LMR EXAMS TEST PAPER QUESTIONS AND ANSWERS
SURE A+
✔✔Neurotransmitters associated with infection - ✔✔Increased in C-reactive protein
levels
Increase WBC
✔✔Neurotransmitters associated with insomnia - ✔✔Histamine 1
Alpha
✔✔Autoimmune diseases can lead to increase in cytokines level - ✔✔True
✔✔Neuroleptic Malignant Syndrome (NMS) - ✔✔Caused by antipsychotics
**Extreme muscular rigidity** (lead-pipe)
**Mutism**
**Elevated CPK** (muscle contraction/destruction)
**Myoglobinuria** (from breakdown of muscle - rhabdomyolysis)
**Elevated WBCs** (leukocytosis)
**Elevated LFTs**
Hyperthermia
Tachycardia
Diaphoresis
Altered level of consciousness
✔✔NMS Treatment - ✔✔DC the offending agent
Dantrolene (Muscle relaxant for the rigidity)
Bromocriptine (Parlodel) - D2 agonist
✔✔Serotonin Syndrome - ✔✔Caused by antidepressants
**Hyperreflexia**
**Clonus**
Agitation
Restlessness
Rapid heart rate and BP elevation
Headache
Sweating, shivering, goose bumps
Confusion, fever, seizures, unconsciousness
✔✔Serotonin Syndrome Treatment - ✔✔DC the offending agent
Cyproheptadine (antihistamine that blocks histamine and serotonin)
,✔✔Risks for serotonin syndrome - ✔✔Use of SSRis and St John's wort (used for
depression)
Switching to SSRI to MAOI (wait 2 weeks)
Switching from fluoxetine to MAOI (wait 5-6 weeks)
Switching from MAOI to fluoxetine (wait 2 weeks)
Triptans (used for headaches)
**Remember to wait 5 half lives
✔✔Neurotransmitters involved in depression - ✔✔Dopamine, Norepinephrine, and
Serotonin
✔✔Depression in adolescents - ✔✔May present differently (anger, irritability, crying,
safeness)
✔✔Brain structures involved in depression - ✔✔Amygdala (enlarged)
Hippocampus (reduced)
Thalamus (reduced)
✔✔Depressed patient + Cancer - ✔✔If on a medication like tamoxifen, use citalopram
or escitalopram, sertraline
✔✔Chronic neuropathic pain treatment - ✔✔Alpha 2 Delta Ligands (Gabapentin and
Pregabalin)
✔✔Rare side effect of SNRIs - ✔✔Interstitial lung disease
✔✔SNRIs and Blood Pressure - ✔✔SNRIs can increase blood pressure
✔✔SSRis and SNRIs - ✔✔Can cause hyponatremia
Hyponatremia could rapidly emerge after 2 days of duloxetine treatment or delayed for
several weeks or even months
SXS include fatigue, weakness, lethargy, headache, nausea, dizziness, altered mental
state and seizure
✔✔Wellbutrin and Seizures - ✔✔Wellbutrin is contraindicated in patients with seizure
disorder/history of seizures or conditions that increase the risk of seizure (i.e. anorexia
or bulimia)
Wellbutrin decreases the seizure threshold (increases seizure risk)
✔✔Antidepressants and Insomnia - ✔✔Trazodone, Mirtazapine, Amitriptyline, Doxepin
,✔✔Trazodone serious adverse effect - ✔✔Priapism
✔✔Mirtazapine side effect - ✔✔Weight gain
✔✔Psychiatric conditions that increase thoughts of self-harm - ✔✔Depression
Bipolar
Alcohol Abuse
Eating Disorder
Schizophrenia
✔✔Psychiatric conditions that likely present with homicidal ideation - ✔✔**Antisocial
personality disorder**
Schizoaffective disorder
Borderline personality disorder
Paranoid personality disorder
Schizophrenia
Obsessive-compulsive personality disorder
Brief psychotic disorder
Unspecified psychosis
Avoidant personality disorder
Schizoid personality disorder
Delusional disorder
Other psychotic disorder
✔✔Antidepressants and placebo effect - ✔✔When compared to adults, children with
depression have a reduced placebo effect
✔✔Adolescent depression often co-occurs with these conditions - ✔✔Anxiety disorders
ADHD
SUD
Eating Disorders
Suicidality
**CBT and DBT can help decrease suicidal behaviors in adolescents**
✔✔Genetic dysfunction and 5HT2C receptor - ✔✔SSRIs efficacy may be impacted
SNRIs may be an alternative
