Psych Review Shelf 1-4

Front 1

Describe mood v affect

Back 1

pt's subjective experience v objective signs of emotional state

Front 2

illusion v hallucination

Back 2

misperception of stimulus/something's there v perception of non–existent stimulus

Front 3

obsession v compulsion

Back 3

recurrent,distressing thought (never an action) v repetitive actions performed to relieve anxiety (act can be a thought, but more often is a physical action)

Front 4

circumstantial v tangential v loose association

Back 4

giving excessive details but not necessarily changing topic v wandering from topic to topic where each transition following logically, often forgetting the question that was asked v jumping from topic to topic without clear connections (All 3 related to thought process)

Front 5

word salad v clanging

Back 5

nonsensical grammatical constructions where words are thrown out v words rhyme with one another

Front 6

hypnaogoic v hypnopompic hallucinations

Back 6

during the period going to sleep v during the period of awakening. both commonly occur in healthy individuals; hypnoaGOgic (GO to sleep) & hypnoPOmpic (POpping up from sleep)

Front 7

Define delirium

Back 7

acute onset; characterized by inattention (can't repeat days of week in reverse, serial 7s, etc); waxing and waning course, and reversal of sleep–wake cycle

Front 8

T/F: delirium can be caused by conditions other than general medical conditions

Back 8

False

Front 9

Define Dementia

Back 9

amnesia + loss of cognitive function defined as one of the following: aphasia, agnosia, apraxia, poor executive function (includes sequencing, organizing, abstraction, planning)

Front 10

Alzheimer's type vs vascular dementia

Back 10

A: MCC of dementia; often linear decline; definitive dx requires TISSUE vs V: step–wise decline corresponding with descrete vascular insults

Front 11

Dementia vs Pseudodementia

Back 11

demented patients tend to confabulate (they don't want to be seen as demented) vs pseduodementia occurs as a result of depression (tend to over–exaggerate their deficits)

Front 12

mild cognitive impairment v benign senescent forgetfullness

Back 12

MCI: sub–syndromal dementia (only amnesia, agnosia, aphasia, apraxia, executive dysfunction) BSF: normal aging (forgot where placed the keys, etc.)

Front 13

Suicide attempt v parasuicidal gestures

Back 13

SA: intent of dying; PG:aimed at getting attention (but succeed sometimes!)

Front 14

active v passive suicidal ideation

Back 14

Active = "i want to die" or "i want to kill myself"; Passive = "i'd rather be dead" or "things would be better off if i weren't here"

Front 15

Anticholinergic toxidrome

Back 15

hot as a hare, dry as a bone, red as abeet, mad as a hatter, blind as a bat!

Front 16

Anticholinergic v sympathomimetic (cocaine, amphetamines, etc) toxidromes

Back 16

Same. Except that in sympathomimetics, patients will also be diaphoretic. PSNS post synaptic neurons use ACh and SNS PSN use norepi except at sweat glands (Ach is used instead!)

Front 17

What is the triad of wernicke's encephalopathy? Immediate treatment?

Back 17

confusion, ataxia, opthalmoplegia (usually abducens (6th CN)). Give IV Thiamine (B1), which is involved in the metabolism of glucose.

Front 18

Triad for normal–pressure hydrocephalus.

Back 18

urinary incontinence, dementia, ataxia (wet, wacky, wobbly).

Front 19

List the dopamine (DA) pathways that mediate EPS. Tetrad?

Back 19

EPS: nigrostriatal (think substantia nigra – degenerated in PD) ––> acute dystonic rxn, akathisia, parkinsonism, TD

Front 20

List the dopamine pathway that mediate +sx in schizophrenia

Back 20

excessive DA in mesolimbic system

Front 21

List the dopamine pathway that mediates –sx in schizophrenia

Back 21

mesocortical: low DA responsible for –sx in schizophrenia. This explains why typical antipsychotics (solely DA antagonism) do not improve –sx

Front 22

List the dopamine pathway that mediate hyperprolactinemia

Back 22

tuberoinfundibular (DA = pRL inhibitor) ––> antipsychotics (esp haloperidol and atypical, respiradone) can cause gynecomastia & galactorrhea.

Front 23

List tetrad for Narcolepsy

Back 23

excessive daytime sleepiness, hypnoGOgic hallucinations, cataplexy (loss of motor tone in context of emotion i.e. laughing/crying) & sleep paralysis

Front 24

4 D's of malpractice

Back 24

duty (presence of MD–pt relationship), dereliction/deviation (from standard of care), damage, direct causation. "derelection of duty directly caused damages"

Front 25

5 types of schizophrenia in DSM–IV–TR

Back 25

Catatonic, disorganized, paranoid, residual, undifferentiated.

Front 26

catatonic schizophrenia

Back 26

excessive/inhibited psychomotor activity

Front 27

disorganized schizophrenia

Back 27

prominent disorganization (speech or behavior)

Front 28

Which schizophrenia has the worst prognosis?

Back 28

disorganized type

Front 29

"burnt out" schizophrenia of later life; prominent negative sx

Back 29

residual type

Front 30

Undifferentiated schizophrenia

Back 30

Not catatonic, disorganized, paranoid or residual?

Front 31

Which type of schizophrenia has the BEST prognosis?

Back 31

Paranoid Schizophrenia: prominent delusions/hallucinations

Front 32

5 core symptoms (criteria A) of schizophrenia

Back 32

two of the following are required > 1 month: delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms

Front 33

3 exceptions to the requirement for meeting criterion A of schizophrenia

Back 33

1. bizarre delusions 2. AH of two voices giving a running commentary of pt's life or 3. AH of two voices conversing with each other sufficient to meet criterion A.

Front 34

6 types of delusions in DSM IV–TR

Back 34

persecutory (same as paranoia), erotomanic (belief that someone of higher stature is in love with pt), somatic (e.g. internal organis rotting) gradiose (common with psychosis associated with mania), Jealous, Mixed

Front 35

6 specifiers for MDD in DSM IV

Back 35

with: 1) psychotic features (treat the "depression" and psychosis will resolve, versus schizoaffective d/o); 2) melancholic features (anhedonia, early morning awakening, excessive guilt, mood does not reach with pleasure stimuli; 3) Atypical features (hyperphagia/hypersomnia, reactive mood, rejection sensitivity); 4) seasonal pattern (SA d/o, tx is light therapy or SSRI); with 5) catatonic features, or with 6) postpartum onset (w/in 4 weeks of parturition)

Front 36

Give two examples projective tests

Back 36

1) Rorschach test (inkblots): especially useful for identifying psychotic d/o or paranoia 2) Thematic apperception test: pt tells stories about depressing pictures

Front 37

Give 3 examples of intelligence test and their appropriate age ranges.

Back 37

WAIS (ages 16–75; includes verbal and visuospatial sections; average 100 w / SD of 15) Standord–Binet Test (age 2–23); Wechsler intelligence scale for children–revised (WISC–R) ages 6– 16

Front 38

What is the MMPI–2?

Back 38

Minnesota multiphasic personality inventory: pathology + patterns of behavior

Front 39

Name the 5 neuroleptic–induced syndromes

Back 39

acute dystonic reaction, akathisia, parkinsonism (including rabbit syndrome), Tardive dyskinesia, Neuroleptic malignant syndrome (NMS)

Front 40

What is the timeline for each neuroleptic induced syndrome?

Back 40

ADS (hrs–days), akathisia (days–wks), parkinsonism (wks–mos), TD (mos–yrs)

Front 41

Name 2 SSRI–related syndrome

Back 41

serotonin syndrome, SSRI–discontinuation syndrome

Front 42

Described acute dystonic reaction. Treatment?

Back 42

hrs–days: early EPS characterized by acute msucle spasm, more often d/t typical antipsychotics in a high dose or to an antipsychotic–naive patient. Can be torticollis or oculogyric crisis (painful upward deviations of eyes), and generally involves the neck/face/throat. Occurs w/in hurs but can be delayed up to a day after neuroleptic andminstration. Treat w/ benztropine (central acting anti–cholinergic/histamine) or IM diphenyldramine

Front 43

Which Rx, used as antiemitics, can also cause acute dystonic reactions?

Back 43

promethazine (phenegran), prochlorperazine (compazine), metoclopramide (Reglan).

Front 44

Which is the most dangerous dystonic reaction?

Back 44

laryngospasm (protect the airway)

Front 45

Describe akathisia. Treatment?

Back 45

inner feeling of restlessness + motoric restlessness that makes the person unable to sit still; takes days to weeks to occur. Can be d/t SSRI and by the antiemetics metoclopramide and prochlorperazine. Tx w/ BB, benzo (loraepam) or anticholinergic (benztropine/benadryl).

Front 46

Define parkinsonism (including rabbit syndrome)

Back 46

resembles PD but not idiopathic. Takes weeks to months.

Front 47

Define Tardive Dyskinesia. Management?

Back 47

takes months, usually years to develop. Associated w/ long–term or high dose use of dopamine antagonists. antipsychotics (typicals > atypicals) are usual culprits. Sx include involutnary purposeless reptitive tics and spasms, generally oro–buccal, which are NOT distressing. 50% cases reversible, failure to disclose this SE is a reaction for legal action!! stop offending agent, if 2/2 to antipsychotic, consider a switch to clozapine (least EPS)

Front 48

Define NMS. Rx?

Back 48

usually occurs days after starting antipsychotic or increasing its dose (usually typicals). Often missed or misdiagnosed. 10% fatal. Look for muscle cramps w/ lead pipe rigidity, high fever, autonomic instability, and mental status changes consistent with delirium. Leukocytosis and CPK increases (~20K). treatment involves stopping the offender, bringing down fever and hydrating to prevent renal failure from rhabdo. Rx: dantrolene and bromocriptine (dopamine agonist)

Front 49

What syndrome is very similar to serotonin syndrome?

Back 49

NMS! questions on this typically involve the addition of a new pro–serotonin Rx to a patient who is already on a medication that has pro–serotonin properties (i.e. linezolid, tramadol, SSRI, SNRI, TCA, MAOI) or an insufficient wash–out period b/t Rx (SSRI/SNRI/TCA + MAOI). Sx same as NME but may also have myoclonus (jerks) where NMS is more lead pipe rigidity. Tx by removing offending agents & supporting care. Tx by removing offending agents & supporting care.

Front 50

Define SSRI discontinuations syndrome.

Back 50

abrupt d/c of SSRI leads to the syndrome FLU–like sx. Rx at highest risk if d/c'd abruptly is paroxetine (shortest–half life). similar syndrome occurs w/ SNRIs (esp venlafaxine immediate release aka side effexor). SNRI d/c syndrome more likely to cause paresthesias and "electrical sensations" in extremities (the "zaps").

Front 51

Define Hypertensive crisis. Treatment?

Back 51

Pt on MAOI ingestes tyramine (wine, cheese, fava beans, cured meats, etc.). Can also be with MAOI +meperidine aka demerol). Tx: lower BP w/ phentolamine or Na nitroprusside infusions for true emergencies (diastolic > 120).

Front 52

Why is tyramine c/i in patients taking MAOI?

Back 52

tyramine is an indirect sympathomimetic which is converted to NE pre–synaptically.

Front 53

What serum level does lithium toxicity occur?

Back 53

serum levels > 1.5 (therapeutic levels 0.6–1.2).

Front 54

list symptoms at lithium levels b/w 1.5–2.0.

