Maintenance therapy principles — MCQs

A 35-year-old man is brought to the emergency department by his wife. She was called by his coworkers to come and pick him up from work after he barged into the company’s board meeting and was being very disruptive as he ranted on about all the great ideas he had for the company. When they tried to reason with him, he became hostile and insisted that he should be the CEO as he knew what was best for the future of the company. The patient’s wife also noted that her husband has been up all night for the past few days but assumed that he was handling a big project at work. The patient has no significant past medical or psychiatric history. Which of the following treatments is most likely to benefit this patient’s condition?

A patient with a history of hypertension and bipolar disorder is seen in your clinic for new-onset tremor, increased urination, and mild dehydration symptoms. Her bipolar disorder has been well-controlled with her current medication regimen. She recently started a new medication for better management of her hypertension. Which of the following medications did she most likely start?

A 23-year-old woman is brought to the emergency department by emergency medical services. She was found trying to hang herself in her kitchen. The patient has a past medical history of drug abuse, alcoholism, anxiety, mania, irritable bowel syndrome, and hypertension. Her current medications include naltrexone, sodium docusate, and clonazepam as needed. Her temperature is 99.5°F (37.5°C), blood pressure is 100/65 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 99% on room air. On physical exam, you note a teary young woman. There are multiple bilateral superficial cuts along her wrists. The patient's cardiac and pulmonary exams are within normal limits. Neurological exam reveals a patient who is alert and oriented. The patient claims that you cannot send her home because if you do she will kill herself. Laboratory values are ordered and return as below. Hemoglobin: 15 g/dL Hematocrit: 40% Leukocyte count: 4,500 cells/mm^3 with normal differential Platelet count: 197,500/mm^3 Serum: Na+: 139 mEq/L Cl-: 102 mEq/L K+: 4.4 mEq/L HCO3-: 24 mEq/L BUN: 20 mg/dL Glucose: 90 mg/dL Creatinine: 1.0 mg/dL Ca2+: 10.2 mg/dL AST: 12 U/L ALT: 10 U/L The patient is transferred to the crisis intervention unit. Which of the following is the best next step in management?

A 22-year-old woman with a history of bipolar disorder presents to her psychiatrist’s office for a follow-up appointment. She says she is doing better on the new drug she was prescribed. However, she recently noticed that she is drinking a lot of water and urinates more frequently throughout the day. She also says there are moments recently when she feels confused and agitated. Her vitals include: blood pressure 122/89 mm Hg, temperature 36.7°C (98.0°F), pulse 88/min and respirations 18/min. Her physical examination is within normal limits. Which of the following drugs was she most likely prescribed?

A 45-year-old man is brought to the physician by his wife for the evaluation of abnormal sleep patterns that began 10 days ago. She reports that he has only been sleeping 2–3 hours nightly during this time and has been jogging for long periods of the night on the treadmill. The patient has also been excessively talkative and has missed work on several occasions to write emails to his friends and relatives to convince them to invest in a new business idea that he has had. He has chronic kidney disease requiring hemodialysis, but he has refused to take his medications because he believes that he is cured. Eight months ago, he had a 3-week long period of persistent sadness and was diagnosed with major depressive disorder. Mental status examination shows psychomotor agitation and pressured speech. Treatment of this patient's condition should include which of the following drugs?

A 34-year-old man is brought to a psychiatric hospital by friends for erratic behavior. He has been up for the past several nights painting his apartment walls purple and reading the Bible out loud, as well as talking fast and making sexually provocative comments. Collateral information from family reveals 2 similar episodes last year. Mental status exam is notable for labile affect and grandiose delusions. Urine toxicology is negative. The patient is admitted and started on lithium for mania. His symptoms resolve within 2 weeks. How should this patient’s lithium be managed in anticipation of discharge?

A 34-year-old woman presents with recurrent panic attacks that have been worsening over the past 5 weeks. She also says she has been seeing things that are not present in reality and is significantly bothered by a short attention span which has badly affected her job in the past 6 months. No significant past medical history. No current medications. The patient is afebrile and vital signs are within normal limits. Her BMI is 34 kg/m2. Physical examination is unremarkable. The patient is prescribed antipsychotic medication. She expresses concerns about any effects of the new medication on her weight. Which of the following medications would be the best course of treatment in this patient?

A 37-year-old African American man is brought to the emergency department by police. The patient refused to leave a petting zoo after closing. He states that he has unique ideas to revolutionize the petting zoo experience. The patient has a past medical history of multiple suicide attempts. His temperature is 99.5°F (37.5°C), blood pressure is 130/85 mmHg, pulse is 100/min, respirations are 16/min, and oxygen saturation is 99% on room air. The patient's cardiac and pulmonary exams are within normal limits. He denies any nausea, vomiting, shortness of breath, or systemic symptoms. The patient struggles to answer questions, as he is constantly changing the subject and speaking at a very rapid rate. The patient is kept in the emergency department overnight and is observed to not sleep and is very talkative with the nurses. Which of the following is the best long-term therapy for this patient?

A 27-year-old man comes to the physician for a follow-up examination. Paroxetine therapy was initiated 6 weeks ago for a major depressive episode. He now feels much better and says he is delighted with his newfound energy. He gets around 8 hours of sleep nightly. His appetite has increased. Last year, he had two episodes of depressed mood, insomnia, and low energy during which he had interrupted his job training and stopped going to the gym. Now, he has been able to resume his job at a local bank. He also goes to the gym three times a week to work out and enjoys reading books again. His temperature is 36.5°C (97.7°F), pulse is 70/min, and blood pressure is 128/66 mm Hg. Physical and neurologic examinations show no abnormalities. On mental status examination, he describes his mood as "good." Which of the following is the most appropriate next step in management?

A 25-year-old woman is brought to the emergency department by EMS after being found naked in a busy downtown square. The patient stated that she is liberating people from material desires and was found destroying objects. Her temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is deferred due to patient combativeness. The patient is given diphenhydramine and haloperidol and transferred to the psychiatric ward. On day 1 on the ward, the patient is no longer aggressive or agitated and has calmed down. She states that she feels severely depressed and wants to kill herself. The patient is started on a medication and monitored closely. On day 3 of the patient's stay in the hospital she is found in her room drawing up plans and states that she has major plans to revamp the current energy problems in the country. Which of the following is the most likely medication that was started in this patient?