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148 Cards in this Set

  • Front
  • Back
-body wt < 85% of expected wt (BMI < 17.5)
-intense fear of wt gain even though underwt
-distorted perception of body size, wt, or shape
-amenorrhea of 3 mos duration (women only)
dx of anorexia nervosa
-muscle wasting
-low HR, BP, dizzy, syncope
-constipation, delayed gastric emptying
-cold, blue hands and feet
-secondary amenorrhea, small breast size
physical sxs of anorexia
-hypokalemia, increased HCO3
-euthyroid sick syndrome - abNL TFT
-asx hypoglycemia
-hyponatremia from excess water intake
-low estrogen levels
lab findings for anorexia
-prolonged QT interval, reduced LV mass
-bone loss - 2SD below NL in 50%
-hypothalamic hypogonadism
-cognitive sxs
-cerebral atrophy on CT w/ reduced white and gray matter
findings associated with anorexia
% concordance in monozygotic twins for anorexia nervosa
% concordance in dizygotic twins for anorexia nervosa
-persistent denial of problem
-frequent association w/ OCD and OCD personality
-self-evaluation and self-esteem seen in terms of body shape
-superficial perfect appearance
-special, in control & somewhat superior
psychological etiology of anorexia
onset of anorexia
anorexics have ___ & ___ about food or eating
obsessions & rituals
treatment of anorexia
-refeeding, wt gain, and nutrition counseling
-after stabilization: rework self-concept/self-esteem
-group and individual therapy
-alliance w/ pt and family
-educate pt and family
criteria for hospitalization of anorexic
-wt = 25-30% < BMI
-pulse < 40 BPM
-arrythmia or prolonged QT interval on ECG
-electrolyte abnormalities
what meds are given to anorexics in their tx?
-meds are NOT helpful
-antidepressents for associated depression
-low dose neuroleptics for severe obsessional or borderline psychotic thinking
-recurrent binge eating (>2x/wk, every wk for 3 mos)
-recurrent purging, excess exercise or fasting (>2x/wk, every week for 3 mos)
-excessive concern about body wt or size
-absence of anorexia nervosa
dx of bulimia nervosa
-very secretive illness
-ego dystonic
-near NL wt range
-wt and mood fluctuations
-other impulse control problems
-hx of unsucessful dieting
associated features of bulimia
physical sxs of bulimia
-oral:: dental caries, enamel erosion, parotid enlargement
-GI: esophageal reflux and tears, gastritis, gastric dilation, constipation, GI bleeding
-skin: marks on back of hand
-low K+, low Cl-, and high HCO3
-non-anion gap acidosis
labs for bulimia
what labs indicate vomiting in bulimia?
-low K+, low Cl-, and high HCO3
what labs indicate laxative abuse in bulimia?
non-anion gap acidosis
tx for bulimia
-multidisciplinary approach
-primary care, nutrition, and mental health
-tx associated psychiatric illness (PTSD, personality d/o, or depression)
-therapy (family and individual)
-change in attitude
-accepting self as not ideal
what meds are used to tx bulimia?
-they are helpful
-SSRIs: Zoloft, Paxil, Prozac, and Celexa
sleep problems are often associated w/?
mental illness
the first half of the night is when you ge the most ___ ____
restorative sleep
second half of the night is when you ___ the most
what is the deepest and lightest sleep stage?
Stage 1 - lightest
Stage 4 - deepest
NREM is marked by ___ levels of physiological function
lower (pulse, respiration, BP, and blood flow)
EEG is also slower
in what stage(s) does NREM occur?
stages 1-4
what stage(s) are associated w/ parsomnias: night terrors, nightmares, sleep walking, enuresis?
Stages 3 and 4
the EEG pattern in REM sleep is...
similar to wakefulness
REM is marked by ___ levels of physiological function
increased (pulse, RR, BP, and muscle tone)
T/F: in REM a person's temp is higher (feel hot during the night)
FALSE - feel cold
How are EEG waves & REM sleep affected by aging?
waves are slower and REM sleep is less efficient
Neurotransmitter involved in REM and wakefulness
Neurotransmitter involved in sleep
5HT (Serotonin)
Neurotransmitter involved in sleep regulation
Neurotransmitter involved in wakefulness (blockers cause sedation)
DA (dopamine)
what is a NL amt of sleep hours?
