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119 Cards in this Set

  • Front
  • Back
What is Delirium Tremens?
Hallucinations, Agitation, Tremor from Alcohol withdrawal
Should a patient be given life support in the following DNR situations?
1. Routine mechanical ventilation after Lung Transplant with Living Will and Unhappy Wife.
2. A man with a DNR who is choking
3. Victim of Car Accident with Living Will and Signed Driver's License on the verge of death, Wife is adamant about keeping him alive and keeping his body in tact
4. A Living Will with a request not to life-save and someone with the power of attorney who wants maintain life-support
1. Mechanical Ventilation is routine after the surgery and should be maintained until the patient has a low likelyhood of survival. (Going to Court or Ethics Committee is usually wrong)
2. DNR refers to Cardiopulmonary resucitation unless otherwise specified. So, save the man.
3. Death and Donation, Living Will and Driver's License serve to show the patient's wishes.
4. The Power of Attorney supercedes the Living Will.
A 27 year-old man is warm, happy, works, did not complete high school, speaks in 3 word sentences, and lives with his parrents. What's his deal?
Autistic- no language, can't work
Childhood Disintegrative Disorder- Loss of previously aquired skills
Mixed receptive-expressive disorder- Neuro condition, language disorder.
Rett's Syndrome- Severe Impairment, loss of social engagement and previously aquired skills. Hand wringing. Female
A 27 year-old man is warm, happy, works, did not complete high school, speaks in 3 word sentences, and lives with his parrents. Why does this man not have Autism?
An Autistic person does not use language, and generally can't work
A 27 year-old man is warm, happy, works, did not complete high school, speaks in 3 word sentences, and lives with his parrents. Why does this man not have Childhood Disintegrative Disorder?
In Childhood Disintegrative Disorder one loses previously aquired skills
A 27 year-old man is warm, happy, works, did not complete high school, speaks in 3 word sentences, and lives with his parrents.
Why does this man not have Mixed Receptive-Expressive Disorder?
Mixed receptive-expressive disorder is a language disorder manifested by a Neuro Disorder.
A 27 year-old man is warm, happy, works, did not complete high school, speaks in 3 word sentences, and lives with his parrents. Why does this man not have Rett's syndrome?
Rett's Syndrome is a severe Impairment:
loss of social engagement
previously aquired skills
Hand wringing
What does the Stanford Binet Intelligence Test test?
IQ=mental age/chronological age
What does the Vineland Adaptive Behavior Scale test?
Developmental and social functioning.
What does the Wechsler Adult Intelligence Scale test, and more importantly, what does it not test?
Tests Intelligence with 6 verbal and 5 performance test. It does not test Neuro Function
What does the Wide Range Achievement Test test?
Academic Achievement
What is the role of Estrogen and Progesterone in men with sexual dysfunction?
Estrogen- In a demented patient with overactive libido and increased testosterone, it can decrease the libido.
Progesterone- Can lower Libido and cause Impotence
What is the role of Methaline Bromide in men with sexual dysfunction?
It can cause impotence
What is Propanolol used for in men with sexual dysfunction?
It can be used in low doses for performance anxiety. Can cause Impotence and lower libido.
What is Sertraline used for in men with sexual dysfunction?
This SSRI can improve depression and delay ejaculation.
What is the Defense Mechanism Sublimation?
Diversion of unacceptable impulses into more acceptable ones.
Some examples:
Mom who's child dies gets active in and NGO or Senate to fight the disease.
Girl who's best friend dies starts writing in a diary.
What is the Defense Mechanism Identification?
Adoption of the characteristics of another person.
What is the Defense Mechanism Projection?
When someone attributes their thoughts on another person.
What is the Defense Mechanism Rationalization?
Offering false, but acceptable explanation for behavior
At what age do children begin cooperative play?
Around the age of 4. (At this age they can also groom themselves, have imaginary friends, and can draw stick figures)
Before this, kids may play in parallel but no true interaction.
What information do you need with a man with erectile dysfunction?
Marital Conflict
What are the signs and symptoms of PCP use?
Impaired Judgement
Distorted Body Image


High Doses:
What are the signs and symptoms of Amphetamine use?
Short Attention Span

