Exam (elaborations)
GEORGETTE-S - LMR FINAL QUESTIONS & ANSWERS
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GEORGETTE-S - LMR FINAL QUESTIONS & ANSWERS
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GEORGETTE'S - LMR FINAL QUESTIONS & ANSWERSWhat is the normal range for TSH? - Answers- 0.5 - 5.0 mu/L
What are lab values in Hyperthyroidism - Answers- Decreased TSH
Increased T4 and T3
What are labs in Hypothyroidism? - Answers- Increased TSH
Decreased T4 and T3
What are 5 primary symptoms of Hyperthyroidism? - Answers- Heat intolerance
Agitation, Anxiety, Irritability
Tachycardia
Mood swings
Weight loss
What are 4 primary symptoms of Hypothyroidism? - Answers- Cold intolerance
Lethargy
Weight gain
Decreased libido
Hypothyroidism mimics symptoms of what psychiatric disorder? - Answers- Depression
Hyperthyroidism mimics symptoms of what psychiatric disorder? - Answers- Mania
Valproic acid produces what teratogenic effect? - Answers- Spina bifida (neural tube
defect)
What is the primary organ where valproic acid is toxic? - Answers- Liver (hepatoxicity)
What are 4 signs of hepatoxicity? - Answers- Abdominal pain in the RUQ
Reddish-brown urine
Yellowing of the skin/sclera
Fatigue
What is the therapeutic range for valproic acid? - Answers- 50-125 mcg/ml
What is a toxic level of valproic acid? - Answers- >150 mcg/ml
What are 4 signs of valproic acid toxicity? - Answers- Disorientation
Lethargy
Respiratory depression
Nausea/vomiting
,A patient on depakote complains of abdominal pain in the RUQ and reddish-brown
urine. What do you suspect? What do you do? - Answers- Suspect: hepatotoxicity
Interventions:
-hold med
-draw LFT's (priority)
-VPA/DVP level
With suspected toxicity with valproic acid, what steps/labs should be drawn? - Answers-
D/C drug
Check drug level
Obtain LFTs
Obtain ammonia level
A pregnant patient is taking accutane, zyprexa, and abilify. What medication needs to be
discontinued? - Answers- Accutane
Accutane is used for acne and is contraindicated in pregnancy as it can cause birth
defects
What herbal supplement is used for anxiety, stress, and insomnia? - Answers- Kava
Kava
What is a major side effect of Kava Kava? - Answers- Liver damage
What drugs should be avoided with Kava Kava? - Answers- Alprazolam
CNS depressants (e.g., phenobarbital, zolpidem)
What are 5 symptoms of Stephen's Johnson Syndrome (SJS)? - Answers- Key
symptoms:
-Fever
-Burning of mouth/eyes
Additional symptoms:
Body aches
Severe red rash
Peeling skin
Facial and tongue swelling
Which mood stabilizer causes the least weight gain? - Answers- Lamotrigine (Lamictal)
Which 3 SGAs cause the least weight gain? - Answers- Lurasidone (Latuda)
Aripiprazole (Abilify)
Ziprasidone (Geodon)
Which SGA is the least sedating? - Answers- Aripiprazole (Abilify)
,Your patient is taking Kava Kava and you need to add an antipsychotic to manage their
schizophrenia. Which medication do you add? - Answers- Aripiprazole (least sedating)
What are 2 hallmark symptoms of delirium? - Answers- Acute onset
Altered LOC
impaired cognition
inattention
How are agitation and psychotic symptoms treated in delirium? - Answers- Low-dose
Haldol
Ensure you check QTc first as Haldol can cause QTc prolongation
Your 16 year old patient complains of feeling "funny" after inhaling Acetone (nail polish
remover). What is your action? - Answers- Obtain a UDS
They may be abusing other substances
What 4 drugs can cause mania? - Answers- "SAID"
Steroids
Antidepressants (in bipolar disorder)
Isoniazid (INH)
Disulfiram (Antabuse)
What 6 drugs can induce depression? - Answers- "SIP BARB"
Steroids
Interferon
Progesterone
Beta blockers
Accutane, (Isotretinoin)
Retroviral drugs, Antineoplastic drugs
Benzodiazepines
Steroids can induce what 3 psychiatric states? - Answers- Mania
Depression
Psychosis
You see a patient after an assault. Your initial action is_____.
What is the best environment to interview this patient in? - Answers- Initial action:
reassure safety, provide environment of safety
Environment: private area with door open/partially open
, What is the therapeutic range for lithium? - Answers- 0.6-1.2 mEq/L
Many postpartum women have SI after delivery, yet they don't have psychiatric
evaluations performed prior to leaving the hospital. What could a possible solution be? -
Answers- COLLABORATING CARE between psychiatry and OBGYN to provide the
best care for that patient
If you are collaborating with a provider who is not in the same clinic or hospital, the
informed consent _________ [does/does not] apply? - Answers- DOES NOT
The patient will need to sign consent for labs/ chart to be sent
When discharging from inpatient, you want to ______ [fax/print/give to patient] their labs
for the outpatient provider before discharge? - Answers- FAX
So that the new provider has them for follow-up appointment
Before referring a patient out or discharging them, it is good to ask yourself _______
[what question]? - Answers- Is there something I can do for this patient first?
What 3 things should every provider know about Lithium? - Answers- Lithium has a
neuroprotective effect for bipolar disorder
Lithium is the gold standard for treating manic episodes
Lithium is a mood stabilizer with anti-suicidal effects
What mood stabilizer has anti-suicidal effects? - Answers- Lithium
What 5 labs should be drawn with lithium? - Answers- Thyroid panel (TSH)
Serum creatinine
BUN
UA
HCG
What is a normal Serum Cr range? - Answers- 0.6-1.2 mg/dL
What is the normal range for BUN? - Answers- 10-20 mg/dL
When should you suspect kidney disease with a urinalysis? - Answers- 4+ protein
If your patient is on Lithium, you must monitor closely TOXICITY
What are 7 side effects of lithium? - Answers- Hypothyroidism
Fine hand tremors
Maculopapular rash
GI upset (N/V/D, cramps, anorexia)
Polyuria, polydipsia, diabetes insipidus
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