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487 Cards in this Set

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Woman with anxiety about a gynecological exam is told to relax and imagine going through the steps of the exam.

What process does this exemplify?
Systematic desensitization.
65-year old man is diagnosed with incurable metastatic pancreatic adenocarcinoma. His family asks you, the doctor, not to tell the patient.

What do you do?
Assess whether telling the patient will negatively affect his health. If not, tell him.
Man admitted for chest pain is medicated for ventricular tachycardia. The next day he jumps out of bed and does 50 pushups to show the nurses he has not had a heart attack.

What defense mechanism is he using?
Denial.
You find yourself attracted to your 26-year-old patient.

What do you say?
Nothing! The tone of the interview must be professional ... if you feel your actions may be misinterpreted, have a chaperone in the room.
Large group of people is followed over 10 years. Every 2 years, it is determined who develops heart disease and who does not.

What type of study is this?
Cohort study.
Girl can groom herself, can hop on 1 foot, and has an imaginary friend.

How old is she?
4 years old.
Man has flashbacks about his girlfriend's death 2 months ago following a hit-and-run accident. He often cries and wishes for the death of the culprit.

What is the diagnosis?
Normal bereavement.
36-year old woman with a strong family history of breast cancer refuses mammogram because she heard it hurts.

What do you do?
Discuss the risks and benefits of not having a mammogram. Each patient must give her own informed consent to each procedure. If the patient refuses, you must abide by her wishes.
During a particular stage of sleep, man has variable blood pressure, penile tumescence, and variable EEG

What stage of sleep is he in?
REM sleep.
15 year old girl of normal height and weight for her age has enlarged parotid glands but not other complaints. The mother confides that she found laxitives in the daughter's closet.

What is the diagnosis?
Bulimia.
11-year old girl exhibits Tanner stage 4 sexual development (almost full breats and pubic hair).

What is the diagnosis?
Advanced stage, early development.
4 year old girl complains of a burning feeling in her genitalia; otherwise she behaves and sleeps normally. Smear of discharge shows N. gonorrhoeae.

How was she infected?
Sexual abuse.
72 year old man insists on stopping treatment for his heart condition because it makes him feel "funny"

What do you do?
Although you want to encourage the pt to take his meds, the pt has the final say in his own rx regimen. you should investigate the "funny" feeling and determine if there are drugs available that won't elicit this particular side effect.
Person demands only the best and most famous doctor in town.

What is the personality disorder?
Narcissism.
Nurse has episodes of hypoglycemia; blood analysis reveals no elevation in C-protein.

What is the diagnosis?
Factitious disorder, self scripted insulin.
55 year old businessman complains of lack of successful sexual contacts with women and an inability to reach a full erection. Two years ago he had a heart attack.

What might be the cause of his problem?
Fear of sudden death during intercourse.
Observational Study. Sample chosen on presence of absence of disease. Information collected about exposure.
Case-control Study.
Often retrospective
Observational study. sample chosen based on presence of absence of risk factors. Subjects followed over time for development of disease.
Cohort Study.
The Framingham heart study.
Pooling data from several studies (often via a literature searach) to acheive greater statistical power.
Meta-analysis.
Cannot overcome limitations of individual studies or bias in study selection.
Experimental study. compares therapeutic benefit of 2 or more treatments, or treatment and placebo.
clinical trial.
Highest-quality study when randomized and double blinded.
List 4 ways to reduce bias in a study.
1. Blind studies.
2. Placebo responses.
3. Case-crossover design.
4. Randomization
When the subjects choose the groups it may lead to what type of bias?
Selection bias.
When knowledge of the presence of the disease alters recall by the subjects what type of bias is likely?
Recall bias.
When subjects are not representative of the population and results are not generalizable, what type of bias is this?
Sampling bias.
When information gathered on subjects is done so at an inappropriate time, what bias is likely?
Late-look bias.
The total proportion of cases in a population at a given time.
Prevalence.
The rate of new cases in a population in a given time.
Incidence.
Incidence x Disease Duration
Prevalence
For chronic diseases, which is larger - prevalence or incidence?
Prevalence > Incidence for Chronic Disease
When does prevalence = incidence?
For acute disease (ie the common cold)
What is sensitivity?
TP/(TP+FN) x 100 = Sensitivity
When is high sensitivity desirable?
In a screening test.
SNOUT = Sensitivity Rules Out
What is 1-sensitivity?
False negative ratio.
What is specificity?
TN/(TN+FP) x 100 = specificity
What is 1-specificity?
False positive ratio.
When is high specificity desirable?
In a confirmatory test.
SPIN = specificity rules in.
What is the PPV?
The probability of having a condition given a positive test.

TP/(TP+FP) = PPV
What is NPV?
The probability of not having the condition given a negative test.

TN/(TN+FN) = NPV
Unlike sensitivity and specificity, the predictive values are ....
dependent on the prevalence of disease. The higher the prevalence of disease, the higher the predictive value of the test.
a/(a+c)
sensitivity
d/(b+d)
specificity
a/(a+b)
PPV
d/(c+d)
NPV
(a/b)/(c/d)
OR - approximates RR if prevalence of disease is not too high.
Used in case control studies
[a/(a+b)]/[c/(c+d)]
RR - relative risk
Used in cohort studies
Attributable risk formula?
[a/(a+b)]-[c/(c+d)]
The consistency and reproducibility of a test is the ....
Precision.
Absence of random variation in a test ....
Precision.
The trueness of the test measurements is the ...
Accuracy
Reduced precision means
increase in random error
Reduced accuracy means
increase in systematic error
Number needed to treat
NNT = 1/(Ic-Ie)

The number of pts that need to be treated to prevent 1 additional bad outcome.
Reliability is ...
the reproducibility of a test. a Test is reliable if repeat measurements are the same.
Validity is ...
whether the test truly measures what it purports to measure. A test is valid if it measures what it is supposed to measure.
often compare to a gold standard.
Gaussian distribution is ...
a normal distribution (bell curve) (mean=median=mode)
A bimodal distribution ...
has 2 humps
A positive skew distribution ...
is asymmetry with the tail to the right, hump on the left (mean>median>mode)
a Negative skew distribution ...
is asymmetry with the tail to the left, hump on the right (mean<median<mode)
A null hypothesis is ...
There is no association (ie between the risk factor and the disease in the popuation.)
The alternative hypothesis is ...
There is some difference (ie between the disease and the risk factor in the population)
Type 1 error (alpha)
Stating there IS an effect or difference where none really exists.
usually present at p=.05 (p is the probability of making a type 1 error)
Type II error (beta)
Stating there IS NOT an effect or difference when one really exists.
B is the probability of making a type II error.
Power
the probability of rejecting the null hypothesis when it is in fact false.
Power = 1-B
Power in a study depends on what two things ...
1. total number of endpoints experienced by the population
2. difference in compliance between treatment groups
How do you increase study power
increase the sample size.
Confidence interval
mean +/- 1.96 (SEM)

