Psychiatry: NBME

Question 1

adjustment d/o vs. bereavement

Answer 1

Bereavement = normal rxn to loss; feelings of loss and emptiness; sx revolve around deceased
Adjustment d/o = rxn to loss w/out full criteria for depression re:sx or duration

Question 2

narrow based gait with hallucinations + cognitive decline ==> dx?

Answer 2

lewy body dementia

Question 3

lip smacking last 1-2 min ==> dx?

Answer 3

Left temporal lobe seizure - Complex partial seizure

Question 4

What drugs can cause seotonin syndrome - dilated pupils, hyperreflexia, generalized muscle ridcity?

Answer 4

Opiod - tramadol
Antidepressants
triptans

Question 5

Nocturnal Enuresis dx/tx

Answer 5

• NE = nighttime bedwetting > 5yo; usual dx in childhood, occ. in adolescence
• incidence: boys > girls
• Behavioral interventions/alarms
• Meds: Imaprime

Question 6

Prevent tardive dyskinesia

Answer 6

• switch from typical ==> atypical (e.g. apriprazole has lower risk)
• decrease dose or d/c if possible

Question 7

heroin/opiates affect what part of the brain

Answer 7

substantia nigra

Question 8

Common congenital diseases w/epicanthal folds

Answer 8

• Down’s

- Fetal Alcohol Syndrome

Question 9

acute stress disorder

Answer 9

• severe levels of re-experiencing after a traumatic event
• ~short-term/acute PTSD
• full criteria = three or more dissociative symptoms) may present with a flat or blunted affect, described as emotional numbing
• may be amnesia of aspects of event

Question 10

GAD criteria

Answer 10

-excessive worry/anxiety about multiple event + -6 months of 3+ sx: -impaired sleep -poor concentration -easy fatigability -irritability -m. tension -restlessness

Question 11

Bipolar Criteria

Answer 11

-Bipolar = elevated/irritable mood, increased energy, + 3-4 or DIGFAST -Manic = severe sx, 1 week+, marked impairment, +/- psychosis -hypomanic = less severe sx, >=4 days, no hospitalization, no psychosis

Question 12

DIGFAST

Answer 12

D = Distractibility and easy frustration
I = Irresponsibility and erratic uninhibited behavior
G = Grandiosity

F = Flight of ideas
A = Activity increased with weight loss and increased libido
S = Sleep is decreased
T = Talkativeness

Question 13

Neuroimaging: autism

Answer 13

increased total brain volume

Question 14

Neuroimaging: OCD

Answer 14

abnormal orbitofrontal cortex and striatum

Question 15

Neuroimaging: Panic

Answer 15

decreased volume of amygdala

Question 16

Neuroimaging: PTSD

Answer 16

Decreased hippocampal volume

Question 17

Tx of narcolepsy

Answer 17

-sleep habits, minimize EtOH, avoid meds that cause drowsiness -1. Modafinil = chemically novel stimulant -2nd line = amphetamine stimulants -sodium oxybate ==> decreased cataplexy (but has potential for abuse)