1.The parents of a 3-year-old boy come to you requesting a consultation with a psychiatrist for their son because he refuses to sleep in his own bed. The only place he will sleep is in his parent’s bed but his kicking keeps them awake. Both parents have missed work because of exhaustion. Examination of the child is unremarkable. Your immediate management of this situation would be to
refer the son to a child psychologist.
refer the family for counseling.
order chloral hydrate nightly.
lock the child in his bedroom.
review bed-time routine and offer advice.
A 26-year-old pregnant woman who has a history of mild hypertension, edema and light proteinuria from her twenty-first week of pregnancy is brought to the Emergency Department after one episode of seizure. She is now on her thirty-fourth week of pregnancy. She is conscious, her pulse rate is 120/minute and her blood pressure is 160/105 mm Hg. The definitive treatment in this case is
diazepam 5 mg intravenous bolus.
perform delivery.
magnesium sulfate 2 g intravenously in 6 minutes.
hydralazine in intravenous infusion (40 mg/1000 mL).
bed rest.
A 78-year-old woman presents to the clinic for evaluation after a fall. She states that her balance is not very good lately, and she must have tripped on her way to the bathroom. Over the last several years, her bipolar mood disorder has been well controlled with lithium 600 mg in evening. She also has mild hypertension, controlled with a beta-blocker and osteoarthritis, managed with acetaminophen 650 mg 2 to 3 times daily. Lithium level was 0.8mEq\L 3 months ago and is now 1.0 mEq\L. Which one of the following is the most appropriate pharmacological management?
Repeat lithium level in 1 month and reduce dosage of lithium if level greater than 1.2 mEq\L
Stop lithium immediately, switch to valproic acid, and check valproic level in 1 week.
Change lithium schedule to 150 mg 4 times per day and repeat lithium level in 1 month.
At weekly intervals decrease lithium by 150 mg and add valproic acid 250 mg per day until levels are therapeutic
Hold lithium for 24 hours, resume at 300 mg in the evening, and repeat lithium level in 1 week.
4.A 75-year-old woman presents with a 1-year history of cognitive impairment with periodic confusion and delirium-like episodes of unclear etiology. She has frequent visual hallucinations and over the last month had 2 episodes of syncope. The only findings on physical exam are mild rigidity and loss of associated arm movement while walking. ECG and Holter monitoring are normal. Which one of the following classes of medications will be most important to avoid in this patient?
Benzodiazepines.
Anti psychotics.
Cholinesterase inhibitors.
Mood stabilizers.
Selective Serotonin Re-uptake Inhibitor antidepressants.