PSYCHIATRY

 Fatigue + dyspnea + eat ice  pica (ice= pagophagia, trichophagia= hair,

xylophagia=paper, metal= metallophagia, lithophagia= stones, soil= geophagia, glass=
hyalophagia, feces= coprophagia)
 Panic disorder= SSRI
 20y.o + SOB and palpitation + chest pain + worried of dying  panic disorder
 Associated with manic episode  bipolar I!!! NOT II
 60 y.o + lost his wife 6w ago + since then he has feelings of guilt + returned to work but
finds it less interesting  bereavement (up to 1y its bereavement/ normal grief)
 60y.o + depression + tell u he has a friend who tells him that he’s useless + his son
claims no such friend exist  auditory hallucination
 SSRI is NOT used in  anorexia
 GAD  escitalopram
 50y.o + depression + given 30ng TCA + now complains of dizziness  switch to SSRI
 Weight gain and erectile dysfunction as s/e  amitryptiline
 Acute disorientation and tremors, now admitted for urinary sepsis  delirium
 Delirium vs dementia  state of consciousness
 Clozapine in children is rx of  scx
 Behavioral changes + father died 3d ago + walking naked, soon return normal  brief
psychotic disorder (same q, what should be excluded???? Scx)
 Immediate choice for heroin addict rehab  methadone
 Tells you he was dx with pancreatic ca and asks for meds as he lost his, nurse tells u he
seen several drs  illness anxiety disorder
 Alzheimer’s dementia + became agitated with hallucination and delusions 
haloperidol
 Antipsychotic to cause weight gain  quetiapine
 Old man walking on street and asking same q to random people, he doesn’t stop 
preservation
 3m of delusion and hallucination which remitted by themselves  schizophreniform
disorder
 BEST rx for somatization disorder  periodic office visits to same dr
 Paresthesia, numb toes, abdominal pain, nausea and vomiting for 2y, dr say she’s fine 
somatization disorder***
 Patient thinks he has lung ca but he doesn’t  illness anxiety disorder
 2y of hallucination and delusion  scz
 When dr ask, do you think you are mentally ill?, he’s evaluating  insight
 s/e restlessness, insomnia, and drowsy  SSRI
 cardiac patient on depression meds, started to have convulsion and coma, he overdosed
of what  imipramine
 72y.o disoriented and hallucinated with disorganized thoughts after surgery, sx fluctuate
 delirium
 Loss of selfcare and hallucination  give antipsychotic
 People on TV talking to him  delusion of reference
 False belief and unacceptable by the culture  delusion
 Drug used in rx of dementia  revistagmine
 Low mood and anhedonis for 3m, loss of appetite and sleep  affect disorder
 Not seen in labs of anorexia  (hyperkalemia, hypochloremia, metabolic acidosis or
alkalosis) “they have hypokalemia”
 Anxiety in work place, anxious of being judged and develops flushing whenever feared
situation comes up  social anxiety disorder
 Treated with haloperidol and developed generalized rigidity and rolling up of eyes 
acute dystonia
 Poor prognosis for scz  fx
 Patient with weight gain, cuz she can’t taste food or smell, on exam= normal 
malingering “wants to lose weight”
 Not used in smoking cessation  (venlafaxine, bupropion, nicotine, verniciline)
 Drug of choice in ADHD  methylphenidate
 Maintenance rx of bipolar  lithium
 Woman feel abandoned by everyone and tried to commit suicide  borderline
 Pathognomic in alzheimer’s pathology  neurofibrillary tangles
 CAGE  alcohol dependence
 Haloperidol, has up rolling of eyes and dyskinesia  tardive dyskinesia
 Scared of germs  specific phobia
 Drug used in management of ADHD  atomoxetine
 Seeing snake in house and wife says it’s a rope  illusion
 Sees his mother who died and no one else can see her  hallucination
 >2y of depression sx  dysthymia
 Rx of choice in children with depression  fluoxetine
 Erectile dysfunction what to avoid  fluoxetine
 Lithium s/e  nephrogenic DI
 Non-adherence to chronic scz  injection haloperidol deconate
 Not a s/e of TCA  (insomnia, weight gain, constipation, arrhythmia)
 long term rx of GAD  esitalopram
 Not a s/e of TCA  (diarrhea, weight gain, sedation, vision blurring)
 Drugs causing insomnia  SSRI
 Effective half-life of fluoxetine in patient who took it for 5m  4d
 Best rx for trichotillomania  CBT
 Delusion + hallucination, low mood and anhedonia, for 6y  schizoaffective disorder
 Rapidly talking about one topic without completion then goes to another  flight of
ideas
 Man angered about politics and unable to control his anger, to vent out he joined
kickboxing class  sublimation
 Best rx for OCD  exposure with response prevention (ERP)
 Rx for adjustment disorder  supportive psychotherapy
