Kpsychiatry: Kaplan Companion To First Aid For Usmle Step 2 Ck

Front 1

Q001. What is akathisia?

Back 1

A001. psychomotor agitation; shoes anxiety

Front 2

Q002. How do you spot akathisia?

Back 2

A002. patients is moving all the time and can't help it. Moving fingers or legs

Front 3

Q003. Tx for Acathisia?

Back 3

A003. 1) decrease dose; 2) B-blockers; 3) benzodiazepines

Front 4

Q004. What is the difference between hallucination and illusion?

Back 4

A004. illusions are what magicians do... Illusions are stimulus present but miss perception of them; Hallucination is no stimulus and perception

Front 5

Q005. What are the MC hallucination types?

Back 5

A005. Auditory 2/3's; Visual 1/3; Tactile; Smell

Front 6

Q006. What pathology is involved with auditory hallucinations?

Back 6

A006. schizophrenia; Psychotic Disorder

Front 7

Q007. What is visual hallucination due to?

Back 7

A007. Drugs; Organic Tumor of Visual pathways

Front 8

Q008. What is tactile hallucination associated with?

Back 8

A008. MC drugs; Cocaine; Alcohol Withdrawal (Delirium Tremens)

Front 9

Q009. What pathology is associated with blunted/flat affect?

Back 9

A009. Schizophrenia; Parkinson

Front 10

Q010. What does it mean when the mood and affect are incongruent?

Back 10

A010. the person says he is happy but his body language (affect) doesn't reflect it

Front 11

Q011. What is associated with mood and affect incongruency?

Back 11

A011. Psychotic Disorder

Front 12

Q012. What is projection?

Back 12

A012. wishes to someone else; she doesn't like me... (really I don't like her); You are cheating on me (really I am cheating on you)

Front 13

Q013. What personality has projection?

Back 13

A013. Paranoid Personality; all attacking them

Front 14

Q014. What is denial?

Back 14

A014. use to avoid painful; I didn't have a heart attack; Woman who's husband died but she cooks for 2 and places the table for two

Front 15

Q015. Patient comes in with an MI?; Telemetry, patient takes medication with leads on himself. Patient says I didn't have a Heart Attack... What is the next step?

Back 15

A015. DO NOT refer to psych; Confront denial; Interpret denial with dream analysis; Find out patients view about death; Do nothing; Answer is DO NOTHING; Patients defense mechanism is not interfering with Tx

Front 16

Q016. If patient spits out pill, takes all I.V. lines out... Patient in denial then you need to?

Back 16

A016. Ask the patient why

Front 17

Q017. When patient thinks all good or all bad, Splitting... Which personality uses this?

Back 17

A017. Borderline; good is idealized; bad is devalued; The morning staff is the best

Front 18

Q018. What is somatization?

Back 18

A018. Psychic converted to bodily symptoms

Front 19

Q019. What personality is associated with somatization?

Back 19

A019. Physical exam normal; Somatoform Disorders; 1) Hypochondriasis; 2) Body Dysmorphic

Front 20

Q020. Tx of postpartum blues?

Back 20

A020. no treatment

Front 21

Q021. What is the Tx for postpartum depression?

Back 21

A021. SSRIs; Antidepressants

Front 22

Q022. What are the Tx for Postpartum Psychosis?

Back 22

A022. Antipsychotics; Mood stabilizers; antidepressants

Front 23

Q023. Stages of Death and Dying?; Stage I

Back 23

A023. Shock and Denial; It's not possible

Front 24

Q024. Stages of Death and Dying?; Stage II?

Back 24

A024. Anger; Why me?

Front 25

Q025. Stages of Death and Dying?; Stage III?

Back 25

A025. Bargaining; Night before test going to pray

Front 26

Q026. Stages of Death and Dying?; Stage IV?

Back 26

A026. Depression

Front 27

Q027. Stages of Death and Dying?; Stage V?

Back 27

A027. Acceptance

Front 28

Q028. Do the stages of death and dying are in what order?

Back 28

A028. Not in order; It can be any stage, in any order

Front 29

Q029. How long does the person need to have the symptoms to diagnose schizophrenia?

Back 29

A029. 6 months

Front 30

Q030. How is Schizophrenia different from other psychiatric problems?

Back 30

A030. - It tends to affect all the aspects of an individuals life; worst prognosis; 1/3 don't go back to their normal state continue with Disease

Front 31

Q031. What are the risk factors?

Back 31

A031. men get Disease younger 15-25; women 25-35

Front 32

Q032. What is the worst prognosis?

Back 32

A032. the younger the patient gets a Disease the worst prognosis; so men have a worst prognosis

Front 33

Q033. What is the neurotransmitter unbalance of schizophrenia?

Back 33

A033. Increase levels of DOPA; Also serotonins; (New drugs work on both)

Front 34

Q034. How do patients develop Schizophrenia? Theories?

Back 34

A034. Double Bind; Mother talked to you like an adult but treated you like a baby; mixed message from mother; you don't know what to do... in a bind

Front 35

Q035. Another theory is High EE family? Expressed Emotions

Back 35

A035. A family that has high emotions (Italians?); family very critical, intrusive, emotional

Front 36

Q036. What is important about High EE family and relapse?

Back 36

A036. Chances are very high that you will relapse and return to hospital; you go back to the same environment

Front 37

Q037. Viral Theory for Schizophrenia?

Back 37

A037. They believe that viruses infect patients when they are born since lots of patients are born in winter and early spring

Front 38

Q038. Downward Drift or Social Causation theory?

Back 38

A038. Schizophrenia in low-socioeconomic status (low SES)

Front 39

Q039. Social Causation Theory?

Back 39

A039. Different stress levels; low SES with high stress

Front 40

Q040. Prevalence vs. genetics?

Back 40

A040. Monozygotic (47%)increase; Dizygotic 12%

Front 41

Q041. What is schizophrenia percentage in the general population?

Back 41

A041. 1%

Front 42

Q042. One parent with schizophrenia what is the chance?

Back 42

A042. 12%

Front 43

Q043. Two schizophrenic parents??

Back 43

A043. 40%

Front 44

Q044. Monozygotic Twins?

Back 44

A044. 47%

Front 45

Q045. Dizygotic Twins?

Back 45

A045. 12%

Front 46

Q046. First-degree relative with schizophrenia?

Back 46

A046. 12%

Front 47

Q047. Second-degree relative with schizophrenia?

Back 47

A047. 5-6% chance

Front 48

Q048. What percentage was the chance for bipolar disorder? two parents having bipolar

Back 48

A048. 50-75%

Front 49

Q049. Symptoms of Schizophrenia?

Back 49

A049. Auditory Hallucinations (2/3's); Visual Hallucinations; Bad voices; You are evil, terrible; kill yourself

Front 50

Q050. Command voice hallucinations?

Back 50

A050. Tell you to do things; most patients hears voice and don't pay attention to it; but there are some that do

Front 51

Q051. What is a delusion?

Back 51

A051. false belief; mostly bizarre; not believable (makes no sense in what they believe)

Front 52

Q052. What is catatonia?

Back 52

A052. not moving

Front 53

Q053. What are negative symptoms?

Back 53

A053. flat affect; social withdrawal; cognitive defects

Front 54

Q054. Are Schizophrenics functional?

Back 54

A054. No, usually lose jobs; Withdrawal

Front 55

Q055. What is a saccadic eye movement?

Back 55

A055. Irregularity of eye movements; REM like; trade mark (Pathognomonic)

Front 56

Q056. What is another characteristic of schizophrenic behavior?

Back 56

A056. Scanning behavior; Hypervigilance; (Paranoid)

Front 57

Q057. What is a common finding in a CT scan of the head?; Or MRI

Back 57

A057. Lateral and Third Ventricular Enlargement

Front 58

Q058. What other patients have ventricular enlargement?

Back 58

A058. Alzheimer patients have it

Front 59

Q059. What is associated with ventricular enlargement?

Back 59

A059. the larger the enlargement; the greater the negative symptoms; worst prognosis

Front 60

Q060. What do you find in a PET scan?

Back 60

A060. hypoactivity of frontal lobes; no areas of pickup; no red/yellow; black areas (frontal)

Front 61

Q061. What is the frontal lobe responsible for?

Back 61

A061. - personality; abstract thinking; higher order function; ability to change

Front 62

Q062. What kind of answers do you get in abstract thinking?

Back 62

A062. what does a rolling stone gathers no moss; it is rolling so nothing sticks

Front 63

Q063. How is schizophrenia correlate with IQ?

Back 63

A063. low IQ

Front 64

Q064. Schizophrenia associated with problems in neuropsychological tests?

Back 64

A064. problems in frontal lobe

Front 65

Q065. What psychological tests are worst in Schizophrenia?

Back 65

A065. Personality test; Projective tests are worst; since they will give bizarre answers; Ink blot

Front 66

Q066. Tx of Schizophrenia?

Back 66

A066. Antipsychotics; typical; newer atypicals

Front 67

Q067. What is the first line tx of schizophrenia?

Back 67

A067. Atypical Drugs; since less side effects; (better compliance)

Front 68

Q068. What is special about the atypical drugs?

Back 68

A068. both positive and negative symptoms

Front 69

Q069. What symptoms do the typical antipsychotics cover?

Back 69

A069. Only positive symptoms

Front 70

Q070. What is the theory of therapy?

Back 70

A070. the sicker the patient the less intrusive the therapy; the sicker the patient the more intrusive therapy

Front 71

Q071. What is the most intrusive therapy?

Back 71

A071. Psychoanalisis; therapist sits behind you; patient says whatever is on their mind free association

Front 72

Q072. What is supportive psychotherapy?

Back 72

A072. how is your job; the sickest patient since you want to gain their trust

Front 73

Q073. What is differential diagnosis for Schizophrenia?

Back 73

A073. Rule out organic; Drugs (psychostimulants cocaine/amphetamine); Looks paranoid/scanning the room

Front 74

Q074. What is the first test?

Back 74

A074. Urine test; Cocaine stays in body for 3-4 days

Front 75

Q075. What does hallucinogens produce?

Back 75

A075. LSD; Alcohol withdrawal

Front 76

Q076. What other medical condition is associated with bizarre disorders, hallucinations in the brain?

Back 76

A076. Temporal Lobe Epilepsy/Seizures

Front 77

Q077. What other psychiatric disorders are part of the differential?

Back 77

A077. Personality; Schizoaffective

Front 78

Q078. What other disorders are involved?

Back 78

A078. Malingering; Factitious Disorder (physical and psychological symptoms)

Front 79

Q079. How long do mood disorders last in schizophrenia?

Back 79

A079. brief/short; so different

Front 80

Q080. What are some medical causes of schizophrenia like?

Back 80

A080. - HIV (psychotic); Steroids (rage); tumors; CVAs

Front 81

Q081. What personality disorder is involved in the differential?

Back 81

A081. - Schizotypal; Schizoid (short live psychotic episodes); Borderline (short live psychotic episodes); they go back to normal though; functioning patients in society

Front 82

Q082. Types of Schizophrenia?

Back 82

A082. - Paranoid; Disorganized type; Catatonic Type; Undifferentiated type; Residual

Front 83

Q083. What is the MC type of Schizophrenia?

Back 83

A083. Paranoid Type; Later in Life (so better prognosis)

Front 84

Q084. What is characteristic of Disorganized type?

Back 84

A084. Bizarre behavior; dressed inappropriate; making faces; laughing; making animal noises; masturbating in public

Front 85

Q085. What is the prognosis of disorganized type?

Back 85

A085. they have the worst prognosis since they get it a young age; <25 y.o.

Front 86

Q086. What is the hallmark of Residual type?

Back 86

A086. Negative symptoms; flat affect, anhedonia, attention deficit, isolation; they don't hear voices (but they use to probably)

Front 87

Q087. What is the theme in Paranoid Schizophrenia?

Back 87

A087. Persecution

Front 88

Q088. What is the theme catatonic type?

Back 88

A088. psychomotor; excitation or not moving

Front 89

Q089. What is the theme of disorganized type of schizophrenia?

Back 89

A089. Weird; everything is weird/bizarre; look/talk/behave

Front 90

Q090. What is the theme of Residual type?

Back 90

A090. No hallucinations/delusions; Homeless; Negative Symptoms

Front 91

Q091. What is the theme for Undifferentiated type?

Back 91

A091. not clear

Front 92

Q092. What is the schizophreniform disorder?

Back 92

A092. duration of symptoms is 3 months; hallucination (auditory); delusions (bizarre); disorganized speech; negative symptoms; Duration needs to be less than 6 months

Front 93

Q093. What is the prognosis of schizophreniform disorder?

Back 93

A093. Better than schizophrenia since the duration is less

Front 94

Q094. What is a risk factor of schizophreniform disorder?

Back 94

A094. Suicide

Front 95

Q095. What is the tx? How long is the Tx

Back 95

A095. Antipsychotics; 3-6 months

Front 96

Q096. What is schizoaffective disorder?

Back 96

A096. Waste paperbasquet patient; Mood symptoms; Psychotic Symptoms; can differentiate patient; pure garabage; both mood disorder and schizophrenia; major depression, mania

Front 97

Q097. What is better major depression or schizophrenia?

Back 97

A097. better is to have major depression; better prognosis

Front 98

Q098. Major Depression vs. Schizoaffective Disease?

Back 98

A098. Major depression has a better prognosis; all mood

Front 99

Q099. Schizoaffective vs. schizophrenia?

Back 99

A099. Schizoaffective is better prognosis; since has mood disorder

Front 100

Q100. Family history of Mood Disorder vs. Psychotic Disorders?

Back 100

A100. History of Mood Disorder has a better prognosis on the patient

Front 101

Q101. Tx for Schizoaffective Disease?

Back 101

A101. Tx with Schizo part with antipsychotic and Antidepressant; First Antipsychotic since worse symptoms treated first; If you start with mood tx then you worsen the psychosis

Front 102

Q102. Delusional disorder?

Back 102

A102. Scenario is possible; Delusions are believable; like wife trying to kill patient

Front 103

Q103. Delusion Disorder patients characteristic?

Back 103

A103. Reliable; no impairment of level of fx; thoughts are logical and coherent

Front 104

Q104. Delusional vs. Schizophrenia?

Back 104

A104. Non-bizarre delusion 1 month; schizophernics not working; not functioning

Front 105

Q105. What are the types of delusional disorders?

Back 105

A105. erotomanic; jealous; grandiose; somatic; mixed

Front 106

Q106. What are erotomanic delusional disorder?

Back 106

A106. Patient believe that a famous person is in love with them; brad pitt; Billy Jean think Michael Jackson made the song for her; Stalker

Front 107

Q107. MC type of Delusional Disorder?

Back 107

A107. Persecutory Delusional Disorder

Front 108

Q108. MC type of schizophrenia?

Back 108

A108. Paranoid

Front 109

Q109. What are the risk factors for delusional disorder?

Back 109

A109. - onset about 40 years; Prognosis better; women (MC); recent immigration

Front 110

Q110. Which part of the brain is affected in delusional disorder?

Back 110

A110. - limbic system; or basal ganglia

Front 111

Q111. What is the Tx of Delusional Patient?

Back 111

A111. Not really Tx; unless stalker; antipsychotics; Delusions very hard to treat; Try to give individual psychotherapy; get the patient trust; Confront the delusion

Front 112

Q112. What is brief psychotic disorder?

Back 112

A112. hallucination; delusion; Disorganized speech; very similar to schizophrenia

Front 113

Q113. What is responding to internal stimuli?

Back 113

A113. Turn their head as if to listen to someone

Front 114

Q114. How long does the brief psychotic disorder?

Back 114

A114. Symptoms last 1 day but <30 days

Front 115

Q115. If symptoms last for more than 6 weeks?

Back 115

A115. Schizophreniform

Front 116

Q116. If psychotic symptoms last for 7 months or more?

Back 116

A116. Schizophrenia

Front 117

Q117. What are the risk factors of brief psychotic sx?

Back 117

A117. Low SES; Accident and hear voices; Pat in a fire and then he hear voices

Front 118

Q118. Tx for Brief Psychotic Disorder?

Back 118

A118. Hospitalized; 1st line antipsychotics; also treat with

Front 119

Q119. Haloperidol vs. Risperidone?

Back 119

A119. Always choose Risperidone; Less Side Effects

Front 120

Q120. What is the key to somatoform disorder?

Back 120

A120. think they have something wrong; present physical symptoms with no medical explanations

Front 121

Q121. What problems do the somatoform patients have?

Back 121

A121. Always complaining; so problems in social and occupational activities

Front 122

Q122. What is somatization disorder?

Back 122

A122. very easy; 8 or more symptoms; 4 pains (GI, pseudoneurological, shortness of breath, ringing in my ear, heart racing, pain during sex); more women than men

Front 123

Q123. Classic somatoform patient?

Back 123

A123. Young female from Low SES; begins by age 30

Front 124

Q124. What is it associated with?

Back 124

A124. Personality Disorder; Long complicated medical histories

Front 125

Q125. Never choose answer?

Back 125

A125. There is nothing wrong with you; never refer patient to another doctor

Front 126

Q126. What do you need to do with somatoform disorder?

Back 126

A126. regular check-ups; single physician; Tx: Psychotherapy; need to fix their head; get their trust

Front 127

Q127. Differential for Somatoform?; medical

Back 127

A127. MS; Myasthenia Gravis; SLE; AIDS; Thyroid; Chronic Systemic Infection

Front 128

Q128. What is the differential for somatoform (psychiatric)?

Back 128

A128. depression; anxiety; schizophrenia

Front 129

Q129. What is conversion disorder?

Back 129

A129. Patient experience a stressor; and then has symptoms; voluntary muscle; or sensory control

Front 130

Q130. Classical conversion disorder?

Back 130

A130. Patient hears something bad and can't hear; patient sees something terrible and can't see; Patient wants to hit somebody in the head and becomes paralyzed

Front 131

Q131. What personalities are associated with conversion disorder?

Back 131

A131. dependent personality; passive-aggressive; antisocial; histrionic; young female low SES

Front 132

Q132. Psychiatric and physical symptoms?

Back 132

A132. neurological voluntary or sensory; usually paralysis (paresthesia); sensory mutism, blindness; Pseudoseizures

Front 133

Q133. What is a real clue for conversion disorder?

Back 133

A133. la belle indifference,; the beautiful indifference; the patient doesn't share; unconcerned about disorder

Front 134

Q134. What does identification or model?

Back 134

A134. knew someone that was paralyzed or blind; but patient doesn't hurt themselves; they don't hit themselves on walls

Front 135

Q135. Tx of conversion?

Back 135

A135. Psychotherapy; Also Amotal interview; Amobarbital; tells the truth; truth serum

Front 136

Q136. What is associated with conversion?

Back 136

A136. Malingering

Front 137

Q137. What is the difference of somatization vs. hypochondriasis patient?

Back 137

A137. the hypochondriasis says they have a headache and you do a MRI or CT scan normal; but they still believe they have a brain tumor

Front 138

Q138. What are the characteristics of hypochondriasis?

Back 138

A138. young patients; equal male/fem

Front 139

Q139. What is the age of onset of hypochondriasis?

Back 139

A139. 20-30 year old

Front 140

Q140. Tx of Patient with hypochondriasis?

Back 140

A140. Psychotherapy

Front 141

Q141. Somatoform pain disorder involves?

Back 141

A141. Pain

Front 142

Q142. Risk Factors/Etiology?

Back 142

A142. Late in life; At least in 1 or more anatomic sites; pain is very distressing

Front 143

Q143. Etiology of pain?

Back 143

A143. psychological factors; often submitted to surgery

Front 144

Q144. Best Tx for Pain Somatoform?

Back 144

A144. BEST: Psychotherapy; Anti-depressants since patient have mood disorder; hypnosis, etc

Front 145

Q145. Differential Diagnosis for Pain Somatoform?

Back 145

A145. Muscle contraction; Headaches

Front 146

Q146. What is body dysmorphic disorder?

Back 146

A146. Patient who believes a part of his body is miss-shaped; defective, abnormal

Front 147

Q147. What do the body dysmorphic disorder search for professionally?

Back 147

A147. Plastic Surgeons; Michael Jackson; patients cover/hide their "deformities"; Usually young women

Front 148

Q148. What Neurotransmitter is linked to Body dysmorphic Disorder?

Back 148

A148. Serotonin

Front 149

Q149. What is the TX for body dysmorphic disorder?

Back 149

A149. SSRIs; plus psychotherapy (individualized)

Front 150

Q150. Symptom production?

Back 150

A150. Do you know as a patient where the symptoms are coming from

Front 151

Q151. What is symptom motivation?

Back 151

A151. What do you know/drives these symptoms forward

Front 152

Q152. Symptom production of somatoform?

Back 152

A152. Unconscious; No...

Front 153

Q153. Symptom motivation for somatoform?

Back 153

A153. No; Unconscious; not trying to lie or be deceitful

Front 154

Q154. Factitious Disorder?

Back 154

A154. Patients who have conscious productions of symptoms; medical or mental; faking both; fever, chills, pain, patient says it had blood in urine; (they will prick their finger when given pee cup)

Front 155

Q155. What is another factitious disorder case? mental

Back 155

A155. Patient says they hear voices; they want to be admitted to hospital and get treated; swallow glass, spoon, forks

Front 156

Q156. Factitious Disorder person?

Back 156

A156. Physician Assistant; Nurse or Pharmacist; Cardiologist (even if results are negative); Psychiatrists

Front 157

Q157. Patient history includes what?

Back 157

A157. Child abuse; Patient was sick a lot in childhood

Front 158

Q158. What is a common physical finding of factitious disorder?

Back 158

A158. typically dridiron abdomen from multiple surgeries

Front 159

Q159. What is a characteristic after being diagnosed?

Back 159

A159. they leave to another hospital; enraged; they will move to another state, city

Front 160

Q160. Doctor must be aware of what condition?

Back 160

A160. countertransference; since it is a patient nobody wants

Front 161

Q161. What personality is associated with factitious disorder?

Back 161

A161. Antisocial (they lie a lot); histrionic(need for attention); schizophrenia(bizarre behavior); malingering; Ganser Sx

Front 162

Q162. What is Ganser Syndrome involved in factitious disorder?

Back 162

A162. usually prison inmates; nearmissed answer to questions; what is the color of the sky? red; How many feet does a cat have? 8

Front 163

Q163. What is malingering characterized?