Chronic Use can cause Paranoid Schizo
No Nystagmus
What are the signs and symptoms of Heroin use?
Contricted Pupils
Decreased Bowel Sounds
What are the signs and symptoms of Cocaine intoxication?
Symp Activiation
What are the signs and symptoms of LSD use?
Perceptual Disturbances
Little Behavior Change
What are the Side Effects of Electro Shock Therapy?
Memory Loss is #1
What is an Oneiroid State?
The Dream-like state of a Schizophrenic who looks perplexed: not oriented to time and place and hallucinating.
What is the Defense Mechanism Splitting?
Objects or People are "all good" or "all bad"
What is the Defense Mechanism Displacement?
Feelings are transferred from one subject to a more acceptable substitute.
What is the Defense Mechanism Fixation?
It is arrested development at a certain stage.
What is the Defense Mechanism Reaction Formation?
It is one where a person takes the opposite opinion of what they feel.
In what situations can an adolescent make decisions without their parents?
STD treatment
Substance Abuse
birth control
prenatal care
What are the side effects of Valproic Acid?
What are the side effects of Haloperidol?
What are the side effects of Lorazepam?
Increase in lactate dehydrogenase
What are the side effects of Trazodone?
Strong Sedative
What is Delusional Disorder?
Non-bizarre Delusions for 1 month. No real Hallucinations
What is Schizoaffective Disorder?
Must have:
Major Affective Disorder (Mood Disorder)
Hallucinations can rule out what class of disorders?
Personality Disorders
What is systematic desensitization?
Going step by step to relax.
What is selection bias?
non-random assignment to a study group
What is recall bias?
knowledge of presence of disorder alters the recall by a study subject
What is sampling bias?
The subjects are not representative of the general population, so it is not generalizable.
Late-look bias
Information gathered at an inappropriate time.
How is bias reduced?
(4 things)
1. Blinding
2. Placebo
3. Crossover studies
4. Randomization
What type of test is good for screening?
What characteristic of a test makes it better for diagnosis?
What is the equation for Odds Ratio, Relative Risk, and Attributable Risk?
Define Precision, Accuracy, Random Error, and Systematic Error.
Precision is:
1. reliability (consistency and reproducibility)
2. The absence of random variation in a test.
Accuracy: the trueness of test measures. (validity)
Random Error- Reduced precision
Systematic Error- Reduced accuracy.
Define Type I Error, Type II Error.
Type I= There IS an effect when there really isn't.
Type II= There is NOT an effect when there really is.
What changes Power?
Power is 1-Beta. It is the probability of rejecting the null hypothesis when it IS false.
Affected by:
1. The number of different end points
2. Compliance
3. The size of expected effect
Increase in sample size=Increased power
What is the Standard Error of the mean?
SEM decreases as N increases.
What is the difference between a t-test, chi2 test, and ANOVA?
t-test is the difference between means of 2 groups
ANOVA checks the means of 3 or more groups
Chi2 is the difference between 2 categorical outcomes.
What is the coefficient of determination?
What is 1ry, 2ry, 3ry disease prevention?
1- Prevent the disease
2- Detect the disease early
3- Reduce disability
What preventative measures should you take with the following risk factors?
1. Diabetes
2. Drug Use
3. Alcoholism
4. Overweight
5. Homeless, Recent Immigrant, Inmate
6. High-Risk Sexual Behavior
1. Diabetes- Eye, foot, urine exam
2. Drugs- Hepatitis, HIV, TB
3. Alcohol- Flu, Pneumococcal Immunization, TB
4. Blood Sugar, Cholesterol
5. TB
6. HIV, Hep B, Syphilis, Gonorrhea, Chlamydia
What are the Reportable Diseases?
B.A. SSSMMART, Chicken or your Gone
B- Hep B
A- Hep A
S- Salmonella
S- Shigella
S- Syphilis
M- Measles
M- Mumps
R- Rubella
C- Chicken Pox
G- Gonorrhea
What are the leading causes of Death for Infants?
Congeniatl Anomalies, short gestation/low birth weight, SIDS, Maternal Complications, Resp Death Syndrome
What are the leading causes of Death for ages 1-14?
Injuries, cancer, congenital anomalies, homicide, heart disease
What are the leading causes of Death for ages 15-24?
Injuries, homicide, suicide, cancer, heart disease
What are the leading causes of Death for ages 25-64?
Cancer, heart disease, injuries, suicide, stroke
What are the leading causes of Death for 65+?
Heart disease, cancer, stroke, COPD, pneumona, flu
What are Medicare parts A and B?
A= Hospital (A is where you stay)
B= Doctor Bills (B is ME)
What does informed consent legally require? What are the exceptions?
1. Discussion of pertinent info
2. Patient's aggrement
3. No coercion

