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Psychiatry 2
USMLE step 2
| Question | Answer |
|---|---|
| Pt's belief that she is pregnant + physical signs of early pregnancy (breast tenderness, nausea, weight gain, urinary frequency, mild abdominal enlargement), with -ve confirmatory testing (undetectable β-hCG, empty uterus on u/s) is consistent with . | pseudocyesis |
| Conversion disorder | - manifests with neurologic symptoms that are inconsistent with neurologic disease. -more common among young women who have comorbid psychiatric condition -typically develops after an acute stressor Pt education is the first step of care |
| Malingering management | Pts should be approached in a nonthreatening, calm, distant yet empathetic manner to improve the physician-patient relationship & give the patient the opportunity to be honest |
| Malingering | - act by which a pt feigns symptoms/ claims to have a disease to attain a secondary gain ( compensation or time off from work). - individuals are also typically uncooperative during physical examination. |
| pt is preoccupied with having diabetes despite no clinical evidence to support this diagnosis & has visited multiple doctors over the past 2 years for this condition. | Illness anxiety disorder - for ≥ 6 months. - Somatic symptoms are usually absent or mild |
| Pt intentionally falsify symptoms in the absence of external rewards (e.g., financial gain, medications) to assume a pt role. | factitious disorder - more prevalent among women - has association with exposure to health care (including health care workers |
| Fibromyalgia | - common in middle-aged women often associated with; - tension headaches - neuropsychiatric disorders (e.g., anxiety, depression) - sleep and cognitive disorders (e.g., insomnia, difficulty concentrating |
| man's frequent urination has caused him significant distress. he spends a significant amount of time attending to his health concerns. Patients with this man's condition typically have a history of extensive diagnostic testing. | Somatic symptom disorder - a psychiatry disorder |
| Regularly scheduled office visits with the same physician are recognized as the most effective treatment for ? | somatic symptom disorder |
| Premenstrual dysphoric disorder | severe form of premenstrual syndrome associated with behavioral changes severe enough to cause clinically significant disturbance of daily functional capacity |
| pt with recurrent episodes of headaches, sleep disturbance, difficulty concentrating, marked anger with increased interpersonal conflicts. symptoms occur every month around the same time, in the final week before the onset of menses, which indicates | premenstrual dysphoric disorder (PMDD). Rx; SSRI for the mood |
| SSRI-induced sexual dysfunction can remit spontaneously within 2–8 weeks. | if sexual dysfunction persists, decreasing the SSRI dose or switching to a non-SSRI antidepressant (bupropion, mirtazapine) may be indicated. |
| combination of antimuscarinic effects (e.g., altered mental status, pupillary dilation, urinary retention, sinus tachycardia) with α1 receptor blockade (hypotension) is suggestive of an overdose of | clomipramine, a tricyclic antidepressant (TCA) **cases of TCA toxicity involving arrhythmias, IV NAHCO3 is indicated to alkalinize plasma so that protein binding of TCAs (weak bases) prevent TCA from binding to fast Na channels |
| pt is in a hypertensive crisis after recent ingestion of cured meats, dried fruits, and red wine, all of which are rich in tyramine. | MAO breaks down excess tyramine in the body. - MAOIs block this enzyme so consumption of tyramine-rich foods (e.g., red wine, certain nuts, aged cheeses or meats, dried fruits) leads to an accumulation of tyramine. |
| Electroconvulsive therapy | AVR;, - most common being reversible amnesia (retrograde amnesia more often than anterograde amnesia), - tension headaches - nausea - transient muscle pain |
| trazodone An atypical antidepressant | - serotonin reuptake inhibition & antagonism - H1-receptor and α1-receptor antagonism. Also commonly used as a hypnotic. May cause priapism. |
| Neuroleptic malignant syndrome | - fever - altered mental status -parkinsonism-like features (e.g., muscle rigidity, tremors) - autonomic instability (hypertension, tachycardia, diaphoresis) that worsen over 1–3 days |
| Sumatriptan A 5-HT receptor agonist | - acts by vasoconstriction of (dilated) cranial and basilar arteries. - Used for acute treatment of migraine and cluster headaches |
| serotonin syndrome | - hyperthermia, tachycardia, tachypnea - altered mental status - mydriasis - sweating - neuromuscular hyperactivity (e.g., myoclonus, hyperreflexia, tremor) - diarrhea. Severe serotonin syndrome can cause seizures, rhabdomyolysis, and death. |
| Pt has MDD. the pt's comorbidity with bulimia nervosa (binge-purge behavior) increases the risk of seizures with the administration of one particular antidepressant. | Bupropion ***contraindicated in pts with other seizure risk factors (anorexia/bulimia, epilepsy, alcohol withdrawal). ***other side effects; reduction of the seizure threshold, tachycardia, insomnia, and headache |
| Mirtazapine An atypical antidepressant that increases synaptic serotonin and norepinephrine | - antagonizing presynaptic α-2-receptors & postsynaptic 5-HT2 & 5-HT3 receptors. - a second-line treatment for major depressive disorder. Adverse effects include sedation, dry mouth, weight gain |
| clinical features of antidepressant discontinuation syndrome | mnemonic FINISH: - Flu-like symptoms - Insomnia - Nausea, - Instability - Sensory disturbances - Hyperarousal. |
| Rapidly progressing mental decline combined with myoclonus and mutism, in a pt | are typical clinical findings in patients with Creutzfeldt-Jakob disease. |
| Normal pressure hydrocephalus (NPH) presents with | gait instability cognitive disturbance urinary incontinence – the classic “wet, wacky, and wobbly” triad. |
