Psych-
Rosh Review exam questions and answ
k k k k k k
ers
OCD
higherkdoseskofkSSRIskarekusuallykcommonkinkwhatkpsychiatrickcondition
TCAs
whatkclasskofkantidepressantskiskassociatedkwithkanticholinergicksidekeffects,kincludingkcardiackdysr
hythmias,kdrykmouth,ksedation,kandkorthostatickhypotension?
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conversionkdisorder
whatkconditionkiskthis:
-
Patientskhavekabruptklosskofkmotorkorksensorykfunctionkcausedkbykpsychologicalkfactorskthatkoftenkp
recedekthekphysicalksymptoms
benzodiazepines
Thoughknokpharmacologicktherapieskhaveksubstantialksupportivekdatakinktreatingkalcoholismknotkas
sociatedkwithkakmoodkorkanxietykdisorderkshortktermkusekofk_____khaskthekgreatestkbenefitkespecially
kwithkacutekcessationkofkalcohol.
,schizoidk=ksolitary
schizotypalk=kodd
schizoidkvskschizotypal
whichkiskknownktokbekoddkandkeccentrickandkwhichkiskknownktokchooseksolitarykactivities
TCAs
whatkclasskofkantidepressantskiskassociatedkwithkanticholinergicksidekeffects,kincludingkcardiackdysr
hythmias,kdrykmouth,ksedation,kandkorthostatickhypotension?
Formicationskarektheksensationkofkinsectskcrawlingkonkthekskinkandkiskcommonlykassociatedkwithkde
liriumktremenskfromkalcoholkwithdrawalkandkcocainekaddiction.
whatkarekformicationskandkwhatkpsychkconditionkarektheykmostkcommonlykassociatedkwith
manick=klithium,kvalproatekandkolanzapine
depressivek=kquetiapinekandklurasidone
whatk3kmedskcankbekusedkforkthektxkofkakmanickphasekofkbipolarkdisorderkandkwhatk2kmedskarekusedk
askmonotherapyktoktreatkthekdepressivekstagekofkbipolardkdisorder
lithium,kvalproatekandkolanzapine
whatk3kmedskcankbekusedkforkthektxkofkakmanickphasekofkbipolarkdisorder
quetiapinekandklurasidone
nextkstep=kSSRIkcombinationklikekolanzapinek(zyprexa)k+kfluoxetine
whatk2kmedskarekusedkaskmonotherapyktoktreatkthekdepressivekstagekofkbipolardkdisorder,kandkwhat
kwouldkbektheknextkstepkifkthosekdontkwork?
anxiety,ktremulousness,kagitation,kincreasingkirritabiltykandkhyperactivtiy
commonkearlykcuesktokimpendingkdelirieumktremens
fluoxetinek(zoloft)korkescitalopramk(lexapro)
thiskptkhaskbodykdysmorphickdisorder
Ak26-year-
oldkwomankpresentsktokakplasticksurgerykclinickconcernedkaboutkthekappearancekofkherknose.kShekre
portskthatkherknosekisklongkandkcauseskherktokhavekankuglykface.kShekfrequentlykaskskherkclosekfriend
skifkherknoseklooksktooklongkandkspendskseveralkhourskeachkdayklookingkatkherknosekinkthekmirror,kw
hichktemporarilykmakeskherkfeelkbetter.kPhysicalkexamkrevealskakrelativelyknormal-
appearingknose.kYoukreviewkherkchartkandknoticekshekhaskpreviouslykhadktwokplasticksurgerieskonkhe
rknose.kWhatk2kmedskarekankacceptablekfirst-linektreatmentkforktheksuspectedkdiagnosis?
bodykdysmorphickdisorder
akpsychiatrickconditionkinkwhichkankindividualkhaskakpreoccupationkwithkonekorkmorekperceivedkdef
ectskinkphysicalkappearance.