Atypical antidepressants (mirtazapine or bupropion) are alternatives depending on the
specific genetic dysfunction
TCAs (amitriptyline or nortriptyline) may be an option is SSRIs or SNRIs are ineffective
✔✔Schizophrenia age of onset - ✔✔18-25-year-old in males
25-35-year-old in females
**most people mid to late 20s**
, ✔✔Schizophrenia hallmark - ✔✔Impaired proverb interpretation (abstraction)
✔✔Schizophrenia and Intrauterine Insults - ✔✔Prenatal exposure to toxins including
viral agents
Oxygen deprivation
Maternal malnutrition, substance use, or other illness
✔✔Schizophrenia and Lipids - ✔✔Schizophrenia is associated with lipid disorder,
specifically reduced HDL and increased triglycerides
✔✔Which drug classes do patients with schizophrenia have low tolerability? - ✔✔Alpha
2 Adrenergic Agonists (Guanfacine and Clonidine)
**The neuroprotective effects of these medications can be limited in these patients**
✔✔Schizophrenia and Stimulants - ✔✔Not recommended
Can increase dopamine activity in brain
Can exacerbate symptoms (particularly psychosis)
✔✔Neurobiological defect associated with schizophrenia - ✔✔**Enlarged ventricles**
Cerebral cortex atrophy
Smaller frontal and temporal lobes
Reduced symmetry in temporal, frontal, and occipital lobes
Decreased cerebral blood flow
Hippocampal and amygdala reduction
✔✔What do abnormalities, changes, or deficits in the prefrontal cortex, amygdala, basal
ganglia, hippocampus, and limbic regions of the brain cause? - ✔✔Aggression,
impulsivity, and abstract thinking problems in schizophrenia
✔✔Nonpharmacological management of schizophrenia - ✔✔Group therapy
Individual therapy
Assertive community treatment (ACT)
**If newly diagnosed, IOP
✔✔What is the standard conversion from oral to injectable dosing of Haldol? - ✔✔10-15
x the daily oral dose
**Initiation dose often capped around 100mg**
Then dose the rest 5-7 days or 14 days later
SURE A+
✔✔Neurotransmitters associated with infection - ✔✔Increased in C-reactive protein
levels
Increase WBC
✔✔Neurotransmitters associated with insomnia - ✔✔Histamine 1
Alpha
✔✔Autoimmune diseases can lead to increase in cytokines level - ✔✔True
✔✔Neuroleptic Malignant Syndrome (NMS) - ✔✔Caused by antipsychotics
**Extreme muscular rigidity** (lead-pipe)
**Mutism**
**Elevated CPK** (muscle contraction/destruction)
**Myoglobinuria** (from breakdown of muscle - rhabdomyolysis)
**Elevated WBCs** (leukocytosis)
**Elevated LFTs**
Hyperthermia
Tachycardia
Diaphoresis
Altered level of consciousness
✔✔NMS Treatment - ✔✔DC the offending agent
Dantrolene (Muscle relaxant for the rigidity)
Bromocriptine (Parlodel) - D2 agonist
✔✔Serotonin Syndrome - ✔✔Caused by antidepressants
**Hyperreflexia**
**Clonus**
Agitation
Restlessness
Rapid heart rate and BP elevation
Headache
Sweating, shivering, goose bumps
Confusion, fever, seizures, unconsciousness
✔✔Serotonin Syndrome Treatment - ✔✔DC the offending agent
Cyproheptadine (antihistamine that blocks histamine and serotonin)
,✔✔Risks for serotonin syndrome - ✔✔Use of SSRis and St John's wort (used for
depression)
Switching to SSRI to MAOI (wait 2 weeks)
Switching from fluoxetine to MAOI (wait 5-6 weeks)
Switching from MAOI to fluoxetine (wait 2 weeks)
Triptans (used for headaches)
**Remember to wait 5 half lives
✔✔Neurotransmitters involved in depression - ✔✔Dopamine, Norepinephrine, and
Serotonin
✔✔Depression in adolescents - ✔✔May present differently (anger, irritability, crying,
safeness)
✔✔Brain structures involved in depression - ✔✔Amygdala (enlarged)
Hippocampus (reduced)
Thalamus (reduced)
✔✔Depressed patient + Cancer - ✔✔If on a medication like tamoxifen, use citalopram
or escitalopram, sertraline
✔✔Chronic neuropathic pain treatment - ✔✔Alpha 2 Delta Ligands (Gabapentin and
