Rotations Psychiatry Uworld

Front 1

Tardive Dyskinesia

1) What is TD?
a) What are the 4 extrapyramidal symptoms / SE?
b) What are SOME of the mvts of TD?

2) Et(s) of TD?
a) Give some examples of Rx --> TD?
b) MOA of Risperidone?
c) If a pt on an atypical or typical psychotic begins to develop TD, he/she should be taken off that psychotic and put on what? why?
d) Why is replacement of an atypical or typical anti-psychotic w/ clozapine a last resort?

3) OK, so we already said that typical and atypical antipsychotics can --> 4 EPS, BUT typical and atypical anti-psychotics can ALSO have what other SE?

4) Misc
a) What is Akasthisia?;
b) Et and time course of Akasthisia?
c) Tx for Akasthisia?

d) What is dystonia?
e) Et and time course of dystonia?
f) Tx of dystonia?

g) What is parkinsonism?
h) Et and time course of parkinsonism?
i) Tx of parkinsonism?

j) What is one drug that can cause tremors but NOT perioral mvts?

Back 1

1) Hyperkinetic mvt disorder that is considered one of the 4 types of Extrapyramidal sx / SE
a) TD;
Dystonia;
Akasthisia;
Pseudoparkinsonism
b) Oral and Facial mvts;
Limb mvts;
Neck and Trunk Mvts;
Repiratory / Grunting Mvts

2) Usually Typical Anti-psychotics, but sometimes Atypical Anti-psychotics as well
a) Risperidone (Typical or Atypical?)
b) D2 Receptor Antag;
Serotonin 5-HT2 receptor Antag
c) Clozapine;
BC it i the least likely atypical antipsychotic to cause EPS
d) BC Clozapine CAN cause agranulocytosis (TF get a CBC before starting it)

3) Neuroleptic Malignant Syndrome
(Look up what this is)

4)
a) A subjective feeling of restlessness that compels pts to not sit still
b) Antipsychotics; Any time after onset of tx
c) beta-blockers provide some relief

d) Muscle spasms / stiffness,
Tongue protrusion (like TD),
opisthotonus and aculogyric crisis
d) Antipsychotics; Onset b/t 4 hrs and 4 days after receiving antipsychotic medications
f) Antihistamines or Anticholinergics

g) Parkinson Syndrome-like effects
h) Antipsychotics; Onset b/t 4 days to 4 months after onset of antipsychotic med
i) Anticholinergic (ie: benztropine)

j) Lithium

Front 2

Narcissistic Personality Disorder

***Make a Chart / Copy Chart of Personality Disorders from Step up to Step 2!!!!!!!***

1) List some of the characteristics of narcissistic personality disorder?

Back 2

1)
Arrogant behavior;
Craving constant admiration;
Exagerrated sense of self-importance;
Lack of empathy;
Thoughts of unlimited power and success;
Willing to exploit others

Front 3

Some SE of Olanzapine and Clozapine

1) What type of drugs are Olanzapine and Clozapine?
a) Olanzapine and Clozapine are atypical antipsychotics that are used to treat what 3 cond'ns in particular
b) MOA of Clozapine?
c) MOA of olanzapine?

2) All atypical antipsychotics, but especially Clozapine and Olanzapine have an increased risk of what SE?
a) d/t these SE, the APA suggests what?

3) Misc
a) Baseline kidney fnctn should be assessed in pts taking what medication?
b) Weekly blood counts for 1st six mos of tx bc of risk agranulocytosis?
c) ECG should be obtained in pts taking this atypical anti-psychotic bc of potential QT prolongation?
d) Apart from the above SE of olanzapine, what is one other SE?
e) Many typical and atypical anti-psychotics (except olanzapine) can cause an increase in the levels of what hormone?
f) This medication can cause hypothyroidism and TF requires monitoring of thyroid fnctn?

