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100 Cards in this Set

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CAGE questionaire for suspected EtOH abuse.
felt a need to Cut down?
ever been Annoyed at someone for criticizing your drinking?
feel Guilty about your drinking?
ever have an Eye-opener drink to get you going in the morning?
EtOH withdrawal: these sx start 6-12 hours after last drink
Minor withdrawal symptoms: tremulousness is most tested; others: insomnia, mildanxiety, gastrointestinal upset, headache, diaphoresis, palpitations, anorexia
EtOH withdrawal: these sx start 12-24 hours after last drink (generally resolve within 48 hours).
Alcoholic hallucinosis: visual, auditory, or tactile hallucinations
EtOH withdrawal: these sx usually start 24-48 hours after last drink (can start earlier)
Withdrawal seizures: generalized tonic-clonic seizures
EtOH withdrawal: these sx start 48-72 hours after last drink (peak at day 5)
Alcohol withdrawal delirium (delirium tremens): hallucinations accompanied by disorientation; other sx: tachycardia, hypertension, low-grade fever, agitation, diaphoresis
EtOH intoxication (remember 4 sx: SAND mnemonic)
slurred speech
ataxia
nystagmus
disinhibition
EtOH intoxication in ER: 3 labs to aid treatment.
Blood Glucose, Thiamine, Folate
EtOH withdrawal treatment.
Benzo taper: can use Chlordiazepoxide (Librium), but generally use Lorazepam (Ativan) 2/2 liver disease risk
Most feared complication in cocaine intoxication/overdose.
sudden cardiac death due to arrhythmias and vasospasm
Cocaine withdrawal "crash:" what is the biggest concern?
depression and suicidality
Amphetamine, Meth, or Ecstasy intoxication: remember 4 things.
agitation, tachycardia, delusions, pupil dilation
Methamphetamine intoxication pearl in Step 2 questions.
psychosis
PCP intoxication (3 things to remember)
remember it's always a WEIRD presentation: combative, psychosis, STRANGE BEHAVIOR
Most important Barbiturate and Benzo overdose sx.
respiratory depression
Opiate intoxication vs withdrawal: pupil size.
INtoxicated=pIN-point
withDrawal=Dilated
Opiate withdrawal sx.
cold turkey with diarrhea: sweating, dilated pupils, piloerection, rhinorrhea, N/V, cramps, diarrhea
Other drug besides Benzos that can cause respiratory depression in overdose.
Opiates (common post-op)
Marijuana/Spice addiction/intoxication symptoms.
social withdrawal, increased appetite (munchies), dry mouth, CONJUNCTIVAL INJECTION
Caffeine withdrawal sx pearl in Step 2 questions.
headache
Nicotine withdrawal craving (addiction) treatment.
Nicotine patch or gum, Zyban (Wellbutrin), Clonidine, Chantix, counseling, hypnosis
What are "cocaine bugs"?
intoxication hallucinations are usually tactile and feel like bugs crawling on skin
Very important treatment in EtOH detox (besides benzos via CIWA)?
Thiamine, Folate, and nutrition
Schizophrenia DSMIV criteria (DOWNSHIfT mnemonic).
Delusion
Odd Behavior
W/out mood sx
Negative sx
Speech disorganized
Hallucinations
If = Impaired Function
Time > 6 months
Schizophrenia negative sx (5 A's)
Affect flat
Anhedonia
Apathy
Alogia
Attention
Major Depressive Episode DSMIV criteria (2 weeks or more of these sx: D-SIGECAPS mnemonic).
Sleep changes
Interest decreased (anhedonia) or Depressed
Guilt
Energy down
Concentration down
Appetite changes
Psychomotor retardation
Suicidality
Manic Episode DSMIV criteria (DIG-FAST mnemonic sx)
Distracted
Insomnia
Grandiose
Flight of Ideas
Activity/Agitation
Speech pressured
Thoughtless (impulsive)
Panic Attack DSMIV criteria (PANICS mnemonic)
Palpitations
Abdominal distress
No-control/No known cause
Impending doom/fear of death
Chest pain
Sweating, shaking, SOB
OCD mnemonic
Obsessions and Compulsions AND DISTRESSED ABOUT THEM (OCPD is egosyntonic, OCD is egodystonic)
PTSD criteria from DSMIV (TRAUMA mnemonic)
Traumatic experience in past
Re-experiencing it (flashbacks etc.)
