Show:
I'm Feeling Moody
Mother's Little Helper
Mix it Up
It Starts with a Thought
Give Me a Cure
100
You are seeing a 48 year old female who presents with a 3-month history of low mood, low energy, poor concentration, and irritability. She has lost interest in most things she had enjoyed and has also noticed a 20-pound weight gain. She has been having frequent headaches, has been short tempered, and has noticed that it is hard to wake up in the morning. She reports no thoughts of suicide but has wondered if death would be a relief. She says she has felt restless for a while and feels that she is a bad person. Her mother suffered from depression. She does not consume alcohol or any other substances. She is divorced and has no children. You think that this patient may meet criteria for a depressive disorder. Which of the following is NOT a criterion for the diagnosis of major depressive disorder (MDD)? a) Low mood b) Presence of suicidal ideation c) Decreased appetite d) Anhedonia e) Irritability
What is E: Irritability
100
You choose an SSRI to treat a patient with depression and tell her to contact you if she suffers from adverse effects. Which of the following is NOT a typical adverse effect of SSRIs? a) Nausea b) Headaches c) Restlessness d) Insomnia e) Urinary retention
What is E: Urinary Retention
100
You are assessing a 45 year old professional male who has a history of MDD in his early 20s but has since fully recovered. He recently suffered an uncomplicated anterior wall myocardial infarction. His wife mentions that she thinks he is depressed. He is tired all the time, has poor sleep, a poor appetite, and he has been irritable. He has also been tearful and blames himself for his MI (too many “pounder” burgers…with cheese and bacon). He is willing to consider the diagnosis of depression because he remembers having suffered from it before. He also knows a history of MDD puts him at risk of medical illnesses. Which of the following illnesses is more prevalent in patients with MDD? a) Coronary heart disease b) Cerebrovascular disease c) Diabetes mellitus d) Osteoporosis e) All of the above are more prevalent in depressed patients
What is E: All of the above are more prevalent in depressed patients.
100
Which of the following is NOT TRUE about suicide in the general population? a) Medical diagnoses can increase the risk of suicide. b) Over 90% of people who commit suicide have a mental or substance abuse disorder c) Older American are at higher risk of suicide than the general population d) The rate of successful suicides has increased over the years. e) Suicide is one of the top 10 causes of death in the U.S.
What is D: The rate of successful suicides has increased over the years.
100
Which of the following therapies has NOT shown efficacy in childhood depression in randomized controlled trials? a) Fluoxetine b) Sertraline c) CBT d) Venlafaxine e) Interpersonal Therapy
What is D: Venlafaxine
200
Which of the following symptoms is considered an atypical symptom of “atypical depression” or MDD? a) Hypersomnia b) Low Mood c) Anhedonia d) Psychomotor retardation e) Irritability
What is A: Hypersmonia
200
A patient returns to see you 2 weeks after starting her SSRI and reports that she has not noticed any benefit from the medication. Which of the following statements is most accurate? a) The antidepressant is not going to work, so she should switch medicines to one of the same class b) The antidepressant is not going to work, so she should switch medicines to another antidepressant from a different class c) It is too early to judge the efficacy of the antidepressant at this point d) She’s probably suffering a paradoxical reaction of increased depression with her medication e) Going up on the dose is not an option at this time
What is C: It is too early to judge the efficacy of the antidepressant at this point.
200
Which of the following SSRI's is LEAST likely to havve drug-drug interactions via P450 enzymes? a) Fluoxetine b) Paroxetine c) Citalopram d) Sertraline e) Fluvoxamine
What is C: Citalopram
200
A 62 year old woman whose husband died 6 months ago tells her physician that she believes killing herself would end her suffering. Physical exam is unremarkable. Analysis of neurotransmitter availability in the brain of the patient is most likely to reveal: a) increased dopamine b) decreased histamine c) increased acetylcholic d) decreased acetylcholine e) decreased serotonin
What is E: decreased serotonin
200
You decide to switch a patient's medication from bupropion to citalopram (Celexa). Which is the best way to accomplish this switch? a) Stop the bupropion immediately and then wait for 2 weeks before starting citalopram. b) Taper the bupropion over 2 weeks to avoid a discontinuation syndrome, and then start the citalopram. c) Start citalopram immediately, and then taper the bupropion over several days. d) Start citalopram now; then taper off the bupropion a couple of weeks later if he is doing well.
What is C: Start citalopram immediately, and then taper the bupropion over several days.
300
You believe that your patient is suffering from an episode of major depression, and you decide to initiate treatment with an antidepressant. Following the first episode of depression, what is her risk of relapse? a) <1% b) 25% c) 50% d) 75% e) >99%
What is C: 50%
300
During a recent visit, you increase your patients SSRI, and ask him to return to see you in 2 weeks. At this visit, he is feeling better and more energetic. People at work are beginning to notice his improved attitude, and he reports sleep has become more refreshing. He wants to know how long he should stay on the medication. You tell him he should expect to stay on the medication for AT LEAST ____
What is 4-6 months
300
Which of the following statements is NOT true about depression post-MI? a) Major depression is an independent risk factor for post-MI mortality b) Minor depression is an independent risk factor for post-MI mortality c) Minor depression is more prevalent than major depression post-MI d) Treating depression improves cardiac outcomes in post-MI patients e) Approximately half of the people who sustain an MI have symptoms of depression afterward
What is D: Treating depression improves cardiac outcomes in post-MI patients.
