NYU's "Interactive Psychiatry Testing"

[Anasazi23]

i.e. A multiple choice test.

It's somewhat similar to the PRITE, for any/all who are interested.

http://www.med.nyu.edu/psych/psychiatrist/itp.html

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[fiatslug]

this is great--thanks for the link!

 

[psych2b]

I tried it, but when I hit "submit" at the bottom, it brings up a page with a non-loaded image, and nothing else...? Did it actually score it for any of you? What browser did you use?

 

[fiatslug]

same problem for me...

 

[Anasazi23]

Yeah, it's with me too.

Well, the answers are all in Kaplan & Sadock...let's bust 'em out!

Someone start with number one.

 

[fiatslug]

I love the questions about Moban, and other "hot new typicals!" Does anyone remember the PRITE question about DSM-III on last year's test? Or the one about treating acute depression with 1 gm serotonin? So cutting edge!

 

[fiatslug]

1-1. What is the best approach that a physician can take with a hostile patient who is hospitalized?

a. offer straightforward explanations of procedures
b. be sympathetic about the patient's fears
c. set firm limits on the patient's behavior
d. avoid isolating the patient
e. let the patient share in the treatment decisions

I'm with C. All about the behavior smackdown.

1-2. Each of the following drugs is helpful in treating obsessive-compulsive disorder EXCEPT

a. bupropion
b. fluvoxamine
c. sertraline
d. fluoxetine
e. clomipramine

KS: 1st line: SSRIs or Clomipramine. Augment: VPA, Li+, Tegretol (didn't know that!). Other drugs: venlafaxine, pindolol, MAOis, esp phenelzine. Tx resistant: Buspar, 5-HT (where do you get a bottle of serotonin??), l-tryptophan & klonopin. Let's pick A!

1-3. The generally accepted therapeutic range of blood levels for lithium carbonate is:

a. 0.8 to 1.0 mEq/liter
b. 0.8 to 1.5 mEq/liter
c. 8.2 to 2.5 mEq/liter
d. 8 to 15 mEq/liter
e. 10 to 20 mEq/liter

From memory, I'd say B. Per KS: acute mania: 1.0 to 1.5. Maintenance: 0.4 to 0.8.

1-4. The side-effect that is least likely to be caused by fluoxetine (Prozac) is

a. orgasmic dysfunction
b. insomnia
c. nausea
d. fatigue
e. constipation

I'd go with D.

1-5. It is advisable to measure serum lithium concentrations how many hours after a dose?

a. 2 hours
b. 4 hours
c. 6 hours
d. 12 hours
e. 24 hours

KS: must be at steady state (after 5 days of constant dosing), blood sample must be drawn 12 hrs (+/- 30 min) after a given dose. D, baby.

Next....

Dang, maybe I'd do better on the PRITE if I um, you know, actually READ Kaplan & Sadock once in awhile!

 

[Anasazi23]

1-1. What is the best approach that a physician can take with a hostile patient who is hospitalized?

a. offer straightforward explanations of procedures
b. be sympathetic about the patient's fears
c. set firm limits on the patient's behavior
d. avoid isolating the patient
e. let the patient share in the treatment decisions

I'm with C. All about the behavior smackdown.

I think the answer is E. I definately could be wrong. Though, I like your reasoning.

1-2. Each of the following drugs is helpful in treating obsessive-compulsive disorder EXCEPT

a. bupropion
b. fluvoxamine
c. sertraline
d. fluoxetine
e. clomipramine

KS: 1st line: SSRIs or Clomipramine. Augment: VPA, Li+, Tegretol (didn't know that!). Other drugs: venlafaxine, pindolol, MAOis, esp phenelzine. Tx resistant: Buspar, 5-HT (where do you get a bottle of serotonin??), l-tryptophan & klonopin. Let's pick A!

I agree...A.

1-3. The generally accepted therapeutic range of blood levels for lithium carbonate is:

a. 0.8 to 1.0 mEq/liter
b. 0.8 to 1.5 mEq/liter
c. 8.2 to 2.5 mEq/liter
d. 8 to 15 mEq/liter
e. 10 to 20 mEq/liter

From memory, I'd say B. Per KS: acute mania: 1.0 to 1.5. Maintenance: 0.4 to 0.8.

B. Acute up to 1.5. Agree there too.

1-4. The side-effect that is least likely to be caused by fluoxetine (Prozac) is

a. orgasmic dysfunction
b. insomnia
c. nausea
d. fatigue
e. constipation

I'd go with D.

This is a boring question. Though I agree again that the point of the question is to get you to think of fluoxetine as activiating.

1-5. It is advisable to measure serum lithium concentrations how many hours after a dose?

a. 2 hours
b. 4 hours
c. 6 hours
d. 12 hours
e. 24 hours

KS: must be at steady state (after 5 days of constant dosing), blood sample must be drawn 12 hrs (+/- 30 min) after a given dose. D, baby.

D. Correct again. The long release preparation will be about 30% higher than the normal release formula 12 hours after dosing.

Next....

Dang, maybe I'd do better on the PRITE if I um, you know, actually READ Kaplan & Sadock once in awhile!

