SAEM AMS questions with correct answers
A 25 year old male is brought to the emergency department by his
family, with a complaint of feeling depressed for the past week. In
obtaining the history, which of the following statements regarding this
patient would support a diagnosis of major depression?
A. The patient has no history of medical illness
B. The patient has a history of Crohn's disease
C. There is no family history of depression
D. The screening mnemonic in SAD CAGES is negative Correct
Answer-The answer is B. In SAD CAGES is a screening mnemonic for
symptoms, not causes, of major depression. Depression is more common
in patients with history of other medical illnesses, some of which may
actually cause depressive symptoms. As compared with major
depression, dysthymic disorder is a more chronic, and less severe, form
of depressive illness.
A 42 year old male with end stage liver disease due to chronic hepatitis
C infection arrives to the emergency department in stable condition after
an unsuccessful suicide attempt by bilateral wrist laceration. He reports
no history of depression or psychiatric disorder. Aside from his liver
disease, for which he takes interferon alpha and ribavirin, he reports that
he is in good health and takes no other medications. Which of the
following factors increased this patient's risk of new-onset suicidal
ideation?
A. chronic hepatitis C infection
B. end-stage liver disease
,C. interferon alfa therapy
D. ribavirin therapy Correct Answer-The answer is C. Interferon alfa,
an important cytokine in the early immune response to viral infection,
has both antiproliferative and antiviral properties. It is the only therapy
approved by the Food and Drug Administration for hepatitis C infection.
Interferon alfa has been associated with high rates of central nervous
system side effects, including anhedonia, fatigue, anorexia, impaired
concentration, sleep disturbance, and suicidal ideation. Clinicians should
always look up the side effects of their patients' medications, especially
unfamiliar drugs. This can both expedite diagnosis of drug-induced
complications and prevent them with appropriate pretreatment.
Pretreatment with a selective serotonin reuptake inhibitor appears to be
an effective strategy to minimize depression induced by interferon alfa.
Chronic hepatitis C infection and end-stage liver disease can both be
difficult diseases to live with, however, these conditions are not known
to significantly increase a patients' risk for new suicidal ideation.
Depression is not a known side effect of ribavirin treatment. Although
males have a higher percentage of successful suicide attempt than
females, females have a much higher incidence of suicide attempt and
ideation than males overall.
A 35 year old female is brought to the emergency department after
family members called the police to say she was threatening to kill
herself by jumping out a window. She has a long history of depression.
Regarding suicide, which of the following statements is FALSE?
A. All states have laws giving law enforcement the right to place into
custody any individual suspected of being a danger to themselves or
others.
, B. Family sitters provide the best option for close observation of
suicidal patients since they often have a calming influence on the
patient.
C. The patient's room needs to be cleared of all potentially dangerous
objects such as blunt instruments, glass objects, and the patient's
belongings.
D. The majority of suicide attempts involve minor injuries or drug
overdoses. Correct Answer-The answer is B. For any patient presenting
with suicidal ideation, the emergency department physician must first
stabilize medical condition as most attempts involve minor injury or
drug overdoses treatable by emergency room staff. Secondly, all objects
and substances should be kept strictly out of reach of the suicidal patient.
Once stabilized these patients may be kept under direct supervision. It is
not recommended that family members provide the direct supervision
because of a possibility of collaboration between family and patient to
leave the hospital. In this event, or even before coming into the hospital,
all law enforcement has the right to bring into custody any patient at risk
of harming self or others.
Suicide rates are consistent with the average population in this
population:
A. Females with breast implants
B. Men with AIDS
C. African-American males
D. Presence of underlying panic disorder Correct Answer-The answer is
C. The epidemiology of suicide varies according to age, gender and race.
, Overall, men have higher rates of completed suicide and women have
greater numbers of suicide attempts. Suicide risk among men shows a
bimodal distribution with increased risk between the ages of 15 and 24
and after age 65. Suicide risk among women peaks after age 60. People
who suffer from a chronic disease such as AIDS are at increased risk for
committing suicide. The dramatic increase in suicide rates among
adolescents is thought to be due to changing demographics and greater
access to firearms. Underlying psychiatric illness increases a person's
risk of suicide. Major depression, bipolar, borderline personality
disorder, schizophrenia, and panic disorder are all associated with
increased suicide rates. Of note, One study demonstrated that 40% of
people who suffer from panic attacks would attempt suicide at some
point in their lives. Studies have demonstrated that the presence of breast
implants portends a higher risk of suicide.
Which clinical scenario is use of chemical restraint indicated?
A. Patient is uncooperative with the history
B. Patient's remarks are felt to warrant negative reinforcement
C. Patient's behaviors and actions pose an imminent harm to self
D. Patient is responding to verbal tactics, but requires multiple attempts
Correct Answer-The answer is C. Physical and chemical restraints
should only be used when verbal tactics have failed and when the patient
is an immediate threat to himself, others or the integrity of the
emergency department. From a medico-legal standpoint, clear
documentation is very important when a decision is made to apply
restraints. Answers A, C, D, and E are all valid reasons for physical or
chemical restraints.