Back 163

A163. Usually mother that fakes all symptoms of the child; notice blood in urine; mother places blood (from prick on finger) in the urine cup to get admitted; Child Abuse; REPORT TO AUTHORITIES

Front 164

Q164. What is characteristic of malingering?

Back 164

A164. Injecting fecal matter in I.V. hitting children; suffocating them; place hidden cameras in patient room

Front 165

Q165. Is malingering conscious?

Back 165

A165. Yes; they don't know why; symptom production conscious; symptom motivation unconscious

Front 166

Q166. Risk Factors for malingering?

Back 166

A166. Malingering seen in prison; in order to get out of prison; factory and military settings also; to get out

Front 167

Q167. What are the physical and psychiatric symptoms?

Back 167

A167. complain a lot; exaggerate; they are preoccupied with gain rather than alleviation of symptoms

Front 168

Q168. Is malingering a mental disorder?

Back 168

A168. no; it is not a mental disorder

Front 169

Q169. Tx of Malingering?

Back 169

A169. not a mental disorder; so must avoid confronting the patient; anger the patient; establish patient-relation

Front 170

Q170. Malingering?; Production?; Motivation?

Back 170

A170. Production conscious; Motivation conscious; intentional; patient wants to deceive you

Front 171

Q171. What do you look in the question for somatoform dis.?

Back 171

A171. no alteration of physical; work-up tests negative

Front 172

Q172. What must be present in malingering?

Back 172

A172. lawsuit; avoiding prison; trying to get out of military; look for a gain

Front 173

Q173. What must be present in factitious dis.?

Back 173

A173. Physical findings; or Psychological Findings; will find glucose or blood in urine

Front 174

Q174. If the question says lost of symptoms? If it is just pain?

Back 174

A174. Somatization; pain disorder

Front 175

Q175. if you complain of only one part of your body?

Back 175

A175. body dysmorphic

Front 176

Q176. if patient has some traumatic experience and then develops symptoms?

Back 176

A176. conversion disorder

Front 177

Q177. if patient thinks he's got an illness and still not convinced even after surgical/tests done?

Back 177

A177. hypochondriasis

Front 178

Q178. Impulses vs. compulsive?

Back 178

A178. Impulse you feel ok after you do it - egosyntonic; Compulsive you feel terrible afterward... egodystonic

Front 179

Q179. What Neurotransmitter is involved with impulses?

Back 179

A179. Serotonin; very violent behavior

Front 180

Q180. Patient with intermittent explosive disorder? (IED)

Back 180

A180. Reaction is out of proportion; Driving and a cab cuts you off; Patient says that he injured somebody's neck because someone took his potato chips

Front 181

Q181. What sex is IED seen?

Back 181

A181. men

Front 182

Q182. What is in a patient history of IED?

Back 182

A182. Head Trauma History

Front 183

Q183. What are the levels of neurotransmitters in IED?

Back 183

A183. Linked to low levels of serotonin; low level of 5-HIAA; abnormalities of lymbic system

Front 184

Q184. As the years progress what happens to IED?

Back 184

A184. Symptoms become better

Front 185

Q185. Tx of Patients with I Explosive Disorder?

Back 185

A185. anticonvulsant; antipsychotics; beta blockers; SSRIs some what helpful; group psychotherapy

Front 186

Q186. Differential Diagnosis of IED?

Back 186

A186. Epilepsy; Brain Tumors; Endocrine Disorder

Front 187

Q187. What personality disorder is a differential diagnosis?

Back 187

A187. Antisocial; Borderline; Schizophrenia; Substance Intoxication; all lead to violent behavior

Front 188

Q188. What other condition is associated with kleptomania?

Back 188

A188. Bulimia strongly associated

Front 189

Q189. What is a personality disorder?

Back 189

A189. maladaptive pattern of behavior; behavior done all of our life; Patient doesn't think he has a problem

Front 190

Q190. Are personality Disorders egosyntonic or egodystonic?

Back 190

A190. Egosyntonic; that's why suggesting treatment to them is not successful; patients don't want to be treated

Front 191

Q191. When do you usually diagnose a personality disorder?

Back 191

A191. adulthood; since personality still changing

Front 192

Q192. Which is the only personality disorder that you need to give this person after 18?

Back 192

A192. Antisocial after 18; Conduct Disorder if younger than 18

Front 193

Q193. Cluster A is what?

Back 193

A193. Eccentric; Peculiar; Weird

Front 194

Q194. What is cluster B?

Back 194

A194. Theatrical; Dramatic/Emotional; Dissociative; Forget their name, who they are; Preoccupation with rejection

Front 195

Q195. What is cluster C?

Back 195

A195. Anxious or Fearful cluster; Sensitive to rejection; Rigid (their way or the highway)

Front 196

Q196. What is a higher prevalence in Male PDs?

Back 196

A196. antisocial; narcisitic; adulthood only; others can be diagnosed in adolescence

Front 197

Q197. What PD is mostly seen in women?

Back 197

A197. borderline; histrionic

Front 198

Q198. What happens to the mood disorders in adulthood?

Back 198

A198. they get worse

Front 199

Q199. What happens to symptoms for violent behavior as the patient reaches adulthood and gets older?

Back 199

A199. they get better with time

Front 200

Q200. What is the Tx for PDs?

Back 200

A200. Psychotherapy; individual; if psychotherapy not working; anxious (anti-anxiety); depression (anti-depressant)

Front 201

Q201. Diff. Diagnosis for PDs?

Back 201

A201. Mood disorder; Adjustment Disorder

Front 202

Q202. What is the defense mechanism of paranoid personality Disorder?

Back 202

A202. projection

Front 203

Q203. What is common among paranoid?

Back 203

A203. Immigrants; Deaf people

Front 204

Q204. What is the difference between paranoid and schizophrenia?

Back 204

A204. 3 things to focus; duration of symptoms; level of functioning; psychosis; personality disorder is a long time; level of function is normal in PDs; Psychosis in PDs is not present

Front 205

Q205. What is schizoid personality?

Back 205

A205. Loner; Person who goes to movies, vacation by themselves

Front 206

Q206. Where do the schizoid's work?

Back 206

A206. night jobs; park ranger; lab work

Front 207

Q207. What is schizotypal?

Back 207

A207. most strange; resembles to schizophrenia; dress, talk, think, looks; is strange

Front 208

Q208. What is the difference between schizotypal vs. schizophrenic?

Back 208

A208. schizotypal all their life with symptoms; when stressor is maximal they become psychotic; schizophrenics very seldom recover from their psychosis to normal

Front 209

Q209. What problems do schizotypal PD have?

Back 209

A209. social relationships; thought distortions; eccentric; isolated

Front 210

Q210. What are the clues of schizotypal?

Back 210

A210. magical thinking; magical caps (lucky pencil); lucky shirt

Front 211

Q211. What is a common symptom of schizotypal?

Back 211

A211. Illusions; misperceive things

Front 212

Q212. What is Illusion vs. hallucination?

Back 212

A212. sensory stimuli in Illusion

Front 213

Q213. Histrionics what class?

Back 213

A213. Cluster B; dramatic and emotional cluster

Front 214

Q214. What is characteristic of histrionics?

Back 214

A214. Over the top; very colorful, exaggerated talking, dress, behavior; want to be the center of attention; Sexually Seductive

Front 215

Q215. What is the borderline personality?

Back 215

A215. very unstable; problem with affect; impulsive; use drugs, sexually promiscuous, gambling; mood swings

Front 216

Q216. What is very characteristic of borderline PDs?

Back 216

A216. Chronic feelings of emptiness or boredom; Emotional numbness; clue for suicidal gestures; women who constantly cut themselves; wants to feel pain

Front 217

Q217. What is in the history of borderline PDs?

Back 217

A217. child abuse; splitting; Fatal Attraction

Front 218

Q218. Psychotic or Neurotic?

Back 218

A218. Psychotic you loose sense of reality; Borderlines go back after having a brief episode of psychosis

Front 219

Q219. What is the characteristic of antisocial?

Back 219

A219. don't care about the rules; egodystonic; ignore rules; lie and steal

Front 220

Q220. Is antisocial inherited?

Back 220

A220. Yes, superEgo; usually one parent also antisocial

Front 221

Q221. What is the last one in the cluster B?

Back 221

A221. Narcissistic PD; they are the best; smartness, brightest; convinced they are special

Front 222

Q222. Narcissistic expects what?

Back 222

A222. admiration; want special treatment; don't accept criticism; when they get older they get depressed; fragile self-esteem; actors; Physicians (neurosurgeon)

Front 223

Q223. What does Cluster C involved?

Back 223

A223. Fearful; Anxious

Front 224

Q224. What is the first personality of Cluster C?

Back 224

A224. Avoidant; not go getters; restrained in relationships

Front 225

Q225. What is the main issue of avoidant PDs?

Back 225

A225. afraid of rejection; avoid all kinds of rejection; phobias: social; restraint in everything; sensitive to criticism

Front 226

Q226. If patient with criticism:; 1) angry; 2) don't care; 3) freak out/very depressed/ very sensitive

Back 226

A226. Dx?; 1) Narcissistic; 2) Schizoid; 3) Avoidant

Front 227

Q227. What is the difference between schizoid vs. avoidant?

Back 227

A227. Schizoid wants to be alone; Avoidant is alone because they feel inadequate and don't want to be rejected

Front 228

Q228. Another PD in cluster C?

Back 228

A228. Dependant Personality; In abusive relationships; can't be alone; need to be told what to do; subordinate; constantly need advice

Front 229

Q229. What happens when they get a promotion?

Back 229

A229. they don't want it; don't want to assume responsibility; woman beaten by husband; they are unable to make decisions/make it on their own

Front 230

Q230. What is characteristic of dependant disorder?

Back 230

A230. Classic abusive relationship

Front 231

Q231. What is the obsessive compulsive development?

Back 231

A231. anal retentive; anally fixated; orderly; Perfectionistic; in control; class assignment (excellent); i'll do all the work; they make lists for everything

Front 232

Q232. What are associated features with obsessive compulsive?

Back 232

A232. indecisive; dysphoria (sad, mood down); angry; social inhibition; problem with interpersonal

Front 233

Q233. Do not confuse Obsessive compulsive Disorder than obsessive compulsive personality disorder (behavior)?

Back 233

A233. Person riddled with obsession; linked to serotonin; OCD they were normal before then develop disease; Pharmacotherapy; people with OCD don't function; People with OCPD (obsessive personality disorder) disorder function since Adolescence; Tx: Psychotherapy

Front 234

Q234. Tx for OCPD?

Back 234

A234. Psychotherapy

Front 235

Q235. Tx for OCD?

Back 235

A235. Pharmacotherapy

Front 236

Q236. What is sexual identity?

Back 236

A236. based on person's sexual characteristics; genitalia external/internal; objective

Front 237

Q237. What is gender identity?

Back 237

A237. has nothing to do with packet; from the neck up; inside your head; what you think you are; subjective; by age 3

Front 238

Q238. Who determines gender identity?

Back 238

A238. The parents; they dress you like a boy; or they dress you like a girl

Front 239

Q239. What is gender role?

Back 239

A239. Based on external behavior; reflect the person's inner sense of gender identity; act like a boy

Front 240

Q240. What is sexual orientation?

Back 240

A240. who you choose to love; object; heterosexual; homosexual; bisexual; asexual

Front 241

Q241. Is there excessive masturbation?

Back 241

A241. only if it interferes with normal everyday life

Front 242

Q242. What is Homosexuality?

Back 242

A242. variant of human sexuality

Front 243

Q243. What causes homosexuality?

Back 243

A243. genetics; monocygotic twins 50%; greater than dizygotic

Front 244

Q244. What is more stable?

Back 244

A244. female more stable homosexual relations

Front 245

Q245. Do homosexuals have more mental illnesses?

Back 245

A245. NO. No higher incidence of Pedophilia

Front 246

Q246. What is the definition of paraphilias?

Back 246

A246. recurrent sexual arousing from:; 1) humiliation/suffering; 2) nonliving objects; 3) non-consenting partners

Front 247

Q247. How long do paraphilias last?

Back 247

A247. more than 6 months

Front 248

Q248. What is characteristic in the life of paraphilias?

Back 248

A248. they become impaired in their level of functioning; loose their jobs, etc...

Front 249

Q249. What is exhibitionist?

Back 249

A249. expose oneself to strangers

Front 250

Q250. What is fetishism?

Back 250

A250. use of nonliving objects usually associated with the human body; panties, shoes

Front 251

Q251. What is a frotteurism?

Back 251

A251. rubs himself against another nonconsenting partners

Front 252

Q252. What is the MC paraphilia?

Back 252

A252. pedophilia

Front 253

Q253. What is pedophilia?

Back 253

A253. urges or arousal toward prepubescent; age <16

Front 254

Q254. What if person has sex with >16 yo?

Back 254

A254. statutory rape

Front 255

Q255. What is a voyeurism?

Back 255

A255. pepping tom; observing an unsuspecting person who is engagin in sexual activity, disrobing

Front 256

Q256. What is a Masocichst? and Sadist?

Back 256

A256. Masochist involves in inflicting pain/humiliation; sadist is the one who receive the inflicting pain

Front 257

Q257. What is transvestic fetishism?

Back 257

A257. cross-dressing

Front 258

Q258. What sexual tendency is seen in transvestite fetishism?

Back 258

A258. heterosexual men

Front 259

Q259. What is the Tx for paraphilia?

Back 259

A259. Antiandrogens; also SSRIs

Front 260

Q260. What is the MCC of periodical middle age man impotence?

Back 260

A260. Alcohol

Front 261

Q261. MCC of psychological impotence?

Back 261

A261. Fear of failure; man is afraid of not getting the erection

Front 262

Q262. MC Medical cause of impotence?

Back 262

A262. Diabetes M.

Front 263

Q263. What do old anti-psychotic drugs attach to?

Back 263

A263. D2

Front 264

Q264. Newer anti-psychotic drugs bind to what?

Back 264

A264. D4

Front 265

Q265. What do old anti-psychotic drugs SIDE EFFECT?

Back 265

A265. block muscarinic receptors: dry mouth, blurry vision, urinary retention, confusion, hallucination

Front 266

Q266. What other Symptoms Do you expect with histamine block?

Back 266

A266. sedation and weight gain

Front 267

Q267. What symptoms Do you get with alpha block?

Back 267

A267. orthostatic hypotension

Front 268

Q268. What are the older antipsychotics?

Back 268

A268. -

Front 269

Q269. What antipsychotic gives your retinitis pigmentosa?

Back 269

A269. thioridizine eye

Front 270

Q270. What happens when you block the mesolimbic tract?

Back 270

A270. reduce psychotic symptoms

Front 271

Q271. What happens when you block nigrostriatal block?

Back 271

A271. increase tremors, Parkinson’s EPS symptoms!

Front 272

Q272. What tract does clozapine block?

Back 272

A272. Mesolimbic Tract

Front 273

Q273. What does a block in the tuberoinfundibilar block?

Back 273

A273. no galactorrhea, gynecomastia, amenorrhea

Front 274

Q274. Patient with psychotic, what tx?

Back 274

A274. olanzapine (atypical any)

Front 275

Q275. If all other drugs fail what is next tx?

Back 275

A275. clozapine (agranulocytosis be careful)

Front 276

Q276. If patient Is noncompliant?

Back 276

A276. 1st choice haloperidol or fluphenazine depot decanoid form

Front 277

Q277. Patient Is agitated?

Back 277

A277. use IM forms (typicals)

Front 278

Q278. How do antipsychotic medication work?

Back 278

A278. block dopamine receptors; old D2; new D4

Front 279

Q279. What do new antipsychotics work as well as D4?

Back 279

A279. they work on serotonin as well; 5HT3

Front 280

Q280. What are some other effects of antipsychotics?

Back 280

A280. 1) block central and peripheral cholinergic receptors; 2) histaminic block; 3) alpha-block

Front 281

Q281. What are the symptoms of muscarinic block?

Back 281

A281. urinary retention; dry mouth; blurry vision; constipation; confusion; hallucinations

Front 282

Q282. If you are going to prescribe to the elderly what do you avoid?

Back 282

A282. avoid drugs with muscarinic block

Front 283

Q283. Where do new antipsychotics work on?

Back 283

A283. D4 more and also serotonin 5HT3

Front 284

Q284. What do antipsychotics block?

Back 284

A284. muscarinic block, alpha block, histamine block

Front 285

Q285. What is an important SIDE EFFECT of antipsychotics?

Back 285

A285. sedation and weight gain (histamine blockade); hypotension (alpha block); dry mouth, urinary retention, constipation, confused, blurry vision (muscarinic block)

Front 286

Q286. Where do antipsychotics work on?

Back 286

A286. Dopamine; D2 and D4 receptors; Old work on D2; new on D4

Front 287

Q287. What are the side-effects of histamine blockade?

Back 287

A287. weight gain and sedation

Front 288

Q288. What do you find with alpha blockade?

Back 288

A288. hypotension; so be careful on the elderly; they might fall and break a hip

Front 289

Q289. Main groups for antipsychotics?

Back 289

A289. typicals D2 antagonists only low-potency: Clopromazine; High-potency: Haloperidol; old drugs D2: Haloperidol, Thioridazine, Olanzapine, fluphenazine; new drugs Risperidone

Front 290

Q290. Of the newer drugs, which one of these cause movement side effects of antipsychotics? EPS symptoms?

Back 290

A290. Risperidone is the answer

Front 291

Q291. WHat are the multiple receptor antagonist work on?

Back 291

A291. D2, D4 and Serotonin 5HT

Front 292

Q292. What are the new antipsychotics multiple receptors?

Back 292

A292. clozapine; olanzapine; quetiapine

Front 293

Q293. What does the D2 blockade cause?

Back 293

A293. EPS symptoms

Front 294

Q294. What decreases EPS symptoms?

Back 294

A294. D4 receptors

Front 295

Q295. What are the indications of antipsychotics?

Back 295

A295. E.R. patients get agitated

Front 296

Q296. Which one in the E.R. antipsychotics?

Back 296

A296. Haloperidol; since it comes in I.V. high-potency; easier to give them a shot

Front 297

Q297. DOC for schizophrenia?

Back 297

A297. antipsychotics

Front 298

Q298. Tx for agitation for schizophrenia, mood disorders, psychoses, delusional disorders, brief psychotic disorders, schizophreniform disorder?

Back 298

A298. antipsychotics

Front 299

Q299. Why do you avoid giving elderly diazepam?

Back 299

A299. makes them more confused; problems with their memory

Front 300

Q300. What is another name for Dopamine?

Back 300

A300. Prolactin Inhibitory Factor; PIF

Front 301

Q301. What happens when you inhibit dopamine with antipsychotics?

Back 301

A301. PIF is not there; so prolactin goes up

Front 302

Q302. What happens when prolactin goes up?

Back 302

A302. galactorrhea, gynecomastia, amenorrhea

Front 303

Q303. What does dopamine block?

Back 303

A303. tuberoinfundibular tract; mesolymbic / mesocortical tract; nigrostriatal tract; all involved

Front 304

Q304. What happens when you block tuberoinfundibular block?

Back 304

A304. prolactin increases

Front 305

Q305. What are other SIDE EFFECT of the older antipsychotics?

Back 305

A305. photosensitivity; Retinitis pigmentosa

Front 306

Q306. What antipsychotics produces retinitis pigmentosa?

Back 306

A306. thioridizine

Front 307

Q307. What are other problems with thioridazine?

Back 307

A307. cardiac conduction problems

Front 308

Q308. What are SIDE EFFECT of clozapine?

Back 308

A308. agranulocytosis

Front 309

Q309. What happens when dopa blocks mesolymbic tract?

Back 309

A309. reduce psychotic symptoms; decrease psychosis

Front 310

Q310. What happens when you block nigrostriatal tract?

Back 310

A310. increase in movement disorders; tremors, Parkinsonian disease

Front 311

Q311. What does clozapine block?

Back 311

A311. mesolimbic; no EPS (nigrostriatal); no amenorrhea, no galatorrhea, no gynecomastia (tuberinfundibular)

Front 312

Q312. Does clozapine cause amenorrhea, galactorrhea, gynecomastia, EPS symptoms?

Back 312

A312. NO!; only blocks mesolimbic tract; reducing psychosis

Front 313

Q313. What are the types of movement disorders?

Back 313

A313. acute dystonia; parkinsonism; tardive dyskinesia

Front 314

Q314. Which movement disorder is the first one to appear?

Back 314

A314. acute dystonia

Front 315

Q315. When does acute dystonia appear?

Back 315

A315. occurs within hours or days of treatment; patients get really scared

Front 316

Q316. Why do patients get scared with acute dystonia?

Back 316

A316. its a muscle spasms; cant' move

Front 317

Q317. What happens to Ach when Dopamine is high?

Back 317

A317. Ach decreases; antagonists

Front 318

Q318. What are first choice drugs of psychosis?

Back 318

A318. Olanzapine,; Quetiapine,; Ziprasidone

Front 319

Q319. What are the SIDE EFFECT of Olanzapine, quetiapine, ziprasidone?

Back 319

A319. Weight gain and sedation

Front 320

Q320. What is the SIDE EFFECT of clozapine?

Back 320

A320. agranulocytosis

Front 321

Q321. What are the SIDE EFFECT of ziprasidone?

Back 321

A321. prolongation of QT interval

Front 322

Q322. What patients have a contraindication of ziprasidone?

Back 322

A322. arrhythmias

Front 323

Q323. What are the SIDE EFFECT of Olanzapine and Clozapine?

Back 323

A323. Cause Diabetes

Front 324

Q324. What patients have a contraindication of Olanzapine/Clozapine?

Back 324

A324. DM

Front 325

Q325. What antipsychotics are used to tx non-compliant patients?

Back 325

A325. haloperidol and fluphenazil

Front 326

Q326. Why do haloperidol and fluphenazil are prolonged in their action?

Back 326

A326. they have the decanoid form; I.M. deposit

Front 327

Q327. Is Tardive Dyskinesia reversible or irreversible for Step 2 USMLE?

Back 327

A327. Irreversible

Front 328

Q328. Antidepressants are used to Tx what?

Back 328

A328. Mood disorders, adjustment disorders, psychotic disorders

Front 329

Q329. What are other uses for antidepressants?

Back 329

A329. anxiety disorders; bulimia

Front 330

Q330. Why is anxiety treated with antidepressants?

Back 330

A330. use same neurotransmitter

Front 331

Q331. What percentage of patient with depression have anxiety?

