Random Psych Stuff

Front 1

Abnormal tests w/ schizophrenia

Back 1

1 - PET scan of DA-R (decreased)
2 - EEG w/decreased alpha-adrenergic activity
3 - Patient can't follow moving visual target
4 - CT = lateral and third ventral enlargement

Front 2

Ideal qualities for patient undergoing insight-oriented psychotherapy

Back 2

-can tolerate high frustration levels
-good capacity for insight
-good impulse control --> can talk about feelings w/o acting them out
-moderate to high intelligence
-no cognitive dysfunctions

Front 3

Periodic Limb Movement D/o

Back 3

-frequent stereotyped movements (mostly legs)
-accompanied by brief (unaware) arousal and disruption of sleep patterns
--> causes daytime tiredness
-check w/bed partner

Front 4

MCC (1 and 2) of psychiatry malpractice claims

Back 4

1 - Improper Tx (33%)
2 - Suicide (20%) --> attempt or complete

Front 5

Tumor causing HA + papilledema + homonymous hemianopsia + visual problems + seizures + visual hallucinations of light/movement

Back 5

occipital lobe tumors

Front 6

Best SSRI for not impairing erections

Back 6

fluoxetine (may retard ejaculation/orgasm/sex drive)

Front 7

Blood test for recent grand mal seizures

Back 7

Spike in prolactin concentration 20 minutes post-ictal
-less reliable w/partial complex
-not at all reliable w/simple partial and status epilepticus

Front 8

Tx for Tourette's

Back 8

Neuroleptics + Alpha-2 Anatagonists
(haloperidol) (clonidine, guanfacine)

Front 9

Clozapine and leukopenia (SE)
-levels and Tx

Back 9

Mild --> 3000-3500 --> monitor, check CBC 2x/week
Moderate --> 2000-3000 --> stop clozapine (can restart when better)
Uncomplicated agranulocytosis --> protective isolation, bone marrow specimen, d/c clozapine forever

Front 10

Schizophrenic patient on traditional antipsychotics --> next steps

Back 10

Switch to lower dose w/ 5HT-DA antagonists (2nd gen/atypical APs, lke olanzapine)

Front 11

Don't use carbamazepine as an anticonvulsant w/ ___(other med) b/c ____

Back 11

clozapine --> increased risk of agranulocytosis

Front 12

clozapine (500 mg/day) used in pt with well-controlled schizophrenia --> experiences 2 grand-mal seizures --> Tx?

Back 12

1 - d/c clozapine
2 - add phenobarbital
3 - restart clozapine at 1/2 dose

Front 13

Psychotic Sx in PD patient

Back 13

clozapine
-spares nigrostriatal DA system
-anticholinergic
-may HELP PD!

Front 14

Tx of acute/severe panic d/o w/no Hx of substance abuse

Back 14

1 - start SSRIs (like paroxetine) w/BZD (like alprazolam)
2 - Taper off BZD over several weeks
3 - SSRI alone continued

Front 15

DOC for Panic D/o

Back 15

SSRIs

Front 16

DOC for OCD

Back 16

SSRIs (at higher doses)

Front 17

DOC for hyperarousal

Back 17

Beta blockers

Front 18

DOC for GAD

Back 18

SSRIs or buspirone (nonBZD anxiolytic)

Front 19

Reaction Formation

Back 19

Have unacceptable urge/thought/feeling --> replace w/opposite

Front 20

Cocaine rewards user via ___ system

Back 20

DA

Front 21

TD interventions

Back 21

1 - D/c med
--> if can't:
2 - Lower dose
--> if doesn't work
3 - Add clozapine

Front 22

Seizures of unpleasant smell

Back 22

Temporal lobe (uncus)
-partial complex

Front 23

Time remaining in urine for:
THC
PCP
Alprazolam (BZDs)

Back 23

3-4 wks
8 days
3 days

Front 24

Ramelteon

Back 24

Mimics melatonin
-decreases time to sleep onset (and increases time asleep)
-MC SE = HA
-CI w/severe hepatic impairment, " COPD, " sleep apnea
-no rebound insomnia or w/d Sx
-good for pts w/substance abuse Hx

Front 25

Dx:
carbamazepine for 3 wks, then high fever, chills, bleeding gums, fatigue, pallor

Back 25

acute aplastic anemia

Front 26

SE of Ritalin (Methylphenidate)

Back 26

-insomnia --> don't take after noon
-lower appetite, HA, GI upset, tics (rare)

Front 27

Cognitive Impairment
+
Motor deficits
+
Behavioral Changes of Subcortical Dementia (moods changes, psychomotor slowing, forgetfulness, impaired attention and concentration)