A 25 year old male is brought to the emergency department by his
family, with a complaint of feeling depressed for the past week. In
obtaining the history, which of the following statements regarding this
patient would support a diagnosis of major depression?
A. The patient has no history of medical illness
B. The patient has a history of Crohn's disease
C. There is no family history of depression
D. The screening mnemonic in SAD CAGES is negative Correct
Answer-The answer is B. In SAD CAGES is a screening mnemonic for
symptoms, not causes, of major depression. Depression is more common
in patients with history of other medical illnesses, some of which may
actually cause depressive symptoms. As compared with major
depression, dysthymic disorder is a more chronic, and less severe, form
of depressive illness.
A 42 year old male with end stage liver disease due to chronic hepatitis
C infection arrives to the emergency department in stable condition after
an unsuccessful suicide attempt by bilateral wrist laceration. He reports
no history of depression or psychiatric disorder. Aside from his liver
disease, for which he takes interferon alpha and ribavirin, he reports that
he is in good health and takes no other medications. Which of the
following factors increased this patient's risk of new-onset suicidal
ideation?
A. chronic hepatitis C infection
B. end-stage liver disease
,C. interferon alfa therapy
D. ribavirin therapy Correct Answer-The answer is C. Interferon alfa,
an important cytokine in the early immune response to viral infection,
has both antiproliferative and antiviral properties. It is the only therapy
approved by the Food and Drug Administration for hepatitis C infection.
Interferon alfa has been associated with high rates of central nervous
system side effects, including anhedonia, fatigue, anorexia, impaired
concentration, sleep disturbance, and suicidal ideation. Clinicians should
always look up the side effects of their patients' medications, especially
unfamiliar drugs. This can both expedite diagnosis of drug-induced
complications and prevent them with appropriate pretreatment.
Pretreatment with a selective serotonin reuptake inhibitor appears to be
an effective strategy to minimize depression induced by interferon alfa.
Chronic hepatitis C infection and end-stage liver disease can both be
difficult diseases to live with, however, these conditions are not known
to significantly increase a patients' risk for new suicidal ideation.
Depression is not a known side effect of ribavirin treatment. Although
males have a higher percentage of successful suicide attempt than
females, females have a much higher incidence of suicide attempt and
ideation than males overall.
A 35 year old female is brought to the emergency department after
family members called the police to say she was threatening to kill
herself by jumping out a window. She has a long history of depression.
Regarding suicide, which of the following statements is FALSE?
A. All states have laws giving law enforcement the right to place into
custody any individual suspected of being a danger to themselves or
others.
, B. Family sitters provide the best option for close observation of
suicidal patients since they often have a calming influence on the
patient.
C. The patient's room needs to be cleared of all potentially dangerous
objects such as blunt instruments, glass objects, and the patient's
belongings.
D. The majority of suicide attempts involve minor injuries or drug
overdoses. Correct Answer-The answer is B. For any patient presenting
with suicidal ideation, the emergency department physician must first
stabilize medical condition as most attempts involve minor injury or
drug overdoses treatable by emergency room staff. Secondly, all objects
and substances should be kept strictly out of reach of the suicidal patient.
Once stabilized these patients may be kept under direct supervision. It is
not recommended that family members provide the direct supervision
because of a possibility of collaboration between family and patient to
leave the hospital. In this event, or even before coming into the hospital,
all law enforcement has the right to bring into custody any patient at risk
of harming self or others.
Suicide rates are consistent with the average population in this
population:
A. Females with breast implants
B. Men with AIDS
C. African-American males
D. Presence of underlying panic disorder Correct Answer-The answer is
C. The epidemiology of suicide varies according to age, gender and race.
, Overall, men have higher rates of completed suicide and women have
greater numbers of suicide attempts. Suicide risk among men shows a
bimodal distribution with increased risk between the ages of 15 and 24
and after age 65. Suicide risk among women peaks after age 60. People
who suffer from a chronic disease such as AIDS are at increased risk for
committing suicide. The dramatic increase in suicide rates among
adolescents is thought to be due to changing demographics and greater
access to firearms. Underlying psychiatric illness increases a person's
risk of suicide. Major depression, bipolar, borderline personality
disorder, schizophrenia, and panic disorder are all associated with
increased suicide rates. Of note, One study demonstrated that 40% of
people who suffer from panic attacks would attempt suicide at some
point in their lives. Studies have demonstrated that the presence of breast
implants portends a higher risk of suicide.
Which clinical scenario is use of chemical restraint indicated?
A. Patient is uncooperative with the history
B. Patient's remarks are felt to warrant negative reinforcement
C. Patient's behaviors and actions pose an imminent harm to self
D. Patient is responding to verbal tactics, but requires multiple attempts
Correct Answer-The answer is C. Physical and chemical restraints
should only be used when verbal tactics have failed and when the patient
is an immediate threat to himself, others or the integrity of the
emergency department. From a medico-legal standpoint, clear
documentation is very important when a decision is made to apply
restraints. Answers A, C, D, and E are all valid reasons for physical or
chemical restraints.
