This document provides explanations for 47 multiple choice questions related to psychiatry. It covers topics like circadian rhythm sleep disorders, Down syndrome, substance-induced mood disorders, bipolar disorder, schizophrenia, anxiety disorders, depression, psychosis, childhood disorders, and more. For each question, it lists the main diagnosis or condition being tested, along with 1-3 brief points about signs, symptoms, diagnostic criteria, or treatment recommendations for that diagnosis. The overall document serves as a review aid for a psychiatry shelf or board exam.
This document provides explanations for 47 multiple choice questions related to psychiatry. It covers topics like circadian rhythm sleep disorders, Down syndrome, substance-induced mood disorders, bipolar disorder, schizophrenia, anxiety disorders, depression, psychosis, childhood disorders, and more. For each question, it lists the main diagnosis or condition being tested, along with 1-3 brief points about signs, symptoms, diagnostic criteria, or treatment recommendations for that diagnosis. The overall document serves as a review aid for a psychiatry shelf or board exam.
This document provides explanations for 47 multiple choice questions related to psychiatry. It covers topics like circadian rhythm sleep disorders, Down syndrome, substance-induced mood disorders, bipolar disorder, schizophrenia, anxiety disorders, depression, psychosis, childhood disorders, and more. For each question, it lists the main diagnosis or condition being tested, along with 1-3 brief points about signs, symptoms, diagnostic criteria, or treatment recommendations for that diagnosis. The overall document serves as a review aid for a psychiatry shelf or board exam.
This document provides explanations for 47 multiple choice questions related to psychiatry. It covers topics like circadian rhythm sleep disorders, Down syndrome, substance-induced mood disorders, bipolar disorder, schizophrenia, anxiety disorders, depression, psychosis, childhood disorders, and more. For each question, it lists the main diagnosis or condition being tested, along with 1-3 brief points about signs, symptoms, diagnostic criteria, or treatment recommendations for that diagnosis. The overall document serves as a review aid for a psychiatry shelf or board exam.
• This patient is unable to sleep and wake at the time required for normal work and social needs • These patients will have normal sleep, energy and functioning when they can set their own sleep cycle
2) Down syndrome • Epicanthal folds, cardiac murmur, developmental delay
3) Substance-induced mood disorder
• Must rule out any substance or medical related mood disorder before diagnosing a psychiatric condition • Central acting beta-blockers (eg, propranolol, nadolol) can cause depression and psychosis
4) Admit the patient to the psychiatric unit
• When someone is a danger to themselves or others they should be admitted
5) Focal spikes localized to the temporal lobe
• Complex partial seizure most commonly arise from the temporal lobe, which is confirmed by smelling burnt rubber and hissing noise - spikes on EEG localize the seizure activity • Burst suppression pattern = patients with inactivated brain (eg, coma) • Hypsarrhythmia = infantile spasms • Diffuse 3-Hz spike and slow wave activity = absence seizures • Triphasic wave = toxic metabolic encephalopathy
6) Add bupropion to the medication regimen
• Buproprion is an atypical antidepressant that has favorable sexual side effects and will help with this patients weight gain
7) Explain the risk of illness recurrence without medication
• This patients bipolar disorder has been well controlled with his medication, and the importance of maintaining this should be explained
8) Social phobia • Social anxiety disorder, performance type: anxiety restricted to public speaking • Fear of embarrassment or judgement is a classic sign of social phobia
9) Decreased concentration of 5-hydroxyindoleacetic acid in cerebrospinal fluid analysis
• The neurotransmitters that are decreased in depression include dopamine, norepinephrine, and serotonin • Delayed REM sleep on nighttime polysomnography is seen in delayed phase sleep disorder • Enlarged lateral ventricles is seen in schizophrenia • Increased sensitivity to lactate infusion is seen in generalized anxiety disorder 10) Clonazepam • For mild agitation and anxiety, give a benzodiazepine • For agitation and psychosis you’d normally give an antipsychotic, but this patient has a prolonged QT interval, so Ziprasidone is contraindicated
