Phobia And Ocd

Front 1

A 28 y/o female is brought in by EMS complaining of shortness of breath, palpitations and chest pain. She smokes 1 PPD and her only medication is OCPs. She had one of these attacks previously while grocery shopping. She shares with you that she is so afraidof having another one she rarely leaves her house.

- Next step?

- Drug regimen of choice?

Back 1

Next step:

- EKG, cardiac enzymes, echocardiogram, TSH or T4, urine drug screen

Drug regimen of choice:

- Alprazolam or clonazepam low dose prn show term, but SSRIs are the preferred drug

Front 2

Who should you NOT give benzos to?

Back 2

- Drug addicts

- COPDers

- Restrictive lung disease

Front 3

You start a patient who has social anxiety/panic disorder on benzos and SSRI's.

She is brought in 3 months later with temp of 101, convulsions, confusion, and HTN. She recently lost her drug prescription coverage. What does she have?

Back 3

Acute benzo withdrawal reaction. Similar to DTs.

Treat with diazepam or chlordiazepoxide + haloperidol if psychotic.

Front 4

MS4 w/ deathly fear of flying that inhibits her from interviewing at the program of her dreams.

- Diagnosis?

- Treatment?

Back 4

Diagnosis:

- Specific phobia

Tx:

- CBT w/ flooding or exposure/extinction.

- Can give benzos for situational use

Front 5

MS3 w/ deathly fear of presenting a case in grand rounds b/c she is afraid the surgeons will laugh at her.

- Diagnosis?

- Tx?

Back 5

Diagnosis:

- Social phobia

Tx:

- Propranolol to stop hyperarousal and benzo

Front 6

MS2 keeps to herself and doesn’t talk with peers b/c she is afraid they will laugh at her.

- Diagnosis?

- Tx?

Back 6

Diagnosis:

- Avoidant personality disorder

Tx:

- Best tv is CBT

Front 7

MS1 is having difficulty falling asleep b/c she keeps thinking about failing biochem. In class she cannot concentrate b/c she worries her boyfriend will leave her. Sxslasting >6mo

- Diagnosis?

- Tx?

Back 7

Diagnosis:

- Generalized anxiety disorder

Tx:

- Buspirone (5HT 1a partial agonist), but must give benzos to bridge because it takes > 3 weeks to work.

Front 8

18y/o who just started college has declining grades. He states he can’t make it to class on time because he spends 2-3 hours scrubbing in the shower each morning. He knows this is excessive but on days he takes shorter showers, he states he can “feel the bacteria” and worries about contracting an illness.

- Diagnosis?

- Comorbid condition risk?

- Treatment?

Back 8

Diagnosis: OCD

Comorbid condition:

- High prevalence of vocal-motor ticks and 5-7% of OCD pts have full blown Tourettes.

Tx:

- Clompiramine is gold standard. SSRI's are first line.

Front 9

A 25 y/o sexual assault survivor comes to you with a 6wk history of recurrent nightmares of when she was raped at knifepoint. She now avoidssituations where unknown men will be present, to the point that she had to quit her job at a bank. She reports being “jumpy” anytime she hears footsteps behind her.

- Diagnosis?

- Treatment?

- If same s/s, but only present for 3 weeks?

- If same s/s, but in response to a bad breakup?

Back 9

Diagnosis:

- PTSD

Tx:

- Sertaline or paroxetine, combined with CBT

- Prazosin for NMs

If same sxs, but only present for 3 weeks?

- Acute stress reaction

If same s/s, but in response to a bad breakup?

- Adjustment Disorder

Front 10

A 54 y/o RN presents w/ a history of 2mo of diarrhea and abdpain. He has presented to 4 other hospitals w/ the same complaint. Colonoscopy reveals pigmentation in the wall of the colon

- Diagnosis?

- Do it for what kind of gain?

Back 10

Munchausen Syndrome. More severe than simple factitious d/o b/c they actually induce sxs. (in this case, w/ laxative abuse). They do it for primary gain.

Front 11

A concerned mother presents with her 15mo baby who is having recurrent seizures. She requests an MRI, sleep deprived EEG with intracranial leads.

- Diagnosis?

Back 11

Munchausen Syndrome by proxy. A form of child abuse!10% of children die before reaching adulthood.

Front 12

A 45 y/o unemployed man is involved in a car accident. He sues the driver stating he has nerve damage to his legs that keeps him from walking. Video evidence shows him dancing at a club the night before.

- Diagnosis?

- Associated with what?

- What gain?

Back 12

- Malingering

- Associated w/ antisocial personality disorder.

- They do it for secondary gain.

Front 13

A 18 y/o F presents with no menstrual cycle for 3mo. A pregnancy test is negative but her BMI is calculated to be 17. Her teeth are eroded and she has calluses on her knuckles (Russel sign).

- Likely vital signs?

- Likely CBC?

- Likely chem?

- Likely TFTs?

- Fasting lipid profile?

- Hormones?

Back 13

Vital signs:

- Hypotension, bradycardia, hypothermia

CBC:

- Leukopenia

Chemistry:

- High bicarb, low Cl, low K, high carotene, high LFTs and amylase

TFTs:

- Normal

Fasting lipid profile:

- High cholesterol

Hormones:

- High cortisol

- Low LH/FSH

- Low estrogen

Front 14

Bulemia:

- Long term complications?

- MC cause of death?

- Treatment?

- Complications of treatment?

Back 14

LT complications:

- Osteoporosis

MC cause of death:

- Heart disease, then suicide

Treatment:

- Admit them to maximize nutrition

- SSRI's help bulemia, anorexia needs intensive counseling

Complications of treatment:

- Re-feeding syndrome- low phosphorus, low mg, low calcium and fluid retention.

Front 15

Back 15

Awake

Front 16

Back 16

Stage 1 sleep

Front 17

Back 17

Stage 2 sleep

Front 18

Back 18

Slow wave sleep- stage 3 < 50% delta, stage 4 < 50%

Sleep walking/talking/night terrors.

Front 19

Back 19

REM. Skeletal muscle paralysis.