-
Thekpreoccupationskfrequentlykleadktokcompulsions,kwhichkarekrepetitivekbehaviorskorkmentalkactsk
aimedktokalleviatekthekpreoccupations
,compulsions
Thekpreoccupationskfrequentlykleadktok,kwhichkarekrepetitivekbehaviorskorkmentalkactskaimedktokalle
viatekthekpreoccupations
compulsions
Commonkexampleskofk______kincludekcomparingkone'skdislikedkfeatureskwithkthosekofkotherkpeople,k
excessivekgrooming,kseekingkfrequentkreassurancekfromkothers,kandkskinkpicking.
theykshouldkbekeducatedktokavoidkcosmeticksurgeriesktokcorrectkthekperceivedkdefectkbecausekthiskra
relykproduceskclinicalkimprovement.
ptkeducationkwithkbodykdysmorphickdisorder
Selectivekserotoninkreuptakekinhibitorsk(SSRIs),ksuchkaskescitalopramkorkfluoxetine
-ClomipraminekcankalsokbekusedkifkthekpatientkdoesknotkhavekakgoodkresponsektokSSRIs,
whatkarekthekfirstklinekmedskusedktoktreatkbodykdysmorphickdisorder
considerkaddingksecondkagentktokSSRIklikekatypicalkantipsychotickorkbuspirone
-orkconsiderkswitchingktokclomipramine
whatkshouldkyoukdokforkpatientkwithkbodykdysmorphickdisorderkthatkSSRIskdidntkwork
bodykdysmorphickdisorder
Concernedkwithkperceivedkflawskorkdefectskinkphysicalkappearance
Commonlykpresentskforkcosmetickprocedureskratherkthankforkmentalkhealthkconcerns
Cosmetickprocedureskcontraindicated,kasklikelyktokresultkinkdissatisfactionkandklitigationkorkthreatsk
towardkclinician
Interventionskincludekpsychoeducation,kmodifiedkCBT,kSSRI
BkCheckingkakserumkglucoseklevel
Checkingkakserumkglucoseklevelkiskthekmostkurgentkstepkduektokthekpossibilitykofkhyperglycemiakand
kDKA.
Thiskiskassociatedkwithkthekusekofkatypicalkantipsychoticskandkmaykhavekakrapidkonsetkofkpolyuria,kp
olydipsia,kN/V,kweightkloss,kdehydration,krapidkrespiration,kweakness,kcloudingkofksensorium,kandke
venkcoma.k
Ifkthekpatientkwerekmedicallykstablekandkonlykexperiencingksedation,kdecreasingkquetiapinektok75km
gktidk(C)korkchangingktotalkquetiapinekdosektokbedtimek(A)kwouldkbekreasonablekconsiderations.kBe
dtimekdosingkwouldkbekpreferablekinkthatkitkwouldkpreservekthekcurrentkeffectivekdailykdose,kproba
blykminimizekdaytimeksedation,kandkimprovekcompliancekthroughkoncekperkdaykdosing.kObtainingka
kserumksodiumklevelk(D)kiskalsokankimportantkstep,kespeciallykgivenkhiskreportedkpolydipsiakandkapp
arentkdehydration.kQuetiapinekisknotkspecificallykassociatedkwithkhyponatremia
-teenagekmalekpresentingktokurgentkcarekbykparentskforkconcerningksedationkforkpastk48khours
-pmh:kbipolarkdepressionk
-onkseroquelk100mgkTIDkfork3kmonthskandkdosekwaskuppedk50mgkapproxk10kdayskagok
, -depressionkhaskimprovedk
-PE:kptkappearsksomewhatkdehydratedkandkhaskakmildkincreasekinkrespiratorykratek
whatkisktheknextkbestkstep:k
AkChangingktotalkquetiapinekdosektokbedtime
BkCheckingkakserumkglucoseklevel
CkDecreasingkquetiapinektok75kmgktid
DkObtainingkakserumksodiumklevel
DKA
sidekeffectkassociatedkwithkthekusekofkatypicalkantipsychoticskandkmaykhavekakrapidkonsetkofkpolyuri
a,kpolydipsia,knausea,kvomiting,kweightkloss,kdehydration,krapidkrespiration,kweakness,kcloudingkofk
sensorium,kandkevenkcoma.kThiskrequireskimmediatektreatment,kaskitkmaykbeklife-threatening.
Topiramate,kduektokthekpotentialkforkhyperchloremic,knon-anionkgapkmetabolickacidosis.
Whatkmedicationkshouldkbekmonitoredktokidentifyklowkserumkbicarbonateklevels?
