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Hi Guys i made some Points about Diagnostic tests, Most Commons scenarios and Red flags in

flags. I hope it helps


1) Nutrition and Deficiencies
• Breast milk has an inadequate supply of vitamin D and exclusively breast-fed infants must receive
supplemented vitamin D.
• Introduce pureed foods at 6 months
• Introduce cow’s milk at 1 year
• Full term infants are born with adequate iron stores to prevent anemia in the 1st 4-6 months of life
regardless of diet. But pre-term infants need Iron supplementation
• Early introduction to cow’s milk can cause iron deficiency anemia
• Supplement B-12, if mother is strictly vegan.
• Formula is associated with more colic (excessive crying in an infant) then breast milk.
• In case of constipation increase dietary fiber (too much stool leads to dilation and sphincter relation
which can cause fecal incontinence), watch out for urinary incontinence.
• Term infants are born with adequate iron supply until 6 months, exclusively breast feed infants after
6 months should get iron supplements.
2) Diagnostic Tests
• CT-Scan has excessive radiation exposure, and is avoided if possible in infants and children. X-
rays and fluoroscopy (e.g. upper GI series) use less radiation.
• Abdominal Ultrasound is preferred for Pyloric stenosis
• Serial X-rays are used to follow non-surgical conditions like, ileus and mild necrotizing enterocolitis
• Normal bowel has air only in the bowel lumen, necrotizing enterocolitis has air in the bowel lumen
resulting in “Train” or “Double line” appearance.
• In Biliary atresia the first step is ultrasound (may show absent or abnormal gallbladder) , maybe
then Scintigraphy (failure of liver to excrete tracer in small bowel) but Cholangiogram in the OR is a
gold standard.
• IN children if constipation presistce despite standard therapy, then we can evaluate using anorectal
manometry.
• Audiometry is the best initial screening test for Acoustic Neuromas
• Abdominal Ultrasound is the 1st step in diagnosing Wilms tumor.
• Diagnose strep pharyngitis with Rapid strep antigen testing, ASO titers take a month after the
infection to be detected.
• Hetrophill antibody test can be negative in the 1st week on infection, so negative test does not rule
out IM.
• The atypical lymphocytes in the peripheral smear are non-specific for IM.
• Complete skeletal survey is ordered when child abuse is suspected and we try to determine if there
are other healing injuries.
• Voiding cystourethrogram is used to diagnose urinary reflux.
• Chest physiotherapy is helpful in removing tenacious secretions and mucous plugs and is indicated
in patients with bronchiectasis.
• Chest tube placement is indicated for patients with respiratory distress secondary to a large
pneumothorax, hemothorax or pleural effusion
3) Most common’s Things
• Most common heart defect associated with Downs is Complete Atrioventricular septal defect
• Most common heat defect associated with Digeorge syndrome is Truncus Arteriosus and
transposition of the great vessels.
• Most common heart defect associated with Edwards Syndrome is Ventricular septal defect.
• Most common condition with congenital heart block is lupus
• Most common complication with Trisomy 18 and rubella is PDA (check murmur)
• Most Common Risk factor for cerebral Palsy is Pre-maturity
• Interventricular hemorrhage is most commonly seen in premature and low birth weight infants.
• Lennox gastaut most commonly presents less than 7, with a variety of seizures and mental
retardation.
• Most common age of ITP is 2-5
• Iron deficiency is the most common nutritional deficiency in children.
• Most common primary bone tumor affecting children and adult’s osteosarcoma
• Pilocytic astrocytoma is the most common brain tumor in children
• Ependymomas are tumor of the ventricles, they have increased ICP but no seizure
• CT may show nothing in the 1st few hours of a stroke.
• Most common complication of sickle cell trait is painless hematuria.
• Headache is the most common early symptom of cavernous sinus thrombosis.
• Most common cause of neonatal sepsis in term infants is GBS
• Most common cause of sepsis in preterm infants is E. coli
• A common cause of neonatal conjunctivitis is Chlamydia (via birth canal → 50% neonates get
conjunctivitis and 30% get pneumonia) and presents as bilateral chemosis (thickened, injected
conjuctivae) eyelid swelling and watery or purulent discharge.