Back 54

n/v/ataxia, slurred speech, weakness, nystagmus

Front 55

list symptoms at lithium levels b/w 2.0–2.5

Back 55

axnorexia, blurred vision, fasiculations, delirium, stupor, increased DTRs

Front 56

list symptoms at lithium levels > 2.5

Back 56

generalized convulsions, oliguric renal failure.

Front 57

list symptoms at lithium levels > 3.5

Back 57

severe! cardiovascular collapse, potentially lethal.

Front 58

Treatment for mild v severe lithium toxicity?

Back 58

mild/moderate: IVF; severe: hemodialysis (look for seizures, delirium, stupor, coma, etc.)

Front 59

Lithium side effects (therapeutic levels)?

Back 59

hypothyroidism (F>M), nephrogenic DI, acne, weight gain, sedation, benign leukocytosis, psoriasis

Front 60

teratogenic side effects of lithium?

Back 60

ebsteins abnormality (highest risk in 1st trimester; tricuspid valve is displaced down)

Front 61

therapeutic trough levels of valproic acid

Back 61

50–100 (can titrate to side effects)

Front 62

Mild sx of valproic acid toxicity

Back 62

GI upset w/ n/v and confusion

Front 63

Sx of severe valproic acid toxicity

Back 63

hypotension, cerebral edema ––> lethargy, coma, cardiac arrest. treat based on symptoms.

Front 64

Side effects of valproic acid (at therapeutic levels)

Back 64

sedation, weight gain and tremor (use propranolol).Alopecia, thrombocytopenia are rare. hepatotoxicity (encephalopathy, edema, jaundice) and pancreatitis (black box warning).

Front 65

T/F: any physician can prescribe clozapine

Back 65

False. need a special license to prescribe it

Front 66

What are the 5 black box warnings of clozapine?

Back 66

1. agranulocytosis 2. seziures 3 myocarditis (may see peripheral eosinophilia) 4. cardiopulmonary collapse 5. increased mortality in treating psychosis related to dementia

Front 67

Define agranulocytosis.

Back 67

absolute neutrophil count (ANC) < 1000.

Front 68

What CBC finds should make you suspicious of possible agranulocytosis in patients using clozapine?

Back 68

If WBC drops 3–4k, stop clozpaine. w/o neutrophils the body can't fight infections ))> malaise, fever, sepsis and death

Front 69

Other side effects of clozapine (not black box)

Back 69

significant drooling (d/t esophageal dysmotolity), orthostatic hypotension and can SIGNIFICANT (40+ lbs) we gain/metabolic syndrome

Front 70

Side effects of Lamotrigine

Back 70

Stevens–Johnson syndrome/toxic episdermal necrolysis; 8% w/ benign rash but up to 1:1000 develop SJS/TEN

Front 71

Major side effects of Carbamazepine

Back 71

aplastic anemia and agranulocytosis

Front 72

Acute dystonic reaction is a typical side effect in what psychiatric drug?

Back 72

typical antipsychotics (short–term use)

Front 73

Tardive dyskinesia is a long term side effect of what drug?

Back 73

typical antipsychotic

Front 74

Major side effect of tarzodone? Nefazodone?

Back 74

priapism and hepatotoxicity

Front 75

How do you distinguish Brief psychotic d/o v schizophreniform d/o v schizophrenia

Back 75

Durtation of sx (criterion A). BPD < 1 mo sx; schizphreniform is 1–6 months (including prodrome sx); schizophrenia is > 6 mo sx (including prodrome + at least 1 month of active sx)

Front 76

Distinguish MDD w/ psychotic features v schizoaffective d/o.

Back 76

In a patient with concurrent depression and psychosis. MDD psychotic sx occur ONLY in context of depression. SAD, look for psychotic sx for 2 weeks in ABSENCE of depression and pt should meet criteria for BOTH MDD and schizophrenia.

Front 77

How do you distinguish Brief psychotic d/o v schizophreniform d/o v schizophrenia

Back 77

Durtation of sx (criterion A). BPD < 1 mo sx; schizphreniform is 1–6 months (including prodrome sx); schizophrenia is > 6 mo sx (including prodrome + at least 1 month of active sx)

Front 78

Distinguish MDD w/ psychotic features v schizoaffective d/o.

Back 78

In a patient with concurrent depression and psychosis. MDD psychotic sx occur ONLY in context of depression. SAD, look for psychotic sx for 2 weeks in ABSENCE of depression and pt should meet criteria for BOTH MDD and schizophrenia.

Front 79

PTSD v Acute stress d/o

Back 79

Major difference is duration of sx. PTSD req sx > 1month. ASD requires sx for less than 4 weeks. Both occur w/in 4 weeks of index trauma. Both require 3 symptom clusters: re–experiencing, hyperarousal and avoidance/numbing. ASD also requires 3 sx of dissociation.

Front 80

Social phobia v panic d/o

Back 80

social phobia is specific to an uncomfortable social situation and panic attacks may be present (triggered by situation). Panic d/o requires h/o recurrent, unexpectected/untriggered panic attacks and after at least one of these there must be a period of > 1 month where pt has significant anxiety about having another attack (2/2 unexpected nature)

Front 81

OCD v GAD

Back 81

OCD – presence of obsessions or compulsions that don't respond to simple re–assurance. GAD = anxiety regarding many things (the "worry wart") but can usually recognize irrational nature of worries (better insight)

Front 82

T/F: panic attacks are pathognomic for panic d/o

Back 82

False. Panic attacks can exist in nearly any anxiety d/o and even be substance induced or d/t general medical condition. First distinction is if they are triggered ––> insight into specific anxiety d/o.

Front 83

BP I v BP II v Cyclothymic d/o

Back 83

BP1: h/o manic or mixed episode; BP2: requires h/o hypomanic episode AND MDD episode. Cyclothymia: persistent mood episodes on most days > 2 yrs straight! (w/o euthymia for over 2 months)

Front 84

MDD v dysthymic d/o

Back 84

MDD: depression or anhedonia + 4 sx from SIGECAPS x 2 weeks. Dysthymic d/o: depression + 2 of ACHEWS (allergic to happiness – Appetite changes, dec concentrations, hopeless, dec energy, worthless, sleep) x 2 years w/o 2 mon euthymia

Front 85

MDD v Bereavment

Back 85

Time and functioning. Bereavement can last up to a year, but MDD is reserved for significant sx that last > 2 months AFTER LOSS. If pt is not functioning w/in the 2month a dx of MDD can be made(sx to suggest MDD are guilt, SI, worthlessness).

Front 86

T/F: VH can occur in individuals suffering from bereavement

Back 86

True. 30%

Front 87

MDD v adjustment d/o

Back 87

SEVERITY. sx meet criteria for MDD, then mood disorder (BP or MDD). If there is functional impairment w/ MDD criteria NOT met, then adjustment d/o.

Front 88

somatoform d/o (somatization /do, hypchondriasis, etc.) v factitious d/o v malingering

Back 88

somatoform = doesn't understand and does know why; factitious (munchausen's or M by proxy) = knows whats going on but doesn't appreciate why they're doing it (no clear secondary gain); malingering = secondary gain is clear

Front 89

Body dysmorphic d/o v delusion d/o

Back 89

BDD = excessive, strong beliefs about body's imperfections (45x increase in suicide!); Delusional d/o = single, isolated, non–bizarre (FBI following you)

Front 90

primary d/o v. substance d/o v. d/o due to general medical condition

Back 90

If you get a question where patient is taking a substance known to cause a particular syndrome (e.g interferon for depression) then its usually substance induced. Same goes for general medical condition (e.g. L frontal CVA or pancreatic CA ––> depression). Primary means that it can't be due to the other two

Front 91

T/F: Personality disorders are generally ego–dystonic.

Back 91

False. They are egosyntonic, which means patient thinks that their sx are reasonable and appropriate (e.g schzoid perfers to be left alone and OCPD thinks its okay to be aperfectionist)

Front 92

Differentiate Schizoid/typal vs schizophrenia

Back 92

Schizoid = loner; odd interactions with others; Schizotypal = odd, eccentric personality; may have magical thoughts. BOTH LACK frank delusions, hallucinations and disorganization although they may display negative sx.

Front 93

Avoidant v panic d/o with agoraphobia/social phobia

Back 93

Difficult to differentiate. avoidant PD = egosyntonic to have thoughts of inadequancy and pervasive fear of not being accepted (drive to avoid contact). Panic d/o w/ agoraphobia/social phobia pts are driven BY ANXIETY. avoid contact in order to avoid having a panic attack.

Front 94

Antisocial v intermittent explosive d/o

Back 94

IED is characterized by discrete episodes of violent/aggressive behavior interspersed by much longer periods of remorse and non–aggressive behavior. They have significant regret v antisocial, who rarely express remorse.

Front 95

OCPD v OCD

Back 95

OCPD = perfectionistic & rule driven, come off as cold toward others. OCD = defined by presence of either obsessions and/or compulsions > 1 hr/day

Front 96

borderline/histrionic v cyclothymic/bipolar d/o

Back 96

borderlines can't see shades of fray (splitting). They also evoke strong emotion from care providers (usually frustrations), and they routinely cause drama (parasuicidal thoughts/actions). Histrionics make extravagant shows and can be seductive. Cyclothymic is hypomanic and depressive sx for at least 2 years w/o 2month consecutive interval of sx free

Front 97

What else goes on Axis II other than personality d/o?

Back 97

MR (soon to be called intellectual disability).

Front 98

What else goes on in Axis I besides psychotic, mood and anxiety d/o?

Back 98

borderline intellectual functioning (IQ 71–84).

Front 99

what is the 15/20/20/15 rule?

Back 99

IQ < 15 is profound MR, 16–35 (15+20) severe MR, 36–55 (35+20) moderate MR, 56–70 (55+15) mild MR.

Front 100

What disease would you expect with CT/MRI findings positive for neurofibrillary tangles and senile plaques?

Back 100

Alzheimer's

Front 101

What pathologic findings would you expect to make the diagnosis of prion disease?

Back 101

spongiform changes (confluent vacuoles), amyloid plaques. (creutzfeld–jakob)

Front 102

What CT/MRI findings would you expect to see in Huntington's disease?

Back 102

bilateral caudate atrophy or "boxcar ventricles"

Front 103

Name the gene and its chromosome for huntington's disease

Back 103

Hungtingtin on chromosome 4

Front 104

What disease would you suspect if patient had neuronal loss in substantia nigra?

Back 104

parkinson's

Front 105

What CT/MRI findings would suggest Pick's disease?

Back 105

frontotemporal loss (picks = frontotemporal dementia)

Front 106

What MRI/CT findings would you expect to see in patient w/ MS?

Back 106

periventricular white matter lesions

Front 107

Punctate hemorrhages into the mammillary bodies is suggestive of...

Back 107

Wernicke's

Front 108

What CT/MRI finding would suggest schizophrenia?

Back 108

ventricular enlargement & diffuse cortical atrophy

Front 109

Name 3 cortical dementias

Back 109

Alzheimer's Pick's, CJD

Front 110

Name 3 subcortical dementias (including basal ganglia)

Back 110

huntington's, parkinson's/lewy body, vasuclar (Binswanger's disease) and AIDS dementia

Front 111

What are the 3 M's of subcortical dementia?

Back 111

Mood (depressed), motor (ataxic) and memory (amnesia)

Front 112

What imaging would you order if suspect fracture or bleeding intracranially?

