NMS Q&A Family Medicine

chapter 51Anxiety and PhobiasExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 Each of the following items is a side effect of withdrawalfrom benzodiazepines after modest to moderate usageexcept for which one?(A) Insomnia(B) Irritability(C) Visual hallucinations(D) Poor coordination(E) Tremor2 Selective serotonin reuptake inhibitors (SSRIs) are amainstay of treatment of obsessive compulsive disorder(OCD). Which of the following is true regardingtheir use for OCD?(A) Response time for SSRIs in OCD is shorter thanthat for depression.(B) SSRIs may be used in dosages lower than thoseemployed in treatment of depression.(C) SSRIs are virtually always successful intreatment of OCD.(D) Buspirone, although useful as an adjunct toSSRIs in treatment of depression, is not helpfulas an adjunct to SSRIs in OCD(E) Antipsychotic medications may be helpfuladjuncts to SSRIs in treatment of SSRIs.3 A 35-year-old female patient comes to your officecomplaining of bouts of palpitations, pounding heart,shortness of breath, and diaphoresis, along with feelingsof impending doom. During an attack witnessedin the physician’s office, the patient’s blood pressure(BP) was 160/70 and her heart rate was 120 beats perminute and regular. The patient’s face was flushed duringthe attack. After the attack passed over a period of15 minutes, the BP had subsided to 110/75 and theheart rate to 80 beats per minute and regular. Which ofthe following would least resemble the clinical picturepresented?(A) Thyrotoxicosis(B) Depression(C) Carcinoid syndrome(D) Pheochromocytoma(E) Panic disorder4 The patient in Question 3 is interviewed further. Theonset of the first attack surprised her and led quicklyto catastrophizing about possible situations that hadnever entered her mind before. She then began todread the attacks and such ideations that accompaniedthem. She is stably married with three children,is college educated, and stays at home to care for herchildren. During the attacks, she feels that she is “losing(her) mind.” Her affect is appropriate to the situation.Her vital signs, repeated, show BP is 115/75and heart rate is 84 and regular. Along with counseling,which of the following would be the most appropriatefor her acute attacks?(A) Propranolol 20 mg by mouth (po)(B) Diazepam 5 mg po(C) Buspirone 10 mg po(D) Lorazepam 0.5 mg, given sublingually(E) Rebreathing exhaled air5 In treating uncomplicated panic attacks with somesuccess, which of the following pharmacologicapproaches would be most helpful as maintenancetherapy?(A) Sertraline (Zoloft) 25 to 50 mg daily(B) Propranolol (Inderal) 20 to 40 mg daily(C) Trazodone (Desyrel) 50 mg daily(D) Divalproex (Depakote) 250 mg daily(E) Chlorpromazine (Thorazine) 25 mg daily6 A 25-year-old woman with panic attacks has begunto structure her day around her attacks and collectingan increasing number of situations, which sheavoids. She stays away from crowds and fears visits toa supermarket to shop for food for her family. Concludingthat she now suffers from phobic disorder,which of the following would be the least reasonabletherapeutic maintenance agent for this patient?(A) Sertraline (Zoloft)(B) Diazepam (Valium)(C) Gabapentin (Neurontin)295