Symptoms/Evaluation
3 symptoms of a patient having a panic attack
Chest pain
Palpitations
Dyspnea (Shortness of Breath)
Top 3 ED psychiatric diagnosis
Panic Attacks
Alcohol Withdrawal
Major depressive disorder
What is the long term treatment of panic attack disorder?
SSRIs
SNRIs
3 symptoms an alcohol withdrawal patient in the first 12 hours
Tremor
Diaphoresis
Anxiety
Patient presents with crushing chest pain radiating to the left arm and jaw. He has profusely sweating and has difficulty breathing. EKG shows ST elevation is Leads II, III, and aVF. What is the diagnosis
Inferior wall MI
Which psychiatric drug class is used to manage acute panic attack?
Benzodiazepines
3 common symptoms of major depressive disorder
Disturbance in sleep patterns
Loss of interest or pleasure in activities once enjoyed
Feelings of worthlessness or excessive guilt
Decreased energy.
Decreased concentration
Significant decreases or increases in appetite
Observable psychomotor agitation
Recurrent thoughts of death, suicidal ideation, or suicide attempts.
A 30yo female presents to ED with palpitations. While she is home, she suddenly feels like her heart is jumping out of her chest, and is sometimes awoken by the symptoms in the middle of the night. These episodes are often associated with sweating, nausea, and paresthesias. She has had several episodes over the past few months. Her vitals and EKG is unremarkable. What is likely primary diagnosis?
Panic attack disorder
A 48yo man is brought to the ED by his roommate with a 1-week history of increasing confusion and difficulty walking. The roommate reports that the patient has been drinking excessive amounts of alcohol for many years. He has also been eating very little food in the past few months. During the evaluation, the patient tells stories about his life that the roommate refutes. What is the initial treatment?
Thiamine or Vitamin B1
3 symptoms an alcohol withdrawal patient after 48-96 hours
Autonomic Instability (Fever, tachycardia, Hypertension)
Delirium (Confusion, Severe agitation)
Tremors
Diaphoresis
A 55yo man is brought to ED after being found confused and agitated. His landlord reports he has been drinking heavily for the past week but stopped 2 days ago. The patient appears disoriented and keeps saying he sees spiders crawling on the walls. He is diaphoretic, tremulous, and repeatedly tries to get off the stretcher to "escape the bugs." What is the presumptive diagnosis?
Delirium Tremens
A 14 yo female is brought to the ED by her parents following a suspected suicide attempt. Her mother found her crying and saying, "I just want to die." When asked if she would attempt something like this again, her father interrupts and says, "Of course not. My daughter is not crazy; she doesn't want to die." The parents subsequently refuse inpatient psychiatric hospitalization, noting that "We can take care of her at home" and "We will get her in to see a therapist tomorrow." The daughter also requests to go home. The most appropriate next step
Admit the patient to the hospital involuntarily
A 33yo female is brought into the ED after she develops increasing substernal crushing chest pain, palpitations, shortness of breath and diaphoresis. This episode developed after she learned that she had lost her job, which led to progressively increasing anxiety prior to development of her current symptoms. She expresses a great deal of concern that she is about to die. Vitals show BP 168/110, HR 128, RR 24.
Which of the following is the most appropriate next step in management?
ECG
A 74 yo female presents to the office at the request of her oncologist approximately 4 weeks after receiving the diagnosis of stage IV pancreatic cancer. She reports that since receiving the cancer diagnosis, she has been experiencing a lack of interest in things that she used to enjoy, decreased appetite with associated weight loss, and feelings of worthlessness. There is also increased anxiety and restlessness surrounding the writing of the patient's will. The patient denies suicidal ideation and thoughts of self-harm. The most likely diagnosis is
Major Depressive Disorder
A 35 yo female with a history of liver disease is brought to ED after being found confused and agitated. Her roommate reports she has history of heavy drinking for the past week but stopped 3 days ago. The patient appears disoriented and has visual hallucinations. She is diaphoretic, tremulous, and agitated. What is the most appropriate immediate management?
Lorazepam