Mental STATUS
Mvmt
Strictly RANDO
1st Rank
2 Random
100
This is the term for when a patient's thoughts shift rapidly between topics via superficial connections, making it difficult to follow their train of thought.
- A) Circumstantial
- B) Derailment
- C) Flight of ideas
- D) Thought blocking
- E) Glue sniffing
What is C, FOI.
100
The most common acute dystonia.
What is torticollis?
In general, the head and neck are most commonly affected (e.g., oculogyric crisis, torticollis, trismus, grimacing, tongue protrusion).
100
This medications is most likely to cause cognitive impairment at typical therapeutic dosages.
A. Divalproex
B. Carbamazepine
C. Topiramate
D. Lamotrigine
E. Olanzapine
F. Gas station sex pills
What is C, topiramate?
Although all the mood stabilizers listed here can cause cognitive impairment at supra-therapeutic doses, topiramate is most likely to cause cognitive impairment at therapeutic levels. In comparison studies, topiramate was found to cause greater cognitive impairment than lamotrigine or gabapentin.
100
The patient’s thoughts escape into the outside world and are experienced by others.
What is thought broadcasting?
100
A 47-year-old man with a history of alcoholic liver cirrhosis and alcohol use disorder presents to the emergency department with altered mental status. He consumed an average of 12 to 18 beers daily from ages 20 to 45 but successfully underwent alcohol detoxification and a 90-day residential rehabilitation program. He has been abstinent from alcohol for the past 18 months. At a psychosocial screening one month ago, he was deemed psychiatrically stable and an excellent candidate for liver transplantation, for which he is currently on the waiting list. Upon presentation, the patient exhibits mild confusion, acute anxiety, panic symptoms, and paranoid ideation. His mini-mental status examination score is 20. Laboratory tests and a computed tomography scan of the brain are normal, except for an elevated ammonia level of 95 μmol/L. Which of the following medications is most appropriate for managing the patient's current clinical presentation?
A. Haloperidol 5 mg and benztropine 2 mg orally
B. Lorazepam 2 mg intravenously
C. Diazepam 5 mg orally
D. Lactulose 30 mL orally
E. Rifaximin 550 mg orally
F. An ice cold beer
What is D, lactulose?
Lactulose 30 mL orally is correct because the patient's symptoms, including altered mental status and elevated ammonia levels, are consistent with hepatic encephalopathy, a complication of liver cirrhosis. Lactulose is a nonabsorbable disaccharide that reduces ammonia absorption in the colon by converting ammonia into ammonium, which is then excreted. This treatment effectively lowers systemic ammonia levels, helping to alleviate the neurological symptoms associated with hepatic encephalopathy. Rifaximin is used preventatively.
200
A patient is asked to start at 100 and subtract 7 repeatedly (100, 93, 86...). This task is primarily used to assess this cognitive function:
- A) Remote memory
- B) Orientation
- C) Concentration and attention
- D) Abstract reasoning
What is C, concentration/attention?
200
The _ _ _ _ _ _ and _ _ _ _ _ _ _ _ _ _ _ are the second most commonly affected.
(e.g., opisthotonos, tortipelvic crisis, hand/arm/leg cramps)
What are the trunk and extremities?
"My back has been hurting a few days, I think it is the beds here," after starting a new antipsychotic...
200
How long should a person abstain from alcohol before starting disulfiram?
A. 6 hours.
B. 12 hours.
C. 24 hours.
D. 72 Hours.
E.A week.
What is C, 24 hours?
Each standard drink of alcohol leads to 15-20 mg/dL increase in blood alcohol levels and it is metabolized at a similar rate. Once an individual stops drinking, an interval of 24 hours is usually enough to clear all alcohol from the system and allow initiation of disulfiram, which works by inhibiting acetaldehyde dehydrogenase, allowing the buildup of acetaldehyde, which produces symptoms of toxicity in the event of alcohol consumption (the Antabuse reaction).
200
A patient keeps pausing while giving their history, having problems recalling recent events. They believe they keep forgetting things because a new computer was put in the library and keeps stealing these memories so the government can have them.
What is thought withdrawal?
200
A 55-year-old man is taking phenelzine for depression. He takes an over-the-counter cold medication and subsequently develops a hypertensive crisis. Which one of the following medications did he most likely take?
A. Zinc
B. Diphenhydramine
C. Acetaminophen
D. Pseudoephedrine
E. Ibuprofen
F. Bang Energy Drink
What is D, pseudoephedrine?
Pseudoephedrine is correct because it is a sympathomimetic agent commonly found in over-the-counter cold medications. Monoamine oxidase inhibitors (MAOIs) like phenelzine inhibit the breakdown of neurotransmitters such as norepinephrine, serotonin, and dopamine, as well as sympathomimetic medications. When taken together with pseudoephedrine, the excessive accumulation of norepinephrine can lead to a hypertensive crisis due to excessive vasoconstriction and increased heart rate.
300
This term describes speech that is so disorganized that it is incomprehensible to the listener, appearing as a random collection of words and phrases.
- A) Incoherence (Word Salad)
- B) Circumstantiality
- C) Echolalia
- D) Retardation of thought
- E) Neologisms
What is A?
