A 67-year-old woman with a past medical history of stage 4 breast carcinoma is
inpatient receiving hospice care. The patient mentions that she is feeling tearful
and anxious about death. She regrets many things she did in her life. However,
there is no complaint of low mood. Which of the following medications is most
appropriate to relieve her anxiety?
a. Propranolol
b. Alprazolam
c. Sertraline
d. Haloperidol
Give this one a try later!
, b. Alprazolam
Teaching Points
Psychiatric symptoms such as depression and anxiety affect the
psychological health domain of the dying patient. These symptoms can
range from moderate to severe and should be assessed using valid tools to
direct treatment.
The General Anxiety Disorder (GAD-7) and Hamilton Anxiety Rating Scale
can be used to measure symptoms of anxiety.
Among the most common pharmacological interventions to treat anxiety
symptoms are benzodiazepines.
Sertraline, a selective serotonin reuptake inhibitor, may be effective in the
long term but take weeks to take effect.
Cognitive-behavioral therapy, as well as meditation, is effective in reducing
anxiety symptoms.
A 20-year-old female patient is admitted to the psychiatry unit with a diagnosis of
anorexia nervosa. Nutrition rehabilitation and psychotherapy are started. Which of
the following can be seen as a complication of treatment for this patient's disease?
a. Hypernatremia
b. Hyperkalemia
c. Hyperphosphatemia
d. Hypophosphatemia
Give this one a try later!
, d. Hypophosphatemia
Refeeding syndrome is a rare, life-threatening condition that occurs during
the reintroduction of food in persons who have experienced severe weight
loss.
As the body utilizes glucose to produce molecules of adenosine
triphosphate (ATP), it depletes the remaining stores of phosphorus. Also,
glucose entry into cells is mediated by insulin and occurs rapidly following
long periods without food leading to hypoglycemia.
Both cause electrolyte abnormalities such as hypophosphatemia and
hypokalemia, triggering cardiac and respiratory compromise. Patients
should be followed carefully for signs of refeeding syndrome and
electrolytes should be closely monitored.
The goal of nutrition rehabilitation and psychotherapy in patients with
anorexia nervosa is to gain 1 to 2 pounds (0.5 to 1 kg) per week.
A 40-year-old man presents for counseling regarding smoking cessation. His
history is significant for hypertension, type 1 diabetes mellitus, cataracts, and
osteoarthritis. He has a 20-pack-year history of smoking. The patient is started on
varenicline, and he should be warned of which of the following adverse effects?
a. Worsening of preexisting depression
b. Anxiety
c. Somnolence
d. Mania
Give this one a try later!
, a. Worsening of preexisting depression
Teaching Points
Varenicline's adverse effects include a possible increase in depression and
suicidal ideation, strange dreams, nausea, vomiting, headaches, and
insomnia.
Significant neuropsychiatric adverse events include mood changes such as
depression or mania, psychosis, hallucinations, delusions, paranoia,
homicidal ideation, aggression, hostility, agitation, anxiety, and panic, as
well as suicidal ideation, suicide attempt, and completed suicide.
Weight gain is an adverse effect of nortriptyline, another smoking cessation
medication. Dizziness can be a usual nicotine withdrawal symptom, which
typically resolves in 1 to 3 days.
Mild nausea is the most common adverse effect seen in approximately 30%
of people taking varenicline. Other adverse effects include a headache,
difficulty sleeping, and nightmares. Rare adverse effects include a change
in taste, vomiting, abdominal pain, flatulence, and constipation.
A 46-year-old man comes to the office with concerns about poor sleep for the past
five weeks. He describes being restless and having difficulty falling asleep as well
as maintaining his sleep. The patient feels that his lack of sleep has made it difficult
to focus on his work. He has to consume 2-3 cups of coffee before his shifts to keep
himself focused on his work. He previously worked in the emergency department
and has witnessed a lot of gunshot wounds at the hospital. He still recollects about
the patients he treated and how he could have changed their treatment plans to
save them. He drinks 3-4 beers on weekends and does not use illicit drugs. He
avoids going near hospitals because this causes him increased stress. Physical
examination is within normal limits. The patient appears tired. What is the best next
step in the management of this patient?
a. Provide reassurance and follow-up in two weeks
b. Prescribe melatonin
c. Advise the patient to discontinue the caffeine use
d. Prescribe paroxetine
inpatient receiving hospice care. The patient mentions that she is feeling tearful
and anxious about death. She regrets many things she did in her life. However,
there is no complaint of low mood. Which of the following medications is most
appropriate to relieve her anxiety?
a. Propranolol
b. Alprazolam
c. Sertraline
d. Haloperidol
Give this one a try later!
