Psychiatry

Question 1

what is dx:

MDD or Manic episode concurrent w symptoms of schizophrenia

lifetime hx of delusions or hallucinations for >/= 2 weeks in the absence of major depressive or manic episode

Answer 1

Schizoaffective disorder

Question 2

what is dx and mgmt:

Psyche pt w hx of shizo, current unresponsiveness, normal vitals/labs, immobility, passively allows examiner to position extremities

Answer 2

Catatonia

• Benzo’s (esp Lorazepam) - IV bolue resulting in partial relief confirms diagnosis
• –or ECT

Question 3

What is dx:
Pt on ibuprofen, diphenhydramine, lorazepam, long hx of fluoxetine which was d/c’d a month ago. Recently started on Phenelzine presents diaphoretic, tremulous, shaking, lower extremity muscular rigidity
VS: 101 F, 160/90, 116 bpm,

Answer 3

Serotonin syndrome
-fluoxetine has long half life - should d/c for 5 weeks before starting MAOi (phenelzine)

Classic Triad:

1. Mental status changes
2. Autonomic dysregulation
3. neuromuscular hyperactivity

Question 4

How long should a patient be on a newly prescribed SSRI after
1. a single episode of MDD

2. hx of multiple episodes of MDD, chonic episodes (>2yrs), strong family hx, severe episodes
3. > 3 lifetime episodes of MDD

Answer 4

1. 6 months
2. 1-3 years following remission to prevent relapse
3. indefinitely

Question 5

How do you manage a patient w a 2 year hx of parkinson’s dz on levadopa/carbidopa who presents with blunted affect, masked facies, psychomotor slowing, bradykinesia. mild hand tremor and postural instability have improved since last visit

Answer 5

add sertraline

Question 6

How do you treat a pt with narcolepsy who experiences sudden onset muscle weakness and falls especially with family members

Answer 6

Cataplexy - pathognomonic in 70% of pts with narcolepsy

–Venlafaxine

Question 7

How do you manage a pt with akathisia who has auditory hallucination after a trial of reducing dosage?

Answer 7

Propranolol

-also, benztropine or benzodiazepines

Question 8

What medications can be used for tourettes syndrome?

Answer 8

2nd gen antipsychotics - risperidone, aripiprazole,

A-2 adrenergic receptor agonists - clonidine, guanfacine

dopamine depleter - tetrabenzine

Question 9

How do you manage a pt who is 12 weeks gestation w history of seizures on valproate. last seizure was a year ago after trying to change med regimen.

Answer 9

Continue valproate and offer alpha-fetoprotein screening

-Antiepileptic drugs a/w increased risk of congenital abnormalities, neural tube defects, heart anomalies, cleft palate.

Question 10

What are ways to reduce radial head subluxation?

Answer 10

Hyperpronation of forearm

Supination of forearm and flexion of elbow