300
An _ _ _ _ _ _ _ _ _ _ crisis is a fixed upward gaze or the eyes fixed in a dysconjugate gaze after antipsychotic administration.
What is an "oculogyric" crisis?
300
A 40-year-old woman is referred to the clinic to evaluate nausea and abdominal pain for the past 2 days. She reports that she has had similar symptoms intermittently for the past year, and despite numerous visits to multiple physicians, she remains convinced that she has a severe gastrointestinal illness. She has researched her symptoms online and wishes to speak to an oncologist. She cannot work due to her symptoms. She reports no weight loss and denies recent travel, sick contacts, or new medications. She last passed stool in the morning. Her vital signs are within normal limits, and her physical examination is unremarkable except for mild abdominal tenderness. What is the most likely diagnosis for this patient?
A. Irritable bowel syndrome
B. Acute gastroenteritis
C. Inflammatory bowel disease
D. Gastrointestinal malignancy
E. Illness anxiety disorder
F. She's a witch. Burn her.
What is E, IAD?
300
Someone is a vague, psychotic state (a delusional mood) hears the AC turn on and, seemingly out of nowhere, thinks people are sending nano-bots into their apartment.
"Normal perception has a private, illogical meaning."
Sudden, idiosyncratic, and often self-referential delusion triggered by a neutral perceptual content. In classical psychopathology, ---------- ---------- was considered almost pathognomonic for schizophrenia. Since ---------- ---------- has been erased from ICD-11 and always been absent in DSM, it risks slipping out of clinical awareness.
What is a delusional perception?
300
A 66-year-old man explains during review of systems that he occasionally sees a visual trail behind moving objects in his field of vision. With additional questioning, he also describes transient visual distortions, occasional brief hallucinations of geometric figures or sounds or voices, and episodes of sudden, intense emotion. He denies any past history of seizure disorder, migraine headache, posttraumatic stress disorder, or other persisting visual problems. He denies any current substance use but reports that he used many substances when in college. Which one of the following options is the most likely diagnosis for this patient?
A. Transient ischemic attacks (TIAs)
B. Hallucinogen persisting perception disorder
C. A demyelinating disorder such as multiple sclerosis
D. Auras of either a migraine syndrome or seizure disorder occurring in the absence of a headache or seizure
E. Transient global amnesia
What is B??
Transient ischemic attacks (TIAs) often have a specific pattern of occurrence, reflecting the anatomic position of the affected vessel and its watershed, and will often be of recent onset and escalating frequency preceding a stroke event. TIAs from an embolic source can be varied in their symptoms, depending on where the embolus lodges in the cerebral vasculature. The varied nature of the symptoms and their chronicity makes aura without migraine or seizure unlikely as well, as these tend to have a recurring stereotypical pattern. They can cause visual disturbances, but likely less complex than what is described here. Attacks of multiple sclerosis or other demyelinating syndromes usually have less abrupt onset and more persistent duration. Typically, pain or loss of function is seen in these demyelinating syndromes.
400
A patient is halfway through explaining a story and then suddenly stops speaking and cannot recall what they were saying. After a brief pause, they start a new topic. This phenomenon is known as:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _.
What is thought blocking?
400
A mnemonic for Parkinsonism is TRAP: tremor, rigidity, akinesia, and...
What are postural changes?
400
A 22-year-old treatment-naive woman is diagnosed with major depressive disorder during the 9th week of her pregnancy. Which of the following is the antidepressant of choice to be used in the management of this patient?
A. Paroxetine
B. Bupropion
C. Clomipramine
D. Phenelzine
E. Sertraline
F. It'll pass
What is E, sertraline?
Sertraline is correct because the patient in this question is treatment naïve, and according to recommendations, the SSRI of choice to be initiated in a treatment-naive pregnant woman is sertraline due to fewer reports of toxicity and fewer anticholinergic effects.
Paroxetine is incorrect because it is the most teratogenic SSRI among the group, so it is not recommended.
Bupropion is incorrect because the first-line treatment agents for depressive disorders in non-pregnant and pregnant patients are SSRIs, and bupropion does not belong to the SSRI group. Bupropion is also associated with attention-deficit hyperactivity disorder (ADHD) in young children exposed to it in utero.
Clomipramine is incorrect because the first-line treatment agents for depressive disorders in non-pregnant as well as pregnant patients are SSRIs and clomipramine, which is a TCA, is not recommended in pregnant patients.
Phenelzine is incorrect because it is an MAO-inhibitor which is not recommended to be used during pregnancy due to a hypertensive crisis.
400
Auditory hallucinations that ----- with each other and/or ------- on the patient's actions.
What are argue and/or comment?
400
A 40-year-old woman, with a history of hypothyroidism, is brought to the emergency department with complaints of weakness in the left lower extremity after suffering a witnessed focal seizure involving the left side of the body. Her son explained that she had been in an altered mental status for 3-4 hours and then started seizing 50 minutes ago. On examination, blood pressure is 100/70 mmHg, pulse is 92/min, and respiratory rate is 18/min. Her laboratory investigations revealed that TSH was 3.5 mIU/L, T4 was 7 micrograms/dL, and T3 was 124ng/dL. High anti-thyroid antibodies were detected in the serum. Which of the following is the best management option for this patient?
