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Depression Quiz


Depression Quiz

since most of you guys are prep for Step1, so i thought it would be a good idea to cover this topic also

(والمؤمنون والمؤمنات بعضهم أولياء بعض يأمرون بالمعروف وينهون عن المنكر ويقيمون الصلاة ويؤتون الزكاة ويطيعون الله و رسوله أولئك سيرحمهم الله إن الله عزيز حكيم)

Al Durra's picture
by
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1) You suspect a 72-year-old woman that you are evaluating for painful peripheral neuropathy due to diabetes is depressed. Past medical history also includes hypertension. She was treated for panic disorder in the past. Medications include metformin and lisinopril/HCTZ. Family history is notable for schizophrenia. Risk factors for depression in this woman include:

a). Peripheral neuropathy and family history of schizophrenia

b). Peripheral neuropathy and hypertension

c). Family history of schizophrenia and treatment with metformin

d). Female gender and advanced age

2) A 54-year-old woman presents with complaints of fatigue. Despite being fatigued, she has trouble falling asleep, and notes her sleep is heavily interrupted. Symptoms have been present for three months. She divorced her husband six months ago; finances have been tight ever since. She is not getting along with her daughter, whom she feels has sided with her ex-husband. She admits to feeling "depressed," enjoys little, and feels guilty about her failed marriage. She has no appetite and has lost 12 pounds since her last visit. However, she is functional at work, and denies feeling suicidal.
Which ONE of the following statements concerning this patient is true?

a). Psychotherapy is superior to pharmacotherapy at inducing long-term remissions in depressed patients.

b). Patients such as this one, with multiple external stressors, respond better to pharmacotherapy than to counseling.

c). If a patient has depression and a personality disorder, pharmacotherapy is superior to psychotherapy for management of both disorders.

d). Patients who miss work frequently because of depression should be treated with both pharmacotherapy and counseling.

3) You diagnose a 37-year-old woman with depression. Which one of the following statements about suicide risk is true?

a). Suicide risk decreases once treatment has begun.

b). Obtaining a promise from the patient to not harm herself ("contracting for safety") is required before she leaves the office.

c). Suicide risk increases with a more specific plan on how to commit suicide.

d). Women are more at risk for committing suicide than men.

4) A 55-year-old male is diagnosed with depression. Past history is notable for diabetes, hypothyroidism, benign prostatic hypertrophy, and painful peripheral neuropathy. Medications include insulin, tamsulosin, and levothyroxine. Among the choices provided, which antidepressant is the most appropriate for treating this patient?

a). Amitriptyline

b). Sertraline

c). Imipramine

d). Venlafaxine

5) When starting pharmacotherapy for the treatment of depression, which ONE of the following statements is true?

a). Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are equally dangerous if used for overdose in a suicide attempt.

b). SSRIs are superior to TCAs in achieving a clinical response.

c). Delayed ejaculation is the most common complaint (side effect) given by men treated with TCAs.

d). Bupropion increases the risk of seizure, especially early in treatment.

6) A 38-year-old male is being treated for depression with sertraline. He is pleased with the clinical response, feeling "about 70%" improved. He is currently on 100mg of sertraline; higher doses cause delayed ejaculation and diarrhea. He would like to feel better, and asks you to help. He is not interested in getting counseling. Among the options listed, which is the most appropriate to result in improvement in his mood?

a). Increase sertraline and add Imodium to treat diarrhea.

b). Add bupropion sustained-release

c). Add amitriptyline nightly

d). Switch sertraline to paroxetine

7) A 37-year-old man comes in for follow up. He has responded to treatment with paroxetine, and has felt well for six months. He has no family history of depression, feels back to his "old self", and wants to discontinue therapy.
Which ONE of the following statements concerning this patient is true?

a). It is premature to discontinue medication at this time.

b). SSRIs should be tapered over two to three months in order to avoid withdrawal symptoms.

c). Patients may be appropriately discontinued from treatment for depression three months after a response to treatment has been seen.

d). The patient should be referred to a psychiatrist to replace pharmacotherapy with counseling.
-END-

Al Durra's picture
Al Durra
بعد التخرج


up

Al Durra's picture
Al Durra
بعد التخرج


1) You suspect a 72-year-old woman that you are evaluating for painful peripheral neuropathy due to diabetes is depressed. Past medical history also includes hypertension. She was treated for panic disorder in the past. Medications include metformin and lisinopril/HCTZ. Family history is notable for schizophrenia. Risk factors for depression in this woman include:

a). Peripheral neuropathy and family history of schizophrenia

b). Peripheral neuropathy and hypertension

c). Family history of schizophrenia and treatment with metformin

d). Female gender and advanced age

2) A 54-year-old woman presents with complaints of fatigue. Despite being fatigued, she has trouble falling asleep, and notes her sleep is heavily interrupted. Symptoms have been present for three months. She divorced her husband six months ago; finances have been tight ever since. She is not getting along with her daughter, whom she feels has sided with her ex-husband. She admits to feeling "depressed," enjoys little, and feels guilty about her failed marriage. She has no appetite and has lost 12 pounds since her last visit. However, she is functional at work, and denies feeling suicidal.
Which ONE of the following statements concerning this patient is true?

a). Psychotherapy is superior to pharmacotherapy at inducing long-term remissions in depressed patients.

b). Patients such as this one, with multiple external stressors, respond better to pharmacotherapy than to counseling.

c). If a patient has depression and a personality disorder, pharmacotherapy is superior to psychotherapy for management of both disorders.

d). Patients who miss work frequently because of depression should be treated with both pharmacotherapy and counseling.

