Geriatric QB 3

1. Schizoaffective disorder dx requirement
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11. What is treatment for NMSCooling, stopping agent, using dantrolene(muscle relaxant)/bromocriptine (dopamine agonist (also used in hyperprolactinemia). Dantrolene is not used for seratonin syndrome12. Toxic exposure of lead/aluminum/manganese/bismuth/cyanide can lead to encephalopathy. Match the toxin to the following unique clinical finding 1. Blue/black gum line + skin lichen lesions+black stool 2. Parkinson-like sxs 3. Generalized weakness/tachypnea/hypoxia 4. motor neuropathy (symmetric distal weakness associated with atrophy, reflex loss, and occasionally fasciculations) 5. Associated with NCD1. Blue/black gum line + skin lichen lesions+black stool - Bismuth poisoning 2. Parkinson-like sxs - manganese can cause manganese madness with compulsive+impulsive acts + hallucinations 3. Generalized weakness/tachypnea/hypoxia - cyanide poisoning(least specific, but can see a cherry red color due to excess oxygen in the bloodstream. 4. Motor neuropathy - lead poisoning 5. Associated with NCD - Aluminum poisoning13. CBSST (Cognitive-behavioral social skills training) and HOPES (Helping older people experience success) are 2 social skills training non-pharmacological interventions, which specific population are they meant forFor serious mental illness like schizophrenia - CBSST is for middle/older pts only with schizophrenia whereas HOPES is combining social skills training and preventive health care for older adults with serious chronic mental illness like schizophrenia (more general)14. What are some examples of tests that test for executive dysfunctionTrails test, Wisconsin card sorting test (evaluates abstract reasoning and flexibility in problem solving), Stroop task (different colors spelled out with different colors like PURPLE in green color - which measures selective attention, cognitive flexibility and processing speed which area all exec functioning related) and the Tower of London Test15. Late onset bipolar (like 1st mania in 50s-60s) is strongly related to whatLate-onset bipolar disorder accounts for approximately 10% of bipolar disorder diagnoses among the elderly. Strongly related to the presence of cerebrovascular disease, cognitive impairment, and neurological dysfunction16. For CJD or Creutzfeldt-Jakob disease what is presentation and life expectancy, also what do you see in EEG and in CSF that is unique?Rapidly progressive cognitive decline and behavioral change, as well as gait disturbance, myoclonic jerks, and fatigue. Life expectancy is 1 year! In EEG hallmark sign of CJD is periodic spike and slow wave complexes on EEG. In CSF see elevated 14-3-3 protein. Also cortical ribonning in MRI.17. For pt with liver cirrhosis which antidepressant is safestMost antidepressant are metabolized in liver so can dmg liver or accumulate due to low liver function (even Zoloft/trazodone etc). Fluvoxamine is a safe drug to give in patients with extensive liver damage as it does not cause further hepatotoxicity and does not have extensive first-pass metabolism.18. Visual hallucinations that are unique to seeing small things ("liluputian in nature:) can occur in related to eye issues (like macular degeneration). What is it called and are antipsychotics effectiveCharles bonnet syndrome, Antipsychotics do not help. Therapy maybe helpful if distressing but if not distressing, can just reassure patients and help with coping skills.19. What is expected change in cognitive scores with cholinesterase inhibitors in MMSE and ADAS-Cog ScaleMMSE 1 point per year, ADAS-Cog -2.7pts20. What are common sxs between NPH and depressionApathy and depression also present in NPH21. If pts are showing sexual disinhibition or sexual inappropriate behaviors, what drugs can cause it and what can we doDopamine agonists can cause it. Reduce dose, can consider nonpharm interventions +CBT/psychoeducation first as meds have no RCTs - can try SSRI, antipsychotics, anti-androgen agents Or maybe even Medroxyprogesterone (MPA) does not bind to androgen receptors, but indirectly decreases the level of testosterone by inhibiting the secretion of pituitary luteinizing hormone (LH) and follicle-stimulating hormone (FSH) as last resort?22. Among SSRIs we usually consider citalopram, escitalopram and Zoloft as the least side effect profile (except for GI issues with Zoloft) - why is this the caseThese have lowest profile of messing with cytochrome P450 induction, inhibition, or competition23. Following ECT remission for SI, what is the most effective therapy for long term tx (psychotherapy/cbt/psychotropics etc)Pharmacotherapy for post treatment maintenance. ECT is generally acute tx, only if post-pharmacotherapy tx relapse occurs can continue ECT upto 6 mos and even maintenance more than that.24. In histology, Where do we see the following 1. Coiled bodies (comma shaped) 2. Papp-Lantos bodies (inclusion bodies in glial cells), 3. Hirano bodies (eosinophilic rod like bodies)Coiled bodies (comma shaped) - in PSP, ) 2. Papp-Lantos bodies (inclusion bodies in glial cells) in Multiple system atrophy, 3. Hirano bodies (eosinophilic rod like bodies) seen