Avoiding triggers like social anxiety
Unable to function
More than 1 month
Arousal (easily startled)
General Anxiety Disorder (GAD) sx from DSMIV criteria (CANTREST mnemonic)
Concentration decreased
Agitated
No control
Time more than 6 months
Restless
Energy down
Sleep changes
Tense muscles
Borderline sx from DSMIV criteria (AM-SUICIDE mnemonic)
Abondonment (fear of)
Mood instability
Suicidal or Self-mutilating behavior
Unstable relationships
Impulive
Control of anger lacking
Identity disturbed
Dissociative thinking (splitting)
Emptiness (chronic feeling of)
Cluster A personality disorders (weird)
paranoid
schizoid
schizotypal
Cluster B personality disorders (wild)
Borderline
Histrionic
Narcissistic
Antisocial
Cluster C personality disorders (wimpy)
Obsessive/Compulsive (OCPD)
Avoidant
Dependant
Schizoid vs. Schizotypal Personality Disorder
Schizoid: loner
Schizotypal: magical thinking/odd
What disorder leads to Antisocial Personality Disorder?
Conduct disorder in children (remember torchering animals is pathognomonic)
Dementia vs. Delirium acute or gradual?
Dementia: gradual
Delirium: acute
Assessment of dementia: Activity of Daily Living (ADL) mnemonic ABCDEF
Ambulates
Bathes
Continent (toilets)
Dresses/undresses
Eats
Functional transfers (OOB etc.)
Assessment of dementia: Independent Activities of Daily Living (IADLs) mnemonic SCUM
Shopping
Cook and Clean
Use telephone and transportation
Manage Money and Medication
DEMENTIAS mnemonic for causes of Dementia.
Degenerative diseases (PD, Huntington's)
Endocrine (thyroid, adrenal, etc.)
Metabolic (alcohol, electrolytes, B12, hepatic, renal, etc.)
Exogenous (heavy metals, CO, drugs)
Neoplasm
Trauma (subdural)
Infection (meningitis, encephalitis, HIV, prion, etc.)
Affective (psuedodementia of depression)
Stroke/Structure (ischemia, NPH, etc.)
2 most common causes of dementia.
Alzhiemer's (50%)
Multi-Infarct Dementia (25%)
Abuse vs Dependence.
Abuse messes up your life
Dependence messes up your body
Most common reason to discontinue SSRI's
sexual dysfunction
Avoid Bupropion (Wellbutrin) in these individuals.
Bulimics, Anorexics, Epilepsy
Buspar is good anxiety med especially in this cohort.
Alcoholic
Use for performance anxiety
Beta blocker
Why is Xanax not the best med for anxiety?
short half-life (withdrawal anxiety every day)
Antidote to Benzo intoxication/overdose.
Flumazenil
Agorophobia vs Social Phobia
Agorophobia: fear of being trapped in a crowd
Social Phobia: fear of being embarassed in a crowd
Mental Status Exam (MSE) ASEPTIC mnemonic
Appearance
Speech
Emotion (mood and affect)
Perceptions (hallucinations?)
Thought process and content
Insight/Judgment
Cognition (MMSE)
IWATCHDEATH mnemonic for causes of delirium
Infection
Withdrawal
Acute metabolic or subtance Abuse
Trauma
CNS pathology
Hypoxia
Deficiencies
Endocrine
Acute vascular/MI
Toxins/drugs
Heavy metals
Lithium side effects (4 to remember)
Diabetes Insipidus, Teratogen (Ebstein's anomaly), Renal Failure, Cardiac Conduction defects
Neuroleptic Malignant syndrome.
MUSCLE RIGIDITY, HIGH FEVER, autonomic instability, AMS
Treatment for Neuroleptic Malignant syndrome
stop med and give dantrolene or bromocriptine (anticholinergics)
TCA overdose.
can be lethal 2/2 arrhythmias (don't give if h/o suicide attempts by overdose)
Use this TCA for enuresis (bed-wetting).
Imipramine
What MOAI side-effect necessitates avoidance of tyramine in diet (e.g. cheese)?
Hypertensive crisis
After discontinuing MAOI, how long to wait before starting a new anti-depressant?
2 weeks (wait for MAO enzyme to regenerate)
Thing to remember about discontinuing Paroxetine (Paxil).
brisk discontinuation symptoms (taper to d/c)
1st major depressive episode: treat how long?
6 months
SSRI doesn't seem to be working after 4 weeks. How long to try before switching to a new med?
6 weeks (2 more weeks)
Anti-depressant with least sexual side effects?