Back 27

HIV dementia

Front 28

Psych Sx in 90% of terminal patients

Back 28

Delusions

Front 29

Drug to decrease sleep attacks + lessen cataplexy in narcolepsy

Back 29

Modafinil
-stimulant, but w/o AE of some similar meds
-increases monoamines and histamine
-monitor, b/c can develop tolerance

Front 30

Opiate Intoxication Tx

Back 30

1 - Insure adequate ventilation
-monitor tracheopharyngeal secretions
-mechanical ventilation
2 - IV naproxene
-usually 4-5 ,g total sufficient
-buprenorphine may require higher doses

Front 31

Tx APAP or ASA OD

Back 31

Forced diuresis

Front 32

ECT anesthetic

Back 32

Methohexital IV
-lower cardiac risk
-rapind unconsciousness and duration of only 5-7 min

Front 33

At what age to kids learn about reversibility?

Back 33

7-11 y/o

Front 34

At what age to kids learn about humor?

Back 34

5-6 y/o

Front 35

Fluoxetine affects (neurotransmitter)

Back 35

Seratonin

Front 36

Visual hallucination of transparent phantom of patient's own body

Back 36

Autoscopic psychosis

Front 37

Patient takes a med --> sustained spasms of neck/trunk/tongue/face/EO m. --> Med? Dx? Tx?

Back 37

Med = Typical high-potency antipsychotic (like haliperidol)
Dx = acute dystonic reaction (caused DA-R blockade in nigrostiatum)
Tx = anticholinergics

Front 38

Neurotransmitter that stimulates appetite

Back 38

Neuropeptide Y

Front 39

Broca's Aphasia

Back 39

Comprehension

No Fluent speech, No Spontaneous speech, No Repetition, No Naming

Front 40

Wernicke's Aphasia

Back 40

Fluent, Spontaneous speech,

No Comprehension, No Repetition, No Naming

Front 41

Conduction Aphasia

Back 41

Fluent, Spontaneous speech, Comprehension,

No Repetition, No Naming

Front 42

Global Aphasia

Back 42

No Fluent, No Spontaneous speech, No Comprehension, No Repetition, No Naming

Front 43

Anomic Aphasia

Back 43

Fluent, Spontaneous speech, Comprehension, Repetition

No Naming

Front 44

Factors predicting good outcome w/schizophrenia

Back 44

-F
-20-25 onset
-middle to high SEC
-stable occupation
-FHx affective d/o (not schizo)
-good social support
-precipitating factor
-rapid onset

Front 45

Age at which kids learn about irreversibility

Back 45

2-4 y/o

Front 46

Lesion causes uncontrolled laughter, euphoria, jokes, puns --> where?

Back 46

R prefrontal
(R = robot, pre = car --> Data in Generations)

Front 47

Lesion causes dysphoria, lack of laughter --> where?

Back 47

L prefrontal
(L = laughter, w/o it you lose it!)

Front 48

Lesion causes decrease in planning/monitoring/motivation/flexibility, trivia fixation, echoing --> where?

Back 48

dorsolateral

Front 49

25 y/o F c personality changes in last 6 months
-bizarre behavior
-hyposexuality
-emotional intensity
-perseverative interactions (viscosity)

Back 49

TLE (temporal lobe epilepsy)

Front 50

Perseverative interactions

Back 50

Viscosity

Front 51

20 month old M runs around, periodically returning to mom for check and quick hug

Back 51

Rapprochement
-mobility and exploring but frequent "refueling" w/caregiver
- normal

Front 52

A "blankie" is an example of a

Back 52

Transitional object

Front 53

Projective identification

Back 53

1 - Patient projects own traits onto another
2 - Convinces other that they have those traits/identify with projection
3 - Both have oneness or union

MCC = Borderline personality d/o

Front 54

Sleep deprivation has a ___ effect on depressed patients and can trigger ____ in BP patients

Tx?

Back 54

Antidepressant
A manic episode
Long-acting BZD (ex: clonazepam 1 mg qhs)

Front 55

After antidepressant isn't working, raise dose to ___ and keep there for ___ before declare unsuccessful

Back 55

maximum
4-5 weeks

Front 56

MC post-ECT SE

Back 56

headache

Front 57

post-ECT SE

Back 57

#1 = HA
Others = nausea, muscle soreness
Rare = memory impairment (retro and antero), interictal confusion, CV changes

Front 58

Monitor these w/Lithium

Back 58

-Plasma Lithium level
-Thyroid function tests
-Creatinine
-Urinalysis
-ECGs (if >50 y/o)

Front 59

Not characteristic of Normal Bereavement

Back 59

1 - guilt about anything other than events surrounding death
2 - thoughts of death other than that patient would be better off dead w/o loved one
3 - morbid preoccupation w/worthlessness
4 - marked psychomotor preoccupation
5 - marked/prolonged functional impairment
6 - hallucinations other than of loved one

