4.4 Therapeutics Quiz

Which of the following is correct regarding the autonomic nervous system (ANS)?

Which of the following changes could theoretically happen in a person when the parasympathetic system is inhibited using a pharmacological agent?

Which of the following statements is correct regarding the sympathetic and parasympathetic systems?

Which of the following is correct regarding membrane receptors and signal transduction?

In Alzheimer’s disease, there is a deficiency of cholinergic neuronal function in the brain. Theoretically, which of the following strategies will be useful in treating the symptoms of Alzheimer’s disease?

Atropa belladonna is a plant that contains atropine (a muscarinic antagonist). Which of the following drugs or classes of drugs will be useful in treating poisoning with belladonna?

Peripheral adverse effects of levodopa, including nausea, hypotension, and cardiac arrhythmias, can be diminished by including which of the following drugs in the therapy?

A 71-year-old presents with type I bipolar disorder, which is treated with lithium 300 mg twice daily. A lithium serum concentration, obtained yesterday before the morning lithium dose, is 1.0 mEq/L. There have been no manic symptoms for the past few years. Current admission is for a suicide attempt using acetaminophen. For the past few weeks, they have lost interest in their job and isolated themselves from other people. Which medication would best help the acute symptoms?

Which medication is a glutamate receptor antagonist that can be used in combination with an acetylcholinesterase inhibitor to manage the symptoms of Alzheimer’s disease?

Which one of the following statements is correct regarding the anxiolytic and hypnotic agents?

A 20-year-old Male patient present with chief complaint of insomnia Which one of the following is a better option for sleep induction?

Josh a 40-year-old male patient has been diagnosed for acute anxiety Which of the following agents has a rapid anxiolytic effect and would be best for the acute management of anxiety?

A 55-year-old woman presents with major depression . Concomitant medical conditions include a history of DM, cancer, dyslipidaemia, osteoarthritis, Hypertension , and osteopenia. She is on antidepressant . She want to know that Which antidepressant is the most sedating?

A 74-year-old has difficulty getting to sleep. Once asleep, rest is comfortable throughout the night. Clozapine differs from typical antipsychotic drugs in having a

A 22-year-old HIV patient has been told that marijuana may benefit him should he start using the substance. Which of the following adverse effects has been associated with marijuana usage and may be a reason for this patient to avoid use of marijuana?

A 21-year-old college student is curious about the effects of LSD. She asks what type of risks may be involved with using the drug for the first time. Which of the following is a correct response to her question?

A 58-year-old male is brought into the emergency department following an automobile accident. His blood alcohol level on admission is 280 mg/dL. He has been treated in the past for seizures related to alcohol abuse, and he confirms that he has been drinking heavily over the past month since losing his job. What treatment should be given to this patient if he begins to go into withdrawal while hospitalized?

A 35-year-old man has been abusing cocaine and is agitated, tachycardic, hypertensive, and hyperthermic. Which of the following is correct regarding treatment in this situation?

A 22-year-old man with a history of substance abuse arrives in the emergency department hypertensive, hyperthermic, and tachycardic, with altered mental status and hyperreflexia. His friends say he has been snorting “bath salts.” Which of the following is correct regarding this patient?

JM is a 10-year-old male who is sent to a paediatric neurologist for an evaluation due to receiving poor grades in class. JM’s parents have recently received complaints from his teacher that he is performing poorly in school and he is repeatedly caught not paying attention in class. Several times a day during class, JM is noted to be getting out of his chair and socializing with other students. He has also been getting into fights with some children, as he is being singled out by others and teased. JM is given a diagnosis of ADHD with impulsivity and irritability. Which of the following is the most appropriate recommendation for management of the ADHD?

Which of the following treatments for ADHD is a controlled substance (DEA Schedule II)?

Which of the following CNS stimulants occurs naturally and can be found in certain sweets?

A 21-year-old has newly diagnosed OCD. They cannot hold a job because they are consumed by their obsessions and compulsions. They are convinced that their obsessions are reality. Which medication is most appropriate to initiate?

A 4-year-old female presents to the emergency department with CNS depression. Her vital signs indicate that she is slightly bradycardic and slightly hypotensive for her age. Upon further questioning, the mother admits that there are two clonidine 0.2 mg tablets missing from the home. Which of the following antidotes might be beneficial for this patient?

A 3-year-old healthy female ingested one of her mother’s 1 mg Alprazolam tablets 45 minutes ago. The child presented to the emergency department with CNS depression but a normal heart rate and blood pressure. Her bedside glucose check is also normal. Which of the following antidotes might be helpful?

A 34-year-old male with a history of a seizure disorder, maintained on phenytoin and phenobarbital, presented to the emergency department for CNS depression. The phenobarbital level was 70 mg/L (15 to 40 mg/L therapeutic range) and the phenytoin level was 15 mg/L (10 to 20 mg/L therapeutic range). He denies any acute ingestion. What therapy can be considered to enhance the elimination of phenobarbital without impacting the phenytoin?

