PKM lecture on lab medicine in Beh Med - aa

Question 1

What infection can greatly mimic various psychiatric disorders (personality changes, dementia)?

Answer 1

neurosyphilis

Question 2

What are the screening and confirmatory tests for syphilis?

Answer 2

screening: VDRL/RPR
confirmatory: FTA-ABS

Question 3

What are the neuropsychiatric manifestations of low B12?

Answer 3

Weakness, paresthesias, memory loss, irritability,

dementia, personality changes

Question 4

What are the high risk populations for B12 deficiency?

Answer 4

elderly, alcoholics, the malnourished, and pure vegans

Question 5

What lab test do you want to get on this patient?
 38 y/o female reporting 3 month history of feelings of despondency, low self‐esteem, labile mood (tearfulness/irritability), poor concentration, extreme fatigue, and suicidal ideation with no plan.
 ROS positive for weight gain, decreased appetite, sleep disturbance, HA, constipation, tightness in throat

Answer 5

TSH, T4

Question 6

What lab test should always be considered in psychotic patients?

Answer 6

drug screen

Question 7

What lab tests should always been considered in patients with mania or depression?

Answer 7

thyroid tests

Question 8

If your patient is depressed and you suspect alcohol use, but are unable to elicit this in HPI, what lab tests should you run?

Answer 8

 CBC: elevated MCV
 GGT (gamma glutamyl transferase) elevated
 AST/ALT: elevated in classic 2:1 ratio
 Urine tox screen

Question 9

What depression cause tends to improve after correction of hyperparathyroidism?

Answer 9

hypercalcemia

Question 10

What is the lab workup for first-break psychotic symptoms?

Answer 10

 Complete metabolic panel
 Serum electrolytes and glucose
 BUN and creatinine
 Liver enzymes
 CBC with diff
 Thyroid panel
 Syphilis screening (i.e. VDRL, RPR)
 Vitamin B12, folate levels
 HIV
 Urine toxicology screen
 Blood alcohol level
 Urinalysis

Question 11

What is the lab workup for depression?

Answer 11

 Complete blood count
 Complete metabolic panel
 Serum electrolytes and glucose
 BUN and creatinine
 Liver enzymes
 TSH
 VDRL/RPR
 Serum B12 and folate
 Urinalysis

Question 12

What are 3 causes of reversible dementia in the elderly?

Answer 12

drugs, depression, thyroid disease