If the CI includes 0, H0 is accepted.
SEM = standard deviation / (sqrt(sample size))
Normal (Gaussian) distribution has what percentage of the population in each standard deviation?
68% within 1 SD, 95% within 2 SDs, 99.7% within 3 SDs.
what does a t-test measure
the difference between the means of two groups
apple weight vs. orange weight.
What does ANOVA measure
the difference between means of 3 or more groups
apple wgt vs. orange wgt. vs. grape wgt.
What does a Chi square measure?
the difference between 2 or more proportions of categorial outcomes (NOT mean values)
bad apples vs. bad oranges
Correlation coefficient indicates
the strength of the correlation between two variables. The sign indicates a positive or negative.
always between -1 and 1
What is Primary Disease Prevention?
Prevent the disease from occuring.
Vaccination
What is Secondary Disease Prevention?
Early detection of the disease.
Screening.
What is Tertiary Disease prevention?
Reduce mobidity from the disease.
Exogenous insulin for DB
What are important preventative measure for patients with DM?
Eye exams, foot exams, urine tests.
What are important preventive measures for pts with drug abuse problems?
HIV test, TB test, Hep immunizations.
What are important prevetive measures for pts with alcoholism?
influenza, pneumococcal immunizations and TB testing
What is an important preventive measure to offer obese pts?
Blood sugar testing for diabetes.
What is an important preventive measure to offer homeless pts or recent immigrants?
TB tests
What tests are important for pts engaging in high risk sexual behavior?
HIV, Hep B, Syphilis, gonorrhea, chlamydia tests.
List the Reportable Diseases
1. Hep B
2. Hep A
3. Salmonella
4. Shigella
5. Syphilis
6. Measles
7. Mumps
8. AIDS
9. Rubella
10. TB
11. Chickenpox
12. Gonorrhea
B.A. SSSMMART Chicken or you're Gone.
Is HIV reportable?
While AIDS is reportable in all states, HIV reporting laws are state dependent.
What are the leading causes of death for infants in the US?
1. Congenital anomalies
2. Short gestation/LBW
3. SIDS
4. Maternal complications of pregnancy
5. RDS
What are the leading causes of death for children age 1-14 in the US?
1. Injuries
2. Cancer
3. Congenital anomalies
4. Homicide
5. Heart disease
What are the leading causes of death for people 15-24 years of age in the US?
1. Injuries
2. Homicide
3. Suicide
4. Cancer
5. Heart disease
What are the leading causes of death for adults 25-64 yo in the US?
1. Cancer
2. Heart disease
3. Injuries
4. Suicide
5. Stroke
What are the leading causes of death for adults over the age of 65 in the US?
1. Heart disease
2. Cancer
3. Stroke
4. COPD
5. Pneumonia
6. Influenza
Define autonomy
The obligation to respect patients as individuals and to honor their preferences in medical care.
Informed consent implies pts must understand the risks, benefits, and alternatives which include no intervention.

What is legally required for IC?
1. discussion of pertinent information
2. patient's agreement to the plan of care
3. freedom from coercion
In what circumstances is there an exception to the mandates of informed consent?
1. Patient lacks decision making capacity.
2. Implied consent is an emergency
3. Therapeutic privledge
4. Waiver - pt waives the right to informed consent
What is Therapeuic Privledge
Withholding information when disclosure would severely harm the patietn or undermine informed decision making capacity.
True or False: A patients family cannot require that a doctor withhold information from the patient.
True
What are some variables in determining a patients decision making capacity?
1. pt makes and communicates a choice
2. pt is informed
3. decision remains stable in time
4. decision is consistent with pt values and goals
5. decision is not a result of hallucinations or delusions
Define Transference.
When the patient projects feelings stemming from their personal life onto their physician.
Define Countertransference.
When the doctor projects feelings stemming from their personal life onto the pt.
Define classical conditioning.
Leaning where a natural response is elicited by a contitioned stimulus that was previously presented in conjuction with an unconditional natural stimulus.
pavolv - response (salivation) to conditioned stimulus (bell) presented in conjuction with natural stimulus (food)
Define operant conditioning.
learning in which a particular action is elicited because it produces a reward.
Define positive reinforcement.
desired reward produces action
mouse presses button ... gets food.
Define negative reinforcement.
removal of averse stimuli incresases the behavior.
mouse presses button ... avoids shock. DO NOT CONFUSE WITH PUNISHMENT.
True or False: reinforcement schedules determine how quickly a behavior is learned or extinguished.
True
Describe a continuous reinforcement schedule.
reward received after every response. rapidly extinguished.
vending machine
Define a variable ratio reinforcement schedule.
reward received after random number of responses. slowly extinguished.
slot machine.
What are Stanfornd-Binet and Wechsler?
Intelligence tests.
How does the Stanford Binet test calculate intelligence?
IQ as (mental age/chronological age) x 100
How does Wechsler (WAIS) measure intelligence?
11 subtests (6 verbal, 5 performance)... Mean is 100, SD - 15.
What is the IQ cuttoff for diagnosis of mental retardation?
IQ < 70 or 2 SD below mean.
IQ < 40 = severe
IQ < 20 = profound
True or False: IQ tests are objective test.
True ... but they are NOT projective tests.
Are IQ scores correlated with genetic factors or school achievement?
Yes to both ... but more highly correlated to school achievement.
What is an oral advanced directive?
In an incapacitated state, a pts prior oral statement is commonly used as a guide.
more valid if pt was informed, directive is specific, chosen, and the wishes were repeated over time.
What is a written advanced directive?
a living will.
pt can issue a DNR
What is a durable power of attorney?
pt desingnates a surrogate to make a medical decision in the event that the patient loses decision making capacity. pt can specify decisions in certain clinical situations, and can revoke power.
a form of written advanced directive. more flexible than a living will.
What is nonmaleficence.
"do no harm". However, if benfits of an intervention outweigh the risks, a patient may make an informed decision to proceed.
Define beneficence
The physicians ethical responsibility to act in the patients best interest (as a fiduciary). Can conflict with autonomy.
If the pt is informed and has capacity ... it is ultimately their decision.
What should guide the physicans decision to disclose information to family and friends?
What the patient wants, or would want.
A pt may also waive right to confidentiality (ie with insurance companies)
In what circumstances can a physician break confidentiality?
1. potential harm to others is serious.
2. liklihood of harm to self is great.
3. no alternative means exist to warn and protect those at risk
What steps may a physician take to prevent harm caused by a patients infectious disease?
Physician may have a duty to warn public health officials (reportable diseases) and identify people at risk.
What is the Tarasoff decision?
A law requiring physician to directly inform and protect a potential victim from harm; may involve a breach of confidentiality.
May a physician break confidentiality if they suspect child or elder abuse?
Yes.
May a physician break confidentiality if in cases of an automobile accident?
Only if they suspect that the driver was imparied.
How may a physician handle a suicidal or homicidal patient?
The physician may hold the patient involuntarily for a period of time ... or until psychiatric evaluation is completed.
A civil suit under negligence requires what 3 things?
1. Physician breach of duty to patient (Dereliction)
2. patient suffers harm (damage)
3. Breach of duty causes harm (Direct)
3 Ds - Dereliction, Damage, Direct
What is the most common factor leading to litigation between the physician and pt?
poor communication.
In a criminal suit the burden of proof is "beyond a reasonable doubt" ... in a malpractice suit the burden of proff is ...
"more likely than not"
Define Anosognia
unaware that one is ill
Define Autotopagnosia
unable to locate ones own body parts
Define depersonalization
body seems unreal or dissociated
What is involved in orienting the patient
person, place, and time
Does pt know his/her name, where they are, when it is?
What is the order of orientation loss in a disoriented patient?
time goes first, then place, and last person
Define anterograde amnesia
the inability to remember things that occred AFTER an CNS insult ... cannot make new memories
Define retrograde amnesia
inability to remember things that occured before a CNS insult
Complication of ECT
What is Korsakoff's anmesia
classic anterograde anmesia caused by a thymine deficiency.
bilateral destruction of the mammillary bodies
A alcoholic patient presents with anterograde amnesia, and confabulations.