Back 331

A331. 90% of the patients have anxiety with depression

Front 332

Q332. Why are antidepressants used to tx bulimia?

Back 332

A332. act on same neurotransmitter; serotonin

Front 333

Q333. Why do antidepressants work on impulse control disorders?

Back 333

A333. serotonin

Front 334

Q334. What are amitriptyline of TCA (tricyclics) commonly used for?

Back 334

A334. Enuresis

Front 335

Q335. If the patient has depression he will surely have?

Back 335

A335. anxiety

Front 336

Q336. What is used for chronic pain?

Back 336

A336. amitriptyline

Front 337

Q337. Why is amitriptyline used for chronic pain?

Back 337

A337. amitriptyline increases endorphins; increase endogenous opiates; patients complain less of pain

Front 338

Q338. Which ones are dangerous in OD?

Back 338

A338. specially TCA

Front 339

Q339. Patient comes after OD of TCA, what do they need to be attached to?

Back 339

A339. cardiac monitor; causes conduction problems

Front 340

Q340. What is the effect/toxicity of TCAs Overdose?

Back 340

A340. heart conduction problems

Front 341

Q341. How do TCAs work?

Back 341

A341. block the reuptake of neurotransmitter (serotonin and NE, and dopamine); work by down regulation of beta adrenergic receptors

Front 342

Q342. How do the MAO inhibitors work?

Back 342

A342. work on the enzyme that metabolizes Serotonin, NE, Dopa; doesn't break down the neurotransmitters; so more NE, Ser, DOPA

Front 343

Q343. Where do the SSRIs work?

Back 343

A343. they only block the reuptake of serotonin

Front 344

Q344. Why do you choose an SSRI instead of TCA or MAO?

Back 344

A344. because of less SIDE EFFECT

Front 345

Q345. What is the first line of antidepressants?

Back 345

A345. SSRIs; cleaner, patient like it, less SIDE EFFECT

Front 346

Q346. What other receptors are blocked with TCAs?

Back 346

A346. muscarinic receptors are blocked

Front 347

Q347. What do you expect with the TCA muscarinic block?

Back 347

A347. sedation; dry mouth; blurry vision; urinary retention

Front 348

Q348. What are other two receptors that TCA block?

Back 348

A348. Histamine and alpha receptors

Front 349

Q349. What happens when you give TCAs and block alpha receptors?

Back 349

A349. hypotension

Front 350

Q350. What happens when you give TCAs and block histamine?

Back 350

A350. sedation and weight gain

Front 351

Q351. Which TCA is the worst cause it gives you the most SIDE EFFECT?

Back 351

A351. amitriptyline; takes you on a bad trip!

Front 352

Q352. What patient would be a relative contraindication for giving him amitriptyline?

Back 352

A352. 90 yo, demented, with glaucoma, and prostathic hyperthrophy... why? hypotension, urinary retention, blurry vision (might fall)

Front 353

Q353. TCA stands for?

Back 353

A353. T for upTake blocker; T is for hisTamine blocker; C is for musCarinic blocker; A is for alpha blocker

Front 354

Q354. Which drugs are the fastest of the TCAs?

Back 354

A354. nortryptiline and disipramine; less SIDE EFFECT

Front 355

Q355. What are antidepressants used for?

Back 355

A355. Tx: depression,; depression in Bipolar Dis. ALL anxiety dis.

Front 356

Q356. What is the efficacy of antidepressants?

Back 356

A356. 70%

Front 357

Q357. Which drugs are used first?

Back 357

A357. Newer ones; SSRIs

Front 358

Q358. Which antidepressants are more dangerous?

Back 358

A358. usually older ones; TCAs; more SIDE EFFECT

Front 359

Q359. How long do we keep patients before we know the antidepressants are working?

Back 359

A359. they start working until 4-6 weeks

Front 360

Q360. What is the MCC of drug failure?

Back 360

A360. the time doctors try the drugs less than 4-6 weeks. Need to maximize doze and maximize dose switching

Front 361

Q361. When do you stop antidepressants?

Back 361

A361. if SIDE EFFECT are not tolerated by patient

Front 362

Q362. If you have a patient not responding you need to give another medication in order to boost 1st antidepressants?

Back 362

A362. Lithium or Thyroxine; or even Amphetamine like drugs

Front 363

Q363. How long do we keep patients on antidepressants?

Back 363

A363. Tx should continue for 6 months to 1 year; since they relapse

Front 364

Q364. What antidepressant drugs cause the most sedation?

Back 364

A364. Doxapine, amytriptiline, trazodone

Front 365

Q365. What is the use of doxapine and trazodone?

Back 365

A365. give it to patients at night so they can sleep; causes sedation; (antidepressant)

Front 366

Q366. Which antidepressants cause less sedation?

Back 366

A366. Cleaner ones, newer less SIDE EFFECT; Desipramine, protrityline and SSRIs

Front 367

Q367. Which antidepressant causes most Hypotension?

Back 367

A367. TCAs

Front 368

Q368. Which TCA causes the most hypotension?

Back 368

A368. amitriptyline

Front 369

Q369. Which is Best TCA for antidepressants?

Back 369

A369. Nortriptyline and Desipramine

Front 370

Q370. Which antidepressant drug has the worst anticholinergic?

Back 370

A370. amitriptyline

Front 371

Q371. Which antidepressant has less anticholinergic effects?

Back 371

A371. nortriptyline and desipramine; also SSRIs since they only work on serotonin

Front 372

Q372. What do you have to remember about the TCAs and the heart?

Back 372

A372. prolong the QRS interval; need to do a EKG

Front 373

Q373. What is the effects of antidepressant and seizures?

Back 373

A373. lower the seizure threshold

Front 374

Q374. Which TCA causes the most seizures?

Back 374

A374. maprotaline

Front 375

Q375. Does bupoprion cause seizures?

Back 375

A375. no

Front 376

Q376. Do women with bulimia have a high incidence of seizures?

Back 376

A376. yes

Front 377

Q377. Do antidepressants cause sexual dysfunction?

Back 377

A377. yes all of them cause

Front 378

Q378. What are the sexual dysfunction SIDE Effects caused by antidepressants?

Back 378

A378. anorgasmia; decrease libido; delayed ejaculation; priapism

Front 379

Q379. What antidepressant causes anorgasmia and decrease libido? also delayed ejaculation

Back 379

A379. SSRIs

Front 380

Q380. What antidepressant causes priapism?

Back 380

A380. trazodone

Front 381

Q381. Which one of the SSRIs causes less sexual dysfunction?

Back 381

A381. citalopram; bupoprion

Front 382

Q382. What is priapism?

Back 382

A382. prolonged and painful erections

Front 383

Q383. What are the SSRIs?

Back 383

A383. Fluoxetine; Paroxetine; Sertraline; Fluvoxamine; Citalopram

Front 384

Q384. SSRI with least sexual SIDE EFFECT?

Back 384

A384. citalopram

Front 385

Q385. Why are SSRIs used to Tx OCD?

Back 385

A385. serotonin involved; panic as well as bulimia

Front 386

Q386. What are the SIDE EFFECT of SSRIs?

Back 386

A386. patient agitation

Front 387

Q387. What do you tell a patient that gets agitated when taking SSRI?

Back 387

A387. tell them to take it at night

Front 388

Q388. What if a patient feels sedation of SSRIs?

Back 388

A388. take the SSRI at night to take advantage of the SIDE EFFECT

Front 389

Q389. What are all the SIDE EFFECT of SSRI?

Back 389

A389. agitation; sedation; diarrhea; nausea; sexual dysfunction

Front 390

Q390. What is trazodone called?

Back 390

A390. heterocyclic antidepressant; off shoot of TCA family; used for its sedation effect; used in insomnia

Front 391

Q391. Where does fenazodome works?

Back 391

A391. NE and serotonin; more like an SSRIs

Front 392

Q392. What is bupoprion used for tx what age patients?

Back 392

A392. older patients less SIDE EFFECT

Front 393

Q393. What neurotransmitter is involved when using Bupoprion?

Back 393

A393. dopamine

Front 394

Q394. What is bupoprion similar to?

Back 394

A394. Zyban; used as Wellbutrin; dose is different

Front 395

Q395. Why is dopamine associated with smoking cessation?

Back 395

A395. Dopamine is linked to reward centers; endorphins; decrease the pleasure

Front 396

Q396. What is bupoprion use to Tx?

Back 396

A396. smoking cessation

Front 397

Q397. What drug blocks the pleasure of alcohol?

Back 397

A397. naltrexone

Front 398

Q398. What is venlafaxine similar to?

Back 398

A398. SSRI

Front 399

Q399. What is mirtazapine similar to and SIDE EFFECT?

Back 399

A399. SSRI; lots of Sedation

Front 400

Q400. What are TCAs divided into?

Back 400

A400. tertiary and secondary

Front 401

Q401. What are the tertiary TCAs?

Back 401

A401. imipramine; amitriptyline; doxepin; clomipramine; trimipramine

Front 402

Q402. What are the secondary TCAs?

Back 402

A402. desipramine; nortriptyline; protriptyline

Front 403

Q403. What happens when imipramine is broken down from its tertiary form?

Back 403

A403. it converts into its active form desipramine secondary form

Front 404

Q404. When amitriptyline breaks down, what does it form?

Back 404

A404. nortriptyline; the secondary active form

Front 405

Q405. Which ones are cleaner talking about SIDE EFFECT between tertiary and secondary?

Back 405

A405. secondary don't have that many SIDE EFFECT since they are the active form of the drug; no intermediates; less SIDE EFFECT

Front 406

Q406. What is a problem for all TCAs?

Back 406

A406. they have a therapeutic window; the drug has to fall within range to be effective

Front 407

Q407. What is the efficacy of TCA drugs?

Back 407

A407. mood disorders

Front 408

Q408. Which drug can be used to tx panic?

Back 408

A408. imipramine

Front 409

Q409. What is clomipramine used for?

Back 409

A409. OCD; works most on serotonin

Front 410

Q410. What is amytriptyline used for?

Back 410

A410. Chronic Pain

Front 411

Q411. Why are MAOIs are not used in a regular basis?

Back 411

A411. Can't eat foods rich in Tyramine; will cause a reaction of increase blood pressure

Front 412

Q412. What foods should you avoid if taking MAOIs?

Back 412

A412. - red wine; aged cheeses; chocolate; sausages; nuts; pickled products; herring; white wine ok, processed cheeses ok

Front 413

Q413. What is the best tx for depression?

Back 413

A413. ECT

Front 414

Q414. Is ECT the MC tx for depression?

Back 414

A414. no

Front 415

Q415. Why is ECT not used as first line for depression?

Back 415

A415. nobody wants ECT

Front 416

Q416. When is ECT prescribed?

Back 416

A416. severely depressed/suicidal tendencies; 1)patient still tries to kill himself; 2) patient has not responded on TCA,MAIO, Lithium, Amphetamine like drugs

Front 417

Q417. Is ECT used only for depression?

Back 417

A417. no, also:; schizophrenia

Front 418

Q418. In synthesis when do you use ECT?

Back 418

A418. typically when all other conventional therapies have failed

Front 419

Q419. Are there any absolute contraindications of ECT use?

Back 419

A419. none

Front 420

Q420. What is the only situation you have to be careful with the use of ECT?

Back 420

A420. only in a case of increase intracranial pressure; since ECT increase pressure

Front 421

Q421. What is another case in a patient with depression which you might be inclined to use ECT?

Back 421

A421. when the patient has received ECT previously with success

Front 422

Q422. What is the only problem with ECT?

Back 422

A422. some memory loss

Front 423

Q423. What is the characteristic of the memory loss with ECT?

Back 423

A423. transient

Front 424

Q424. What does transient memory loss mean?

Back 424

A424. when the Tx is over, your memory comes back

Front 425

Q425. What are some of the complications of ECT?

Back 425

A425. anesthesia; induced paralysis

Front 426

Q426. Do you need a seizure in order for ECT to work?

Back 426

A426. no

Front 427

Q427. What is the typical course of ECT?

Back 427

A427. 10-15 treatments

Front 428

Q428. What tests are done before ECT administration?

Back 428

A428. CT-scan; rule out tumors that increase intracraneal pressure; x-rays of bodies (fractures that haven't healed)

Front 429

Q429. What are the mood stabilizer medications?

Back 429

A429. lithium (bipolar); divalproex; carbamazepine; topiramate; lamotrigine; gabapentine

Front 430

Q430. What are some of the symptoms treated with mood stabilizers?

Back 430

A430. Bipolar; impulse control disorder; violence/agitation/agression/impatience

Front 431

Q431. What are the indications of lithium?

Back 431

A431. bipolar disorder; schizoaffective disorders; also mood disorders; (augment response to medication)

Front 432

Q432. What is lithium not perfect?

Back 432

A432. Has a narrow margin or safety

Front 433

Q433. What does narrow margin of safety mean?

Back 433

A433. constantly have to monitor lithium in blood; check blood levels since it could become toxic/lethal

Front 434

Q434. What is the most common SIDE EFFECT of lithium?

Back 434

A434. tremor, shaking; diarrhea; headaches; worsen acne; gain weight; conduction problems

Front 435

Q435. What test is essential to perform before administering lithium?

Back 435

A435. TSH before starting lithium

Front 436

Q436. What are other major SIDE EFFECT of Lithium?

Back 436

A436. leukocytosis; polyuria; polydipsia; Nephrogenic DI

Front 437

Q437. What is the most important SIDE EFFECT for Lithium?

Back 437

A437. teratogenic; cardiac malformations

Front 438

Q438. What are the teratogenic effects of lithium on the fetus?

Back 438

A438. cardiac malformations; Epstein’s anomaly; (tricuspid valve affected)

Front 439

Q439. What test do you give a woman that is young and needs to start lithium Tx?

Back 439

A439. Test pack; pregnancy test

Front 440

Q440. What advice do you give the female patient if they are on lithium?

Back 440

A440. make sure not to get pregnant while on lithium; if she does get pregnant she should stop lithium immediately

Front 441

Q441. What is the therapeutic index of lithium?

Back 441

A441. 0.6-1.3 or 1.5; you should keep it at 1; the higher the dose, the higher the SIDE Effects

Front 442

Q442. What is a recommendation to ALL patients on Lithium?

Back 442

A442. drinks lots of fluids; if patient becomes dehydrated, then toxic levels may accumulate in plasma; hyponatremia increases toxicity; lithium follows sodium

Front 443

Q443. What is the Tx of Choice for Lithium at toxic levels above 2.0?

Back 443

A443. Dialysis

Front 444

Q444. What are some SIDE EFFECT of lithium at high doses?

Back 444

A444. Seizures/Coma; Ataxia

Front 445

Q445. What is one of the first indications that lithium levels are high?

Back 445

A445. gait disturbances (Ataxia)

Front 446

Q446. What is valproex used for?

Back 446

A446. bipolar; rapid cyclers (within days); mania/depression

Front 447

Q447. When do you use valproex?

Back 447

A447. - when lithium is not working; when lithium is contraindicated (ie. thyroid disease)

Front 448

Q448. How many days does valproex take to reach desired effect?

Back 448

A448. 10-14 days

Front 449

Q449. What are the SIDE EFFECT of divalproex?

Back 449

A449. sedation; cognitive impairment; tremors (like lithium); GI disturbances

Front 450

Q450. What is the difference in toxicity of valproex?

Back 450

A450. hepatotoxicity; lithium (nephrotoxic)

Front 451

Q451. What test do you request before administering divalproex?

Back 451

A451. liver function tests; hepatic function panel

Front 452

Q452. What is the teratogenicity of valproex?

Back 452

A452. Spina Bifida; shape of the letter V

Front 453

Q453. What is second line of bipolar?

Back 453

A453. carbamazepine; also valproate (divalproex)

Front 454

Q454. Tx of Choice for bipolar disorder?

Back 454

A454. Lithium (if lithium not there divalproex); last resort carbamazepine

Front 455

Q455. What toxicity does carbamazepine produce?

Back 455

A455. hepatic toxicity

Front 456

Q456. What are SIDE EFFECT of carbamazepine?

Back 456

A456. rashes; agranulocytosis

Front 457

Q457. What are two drugs that cause agranulocytosis?

Back 457

A457. carbamazepine and clozapine

Front 458

Q458. What are the other mood stabilizers?

Back 458

A458. lamotrigine; gabapentin; topiramate; not as effective

Front 459

Q459. What is different about topiramate?

Back 459

A459. helps patients reduce weight

Front 460

Q460. Patient comes in with mania... tx?

Back 460

A460. mood stabilizer; lithium

Front 461

Q461. If a patient has acute mania (emergency) can't wait two weeks to calm him down?

Back 461

A461. benzodiazepines; antipsychotic

Front 462

Q462. What are the anxiolytics?

Back 462

A462. benzodiazepines

Front 463

Q463. MOA of anxiolytics/benzodiazepines?

Back 463

A463. work on GABA receptors; open Cl- channels increasing the frequency

Front 464

Q464. What are other uses of benzodiazepines other than anxiety?

Back 464

A464. insomnia specially in the elderly

Front 465

Q465. Where does buspirone work?

Back 465

A465. buspirone maybe works on serotonin

Front 466

Q466. What is buspirone used for?

Back 466

A466. Generalized Anxiety Disorder (GAD); Social Phobias

Front 467

Q467. What is the Treatment for adjustment disorder? anxious

Back 467

A467. benzos with psychotherapy

Front 468

Q468. What is the Treatment for Panic Disorder? anxiety

Back 468

A468. Benzos, SSRIs

Front 469

Q469. What is the Treatment of OCD?

Back 469

A469. SSRIs

Front 470

Q470. What is MC used for social phobias?

Back 470

A470. SSRIs

Front 471

Q471. What do you adjust with the elderly on Treatment with benzos?

Back 471

A471. lower the dosage; sedation, memory problems, confusion

Front 472

Q472. What DDI (drug-drug interaction) is lethal with benzos?

Back 472

A472. alcohol; potentiates benzos; respiratory arrest (diaphragm paralysis)

Front 473

Q473. What is the problem with taking benzos?

Back 473

A473. Very Addictive

Front 474

Q474. What are the SIDE Effects of benzos?

Back 474

A474. sedation, memory problems, confusion; impairment of cognitive and motor performance; abuse; possible teratogenicity

Front 475

Q475. Is buspirone addictive?

Back 475

A475. no

Front 476

Q476. What is buspirone the DOC for?

Back 476

A476. GAD (generalized anxiety disorder)

Front 477

Q477. Patient alcoholic that needs to be placed on anti-anxiety medication?

Back 477

A477. then better to place him on buspirone since not addictive/no withdrawal symptoms; patient is going to drink and might have DDI with benzo+alcohol

Front 478

Q478. What is the only SIDE EFFECT of buspirone?

Back 478

A478. cabezon; complain some patients headache

Front 479

Q479. Tx for Depression? A) fluoxetine or b) nortriptiline?

Back 479

A479. fluoxetine; SSRI

Front 480

Q480. Tx for Depression?; Nortryptiline or Amitriptyline?

Back 480

A480. Nortriptyline; less SIDE EFFECT; safer

Front 481

Q481. Patient with bipolar disorder who has kidney problems?

Back 481

A481. not lithium; but valproic acid (metabolized in liver)

Front 482

Q482. What 3 test do you ask for if patient needs to start lithium?

Back 482

A482. Pregnancy Test; Thyroid (TSH); Kidney function; regular blood work

Front 483

Q483. Tx for panic disorder? general and specific...

Back 483

A483. any benzos but specifically alprazolam; ALPRAZOLAM (ZANAX)

Front 484

Q484. What drug is used for the prevention of alcohol withdrawal?

Back 484

A484. benzo... chlordiazepoxide (taper dose)

Front 485

Q485. What other drug besides chlordiazepoxide is used on alcohol withdrawal?

Back 485

A485. safe detox with oxazepam; (out the liver)

Front 486

Q486. Which benzo doesn't go through CP450?

Back 486

A486. oxazepam; temazepam; lorazepam

Front 487

Q487. Patient comes in with alcohol abuse, while in E.R. he becomes agitated? What benzo do you use?

Back 487

A487. Oxazepam, temazepam, or lorazepam; lorazepam is I.V. or I.M.

Front 488

Q488. acute dystonia

Back 488

A488. involuntary muscle contraction, torticollis

Front 489

Q489. Akathisia

Back 489

A489. Subjective/objective restlessness; treat: propranolol. Benzodiazepines, anticholinergics

Front 490

Q490. Dyskinesia

Back 490

A490. Pseudoparkinsonism (shuffled gait cogwheel rigidity).

Front 491

Q491. Tardive dyskinesia

Back 491

A491. Stereotypic oral facial movements. Dopamine receptor sensitization. irreversible.

Front 492

Q492. Treat acute dystonia

Back 492

A492. treat: anticholinergic or diphenhydramine or benztropine and antipsychotic with.

Front 493

Q493. Voyeurism

Back 493

A493. observing unsuspecting person unclothed

Front 494

Q494. fetishism

Back 494

A494. use non living objects

Front 495

Q495. Transvestic fetishism

Back 495

A495. cross dress for sexual arousal

Front 496

Q496. frotteurism

Back 496

A496. touching or rubbing against nonconsenting person

Front 497

Q497. sexual sadism

Back 497

A497. sexually aroused from inflicting suffering

Front 498

Q498. Is it true that when you ask a patient about suicide you are provoking their interest?

Back 498

A498. NO. this is completely a false belief.

Front 499

Q499. How do you ask questions about suicide?

Back 499

A499. 1) suicide ideation; 2) intent; 3) plan; SIIP

Front 500

Q500. When do patient that have a previous suicide attempt will try to commit suicide again?

Back 500

A500. within 3 months of 1st attempt

Front 501

Q501. What is suicidal behavior?

Back 501

A501. they go to the doctor; Dr. doesn't find depression

Front 502

Q502. What are the risk factors for suicide?

Back 502

A502. - previous attempts; hopelessness; illness (medical or psychiatric) HIV/Cancer/dialysis; Drug abuse

Front 503

Q503. What is the MCC of death for adolescents?

Back 503

A503. motor vehicle accidents; they believe they are not accidents but suicide attempts; after drinking alcohol

Front 504

Q504. What sex is more predominant for suicide successful attempts?

Back 504

A504. men; men more likely to

Front 505

Q505. What sex has more attempts of suicide?

Back 505

A505. women; because they are less successful

Front 506

Q506. What is the #1 method of death for suicide men/women?

