Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/442

Click to flip

442 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
Woman with anxiety about a gynecological exam is told to relax and imagine going through the steps of the exam. What process does this exemplify?
Systematic desensitization.
65-year old man is diagnosed with incurable metastatic pancreatic adenocarcinoma. His family asks you, the doctor, not to tell the patient. What do you do?
Assess whether telling the patient will negatively affect his health. If not, tell him.
Man admitted for chest pain is medicated for ventricular tachycardia. The next day he jumps out of bed and does 50 pushups to show the nurses he has not had a heart attack. What defense mechanism is he using?
Denial.
You find yourself attracted to your 26-year-old patient. What do you say?
Nothing! The tone of the interview must be professional ... if you feel your actions may be misinterpreted, have a chaperone in the room.
Large group of people is followed over 10 years. Every 2 years, it is determined who develops heart disease and who does not. What type of study is this?
Cohort study.
Girl can groom herself, can hop on 1 foot, and has an imaginary friend. How old is she?
4 years old.
Dx:

Cannot get an erection only with certain people
Erectile Dysfunction that is
Psychogenic
36-year old woman with a strong family history of breast cancer refuses mammogram because she heard it hurts. What do you do?
Discuss the risks and benefits of not having a mammogram. Each patient must give her own informed consent to each procedure. If the patient refuses, you must abide by her wishes.
During a particular stage of sleep, man has variable blood pressure, penile tumescence, and variable EEG What stage of sleep is he in?
REM sleep.
A 15 year old girl of normal height and weight for her age has enlarged parotid glands but no other complaints; The mother confides that she found laxitives in the daughter's closet. What is the diagnosis?
Bulimia
11-year old girl exhibits Tanner stage 4 sexual development (almost full breats and pubic hair). What is the diagnosis?
Advanced stage, early development.
4 year old girl complains of a burning feeling in her genitalia; otherwise she behaves and sleeps normally. Smear of discharge shows N. gonorrhoeae. How was she infected?
Sexual abuse.
72 year old man insists on stopping treatment for his heart condition because it makes him feel "funny" What do you do?
Although you want to encourage the pt to take his meds, the pt has the final say in his own rx regimen. you should investigate the "funny" feeling and determine if there are drugs available that won't elicit this particular side effect.
Person demands only the best and most famous doctor in town. What is the personality disorder?
Narcissism.
Nurse has episodes of hypoglycemia; blood analysis reveals no elevation in C-protein. What is the diagnosis?
Factitious disorder, self scripted insulin.
55 year old businessman complains of lack of successful sexual contacts with women and an inability to reach a full erection. Two years ago he had a heart attack. What might be the cause of his problem?
Fear of sudden death during intercourse.
What type of Observational Study: Sample chosen on presence of absence of disease. Information collected about exposure from past.
Case-control Study.
What type of Observational study: sample chosen based on presence of absence of risk factors. Subjects followed over time for development of disease.
Cohort Study.
Test type:
Pooling data from several studies (often via a literature search) to acheive greater statistical power
Meta-analysis
Experimental study:

compares therapeutic benefit of 2 or more treatments, or treatment and placebo
Clinical Trial
When the subjects choose the groups it may lead to what type of bias?
Selection bias.
When knowledge of the presence of the disease alters recall by the subjects what type of bias is likely?
Recall bias.
When subjects are not representative of the population and results are not generalizable, what type of bias is this?
Sampling bias.
When information gathered on subjects is done so at an inappropriate time, what bias is likely?
Late-look bias.
The total proportion of cases in a population at a given time.
Prevalence.
The rate of new cases in a population in a given time.
Incidence.
Incidence x Disease Duration
Prevalence
For chronic diseases, which is larger - prevalence or incidence?
Prevalence > Incidence for Chronic Disease
When does prevalence = incidence?
For acute disease (ie the common cold)
What is sensitivity?
TP/(TP+FN) x 100 = Sensitivity
When is high sensitivity desirable?
In a screening test

Sensitivity = the number of people who HAVE the Dz
What is 1-sensitivity?
False negative ratio.
What is specificity equation?
TN/(TN+FP) x 100 = specificity
What is 1-specificity?
False positive ratio.
When is high specificity desirable?
In a confirmatory test

Specificity = # of people who DON'T have the Dz
Define: PPV
The probability of having a condition given a positive test

TP/(TP+FP) = PPV
What is NPV?
The probability of not having the condition given a negative test.
TN/(TN+FN) = NPV
TP/(TP+FN)
Sensitivity
TN/(FP+TN)
Specificity
TP/(TP+FP)
PPV
TN/(FN+TN)
NPV
(TPxTN)/(FPxFN)

(trues over falses)
OR - approximates RR if prevalence of disease is not too high.
Best data analysis for:

1. Case-control

2. Cross-sectional

3. Cohort

Which deals w/ Prevalence? Incidence?
Case-control: Odds Ratio

Cross-Sectional: Chai squared
(Prevalence)

Cohort: Relative Risk
(Incidence)
Attributable risk formula?
(TP/TP+FP) - (FN/FN+TN)
The consistency and reproducibility of a test is the ....
Precision.
The trueness of the test measurements is the ...
Accuracy
Gaussian distribution is ...
a normal distribution (bell curve) (mean=median=mode)
Where is the "tail" on a positive skew distribution?

relation b/t mean, median and mode?
is asymmetry with the tail to the right, hump on the left

(Mean > Median > Mode)
[alphabetical]
Where is the "tail" on a Negative skew distribution?

relation b/t mean, median and mode?
is asymmetry with the tail to the left, hump on the right

(Mean < Median < Mode)
[alphabetical]
A null hypothesis is ...
Opposite of what you want to show.