Back 112

CT

Front 113

What imaging would you order in a patient whom you suspect for papilledema

Back 113

MRI (tumors often isodense w/ healthy brain so CT won't always see them) CT can show midline shift but necessarily define borders of a tumor

Front 114

Imaging for a patient with focal neurological sx?

Back 114

MRI

Front 115

Patient presents with ataxia, nystagmus and/or n/v. What imaging would you order?

Back 115

These are posterior fossa sx. MRI, because CT cannot visualize posterior fossa

Front 116

suspected intracranial hemorrhage

Back 116

CT (faster than an MRI!)

Front 117

What labs would you order in a patient with a suspected pheochromocytoma

Back 117

urine catecholamines, metanephrine and VMA (all urine)

Front 118

What lab test/procedure would you order in a patient whom you suspect wilson's dz?

Back 118

serum ceruloplasmin (dont' forget about kayer–fleischer rings)

Front 119

What lab/procedure would you order in a patient whom you suspect cushing's?

Back 119

serum cortisol or dexamethasone supppression test

Front 120

When would carcinoid tumor become carcinoid syndrome? What test would you order to dx?

Back 120

when mets to liver/lungs. get 5–HIAA serum levels

Front 121

T/F: 5–HIAA is high in the CSF of patients who commit suicide.

Back 121

False. Its low

Front 122

What would you order in patient with AIP?

Back 122

urine porphobilinogens & urobilinogens (including d–aminolevulinic acid (ALA)).

Front 123

Patient in clinic c/o depression, weight gain, inability to concentrate, consitpation. What tests would you order?

Back 123

TSH. think depressive d/o d/t hypothyroid

Front 124

What lab test/procedure can help differentiate seizure from pseudoseizure

Back 124

arterial serum prolactin 10–20min after event ––> put on ice and send to lab stat. prL is often elevated after a seizure but not in pseduoseizure

Front 125

Besides an MRI, what test would you order to clinch MS diagnosis?

Back 125

CSF – oligoclonal bands

Front 126

What imaging would you order if you suspect a subdural hematoma?

Back 126

CT

Front 127

What imaging/procedure(s) would you order if you suspect normal pressure hydrocephalus?

Back 127

head CT, LP (opening pressure > 20)

Front 128

what tests would you order if you suspected CJD?

Back 128

EEG, CSF for protein 14–3–3

Front 129

what test would you order if you suspected temporal lobe epilepsy

Back 129

EEG

Front 130

Besides a head CT, what other test could help you dx subarachnoid hemorrhage?

Back 130

LP looking for xanthochromia (yellow CSF)

Front 131

What kind of CT would you order in a patient whom you suspect CVA?

Back 131

non–contrast CT

Front 132

What test would you order in guillain–Barre syndrome?

Back 132

LP (may see cytoalbuminologic dissociations = protein > 45 w normal WBC)

Front 133

Emergency psychiatry: differential for catatonia

Back 133

schizophrenia, MDD, bipolar, NMS or serotonin syndrome, encephalitis, non convulsive status epilepticus

Front 134

ER psych: cocktails for agitation?

Back 134

5:2:1 (5 mg halperidol:2 mg lorazepam: 1 mg cogentin) or 5:2: 50 (50 mg diphenhydramine). IM/PO Usually IM.

Front 135

ER psych: patient presents with confusion, ataxia and opthalmopelgia. What do you do first?

Back 135

thiamine before glucose. you'll probably start a banana bag later (NS + Folate, thiamine, etc.)

Front 136

Withdrawal from what drugs can be fatal?

Back 136

alcohol or benzos (and barbs)

Front 137

What lab values are classic in alcoholics?

Back 137

Look for AST/ALT > 2:1 with significant intoxication. MCV will be elevated (d/t poor nutrition, and decreased folate and possibly B12, which can cause neuro sx (folate can't)).

Front 138

Patient presents to ER w/ headache, anxiety, n/v, tremulous. what would you suspect?

Back 138

alcohol withdrawal.

Front 139

T/F: alcohol withdrawal can present with hallucinations and seizures.

Back 139

True. within 12–24 hrs and 12–48 hrs respectively.

Front 140

When does DTs occur?

Back 140

36–72hrs after last drink

Front 141

Withdrawal from benzodiazepines presents similarly to withdrawal from what drug?

Back 141

Et–OH.

Front 142

What treatment can you provide in patient who you suspect BDZ toxicity?

Back 142

flumazenil (watch out for seizures if you give it...)

Front 143

If a patient who has sx of opioid overdose doesn't respond to narcan, what would you suspect?

Back 143

multiple drug overdose including benzos! (or Et–OH)

Front 144

What 2 drugs did Heath Ledger overdose on?

Back 144

opioids and benzos. worried about respiratory depression/anoxia

Front 145

How does narcan (naloxone work)

Back 145

IV opiod mu receptor antagonist

Front 146

Patient presents with slowed cognition (bradyphrenia), blood shot eyes, increase appetite.

Back 146

MJ intoxications.

Front 147

How long will Urine tox remain + for MJ?

Back 147

up to a month with chronic use as its stored in fat

Front 148

What intoxication presents very similar to an anticholinergic intoxication?

Back 148

cocaine/amphetiamines. May also present with diaphoresis and seizures and psychotic sx. Keep high on ddx in young patient with MI or CVA (but ask about thrombophilias, sickle cell and fam hx)

Front 149

Mechanism of action of cocaine?

Back 149

dopamine reuptake inhibition (@ DAT1)

Front 150

mechanism of action of amphetamines?

Back 150

causes direct release of dopamine

Front 151

Pt is very aggressive and has rotary nystamus. Dx

Back 151

PCP. Ketamine only causes sedation (no aggressiveness)

Front 152

What can cause hallucinogen persisting perception d/o

Back 152

LSD! patients has flashbacks for rest of his/her life

Front 153

MC psychoactive substance

Back 153

caffeine

Front 154

MC substance abused/dependence?

Back 154

nicotine

Front 155

Substance which causes most deaths (by far!)

Back 155

nicotine

Front 156

MC used illicit psychoactive substance?

Back 156

MJ

Front 157

First–line treatment MDD

Back 157

mild to moderate: Rx or psychotherapy (interpersonal or CBT). Severe: requires Rx

Front 158

Is one Rx for MDD more efficacious than another?

Back 158

No. all antidepressants are equally efficacious. Exception: MAOIs > TCA in atypical depression

Front 159

Most effective Rx for depression?

Back 159

ECT

Front 160

First line treatment for bipolar p/w mania or mixed episode

Back 160

mild–mod: lithium, valproic acid or antipsychotic; if severe: add antipsychotic to either lithium or valproic acid

Front 161

First line treatment for bipolar p/w MDD

Back 161

lithium or lamotrigine

Front 162

First line treatment for bipolar p/w rapid cycling?

Back 162

valproic acid or lithium (VPA is generally better)

Front 163

first line treatment in schizophrenia

Back 163

antipsychotic (usually tailoring side effects: consider ziprasidone/aripiprazole for those who are overweight; use sedating Rx at night if not sleeping well, etc.)

Front 164

First line treatment in schizophrenia w/ history of med non–compliance

Back 164

consider depot antipsychotic (decanoate formulation of haloperidol or fluphenazine or newer atypical depots, risperidone (consta) or paliperidone (invega sustennal)

Front 165

first line treatment for delirium

Back 165

high potency antipsychotic (haloperidol & fluphenazine)

Front 166

first line treatment for catatonia

Back 166

lorazepam (ativan)

Front 167

first line treatment for generalized anxiety d/o?

Back 167

SSRI

Front 168

first line treatment for panic d/o

Back 168

start w/ SSRI + benzo and taper off benzo after a month or so

Front 169

first line treatment of PTSD

Back 169

SSRI (esp paroxetine or sertraline)

Front 170

Time period for delusional d/o

Back 170

1 month

Front 171

time period for cyclothymic or dysthymic d/o

Back 171

2 years in adults; 1 year in children (no period longer than 2 months of sx free)

Front 172

Time period of sx for GAD?

Back 172

6 months

Front 173

duration of sx for MD episode

Back 173

2 weeks

Front 174

duration of sx for manic episode

Back 174

7 days

Front 175

Duration of sx for mixed episode

Back 175

1 wk or less if hospitalized as a result of sx

Front 176

duration of sx for hypomanic episode?

Back 176

> 4 days

Front 177

ODD v conduct d/o

Back 177

ODD children are peevish, obstinate and angry, but those with conduct d/o violate other's right (theft, setting fires, fights, animal cruelty).

Front 178

ADHD v bipolar d/o

Back 178

Bipolar are discrete episodes whereas ADHD are defined by ongoing hyperactivity (>6mo) and/or inattention in at least two settings (home, school, etc)

Front 179

Separation anxiety disorder v reactive attachment disorder

Back 179

separation anxiety d/o = anxiety when being apart from person to whom child is attached; reactive attachment d/o has two subtypes (both manifesting < 5 y/o): either the child will not attach readily & indiscriminately to just about everyone

Front 180

Name the 5 pervasive development

Back 180

autistic d/o, asperger's d/o, rett's d/o, childhood disintegrative d/o, NOS

Front 181

name the pervasive developmental d/o: poor social interactions, restricted/sterotyped behaviors/interest & communications.

Back 181

Autistic d/o

Front 182

Name the pervasive developmental d/o: poor social interaction & restricted/sterotyped behaviors/interests; can be very intelligent and very gifted at communication

Back 182

Asperger's d/o

Front 183

Name the pervasive developmental d/o: deceleration of head growth from 5–30mos., sterotyped hand movements (e.g. wringing); generally female

Back 183

Rett's d/o

Front 184

Name the pervasive developmental d/o: normal development until 2 yrs. then lose previously acquired skills + 2/3 autistic d/o sx; generally male

Back 184

childhood disintegrative d/o

Front 185

Name the pervasive developmental d/o: looks like others but doesn't meet the strict criteria

Back 185

NOS

Front 186

MCC of mental retardation

Back 186

down syndrome

Front 187

MCC of preventable MR

Back 187

fetal alcohol syndrome

Front 188

this common form of MR is found exclusively in males

Back 188

fragile X syndrome

Front 189

occurs during childhood and is characterized by persistent failure to speak in one or more major social situations, despite the ability to speak and comprehend spoken language

Back 189

selective mutism

Front 190

a behavioral disorder that is most commonly identified among mentally–disadvantaged children, although it is increasingly recognized among adolescents and adults of normal mental capacity. The behavior consists of daily, effortless regurgitation of undigested food within minutes of starting or completing ingestion of a meal.

Back 190

rumination d/o

Front 191

Treatment for ADHD

Back 191

psychostimulants (methylphenidate or amphetamine analogs), the newer non–stimulant atomoxetine (strattera; acts as a norepi reuptake inhibitor), or guanfacine (a2 agonist)

Front 192

Treatment for enuresis

Back 192

bed alarms are 1st line; consider imipramine

Front 193

Tourette's treatment

Back 193

antipsychotics (risperidone, pimozide) or clonidine/guanfacine

Front 194

treatment for absent seizures

Back 194

ethosuximide or valproic acid

Front 195

postpartum blues v postpartum depression v postpartum psychosis

Back 195

blues = normla response after pregnancy but sx doesn't meet criteria for MDD & occurs in up to 30% of women. Sx peak ~ 5d post partum and resolve within 2 weeks. Pp Depression meets full criteria for MDD. Pp psychosis is psychosis (bipolar d/o until otherwise proven) address immediately

Front 196

Premenstrual dysphoric disorder

Back 196

severe PMS (dx'd as depressive d/o NOS). Can give SSRIs ONLY during luteal phase

Front 197

What causes ebstien's anomaly?

