Fa: Step 2 Ck. Psychiatry.

Front 1

TCAs: neurotransmitters affected (2)

Back 1

inhibit reuptake of norepi and serotonin

Front 2

Name important TCAs (7)

Back 2

amitriptyline
nortriptyline
doxepin
clomipramine
desipramine
imipramine
trimipramine

Front 3

TCA side effects (6)

Back 3

"Anti-HAM:"
1. anti-histaminic (sedation)
2. anti-adrenergic (orthostatic hypotension; tachycardia, arrhythmias)
3. anti-muscarinic (dry mouth, constipation, urinary retention, blurred vision, tachycardia)
4. Weight gain
5. Lethal in overdose!
6. 3Cs: convulsions, coma, cardiotoxicity

Front 4

MAOIs: mechanism

Back 4

Irreversibly inhibit MAO-A/B, enzymes involved in deactivating biogenic amines

Front 5

MAO-A: mechanism

Back 5

preferentially deactivates serotonin

Front 6

MAO-B: mechanism

Back 6

preferentially deactivates norepi/epi

Front 7

venlafaxine: use

Back 7

refractory depression, CAP

Front 8

Side effects of traditional antipsychotics (8)

Back 8

1. Antidopaminergic (EPS)
2. Anti-HAM
3. Weight gain
4. LFTs elevated
5. Ophthalmologic problems
6. Dermatologic problems
7. Seizures
8. Tardive Dyskinesia

Front 9

Name one from each class:

1. SNRI
2. NDRI
3. SARI
4. NASA

Back 9

1. venlafaxine
2. bupropion
3. trazodone
4. mirtazapine

Front 10

LOW-POTENCY traditional antipsychotics:

1. List two

2. Give ophthalmic side effects for each

Back 10

1. chlorpromazine, thioridazine

2. chlorpromazine: corneal, lens deposits

thioridazine: irreversible retinal pigmentation

Front 11

Neuroleptic malignant syndrome: signs and symptoms

Back 11

"FALTER"

Fever
Autonomic instability
Leukocytosis
Tremor
Elevated CPK
Rigidity

Front 12

Atypical antipsychotics: how different from typical?

Back 12

Block serotonin receptors as well as dopamine receptors

Front 13

clozapine: side effects (incidence)

Back 13

agranulocytosis (1%)
seizures (2-5%)

Front 14

olanzapine: side effects (4)

Back 14

hyperlipidemia
glucose intolerance
weight gain
liver toxicity (monitor LFTs)

Front 15

mood stabilizers (3)

Back 15

lithium
valproic acid
carbamazepine

latter two are anti-seizure drugs, both with NTDs in pregnancy

Front 16

lithium: side effects (2)

Back 16

hypothyroidism
nephrogenic DI

Front 17

carbamazepine: indication, side effects (4)

Back 17

indication: mixed and rapid-cycling bipolar disorder

side effects:
1. hyponatremia
2. leukopenia
3. agranulocytosis
4. aplastic anemia

NTDs in pregnancy

Front 18

valproic acid: indication, side effects

Back 18

indication: mixed and rapid-cycling bipolar disorder

side effects:
1. hepatotoxicity
2. thrombocytopenia

NTDs in pregnancy

Front 19

long-acting BZDs, 1-3d

Back 19

chlordiazepoxide
diazepam
flurazepam

Front 20

intermediate-acting BZDs, 10-20h

Back 20

alprazolam
clonazepam
lorazepam
temazepam

Front 21

short-acting BZDs, 3-8h

Back 21

oxazepam
triazolam

Front 22

zolpidem/zaleplon: MOA and features

Back 22

selectively bind BZD binding site on GABA receptor

features:
no muscle relaxation
no withdrawal, minimal rebound insomnia
little-no tolerance, dependence

Front 23

buspirone: MOA

Back 23

partial agonist at serotonin 5HT-1A receptor

Front 24

propanolol: uses in psychiatry (2)

Back 24

treatment of:
1. autonomic effects of panic/performance anxiety
2. akathisia

Front 25

Psychiatric symptoms due to general medications (5)

Back 25

1. psychosis
2. agitation/confusion/delirium
3. depression
4. anxiety
5. sedation

Front 26

medical causes of psychosis (4)

Back 26

1. CNS disease
2. endocrinopathies
3. nutritional/vitamin deficiency
4. other (SLE, GCA, porphyria)

Front 27

schizophreniform v. schizophrenia

Back 27

schizophreniform: 1-6 mo
schizophrenia: >6 mo

Front 28

schizoaffective disorder v. mood disorder with psychotic Sx?

