Mental health Q3&4

Alcohol

100

• alcoholic pt comes in 3 days after last drink, CNS issues, tachycardia, high BP, diaphoresis and hallucinations

Alcohol withdrawal with delirium 

200

• A 32 year old man was found sleeping on a subway vent. Physical exam shows a BP of 90/50 with HR 135. He has bilateral nystagmus, but pupils are normal. He is ataxic and cannot stand for longer than a few seconds. During the exam he does not speak spontaneously and he sometimes falls asleep but is easily aroused. His answers to questions are minimal and some questions are not answered at all. He is disoriented and confused. You are unable to complete a mental status exam because he is unable to cooperate fully. What is the most likely diagnosis

Wernicke's syndrome

300

• Drunk man comes in with CNS issues (ataxia, word slurring) and is withdrawing from alcohol. What do you give him

Thiamine to prevent/correct wernickes

400

• What do you give the pt that comes in 3 days after last drink (alcohol withdrawl)

Librium 

500

• drunk kid in the ER spit on you, sedate with what?

• 2mg Ativan, 5mg Haldol

Drugs

100

A 16 year old male with a long history of arrests for breaking and entering, assault and battery, and drug possession is found dead in his room. For several months he had been experiencing headaches, tremors, muscle weakness, unsteady gait, and tingling sensation in his hands and feet. An empty CVS plastic bag was found beside his body. These symptoms and the manner of his death suggest that he was addicted to which of the following substances.

Inhalant

200

• A 30 year old man presents in a state of euphoria, but he is also demonstrating impairment of judgement. He was walking on the railing of a local bridge before being brought to the ED by his friends. His friends relay that he has been skipping work or arriving late over the past few weeks. His pupils are dilated, and he has tract marks to the left ac. His BP is elevated, and he is diaphoretic. His clothes are too loose. The manner in which he relates to you is somewhat condescending and he is grandiose in his thinking. There is no history of psychiatric illness, and no medical illness is present. What is the most likely diagnosis?

cocaine

300

• Treating opioid dependence (heroin for 5-6 years IV)

• Buprenorphine/suboxone

400

• Man comes in with pinpoint pupils and had a grand mal seizure in the ambulance. ODing on what?

morphine

500

• best withdrawal med for opioids

clonidine

psych tings

100

Delusional women that wont leave the house because she thinks her neighbors are out to get her (placing trash barrels so she can trip etc.)

delusional

200

Guy think he is always giving off a bad odor

somatic delusion

300

• Which of the following does this statement fit? “Conscious, intentional production of symptoms with secondary gain.”

Malingering

400

• A mid level manager complains that he is having problems at work because his employees just will not take the care he does in doing their jobs.  Consequently, he says, he fears that their lack of interest in their work will prevent him from getting ahead, because his attention to detail & devotion are not seen by his boss when overall productivity is low.  Probing reveals that there are actually more problems here that just the attitudes of this man’s employees.  His attention to detail often gets in the way, & it prevents work from being accomplished in a timely manner.  ML diagnosis

obsessive-compulsive personality

500

• A mid level manager complains that he is having problems at work because his employees just will not take the care he does in doing their jobs.  Consequently, he says, he fears that their lack of interest in their work will prevent him from getting ahead, because his attention to detail & devotion are not seen by his boss when overall productivity is low.  Probing reveals that there are actually more problems here that just the attitudes of this man’s employees.  His attention to detail often gets in the way, & it prevents work from being accomplished in a timely manner.  ML diagnosis

Histrionic 

schizo

100

• How long do you have to have symptoms in order to have schizophrenia

6 months

200

Factor that indicates worse prognosis for schizophrenia

insidious/slow onset

300

• Treat schizophrenia (noncompliant with medication regimen, relapsing every 6 months)

Risperdal 

400

• 79 yo patient with dx delirium & then psychotic symptoms, what med do you give him.

zyprexa

500

• Treatment for a treatment-resistant schizophrenic

Clozaril 

Rando Shmando

100

• 25 yo man comes to see you after breaking up with his girlfriend.  He is in a panic.  He tells you that he has never been on his own & wants to know what you think he should do.  He says he does not understand why his GF broke up with him.  He always did everything she asked of him & never disagreed with her.  All I wanted to do was make her happy he says to you.  You asked him if his ex gave him a reason for the breakup.  He stated that she told him that she was tired of making all of the decisions in the relationship such as where to go for dinner, which apartment the should choose etc.  She told him that he never helped her make any of the decisions they should make together.  The client tells you that he must find a new GF quick of his whole like will fall apart.  Axis II diagnosis?

Dependent personality disorder

200

• During therapy, your client begins to revel what appears to be distinct personalities & identities appear to repeatedly take control of the patients behavior.  She is an incest survivor.  She is dx with PTSD & you suspect she may also have what?

Dissociative Identity disorder

300

• 49 yo man calls his physician repeatedly demanding a work up for his severe back pain.  The PE is WNL & a CT of his back is unremarkable.  This is only temporarily reassuring to the patient who wholeheartedly believes he has bone cancer.  ML diagnosis?

Illness anxiety disorder

400

• 23 yo women presents to your with a CC that she is anxious about the way she looks.  She notes that for “as long as she can remember” she has been obsessed about the fact that something is wrong with her face.  She notes that her eyes are too far apart and her nose is misshapen.  She says that this concern is ruining her life because she spends all her time isolated from others so that they can’t see her face.  You don't notice anything unusual about the pts face but she cant be consoled. ML diagnosis?

Body dysmorphia  

500

• A women continues to complain of significant pain several months after undergoing abdominal surgery, there is no physiological basis for her symptoms; all test are negative.  In the absence of a mood disorder or an anxiety disorder to explain the symptoms.  ML diagnosis?

Somatoform pain disorder