Front 60

___ very effective when added to antidepressants in Tx of refractory depression

Back 60

Lithium (others = thyroid hormones, stimulants, estrogens, light therapy)

Front 61

ECT CI

Back 61

-recent MI
-increased ICP (tumor, mass)
-aneurysms
-bleeding d/o
-condition disrupting BBB

Front 62

3 y/o M assumes that you see what he does, even on opposite sides of a sculpture

Back 62

ego-centrism (normal)
-2-7 y/o
-stage of cognitive development

Front 63

Age of ego-centrism in kids' cognitive development

Back 63

2-7 y/o

Front 64

22 y/o F
-SOB in anxiety-provoking situations
-perioral tingling, carpopedal Sx
-derealization
-all Sx fade w/situation
-never out of blue
Dx? Tx?

Back 64

Dx = hyperventilation
-causes hypokalemia and respiratory alkalosis --> decreased cerebral blood flow and Ca++

Tx = breathe into paper bag

Front 65

Chronic, treated schizophrenia
+
noncommunicative in bed
+
confused and disoriented w/severe muscle rigidity and fever (103 F), high BP, leukocytosis

Dx? Tx?

Back 65

Dx: NMS

Tx: dantrolene followed by bromocriptine (sometimes amantadine)

Front 66

Post-stroke, increased risk period for depression is ___ years and ___ increase in mortality risk

Back 66

12 years
8x

Front 67

Euphoria w/suspiciousness
+
agitation/anxiety/hyperactivity
+
sympathetic stimulation (HTN, tachycardia, arrythmias, dilated pupils, sweating, chills)
+
visual/tactile hallucinations

Back 67

cocaine intoxication

Front 68

false perception of having "lost everything" (money, status, strength, health, internal organs)

Back 68

Cotard syndrome

Front 69

Main mechanism of action for amphetamines

Back 69

released stored monoamines in synaptic clefts

Front 70

Main mechanism of action for cocaine

Back 70

inhibits NT reuptake (esp catecholamines, esp esp DA)

Front 71

Main mechanism of action for BZDs

Back 71

increase affinity of GABA-type-A-Receptors

Front 72

Main mechanism of action for barbituates

Back 72

increase affinity of GABA-type-A-Receptors

Front 73

Main mechanism of action for PCP

Back 73

NMDA asparate receptor activation (glutamate)

Front 74

Main mechanism of action for antipsychotics

Back 74

Block DA-R

Front 75

autonomic hyperactivity (tachycardiac, HTN)
+
hallucinations, disoriented
+
fluctuating activity levels (agitation to lethargy)

Dx? Fatality level?

Back 75

EtOH w/d delirium

20% if not Txed

Front 76

Cataplexy vs Catalepsy

Back 76

Cataplexy = sudden and transient episode of loss of muscle tone, often triggered by emotions
Catalepsy = nervous condition characterized by muscular rigidity and fixity of posture regardless of external stimuli, often found in psychotic pts --> "waxy" posture

Front 77

If suspect DTs from clinical picture, next step is

Back 77

check for autonomic instability

Front 78

Urine tox + for heroin and cocaine, high fever, agitation, multiple excoriated lesions on UE, heart murmur
-->Dx<--
-->next step<--

Back 78

Draw blood cultures and admit him to a medical floor

Front 79

Naloxone used for

Back 79

Cocaine OD

Front 80

Urine tox + for heroin and cocaine, high fever, agitation, multiple excoriated lesions on UE, heart murmur
-->admitted and on IV antibiotics<--
Dark streaks on fingernails, calm/alert/oriented
-->next step?

Back 80

ECG
(splinter hemorrhages)

Front 81

blocking vs derailment

Back 81

thought stops, pause and...
blocking = totally new thought begins
derailment = same thought continues OR stop entirely

Front 82

loosening of ideas vs derailment

Back 82

Loosening of ideas = a whole series of derailments

Front 83

flight of ideas

Back 83

a nearly continuous flow of rapid speech that jumps from topic to topic, usually based on discernible associations, distractions, or plays on words, but sometimes disorganized and incoherent
-indicates disorganized thought process such as in mania or schizophrenia

Front 84

Alzheimer disease on PET scan

Back 84

blue areas (decreased activity) in parietal cortex

Front 85

PET scan w/blue areas (decreased activity) in parietal cortex

Back 85

Alzheimer disease

Front 86

Non-specific white spots on MRI brain

Back 86

unidentified bright objects
-indicate bipolar d/o or MDD in elderly

Front 87

MRI of brain of elderly pt w/MDD or bipolar

Back 87

Non-specific white spots (unidentified bright objects)

