- Joined
- Jul 7, 2014
- Messages
- 13
- Reaction score
- 1
1. 24yo male college student comes to follow up exam 2wks after starting sertraline for tx of major depressive disorder. before starting medication, the patient had 6-mo history of decreased motivation, lack of interest in academic work and fraternity activities, feelings of sadness and worthlessness. he also had decreased appetite and difficulty falling sleep at night. he had thought about suicide but made no attempts. P/E no abnormalities. Now he feels better but still difficulty sleeping. next step?
a)maintain current dosage of sertraline and schedule f-u in 4 mo
b)maintain current dosage of sertraline and schedule f-u for the next month
c)maintain current dosage of sertraline and add amitryptyline to medication regimen
d) discontinue sertraline and begin fluoxetine
e)increase dosage of sertraline and schedule f-u in 2 mo
2. 27yo man comes to ED after MVA. He states that he feels he is being followed by FBI. 37.6C, pulse 96/min, respiration 16/min BP130/90. P/E mild hyperreflexia. no evidence of head trauma. no other abnormalities. he is agitated with affective lability and rapid speech. oriented only to person and place.
a)amphetamine intoxication
b)hallucinogen intoxication
all others are obviously wrong..
3. a 47yo woman is admitted to the hospital because of a 12 hr history of tremors and confusion. she has a history of alcoholism and last consumed alcohol 24 hours ago. she has no other history of serious illness. she does not smoke cigarettes or use illicit drugs. on admission, she is agitated, diaphoretic, orientnted to person but not to time or place. vitamin B1 , folic acid, and three doses of diazepam are administered intravenously. 35 min later, respiratory compromise develops. patient is intubated, mechanical ventilation is started . 2 hr later, she remains agitated. she is pulling at her peripheral intravenous and urethral catheters and picking at her blankets. pulse 140/min, bp160/100, neurologic exam show tremor of upper and lower extremities and hyperreflexia bilaterally. next step pharmacotherapy?
a) add flumazenil
b)add haloperidol
c)add phenytoin
d)administer additional diazepam
e)administer additional B1
4. in a fit of anger, 22yo woman slaps her 2yo child across face. No other abuse history. which outcome of this experience for child?
a) brief psychotic disorder
b) dysthymic disorder
c) pain disorder
d) PTSD
e) no impact on development
choose e?
5. 32yo financial analyst comes to physician at employer’s request because of bizarre behavior and poor work productivity over past 6 mo. She has been arriving late, leaving early, frequently taking long breaks. She has had daily mood swings; sometimes appears withdrawn, lethargic, and belligerent and other times energetic and loquacious. Over the past 2 wks, she has several arguments with coworkers n which she accused them of stealing or sabotaging her work. This morning, she threatened to physically assault her supervisor after he questioned her about a 2-hr absence from work. 37c, pulse 90/min, respiration 16/min, 160/100, pupil dilated and reactive to light. DTR increased. She describes her supervisor’s unfairness and unfriendliness of other analysts. She suspects that they are jealous of her. She speaks in loud, rapid voice, frequently interrupting physician. She is oriented to person, place, time. She is able to recall three of three objects after 5 min and quickly and accurately performs 2-digit calculations. Diagnosis?
A) alcohol withdrawl
b) bipolar disorder (wrong)
c) cocaine abuse
d) delusional disorder, persecutory type
e) inhalant abuse
f) paranoid personality disorder
g) PCP abuse
h)schizophrenia, paranoid type
6. 27yo man comes to physician because of anxiety about major speech that he must deliver in 3 days. He has a great fear of public speaking and is convinced that his apprehension and tremulous delivery will damage his performance. He requests a tranquilizer to help with his anxiety. He takes theophylline and uses corticosteroids and albuterol inhalers for asthma. He has family history of alcohol dependence. He does not drink alcohol or use drugs. Pulse 66/min, respiration 12/min, 132/88. Pharmacotherapy ?
a) bupropion
b)buspirone
c) chlorpromazine
d) floxetine
e) haloperidol
f) imipramine
g) lorazepam
h) penphenazine
i) propranolol
7. 37yo male police officer comes to physician at the request of his superiors 1 wk after he witnessed a terrorist bombing during which several people were killed. He sustained only minor injuries and assisted in rescuing survivors and gathering body parts. Since the bombing, he has felt emotionally numb and has been unable to enjoy activities he used to find pleasurable. He has continued to work but has requested assignments far removed from the site of the attack. He describes his sleep as fitful. He is arritable and says he is not depressed. He said “they made me come. I’m not interested in talking with anyone. I just want to spend time with my buddies and be left alone”. Next step?
