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2019 Bank of Goodness > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Which of the following medications causes sexual dysfunction?

a) Calcium Channel Blockers
b) Antidepressants
c) Beta-2 agonists
d) Theophylline

A

b) Antidepressants

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2
Q

Which of the following is a late side effect of ADHD stimulant treatment?

a) Decreased weight gain
b) Sleep difficulties
c) Tics
d) Depression

A

d) Depression

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3
Q

Child on risperdol for Tourette syndrome has frequent syncopal episodes with exertion. What is the cause?

a) hypoglycemia
b) Prolonged QT

A

b) Prolonged QT

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4
Q

List 3 serious side effects of risperidone, in addition to weight gain

A
  • long QT
  • neuroleptic malignant syndrome
  • agranulocytosis
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5
Q

A teen in your practice has been on fluoxetine and risperdal. He presents to your office with hyper-reflexia and tremor and ataxia and 5 or 6 more symptoms. What to do you do?

a. stop fluoxetine
b. decrease fluoxetine
c. increase fluoxetine
d. decrease respirdal

A

a. stop fluoxetine
serotonin syndrome: usually rapid onset, mild symptoms incld increased HR, shivering, diaphoresis, dilated pupils, myoclonus, hyperreflexia, hypervigilance, insomnia, agitation

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6
Q

Patient has been treated with prozac for 2 years. What is the chance of recurrence of depression once she is taken off this medication?

a) 10%
b) 20%
c) 40%
d) 75%
e) 90%

A

c) 40%
The risk of recurrence ranges from 34% to 50% within the first year after discontinuation of treatment

Response rates to SSRIs in the treatment of depression are 40-70%

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7
Q

Describe a kid who has a change in behaviour over the last year. No longer gets As. 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

b. Major depressive d/o

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8
Q

Teen with change in his behaviour. Mgt?

a. Psychology assessment
b. TSH
c. Tox screen

A

c. Tox screen

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9
Q

A girl is referred to you for assessment of possible ADHD. She has been agitated, irritable and is sleeping only 4 hours per night. Her mother has bipolar disorder. What is the most likely diagnosis?

a) Drug use
b) Bipolar disorder
c) ADHD

A

b) Bipolar disorder - symptoms most in keeping and bipolar disorder is highly heritable

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10
Q

A teenager is suspected of having depression by her parents. What five questions would you ask her to make your diagnosis of depression.

A

Over the last 2 weeks:

  • depressed mood
  • loss of interest
  • increased sleep
  • feelings of guilt or worthlessness
  • decreased energy
  • difficulty concentrating
  • change in appetite (up or down)
  • suicidal ideation
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11
Q

A mother is concerned that her thirteen year old boy has recently started spending more time in his room, he is more tired and has difficulty awakening in the morning. He doesn’t participate in sports, and spends all of his time on his computer or with his friends. He is doing just below
the average in school. When you speak to him, he says he smokes occasionally but denies any other alcohol or drug use. What do you do next:
a) Psychological assessment
b) Trial of stimulant medication
c) Reassure

A 
a) Psychological assessment
Sounds typical (increased need for sleep, increased value placed on opinions of friends) but should be screened for depressive symptoms, substance abuse, social anxiety, hypothyroidism, toxic exposures (e.g. lead toxicity)
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12
Q

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

c. lithium

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13
Q

Teen has been depressed since being bullied at school after coming out as a homosexual. He has taken pills from his parents 4 months ago so now all meds in the house are locked up. What to do?
a) do not tell his parents because he insists that you don’t tell them
b) get more information from the school principal
c) he is at low risk for suicide because the pills are locked away
d ) he is at increased risk for suicide because he is a homosexual

A

d ) he is at increased risk for suicide because he is a homosexual

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14
Q

A 12 y.o. teen took 10 regular strength Tylenol. What does this act signify

a) a plan to die
b) a cry for help

A

b) a cry for help

- probably - depends on the intention

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15
Q

List 5 risk factors for suicide in teenagers.

