EOR
Psychiatry EOR Exam
_____diagnosis via how many of the following s/s for a 2 week time period:
a. depressed mood most of day most every day
b. loss of interest/pleasure in activities
c. significant weight loss or gain
d. insomnia/hypersomnia
e. psychomotor agitation nearly everyday
f. fatigue, loss of energy
g. feelings of worthlessness or guilt
h. decreased ability to think or concentrate
i. recurrent thoughts of death, suicidal ideation w or wo plan - Correct Ans-Major
Depressive Disorder; 5 plus s/s for 2 week time period
The death of ___or___ is a risk factor for depression. - Correct Ans-parent or spouse
What stage of sleep is decreased and increased in depression? - Correct Ans-
decreased - delta stage 3 deep sleep
increased - REM sleep
Explain these models as related to depression: cognitive behavioral, learned
helplessness, genetics, neurotransmitters - Correct Ans-c-b: cognitive distortions foster
negative misperception of the world
l-h: people come to believe they have no control over stresses
genetics: unipolar depression in parent increases incidence in children
neurotransmitters: deficiences in serotonin & NE in depressive patients
15% of depressed patients die by ___ at some point in their lives. - Correct Ans-suicide
What labs should be drawn to rule out medical disorders as a cause for depression? -
Correct Ans-Vit D, thyroid, electrolyte imbalances
Non pharm tx of MDD:
___is often 1st line in milder cases often in conjunction with meds
___is used in psychotic, severe, or treatment refractory depressions.
___stimulation via implantation of surgical device. - Correct Ans-Psychotherapy;
electroconvulsive therapy; vagal nerve
____is the 1st line pharm treatment for depression. Frequent side effects? - Correct
Ans-SSRIs; nausea, constipation, sexual dysfunction, sedation, restlessness
____can result when SSRI's are combines with MAOi's. Rapid onset of tachycardia,
shivering, sweating, dilated pupils, hyperreflexia, HTN, hyperthermia. - Correct Ans-
Serotonin syndrome
EOR
,EOR
What is the BBW with SSRI's? - Correct Ans-increased suicidal ideation in children and
teens
Which SSRI is typically the most sedating? Which SSRI typically causes more agitation
and is frequently a good choice in adolescents? - Correct Ans-Paxil; Zoloft
SNRI's are typically 2nd line and have better side effect profile that TCA's or MAOi's.
Name two. - Correct Ans-Venlafaxine; Duloxetine
TCA's are not as well tolerated because of what two side effects? 2 others? - Correct
Ans-orthostatic hypotension & cardiac toxicity; sexual dysfunction & anticholinergic side
effects
____are frequently associated with hypertensive crisis due to ingestion of
hyperadrenergic amines that fail to be detoxified. Treatment of hypertensive crisis with
what? - Correct Ans-MAOI's; treat with IV phentolamine or IV nitroprusside
What must be avoided with MAOI's? - Correct Ans-cured meats/fish, beer, red wine,
cheese, overripe fruits, OTC cold/pain remedies
Other antidepressants:
____inhibits the uptake of dopamine and NE and can increase the risk of seizures at
doses >450mg.