• Dacryostenosis is the most common cause of neonatal eye discharge due to poor drainage through
nasolacrimal duct, no conjunctival or eyelid inflammation. Gentle massage over the nasolacrimal
duct is recommended.
• Chemical conjunctivitis most commonly occurs in the 1st few days of life, because silver nitrate is
used to prevent bacterial conjunctivitis.
• Lymphadenitis is diagnosed when the lymph node becomes tender and erythematous in addition to
being enlarged. Acute, unilateral lymphadenitis in children is usually caused by bacterial infection
and staph aureus is the most common cause followed by group A strep. Patient with bacterial
lymphadenitis are less than five and non-toxic appearing
• Measles tend to more severe than rubella, with high fever up to 40 C 0, coryza and malaise. The
rash in measles spread gradually and appears darker (reddish-brown) in comparison to rubella
which spreads quickly and has lighter red kind of rash.
• Gram negative rods, pseudomonas, klebseilla are a common cause of osteomyelitis when the
patient has a Hx of UTI or urinary tract instruments.
• In rabies infected patients, the feeling of air or water in the throat → involuntary pharyngeal muscle
spasms.
• Most common cause of Rabies in the US are Bats, other causes include raccoons, skunks, and
foxes. In contrast to theses other animals, bat bites are small, painless and can often go unnoticed
(can occur in sleep).
• Treatment of HUS is supportive and plasmapheresis to remove toxins.
• Most common cause of viral meningitis are the enteroviruses (echovirus and coxsackeiviruses)
• Transient synovitis is the most common cause of hip pain in children.
• Growing pains are not related to growth despite their name.
• Most common age for legg-clave perthes disease is 4-10
• Symptoms of transient synovitis should resolve in 1-4 weeks after URI
• Most common cause of a bloody synovial fluid is an ACL tear.
• Hyperparathyroidism most commonly affects patients >50 years.
• A solitary lytic lesion and hypercalcemia in a toddler has an increased likelihood of Langerhans
histocytosis.
• Posterior urethral valves are the most common cause of urinary tract obstruction in the newborns.
• Oxybutynin is most commonly used with desmopressin in children with daytime incontinence to
increase bladder capacity.
• Children with isolated enuresis who do not respond to desmopressin maybe given TCA’s (not first
line)
• Electron microscopy finding of alport syndrome include alternating areas of thinned and thickened
capillary loops with splitting of the GBM.
• Oral succimer is used as chelating agent to treat mild to moderate lead poisoning.
• Calcium EDTA for moderate to severe cases of lead poisoning.
• # of wet diapers should equal age in the first week of life. After the first week’s infants should have
>6 wet diapers per day.
• Most common long term complication of vesicoureteral reflex is renal scaring.
• In the newborn dry flaky peeling of the skin, hands and feet are normal and is expected as the skin
adjust to the dry extrauterine environment
• Normally infants loose up to 7% of birth weight in the first 5 days due to excretion of fluid acquired
in utero.
• Urate crystals “pink stains” are common in the newborn and until the uric acid levels get to adult
levels.
• Infants have immature kidneys that cannot reabsorb sodium effectively, plain water should never
be given to an infant <6 months as it can dilute the blood → hyponatremia and seizures.
• Cryptorchidism is the most common congenital anomaly of the genitourinary tract, orchiopexy is
done before 1 year and can reduce all complications but there might still be subfertility.
• At the first year of life a child’s weight should triple from birth weight and height should 50%
• Do fish if karyotype is normal and turners is suspected.
• Kartageners syndrome is characterized by the triad of recurrent sinusitis, bronchiectasis and situs
inverus.
• CAH is a cause of peripheral precocious puberty and serum FSH and LH are low, central causes of
precocious puberty present with ↑FSH and LH.
• Estrogen replacement therapy is given to all patients with turners to promote maturation and
reduce the risk of osteoporosis.