 Hopeless might be an indication of  suicidal attempt
 Premature ejaculation, decreased libido, thin and looks sad  SSRI
 Elderly always occupied by the idea that his backyard is invaded by aliens, he knows
they don’t exist, he’s afraid he’s going insane  obsessions
 Laughed at dx of lung ca  denial
 Hypertensive crisis after eating cheese, he’s on antidepressants  phenelzine
 Not a RF for eating disorder  (hx of sexual abuse, OCD, genetic, hx of postpartum
blues)
 Man says fridge told him that the food is poisoned  auditory hallucination
 Drug of choice in delirium  haloperidol
 Overdose of drug, convulsions, dilated pupil, hyperreflexia, strabismus  TCA
 10y.o with nocturnal enuresis + depression  imipramine “reduce bedwetting”
 Man can observe himself outside of his body  depersonalization
 Unable to sleep cuz she has to go check if house doors are locked and gas is turned off
and likewise, provincial dx  OCD
 How long does it take for an antidepressants to work  4-6w
 ED with HTN, diaphoresis and tachycardia, tremor, confused with feeling of rats
crawling, has ascites and hepatosplenomegaly  benzodiazepine “alcoholic liver
diseae”
 Common affect sx in PMS  mood swing* irritability*
 Parent come with their teenager for his bad behavior  best way is individual therapy
 Female has urge to count lines, she’s unable to resist and cause her psychologica
distress, she ends up counting them  compulsion
 Med associated with QT prolongation  (ziprasidone, clozapine, haloperidol,
chlorpromazine”
 Man with anxiety and impotence  relaxation exercise!!
 Tachycardia, abdominal pain + peripheral tingling after she failed her exam 
hyperventilation syndrome
 Agitation, vertical and horizontal nystagmus  phencyclidine abuse
 Irritability + depressed mood with personality change! + grandmother suffered from
memory problems and died before 57  huningtons disease
 Drug of choice for PMS  fluoxetine
 Least likely to cause tardive dyskinesia (clozapine, haloperidol, metoclopramide,
risperidone)
 Rx for panic disorder  fluxe
 Olanzapine s/e weight gain “atypical antipsychotic ass/ with metabolic syndrome”
 Conversion disease  education
 1st line for diabetic with erectile dysfunction  sildenafil
 Neuroleptic malignant syndrome  haloperidol “high fever, tachycardia, tachypnea,
diaphoresis, HTN  neuroleptic malignant syndrome”
 Delusional disorder  one or more delusion <1m in absence of other psychotic sx
 c/I to use of bupropion  hx of seizure
 narcolepsy  excessive daytime sleepiness
 vague sx with no medical justification  paranoid personality disorder
 done multiple tests for abdominal pain, tests are normal, patient is still coming back 
hypochondriasis (illness anxiety disorder)
 feels he’s not in this world and feels disconnected  depersonalization
 surrounding environment is not real  derealization
 24, sx of depression for 3w  major depressive disorder
 Father has scz, percentage of child to have it  10%
 ADHD, unable to be involved in anything for a long time  inattentive
 Tachycardia and hypotrnsion with overdoes  TCA
 SSRI has greatest risk in pregnancy  paroxetine
 Impulsive behavior and communication impairment + echolalia and small head  rett
syndrome
 According to ICD 10 diagnostic criteria for ADHD, how many sx of inattention,
hyperactivity, and impulsively should be present respectively  6, 3, 1
 23 has hallucination and delusions for 1m, dr dx him with scz, which is AGAINST dx of
scz (age, hallucination, absence of negative, DURATION)
 How long do sx of scz should be present  more than 6m
 Depressed used paroxetine for 3m now she’s pregnant, what to do  replace it with a
safer alternative
 3rd person hallucination for 3m then returned to normal  schizophreniform disorder
 Not a 2nd line anti-psychotic  (topiramate, risperidone, asenapine, ziprasidone)
 Hight potential to cause extrapyramidal sx  risperodpne “isperidone also”
 Anti-parkinson to cause hepatotoxicity  tolcapone
 Toxidrome of TCA s/e is  anticholnergic
 TCA most ass/ with weight gain  amitriptyline
 Patient on phenelzine told not to eat cheese due to  CHEESE REACTION!!
 Half-life of fluoxe  2d
 Best short term rx of anxiety w/o causing addiction  buspirone
 Scz, increased suspicion, starring and saying “you can’t kill me”  delusion
 Alzheimer’s disease + developed hallucination, bizzare behavior, aggressive  add
risperidone** “helpful with psychotic sx”
 Patient came with sx of depression, when dr asked about psychosis sx he left room 
acting out
 Tooth decay + dentist find teeth smooth and multiple teeth erosions, she’s meeting a
psychiatrist  bulimia!
