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244 Cards in this Set

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what are the kubler-ross grief stages?
denial, anger, bargaining, grief, acceptance. not in order and can have >1 at a time
what 5 enzymes are induced in stress?
fatty acids, corticosteroids, lipids, cholesterol, catecholamines
what 4 physical effects can be affected in stress?
water absorption, muscle tonicity, gastrocolic reflex, and mucosal circulation
what 5 diseases can be exacerbated by stress?
irritable bowel syndrome, gastric ulcer disease, rheumatoid arthritis, diabetes, CHF
name 4 drugs that can cause sexual dysfunction
antihypertensives, SSRI, neuroleptics, ethanol
name two diseases that can cause sexual dysfunction
diabetes, depression
what psychological problem can cause sexual dysfunction?
performance anxiety
what are the most famous tests for IQ?
stanford-binet and wechsler
how does the stanford-binet test work?
calculates IQ as mental age/chronological age x 100
how is the wechsler adult intelligence scale scored?
11 subtests (6 verbal, 5 performance). mean 100, standard deviation 15
name the IQ definitions for mental retardation, severe mental retardation, and profound mental retardation
IQ <70 (2 standard devs below), IQ <40, IQ < 20
what two factors are correlated with IQ scores?
genetic factors, school performance
define classical conditioning
learning where natural response is elicited by conditioned response that previously was in conjunction with unconditioned stimulus
what is the natural response in pavlov's experiments
salivation
what is the conditioned (learned) stimulus in pavlov's experiments
bell
what is the unconditioned stimulus in pavlov's experiments
food
define operant conditioning
learning where certain action is done becuase you get reward
give an example of positive reinforcement
mouse presses button to get food
give an example of negative reinforcement
mouse presses button to avoid shock
what is the difference between negative reinforcement and punishment
negative reinforcement - being nice to younger brother to avoid being scolded (active). punishment: decreasing behavior after being scolded (passive)
define reinforcement schedule
pattern of reinforcement determines how quickly behavior is learned or extinguished
give an example of continuous reinforcement
like vending machine: stop using if doesn't deliver (rapidly extinguished)
give an example of variable ratio?
slot machine - continue to play even if it rarely rewards. slowly extinguished.
define transference
patient proejcts feelings about important person onto physician (physician=parent)
define countertransference
doctor projects feelings about important person onto patient (patient=child)
what are Frued's 3 structures of the mind?
id, superego ego
define Id
primal urges, sex, aggression ( I want it)
define superego
moral values, conscience (you know you can't have it)
define ego
mediator between unconscious mind and external world (deals with conflict)
define conscious
what you are aware of
define preconscious
what you are able to make conscious with effort (phone number)
define unconscious
what you are not aware of (goal of Freudian psychoanalysis)
define oedipus complex
repressed sexual feelings of child for opposite-sex parent, acompanied by rivalry with same-sex parent
what are automatic and unconscious reactions to psychological stress?
ego defenses
ego defense: mafia boss makes large donation to charity
altruism
ego defense: nervous medical student jokes about the boards
humor
ego defense: aggressive impulses used to succeed in business
sublimation
ego defense: choosing not to think about USMLE until week before test (conscious)
suppression
is suppression conscious or unconscious?
conscious (and voluntary)
what are mature responses?
sublimation, altruism, humor, suppression (mature women wear a SASH)
ego defense: tantrums
acting out
temporary, drastic changes in personality, memory, consciousness, motor behavior to avoid stress
dissociation
avoidance of awareness of painful reality
denial (subconscious)
ego defense: mother yells at child because she is angry at husband
displacement
partially at more childish level of development (men and sports)
fixation
abused child becomes abuser
identification
describes murder in graphic detail with no emotional response
isolation
man who wants another woman think his wife is cheating on him
projection
saying the job was not important anyway after getting fired
rationalization
patient with sexual thoughts enters monastery
reaction formation
patient crying in dialysis, child bed-wetting in stress
regression
involuntary withholding of an idea or feeling from conscious
repression
what is the basic mechanism underlying all other ego defenses?
repression
patient says that all nurses are insensitive but all doctors are nice
splitting
what is the difference between substance abuse and substance dependence?
substance abuse = impairement symptoms (i.e. recurrent use in physically hazardous situations) vs substance dependence (attempts to cut back, energy spent getting substance)
characteristics of substance abuse (1 or more in 1 year)
recurrent use results in failure to fulfill major obligations, recurrent use in physically hazardous situations, recurrent substance-related legal problems, continued use despite personal problems
drug intoxication that causes disinhibition, slurred speech
alcohol
what is the best enzyme test for alcohol intoxication?