300
A 15 year old girl is brought to the ED after ingesting 20 acetaminophen tablets. She tells the physician that she tried to commit suicide because she was not admitted to an honors English class. the girl is the president of her grade in school and always tries to be perfect. The most important factor in whether this girl tries to kill herself again is: a) that she is female b) the method of the suicide attempt c) that she has major depressive disorder d) that she tried to commit suicide once e) her need to be perfect
What is d) that she tried to commit suicide once.
300
You are assessing a 45 year old professional male who has a history of MDD in his early 20s but has fully recovered since then. He recently suffered an uncomplicated anterior wall myocardial infarction. His wife mentions that she thinks he is depressed. He is tired all the time, has poor sleep, a poor appetite, and he has been irritable. He has also been tearful and blames himself for his MI (too many “pounder” burgers…with cheese and bacon). He is willing to consider the diagnosis of depression because he remembers having suffered from it before. He also knows a history of MDD puts him at risk of medical illnesses. You decide to recommend treatment to this patient. Which of the following therapies is the LEAST desirable choice for treating his depression? a) Bupropion (Wellbutrin) b) Cognitive Behavioral Therapy c) Nortriptyline d) Paroxetine (Paxil) e) Sertraline (Zoloft)
What is C: Nortriptyline.
400
Which of the following is NOT TRUE about depression in children? a) Abuse or neglect increases the risk of depression b) Having a depressed parent increases the risk of being a depressed child c) The clinic course is roughly the same as an adult d) "Masked" symptoms, such as abdominal pain, are more common in children than the typical symptoms of depression, such as sleep disturbance e) Male and female children are equally affected by depression
What is D: "Masked" symptoms, such as abdominal pain, are more common in children than the typical symptoms of depression, such as sleep disturbance.
400
You have a 34 year old male patient who has started sustained-release bupropion (Wellbutrin SR) 150 mg BID for depression. He reports partial but not total resolution in his symptoms. He also thinks that the medication is causing some side effects. Which of the following is the most likely adverse effect attributable to this medication? a) Insomnia b) Sexual dysfunction c) Weight gain d) QT prolongation e) Increased smoking
What is A: Insomnia
400
Regarding the epidemiology of bipolar illness, which of the following is FALSE? a) The prevalence of bipolar 1 is about 0.6% to 1.5% b) Many patients are misdiagnosed initially with depression c) Untreated, the suicide rate is almost 20% d) Women are twice as likely to be affected as men e) Suicide risk is highest in the depressed or mixed state
What is D: Women are twice as likely to be affected as men.
400
You have a colleague who is depressed and has transient thoughts of suicide. Which of the following would suggest that he should be hospitalized today? a) He thinks about suicide only infrequently b) He has not formulated a plan to commit suicide c) He has updated his will within the past few days d) He is willing to follow up in clinic tomorrow e) He has given away his guns
What is C: He has updated his will within the past few days.
400
You have admitted a patient under a 72 hour hold and you are discussing treatment options with the psychiatrist, who thinks ECT might be appropriate. You are concerned about cognitive problems in the patient. All of the following are associated with an increased risk of memory loss with ECT EXCEPT: a) Concomitant lithium b) Bilateral electrode placement c) High stimulus doses d) History of seizure disorder
What is D: History of seizure disorder
500
A 22 year old male college student is taken to the ED by police because he tried to enter a state office building to have a "conference with the governor" about conducting a fund drive to "finance my cure for cancer." When police prevent him from entering the building, he becomes irritable and hostile and resists attempts to restrain him. What is the most appropriate diagnosis for this patient?
What is bipolar disorder.
500
You are seeing a new patient with a history of recurrent major depression. Many years ago a different physician put him on phenelzine (Nardil), which you recognize as having potentially serious food and drug interactions. You are considering switching him to an SSRI. How long after an MAOI is discontinued can an SSRI be started?
What is 14 days.
500
Which of the following epidemiological statements about depression in primary care is true? a) Most depressed patients (about 80%) seek mental health care from his/her PCP b) Only about 50% of the patients with depression are recognized by his/her PCP c) Only about half of the patients diagnosed with MDD receive adequate treatment d) the 2015 USPSTF recommends screening and having adequate systems for treatment, follow-up and/or referral e) All of the above
What is E: All of the above
500
____ % of adolescents experience suicidal ideation each year and _____% will attempt suicide each year. a) 5; 1-3 b) 10; 5-7 c) 12; 8-10 d) 15; 9-12 e) 20; 5-8
What is E: 20; 5-8
500
A 37 year old female patient returns to see you for follow-up of depression. You last saw her 4 weeks ago, and at that time she was experiencing her third relapse of recurrent major depression. She had been in remission for 3 years before, and until 2 years ago, she had been taking sertraline 150 mg daily, a regimen that she had found effective during an 18-month course of treatment. At her visit last month, you assessed her symptoms with the PHQ-9, and her score at that time was a 21. You re-instituted sertraline at 50 mg daily for 2 weeks and then increased to 100 mg daily. At her visit today, having been on sertraline 100mg daily for 2 weeks, her PHQ-9 score is 17. She denies having thoughts about death or suicide. Which of the following options is LEAST appropriate to recommend to your patient at this time? a) Continue sertraline 100mg daily and return for follow-up in 1 month. b) Continue sertraline 100mg daily, add weekly CBT and return for follow-up in 1 month. c) Increase sertraline to 150 mg daily and return for follow-up in 1 month. d) Stop the sertraline and start citalopram 20mg daily and return for follow-up in 1 month. e) Continue sertraline 100mg daily and add buproprion SR 150mg BID, return for follow-up in 1 month.
What is D: Stop the sertraline and start citalopram 20mg daily and return for follow-up in 1 month.