Back 3

1) Atypical Anti-psychotics
a) Schizophrenia,
Bipolar Disorder,
Agitation
b) Antags D1 and D4 receptors;
Antags Serotonin 5-HT2 receptors;
Antags cholinergic muscarinic receptors
c) Antags Dopamine receptors;
Antags Serotonin 5-HT2 receptors

2) Wt gain,
Hyperglycemia,
Dyslipidemia,
HTN
a) Baseline assessment of:
wt,
fasting plasma glucose level,
fasting lipid profile
BP
-->
All rechecked after 12 wks

3)
a) Lithium
b) Clozapine
c) Ziprasidone
d) Inc liver transaminase levels
e) Prolactin --> Hyperprolactinemia
f) Lithium

Front 4

Kleptomania

1) What is Kleptomania?
a) Pts w/ Kleptomania occasionally develop significant _____ that is relieved by stealing?
b) Which sex is more likely to develop Kleptomania?
c) Kleptomania is associated w/ what other disorder?

Back 4

1) Inability to resist the impulse to steal objects of low monetary value or that are not needed for personal use
a) Tension
b) Females
c) Bulimia Nervosa

Front 5

Bereavement --> Depression

***Give the mnenonic --> Sx of major depression***

1) What is the criteria for the prescription of psychotherapy and anti-depressants in a pt w/ a recent history fo loss?

2) What is 1st line depression medication for pts who are NOT suicidal?

3) Misc
a) Which class of anti-depressants causes many SE (like orthostatic hypo-TN in the elderly) and TF are not recomended as first line for depression in the elderly?
b) Give 1 example of a benzo and what it treats?
c) Give 3 uses for ECT?

Back 5

***SIG E CAPS
Sleep disorder
Interest deficit (anhedonia)
Guilt
Energy deficit
Concentration deficit
Appetite disorder
Psychomotor retardation or agitation
Suicidality

1) 2 wks of sx of depression 6-8 wks after a major loss

2) SSRI such as Sertraline

3) Misc
a) Tricyclic medications like amitriptyline
b) Alprazolam, which is usually used to treat anxiety
c) Pts who do NOT respond to a prolonged course of anti-depressants,
Pts w/ severe suicidality,
Pts w/ severe psychosis

Front 6

Bereavement

1) What is bereavement?
a) Does Bereavement effect an individuals ability to function?
b) This is different than what?
c) Bereavement will usually taper significantly after what period of time?

2) Although bereavement may lead to depression, it is not the same.
Give the Definition of Major Depressive Disorder
a) How to make the dx of Major Depressive Disorder?

Back 6

1) Grief following the death of a loved one
a) NO!
b) Major Depressive Disorder
c) 2 months

2) Experience of significant depression,
that is not attributable to drug use, medical cond'ns or bereavement,
Has an impact on the pts ability to fnctn,
Lasts > 2 wks
a) @ least 5 of the SIG E CAPS s/s

Front 7

Child Abuse

1) What are 2 red flags that child abuse may be occuring from a parent / guardian?

2) Give the steps that should be performed when child abuse is suspected?

Back 7

1) When an injury cannot be explaiend or is inconsistent w/ the provided history

2)
1. Complete PE
2. Radiographic skeletal exam (if necessary)
3. Coag profile (if multiple bruises are present)
4. Report incident to CPS
5. Admit child to hospital (if necesarry)
6. Consult a psychiatrist and evaluation of family dynamics

Front 8

Cannabis (Marijuana, THC) Intoxication

****LOOK UP S/S OF DIFFERENT DRUGS OF ABUSE***

1) How does marijuana abuse present?

2) Misc
a) What is the triad of opioid OD?
b) What are some other features of opioid OD apart from the above triad?

c) What are some signs of ETOH intoxication?

d) What are the s/s of cocaine withdrawal?

e) What does opioid withdrawal look like in a pt?