a)encourage patient to discuss trauma in details
b)provide info about range of reactions to trauma
c)recommend group therapy with other trauma survivors (wrong)
d)recommend 1-month medical leave of absence from active duty
e) recommend a physician-led trauma debriefing series
f)recommend a 12-step program
g) begin clonazepam
h)begin fluoxetine
a)maintain current dosage of sertraline and schedule f-u in 4 mo
b)maintain current dosage of sertraline and schedule f-u for the next month
c)maintain current dosage of sertraline and add amitryptyline to medication regimen
d) discontinue sertraline and begin fluoxetine
e)increase dosage of sertraline and schedule f-u in 2 mo
2. 27yo man comes to ED after MVA. He states that he feels he is being followed by FBI. 37.6C, pulse 96/min, respiration 16/min BP130/90. P/E mild hyperreflexia. no evidence of head trauma. no other abnormalities. he is agitated with affective lability and rapid speech. oriented only to person and place.
a)amphetamine intoxication
b)hallucinogen intoxication
all others are obviously wrong..
3. a 47yo woman is admitted to the hospital because of a 12 hr history of tremors and confusion. she has a history of alcoholism and last consumed alcohol 24 hours ago. she has no other history of serious illness. she does not smoke cigarettes or use illicit drugs. on admission, she is agitated, diaphoretic, orientnted to person but not to time or place. vitamin B1 , folic acid, and three doses of diazepam are administered intravenously. 35 min later, respiratory compromise develops. patient is intubated, mechanical ventilation is started . 2 hr later, she remains agitated. she is pulling at her peripheral intravenous and urethral catheters and picking at her blankets. pulse 140/min, bp160/100, neurologic exam show tremor of upper and lower extremities and hyperreflexia bilaterally. next step pharmacotherapy?
a) add flumazenil
b)add haloperidol
c)add phenytoin
d)administer additional diazepam
e)administer additional B1
4. in a fit of anger, 22yo woman slaps her 2yo child across face. No other abuse history. which outcome of this experience for child?
a) brief psychotic disorder
b) dysthymic disorder
c) pain disorder
d) PTSD
e) no impact on development
choose e?
5. 32yo financial analyst comes to physician at employer’s request because of bizarre behavior and poor work productivity over past 6 mo. She has been arriving late, leaving early, frequently taking long breaks. She has had daily mood swings; sometimes appears withdrawn, lethargic, and belligerent and other times energetic and loquacious. Over the past 2 wks, she has several arguments with coworkers n which she accused them of stealing or sabotaging her work. This morning, she threatened to physically assault her supervisor after he questioned her about a 2-hr absence from work. 37c, pulse 90/min, respiration 16/min, 160/100, pupil dilated and reactive to light. DTR increased. She describes her supervisor’s unfairness and unfriendliness of other analysts. She suspects that they are jealous of her. She speaks in loud, rapid voice, frequently interrupting physician. She is oriented to person, place, time. She is able to recall three of three objects after 5 min and quickly and accurately performs 2-digit calculations. Diagnosis?
A) alcohol withdrawl
b) bipolar disorder (wrong)
c) cocaine abuse
d) delusional disorder, persecutory type
e) inhalant abuse
f) paranoid personality disorder
g) PCP abuse
h)schizophrenia, paranoid type
6. 27yo man comes to physician because of anxiety about major speech that he must deliver in 3 days. He has a great fear of public speaking and is convinced that his apprehension and tremulous delivery will damage his performance. He requests a tranquilizer to help with his anxiety. He takes theophylline and uses corticosteroids and albuterol inhalers for asthma. He has family history of alcohol dependence. He does not drink alcohol or use drugs. Pulse 66/min, respiration 12/min, 132/88. Pharmacotherapy ?
a) bupropion
b)buspirone
c) chlorpromazine
d) floxetine
e) haloperidol
f) imipramine
g) lorazepam
h) penphenazine
i) propranolol
7. 37yo male police officer comes to physician at the request of his superiors 1 wk after he witnessed a terrorist bombing during which several people were killed. He sustained only minor injuries and assisted in rescuing survivors and gathering body parts. Since the bombing, he has felt emotionally numb and has been unable to enjoy activities he used to find pleasurable. He has continued to work but has requested assignments far removed from the site of the attack. He describes his sleep as fitful. He is arritable and says he is not depressed. He said “they made me come. I’m not interested in talking with anyone. I just want to spend time with my buddies and be left alone”. Next step?
a)encourage patient to discuss trauma in details
b)provide info about range of reactions to trauma
c)recommend group therapy with other trauma survivors (wrong)
d)recommend 1-month medical leave of absence from active duty
e) recommend a physician-led trauma debriefing series
f)recommend a 12-step program
g) begin clonazepam
h)begin fluoxetine
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. But what was the cause of her sudden respiratory depression? The 3 doses of BZD?
