Rasul
Forum Guru
Topics: 56
Posts: 485
|
1. 32 yo female, known paranoid schizophrenic, in closed psych unit. Few days after admission she develops polyuria, vomiting, stupor, diarrhea, restlessness. No other medical condition present. Most likely ds:
a. anticholinergic crisis
b. acute dystonic reaction
c. serotonin syndrom
d.tardive dyskinesia
e.H2O intoxication
2. 27yo man brought in because of suicide attempt. Hx of depression with multiple serious but unsuccessful attmepts(were most of the time pt was"saved by the bell"). The attempts included firearms(which fortunately misfired, knife etc). Pt is very short-tempered, has poor anxiety tolerance, noncompliant with the meds despite the constant parental supervision. Which is most likely finding:
a. changes in dopaminergic system
b. low 5-hydroxyindolacetic acid levels in cerebrospinal fluid
c. low TSH
d. high level of platelet MAO
e. normal EEG
3. 18yo female brought to clinic coz periodically pulls her hair and puts it in her mouth. Objectively- bold patches on the head. Pt describes sense of relief from procedure, says, she does it for last 2 years(since parents are divorced)Most appr step:
a. Rx benzos
b. Rx TCAs
c. rule out comorbid conditions
d. interpersonal psychotherapy
e. Rx carbamazepine
4. 25 yo moderately obese female with Hx of bipolar disorder since 19 complaints that her recent struggles with weight and food make her depressed. She has trouble sleeping, excessive anxiety and agitation, increased irritability, thoughts of suicide. Often finds herself fidgety, unable to seat in one position for extended time. Never attempted suicide: Current Tx: Li, Zolpidem.Which is more consistent with diagnosis of major deppressive disorder rather than bipolar depression in this episode:
a. early onset of bipolar disorder
b. increased appetite
c. insomnia
d. increased thoughts of suicide
e. psychomotor agitation
|
| achilles
Forum Guru
Topics: 86
Posts: 1,202
|
1-e
2-b ??
3-d (surgical removal of the bezoar, cognitive therapy and SSRI's)
4-e
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| Rasul
Forum Guru
Topics: 56
Posts: 485
|
The answers are:
-e
-b
-c-answering this question I went for carbamazepine-the correct answer is to check com-morbid conditions, coz trichotillomania is usually sign of some bigger problem, e.g.mood disorder, borderline personality, OCD etc-so You have to treat the main condition first. Bezoars are suspected but their clinical picture is not actually depicted in the question
-e-You got it! I didn't know, but apparently psychomotor agitation is a sign of depressive disorder, it's not usual for bipolar depressive episode. I went for suicide thoughts. According to Kaplan they are more frequent in people with bipolar disorder, and bipolar patients are usually more successful in dying from suicide(!!!)
|
| msyamp
Forum Fanatic
Topics: 60
Posts: 1,462
|
hmmm good ones
thank you
___________________
If you think you can You can! If you think you cant you are right again!!
|
| Rasul
Forum Guru
Topics: 56
Posts: 485
|
Dear msyamp!
The symptoms she experiences can be cholinergic crisis(SLUDGE, constricted pupils, bronchospasm), except:where did she get the medication? We assume she 's in closed facility, monitored by nurses who control the dispension of meds. Side effects of antipsychotics?-OK. I work with new antipsychotics, and I saw slight cholinergic syptoms-salivation mostly, nothing heavier.
Water on the other hand is not a controlled substance. Lot of psych pts have psychogenic polydipsia, and to prevent them from drinking that much You have to really knock them down, which is not applicable to our pt (she's on 10 mg po qHS only, nothing at daytime)
Hope I answered Your question.
|
| msyamp
Forum Fanatic
Topics: 60
Posts: 1,462
|
thank you rasul. but i could get the piont that antipsychotics cause ANTICHOLINERGIC rather than cholinergic. so water intoxication seems very appropriate. thank you
___________________
If you think you can You can! If you think you cant you are right again!!
|
| achilles
Forum Guru
Topics: 86
Posts: 1,202
|
thanks rasul for correction on the 3rd question.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
|
| |
| | | | | | | |