Back 197

lithium

Front 198

what psychiatric medications cause neural tube defects on the fetus?

Back 198

valproate and carbamazapine

Front 199

What side effects can SSRIs have fetus?

Back 199

persistent pulmonary hypertension & fussy babies

Front 200

what is medication can be used for premature ejaculation

Back 200

SSRI

Front 201

painful spasm of external 1/3 of vagina (ectoderm derived under voluntary control)

Back 201

vaginismus. often h/o sexual trauma

Front 202

voyeurism

Back 202

paraphilia of watching others

Front 203

exhibitionism

Back 203

paraphilia of revealing self to others

Front 204

frotteurism

Back 204

paraphilia of rubbing against strangers typically in crowded places

Front 205

sadism

Back 205

paraphilia of feeling pleasure when inflicting pain

Front 206

masochism

Back 206

paraphilia of feeling pleasure in being humiliated/experiencing pain

Front 207

dyssomnias v parasomnias

Back 207

too much or too little sleep AND abnormalities occur during sleep or the period going to or awakening from sleep

Front 208

Define restless leg syndrome. Treatment.

Back 208

crawling/tinglings sensation of legs, worst at night; sensation improves with leg movement. Use pramipexole (Mirapex) or ropinirole (Requip)

Front 209

What should you rule out first when you suspect restless leg syndrome?

Back 209

iron deficiency syndrome. If it is, give iron

Front 210

What are pramipexole (mirapex) and ropinirole (requip) both associated with?

Back 210

new onset pathological gambling and sleep attacks.

Front 211

Define night terrors (pavor nocturnus)

Back 211

most often a child appears to awaken from a terrifying dream and may even scream, but he or she doesn't truly awaken and doesn't recall the event the following morning. Occurs in non–REM sleep; more common in 1st 1/2 of the night. Can treat w/ long–acting benzodiazepines.

Front 212

Excessive daytime sleepiness, hypnoGOgic hallucinations, cataplexy (loss of motor tone in context of emotion such as laughing/crying), sleep paralysis

Back 212

narcolepsy

Front 213

T/F: narcoleptics may have REM episode within 10–20 min

Back 213

True. healthy individuals have their first REM episode 90min into sleep

Front 214

delayed sleep phase (in adolescents), advanced sleep phase (elderly), jet lag sleep disorder, shift work)

Back 214

circadian rhythm sleep d/o

Front 215

What should always be implemented for sleep disorders?

Back 215

good sleep hygiene

Front 216

What should you always rule out when dealing with sleep disorders?

Back 216

substance–induced sleep disorders

Front 217

Name the 3 eating d/o

Back 217

anorexia nervosa, bulimia nervosa, eating d/o NOS

Front 218

<85% of ideal body weight, amenorrhea, afraid to gain wt. Has restricting and binge–eating/purging types.

Back 218

anorexia nervosa. Anorexics consider their condition egoSYNtonic (they will tell you they're fat (despite being utterly cachectic) and they need to lose weight).

Front 219

recurrent binge eating with excessive attention paid to the body and compensatory techniques to lose weight

Back 219

Bulumia nervosa. There is a purging and non–purging type. egoDYStonic. these patients feel very ashamed of their behavior and go to great lengths to hide it.

Front 220

What is Russell's sign?

Back 220

scarring on the extensor surface of a finger/fingers as a result of repetitive purging.

Front 221

Define eating d/o NOS

Back 221

NOT anorexia or bulimia

Front 222

Name the Impulse Control Disorders Not Elsewhere Classified

Back 222

kleptomania, trichotillomania, pathological gambling, pyromania, intermittent explosive d/o.

Front 223

What class of disorders contains depersonalization d/o, dissociative amnesia, dissociative fuge, dissociative identity d/o

Back 223

dissociative disorders

Front 224

Patient under significant stress, states that they do not feel "real"

Back 224

depersonalization d/o

Front 225

patient states he can't recall something

Back 225

dissociative amnesia

Front 226

A nun in her own town who works as a prostitute in another town.

Back 226

dissociative fugue

Front 227

Patient has multiple personalities or "alters"; often find things at home they don't recall purchasing... controversial fx

Back 227

dissociative identity disorder

Front 228

Describe mood v affect

Back 228

pt's subjective experience v objective signs of emotional state

Front 229

illusion v hallucination

Back 229

misperception of stimulus/something's there v perception of non–existent stimulus

Front 230

obsession v compulsion

Back 230

recurrent,distressing thought (never an action) v repetitive actions performed to relieve anxiety (act can be a thought, but more often is a physical action)

Front 231

circumstantial v tangential v loose association

Back 231

giving excessive details but not necessarily changing topic v wandering from topic to topic where each transition following logically, often forgetting the question that was asked v jumping from topic to topic without clear connections (All 3 related to thought process)

Front 232

word salad v clanging

Back 232

nonsensical grammatical constructions where words are thrown out v words rhyme with one another

Front 233

hypnaogoic v hypnopompic hallucinations

Back 233

during the period going to sleep v during the period of awakening. both commonly occur in healthy individuals; hypnoaGOgic (GO to sleep) & hypnoPOmpic (POpping up from sleep)

Front 234

Define delirium

Back 234

acute onset; characterized by inattention (can't repeat days of week in reverse, serial 7s, etc); waxing and waning course, and reversal of sleep–wake cycle

Front 235

T/F: delirium can be caused by conditions other than general medical conditions

Back 235

False

Front 236

Define Dementia

Back 236

amnesia + loss of cognitive function defined as one of the following: aphasia, agnosia, apraxia, poor executive function (includes sequencing, organizing, abstraction, planning)

Front 237

Alzheimer's type vs vascular dementia

Back 237

A: MCC of dementia; often linear decline; definitive dx requires TISSUE vs V: step–wise decline corresponding with descrete vascular insults

Front 238

Dementia vs Pseudodementia

Back 238

demented patients tend to confabulate (they don't want to be seen as demented) vs pseduodementia occurs as a result of depression (tend to over–exaggerate their deficits)

Front 239

mild cognitive impairment v benign senescent forgetfullness

Back 239

MCI: sub–syndromal dementia (only amnesia, agnosia, aphasia, apraxia, executive dysfunction) BSF: normal aging (forgot where placed the keys, etc.)

Front 240

Suicide attempt v parasuicidal gestures

Back 240

SA: intent of dying; PG:aimed at getting attention (but succeed sometimes!)

Front 241

active v passive suicidal ideation

Back 241

Active = "i want to die" or "i want to kill myself"; Passive = "i'd rather be dead" or "things would be better off if i weren't here"

Front 242

Anticholinergic toxidrome

Back 242

hot as a hare, dry as a bone, red as abeet, mad as a hatter, blind as a bat!

Front 243

Anticholinergic v sympathomimetic (cocaine, amphetamines, etc) toxidromes

Back 243

Same. Except that in sympathomimetics, patients will also be diaphoretic. PSNS post synaptic neurons use ACh and SNS PSN use norepi except at sweat glands (Ach is used instead!)

Front 244

What is the triad of wernicke's encephalopathy? Immediate treatment?

Back 244

confusion, ataxia, opthalmoplegia (usually abducens (6th CN)). Give IV Thiamine (B1), which is involved in the metabolism of glucose.

Front 245

Triad for normal–pressure hydrocephalus.

Back 245

urinary incontinence, dementia, ataxia (wet, wacky, wobbly).

Front 246

List the dopamine (DA) pathways that mediate EPS. Tetrad?

Back 246

EPS: nigrostriatal (think substantia nigra – degenerated in PD) ––> acute dystonic rxn, akathisia, parkinsonism, TD

Front 247

List the dopamine pathway that mediate +sx in schizophrenia

Back 247

excessive DA in mesolimbic system

Front 248

List the dopamine pathway that mediates –sx in schizophrenia

Back 248

mesocortical: low DA responsible for –sx in schizophrenia. This explains why typical antipsychotics (solely DA antagonism) do not improve –sx

Front 249

List the dopamine pathway that mediate hyperprolactinemia

Back 249

tuberoinfundibular (DA = pRL inhibitor) ––> antipsychotics (esp haloperidol and atypical, respiradone) can cause gynecomastia & galactorrhea.

Front 250

List tetrad for Narcolepsy

Back 250

excessive daytime sleepiness, hypnoGOgic hallucinations, cataplexy (loss of motor tone in context of emotion i.e. laughing/crying) & sleep paralysis

Front 251

4 D's of malpractice

Back 251

duty (presence of MD–pt relationship), dereliction/deviation (from standard of care), damage, direct causation. "derelection of duty directly caused damages"

Front 252

5 types of schizophrenia in DSM–IV–TR

Back 252

Catatonic, disorganized, paranoid, residual, undifferentiated.

Front 253

catatonic schizophrenia

Back 253

excessive/inhibited psychomotor activity

Front 254

disorganized schizophrenia

Back 254

prominent disorganization (speech or behavior)

Front 255

Which schizophrenia has the worst prognosis?

Back 255

disorganized type

Front 256

"burnt out" schizophrenia of later life; prominent negative sx

Back 256

residual type

Front 257

Undifferentiated schizophrenia

Back 257

Not catatonic, disorganized, paranoid or residual?

Front 258

Which type of schizophrenia has the BEST prognosis?

Back 258

Paranoid Schizophrenia: prominent delusions/hallucinations

Front 259

5 core symptoms (criteria A) of schizophrenia

Back 259

two of the following are required > 1 month: delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms

Front 260

3 exceptions to the requirement for meeting criterion A of schizophrenia

Back 260

1. bizarre delusions 2. AH of two voices giving a running commentary of pt's life or 3. AH of two voices conversing with each other sufficient to meet criterion A.

Front 261

6 types of delusions in DSM IV–TR

Back 261

persecutory (same as paranoia), erotomanic (belief that someone of higher stature is in love with pt), somatic (e.g. internal organis rotting) gradiose (common with psychosis associated with mania), Jealous, Mixed

Front 262

6 specifiers for MDD in DSM IV

Back 262

with: 1) psychotic features (treat the "depression" and psychosis will resolve, versus schizoaffective d/o); 2) melancholic features (anhedonia, early morning awakening, excessive guilt, mood does not reach with pleasure stimuli; 3) Atypical features (hyperphagia/hypersomnia, reactive mood, rejection sensitivity); 4) seasonal pattern (SA d/o, tx is light therapy or SSRI); with 5) catatonic features, or with 6) postpartum onset (w/in 4 weeks of parturition)

Front 263

Give two examples projective tests

Back 263

1) Rorschach test (inkblots): especially useful for identifying psychotic d/o or paranoia 2) Thematic apperception test: pt tells stories about depressing pictures

Front 264

Give 3 examples of intelligence test and their appropriate age ranges.

Back 264

WAIS (ages 16–75; includes verbal and visuospatial sections; average 100 w / SD of 15) Standord–Binet Test (age 2–23); Wechsler intelligence scale for children–revised (WISC–R) ages 6– 16

Front 265

What is the MMPI–2?