Front 88

Cut-off between adult and child Weschler Intelligence Scale

Back 88

15 y/o

Front 89

MMPI-2 (test)

Back 89

Minnesota Multiphasic Inventory (personality test)

Front 90

Blessed Rating Scale

Back 90

Functional test, caregiver administered
(like WCST, but not given by pro)

Front 91

WCST (test)

Back 91

Wisconsin Card Sorting Test --> Functional

Front 92

Rey-Osterrieth Test

Back 92

Cognitive test --> reproduce complex line-drawing
-elucidate any secondary effect of brain injury in neurological patients, test for dementia, or study degree of cognitive development in children

Front 93

Bender-Gestalt test

Back 93

Figure copying --> evaluate visual-motor maturity to screen for developmental disorders, or to assess neurological function or brain damage.

Front 94

Wada test

Back 94

Hemisphere dominance for Language
-inject Na+ amobarbital into R carotid a. -->if person losing language for a bit, the R is the dominant language center; then fo L (usual one)

Front 95

5 y/o M
Acute onset "running from lions trying to eat him" in last 24h

Back 95

Substance-induced Psychotic D/o
(he ate something)

Front 96

3 y/o F
-into ER for broken arm
-->greenstick ulnar fracture
-multiple fractures of different ages and increased density at metapyseal plate
-several bruises on thorax and wrist
-CBC = normocytic, normochromic anemia w/basophilic stippling
-mom = "she fell out of her bunk bed"
DD? Now what?

Back 96

1 - child abuse
-basophilic stippling a red herring --> kids frikkin eat things
2 - Admit, call DCFS, give CaEDTA (edetate calcium disodium) for led poisoning

Front 97

Newly Dx'ed Tourette syndrome

Back 97

Begin clonidine (safer) --> if doesn't work --> haloperidol

Front 98

Meds for enuresis

Back 98

Imipramine or DDAVP (antidiuretical)

Front 99

Teaching a 4 y/o not to steal - what to do and why?

Back 99

Help the kid return the items to the store - *MODELING* - shows the kid the correct behavior and why what she's doing is wrong

Front 100

MRI of schizophrenic brain shows

Back 100

Decreased temporal lobe size

Front 101

Decreased temporal lobe size on brain MRI

Back 101

psychosis

Front 102

Thrombocytopenia is a common SE of

Back 102

(any antiepileptic, but esp)
Valproic Acid

Front 103

Patient comes in psychotic and threatening his wife w/violence --> what do you do and why?

Back 103

Hospitalize (voluntary or involuntary)
-duty to protect supersedes duty to inform (if do former, won't *need* to do latter!)
-Tarasoff 1 and 2

Front 104

If patient is found ______ she will have to stand trial once she is sane, if she is found _______ she will not

Back 104

Unfit to stand trial
NG by reason on insanity

Front 105

"Stomach medication" that can cause a "thick tongue" with slurring of words and dyphagia
-what is this?
-what's the med?

Back 105

TD
Compazine (Prochlorperazine) or Reglan (Metoclopramide)
--> dopamine D2 receptor antagonist --> can cause TD just like APs

Front 106

Non-specific white spots on MRI brain

Back 106

unidentified bright objects
-indicate bipolar d/o or MDD in elderly

Front 107

MRI of brain of elderly pt w/MDD or bipolar

Back 107

Non-specific white spots (unidentified bright objects)

Front 108

Cut-off between adult and child Weschler Intelligence Scale

Back 108

15 y/o

Front 109

MMPI-2 (test)

Back 109

Minnesota Multiphasic Inventory (personality test)

Front 110

Blessed Rating Scale

Back 110

Functional test, caregiver administered
(like WCST, but not given by pro)

Front 111

WCST (test)

Back 111

Wisconsin Card Sorting Test --> Functional

Front 112

Rey-Osterrieth Test

Back 112

Cognitive test --> reproduce complex line-drawing
-elucidate any secondary effect of brain injury in neurological patients, test for dementia, or study degree of cognitive development in children

Front 113

Bender-Gestalt test

Back 113

Figure copying --> evaluate visual-motor maturity to screen for developmental disorders, or to assess neurological function or brain damage.

Front 114

Wada test

Back 114

Hemisphere dominance for Language
-inject Na+ amobarbital into R carotid a. -->if person losing language for a bit, the R is the dominant language center; then fo L (usual one)

Front 115

5 y/o M
Acute onset "running from lions trying to eat him" in last 24h

Back 115

Substance-induced Psychotic D/o
(he ate something)

Front 116

Compazine (Prochlorperazine) or Reglan (Metoclopramide)
-serious SE

Back 116

Tardive Dyskinesia