A
  • male
  • aboriginal
  • LGBTQ
  • previous attempt
  • family history of suicide
  • pre-existing psychiatric illness
  • negative self-image/hopelessness
  • lack of social support/living alone
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16
Q

Girl with suicidal ideation, admitted. You, the parents, and the patient all agree that she is now ready for discharge. The family lives in a remote community, and there are no mental health resources available over the weekend. List 5 things you would recommend to keep her safe over the weekend before she can be re-evaluated on Monday.

A
  • Recognize personal warning signs
  • Use coping skills to deal with stress without contacting others
  • Naming people who can support and distract
  • Identify close friends/adults who can help resolve a crisis
  • Knowing mental health professionals/agencies to contact (including local ED and helpline)
  • ensure safe environment (eliminate access to lethal means ie fire arms, medications)
  • positive focus to leverage (something to live for)
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17
Q

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

A

c. schizophrenia

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18
Q

15 y.o. boy with a history of significant school absenteeism. He has had symptoms of intermittent abdominal pain and recently has developed daily headaches with onset in the later afternoon. He continues to get A’s despite missing 40% of the days in school. His height and weight continue along the same percentiles as previously. What is the most likely diagnosis?

a) Anxiety
b) Brain tumor

A

a) Anxiety

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19
Q

7 y.o. girl whom you have seen before for her asthma. She has missed 1 month of school because in the morning she complains of feeling “tight”. Later in the day she feels fine and is not missing other extracurricular activities. What is the likely cause?

a) generalized anxiety disorder
b) depression
c) status asthmaticus
d) separation anxiety

A

d) separation anxiety

not interfering with other activities; most common form of anxiety in kids; school refusal common

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20
Q

7 year old boy described as having separation anxiety. He has just had surgery for appendicitis and since the surgery has refused to go to school. He has always been a good student. What four things would you do in your management?

A
  • work with school personnel
  • parental mgmt training and family therapy
  • screen for comorbid mental health conditions (e.g. depression)
  • screen for medical causes (thyroid disorder, medication side effect)
  • educate family around importance that he return to school, and not let him stay home as this will make it worse; reward for each completed day at school
  • SSRIs may be indicated in severe cases
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21
Q

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

A

a) Send back to school immediately

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22
Q

11 year old with severe symptoms of separation anxiety. Very worried about something happening to his parents (and to him). Best treatment?

a. Desensitization
b. SSRI
c. Parent therapy

A

b. SSRI (because symptoms severe)

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23
Q

15 y.o. girl with frequent brief attacks where she feels short of breath and vaguely uneasy. Which of the following would support your diagnosis.

a) Fear of episodes recurring and sudden onset of episodes
b) Family history of OCD
c) History of emotional trauma

A

a) Fear of episodes recurring and sudden onset of episodes

- panic attacks

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24
Q

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

A

c) episodes occur unexpectedly and she would fear more of these episodes

25
Q

A child presents with recurrent episodes of tachypnea, tachycardia, diaphoresis, nausea and vomiting. This occurs twice per week, never at school, for past six months. What is the cause?

a) panic attacks
b) social phobia
c) arrhythmia

A

a) panic attacks

26
Q

Which of the following treatments have been proven to be effective?

a) behavioural therapy for social phobia
b) paroxetine in panic disorder

A

a) behavioural therapy for social phobia

- panic disorder treatment is CBT +/- SSRI but generally would use fluoxetine, not paroxetine in kids

27
Q

A teen with panic attacks (described).

a) What is the most likely diagnosis?
b) What are 2 treatment modalities?

A

b) CBT

- SSRIs

28
Q

A teenage boy admits to having violent thoughts which overwhelm him. He says the thoughts are frequent and that he has not hurt anyone yet, but fears that he will soon. What diagnosis is most likely.

a) Behavioural problems
b) OCD
c) Schizophrenia
d) Antisocial personality

A

b) OCD

- less likely schizophrenia because he has insight and finds the thoughts distressing

29
Q

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

A

b) Group A strep

PANDAs

30
Q 
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
A

c ) Penicillin (only treat if existing strep symptoms; antibodies not bacteria is cause)

Unproven hypothesis- routine diagnostic lab testing for GAS and ASOT, long term antibiotics, or IVIG/ plasma exchange to treat exacerbations are NOT recommended

*Main issue here is OCD symptoms so if you were going to treat anything medically you should treat her OCD (with an SSRI)

31
Q

A child is referred for evaluation of ADHD. He is have trouble finishing work at school. He is very slow at writing and copies over his letters 3 times. No problems with class disruption, inattentions, hyperactivity or peer relationships. What is the diagnosis?

a) ADHD
b) OCD
c) Anxiety disorder

A

b) OCD

32
Q

Give two characteristics of “obsessions” in the diagnosis of Obsessive Compulsive Disorder.