Back 265

Minnesota multiphasic personality inventory: pathology + patterns of behavior

Front 266

Name the 5 neuroleptic–induced syndromes

Back 266

acute dystonic reaction, akathisia, parkinsonism (including rabbit syndrome), Tardive dyskinesia, Neuroleptic malignant syndrome (NMS)

Front 267

What is the timeline for each neuroleptic induced syndrome?

Back 267

ADS (hrs–days), akathisia (days–wks), parkinsonism (wks–mos), TD (mos–yrs)

Front 268

Name 2 SSRI–related syndrome

Back 268

serotonin syndrome, SSRI–discontinuation syndrome

Front 269

Described acute dystonic reaction. Treatment?

Back 269

hrs–days: early EPS characterized by acute msucle spasm, more often d/t typical antipsychotics in a high dose or to an antipsychotic–naive patient. Can be torticollis or oculogyric crisis (painful upward deviations of eyes), and generally involves the neck/face/throat. Occurs w/in hurs but can be delayed up to a day after neuroleptic andminstration. Treat w/ benztropine (central acting anti–cholinergic/histamine) or IM diphenyldramine

Front 270

Which Rx, used as antiemitics, can also cause acute dystonic reactions?

Back 270

promethazine (phenegran), prochlorperazine (compazine), metoclopramide (Reglan).

Front 271

Which is the most dangerous dystonic reaction?

Back 271

laryngospasm (protect the airway)

Front 272

Describe akathisia. Treatment?

Back 272

inner feeling of restlessness + motoric restlessness that makes the person unable to sit still; takes days to weeks to occur. Can be d/t SSRI and by the antiemetics metoclopramide and prochlorperazine. Tx w/ BB, benzo (loraepam) or anticholinergic (benztropine/benadryl).

Front 273

Define parkinsonism (including rabbit syndrome)

Back 273

resembles PD but not idiopathic. Takes weeks to months.

Front 274

Define Tardive Dyskinesia. Management?

Back 274

takes months, usually years to develop. Associated w/ long–term or high dose use of dopamine antagonists. antipsychotics (typicals > atypicals) are usual culprits. Sx include involutnary purposeless reptitive tics and spasms, generally oro–buccal, which are NOT distressing. 50% cases reversible, failure to disclose this SE is a reaction for legal action!! stop offending agent, if 2/2 to antipsychotic, consider a switch to clozapine (least EPS)

Front 275

Define NMS. Rx?

Back 275

usually occurs days after starting antipsychotic or increasing its dose (usually typicals). Often missed or misdiagnosed. 10% fatal. Look for muscle cramps w/ lead pipe rigidity, high fever, autonomic instability, and mental status changes consistent with delirium. Leukocytosis and CPK increases (~20K). treatment involves stopping the offender, bringing down fever and hydrating to prevent renal failure from rhabdo. Rx: dantrolene and bromocriptine (dopamine agonist)

Front 276

What syndrome is very similar to serotonin syndrome?

Back 276

NMS! questions on this typically involve the addition of a new pro–serotonin Rx to a patient who is already on a medication that has pro–serotonin properties (i.e. linezolid, tramadol, SSRI, SNRI, TCA, MAOI) or an insufficient wash–out period b/t Rx (SSRI/SNRI/TCA + MAOI). Sx same as NME but may also have myoclonus (jerks) where NMS is more lead pipe rigidity. Tx by removing offending agents & supporting care. Tx by removing offending agents & supporting care.

Front 277

Define SSRI discontinuations syndrome.

Back 277

abrupt d/c of SSRI leads to the syndrome FLU–like sx. Rx at highest risk if d/c'd abruptly is paroxetine (shortest–half life). similar syndrome occurs w/ SNRIs (esp venlafaxine immediate release aka side effexor). SNRI d/c syndrome more likely to cause paresthesias and "electrical sensations" in extremities (the "zaps").

Front 278

Define Hypertensive crisis. Treatment?

Back 278

Pt on MAOI ingestes tyramine (wine, cheese, fava beans, cured meats, etc.). Can also be with MAOI +meperidine aka demerol). Tx: lower BP w/ phentolamine or Na nitroprusside infusions for true emergencies (diastolic > 120).

Front 279

Why is tyramine c/i in patients taking MAOI?

Back 279

tyramine is an indirect sympathomimetic which is converted to NE pre–synaptically.

Front 280

What serum level does lithium toxicity occur?

Back 280

serum levels > 1.5 (therapeutic levels 0.6–1.2).

Front 281

list symptoms at lithium levels b/w 1.5–2.0.

Back 281

n/v/ataxia, slurred speech, weakness, nystagmus

Front 282

list symptoms at lithium levels b/w 2.0–2.5

Back 282

axnorexia, blurred vision, fasiculations, delirium, stupor, increased DTRs

Front 283

list symptoms at lithium levels > 2.5

Back 283

generalized convulsions, oliguric renal failure.

Front 284

list symptoms at lithium levels > 3.5

Back 284

severe! cardiovascular collapse, potentially lethal.

Front 285

Treatment for mild v severe lithium toxicity?

Back 285

mild/moderate: IVF; severe: hemodialysis (look for seizures, delirium, stupor, coma, etc.)

Front 286

Lithium side effects (therapeutic levels)?

Back 286

hypothyroidism (F>M), nephrogenic DI, acne, weight gain, sedation, benign leukocytosis, psoriasis

Front 287

teratogenic side effects of lithium?

Back 287

ebsteins abnormality (highest risk in 1st trimester; tricuspid valve is displaced down)

Front 288

therapeutic trough levels of valproic acid

Back 288

50–100 (can titrate to side effects)

Front 289

Mild sx of valproic acid toxicity

Back 289

GI upset w/ n/v and confusion

Front 290

Sx of severe valproic acid toxicity

Back 290

hypotension, cerebral edema ––> lethargy, coma, cardiac arrest. treat based on symptoms.

Front 291

Side effects of valproic acid (at therapeutic levels)

Back 291

sedation, weight gain and tremor (use propranolol).Alopecia, thrombocytopenia are rare. hepatotoxicity (encephalopathy, edema, jaundice) and pancreatitis (black box warning).

Front 292

T/F: any physician can prescribe clozapine

Back 292

False. need a special license to prescribe it

Front 293

What are the 5 black box warnings of clozapine?

Back 293

1. agranulocytosis 2. seziures 3 myocarditis (may see peripheral eosinophilia) 4. cardiopulmonary collapse 5. increased mortality in treating psychosis related to dementia

Front 294

Define agranulocytosis.

Back 294

absolute neutrophil count (ANC) < 1000.

Front 295

What CBC finds should make you suspicious of possible agranulocytosis in patients using clozapine?

Back 295

If WBC drops 3–4k, stop clozpaine. w/o neutrophils the body can't fight infections ))> malaise, fever, sepsis and death

Front 296

Other side effects of clozapine (not black box)

Back 296

significant drooling (d/t esophageal dysmotolity), orthostatic hypotension and can SIGNIFICANT (40+ lbs) we gain/metabolic syndrome

Front 297

Side effects of Lamotrigine

Back 297

Stevens–Johnson syndrome/toxic episdermal necrolysis; 8% w/ benign rash but up to 1:1000 develop SJS/TEN

Front 298

Major side effects of Carbamazepine

Back 298

aplastic anemia and agranulocytosis

Front 299

Acute dystonic reaction is a typical side effect in what psychiatric drug?

Back 299

typical antipsychotics (short–term use)

Front 300

Tardive dyskinesia is a long term side effect of what drug?

Back 300

typical antipsychotic

Front 301

Major side effect of tarzodone? Nefazodone?

Back 301

priapism and hepatotoxicity

Front 302

How do you distinguish Brief psychotic d/o v schizophreniform d/o v schizophrenia

Back 302

Durtation of sx (criterion A). BPD < 1 mo sx; schizphreniform is 1–6 months (including prodrome sx); schizophrenia is > 6 mo sx (including prodrome + at least 1 month of active sx)

Front 303

Distinguish MDD w/ psychotic features v schizoaffective d/o.

Back 303

In a patient with concurrent depression and psychosis. MDD psychotic sx occur ONLY in context of depression. SAD, look for psychotic sx for 2 weeks in ABSENCE of depression and pt should meet criteria for BOTH MDD and schizophrenia.

Front 304

How do you distinguish Brief psychotic d/o v schizophreniform d/o v schizophrenia

Back 304

Durtation of sx (criterion A). BPD < 1 mo sx; schizphreniform is 1–6 months (including prodrome sx); schizophrenia is > 6 mo sx (including prodrome + at least 1 month of active sx)

Front 305

Distinguish MDD w/ psychotic features v schizoaffective d/o.

Back 305

In a patient with concurrent depression and psychosis. MDD psychotic sx occur ONLY in context of depression. SAD, look for psychotic sx for 2 weeks in ABSENCE of depression and pt should meet criteria for BOTH MDD and schizophrenia.

Front 306

PTSD v Acute stress d/o

Back 306

Major difference is duration of sx. PTSD req sx > 1month. ASD requires sx for less than 4 weeks. Both occur w/in 4 weeks of index trauma. Both require 3 symptom clusters: re–experiencing, hyperarousal and avoidance/numbing. ASD also requires 3 sx of dissociation.

Front 307

Social phobia v panic d/o

Back 307

social phobia is specific to an uncomfortable social situation and panic attacks may be present (triggered by situation). Panic d/o requires h/o recurrent, unexpectected/untriggered panic attacks and after at least one of these there must be a period of > 1 month where pt has significant anxiety about having another attack (2/2 unexpected nature)

Front 308

OCD v GAD

Back 308

OCD – presence of obsessions or compulsions that don't respond to simple re–assurance. GAD = anxiety regarding many things (the "worry wart") but can usually recognize irrational nature of worries (better insight)

Front 309

T/F: panic attacks are pathognomic for panic d/o

Back 309

False. Panic attacks can exist in nearly any anxiety d/o and even be substance induced or d/t general medical condition. First distinction is if they are triggered ––> insight into specific anxiety d/o.

Front 310

BP I v BP II v Cyclothymic d/o

Back 310

BP1: h/o manic or mixed episode; BP2: requires h/o hypomanic episode AND MDD episode. Cyclothymia: persistent mood episodes on most days > 2 yrs straight! (w/o euthymia for over 2 months)

Front 311

MDD v dysthymic d/o

Back 311

MDD: depression or anhedonia + 4 sx from SIGECAPS x 2 weeks. Dysthymic d/o: depression + 2 of ACHEWS (allergic to happiness – Appetite changes, dec concentrations, hopeless, dec energy, worthless, sleep) x 2 years w/o 2 mon euthymia

Front 312

MDD v Bereavment

Back 312

Time and functioning. Bereavement can last up to a year, but MDD is reserved for significant sx that last > 2 months AFTER LOSS. If pt is not functioning w/in the 2month a dx of MDD can be made(sx to suggest MDD are guilt, SI, worthlessness).

Front 313

T/F: VH can occur in individuals suffering from bereavement

Back 313

True. 30%

Front 314

MDD v adjustment d/o

Back 314

SEVERITY. sx meet criteria for MDD, then mood disorder (BP or MDD). If there is functional impairment w/ MDD criteria NOT met, then adjustment d/o.