There is no association (ie between the risk factor and the disease in the popuation.)
The alternative hypothesis is ...
There is some difference (ie between the disease and the risk factor in the population)
Error type:
Stating there IS an effect or difference where none really exists.
Type 1 error

(alpha probability)
Error type:
Stating there IS NOT an effect or difference when one really exists.
Type II error (beta)
the probability of rejecting the null hypothesis when it is in fact false.
Power
Equation for Relative Risk
(TP/TP+FP)/(FN/FN+TN)

or

PPV/(FN/FN+TN)
How do you increase study power in a test?
increase the sample size.
Confidence interval equation

What is Z for 95%?
99%?

When is Null Accepted w/ respect to CI?
CI = mean +/- Z (SD/sqroot of N)

95% = 2

99% = 2.5

If the CI includes zero, Null is accepted.
Normal (Gaussian) distribution has what percentage of the population in each standard deviation?
- 68% within 1 SD

- 95% within 2 SDs

- 99.7% within 3 SDs.
what does a t-test measure?

How many nominals vs intervals?
the difference between the means of two groups only

1 nominal and 1 interval
What does ANOVA measure?

How many nominal vs interval?
the difference between means of 3 or more groups

2+ nominal and 1 interval
What does a Chi square measure?
Difference b/t 2+ nominal data types
(NO mean values)
What does a Correlation coefficient indicate?
the strength of the correlation between two consecutive variables. The sign indicates a positive or negative.
(no nominals...intervals only)
What is Primary Disease Prevention?
Prevent the disease from occuring.
What is Secondary Disease Prevention?
Early detection of the disease

(screening)
What is Tertiary Disease prevention?
Reduce mobidity from the disease.
List the (12)* Reportable Diseases
B.A. SSSMMART CHICKEN or your GONe
Hep B; Hep A;
Salmonella / Shigella / Syphilis; Measles / Mumps; AIDS; Rubella; TB;
Chickenpox; Gonorrhea
B.A. SSSMMART CHICKEN or your GONe
Is HIV reportable?
While AIDS is reportable in all states, HIV reporting laws are state dependent.
What are the (3) leading causes of death for infants in the US?
1. Congenital anomalies

2. Short gestation/LBW

3. SIDS
What are the leading (4) causes of death for children age 1-14 in the US?
1. Injuries

2. Cancer

3. Congenital anomalies

4. Homicide
What are the top (3) leading causes of death for people 15-24 years of age in the US?
1. Injuries

2. Homicide

3. Suicide
What are the leading (5)causes of death for adults 25-64 yo in the US?
1. Cancer
2. Heart disease
3. Injuries
4. Suicide
5. Stroke
What are the leading (5)causes of death for adults over the age of 65 in the US?
1. Heart disease
2. Cancer
3. Stroke
4. COPD
5. Pneumonia
Difference b/t Transsexual and Transvestite
Transsexual:
Cross-dresses and uncomfortable w/ gender

Transvestite:
Cross-dresses but comfortable w/ gender
What is Therapeuic Privledge
Withholding information when disclosure would severely harm the patient or undermine informed decision making capacity.
True or False: A patients family cannot require that a doctor withhold information from the patient.
True
What does the CI mean if it excludes "1"?
It is significant

(if CI is greater then 1 = higher risk; less then 1 = lower risk)
Define Transference.
When the patient projects feelings stemming from their personal life onto their physician.
Define Countertransference.
When the doctor projects feelings stemming from their personal life onto the pt.
Stimulus changes but produces same response
Classical conditioning
Same stimulus leads to different response
Operant conditioning
Adding a stimulus increases behavior
Positive Reinforcement
Learning:

Removing a stimulus increases behavior
Negative Reinforcement
True or False: reinforcement schedules determine how quickly a behavior is learned or extinguished.
True
Reinforcement type:

reward received after every response;
rapidly extinguished
Continuous reinforcement schedule
Reinforcement type:
reward received after random number of responses;
slowly extinguished.
Variable Ratio reinforcement schedule
What are ages for the following IQ tests: Stanfornd-Binet; WISC-III; WPPSI; Denver Developmental; WAIS-R?
Denver Developmental: < 2yo

Stanford-Binet: 2-4 yo

WPPSI: 4-6 yo
(age where still may PP in pants)

WISC-III: 6-16 yo

WAIS-R: >17 (like R-rated movies)
How does the Stanford Binet test calculate intelligence?
IQ as (mental age/chronological age) x 100
How does Wechsler (WAIS) measure intelligence?
11 subtests (6 verbal, 5 performance)

Mean is 100, SD = 15.
What is the IQ cuttoff for diagnosis of mental retardation?
(2)
IQ < 70 or 2 SD below mean.
True or False: IQ tests are objective test.
True ... but they are NOT projective tests.
What type of reinforcement is the best way to learn?
Start w/ Continuous then move to Variable Ratio
What is an oral advanced directive?
In an incapacitated state, a pts prior oral statement is commonly used as a guide.
What is a written advanced directive?
a living will.
Define:
pt desingnates a surrogate to make a medical decision in the event that the patient loses decision making capacity. pt can specify decisions in certain clinical situations, and can revoke power.
Durable power of attorney
"do no harm"
Nonmaleficence
The physicians ethical responsibility to act in the patients best interest. Can conflict with autonomy.
Beneficence

[Best interest = Beneficence]
What should guide the physicans decision to disclose information to family and friends?
What the patient wants, or would want.
In what circumstances can a physician break confidentiality?
(3)
1. potential harm to others is serious.

2. liklihood of harm to self is great.

