Mental Health in Primary Care Flashcards

An 82-year-old hospitalized with pneumonia develops acute confusion that waxes and wanes, with poor attention and disturbed sleep-wake cycle. Which diagnosis best fits?

Answer: Delirium

Acute onset, fluctuating course, and inattention distinguish delirium from dementia.

A patient with heavy daily alcohol use stops drinking. When is the risk of alcohol withdrawal seizures greatest?

Answer: Within 6 to 48 hours after the last drink

Withdrawal seizures typically occur within 6-48 hours, whereas delirium tremens usually appears at 48-96 hours.

When nutrition is restarted in a severely malnourished patient with anorexia nervosa, which electrolyte abnormality is the hallmark of refeeding syndrome?

Answer: Hypophosphatemia

Insulin release during refeeding moves phosphate into cells, causing dangerous hypophosphatemia.

A 16-year-old is started on fluoxetine for major depression. What does the FDA boxed warning require of the prescriber?

Answer: Close monitoring for worsening depression and suicidal thoughts, especially early in treatment

Antidepressants have a boxed warning for increased suicidality in patients under 25, so close monitoring is required, especially after starting or changing the dose.

Before prescribing a stimulant for ADHD, which history item matters most to screen for?

Answer: Personal or family history of structural heart disease or sudden cardiac death

Stimulants raise heart rate and blood pressure, so cardiac risk factors should be assessed before starting.

Why are benzodiazepines generally avoided for insomnia or anxiety in adults over 65 according to the Beers Criteria?

Answer: They increase the risk of cognitive impairment, delirium, falls, and fractures

Older adults are more sensitive to benzodiazepines and have slower metabolism, raising the risk of falls and cognitive effects.

A patient taking phenelzine eats aged cheese and cured meats and presents with severe occipital headache and a blood pressure of 220/120. What is the mechanism?

Answer: Tyramine-induced norepinephrine release with MAO inhibition

MAOIs block tyramine breakdown, and the tyramine then releases excess norepinephrine, causing a hypertensive crisis.