Back 28

schizoaffective disorder: delusions or hallucinations in the ABSENCE of mood disorder symptoms

Front 29

in the listed disorder, mood Sx must last at least:

1. Major depressive episode
2. Manic episode
3. Mixed episode
4. Hypomanic episode

Back 29

1. 2 weeks
2. 1 week
3. 1 week
4. 4 days

Front 30

PTSD: criteria (6)

Back 30

1. experience (of a traumatic event)
2. re-experience (of same event)
3. avoidance (of stimuli associated with event)
4. numbing (of affect, social relatedness)
5. increased arousal (insomnia, anger bursts)
6. Sx present for at least 1 month

Front 31

PTSD v. Acute Stress Disorder

Back 31

PTSD: any time in the past, Sx for >1 month

Acute Stress Disorder: within 1 month of trauma, Sx for <1 month

Front 32

GAD: criteria (3)

Back 32

1. anxiety about daily activities for >6 months
2. difficult to control the worry
3. associated with at least 3 of the following: restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disturbance

Front 33

Adjustment Disorder: criteria (3)

Back 33

1. Sx (emotional/behavioral) begin within 3 months of stressful life event
2. Sx are not those of bereavement
3. Sx resolve within 6 months after stressor has terminated

Front 34

Personality Disorders: Sx manifestations (4)

Back 34

Two or more of "CAPRI" for Dx:

Cognition
Affect
Personal Relations
Impulse control

Front 35

Cluster A disorders (3)

Back 35

Paranoid
Schizoid
Schizotypal

Front 36

Avoidant v. Schizoid personality disorders

Back 36

Avoidant: desires relationships but hides in corner

Schizoid: no desire for close relationships

Front 37

Schizotypal: criteria (9)

Back 37

Five or more of these:
1. ideas of reference (but not delusions)
2. odd beliefs, magical thinking
3. unusual perceptual experiences
4. suspiciousness
5. inappropriate/restricted affect
6. odd/eccentric appearance/behavior
7. few close friends
8. odd thinking or speech
9. excessive social anxiety

Front 38

Antisocial Personality Disorder: minimum age for diagnosis

Back 38

18

Hx of childhood behavior consistent with conduct disorder

Front 39

Borderline Personality Disorder: features (9)

Back 39

"IMPULSIVE"
Impulsive
Moody
Paranoid under stress
Unstable self-image
Labile, intense relationships
Suicidal
Inappropriate anger
Vulnerable to abandonment
Emptiness

Front 40

Social Phobia v. Avoidant Personality Disorder

Back 40

Social Phobia: fear of embarrassment in a particular setting

Avoidant Personality Disorder: fear of rejection and sense of inadequacy

Front 41

OCD v. OCPD

Back 41

OCPD: perfectionist, miserly, stubborn; ego-syntonic

OCD: obsessions, compulsions; ego-dystonic

Front 42

Substance Abuse: criteria (4)

Back 42

At least one of the following for at least 1 year:

1. failure to fulfill work/school obligations
2. use in dangerous situations
3. recurrent substance-related legal problems
4. continued use despite social/interpersonal problems due to use

Front 43

Substance Dependence: criteria (7)

Back 43

At least three within a 12-month period

1. tolerance
2. withdrawal
3. more use than intended
4. persistent desire to cut down/quit
5. significant time spent obtaining, using, or recovering
6. decreased social/occupational/recreational activities due to use
7. continued use despite physical/psychological problem

Front 44

Incute EtOH intoxication: treatment (3)

Back 44

1. ABCs, monitor lytes and acid-base
2. Finger-stick glucose to r/o hypoglycemia
3. Give thiamine, naloxone, folate

Front 45

EtOH withdrawal: treatment (3)

Back 45

1. tapering doses of BDZs (chlordiazepoxide, lorazepam)
2. thiamine, folate, multivitamin
3. Magnesium sulfate for postwithdrawal seizures

Front 46

Cocaine: MOA

Back 46

blocks dopamine reuptake from synaptic cleft

Front 47

Wernicke encephalopathy v. Korsakoff syndrome

Back 47

Both due to thiamine (B1) deficiency. Korsakoff syndrome develops from untreated Wernicke encephalopathy.