Back 506

A506. guns=men; pills=women

Front 507

Q507. Cotard syndrome

Back 507

A507. Severe Niliistic delusion; psychosis associated with severe depression

Front 508

Q508. Schizotypal personality

Back 508

A508. Odd behacoir, perception, appearance, magical thinking, ideas of reference

Front 509

Q509. fibromusclular dysplasia

Back 509

A509. low K, nigh CO2; Hyperaldosteronism; mid age female; captopril renal scan,; MRA of renal arteries; CT angiogram

Front 510

Q510. HTN med that causes depression

Back 510

A510. B-blocker; also causes:

Front 511

Q511. Negativism

Back 511

A511. catatonic symptom; motiveless resistance to all attempts to be moved or all instructions

Front 512

Q512. signs of catatonia

Back 512

A512. stupor,; negativism,; rigidity,; posturing,; mutism,; stereotypes,; mannerisms,; wazy flexibility,; catatonic excitement.

Front 513

Q513. cataplexy

Back 513

A513. temp loss of muscle tone; weakness from emotional state; associated with narcolepsy

Front 514

Q514. Echopraxi

Back 514

A514. pathological imitations of movements of another person seen in catatonia, delirium dementia

Front 515

Q515. Stereotypy

Back 515

A515. repetitive fixed pattern of physical action, movement or speech

Front 516

Q516. NORMAL PRESSURE HYDROCEPHALUS

Back 516

A516. URINARY incontinence, gait ataxia; dementia

Front 517

Q517. polyuria vomiting diarrhea

Back 517

A517. water intoxication

Front 518

Q518. delusions, and psychoses after taking ulcer meds

Back 518

A518. Cimetidine

Front 519

Q519. delirium in patient with heart failure meds

Back 519

A519. digoxin

Front 520

Q520. Which anti-depressants can --> delirium; how to treat this?

Back 520

A520. MAOI; IV BZ (lorazepam is a good one, b/c there is a short t 1/2)

Front 521

Q521. how many days should you wait to give an SSRI, in a patient that has been previously treated with MAOI?

Back 521

A521. 14 days

Front 522

Q522. what is used to treat atypical depression?

Back 522

A522. MOAI

Front 523

Q523. which etoh detox drugs are metabolized by the liver?

Back 523

A523. chlordiazepoxide (librim); diazepam

Front 524

Q524. which Etoh detoxifying drug is good to give to someone w impaired liver function?

Back 524

A524. oxazepam (serax)

Front 525

Q525. what effect do SSRIs have on post-synaptic 5HT-2 receptors?

Back 525

A525. Down-regulates them

Front 526

Q526. which NSAID does not interfere with lithium metabolism?

Back 526

A526. ASA

Front 527

Q527. what decreases lithium excretion?

Back 527

A527. Metronidazole; ACE inhibitors; Tetracycline; Thiazide diuretics; NSAIDS (not ASA); CCBs

Front 528

Q528. what increases lithium clearance?

Back 528

A528. Theophillline; Acetazolamide; Caffeine; Osmotic diuresis

Front 529

Q529. side effects of lithium?

Back 529

A529. nephrogenic DI; hypothyroid; leukocytosis; tremors; acne; sedation; arrhythmias; T wave flattening/inversion

Front 530

Q530. What med can exacerbate tics?

Back 530

A530. mehtylphenidate

Front 531

Q531. what is the MOA of treating Tourrette's?

Back 531

A531. D2 antagonism (antipsychotics)

Front 532

Q532. what drugs can be used to treat OCD?

Back 532

A532. Clomipramine; Fluvoxamine

Front 533

Q533. What decreases impulsiveness in Borderline PD?

Back 533

A533. SSRI (especially fluoxetine); haloperidol

Front 534

Q534. If looking for immediate relief of GAD, what class of meds should be given?

Back 534

A534. BZ

Front 535

Q535. Effect of lithium in pregnancy?; %?

Back 535

A535. Epstein’s; 7.7%

Front 536

Q536. mood stabilizer that has causes fetal abnormalities if given during pregnancy?

Back 536

A536. clonazepam

Front 537

Q537. What meds can be given to delirious patients?

Back 537

A537. low-dose atypical antipsychotics; low-dose haldol

Front 538

Q538. why do atypical antipsychotic meds --> orthostatic hypotension?

Back 538

A538. alpha 1 blockade

Front 539

Q539. What drugs are used to treat PTSD and why?; which drug class is NOT effective in PTSD?

Back 539

A539. Clonidine: to decrease the re-experiencing of PTSD; SSRIs: to reduce the "numbness" associated w PTSD; BZ not effective

Front 540

Q540. What is the 1st line med for panic disorder?; other drugs to treat panic disorder?

Back 540

A540. fluvoxamine; imipramine and phenelzine can also be used, but less desirable d/t side effects

Front 541

Q541. which mood stabilizer --> pancreatitis?

Back 541

A541. valproic acid

Front 542

Q542. how long should patients be treated for 1st episode of depression?

Back 542

A542. at least 6 mos, usually 8-12 mos to prevent relapse

Front 543

Q543. how to treat drooling associated with clozapine?

Back 543

A543. anti-cholinergic

Front 544

Q544. how to treat clozapine induced tachycardia?

Back 544

A544. propanolol

Front 545

Q545. which of the atypical anti-psychotics are least likely to increase cholesterol or cause DM?

Back 545

A545. aripiprazole; ziprasadone

Front 546

Q546. which antidepression is used to treat depression and diabetic neuropathy?

Back 546

A546. duloxetine

Front 547

Q547. what is the most common underlying cause for post-partum psychosis?

Back 547

A547. underlying bipolar I disorder

Front 548

Q548. cortisol levels in MDD?; catecholamine levels?; sex hormones?; immune function?

Back 548

A548. increased (50% fail dexamethasone suppression test); decreased; decreased; decreased

Front 549

Q549. which of the psych disorder has the strongest genetic association?

Back 549

A549. bipolar I

Front 550

Q550. manifestations of porphyria?

Back 550

A550. mania/psychosis + abdominal pain

Front 551

Q551. organic changes seen in Kluver-Bucy syndrome

Back 551

A551. bilateral damage to amygdala

Front 552

Q552. what effect does starvation have on:; BUN; cortisol; TSH response; GH

Back 552

A552. increased; increased; normal; increased

Front 553

Q553. what is the relationship between MDD and TSH?

Back 553

A553. 1/3 of patients have no increase in TSH wiht TRH administration

Front 554

Q554. what is cluster of sx seen in normal pressure hydrocephalus?

Back 554

A554. ataxia; confusion; incontinence

Front 555

Q555. length of time sx need to be present in PTSD?; acute stress disorder?

Back 555

A555. >4 wks; <4 wks

Front 556

Q556. long term tx for Borderline PD?

Back 556

A556. therapy and steady social support

Front 557

Q557. how does insight relate to psychosis?

Back 557

A557. if patients have insight into their delusions/hallucinations, etc, they are not psychotic

Front 558

Q558. what fraction of patients with MDD respond to placebo?

Back 558

A558. 1/3

Front 559

Q559. what is the clinical course expected in a schizophrenic not on meds?

Back 559

A559. unknown

Front 560

Q560. in men 30-50 yo, what % of impotence is related to physiologic reasons?

Back 560

A560. 10%

Front 561

Q561. what is the % likelihood of a patient developing schizophrenia if:; 1 parent has schizo; both parents have schizo; MZ twin has schizo

Back 561

A561. 12%; 40%; 50%

Front 562

Q562. other than +/- sx of schizophrenia, what behavioral can be seen

Back 562

A562. short-term memory deficits; unstable smooth eye pursuit; can't habituate to repeated stimulus

Front 563

Q563. causes of delirium

Back 563

A563. Impaired delivery of brain substrates; Metabolic; Drug; Endocrinopathy; Liver disease; Infrastructure; Renal failure; Infection; Oxygen; UTI; Sensory deprivation

Front 564

Q564. changes in sleep structure in elderly

Back 564

A564. increased REM episodes (but duration is shorter) --> decreased total REM sleep; non-REM is increased (increased stage I and II, with decrease in stages III and IV); increased awakenings after sleep onset

Front 565

Q565. what changes in sleep are seen in depressed young patients

Back 565

A565. increased REM; decreased REM latency; decreased REM towards morning; less than 25% delta sleep; increased nighttime awakening

Front 566

Q566. what is normal % of REM in YA?; REM latency?; REM pattern?; percentage delta?; nighttime awakenings

Back 566

A566. 25%; 90 min; increased REM towards AM; 35%; 1-3

Front 567

Q567. what EEG pattern is seen in stage 1 of sleep?

Back 567

A567. theta

Front 568

Q568. what EEG pattern is seen in stage 2 of sleep?

Back 568

A568. sleep spindle; K complex

Front 569

Q569. what EEG pattern is seen in stage 3 of sleep?

Back 569

A569. delta waves

Front 570

Q570. what EEG pattern is seen in stage 4 of sleep?

Back 570

A570. delta waves

Front 571

Q571. what EEG pattern is seen in REM?

Back 571

A571. sawtooth; beta; alpha; theta

Front 572

Q572. what stage of sleep do sleep terrors, sleep walking, and bedwetting occur?

Back 572

A572. stages 3 and 4

Front 573

Q573. what stage of sleep do nightmares occur?

Back 573

A573. REM

Front 574

Q574. what stage of sleep do night terrors occur?

Back 574

A574. stages 3/4

Front 575

Q575. when in sleep does bruxim occur

Back 575

A575. stage 2

Front 576

Q576. what is Kleine-Levin syndrome

Back 576

A576. recurrent periods of excessive sleepiness daily for 1+ months; sleepiness not relieved by daytime naps; often accompanied by hyperphagia

Front 577

Q577. what is localized amnesia?

Back 577

A577. memory loss occurring during a particular time period, especially after a traumatic event

Front 578

Q578. what is selective amnesia/

Back 578

A578. can't remember certain aspects of an event

Front 579

Q579. what is Cotard syndrome

Back 579

A579. delusion that nothing exists; feeling that body is disintegrated or that they are dead

Front 580

Q580. what is Fregoli syndrome?

Back 580

A580. person takes the form of many other people/creatures

Front 581

Q581. what is physiologically occurring in a person with OCD

Back 581

A581. increased metabolism in caudate nucleus, frontal lobe, and cigulum

Front 582

Q582. what is circumlocution?

Back 582

A582. word substitution

Front 583

Q583. what structures shrink in schizophrenia

Back 583

A583. hippocampus; parahyoppocampal gyrus; amygdala

Front 584

Q584. what is verbigeration

Back 584

A584. repetitive meaningless talking

Front 585

Q585. what is glossolalia

Back 585

A585. ability to speak new language suddenly

Front 586

Q586. si/sx of Wernicke’s encephalopathy

Back 586

A586. CN VI palsy (bilateral); horizontal nystagmus; ataxia; global confusion

Front 587

Q587. what is oculogyric crisis?

Back 587

A587. acute dystonia reaction with spasm of extraocular muscles

Front 588

Q588. what is trismus?

Back 588

A588. spasm of jaw muscles

Front 589

Q589. can hallucinations + delusions = delusional disorder

Back 589

A589. NO

Front 590

Q590. sx of tertiary syphilis

Back 590

A590. sensory ataxia; positive Romberg; decreased vibration/proprioception in lower extremities; decreased DTR; pupil abnormalities

Front 591

Q591. mens rea

Back 591

A591. criminal intent

Front 592

Q592. actus rea

Back 592

A592. criminal act

Front 593

Q593. schizophrenia, residual type

Back 593

A593. absence of + sx

Front 594

Q594. testamentary capacity

Back 594

A594. competence required to write a will; 1. ability to understand the writing/signing of will; 2. knowledge of potential heirs; 3. understanding extent of one's assets; 4. Lack of undue influence; 5. Absence of delusions compromising rational thought

Front 595

Q595. what --> not guilty by reason of insanity

Back 595

A595. can't appreciate wrongfulness of act; can't conform to conduct laws

Front 596

Q596. habeus corpus

Back 596

A596. due process

Front 597

Q597. parens patriae

Back 597

A597. state cares for people that can't care for themselves

Front 598

Q598. informed consent requires:

Back 598

A598. 1. mental competency; 2. voluntary choice; 3. risk-benefit analysis; 4. alternative tx options

Front 599

Q599. what makes someone an emancipated minor

Back 599

A599. married; have kids; in military; self-supporting

Front 600

Q600. when is parental consent not required for a minor:

Back 600

A600. OB care; STD tx; substance abuse

Front 601

Q601. what type of therapy is useful in bulimia

Back 601

A601. CBT

Front 602

Q602. rumination disorder

Back 602

A602. repeated regurgitation and rechewing of food >1 month following normal functioning; seen when there are multiple caregivers

Front 603

Q603. how to confirm rumination disorder

Back 603

A603. esophageal pH

Front 604

Q604. what is the #1 cause of hallucination in children

Back 604

A604. substance induced

Front 605

Q605. common side effects from fluoxetine

Back 605

A605. H/A and nausea

Front 606

Q606. describe progression with Rette disorder

Back 606

A606. normal prenatal and perinatal development, till about 5 months; then, decreased head growth, stereotyped hand movement and decreased social interaction; MR

Front 607

Q607. what is the first line tx for Tourette's

Back 607

A607. Clonidine (also good for ADHD, so good when there is comorbidity)

Front 608

Q608. medical tx for enuresis

Back 608

A608. imipramine

Front 609

Q609. what happens to brain of anorexic patient

Back 609

A609. ventricles enlarge

Front 610

Q610. #1 side effect from clonidine

Back 610

A610. sedation

Front 611

Q611. what illness is associated with psychiatric issues

Back 611

A611. strep --> OCD and Tourette's

Front 612

Q612. What are the 5 Axes in the Multiaxial Classification?

Back 612

A612. Axis I: Clinical Disorders, "Chief complaint";; Axis II: Personality Disorders,; Mental Retardation;; Axis III: General Medical Conditions;; Axis IV: Psychosocial and Environmental Problems;; Axis V: Global Assessment of Functioning

Front 613

Q613. What is the most commonly known (preventable) cause of Mental retardation?

Back 613

A613. Fetal Alcohol Syndrome

Front 614

Q614. (2) MC genetic causes of Mental Retardation

Back 614

A614. Down's Syndrome; Fragile-X Syndrome

Front 615

Q615. Define the (4) levels of mental retardation with IQ and brief summary

Back 615

A615. 70-50 IQ: Mild - self-supporting (6th grade level); 49-35 IQ: Moderate - Trainable but needs supervision; (2nd grade level); 34-20 IQ: Severe - can learn to communicate; basic habits; < 20 IQ: Profound - needs highly structured environment

Front 616

Q616. (2) possible causes of specific Learning Disorders

Back 616

A616. Focal Cerebral Injury; or Neurodevelopmental Defect

Front 617

Q617. MC Learning Disorder

Back 617

A617. Reading Disorder; (more common in boys)

Front 618

Q618. (4) Pervasive Developmental Disorders

Back 618

A618. Autistic disorder;; Rett's disorder;; Childhood Disintegrative disorder;; Asperger's disorder

Front 619

Q619. What are the (3) basic signs of Autism?

Back 619

A619. 1. impairment in Social interaction (failure to develop social smile, eye-to-eye gaze, etc); 2. impairment in Communication; 3. Restrictive, Repetitive or stereotyped patterns of behavior, interests or activities (preoccupation of an interest, inflexible adherence to rituals, whole body rocking, etc)

Front 620

Q620. A female with normal development the first 5 months after birth, then head circumference decreases, skills are lost such as language, social interactions and appropriate gait. Dx?

Back 620

A620. Rett's disorder

Front 621

Q621. What are the (2) Serotonin receptor agonists and antagonists?; Use?

Back 621

A621. Trazodone; Nafazodone; Use: Anti-depressants

Front 622

Q622. What is the NE-DA reuptake inhibitor used for depression?; (generic and trade name)

Back 622

A622. Bupropion (Wellbutrin)

Front 623

Q623. What is the difference b/t Typical and Atypical Antipsychotics with relation to NT?

Back 623

A623. Typical = Dopamine Antagonists; Atypical = Dopamine and Serotonin Antagonists

Front 624

Q624. Aside from Schizophrenia, what are (5)* other uses for Haloperidol?

Back 624

A624. PHAT T:; PCP overdose;; Huntington's Disease (and other movement disorders);; Acute Mania;; Tx-resistant Bipolar disorder;; Tourette's disorder

Front 625

Q625. What dopamine tracts are responsible for the patient's psychosis? (2); Where in the brain does it arise from?; What is the only drug that treats just these two tracts without affecting the others?

Back 625

A625. Mesocortical and Mesolimbic tracts; from Ventral Tegmental area of the brain; Clozapine; (only works on these tracts)

Front 626

Q626. What is the only Atypical antipsychotic not also approved for Bipolar disorder?

Back 626

A626. Clozapine

Front 627

Q627. what is a possible side effect of blocking the tubuloinfundibular tract of Dopamine (using any type of dopamine blocker aside from Clozapine)?

Back 627

A627. Increased Prolactin levels; (Glactorrhea, amenorrhea and gynecomastia can occur; it is usually a side effect of Typical antipsychotics)

Front 628

Q628. A patient from Europe moved to the USA and needed to be placed on antidepressant medication. The physician gave him a SSRI without knowing of his previous medication. Within a few days the patient began to become restless, confused, hyperthermic and have severe muscle rigidity. Dx?

Back 628

A628. Serotonin Syndrome; (from mixing a SSRI and a MAOI)

Front 629

Q629. Aside from blocking Dopamine, what else is blocked with the use of Antipsychotics? (5)

Back 629

A629. Muscarinic receptors (causing anticholinergic sx);; Alpha receptors (causing hypotension);; NE uptake;; Serotonin receptors;; Histamine receptors (sedation)

Front 630

Q630. What are the adverse Metabolic effects of Atypical antipsychotics?; (3)

Back 630

A630. Weight Gain;; Adult-onset Diabetes;; Dyslipidemia

Front 631

Q631. What is the evolution of Extra-Pyramidal Symptom side effects of Antipsychotics in hours, days, weeks and months?

Back 631

A631. 4 hours: Acute Dystonia; 4 days: Akinesia; 4 weeks: Akathisia; 4 months: Tardive Dyskinesia; (often irreversible)

Front 632

Q632. A man that just began taking medication for schizophrenia begins to get muscle spasms in his head and neck and rolling of his eyes upward. Dx?; Tx?

Back 632

A632. Acute Dystonia; Tx: Anticholinergic; (Benztropine)

Front 633

Q633. How do you treat neuroleptic-induced Parkinsonism?; (2)

Back 633

A633. 1. Oral Anticholinergics; 2. Amantidine; (a DA releasing agent)

Front 634

Q634. A few weeks after starting neuroleptics a patient begins to get an inner restlessness in his legs and cant remain still. Dx?; Tx? (2 possible)

Back 634

A634. Dx: Akathisia; Tx:; 1. Beta-blocker; 2. Benzodiazepine

Front 635

Q635. A few days after starting neuroleptics a patient gets tachycardia, HTN, rigidity, agitation and a clouding of consciousness. His labs show an increased CK, Myoglobinuria, WBC and LFT. Dx?; Tx? (3 possible)

Back 635

A635. Dx: Neuroleptic Malignant Syndrome; Tx: ir could be "BAD" if you don’t give either Bromocriptine, Amantidine or Dantrolene

Front 636

Q636. An elderly woman on neuroleptics for a few years begins to get involuntary movements of the tongue, face, neck and upper extremities. Dx?; Tx?

Back 636

A636. Dx: Tardive Dyskinesia; (often irreversible); Tx: (no cure); 1. Don't abruptly stop meds, switch to atypicals; 2. give Clozapine to help Sx

Front 637

Q637. What neuroleptic (antipsychotic) drug causes Agranulocytosis?; What must every patient do on this durg?

Back 637

A637. Clozapine; Patient must have Weekly WBC; (never use as first line due to AE...only in patient who has failed other medication and has a lot of negative Sx)

Front 638

Q638. what type of Sx do Typical and Atypical antipsychotics treat?

Back 638

A638. Typical: Positive Sx only; (DA receptor blocker); Atypical: Positive and Negative Sx; (DA and Serotonin receptor blocker)

Front 639

Q639. What drugs should be used first-line for antipsychosis?; (3)

Back 639

A639. Risperidone;; Olanzapine;; Quetiapine; (these atypicals are DOC before Haloperidol and Clozapine)

Front 640

Q640. where does the serotonin system arise from in the brain?

Back 640

A640. Raphe Nuclei

Front 641

Q641. What antidepressant is also prescribed for sleep disorders?

Back 641

A641. Trazodone

Front 642

Q642. What is the main side-effect of a SSRI (causing people to stop using it)?

Back 642

A642. Sexual Dysfunction:; Anorgasmia, ED and Diminished Libido

Front 643

Q643. what is the best Tx for Depression?; What are the contraindications?; AE? (3)

Back 643

A643. Electroconvulsive Therapy; (usually done to patient that is severely suicidal and cant wait for drugs to set in); CI: No contraindications! Good for everyone; AE: Memory, Seizures and Increases ICP

Front 644

Q644. What can Lithium cause in an unborn child?

Back 644

A644. Ebstein's Anomaly; (cardiac malformation of the tricuspid valve)

Front 645

Q645. DOC for an Acute Mania attack

Back 645

A645. Haloperidol

Front 646

Q646. what non-Rx Tx is used for Treatment-refractory major depression?

Back 646

A646. Vagus Nerve Stimulation

Front 647

Q647. Name the (5) main drugs used as Mood Stabilizers

Back 647

A647. Lithium;; Valproic Acid;; Lamotrigine;; Carbamazepine;; Gabapentin

Front 648

Q648. what drug can be used in acute episodes of bipolar disorder but has AE of blood dyscrasia, impaired liver function, thrombocytopenia and prolonged coagulation times?

Back 648

A648. Valproic Acid

Front 649

Q649. what is a second-line agent for Bipolar disorder if the patient does not respond to lithium?; (2 possible)

Back 649

A649. Carbamazepine; (or Valproic Acid)

Front 650

Q650. what drug used for Bipolar disorder renders birth control pills ineffective?

Back 650

A650. Carbamazepine

Front 651

Q651. what drug for bipolar disorder induces P450?

