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Psychiatry
Questions PSYCHOLOGY
1. Match the term with its definition. (pp. 438-439) _____ A. Application of aversive stimulus extinguishes 1. Classical conditioning unwanted behavior 2. Countertransference _____ B. Behavior achieved by assimilating actions of 3. Continuous reinforcement others into one's own repertoire 4. Extinction _____ C. Behavior achieved by closer and closer 5. Habituation approximation of desired behavior 6. Modeling _____ D. Discontinuation of reinforcement eliminates 7. Negative reinforcement behavior 8. Positive reinforcement _____ E. Patient projects feelings about someone 9. Punishment onto physician 10. Sensitization _____ F. Physician projects feelings about someone 11. Shaping onto patient 12. Transference _____ G. Removal of aversive stimulus produces 13. Variable ratio reinforcement desired action _____ H. Repeated stimulation leads to response _____ I. Repeated stimulation leads to response _____ J. Reward produces desired action _____ K. Reward received after every response _____ L. Reward received after random number of responses _____ M. Response is elicited by a learned stimulus presented in conjunction with an unconditioned stimulus 2. In the chart below, identify the defense mechanism and label it as mature or immature. (p. 440) Behavior A football player jokes about playing the defending state champions the following week A survivor of an earthquake describes the event and her towns destruction with no emotional response A man wants to cheat on his wife, but instead buys flowers for her A man throws a temper tantrum because he does not get a promotion at work A child throws a temper tantrum when he cannot have candy A heroin addict decides to volunteer at an antidrugabuse program at a local school A man who is angry at his wife thinks she is angry at him A man who is angry at his wife becomes angry at his son Defense Mechanism Mature or Immature

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PATHOLOGY
3. What are the signs and symptoms of physical child abuse? (p. 441) ________________________ ______________________________________________________________________________ 4. What are the signs and symptoms of child neglect? (p. 441) ______________________________ ______________________________________________________________________________ 5. In the chart below, compare and contrast Aspergers syndrome vs. autism. (p. 442)

Characteristic
Difficulty socializing Gender predilection Intelligence Language impairment Repetitive behaviors 6.

Aspergers Syndrome

Autism

What are the most common causes of a loss of orientation? (p. 443) _______________________ ______________________________________________________________________________

7.

In the chart below, compare and contrast delirium vs. dementia. (p. 443) Characteristic Caused by anticholinergic drugs Changing level of consciousness EEG Memory loss Onset Relationship to age Reversible Delirium Dementia

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8.

Fill in the chart comparing the following disorders. (pp. 444-446) Criteria Must be Present How Long?

Disorder

Criteria

No. of Criteria Needed to Diagnose

Major depressive episode

Manic episode

Panic disorder

Schizophrenia

9.

In one word, patients with cluster A personality disorder can be described as _______________. Those with cluster B personality disorder can be described as ______________. Those with cluster C personality disorder can be described as _______________. (p. 448) Identify the type of personality disorder. (Numbers may be used more than once.) (p. 448) _____ A. Antisocial personality disorder _____ B. Avoidant personality disorder _____ C. Borderline personality disorder _____ D. Dependent personality disorder _____ E. Histrionic personality disorder _____ F. Narcissistic personality disorder _____ G. Obsessive-compulsive disorder _____ H. Paranoid personality disorder _____ I. Schizoid personality disorder _____ J. Schizotypal personality disorder 1. Cluster A 2. Cluster B 3. Cluster C

10.

11.

_______________ is a common defense mechanism used by patients who have borderline personality disorder. (p. 448)

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12.

______________ is a common defense mechanism used by patients who have paranoid personality disorder. (p. 448) What is Russells sign? (p. 449) _____________________________________________________ Cocaine intoxication is characterized by _______________ (constricted/dilated) pupils, while opioid intoxication is characterized by _______________ (constricted/dilated) pupils. (p. 450)

13. 14.

PHARMACOLOGY
15. List four treatment options for bipolar disorder. (p. 452) __________________________________ ______________________________________________________________________________ 16. List three treatment options for panic disorder. (p. 452) _________________________________ ______________________________________________________________________________ 17. List three treatment options for generalized anxiety disorder. (p. 452) ______________________ ______________________________________________________________________________ 18. List two treatment options for obsessive-compulsive personality disorder. (p. 452) _____________ ______________________________________________________________________________ 19. A 24-year-old man began treatment for schizophrenia 1 month ago. Today he presents with feelings of restlessness. What type of medication is he most likely using? (p. 453) _____________ ______________________________________________________________________________ 20. 21. Which extrapyramidal symptom of typical antipsychotics is not reversible? (p. 453) _____________ Which adverse effects of both olanzapine and clozapine do not occur with other atypical antipsychotics? Which other adverse effect of clozapine does not occur with other atypical antipsychotics? (p. 453) ___________________________________________________________ ______________________________________________________________________________ 22. What are the classic adverse effects of lithium? (p. 454) __________________________________ ______________________________________________________________________________ 23. A patient presents to the emergency department with muscle rigidity and fever. He has an extensive psychiatric history, but his specific diagnosis and prescription history are not immediately available. Which symptoms are important in determining whether the patient is suffering from serotonin syndrome or neuroleptic malignant syndrome? (pp. 453 and 455) __________________ ______________________________________________________________________________ 24. Which drugs block reuptake of both serotonin and norepinephrine? Which agents block the reuptake of serotonin exclusively? Which agents block reuptake of norepinephrine exclusively? (pp. 455-456) _______________________________________________________________________ ______________________________________________________________________________ 25. Why is nortriptyline a better choice than amitriptyline for an elderly patient with depression? (p. 455) __________________________________________________________________________ Copyright 2011 by MedIQ Learning, LLC All rights reserved

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26.

