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Breaking bad
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Mental health
100
The positive symptoms of schizophrenia are due to hyperactivity of what dopamine tract?
What is the Mesolimbic Pathway?
100
This 2nd generation anti-psychotic is associated with greatest risk of metabolic side effects.
What is Olanzapine or Clozapine ?
100
The antipsychotic side effect seen in this patient is this
What is oculogyric crisis?
100
Antidepressant (NDRI) that can lower the seizure threshold and is contraindicated in eating disorder patients.
What is Bupropion?
100
Following the first episode of depression, what is the risk of relapse?
What is 50%?
200
About 75% of patients with schizophrenia do this unhealthy activity which also induces an increased metabolic rate of antipsychotic medications.
What is cigarette smoking?
200
The mainstay of treatment for anorexia nervosa is nutritional rehabilitation plus psychotherapy. In treatment-resistant cases, ______ can be used as an adjunct to help accelerate weight gain.
What is Olanzapine?
200
A 75-year-old man with a history of Parkinson disease, bipolar disorder, and hypertension is brought to the emergency department with confusion and fever. His caregivers report that last week he complained of stomach cramps and diarrhea and stopped taking his medications as he thought they were worsening his symptoms. His medications include carbidopa/levodopa, sertraline, lithium, lisinopril, and amlodipine. He does not use tobacco or illicit drugs but drinks 2 or 3 beers on weekends.
On evaluation, the patient is diaphoretic and confused. Temperature is 38.3 C (101 F), blood pressure is 180/95 mm Hg, pulse is 114/min, and respirations are 20/min. The mucous membranes are dry. He has prominent generalized muscular rigidity and bilateral tremor. The abdomen is nontender and bowel sounds are present.
Laboratory results are as follows:
Complete blood count Hematocrit40% Platelets300,000/mm3 Leukocytes13,000/mm3
Serum chemistry Sodium146 mEq/L Potassium4.8 mEq/L Chloride100 mEq/L Bicarbonate24 mEq/L Blood urea nitrogen40 mg/dL Creatinine1.4 mg/dL Glucose120 mg/dL
Creatine kinase, serum1,520 U/L
ECG shows sinus tachycardia and nonspecific T-wave changes. Spinal fluid evaluation shows no abnormalities. Which of the following is the most likely diagnosis?
What is neuroleptic malignant syndrome?
200
More common with typical antipsychotics, this side effect is characterized by repetitive, involuntary, purposeless movements.
What is Tardive Dyskinesia?
200
Patients with MDD with psychotic features who are refractory to antipsychotics and/or antidepressants and who are unable to tolerate or comply with medications should be treated with ______
What is Electro-Convulsive Therapy?
300
This personality trait is characterized by a longstanding pattern of odd, magical thinking and eccentric behavior.
What is Schizotypal personality disorder?
300
This drug is a very effective augmenting therapy for patients with PTSD associated nightmares.
What is Prazosin?
300
A 21-year-old woman is referred for evaluation of sleep and appetite disturbance. The patient is a college senior who initially went to student health services following a romantic breakup a week ago. Her sleep has returned to normal, but "my eating is still out of control." The patient has been eating entire containers of ice cream and bags of cookies and chips. She says, "I'm sure one of the reasons he dumped me was because of my weight and disgusting body." The patient acknowledges that, throughout college, she has had a pattern of eating very large amounts of food several times a week and daily while preparing for final exams. She does not vomit but takes laxatives and exercises for several hours after one of these eating episodes. The patient has no medical issues but reports that her menstrual cycle is irregular. Her older sister has a history of anorexia nervosa.
Temperature is 37 C (98.6 F), blood pressure is 108/62 mm Hg, pulse is 88/min, and respirations are 14/min. BMI is 21 kg/m2. Physical examination is unremarkable. Pregnancy test is negative.
Which of the following is the most likely diagnosis?
What is bulimia nervosa?
300
Of all the SGAs, this medication has the highest risk of causing QTc prolongation.
What is ziprasidone (Geodon)?
300
While prochlorperazine (Compazine) is a D2 blocker it is more commonly used for ______ than its antipsychotic properties.
What is antiemetic properties?
400
First generation antipsychotics (FGAs) usually cause extrapyramidal side effects (EPS) & second-generation antipsychotics (SGAs) usually cause metabolic syndrome.
Amongst the SGAs, this medication has the lowest potential to cause weight gain and metabolic effects.
What is aripiprazole?
400
This is the first-line antidepressant of choice for depressed elderly patients with insomnia, anxiety and weight loss.
What his mirtazapine?
400
A 38-year-old man comes to the office stating that "my skin is being eaten away by flesh-eating bacteria." He has repeatedly used a stiff brush to apply antibacterial soap and disinfectant to the skin he insists is infected. The patient describes a progression of itching and redness followed by intense, burning pain at infected sites that spreads almost daily to new body areas. The patient systematically inspects his skin twice a day and records detailed descriptions of the affected areas. He is able to fall asleep at night but awakens sometimes to scratch his skin. He works as an accountant and has had a stable job performance. Current medications include a multivitamin and acetaminophen as needed. He drinks alcohol socially and does not use tobacco or illicit drugs.
Temperature is 36.5 C (97.7 F), blood pressure is 122/76 mm Hg, and pulse is 62/min. Physical examination reveals scattered lesions on his extremities that appear to have been caused by intense, abrasive scrubbing. The remainder of the physical examination is unremarkable.
Which of the following is the patient's most likely psychiatric diagnosis?
What is Delusional disorder?
400
The picture shows a patient experiencing this EPS side effect.
What is dystonia?
400
There is a blackbox warning for the use of antipsychotics in elderly dementia patients due to increased risk of this
What is sudden death (cardiovascular cause)?
500
A 34-year-old man is brought into the emergency department by his friends who found him unresponsive in his apartment. Upon arrival, patient is noted to have pinpoint pupils, slow and shallow breathing and a decreased level of consciousness. His friends report that he has a history of substance abuse. Administration of which medication is the most appropriate initial management for this patient?
What is Naloxone?
500
This class of medications (or medication) should be considered for treating major depression in terminally ill patients.
What are psychostimulants (i.e. methylphenidate, dextromethorphan, modafinil) ?
500
A 35-year-old woman is experiencing a particularly stressful period at work. She has several projects with tight deadlines, and her boss has been demanding and critical. In order to cope with the stress, the woman decides to put her negative feelings about her boss aside temporarily and focus on completing her tasks. This allows her to perform well at work and meet her deadlines. Which of the ego defense mechanism is the woman employing in this situation?
What is suppression?
500
A 44-year-old patient of yours has come to see you multiple times for low mood. She does not have trouble with energy or sleep, but with prompting reports occasional problems with concentration and appetite. Basically, she tells you, "I've been depressed for as long as I can remember." You have tried treating her with two different SSRIs, but she had trouble with side effects and did not notice much improvement in her mood. What is the best diagnosis for this patient?
What is persistent depressive disorder (dysthymia)?
500
When used in their long-acting injectable form, these 2 FGAs are given IM every 2-4 weeks to treat patients with chronic schizophrenia.
What is haloperidol (Haldol) & fluphenazine (Prolixin)?