Front 315

somatoform d/o (somatization /do, hypchondriasis, etc.) v factitious d/o v malingering

Back 315

somatoform = doesn't understand and does know why; factitious (munchausen's or M by proxy) = knows whats going on but doesn't appreciate why they're doing it (no clear secondary gain); malingering = secondary gain is clear

Front 316

Body dysmorphic d/o v delusion d/o

Back 316

BDD = excessive, strong beliefs about body's imperfections (45x increase in suicide!); Delusional d/o = single, isolated, non–bizarre (FBI following you)

Front 317

primary d/o v. substance d/o v. d/o due to general medical condition

Back 317

If you get a question where patient is taking a substance known to cause a particular syndrome (e.g interferon for depression) then its usually substance induced. Same goes for general medical condition (e.g. L frontal CVA or pancreatic CA ––> depression). Primary means that it can't be due to the other two

Front 318

T/F: Personality disorders are generally ego–dystonic.

Back 318

False. They are egosyntonic, which means patient thinks that their sx are reasonable and appropriate (e.g schzoid perfers to be left alone and OCPD thinks its okay to be aperfectionist)

Front 319

Differentiate Schizoid/typal vs schizophrenia

Back 319

Schizoid = loner; odd interactions with others; Schizotypal = odd, eccentric personality; may have magical thoughts. BOTH LACK frank delusions, hallucinations and disorganization although they may display negative sx.

Front 320

Avoidant v panic d/o with agoraphobia/social phobia

Back 320

Difficult to differentiate. avoidant PD = egosyntonic to have thoughts of inadequancy and pervasive fear of not being accepted (drive to avoid contact). Panic d/o w/ agoraphobia/social phobia pts are driven BY ANXIETY. avoid contact in order to avoid having a panic attack.

Front 321

Antisocial v intermittent explosive d/o

Back 321

IED is characterized by discrete episodes of violent/aggressive behavior interspersed by much longer periods of remorse and non–aggressive behavior. They have significant regret v antisocial, who rarely express remorse.

Front 322

OCPD v OCD

Back 322

OCPD = perfectionistic & rule driven, come off as cold toward others. OCD = defined by presence of either obsessions and/or compulsions > 1 hr/day

Front 323

borderline/histrionic v cyclothymic/bipolar d/o

Back 323

borderlines can't see shades of fray (splitting). They also evoke strong emotion from care providers (usually frustrations), and they routinely cause drama (parasuicidal thoughts/actions). Histrionics make extravagant shows and can be seductive. Cyclothymic is hypomanic and depressive sx for at least 2 years w/o 2month consecutive interval of sx free

Front 324

What else goes on Axis II other than personality d/o?

Back 324

MR (soon to be called intellectual disability).

Front 325

What else goes on in Axis I besides psychotic, mood and anxiety d/o?

Back 325

borderline intellectual functioning (IQ 71–84).

Front 326

what is the 15/20/20/15 rule?

Back 326

IQ < 15 is profound MR, 16–35 (15+20) severe MR, 36–55 (35+20) moderate MR, 56–70 (55+15) mild MR.

Front 327

What disease would you expect with CT/MRI findings positive for neurofibrillary tangles and senile plaques?

Back 327

Alzheimer's

Front 328

What pathologic findings would you expect to make the diagnosis of prion disease?

Back 328

spongiform changes (confluent vacuoles), amyloid plaques. (creutzfeld–jakob)

Front 329

What CT/MRI findings would you expect to see in Huntington's disease?

Back 329

bilateral caudate atrophy or "boxcar ventricles"

Front 330

Name the gene and its chromosome for huntington's disease

Back 330

Hungtingtin on chromosome 4

Front 331

What disease would you suspect if patient had neuronal loss in substantia nigra?

Back 331

parkinson's

Front 332

What CT/MRI findings would suggest Pick's disease?

Back 332

frontotemporal loss (picks = frontotemporal dementia)

Front 333

What MRI/CT findings would you expect to see in patient w/ MS?

Back 333

periventricular white matter lesions

Front 334

Punctate hemorrhages into the mammillary bodies is suggestive of...

Back 334

Wernicke's

Front 335

What CT/MRI finding would suggest schizophrenia?

Back 335

ventricular enlargement & diffuse cortical atrophy

Front 336

Name 3 cortical dementias

Back 336

Alzheimer's Pick's, CJD

Front 337

Name 3 subcortical dementias (including basal ganglia)

Back 337

huntington's, parkinson's/lewy body, vasuclar (Binswanger's disease) and AIDS dementia

Front 338

What are the 3 M's of subcortical dementia?

Back 338

Mood (depressed), motor (ataxic) and memory (amnesia)

Front 339

What imaging would you order if suspect fracture or bleeding intracranially?

Back 339

CT

Front 340

What imaging would you order in a patient whom you suspect for papilledema

Back 340

MRI (tumors often isodense w/ healthy brain so CT won't always see them) CT can show midline shift but necessarily define borders of a tumor

Front 341

Imaging for a patient with focal neurological sx?

Back 341

MRI

Front 342

Patient presents with ataxia, nystagmus and/or n/v. What imaging would you order?

Back 342

These are posterior fossa sx. MRI, because CT cannot visualize posterior fossa

Front 343

suspected intracranial hemorrhage

Back 343

CT (faster than an MRI!)

Front 344

What labs would you order in a patient with a suspected pheochromocytoma

Back 344

urine catecholamines, metanephrine and VMA (all urine)

Front 345

What lab test/procedure would you order in a patient whom you suspect wilson's dz?

Back 345

serum ceruloplasmin (dont' forget about kayer–fleischer rings)

Front 346

What lab/procedure would you order in a patient whom you suspect cushing's?

Back 346

serum cortisol or dexamethasone supppression test

Front 347

When would carcinoid tumor become carcinoid syndrome? What test would you order to dx?

Back 347

when mets to liver/lungs. get 5–HIAA serum levels

Front 348

T/F: 5–HIAA is high in the CSF of patients who commit suicide.

Back 348

False. Its low

Front 349

What would you order in patient with AIP?

Back 349

urine porphobilinogens & urobilinogens (including d–aminolevulinic acid (ALA)).

Front 350

Patient in clinic c/o depression, weight gain, inability to concentrate, consitpation. What tests would you order?

Back 350

TSH. think depressive d/o d/t hypothyroid

Front 351

What lab test/procedure can help differentiate seizure from pseudoseizure

Back 351

arterial serum prolactin 10–20min after event ––> put on ice and send to lab stat. prL is often elevated after a seizure but not in pseduoseizure

Front 352

Besides an MRI, what test would you order to clinch MS diagnosis?

Back 352

CSF – oligoclonal bands

Front 353

What imaging would you order if you suspect a subdural hematoma?

Back 353

CT

Front 354

What imaging/procedure(s) would you order if you suspect normal pressure hydrocephalus?

Back 354

head CT, LP (opening pressure > 20)

Front 355

what tests would you order if you suspected CJD?

Back 355

EEG, CSF for protein 14–3–3

Front 356

what test would you order if you suspected temporal lobe epilepsy

Back 356

EEG

Front 357

Besides a head CT, what other test could help you dx subarachnoid hemorrhage?

Back 357

LP looking for xanthochromia (yellow CSF)

Front 358

What kind of CT would you order in a patient whom you suspect CVA?

Back 358

non–contrast CT

Front 359

What test would you order in guillain–Barre syndrome?

Back 359

LP (may see cytoalbuminologic dissociations = protein > 45 w normal WBC)

Front 360

Emergency psychiatry: differential for catatonia

Back 360

schizophrenia, MDD, bipolar, NMS or serotonin syndrome, encephalitis, non convulsive status epilepticus

Front 361

ER psych: cocktails for agitation?

Back 361

5:2:1 (5 mg halperidol:2 mg lorazepam: 1 mg cogentin) or 5:2: 50 (50 mg diphenhydramine). IM/PO Usually IM.

Front 362

ER psych: patient presents with confusion, ataxia and opthalmopelgia. What do you do first?

Back 362

thiamine before glucose. you'll probably start a banana bag later (NS + Folate, thiamine, etc.)

Front 363

Withdrawal from what drugs can be fatal?

Back 363

alcohol or benzos (and barbs)

Front 364

What lab values are classic in alcoholics?

Back 364

Look for AST/ALT > 2:1 with significant intoxication. MCV will be elevated (d/t poor nutrition, and decreased folate and possibly B12, which can cause neuro sx (folate can't)).

Front 365

Patient presents to ER w/ headache, anxiety, n/v, tremulous. what would you suspect?

Back 365

alcohol withdrawal.

Front 366

T/F: alcohol withdrawal can present with hallucinations and seizures.

Back 366

True. within 12–24 hrs and 12–48 hrs respectively.

Front 367

When does DTs occur?

Back 367

36–72hrs after last drink

Front 368

Withdrawal from benzodiazepines presents similarly to withdrawal from what drug?

Back 368

Et–OH.

Front 369

What treatment can you provide in patient who you suspect BDZ toxicity?

Back 369

flumazenil (watch out for seizures if you give it...)

Front 370

If a patient who has sx of opioid overdose doesn't respond to narcan, what would you suspect?

Back 370

multiple drug overdose including benzos! (or Et–OH)

Front 371

What 2 drugs did Heath Ledger overdose on?

Back 371

opioids and benzos. worried about respiratory depression/anoxia

Front 372

How does narcan (naloxone work)

Back 372

IV opiod mu receptor antagonist

Front 373

Patient presents with slowed cognition (bradyphrenia), blood shot eyes, increase appetite.

Back 373

MJ intoxications.

Front 374

How long will Urine tox remain + for MJ?

Back 374

up to a month with chronic use as its stored in fat

Front 375

What intoxication presents very similar to an anticholinergic intoxication?

Back 375

cocaine/amphetiamines. May also present with diaphoresis and seizures and psychotic sx. Keep high on ddx in young patient with MI or CVA (but ask about thrombophilias, sickle cell and fam hx)

Front 376

Mechanism of action of cocaine?

Back 376

dopamine reuptake inhibition (@ DAT1)

Front 377

mechanism of action of amphetamines?

Back 377

causes direct release of dopamine

Front 378

Pt is very aggressive and has rotary nystamus. Dx

Back 378

PCP. Ketamine only causes sedation (no aggressiveness)

Front 379

What can cause hallucinogen persisting perception d/o

Back 379

LSD! patients has flashbacks for rest of his/her life

Front 380

MC psychoactive substance

Back 380

caffeine

Front 381

MC substance abused/dependence?

Back 381

nicotine

Front 382

Substance which causes most deaths (by far!)

Back 382

nicotine

Front 383

MC used illicit psychoactive substance?

Back 383

MJ

Front 384

First–line treatment MDD

Back 384

mild to moderate: Rx or psychotherapy (interpersonal or CBT). Severe: requires Rx

Front 385

Is one Rx for MDD more efficacious than another?

Back 385

No. all antidepressants are equally efficacious. Exception: MAOIs > TCA in atypical depression

Front 386

Most effective Rx for depression?

Back 386

ECT

Front 387

First line treatment for bipolar p/w mania or mixed episode

Back 387

mild–mod: lithium, valproic acid or antipsychotic; if severe: add antipsychotic to either lithium or valproic acid

Front 388

First line treatment for bipolar p/w MDD

Back 388

lithium or lamotrigine

Front 389

First line treatment for bipolar p/w rapid cycling?

Back 389

valproic acid or lithium (VPA is generally better)

Front 390

first line treatment in schizophrenia

Back 390

antipsychotic (usually tailoring side effects: consider ziprasidone/aripiprazole for those who are overweight; use sedating Rx at night if not sleeping well, etc.)