3. no alternative means exist to warn and protect those at risk
What steps may a physician take to prevent harm caused by a patients infectious disease?
Physician may have a duty to warn public health officials (reportable diseases) and identify people at risk.
What is the Tarasoff decision?
A law requiring physician to directly inform and protect a potential victim from harm; may involve a breach of confidentiality.
May a physician break confidentiality if they suspect child or elder abuse?
Yes.
When may a physician break confidentiality if in cases of an automobile accident?
Only if they suspect that the driver was imparied
How may a physician handle a suicidal or homicidal patient?
The physician may hold the patient involuntarily for a period of time ... or until psychiatric evaluation is completed.
A civil suit under negligence requires what 3 things?
1. Physician breach of duty to patient (Dereliction)

2. patient suffers harm (damage)

3. Breach of duty causes harm (Direct)
What is the most common factor leading to litigation between the physician and pt?
poor communication.
In a criminal suit the burden of proof is "beyond a reasonable doubt" ... in a malpractice suit the burden of proof is ...
"more likely than not"
Unaware that one is ill
Anosognia
unable to locate ones own body parts
Autotopagnosia
Define depersonalization
body seems unreal or dissociated
What is involved in orienting the patient?
(3)
person, place, and time
What is the order of orientation loss in a disoriented patient?
time goes first, then place, and last person
Sleep disorder:

patient kicks and hits spouse without knowledge
REM sleep disorder

(normal paralysis of muscles not present)
Define retrograde amnesia
inability to remember things that occured before a CNS insult
What is Korsakoff's anmesia?
classic anterograde anmesia caused by a thymine deficiency.
A alcoholic patient presents with anterograde amnesia, and confabulations. What is the likely diagnosis?
Korsakoffs amnesia
chance of having DM is 10%, chance of obesity is 30%. What is the chance of meeting someone obese, wth DM or both?
.1 + .3 - (.1 x .3) =

.4 - .03 = .37 = 37%
What is SES based on?
Education and Occupation

(not income)
When is suicide most likely?

What is the best Tx?
coming out of a depression

Tx:
Hospitalization
(giving meds leads to malpractice)
Most common work-related disability anywhere
musculoskeletal
What are Freud's three structures of the mind?
Id, Ego, Superego
Define the Id.
Primal urges, sex and aggression.
Define the Superego.
Moral values and conscience
None
Define the Ego.
Mediator between unconcious mind and external world.
define:

pleasure from watching others
Voyerism
Define:

1. Pleasure from giving others pain

2. Pleasure from receiving pain from others
Sadism


Masochism

(S and M)
Define: Pre-concious
What you are able to make consious with effort
Define:

Gender Identity
Who you think you are sexually
What is the Gender identity and Partner preference for:

1. Heterosexual male

2. Homosexual male

3. Transexual male

4. Transvestite male
1. G = male; P = female

2. G = male; P = male

3. G = female; P = male (usually)

4. G = male; P = female
Dx:
auditory hallucinations, delusions, strange behavior, and loose associations
Schizophrenia
What are some negative symptoms of schizophrenia?
(3)
flat affect;
social withdrawal;
lack of motivation
How long must a patient experience symptoms of schizophrenia for a diagnosis?
Periods of psychosis or disturbed behavior lasting > 6 months.
What are the 5 types of schizophrenia?
1. Disorganized (strangest)

2. Catatonic

3. Paranoid

4. Undifferentiated (many)

5. Residual (had it before)
Dx:
schizophrenia for a brief period of 30 days to six months
Schizophereniform
What is schizoaffective disorder?
combination of Schizophrenia and Depression
In one word, describe Clusters A, B, and C personality disorders.
A = weird

B = wild

C = worried
What are 3 types of Cluster A personality disorders?
A's:

1. Paranoid (Afraid)

2. Schizoid (Alone)

3. Schizotypal (Amazing powers)
Personality Disorder:

distrust and suspiciousness, projection is main defense mechanism
Paranoid personality
Personality disorder:

voluntary social withdrawal, limited emotional expression
Schizoid personality
Personality disorder:

interpersonal awkwardness, odd thought patterns and appearance; eccentric behaviors (thinks they are magical)
Schizotypal personality
Personality disorders that lead pts to be erratic, emotional, or dramatic and have a genetic association with mood disorders are classified as what Cluster type?
Cluster B
What are the 4 types of Cluster B personality disorders
B disorders:
1. Antisocial (Bad)
2. Borderline
3. Histrionic (Boobs in face)
4. Narcissistic (Better then you)
Personality disorder:

disregard for and violation of rights of others, criminality, males more often affected than females
Anti-social personality
Personality disorder:

unstable mood and behavior, impulsiveness, sense of emptiness. women more often affected than men
Borderline personality
Personality disorder:

excessive emotionality, somatization, attention seeking, sexually provacative
Histrionic personality
Personality disorder:

gradiosity, sense of entitlement, may demand "top" physician, or best health care
Narcissistic personality
Pts with personality disorders that leave them anxious or fearful and have a genetic association with anxiety disorders are classified as what Cluster type?
Cluster C personality disorders
List 3 types of Cluster C personality disorders
C's:

1. Avoidant (Coward)

2. Obsessive-Compulsive

3. Dependent (Clingy)
Personality disorder:

sensitive to rejection, socially inhibited, timid, feelings of inadequacy
Avoidant personality
Personality disorder:

preoccupation with order, perfectionism, and control
Obsessive-Compulsive personality
Personatliy disorder:

submissive and clinging, excessive need to be taken care of, low self confidence
Dependent personality
Who does MedicarE provide for?
The Elderly
Who does MedicaiD provide for?
The Destitute.
Medicaid is federal and state assistance for very poor people.
Ethically, what do you do if your patient is non-compliant?
Work to improve the physician patient relationship.
Ethically, what do you do if your patient has difficulty taking medication?
Provide written instructions, attempt to simplify the treatment regimen.
MCC of significant downward shift in SES
Disabling Physical problems
What do you do if a 17 year old girl is pregnant and asks for an abortion.
inform the patient that most states require parental conset for minors for an abortion.
What do you do if a terminally ill patient requests assistance in ending his life?
refuse involvement in any form of euthanasia.
physician may however prescribe appropriate analgesics that may coicidentally shorten a patient's life.
What do you do if a patient states that he finds you attractive?
ask direct, closed ended questions and use a chaperone if necessary.
What do you do if a patient refuses a necessary procedure or desires and unnecessary one?
attempt to understand why the patient wants/does not want the procedure. address underlying concerns. avoid performing unnecessary procedures.
What do you do if a patient is angry about the amount of time he spent in the waiting room?
apologize for any inconvenience. stay away from efforts to try to explain the delay.
what do you do if the patient is upset with the way he was treated by another doctor?
suggest that the patient speak directly to the physician regarding the concerns. if the problem is with a member of the office staff ... tell the patient you will speak to that individual.
What do you do if a child wishes to know more about his illness?
Ask what the parents have told the child about his illness. Parents of a child decide what information can be relayed about the illness.
How is Tardive Dyskinesia managed?
(2)

what is the adverse affect of the drug?
1. Do not stop taking the meds abruptly, instead switch to an atypical...
2. Clozapine

AE:
Agranulocytosis
A child puts everything in their mouth. How old are they?
1st year of life.
An infant sits with support, how old is she?
4 months
An infant stands with help, how old is he?
8 months
A baby is crawling, how old is she?
9 months
A little girl just learned to walk on her own, how old is she?
13 months
A child has just learned to climb (crawl up) the stairs alone, how old is he?
18 months
At what age does an emergence of hand preference first appear?
18 months
A child has lots of energy, can walk backwards, turn doorknobs, unscrew jars, and scribble with crayons. How old is she?
2 years
A child can ride a tricycle, go up the stairs normally, draw recognizable figures and has just started toilet training. How old is he?
3 years.
A child can descend the stairs normally and hop on one foot. How old is she?
4 years
At what age will a child develop complete sphincter control (toilet trained)?
5 years
At 5 years of age, what percentage of the adult brain mass does the child have?
75%
A child has most of her permanent teeth, how old is he?
11 years
True or False: Boys and girls have roughly the same height to weight ratio between ages 6-12 years?
False: boys are heavier than girls.
At what age does the adolescent growth spurt usually kick in?
Around 12 years, earlier for girls than for boys.
A baby plays patty cake and peek a boo, how old is she?
10 months
A baby is experiencing stranger anxiety, how old is he?
6 months
A baby has started showing signs of normal separation anxiety, how old is she?
1 year.
The parent is the central figure and issues of trust are key, how old is the child?
1st year of life.
A toddler will engage in parallel play, but "no" is still her favorite word, how old is she?
1 year
A toddler is selfish and self centered, aggresive, and tends to immitate mannerisms and activities, how old is he?
2 years
A baby can follow objects to midline, how old is she?
4 months
A baby is putting his feet in his mouth, how old is he?
5 months
A baby will approach a toy with one hand, and then change hands with the toy, how old is she?
1st year of life
A baby first laughs outloud, how old is she?
4 months
A baby has started saying "ma-ma-ma" and "da-da-da", how old is he?
10 months
Sensation and movement are most important, schemas are being developed, and assimilation and accomidation are priorities at what age in Piaget's development?
1st year of life.
In Piaget's Cognitive Development, at what age does a baby acheive object permanence?
1 year
A baby kicks and throws a ball, how old is he?
1 year
A baby can stack three cubes, how old is she?
18 months.
A todler is using two word sentences and has a vocabulary of about 250 words, how old is he?
1 year
A todler has started using pronouns and shows great variations in timing of language. Her parents seem to understand her better. How old is she?
2 years
A toddler is using complete sentences and has a vocabulary of 900 words, although he appears to understand 4x that many words. Strangers can understand him. How old is he?
3 years
A child tells stories, uses prepositions, plurals, and has discovered compound sentences, how old is she?
4 years
A child can stand on her tiptoes, how old is she?
2.5 years
A child is able to aim and throw a ball and stack 6 cubes, how old is he?
2 years
In Piaget's view, a child who can use symbols and has concrete use of objects and use of symbols along with a strong egocentrism is how old?
2 years
At what age is gender identity fixed?
3 years
A child knows her full name and what sex she is, how old is she?
3 years
Two children are observed to be taking turns with a toy, how old are they?
3 years
At what age is a child likely to start grooming themselves and brushing their own teeth?
4 years
A toddler can catch a ball, stack 9 cubes, cut paper with scissors and keeps unbottoning his shirt buttons, how old is he?
3 years
A child can point to and count three objects, repeat four digits, and name colors correctly, how old is she?
4 years
A child has an imaginary friend and this is entirely normal for this age group, how old is she?
4 years
Two children are caught "playing doctor", at what age does this curiosity manifest?
4 years
A child is having terrible nightmares and needs the light left on at night for fear of monsters, how old is he?
4 years
At what age does a child adopt personal speech patterns?
adolescence (12+)
At what age does communication become the focus of friendships?
adolescence (12+)
A child repeatedly asks for the meaning of words, how old is she?
5 years
A child can count 10 objects correctly, how old is she?
5 years
A child is having terrible nightmares and needs the light left on at night for fear of monsters, how old is he?
4 years
What figures can children copy at ages:
1. 3
2. 4
3. 4.5
4. 5
5. 6
6. 7
(in alphabetical order except diamond is last)