Pregabalin)
✔✔Rare side effect of SNRIs - ✔✔Interstitial lung disease
✔✔SNRIs and Blood Pressure - ✔✔SNRIs can increase blood pressure
✔✔SSRis and SNRIs - ✔✔Can cause hyponatremia
Hyponatremia could rapidly emerge after 2 days of duloxetine treatment or delayed for
several weeks or even months
SXS include fatigue, weakness, lethargy, headache, nausea, dizziness, altered mental
state and seizure
✔✔Wellbutrin and Seizures - ✔✔Wellbutrin is contraindicated in patients with seizure
disorder/history of seizures or conditions that increase the risk of seizure (i.e. anorexia
or bulimia)
Wellbutrin decreases the seizure threshold (increases seizure risk)
✔✔Antidepressants and Insomnia - ✔✔Trazodone, Mirtazapine, Amitriptyline, Doxepin
,✔✔Trazodone serious adverse effect - ✔✔Priapism
✔✔Mirtazapine side effect - ✔✔Weight gain
✔✔Psychiatric conditions that increase thoughts of self-harm - ✔✔Depression
Bipolar
Alcohol Abuse
Eating Disorder
Schizophrenia
✔✔Psychiatric conditions that likely present with homicidal ideation - ✔✔**Antisocial
personality disorder**
Schizoaffective disorder
Borderline personality disorder
Paranoid personality disorder
Schizophrenia
Obsessive-compulsive personality disorder
Brief psychotic disorder
Unspecified psychosis
Avoidant personality disorder
Schizoid personality disorder
Delusional disorder
Other psychotic disorder
✔✔Antidepressants and placebo effect - ✔✔When compared to adults, children with
depression have a reduced placebo effect
✔✔Adolescent depression often co-occurs with these conditions - ✔✔Anxiety disorders
ADHD
SUD
Eating Disorders
Suicidality
**CBT and DBT can help decrease suicidal behaviors in adolescents**
✔✔Genetic dysfunction and 5HT2C receptor - ✔✔SSRIs efficacy may be impacted
SNRIs may be an alternative
Atypical antidepressants (mirtazapine or bupropion) are alternatives depending on the
specific genetic dysfunction
TCAs (amitriptyline or nortriptyline) may be an option is SSRIs or SNRIs are ineffective
✔✔Schizophrenia age of onset - ✔✔18-25-year-old in males
25-35-year-old in females
**most people mid to late 20s**
, ✔✔Schizophrenia hallmark - ✔✔Impaired proverb interpretation (abstraction)
✔✔Schizophrenia and Intrauterine Insults - ✔✔Prenatal exposure to toxins including
viral agents
Oxygen deprivation
Maternal malnutrition, substance use, or other illness
✔✔Schizophrenia and Lipids - ✔✔Schizophrenia is associated with lipid disorder,
specifically reduced HDL and increased triglycerides
✔✔Which drug classes do patients with schizophrenia have low tolerability? - ✔✔Alpha
2 Adrenergic Agonists (Guanfacine and Clonidine)
**The neuroprotective effects of these medications can be limited in these patients**
✔✔Schizophrenia and Stimulants - ✔✔Not recommended
Can increase dopamine activity in brain
Can exacerbate symptoms (particularly psychosis)
✔✔Neurobiological defect associated with schizophrenia - ✔✔**Enlarged ventricles**
Cerebral cortex atrophy
Smaller frontal and temporal lobes
Reduced symmetry in temporal, frontal, and occipital lobes
Decreased cerebral blood flow
Hippocampal and amygdala reduction
✔✔What do abnormalities, changes, or deficits in the prefrontal cortex, amygdala, basal
ganglia, hippocampus, and limbic regions of the brain cause? - ✔✔Aggression,
impulsivity, and abstract thinking problems in schizophrenia
✔✔Nonpharmacological management of schizophrenia - ✔✔Group therapy
Individual therapy
Assertive community treatment (ACT)
**If newly diagnosed, IOP
✔✔What is the standard conversion from oral to injectable dosing of Haldol? - ✔✔10-15
x the daily oral dose
**Initiation dose often capped around 100mg**
Then dose the rest 5-7 days or 14 days later
