Uworld 7/18

Question 1

what are the first line treatments for acute mania?

Answer 1

So first line would be an atypical antipsychotic such as resperidone. Also you could augment with lithium and valproate acid. Make sure to check renal function with lithium and liver function with valproic acid.

Question 2

patients who experience a period of acute depression and pronounced fatigue following a period of increased energy…

Answer 2

cocaine withdrawal. following abrupt cessation of Cocaine usage, patients may experience a “crash”. Initial sx of cocaine withdrawal include: severe depression with suicidial ideation and psychomotor slowing.

depression, fatigue, hypersomnia, increased dreaming, hyperphagia, impaired concentration and drug craving are also symptoms of cocaine withdrawal.

Question 3

recurrent suicidal behavior and unstable relationships…

Answer 3

boarderline personality disorder

Question 4

Abrupt cessation of alprazolam, a short acting benzodiazepine can cause what…

Answer 4

Seizures.

Question 5

what is the strongest risk factor for suicidal behavior?

Answer 5

past suicidal attempts.

Question 6

dopamine blockade by an antipsychotic vs prolactinoma

Answer 6

In a prolactinoma, you would see very high levels of prolactin around > 200 ng/mL vs in a patient taking resperidone you would see a level more around 70.

Question 7

postpartum psychosis

Answer 7

although very rare, does occur, especially in patients with prior Bipolar diagnosis. Treatment includes HOSPITALIZATION of the patient to protect both herself and her baby. Also start antipsychotics and possible mood stabilizers/anti-depressants.

Question 8

How could you differentiate between amphetamine intoxication vs opioid withdrawal.

Answer 8

in amphetamine intoxication you commonly see psychosis. It will improve when the drug wears off. You don’t typically see psychosis in opioid withdrawal and additionally, the withdrawal from opioids is about 3-5 days of sx.

Question 9

Shared delusional dissorder

Answer 9

The best initial management is to separate the two and interview them separately. Often the dominant delusional individual will require treatment while the more submissive may be able to avoid this

Question 10

Somatic symptom disorder vs illness anxiety disorder…

Answer 10

Somatic symptom disorder the patient actually has a symptom and they have excessive anxiety due to their tests always coming back “negative”

Illness anxiety disorder was also known as hypochondriasis, is where the patient has excessive fear that they have an illness, however they lack any symptoms.

Question 11

schizotypal personality disorder

Answer 11

in addition to weird and eccentric beliefs, these patients have very little social skills and actually have social anxiety even in the presence of familiarity with the social situation.

Question 12

how would you differentiate dementia from normal aging?

Answer 12

Getting lost in familiar territories is specific for dementia and not found in normal aging.

Question 13

What is the first step in treating PMS or PMDD?

Answer 13

Taking a detailed diary for about 2-3 cycles to make the definative diagnosis. Then you can follow with a luteal phase only fluoxetine.