T/F: the need for speed in increased w/ exercise, pregnancy, illness, and stress
what is needed in a sleep hx?
-typical night's sleep
-pattern on wkend
-acute vs. chronic
-awaken or difficulty falling asleep
-caffeine and tabacco
-illicit drugs and alcohol
-meds (stimulants)
-snoring, sleep apnea
-depression, anxiety, other psych illness
-interview the partner
insomnia, hypersomina, narcolepsy, breathing-related sleep disorder, and circadian rhythm sleep disorder
nightmare d/o, sleep terror d/o, sleepwalking, and parasomnia not otherwise specified
-difficulty fallings asleep or staying asleep for at least a month
-happens at least 3x/wk
-causes sig distress or impairment in social or occupational function
-not due to substance, medical condition, or other sleep disorder
primary insomnia
-excess sleepiness or prolonged daytime sleep episodes for at least 1 mo
-causes sig distress or impairment in social or occupational functioning
-not due to med condition, substance, or other d/o
primary hyperinsomnia
-irresistible attacks of refreshing sleep daily over at least 3 mos
-not due to substance or med conditon or other sleep d/o
-one or both: cataplexy and/or recurrent intrusions of REM manifested as hallucinations or sleep paralysis at beginning or end of sleep
loss of muscle tone associated w/ intense emotion
associated w/ leukocyte antigen HLA-DR2
sleep apnea
breathing stops for > 10s, >5h or 30x/night
sxs of sleep apnea
-restless sleep
-loud snoring
-apnea periods
-h/a or fatigue upon wakening
nightmare d/o
-occurs during REM, late at night
-NO tx
sleep terror disorder
-arousal during the first 1/3 of night in NREM
-amnesia for the episode
sleep walking
-first 1/ of night in NREM
-unresponsive and have amnesia for the episode
-NO tx
sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction...experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships.
human sexuality defined by WHO
sex defined as a noun is...
male or female
sex defined as a verb is...
sexual acts; varies widely according to culture, class, etc
what is gender?
social construction of femininity and masculinity
what is sexual orientation?
refers to a person's erotic and romantic attractions to one or more sexes; who you are attracted to
what is sexual identity?
sense of ourselves in both individual and political ways, encompasses both our gender and our sexual orientation.
what is adrogengy?
intergendered; in the middle of masculinity/feminity
what is transgenered?
someone whose gender identity and gender roles encompass both
what is intersex?
people who are in the middle; have some of both biological features; used to be called hermaphrodites
what is sexual coercion?
any nonconsensual sexual behavior that occurs as a result of arguing, pleading and cajoling and includes, but is not limited to, force.
what is deconstruction?
see normal and deviant as deliberate social practices and cultural discourses.
interrogate the proscribed expectations, duties, and rights that define the relationship b/w a perosn in a particular position and the other people w/ whom she or he interacts
in the dying, tx delusions w/?
low dose antipsychotics (1mg Risperdal)
in the dying, tx fatigue/weakness w/?
in the dying, tx dysphagia w/?
liquid diets
in the dying, tx dyspnea, cough w/?
bronchodilators, opioids
in the dying, tx n/v w/?
odansetron and compazine
in the dying, tx anxiety/depression w/?
antidepressents, benzos
Elisabeth Kubler-Ross Stages of Dying
-shock and denial
hospice care is for pts w/ ___ ___ to live
< 6mos
in the dying, tx pain w/?
aggressive opioids
in the dying, a very ___ threshold for tx is used
loss of a parent under the age of 14 is associated w/
higher rates of depression as an adult
existenstial crisis
-what is the purpose of living?
-i'm angry w/ God for letting this happen
-is this all there is to life?
mid-life crisis
-illusion of control and invulnerability taken away
-realization that life has limits
-new sports car, new career, changes in relationships
-attempt to reassert youth and vitality as a defense against againg and death
NL grief
-sadness, crying, sleep and appetite disturbance, weakness and fatigue
-rollercoaster course
-6mos-1yr for resolution is common
-complex psychological process of working through and making some sense of the loss and continuing w/ life
abNL grief
-suicidal ideaion or psychotic sxs
-intense and excessive guilt or self-reproach
-interference w/ daily functioning, work or school
among teens, every drug is decreased in use, except?
-Rx drugs (vicodin & oxycotin)
-inhalants (easy access)
what are the gateway to drugs?