in Alzheimers25. Epidural vs subdural vs subarachnoid bleeds - give presentations and respective arteries/veins involved with bleedEpidural classic brief loss of consciousness with a period of lucidness followed by deterioration - bleed at middle meningeal artery with lens shaped appearance. Subdural bleeds usually seen in alcoholics with bridging veins bleed, presents as subtle cognitive changes with worsening gait, symptoms can take as long as a number of weeks to notice in mild cases. Subarachnoid hemorrhage classically presents as "worst headache of my life" from bleed intracranial aneurysm bleed (say AVM malformation)/rupture - damage to RAS (reticular activating system in brain stem) can cause unconsciousness, frontal lobe damage from TBI can cause frontal lobe issues (executive fn, planning, impulsivity etc).26. Which antipsychotic has least chance of getting TardiveDyskinesia so switch to this if you see itSeroquel (not abilify), abilify does have low risk for dyskinesia and low Qtc though and no risk of anticholinergic side effects!.27. Which antipsychotic can be used for liver cirrhosis/hepatic impairment and hence does not need dose adjustmentAbilify as even though it has liver metabolism, it is safe in elderly with hepatic impairment and no cases of liver injury has been reported.28. Can fluoxetine cause akathisia or tremorsYes but this is rare.29. What is the preferred mood stabilizer for rapid cycling bipolarLithium then Valproate/Depakote.30. What are sexual side effects of SSRI/SNRITreatment with SSRIs and SNRIs are associated with sexual dysfunction, including loss of libido, inability to achieve orgasm, premature ejaculation, performance anxiety, erection problems31. Serotonin syndrome can be caused by combination to which agents in particularMAOI, lithium, linezolid32. In serotonin syndrome if pt has fever and temperature is higher than 41 degC or 105 deg F, what should the treatment includeIntubation with neuromuscular paralysis first then hydration etc33. Can thiazide lower serum sodiumYes but it is very rare and not of consequence unless we are also restricting salt intake.34. Can putting up bed rails shown to be helpful for delirium, what about putting in urinary Foley cathetersNo, both are not helpful to delirium nor have prophylactic antipsychotics shown benefit.35. Atypical vs typical initiation, what labs do you need to considerFor atypical consider metabolic syndrome so at baseline, a fasting lipid panel, weight, and fasting plasma glucose levels. For typical get EKG for Qtc monitoring nothing else.36. How long do we need to stop MAOI before starting SSRI/SNRIAtleast 2 weeks37. What are the differential diagnosis for daytime fatigue (4)Diff dx for excessive daytime sleepiness (EDS) include obstructive sleep apnea, periodic limb movement disorder, narcolepsy, and hypersomnias of various types38. For apathy in recently dx Parkinson's pt what can you useDopamine plays a role in motivating decision-making and is, therefore, suggested as apathy treatment in PD patients.39. What are sexual functioning changes in agingSexual functioning changes in the elderly include slowing in reaching arousal, delayed ejaculation, and decreased erotic sensitivity.40. Anticholinergic medications (acetylcholinesterase inhibitors, TCAs, atypicals) should be used with caution with pts with COPD or asthma whyPatients with a history of asthma or COPD potentially can experience increased airway reactivity and bronchoconstriction due to parasympathetic pathway.41. Which cancer treatment is linked to depression or suicidal thoughtsInterferon-alpha is an antiviral and immunomodulatory glycoprotein that is documented to result in patients experiencing suicidal thoughts42. Late onset schizophrenia can occur more in males or femalesTill age 45 incidence is about same, after that more often in females (75%!). Look for disorganized thinking, social withdrawal, psychosis persisting for >6 mos43. What timeline do you start considering Persistent complex bereavement disorder12 mos after death of loved one.44. Which among these have lowest risk of developing hyponatremia - Lexapro, Zoloft, Prozac or RemeronRemeron45. Which outcome has been shown by cholinesterase inhibitorsDelay nursing home placement, minor increase in MMSE46. Can psychiatrists accept any gifts from patientsCan accept small gifts as token of appreciation that do not influence care, in general don't accept.47. Information retrieval rather than storage (I.e. recall with cues successful but not delayed recall) may indicate AD or Vacsular dementiaVascular dementia. Neuropsychological testing reveals difficulty with retrieval, rather than storage, of information, a pattern consistent with neurocognitive disorder due to vascular disease.48. Can opioid withdrawal cause deliriumYes, Opioid withdrawal is one of the leading causes of delirium, especially in elderly patients taking it long-term49. APOE2 is protective against AD but what is a problem with thisCan increase cerebral amyloid angiopathy (CAA), a disease characterized by deposition of beta amyloid in the cerebral blood vessels, CAA can predispose a patient to lobar hemorrhage. So increases risk of this!