Residency 1

Question 1

Wernicke’s Encephalopathy Treatment

Answer 1

Thiamine 500 mg TID

Question 2

What is ethinylestradiol a substrate of?

Answer 2

CYP P450 3A4

Question 3

Is paroxetine an inhibitor or inducer? Of which P450 enzyme?

Answer 3

2D6 inhibitor

Question 4

Is mirtazapine an inhibitor or inducer?

Answer 4

Neither

Question 5

What is lamotragine a substrate of?

Answer 5

UGT1A4

Question 6

What percentage of individuals experience sexual side effects?

Answer 6

Roughly 30%

Question 7

What tool to screen for sexual dysfunction in patients with MDD?

Answer 7

Arizona ASEX

Question 8

Treatment for sexual dysfunction associated with SSRI use

Answer 8

1) Reduce alcohol and cigarette use
2) Treat medical conditions e.g. diabetes or hypertension
3) Watch and wait or decrease the dose
4) Switch to Remeron or Wellbutrin
5) Drug holiday — but not for Prozac because of long half-life. Can cause SSRI withdrawal.
6) Augmenting agents including: Wellbutrin, Sildenafil (for both men and women), testosterone patch, maca root

Question 9

Which antipsychotic is contraindicated in recent MI?

Answer 9

Ziprasidone

Question 10

What is ketamines mechanism?

Answer 10

NMDA antagonist

Question 11

Capacity Assessment

Answer 11

1) Communication: Express a treatment choice
2) Understanding: Does the patient understand the
3) Appreciation: Acknowledge medical condition and likely consequences of treatment options
4) Reason: Engage in a rational process of manipulating the relevant information

Question 12

CIWA Scoring

Answer 12

Nausea/vomiting
Anxiety
Paroxysmal sweating
Tactile hallucinations 
Visual hallucinations 
Tremor
Agitation
Orientation
Auditory hallucinations 
Headache 
-each is scored 0-7
0-9 is minimal/absent withdrawal
10-19 is moderate withdrawal
>20 is severe withdrawal

Question 13

PANDAS

Answer 13

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection

1) Presence of obsessions, compulsions or tics
2) Unusually abrupt onset of symptoms or relapsing/remitting course
3) Prepeburtal onset
4) Associated with other neuropsychiatric symptoms
5) Preceded by streptococcal infection

Question 14

Cholinesterase Inhibitors (treatment for AD)

Answer 14

Donepezil
Rivastigmine
Galantamine

Question 15

Memantine

Answer 15

NMDA receptor antagonist. Excessive NMDA stimulation can be induced by ischemia and lead to excite toxicity, thus memantine may protect further damage in those with vascular dementia.

• Benefit is modest and in those with moderate to severe AD
• Likely does not benefit patients with Down’s Syndrome for mild AD
• SEs include dizziness. Lower frequency is confusion, hallucinations, delusions.

Question 16

Conversion Disorder physicalexam signs

Answer 16

Hoover’s sign, hip abductor sign, co-contraction sign, give way or collapsing weakness (soft), drift without pronation

Question 17

Prevalence of OCD

Answer 17

2%

Question 18

Prevalence of SCZ

Answer 18

1%

Question 19

Response to SRIs in OCD

Answer 19

Up to 65% achieve a 20-40% reduction in symptoms

Question 20

OCD treatment augmentation

Answer 20

1/3 of patients will respond to augmentation with antipsychotics. If they do no respond in 2-4 weeks, discontinue it.

Question 21

Screening Scale for OCD

Answer 21

C-YBOCS

Question 22

FDA-approved agents for generalized social anxiety disorder

Answer 22

Paroxetine, sertraline, fluvoxamine, venlafaxine (none superior to another)