1. Patient is not capable of decision-making.
2. Implied consent in an emergency
3. Withholding information is benificial to the patient
4. Patient Waived his rights.
When can confidentiality be broken?
1. Potential Harm to others is serious (Infectious Disease)
2. Likelihood of Harm to oneself is high (suicide)
3. No alternative means to warn or protect those at risk. (Child or elder abuse)
4. Preventing Harm (Impaired auto drivers)
What are the 3 D's of malpractice?
Dereliction- Physician breach of duty
Damage- Patient suffers harm
Direct- Breach of duty causes harm.
Breakdown APGAR scores
Appearance- Color (blue/pale, trunk pink, all pink)
Pulse- Heart Rate
Grimace- Reflex Irritability (0, Grimace, Grimace + Cough)
Activity- Muscle tone (limp, some, active)
Respiration- (0, irregular, regular)
Scored, 0-2 for each, max of 10
What's the deal with Low Birth Weights?
less thean <2500 g
> incidence of emotional, physical problems
Caused by prematurity or intrauterine growth retardation.
Complications are infections, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrahage, adn persistent fetal circulation.
Why should you not neglect your kid? Don't deprive him these 7 things could happen.
4 W's: Weak, Wordless, Wanting, Wary. >6 months could be irreversible.

Decrease in muscle tone
Poor language skills
Poor socialization skills
Lack of trust
Anaclitic depression
Weight loss
Physical Illness
(this can all lead to death)
What is Anaclitic depression?
Depression in an infant owing to continued separation from caregiver- can result in failure to thrive. Infant becomes withdrawn and unresponsive
What are the signs of Physical and Sexual Child Abuse?
Healed Fractures on x-ray, cigaretter burns, subdural hematomas, multiple bruises, retinal hemorrage or detachment.
Abused by female, 1ry caregiver.
3000 deaths

Sexual abuse
Genital/anal trauma, STDs, UTIs
Known to victim, usually male
around 9-12 y/o.
What are the milestones of a 3 month child?
Holds head up, Moro reflex disappears (flexion and extension of arms in response to any startling event).
Social Smile
How old is a child who rolls front to back, sits when propped and recognizes people?
4-5 months
What are the milestones of a 7-9 month child?
Sits alone, crawls
Stranger anxiety, orients to voice
How old is a child who loses their upgoing Babinski?
12-14 months
What are the milestones of a 15 month child?
Few Words, Seperation anxiety
How old is a child who climbs stairs, stacks 3 blocks, and has Object Permanence?
12-24 months
What are the milestones of a 18-24 month child?
Stacks 6 blocks, Rapprochement (Reestablishing Coordial Relationships)
How old is a child who engages in parallel play?
24-48 months
What are the milestones of a 24-36 month child?
They have their core gender identity established.
How old is a child who can stack 9 blocks, and is toilet training?
30-36 months
What are the milestones of a 3y/o?
Rides tricycle, copies line or circle drawing.
Group Play
At what age do kids understand death, read, develop the superego, have same-sex friends, and identify with same-sex parents?
At what age do kids start with abstract resoning (formal operations) and formation of a personality?
11 (girls)
13 (boys)
What sexual changes occur in the elderly?
Sexual Interest does not decrease.
Men: Slower erection/ejaculation, longer refractory period
Women: vaginal shortening, thinning, and dryness.
What changes in sleep pattern occur in the elderly?
Decreased REM and slow-wave sleep.
Increased sleep latency and awakenings.
What are common medical conditions in the elderly?
arthritis, HTN, heart disease, osteoporosis, psychiatric problems, increased suicide rate
What major changes are associated with aging?
Decreased vision, hearing, immune response, bladder control.
Decreased renal, pulmonary, GI function
Decreased muscle mass and increased fat.
NO DECREASE in Intelligence
What is the difference between pathologic grief and normal grief?
Normal: shock, denial, guilt, and somatic symps last 6 months to a year. Some get illusions
Pathologic grief is intense or prolonged; or delayed, inhibited, or denied. May experience depressive symptoms, delusions, and hallucinations.
What are teh Kuble-Ross Stages of Grief?
Death Arrives Bringing Grave Adjustments