A. Give intravenous immunoglobulin
B. Supplement thyroxine at a higher dose
C. Continue the same dose of thyroxine with anti-seizure medication
D. Start liothyronine
E. Start corticosteroids
What is E, start corticosteroids?
This is a case of Hashimoto’s encephalopathy; it usually affects women around 40 years of age. It may present as a delirium with psychosis, focal neurological signs, and seizures. It is an autoimmune condition and is characterized by high serum anti-thyroid antibodies. This usually occurs when the patient is euthyroid but may also occur in hypothyroid patients. This condition is best managed with corticosteroids.
500
The clinician asks a patient, "What brings you to the hospital today?" The patient responds, "The hospital, my head, my head is full of knowledge, the library is full of knowledge, I love libraries, do you love libraries?" This is the thought process the patient is exhibiting:
- A) Logical and goal-directed
- B) Thought blocking
- C) Loose associations (derailment)
- D) Tangentiality
- E) Circumstantial
What is C, a loosening of associations?
Also would accept that this is a tangent with a loose association making the jump.
500
EPS related Parkinsonism is thought of as an imbalance between dopamine and this neurotransmitter.
What is acetylcholine?
500
A 25-year-old woman recently experienced a fall from stairs, developed paraplegia, and is in rehabilitation now. She is actively participating in the rehabilitation exercises but insists that one day she will walk on her own again. What must be done to deal with denial in this patient?
A. Tolerate this denial
B. Change rehabilitation strategies
C. Administer pharmacotherapy
D. Exposure-based interventions
E. Motivational interviewing
F. Immediate challenge
What is A, tolerate the denial?
Tolerating this denial is the correct response because even though the patient demonstrates verbal denial, she is not engaging in behavioral denial. As long as this type of denial is not detrimental to her rehabilitation and general recovery, such denial may be tolerated by the clinical team. Given the dual-process model, this type of denial is the patient's way of avoiding the loss. Moreover, her denial, coupled with her active participation in rehabilitation, actually represents the patient's wish for neurological recovery.
500
A person believes that radio waves from a neighbor are causing them to feel stomach pain.
This can include experiencing sensations like tingling, burning, or pressure that are not caused by any physical stimulus. For instance, feeling like there's an object inside the body when there isn't one.
Experience of bodily sensations (including actions, thoughts, or emotions) imposed by external agency.
--We use these general terms. I will sometimes use it in notes.
What is somatic passivity or passivity phenomena?
There are related phenomena:
DOC, somatic delusions, etc.
https://www.scielo.br/j/rbp/a/HsznpbqCfdc8J9HzwwS7yCj/?format=pdf
500
A 32-year-old woman with a renal transplant for glomerulonephritis is evaluated in the emergency department for irritability and altered mental state. Her partner states that she has had nausea and blurring of vision for a day. She had a kidney transplant 4 months ago and is currently taking lisinopril, tacrolimus, and low-dose prednisolone. She was taking cyclosporin previously but had switched over to tacrolimus a week ago. Physical examination shows a blood pressure of 217/115 mmHg, a pulse of 102 beats per minute, and a Glasgow coma scale (GCS) of 11/15. Urgent fundoscopy reveals bilateral papilledema and flame-shaped hemorrhages. There is restricted lateral gaze and reduced light perception bilaterally. Laboratory investigations are unremarkable. MRI shows increased white matter T2 signals, especially in the occipital and parietal lobes. What is the most likely diagnosis?
A. Tacrolimus toxicity
B. Posterior reversible encephalopathy syndrome (PRES)
C. Metabolic encephalopathy
D. Progressive multifocal leukoencephalopathy
E. Steroid-induced psychosis
What is B, PRES?
Posterior reversible encephalopathy syndrome (PRES) is the correct option. This patient has a headache and altered mental status. Clinical examination is significant only for visual loss and hypertension. Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological diagnosis characterized by vasogenic edema and bilateral white matter signal abnormalities in the occipital and parietal lobes. This patient has several risk factors for developing this syndrome. Chronic kidney disease, cyclosporin, tacrolimus and steroids all elevate blood pressure. Rapid control of blood pressure leads to the resolution of signs and symptoms.
Tacrolimus toxicity is an incorrect option because it manifests as acute renal failure, tremors, the elevation of liver enzymes and electrolyte disturbances. In the presence of normal laboratory findings it is an unlikely possibility.
Metabolic encephalopathy is an incorrect option because this patient has normal laboratory investigations. Metabolic encephalopathy may be caused by electrolyte imbalance, uremia, hyper or hypoglycemia and liver injury.
Progressive multifocal leukoencephalopathy is an incorrect option because these patients typically present with confusion, clumsiness and weakness. It progresses over weeks to months. This patient has an acute history making progressive multifocal leukoencephalopathy less likely.
Steroid-induced psychosis is an incorrect option because it is typically characterized by aggressive and irritable behavior along with psychotic symptoms. Patients are often on a high dose of steroids and may not present with hypertension or MRI changes.