Front 391

First line treatment in schizophrenia w/ history of med non–compliance

Back 391

consider depot antipsychotic (decanoate formulation of haloperidol or fluphenazine or newer atypical depots, risperidone (consta) or paliperidone (invega sustennal)

Front 392

first line treatment for delirium

Back 392

high potency antipsychotic (haloperidol & fluphenazine)

Front 393

first line treatment for catatonia

Back 393

lorazepam (ativan)

Front 394

first line treatment for generalized anxiety d/o?

Back 394

SSRI

Front 395

first line treatment for panic d/o

Back 395

start w/ SSRI + benzo and taper off benzo after a month or so

Front 396

first line treatment of PTSD

Back 396

SSRI (esp paroxetine or sertraline)

Front 397

Time period for delusional d/o

Back 397

1 month

Front 398

time period for cyclothymic or dysthymic d/o

Back 398

2 years in adults; 1 year in children (no period longer than 2 months of sx free)

Front 399

Time period of sx for GAD?

Back 399

6 months

Front 400

duration of sx for MD episode

Back 400

2 weeks

Front 401

duration of sx for manic episode

Back 401

7 days

Front 402

Duration of sx for mixed episode

Back 402

1 wk or less if hospitalized as a result of sx

Front 403

duration of sx for hypomanic episode?

Back 403

> 4 days

Front 404

ODD v conduct d/o

Back 404

ODD children are peevish, obstinate and angry, but those with conduct d/o violate other's right (theft, setting fires, fights, animal cruelty).

Front 405

ADHD v bipolar d/o

Back 405

Bipolar are discrete episodes whereas ADHD are defined by ongoing hyperactivity (>6mo) and/or inattention in at least two settings (home, school, etc)

Front 406

Separation anxiety disorder v reactive attachment disorder

Back 406

separation anxiety d/o = anxiety when being apart from person to whom child is attached; reactive attachment d/o has two subtypes (both manifesting < 5 y/o): either the child will not attach readily & indiscriminately to just about everyone

Front 407

Name the 5 pervasive development

Back 407

autistic d/o, asperger's d/o, rett's d/o, childhood disintegrative d/o, NOS

Front 408

name the pervasive developmental d/o: poor social interactions, restricted/sterotyped behaviors/interest & communications.

Back 408

Autistic d/o

Front 409

Name the pervasive developmental d/o: poor social interaction & restricted/sterotyped behaviors/interests; can be very intelligent and very gifted at communication

Back 409

Asperger's d/o

Front 410

Name the pervasive developmental d/o: deceleration of head growth from 5–30mos., sterotyped hand movements (e.g. wringing); generally female

Back 410

Rett's d/o

Front 411

Name the pervasive developmental d/o: normal development until 2 yrs. then lose previously acquired skills + 2/3 autistic d/o sx; generally male

Back 411

childhood disintegrative d/o

Front 412

Name the pervasive developmental d/o: looks like others but doesn't meet the strict criteria

Back 412

NOS

Front 413

MCC of mental retardation

Back 413

down syndrome

Front 414

MCC of preventable MR

Back 414

fetal alcohol syndrome

Front 415

this common form of MR is found exclusively in males

Back 415

fragile X syndrome

Front 416

occurs during childhood and is characterized by persistent failure to speak in one or more major social situations, despite the ability to speak and comprehend spoken language

Back 416

selective mutism

Front 417

a behavioral disorder that is most commonly identified among mentally–disadvantaged children, although it is increasingly recognized among adolescents and adults of normal mental capacity. The behavior consists of daily, effortless regurgitation of undigested food within minutes of starting or completing ingestion of a meal.

Back 417

rumination d/o

Front 418

Treatment for ADHD

Back 418

psychostimulants (methylphenidate or amphetamine analogs), the newer non–stimulant atomoxetine (strattera; acts as a norepi reuptake inhibitor), or guanfacine (a2 agonist)

Front 419

Treatment for enuresis

Back 419

bed alarms are 1st line; consider imipramine

Front 420

Tourette's treatment

Back 420

antipsychotics (risperidone, pimozide) or clonidine/guanfacine

Front 421

treatment for absent seizures

Back 421

ethosuximide or valproic acid

Front 422

postpartum blues v postpartum depression v postpartum psychosis

Back 422

blues = normla response after pregnancy but sx doesn't meet criteria for MDD & occurs in up to 30% of women. Sx peak ~ 5d post partum and resolve within 2 weeks. Pp Depression meets full criteria for MDD. Pp psychosis is psychosis (bipolar d/o until otherwise proven) address immediately

Front 423

Premenstrual dysphoric disorder

Back 423

severe PMS (dx'd as depressive d/o NOS). Can give SSRIs ONLY during luteal phase

Front 424

What causes ebstien's anomaly?

Back 424

lithium

Front 425

what psychiatric medications cause neural tube defects on the fetus?

Back 425

valproate and carbamazapine

Front 426

What side effects can SSRIs have fetus?

Back 426

persistent pulmonary hypertension & fussy babies

Front 427

what is medication can be used for premature ejaculation

Back 427

SSRI

Front 428

painful spasm of external 1/3 of vagina (ectoderm derived under voluntary control)

Back 428

vaginismus. often h/o sexual trauma

Front 429

voyeurism

Back 429

paraphilia of watching others

Front 430

exhibitionism

Back 430

paraphilia of revealing self to others

Front 431

frotteurism

Back 431

paraphilia of rubbing against strangers typically in crowded places

Front 432

sadism

Back 432

paraphilia of feeling pleasure when inflicting pain

Front 433

masochism

Back 433

paraphilia of feeling pleasure in being humiliated/experiencing pain

Front 434

dyssomnias v parasomnias

Back 434

too much or too little sleep AND abnormalities occur during sleep or the period going to or awakening from sleep

Front 435

Define restless leg syndrome. Treatment.

Back 435

crawling/tinglings sensation of legs, worst at night; sensation improves with leg movement. Use pramipexole (Mirapex) or ropinirole (Requip)

Front 436

What should you rule out first when you suspect restless leg syndrome?

Back 436

iron deficiency syndrome. If it is, give iron

Front 437

What are pramipexole (mirapex) and ropinirole (requip) both associated with?

Back 437

new onset pathological gambling and sleep attacks.

Front 438

Define night terrors (pavor nocturnus)

Back 438

most often a child appears to awaken from a terrifying dream and may even scream, but he or she doesn't truly awaken and doesn't recall the event the following morning. Occurs in non–REM sleep; more common in 1st 1/2 of the night. Can treat w/ long–acting benzodiazepines.

Front 439

Excessive daytime sleepiness, hypnoGOgic hallucinations, cataplexy (loss of motor tone in context of emotion such as laughing/crying), sleep paralysis

Back 439

narcolepsy

Front 440

T/F: narcoleptics may have REM episode within 10–20 min

Back 440

True. healthy individuals have their first REM episode 90min into sleep

Front 441

delayed sleep phase (in adolescents), advanced sleep phase (elderly), jet lag sleep disorder, shift work)

Back 441

circadian rhythm sleep d/o

Front 442

What should always be implemented for sleep disorders?

Back 442

good sleep hygiene

Front 443

What should you always rule out when dealing with sleep disorders?

Back 443

substance–induced sleep disorders

Front 444

Name the 3 eating d/o

Back 444

anorexia nervosa, bulimia nervosa, eating d/o NOS

Front 445

<85% of ideal body weight, amenorrhea, afraid to gain wt. Has restricting and binge–eating/purging types.

Back 445

anorexia nervosa. Anorexics consider their condition egoSYNtonic (they will tell you they're fat (despite being utterly cachectic) and they need to lose weight).

Front 446

recurrent binge eating with excessive attention paid to the body and compensatory techniques to lose weight

Back 446

Bulumia nervosa. There is a purging and non–purging type. egoDYStonic. these patients feel very ashamed of their behavior and go to great lengths to hide it.

Front 447

What is Russell's sign?

Back 447

scarring on the extensor surface of a finger/fingers as a result of repetitive purging.

Front 448

Define eating d/o NOS

Back 448

NOT anorexia or bulimia

Front 449

Name the Impulse Control Disorders Not Elsewhere Classified

Back 449

kleptomania, trichotillomania, pathological gambling, pyromania, intermittent explosive d/o.

Front 450

What class of disorders contains depersonalization d/o, dissociative amnesia, dissociative fuge, dissociative identity d/o

Back 450

dissociative disorders

Front 451

Patient under significant stress, states that they do not feel "real"

Back 451

depersonalization d/o

Front 452

patient states he can't recall something

Back 452

dissociative amnesia

Front 453

A nun in her own town who works as a prostitute in another town.

Back 453

dissociative fugue

Front 454

Patient has multiple personalities or "alters"; often find things at home they don't recall purchasing... controversial fx

Back 454

dissociative identity disorder

Front 455

Which anti–depressants can ––> delirium
how to treat this?

Back 455

MAOI
IV BZ (lorazepam is a good one, b/c there is a short t 1/2)

Front 456

how many days should you wait to give an SSRI, in a pt that has been previously treated with MAOI?

Back 456

14 days

Front 457

what is used to treat atypical depression?

Back 457

MOAI

Front 458

which etoh detox drugs are metabolized by the liver?

Back 458

chlordiazepoxide (librim)
diazepam

Front 459

which etoh detox drug is good to give to someone w impaired liver fxn?

Back 459

oxazepam (serax)

Front 460

what effect do SSRIs have on post–synaptic 5HT–2 receptors?

Back 460

downregulates them

Front 461

which NSAID does not interfere with lithium metabolism?

Back 461

ASA

Front 462

what decreases lithium excretion?

Back 462

Metronidazole
ACE inhibitors
Tetracycline
Thiazide diuretics
NSAIDS (not ASA)
CCBs

Front 463

what increases lithium clearance?

Back 463

Theophillline
Acetazolamide
Caffeine
Osmotic diuresis

Front 464

side effects of lithium?

Back 464

nephrogenic DI
hypothyroid
leukocytosis
tremors
acne
sedation
arrhythmias
T wave flattening/inversion

Front 465

What med can exacerbate tics?

Back 465

mehtylphenidate

Front 466

what is the MOA of treating Tourrette's?

Back 466

D2 antagonism (antipsychotics)

Front 467

what drugs can be used to treat OCD?

Back 467

Clomipramine
Fluvoxamine

Front 468

What decresaes impulsiveness in Borderline PD?

Back 468

SSRI (esp fluoxetine)
haloperidol

Front 469

If looking for immediate relief of GAD, what class of meds should be given?

Back 469

BZ

Front 470

Effect of lithium in pregnancy?
%?

Back 470

Ebstien's
7.7%

Front 471

mood stabilizer that has causes fetal abnormalities if given during pregnancy?

Back 471

clonazepam

Front 472

Whath meds can be given to delirius pts?

Back 472

low–dose atypical antipsychotics
low–dose haldol

Front 473

why do atypical antipsychotic meds ––> orthostatic hypotension?

Back 473

alpha 1 blockade

Front 474

What drugs are used to treat PTSD and why?
which drug class is NOT effectve in PTSD?

Back 474

Clonidine: to decrease the re–experiencing of PTSD
SSRIs: to reduce the "numbness" associated w PTSD
BZ not effective

Front 475

What is the 1st line med for panic d/o?
other drugs to treat panic d/o?

Back 475

fluvoxamine
imipramine and phenelzine can also be used, but less desirable d/t side effects

Front 476

which mood stabilizer ––> pancreatitis?