A
  • recurrent and persistent thoughts, urges or images
  • intrusive and unwanted
  • cause anxiety and distress
33
Q

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

A

a) desensitization - part of CBT which is first line for mild-moderate OCD
- fluoxetine is a good treatment for more severe OCD

34
Q

Trichotillomania, which is true?

a) is associated with OCD in older kids
b) is usually self-limiting
c) is rare

A

a) is associated with OCD in older kids

35
Q

A girl with PTSD. List 4 characteristics of PTSD.

A
  • exposure to actual or threatened death, serious injury or sexual violence
  • re-experiencing of event
  • avoidance of situations that remind them of event
  • negative thoughts or feelings following traumatic event (amnesia, self-blame, negative self image, anhedonia)
  • hyperarousal (irritation, aggression, poor sleep or concentration, easily startled)
36
Q

5 yr old with 21 yr old single mom. Teacher says she is hyperactive, hoarding food and not remorseful for inappropriate behaviour. No eye contact with mom, but runs up and hugs you. Most likely diagnosis?

a. ADHD
b. Autism
c. Attachment disorder

A

c. Attachment disorder

37
Q

Kid eats like crazy, very skinny, runs up to hug you. What does this kid have?

a. diencephalic syndrome.
b. emotional deprivation

A

b. emotional deprivation

*diencephalic syndrome: Severe emaciation/FTT despite normal/increased appetite and preserved ht/length curve
o Accompanied by: overactivity, hyperkinesia, euphoria, vomiting, nystagmus - associated with low grade astrocytomas in anterior hypothalamus

38
Q

Child comes to the office because his teacher wants him investigated for disruptive behaviour and is concerned about ADHD. Parents may have some concerns about his attention but none about his behaviour
A) What do you think is the diagnosis?
B) What are 4 things to request to investigate for this diagnosis?

A 
A) Likely ADHD
B) SNAP scales for parents and teachers
Report cards
Thorough physical exam to rule out comorbid medical condition
Vision and hearing screening
Developmental assessment
Consider psychoeducational testing
Consider genetic testing
Consider screening blood work (thyroid, lead level)
39
Q

A guidance counselor calls you about a 12 y.o from Inuit population. He things that the boy may have ADHD. Give four other things on your differential diagnosis.

A
  • learning disability
  • hearing or visual impairment
  • FASD
  • substance use
  • anxiety or mood disorder
  • fragile X
  • medical disorder (hyperthyroid, lead poisoning)
40
Q

Teen with ADHD, 14 lb weight loss. Currently ADHD is better controlled on his long-acting ADHD med. What is the best thing to do?

a. start Straterra (Atomoxetine)
b. Consult a psychiatrist
c. Change from 7 days a week dosing to 5-days a week

A

c. Change from 7 days a week dosing to 5-days a week

41
Q 
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
A

B) Change from Concerta to Adderall

42
Q

7 yo male with normal intelligence is struggling at school. He cannot read aloud and doesn’t understand reading material but can learn when read to. What is the cause?

a) ADHD
b) Expressive aphasia
c) Global delay
d) Dyslexia

A

d) Dyslexia

- learning disorder (underperforming compared to his intelligence)

43
Q

A 4 year old boy has trouble with expressive language. Currently speaks only 50 words and is using 2 word phrases. His receptive language is good. Development otherwise normal (build 12 piece puzzle and house with Lego). What is he most likely at risk for?

a) developmental disability
b) difficulty with reading
c) Autism spectrum disorder
d) ADHD

A

b) difficulty with reading

early lang disorder strongly related to reading disorder (50%), early lang dx (esp auditory comprehension) RF for later emotional dysfunction (higher rate of anxiety)

44
Q

10 y.o. boy steals, kills a pet and lights fires. What is the diagnosis?

