Psychiatry

Question 1

Treatment options in patient presenting with catatonia

Answer 1

1st line = lorazepam and/or ECT

2nd line= ECT (if patient doesn’t improve)

Question 2

Muscular rigidity, delirium, autonomic instability and high fever.. dx?

Answer 2

NMS (neruoleptic malignant syndrome)

Question 3

NMS is due to dysregulation of which neurotransmitter?

Answer 3

Dopamine

Question 4

1st line treatment for a patient presenting with MDD with psychotic features.

Answer 4

Antidepressant plus antipsychotic (ECT is also 1st line however it is reserved for patients who require rapid response due to refusal to eat or drink or suicidality)

Question 5

1st line treatment for acute bipolar depression

Answer 5

2nd generation anti psychotics quetiapine and lurasidone

Question 6

Social awkwardness, intense interest in and restricted focus on a single topic and unusual sensory interest… Dx?

Answer 6

Autism spectrum disorder

Question 7

first-line pharmacological therapy for restless leg syndrome.(RLS)

Answer 7

Pramipexole (dopamine agonist)

other include ropinirole apomorphine and rotigotine

Question 8

Diagnostic tests indicated for restless leg syndrome

Answer 8

Iron studies, Polysomnogram

Question 9

1st line therapy for RLS

Answer 9

Lifestyle changes: abstinence from coffee, nicotine, and alcohol
Discontinue offending agent (e.g., dopamine antagonists)
Supplemental iron if serum ferritin < 50 ng/mL

Question 10

Passive aggression

Answer 10

expressing negative feelings toward someone in a non-confrontational way. (e.g. Rather than confront his boss about feeling overworked and undervalued, he feigns illness and thereby forces his boss to take over his workload)

Question 11

Individuals with panic disorder are at increased risk of developing?

Answer 11

MDD (. Approximately 50% of patients with panic disorder have at least one episode of MDD in their lifetime)

Question 12

The best management in patients on MMT ( methadone maintenance therapy) who require opioid analgesic

Answer 12

scheduled short-acting opioid administration such as morphine given every 3–4 hours in addition to methadone.

Question 13

1st line treatment for generalized anxiety disorder (GAD) with sexual dysfunction

Answer 13

Buspirone

Question 14

What psychiatric disorder predisposes a pregnant patient to IUGR?

Answer 14

Patients with a history of anorexia nervosa are at increased risk for intrauterine growth restriction due to chronic malnutrition and low pregnancy weight.

Question 15

What is the difference in a child with temporal lobe epilepsy and absence seizure

Answer 15

absence have episodes are typically shorter (5–10 seconds) compared to epilepsy (1-2 mins) and are not followed by a postictal phase

Question 16

What deficiency is a complication of carcinoid syndrome

Answer 16

Pellagra, or niacin deficiency

Question 17

Initial treatment in a patient that is terminally ill with severe acute depression and a very limited life expectancy

Answer 17

Methylphenidate and other psychostimulants (can be combined with SSRI)

Question 18

What is a relative contraindication for ECT in a patient with breast cancer

Answer 18

Metastasis to the brain

Question 19

Difficulty with vaginal penetration, vulvovaginal or pelvic pain during intercourse, anticipatory anxiety, and pronounced tightening of the pelvic floor muscles during attempted vaginal penetration.. dx?

Answer 19

Genitopelvic pain/penetration disorder (penetration disorder)

Question 20

Individuals with a persistent fear of having or developing an illness despite having no physical symptoms

Answer 20

Illness anxiety disorder

Question 21

Individuals with this disorder show a preoccupation with their health and develop significant distress and fear of severe illness over benign symptoms.

Answer 21

somatic symptom disorder. (anxiety is caused by physical symptoms)

Question 22

What is Advanced sleep phase disorder

Answer 22

circadian rhythm sleep-wake disorder in which the sleep-wake cycle begins and ends earlier than normal. This causes individuals to feel the need to go to bed early and to wake up early in the morning irrespective of when they go to bed.

Question 23

What is Advanced sleep phase disorder treatment?

Answer 23

Timed bright light phototherapy

Question 24

Pathophysiology of refeeding syndrome

Answer 24

An increase in insulin levels, which causes an intracellular shift of glucose, potassium, phosphate, and magnesium.

Question 25

Clinical features of Refeeding syndrome

Answer 25

Paresthesias as well as QTc prolongation and cardiac arrhythmias such as SVT which can present as palpitations and fluid retention

Question 26

Identification (psychiatry)

Answer 26

Unconscious modeling of one’s behavior, whether good or bad, on another person (classic example of identification with an aggressor is an abused child who later becomes an abusive parent)

Question 27

First-line therapy for PMDD,

Answer 27

Fluoxetine and other SSRIs

Question 28

Features of Premenstrual dysphoric disorder (PMDD)

Answer 28

severe form of affective symptoms that interferes with daily life, including having abnormal disagreements with family, friends, and colleagues

Question 29

1st line treatment of acute psychosis

Answer 29

A second generation antipsychotic (SGA), such as ziprasidone or risperidone

Question 30

What is neonatal abstinence syndrome

Answer 30

Withdrawal reaction in a newborn due to maternal opioid use (or sometimes other substances) during pregnancy. Usually presents during the first days of life with variable symptoms (e.g., irritability, seizures, gastrointestinal problems, sneezing, and sweating).

Question 31

Neonatal abstinence syndrome treatment in mild opiate withdrawal symptoms

Answer 31

supportive care (e.g., swaddling, IV fluids, quiet room)

Administration of oral morphine is recommended to treat the withdrawal in severe sx.

Question 32

Neonatal abstinence syndrome treatment in severe opiate withdrawal symptoms

Answer 32

Administration of oral morphine is recommended

Question 33

intentionally or consciously choosing not to think about a feeling or thought.

Answer 33

suppression

Question 34

What is sedative‑hypnotic toxidrome and what are some features and treatment

Answer 34

Benzodiazepine intoxication presents with a combination of CNS depression and fairly normal vital signs, respiratory depression is usually only mild and there is no pupil constriction. tx is supportive

Question 35

Side effect of phenothiazines (e.g., fluphenazine) therapy.

Answer 35

Impaired thermoregulation leading to intolerance of extremes in environmental temperature (i.e., hypothermia or hyperthermia) (effects the hypothalamus)

Question 36

What are the risk of antipsychotic drugs in pregnancy

Answer 36

Most studies have found that prenatal exposure to antipsychotics, including risperidone and clozapine, does not increase the risk of physical malformations.

The decision to initiate or continue antipsychotic therapy during pregnancy should always be discussed with the patient’s partner and/or family members.

Question 37

A neurotic defense mechanism that involves concentrating on the intellectual components of a situation in order to avoid dealing with the anxiety provoked by this situation.

Answer 37

Intellectualization.

Question 38

A type III (neurotic) defense mechanism that is classified as neurotic and involves justifying ideas, actions, or emotions with fallacious reasoning.

Answer 38

Rationalisation