3) You diagnose a 37-year-old woman with depression. Which one of the following statements about suicide risk is true?

a). Suicide risk decreases once treatment has begun.

b). Obtaining a promise from the patient to not harm herself ("contracting for safety") is required before she leaves the office.

c). Suicide risk increases with a more specific plan on how to commit suicide.

d). Women are more at risk for committing suicide than men.

4) A 55-year-old male is diagnosed with depression. Past history is notable for diabetes, hypothyroidism, benign prostatic hypertrophy, and painful peripheral neuropathy. Medications include insulin, tamsulosin, and levothyroxine. Among the choices provided, which antidepressant is the most appropriate for treating this patient?

a). Amitriptyline

b). Sertraline

c). Imipramine

d). Venlafaxine

5) When starting pharmacotherapy for the treatment of depression, which ONE of the following statements is true?

a). Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are equally dangerous if used for overdose in a suicide attempt.

b). SSRIs are superior to TCAs in achieving a clinical response.

c). Delayed ejaculation is the most common complaint (side effect) given by men treated with TCAs.

d). Bupropion increases the risk of seizure, especially early in treatment.

6) A 38-year-old male is being treated for depression with sertraline. He is pleased with the clinical response, feeling "about 70%" improved. He is currently on 100mg of sertraline; higher doses cause delayed ejaculation and diarrhea. He would like to feel better, and asks you to help. He is not interested in getting counseling. Among the options listed, which is the most appropriate to result in improvement in his mood?

a). Increase sertraline and add Imodium to treat diarrhea.

b). Add bupropion sustained-release

c). Add amitriptyline nightly

d). Switch sertraline to paroxetine

7) A 37-year-old man comes in for follow up. He has responded to treatment with paroxetine, and has felt well for six months. He has no family history of depression, feels back to his "old self", and wants to discontinue therapy.
Which ONE of the following statements concerning this patient is true?

a). It is premature to discontinue medication at this time.

b). SSRIs should be tapered over two to three months in order to avoid withdrawal symptoms.

c). Patients may be appropriately discontinued from treatment for depression three months after a response to treatment has been seen.

d). The patient should be referred to a psychiatrist to replace pharmacotherapy with counseling.
-END-

Green Wave's picture
Green Wave


green, 4/7

Al Durra's picture
Al Durra
بعد التخرج


1-d
2-b
3-c
4-c
5-d
6-a
7-b

hope that i score higher than 5

OmHa
السنة السادسة


OmHa, 4/7

Al Durra's picture
Al Durra
بعد التخرج


1) You suspect a 72-year-old woman that you are evaluating for painful peripheral neuropathy due to diabetes is depressed. Past medical history also includes hypertension. She was treated for panic disorder in the past. Medications include metformin and lisinopril/HCTZ. Family history is notable for schizophrenia. Risk factors for depression in this woman include:

a). Peripheral neuropathy and family history of schizophrenia

b). Peripheral neuropathy and hypertension

c). Family history of schizophrenia and treatment with metformin

d). Female gender and advanced age

2) A 54-year-old woman presents with complaints of fatigue. Despite being fatigued, she has trouble falling asleep, and notes her sleep is heavily interrupted. Symptoms have been present for three months. She divorced her husband six months ago; finances have been tight ever since. She is not getting along with her daughter, whom she feels has sided with her ex-husband. She admits to feeling "depressed," enjoys little, and feels guilty about her failed marriage. She has no appetite and has lost 12 pounds since her last visit. However, she is functional at work, and denies feeling suicidal.
Which ONE of the following statements concerning this patient is true?

a). Psychotherapy is superior to pharmacotherapy at inducing long-term remissions in depressed patients.

b). Patients such as this one, with multiple external stressors, respond better to pharmacotherapy than to counseling.

c). If a patient has depression and a personality disorder, pharmacotherapy is superior to psychotherapy for management of both disorders.

d). Patients who miss work frequently because of depression should be treated with both pharmacotherapy and counseling.

