Psychiatry Flashcards
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What are the 5 stages of loss as described by Elizabeth Kübler-Ross (*DABDA*)
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The 5 stages, popularly known by the acronym DABDA, include: *Denial* — The first reaction is denial. In this stage individuals believe the diagnosis is somehow mistaken, and cling to a false, preferable reality. *Anger* — When the individual recognizes that denial cannot continue, it becomes frustrated, especially at proximate individuals. Certain psychological responses of a person undergoing this phase would be: "Why me? It's not fair!"; "How can this happen to me?"; '"Who is to blame?"; "Why would this happen?". *Bargaining* — The third stage involves the hope that the individual can avoid a cause of grief. Usually, the negotiation for an extended life is made in exchange for a reformed lifestyle. People facing less serious trauma can bargain or seek compromise. *Depression* — "I'm so sad, why bother with anything?"; "I'm going to die soon, so what's the point?"; "I miss my loved one, why go on?" During the fourth stage, the individual becomes saddened by the mathematical probability of death. In this state, the individual may become silent, refuse visitors and spend much of the time mournful and sullen. *Acceptance* — "It's going to be okay."; "I can't fight it, I may as well prepare for it."; "Nothing is impossible, just do it." In this last stage, individuals embrace mortality or inevitable future, or that of a loved one, or other tragic event. People dying may precede the survivors in this state, which typically comes with a calm, retrospective view for the individual, and a stable condition of emotions.
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Most common perpetrator of elder abuse?
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Family member
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Physical sexual or emotional mistreatment or neglect of a child?
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Child Abuse
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Treatment for Lithium overdose?
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Dialysis
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Long term treatment for alcohol withdrawal?
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Librium
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Treatment for benzodiazepine overdose AND hypertension?
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Labetalol
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Antidote for pyrexia?
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Dantrolene
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Calcium channel blocker antidote?
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Calcium chloride
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Benzodiazepine antidote?
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Flumazenil
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Tricyclics antidote?
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Sodium bicarbonate
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Digoxin antidote?
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Digoxin immune Fab (AKA: Digibind)
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Amphetamine antidote?
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Benzodiazepines
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Warfarin antidote?
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Vitamin K - Fresh frozen plasma
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Heparin antidote?
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Protamine sulfate
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Tylenol antidote?
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N-acetylcysteine
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Opiate antidote?
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Naloxone
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Beta-blocker antidote?
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Glucagon
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Cocaine antidote?
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Benzodiazepines
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Treatment for psychosis related to drug overdose?
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Haloperidol
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Treatment for acute seizures?
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Benzodiazepines
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Taking these drugs causes constricted pupils?
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Opiates (Heroin morphine etc.) - Depressants
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Taking these drugs causes dilated pupils?
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Stimulants - Alcohol - Hallucinogens
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Loss of control over urges to take a drug even though consequences are known?
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Addiction
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Using a substance to maintain normal functioning?
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Dependence
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Exaggerated feeling of a defect in physical condition?
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Body dysmorphic disorder
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Sudden onset of an severe condition such as blindness or paralysis which on evaluation is clinically impossible?
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Conversion disorder
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Excessive worry of having a serious disease?
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Hypochondriac
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Faking symptoms to assume the sick role?
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Factitious disorder
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Faking sickness to miss work?
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Malingering
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List five common Selective serotonin reuptake inhibitors (SSRIs)
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Fluoxetine - Escitalopram - Sertraline -Paroxetine - Citalopram
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Treatment for somatoform disorders?
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Selective serotonin reuptake inhibitors and psychotherapy
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Treatment for delusional disorders?
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Psychotherapy
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Medical treatment for Schizophrenia?
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Antipsychotics (e.g. olanzapine risperidone quetiapine)
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Major psychosis for greater than 6 months difficulty functioning?
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Schizophrenia
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Otherwise normally functioning person with a belief in something that does not exist?
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Delusional disorder
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Focus on obsessions repetition of compulsive behaviors?
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Obsessive compulsive disorder
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Sociopath lack of morals, empathy or remorse?
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Antisocial personality disorder
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Concerned what others think of them and need admiration?
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Narcissistic personality disorder
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Black and white perception unstable interpersonal relationships?
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Borderline personality disorder
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Odd eccentric behavior and discomfort with social relationships?
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Schizotypal personality disorder
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Attention seeking dramatic seductive behaviors?
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Histrionic personality disorder
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Subclinical bipolar mania and depression in a patient who is functional?
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Cyclothymia
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At least 2 years of chronically depressed mood less severe depression than major depression?
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Dysthymic disorder
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Depression with a change from previous functioning difficult to perform daily activities?
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Major depression
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Medical treatment for Bipolar II?
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Antipsychotics (e.g. olanzapine risperidone quetiapine)
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Class of medication you never give to Bipolar I?