11) Reassurance • Sleep changes in elderly: ↓ REM sleep time, ↑ REM latency, ↓ stage N3 (non-REM sleep) • This patient is experiencing normal age related changes
12) Reassurance that this is normal behavior
• Enuresis is normal until age 5 • Encopresis is normal until age 4
13) Recommend alcohol rehabilitation
• This patient does not believe he has a drinking problem, but has cut back on the amount he drinks - therefore he’s in the action phase, not the pre-contemplation phase • Disulfiram is given to patients who are not actively drinking and are highly motivated to quit • Clonidine is given in alcohol withdrawal, but should not be given to a patient that is actively drinking • This patient has cirrhosis, so the only benzodiazepines that should be used are lorazepam, oxazepam, and temazapam due to minimal first-pass metabolism
• CT scans of patients with schizophrenia often show ventriculomegaly (particularly the lateral cerebral ventricles) and diffuse cortical atrophy
16) Surreptitious administration of insulin
• Oral hypoglycemic agents stimulate production of endogenous insulin (↑ insulin & ↑ C-peptide)
17) Discuss normal pubertal development
• Absence of 2° pubertal development is normal in girls ≤ 14, and boys ≤ 15
18) Switch from haloperidol to aripiprazole
• First generation antipsychotics treat positive symptoms only • Second generation antipsychotics treat positive and negative symptoms • Second generation antipsychotics are less likely to cause EPS than 1st generation antipsychotics (eg, haloperidol) • This patients negative symptoms (blunted affect) remain untreated
19) Maintain the current dosage of sertraline and schedule weekly follow-up examinations for the next month • SSRIs take 4-6 weeks to work - if there is no improvement at that time, then the dose can be titrated accordingly • This patient has a mild-moderate risk for suicide - not enough to hospitalize, but they should be monitored closely outpatient (weekly examinations) • Black box warning: patients age 18-24 have a slightly increased risk of becoming suicidal when initiating antidepressant treatment
20) Administer additional diazepam
• The benefit of preventing death from alcohol withdrawal far outweighs the possible respiratory depression from benzodiazepines, especially since she is already intubated
Need a little help preparing for your shelf exam? Elite Medical Prep can help with personalized 1-on-1 tutoring!
21) Restless legs syndrome
• Worse at night and at rest, Relieved by movement • Associated with iron deficiency → this patients fatigue
22) Brief psychotic disorder
• Presence of ≥1 psychotic symptom (eg, paranoia, auditory hallucinations) with a sudden onset and full remission in 1 month
23) Administration of morphine
• Management of acute pain is similar in all patients regardless of substance abuse history • This patient is about to undergo wound debridement and suturing - they require a stronger analgesic than ibuprofen
24) Acute intermittent porphyria
• Presents with the 5 P’s • Painful abdomen • Port wine colored urine • Polyneuropathy • Psychological disturbances • Precipitated by drugs (eg, alcohol)
25) Separation anxiety disorder
• Persistent anxiety with separation and excessive worry about losing major attachment figures for ≥4 weeks
26) Dopamine • Blockade of the nigrostriatal dopamine pathway is responsible for EPS in patients taking antipsychotics
27) Psychotherapy • Psychotherapy is the treatment of choice for adjustment disorder
28) Adjustment disorder
• Onset within 3 months of a non-life threatening stressor • Poor test performance = functional impairment • For bereavement, someone has to have died (according to the DSM-5)
29) Begin parent management training
• Child is behaved in daycare, at the doctors office, and with her grandmother • Tantrums are most likely due to parental interactions
30) Major depressive disorder
• This patient presents with 5/9 SIG E CAPS • “Withdrawn” = anhedonia • “-15lb” = appetite/weight loss • “sad” = depressed mood • “poor energy” = fatigue • “decreased sleep” = insomnia • Common to develop MDD in chronic diseases
31) Anorexia nervosa
