Family Medicine Aquifer Cases Test- Solo
| Questions AND 100% Correct Verified
Answers
Risk factors for Late-life depression - ANSWER
SAFE-T (Suicide Assessment Five-Step Evaluation and Triage) - ANSWER 1.
Risk factors:
*a.* Suicidal behavior: history of prior suicide attempts, aborted suicide attempts, or self-
injurious behavior
*b.* Current/past psychiatric disorders: especially mood disorders, psychotic disorders,
alcohol/substance abuse, ADHD, TBI, PTSD, Cluster B personality disorders, conduct
disorders (antisocial behavior, aggression, impulsivity) Co-morbidity and recent onset of
illness increase risk
*c.* Key symptoms: anhedonia, impulsivity, hopelessness, anxiety/panic, global
insomnia, and command hallucinations
*d.* Family history: of suicide, attempts, or psychiatric disorders requiring hospitalization
*e.* Precipitants/stressors/Interpersonal: triggering events leading to humiliation,
shame, or despair (e.g, loss of relationship, financial or health status—real or
anticipated). Ongoing medical illness (esp. CNS disorders, pain). Intoxication.
Family turmoil/chaos. History of physical or sexual abuse. Social isolation
*f.* Change in treatment: discharge from psychiatric hospital, provider or treatment
change
*g.* Access to firearms
*2. Protective factors:*
*a.* Internal: ability to cope with stress, religious beliefs, and frustration tolerance
*b.* External: responsibility to children or beloved pets, positive therapeutic
relationships, and social supports
*3.* *Suicide Inquiry:*
*a.* Ideation: frequency, intensity, duration—in last 48 hours, past month, and worst
ever
*b.* Plan: timing, location, lethality, availability, and preparatory acts
,*c.* Behaviors: past attempts, aborted attempts, rehearsals (tying noose, loading gun)
versus non-suicidal self injurious actions
*d.* Intent: extent to which the patient (1) expects to carry out the plan and (2)
believes the plan/act to be lethal versus self-injurious.
*e.* Explore ambivalence: reasons to die versus reasons to live
*4.* *Risk level/ interventio
*True or false:* The USPSTF recommends *screening for depression in the general
adult population*, including pregnant and postpartum women. Screening should be
implemented with adequate systems in place to ensure accurate diagnosis, effective
treatment, and appropriate follow-up. - ANSWER *True*
"Over the past two weeks, have you often been bothered by either of the
following problems?"
Little interest or pleasure in doing things.
Feeling down, depressed, or hopeless.
If positive, it should be followed up by a diagnostic instrument such as:
PHQ-9
Geriatric Depression Scale - Short Form (GDS-SF)
*True or False:* *Screening for dementia is not important in geriatric patients with
depression* because the Geriatric Depression Scale is less sensitive in
demented patients. - ANSWER *False*
Screening for dementia *is important* in geriatric patients with depression because *the
Geriatric Depression Scale is less sensitive in demented patients.*
There are two dementia screening tools:
The Mini-Cog exam
The Mini-Mental State Exam (MMSE)
*The Mini-Cog exam is faster and more sensitive and specific than the MMSE.*
What are the four major antidepressant drugs? - ANSWER *Selective serotonin
reuptake inhibitors (SSRIs):* Selectively block reuptake of serotonin,
potentiating serotonin's effect on the post-synaptic neuron
e.g. Citalopram (Celexa), Fluoxetine (Prozac), Fluvoxamine (Luvox), Paroxetine
(Paxil), Sertraline (Zoloft), Escitalopram (Lexapro)
*Tricyclic antidepressants (TCAs):* Block reuptake of norepinephrine and
serotonin, potentiating their effects on the post-synaptic neuron
, e.g. Nortriptyline (Pamelor), Amitriptyline, Clomipramine (Anafranil), Doxepin (Sinequan)
*Monoamine oxidase (MAO) inhibitors:* Block pre-synaptic catabolism of
norepinephrine and serotonin (rarely used today) e.g. Phenelzine
(Nardil), Tranylcypromine (Parnate)
*Serotonin and norepinephrine reuptake inhibitors:* Block reuptake of
norepinephrine and serotonin, increasing their concentration/availability e.g.
Venlafaxine (Effexor) and Duloxetine (Cymbalta)
What are common side effects associated with selective serotonin reuptake inhibitors
(SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)? Select all that apply.
A. Arthralgias
B. Cardiac arrhythmias
C. Headaches
D. Insomnia
E. Nausea - ANSWER Common side effects of SSRI/SNRIs include:
*Headaches*
*Sleep disturbances (drowsiness and, less frequently, insomnia)*
*Gastrointestinal problems such as nausea and diarrhea*
*Sexual dysfunction*
They can also cause:
Hyponatremia, due to the syndrome of inappropriate secretion of antidiuretic hormone
(SIADH)
*Serotonin syndrome* (lethargy, restlessness, hypertonicity, rhabdomyolysis,
renal failure, and possible death)
Increased risk of gastrointestinal bleeding
Which of the following would be considered treatment(s) of choice in treating an elderly
depressed woman? Select all that apply.
A. Amitriptyline - a tricyclic antidepressant
B. Cognitive-behavioral therapy
C. Electroconvulsive therapy (ECT)
D. Exercise
E. Sertraline - a selective serotonergic reuptake inhibitor (SSRI) - ANSWER The correct
answers are B, D, E
SSRI Drug profiles - ANSWER *Fluoxetine (Prozac):* Unusually long half life (two
to four days), so effects can last for weeks after discontinuation. Most problematic
(but uncommon) side effects include *agitation, motor restlessness, decreased
libido in women, and insomnia.*
| Questions AND 100% Correct Verified
Answers
Risk factors for Late-life depression - ANSWER
SAFE-T (Suicide Assessment Five-Step Evaluation and Triage) - ANSWER 1.