GGT
drug withdrawal that causes tachycardia, delirium tremons, hallucinations
alcohol
drug intoxication that causes cns depression, nausea/vomiting, pinpoint pupils
opioids
what drug withdrawal causes piloerection, flulike symptoms, dilated pupils
opioids
intoxication includes pupillary dilation, euphoria, prolonged wakefulness and attention
amphetamines
withdrawal leads to post-use crash including depression, lethargy, headache, stomach cramps, hunger, hypersomnolence
amphetamines
intoxication leads to euphoria, tactile hallucination, paranoid, sudden cardiac death
cocaine
withdrawal leads to severe depression, severe psychological carving
cocaine
intoxication: belligerence, nystagmus, psychosis
PCP
withdrawal: recurrence of intoxication symptoms due to reabsorption in GI tract: sudden onset of severe, random, homicidal violence
PCP
intoxication: marked anxiety or depression, delusions, visual hallucinations, flashbacks, pupil dilation
LSD
intoxication: paranoid, slowed time, dry mouth
marijuana
intoxication: low safety margin, respiratory depressoin
barbituates
withdrawal: delirium, anxiety, life-threatening cardiovascular collapse
barbituates
intoxication: somnolence, minor respiratory depression, ataxia
benzodiazepines
withdrawal: rebound anxiety, insomnia, tremors
benzodiazepines
intoxication: increased diuresis, restlessness, muscle twitching
caffeine
withdrawal: headache, lethargy, depression, weight gain
caffeine
intoxication: restlessness, insomnia, anxiety, arrythmias
nicotine
withdrawal: irritability, headache, anxiety, weight gain, craving
nicotine
treatment for alcoholism
disulfiram to condition patient to abstain, supportive treatment of systemic problems, peer support groups
life-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink
delirium tremens
what is the order of appearance of DT symptoms
first autonomic hyperactivity (tachycardia, anxiety), then psychotic symptoms (hallucinations, delusions) then confusion
what is the treatment for delirium tremens?
benzodiazepines
alcoholic hepatitis/cirrhosis, pancreatitis, dilated cardiomyopathy, peripheral neuropathy, cerebellar degeneration, wernicke-korsakoff, testicular atrophy + hyperestrinism, mallory-weiss are complications of what?
alcoholism
name 4 late consequences of alcoholic cirrhosis
peirpheral edema/ascites, encephalopathy, asterixis (flapping of hands), esophageal varices
name 4 symptoms of alcoholic cirrhosis
jaundice, hypoalbuminemia, coagulation factor deficiencies, portal hypertension
deficiency of what causes Wernicke-Korsakoff syndrome?
thiamine (B1)
what is the classic triad of Wernickes's encephalopathy
confusion, ophthalmoplegia, ataxia
what are 3 symptoms of korsakoff's psychosis?
memory loss, confabulatoin, personality change
is korsakoff's reversible or irreversible
irreversible
what is the anatomical defect in the brain in wernicke-korsakoff syndrome?
periventricular hemorrahge/necrosis particularly in mamillary bodies
what is the treatment of wernicke-korsakoff?
