Step 3 Ch 19 Psychiatry 1-8

Front 1

161. presentation of serotonin syndrome?

Back 1

a. History of SSRI use and the use of a migraine medication (triptan) or an MAOI.
b. Agitation
c. hyperreflexia
d. hyperthermia
e. muscle rigidity with volume contraction secondary to sweating and insensible fluid loss.

Front 2

162. Treatment of serotonin syndrome?

Back 2

a. IV fluids
b. Ciproheptadine to decrease serotonin production
c. benzodiazepines to reduce muscle rigidity

Front 3

163. presentation of MAOI-induced hypertensive crisis?

Back 3

a. Acute hypertension and a history of MAOI use and either antihistamines, nasal decongestants, or consumption of tyramine rich foods (cheeses, pickled foods).
b. May also be seen in patients who take a MAI and a TCA concurrently.

Front 4

164. Treatment of an AOI induced hypertensive crisis?

Back 4

a. Tree has hypertensive crisis.
b. There is no specific antihypertensive indicated.

Front 5

165. What is the first assessment prior to prescribing antidepressants?
a. CBC
b. family history of depression
c. Previous use of antidepressants
d. suicidal ideation
e. Thyroid function tests

Back 5

1. answer: D- always assessed for suicidal ideation. Prior to starting antidepressants as there is increased risk in suicidal ideation in some patients within the first two weeks. Know how to manage acute suicidal ideation.
2. If the patient has been acutely suicidal, you must hospitalize and consider electroconvulsive therapy, which can help mood in acute setting.

Front 6

166. Somatoform disorders?

Back 6

a. Involves multiple systems affecting multiple organs, with no medical explanation.
b. . There must be at least four pain symptoms, 2 GI symptoms, one sexual symptom, and one pseudo-neurological symptom to make a diagnosis.

Front 7

167. A 47-year-old woman presents to the clinic with shortness of breath, chest pain, abdominal pain, back pain – and difficulty walking due to weakness in her legs. She remembers being sick all the time for the past 10 years. According to her husband. She currently takes medications for all of her ailments. She has visited numerous physicians and none has been able to diagnose her condition correctly. What is the next step in management?
a. Order ANA
b. order CT of the abdomen
c. order CT of the head
d. hospitalize
e. schedule regular monthly visits.

Back 7

1. Answer: E- schedule regular monthly visits to establish a single physician as the primary caregiver is the most important first of the management.

Front 8

168. Management of somatoform disorder?

Back 8

a. Maintain a single physician is the primary caretaker
b. schedule brief monthly visits
c. avoid diagnostic testing therapies
d. schedule individual psychotherapy
e. do not hospitalize the patient

Front 9

169. conversion disorder?

Back 9

a. One or more neurological symptoms that cannot be explained by any medical or neurological disorder.
b. Most common symptoms are mutism, blindness, paralysis, and anesthesia/paresthesias.
c. Look for psychologic factors associated with the onset or exacerbation of symptoms.
d. A clue to diagnosis is that patients often are unconcerned about their impairment (La belle indifference).

Front 10

170. Management of conversion disorder?

Back 10

a. Supportive physician-patient relationship
b. psychotherapy

Front 11

171. note: some meditation disorder and conversion disorder are never the correct diagnosis. If symptoms are produced intentionally or feigned.

Back 11

171. note: some meditation disorder and conversion disorder are never the correct diagnosis. If symptoms are produced intentionally or feigned.

Front 12

172. Hypochondriasis?

Back 12

a. Hypochondriasis is the diagnosis and the patient falsely believes that he has a specific disease, despite repeated negative medical tests and work-up.
b. Symptoms must've been present for at least six months and physicians reassurance has failed to relieve concerns.

Front 13

173. Management of hypochondriasis?

Back 13

a. Identify one primary caregiver.
b. Schedule regular routine visits
c. provide psychotherapy.

Front 14

174. Presentation of factitious and malingering disorders?

Back 14

a. In both factitious disorder and malingering, the case will suggest that a patient has intentionally feigned symptoms.
b. The diagnosis is factitious disorder when the case describes a patient that has seen many doctors and visited many hospitals, has large amounts of medical knowledge (e.g. healthcare worker), and demands treatment.
c. They are typically agitated and threaten litigation if tests return negative.

Front 15

175. Factitious disorder by proxy?

Back 15

a. If the signs and symptoms are faked by another person, as in a mother making of symptoms and her child.
b. The motivation is to assume the caretaker role.

Front 16

176. Malingering

Back 16

a. Malingering is the diagnosis when obvious gain (shelter, medications or disability insurance) results from pain symptoms.
b. Malingering patients are more preoccupied with rewards or gain than with alleviation of presenting symptoms.

Front 17

177. A 23-year-old nursing student presents to the ED with fever and chills at home. She has had multiple missions and other hospitals because of pneumonia and chronic pain problems. She was found to be tampering with the blood culture bottles and dipping her thermometer in hot water. Which of the following is the most likely diagnosis?
a. Conversion disorder
b. factitious disorder
c. factitious disorder by proxy
d. malingering
e. somatization disorder

Back 17

1. answer: B.

Front 18

178. the 46-year-old homeless man presents to the hospital reporting that he had a seizure this morning. He's adamant that he be admitted, however, he refuses all bloodwork and imaging studies. We cannot answer questions about the seizure, and cannot describe the symptoms of the time of seizure. Instead, he demands to be admitted and is wondering why you're taking so long. When you ask about his social history, he admits that he is homeless at the moment, as he was kicked out of the shelter because of drug taking and alcohol abuse. Which of the following is the most likely diagnosis?
a. Conversion disorder
b. factitious disorder
c. factitious disorder by proxy
d. malingering
e. somatization disorder?

Back 18

1. Answer: D.

Front 19

179. treatment for factitious and malingering disorders?

Back 19

a. Supportive psychotherapy treatment of choice
b. do not confront or accuse the patient (the patient will become angry, more guarded, and suspicious).
c. Only provide the minimum amount of treatment and workup needed. Aggressive management of the patient's symptoms only reinforces the behavior.

Front 20

180. Diagnosis of anorexia?

Back 20

a. Case will describe:
1. young female
2. underweight because of food restriction and excessive exercise, and has not had a menstrual period for three cycles or more.
3. The question may also include a history of purging (50% of anorexia patients also purge), the diagnosis will still be anorexia.