A
What is phobic neurosis?
A phobic ideation of displacement where the patient transfers feelings of anxiety from the object to one that can be avoided.
The most important initial component of evaluating a patient with depressive illness is
A. assessment of suicidal risk.
B. assessment of memory function.
C. determination of the presence of hallucinations.
D. determination of the degree of intellectual impairment.
A. Two-thirds of all depressed patients contemplate suicide, and 10 to 15% commit suicide.
Rates of alcohol use in the adolescent are reportedly higher in:
A. families with rigorous parental monitoring
B. Japanese families
C. adoptive children whose biological parent is an alcoholic D. mood disorders in a grandparent
C. There is a three-to fourfold increase in risk for alcohol dependence in adopted children whose biological parents are alcohol dependents.
What are the only two approved drugs for aiding smoking cessation?
Nicotine and bupropion
What drug is first-line therapy for schizophrenia?
Initial pharmacologic therapy of schizophrenia should begin with one of the newer, "atypical" antipsychotic drugs, such as olanzapine, risperidone, quetiapine, ziprasidone, and clozapine because their side effect profile is significantly better than the older drugs, and they may be more effective for negative psychotic symptoms.
A 20 year-old male presents to the ED with complaints of palpitations and agitation, which developed suddenly while attending a party. On examination, the patient is moderately agitated and tremulous. Vital signs include a pulse of 110/minute and regular; respiratory rate 22/minute and blood pressure 160/92 mmHg. Skin is diaphoretic and pupils are dilated. Which of the following is the most likely diagnosis?
A. Heroin use
B. Cocaine use
C. Scombroid ingestion
D. Alcohol intoxication
B. Cocaine, as well as amphetamines, leads to a clinical picture of increased sympathetic stimulation and dilated pupils.
A 20 year-old female presents with episodes of binge eating, overuse of laxatives, and periods of starvation. Which of the following is the best treatment option for this patient?
A. fluoxetine (Prozac)
B. gabapentin (Neurontin)
C. amitriptyline (Elavil)
D. phenelzine (Nardil)
A. Fluoxetine, a SSRI, is the drug of choice for the treatment of bulimia nervosa.
Early clues to impending delirium tremens include
A. agitation and decreased cognition.
B. visual hallucinations and diaphoresis.
C. autonomic hyperactivity and dehydration.
D. mental confusion and sensory hyperacuity.
A. Anxiety, decreased cognition, tremulousness, increasing irritability, and hyperactivity are common early clues to impending delirium tremens.
What is tardive dyskinesia characterized by?
A. infrequent blinking, tremor, rigidity, and bradykinesia.
B. Involuntary movements of the face, mouth, tongue, trunk and limbs and may develop after months or years of treatment with neuroleptic drugs.
C. Involuntary movements with a positive family history and develops after the age of 50.
D. Symptoms begin before the age of 21 and include facial motor tics.
B. Involuntary movements of the face, mouth, tongue, trunk and limbs and may develop after months or years of treatment with neuroleptic drugs.
A 54 year-old patient has acute onset of palpitations, tremulousness, profuse sweating, shortness of breath, and numbness and tingling of the extremities. Physical examination reveals a pulse of 104 beats/min and regular, respiratory rate of 30/min, blood pressure of 160/95 mm Hg. Arterial blood gases reveal a low pCO2. ECG shows no acute changes. The most likely diagnosis is
A. anxiety neurosis.
B. atrial fibrillation.
C. depressive neurosis.
D. myocardial infarction.
A. Anxiety is characterized by short-lived, recurrent, unpredictable episodes of intense anxiety accompanied by marked physiological manifestations.
Which of the following effects result from cigarette smoking and contributes to atherogenesis?
A. transient decrease in blood pressure
B. polycythemia with relative hyperoxemia
C. decreased blood viscosity
D. chronic inflammation
D. Cigarette smoking induces a chronic inflammatory state, which is believed to contribute to atherogenesis.
A patient presents within one hour of ingesting 30 tablets of diazepam (Valium). Which of the following is the most appropriate intervention?
A. IV naloxone
B. alkalinization of the urine
C. cardiac pacing
D. gastric lavage
D. Gastric lavage, along with the administration of activated charcoal and monitoring of vital signs and CNS status is the mainstay of therapy in the person who has overdosed on benzodiazepines. Vomiting should be induced in the person who is not comatose. Flumazenil (Romazicon), a specific benzodiazepine antagonist, might be used with caution in certain patients.
Which of the following dietary substances interact with monoamine oxidase-inhibitor antidepressant drugs?
A. Lysine
B. Glycine
C. Tyramine
D. Phenylalanine
C. Monoamine oxidase inhibitors are associated with serious food/drug and drug/drug interactions. Patient must restrict intake of foods having a high tyramine content to avoid serious reactions. Tyramine is a precursor to
norepinephrine.
A 53 year-old man with a history of hypertension is being treated with atenolol (Tenormin). He currently presents complaining of chronic fatigue, insomnia, decreased appetite, and difficulty concentrating for the past 3 weeks. His wife also notes that he no longer goes bowling with his friends and has lost interest in any sexual intimacy. Physical examination is unremarkable. Which of the following is the most likely diagnosis?