Back 651

A651. Carbamazepine

Front 652

Q652. what drug is used for the maintenance phase of bipolar I disorder (depressive phase) and can cause an allergic rash leading to Stevens-Johnson's syndrome?

Back 652

A652. Lamotrigine

Front 653

Q653. What is the main drug class that treats anti-anxiety (Anxiolytics)?

Back 653

A653. Benzodiazepines

Front 654

Q654. what do you treat a benzodiazepine overdose with?

Back 654

A654. Flumazenil

Front 655

Q655. Main treatment for Generalized Anxiety Disorder that does not cause dependence, sedation or anorgasmia.

Back 655

A655. Buspirone

Front 656

Q656. Which Benzos can be given to patients with liver failure?; (3)

Back 656

A656. Outside The Liver:; Oxazapam,; Lorazapam,; Temazapam

Front 657

Q657. (3) main AE of Benzos

Back 657

A657. Sedation;; Dependence;; Memory impairments; (not good for elderly)

Front 658

Q658. Benzo used for a Panic attack

Back 658

A658. Alprazolam

Front 659

Q659. what separates ADHD from other conduct disorders?

Back 659

A659. Child must have Sx in at least two areas; (such as home and school)

Front 660

Q660. (2) AE of Methphenidate to children

Back 660

A660. 1. Growth Hormone Suppression; 2. Tremor; (recommended to take holiday from drugs during summer)

Front 661

Q661. Tourette's is associated with what (2) comorbid psychiatric illnesses?; Tx? (3 possible)

Back 661

A661. ADHD and OCD; Tx:; 1. Haloperidol; 2. Pimozide; 3. Clonidine

Front 662

Q662. Tx of choice for patient with Anorexia that is not life- threatening?; (2 in order)

Back 662

A662. Tx:; 1. Monitor calories, weight and serum electrolytes (counseling); 2. SSRI (Fluoxetine) (also for Bulimia)

Front 663

Q663. What internal substance can commonly induce a panic attack in those that are predisposed to having them?; (2)

Back 663

A663. Sodium Lactate; or; Carbon Dioxide

Front 664

Q664. What can rapid refeeding after anorexic starvation precipitate?

Back 664

A664. Hypermetabolic HypoPhosphatemia

Front 665

Q665. What musculoskeletal complaint frequently is reported in bulemics?; Why?

Back 665

A665. Muscle Spasms; (due to low serum Potassium and Sodium)

Front 666

Q666. A high GGT and MCV indicates what type of substance abuse?

Back 666

A666. Chronic Alcohol abuse

Front 667

Q667. What is the best way to approach acute pharmacotherapy for GAD?

Back 667

A667. Give a Benzo-Buspirone combo immediately along with having them start a SSRI. In about 3 weeks, when the SSRI begins to work, wean them off the Benzo-Buspirone combo

Front 668

Q668. How is GAD different from Panic disorder?

Back 668

A668. Panic Disorder: Discrete episodes of Anxiety; GAD: Consistent worry about all aspects of their life

Front 669

Q669. What is the behavior therapy and medical Tx (2) for Panic Disorder?; Which med is for Acute Sx?; Chronic?

Back 669

A669. Tx:; 1. Cognitive Behavior Therapy; 2. Benzo (Aprazolam) for Acute Sx; 3. SSRI (first-line) for Chronic Sx

Front 670

Q670. what is the Behavioral therapy for Specific phobias?; (2)

Back 670

A670. Systematic Desensitization (incorporates relaxation); or Flooding (no relaxation techniques)

Front 671

Q671. What is the Tx for stage fright?

Back 671

A671. Beta-Blocker

Front 672

Q672. What type of behavior therapy is good for OCD?; What are the (2) medications and classes that Tx it?

Back 672

A672. BT:; Exposure-Response Therapy (make them dirty and prevent them from washing hands); Meds:; 1. SSRI: Fluoxetine; 2. TCA: Clomipramine

Front 673

Q673. MCC of Post-traumatic Stress Disorder in Men? Women?

Back 673

A673. Men: Combat; Women: Rape

Front 674

Q674. A 10yo boy was raped by his uncle. Whenever he thinks of the rape he goes to the sink and washes his hands 100 times. Dx?; First line Tx?

Back 674

A674. Post-Traumatic Stress Disorder (This is a "Repetition Compulsion" to decrease the boy's level of anxiety; it is a repetitive behavior that stems from an INCIDENT, not like OCD); First line Tx: SSRI

Front 675

Q675. Marty is a 30-year-old male who lives with his mother. He works as a night-time cleaner in a large store since he dropped out of college many years ago. He complains of being “nervous all of the time” and would like to “get his life back”. He stated that he would like to change jobs but prefers his current job because he does not have any contact with other employees. He did not have many friends in high school or in college, mostly due to his feeling “self-conscious”. When among strangers, he would feel nervous and would “break out in a sweat”. He had what he described as “nervous attacks”, which came on suddenly and lasted for a few seconds to minutes. These attacks only came on when in the presence of strangers. Since these episodes increased in intensity and frequency, he dropped out of college. Dx?

Back 675

A675. Social Phobia; (not a panic attack, which occurs “out of the blue” versus someone uneasy around strangers)

Front 676

Q676. What is seen on a CT/MRI and PET-scan to indicate Schizophrenia?

Back 676

A676. CT/MRI: Increase in size of Ventricles; PET-scan: Hypoactivity of Frontal Lobes

Front 677

Q677. Schizophrenia type:; presence of delusions of grandeur or persecution; (example: think they are followed by FBI)

Back 677

A677. Paranoid; (MC type)

Front 678

Q678. Schizophrenia type:; marked regression to primitive, disinherited, and disorganized behavior, worst prognosis, early onset; "Facial Grimacing" or "silly affect"; most inappropriate of all types

Back 678

A678. Disorganized

Front 679

Q679. Schizophrenia type:; Patient is running around and jumping on tables, then finally collapsing in exhaustion; may become rigid or have bizarre postering

Back 679

A679. Catatonic

Front 680

Q680. Schizophrenia type:; characteristics of more then one other type

Back 680

A680. Undifferentiated

Front 681

Q681. Schizophrenia type:; frequent auditory hallucinations

Back 681

A681. Paranoid

Front 682

Q682. Schizophrenia type:; patient meets criteria for schizophrenia in the past but now lacks delusions or hallucinations

Back 682

A682. Residual

Front 683

Q683. what is the difference in Type I or Type II schizophrenia?

Back 683

A683. Type I: Positive and Negative Sx (Tx: Typical or Atypical Anti-psych); Type II: Negative Sx only (Tx: Atypical Anti-psych)

Front 684

Q684. What is this an example of:; "I am the King of Budapest"

Back 684

A684. Delusion; (fixed false belief)

Front 685

Q685. What is this an example of:; Patient describing the trees looking like scary monsters

Back 685

A685. Illusion; (sensory misconception)

Front 686

Q686. If an unstable patient in the ER mentions he is having visual hallucinations, what is you first thought of Dx?

Back 686

A686. Drugs; (visual is more related to drugs and auditory is more related to schizophrenia)

Front 687

Q687. Aside from time, what is the difference between a Brief Psychotic Disorder and other Schizophrenic disorders?

Back 687

A687. BPD involves a Stressor that initiates the Sx; (stressor could include giving birth; time from 1 day to 1 month)

Front 688

Q688. what is the difference b/t Delusional disorder and Schizophrenia?

Back 688

A688. Delusional disorder:; Delusions are non-bizarre and could be possible;; Delusions occur of at least 1 month

Front 689

Q689. Type of Delusional Disorder:; the individual is being harassed or malevolently treated

Back 689

A689. Persecutory

Front 690

Q690. Type of Delusional Disorder:; the individual posses exaggerated power, money or knowledge

Back 690

A690. Grandiose

Front 691

Q691. Type of Delusional Disorder:; thinks that another person, usually of higher status, is in love with the individual

Back 691

A691. Erotomanic

Front 692

Q692. Type of Delusional Disorder:; that the individuals partner is unfaithful

Back 692

A692. Jealous

Front 693

Q693. Type of Delusional Disorder:; that the individual has a physical defect or a medical condition

Back 693

A693. Somatic

Front 694

Q694. what is a "Clang Association"?

Back 694

A694. a Rhyming of words seen in schizophrenics

Front 695

Q695. a patient has sudden loss of muscle tone and drops to the floor, only to be in REM within 10 minutes. Dx?; Tx?; (2 possible)

Back 695

A695. Dx: Cataplexy; Tx:; 1. Imipramine + stimulant; 2. SSRI + stimulant

Front 696

Q696. What is the definition of hallucinations when falling asleep?; Waking up?

Back 696

A696. GOing to sleep: HypnaGOgnic; Waking up: Hypnopompic

Front 697

Q697. (2) Drug Tx for Narcolepsy

Back 697

A697. 1. Methphenidate; 2. Modafinil

Front 698

Q698. How is Narcolepsy waking different from waking after passing out from alcohol?

Back 698

A698. Narcolepsy patients feel refreshed after waking

Front 699

Q699. A middle-aged overweight businessman complains of being tired all day. Dx?; Tx?

Back 699

A699. Dx: Sleep Apnea; Tx: Continuous Positive Ariway Pressure; (C-PAP)

Front 700

Q700. A patient has depressed Sx during winter months but feels fine during the summer. Dx?; Tx?

Back 700

A700. Dx: Seasonal Affective Disorder; Tx: Phototherapy

Front 701

Q701. A 22-yo female was arguing with her boyfriend and the next day she has a depressed mood. Dx?; Tx?

Back 701

A701. Dx: Adjustment Disorder; (characterized by the development of symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressor; examples: car accident, divorce, etc; NOT berevement); Tx: Supportive Psychotherapy

Front 702

Q702. What is the term for a condition similar to post-traumatic stress disorder, but Sx occur within 1 month of the traumatic event and last from 2 days to 1 month?

Back 702

A702. Acute Stress Disorder

Front 703

Q703. A 30-year-old female was fired from her job about 1 month ago. Since then, she has complained of depressed mood and sleep problems. She denies any appetite or weight problems. She denies any suicidal ideation or plan. Her concentration is good and her memory is intact. Dx?

Back 703

A703. Adjustment Disorder

Front 704

Q704. what (3) sleep changes are common in depressed patients?

Back 704

A704. 1. Decreased Slow-Wave Sleep; 2. Decreased REM; 3. Early-morning Awakening

Front 705

Q705. what is the difference b/t Substance Dependence and Abuse?; (3)

Back 705

A705. Abuse leads to Dependence; Dependence also has:; Tolerance;; Withdrawal;; Inability to control ETOH use

Front 706

Q706. A 15yo boy builds model airplanes. What is most likely drug of abuse?

Back 706

A706. Alcohol; (Alcohol is always most abused)

Front 707

Q707. Number one risk factor for Suicide

Back 707

A707. Psychiatric illness; (then: Previous Attempt)

Front 708

Q708. what is the highest rate of suicide for any age group?

Back 708

A708. Elderly (>65) Men

Front 709

Q709. What is the highest ethnicity for suicide?

Back 709

A709. Native American Adolescents

Front 710

Q710. Most common way to commit suicide?

Back 710

A710. Gun

Front 711

Q711. How can you tell the difference b/t a cocaine/amphetamine user and paranoid schizophrenia?

Back 711

A711. Drug test; (Cocaine stays in system for 2 - 3 days)

Front 712

Q712. Substance Abuse Buzz words:; Paranoia

Back 712

A712. Cocaine or Amphetamines

Front 713

Q713. Substance Abuse Buzz words:; Arrhythmia

Back 713

A713. Cocaine or Amphetamines

Front 714

Q714. Substance Abuse Buzz words:; Depression

Back 714

A714. Cocaine withdrawal; (worry about suicide)

Front 715

Q715. Substance Abuse Buzz words:; Severe Violence

Back 715

A715. PCP; (also vertical nystagmus)

Front 716

Q716. Substance Abuse Buzz words:; Pinpoint pupils

Back 716

A716. Opiate overdose; (Heroin)

Front 717

Q717. Substance Abuse Buzz words:; Flu-like Sx

Back 717

A717. Opiate Withdrawal

Front 718

Q718. Substance Abuse Buzz words:; Seizures; (2)

Back 718

A718. 1. Benzodiazepine intoxication; 2. Opioid withdrawal (?)

Front 719

Q719. Substance Abuse Buzz words:; Death

Back 719

A719. Barbiturates

Front 720

Q720. Substance Abuse Buzz words:; Tremors after hospital admit

Back 720

A720. Alcohol

Front 721

Q721. What are the steps of treating Alcohol withdrawal?; (4)

Back 721

A721. 1. Rule-out Medical complications (hepatic dysfunction or Wernicke's encephalopathy) by Lab tests and exam; 2. Diazepam (Benzodiazepine); 3. Multi-vitamins with Thiamine and Folate; 4. Control electolytes and fluids (inc Glucose)

Front 722

Q722. what is given to manage cocaine/amphetamine intoxication?; (2 possible meds)

Back 722

A722. Haloperidol; or; Benzodiazepine

Front 723

Q723. A patient enters the ER with confusion, ophthalmoplegia, ataxia with memory loss and a personality change and smells of alcohol. Dx?

Back 723

A723. Wernicke-Korsakoff syndrome

Front 724

Q724. A patient presents complaining about multiple problems in various organ systems. Dx?; Tx? (2 in order)

Back 724

A724. Dx: Somatization Disorder; Tx:; 1. Continue to Treat with brief monthy visits (fearing that if you deny Tx, then they may go to someone else costing the patient time and money); 2. Slowly begin to tell patient that Sx are psychological (never refer to psychiatrist)

Front 725

Q725. A 50yo woman was referred by her husband’s psychiatrist because of “attacks of dizziness” that have been occurring for more than 10 years. Every day, at about 3pm, the attacks occur. They leave her helpless and, when her husband arrives, she is unable to attend to him. She remains in bed until 8pm when the attacks subsided then falls asleep. She describes her husband as someone who repeatedly abused her and their children, which resulted in their leaving home at an early age, and moving in with their grandmother. He would make comments about the house, dinner, etc. Many times, these verbal comments were followed by actual episodes of violence, several of which have resulted in her hospitalization. Dx?; Tx?

Back 725

A725. Dx: Conversion Disorder (One or two neurological symptoms affecting voluntary or sensory function that cannot be explained by any known neurological disorder; as a result of stressor the person has sx like paralysis or blindness or deafness...usually from seeing, hearing or doing something wrong); Tx: Psychotherapy

Front 726

Q726. what is "La Belle Indifference" and what disorder is it seen in?

Back 726

A726. Seen in: Conversion Disorder; Lack of concern about being paralyzed, blind or deaf

Front 727

Q727. A patient believes that she has a specific disease, giving the actual name of the disease, regardless of reassurance that the person is healthy. Dx?

Back 727

A727. Hypochondriasis

Front 728

Q728. A patient believes a body part is abnormal, defective, or misshapen. Dx?; Tx? (2 together)

Back 728

A728. Dx: Body Dismorphic Disorder; Tx:; 1. Psychotherapy; 2. SSRI (or a TCA or MAOI)

Front 729

Q729. A patient with conscious production of signs and symptoms of a medical or mental disorder (example: placing blood in urine test to alter labs) to assume a sick role. Dx?

Back 729

A729. Factitious Disorder (Munchausen's syndrome); If doing it to a child it is Factitious by proxy (illness caused by a parent). Parent should be reported to child abuse.

Front 730

Q730. A person who has conscious claims of a medical problem for a specific gain; Dx?

Back 730

A730. Malingering; (Different from Factitious disorder b/c it is for a specific gain and not attention)

Front 731

Q731. A patient cannot remember what his name is, but remembers what he had for lunch. He is otherwise healthy. Dx?

Back 731

A731. Dissociative Amnesia; (This clinical picture is exactly the reverse of the one seen in dementia, in which patients may remember their names but forget general information, such as what they had for lunch. Except for their amnesia, patients with dissociative amnesia seem completely intact and function coherently. By contrast, in most amnesias due to a general medical condition (such as postictal and toxic amnesias), patients may be confused and behave in a disorganized manner. Other types of amnesias (e.g., transient global amnesia and postconcussion amnesia) are associated with an ongoing anterograde amnesia, which does not occur in patients with dissociative amnesia. This Amnesia deals with forgetting something of a stressful nature)

Front 732

Q732. Definition:; The invention of false information to cover up a gap in memory

Back 732

A732. Confabulation

Front 733

Q733. Dx:; an acute and transient retrograde amnesia that affects recent memories such as date and location, but maintains personal information like name. Although patients are usually aware of the amnesia, they may still perform highly complex mental and physical acts during the 6 to 24 hours that the episodes usually last.

Back 733

A733. Transient Global Amnesia; (can be due to a TIA, migraine, or seizure)

Front 734

Q734. Dx:; A patient physically travel away from their customary homes or work situations and fail to remember important aspects of their previous identities (name, family, occupation).

Back 734

A734. Dissociative Fugue; (Such patients often, but not always, take on an entirely new identity and occupation, although the new identity is usually less complete than the alternate personalities in dissociative identity disorder, and the old and new identities do not alternate, as they do in dissociative identity disorder)

Front 735

Q735. Dx:; A patient has two or more distinct personalities, each of which determines behavior and attitudes during any period in which it is dominant. Its cause typically involves a traumatic event, usually childhood physical or sexual abuse; Tx? (2)

Back 735

A735. Dissociative Identity disorder (multiple personality disorder); Tx:; Psychotherapy; Hypnotherapy

Front 736

Q736. Dx:; A persistent or recurrent alteration in the perception of the self to the extent that a person's sense of his or her own reality is temporarily lost. Patients may feel that they are mechanical, in a dream, or detached from their bodies. Next step?

Back 736

A736. Depersonalization Disorder; Next step: Neurologic testing; (The fact that depersonalization phenomena may result from gross disturbances in brain function underlies the necessity for a neurological evaluation, especially when the depersonalization is not accompanied by common and obvious psychiatric symptoms. In particular, the possibility of a brain tumor or epilepsy should be considered. The experience of depersonalization may be the earliest presenting symptom of a neurological disorder)

Front 737

Q737. Define:; Anterograde Amnesia; Retrograde Amnesia

Back 737

A737. Anterograde: Ability to learn new information; Retrograde: Ability to recall previously remembered knowledge

Front 738

Q738. What type of amnesia is assoc with ECT?

Back 738

A738. Retrograde (a few minutes before Tx); and; Anterograde (for up to 5 hours after Tx)

Front 739

Q739. A 50-year-old man presents to an ED with a one day History of bilateral tremor in his hands, diaphoresis, anxiety, headache, and the sensation that "my skin is crawling". He denies other symptoms. He takes hydrochlorothiazide for HTN. He states that he sees a psychiatrist for bipolar disorder and anxiety, and that he takes three psych meds, the names of which he can not remember. He ran out of his meds three days ago. His temperature is 37 C (98.6 F), blood pressure is 150/100 mm Hg, pulse is 115/min, and respirations are 20/min. Physical examination is notable for diaphoresis and tremulousness. What drug is the most appropriate initial step in this patient's care?

Back 739

A739. Lorazepam; (The patient takes an unknown anxiety medication, and is most likely experiencing benzodiazepine withdrawal symptoms. Commonly observed symptoms of benzodiazepine withdrawal include: anxiety, diaphoresis, irritability, insomnia, fatigue, headache, myalgias, nausea, perceptual disturbances, tremors, and seizures. The most appropriate management step would be parenteral administration of a short-acting benzodiazepine, such as lorazepam)

Front 740

Q740. A 61-year-old woman, who has been treated with amitriptyline for depression, is brought to her psychiatrist by her family. The woman is confused, disoriented, and hallucinating, and her skin appears dry and warm. The family noticed that she took more pills than prescribed. Dx?

Back 740

A740. Anticholinergic delirium; (caused by the use of anticholinergics or other drugs with anticholinergic properties, like tricyclic antidepressants. In elderly patients, the symptoms can be present even with usual doses. Overdosing results in clouding of consciousness, as well as constipation, urinary retention, dry mouth, elevated temperature, dry flushed skin, worsening of glaucoma, and tachycardia)

Front 741

Q741. A 63-year-old white male who has recently retired from work as a plumber for over 30 years returns to his family physician saying that he has been feeling very down lately, and has been having decreased appetite and a loss of interest in activities that used to give him pleasure. He is a smoker, drinks no alcohol, and is being treated by his family physician for moderate essential hypertension. What is the most appropriate next step in management?

Back 741

A741. Review the patient's medication history; (Many medications used to control hypertension, such as propranolol, and in the past, reserpine, are known to occasionally lead to depressive symptoms. By evaluation of the patient's medication record, the physician can evaluate which medications were started at what time and can make adjustments to dosage or switching to alternative medications to control hypertension)

Front 742

Q742. A woman who attends weekly psychotherapy sessions becomes furious at her psychiatrist, who is about to leave for vacation and is not willing to reveal where he is going. She angrily says that he is just like her father, who always had his own "own life" outside the family. What best describes this patient's reaction?

Back 742

A742. Transference; (Transference is defined by psychoanalysts as a patient's unconscious feelings and behavior toward the analyst that are based on infantile wishes the patient has toward parental figures)

Front 743

Q743. A 44-year-old, HIV-positive patient has been treated for Pneumocystis carinii pneumonia in the hospital. He has a prior history of depression and was treated with paroxetine, which was continued in the hospital. While in the hospital, he became delirious and had visual hallucinations. The psychiatry consult team started him on olanzapine. The patient's delirium gradually resolved, but prior to discharge he complained that his urine stream became weak and his bladder felt full. On examination, the physician confirmed lower abdominal distention. What medicine is the most effective treatment?

Back 743

A743. Bethanechol; (Bethanechol is direct-acting cholinergic stimulant effective in reducing the peripheral anticholinergic effects of some psychotropic medications. It can be administered intramuscularly, orally, or subcutaneously to efficiently relieve the symptoms of urinary retention)

Front 744

Q744. A 24-year-old man was recently hospitalized in a psychiatric unit, where he was started on olanzapine. Upon visiting his new primary care physician for a routine physical examination prior to participating in a vocational rehabilitation program, his physician notices that his thoughts are quite illogical. For example, when she asks the young man what sort of employment he hopes to work toward, he answers, "if you subtract some yellow from the sky, it becomes greener." After a brief silence, he then states, "telephone bills should never exceed twenty dollars ... according to the Book of Numbers." What mental status examination finding most accurately describes this patient's thought processes?