A 30-year-old patient with a 20-year history of alcohol dependence was found unconscious after a drinking binge. The patient was first admitted to the medical unit for alcohol withdrawal symptoms before being transferred to the substance dependence unit. The last drink was 8 hours ago, and fluids have been initiated. The patient has had three alcohol withdrawal seizures in the past and an episode of delirium tremens. Which symptom are you most likely to observe in the medical unit in this patient on admission?

An 80-year-old woman presents to your clinic accompanied by her daughter, who no longer feels comfortable leaving her mother alone because of her mother’s “increasing forgetfulness.” The patient’s medical history is significant for type 2 diabetes, hypertension, coronary artery disease, congestive heart failure, and OA. She takes the following medications: Paracetamol 1g every 6 hours as needed for pain, lisinopril 20 mg daily, furosemide 20 mg daily, potassium chloride 20 mEq daily, carvedilol 12.5 mg twice daily, and glipizide 5 mg daily. One year later, the patient returns to the clinic. She has moved in with her daughter. Lately, she wanders around the house continuously. She often changes clothes, cries out, and asks repetitive questions. Her current medication regimen includes rivastigmine 9.5 transdermal patch daily, which she has been taking for the past 6 months. Which would be most appropriate for this patient’s new behavioral symptoms?

A 70-year-old woman is admitted to the hospital with a broken arm after a fall. While in the hospital, she is on bedrest most of the time, loses 2 kg (current weight 63 kg), and has trouble sleeping. She is to be discharged to a rehabilitation facility for 2–3 weeks of therapy. Her medications at discharge are glipizide 5 mg daily, lisinopril 10 mg daily, aspirin 81 mg daily, a multivitamin daily, mirtazapine 15 mg at bedtime, calcium 500 mg twice daily, and tramadol 25 mg every 8 hours as needed for pain. To maintain and improve function in this patient, which intervention is best to implement?

A 75-year-old woman with AD who lives at home with her husband has been treated with Donepezil 10 mg daily for about 3 years. When she began therapy, her MMSE score was 21/30; her present MMSE score is 17/30. The patient cannot perform most IADLs but can perform most ADLs with cueing. About 2 months ago, her Donepezil dose was increased to 20 mg, but she could not tolerate it, and it was reduced back to 10 mg daily. Her husband asks about changing her drug treatment to help maintain her function. Which is the next best course of action?

A 75-year-old woman with AD who lives at home with her husband has been treated with Donepezil 10 mg daily for about 3 years. When she began therapy, her MMSE score was 21/30; her present MMSE score is 17/30. The patient cannot perform most IADLs but can perform most ADLs with cueing. About 2 months ago, her Donepezil dose was increased to 20 mg, but she could not tolerate it, and it was reduced back to 10 mg daily. After 2 months, the patient’s agitation increases such that the nursing staff cannot bathe or feed her. Assuming nonpharmacologic approaches are ineffective, which is the best pharmacologic approach to treat her behavioral symptoms?

A 37-year-old Caucasian male with a history of chronic paranoid schizophrenia is hospitalized for a relapse of symptoms. He is given parenteral haloperidol because he is very agitated and threatening. The patient continues to be belligerent and has to be put in physical restraints. The next day the patient is less agitated and belligerent, but he reports feeling nauseated and tired and toward evening is found to be disoriented to time and place. His laboratory work-up shows an increase in BUN and creatinine. He is diagnosed with acute renal failure and transferred to the medical floor. What could be the cause of his acute presentation?

Which of the following is one of the four As identified by Eugene Bleuler as the primary symptoms of schizophrenia?

A 23-year-old college student is brought to the ER in the early morning by friends who found him behaving strangely. He was very irritable, abusive, and assaultive toward them. He also reported getting special messages from the TV instructing him to perform special missions. What should the psychiatry resident who sees him in the ER do first?

Which of the following neurotransmitters has been implicated in the pathophysiology of schizophrenia?

Which of the following is the most common symptom of acute schizophrenia?

Which of the following atypical antipsychotics used in the treatment of schizophrenia is also a norepinephrine reuptake inhibitor?

Which of the following is a positive symptom of schizophrenia?

In persons with schizophrenia, paranoid symptoms are more common in?

Plasma levels of clozapine should be above what level for an adequate response?

The dose of lamotrigine should be lower than the usual dose, if lamotrigine is used in combination with which medication?

Evidence exists for the effectiveness of all of the following antiepileptics as mood stabilizers except?