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Antidepressants
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Medical treatment for Bipolar I?
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Lithium
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Hypomania with more depression?
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Bipolar II
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More manic with some depression?
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Bipolar I
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Symptoms due to extreme sorrow or loss which resolve in a few weeks?
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Grief reaction
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Significant depression due to inability to adjust to recent stressor?
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Adjustment disorder
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Episodes of eating large amounts of food for at least 2 days a week for 6 months in an overweight patient?
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Binge eating disorder
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Binging followed by vomiting laxative use or extreme exercise in a normal weight patient?
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Bulimia nervosa
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Fear of gaining weight and patient weighs less than 85% of normal?
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Anorexia nervosa
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Disruption of social interaction and language at age 3 or earlier?
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Autism
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Multiple motor and vocal tics?
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Tourette Syndrome
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Treatment for ADHD in preschool kids?
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Behavior therapy
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Treatment for Attention deficit hyperactivity disorder (ADHD) in school aged children?
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Amphetamines
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Symptoms of inattention and hyperactivity for at least 6 months that are present at home and in school?
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Attention deficit hyperactivity disorder (ADHD)
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Aggressive destructive behavior that causes impairment in social or academic functioning?
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Conduct Disorder
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Children that are disobedient and show resistance to authority?
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Oppositional Defiance Disorder
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Treatment for nightmares related to post traumatic stress disorder (PTSD)?
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Prazosin
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Intense fear of a specific situation?
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Phobia
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Treatment for panic disorder?
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Selective serotonin reuptake inhibitors and cognitive behavioral therapy
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Abrupt onset of fear with symptoms peaking in 10 minutes?
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Panic Disorder
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First line Treatment for GAD?
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Selective serotonin reuptake inhibitors and cognitive behavioral therapy
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Excessive anxiety and worry for at least 6 months?
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Generalized Anxiety Disorder
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Most common psychiatric disorder?
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Anxiety disorder
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Which patient, a man or woman, is more likely to have a somatoform disorder?
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Women are more likely to have a somatoform disorder
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List five tricyclic antidepressants (TCAs)
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Amitriptyline - Doxepin - Imipramine - Nortriptyline - Amoxapine
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What is the treatment of choice for a patient with factitious disorder?
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SSRI (Selective Serotonin Reuptake Inhibitor) or tricyclics with psychotherapy
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Define Munchausen syndrome?
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"Munchausen syndrome is a factitious disorder in which the patient fakes a disease to get repeated procedures such as surgeries, etc.
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What is the difference between conversion disorder and somatoform delusional disorder?
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Conversion disorder patients focus on one symptom. Somatoform delusional disorder patients believe they have an entire medical condition
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A 34 year old male that fakes an injury to get out of work or to get narcotics has what condition?
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Malingering
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A person that likes being the "sick" person all the time has what disorder?
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Factitious disorder
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A beautiful woman is noted to complain that her hands are too big, yet they appear well formed and appropriate. What do you suspect?
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Body dysmorphic syndrome
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While studying, a PA student begins to think they have all the illnesses they are studying. What is your suspicion?
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Hypochondria
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A young female presents to the ER with seizures. During a seizure episode, she is talking to you and can drink from a soda can. What is your suspected diagnosis?
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Conversion disorder
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True or false: Patients with schizophrenia commonly have no facial expressions and poor hygiene.
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"True - Negative symptoms such as no facial expression
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True or false: Patients with schizophrenia hear voices?
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True - Positive symptoms such as hallucinations and hearing voices are commonly associated with schizophrenia
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What is the treatment of choice for patients with schizophrenia?
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Antipsychotics such as olanzapine, risperidone or quetiapine
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What differentiates schizophrenia from schizophreniform?
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If the condition is less than six months it is schizophreniform, over six months it is schizophrenia
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What is the treatment of choice for delusional disorder?
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Psychotherapy
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What functional capacity does a patient with a delusional disorder have?
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They function normal in life but have a delusion about one specific part of it
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A man who thinks his wife is being unfaithful even though it's not true is considered to have what disorder?
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Jealousy delusional disorder
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A female stalker of a famous movie star is considered to have what disorder?
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Erotomanic delusional disorder
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What is the difference between delusional disorder and narcissistic personality?
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Both are grandiose, but the delusional disorder patient thinks that they are famous like a movie star
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Patients with OCD (Obsessive Compulsive Disorder) perform repetitive behaviors in an effort to do what?
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The repetitive behavior is aimed at reducing stress or preventing a dreadful event
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What personality disorder is associated with eccentric behavior and discomfort with social and interpersonal relationships?
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Schizotypal
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What personality disorder is associated with perfectionism and performance of compulsions that impede their daily functioning?