What is the likely diagnosis?
Korsakoffs amnesia
List some maladaptive patterns of substance use.
1. Tolerance
2. Withdrawal
3. Substance taken in larger than intended amounts
4. Persistent desire or attempts to cut down
5. lots of energy spent trying to obtain the substance
6. important social, occupational, or recreational activites reduced because of substance abuse
7. continued use in spite of knowing the problems it's causing
How many signs of maladaptive substance abuse must be present in a years time to diagnose substance dependance?
3 or more.
What is the difference between substance dependence and substance abuse?
substance abuse is maladaptive patterns leading to clinicall or socially significant impairment or distress that have not met the criteria for substance dependence.
What are some indications of substance abuse?
1. recurrent use resulting in failure to fulfill major obligations at work, school, or home.
2. recurrent use in physically hazardous situations
3. recurrent substance related legal problem
4. continued use in spite of persistent problems cause by use.
What are Freud's three structures of the mind?
Id, Ego, Superego
Define the Id.
Primal urges, sex and aggression.
I want it.
Define the Superego.
Moral values and concience.
I know I can't have it.
Define the Ego.
Mediator between unconcious mind and external world.
Deals with conflicts.
The Topographic thoery of the mind deals with what three topographys?
Concious, preconcious, and unconcious.
Define Concious.
What you are aware of.
Define preconcious.
What you are able to make consious with effort
your phone number
Define unconcious
what you are not aware of.
The central goal of Freudian psychoanalysis is to make the patient aware of his/her unconcious.
What is an Oedipus complex?
repressed sexual feelings of a child for the opposite sex parent, accompanied by a rivalry with same sex parent.
hallucinations, delusions, strange behavior, and loose associations are positive symptoms of what disorder?
Schizophrenia.
What are some negative symptoms of schizophrenia?
flat affect, social withdrawal, thought blocking, lack of motivation
How long must a patient experience symptoms of schizophrenia for a diagnosis?
Periods of psychosis or disturbed behavior lasting > 6 months.
What are the 5 types of schizophrenia?
1. Disorganized
2. Catatonic
3. paranoid
4. Undifferentiated
5. Residual
What are the 4 A's of schizophrenia described by Bleuler?
1. Ambiavlence
2. Autism
3. Affect (blunted)
4. Associations (loose)
A 5th a should be Auditory hallucinations.
What is schizoaffective disorder?
a combination of schizophrenia and a mood disorder.
What is the lifetime prevalence of schizophrenia?
1.5% (males=females, blacks=whites)
presents earlier in men
Are genetic or envionmental factors stronger in the etiology of schizophrenia
Genetic factors outweigh environmental factors
In one word, describe Clusters A, B, and C personality disorders.
A = weird
B = wild
C = worried
Describe a pt with a Cluster A personality disorder.
odd or eccentric, cannot develop meaningful social relationships.