A 67-year-old woman with depression and anxiety is prescribed paroxetine and clonazepam by her primary care physician. She also has a history of seizure disorder, which has been stable with phenytoin for many years. A few weeks after she begins taking paroxetine and clonazepam, the patient complains of unsteady gait. Which of the following is the most common cause of ataxia in this patient?

A 23-year-old woman is diagnosed with schizophrenia, paranoid type, following a first episode of psychosis and is started on an atypical antipsychotic. She is worried that the antipsychotics will cause weight gain. Which of the following is the most accurate statement regarding weight gain and antipsychotics?

A 48-year-old male patient with difficult-to-treat depression has tried all the antidepressants except MAOIs. He is currently on an SSRI. Which of the following SSRIs needs the longest washout period before switching a patient to an MAOI?

Which of the following tricyclic antidepressants closely resembles an SSRI in its action mechanism?

Which of the following can cause depression?

All of the following are true about Zopiclone except?

Venlafaxine mechanism of action is described as?

A 48-year-old man with treatment-resistant schizophrenia has been relatively stable for the past 6 months on clozapine. On a routine follow-up visit, the patient is observed to be depressed and reports lack of appetite and insomnia, among other features of depression. The attending psychiatrist decides to treat the patient with antidepressants. Which of the following antidepressants would mandate particular caution in this patient?

An obese 24-year-old woman is admitted to the psychiatry inpatient unit following an overdose of Tylenol. She has a history of being impulsive and on occasion has induced vomiting, but these instances were not frequent enough to warrant diagnosis of an eating disorder. Over the course of the next few days of observation, the psychiatrist determines that she is depressed and the treatment team debates over the choice of antidepressants. Which of the following would be the most appropriate in this patient?

What does the term “double depression” describe?

All of the following antidepressants increase serotonin neurotransmission by reuptake inhibition except?

A 73-year-old woman with a diagnosis of major depressive disorder fails to respond to treatment with an SSRI. The psychiatrist discusses the option of starting a tricyclic antidepressant. The woman states that “anything” is fine except that she does not like to be sedated by medications. Which of the following tricyclic antidepressants is relatively less sedating?

All of the following are side effects resulting from muscarinic receptor blockade of antidepressants except?

All of the following are known causes of secondary mania except?

Following childbirth, a 32-year-old woman has developed severe depression. The woman refuses to eat, is found to be very agitated, and is expressing fears that her baby has an incurable illness. What is the most appropriate treatment at this point?

A 26-year-old woman presents who appears to have generalized anxiety disorder with panic attacks. Terrified by the panic attacks, she requests medication, saying: “I need something to control them immediately.” She is otherwise fit and healthy and has no history of any substance abuse or dependence. A reasonable approach would be to?

28-year-old female patient is diagnosed with generalized anxiety disorder and substance abuse. A trial of SSRIs fails, and the physician is reluctant to prescribe any benzodiazepines for symptomatic relief in view of the patient’s history of substance abuse. He prescribes buspirone. Buspirone acts as a what description?

People with anxiety disorders have all of the following cardiac abnormalities except?

All of the following neurotransmitter abnormalities are detected in anxiety disorders except?

A 24-year-old woman is diagnosed with social phobia. All of the following are effective treatments except?

A 65-year-old man experiences a panic attack for the first time. He also has angina and COPD. The physician makes a diagnosis of organic anxiety syndrome. All of the following are features of organic anxiety syndrome except?

A 36-year-old woman is diagnosed with post-traumatic stress disorder following a violent assault and rape. Over the next 2 years, although the posttraumatic stress disorder abates, she feels anxious and depressed and starts using alcohol and other illicit drugs. Which of the following is the most common comorbid condition in women with PTSD?

Which of the following SSRIs has been approved by the FDA for the treatment of post-traumatic stress disorder?

42-year-old male is diagnosed with dissociative fugue after he is found in a nearby town 3 days after his “disappearance.” The patient has a hard time understanding the concept of dissociative fugue and would like to “come to terms” with what has happened. The choice of treatment, in this patient would be?

Which of the following is associated with impaired consciousness?

Which of the following terms describes the primary mechanism of neurotransmission in the autonomic ganglia?

Which of the following is not a feature of migraine?

55-year-old male being treated for hypertension has a headache of sudden onset that he describes as the worst ever in his life. What is the most likely cause of the headache?

All of the following are common presentations of psychosis in patients with Parkinson disease except?

A 70-year-old presents for evaluation of forgetfulness. Early dementia is suspected. Alzheimer dementia is most likely with which of the following symptoms?

Which of the following is seen in Tourette syndrome?

What is the treatment of choice for subacute combined degeneration?

A 62-year-old man with diabetes and hypertension is admitted to the emergency department because he has a severe headache and acute onset of double vision. Examination reveals that the man has ptosis on the right side and an inability to elevate or adduct the right eye, although lateral eye movements are spared. The man’s right pupil is dilated and unreactive. What is the most likely diagnosis?