Back 744

A744. Loose Associations; (His ideas are disconnected and seem to jump from one topic to an unconnected topic. Loose associations are one of the characteristic signs of a primary thought disorder, such as schizophrenia)

Front 745

Q745. Dx:; poor ability to think in abstract terms, despite normal intelligence

Back 745

A745. Concrete thinking

Front 746

Q746. Dx;; when thoughts and speech halt, often in mid-sentence, as if forgotten. The idea may be picked up later, after a period of apparent confusion

Back 746

A746. Thought Blocking

Front 747

Q747. Define:; a person's biological sexual characteristics: chromosomes, external genitalia, internal genitalia, hormonal composition, gonads, and secondary sexual characteristics

Back 747

A747. Sexual Identity

Front 748

Q748. A 40-year-old man is admitted to the hospital for evaluation and treatment of depression associated with suicidal thoughts. He denies any past psychiatric history. His medical history is significant for hypertension, for which he currently takes hydrochlorothiazide. He also describes a history of once having a painful erection that lasted for eight hours and had to be treated with intracavernous injections in the emergency room. He states that this was thought to be related to an antihypertensive medication that he used to take. During the treatment of this man's psychiatric condition, what medication should be avoided?

Back 748

A748. Trazodone; (Trazodone is an older antidepressant medication that is commonly used in lower doses for the treatment of insomnia associated with depression. Due to its significant alpha- adrenergic blocking properties, it has been associated with priapism)

Front 749

Q749. A 28-year-old man presents to his primary care physician for his yearly physical examination. He currently smokes approximately one pack of cigarettes a day and is interested in quitting. He has no significant past medical history and has no allergies. He is interested in smoking cessation classes, but would like additional help. What medication would be the most appropriate agent for treating nicotine dependence in this patient? (spell it)

Back 749

A749. Bupropion (Wellbutrin)

Front 750

Q750. A 72-year-old man with a history of renal dysfunction, congestive heart failure, and previous myocardial infarction is currently undergoing dialysis. Over the past few weeks, he has been feeling increasingly depressed and has begun to act bizarrely, with persecutory delusions that the government is poisoning the chemicals used on him for dialysis. Also in the last few weeks, due to increased stomach pain, his medications have been adjusted and now include cimetidine for stomach ulcers, digoxin, and a baby aspirin daily. He also takes docusate sodium as needed for stool softening and ibuprofen as needed for mild arthritis pain. Which of the medications would be most likely to have induced the symptoms the patient is now experiencing?

Back 750

A750. Cimetidine; (the only drug listed known to cause psychiatric effects of clinical significance, including delusions and psychosis. The exact mechanism is unknown, but is thought to be related to the effects of cimetidine on the H-2 histamine receptor in the brain. The treatment of cimetidine-induced psychosis is to reduce the dosage of the medication, and discontinue it if an alternative therapy is available)

Front 751

Q751. A 34-year-old man is admitted to the psychiatric temporary observation unit complaining of depression and suicidal ideation following a cocaine binge. During his stay, he starts feeling as if insects are crawling under his skin. This is most typical of what phenomena?

Back 751

A751. Formication; (a form of haptic hallucinations, associated with the sensation of touch. It is commonly seen in delirium tremens, amphetamine psychosis, and cocaine intoxication)

Front 752

Q752. A 20-year-old white man is brought to the emergency clinic by two friends on a Sunday morning after a fraternity party the night before. His friends note that since the party, he has been very belligerent, agitated, and loud. They suspect that he may have used drugs with some friends at the party. His temperature is 37 C (98.6 F), blood pressure is 145/95 mm Hg, pulse is 105/min, and respirations are 20/min. Physical examination reveals slurred speech, unsteady gait, and nystagmus. The patient appears to be responding to auditory hallucinations. Dx?

Back 752

A752. Phencyclidine (PCP) intoxication; (intoxication is characterized by maladaptive behavioral changes, and may be associated with vertical or horizontal nystagmus, hypertension, tachycardia, numbness or decreased response to pain, ataxia, dysarthria, muscle rigidity, and seizures; not alcohol withdrawal b/c of the nystagmus)

Front 753

Q753. A 25-year-old woman presents to the emergency department complaining that she is having auditory hallucinations and tremors, along with associated nausea and vomiting. She feels very anxious. On mini-mental status examination, she scores 22 of 30, and she appears to be obtunded. From what substances is this patient most likely withdrawing?

Back 753

A753. Benzodiazepines, such as alprazolam (Xanax); (Symptoms include insomnia, tremor, gastrointestinal distress, hallucinosis, and anxiety. Withdrawal from benzodiazepines can also be accompanied by generalized seizures)

Front 754

Q754. A 68-year-old woman with hypertension comes to the physician because of decreased appetite, fatigue, insomnia, inability to concentrate, and feelings of worthlessness over the past two months. She states that her grandchildren are coming to stay with her for three weeks and she "wants to get to the bottom of this" before they arrive. Her antihypertensive medication was changed three months ago. What antihypertensive medication is the most likely cause of the patient's new symptoms?

Back 754

A754. Propranolol; (The symptoms of change in appetite, fatigue, insomnia, lack of concentration, and worthlessness for greater than 2 weeks are consistent with depression. Propranolol is one of the most common pharmacological agents to cause depression. Other side effects of propranolol include dizziness, bronchospasm, nausea, vomiting, diarrhea, and constipation. It may also precipitate asthma, congestive heart failure, and hypoglycemia in susceptible patients)

Front 755

Q755. A medicine consult is requested on a 32-year-old woman with paranoid schizophrenia who is a patient in a closed psychiatric unit. Several days after the patient's admission, she developed polyuria, vomiting, stupor, diarrhea, and restlessness. She is currently taking risperidone, 10 mg given at bedtime, but no other medications. What is the most likely diagnosis?

Back 755

A755. Water Intoxication; (This patient is showing the symptoms of psychogenic polydipsia, which is the excessive intake of water as a result of a psychiatric disorder. The symptoms of excessive water intake include polyuria, vomiting, and diarrhea. As the patient is on a closed psychiatric unit, the chances of reactions to excessive medications are rare, given the careful monitoring of medication intake on most psychiatric units. Surreptitious water consumption would be easy to overlook in a patient without a previous history)

Front 756

Q756. What Dx can occur to an infant if the mother uses Benzodiazepines in the first trimester?

Back 756

A756. Cleft Palate; (During the first trimester of pregnancy, the use of benzodiazepines increases the risk of cleft palate 10-fold)

Front 757

Q757. A 29-year-old, previously successful woman was climbing stairs in her new home about a month ago, when the whole house fell apart. She ended up in a hospital with a fractured left femur. The psychiatry team was consulted because the patient complained of nightmares and flashbacks and was afraid to go to sleep as a result. During the interview, she is tearful, and afraid that her fear of falling is preventing her from participating enough in her rehabilitation, and that the team will discharge her from hospital. Dx?; What is the most appropriate med for this patient?

Back 757

A757. Dx: Posttraumatic Stress Disorder (PTSD), as well as depressive symptoms; Tx: Sertraline - SSRI; (an antidepressant approved for treatment of this disorder. Other antidepressants and anticonvulsants have also been shown to be effective in the treatment of PTSD)

Front 758

Q758. A young woman who sustained minor injuries after a motor vehicle accident is admitted to the hospital. During the observation period, the intern notices that the patient's vital signs are all increased, and she seems confused, disoriented, and delirious. On admission, she states she has been using medication to help with anxiety for couple of months. However, she ran out of it 2 days prior to the accident. From what medication is this patient most likely experiencing withdrawal?

Back 758

A758. Alprazolam is a short-acting Benzodiazepine; (It has a rapid onset of action and a relatively short half-life. It is indicated for treatment of panic attacks and anxiety disorders in general. Given its properties, however, it also has a highly addictive potential. The abrupt discontinuation of its use may result in withdrawal delirium, seizures, or death)

Front 759

Q759. Abrupt discontinuation of what psychiatric drug class can lead to Flu-like symptoms?

Back 759

A759. SSRI

Front 760

Q760. A woman comes to the clinic with her 13-year-old grandson, stating he has had behavioral problems for the past 4 years. He is living with her now because his mother is in drug rehabilitation center. She describes that he has run from home twice and has been kicked off the school bus for threatening other kids and challenging the driver. He is about to be expelled from school, since he was caught extorting money from other children. What is the most likely diagnosis?

Back 760

A760. Conduct disorder; (a childhood/adolescent disorder defined as a pattern of behavior in which the basic rights of others are violated with three or more of the following present in the past 12 months: destruction of property, cruelty to animals and people, deceitfulness or theft, and serious violations of rules. It causes clinically significant impairment in social functioning and it is reserved for patients younger than 18)

Front 761

Q761. A parent comes to you to talk about their 16yo who, in the past 7 months, has had a loss of temper, arguments with adults, defying of rules, deliberately annoying other people, blaming others for own faults, presence of vindictive behavior, presence of anger, and resentment. Dx?

Back 761

A761. Oppositional Defiant Disorder; (a pattern of negativistic and defiant behavior lasting at least 6 months with four or more of the following: loss of temper, arguments with adults, defying rules, deliberately annoying other people, blaming others for own faults, presence of vindictive behavior, presence of anger, and resentment)

Front 762

Q762. A 27-year-old woman is 2 weeks' postpartum with her first child. During her first postpartum follow-up visit, she complains to her physician that she has had several crying spells and has been increasingly irritable; however, she has had some spells during which she has felt almost euphoric. She has had these symptoms over the past week. She has not had any previous psychiatric disorders. What is the most likely diagnosis?

Back 762

A762. Maternity Blues; (a normal state of sadness, dysphoria, frequent tearfulness, and dependence that about 20% to 40% of women experience in the postpartum period. It is thought to be derived from rapid changes in women's hormonal levels and the stress of childbirth associated with maternity)

Front 763

Q763. A 43-year-old woman presents to the emergency department complaining of dizziness, tremor, diaphoresis, and shortness of breath. She indicates to the physician that she has come into the hospital with similar complaints twice in the past several weeks. On those occasions, as well as currently, her physical examination, routine laboratory studies, ECG, and cardiac enzymes have all been unremarkable. The patient states that these episodes are starting to concern her greatly and she is worried about going out of her house alone now. What is the most likely diagnosis?

Back 763

A763. Panic Disorder; (This patient's symptoms are all suggestive of panic attacks. Her symptoms do not appear to be related to substance use or a general medical condition. The frequency of her symptoms and her agoraphobia are also indicative of a diagnosis of panic disorder)

Front 764

Q764. A 24-year-old graduate student and teaching assistant comes into the student health center after being instructed by his college dean to seek counseling. According to the collateral history obtained from the patient's roommates and instructors, the man exhibits annoyingly grandiose behavior, is frequently demanding of his peers' admiration, and has had to be reprimanded for treating his undergraduate students without empathy or understanding in demanding that their work be submitted in two different forms for each assignment. Given this history, what is the most likely diagnosis?

Back 764

A764. Narcissistic personality disorder; (patients frequently demand constant attention and admiration, and they are often indifferent to criticism. They frequently exhibit grandiosity in behaviors or fantasies, show lack of empathy, often exhibit a sense of entitlement, and frequently exploit whatever interpersonal relationships they have developed)

Front 765

Q765. A mother brings her 8-year-old son to a psychiatrist for new- onset enuresis. A prior workup to determine a medical cause was negative. In conversation, it seems that the enuresis started following parental arguments and separation. The boy wets himself at least twice a week and feels upset about it, refusing to go for a sleep-over at his friend's house. What is the most commonly used treatment for this condition?

Back 765

A765. Behavioral therapy; (the most frequently used treatment in children with enuresis. Dry nights are recorded on a calendar and rewarded with a star as a gift)

Front 766

Q766. A 35-year-old man is brought to the emergency clinic by his mother because of an episode of slurred speech associated with the uncomfortable sensation that his tongue is thick and curling up. The episode started suddenly 30 minutes ago. The patient is noted to be holding on to his tongue with his thumb and forefinger. When asked about this, the patient responds with dysarthria, saying that his medication has caused this once before and that he needs a shot to make it go away. His mother reports that the patient has had schizophrenia for 10 years and consistently takes two medications prescribed by his psychiatrist. Several days ago he ran out of one of his medications, but has continued to take the other one. What is the most appropriate initial step in the management of this patient?

Back 766

A766. Quickly administer an Anticholinergic meds IM; (The patient is experiencing an acute dystonic reaction, which is a form of extrapyramidal side effect (EPS) associated with antipsychotic medications. These side effects are related to antagonism of dopamine receptors in the nigrostriatal pathway. The patient is likely taking a conventional antipsychotic agent plus a prophylactic anticholinergic agent (such as benztropine, diphenhydramine, or trihexyphenidyl). Upon stopping the anticholinergic, the dystonic reaction was more likely to occur. The appropriate initial management of this patient would include immediate IM administration of an anticholinergic agent, such as 2 mg of benztropine or 50 mg of diphenhydramine)

Front 767

Q767. A 45yo woman presents to her physician because of blurred vision for 2 days. She has no medical Hx. She does state that several days ago she started Tx for depression with a psychiatrist, due to a two-month period during which she had several depressive symptoms. She has a dry mouth and dizziness when she stands up from lying or sitting. Her temperature is 98.6 F, BP lying down is 135/75 mm Hg, BP standing is 110/64 mm Hg, pulse lying down is 84, pulse standing is 95, and respiratory rate is 16/min. Examination is unremarkable except for mild mydriasis. What medication accounts for this patient's symptoms?

Back 767

A767. TCA (Imipramine); (inhibits norepinephrine and serotonin reuptake. Like most TCAs, imipramine also has antagonistic effects at muscarinic, histaminic, and a-adrenergic receptors. This patient's complaint of blurred vision is most likely due to the antimuscarinic effects of the medication. The blockade of muscarinic acetylcholine receptors causes mydriasis (pupillary dilation) resulting in blurred vision. Dry mouth is also due to the anticholinergic effect of imipramine. Orthostatic hypotension is caused by the a1-adrenergic receptor blockade associated with TCAs)

Front 768

Q768. A 19-year-old student is admitted to the psychiatry inpatient unit with the working diagnosis of first-break psychosis. Because of combativeness and threats to others, he is put in seclusion. At first, he refused to take medication by mouth; however, after attacking a nurse he is given haloperidol intramuscularly on two occasions. He has now developed acute torticollis and twitching of the mouth and face on that side. The family is furious, stating that the treatment caused the seizures. What reaction did this patient most likely have?; Tx?

Back 768

A768. Acute Dystonia; (an involuntary spasm of a particular group of muscles that can involve the neck, jaw, tongue, eyes, or the entire body. It can be an early adverse effect of antipsychotics, and it is more common in younger men. It is more common with typical antipsychotics); TX: parenteral administration of anticholinergics; (Benztropine)

Front 769

Q769. A 45-year-old woman returns to her psychiatrist two months after being hospitalized for an episode of major depressive disorder, recurrent, severe with psychotic features. At the hospital, she was started on two meds, an antidepressant and an atypical antipsychotic. At her appointment, she complains to her physician that she has missed her menstrual period for two months. She also complains of tenderness in her breasts, and an occasional small amount of milky discharge from her breasts onto her blouse. She also admits to low libido over the past month. What medication is most likely responsible for this constellation of symptoms?

Back 769

A769. Risperidone; (Although it is an atypical antipsychotic, it is like conventional antipsychotics in its ability to cause significant elevations in plasma prolactin levels. In the tuberoinfundibular dopamine pathway, dopamine inhibits the release of prolactin from the anterior pituitary. Conventional antipsychotics and risperidone can cause hyperprolactinemia due to their dopamine antagonism in this pathway, releasing the tonic dopamine inhibition. Clinical manifestations of hyperprolactinemia may include galactorrhea, sexual dysfunction, menstrual irregularities including amenorrhea, infertility, and weight gain)

Front 770

Q770. A 42-year-old, unemployed laboratory technician is admitted to the hospital for nausea, vomiting, and abdominal pain. She tells the physician that she had been diagnosed in the past with disseminated lupus erythematosus and that she had Hodgkin disease. She seems worried that an extensive medical workup failed to confirm any of the previous diagnoses or find a cause of her actual symptoms. She insists on being given meperidine to relieve her pain. On examination, the only physical findings are scars and some abscesses on her thighs. She explains that she had been intentionally injured by the nurses in a previous hospital. What is the most likely diagnosis?

Back 770

A770. Factitious disorder; (the individual deliberately feigns the signs of a medical or mental disorder to assume the "sick" role. The symptoms are under voluntary control and cannot be explained by other underlying condition. External incentives for such behavior are usually absent. The disorder is severely incapacitating to the patients, since they usually have multiple hospitalizations and submit themselves to invasive procedures and surgeries. This is unlike Hypochondriasis which involves the excessive and pervasive preoccupation with the fear of having a serious illness based on a misinterpretation of bodily symptoms. It must be present at least 6 months and causes significant impairment in all areas of life)

Front 771

Q771. A 43yo woman with a long History of Schizophrenia complains of a loss of night vision. What medication is she taking?

Back 771

A771. Thioridazine

Front 772

Q772. A 28yo man with a History of psychiatric admission 6 months previously is seen in the ED with a painful erection, which has persisted for 18 hours. What is the next best step?; What drug is he using?

Back 772

A772. Next step: Epinepherine injection into Penis; Drug: Trazodone

Front 773

Q773. A 57yo woman complains of feeling dizzy when she gets up in the morning and when standing. She takes imipramine each evening for depression. What physiologically is the cause of her Sx?

Back 773

A773. Alpha-Adrenergic Blockade

Front 774

Q774. A 34yo man is seen in the ED with HA, dizziness and BP of 210/150. He has no medical problems, states he is feeling fine and says last night he had a nice meal with red wine and french cheese. What possible medications is he taking?; (2)

Back 774

A774. Phenelzine; or Tranylcypromine

Front 775

Q775. A 22yo college student who enjoys drinking beer attempted to take a SSRI for his depression but was upset with the side- effects. He switched to another class and several days later he was admitted to the ED with muscle spasms, confusion, fever, tachycardia and HTN. What was the cause?

Back 775

A775. Serotonin Syndrome; (switched from SSRI to MAOI without giving enough time between the meds to flush the excess SSRI out of the system. Five weeks should elapse before switching from an SSRI to a MAOI)

Front 776

Q776. A 17yo adolescent with Bulimia is very depressed. She is also suffering from insomnia and apathy. Why should she avoid Bupropion?

Back 776

A776. It can lower Anorectic effects; (and seizure threshold in person with seizure disorder)

Front 777

Q777. A 38yo woman is admitted to the hospital for an elective Hysterectomy. On post-op day 3 she experiences auditory and visual hallucinations, tremors and agitation. What is the best therapy?

Back 777

A777. Benzodiazepine; (she is probably experiencing an alcohol or Benzo withdrawal; this is Tx)

Front 778

Q778. A 25yo man with bipolar disorder took too many pills, had 2 seizures and is now in a coma. What is the best therapy?; What drug caused this?

Back 778

A778. Drug: Lithium; Therapy: Dialysis (Dialysis is used to Tx lithium toxicity, when it is severe and life-threatening)

Front 779

Q779. A 38yo Schizophrenic woman feels restless and cannot sit still; her physician thinks this is due to her medication. What can be given to calm her?; What is this Dx?

Back 779

A779. Tx: Propranolol; Dx: Akathisia

Front 780

Q780. A 32yo woman with panic disorder and anxiety took an overdose of Diazepam and is taken to the ED with somnolence and hypoventilation. What is the best Tx?

Back 780

A780. Flumazenil

Front 781

Q781. A 30yo man being Tx for schizophrenia complains of tremor and a slow gait. What is the best Tx?; (2)

Back 781

A781. Amantidine or Levodopa; (for the Drug-induced Parkinsonism)

Front 782

Q782. After taking a SSRI for weeks to months, what is a side effect a Woman may complain of?

Back 782

A782. Anorgasmia

Front 783

Q783. What is the Tx for a patient that develops Neuroleptic Malignant Syndrome?; (3)

Back 783

A783. Mostly supportive therapy, but the following drugs are also used:; Bromocriptine;; Amantidine;; Dantrolene

Front 784

Q784. What is the definitive Tx for Tardive Dyskinesia?

Back 784

A784. Nothing--it is a permanent condition

Front 785

Q785. what is the best Tx for EPS, such as Dystonic reactions?(2)

Back 785

A785. Tx:; 1. Benztropine (an Anticholinergic med); 2. Reducing the dose of the Antipsychotic

Front 786

Q786. A 33yo man thinks he is "going to have a heart attack like his father". He explains his father died at 45 of a MI. He is experiencing angina attacks consisting of nervousness, sweating, palpitations, flushing and numbness in his hands lasting 5 minutes. He is anxious about having these Sx despite negative lab results and ECGs. Dx?

Back 786

A786. Panic Disorder (without Agoraphobia)

Front 787

Q787. A 33yo female who is being treated for hypothyroidism is beginning to get panic attacks. Dx?

Back 787

A787. Dx: Synthroid-induced panic attacks

Front 788

Q788. What is a common defense mechanism seen in Dependent Personality Disorder?

Back 788

A788. Idealization

Front 789

Q789. (3) Possible drug Tx for Generalized Anxiety Disorder

Back 789

A789. Buspirone (not good to give after Benzo; starts to work in 2- 3 weeks);; Benzodiazepines;; SSRIs

Front 790

Q790. Dx:; A person with 4 or more episodes of mania in a year

Back 790

A790. Rapid Cycling Bipolar Disorder

Front 791

Q791. What is the drug Tx for someone experiencing acute Mania?; (2 together)

Back 791

A791. Mood Stabilizer and Antipsychotic; (then take patient off the anti-psych as soon as Sx go away)

Front 792

Q792. When is ECT used first in a Depressed patient?; (3)

Back 792

A792. Suicidal;; Catatonic;; Not eating or drinking

Front 793

Q793. What medication causes sickness to those trying to stop alcohol dependence?

Back 793

A793. Disulfiram; (blocks Acetylaldehyde DH)

Front 794

Q794. what medication decreases cravings of alcohol in patients who are alcoholics?

Back 794

A794. Naltrexone

Front 795

Q795. How do you know if Wernicke's progresses to Wernicke- Korsakoff?