No psychosis, but genetic associations with schizophrenia.
What are 3 types of Cluster A personality disorders?
1. Paranoid
2. Schizoid
3. Schizotypal
What is a Paranoid personality disorder?
distrust and suspiciousness, projection is main defense mechanism
Cluster A
What is a Schozoid peronality disorder?
voluntary social withdrawal, limited emotional expression
Cluster A
What is a Schizotypal personality disorder
interpersonal awkwardness, odd thought patterns and appearance
Cluster A
Personality disroders that lead pts to be erratic, emotional, or dramatic and have a genetic association with mood disorders are classified as ...
Cluster B
What are the 4 types of Cluster B personality disorders
1. Antisocial
2. Borderline
3. Histrionic
4. Narcissistic
"wild"
Describe an antisocial personality disorder.
disregard for and violation of rights of others, crimilatiy, males more often affected than females.
a "conduct" disorder if pt < 18
Describe a borderline personality disorder
unstable mood and behavior, impulsiveness, sense of emptiness. women more often affected than men.
cluster b
Describe a Histrionic personality disorder.
excessive emotionality, somatization, attention seeking, sexually provacative.
cluster B
Describe a Narcissistic personality disorder.
gradiosity, sense of entitlement, may demand "top" physician, or best health care
Cluster B
Pts with personality disorders that leave them anxious or fearful and have a genetic association with anxiety disorders are classified as ...
Cluster C personality disorders
List 3 types of Cluster C personality disorders
1. Avoidant
2. Obsessive-Compulsive
3. Dependent
Describe an avoidant personality disorder.
sensitive to rejection, socially inhibited, timid, feelings of inadequacy
Cluster C
Describe OCD
preoccupation with order, perfectionism, and control
cluster C
Describe a dependent personatliy disorder.
submissive and clinging, excessive need to be taken care of, low self confidence
Cluster c
What are Medicare and Medicaid?
federal health care programs that originated from ammendments to the Social Security Act.
Medicare Part A = hospital
Medicare Part B = doctor
Who does MedicarE provide for?
The Elderly
Who does MedicaiD provide for?
The Destitute. Medicaid is federal and state assistance for very poor people.
Ethically, what do you do if your patient is non-compliant?
Work to improve the physician patient relationship.
Ethically, what do you do if your patient has difficulty taking medication?
Provide written instructions, attempt to simplify the treatment regimen.
What do you do if a family member asks for information about a patient's prognosis?
avoid discussing issues with relatives without permission of the patient.
What do you do if a 17 year old girl is pregnant and asks for an abortion.
informthe patient that most states require parental conset for minors for an abortion.
parental consent is NOT required for emergency situations, treatment of STDs, medical care during pregnancy, prescription for contraceptives, and management of drug addiction.
What do you do if a terminallyl ill patient requests assistance in ending his life?
refuse involvement in any form of euthanasia. physician may however prescribe appropriat analgesics that may coicidentally shorten a patient's life.
What do you do if a patient states that he finds you attractive?
ask direct, closed ended questions and use a chaperone if necessary.
What do you do if a patient refuses a necessary procedure or desires and unnecessary one?
attempt to understand why the patient wants/does not want the procedure. address underlying concerns. avoid performing unnecessary procedures.
What do you do if a patiend is angry about the amount of time he spent in the waiting room?
apologize for any inconvenience. stay away from efforts to try to explain the delay.
what do you do if the patietn is upset with the way he was treated by another doctor?
suggest that the patient speak directly to the physician regarding the concerns. if the problem is weith a member of the office staff ... tell the patient you will speak to that individual.
What do you do if a child wishes to know more about his illness?
Ask what the parents have told the child about his illness. Parents of a child decide what information can be relayed about the illness.
What do you do if a patient continues to smoke, believing that cigarettes are good for him?
Ask how the pt feels about his smoking. Offer advice on cessation if the patient seems willing to make an effort to quit.
A child puts everything in their mouth. How old are they?
1st year of life.
An infant sits with support, how old is she?
4 months
An infant stands with help, how old is he?
8 months
A baby is crawling, how old is she?
9 months
A little girl just learned to walk on her own, how old is she?
13 months
A child has just learned to climb the stairs alone, how old is he?
18 months
At what age does an emergence of hand preference first appear?
18 months
A child has lots of energy, can walk backwards, turn doorknobs, unscrew jars, and scribble with crayons. How old is she?
2 years
A child can ride a tricycle, go up the stairs normally, draw recognizable figures and has just started toilet training. How old is he?
3 years.
A child can descend the stairs normally and hop on one foot. How old is she?
4 years
At what age will a child develop complete sphincter control (toilet trained)?
5 years
At 5 years of age, what percentage of the adult brain mass does the child have?
75%
A child has most of her permanent teeth, how old is he?
11 years
True or False: Boys and girls have roughly the same height to weight ratio between ages 6-12 years?
False: boys are heavier than girls.
At what age does the adolescent growth spurt usually kick in?
Around 12 years, earlier for girls than for boys.
A child plays patty cake and peek a boo, how old is she?
10 months
A baby is experiencing stranger anxiety, how old is he?
6 months
A baby has started showing signs of normal separation anxiety, how old is she?
1 year.
The parent is the central figure and issues of trust are key, how old is the child?
1st year of life.
A toddler will engage in parallel play, but "no" is still her favorite word, how old is she?
1 year
A toddler is selfish and self centered, aggresive, and tends to immitate mannerisms and activities, how old is he?
2 years
A baby can follow objects to midline, how old is she?
4 months
A baby is putting his feet in his mouth, how old is he?
5 months
A baby will approach a toy with one hand, and then change hands with the toy, how old is she?
1st year of life
A baby first laughs outloud, how old is she?
4 months
A baby has started saying "ma-ma-ma" and "da-da-da", how old is he?
10 months
Sensation and movement are most important, schemas are being developed, and assimilationand accomidation are priorities at what age in Piaget's development?
1st year of life.
In Piaget's Cognitive Development, at what age does a baby acheive object permanence?
1 year
A baby kicks and throws a ball, how old is he?
1 year
A baby can stack three cubes, how old is she?
18 months.
A todler is using two word sentences and has a vocabulary of about 250 words, how old is he?
1 year
A todler has started using pronouns and shows great variations in timing of language. Her parents seem to understand her better. How old is she?
2 years
A toddler is using complete sentences and has a vocabulary of 900 words, although he appears to understand 4x tht many words. Strangers can understand him. How old is he?
3 years
A child tells stories, uses prepositions, plurals, and has discovered compound sentences, how old is she?
4 years
A child can stand on her tiptoes, how old is she?
30 months
A child is able to aim and throw a ball and stack 6 cubes, how old is he?
2 years
In Piaget's view, a child who can use symbols and has concrete use of objects and use of symbols along with a strong egocentrism is how old?
2 years
At what age is gender identity fixed?
3 years
A child knows her full name and what sex she is, how old is she?
3 years
Two children are observed to be taking turns with a toy, how old are they?
3 years