• Excessive dieting, exercising, or binge eating/purging with BMI <18.5 (adults) or <5th percentile (children/adolescents)
32) Lewy body dementia
• Parkinsonism, Hallucination, Dementia (LEWY has a PHD)
33) Conversion disorder
• Loss of sensory or motor function following an acute stressor • La belle indifference = patient is aware but indifferent toward symptoms
34) Decrease the dosage of carbidopa-levodopa
• The psychotic symptoms of Parkinson’s disease may be treated with dose reduction of antiparkinson agents and/or low potency antipsychotics (eg, quetiapine) • In the elderly (this patient is 87) it is better to remove medications rather than adding more if it will lead to the sam result 35) Panic disorder • Recurrent and unexpected attacks + >1 month of preoccupation with the attacks • Preoccupation with unexplained symptoms overlaps with somatic symptom disorder, but the abrupt onset of physical symptoms that resolve quickly is more consistent with panic disorder • Tx: SSRI or SNRI + CBT
36) Child abuse
• Forceful twisting of a limb → spiral fractures = child abuse • Demineralization occurs with all bony injuries
37) Decreased binding of dopamine at the postsynaptic receptor
• Haloperidol is a typical antipsychotic that blocks dopamine D2 receptors
38) Serotonin • Fluoxetine (SSRI) → ↑ serotonin in the synoptic cleft • Tramadol inhibits the re-uptake of NE and serotonin • Fluoxetine + Tramadol → Serotonin Syndrome
39) Begin escitalopram therapy
• This patient has MDD - 5/9 SIG E CAPS: • Not sleeping = insomnia • Avoids social activities = anhedonia • Tired = ↓ energy • Wight loss = appetite/weight changes • Not remembering like he used to = ↓ concentration or psychomotor retardation • SSRI is first line pharmacotherapy for MDD
40) Generalized anxiety disorder
• Excessive anxiety/worry for ≥ 6 months with significant distress or impairment • Muscle tension, sleep disturbance, irritability, difficulty concentrating, and fatigue are common associated symptoms Need a little help preparing for your shelf exam? Elite Medical Prep can help with personalized 1-on-1 tutoring!
• Perceptual distortion (visual), anxiety, paranoia, negative urine toxicology (LSD isn’t included on a standard drug test)
43) Amenorrhea • Anorexia nervosa → ↓ GnRH → ↓ LH, FSH → ↓ estrogen → amenorrhea, bone loss
44) Ziprasidone • Antipsychotics are the first-line pharmacotherapy for patients with acute psychosis • Second-generation is usually preferred due to less EPS side effects
45) Clomipramine • Tx of OCD: CBT + SSRI; clomipramine and venlafaxine are second line
46) Obsessive-compulsive disorder
• This patients disorder is ego-dystonic (behavior inconsistent with one’s own beliefs and attitude) making OCD the most likely diagnosis • Tx: CBT + SSRI (clomipramine and venlafaxine are second line)
47) Caudate atrophy
• Trinucleotide repeat diseases often show anticipation (earlier onset of disease in succeeding generations) - this patients symptoms began when she was 47 years old and it began in her father when he was 56 years old • This patient has Huntington disease which often presents wit chorea, aggression, depression and dementia • Imaging of the brain in Huntington disease will show atrophy of the caudate nucleus and putamen with ex-vacuo ventriculomegaly
48) Dissociative fugue
• Dissociative amnesia is an inability to recall important personal information • Dissociative fugue is a subtype of dissociative amnesia characterized by travel or wandering
49) Conduct disorder
• Repetitive and pervasive behavior that violates the basic rights of others or societal norms (eg, aggression to people and animals, destruction of property, theft) • The kid killed his cat with no remorse...
50) Delusional disorder
• Fixed, persistent, false belief system lasting >1 month with otherwise normal functioning • Schizophrenia/Schizophreniform requires greater functional impairment and other psychotic symptoms (eg, hallucinations, disorganization, negative symptoms)
Found a mistake or have a suggestion? Submit errata here
DR Kumar Ponnusamy Biochemistry-Genetics USMLE Preparatory Course BIOGEN Reusable On-Line Resources For Large Group Teaching-Learning in Relatively Short Time
DR Kumar Ponnusamy Biochemistry-Genetics USMLE Preparatory Course BIOGEN Reusable On-Line Resources For Large Group Teaching-Learning in Relatively Short Time