Back 795

A795. Anterograde Amnesia develops

Front 796

Q796. A 32-year-old man is in twice-weekly insight-oriented psychotherapy with a psychiatrist. Recently, the patient has been exploring his thoughts and feelings around his wife's complaint that he is too restricted and inhibited in their sexual activity. The patient admits that he wishes to be more sexually available for his wife, but finds himself maintaining a restricted stance. What defense mechanisms would best describe this patient's tendency in his sexual relationship with his wife?

Back 796

A796. Reaction formation; (often seen in obsessional characters, is the term for the defense mechanism in which an unacceptable impulse is transformed into its opposite. In this case, during insight- oriented psychotherapy, the patient realizes his wish to be freer in his sexual relationship with his wife, an impulse which he finds unacceptable on some level, but finds himself responding in the opposite way by maintaining a restricted stance)

Front 797

Q797. What defense mechanism occurs when a socially acceptable means of expressing an impulse replaces one that would be socially unacceptable?

Back 797

A797. Sublimination; (a Substitution that allows instincts to be channeled, rather than blocked or diverted)

Front 798

Q798. A 26yo man is brought to the ED for schizophrenic symptoms. During examination, the patient appears to be awake, but firmly resists any attempts to be moved. He does not follow instructions, and the nurse was unable to move his arm to obtain a blood pressure measurement without assistance. What term would best describe this patient's resistance to being moved?

Back 798

A798. Negativism; (a motiveless resistance to all attempts to be moved or to all instructions. Signs of catatonia include stupor, negativism, rigidity, posturing, mutism, stereotypes, mannerisms, waxy flexibility, and catatonic excitement. Catatonia may be associated with schizophrenia of the catatonic type, mood disorders with catatonic features, or general medical conditions)

Front 799

Q799. Dx:; a pathological imitation of the movements of one person by another. It can be seen in catatonia, delirium, dementia, and other disorders.

Back 799

A799. Echopraxia; (Practices your behavior; not to be confused with Echolalia - repeating words or phrases)

Front 800

Q800. Dx:; a repetitive fixed pattern of physical action, movement, or speech. It may be seen in catatonia

Back 800

A800. Stereotypy

Front 801

Q801. A 53-year-old woman is admitted for depression with psychotic features. During the examination, the psychiatrist asks her whether she has ever had problems with her heart. The patient responds, "What are you saying? I don't have a heart any more; there is nothing left inside me." What is the patient most likely exhibiting?

Back 801

A801. Nihilistic delusions; (False feelings that the self or others do not exist or are destroyed. It is typical for depression with psychotic features. At its extreme, it is called Cotard's syndrome. The patient complains that he or she has lost possessions, status, strength, heart, blood, and intestines, and that the world has been reduced to nothingness)

Front 802

Q802. Hallucination type:; a false sensation of things occurring in or to the body, most frequently of visceral origin

Back 802

A802. Cenesthetic hallucination

Front 803

Q803. Dx:; a disorder of thought process in which a patient meaninglessly repeats certain phrases or words

Back 803

A803. Verbigeration

Front 804

Q804. A 28-year-old woman with a history of paranoid schizophrenia is brought by a friend to the hospital. The woman had been an inpatient at a psychiatric hospital; for several months after being discharged, she had been maintained on haloperidol decanoate shots. For the past couple of days, after the last injection, she has appeared "strange." She is stiff, cannot swallow or talk, and appears tremulous. The friend is concerned that she has some kind of infection, since she has a fever. On examination, her temperature is 38.7 C (101.7 F), blood pressure is 157/104 mm Hg, pulse is 122/min, and respirations are 24/min. She has increased tone in her neck and extremities, and appears tremulous, diaphoretic, and confused. Her leukocyte count is 19,600/mm3 and the serum creatine phosphokinase is markedly elevated. A workup for infection is negative. What is the most likely diagnosis?

Back 804

A804. Neuroleptic malignant syndrome (NMS); (A rare complication of neuroleptic therapy that confers high mortality if not recognized and treated promptly. It is defined by the development of severe muscle rigidity and elevated temperature in association with at least two or more of the following: dysphagia, tremor, diaphoresis, tachycardia, change in level of consciousness, leucocytosis, elevated or labile blood pressure, and elevated creatine phosphokinase as an indicator of muscle injury. The predisposing factors include high neuroleptic doses, intramuscular injections, and lithium treatment)

Front 805

Q805. A 49-year-old woman, who is being treated with chemotherapy after surgery for breast cancer, presents at the emergency department of the local hospital. She had just started taking prochlorperazine for nausea the day before. She is brought in by the her husband because she has been acting bizarrely over the past 24 hours, with waxy flexibility in her movements and mutism. She has no previous psychiatric history. Her physical examination, laboratory tests, and vital signs are all within normal limits. What is the most appropriate pharmacotherapy?

Back 805

A805. Benztropine; (Prochlorperazine (Compazine) is frequently used to treat nausea and emesis in some patients. Side effects of this medication, including extrapyramidal reactions (e.g., catatonia), are treated best by anticholinergic / antiparkinsonian medications such as benztropine)

Front 806

Q806. A patient is seen on the psychiatry consultation liaison service by a medical student. To assess the patient's cognitive functions, the student asks the patient what the proverb "Don't cry over spilled milk" means. The patient answers that if you spill what you cook, you have to do it all over again. What type of thinking is this patient most likely exhibiting?

Back 806

A806. Concrete Thinking; (Literal thinking that shows a lack of understanding of the nuances of meaning. These individuals lack the ability to use metaphors)

Front 807

Q807. What is it called when a patient has the ability to appreciate nuances of meaning and the ability to use metaphors and hypotheses appropriately?

Back 807

A807. Abstract Thinking

Front 808

Q808. A 30-year-old woman presents to her primary care physician with multiple symptoms of depression. She complains of about 2 months of feeling sad and anxious. She describes difficulty falling asleep at night, decreased appetite with a 15 lb weight loss, diminished interest in her hobbies, and poor concentration. The patient denies any other problems. Physical examination is within normal limits. The patient and her physician discuss initiating treatment with a selective serotonin reuptake inhibitor (SSRI). Aside from sexual consequences, what would be the most important additional information to gather before starting the SSRI?

Back 808

A808. Past history of hypomanic or manic episodes; (This might significantly alter treatment planning. It is likely that all antidepressants, including SSRIs, have a potential to cause a switch into hypomania or mania, or to accelerate cycling in patients with bipolar disorder. If the patient has a history of hypomanic or manic episodes, her depression would be considered a bipolar depression rather than a unipolar depression. In this case, the patient would likely need to be started on a mood stabilizer before beginning treatment with an antidepressant medication)

Front 809

Q809. A 40-year-old man is brought in for evaluation by the Coast Guard after the small plane he was piloting crashed into the ocean. The man's wife and two friends were also on the plane. The man has survived the crash with cuts and a broken arm, but he claims he has no memory of the crash or how he escaped the plane. He is also unable to explain how he got his life jacket on. His physical examination now is significant only for minor lacerations and a fractured right humerus, and he has no alteration in consciousness. A CT scan is normal. He is very upset that the fate of his wife is unknown, and he has nightmares for the next several nights while trying to sleep. What is the most likely diagnosis?

Back 809

A809. Dissociative Amnesia; (an extremely stressful event has been followed by localized loss of memory or amnesia of circumstances surrounding the event, making the diagnosis of dissociative amnesia the most likely diagnosis. Dissociative amnesia is often accompanied by nightmares and anxiety concerning the event, both of which this patient also has)

Front 810

Q810. A 26-year-old man presents to his primary care physician complaining that he has been more and more afraid to leave his house because he has been having frequent anxiety attacks that occur without warning. He is worried that he will have an attack at some time while he is in public. What is the most appropriate initial medication for this patient in an acute situation?

Back 810

A810. a Benzodiazepine; (This patient's symptoms suggest that he has panic disorder, which is most appropriately treated acutely with a benzodiazepine with a medium length half-life and duration of action, such as clonazepam)

Front 811

Q811. A 22-year-old African American male is admitted to a psychiatric unit for stabilization of an acute episode of psychosis. He has experienced several weeks of depressive and psychotic symptoms, and has had periods of anxiety and aggression associated with psychotic symptoms and anger about his involuntary civil commitment. He has been started on an antidepressant, an antipsychotic, and has required additional medications on several occasions for agitation. On the fifth day of his hospitalization, he develops a sustained muscular contraction involving his left neck muscles, with associated pain and distress. Dx?

Back 811

A811. Acute Dystonia

Front 812

Q812. Dx:; A condition in which the patient has signs and symptoms of pregnancy. It is related to conversion symptoms and can be viewed as a psychosomatic disorder.

Back 812

A812. Pseudocyesis

Front 813

Q813. A 40-year-old woman is brought to the hospital after overdosing on alcohol and pills. In talking to a psychiatrist, she denies any prior psychiatric problems but says that about a week ago her apartment burned down. She was trying to get a job before that happened, but when she realized that she had lost everything she had, and that moving in with her family would probably not be possible, she decided to take her own life. What is the most likely diagnosis?

Back 813

A813. Adjustment Disorder; (A set of behavioral or emotional symptoms developing as a response to an identifiable stressor within 3 months after exposure to the stressor. The symptoms are excessive compared with what one would expect from the exposure, and they cause marked impairment in social functioning)

Front 814

Q814. A 52-year-old man is recuperating in a hospital after having sustained a recent cerebrovascular accident that damaged part of his right temporal lobe. Once the patient has recuperated from the immediate effects of his stroke, to what psychiatric disorder will he be most predisposed?

Back 814

A814. Major Depressive Disorder; (Any event that affects the vasculature, such as a myocardial infarction or a cerebrovascular accident (CVA), has been shown to increase the risk of major depressive disorder in the months following such an event. The pathophysiology of such a development is unclear, but is thought to be related to the effects of serotonin on vascular physiology)

Front 815

Q815. A 26-year-old man with schizophrenia comes to the emergency department with a 2-hour history of involuntary contractions of the muscles in his neck. He states that he was watching television and "all of a sudden I turned my head and my neck locked". He began taking a high-potency antipsychotic agent 3 days earlier. Examination shows no abnormalities except torticollis. What is the most appropriate pharmacotherapy?

Back 815

A815. Benztropine; (The treatment of acute dystonia is with anticholinergic medications, such as benztropine or diphenhydramine)

Front 816

Q816. A 22-year-old white woman comes to a psychiatrist's office after having been referred by her family physician. She reports no mental problems but tells the psychiatrist that she is concerned about hair loss. Her mother says that the patient has been grooming herself frequently and checking her image in the mirror. Her family physician has examined her several times; there is no evidence of hair loss. He has run multiple tests, but there is no evidence of any abnormality. The woman states that she is embarrassed and tries to avoid going out because everyone "will notice" and ask questions. She denies pulling her hair. Despite this problem, she is still doing well on her job. What is the most likely diagnosis?; Tx? (2 possible)

Back 816

A816. Body dysmorphic disorder; (The preoccupation with an imagined defect in appearance or excessive preoccupation with a slight anomaly present. Patient are often ashamed to present for treatment. They may frequently check their image and try to compensate for the imagined defect. The disorder leads to social isolation secondary to imagined mockery); Treatment:; 1. prevention of iatrogenesis; 2. SSRI

Front 817

Q817. A 69-year-old patient is admitted to the neurology service following a stroke. During the next few days, the staff observes that the patient has developed the clinical picture of mania. What area of the brain has most likely been affected by the stroke?

Back 817

A817. Right Frontal Lobe; (or other parts of right hemisphere)

Front 818

Q818. A 69-year-old patient is admitted to the neurology service following a stroke. During the next few days, the staff observes that the patient has developed catastrophic reactions that include restlessness, hyperemotionality, irritability, and sudden outbursts of emotion. What area of the brain has most likely been affected by the stroke?

Back 818

A818. Left hemispheric lesions including Broca's area

Front 819

Q819. A 69-year-old patient is admitted to the neurology service following a stroke. During the next few days, the staff observes that the patient has developed the clinical picture of depression. What area of the brain has most likely been affected by the stroke?

Back 819

A819. Left Prefrontal Cortex

Front 820

Q820. A 69-year-old patient is admitted to the neurology service following a stroke. During the next few days, the staff observes that the patient has developed the clinical picture of Peduncular Hallucinosis (dreamlike hallucinations). What area of the brain has most likely been affected by the stroke?

Back 820

A820. Midbrain lesions

Front 821

Q821. A 10-year-old boy diagnosed with attention deficit/hyperactivity disorder (ADHD) comes to a new doctor for the first time. His mother reports that they moved recently to the city, but that he was started on a medication for his ADHD by his previous doctor. After learning which medication the patient has been taking, the doctor becomes concerned about the patient's liver function. What medication is the patient most likely taking?

Back 821

A821. Pemoline; (A sympathomimetic agent approved for the treatment of attention deficit/hyperactivity disorder. Given the rate of reported cases of hepatic failure, which ranges from 4 to 17 times higher than expected in general population)

Front 822

Q822. A 22-year-old woman with anorexia nervosa and a history of depression, for which she is currently taking bupropion, moves to a new city and presents to a local psychiatrist to establish care in her new location. She tells the doctor that she has been on the same dose of bupropion since she was 18 years old, and that her depression has been stable, but that she has lost 10 pounds over the last month and weighs only 90 pounds (41 kg) now with a height of 5 feet 5 inches (165 cm). What medicine complication should the physician be most concerned?

Back 822

A822. Seizures; (Bupropion is an antidepressant that can lower the seizure threshold for some patients, and as a result should be discontinued or carefully monitored in a patient with anorexia nervosa. Patients with anorexia are at increased seizure risk related to large fluid shifts and electrolyte disturbances caused by bingeing and purging behavior)

Front 823

Q823. Thought Process Disorder:; Using Made-up words

Back 823

A823. Neologisms

Front 824

Q824. Thought Process Disorder:; the point of conversation is reached after a long, circuitous path

Back 824

A824. Circumstantiality

Front 825

Q825. Affect type:; Laughing one second and crying the next

Back 825

A825. Labile affect

Front 826

Q826. Delusion Type:; Belief that some event is uniquely related to the individual; ("Jesus is speaking to me through TV characters")

Back 826

A826. Ideas of Reference

Front 827

Q827. Name (4) Typical Antipsychotics

Back 827

A827. ("-AZINEs") + Haloperidol:; ChlorpromAZINE;; ThioridAZINE;; FluphenAZINE;; Haloperadol

Front 828

Q828. What are the (2) suffixes (endings) for Atypical Antipsychotics?; Name (4) drugs

Back 828

A828. ("-APINE") or ("-IDONE"):; ClozAPINE;; OlanzAPINE;; QuetiAPINE;; RisperIDONE;; (ZiprosIDONE)

Front 829

Q829. A 28yo woman taking care of her schizophrenic husband starts believing her husband's claim that he invented the telephone. When she went abroad a few months her belief disappeared. Dx?

Back 829

A829. Shared Psychotic Disorder

Front 830

Q830. Dx:; A type of depression characterized additionally by hypersomnia, hyperphagia, reactive mood, leaden paralysis and hypersensitivity to interpersonal rejection

Back 830

A830. Dx: Atypical depression

Front 831

Q831. First-line Tx for Adjustment Disorder

Back 831

A831. Supportive Psychotherapy

Front 832

Q832. What is a common defense mechanism of Histrionic Personality Disorder?

Back 832

A832. Regression; (reverting to childlike behaviors)

Front 833

Q833. how do you differentiate Dependent Personality Disorder from a dependence of a debilitated person?

Back 833

A833. DPD features must manifest before early adulthood

Front 834

Q834. Dx:; An overweight woman starts a diet, loses 5 pounds, and then says she's taking a break from the diet because she "hasn't been feeling well."

Back 834

A834. Passive-Aggressive Personality Disorder; (stubborn, inefficient procrastinators that manipulate others to do their chores or errands while complaining about their own misfortune)

Front 835

Q835. What is the Tx of choice for all Personality Disorders?

Back 835

A835. Psychotherapy

Front 836

Q836. what controlled substance is commonly seen in cough syrup?

Back 836

A836. Dextromethophan; (Opiate)

Front 837

Q837. A patient presents to the ED with dysphoria, Rhinorrhea, Piloerection, insomnia, increased lacrimation, N/V, dilated pupils and sweating; Dx?; Tx?

Back 837

A837. Opiate Withdrawal (piloerection and rhinorrhea are key Sx); Tx:; if moderate - Clonidine; if severe - Methadone detox

Front 838

Q838. withdrawal from what class of drugs in abuse can be life threatening?

Back 838

A838. Sedatives; (Benzos / Barbs)

Front 839

Q839. Dx:; a patient has dementia, diminished position and vibration sensation and a pupillary accommodation response without a light response. Diagnostic test?

Back 839

A839. Dx: Neurosyphilis; Dx test:; CSF Fluorescent Treponemal Ab Absorption test; (CSF FTA-ABS or CSF VDRL)

Front 840

Q840. Define:; Inability to perform purposeful movements; (copying a picture)

Back 840

A840. Apraxia

Front 841

Q841. Define:; Inability to interpret sensations correctly; (if visual: inability to recognize a previously known object)

Back 841

A841. Agnosia

Front 842

Q842. Dx:; progressive dementia, muscular hypertonicity, choreform movements; Genetics?

Back 842

A842. Huntington's Disease; genetics: Autosomal Dominant; (HD is Hereditary Dominant)

Front 843

Q843. Dx:; rapidly progressive dementia 6 - 12 months after onset of Sx and myoclonus (muscle spasms), generalized hypertonicity, and profound speech disturbances; what does brain tissue look like?

Back 843

A843. Creutzfield-Jakob Disease (CJD); brain: Spongiform changes (and Prions)

Front 844

Q844. what are the TORCH toxins that can lead to mental retardation?

Back 844

A844. Toxoplasmosis;; Other (Syphilis, AIDS);; Rubella;; CMV;; Herpes

Front 845

Q845. when suspecting a learning disorder, what is the first step?

Back 845

A845. rule-out a Hearing or Visual deficit

Front 846

Q846. Another name for Dissociative Identity Disorder

Back 846

A846. Multiple personality Disorder

Front 847

Q847. A 33yo nun is astounded when a man claims that he saw her at a strip club the night before. She denies his accusations and has no memory of the event. Dx?

Back 847

A847. Dissociative Identity Disorder; (multiple personalities)

Front 848

Q848. A 68-year-old man is admitted to the hospital for delirium associated with a urinary tract infection. Upon adequate treatment of the infection, the patient's mental status improves significantly, though he is noted to remain partly disoriented. He also has an impairment in short-term memory, difficulties in naming simple objects, and impaired concentration. His family members confirm an 8-month history of gradual progressive decline in cognitive abilities, which they attribute to old-age.Prior to discharge from the hospital, the nursing staff reports that the patient continues to have urinary incontinence, though his infection has resolved. He is also noted to have a very unsteady gait, requiring assistance when walking. Dx?

Back 848

A848. Normal Pressure Hydrocephalus; (A potentially reversible cause of dementia that causes gait disturbances (unsteady or shuffling gait), urinary incontinence, and dementia. Enlargement of the ventricles with increased cerebrospinal fluid (CSF) pressure is found, and therapeutic lumbar punctures may significantly improve symptoms)

Front 849

Q849. Dx:; the excessive and compulsive need for coitus in a man. Its corollary in a female is termed nymphomania.

Back 849

A849. Satyriasis

Front 850

Q850. A 29-year-old woman presents to her new primary care physician requesting medication to help with her recent spells of anxiety and depression. She wishes to be started on a medication that will not cause too much sedation. Examination of the patient's old records reveals two previous suicide attempts by overdose, once with acetaminophen at age 16 and another, with aspirin, during college. Given this history, what antidepressant medication would most likely be contraindicated for this patient?

Back 850

A850. Tricyclic Antidepressant; (It is lethal in overdose and is the leading cause of overdose-related deaths in the psychiatric population. Overdose is associated with prolongation of the QT interval, leading to cardiac arrhythmia and death. Given this patient's history of previous overdoses, a TCA would be contraindicated)

Front 851

Q851. Dx:; delusion in which a person believes that he or she is being controlled by another person or external force

Back 851

A851. Ideas of Influence

Front 852

Q852. Dx:; delusions in which a person has a false belief that others (including people on TV or radio) are talking about him or her. In a broader sense, the behavior of others refers to oneself, other persons, or objects that have special significance and meaning

Back 852

A852. Ideas of Reference

Front 853

Q853. Dx:; the feeling of revelation in which a person experiences illumination associated with a sense of being chosen as a leader

Back 853

A853. Noesis

Front 854

Q854. A 64-year-old man is undergoing chemotherapy and has occasional nausea and vomiting, which are treated with IV prochlorperazine. After several days of therapy, the patient complains that he feels very restless and agitated and he cannot stop moving his legs. What medication, if given during his initial regimen, might have best prevented this reaction?

Back 854

A854. Lorazepam; (This patient has evidence of akathisia, the feeling of restlessness that sometimes occurs as a reaction to use of neuroleptic medications, such as prochlorperazine and haloperidol. Prevention of akathisia is most reliably maintained by use of a benzodiazepine medication, such as lorazepam given IV during administration of the neuroleptic drug. This is particularly important in a patient whose immune system and metabolic capacity may show signs of compromise)

Front 855

Q855. Dx:; mental retardation, short stature, continuous eyebrows, thin downturning lip, microcephaly, small and malformed hands, and hirsutism

Back 855

A855. Cornelia de Lange syndrome

Front 856

Q856. A 41-year-old man with a long history of schizophrenia, paranoid type, has been on the inpatient unit for almost 2 weeks. This is his third admission in the past 6 months, and each time he seems to be less responsive to treatment. In the past, he has been on typical antipsychotics and then tried on different combinations, including some atypical ones, with limited success. His family is supportive and makes sure he takes his medication. Given his most recent poor response, what is the most appropriate next step in treatment?

Back 856

A856. Clozapine; (An atypical agent that has been proven to be more effective than conventional antipsychotics in the treatment of patients with resistant schizophrenia. It exerts an antagonistic effect on D1 and D4 receptors, as well as on the alpha-adrenergic, histaminergic, serotonergic, and cholinergic systems. It is 30% effective in the treatment of patients with resistant schizophrenia in the first 6 weeks)

Front 857

Q857. A patient is talking to his psychiatrist about a conflict he has with his partner. They argue because the partner complains that the patient is inefficient and procrastinates doing things that are his responsibility. He never completes a task the way in which he was asked to do it, but in his own way and usually much later. What type of defense mechanism is this patient exhibiting?