A 54-year-old woman presents for assessment because of headaches and vision problems. Examination reveals that the patient has bitemporal hemianopia. What is the most likely cause of the patient’s problems?

A family brings in their 1- week- old child for evaluation. The patient is having multiple brief focal clonic seizures per day. They started at 3 days of life. She has not had fever. The examination findings are normal. Her inter- ictal EEG is normal. The family reports that the patient’s father, paternal uncle, and paternal grandmother had similar events, but their seizures resolved before 1 month of age and they had no further neurologic problems. A defect in which of the following structures is most likely?

An 18- year- old female patient who is taking Valproic acid for juvenile myoclonic epilepsy (JME) asks for a different medicine because she is gaining too much weight. The decision is made to transition her from Valproic acid to Lamotrigine. Three weeks later, she calls to report a rash that seems to be spreading. What is the next step?

A 26- year- old man has right temporal lobe epilepsy. His seizures have not responded to Levetiracetam or Lacosamide. What is the next step?

A 7- year- old boy presents with frequent staring episodes. The mother says he pauses during activities, stares off, and then returns to the activity. She can’t get his attention during the episodes. He is normal afterward. This occurs multiple times per day. His mother states that he once had an episode while blowing a pinwheel. He is otherwise normal, and his neurologic examination is normal. What is the medication of choice?

A 20- year- old woman with Lennox-Gastault syndrome has daily myoclonic, atonic, and tonic seizures. Her seizures have not responded to Levetiracetam, Topiramate, Zonisamide, Clobazam, Clonazepam, or Rufinamide. Which medication should be considered?

A 32- year- old woman with a history of frequent migraines presents after having three focal- onset seizures. Her family history is remarkable for osteoporosis. Her EEG shows occasional right frontal epileptiform discharges. What do you recommend?

Which of the following medications may be associated with polycystic ovary syndrome and fatal haemorrhagic pancreatitis?

A 30- year- old woman presents in generalized status epilepticus. Which of the following medications should be administered intravenously first?

Which of the following anti- epileptic medications is not a T- type (low voltage‒activated) calcium channel blocker?

Which of the following medications can exhibit zero order kinetics?

Which of the following anti- epileptic medications is not usually associated with weight loss?

Which of the following medications places people of Asian descent with the HLA- B*1502 antigen at higher risk for Stephens- Johnson syndrome than other patients taking the same medication?

Which of the following medications can increase absence and myoclonic seizures?

A 75- year- old woman presents with confusion. Her laboratory studies show hyponatremia. Which of the following medications is most likely to cause this condition?

Which of the following medications has high protein binding?

Which of the following statements is false regarding the diagnosis of attention deficit hyperactivity disorder (ADHD) in the DSM- 5?

A 20- year- old patient believes that his neighbour is a spy. He has been convinced of this for 3 months. Despite this belief, the patient is able to function normally. Apart from avoiding his neighbour, the patient behaves normally. What is the most likely diagnosis?

A 20- year- old woman with bulimia is diagnosed with depression. Which of the following antidepressants should be avoided?

Which of the following is not usually a side effect of tricyclic antidepressants (TCAs)?

Which of the following statements about Clozapine is false?

Which of the following is preferred for short- term treatment of tardive dyskinesia symptoms?

Which of the following is not usually a side effect of Lithium?

An 18- year-old patient presents with altered mental status, mydriasis, tachycardia, dry mucous membranes, and decreased bowel sounds. Which of the following medications is most likely responsible?

Which of the following medications is used least often to treat restless leg syndrome?

Which of the following medications does not increase slow-wave sleep?

Which of the following medications inhibits aldehyde dehydrogenase and has been used to treat alcohol dependence but requires abstention from alcohol in medicines and desserts in order to avoid unpleasant symptoms?

A 56 year-old woman presents with confusion, wide based gait, and dysconjugate gaze. She smells of alcohol. What is the best treatment?

At which receptor does Lysergic acid diethylamide (LSD) primarily act?

A 20 year-old post-operative patient is difficult to arouse. On examination, his pupils are pinpoint and he has slowed respirations. Which of the following medications is most likely to be diagnostic and therapeutic?

Which of the following is most likely to cause seizures, delirium, myoclonus, and tremor?

A child presents with altered mental status, diaphoresis, salivation, vomiting, and diarrhoea. Which of the following is the most likely cause?

A 52 years old female who was diagnosed with a meningioma underwent surgery. After tumour resection the patient experienced episodes of seizures. Her neurosurgeon recommended her anti-epileptics Anti-epileptics have been known to affect mental health. Following the use of medication, the patient starts overthinking, experiences negative thoughts and has suicidal ideation. Her psychiatrist starts giving her a new therapy to overcome her psychiatric illness. What is the most suitable therapy for this patient?