Back 8

1) Behavioral Changes
(social withdrawal, euphoria, anxiety)
+
2 or more of the following:
a. Conjunctival injection
b. dry mouth
c. tachycardia
d. increased appetite ("munchies")

2)
a) Respiratory depression,
Pinpoint pupils,
CNS depression --> Coma
b) Hypo-TN, Hypothermia, Tachycardia

c) Poor coordination,
Unsteady gait,
Slurred speech,
Nystagmus

d) Dyshoric mood and increased appetite
WITHOUT
dry mouth and conjunctival injection

e) n/v;
diarrhea;
muscle spasms;
joint pain;
ABD cramps;
Rhinorrhea;
Lacrimation;
Sweating;
Pupilary dilation;
Autonomic Instability (HTN)

Front 9

Psychiatric Illness and Informed Consent for Medical Procedures

1) Can pts w/ psychiatric illnesses give informed consent for a medical procedure they need / want to have done on themselves?

Back 9

1) YES! As long as their judgment and decision-making abilities are intact

Front 10

Anorexia Nervosa

1) What is the definition of Anorexia Nervosa?

2) What are the DSM-IV criteria for the diagnosis of anorexia?

3) What are the 2 subtypes of anorexia nervosa?

4) List some other findings consisent w/ anorexia nervosa?

5) Misc
a) What is the difference b/t anorexia nervosa and bulimia nervosa?

Back 10

1) Eating disorder in which ts REFUSE TO MAINTAIN NORMAL BODY WEIGHT
via fasting, excessive exercise, purging (tricky, bc similar to bulimia)

2)
1. Body wt @ least 15% below normal + Refusal to maintain body wt @ normal levels
2. Amenorrhea for 3 months
3. Distorted body image in which he/she views themself as obese when he/she is in fact thin
4. Fear of gaining wt or becoming fat

3) Restricting Subtype:
Fasting &/or exercise

Binge & Purge Subtype:
Binge eating -->
Laxative use or induced vomiting

4)
Enlarged Parotids (binge and purse subtype);
Dental Erosion (B&P ST);
Scars or Calluses on hand from contact w/ teeth (B&P ST);
Electrolyte abnorms (B&P ST)

5)
a) Anorexia ALWAYS -->
Amenorrhea + Body wt below nl

Bulimia ALWAYS -->
Normal Menses + Normal Body Wt

Lanugo on back or ABD;
Bradycardia;
HYPO-TN;
HYPO-thermia;
Dry skin;

Front 11

Narcolepsy

1) What are the characteristics of narcolepsy?

2) What is the tx for narcolepsy?

3) What is the MOA of modafinil?

4) What is the MOA of methylphenidate?

Back 11

1) Episodes of irresistible, refreshing sleep during the daytime
+
1 or more of the following:
a. Cataplexy (diffuse muscle weakness --> collapse)
b. Hypnogogic and Hypnopompic Hallucinations (Hallucinations while falling asleep or waking)
c. Sleep paralysis

2) Scheduled daytime naps;
Psychostimulants (Modafanil or Methylphenidate);
Combination of Psychostimulants and anti-depressants

3) Unknown

4) Stims CNS activity;
Sympathomimetic by:
a. Blocking reuptake of NE and Dopamine in the synaptic cleft
b. Increasing release of NE and Dopamine

Front 12

Major Depression --> Suicidal Ideation

1) Review SIG E CAPS criteria for Major Depression
(Remember you need @ least 5 of the sx lasting > 2 wks

2) If the pt expresses suicidal ideations as one of his SIG E CAPS sx of major depression, then what is the next step?

Back 12

1) Review SIG E CAPS criteria for Major Depression
(Remember you need @ least 5 of the sx lasting > 2 wks

2) Admit to psychiatric unit (agaisnt his will if necesarry)

Front 13

Child Abuse

1) List some circumstances that should --> a high index of suspicion for child abuse?

2) Which gender should you be especially conscious of abuse in?

3) Misc
a) What is adjustment disorder?
b) What are some of the characteristics of panic disorder?

Back 13

1) Child presents w/ behavioral changes,
Family has an unstable economic background,
Hx of drug/ETOH abuse in parents

2) Females

3)
a) A behavioral response TO
and that is out of proportion TO
an identifiable stressor
b) Multiple Physical Complaints:
Dizziness,
CP,
SOB,
Palpitations,
Sweating,
Fear of dying
+
Sense of impending doom

Front 14

OCD

1) What is OCD?