IV thiamine
what distinguished mallory-weiss from esophageal varices?
pain
longitudinal lacerations at gastroesophageal junction caused by excessive vomiting
mallory-weiss syndrome
name two competitive inhibitor for opioids
naloxone and naltrexone
what is used for heroin detoxification or long-term maintenance?
methadone (long acting oral opiate)
name 6 risks in heroin addiction?
hepatitis, abscess, overdose, hemorrhoids, AIDS, right-sided endocarditis
rapid decrease in attention span and level of arousal -disorganized thinking, hallucinations, illusions, misperceptions, disturbance in sleep-wake cycle, cognitive dysfunction
delirium
2 keys to diagnosing delirium
waxing/waning consciousness, rapid development
2 causes of delirium
substance abuse, medical illness
is delirium reversible or irreversible?
reversible
what is the characteristic of drugs that can cause delirium?
anticholinergic
what is the most common psychiatric illness on medical/surgical floors?
delirium
gradual decrease in cognition: memory deficits, aphasia, apraxia, agonsia, loss of abstract thought, behavior/personality changes, impaired judgement
dementia
name 3 keys to diagnosing dementia?
patient is alert, no change in level of consciousness, more gradual
what condition can present like dementia in the elderly?
depression
is dementia irreversible or reversible?
irreversible
sleep disturbance, loss of interest, guilty, loss of energy, loss of concentratoin, change in appetite, psychomotor retardation, suicidal ideations
major depressive disorder
are males or females more likely to get major depressive disorder?
females
define intervals of major depressive disorder
2 or more episodes with symptom-free interval of 2 months
what is a mild form of depression lasting at least 2 years?
dysthymia
name 3 sleep patterns of depressed patients
decreased slow-wave sleep, decrease REM latency, early moring awakening
what is the most important sleep screening question for depressed patients?
early morning awakening
these are risk factors for what condition: male, teenaged/elderly, depressed, previous atempt, drugs, loss of rational thinking, sickness, organized plan, no spouse, no social support
suicide completion
what is the gender difference between suicide?
women try more, men succeed more often
what is a treatment option for refractory major depressive disorder
electroconvulsive therapy
is ECT painful or painless?
painless
what response does ECT provoke?
seizure
what are the 3 major adverse affects of ECT?
disorientation, anterograde amnesia, retrograde amnesia
what causes complications of ECT?
anesthesia
distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week
manic episode
distractibility, irresponsibiliy, grandiosity, flight of ideas, agitation, goal directed activity, decreased sleep, talkativeness
manic episode
what are 3 differences between hypomania and mania?
hypomania not severe enough to cause marked impairment in functioning or hospitalization and also no psychotic features
combination manic and depressed episodes
bipolar I
combination of hypomanic and depressed episodes
bipolar II
how many manic episodes do you need to define bipolar disorder?
1
what is the treatment of choice for bipolar disorder
lithium
what is a mild form of bipolar disorder lasting two years?
cyclothymic disorder
patient consciously fakes to have a disorder for specific gain
malingering
patient consciously creates symptoms to assume sick role and get medical attention
factitious disorder
chronic history of multiple hospital admissions and willingness to receive invasive procedures
Munchausen's syndrome
illness in child is caused by parent, motivation is unconscious. child abuse
munchausen's syndrome by proxy
is somatoform disorder more common in men or women?
women
is illness production/motivation of somatoform disorder conscious or unconscious?
unconscious
motor or sensory symptoms that suggest neurological/physical disoder but tests negative, acute stressor, patient unconcerned about symptoms
conversion
prolonged pain that is not explained by illness
somatoform pain disorder
preoccupation with and fear of getting sick despite medical reassurance
hypochondriasis
variety of complaints in multiple organ systems with no identifiable underlying physicial finding
somatization disorder
preoccupation with minor or imagined physical flaws, patients seek cosmetic surgery
body dysmorphic disorder
false belief of being pregnant
pseudocyesis
define primary gain
what symptom does for patient's psyche (nothing to do w/ what get from other people)
define secondary gain
what the symptoms gets patient from other people(sympathy, attention)
define tertiary gain
what the caretaker gets (MD on interesting case)
recurrent periods of fear/discomfort with palpitations, paresthesias, abdominal distress, nausea, intense fear of dying, light-headedness, chest pain, chills, choking, disconnectedness, sweating, shakng, shortness of breath
panic disorder
how do you describe panic disorder?
in context of occurence (i.e. panic disorder with agoraphobia)
fear that is excessive or unreasonable, cued by specific object or situation. exposure provokes anxiety response
specific phobia
is a phobia unconscious or does the patient recognize that fear is excessive?
patient recognizes fear is excessive
treatment for phobia
systemic desensitization
fear of marriage
gamophobia (gam in gamete)
fear of pain
algophobia (alg=pain)
fear of heights
acrophobia (acro=height)
fear of being unable to escape from a place
agoraphobia
person witnessed traumatic event. response is intense fear, helplesness, horror. persistent flashbacks and person avoids stimuli associated with trauma
post-traumatic stress disroder
how long does PTSD last?