Risk factors:
*a.* Suicidal behavior: history of prior suicide attempts, aborted suicide attempts, or self-
injurious behavior
*b.* Current/past psychiatric disorders: especially mood disorders, psychotic disorders,
alcohol/substance abuse, ADHD, TBI, PTSD, Cluster B personality disorders, conduct
disorders (antisocial behavior, aggression, impulsivity) Co-morbidity and recent onset of
illness increase risk
*c.* Key symptoms: anhedonia, impulsivity, hopelessness, anxiety/panic, global
insomnia, and command hallucinations
*d.* Family history: of suicide, attempts, or psychiatric disorders requiring hospitalization
*e.* Precipitants/stressors/Interpersonal: triggering events leading to humiliation,
shame, or despair (e.g, loss of relationship, financial or health status—real or
anticipated). Ongoing medical illness (esp. CNS disorders, pain). Intoxication.
Family turmoil/chaos. History of physical or sexual abuse. Social isolation
*f.* Change in treatment: discharge from psychiatric hospital, provider or treatment
change
*g.* Access to firearms
*2. Protective factors:*
*a.* Internal: ability to cope with stress, religious beliefs, and frustration tolerance
*b.* External: responsibility to children or beloved pets, positive therapeutic
relationships, and social supports
*3.* *Suicide Inquiry:*
*a.* Ideation: frequency, intensity, duration—in last 48 hours, past month, and worst
ever
*b.* Plan: timing, location, lethality, availability, and preparatory acts
,*c.* Behaviors: past attempts, aborted attempts, rehearsals (tying noose, loading gun)
versus non-suicidal self injurious actions
*d.* Intent: extent to which the patient (1) expects to carry out the plan and (2)
believes the plan/act to be lethal versus self-injurious.
*e.* Explore ambivalence: reasons to die versus reasons to live
*4.* *Risk level/ interventio
*True or false:* The USPSTF recommends *screening for depression in the general
adult population*, including pregnant and postpartum women. Screening should be
implemented with adequate systems in place to ensure accurate diagnosis, effective
treatment, and appropriate follow-up. - ANSWER *True*
"Over the past two weeks, have you often been bothered by either of the
following problems?"
Little interest or pleasure in doing things.
Feeling down, depressed, or hopeless.
If positive, it should be followed up by a diagnostic instrument such as:
PHQ-9
Geriatric Depression Scale - Short Form (GDS-SF)
*True or False:* *Screening for dementia is not important in geriatric patients with
depression* because the Geriatric Depression Scale is less sensitive in
demented patients. - ANSWER *False*
Screening for dementia *is important* in geriatric patients with depression because *the
Geriatric Depression Scale is less sensitive in demented patients.*
There are two dementia screening tools:
The Mini-Cog exam
The Mini-Mental State Exam (MMSE)
*The Mini-Cog exam is faster and more sensitive and specific than the MMSE.*
What are the four major antidepressant drugs? - ANSWER *Selective serotonin
reuptake inhibitors (SSRIs):* Selectively block reuptake of serotonin,
potentiating serotonin's effect on the post-synaptic neuron
e.g. Citalopram (Celexa), Fluoxetine (Prozac), Fluvoxamine (Luvox), Paroxetine
(Paxil), Sertraline (Zoloft), Escitalopram (Lexapro)
*Tricyclic antidepressants (TCAs):* Block reuptake of norepinephrine and
serotonin, potentiating their effects on the post-synaptic neuron
, e.g. Nortriptyline (Pamelor), Amitriptyline, Clomipramine (Anafranil), Doxepin (Sinequan)
*Monoamine oxidase (MAO) inhibitors:* Block pre-synaptic catabolism of
norepinephrine and serotonin (rarely used today) e.g. Phenelzine
(Nardil), Tranylcypromine (Parnate)
*Serotonin and norepinephrine reuptake inhibitors:* Block reuptake of
norepinephrine and serotonin, increasing their concentration/availability e.g.
Venlafaxine (Effexor) and Duloxetine (Cymbalta)
What are common side effects associated with selective serotonin reuptake inhibitors
(SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)? Select all that apply.
A. Arthralgias
B. Cardiac arrhythmias
C. Headaches
D. Insomnia
E. Nausea - ANSWER Common side effects of SSRI/SNRIs include:
*Headaches*
*Sleep disturbances (drowsiness and, less frequently, insomnia)*
*Gastrointestinal problems such as nausea and diarrhea*
*Sexual dysfunction*
They can also cause:
Hyponatremia, due to the syndrome of inappropriate secretion of antidiuretic hormone
(SIADH)
*Serotonin syndrome* (lethargy, restlessness, hypertonicity, rhabdomyolysis,
renal failure, and possible death)
Increased risk of gastrointestinal bleeding
Which of the following would be considered treatment(s) of choice in treating an elderly
depressed woman? Select all that apply.
A. Amitriptyline - a tricyclic antidepressant
B. Cognitive-behavioral therapy
C. Electroconvulsive therapy (ECT)
D. Exercise
E. Sertraline - a selective serotonergic reuptake inhibitor (SSRI) - ANSWER The correct
answers are B, D, E
SSRI Drug profiles - ANSWER *Fluoxetine (Prozac):* Unusually long half life (two
to four days), so effects can last for weeks after discontinuation. Most problematic
(but uncommon) side effects include *agitation, motor restlessness, decreased
libido in women, and insomnia.*