• In DKA hyper osmolality and volume reduction → ↑ADH production.
• Newborns can develop vaginal spotting or bleeding, because in intrauterine life maternal hormones
cross the placenta and trigger pubertal effects in the newborn which wear off after maternal
hormones disappear from the infant’s circulation.
• The most common cause of congenital hypothyroidism is thyroid dysgenesis (aplasia, hypoplasia
and ectopic gland)
• Hypothalamic-pituitary-gonadal axis immaturity → ↓gonadotropin secretion is a cause of irregular
menstrual cycles (anovulatory) in women shortly following menarche.
• Pubertal gynecomastia is seen up to 2/3 of adolescent boys during mid to late puberty. It can be
unilateral, bilateral and even painful. No workup or treatment is necessary as it usually within a few
months to years
• Most common cause of a unilateral breast mass in an adolescent is fibroadenoma. The
pathogenesis is related to fluctuating levels of estrogen and progesterone so premenstrual breast
tenderness is typical. Adolescent with fibroadenoma → schedule follow up after next menses, if the
mass ↓ in size or tenderness → reassurance, ultrasound for persistent mass or older patients
• Most common cause of death in friiedreich’s ataxia is cardiomyopathy, second is respiratory
complications.
• They karyotype of patients with Kallman syndrome will be consistent with their male or female
phenotype.
• Ovarian Dysgerminoma occur in patients less than 30 that secrete LDH and B-HCG.
• Granulosa cell tumor is an estrogen producing ovarian tumor that can present in pre-pubertal girls
and postmenopausal women.
• Large for gestational age are at ↑ risk for developing hip subluxation.
• Air bronchgrmas is a signs of lung consolidation.
• IUGR, maternal HTN, intra-uterine stress from PROM → ↓ risk of respiratory distress syndrome
due to intra-uterine stress that helps fetal lung maturity.
• In divorced parents, only patients with custody may give consent for medical care. Those who have
conjoined custody might each give a consent but the doctor needs just 1 okay to proceed with care.
• children are predisposed to middle ear infections due to narrower and straighter Eustachian tubes.
• Meconium aspiration: is seen in post term infants with no-clear meconium on amnionotomy.
• Persistent pulmonary hypertension should be suspected in all term and post term newborns with
cyanosis, ↑ pulmonary vascular resistance → right to left shunt via foramen ovale. The diagnosis is
rare in low birth weight infants.
• Infants with SCID who do not undergo bone marrow transplantation usually die before age 1 from
fulminant infections.
• Needle tracheostomy is the 1st line treatment for tension pneumothorax
• First step after delivery? Dry the infant and keep warm, the thermoregulatory system in the infant is
under developed and they can lose heat easily.
• Apgar is score is good in assessing the status not prognosis of the neonate, low Apgar score at 1
minute may need positive pressure ventilation, the Apgar score at 5 minutes can give us a clue if we
need to resuscitate aggressively.
• Recommendations for anaphylaxis? Carry injectable epinephrine at all times.
• In cystic fibrosis approximately 10% of patients with normal pancreatic function during infancy and
childhood develop recurrent or chronic sinusitis in their teens or 20’s. patients with early pancreatic
insufficiency (e.g. oily stools) rarely have pancreatitis. But almost all male patients have obstructive
azoospermia from congenital bilateral absence of the vas deferens. The vas deferens fail to develop
due to inspissated mucus in the fetal genital tract.
4) Red Flags
• If a kid ingests batteries, magnets or Sharp Objects and there are signs like Malena or
hematochezia. Then immediately go for surgery.
• Toddler with sudden onset of wheezes, cough, dyspnea or stridor. Suspect foreign body aspiration
and go for Rigid bronchoscopy.
• 1kg of acute weight loss = 1 L of fluid loss, a child’s weight fluctuates which can make it hard to
determine the last well weight.
• Glasgow coma scale < 13 (normal 13-15) is associated with dangerous or serious traumatic brain
injury.