____modulates serotonin and NE -- major side effect is sedation. - Correct Ans-
Bupropion/Wellbutrin; Mirtazapine/Remeron
A ___is a distinct period of abnormally and persistently elevated, expansive, or irritable
mood and abnormally and persistently increased goal-directed activity or energy, lasting
at least ONE WEEK and present most of the day, nearly every day. _____has same
definition but last only four days. - Correct Ans-Manic episode; hypomania
Mania/Hypomania: ____+ of the following sx or ____+ if mood is only irritable are
present to a significant degree and represent a change from usual behavior:
a. inflated self-esteem or grandiosity
b. decreased need for sleep
c. more talkative than normal
d. racing thoughts
e. distractibility
f. increase in goal-directed activity or psychomotor agitation
g. excessive involvement in activities that have a high potential for painful
consequences - Correct Ans-3+; 4+
In mania and hypomania, the mood disturbances causes ____ in functioning. - Correct
Ans-marked impairment
EOR
, EOR
In hypomania, if there are psychotic features, the episode by definition is ____. - Correct
Ans-manic
In both mania and hypomania, the episode can not be attributed to _____. - Correct
Ans-physiologic effects of a substance
A single manic episode w or wo a depressive episode diagnoses _______. Manic
episodes are usually briefer than depressive episodes. Suicide rates 10-15%. - Correct
Ans-Bipolar I
What other psychological disorders should be considered when diagnosing bipolar I? -
Correct Ans-Schizoaffective disorder, borderline personality, and depression w agitation
_____ is indicated as 1st line treatment in regulating cycling bipolar. Patients must have
a normal ____ function. - Correct Ans-Lithium, renal
What's the normal lithium range? - Correct Ans-0.6-1.2
Common side effects of _____ are hypothyroidism, tremors, polyuria, thirst, GI distress,
acne, weight gain. - Correct Ans-Lithium
_______ levels of lithium can cause ataxia, coarse tremor, diarrhea, confusion, coma,
and death. - Correct Ans-Toxic
____/____ is most effective for rapid cycling and mixed variants of bipolar disorder. Can
be started at a higher than normal loading dose for acute tx and can lead to a rapid
decrease in manic symptoms. Therapeutic range - 50-100. - Correct Ans-
Depakote/Valproate
MOA of Depakote is via augmentation of ____ function. - Correct Ans-GABA
With Depakote bc of risk of toxicity, what levels should be checked most frequently in
the first 6 months? - Correct Ans-LFts
Side effects of _____ include sedation, mild tremor, mild ataxia, GI distress,
thrombocytopenia, impaired platelet function. - Correct Ans-Depakote
______ levels of Depakote can cause confusion, coma, cardiac arrest, and death. -
Correct Ans-Toxic
_____ is second line after lithium and Depakote --- MOA may be via indirectly altering
GABA receptors. - Correct Ans-Carbamazepine
Carbamazepine may be more effective than Li for rapid cycling bipolar. _____ include
CNS, nausea, rash, and mild leukopenia. _____ levels cause autonomic instability, AV
block, respiratory depression, and coma. - Correct Ans-Side effects, toxic
EOR
Psychiatry EOR Exam
_____diagnosis via how many of the following s/s for a 2 week time period:
a. depressed mood most of day most every day
b. loss of interest/pleasure in activities
c. significant weight loss or gain
d. insomnia/hypersomnia
e. psychomotor agitation nearly everyday
f. fatigue, loss of energy
g. feelings of worthlessness or guilt
h. decreased ability to think or concentrate
i. recurrent thoughts of death, suicidal ideation w or wo plan - Correct Ans-Major
Depressive Disorder; 5 plus s/s for 2 week time period
The death of ___or___ is a risk factor for depression. - Correct Ans-parent or spouse
What stage of sleep is decreased and increased in depression? - Correct Ans-
decreased - delta stage 3 deep sleep
increased - REM sleep
Explain these models as related to depression: cognitive behavioral, learned
helplessness, genetics, neurotransmitters - Correct Ans-c-b: cognitive distortions foster
negative misperception of the world
l-h: people come to believe they have no control over stresses
genetics: unipolar depression in parent increases incidence in children
neurotransmitters: deficiences in serotonin & NE in depressive patients
15% of depressed patients die by ___ at some point in their lives. - Correct Ans-suicide
What labs should be drawn to rule out medical disorders as a cause for depression? -
Correct Ans-Vit D, thyroid, electrolyte imbalances
Non pharm tx of MDD:
___is often 1st line in milder cases often in conjunction with meds
___is used in psychotic, severe, or treatment refractory depressions.
___stimulation via implantation of surgical device. - Correct Ans-Psychotherapy;
electroconvulsive therapy; vagal nerve
____is the 1st line pharm treatment for depression. Frequent side effects? - Correct
Ans-SSRIs; nausea, constipation, sexual dysfunction, sedation, restlessness
____can result when SSRI's are combines with MAOi's. Rapid onset of tachycardia,
shivering, sweating, dilated pupils, hyperreflexia, HTN, hyperthermia. - Correct Ans-
Serotonin syndrome
EOR
,EOR
What is the BBW with SSRI's? - Correct Ans-increased suicidal ideation in children and
teens
Which SSRI is typically the most sedating? Which SSRI typically causes more agitation
and is frequently a good choice in adolescents? - Correct Ans-Paxil; Zoloft
SNRI's are typically 2nd line and have better side effect profile that TCA's or MAOi's.