| Lewy bodies ** histopathologic finding of hyaline eosinophilic globules inside nerve cells can be seen on brain biopsy | seen in -Lewy body dementia - multiple system atrophy, which are both Parkinson-plus syndromes. - Parkinson |
| overstimulation of D2-receptors by levodopa may also induce psychosis and hallucinations (usually visual). | especially in older pts *** other adverse effects of L-DOPA therapy include dizziness, somnolence or insomnia, anxiety, and aggressive behavior. |
| Progressive impairment in an individual with cardiovascular disease, hypertension, hypercholesterolemia, focal neurological deficits. head CT shows hypodense periventricular lesions, which confirm this diagnosis. | vascular dementia. - caused by lipohyalinosis Rx; cognitive training |
| frontal lobes are involved in many aspects of | cognition and behavior including personality emotion judgment voluntary movement problem-solving, and attention |
| pt with HIV & <90 CD4 count has neurological impairment (ataxia, confusion, memory dysfunction). The diagnosis can be inferred from her MRI findings (a solitary ring-enhancing lesion) and CSF analysis result (EBV DNA in the CSF). | Primary cerebral lymphoma - a non-Hodgkin lymphoma - by EBV CT scan confirms diagnosis or biopsy. |
| pt's hx (stepwise decline in executive function), physical examination (presence of focal neurologic deficits), & MRI shows multiple deep white matter lesions are suggestive of the second most common type of dementia in the elderly population | Vascular dementia |
| sympathetic overstimulation (anxiety, palpitations, tachycardia, hypertension, diaphoresis, and tremors) & visual hallucinations that are characteristic of ? which typically occurs 48–96 hours after abrupt cessation of alcohol | alcohol withdrawal syndrome with delirium (delirium tremens), first line therapy is benzodiazepine like lorazepam |
| pt's > energy, hyperthermia, hypertension, tachycardia, mydriasis, diaphoresis raise concern for increased sympathetic stimulation. hyponatremia in addition to her altered mental status & bruxism suggests intoxication with a particular substance. | MDMA/ Ecstasy - causes sympathomimetic and bruxism - dehydration |
| alcohol hallucination | 12 hours after the last alcoholic beverage pt is alert & oriented with normal vital signs as well as the absence of autonomic instability (hypertension, tachycardia, hyperthermia), disorientation& agitation help distinguish this from delirium tremens |
| Varenicline partial nicotine agonist used to aid smoking cessation. | AVR headache, insomnia, depression, suicidal ideation |
| Phencyclidine/Sernyl/Angel dust/ PCP | - activation of dopaminergic neurons & NMDA antagonism - stimulant / depressive depending on dose - violent behavior, confusion, vertical /horizontal nystagmus - > pain tolerance, hallucinations, ataxia, amnesia, and seizures, miosis |
| pt's symptoms, ECG findings, urine toxicology screening indicate a diagnosis of cocaine-induced acute coronary syndrome. Cocaine use can precipitate arterial vasoconstriction, thrombus formation, resulting in cardiac ischemia | propranolol is contraindicated due to its non selective beta blocker --> unopposed alpha 1 activation --> increased BP & coronary artery vasoconstriction |
| patient's anxiety, vital sign abnormalities (tachycardia, hypertension), dry mouth, and conjunctival injection suggest | cannabis intoxication ***additionally pt have impaired reaction time, munchies, mydriasis |
| Heroin is an opioid drug | - bilateral pin-point pupils - dry mucous membranes. An overdose of heroin causes bradycardia hypotension a decreased respiratory rate sedation hypothermia. |
| pt with flu-like symptoms (rhinorrhea, chills, abdominal pain, diarrhea), sympathetic hyperactivity (tachycardia, hypertension, mydriasis, hyperreflexia). CNS stimulation (insomnia, irritability). cool, damp skin with piloerection, are characteristic of? | heroin withdrawal. - insomnia & mydriasis is also seen |
| Pt with nosebleed,Mydriasis, tachycardia, & hypertension indicate hyperactivity of the sympathetic system. | cocaine use |
| Synthetic cathinone intoxication | - similar to amphetamines. - sympathetic stimulation (hyperthermia, tachycardia, hypertension, diaphoresis, mydriasis, peripheral vasoconstriction) - markedly altered mental status - aggression, hallucinations, paranoia, and confusion. |
| Methadone | prescribed in a controlled & highly monitored fashion to help control the symptoms of opioid withdrawal. |
| Treatment for symptomatic stimulant intoxication (amphetamine overdose, cocaine overdose) | benzodiazepines such as lorazepam. - sedates & control hypertension, prevent seizures **cardiac ischemia should be treated; antihypertensives such as nitroprusside /phentolamine if blood pressure does not < |
| pt with alcohol use disorder has confusion, oculomotor dysfunction (e.g., nystagmus), gait ataxia, and a brain MRI showing hyperintensities in the thalamus. These signs and symptoms suggest | Wernicke encephalopathy. |
| pt with signs of confabulation. has marked deficits in short-term memory, his long-term memory & other cognitive skills appear to be intact. Atrophic lesions in the anterior thalami and small mamillary bodies support a diagnosis of | Korsakoff syndrome. |
| acute cocaine overdose can also cause hallucinations (including tactile hallucinations such as formication) and paranoid ideation. | Rx; benzo and alpha 1 antagonist |
| Tooth decay (due to xerostomia) and bruxism associated with | methamphetamine use often lead to severe tooth damage, |
| Benzodiazepines are the treatment of choice for | agitation associated with PCP, while antipsychotics (e.g., haloperidol) may be used if there are also symptoms of psychosis. |
| pt with MDD low BMI, recent weight loss & hx of anorexia nervosa will benefit from? | Mirtazapine |
Created by:
beccao
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