> 1 month, usually less than 3 months
what does PTSD usually follow and how long does that last
acute stress disorder, 2-4 weeks
emotional symptoms causing impairment following an identifiable stressor and lasting <6 months
adjustment disorder
uncontrollable anxiety for at least 6 months that is unrelated to specific thing. sleep disturbance, fatigue, difficulty concentrating
generalized anxiety disorder
patient with severe communicaiton problems and difficulty forming relationships. repetitive behavior, unusual abilites, below-normal intelligence
autistic disorder
treatment for autistic disorder
increase communciation and social skills
mild autisim with problems in social relationships and repetitive behavior
asperger's disorder
autism with normal intelligence and lack of social/cognitive defects
asperger's disorder
x-linked disorer in girls. loss of development and mental retardation by age 4. stereotyped hand-wringing
Rett disorder
limited attention span and hyperactivity. emotionally labile, impulsive, prone to accidents. normal intelligence
ADHD
treatment for ADHD
methylphenidate (ritalin)
continued behavior violating social norms. < 18 years old
conduct disorder
child noncompliant in absence of criminality
oppositional defiant disorder
motor/vocal tics and involuntary profanity. onset < 18 years old
Tourette's syndrome
treatment for tourette's
haloperidol
fear of loss of attachment figure leading to factitious physical complaints to avoid going to school. onset 7-8 years old
separation anxiety disorder
abnormal eating habits, body image distortion, increased exercise, severe weight loss, amenorrhea, anemia, electrolyte disturbances, adolescent girls, coexist with depression
anorexia nervosa
bing eating followed by self-induced vomiting/laxatives. normal body weight. parotitis, enamel erosion, electrolyte disturbances, dorsal hand calluses from induced vomiting
bulimia nervosa
perceptions in the absence of external stimuli
hallucinations
misinterpretations of actual external stimuli
illusions
false beliefs not shared by others that are firmly maintained despite obvious proof to contrary
delusion
delusion vs loose association
delusion = disorder in actual idea, loose association - way ideas tied together
common schizophrenia hallucinations
visual/auditory
aura of psychomotor epilepsy
olfactory hallucination
is gustatory hallucination common or rare?
rare
two groups that see tactile hallucination
cocaine users, alcohol users (DTs)
hallucination while going to sleep
hypnagogic
hallucination while waking from sleep
hypnopompic
person stops breathing for at least 10 seconds repeatedly during sleep
sleep anea
sleep apnea with no respiratory effort
central
sleep apnea with effort against obstruction
obstructive
treatment for sleep apnea
weight loss, continuous positive airway pressure, surgery
condition associated with obesity, loud snoring, hypertension, arryhtmias, sudden death, chronic tiredness
sleep apnea
disordered regulation of sleep-wake cycles with strong genetic component
narcolepsy
what stage does narcoleptic sleep episodes start with
REM
loss of all muscle tone following strone emotional stimulus
cataplexy
treatment for narcolepsy
stimulants (amphetamines)
period of psychosis and distubed behavior with decline in function > 6 months
schizophrenia
period of psychosis and distubed behavior with decline in function 1-6 months
schizophreniform
period of psychosis and distubed behavior with decline in function < 1 month. stress related
brief psychotic disorder
delusions, hallucinations, loose associations, disorganized behavior
positive symptoms of schizophrenia
flat affect, social withdrawal, lack of motivation, lack of speech/thought
negative symptoms schizophrenia
are genetic or environmental factors more important in schizophrenia
genetic factors
what group is more likely to get schizophrenia?