A. major depression
B. dysthymic disorder
C. atypical depression
D. drug-induced depression
A. Diagnostic criteria for a major depressive disorder include a loss of pleasure in usual activities, vegetative or physical changes (poor appetite, loss of energy), and cognitive changes such as difficulty in concentrating.
The DSM-IV classifies mental disorders by using five axes in completing the process. Axis III is used to identify which of the following?
A. Clinical disorders and other conditions that may be the focus of clinical attention
B. Any physical disorder or general medical condition that is present in addition to the mental disorder
C. The psychosocial and environmental problems that have had a significant contribution to the development or
exacerbation of the disorder
D. Personality disorders and/or mental retardation
B. Axis III identifies any physical disorder or general medical condition that is present in addition to the mental disorder.
Which of the following is effective in the long-term treatment of panic attacks?
A. Triazolam (Halcion)
B. Propranolol (Inderal)
C. Lorazepam (Ativan)
D. Fluoxetine (Prozac)
D. SSRI's, such as fluoxetine, are the initial drugs of choice for the long-term treatment of panic disorders.
A child has been under treatment for attention-deficit hyperactivity disorder (ADHD). No response has occurred with behavioral adaptations. What medication should this patient be given?
Stimulants, such as Ritalin, Dexedrine, and Cylert, are effective in 50 to 80% of children with ADHD.
A 36 year-old patient presents requesting something to help him sleep. He reports that he has always had a problem sleeping, admits to feeling nervous most days for the last 2 years, and that he has always been "uptight" and a "worry wart." During the previous eight months he has frequently felt tense, shaky, sweaty, with palpitations and frequent headaches. He reports being irritable with his 5 year-old son. Which of the following is the best treatment option for this patient?
A. Alprazolam (Xanax)
B. Haloperidol (Haldol)
C. Paroxetine (Paxil)
D. Diphenhydramine (Benadryl)
C. SSRI's, specifically Paxil, are the mainstay for treatment of generalized anxiety disorder.
Which of the following medications used in the management of anxiety has a delayed onset of action?
A. buspirone (BuSpar)
B. diphenhydramine (Benadryl)
C. lorazepam (Ativan)
D. butalbital (Fiorinal)
A. Buspirone takes several days to weeks for it to have clinical activity.
A patient is started on a new antipsychotic medication for his disorder. Three days later he develops altered consciousness, lead-pipe rigidity, diaphoresis and catatonia. Vital signs reveal respiratory rate of 20, temperature of 105.6 degrees F, and pulse oximetry of 95% room air. Which of the following would be the most appropriate initial intervention in this patient?
A. Immediate oral SSRI's and Benadryl
B. Supportive care with fluids and antipyretics
C. IV antibiotics and naloxone
D. Intubation and mechanical ventilation
B. Neuroleptic malignant syndrome is characterized by extrapyramidal signs, blood pressure changes, altered consciousness, hyperpyrexia, muscle rigidity, dysarthria, cardiovascular instability, fever, pulmonary congestion and diaphoresis. Controlling fever and fluid support are the best initial management. With a normal pulse oximetry mechanical ventilation is not indicated.
Phenothiazines exert their antipsychotic effects by blocking what?
A. alpha-adrenergic receptors.
B. dopamine receptors.
C. histamine receptors.
D. serotonin receptors.
B. Blockage of the dopamine receptors in the mesolimbic areas of the brain is responsible for the antipsychotic effects of the phenothiazines; blockage of the dopamine receptors in the nigrostriatal areas lead to the motor side effects, such as dystonia and akathisia.
A 26 year-old female arrives in the emergency department with friends who say she was standing in front of her church, dressed in a white bathrobe, claiming to be the Virgin Mary and handing out $100 bills to all passers-by. Her friends noted that she had been depressed lately, but now seems completely euphoric. She had a similar episode two years ago. Which of the following is the most appropriate treatment?
A. Inpatient olanzapine (Zyprexa) therapy
B. Inpatient electroconvulsive therapy
C. Outpatient paroxetine (Paxil) therapy
D. Outpatient psychotherapy
A. Treatment of the manic phase is usually done in the hospital to protect patients from behaviors associated with grandiosity (spending inordinate amounts of money, making embarrassing speeches, etc.). Lithium, valproate, and olanzapine are considered effective in the manic stage; the depressive stage is treated with antidepressants.
What test is the most sensitive to detect rhabdomyolysis, a serious complication of seizures and hyperthermia related to drug abuse?
Serum creatinine kinase
A 26 year-old female has a long history of sexual promiscuity and substance abuse. She frequently expresses anger when she feels abandoned. She also has difficulty in controlling her anger at times. Her past relationships have been intense and short-lived. She has attempted suicide twice in the past 18 months. This patient exhibits which of the following disorders?
A. bipolar
B. avoidant personality
C. borderline personality
D. dissociative
C. Borderline personality disorder is characterized by instability of interpersonal relationships, marked impulsivity that is potentially self-damaging, inappropriate, intense anger or control of anger, recurrent suicidal attempts, gestures or threats, and identity disturbances. All of these are exhibited in this patient.
What antipsychotic medications is associated with significant agranulocytosis but not with extrapyramidal side effects?
Clozapine is referred as an "atypical" antipsychotic agent. It can cause agranulocytosis and should be monitored with weekly CBC. This is not a first line treatment drug.