At what age is a child likely to start grooming themselves and brushing their own teeth?
4 years
A toddler can catch a ball, stack 9 cubes, cut paper with scissors and keeps unbottoning his shirt buttons, how old is he?
3 years
A child can point to and count three objects, repeat four digits, and name colors correctly, how old is she?
4 years
A child has an imaginary friend and this is entirely normal for this age group, how old is she?
4 years
Two children are caught "playing doctor", at what age does this curiosity manifest?
4 years
A child is having terrible nightmares and needs the light left on at night for fear of monsters, how old is he?
4 years
At what age does a child adopt personal speach patterns?
adolescence (12+)
At what age does communication become the focus of friendships?
adolescence (12+)
A child repeatedly asks for the meaning of words, how old is she?
5 years
A child can count 10 objects correctly, how old is she?
5 years
A child is having terrible nightmares and needs the light left on at night for fear of monsters, how old is he?
4 years
At what age does a child adopt personal speach patterns?
adolescence (12+)
At what age does communication become the focus of friendships?
adolescence (12+)
A child repeatedly asks for the meaning of words, how old is she?
5 years
A child can count 10 objects correctly, how old is she?
5 years
At what age will a child first express romantic feelings towards others, perhaps as an Oedipal phase?
5 years
A child can draw a recognizable man, dress and undress herself, and catch a ball with two hands, how old is she?
5 years
A child can ride a bicycle, print letters, and her father is excited because she is gaining athletic skill and coordination. How old is she?
6-12 years
By age 12, about how many words will a child have in their vocabulary?
About 50,000
A child shows a shift from egocentric to social speech and incomplete sentences decline, how old is he?
6-12 years
Identity is the critical issue in what age range?
adolescence (12+)
Conformity is most important for what age range?
11-12 years
When do cross gender relationships first take off?
adolescence (12+)
A teacher has noticed many of her kids are quitting oragnized sports, how old is her class likely to be?
adolescents (12+)
A teacher has noticed that for her kids, the "rules of the game" are paramount. How old is her class?
6-12 years
At what age range are organized sports first possible?
6-12 years
Demonstrating competence is key for what age group?
6-12 years
At this age there is a separation of the sexes and sexual feelings are not apparent.
6-12 years
At this age there is an adherence to logic, concrete operations, and no hypotheticals.
6-12 years
Children of this age group can use seriation, and have a personal sense of right and wrong.
6-12 years
At this age, children can handle hypotheticals, being systematic problem solving and deal with the past, present, and future.
adolescence (12+)
APGAR stands for what?
Appearance (color)
Pulse
Grimace
Activity
Respiration
How do you calculate aan APGAR score?
Score 0-2 at 1 and 5 inutes in each of 5 categories.
What is a perfect APGAR score?
10
What the three levels of appearance (color) on the APGAR scale?
0 = blue/pale
1=trunk pink
2=all pink
What describes the three levels of pulse on the APGAR score?
0= 0
1= <100
2= >100
What describes the three levels of reflex irritability (grimace) on the APGAR scale?
0= none
1= grimace
2 = grimace + cough
Describe the 3 levels of muscle tone on the apgar scale.
0 = limp
1 = some
2 = active
Describe the three levels of respiratory effort on the APGAR scale.
0 = none
1= irregular
2 = regular
What is the definition of low birth weight in grams?
< 2500 g
List some complications of low birth weight.
infections
respiratory distress syndrome
necrotizing enterocolitis
intraventricular hemorrhage
persistent fetal circulation
What are two likely etiologies for low birth weight?
prematurity and intrauterine growth retardation
True or False: Low birth weight is associated with a greater RR of physical and emotional problems.
True
Long term infant deprivtaion of affection results in the 4 W's ...
Weak, Wordless, Wanting, Wary
How long does deprivation of affection need to continue before changes may be irreversible?
> 6 months
List some effects of long term deprivation of affection in infants.
1. Decreased muscle tone
2. Poor language skills
3. Poor socialization skills
4. Lack of basic trust
5. Anaclitic depression
6. Weight loss
7. Physical illness
True or False: severe deprivation of affection may result in infant death.
True
What is anaclitic depression?
Depression in an infant owing to continued separation from caregiver - it can result in failure to thrive.
An infant becomes withdrawn and unresponsive when left in a crowded daycare for a few weeks, what may be the problem?
Anaclitic depression
What stimuli may cause children to regress to younger behavior?
Stress: physical illness, birth of a new sibling, tiredness.
When a child is found to be physically abused, who is typically the abuser?
usually female and the primary caregiver.
When a child is found to be sexually abused, who is typically the abuser?
A male who is known to the victim.
Healed fractures on x-ray, cigarette burns, subdural hematoma, multiple brusies, and/or retinal hemorrhage in a child are all signs of ...
physical abuse
Gential/anal trauma, STIs, and UTIs in a child are all evidence of ...
sexual abuse.
How many children die each year in the United States from physical abuse?
about 3000.
At what age are most children sexually abused?
9-12 years.
Describe autistic disorder
pts have severe communication problems and difficulty forming relationships. repetative behavior, savants, and below normal intelligence.
Describe Asperger syndrome
a milder form of autism involving problems with social relationships and repetative behavior. Children are of normal intelligence and lack social or cognitive deficits.
Describe Rett disorder
X-linked disorder seen only in girls. Characterized by loss of development and mental retardation appearing at about 4 years.
Describe ADHD
limited attention span and hyperactivity. children are emotionally labile, impulsive, and prone to accidents. Normal intelligence
What is the current treatment for autism?
increase communication and social skills
Why aren't boys seen with Rett syndrome?
With this X-linked disorder, boys die in utero.
What is the treatment for ADHD?
methylphenidate (Ritalin)
Describe conduct disorder
continued behavior violating social norms.
Describe oppositional definant disorder.
A form of conduct disorder when the child is noncompliant in teh absence of criminality.
Describe Tourette's syndrome.
motor/vocal tics and involuntary profanity. Onsent < 18 years.
What is the treatment for Tourette's?
haloperidol
Describe separation anxiety disorder.
fear of loss of attachment figure leading to factitious physical complaints to avoid going to school. Common in children ages 7-8.
Describe Anorexia nervosa.
abnormal eating habits, body image distortion, and increased excercise.
Severe weight loss, amennorrhea, anemia and electrolyte disturbances in an adolescent girl are signs of ...
anorexia nervosa.
Describe Bulimia nervosa.
binge eating followed by self-induced vomiting or use of laxitives. Body weight is usually normal.
Parotitis, tooth enamel erosion, incrase amylase, and esophageal varicies in an adolescent girl at normal weight are signs of ...
Bulimia nervosa.
What are hallucinations?
perceptions in the absence of external stimuli.
What are Illusions?
misinterpretations of actual external stimuli.
What are Delusions?
false beliefs not shared with other members of culture/subculture that are firmly maintained despite obvious proof to the contrary.
Desribe the difference between a delusion and a loose association.
A delusion is a disorder in the content of thought (the actual idea), while a loose association is a disorder in the form of the thought (how the ideas are tied together)
Patients with schizophrenia commonly experience what kind of hallucinations?
Visual and auditory hallucinations.
