Show:
It all comes down to drugs
Call psych? Call medicine?
Kids and Teens
The old and the bold
You got Personality and Defenses
100
A 37yo man comes to the psychiatrist 6 mos after he suffered a car crash. He endorses difficulty sleeping. He avoids the road where the accident happened, and panics when another car comes close. What would be the best medication for him?
PTSD - antidepressants are fist line, usually SSRIs (Sertraline). If nightmares: prazosin
100
A 37yo man comes to see his doctor complaining of memory problems and "moodiness." CT scan shows atrophy of the caudate. His dad died at 42yo and had the same condition.
What is the diagnosis? BONUS! What are the genetics of this condition?
100
First time parents bring in their daughter for a well-child visit. They're proud of her for saying "mama" and has been pulling herself up and taking a few steps before falling down. How old is she?
Approximately 12 mos (1yr). At 12mos: goals are walking, can shake head for "no", waves "bye bye", responds to simple spoken requests.
100
What medication is most associated with an increased risk in falls in patients 80+yo?
Benzodiazepines
100
Charlie Brown goes to see his therapist, Lucy. He states he feels all alone and is afraid to make friends. He thinks the others will make fun of him or criticize him for not being able to kick a football. He stays off dating sites for fear of rejection. What personality disorder is he likely to have?
Avoidant Personality disorder
200
A 35yo man comes with depressed mood, poor sleep, poor appetite, and decreased concentration. He is accepting treatment but doesn't want something that will affect his sex drive. What would you recommend?
Bupropion - also good for smoking cessation Mirtazapine - can cause weight gain
200
A 50 year old patient with schizophrenia sees the dermatologist for a rash that appeared recently over her arms and neck. She states that she was out at the company picnic the day before and then noticed the rash. She's only taking a multivitamin and the medication prescribed by her psychiatrist for several years. What's causing her rash?
Chlorpromazine
200
A child runs up to mom to show her the mud pie he made on his own tracking mud all over the floor. The child awaits for mom's reaction, holding out the mud pie to her. What Eriksonian stage of development is this?
Initiative vs Guilt Major question: Am I good or bad?
200
81yo man brought to his physician by his caregiver for worsening depression. Patient has been on three other antidepressants with no symptom relief. What would be the next step?
Recommend ECT Safe in elderly and pregnant!
200
A woman is given a diagnosis of breast cancer by her physician. Instead of telling her family right away, she chooses to wait once her husband's presentation to the board is done and her son takes his test at the end of the week, as she doesn't want them doing badly. What defense is she using?
Suppression (purposely ignoring impulse to diminish discomfort and accomplish task)
300
A 27yo man with schizophrenia was recently admitted to the psych unit after he stopped taking his medication because he didn't want "man boobs." What medication was he on before? What medication is least likely to cause this undesired side effect?
Risperidone - strongly binds to D2 Abilify - partial D2 agonist
300
A schizophrenic patient is brought to the ED for palpitations and syncope. He's been compliant with his psych medications. EKG is done at the ED. QTc= 512 What medication is the most likely culprit?
Antipsychotics can cause QTc, clasically Thioridazine and Ziprasidone
300
An 9y girl is crying because her pet rabbit Thumper passed away. Her parents help her bury him in the back yard. The next day, her 5yo sister asks if she can play with Thumper. What concept is demonstrated here?
At approx 7yo, kids understand that death is permanent.
300
A 76yo man comes shuffling into the office, brought in by his caregiver. He has been complaining of seeing a dog running around the yard and in his house. His caregiver states there is no dog. What's the likely diagnosis?
Lewy Body Dementia
300
A woman is cleaning out the closet and she throws out his old sports jacket that he wears out to every dinner party. Her husband gets furious with her and demands she retrieve the jacket. He explains that he wears the jacket to protect them both so they don't get into car accidents. What personality disorder is most likely?
Schizotypal - odd behaviors, loose, vague, or idiosyncratic speech, paranoia in social situations, and magical thinking.
400
A 21 yo goes out to celebrate finally being legally allowed to drink with her friends. Later that night, her friends take her to the ED. She is flushed, endorsing nausea and pounding headache. On exam you notice myoclonus. She tells the you she's only taking her medication for her depression. What should you administer?
Phentolamine Hypertensive crisis caused by MAOIs (selegiline, phenelizine)
400
Patient presents to the ED confused, vomiting, with a coarse tremor and ataxia. Speech is slurred. His wife says he's had headaches this past week and took some over the counter medication. What's the diagnosis? Bonus: What are the EKG findings?
Lithium toxicity due to NSAID use EKG: T-wave flattening or inversion
400
A little girl is playing with her ball. Her mother covers the ball with the blanket. She goes over to the blanket and moves it to get her ball back. According to Piaget's, what stage is this child in?
Preoperation stage Object permanence; 1-3yo.
400
A 75yo patient was recently started on paroxetine for anxiety. She is brought to the doctor's office by her son for confusion. Labs: Low serum osmolarity, low plasma osmolarity. UA: Increase sodium and osmolarity. What is the diagnosis?
SIADH due to SSRIs in elderly patients (usually seen in the first 2 wks)
400
A woman has been to see her therapist. Her therapist notes that when coming directly from work, she would dress in a business suit, but if she came during her day off, she would dress in short pants and knee socks, with her hair in braids. On occasion, she storms out of sessions; on others she begs her therapist not to fire her. What's a key aspect needed for diagnosis of this personality disorder?
Borderline personality disorder: unstable sense of self
500
A pregnant woman wants to stop using heroin and Norcos (hydrocodone/acetaminophen). She has been able to stop using in the past, but remembers she felt like she was dying. She wants to get clean for her baby. What treatment would you recommend?
Methadone maintenance Avoid withdrawal and drugs that can cause withdrawal (naltrexone) - risk of abortion, stillbirth, and adverse fetal outcome.
500
A 21 year old man is brought into the ED by police officers after he is found running through the streets, yelling "get these bugs off me!!!" Pupils appear dilated, he's sweating. HR: 120 BP: 150/100. What's the diagnosis? Bonus: What do you treat the HTN and tachycardia with?
Stimulant (Cocaine) intoxication
500
Lack of which of the following features differentiates social communication disorder from autism spectrum disorder in DSM5? A) Deficits of nonoverbal communication behaviors. B) Deficits in developing relationships at the appropriate developmental level C) Deficits in social-emotional reciprocity D) Restrictive and repetitive behavior, interests, or activities
Answer: D ASD diagnosis requires the following: Deficits in social communication and social interaction AND restrictive and repetitive behavior, interests, or activities (RRBs).
500
82yo woman is complaining of incontinence, and difficulty walking. She sometimes gets confused and no longer remembers things the way she used to. What would the CT show?
Enlarged ventricles due to normal pressure hydrocephalus
500
Cersei Lannister has recently become queen of the Seven Kingdoms. She intends to destroy all those who have opposed her, her enemies and reward those she deems her allies. She wants her brother, Jaime, to rule by her side but wants him gone. What defense mechanism is she employing?
Splitting