Wernicke encephalopathy:
1. Ataxia
2. Confusion
3. Ocular abnormalities

Korsakoff syndrome:
1. Impaired recent memory
2. Anterograde amnesia
3. +/- Confabulation

Front 48

Therapy of Wernicke-Korsakoff

Back 48

thiamine BEFORE glucose

Front 49

Tx of cocaine intoxication

Back 49

1. BDZ for mild/mod agitation
2. haloperidol for severe agitation/psychosis
3. Sx support (labetalol, anti-arrhythmics)

Front 50

PCP intoxication: pathognomonic finding

Back 50

rotatory nystagmus

Front 51

BDZs v. barbiturates: MOA

Back 51

BDZs: potentiate GABA by increasing *frequency* of Cl- channel opening

barbiturates: potentiate GABA by increasing *duration* of Cl- channel opening

Front 52

Tx of acute sedative-hypnotic intoxication (4)

Back 52

1. ABCs
2. Activated charcoal
3. BDZs: flumazenil; barbiturates: alkalinize urine with sodium bicarb
4. supportive care

Front 53

Triad of opiate overdose:

Back 53

"Rebels Admire Morphine"

Respiratory depression
Altered mental status
Miosis

Front 54

Opiate that causes mydriasis rather than miosis?

Back 54

meperidine (Demerol)

Front 55

Smoking cessation Tx (4)

Back 55

1. Behavioral counseling
2. Nicotine replacement therapy
3. Zyban
4. clonidine

Front 56

B12 deficiency: cognitive findings (3)

Back 56

1. dementia
2. decreased position/vibration sense
3. megaloblasts on CBC

Front 57

Neurosyphillis: cognitive features (3)

Back 57

1. dementia
2. decreased position/vibration sense
3. Argyll-Robertson pupil's (AKA whore's pupils: accomodate but do not react)

Front 58

Alzheimer's: classic features (4)

Back 58

aphasia
apraxia
agnosia
diminished executive function

personality/mood changes also common

Front 59

Alzheimer's: Tx and MOAs (3)

Back 59

1. NMDA receptor anatogonists (memantine)
2. Cholinesterase inhibitors (tacrine, donepezil, rivastigmine)
3. BDZs, antidepressants, antipsychotics as indicated

Front 60

How do Sx of vascular dementia differ from Alzheimer's?

Back 60

In etiology and presentation (insidious and gradual in Alzheimer's, *stepwise* in vascular/multi-infarct dementia)

Sx otherwise the same: aphasia, apraxia, agnosia, decreased executive function. Vascular dementia may also present with focal neurologic findings.

Front 61

amatadine: MOA

Back 61

unknown, but drug used for Parkinson's

"aMANtadINE eMANcipates dopamINE"

Front 62

EEG in CJD

Back 62

periodic sharp waves/spikes

Front 63

Normal pressure hydrocephalus: features (3)

Back 63

"Wacky, wobbly, and wet"

1. dementia (mild, insidious)
2. gait disturbance (often first to appear)
3. urinary incontinence

Front 64

Treatment of delirium (4)

Back 64

"You may start a FEUD by treating your delirious patients"

Fluids/nutrition
Environment
Underlying cause
Drug withdrawal

Front 65

General Tx strategies for dissociative disorders (3)

Back 65

1. hypnosis
2. drug-assisted interviewing (amobarbital or Ativan)
3. insight-oriented psychotherapy

Front 66

primary v. secondary gain

Back 66

primary gain: expression of unacceptable feelings as physical Sx in order to avoid facing feelings

secondary gain: use of Sx to benefit patient (attention, running from law)

Front 67

Onset before what age for Somatization Disorder?

Back 67

30

Front 68

Findings associated with Anorexia Nervosa (9)

Back 68

amenorrhea
lytes abnormalities
hypercholesterolemia
arrhythmias
cardiac arrest
LANUGO
MELANOSIS COLI
leukopenia
osteoporosis