Patients with psychomotor epilepsy will commonly experience what kind of hallucination?
olfactory hallucination.
True or False: Gustatory hallucination is rare.
True
Patients with DTs or cocaine abusers may experience what kind of hallucinations?
tactile hallucinations
What is a hypnagogic hallucination?
A hallucination that occurs when going to sleep.
What is a hypnopompic hallucination?
A hallucination that occurs when waking from sleep.
How many heroin addicts are there in the United States?
About 500,000
A diagnosis of hepatitis, abscesses, overdose, hemorrhoids, AIDS, or right sided endocarditis (especially in the presence of track marks) should lead the physician to consider
heroin addiction.
What two drugs are used to treat heroin addicts?
Naloxone and Methadone.
How can Naloxone help a heroin addict?
Naloxone (Narcan) and naltrexone competitively inhibit opiods.
How can Methadone help a heroin addict?
Methadone is a long acting oral opiate used for heroin detoxification and long term maintenance.
What is Delirium tremens?
Life threatening alcohol withdrawal syndrome that peaks 2-5 days after the last drink.
tachycardia, tremors, and anxiety followed by halluciantions, delusions, and confusion in an alcoholic may be signs of ...
delirium tremens.
What is the treatment for delirium tremens?
benzodiazepines.
List risk factors for suicide completeion.
"SAD PERSONS": Sex (male), Age, Depression, Previous attempt, Ethanol, RAtional thought, Sickness, Organized plan, No spouse, Social support lacking.
Which gender attempts suicide more often?
Women
Which gender is sucessful at suicide more often?
Men
What is a personality trait?
An enduring pattern of perceiving, relating to, and thinking about the environment and oneself that is exhibited in a wide range of important social and personal contexts.
What is a personality disorder?
When personality traits become inflexible and maladaptive, causing impariment in social or occupational functioning or subjective distress
True or False: A patient with a personality disorder is usually aware of the problem.
False: a person with a personality disorder is usually NOT aware of the problem.
What does the phrase "Mature women wear a SASH" indicate
Mature ego defenses: Sublimation, Altruism, Supression, and Humor
What are ego defenses?
automatic and UNCONCIOUS reactions to psychological stress.
Describe altruism as an ego defense.
guilty feelings alleviated by unsolicited generosity toward others.
Describe humor as an ego defense.
appreciating teh amusing nature of an anxiety provoking or adverse situation.
a mafia boss making a large donation to charity is an example of what ego defense?
altruism.
a cancer patient laughing about their condition is an example of what ego defense?
humor
aggressive impulses used to succeed in sports is an example of what ego defense?
sublimation.
What is sublimation as an ego defense?
process whereby one replaces an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system.
describe supression as an ego defense.
VOLUNTARY withholding of an idea or feeling from concious awareness.
choosing not to think about your taxes until april 13th is an example of what ego defense?
suppression.
Describe acting out as an ego defense.
unacceptable feelings and thoughts are expressed through actions.
tantrums.
Describe dissociation as an ego defense.
temporary, drastic changes in personality, memory, conciousness, or motor behavior to avoid emotional stress.
extreme forms can result in multiple personalities.
Describe denial as an ego defense.
avoidance of awareness of some painful reality.
a common reaction when a patient is diagnosed with a fatal disease.
Describe displacement as an ego defense.
process whereby avoided ideas and feelings are transferred to some neutral person or object.
mother yells at a child because she is angry at her husband.
Describe fixation as an ego defense.
partially remaining at a more childish level of development.
men fixating on sports games.
describe identification as an ego defense.
modeling behavior after another person.
abused child becomes an abuser.
describe isolation as an ego defense.
separation of feelings from ideas or events.
describing murder in graphic detail with no emotional response.
describe projection as an ego defense.
an unacceptable internal impulse is attributed to an external source.
a man who wants another woman thinks his wife is cheating on him.
describe rationalization as an ego defense.
proclaiming logical resons for actions actually performed for other reasons, usually to avoid self blame.
saying a job was not important anyway after being fired from a job.
Describe reaction formation as an ego defense.
process whereby a warded off idea or feeling is replaced by an unconciously derived emphasis on it's opposite.
Describe regression as an ego defense.
turning back the maturational clock and going back to earlier modes of dealing with the world.
Describe Repression as an ego defense
involuntary withholding of an idea or feeling from conscious awareness.
Describe splitting as an ego defense
Belief that people are good or bad ... extremes.
A patient with libidinous thoughts enters a monastary. This is an example of what ego defense?
Reaction formation.
An 8 year old child under stress begins bed wetting again. This is an example of what ego defense?
Regression.
What is the basic underlying mechanism for all ego defenses?
repression.
a patient says that one doctor is a miracle worker, but another is totally incompetent. this is an example of what ego defense?
splitting.
What is dysthymia?
A milder form of depression lasting at least 2 years.
Describe a major depressive episode.
characterized by at least 5 of the following for 2 weeks.
1. sleep disturbances
2. loss of interest
3. guilt
4. loss of energy
5. loss of concentration
6. change in appetite
7. psychomotor retardation
8. suicidal ideation
9. depressed mood
A major depressive episode MUST include one of two symptoms, these are ...
1. depressed mood, or 2. anhedonia
A patients has experienced 2 major depressive episodes with a symptom free interval of 2 months, what is the diagnosis?
Recurrent Major Depressive Disorder.
What is teh lifetime prevalence of major depressive disorder in women? in men?
10-25% in women and 5-12% in men.
What is indicated by "SIG E CAPS"?
Symptoms of major depression: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal.
What is dementia?
the development of multiple cognitive defects including memory, aphasia, apraxia, agnosia, loss of abstract thought, behavioral and personality changes, imparied judgement.
What is the key to diagnosing dementia?
Ruling out delirium.
In an elderly person who seems to apparently have dementia, what other condition should be considered?
Depression.
Describe the difference between dementia and delirium.
Delirium= changes in sensorium while Dementia = changes in memory. Dementia is commonly irreversible.
What is the most common psychiatric illness on medical and surgical floors?
Delirium.
If a patient on a hospital ward presents with delirium, what drugs should you check for in their med list?
Drugs with anticholinergic effects.
A patient presents with a decreased attention span and decreased level of arousal, disorganized thinking, hallucinations, illusions, and cognitive dysfunction ... what is the likely diagnosis?
Delirium
What is the key to diagnosis of delirium?
Waxing and waning level of conciousness, develops rapidly.
A man who has lost his wife appears to be in shock, and expresses denail, guilt and somatic symptoms for the past 4 months. What is the diagnosis?
Normal bereavement.
How long does normal bereavement last?
Typically 6 months to a year.
When does grief become pathologic?
When it becomes excessively intense or prolonged, delayed, inhibited, or denied.
What are the functions of the frontal lobe?
concentration
orientation
language
abstraction
judgement
motor regulation
mood
What deficit is most notable in frontal lobe lesions?
lack of social judgement.
How is REM sleep like sex?
increase pulse, penile/clitoral tumescence, decreases with age.
how often does REM sleep occur while sleeping?
every 90 minutes.