More than one stage can be present
What are the biologic consequences of stress?
Increased Producation of FFAs, 17-OH corticos, lipids, cholesterol, catecholamines
Water absorption muscular tonicity, gastrocolic reflex and mucosal cirulation are affected.
Can exacerbate CHF, DM, RA, IBS, and Gastric Ulcer Disease
What is the DDx of Sexual Dysfunction?
Drugs- anti-HTN, neuroleptics, SSRI, EtOH
Disease- Depression, DM
Psych- Performance anxiety
What is anitsocial personality disorder?
Someone who operates in oppostion to society's rules. Criminal Behavior.
What is avoidant personality disorder?
Socially withdrawn, but dislike their isolation and desire relationships. Hypersensitive and fear rejection.
What symptoms does someone with Generalized Anxiety Disorder present with?
Restlessness, Fatigueability, irritability, muscle tension, sleep disorders, difficulty concentrating. Overall a general anxiety towards everything.
What is the difference between Post-Traumatic Stress Disorder and Adjustment Disorder?
PTSD leads to a "re-experience" of the event in a dream or wakeful.
What is the difference between a Delusional Disorder and Paranoid personality disorder?
A delusional disorder has a basis in something. It does not prevent functioning in other areas of life.
Paranoid personality disorder is pervasive distrust presenting in early adulthood, with unfounded paranoia, preoccupation with doubts, reluctance to confide in others,
What is the difference between schizophrenia and schizophreniform disorder?
schizophreniform- evolves abruptly, is severe, but remits in 6 months. If it lasts, it is schizophrenia.
1. Anosagnosia
2. Prosopagnosia
Anosagnosia- deficit in cognition about one's illness. Parietal lobe lesion. Unaware of motor and sensory deficits.
Prosopagnosia- inability to recognize faces. bilateral lesion of the visual association cortex.
If someone gives approximate answers instead of exact ones and is associated with amnesia, disorientation, and perceptual disturbances, what disorder do they have?
Ganser Syndrome
What is the difference between a Hypnagogic and Hypnopompic Hallucination?
HypNAgogic=NAP (when going to sleep)
Hypnopompic=on awakening
What are 2 person and 3 person auditory hallucinations?
2- Talking to the person
3- Talking about the person
What is a diagnostic test for recent alcohol abuse?
Serum gama-glutamyltransferase
How does alcohol affect the following:
1. Amylase
2. BUN
3. MCV
4. TGs
1. With alcohol induced pancreatitis, the amylase is elevated
2. BUN is elevated if the patient is dehydrated
3. Is elevated in chronic alcoholics, moreso in women
4. TGs are elevated in chronic alcoholics due to their inability to metabolize lipoproteins and TGs.
What is the difference between continuous reward, and variable reward?
Continuous- after every response. Rapid. Like a vending machine.
Various- reward received after a random number of uses. Slow. Like a slot machine.
Define the Id, Ego, and SuperEgo.
Id- Primal urges, sex, and aggrestion (I want it)
Ego- Mediator between the unconcious mind and the external world (Deals with the conflict)
SuperEgo- Moral Values, Concience (You know you can't have it)
Define Conscious, preconcious, adn unconscious
Conscious- what you are aware of
Preconscious- What you are able to make concious with effort (phone number)
Unconscious- What you are not aware of; Freud- make you aware of your unconcious.
What is the defense mechanism Humor?
Appreciating the amusing nature of an anxiety-producing or adverse situation.
What is the defense mechanism Altruism?
Guilty feelings alleviated by unsolicited generosity towards others
What is the defense mechanism Supression?
Voluntary withholding of an idea or feeling from concious awareness
If you're mature, what defense mechanisms would you use?
Mature Women wear a SASH.
What is the defense mechanism acting out?
unacceptable feelings are manifested in action. A tantrum
What is the defense mechanism Dissociation?
Temporary, drastic change in personality, memory, conciousness, or motor behavior. An extreme is multiple personality disorder.
What is the defense mechanism Isolation?
Seperation of ideas and events. Can describe an event with no emotion.
What is the defense mechanism repression?
the involuntary version of suppression.
When do the following reflexes disappear:
1. Babinski
2. Moro
3. Palmar
4. Tonic Neck
1. 1 yr
2. 3 months
3. 2 months
4. 7 and 8 months (ipsi leg extension and contra arm flexion on head turn)
Which of the following is MOST suggestive of alcohol abuse?
a. Desire to cut down
b. Recurrent Drunk Driving
c. Seizure on Withdrawal
d. Suicidal Ideation
e. Tolerance
b. Drunk Driving
DSM says that recurrent use without thinking of the consequences is part of the diagnosis.
Tolerence and Withdrawal are criteria for dependance.
What are the following Erickson stages:
1. Autonomy vs. Shame
2. Identity vs. Identity Confusion
3. Industry vs. Inferiority
4. Initiative vs. Guilt
5. Trust vs. Mistrust
1. The time between 1-3 when kids seek independence. If 1. Autonomy vs. Shame- autonomy is allowed = pride. If there is punishment = shame and doubt
2. Identity vs. Identity confusion- 11 y/o- test who they are. Figure out their role in the world
3. Industry vs. Inferiority- 6-11, master a task and develop a sense of duty. Non-supportive home or school can lead to inadequacy.
4. Initiative vs. Guilt- 3-5 y/o, Learning limits. With punisment comes guilt. Realizes aggressiveness can get out through games
5. Trust vs. Mistrust- infancy, develops trust from the mother.