1. Circle
2. Cross
3. Rectangle
4. Square
5. Triangle
6. Diamond
At what age will a child first express romantic feelings towards others, perhaps as an Oedipal phase?
5 years
A child can draw a recognizable man, dress and undress herself, and catch a ball with two hands, how old is she?
5 years
Age range of Parrallel Play?
2 - 4 years
Age for Object permanence?
12 - 24 mo
A child shows a shift from egocentric to social speech and incomplete sentences decline, how old is he?
6-12 years
Identity is the critical issue in what age range?
adolescence (12+)
Conformity is most important for what age range?
11-12 years
When do cross gender relationships first take off?
adolescence (12+)
A teacher has noticed many of her kids are quitting organized sports, how old is her class likely to be?
adolescents (12+)
A teacher has noticed that for her kids, the "rules of the game" are paramount. How old is her class?
6-12 years
At what age range are organized sports first possible?
6-12 years
Demonstrating competence is key for what age group?
6-12 years
At this age range there is a separation of the sexes and sexual feelings are not apparent.
6-12 years
At this age range there is an adherence to logic, concrete operations, and no hypotheticals.
6-12 years
Children of this age group can use seriation, and have a personal sense of right and wrong.
6-12 years
At this age, children can handle hypotheticals, being systematic problem solving and deal with the past, present, and future.
adolescence (12+)
APGAR stands for what?
Appearance (color)
Pulse
Grimace
Activity
Respiration
Ages of the operational stages:

1. Pre-operational

2. Concrete

3. Formal
Pre-operational: 2-7 yo

Concrete operational: 7-11 yo
(reason, logic, volume, etc)

Formal Operational: >11 yo
(abstract thought)
What the three levels of appearance (color) on the APGAR scale?
0 = blue/pale

1 = trunk pink

2 = all pink
What describes the three levels of pulse on the APGAR score?
0 = 0

1 = <100

2 = >100
Describe the 3 levels of muscle tone on the apgar scale.
0 = limp

1 = some

2 = active
Describe the three levels of respiratory effort on the APGAR scale.
0 = none

1 = irregular

2 = regular
What is the definition of low birth weight in grams?
< 2500 g
How long does deprivation of affection need to continue before changes may be irreversible?
> 6 months
Dx:
Depression in an infant owing to continued separation from caregiver - it can result in failure to thrive
Anaclitic depression
An infant becomes withdrawn and unresponsive when left in a crowded daycare for a few weeks, what may be the problem?
Anaclitic depression
When a child is found to be physically abused, who is typically the abuser?
usually female and the primary caregiver.
When a child is found to be sexually abused, who is typically the abuser?
A male who is known to the victim.
At what age are most children sexually abused?
9-12 years.
Dx:
a milder form of autism involving problems with social relationships and repetative behavior
Asperger syndrome
Dx:
X-linked disorder seen only in girls. Characterized by loss of development and mental retardation appearing at about 4 years.
Rett disorder
What is the current treatment for autism?
increase communication and social skills
Why aren't boys seen with Rett syndrome?
With this X-linked disorder, boys die in utero.
What is the treatment for ADHD?
methylphenidate (Ritalin)
Describe conduct disorder
continued behavior violating social norms.
Dx:
A form of conduct disorder when the child is noncompliant in the absence of criminality.
Oppositional definant disorder
What is the treatment for Tourette's?
haloperidol
Severe weight loss, amennorrhea, anemia and electrolyte disturbances in an adolescent girl are signs of ...
anorexia nervosa.
Parotitis, tooth enamel erosion, increased amylase, and esophageal varicies in an adolescent girl at normal weight are signs of ...
Bulimia nervosa.
None
What are hallucinations?
perceptions in the absence of external stimuli.
What are Illusions?
misinterpretations of actual external stimuli.
What are Delusions?
false beliefs not shared with other members of culture/subculture that are firmly maintained despite obvious proof to the contrary.
Patients with psychomotor epilepsy will commonly experience what kind of hallucination?
olfactory hallucination.
Patients with DTs or cocaine abusers may experience what kind of hallucinations?
tactile hallucinations
What is a hypnagogic hallucination?
A hallucination that occurs when going to sleep

(hallucinate when GO to sleep)
What is a hypnopompic hallucination?
A hallucination that occurs when WAKING from sleep

(POMPed-up to get out of bed)
A diagnosis of hepatitis, abscesses, overdose, hemorrhoids, AIDS, or right sided endocarditis (especially in the presence of track marks) should lead the physician to consider
heroin addiction.
What two drugs are used to treat heroin addicts?
Naloxone and Methadone.
How can Naloxone help a heroin addict (MOA)?
Naloxone (Narcan) and naltrexone competitively inhibit opioids.
How can Methadone help a heroin addict?
Methadone is a long acting oral opiate. It allows them to get their "fix" while still being able to be a valuable member of society.
None
Dx:
tachycardia, tremors, and anxiety followed by hallucinations, delusions, and confusion in an alcoholic
Delirium Tremens
What is the treatment for delirium tremens?
benzodiazepines.
Difference b/t Anterograde and Retrograde amnesia
Anterograde:
Can't form memories of new or present events

Retrograde:
Can't remember events prior to the Dz
Which gender attempts suicide more often?
Women
Which gender is sucessful at suicide more often?
Men
What does the phrase "Mature women wear a SASH" indicate
Mature ego defenses:

Sublimation,

Altruism,

Supression,

Humor
What are ego defenses?
automatic and UNCONCIOUS reactions to psychological stress.
Describe Altruism as an ego defense
guilty feelings alleviated by unsolicited generosity toward others
Describe humor as an ego defense.
appreciating the amusing nature of an anxiety provoking or adverse situation.
a mafia boss making a large donation to charity is an example of what ego defense?
altruism.
a cancer patient laughing about their condition is an example of what ego defense?
humor
aggressive impulses used to succeed in sports is an example of what ego defense?
sublimation.
What is sublimation as an ego defense?
process whereby one replaces an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system.
describe supression as an ego defense.
VOLUNTARY withholding of an idea or feeling from concious awareness.
choosing not to think about your taxes until april 13th is an example of what ego defense?
suppression.
Describe acting out as an ego defense.
unacceptable feelings and thoughts are expressed through actions.
Describe dissociation as an ego defense.
temporary, drastic changes in personality, memory or behavior to avoid emotional stress.
Describe denial as an ego defense.
avoidance of awareness of some painful reality.
Describe displacement as an ego defense.
process whereby avoided ideas and feelings are transferred to some neutral person or object.
Describe fixation as an ego defense.
partially remaining at a more childish level of development.
describe identification as an ego defense.
modeling behavior after another person.
describe Isolation of Effect as an ego defense.
separation of feelings from ideas or events.
Ego Defense:

an unacceptable internal impulse is attributed to an external source
Projection
None
describe rationalization as an ego defense.
proclaiming logical resons for actions actually performed for other reasons, usually to avoid self blame.
Describe reaction formation as an ego defense.
process whereby a warded off idea or feeling is replaced by an unconciously derived emphasis on it's opposite.
Another name for major depression in elderly
Pseudodepression
Describe Repression as an ego defense
involuntary withholding of an idea or feeling from conscious awareness.
Describe splitting as an ego defense
Belief that people are good or bad ... extremes.
A patient with libidinous thoughts enters a monastary. This is an example of what ego defense?
Reaction formation.
An 8 year old child under stress begins bed wetting again. This is an example of what ego defense?
Regression.
What is the basic underlying mechanism for all ego defenses?
Repression
a patient says that one doctor is a miracle worker, but another is totally incompetent. this is an example of what ego defense?
splitting.
What is dysthymia?
A milder form of depression lasting at least 2 years.
A major depressive episode MUST include one of two symptoms, these are ...
1. Depressed mood

or

2. Anhedonia
A patients has experienced 2 major depressive episodes with a symptom free interval of 2 months, what is the diagnosis?
Recurrent Major Depressive Disorder.
What is the key to diagnosing dementia?
Ruling out delirium.
In an elderly person who seems to apparently have dementia, what other psychiatric condition should be considered?
Depression
None
Describe the difference between dementia and delirium.
Delirium = changes in sensorium

Dementia = changes in memory.
(also commonly irreversible)
What is the most common psychiatric illness on medical and surgical floors?
Delirium.
If a patient on a hospital ward presents with delirium, what drug effects should you check for in their med list?
Drugs with anticholinergic effects.
A patient presents with a decreased attention span and decreased level of arousal, disorganized thinking, hallucinations, illusions, and cognitive dysfunction ... what is the likely diagnosis?
Delirium
What are the (2) keys to diagnosis of delirium?
1. Waxing and waning level of conciousness

2. Develops rapidly
None
A man who has lost his wife appears to be in shock, and expresses denial, guilt and somatic symptoms for the past 4 months. What is the diagnosis?
Normal bereavement.
How long does normal bereavement last?
Typically 6 months to a year.
What are the functions of the frontal lobe?
concentration orientation language abstraction judgement motor regulation mood
What deficit is most notable in frontal lobe lesions?
lack of social judgement.
How is REM sleep like sex?
(3)
increase pulse,

penile/clitoral tumescence,

decreases with age
how often does REM sleep occur while sleeping?
every 90 minutes. duration of REM sleep increases throughout the night.
What is the principal neurotransmitter involved in REM sleep?
ACh.
What are the neurotransmitter changes associated with anxiety?
(3)
increase in NE;

decrease in GABA and 5HT
What neurotransmitter changes are associated with Depression?
(2)
decrease NE and 5-HT
What neurotransmitter change are associated with Alzheimers dementia?
decreases ACh
What neurotransmitter changes are associated with Huntington's Disease?
(2)
decrease GABA and ACh
What neurotransmitter changes are associated with Schizophrenia?
increase DA
What neurotransmitter changes are associated with Parkinson's disease?
decrease in DA.
Name the 4 reflexes that are present at birth.
1. Moro

2. Rooting

3. Palmar

4. Babinski
What is the Moro reflex?
extension of limbs when startled
What is the rooting reflex?
nipple seeking
What is the palmar reflex?
grasps object in palm
What is the Babinski reflex?
large toe dorsiflexes with plantar stimulation.
When do the reflexes present at birth typically disappear?
Within the 1st year of life.
What are the Kubler-Ross dying stages?
(5)*
Death Always Brings Great Adjustments:

1. Denial
2. Anger
3. Bargaining
4. Grieving
5. Acceptance
Death Always Brings Great Adjustments
Dx:
Police find person wandering and disoriented; he is from another town and cannot remember taking a trip or the decision to do so.
Fugue

(amnesia w/ travel)
Dx:
emotional symptoms causing impairment following an identifiable psychosocial stressor lasting < 6 months.
Adjustment disorder
What is algophobia?
fear of pain.
what is acrophobia?
fear of heights.
What is agoraphobia?
fear of open places.
What are treatment options for specific phobias?
(2)
Systematic desensitization;

Flooding
In reference to a Somatoform disorder, describe a primary, secondary, and tertiary gain.
Primary gain = what symptom does for patients internal psyche.