duration of REM sleep increases throughout the night.
What is the principal neurotransmitter involved in REM sleep?
ACh.
What are the neurotransmitter changes associated with anxiety?
increase in NE
decrease in GABA and 5HT
What neurotransmitter changes are associated with Depression?
decrease NE and 5HT
What neurotransmitter changes are associated with Alzheimers dementia?
decreases ACh
What neurotransmitter changes are associated with Huntington's Disease?
decrease GABA and ACh
What neurotransmitter changes are associated with Schizophrenia?
increase DA
What neurotransmitter changes are associated with Parkinson's disease?
decrease in DA.
Name the 4 reflexes that are present at birth.
1. Mono
2. Rooting
3. Palmar
4. Babinski
What is the Mono reflex?
extension of limbs when startled
What is the rooting reflex?
nipple seeking
What is the palmar reflex?
grasps object in palm
What is the Babinski reflex?
large toe dorsiflexes with plantar stimulation.
When do the reflexes present at birth typically disappear?
Within the 1st year of life.
What are the Kubler-Ross dying stages?
1. Denial
2. Anger
3. Bargaining
4. Grieving
5. Acceptance
True or False: Kubler Ross stages of dying always occur sequentially?
False: more than one stage may be present at a time and they may not proceed in order.
What does "Death Arrives Bringing Grave Adjustments" indicate.
The Kubler-Ross stages of dying. Denial, Anger, Bargaining, Grieving, Acceptance.
Describe "substance abuse"
Maladaptive pattern leading to clincally significant impairment or distress - 1 or more symptom must be present for 1 year - do not meet criteria for substance dependence.
What are the symptoms of substance abuse?
1. recurrent use = failure to fulfill major obligation
2. recurrent use in physically hazardous situation
3. recurrent use related legal problems
4. continued use despite persistent problems
What is substance dependence?
Maladaptive pattern of substance use defined as 3 or more of the defining symptoms for at least a year.
What are the symptoms of substance dependence?
1. tolerance
2. withdrawal
3. taken in larger than needed amounts
4. persistent desire or attempt to cut down
5. lots of energy spent trying to obtain substance
6. important activities reduced because of substance use
7. continued use despite awareness of problems
Describe adjustment disorder.
emotional symptoms causing impairment following an identifiable psychosocial stressor lasting < 6 months.
Describe generalized anxiety disorder.
uncontrollable anxiety unrelated to a specific person, situation, or event. May include GI symptoms, fatigue, and difficulty concentrating.
Describe post traumatic stress disorder.
intense fear, helplessness, or horror, in which a person who experienced or witnessed an event that involved actual or threatened death or injury persistently reexperiences the event.
What is the difference between acute stress and PTSD?
acute stress lasts 2-4 weeks, PTSD lasts > 1 month and causes distress or social/occupational impairment.
What is Gamophobia?
fear of marriage.
What is algophobia?
fear of pain.
what is acrophobia?
fear of heights.
What is agoraphobia?
fear of open places.
What is a specific phobia?
fear that is excessive or unreasonable, cued by presence or anticipation of a specific object or entity.
Does a person with a specific phobia recognize that their fear is excessive?
Yes.
What are treatment options for specific phobias?
systematic desensitization, flooding.
In reference to a somatoform disorder, describe a primary, secondary, and tertiary gain.
Primary gain = what symptom does for patients internal psyche.
Secondary gain = what symptom gets for patient (ie sympathy)
Tertiary gain = what the caretaker gets (MD on an interesting case)
What does "PANIC" indicate.
The symptoms of a panic attack: palpiations, abdominal distress, nausea, increased perspiration, chest pain, chills, choking.
What is panic disorder?
discrete period of intense fear and discomfort, peaking in 10 minutes, including 4 symptoms, and must be diagnosed in the context of the occurence.
Does sexual interest decline in the elderly?
No, sexual interest does not decline.
What sexual changes to elderly men experience?
slower erection/ejaculation, longer refractory period
What sexual changes do elderly women experience?
vaginal shortening, thinning, dryness.
Describe changes in sleep patterns with advanced age.
decrease REM sleep, slow wave sleep
increase sleep latency, wakings during the night.
What are the most common medical conditions due to advanced age?
arthritis, HTN, CVD.
True or False: Depression is more prevalent in the elderly?
True: depression is more prevalent and the suicide rate is increased.
What percent of time is spent in stage 1 sleep?
5%
What percent of time is spent in stage 2 sleep?
45%
What percent of time is spent in stage 3-4 sleep?
25%
What percent of time is spent in REM sleep?
25%
When do you experience a Beta waveform?
When awake, alert, active mental concentration with your eyes open.
When do you experience an alpha waveform?
awake, but drowsy with eyes closed.
In light sleep, what waveform predominates?
theta
in deeper sleep, stage 2, what waveform predominates?
Sleep spindles and K complexes.
In stage 3-4 sleep, the depenst non REM sleep, what waveforms predominate?
delta waves (lowest frequency, highest amplitude)
When will a person sleepwalk, have night terrors, or wet the bed?
In delta sleep (stage 3-4)
What waveform predominates in REM sleep?
Beta waves (the same as being awake)
when does dreaming occur?
in REM sleep
Describe REM sleep.
dreaming, loss of motor tone, possibly a memory processing function, erections, increased brain oxygen consumption.
What does "At night, BATS Drink Blood" indicate
waveforms of sleepstages: Beta, Alpha, Theta, Spindles and K forms, Delta, Beta.
What is the key to initiating sleep?
5HT predominance of raphe nucleus
What neurotransmitter reduces REM sleep?
NE
What are EOM movements during REM sleep due to?
activity of the PPRF (paramedian pontine reticular formation / conjugate gaze center)
What do the terms "paradoxical sleep" and "desynchronized sleep" apply to
REM sleep having the same EEG pattern as awake and alert
Why are benzodiazepines good for night terrors and sleep walking?
They shorten stage 4 sleep.
What drug shortens stage 4 sleep and is used to treat enuresis?
Imipramine.
What is a conversion disorder?
A somatoform disorder where symptoms suggest motor or sensory neurologic or physical disorder - but tests and physical examination are negative.
What is somatoform pain disorder?
prolonged pain that is not explained completely by illness.
What is hypochondriasis?
misinterpretation of normal physical findings, leading to preoccupation with fear of having a serious illness in spite of medical reassurance.
what is somatization disorder?
variety of complaints in multiple organ systems.
what is body dysmorphic disorder?
patient convinced that part of their own anatomy is malformed.
what is pseudocyesis?
a false belief of being pregnant associated with objective physical signs of pregnancy.
What is electroconvulsive therapy?
a painless procedure that results in a seizure. Complications can result from anesthesia.
What are the major adverse effects of ECT?
disorientation, and amnesia.
When is ECT used?
For major depressive disorder refractory to all other treatment.
What is a hypomanic episode?
like a manic episode, except the mood disturbance is not severe enough to cause marked impairment in the patients life. it does not require hospitalization and there are no psychotic features.
What is malingering?
patient conciously fakes or claims to have a disorder in order to attain a specific gain.
What is facticious disorder?
a patient conciously creates symptoms in order to assume the "sick" roll to get medical attention.
What is Munchausen's syndrome?
manifests as a chronic history of multiple hosptital admissions and willingness to receive invasive procedures.
What is Munchausen's syndrome by proxy?
when the illness in a child is caused by a parent. the motivation is unconcious.
Describe bipolar disorder.
6 separate criteria sets exist for bipolar disorders with combinations of manic, hypomanic, and depressed episodes.
What is the treatment of choice for bipolar disorder?
Lithium.
What is cyclothymic disorder
a milder form of bipolar disorder lasting at least 2 years.
What is a manic episode?
distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week.
During a manic episode, 3 or more symptoms are present ... list the 7 symptoms.