Bupropion (Wellbutrin)
Serotonin Syndrome
Siezures, clonus, diarrhea, cramps, fever, autonomic instability, AMS
What syndrome: Siezures, diarrhea, cramps, fever, autonomic instability, AMS
serotonin syndrome (2/2 SSRIs etc)
What syndrome: MUSCLE RIGIDITY, HIGH FEVER, autonomic instability, AMS
neuroleptic malignant syndrome (2/2 antipsychotics)
Duloxetine (Cymbalta), besides psych indications, is also used for . . .
chronic/neuropathic pain
Valproic Acid and Carbemazepine in pregnant woman. What teratogenic defect?
neural tube defects
Treatment for antipsychotics induced dystonia (2)
dephenhydramine (Benadryl) and Benztropine (anticholinergics)
Treatment for parkinsonism induced by antipsychotics.
Benztropine (anticholinergic)
Antipsychotic meds good for non-compliant patients (3).
Haloperidol decanoate qMonth
Fluphenazine decanoate q2wks
Risperidone CONSTA q2ks
Clozapine (Clozaril) is the most efficacious antipsychotic, but is seldom used because. . .
risk of agranulocytosis (monitor weekly CBC if using)
Risperidone effect on the endocrine axis.
elevates prolactin
Olanzapine (Zyprexa) is this side effect most of all the antipsychotics.
weight gain
Quetiapine (Seroquel) has the least of which side-effects amoung antipsychotics?
least ExtraPyramidal Sympoms (EPS)
Treatment for akathisia induced by antipsychotics.
Propranolol
Management of Tardive Diskinesia induced by antipsychotics
discontinue med
Which 2 antipsychotics don't have weight gain as a side-effect?
Ziprasidone (Geodon) and Aripiprazole (Abilify)
1st line class for mood and anxiety disorders.
SSRIs (guess SSRI if you are guessing in a psych question)
Which antipsychotic in a pregnant woman?
Haldol
Benzo teratogenicity 1st trimester vs 3rd trimester.
1st trim: cleft palate
3rd trim: floppy baby
ANOREXIA mnemonic
*Amenorrhea
No other cause of weight loss
Obviously thin, but feels fat
*Refusal to maintain nl body wt (BMI under 19)
Epigastric discomfor
X-symptoms (peculiar symptoms)
*Intense fear of gaining wt
Always thinking about food
Anorexia vs Bulimia: egosyntonic or egodystonic?
Anorexia: egosyntonic
Bulimia: egodystonic
BULIMIA mnemonic
*Binge eating
Under strict diet
*Lacks control over eating
Induces *vomiting
*Minimum of 2 episodes/wk for 3 mo
Increased concern of body size
Abuse of diuretics/*laxatives
Bupropion (Wellbutrin) is a good anti-depression med in this cohort.
Smokers
The most concerning side-effect of Lamotragine (Lamictal).
Stevens Johnson Syndrome (rash)
Teacher complains kid has poor concentration. 1st question to mom before diagnosing ADHD.
symptoms at home too? (dx requires 2 settings)
Memorize these 4 signs of autism (age 2 mo, 12 mo, 16 mo, and 24 mo).
no eye contact by 2 mo
no babbling by 12 mo
no single words by 16 mo
no 2-word phrases by 24 mo
Treatment for Tourette's.
Dopamine receptor antagonists (Haloperidol, pimozide) or Clonidine
Lanugo. Diagnosis?
Anorexia (lanugo is fine hair all over)
Scar on dorsal hand surface (DIP). Diagnosis?
Bulimia
Osteoporosis/Stress Fractures in female college athlete. Diagnosis?
Anorexia
Good sleep hygiene advice (SLEEP mnemonic).
Schedule sleep time
Limit caffeine
Exercise early in the day
Eating prohibited just before bedtime
Prevent daytime naPs
Morning headaches. Suspected diagnosis?
OSA
Narcolepsy meds.
Modafinil, Methylphenidate
Likes the sick role. Diagnosis?
Factitious
Malingering vs. Factitious: how to differentiate.
Malingering patients have a secondary gain MORE than the sick-role empathy.
Somatization Disorder vs. Conversion disorder: extent of symptoms.
Somatization: multiple organ systems
Conversion: "neuro" sx
SADPERSONS mnemonic for suicide risk.
Sex (male)
Age (elderly)
Depression
Previous attempt
EtOH or Drug abuse
Rational thought (can plan)
Sickness (e.g. chronic pain)
Organized plan
No spouse
Social support lacking
Most common complication of a Somatoform disorder.
Iatrogenic complications from repeated invasive work-up.
How long before bereavement can be called depression?
1 year