 

[Anasazi23]

1-6. A 40-year old physician was hospitalized following a Femoral fracture in an automobile accident. Orthopedic surgery was uneventful and for the first 2 recovery days the patient was restless but well oriented. On the third day after surgery the patient rapidly became confused and fearful, and reported visual and tactile hallucinations of snakes and scorpions crawling over the bedclothes. Physical examination revealed dilated pupils, coarse tremor of the hands and eyelids, profuse diaphoresis, and a rapid, pounding heartbeat. His oral temperature was 100 degree F. His previous medical history was unremarkable. He is described as a moderate social drinker and denied use of other drugs. The diagnosis most strongly suggested by this description is:

a. alcohol withdrawal delirium
b. postanesthesia delirium
c. septicemia
d. subdural hematoma
e. uremia

A.

1-7. Adverse reactions of tricyclic antidepressants are most likely to be clinically significant in patients with:

a. migraine
b. Parkinsonism
c. insomnia
d. pseudo tumor cerebri
e. benign prostatic hypertrophy

E.

1-8. The drug least likely to cause extra pyramidal symptoms is:

a. phenelzine
b. amoxapine
c. perphenazine
d. haloperidol
e. fluphenazine

A.

 

[Milo]

Originally Posted by fiatslug
1-1. What is the best approach that a physician can take with a hostile patient who is hospitalized?

a. offer straightforward explanations of procedures
b. be sympathetic about the patient's fears
c. set firm limits on the patient's behavior
d. avoid isolating the patient
e. let the patient share in the treatment decisions

I'm with C. All about the behavior smackdown.

I think the answer is E. I definately could be wrong. Though, I like your reasoning.

I think this question is about a patient that is hostile secondary to fear and frustration. Frustration is compounded when one cannot see an reasonable explanation for the frustration.

Answer C definitely appeases the psychiatrist's own frustration with a hostile patient.

Answer E (in my opinion) is also incorrect as the patient's treatment decision would be immediate release from the hospital, which is likely not an option.

I like answer A, straightforward explanations that the patient will not necessarily like and/or agree with but which can reduce frustration by conveying why there is a difference in the patient's desires and the treatment team's desires. i.e.,

1) you are hospitalized because you were found with a belt wrapped around your neck in your PCP's office.

2) You meet criteria for a major depressive episode that requires treatment with therapy and <x> biological intervention

3) You will be released from the hospital immediately, when it can be reasonably determined that you are no longer a danger to yourself.

 

[Anasazi23]

I think this question is about a patient that is hostile secondary to fear and frustration. Frustration is compounded when one cannot see an reasonable explanation for the frustration.

Answer C definitely appeases the psychiatrist's own frustration with a hostile patient.

Answer E (in my opinion) is also incorrect as the patient's treatment decision would be immediate release from the hospital, which is likely not an option.

I like answer A, straightforward explanations that the patient will not necessarily like and/or agree with but which can reduce frustration by conveying why there is a difference in the patient's desires and the treatment team's desires. i.e.,

1) you are hospitalized because you were found with a belt wrapped around your neck in your PCP's office.

2) You meet criteria for a major depressive episode that requires treatment with therapy and <x> biological intervention

3) You will be released from the hospital immediately, when it can be reasonably determined that you are no longer a danger to yourself.

Obviously, letting the patient go is not a reasonable option. Offering the patient some treatment options to some degree is reasonable. This is often talked about in hospitals as a way to empower the patient, so that they do not feel helpless, and that by giving some control (whether perceived or not), the hostility and frustration level is reduced. This in turn reduces agitation, which allows for a smaller chance at violence.

Examples would include choice of seclusion or restraint (part of psychiatric advanced directives). Choices of PO or IM medications. Choices of behavioral neuroleptic, etc.

Then again, I could be totally wrong; this is why I hate multiple choice tests.

 

[Anasazi23]

1-9. The psychotropic drug with the lowest degree of lipid solubility is:

a. chlorpromazine
b. haloperidol
c. amitriptyline
d. lithium carbonate
e. diazepam

A. Chlorpromazine

The point of this question is to determine relative safety in the pregnant patient. The higher the degree of lipid solubility, the more likely the molecule (inversely proportional to molecular weight) will pass through the placenta, or be excreted in the breast milk.

Chlorpromazine has some data that it does not cause fetal congenital malformation. Whether or not this is due directly to it's lipid solubility, I don't know. This is my best guess.

 

[psych2b]

I think this question is about a patient that is hostile secondary to fear and frustration. Frustration is compounded when one cannot see an reasonable explanation for the frustration.

Answer C definitely appeases the psychiatrist's own frustration with a hostile patient.

Answer E (in my opinion) is also incorrect as the patient's treatment decision would be immediate release from the hospital, which is likely not an option.

I like answer A, straightforward explanations that the patient will not necessarily like and/or agree with but which can reduce frustration by conveying why there is a difference in the patient's desires and the treatment team's desires. i.e.,

1) you are hospitalized because you were found with a belt wrapped around your neck in your PCP's office.

2) You meet criteria for a major depressive episode that requires treatment with therapy and <x> biological intervention

3) You will be released from the hospital immediately, when it can be reasonably determined that you are no longer a danger to yourself.

Totally digging your rationale for A. Very ethical/professional. Not what I would've picked, but the one I WISH I would've picked.