2) What is the underlying pathophysiology of OCD?
a) TF what is the treatment of choice for OCD?
b) Example of an SSRI?

Back 14

1) Persistent, intrusive thoughts -->
Performance of compulsive acts
to allay inherent anxieties,
but that lead to a fnctnl impairment

2) Altered levels of serotonin
a) SSRI
b) Paroxetine

Front 15

Tourette's Syndrome

1) Tourette's Syndrome is characterized by what?
a) What exacerbates the tics?
b) What causes tics to subside?

2) Pts w/ Tourette's Syndrome are @ an increased risk of developing what 2 things?

Back 15

1) Multiple motor tics
+
@ least one vocal tics,
both of which present before the age of 18,
for @ least 1 year
a) Stress
b) Sleep

2) ADHD,
OCD

Front 16

Somatization Disorder

1) What is somatization disorder?

2) How to dx somatization disorder?
a) What is the tx for somatization disorder?

Back 16

1) Multiple, recurrent physical sx that are unintentional and cannot be explained by any medical cond'n

2) Pt c/o of pain in 4 unrelated body
regions
a) Psychotherapy

Front 17

Anorexia Nerosa

1) When should someone w/ anorexia nervosa be hospitalized?

Back 17

1) When there is evidence of medical complications
AND/OR
they weigh less than 75% of the avg body wt for their age, sex, ht

Front 18

Rights of Parents

1) If a parent is adamant about not vaccinating his/her kids, what should you do?

Back 18

1) Document in the chart that the risks and benefits of vaccination have been explained,
bc if no significant harm is likely to reslt from witholding therapy, the parents wishes should be honored

Front 19

Psychotic Disorders NOT classified as Schizophrenia -
Schizoaffective Disorder

1) What is Schizoaffective Disorder?
a) In order to make the dx, there should be what?

2) Misc
a) What is dysthymia?
b) What is cyclothymia?

Back 19

1) The presenceof sx of schizophrenia
+
Mood sx (major depression, bipolar, mixed episode)
a) @ least 2 wks when pyschotic sx are present WITHOUT any mood sx

2)
a) Presence of depressed mood occuring most days for @ least 2 yrs;
Sx not as severe as major depression;
Minimal fnctnl impairment
b) Presence of alternating episodes of hypomanic sx and depressive sx,
over a period of 2 yrs,
that do NOT meet the criteria for major depression

Front 20

Confidentiality

1) You MUST obtained written consent from the pt to discuss a pt's health information. There is only 1 exception in which a doc may breach confidentiality What is it?

Back 20

1) When the pts diagnosis could prove a risk to others and he/she refuses to divulge this information to those ppl in jeopardy

Front 21

Consent

1) Can an unemancipated minor consent to their own medical treatment?
a) What are 3 circumstances in which a person would be considered an emancipated minor?

Back 21

1) No
a) Married;
In Military;
Lives Separately from parents AND manages own finances

Front 22

Drug SE

1) Which medication, often prescribed for panic disorder, can cause generalized tonic-clonic seizures when it is stopped?

2) NAme 3 anti-depressants that can be used for treatment of panic disorder?
a) MOAs?

Back 22

1) Alprazolam (Xanax)

2) Clomipramine,
Paroxetine,
Venlafaxine
a) Clomipramine: Inhibs reuptake of NE and Serotonin
Paroxetine: Inhibits reuptake of serotonin
Venlafaxine: Inhibits NE, Serotonin AND Dopamine Reuptake

Front 23

Avoidant Personality Disorder

***REVIEW STEP UP CHART FOR PERSONALITY DISORDERS***

1) Avoidant Personality Disorder
a) What are the characteristics of APD?
b) What is the underlying cause of APD?

Back 23

1)
a) Shyness,
Feelings of inferiority,
Desire to make friends that is overridden by an intense fear of embarassment or rejection
b) Pts consider themselves inferior to other and fear being embarassed

Front 24

Dissociative Disorders

1) What are the dissociative disorders?

2) What is dissociative fugue?