 Anti-psychotic to cause constipation  clozapine
 Drug not used in rx of dementia  (phenylephrine, rivastgmine, donepezil,
galantamine)
 Most common s/e of anti-psychotic  EPS
 Fear of elevators, what to offer to her  psychoanalysis
 Impaired focus on current function with disruption of vital physical activities, no loss of
insight  depression
 Potential prevention of dementia  leisure exercise
 Delirium management  allow relative to stay? Or haloperidol*
 Leaden paralysis  atypical depression
 Teen with not so good grades, feel guilty and wants to explain it to parents, told them
he did poor cux it was hard  rationalization
 CARDINAL sign of depression  anhedonia
 Antipsychotic causes eye pigment  chlorpromazine
 Medication causing dry mouth and blurred vision  imipramine “TCA”
 Least fatal dose of TCA  1g
 45y.o + recurrent scz on maintenance therapy  30% will have good prognosis
 Rapid blink while communication in child, everything else normal  tic disorder
 5y.o can only say mama and papa, her brother had similar hx and underwent speech
thrapy  development language disorder
 Cancer aas/ with highest prevalence of depression  pancreas*
 Scz sx <6  scxphreniform disorder
 Dx with depression and has premature ejec  sertraline “prolong time of ejaculation”
 OCD MOA  increase serotonin availability**
 Clozapine is used in which childhood psychiatric disorders  scz
 Anti-dep complains of constipation  TCA
 HIGHER chance of causing dystonia  (respiridone, olanzapine, clozapine,
asenapin)******
 Get angry with something and start throwing objects or breaking things  acting out
 45y.o with erectile dysfunction + morning tumescence  refer to psychiatric clinc “he
has morning arousal which is normal and rules out other causes, like neuropathy,
vascular or endo abnormality”
 PMS, sx DO NOT resolve after menses  refer to psych evaluation “before SSRI”
 MOST POTENT anti-psych  haloperidol
 Drug doesn’t caus ED  (mirtazapine, flux, amoxapine, amitriptyline)
 Patient on chemo + SSRI!!!!!!!! + has fever, agitation, mydriasis, splenomegaly 
SEROTONIN SYNDROME
 Chronic back pain, took NSAID for 1y + now had mild epigastric discomfort  TCA “pain
management”**
 Aggressive hostile, violent  low serotonin***
 Progressive dementia + amyloid plaque and tangles  alzehimer
 Child needs to be coaxed to go to school, while there he has severe pains and patents
take him back home, afraid to sleep alone  separation anxiety disorder
 60 + hx of heart attack 6w ago + not sleeping + evaluation unremarkable for
depression/anxiety  zolpidem “non-benzo sedative”
 OCD may be ass with all except  (increased metabolic activity in corpus callosum, a
need for sameness, excessive fear, overconcern with body waste, prior strept A
infection!!!!!!!!!1)
 Narcolepsy case  ass/ with low levels of hypocretin “orexin”
 Boy likes spending time with a girl, boy tease him, he responds: girls are yucky! 
reaction formation
 Person attributes his/her thoughts to someone else  projection
 Man incarcerated and serving life sentence for murder, after stabilization, he insist he
should stay in hospital until cured and threatens to hurt people  antisocial personality
 Hx of asphyxia, with autism sx  autism
 Seen in alcoholic paranoia  delusion “persecution, jealousy, refrence”
 Differentiate hysterical sx from hypochondrial  sx don’t reflect understandable
mechanism “hysteria=conversion”
 All are drugs for ADHD except  (amphetamine, clonidine, venlafaxine, barbiturates)
 Long term management of alcohol addiction  naltrexone (interfers with pleasure of
drinking, disulfiram= makes you sick) *** nal is preferred?
 Perfectionism and excessive attention to trivial details, annoys family and friends with
lack of flexibility  OC personality disorder!!
 Car accident, 1w sx  BRIEF PSYCHOTIC DISORDERRRR
 Couple therapy, for husband alcohol addiction, wife says he wasn’t compliant, he
screams= I don’t need Antabuse, blab la, I know I have drinking problem but I can
handle them without anyone help’  projection**
 Difficulty thinking + claims he’s an astronaut, he was given rx, now has grand mal
seizure, what neuroleptic was administred  clozapine
 Erectile dysfunction  propranolol
 First she worships therapist, then finds her worthless  splitting
 Patient with tardive dyskinesia (smak lips blab la)  med that she received for past 25y
is perphenazine “it’s a typical anti-psych which has higher risk”*
 Augmentation therapy for depression  lithium
 Most common rx for depressive personality disorder  psychodynamic psychotherapy
 Non-opioid med causing opioid withdrawl syndrome  clonidine
 17y,I spends most of time lifting weights, become very irritable, moody, and aggressive,
what sub was he using  testosterone
 Disease confused with conversion  multiple sclerosis
 S/e of lithium  hypothyroidism
 Drug induced psychosis and confused with paranoid scz  amphetamine
 Social phobia  fear of speaking in public
 True about delirium  affects attention mainly
 Scz thoughts + depression, aggressive language, ataxia, nystagmus  phencylclidine
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