3) You diagnose a 37-year-old woman with depression. Which one of the following statements about suicide risk is true?

a). Suicide risk decreases once treatment has begun(nope,depressed pts commit suicide while they are in the euthymic stete of mind).

b). Obtaining a promise from the patient to not harm herself ("contracting for safety") is required before she leaves the office.

c). Suicide risk increases with a more specific plan on how to commit suicide.

d). Women are more at risk for committing suicide than men. ( they try more ,but men succeed more)

4) A 55-year-old male is diagnosed with depression. Past history is notable for diabetes, hypothyroidism, benign prostatic hypertrophy, and painful peripheral neuropathy. Medications include insulin, tamsulosin, and levothyroxine. Among the choices provided, which antidepressant is the most appropriate for treating this patient?

a). Amitriptyline

b). Sertraline

c). Imipramine

d). Venlafaxine

5) When starting pharmacotherapy for the treatment of depression, which ONE of the following statements is true?

a). Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are equally dangerous if used for overdose in a suicide attempt.

b). SSRIs are superior to TCAs in achieving a clinical response.

c). Delayed ejaculation is the most common complaint (side effect) given by men treated with TCAs.

d). Bupropion increases the risk of seizure, especially early in treatment.

6) A 38-year-old male is being treated for depression with sertraline. He is pleased with the clinical response, feeling "about 70%" improved. He is currently on 100mg of sertraline; higher doses cause delayed ejaculation and diarrhea. He would like to feel better, and asks you to help. He is not interested in getting counseling. Among the options listed, which is the most appropriate to result in improvement in his mood?

a). Increase sertraline and add Imodium to treat diarrhea.

b). Add bupropion sustained-release

c). Add amitriptyline nightly

d). Switch sertraline to paroxetine

7) A 37-year-old man comes in for follow up. He has responded to treatment with paroxetine, and has felt well for six months. He has no family history of depression, feels back to his "old self", and wants to discontinue therapy.
Which ONE of the following statements concerning this patient is true?

a). It is premature to discontinue medication at this time.

b). SSRIs should be tapered over two to three months in order to avoid withdrawal symptoms.

c). Patients may be appropriately discontinued from treatment for depression three months after a response to treatment has been seen.

d). The patient should be referred to a psychiatrist to replace pharmacotherapy with counseling.
-END-

mbs2380's picture
mbs2380
بعد التخرج


good job Bassam, 5/7

u are late this time

Al Durra's picture
Al Durra
بعد التخرج

Quote:
good job Bassam, 5/7

u are late this time

Yup,unfortunately , Step1 issues confused

mbs2380's picture
mbs2380
بعد التخرج


d 1
d 2
c 3
d 4
c 5
c 6
d 7

lonely
طبيب مقيم


lonely, 4/7

Al Durra's picture
Al Durra
بعد التخرج


Answers:
D
D
C
D
D
B
B

Discussion for Question 1
Risk factors for development of depression are as follows:
· Female gender

· Advancing age

· Past history of depression

· Family history of depression

· Other psychological conditions (anxiety, panic disorder, phobia)

· Chronic medical illness

· Chronic pain syndromes

· Substance abuse

· Multiple somatic complaints

Discussion for Question 2
In choosing therapy for a patient who has been diagnosed with depression, factors affecting that choice include the presence or absence of external stressors, the sense of endogenous low mood, and the severity of depression. Those who are unable to make it to work have moderate or severe depression, and should be treated with combination therapy (i.e. pharmacotherapy and counseling).

Discussion for Question 3
Depression carries with it the risk of suicide, which has been shown to increase early in treatment. Men are at greater risk for suicide than women. Contracting for safety is not a guarantee against suicide, particularly if no therapeutic bond exists between the patient and the practitioner. Physicians should inquire if the patient has suicidal ideation, intent or plan. The more specific the plan, the greater the risk of suicide.

Discussion for Question 4
When choosing pharmacotherapy for the depressed patient, recall that all medications are equal in efficacy. Side effects therefore become a major consideration in choosing pharmacotherapy. This patient has BPH, and would not tolerate anticholinergic side effects well; thus, the tricyclics amitriptyline and imipramine would be poor choices. Those with chronic pain may do better on an SNRI such as venlafaxine rather than an SSRI such as sertraline.

Discussion for Question 5
One nice feature of SSRIs is that they are not fatal in overdose, distinguishing them from TCAs. However, TCAs and SSRIs are equally effective at treating depression. SSRIs are associated with sexual side effects, including delayed ejaculation in men. Bupropion is a dopamine reuptake inhibitor that avoids the sexual side effects of SSRIs as well as the GI side effects of SSRIs, but increases the risk of seizure, especially early in treatment. It is often used in combination with SSRIs.

Discussion for Question 6
The patient has had some clinical response to sertraline, which might be lost by switching to another agent. Perhaps better would be to augment his response by adding bupropion, which has been proven effective in just such a clinical scenario

Discussion for Question 7
It is appropriate to consider discontinuation of therapy for depression after 6 months of clinical response (unless the patient has had prior episodes of depression; those patients will need longer treatment). SSRIs should be tapered to avoid withdrawal symptoms (which are essentially harmless, but unpleasant).

Thanks for your participation. It is appreciated.

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Al Durra
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