a) ODD
b) ADHD
c) Conduct disorder
d) Antisocial personality trait

A

c) Conduct disorder

45
Q

A 13 y.o. boy presents to your office with a history of being argumentative with his teachers at school, skipping class and refusing to obey his parents’ rules at home.

a) What is the most likely diagnosis
b) Name 2 treatment modalities that may be beneficial in this situation

A

a) Oppositional defiance disorder
b) parent training (e.g. triple P parenting program) to strengthen child-parent relationship, and youth training to learn how to deal with anger-provoking situations
- anger mgmt programs for youth (Coping Power)
- medications (stimulants or atypical antipsychotics)

46
Q

4 specific behaviours in an adolescent with conduct disorder

A
  • Aggression to people and animals/violation of the rights of others
  • Destruction of property
  • Deceitfulness or theft
  • cruelty to animals
  • truancy before age 13
  • run away from home 2+ times
47
Q

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

A

a. avoidant personality disorder (anxiously detached, hypersensitive to negative evaluation)

48
Q

Tourette’s Syndrome.

a) List 3 diagnostic criteria
b) List 3 associated conditions

A

a) 2 motor + 1 vocal tic; min. 1 year; onset < 18 y.o.

b) ADHD, OCD, LD

49
Q

A kid presents with facial tics. What would support a diagnosis of Tourette’s?

a. tics are present for 6 months
b. family history of tics
c. attention-deficit, hyperactivity disorder

A

b. family history of tics ( usually + FHX)

* 2/3 of patients with Tourette’s do have ADHD

50
Q

Child presenting with writing difficulties and seems moody. What does she have?

a. Lupus
b. Sydenham’s chorea
c. Tourettes
d. Huntington’s disease

A

b. Sydenham’s chorea

SLE also possible, but epidemiologically less likely

51
Q

A 14 y.o. boy recently has had 2 weeks of personality changes, saying weird things, staying in his room and not going to school. (No comments on any physical symptoms.) List 4 causes on your differential diagnosis.

A
  • Brief Psychotic Episode
  • Substance use
  • Mood Disorder (depression)
  • Medical Condition (brain tumour)
52
Q

A 15 y.o. boy is brought in by his parents because he is locking himself in his room and is hearing voices. He broke up with his girlfriend 2 weeks ago.

a) What is the differential diagnosis?
b) List 4 non-psychiatric diagnoses for psychosis/delirium.

A

a) Adjustment Disorder, Substance Induced, Brief Psychotic Episode, Schizoaffective disorder
b) toxins/drugs, infection (encephalitis, meningitis), metabolic (B12, folate deficiency, hyperthyroidism, late onset CAH), liver failure (hepatic encephalopathy), brain tumour

53
Q

11 year old boy who has had recent personality changes, decline in school performance and visual changes. Which is the first diagnosis to rule out:

a) Brain tumour
b) T1DM
c) ADHD

A

a) Brain tumour

54
Q

Child has frightening awakenings, screams, cries. No recollection in the morning. What is the most likely diagnosis?

a. nightmares
b. night terrors

A

b. night terrors

55
Q

5 things you would tell a boy to improve his sleep hygiene

A

o Quiet and comfortable sleep environment
o Consistent bed and waking time
o Avoid stimulation (Tv, computers, video games)
o Read or other active stimulation to mentally fatigue
o Increase physical activity in daytime (not within two hours of bedtime)
o Limit bed use to sleep (not for tv, eating, homework)

56
Q

Divorcing parents. What’s best for the kid?

a) best if joint custody could be given asap
b) best if child gets to see both parents even if the parents are fighting all the time
c) best if parents can settle their differences and not fight in front of kids

A

c) best if parents can settle their differences and not fight in front of kids

57
Q

Marital troubles at home, child is acting out at school and daycare. Mom has come in for advice.

a. give the mom parenting classes
b. request a meeting with both parents to assess the home situation
c. give him Ritalin

A

b. request a meeting with both parents to assess the home situation

58
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

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

59
Q

3 reasons you could breach confidentiality.

A
  • Risk to Self (Form 1)
  • Risk to Others (Report to police)
  • Risk to other children (Child Protection Services)
  • Reportable Infections (Public Health)

2019 Bank of Goodness (22 decks)

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