• Loss of consciousness for > 5 min is associated with Serious traumatic brain injury. <5 min is
associated with mild TBI. Head Trauma = Minor, Mild TBI and Serious TBI.
• A forced vital capacity (TV, IRV and ERV) < 20ml/Kg indicated impending respiratory arrest
requiring endotracheal tube (Spirometry should be done after diagnosing GBS or MG)
• Differential for t wave inversion = MI, myocarditis (remember a cause of HF in Frederic’s),
pericarditis, myocardial contusion and digoxin toxicity)
• Cow’s milk <1 year → ↓ iron stores and intestinal blood loss
• Children >1 year should drink <24 ounces of cow’s milk to ↓ the risk of iron deficiency.
• Rely on the reticulocyte count only when the anemia is normocytic (severe iron deficiency anemia
→ Iron stores and hence reduced reticulocytes)
• avoid contact sports for >3 weeks with infectious mononucleosis
• Fatigue may persist months after infectious mononucleosis is treated.
• Signs and symptoms of neonatal sepsis include, poor oral intake, irritability, hyper/hypothermia,
respiratory distress, vomiting and jaundice
• Oral erythromycin is associated with risk of developing infantile pyloric stenosis but treatment of
chlamydial conjunctivitis outweighs the risk
• Local lymphadenopathy is usual is impetigo but fever is unusual.
• Extensive bullous impetigo (flaccid bullae containing yellow fluid) is an indication for oral antibiotics
(cephalexin, dicloxacillin and clindamycin).
• Flaccid bullae mean’s very loose (nikolosky positive)
• Poor feeding and decreased level of consciousness are among the earliest signs of a serious
infection in neonate.
• Physical exam does not distinguish between sepsis and meningitis is neonates.
• Doxycycline is contraindicated in children <8 years and pregnant women. because of poor bone
and teeth development, use amoxicillin or cefuroxime for Lyme’s disease.
• Obstructive sleep apnea impairs sleep arousal and can therefore result in nocturnal enuresis.
• Every case of leukocoria is considered retinoblastoma until proven otherwise, immediate referral to
an ophthalmologist is warranted. Failure to diagnose early → brain, liver metastasis and death.
• Intermittent stra
• Hepatitis B is a risk factor for developing membranous nephropathy.
• Corneal neovasculization, think chlamydia trochamitis (Trachoma)
• Cognitively, infants develop object permanence (ability to recognize when, something or someone
is missing
• When IV access cannot be obtained, interosseous (in bone) access requires less skills and is safer
than central venous access.
• Gonococcal conjunctivitis = copious purulent eye discharge at 2-5 days, chlamydia conjunctivitis =
5-14 watery mucoid discharge.
• Snellen chart, visual acuity worse than 20/40 at age 3-5 or worse than 20/30 at age >6 years
should prompt ophthalmological referral. Visual acuity should be tested in every well child visit for
strabismus (cover/uncover and cover test) and the Snellen chart.
• Most hydrocele (cystic scrotal mass that transiluminates with light) disappear by age 12 months
and can be watched. Caused by failure of the tunica vaginalis to obliterate.
• Renal biopsy not obtained in patients less than 10.
• Remember iron is radiopaque and can be visualized on x-ray.
• ADPCKD are at risk for developing diverticulitis.
• Patients with Henoch-Schonlein purpura are at ↑ risk of developing intussusception due to bowel
wall edema and localized hemorrhage, which can act as lead points for the intussusception.
• Normal kid at birth→ gradually develops apathy, weakness, hypotonia, large tongue, sluggish
movements, abdominal bloating, and an umbilical hernia (think Congenital Hypothyroidism)
• Werdnig-Hoffman Syndrome is an autosomal recessive disorder that involves degeneration of the
anterior horn cells and cranial nerve motor nuclei and a cause of “floppy baby syndrome”
• Myotonic congenital myopathy is an autosomal dominant disorder characterized by muscle
weakness and atrophy (most predominant in the distal muscles of upper and lower extremities),
myotonia, testicular atrophy and baldness
• Severe coughing paroxysms may → subcutaneous emphysema, where air leaks from the chest
wall in to the subcutaneous tissue due to ↑ intra-alveolar pressure provoked by coughing. By similar
process pneumothorax can occur, therefor in such patients with apparent subcutaneous
emphysema, a chest x-ray should be obtained to rule out pneumothorax.