DKA
Definedkbyk(allkofkthekfollowing):
-kbloodkglucosek>k200kmg/dL
-kvenouskpHk<k7.3korkserumkbicarbonatek<k18
-kketoneskinkthekbloodk(>k3kmmol/L)korkurinek(moderatekorklargekurinekketones)
AkDronabinol
Thekpatientkiskgoingkthroughkcannabiskwithdrawal.kCannabiskusekdisorderkiskclassifiedkaskakpersiste
ntkusekofkcannabiskthatkresultskinkaksignificantkfunctionalkimpairmentkinktwokorkmoreksettingskoverkt
hekcoursekofk12kmonths.kTypicalkpresentationskincludekusingkcannabiskduringkpotentiallykhazardous
ksituations,kakdecreasekinkwork/schoolkfunction,korkdiscontinuationkofkpreviouslykenjoyedkactivities.k
Typicallykwhenkwithdrawing,kakpatientkmaykbekirritable,kangry,kanxious,korkrestless.k
Forkpatientskwhokhavekmildksymptomskthatkdoknotkaffectktheirkdailyklife,knokspecificktreatmentkiskne
cessary.kHowever,kforkpatients,ksuchkaskthiskone,kwhokarekwithdrawingkfromkcannabiskandktheirksy
mptomskbeginktokaffectktheirkworkkorkschoolknegatively,kmedicationkshouldkbekconsidered.kInkthekU
Skthekpreferredktreatmentkiskeitherkdronabinolkorkgabapentin.kPatientskwhoksufferkfromksleepkdistur
bancekmaykbenefitkfromkzolpidem.
-middlekagedkwomankpresentingkw/kdifficultyksleepingkandkirritabilityk
-husbandkstatesksheskbeenkcallingkoutkofkworkkandknotkwantingktokspendktimekwithkfamilyk
-shekrecentlykstoppedksmokingkweedkandkreportskoccassionalkalcoholkusek
whichkofkthekfollowingkiskthekmostkappropriatektxkforkthiskpatientk
AkDronabinol
BkFlumazenil
Rosh Review exam questions and answ
k k k k k k
ers
OCD
higherkdoseskofkSSRIskarekusuallykcommonkinkwhatkpsychiatrickcondition
TCAs
whatkclasskofkantidepressantskiskassociatedkwithkanticholinergicksidekeffects,kincludingkcardiackdysr
hythmias,kdrykmouth,ksedation,kandkorthostatickhypotension?
Previous
Play
Next
Rewindk10kseconds
Movekforwardk10kseconds
Unmute
0:01
/
0:15
Fullkscreen
Brainpower
ReadkMore
conversionkdisorder
whatkconditionkiskthis:
-
Patientskhavekabruptklosskofkmotorkorksensorykfunctionkcausedkbykpsychologicalkfactorskthatkoftenkp
recedekthekphysicalksymptoms
benzodiazepines
Thoughknokpharmacologicktherapieskhaveksubstantialksupportivekdatakinktreatingkalcoholismknotkas
sociatedkwithkakmoodkorkanxietykdisorderkshortktermkusekofk_____khaskthekgreatestkbenefitkespecially
kwithkacutekcessationkofkalcohol.
,schizoidk=ksolitary
schizotypalk=kodd
schizoidkvskschizotypal
whichkiskknownktokbekoddkandkeccentrickandkwhichkiskknownktokchooseksolitarykactivities
TCAs
whatkclasskofkantidepressantskiskassociatedkwithkanticholinergicksidekeffects,kincludingkcardiackdysr
hythmias,kdrykmouth,ksedation,kandkorthostatickhypotension?