Match the medication with its most common usage. (pp. 450-456) _____ A. Bupropion _____ B. Buspirone _____ C. Clozapine _____ D. Cyproheptate _____ E. Dantrolene _____ F. Disulfiram _____ G. Duloxetine _____ H. Haloperidol _____ I. Imipramine _____ J. Lithium _____ K. Methadone _____ L. Methylphenidate _____ M. Mirtazapine _____ N. Phenelzine _____ O. Sertraline _____ P. Thiamine _____ Q. Trazodone 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. ADHD Alcoholism Bedwetting Bulimia Depression with insomnia Diabetic peripheral neuropathy Generalized anxiety disorder Heroin detoxification Hypochondriasis Insomnia Mood stabilizer in bipolar disorder Neuroleptic malignant syndrome Schizophrenia (both positive and negative symptoms) Schizophrenia (primarily positive symptoms) Serotonin syndrome Smoking cessation Wernicke-Korsakoff syndrome

Answers PSYCHOLOGY
1. 2. A-9, B-6, C-11, D-4, E-12, F-2, G-7, H-10, I-5, J-8, K-3, L-13, M-1.

Behavior
A football player jokes about playing the defending state champions the following week A survivor of an earthquake describes the event and her towns destruction with no emotional response A man wants to cheat on his wife, but instead buys flowers for her A man throws a temper tantrum because he does not get a promotion at work A child throws a temper tantrum when he cannot have candy A heroin addict decides to volunteer at an antidrugabuse program at a local school A man who is angry at his wife thinks she is angry at him A man who is angry at his wife becomes angry at his son

Defense Mechanism
Humor Isolation of affect Sublimation Regression Acting out Altruism Projection Displacement

Mature or Immature
Mature Immature Mature Immature Immature Mature Immature Immature

PATHOLOGY
3. Healed fractures on x-ray, cigarette burns, multiple bruises, subdural hematomas, and retinal hemorrhage or detachment.

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4.

Poor hygiene, malnutrition, withdrawal, impaired social/emotional development, and failure to thrive.

5.

Characteristic
Difficulty socializing Gender predilection Intelligence Language impairment Repetitive behaviors

Aspergers Syndrome
Yes, milder Boys Normal No Yes

Autism
Yes, severe None Decreased Yes Yes

6. 7.

Alcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, and nutritional deficiency.

Characteristic
Caused by anticholinergic drugs Changing level of consciousness EEG Memory loss Onset Relationship to age Reversible

Delirium
Yes Yes Abnormal Possible Sudden None Yes in most cases

Dementia
No No Normal Yes Gradual More common in older adults No

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8. Criteria Must be Present How Long?

Disorder

Criteria

No. of Criteria Needed to Diagnose

Major depressive episode

Sleep disturbance, loss of Interest, Guilt, Energy loss, Concentration loss, Appetite change, Psychomotor changes, Suicidal ideation, depressed mood (remember: SIG E CAPS) Distractibility, Irresponsibility, Grandiosity, Flight of ideas, increase in goal-directed Activity, decreased need for Sleep, Talkativeness (remember: DIG FAST) Palpitations, Paresthesias, Abdominal distress, Nausea, Intense fear of dying, lIghtheadedness, Chest pain, Chills, Choking, disConnectedness, Sweating, Shaking, Shortness of breath (remember: PANICS) Delusions, hallucinations (esp. auditory), disorganized speech, disorganized behavior, any type of negative symptom (e.g., flat affect, social withdrawal)

5 out of 9

At least 2 weeks

Manic episode

3 out of 7

At least 1 week

Panic disorder

4 out of 13

None

Schizophrenia

2 out of 5

More than 6 months

9. 10. 11. 12. 13. 14.

Weird; wild; worried. A-2, B-3, C-2, D-3, E-2, F-2, G-3, H-1, I-1, J-1. Splitting. Projection. Dorsal hand calluses due to inducing vomiting; a sign of bulimia nervosa. Dilated; constricted.

PHARMACOLOGY
15. 16. Lithium, carbamazepine, valproate, and atypical antipsychotics. SSRIs, TCAs, and benzodiazepines.

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17. 18. 19. 20. 21.

Benzodiazepines, buspirone, and SSRIs. SSRIs and clomipramine. He is experiencing an extrapyramidal symptom of typical antipsychotics, namely akathisia. Tardive dyskinesia. Weight gain can occur with both olanzapine and clozapine. Clozapine also can cause agranulocytosis. Lithium adverse effects include Movement (tremor), Nephrogenic diabetes insipidus, hypotension, and problems in Pregnancy (e.g., Ebstein anomaly). (Remember LMNOP.) With neuroleptic malignant syndrome, one would expect to see autonomic instability and myoglobinuria. Common symptoms of serotonin syndrome are flushing, diarrhea, and hypotension. TCAs and SNRIs block reuptake of norepinephrine and serotonin. Trazodone blocks reuptake of serotonin exclusively. Maprotilene blocks reuptake of norepinephrine exclusively. Nortriptyline has fewer anticholinergic adverse effects than third-generation TCAs such as amitriptyline. A-16, B-7, C-13, D-15, E-12, F-2, G-6, H-14, I-3, J-11, K-8, L-1, M-5, N-9, O-4, P-17, Q-10.

22.

23.

24.

25.

26.

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