• Acute otitis media common in infants 6-36 months as their Eustachian tubes are short and easily
clogged. Risk factors include formula intake, exposure to cigarette smoke, allergic rhinitis and URI.
• Cricothyroidotomy should be avoided in children because the trachea is incompletely developed
and children age <12 have an ↑ risk of subglottic stenosis

High Yield Psychiatry And Poisoning Review:


(This includes Uworld, Past Exam Questions and Other relevant information).
(Please correct me if i am wrong anywhere).
1- Drugs decresing the siezure threshold: Imipenem, Bupriopion, TCAs and Clozapine.
2- Known case of difficult to treat OCD, already on a drug regimen now comes to the emergency
dept with the complain of a siezure attack, altered level of consciousness and palpitations. ECG
shows QRS widening and PR prolongation. Dx: TCA Overdosage/ toxicity. Next step---- Administer
sodium bicarbinate immediately. (If arrythmias, QRS widening and hypytension in suspected TCA
overdosage then directly administer Sodium Bicarbonate).
3- There are no absolute contraindications to Electro convulsive therapy.
4-Anorexia Nervosa and Bulimina Nervosa Treatment Plan:
Both needs Cognitive behavioral therapy.
Both needs nutriotional Rehabiliation.
Olenzapine For Anorexia Nervosa.
SSRIs for Bulimia Nervosa.
Caution: Remember Bupropion is contraindicated in Anorexia and Bulimia Nervosa!
5- 18 years old girl BMI of 15, diagnosed as Anorexia nervosa. Electrolytes are deranged and she is
hypovolemic. Hosiptal Admission is done. (Recall the criteria of hospital admission in the patients of
anorexia nervosa). She is st arted on Total parenteral nutrition. Three hours after starting of the feed
she becomes unresponsive. Stat Chest Xray Shows Pulmonary Edema and ECG shows ventricular
tachycardia. Dx?
Dx is Refeeding Syndrome. (Clinical Manifestations are Arrythmias, CHF, Siezures and Wernickes'
encephalopathy).
6- Major Depressive Disorder Treatment Strategy:
First Episode- Treat for 6 month with Antidepressants
Second Episode- Treat for 01 year with ADs.
Recurrent Episodes- Lifelong Treatment with ADs.
7- Treatment Strategy for OCD:
First Step- Exposure and Response Congnitive Behavioral Therapy (Recall that the same therapy is
also used for specific phobias).
OR- High Dose SSRIs.
If The above fails or unresponsiveness then:
Antipsychotics OR TCA (Clomipramine).
If all the above fails:
Deep Brain Stimulation.
8- Non REM Sleep Disorders: Night Terrors and Sleep Walking.
Usually they are self limiting- Just reassure and dont treat as such.
If significant distress and episodes are frequent and persistent then give low dose BZDs(
Clonazepam) before bedtime.
(Remember patient wont be able to recall the dreams and whatever happened in the NON REM
Sleep Disorders) .
9- REM Sleep Disorders: Nightmares and REM Sleep behavior Disorder. (Patient can recall the
dreams).
Nightmares Rx: Behavioral therapy is 1st line. BZDS before bedtime is second line.
REM Sleep behaviour Disorder Rx: Melatonin.
10- Most effective pharmacotherapy for smoking cessation is Varenicline (But its use is limited due
to increased risk of cardiovascular events, depression and suicidal ideationf). So most effective
becomes the Nictoine Replacement therapy.
If Depression plus Smoker= Give Bupropion.
Remember Bupropion contrainidcated if the patient has any siezure disorder or concomittant eating
disorder).
11- Oppositional Defiant Disorder and Conduct Disorder:
Both are aggressive.
Both have same age group of presentation.