Formicationskarektheksensationkofkinsectskcrawlingkonkthekskinkandkiskcommonlykassociatedkwithkde
liriumktremenskfromkalcoholkwithdrawalkandkcocainekaddiction.
whatkarekformicationskandkwhatkpsychkconditionkarektheykmostkcommonlykassociatedkwith
manick=klithium,kvalproatekandkolanzapine
depressivek=kquetiapinekandklurasidone
whatk3kmedskcankbekusedkforkthektxkofkakmanickphasekofkbipolarkdisorderkandkwhatk2kmedskarekusedk
askmonotherapyktoktreatkthekdepressivekstagekofkbipolardkdisorder
lithium,kvalproatekandkolanzapine
whatk3kmedskcankbekusedkforkthektxkofkakmanickphasekofkbipolarkdisorder
quetiapinekandklurasidone
nextkstep=kSSRIkcombinationklikekolanzapinek(zyprexa)k+kfluoxetine
whatk2kmedskarekusedkaskmonotherapyktoktreatkthekdepressivekstagekofkbipolardkdisorder,kandkwhat
kwouldkbektheknextkstepkifkthosekdontkwork?
anxiety,ktremulousness,kagitation,kincreasingkirritabiltykandkhyperactivtiy
commonkearlykcuesktokimpendingkdelirieumktremens
fluoxetinek(zoloft)korkescitalopramk(lexapro)
thiskptkhaskbodykdysmorphickdisorder
Ak26-year-
oldkwomankpresentsktokakplasticksurgerykclinickconcernedkaboutkthekappearancekofkherknose.kShekre
portskthatkherknosekisklongkandkcauseskherktokhavekankuglykface.kShekfrequentlykaskskherkclosekfriend
skifkherknoseklooksktooklongkandkspendskseveralkhourskeachkdayklookingkatkherknosekinkthekmirror,kw
hichktemporarilykmakeskherkfeelkbetter.kPhysicalkexamkrevealskakrelativelyknormal-
appearingknose.kYoukreviewkherkchartkandknoticekshekhaskpreviouslykhadktwokplasticksurgerieskonkhe
rknose.kWhatk2kmedskarekankacceptablekfirst-linektreatmentkforktheksuspectedkdiagnosis?
bodykdysmorphickdisorder
akpsychiatrickconditionkinkwhichkankindividualkhaskakpreoccupationkwithkonekorkmorekperceivedkdef
ectskinkphysicalkappearance.
-
Thekpreoccupationskfrequentlykleadktokcompulsions,kwhichkarekrepetitivekbehaviorskorkmentalkactsk
aimedktokalleviatekthekpreoccupations
,compulsions
Thekpreoccupationskfrequentlykleadktok,kwhichkarekrepetitivekbehaviorskorkmentalkactskaimedktokalle
viatekthekpreoccupations
compulsions
Commonkexampleskofk______kincludekcomparingkone'skdislikedkfeatureskwithkthosekofkotherkpeople,k
excessivekgrooming,kseekingkfrequentkreassurancekfromkothers,kandkskinkpicking.
theykshouldkbekeducatedktokavoidkcosmeticksurgeriesktokcorrectkthekperceivedkdefectkbecausekthiskra
relykproduceskclinicalkimprovement.
ptkeducationkwithkbodykdysmorphickdisorder
Selectivekserotoninkreuptakekinhibitorsk(SSRIs),ksuchkaskescitalopramkorkfluoxetine
-ClomipraminekcankalsokbekusedkifkthekpatientkdoesknotkhavekakgoodkresponsektokSSRIs,
whatkarekthekfirstklinekmedskusedktoktreatkbodykdysmorphickdisorder
considerkaddingksecondkagentktokSSRIklikekatypicalkantipsychotickorkbuspirone
-orkconsiderkswitchingktokclomipramine
whatkshouldkyoukdokforkpatientkwithkbodykdysmorphickdisorderkthatkSSRIskdidntkwork
bodykdysmorphickdisorder
Concernedkwithkperceivedkflawskorkdefectskinkphysicalkappearance
Commonlykpresentskforkcosmetickprocedureskratherkthankforkmentalkhealthkconcerns
Cosmetickprocedureskcontraindicated,kasklikelyktokresultkinkdissatisfactionkandklitigationkorkthreatsk
towardkclinician
Interventionskincludekpsychoeducation,kmodifiedkCBT,kSSRI
BkCheckingkakserumkglucoseklevel
Checkingkakserumkglucoseklevelkiskthekmostkurgentkstepkduektokthekpossibilitykofkhyperglycemiakand
kDKA.