, b. Alprazolam
Teaching Points
Psychiatric symptoms such as depression and anxiety affect the
psychological health domain of the dying patient. These symptoms can
range from moderate to severe and should be assessed using valid tools to
direct treatment.
The General Anxiety Disorder (GAD-7) and Hamilton Anxiety Rating Scale
can be used to measure symptoms of anxiety.
Among the most common pharmacological interventions to treat anxiety
symptoms are benzodiazepines.
Sertraline, a selective serotonin reuptake inhibitor, may be effective in the
long term but take weeks to take effect.
Cognitive-behavioral therapy, as well as meditation, is effective in reducing
anxiety symptoms.
A 20-year-old female patient is admitted to the psychiatry unit with a diagnosis of
anorexia nervosa. Nutrition rehabilitation and psychotherapy are started. Which of
the following can be seen as a complication of treatment for this patient's disease?
a. Hypernatremia
b. Hyperkalemia
c. Hyperphosphatemia
d. Hypophosphatemia
Give this one a try later!
, d. Hypophosphatemia
Refeeding syndrome is a rare, life-threatening condition that occurs during
the reintroduction of food in persons who have experienced severe weight
loss.
As the body utilizes glucose to produce molecules of adenosine
triphosphate (ATP), it depletes the remaining stores of phosphorus. Also,
glucose entry into cells is mediated by insulin and occurs rapidly following
long periods without food leading to hypoglycemia.
Both cause electrolyte abnormalities such as hypophosphatemia and
hypokalemia, triggering cardiac and respiratory compromise. Patients
should be followed carefully for signs of refeeding syndrome and
electrolytes should be closely monitored.
The goal of nutrition rehabilitation and psychotherapy in patients with
anorexia nervosa is to gain 1 to 2 pounds (0.5 to 1 kg) per week.
A 40-year-old man presents for counseling regarding smoking cessation. His
history is significant for hypertension, type 1 diabetes mellitus, cataracts, and
osteoarthritis. He has a 20-pack-year history of smoking. The patient is started on
varenicline, and he should be warned of which of the following adverse effects?
a. Worsening of preexisting depression
b. Anxiety
c. Somnolence
d. Mania
Give this one a try later!
, a. Worsening of preexisting depression
Teaching Points
Varenicline's adverse effects include a possible increase in depression and
suicidal ideation, strange dreams, nausea, vomiting, headaches, and
insomnia.
Significant neuropsychiatric adverse events include mood changes such as
depression or mania, psychosis, hallucinations, delusions, paranoia,
homicidal ideation, aggression, hostility, agitation, anxiety, and panic, as
well as suicidal ideation, suicide attempt, and completed suicide.
Weight gain is an adverse effect of nortriptyline, another smoking cessation
medication. Dizziness can be a usual nicotine withdrawal symptom, which
typically resolves in 1 to 3 days.
Mild nausea is the most common adverse effect seen in approximately 30%
of people taking varenicline. Other adverse effects include a headache,
difficulty sleeping, and nightmares. Rare adverse effects include a change
in taste, vomiting, abdominal pain, flatulence, and constipation.
A 46-year-old man comes to the office with concerns about poor sleep for the past
five weeks. He describes being restless and having difficulty falling asleep as well
as maintaining his sleep. The patient feels that his lack of sleep has made it difficult
to focus on his work. He has to consume 2-3 cups of coffee before his shifts to keep
himself focused on his work. He previously worked in the emergency department
and has witnessed a lot of gunshot wounds at the hospital. He still recollects about
the patients he treated and how he could have changed their treatment plans to
save them. He drinks 3-4 beers on weekends and does not use illicit drugs. He
avoids going near hospitals because this causes him increased stress. Physical
examination is within normal limits. The patient appears tired. What is the best next
step in the management of this patient?
a. Provide reassurance and follow-up in two weeks
b. Prescribe melatonin
c. Advise the patient to discontinue the caffeine use
d. Prescribe paroxetine