Name two. - Correct Ans-Venlafaxine; Duloxetine
TCA's are not as well tolerated because of what two side effects? 2 others? - Correct
Ans-orthostatic hypotension & cardiac toxicity; sexual dysfunction & anticholinergic side
effects
____are frequently associated with hypertensive crisis due to ingestion of
hyperadrenergic amines that fail to be detoxified. Treatment of hypertensive crisis with
what? - Correct Ans-MAOI's; treat with IV phentolamine or IV nitroprusside
What must be avoided with MAOI's? - Correct Ans-cured meats/fish, beer, red wine,
cheese, overripe fruits, OTC cold/pain remedies
Other antidepressants:
____inhibits the uptake of dopamine and NE and can increase the risk of seizures at
doses >450mg.
____modulates serotonin and NE -- major side effect is sedation. - Correct Ans-
Bupropion/Wellbutrin; Mirtazapine/Remeron
A ___is a distinct period of abnormally and persistently elevated, expansive, or irritable
mood and abnormally and persistently increased goal-directed activity or energy, lasting
at least ONE WEEK and present most of the day, nearly every day. _____has same
definition but last only four days. - Correct Ans-Manic episode; hypomania
Mania/Hypomania: ____+ of the following sx or ____+ if mood is only irritable are
present to a significant degree and represent a change from usual behavior:
a. inflated self-esteem or grandiosity
b. decreased need for sleep
c. more talkative than normal
d. racing thoughts
e. distractibility
f. increase in goal-directed activity or psychomotor agitation
g. excessive involvement in activities that have a high potential for painful
consequences - Correct Ans-3+; 4+
In mania and hypomania, the mood disturbances causes ____ in functioning. - Correct
Ans-marked impairment
EOR
, EOR
In hypomania, if there are psychotic features, the episode by definition is ____. - Correct
Ans-manic
In both mania and hypomania, the episode can not be attributed to _____. - Correct
Ans-physiologic effects of a substance
A single manic episode w or wo a depressive episode diagnoses _______. Manic
episodes are usually briefer than depressive episodes. Suicide rates 10-15%. - Correct
Ans-Bipolar I
What other psychological disorders should be considered when diagnosing bipolar I? -
Correct Ans-Schizoaffective disorder, borderline personality, and depression w agitation
_____ is indicated as 1st line treatment in regulating cycling bipolar. Patients must have
a normal ____ function. - Correct Ans-Lithium, renal
What's the normal lithium range? - Correct Ans-0.6-1.2
Common side effects of _____ are hypothyroidism, tremors, polyuria, thirst, GI distress,
acne, weight gain. - Correct Ans-Lithium
_______ levels of lithium can cause ataxia, coarse tremor, diarrhea, confusion, coma,
and death. - Correct Ans-Toxic
____/____ is most effective for rapid cycling and mixed variants of bipolar disorder. Can
be started at a higher than normal loading dose for acute tx and can lead to a rapid
decrease in manic symptoms. Therapeutic range - 50-100. - Correct Ans-
Depakote/Valproate
MOA of Depakote is via augmentation of ____ function. - Correct Ans-GABA
With Depakote bc of risk of toxicity, what levels should be checked most frequently in
the first 6 months? - Correct Ans-LFts
Side effects of _____ include sedation, mild tremor, mild ataxia, GI distress,
thrombocytopenia, impaired platelet function. - Correct Ans-Depakote
______ levels of Depakote can cause confusion, coma, cardiac arrest, and death. -
Correct Ans-Toxic
_____ is second line after lithium and Depakote --- MOA may be via indirectly altering
GABA receptors. - Correct Ans-Carbamazepine
Carbamazepine may be more effective than Li for rapid cycling bipolar. _____ include
CNS, nausea, rash, and mild leukopenia. _____ levels cause autonomic instability, AV
block, respiratory depression, and coma. - Correct Ans-Side effects, toxic
EOR