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OCD (Obsessive Compulsive Disorder)
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What personality disorder is associated with a lack of remorse and no concern for others?
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Antisocial personality
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What personality disorder is associated with grandiose thoughts, the need for admiration and heightened concern about what others think?
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Narcissistic personality
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What personality disorder is associated with poor self-image, unstable interpersonal relationships and poor impulse control?
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Borderline personality
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What personality disorder is associated with patients who are overly emotional and attention seeking?
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Histrionic personality
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How can the side effects of antidepressants be minimized?
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By starting with low doses titrating up slowly
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What does the term double depression mean?
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A patient who has dysthymic disorder and also has a major depressive episode at the same time
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What medication is used to treat cyclothymia?
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Lithium
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What condition manifests as a chronically depressed mood for more than a 2 year period?
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Dysthymic disorder
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What is the subclinical form of bipolar disorder that manifests in a functioning individual as hypomania and periods of mild depression?
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Cyclothymia
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Bipolar II is described as what combination of mania and depression?
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Mostly depression with short episodes of mania
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A patient with bipolar I is in a depressive stage and his parents are requesting an antidepressant to help him. What is your recommendation?
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Antidepressants should not be given to patients with Bipolar I as it will worsen their mania
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A 15 year old boy is noted to be in a depressed mood one week after moving to a new city. What is your diagnosis?
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Adjustment disorder
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What is the treatment of choice for binge eating?
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Psychotherapy
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Which eating disorder is commonly associated with mitral valve prolapse, pericardial effusion, and myocardial atrophy?
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Anorexia nervosa
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Of the three eating disorders, which one is commonly treated with SSRIs (Selective Serotonin Reuptake Inhibitors)?
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Bulimia
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Which of the eating disorders is often associated with erosion of the tooth enamel?
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Bulimia due to the frequent self-induced vomiting
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Which of the three eating disorders has the highest suicide rate?
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Anorexia nervosa
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What is the key difference between binge eating and bulimia nervosa?
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There is no weight loss effort in the binge eater
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What condition do you suspect in a patient who has episodes of mass eating and is overweight?
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Binge eating disorder
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What condition do you suspect in a patient who has episodes of mass eating followed by self-induced vomiting or intense exercise?
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Bulimia
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What condition do you suspect in a patient who refuses to eat due to fear of being overweight?
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Anorexia nervosa
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A child has normal cognitive development, poor relationships and does not spontaneously seek activities with others. What condition do you suspect?
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Asperger syndrome
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A 16 month old girl had been developing normally but now is losing her ability to speak and hand functions. You suspect what underlying condition?
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Rett disorder
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What is the class of medication used to treat the bothersome tics associated with Tourette syndrome?
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Antipsychotics such as fluphenazine
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What is the drug of choice for children requiring medication for the treatment of ADHD?
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Methylphenidate
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A 2 year old does not play with other children, has a two word vocabulary and is unimaginative. What is your suspected diagnosis?
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Autism
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A child is found to back talk and resist following instruction from parents or authorities. What is your suspected diagnosis?
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Oppositional defiance disorder
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A child is referred to your office for unusual animal cruelty and bullying at school. What disorder should you suspect?
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Conduct disorder
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A child with ADHD undergoing CBT (cognitive behavioral therapy) is found to have many verbal outbursts and nonverbal tics. What associated condition is suspected?
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Tourette syndrome
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A 4 year old is diagnosed with ADHD. What is the recommended treatment?
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Cognitive behavioral therapy
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What medication used in the therapy of panic disorder is of an abusive potential?
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Benzodiazepines
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A patient with generalized anxiety disorder is having difficulty sleeping. What medication is effective in helping him sleep?
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Hydroxyzine
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What is the medication of choice for an acute panic attack?
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Benzodiazepine such as valium or alprazolam
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Most patients with phobias are treated with exposure therapy as first line treatment. What is the best treatment for agoraphobia?
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Cognitive behavioral therapy and SSRI (Selective Serotonin Reuptake Inhibitor)
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What medication can be added to the regimen of a patient with PTSD to reduce or stop their nightmares?
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Prazosin
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One week after military combat, a soldier is acting withdrawn and appears to be having flashbacks. What is his diagnosis?
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Acute stress disorder (Post traumatic stress disorder can not be considered until one month after the event)
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A 23 year old man is found to be afraid of flying. What is the recommended treatment?
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Exposure therapy
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A young female presents because she "freaks out" and panics in different situations without a specific trigger. What is the treatment of choice?
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SSRI (Selective Serotonin Reuptake Inhibitor) - Benzodiazepine if needed while waiting for SSRI to work (up to 6weeks)
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A patient is constantly worried about everything and that the worst will happen despite it being an unlikely occurrence. What is your diagnosis?
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GAD (Generalized Anxiety Disorder)