-tabacco (down due to education)
why do teens use drugs?
-peer pressure
-feel good/get high
-relax & relieve tension
-to escape
addiction is a ___-____-____ disease
person who has been on a certain prescription for 6mos and goes through a stage of minor w/d after the meds are abruptly stopped
person who is prescribed to take 3 percocet a day but takes 10 instead.
hallmark of addiction
chromosome identified as culprit to addiction?
chromosome 10
addiction =
drug + time + X (genetic or environment)
area of the brain that controls emotions/feeling; "pleasure center"
limbic system
area of the brain responsible for the site of action of cocaine
focus cerellus
area of the brain where the neurotransmitters act
neurotransmitter involved w/ stimulant drugs
neurotransmitter involved w/ multiple drugs of abuse
neurotransmitter involved w/ hallucinogens
neurotransmitter involved w/ cocaine primarily and opioids
neurotransmitter involved w/ sedatives and ETOH
gaba(gamma)-aminobutyric acid
neurotransmitter involved w/ opiates
neurotransmitter involved w/ ETOH
is addiction a brain dysfunction?
C-need to cut down
A-annoyed by criticism
E-need an eye opener

70% sensitive and 90% specific test
substance w/d or alcoholics will have a ___ pulse
sedative drugs will have a ____ BP
alcohol _____ the RR
cocaine use or w/d will have a ____ RR
spider angiomas is a sn of
vascular cirrhosis of the liver; sn of alcohol abuse; usually appear in the chest
telangiectases is a sn of
cirrhosis of the liver due to alcohol abuse; seen in the abdomen and lower chest
enlarged spleen will cause a ____ in the platelet count
pupils are dilated w/ use of ____
pupils are constriced w/ use of ____
nystagmus is found in pts on _____
what can be a tip off for AIDS/HIV?
rhonchi heard w/ use of ____
crack or pot
wheeze heard w/ use of ___ & ___
crack and pot
what is a tip off of liver disease?
murmurs can be caused by use of? pt may have?
consequence of IV drug use; may have subacute endocarditis
decreased bowel sounds indicate?
opioid use
increased bowel sounds indicate?
stimulant drug use
palmar erythema sn of?
cirrhosis of the liver; alcohol disease
testicular atrophy sn of?
liver disease
increased WBC seen in?
early alcoholics
decreased WBC seen in?
chronic alcoholics
H/H decreased in?
endocarditis and alcoholics
MCV increased in?
decreased BUN seen in?
Stage 3/4 of liver disease
increased BUN seen in?
GI bleeding
H-drink to get HIGH
A-drink ALONE
L-LOOK forward to drinking
U-UNPLANNED drinking
P-PROTECT your supply
F-A-T-A-L D-T's
T-THOUGHTS of suicide
L-LEGAL problems

a maladaptive pattern of behavior substance use leading to clinically significant impairment or distress, as manifested by certain traits, over a 12 mo period
substance abuse
a maladaptive pattern of substance use, leading to clinically significant impairment or distress manifested by 3 or more trains over a 12 mo period
substance dependence
legal limit neuro status in PA
3 phases of treatment for drug abuse
-after care
w/d sedatives are dangerous b/c a person can do into ___ ___
status epilepticus
what are the stimulants?
-amphetamines (meth, ritalin)
-opioids (heroin, morphine, opium)
what are the sedatives/hypnotics?
what are the hallucinogens?
what are the inhalants?
-solvents (glue, petroleum products, paint thinner/nail polish, butanediol-industrial solvent)
-amylnitrate & butyl nitrate
-anesthetics (ether, chloroform, NO)
what are the club drugs?
-GHG - #1 date rape drug
-Illis, WET
Grade I seizure
all minor s/s
Grade II seizure
minor + hallucinations
Grade III seizure
minor + hallucinations + seizure
Grade IV
three types of dual dx
-affective or mood d/o
-personality d/o
hallmark of sedative use
tx alcoholism
-antabuse (disulfiram)
also used in tx of cocaine
-antabuse (disulfiram)
antidote for opioid overdose
-naltrexone (Revia)
decreases cravings for alcohol
-campral (acamprostate)
lessens cravings for cocaine
-topamax (topiramate)
tx opioid addiction, blocks mu receptor
-suboxone (buprenorphine)
prevents severe w/d from heroine use