ODD- These people dont break the rules.
Conduct- Breaking the rules is the diagnostic Clue.
Rx plan for ODD:
1- Main reason for ODD is poor parenting. Therfore improve the parenting.
2- Reward the child if he does anything good.
3- As soon as he breaks any law label it conduct disorder.
Rx plan for Conduct Disorder:
1- Punishment and Incarceration wont help (Remember this).
2- Support Programs.
3- Structured Living setting.
12- Starting Clozapine/Olenzapine:
Do baseline CBC/ Fasting Glucose/ Fasting Lipid Profile and Blood Pressure.
Measure Waist Circumference-- At Baseline, three months and then annually.
Do BMI Monthly.
For clozapine also check CBC every week due to risk of agranulocytopenia.
If WBC < 3000 OR ANC <1500 = Stop Clozapine.
13- Personality Disorders- No as such impairment in functional living-- Rx by psychotherapies.
14- Schizoid Personality Disorder And Avoidant Personality Disorder:
They both are loners. They both are socially inhibited. The main difference is that schizoid people
are emotionally cold and just dont want any relationships. BUT Avoidant people want to be with
people and make relationships but they dont do so due to fear of criticism and rejection.
15-Derpession= Increased REM Sleep. (Decreased Latency).
Decreased stage 4 sleep therefore early morning awakenings.
16- Lactate Infusion can trigger Panic Attacks.
17- Psychiatric Radiology:
Schizophrenia= Increased Size of lateral cerebral ventricles.
(NPH-- Also increased size of ventricles)
Autism= Increased Total Brain Volume.
OCD= Structural abnormalities in the orbitofrontal coretx.
Panic attacks: Decreased Volume of Amygdala and Left temporal Lobe.
PTSD= Decreased volume of Hippocampus.
18- Tourette Syndrome people have increased incidence of OCD.
19- Treatment plan for Tourrette Syndrome:
First Line: Habit Reversal CBT.
Second Line: Antipsychotics.
20- Alcoholic patient found unconscious lying on the road in winters. Temp is 84F. First step to do?
EKG. Whats the most specific thing you'll find on ecg? "J waves of Osborn (Looks like ST segment
elevation).
Rx Strategy for hypothermia:
- Intubate all those who are comatose.
- Warmed (107F) Crystalloids to all patients.
21- Burns:
Acute cause of death- CO poisoning.
Late cause of death- Infections/Sepsis.
First step- Give 100% Oxygen.
Then Fluid Administration according to Parkland's Formula.
Fluids= 4ml multiplied %BSA multiplied Body weight.
(Whatever the value comes give half of it in the first 8 hours and the remaining half of it in the other
16 hours) .
22- Organophosphates Poisoning:
First Thing to do- Remove clothing and wash the rest of the patient.
Best initial- Atropine infusion
Most effective- Pralidoxime.
23- Malignant Hyeprthermia and Neuroleptic Malignant Syndrome has no clinical difference. Just the
difference of triggerer.
Malignant Hyperthermia- After use of anesthetic.
NMS- After use of antipsychotics/ Antiemetics (Metoclopramide etc).
Both are treated with Dantrolene.
24- Chocolate Brown Blood- Methemoglobinemia. (Normal pO2 on ABGs)- Administer Methylene
Blue as antidote.
25- MDD patient presents to the ER with the complain of muscle twitching around the mouth and
over all tetani. Meanwhile he had an episode of hematuria and flank pain. Urinalysis shows gross
blood and envelop shaped crystals.
Dx- Ethylene Glycol Poisoning.
Rx- Ethanol or fomepizole.
Dialysis.
(Note: Ethylene Glycol Poisoning can also cause cranial nerve palsies) .
26- Both ethylene glycol and methanol poisoning can case increased anion gap metabolic acidosis
with increased osmolar gap.
27- Methanol Posining- Formic Acid- Causes retinal hyperemia, Blindness, central scotoma and
visual blurring.
28- Aspirin Toxicity:
Direct Stimulant to Brainstem--- Causes Hyperventilation.
