d) Switch to a benzo
Wean gradually to avoid withdrawal Sx of SSRI Withdrawal - Most common Sx: flu-like illness (dizziness, H/A, nausea, fatigue) - Agitation, anxiety, dysphoria, insomnia, irritability - paresthesia, tremors, myalgias - chills, diaphoresis, rhinorrhea - Uncommon: electric-like shocks, ataxia, hallucinations, HTN - onset is 1-4d of abruptly stopping SSRI or tapering too rapidly - Sx spont resolve over 1-2wk
46
58. Which of the following medications causes sexual dysfunction? a) Calcium Channel Blockers b) Antidepressants c) Beta-2 agonists d) Theophylline
Antidepressants CCB: bradycardia, hypotension, hyperglycemia SSRI: irritability, insomnia, appetite changes, GI Sx, H/A, diaphoresis, restlessness, sexual dysfxn, behavioural activation, suicidal thoughts
47
59. A teen has been on prozac and risperidone for 6 months, started to experience ataxia, decreased concentration, etc. What do you do? a) increase prozac b) decrease prozac c) eliminate prozac d) increase risperidone e) decrease risperidone
Decrease prozac ``` SS - excessive serotonin Fever Autonomic Sx MS changes - hyperreflexia, clonus - ataxia ``` ``` NMS - dopamine blockade Fever Autonomic Sx RIGIDITY!! MS changes - elevated CK - Stop offending agent - Bromocriptine, dantrolene ```
48
60. Which of the following is a late side effect of ADHD stimulant treatment? a) Decreased weight gain b) Sleep difficulties c) Tics d) Depression
Depression
49
61. Child on risperdol for Tourette syndrome has frequent syncopal episodes with exertion. What is the cause? a) hypoglycemia b) Prolonged QT
Prolonged QT Risperidone SE - prolonged QT, EPS, hyperprolactinemia, rare leukocytosis or neutropeia
50
62. List 3 serious side effects of risperidone, in addition to weight gain.
1. Prolonged QT 2. Extrapyramidal Sx: dystonia, dyskinesia, akathisia, pseudoparkinsonism 3. Hyperprolactinemia 4. Hyperlipidemia 5. DM 6. Rare: leukocytosis or neutropenia
51
68. A 13y.o. boy with ADHD is taking 36mg of Concerta. His symptoms and school performance have improved and his mother is happy with his improvements. For the past 2 weeks, however, he has been sad, often crying unpredictably. He also is having difficulty falling asleep at night. What is the next best step in his management? A) Decrease the dose of Concerta to 28mg B) Change from Concerta to Adderall C) Add fluoxetine D) Add melatonin
Change from concerta to adderall
52
8. A 13 y/o boy has become more withdrawn over the last year and seems only interested in his friends and his computer. He has difficulty waking up in the morning and seems tired. Which is the next step in management? a) TSH b) Tox screen c) Refer to psychology ------------------------- Teenage boy spending time alone in his room, not doing sports, only wants to be w friends. Exam is normal. He admits smoking cigs but nothing else. What next? a) thyroid testing b) tox screen c) Psychologist -------------------------- 27. Mother of 13 y/o boy comes to your office presenting with concerns about his behavior. He stays in his room, not active in sports, and his school performance has declined. He likes working on his computer and being with his few friends. His physical exam is normal. He states he has smoked before, but denies alcohol use. What is the most appropriate management? a. reassure b. toxicology screen c. TSH d. Psychological assessment --------------------- 49. 13 year old male noted to have change in behaviour over past few months: tired, difficulty getting out of bed, spending long periods of time alone in his room. Not involved with sports, doing poorly academically, only has interest in his computer and his friends. When interviewed alone, he admits to smoking once in a while, but denies taking any drugs or alcohol. What is your approach? a. Reassurance for mother b. TSH c. Toxicology screen d. Psychological assessment ------------- Teenager with change in behaviour, isolation, tired, decrease in school performance. Admits to smoking cigs. Denies drug use or EtOH use. Next step? a. TSH b. Psychiatry consult c. Tox screen ------------- A 13-year old boy is brought in by his parents because they are concerned that he is less social, spending more time in his room and only enjoys playing on his computer and spending time with his friends. He is a below average student, sleeps in a lot and is often tired. He admits to occasionally smoking cigarettes, but denies any alcohol or drug use. Do you: a. reassure the parents b. send for psychological assessment c. send for toxicology screen
Psychological assessment (consensus answer) Vs tox screen

RC Questions (40 decks)

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