Thiskiskassociatedkwithkthekusekofkatypicalkantipsychoticskandkmaykhavekakrapidkonsetkofkpolyuria,kp
olydipsia,kN/V,kweightkloss,kdehydration,krapidkrespiration,kweakness,kcloudingkofksensorium,kandke
venkcoma.k
Ifkthekpatientkwerekmedicallykstablekandkonlykexperiencingksedation,kdecreasingkquetiapinektok75km
gktidk(C)korkchangingktotalkquetiapinekdosektokbedtimek(A)kwouldkbekreasonablekconsiderations.kBe
dtimekdosingkwouldkbekpreferablekinkthatkitkwouldkpreservekthekcurrentkeffectivekdailykdose,kproba
blykminimizekdaytimeksedation,kandkimprovekcompliancekthroughkoncekperkdaykdosing.kObtainingka
kserumksodiumklevelk(D)kiskalsokankimportantkstep,kespeciallykgivenkhiskreportedkpolydipsiakandkapp
arentkdehydration.kQuetiapinekisknotkspecificallykassociatedkwithkhyponatremia
-teenagekmalekpresentingktokurgentkcarekbykparentskforkconcerningksedationkforkpastk48khours
-pmh:kbipolarkdepressionk
-onkseroquelk100mgkTIDkfork3kmonthskandkdosekwaskuppedk50mgkapproxk10kdayskagok
, -depressionkhaskimprovedk
-PE:kptkappearsksomewhatkdehydratedkandkhaskakmildkincreasekinkrespiratorykratek
whatkisktheknextkbestkstep:k
AkChangingktotalkquetiapinekdosektokbedtime
BkCheckingkakserumkglucoseklevel
CkDecreasingkquetiapinektok75kmgktid
DkObtainingkakserumksodiumklevel
DKA
sidekeffectkassociatedkwithkthekusekofkatypicalkantipsychoticskandkmaykhavekakrapidkonsetkofkpolyuri
a,kpolydipsia,knausea,kvomiting,kweightkloss,kdehydration,krapidkrespiration,kweakness,kcloudingkofk
sensorium,kandkevenkcoma.kThiskrequireskimmediatektreatment,kaskitkmaykbeklife-threatening.
Topiramate,kduektokthekpotentialkforkhyperchloremic,knon-anionkgapkmetabolickacidosis.
Whatkmedicationkshouldkbekmonitoredktokidentifyklowkserumkbicarbonateklevels?
DKA
Definedkbyk(allkofkthekfollowing):
-kbloodkglucosek>k200kmg/dL
-kvenouskpHk<k7.3korkserumkbicarbonatek<k18
-kketoneskinkthekbloodk(>k3kmmol/L)korkurinek(moderatekorklargekurinekketones)
AkDronabinol
Thekpatientkiskgoingkthroughkcannabiskwithdrawal.kCannabiskusekdisorderkiskclassifiedkaskakpersiste
ntkusekofkcannabiskthatkresultskinkaksignificantkfunctionalkimpairmentkinktwokorkmoreksettingskoverkt
hekcoursekofk12kmonths.kTypicalkpresentationskincludekusingkcannabiskduringkpotentiallykhazardous
ksituations,kakdecreasekinkwork/schoolkfunction,korkdiscontinuationkofkpreviouslykenjoyedkactivities.k
Typicallykwhenkwithdrawing,kakpatientkmaykbekirritable,kangry,kanxious,korkrestless.k
Forkpatientskwhokhavekmildksymptomskthatkdoknotkaffectktheirkdailyklife,knokspecificktreatmentkiskne
cessary.kHowever,kforkpatients,ksuchkaskthiskone,kwhokarekwithdrawingkfromkcannabiskandktheirksy
mptomskbeginktokaffectktheirkworkkorkschoolknegatively,kmedicationkshouldkbekconsidered.kInkthekU
Skthekpreferredktreatmentkiskeitherkdronabinolkorkgabapentin.kPatientskwhoksufferkfromksleepkdistur
bancekmaykbenefitkfromkzolpidem.
-middlekagedkwomankpresentingkw/kdifficultyksleepingkandkirritabilityk
-husbandkstatesksheskbeenkcallingkoutkofkworkkandknotkwantingktokspendktimekwithkfamilyk
-shekrecentlykstoppedksmokingkweedkandkreportskoccassionalkalcoholkusek
whichkofkthekfollowingkiskthekmostkappropriatektxkforkthiskpatientk
AkDronabinol
BkFlumazenil