none. men=females, black=whites
a combination of schizophrenia and mood disorder
schizoaffective disorder
5 subtypes of schizophrenia
disorganized, catatonic, paranoid, undifferentiated, residual
enduring pattern of perceiving, relating to, and thinking about the environment and onself that is exhibited in a wide range of important and personal contexts
personality
pattersn become inflexible, causing impairment in social functioning, patient not aware of problem.
personality disorder
are personality disorders diagnosed usually in early adulthood or childhood?
early adulthood
personality disorder: odd/eccentric, no meaningful social relationships, no psychosis, genetic association with schizophrenia
Cluster A personality disorders
distrust and suspiciousness, projection is main defense mechanism
paranoid
voluntary social withdrawal, limited emotional expression
schizoid
interpersonal awkwardness, odd beliefs or magical thinking, eccentric appearance
schizotypal
personaliy cluster: dramatic, emotional, erratic: genetic association with mood disorders and substance abuse
cluster B personality disorders
disregard for and violation of rights of others, crimality, males > females, > 18
antisocial
unstable mood and interpersonal relationships, impulsive, sense of emptiness, more females than males
borderline
excessive emotions, attention seeking, sexually provocative
histrionic
grandiosity, sense of entitlement, react to criticism with rage
narcissistic
perosnality cluster that is anxious or fearful, genetic association with anxiety disorders
cluster C personality disorders
sensitive to rejection, socially inhibited, feelings of inadequacy
avoidant
preoccupation with order, perfectionism, control
obsessive-compulsive
submissive and clinging, excessive need to be taken care of, low self-confidence
dependent
Test that reflects basic and higher level cognition and neuro-sensory functioning of the entire brain
halstead-reitan battery
test that is primarily verbal skills
stanford-binet intelligence test
developmental and social functioning test
vineland adaptive behavior scale
intelligence assessment test, not aphasia or neuro-sensory skill
wechsler adult intelligence test
academic achievement only test
wide range achievement test
how to address patient when first meet
leveling: if physician wants title, need to address patient w/ title also
If needle stick from patient occurs, is an AIDS test on the patient a violation of confidentiality?
no, because there is threat to self or others
if you make a mistake with drugs in patient, what do you do?
always admit mistake. this strengthens the patient-physician relationship
do patients with avoidant personality disorder want relationships?
yes they dislike their isolation but fear rejection
therapy for phobia that guides patient through progressive steps
desensitization
change response by denying reward that has maintained that response
extinction
encouraging patient to confront feared object without gradual exposure
flooding
what is the criteria for emancipated minors under 18 (4)
self-supporting, military, married, children
when should you refer patients to others?
NEVER
who do you report an impaired resident to?
person directly in charge of the physician
who do you report an impaired licensed physiican to?
state licensing board
can a patient involuntarily confined in a mental health hospital deny treatment?
yes
under what conditions can organs be harvested after death?
signed donor card (doesn't matter if expired) or informed surrogate
is it ethical and legal for a patient to refuse treatment to HIV positive patient
not ethical but legal
does a pregnant woman have the right to refuse life-saving intervention for the fetus?
yes
do you still need informed consent if you find unexpected non-emergency finding in surgery?
yes
do you still need consent if an unexpected emergency finding is found in surgery?
no
what do you do if parents refuse life saving treatment for dying child?
court order to save life
what conditions can you treat a child without parental consent?
emergency, STD, prenatal care, drug abuse, contraceptive prescription
3 facets of legal informed consent
discuss risks, benefits, alternatives/patient agrees to care/no coercion
4 exceptions to informed consent
1. patient lacks decision-making capabiliy
2. emergency
3. withold information that would severly harm patient
4. patient waives informed consent
5 facets of decision making capability
1. patient makes and communicate s choice
2. patient is informed
3. decision remains stable
4. decision consistent with patient's values and goals
5. decision is not result of delusions/hallucination
algorithmn for ethics questions:
rank priorities in questions for patients
1. introduction. 2. come to diagnosis. 3. talk about diagnosis. 4. talk about treatment.
how to treat regression in sibling of patient?
tell parents to spend more time with child.
term for inability to recognize faces
prosopagnosia
deficit in cognition about one's illness
anosagnosia