3) What is dissociative identiy disorder (Formerly known as multiple personality disorder)

4) What is dissociative amnesia?

5) What is depersonalization disorder?

6) What is derealization?

Back 24

1) A group of disorders characterized by forgetfulness and dissociation

2) SUDDEN OR UNEXPECTED TRAVEL -->
inability to remember your past
AND
Confusion about your identity

3) Presence of 2 or more distinct identities that alternatively assume CTL of the pt's behavior

4) Inability to recall important personal information,
usually following a traumatifc or stressful event

5) Recurrent feelings of detachment from one's own physical and mental processes -->
feelings that pt is observing his/her body and thoughts from a distance

6) State of experiencing familiar persons and surroundings as if they were strange or unreal

Front 25

ETOH Withdrawal

1) List the:
Stage of ETOH Withdrawal;
S/S of ETOH Withdrawal;
Onset of s/s of ETOH Withdrawal

2) What is the tx of choice for any form of ETOH withdrawal?

3) Misc
a) What drug is used for ETOH withdrawal sx in a benzo-refractory pt?
b) What drug is used for benzo toxicity?
c) What is one anti-seizure medication that has been shown to be ineffective in treating alcohol withdrawal seizures?

Back 25

1) Mild Withdrawal;
Anxiety, Palpitations, sweating, tremors;
6 hrs after last drink

Withdrawal seizure;
Single or multiple seizures in a short period of time;
12-48 hrs after last drink

ETOH-ic hallucinosis;
Auditory, visual and tactile hallucinations WITH NORMAL VITAL SIGNS and INTACT SENSORIUM;
12-24 hrs since last drink

Delirium Tremens;
Hallucinations
w/ FEVER, HTN, TACHYCARDIA, DIAPHORESIS and DISORIENTATION;
48-96 hrs since last drink

2) Long-acting benzodiazepine such as Diazepam, Lorazepam, Chlordiazepoxide

3)
a) Phenobarbital
b) Flumazenil
c) Phenytoin

Front 26

MAOIs

1) Give one example of an MAOI?
a) What is the clinical use of MAOIs?
b) What is a MAJOR CI for pts taking MAOIs?
c) If a pt taking an MAOI does ingest something that is high in tyramine, what must you be very concerned for?

Back 26

1) Phenelzine
a) Depression that is REFRACTORY to other meds
b) Pt CANNOT consume foods that are high in tyramine such as aged meat and cheeses
c) HTNsive crisis!

Front 27

Hypochondriasis

1) Hypochondriasis is characterized by what?
a) When are sx of hypochondriasis more prevelant?

2) How should you manage these pts?

Back 27

1) Misinterpretation of bodily sx as a fatal illness DESPITE negative medical w/u
a) During periods of stress

2) Inquire about emotional stressors -->
brief psychotherapy

Front 28

Personality Disorders: Schizotypal
***LOOK UP STEP 2 PERSONALITY DISORDERS***

1) Describe schizotypal personality disorder?

2) Misc
a) Describe Schizoid personality disorder?
b) Describe Avoidant personality disorder

Back 28

1) Lack of close friends
+
Odd and eccetric behavior,
"Magical Thinking"

2)
a) Lack of close friends
+
restricted range of emotional expression
b) Lack of close friends for fear of ridicule and rejection

Front 29

Schizophreniform Disorder

1) How do you differentiate Schizophrenia from Schizophreniform disorder?

2) Misc
a) What is schizoaffective disorder?
b) What is a shared psychotic disorder?

Back 29

1) Duration of Sx:
Schizophrenia-
Sx present for @ least 6 months

Schizophreniform:
Sx present for more than 1 month but less than 6 months

2)
a) When pt has both a mood disorder AND schizophrenia
b) When an individual who is in a close relationship with another person, develops a similar delusion as the person they are in a relationship with

Front 30

Schizoid Personality Disorder

1) Describe Schizoid Personality Disorder

Back 30

1) Do NOT enjoy close relationships (Diff from avoidant)
--> Lack of close relationships;
Dec range of emotional expression