Psychiatry Flashcards
1
Q
- 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
2
Q
- 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
3
Q
- 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
4
Q
- 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
5
Q
- 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
6
Q
- 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
7
Q
- 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
8
Q
- 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%
9
Q
- 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
10
Q
- 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
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
12
Q
- 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
13
Q
- 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
14
Q
- 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
- Previous attempt
- Mental illness
- Impulsivity
- Precipitating factors/stress
- Family factors
- Lack of access to psychosocial support
15
Q
- 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
- Breakup
- Bullying
- Conflict with parents or peers
- Revealing LGBTQ identity
- Legal involvement or impending court proceedings
- Academic challenges
- Situation or interaction triggering memories of prior abuse
16
Q
- 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
- ————- - 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
17
Q
- 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
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
19
Q
- 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
- ——————– - 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
20
Q
- 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
