Step 3 Ch 19 Psychiatry 1-2

Front 1

presentation of bradykinesia (parkinsonism) secondary to the use of antipsychotics?

Back 1

a. Occurs within weeks
b. symptoms: bradykinesia, tremors, rigidity, and other signs of parkinsonism.
c. Elderly are higher risk

Front 2

42. management of parkinsonism, secondary to antipsychotic use?

Back 2

a. Reduce the dose
b. prescribed anticholinergics:
1. benztropine
2. diphenhydramine
3. trihexyphenidyl

Front 3

43. presentation of akathisia, secondary to antipsychotic use?

Back 3

a. Weeks to chronic use.
b. Motor restlessness
c. do not mistake for anxiety or agitation
d. tip: always review medication must.

Front 4

44. Management of akathisia?

Back 4

a. Reduce the dose
b. add benzodiazepines or beta blockers
c. switch to newer antipsychotics.

Front 5

45. Presentation of tardive dyskinesia is a side effect?

Back 5

a. Months to years
b. choreoathetosis and other involuntary movements after chronic use.
c. Often irreversible.

Front 6

46. Management of tardive dyskinesia?

Back 6

a. Stop older antipsychotics
b. switch to newer antipsychotic (e.g., clozapine)
c. tip: symptoms commonly worsen after medication discontinuation.

Front 7

47. Presentation of neurolpetic malignant syndrome?

Back 7

a. CAN OCCUR ANYTIME
b. muscle rigidity, hyperthermia, volatile, vital signs
c. altered
d. loss of consciousness
e. increased WBC and CK.

Front 8

48. Management of neuroleptic malignant syndrome?

Back 8

a. Stop antipsychotic
b. tip: transferred to ICU for monitoring. Mortality rate is 20%.

Front 9

49. a 35-year-old male presents with poor adherence to chlorpromazine and haloperidol. He complains of tics and other uncontrolled movements. His wife reports that even when he takes his medications, they don't appear to help his paranoia. What is and accept the management?
a. Add risperidone
b. add diphenhydramine
c. change to clozapine
d. increase the dose of chlorpromazine
e. increase the dose of haloperidol

Back 9

1. Answer: C-the case describes two main problems in management, poor response to therapy prescribed and movement disorders. A side effect from the regimen. Clozapine is the most effective antipsychotic for schizophrenia and also has no incidence of movement disorders. It is second line therapy because of the risk of seizures and agranulocytosis. Remember to monitor CBC to watch for bone marrow suppression.

Front 10

50. A 78-year-old male with a slow-growing stomach tumor and palliative care is brought in by the family, who have noticed increased sedation and difficulty eating. They are concerned because he continues to lose more weight. On exam, he has repetitive movements of his lips and tongue. He is limited facial expression. His medications include morphine, metoclopramide, and hydrochlorothiazide. Which of the following is the most appropriate management?
a. Decrease morphine
b. discontinue metoclopramide
c. start omeprazole
d. start prochlorperazine
e. place NG tube for supplemental feedings

Back 10

1. answer: B- . Chronic use of dopamine antagonists, including anti-emetics (metoclopramide, prochlorperazine), can result in tardive dyskinesia.
2. Management includes discontinuing the offending agent and, if indicated, beginning a newer antipsychotic.

Front 11

51. What drug can treat tardive dyskinesia?

Back 11

a. Benztropine.

Front 12

52. What are anxiety disorders characterized by?

Back 12

a. Anxiety that interferes with daytime functioning and is not due to any other identifiable cause of symptoms.

Front 13

53. medical conditions that may present as an anxiety disorder include?

Back 13

1. Hyperthyroidism
2. pheochromocytoma
3. excess cortisol
4. heart failure
5. arrhythmias
6. asthma
7. COPD

Front 14

54. drugs which can falsely present as an anxiety disorder?

Back 14

1. Corticosteroids
2. cocaine
3. amphetamines
4. caffeine
5. withdrawal from alcohol and sedatives.

Front 15

55. Adjustment disorder?

Back 15

a. This is a normal psychological reaction (anxiety, depression, irritability) that occur soon after profound changes in a person's life, such as divorce, migration, or birth of a handicapped child.
b. Symptoms are not severe enough to be classified in another category.
c. Adjustment disorder is not a true anxiety disorder.

Front 16

56. Panic disorder?

Back 16

a. Brief attacks of intense anxiety with autonomic symptoms (e.g., tachycardia, tachypnea, dizziness, and sweating)
b. episodes occur REGULARLY, without an obvious precipitant, and in the absence of other psychiatric illness.

Front 17

57. Treatment of panic disorder?

Back 17

a. Cognitive behavioral therapy and/or relaxation training and desensitization.
b. Relaxation and desensitization may be more useful when Agoraphobic symptoms are present.
c. Medications include SSRIs (e.g., fluoxetine), benzodiazepines (alprazolam, clonazepam), imipramine, and MAOIs ( e.g. phenelzine).

Front 18

58. Note: do not treat adjustment disorder patients with medications; instead, provide counseling to help the patient adjust to the life stressor.

Back 18

58. Note: do not treat adjustment disorder patients with medications; instead, provide counseling to help the patient adjust to the life stressor.

Front 19

59. Phobic disorders?

Back 19

a. Persistent, unreasonable, intense fear of situations, circumstances, or objects.
b. Is differentiated from PTSD and acute stress disorder, which has a history of a traumatic event (threat to life or limb).
c. There are no known eliciting events in phobic disorder associated with the onset of symptoms.

Front 20

60. Agoraphobia?

Back 20

a. Fear or avoidance of places due to anxiety about not being able to escape (public places, being outside, alone, public transportation, or crowds).
b. Is more common in women.