Back 476

valproic acid

Front 477

how long should pts be treated for 1st episode of depression?

Back 477

at least 6 mos, usually 8–12 mos to prevent relapse

Front 478

how to treat drooling associated with clozapine?

Back 478

anti–cholinergic

Front 479

how to treat clozapine induced tachycardia?

Back 479

propanolol

Front 480

which of the atypical anti–psychotics are least likely to increase cholesterol or cause DM?

Back 480

aripiprazole
ziprasadone

Front 481

which antidepression is used to treat depression and diabetic neuropathy?

Back 481

duloxetine

Front 482

what is the most common underlying cause for post–partum psychosis?

Back 482

underlying bipolar I d/o

Front 483

cortisol levels in MDD?
catecholamine levels?
sex hormones?
immune fxn?

Back 483

incresaed (50% fail dexamethasone suppression test)
decreased
decreased
decreased

Front 484

which of the psych d/o has the strongest genetic association?

Back 484

bipolar I

Front 485

manifestations of porypheria?

Back 485

mania/psychosis + abdominal pain

Front 486

organic changes seen in Kluver–Bucy syndrome

Back 486

bilateral damage to amygdala

Front 487

what effect does starvation have on:
BUN
cortisol
TSH response
GH

Back 487

increased
increased
normal
increased

Front 488

what is the relationship between MDD and TSH?

Back 488

1/3 of pts have no increase in TSH wiht TRH administration

Front 489

what is cluster of sx seen in normal pressure hydrocephalus?

Back 489

ataxia
confusion
incontinence

Front 490

length of time sx need to be present in PTSD?
acute stress d/o?

Back 490

>4 wks
<4 wks

Front 491

long term tx for Borderline PD?

Back 491

therapy and steady social support

Front 492

hwo does insight relate to psychosis?

Back 492

if pts have insight into their delusions/hallucinations, etc, they are not psychotic

Front 493

what fraction of pts with MDD respond to placebo?

Back 493

1/3

Front 494

what is the clinical course expected in a schizophrenic not on meds?

Back 494

unknown

Front 495

in men 30–50 yo, what % of impotence is related to pysiologic reasons?

Back 495

10%

Front 496

what is the % liklihood of a pt developing schizophrenia if:
1 parent has schizo
both parents have schizo
MZ twin has schizo

Back 496

12%
40%
50%

Front 497

other than +/– sx of schizophrenia, what behavioral can be seen

Back 497

short–term memory deficits
unstable smooth eye pursuit
can't habituate to repeated stimulus

Front 498

treatment for normal pressure hydrocephalus

Back 498

shunt

Front 499

delirium + hemiparesis or other focal neuro signs
dx?
confirm?

Back 499

CVA or mass
brain CT/MRI

Front 500

delirium + elevated BP + papilledema
dx?
confirm?

Back 500

HTN encephalopathy
brain CT/MRI

Front 501

delirium + dilated pupils and tachycardia
dx?
confirm?

Back 501

drug intox
urine toxicology screen

Front 502

delirium + fever + nuchal rigidity + photophobia
dx?
confirm?

Back 502

meningitis
lumbar puncture

Front 503

delirium + tachy + tremor + thyromegaly
dx?
confirm?

Back 503

thyrotoxicosis
T4, TSH

Front 504

dementia w stepwise increase in severity + focal neuro signs
dx?
confirm?

Back 504

multi–infarct dementia
CT/MRI

Front 505

dementia + cogwheel rigidity + resting tremor
dx?
confirm?

Back 505

PArkinson's dz
CT/MRI

Front 506

dementia + ataxia "+ urinary incont + dilated cerebral ventricles
dx?
confirm?

Back 506

NPH
CT/MRI

Front 507

which, delirium or dementia has EEG changes

Back 507

delirium

Front 508

dementia + obesity + coarse hair + constipation + cold intolerance
dx?
confirm?

Back 508

hypothyroid
T4, TSH

Front 509

dementia + tremors + abnormal LFTs + kayser–Fleischer rings

Back 509

Wilson's dz
ceruloplasmin

Front 510

Dementia + diminished position/vibration sense + argyll–robertson pupils
dx?
confirm?

Back 510

neurosyph
CSP VDRL

Front 511

what NT changes are seen in Alzheimer's Dz?

Back 511

decreased NE and ACh

Front 512

treatement for Alzheimer's Dz

Back 512

cholinesterase inhibitors (tacrine, donezepil, rivastigmine)
tx sx as necessary (BZ for anxiety, low dowse anti–psychotics for agitation/psychosis, antidepressants)

Front 513

what is the main difference in presentation between Pick's dz and Alzheimer's dz

Back 513

personality changes are more prominent early in the pick's dz, but late in Alzheimer's

Front 514

what pathology is seen in pick's dz

Back 514

atrophy of fronto–temporal lobe
pick's bodies (intraneuronal bodies, not necessary for dx)

Front 515

pathological changes seen in HD?

Back 515

daudate atrophy
cortical atrophy (sometimes)

Front 516

which chromosome is involved in HD

Back 516

4q

Front 517

what cells are affected in Parkinson's dz

Back 517

loss of cells in substantia nigra of basal ganglia ––> decreased DA and loss of dopaminergic tracts

Front 518

how are MOAIs connected to PArkinsons dz tx?

Back 518

MAO–B inhibitors inhibit breakdown of DA
ex – selegiline

Front 519

surgical options for Parkinson's dz

Back 519

thalamotomy
pallidotomy

Front 520

what causes cortical dementia

Back 520

alzheimer's
pick's
CJD
(see decline in mental fxn)

Front 521

what causes subcortical dementia

Back 521

Huntington's
Parkinson's
NPH
multi–infarct dementia
(see more prominent affective and movement sx)

Front 522

hallmark sx of CJD?

Back 522

myoclonus
EPS
ataxia
LMNS

Front 523

hallmark sx of NPH

Back 523

ataxia
incontinence
dementia

Front 524

pathologica changes seen in NPH

Back 524

enlarged ventricles, increased CSF pressure

Front 525

eiology of NPH

Back 525

idiopathic
or secondary to obstruction of CSF reabsorption

Front 526

causes of delirium

Back 526

Impaired delivery of brain substrates
Metabolic
Drug
Endocrinopathy
Liver dz
Infrastructure
Renal failure
Infection
Oxygen
UTI
Sensory deprivation

Front 527

changes in sleep structure in elderly

Back 527

increased REM episodes (but duration is shorter) ––> decreased total REM sleep
non–REM is increased (increased stage I and II, with decrease in stages III and IV)
increased awakenings after sleep onset

Front 528

what changes in sleep are seen in depressed young pts

Back 528

increased REM
decreased REM latency
decreaed REM towards morning
less than 25% delta sleep
increased nighttime awakening

Front 529

what is nml % of REM in YA?
REM latency?
REM pattern?
percentage delta?
nighttime awakenings

Back 529

25%
90 min
increased REM towards AM
35%
1–3

Front 530

what EEG pattern is seen in stage 1 of sleep?

Back 530

theta

Front 531

what EEG pattern is seen in stage 2 of sleep?

Back 531

sleep spindle
K complex

Front 532

what EEG pattern is seen in stage 3 of sleep?

Back 532

delta waves

Front 533

what EEG pattern is seen in stage 4 of sleep?

Back 533

delta waves

Front 534

what EEG pattern is seen in REM?

Back 534

sawtooth
beta
alpha
theta

Front 535

what stage of slep do sleep terrors, sleep walking, and bedwetting occur?

Back 535

stages 3 and 4

Front 536

what stage of sleep do nightares occur?

Back 536

REM

Front 537

what stage of sleep do night terrors occur?

Back 537

stages 3/4

Front 538

when in sleep does bruxim occur

Back 538

stage 2

Front 539

what is Kleine–Levin syndrome

Back 539

recurrent periods of ecessive leepiness daily for 1+ months
sleepiness not relieved by daytime naps
often accompanied by hyperphagia

Front 540

what is localized amnesia?

Back 540

memory loss ocuring during a particular time period, especially after a traumatic event

Front 541

what is selective amnesia/

Back 541

can't remember certain aspects of an event

Front 542

what is cotard syndrome

Back 542

delusion that nothing exists
feeling that body is disintegrated or that they are dead

Front 543

what is fregoli syndrome?

Back 543

person takes the form of many other ppl/creatures

Front 544

what is pyshiologically occuring in a person w OCD

Back 544

increased metabolism in caudate nucleus, frontal lobe, and cigulum

Front 545

what is circumlocution?

Back 545

word substitution

Front 546

what structures shrink in schizophrenia

Back 546

hippocampus
parahyoppocampal gyrus
amygdala

Front 547

what is verbigeration

Back 547

repetitive meaningless talking

Front 548

what is glossolalia

Back 548

ability to speak new language suddenly

Front 549

si/sx of WErnicke's encephalopathy

Back 549

CN VI palsy (bilat)
horizontal nystagmus
ataxia
global confusion

Front 550

what is oculogyric crisis?

Back 550

acute dystonia reaction with spasm of extraocular muscles

Front 551

what is trismus?

Back 551

spasm of jaw muscles

Front 552

can hallucinations + delusions = delusional d/o

Back 552

NO

Front 553

sx of tertiary syphilis

Back 553

sensory ataxia
+ romberg
decreased vibration/proprioception in lwer extremities
decresed DTR
pupil abnormalities

Front 554

mens rea

Back 554

criminal intent

Front 555

actus rea

Back 555

criminal act

Front 556

schizophrenia, residual type

Back 556

absence of + sx

Front 557

testamentary capacity

Back 557

competence required to write a will
1. ability to understand the writing/signning of awill
2. knowlege of potential heirs
3. understanding extent of one's assets
4. Lack of undue influence
5. Absence of delusions compromising rational thought

Front 558

what ––> not guilty by reason of insanity

Back 558

can't appreciate wrongfulness of act
can't conform to conduct laws

Front 559

habeus corpus

Back 559

due process

Front 560

parens patriae

Back 560

state cares for people that can't care for themselves

Front 561

informed consent requires:

Back 561

1. mental competency
2. voluntary choice
3. risk–benefit analysis
4. alternative tx options

Front 562

what makes someone an emancipated minor

Back 562

married
have kids
in military
self–supporting

Front 563

when is parental consent not required for a minor:

Back 563

OB care
STD tx
substance abuse

Front 564

what type of therapy is useful in bulemia

Back 564

CBT

Front 565

rumination d/o

Back 565

repeated regurgitation and rechewing of food >1 month following nml fxnign
seen when there are multiple caregivers

Front 566

how to confirm rumination d/o

Back 566

esophageal pH

Front 567

what is the #1 cause of halluciation in children

Back 567

substance induced

Front 568

common side effects from fluoxetine

Back 568

H/A and nausea

Front 569

describe progression with Rette d/o

Back 569

nml prenatal and perinatal development, till about 5 months
then, decreased head growth, stereotyped hand movt and decreased social interaction
MR

Front 570

what is the first line tx for Tourette's

Back 570

Clonidine (also good for ADHD, so good when there is comorbidity)

Front 571

medical tx for enuresis

Back 571

imipramine

Front 572

what happens to brain of anorexic pt

Back 572

ventricles enlarge

Front 573

#1 side effect from clonidine

Back 573

sedation

Front 574

what illness is associated with psychiatric issues

Back 574

strep ––> OCD and Tourette's