DIG FAST
1. distractability
2. insomnia
3. grandiosity
4. flight of ideas
5. increase in activity/agitation
6. pressured speech
7. thoughtlessness
Disinhibition, emotional lability, slurred speech, ataxia, coma, and blackouts are indicative of intoxication with what substance?
alcohol.
what symptoms may a patient withdrawing from alcohol experience?
tremor, tachycardia, HTN, malaise, nausea, seizures, DTs, tremulousness, agitation, hallucinations.
A patients appears restless, and complains of insomnia, anxiety, and shows signs of arrhythmias. You suspect the patient is using what substance?
cigarettes ... nicotine intoxication.
When a patient stops smoking cigarettes, what symptoms might they expect during withdrawal?
irritability, headache, anxiety, weight gain, and cravings.
a patient who consumes lots of coffee might experience what symptoms?
restlessness, insomnia, increased diruesis, muscle twitching, cardiac arrhythmias
When a patient stops caffeine consumption, what symptoms might they expect?
headache, lethargy, depression, weight gain.
A patient presents to the ER with nausea and vomiting, constipation, and pinpoint pupils. What substance do you suspect?
opiods.
When a patient ODs on opiods, what symptom are you most concerned with?
seizures ... may be life threatening.
a pt presents with amnesia, ataxia, somnolence, and minor respiratory distress. They do not consume alcohol ... what substance do you suspect?
Benzodiazepines.
Are benzos addictive?
if consumed with alcohol.
When a patient stops taking benzos, what symptoms may they experience?
rebound anxiety, seizures, tremor, and insomnia
a patient presents to the ER with major respiratory depression, their friens state they "took something" ... what do you suspect?
barbituates.
In addition to anxiety, seizures, and delirium, what are you concerned about in a patient who is withdrawing from barbituates?
life threatening cardiovascular collapse.
a patient presents with euphoria, anxiety, paranoid delusions, imparied judgement, and the munchies ... what do you suspect?
marijuana.
Are there withdrawal symptoms from marijuana?
social withdrawal.
a patient presents with marked anxiety, delusions, visual hallucinations, flashbacks, and pupil dilation. what do you suspect?
LSD.
a pt presents with agitation, pupillary dilation, HTN, tachycrdia, euphoria, fever, hallucinations and they have been awake for 36 hours ... waht drug do you suspect?
amphetamines.
what symnptoms can a patient withdrawing from amphetamines expect?
post crash depression, lethargy, headache, stomach cramps, hunger, hypersomnolence.
a pt presents euphoric with psychomotor agitation, tachycardia, pupillary dilation, hallucinations, and angina ... what drug do you suspect?
cocain.
what fatal effect of cocain are you worried about?
sudden cardiac death.
what can a patient in withdrawal from cocain expect to experience?
post crash depression and suicidality, hypersomnolence, fatigue, malaise, and severe psychological craving.
a pt presents with fever and psychomotor agitation, he is belligerant and impulsive, and has horizontal and vertical nystagmus. What drug do you suspect?
PCP.
When a patient is withdrawing from PCP, what symptoms are you concerned about?
sudden onset of severe, random, homicidal thought
A patient recovering from a PCP intoxication appears to be having a recurrence of intoxication symptoms... why?
reabsorption of PCP from the GI tract.
What is the formula for BMI?
weight(kg)/(heightxheight(m))
What is the BMI numerical cutoff for an obesity?
> 30.0
A patient complains of sexual dysfunction, what 3 things are on your differential?
1. drugs
2. disease
3. psychological
What diseases may lead to sexual dysfunction?
depression or DM
What drugs can lead to sexual dysfunction?
anti-HTN, neuroleptics, SSRI, EtOH.
Describe the physiological effects of stress.
Stress induces production of FFA, 17-OH corticosteroids, lipids, cholesterol, and catecholamines. it affects water absorption, muscular tonicity, gastrocolic reflex, and mucusal circulation.
A patient with depression will typically show these three changes in their sleep stages:
1. decrease slow wave sleep
2. decrease REM latency
3. early morning awakening
What is the most important screening question for depression?
Are you experiencing early morning awakening?
Describe narcolepsy.
person falls asleep suddenly. May include hypnagogic or hypnopompic hallucinations.
A person with narcolepsy starts off their sleep cycle with what sleep stage?
REM
What is cataplexy?
sudden collapse while awake. may be present in some patients with narcolepsy.
What is the treatment for narcolepsy?
amphetamines.
A patient stops breathing for at least 10 seconds repeatedly during sleep, what is a possible diagnosis?
Sleep apnea
What is the treatment for sleep apnea?
weight loss, CPAP, surgery
Describe the difference between central and obstructive sleep apnea.
Central sleep apnea involves no respiratory effort, obstructive sleep apnea involves respiratory effort against an airway obstruction.
What symptoms and signs is sleep apnea associated with:
obesity, loud snoring, systemic or pulmonary HTN, arrhythmias, and possibly sudden death.