Tinnitus.
Direct toxin to Lungs---- ARDS.
Labs- Anion Gap Metabolic Acidosis.
Then Respiratory Alkalosis.
Increased Prothrombin Time.
Rx- Sodium Bicarbonate
Dialysis in severe cases.
29- Treatment strategy for Enuresis:
-First Step- Do urinalysis.
-Start with behavioral Modifications.
- If fails then Enuresis Alarms (Best Longterm Outcome).
-Pharmacological therapy (Best for Short term Improvement).
first line- Desmopressin
Second Line- Imipramine (TCA).
30- Most Common Paraphilia--- Pedophilia (Child sexual abuse)
31- Psychiatric Drugs and Sexual effects:
- Alpha blockers= Impaired Ejaculation.
-SSRIs= Decreased Orgasm.
-Beta Blockers= Erectile Dysfunction
- Trazadone= Priapism
-Neuroleptics= Erectile Dysfunction .
31- 6 hours after last alcohol drink- Mild withdrawal Symtpoms
12-24 hours after last drink- Alcoholic Hallucinosis (These are purely the hallucinations. No Altered
Mentation. If altered mentation change your diagnosis)
48 hours after last drink- Withdrawal siezure.
48-96 hours after last drink- Delirum Tremens.
(In Alcohol Withdrawal agigated restless patient, give BZDs, no antipsychotics, they may provoke a
siezure).
32- Explosive Disorders: (Intermittent Explosive Disorder, Kleptomania, pyromania, Pathological
gambling.)
-They all dont have an insight (that is they dont feel if they are doing anything wrong).
-Intermittent Explosive Disorder: Always first rule out cocaine intoxication. Anger bursts twice weekly
for three months confirms the diagnosis. Rx: SSRIs, Mood Stabilizers.
-Pyromania: Remember the trick, if they give you a child in question who gets an anger burst
because his mom refused him for driving and then he goes out and burn all the cars. This is not
pyromania. There is no secondary gain or anger in pyromania.
-Pathological gambling: Treat by Group Psychotherapy.
33- Body Dysmorphic Disorder: High Dose SSRIs.
If the only concern is body wight and shape then its not BDD. Its anorexia nervosa.
If only concern is sexuality then its not BDD. Its Gender Identity Disorder. (Delay Puberty in them).
34- Conversion disorder: Establish physician patient relationship.
And do psychotherapies.
35- SSRIs Use + concomitant use of Triptans OR MAO Inhibitors= Serotonin Syndrome
(Hyperreflexia, High Blood Pressure, Myoclonus, Hyperthermia).
Rx: Fluids, Cyprohepatdine
36- MAO Inhibitors Use + TCAs/ Tyramine containing food/ Antihistamines/ Nasal Decongestants=
MAO Inhibitor induced hypertensive crisis. (High Blood pressure).
Rx- IV Phentolamine .
37- Elderly Man Known case of Bipolar Disoder and Chronic renal failure- Presents with the
complain of Nausea, Vomiting tremors, disorientation, Increased Deep tendon reflexes.
Dx- Lithium Toxicity
Rx- Dialysis.
38- TCAs and SSRIs are safe in pregnancy except for Paroxetine.
39- Panic Disorders:
-Best and Most Effective Rx: CBT and/or Relaxation training and desensitization.
-Immediate Rx: Benzodiazepines.
Remember that specific phobia patients might have a panic attack when exposed to the stimulus,
Dont label it as panic disorder. It remains the same specific phobia.
40- Specific Phobias: Symptoms for 6 or more than 6 months.
(Eg: Fear of exams, fear of plane, fear of crowded places etc). They dont have fear of scrutiny like
Social anxiety disorder.
Rx: First Line- CBT (Exposure and Response Prevention)
Second Line- Benzodiazepines 30 mins prior to exposure.
If recurrent panic attacks-- Initiate SSRIs.
(In Specific phobias we play around SSRIs and Benzos)
(In social phobias we play around Benzos and beta blockers).

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