Secondary gain = what symptom gets for patient (ie sympathy)

Tertiary gain = what the caretaker gets
(MD on an interesting case)
What does "PANIC" indicate?
The symptoms of a panic attack:
Palpiations,
Abdominal distress,
Nausea,
Increased perspiration,
Chest pain, Chills, Choking
What percent of time is spent in stage 2 sleep?
45%
When do you experience a Beta waveform?
When awake, alert, active mental concentration with your eyes open.
When do you experience an alpha waveform?
awake, but drowsy with eyes closed.
In light sleep (stage 1), what waveform predominates?
theta
in deeper sleep, stage 2, what waveform predominates?
Sleep spindles and K complexes.
In stage 3-4 sleep, the deepest non REM sleep, what waveforms predominate?
delta waves (lowest frequency, highest amplitude)
When in the sleep cycle will a person sleepwalk, have night terrors, or wet the bed?
In delta sleep (stage 3-4)
What waveform predominates in REM sleep?
Beta waves (the same as being awake)
What does "At night, BATS Drink Blood" indicate?
waveforms of sleepstages:

Awake = Beta,
Drowsy = Alpha,
Stage 1 = Theta,
Stage 2 = Spindles and K forms,
Stage 3-4 = Delta,
REM = Beta w/ sawtooths.
What NT is the key to initiating sleep?
5HT predominance of raphe nucleus
What neurotransmitter reduces REM sleep?
NE
What are EOM movements during REM sleep due to?
activity of the PPRF (paramedian pontine reticular formation / conjugate gaze center)
What do the terms "paradoxical sleep" and "desynchronized sleep" apply to
REM sleep having the same EEG pattern as awake and alert
Why are benzodiazepines good for night terrors and sleep walking (and Imipramine good for enuresis) in reference to the sleep stage?
They shorten stage 4 sleep.
What drug shortens stage 4 sleep and is used to treat enuresis?
Imipramine.
Dx:
A somatoform disorder where symptoms suggest motor or sensory neurologic or physical disorder - but tests and physical examination are negative
Conversion disorder
Dx:
prolonged pain that is not explained completely by illness.
Somatoform pain disorder
Dx:
misinterpretation of normal physical findings, leading to preoccupation with fear of having a serious illness in spite of medical reassurance
Hypochondriasis

(preoccupation w/ fear)
Dx:
variety of complaints in multiple organ systems
Somatization disorder
what is body dysmorphic disorder?
patient convinced that part of their own anatomy is malformed.
Dx:
a false belief of being pregnant associated with objective physical signs of pregnancy.
Pseudocyesis
What is electroconvulsive therapy?
a painless procedure that results in a seizure. Complications can result from anesthesia.
What are the major adverse effects of ECT?
disorientation, and amnesia.
When is ECT used?
For major depressive disorder refractory to all other treatment.
Dx:
patient conciously fakes or claims to have a disorder in order to attain a specific gain.
Malingering
Dx:
a patient conciously creates symptoms in order to assume the "sick" roll to get medical attention
Facticious disorder
Dx:
manifests as a chronic history of multiple hosptital admissions and willingness to receive invasive procedures
Munchausen's syndrome
What is Munchausen's syndrome by proxy?
when the illness in a child is caused by a parent;
the motivation is unconcious
What is the treatment of choice for bipolar disorder?
Lithium.
What is cyclothymic disorder
a milder form of bipolar disorder lasting at least 2 years.
Disinhibition, emotional lability, slurred speech, ataxia, coma, and blackouts are indicative of intoxication with what substance?
alcohol.
A patients appears restless, and complains of insomnia, anxiety, and shows signs of arrhythmias. You suspect the patient is using what substance?
cigarettes ... nicotine intoxication.
When a patient stops smoking cigarettes, what symptoms might they expect during withdrawal?
irritability, headache, anxiety, weight gain, and cravings.
What central tendency (mean, median or mode) is best measured in a skewed distribution?
Median

(it is always in the middle)
Test used for "frequency data" versus comparison of the means?
Chi-squared
A patient presents to the ER with nausea and vomiting, constipation, and pinpoint pupils. What substance do you suspect?
opiods.
When a patient ODs on opiods, what symptom are you most concerned with?
seizures ... may be life threatening.
a pt presents with amnesia, ataxia, somnolence, and minor respiratory distress. They do not consume alcohol ... what substance do you suspect?
Benzodiazepines.
When are benzos addictive?
if consumed with alcohol.
When a patient stops taking benzos, what symptoms may they experience?
rebound anxiety, seizures, tremor, and insomnia
a patient presents to the ER with major respiratory depression, their friends state they "took something" ... what do you suspect?
Barbituates
In addition to anxiety, seizures, and delirium, what are you concerned about in a patient who is withdrawing from barbituates?
life threatening cardiovascular collapse.
a patient presents with euphoria, anxiety, paranoid delusions, imparied judgement, and hunger ... what do you suspect?
marijuana.
Are there withdrawal symptoms from marijuana?
social withdrawal.
a patient presents with marked anxiety, delusions, visual hallucinations, flashbacks, and pupil dilation. what do you suspect?
LSD.
a pt presents with agitation, pupillary dilation, HTN, tachycrdia, euphoria, fever, hallucinations and they have been awake for 36 hours ... what drug do you suspect?
Amphetamines
Withdrawl:

post crash depression, lethargy, headache, stomach cramps, hunger, hypersomnolence.
Amphetamines
a pt presents euphoric with psychomotor agitation, tachycardia, pupillary dilation, hallucinations, and angina ... what drug do you suspect?
cocain.
what fatal effect of cocain are you worried about?
sudden cardiac death.
Withdrawl:

post crash depression and suicidality, hypersomnolence, fatigue, malaise, and severe psychological craving
Cocaine
a pt presents with fever and psychomotor agitation, he is belligerant and impulsive, and has horizontal and vertical nystagmus. What drug do you suspect?
PCP.
When a patient is withdrawing from PCP, what symptoms are you concerned about?
sudden onset of severe, random, homicidal thought
A patient recovering from a PCP intoxication appears to be having a recurrence of intoxication symptoms... why?
reabsorption of PCP from the GI tract.
What is the BMI numerical cutoff for an obesity?
> 30.0
A patient complains of sexual dysfunction, what 3* things are on your differential?
3-D:

Drugs,

Disease,

Depression / psychological
3-D
What diseases may lead to sexual dysfunction?
(2)
Depression

DM
What drugs can lead to sexual dysfunction?
(4)*
End in Having No Sex:

EtOH;

HTN meds;

Neuroleptics;

SSRI
End in Having No Sex
A patient with depression will typically show these three changes in their sleep stages:
1. decrease slow wave sleep

2. decrease REM latency

3. early morning awakening
What is the most important screening question for depression?
Are you experiencing early morning awakening?
A person with narcolepsy starts off their sleep cycle with what sleep stage?
REM
Dx:
sudden collapse while awake. may be present in some patients with narcolepsy
Cataplexy
What is the treatment for narcolepsy?
amphetamines.
A patient stops breathing for at least 10 seconds repeatedly during sleep, what is a possible diagnosis?
Sleep apnea
Describe the difference between central and obstructive sleep apnea.
Central sleep apnea:
no respiratory effort

Obstructive sleep apnea:
respiratory effort against an airway obstruction
Highest quality study when randomized and double-blind
Clinical trial
total cases in population at a given time/total population
Prevalence
new cases in a population over a given time/total population at risk
Incidence
Number of True Positive tests divided by the number of all people with the disease
Sensitivity
Probability of a positive test given that a person HAS the DISEASE
Sensitivity

(SNOUT = SeNsitivity rules OUT)
Number of True Negatives divided by the number of all people without the disease
Specificity

(SPIN = SPecificity rules IN)
Number of True Positives divided by the number of people who have a positive test for the disease
Positive Predictive Value
Number of True Negatives divided by the number of people who tested negative for the disease
Negative Predictive Value
equation commonly used in Case-control Studies
Odds Ratio
equation commonly used in Cohort studies
Relative Risk
probability of making a Type I error.
p-value If p<0.05, there is less than 5% chance that data will show something that is not really there (less than 5% chance data is incorrect)
Two types of studies that are without procedures on patients or drug tests
Case-control study


Cohort study
Study type that deals with observing previous problems based on patients presenting with a disease versus those without a disease.

What mathematical equation does it incorporate?
Case-control study

Odds Ratio
Study type that deals with observing groups of people over time?

Does it deal with incidence or prevalence?

What mathematical equations does it incorporate?
Cohort study

Prevalence

1. Relative Risk
2. Atributable Risk
Equation that answers:

"chance of having a risk factor, given you have the disease"
Odds Ratio OR =
present time/former time =
AD/BC
Equation that answers:

"how much more likely"
Relative Risk = PPV / (FN/[FN+TN])
Equation that answers:

"how many more cases"
Attributable Risk = PPV - (FN/[FN+TN])
MC female sexual disorder
Hypoactive Sex desire
AE of the neuroleptic medication for Schizophrenia?
Tardive Dyskinesia
AE of Carbamazepine?
SIADH
What do you do in regards to confidentiality if a 15-yo who needs a Rx for a STD or wants contraception?
Not required to inform parents; remains confidential
MC drug for acute insomnia (including jet lag)
Short-acting Benzo:

Triazolam
Toilet training is not possible before what age?
18 months
Type of Learning:

Son models father's example
Social Learning
Type of Learning:

Bonding b/t infant and mother
Imprinting
Can a 16-yo get an abortion w/o parent consent?
Yes...in certain states
Dx:

patient reports Sx to acheive and easily recognizable gain (like drugs)
Malingering
Dx:

patient has neurologic complaints not consistent w/ present-day knowledge about CNS.
clue to Dx: patient has lack of concern about Sx
Conversion Disorder
Dx:

Many unexplained medical Sx in multiple body systems
Somatization Disorder
What is the best response if a patient is crying when you enter the exam room?
"How are you feeling?"

Never assume you know an emotional sign
Most difficult sexual dysfunction to treat?
Primary Ejaculatory Incompetence in Men

(never ejaculated during intercourse)
If patient in ER needing blood transfusion, but is religiously against it, what should doctor do?

What id the patient's 10-yo child needs blood?
Adult: Respect their wishes

Child: Give blood
(Parent beliefs cannot influence child care in an emergency)
Who has the greater chance of commiting suicide:
Increased SES or Decreased SES?
Increased SES
Withdrawl:

Anxiety, delirium, seziures. Can lead to life-threatening CV collapse
Barbiturates
Dx:

patient that reports Sx to enter the "sick role"
Facticious Disorder
Aggression is linked to what NT?
Serotonin
Reward type:

if he cleans-up toys, he will get a reward every Sunday
Fixed Interval
Reward type:

he must clean-up toys 3 times before getting a reward
Fixed Ratio
Reward type:

he may receive a reward the same night he cleans-up his toys or it may be days later
Variable Interval
Reward type:

he may receive reward after cleaning-up toys on one occasion, or sometimes after 4 occasions
Variable Ratio
If a married female wants a tubal ligation, what is also needed?
consent from husband
Dx:

patient is schizophrenic and on meds; has fever, HTN and muscle rigidity
Neuroleptic Malignant syndrome
Difference b/t Bipolar I and II?
I:
Hx of Mania (so far)

II:
Hx of both Hypomania and Depression