Back 857

A857. Passive-Aggressiveness; (Aggression toward others is expressed indirectly, usually through procrastination, stubbornness, passivity, and forgetfulness. The manifestations usually affect others more than the person who is doing it)

Front 858

Q858. A 12-year-old boy is brought to his pediatrician due to failing grades in school. The boy failed last year and is repeating the sixth grade. His parents have suspected for several years that the boy may have low intelligence due to repeated difficulties in school. The family is referred to a psychologist for psychological testing, including an assessment of intelligence. What test would be most appropriate for evaluating the boy's intelligence and to assist with possible placement in special classes in his school?

Back 858

A858. Stanford-Binet Test; (A comprehensive intelligence test that is used in psychiatry and education. Another widely used intelligence test is the Wechsler Adult Intelligence Scale. Such tests are routine intelligence tests in the assessment of borderline intellectual functioning, mental retardation, and specific learning disorders)

Front 859

Q859. A 54-year-old woman presents to her primary care physician for her routine yearly health maintenance examination. She denies any new problems. Her only significant medical history includes a 25-year history of schizophrenia, which has been well-controlled with antipsychotic agents, and a 5- year history of hypertension for which she takes a diuretic. Vital signs and physical examination are within normal limits. However, the patient is noted to have occasional irregular puckering and lip-smacking movements. She denies having noticed the abnormal movements, and her speech is normal. Dx?

Back 859

A859. Tardive dyskinesia; (The abnormal involuntary movements usually involve orofacial muscles but may include the trunk and extremities)

Front 860

Q860. Dx:; the patient often tends to emphasize disability related to memory loss, communicates a strong sense of distress, significant memory loss for both recent and remote events and there is little effort to perform even simple tasks

Back 860

A860. Pseudodementia of Depression

Front 861

Q861. A 48-year-old obese woman with a history of psychotic depression is brought to the psychiatric emergency department following a suicide threat. She is difficult to interview because she feels tired and sleepy and states she is on a continuous positive airway pressure (CPAP) machine at home secondary to having obstructive sleep apnea. She reports that she has been on Prozac and other medications, which she got for "the voices." During the interview, the psychiatrist learns she has gained 20 pounds in the past several months. What medication most likely caused this significant weight gain?

Back 861

A861. Olanzapine; (An atypical antipsychotic indicated for the management of psychotic disorders. In placebo-controlled, 6-week studies, 29% of olanzapine-treated patients gained greater than 7% of their baseline weight compared with 3% of placebo-treated patients. Among patients on long-term treatment with olanzapine 56% gained more than 7% of baseline weight)

Front 862

Q862. Throughout the session, the patient has a sense of depression and views herself as inadequate and disappointing to the therapist. The therapist makes the following comment, "I notice that on a day without your make-up, you fear that I will find you inadequate, probably much like you perceived your father's disappointment if you didn't win the beauty contest. It seems difficult for you to feel accepted if you do not feel attractive. " What psychotherapeutic technique best describes the therapist's comment?

Back 862

A862. Transference Interpretation; (An interpretation involves making something conscious that was previously unconscious, such as the connection between the patient's sense of depression and her lack of make-up as well as the correlation between her relationship styles with her father and with her therapist. An interpretation is an explanatory statement that links a feeling, thought, behavior, or symptom to its unconscious meaning. In this case, the interpretation directly deals with the transference...the patient's feelings and behavior toward the therapist that are based on earlier wishes with important figures)

Front 863

Q863. Dx:; a persisting response to a prior stimulus even though a new stimulus has been presented. It can be verbal or motor, and is seen in cognitive disorders

Back 863

A863. Preservation

Front 864

Q864. A 36-year-old woman comes to her gynecologist because of a three-month history of amenorrhea. Until this time, her menstrual periods had been regular. She also complains of decreased sex drive, worsening over the past couple of months. The patient denies any other symptoms. She has no significant medical history, although she started seeing a psychiatrist five months ago after a brief hospitalization during which she was diagnosed with major depressive disorder, severe, with psychotic features. Her depressive symptoms are resolving. What Atypical antipsychotic is most likely responsible for the patient's presenting complaints during her visit to her gynecologist?

Back 864

A864. Risperidone; (The newer atypical antipsychotics have minimal, if any effect on plasma prolactin concentrations, except for risperidone, which is associated with elevated prolactin. Antipsychotic-induced hyperprolactinemia may cause side effects including amenorrhea and infertility, sexual dysfunction, galactorrhea, and weight gain)

Front 865

Q865. What common childhood disorder is seen in 10-20% of kids with mental retardation?

Back 865

A865. ADHD

Front 866

Q866. Dx:; A child with increased head circumference, facial coarsening, joint hyperextensibility, mental retardation and macro-orchidism; What is the most commonly assoc childhood psych illness?

Back 866

A866. Dx: Fragile X syndrome; assoc with :; ADHD (75%)

Front 867

Q867. Dx:; X-linked metabolism disorder assoc with mental retardation, microcephaly, gout, seizures and self-mutilation

Back 867

A867. Lesch-Nyhan syndrome; (Purine metabolism causing excess Uric Acid due to deficiency in Hypoxanthine-GPT)

Front 868

Q868. Dx:; disorder in amino acid metabolism with mental retardation, seizures, hyperactivity, decreased pigmentation and a mousy body odor

Back 868

A868. Phenylketonuria (PKU); (deficiency in phenylalanine hydroxylase; low levels of Tyrosine)

Front 869

Q869. Dx:; child who is a compulsive over-eater, has hyperphagia, obesity and predisposed to Oppositional Defiant Disorder

Back 869

A869. Prader-Willi; (chromosome 15)

Front 870

Q870. Which autosomal dominant disorder is characterized by adenoma sebaceum, brain lesions, seizures and mental retardation?

Back 870

A870. Tuberous Sclerosis

Front 871

Q871. Dx:; cafe au lait spots, pigmented iris hamartoma, skeletal disorder, schwann cell tumor; 1/3 of these patients have MR

Back 871

A871. Neurofibromatosis; (Von Recklinghausen Disease)

Front 872

Q872. Dx:; a 3-9yo child with a seizure disorder and language problem

Back 872

A872. Landau-Keffler Syndrome; (Acquired Epileptic Aphasia)

Front 873

Q873. Dx:; child who is normal until the age of 2, then loses skills in language, behavior, bowel/bladder, play or motor

Back 873

A873. Childhood Disintegrative Disorder; (skills begin to "Disintegrate")

Front 874

Q874. Definition:; Coprolalia; what Dx is it seen in?

Back 874

A874. "Cursing"; Tourette's Disorder

Front 875

Q875. what is the Tx for a mentally retarded girl with worsening behavior?

Back 875

A875. Review Behavior Management Plan

Front 876

Q876. when do you start treating a child with Enuresis?

Back 876

A876. Age 5

Front 877

Q877. What is most likely to happen to the child who is a hyperactive kid (untreated)?

Back 877

A877. Substance Abuse in future

Front 878

Q878. First Tx for a stroke-induced dementia?

Back 878

A878. Tx the Vascular problems first

Front 879

Q879. Aside from finding the underlying cause of Delirium, what medication is the first-line of Tx?

Back 879

A879. Haloperidol

Front 880

Q880. if patient has alcohol withdrawal with hallucinations, what is the additional Tx (specific Rx)?

Back 880

A880. Haloperidol

Front 881

Q881. A 5yo child with cold-like Sx and hallucinations is being treated by mother with OTC medications. What is the cause of the Sx?

Back 881

A881. Benadryl

Front 882

Q882. A homeless alcoholic has oxalate crystals in his urine. What is cause?

Back 882

A882. Ethylene Glycol

Front 883

Q883. a woman is on corticosteroids for one month for her arthritis. What psych disorder can it lead to?

Back 883

A883. Depression

Front 884

Q884. Tx for Premenstrual Dysphoric Disorder

Back 884

A884. SSRI

Front 885

Q885. a patient with asthma and a substance abuse problem in his family is anxious about giving a speech. What is the best med?

Back 885

A885. Benzodiazepine; (normally propranolol, but not in an asthmatic)

Front 886

Q886. Hyperthyroidism is associated with what psychiatric disorder?

Back 886

A886. Panic Disorder

Front 887

Q887. What type of cancer is assoc with Depression?

Back 887

A887. Pancreatic CA

Front 888

Q888. Dx:; Dementia, visual hallucinations, delusions and parkinson- like features; cause is brain-related; Tx for the delusions/hallucinations?

Back 888

A888. Dx: Lewy Body Disease; Tx for delusions: Benzodiazepine (not an antipsychotic b/c it will increase EPS)

Front 889

Q889. DOC for Nightmares

Back 889

A889. Tranylcypromine; (MOAI b/c it works in REM)

Front 890

Q890. DOC for Night Terrors

Back 890

A890. Benzodiazepine; (works in stage 4)

Front 891

Q891. What genetic disorder is assoc with Schizotypal Personality disorder?

Back 891

A891. Fragile X (females)

Front 892

Q892. After a cocaine binge and detoxification in a hospital thereby resolving his euphoria and paranoia, a patient begins to describe his history of cocaine use for the past 5 years. There were times of sobriety where he felt depressed, but they were infrequent in the constant use the past 5 years. What is the best Tx?

Back 892

A892. Narcotics Anonymous

Front 893

Q893. What is the most sensitive test in diagnosing delirium?

Back 893

A893. Electroencephalogram; (shows generalized slowing; if alcohol or sedative-induced it will show fast low-voltage activity; in hepatic encephalopathy it will show triphasic delta waves)

Front 894

Q894. What NT is most likely involved in Delirium?

Back 894

A894. Acetylcholine; (why anticholinergics are most commonly a cause)

Front 895

Q895. A 16yo woman experienced a depressed mood with anergia, insomnia, and a decreased appetite with weight loss since her boyfriend left her 6 weeks ago. She also has decreased energy, suicidal ideation and hears voices that tell her she is "no good." She is well dressed and has good hygiene. She admits to having frequent thoughts of suicide in the past few days but would not act on them because it would be a "sin."; Dx?; Tx? (3 together)

Back 895

A895. Dx: Major Depression with Psychotic features; Tx:; 1. She should be Hospitalized; 2. begin SSRI; 3. begin Antipsychotic

Front 896

Q896. Psychotic depression is diagnosed in a 14yo boy and he is treated with risperidone and an SSRI. Three months later his Sx have resolved and he is no longer psychotic. What is the next step?

Back 896

A896. The Antipsychotic should be discontinued via a Tapering dose; (children with major depression and psychotic features respond to a combo antidepressant and atypical antipsychotic. The atypical antipsychotic should be continued for 3 months and then tapered off. The antidepressant should be continued for 6-9 months and then tapered off over 2-3 months at 33% per month)

Front 897

Q897. what action is most appropriate in treating a patient with Conduct Disorder?

Back 897

A897. Patients should receive jail time in keeping in line with their behavior; (natural consequences is one of the most effective Tx)

Front 898

Q898. A 23yo medical student makes lists of all the tasks he must accomplish in a day, spends hours studying instead of time with classmates, attends every lecture and takes meticulous notes, not trusting others to do so. He and his girlfriend are both doing very well in medical school. Dx?

Back 898

A898. Obsessive-Compulsive Traits; (his social and occupational functioning are both good, which rules out OCPD)

Front 899

Q899. Defense mechanism:; A man comes home to find his wife in bed with another man. When relating the information to his friend, the man can tell of certain details of the scene but appears emotionally unmoved by the event.

Back 899

A899. Isolation of Effect

Front 900

Q900. Defense mechanism:; A woman steals a coat and states "it's okay--the store has plenty of money and they wont miss one coat."

Back 900

A900. Rationalization

Front 901

Q901. Defense mechanism:; a child avoids stepping on a crack in the sidewalk to avoid "breaking your mother's back."

Back 901

A901. Undoing

Front 902

Q902. A 36yo man who survived a serious car accident 4 months ago complains of "jitteriness" when driving to work and is currently using public transportation due to anxiety. He "spaces out" at work and has difficulty concentrating at his job, which has caused his performance to slip. He has trouble sleeping at night and has lost 4 pounds because of a decreased appetite. Dx?

Back 902

A902. Major Depression; (commonly occurs with PTSD as a comorbid condition)

Front 903

Q903. Tx for Post-Traumatic Stress Disorder; (3 together)

Back 903

A903. 1. SSRI; 2. Psychotherapy; 3. Social Interventions

Front 904

Q904. Tx for Alzheimer's Dementia

Back 904

A904. Acetylcholinesterase Inhibitor; (increasing ACh)

Front 905

Q905. what type of behavioral therapy is useful in a patient with Dysthymia?

Back 905

A905. Cognitive-Behavioral Therapy; (shown to have better outcome then psychotherapy or supportive therapy)

Front 906

Q906. If a patient with dementia progresses to become agitated and aggressive, what class of med would help manage his behavior?

Back 906

A906. Antipsychotic (high-potency)

Front 907

Q907. What are the steps to medical management in a patient with Depression?; (4 steps)

Back 907

A907. 1. start low dose SSRI; 2. Increase SSRI dose (up to max dose for body size); 3. if still not working - try alternate SSRI; 4. Change class (TCA or MOAI)

Front 908

Q908. What type of amnesia is assoc with loss of memory for a few hours to a few days?

Back 908

A908. Localized Amnesia

Front 909

Q909. What type of amnesia covers a whole lifetime?

Back 909

A909. Generalized Amnesia

Front 910

Q910. What type of amnesia involves forgetting successive events as they occur despite being alert?

Back 910

A910. Continuous Amnesia

Front 911

Q911. Describe the DEA Control Levels I - V of drugs

Back 911

A911. I: Not for Rx (LSD); II: No refills without examination; III: Moderate physical dependence but high Psych dependence; IV: Rx must be written after 5 refills (lower abuse potential); V: Lowest abuse potential

Front 912

Q912. Describe the Classes A-X for psychtropic meds during pregnancy

Back 912

A912. A: no risk; B: adverse findings in animals, not humans; C: Risk not ruled out; benefits outweigh risk; D: Positive risk; X: Contraindicated in Pregnancy

Front 913

Q913. A 26yo single mother of three is admitted to the neurology service with complaints of diminished sensation in both legs. What psychological defense mechanism could this person be suffering from that is assoc with a breakdown of consciousness, memory, sensory or motor behavior?

Back 913

A913. Dissociation

Front 914

Q914. Definition:; Fear that one's penis is shrinking

Back 914

A914. Koro

Front 915

Q915. Definition:; Another name for Voyerism

Back 915

A915. Scopophilia

Front 916

Q916. Dx:; Overt compliance by subbordinates masking covert resistance or hostility

Back 916

A916. Passive-Aggressive

Front 917

Q917. What meds are useful in reducing aggressive behavior in Antisocial Personality Disorder?; (3)

Back 917

A917. 1. SSRI; 2. Mood Stabilizers; 3. Propranolol

Front 918

Q918. what is the best behavior therapy for Antisocial Personality Disorder?

Back 918

A918. Socially-based Interventions; (group therapy)

Front 919

Q919. What are the (2) Antisocial Personality Disorder defense mechanisms?

Back 919

A919. 1. Acting Out; 2. Projective Identification

Front 920

Q920. What diagnostic test can be used to confirm a clinical impression of Antisocial Personality Disorder?

Back 920

A920. Electroencephalogram (EEG); (shows soft neurological signs suggestive of minimal brain damage that occurred in childhood)

Front 921

Q921. A 39yo man with antisocial personality disorder, incarcerated for murdering a man, has a multitude of medical complaints over the course of several years. Yearly physicals never show anything wrong with him, yet he complains of a variety of aches and pains, neurological symptoms and GI distress. He does not enjoy the time he spends in the jail infirmary. Dx?

Back 921

A921. Somatization Disorder; (development becomes more common in patients with APD as they grow older)

Front 922

Q922. A 15yo girl who has a diagnosis of major depression with suicide attempt is treated for this and seems to respond well. Her parents report that for years now she is constantly worried that the cameras in the doctor's office are recording her and she believes that she is being stalked by several boys at her school. Dx?; Tx?

Back 922

A922. Dx: Schizoaffective Disorder (Schizophrenia Sx are predominant, with depression during the schizophrenic episodes); Tx: Antipsychotic (if ineffective, add a SSRI)

Front 923

Q923. A 40yo with Schizoaffective disorder has been hospitalized for the third time in 5 years. During each episode he becomes non-compliant in taking his meds, develops acute manic Sx and hallucinations and then becomes violent. The patient is prescribed a mood stabilizer and an antipsychotic. What other medication may be helpful for his acute mania?

Back 923

A923. Lorazepam (or Clonazepam); (both have been shown to be effective adjunctive Tx for acute mania both in patients with schizoaffective disorder and bipolar disorder)

Front 924

Q924. what is the key to diagnosing Schizoaffective disorder?

Back 924

A924. the psychotic episodes occur during the mood episodes; (but the mood symptoms do not always occur during the psychotic episodes)

Front 925

Q925. A 24yo woman has olfactory hallucinations several times a week for the past month. She smells burning rubber and rotting flesh. Her friends report seeing her "staring off into space," although she is unaware of this behavior. She has no other psychiatric symptoms. She has a history of a concussion resulting from a car accident 1 year previously. Dx?; How is it coded?; Tx? (2 together)

Back 925

A925. Dx: Psychosis caused by a General Medical Condition (Seizure disorder); Coded: "Psychosis secondary to a general medical disorder" in Axis I; "Seizure disorder" in Axis III; Tx:; 1. Underlying problem; 2. Antipsychotics for psychosis

Front 926

Q926. (3) main drug treatments for ADHD; (and AE of each)

Back 926

A926. 1. Methylphenidate (tics); 2. Atomoxetine (sedation); 3. Pemoline (hepatotoxicity)

Front 927

Q927. What drug treats the autonomic symptoms of opioid withdrawal such as HTN, tachycardia, sweating, lacrimation and rhinorrhea?

Back 927

A927. Clonidine

Front 928

Q928. Tx in Pain Disorder; (3 together)

Back 928

A928. 1. Validate pain and explain psychological factors; 2. consider SSRI; 3. referral to pain clinic

Front 929

Q929. Acute Stress disorder is diagnosed in a 32yo woman who witnessed her fiancée being shot to death in a robbery attempt. She has difficulty sleeping and feels she is not emotionally attached to anything around her. She also has repetitive flashbacks of the event. What med might help her over the short term?

Back 929

A929. Zolpidem; (a hypnotic for the insomnia)

Front 930

Q930. A 42yo woman is determined to kick her heroin habit at home without use of methadone or any prescription drugs. What over-the-counter medication is most likely to be of benefit to the patient as she goes through opioid withdrawal?

Back 930

A930. Acetaminophen; (to relieve the muscle cramps assoc with withdrawal)

Front 931

Q931. (5)* signs of opioid withdrawal

Back 931

A931. SLUMP:; Salivation / Sweating;; Lacrimation;; Urination / Defecation;; Muscle cramps;; Piloerection

Front 932

Q932. In a patient with Pain Disorder who suffers from headaches that are "unbearable", what is the suggested treatment?

Back 932

A932. Biofeedback and Relaxation techniques; (analgesics are not helpful in these patients and addicting meds should be avoided)

Front 933

Q933. What type mood disorder specifier is Anhedonia, diurnal variation and early morning wakening?

Back 933

A933. Melancholic features

Front 934

Q934. what is a neurophysical effect of Autism?

Back 934

A934. Rapid brain growth

Front 935

Q935. What gene and allele is a risk for Alzheimer's Disease?; What does it do?

Back 935

A935. APOE gene 4 allele; Decreases the clearance of A-beta 42 amyloid; (not increases production)

Front 936

Q936. What medication increases the levels of Lithium?; (2); What decreases the levels?; What hormone does it affect?

Back 936

A936. Increases:; 1. Thiazide Diuretics; 2. NSAIDs; Decreases: other Diuretics; affects: Thyroid Hormone (decreases)

Front 937

Q937. Adverse effects of this atypical antipsychotic include:; sedation, increased appetite, tachycardia and hyperlipidemia.

Back 937

A937. Clozapine; (also Agranulocytosis)

Front 938

Q938. Adverse effects of this antipsychotic include:; sedation, increased appetite, possible hyperlipidemia and arrhythmias

Back 938

A938. Haloperidol

Front 939

Q939. Portion of the brain:; processes info to establish and maintain new and longer lasting memories

Back 939

A939. Medial Temporal region

Front 940

Q940. Portion of the brain:; involved in ambiguous learning situations such as gambling

Back 940

A940. Orbitofrontal Cortex

Front 941

Q941. Portion of the brain:; involved in Working memory, which allows one to keep several ideas in the mind at once

Back 941

A941. Prefrontal Cortex

Front 942

Q942. Drug class with following action on 5-HT receptors:; downregulation of terminal 5-HT 1b autoreceptors after long administration

Back 942

A942. SSRI

Front 943

Q943. Drug class with following action on 5-HT receptors:; increases responsiveness of postsynaptic 5-HT 1a receptors

Back 943

A943. TCAs

Front 944

Q944. Drug class with following action on 5-HT receptors:; decreased responsiveness of 5-HT 1a receptors

Back 944

A944. MAOIs

Front 945

Q945. what occurs physiologically to the hematological system with stress?

Back 945

A945. Platelet aggregation increases

Front 946

Q946. What is the adverse effect if mixing a SSRI and an Antispasmotic for IBS?

Back 946

A946. Sedation

Front 947

Q947. what atypical antipsychotic is most commonly associated with elevated lipids and diabetes?

Back 947

A947. Olanzapine; (also weight gain)

Front 948

Q948. what additional diagnosis is a risk factor of developing Tardive Dyskinesia in those treated for schizophrenia?

Back 948

A948. Mood disorders

Front 949

Q949. MOA of Disulfiram

Back 949

A949. Acetalydehyde metabolism inhibitor

Front 950

Q950. What antipsychotic has the highest risk for QTc cardiac conduction prolongation?

Back 950

A950. Ziprasidone

Front 951

Q951. MOA of Amantidine

Back 951

A951. Releases Dopamine; (in substantia nigra, causing antiparkinson effects)

Front 952

Q952. MOA of Donepezil; Use?

Back 952

A952. Anticholinesterase inhibitor; Use: Mild Dementia

Front 953

Q953. MOA of Haloperidol

Back 953

A953. Block Post-synaptic Dopamine receptors

Front 954

Q954. Anticholinergic agent used to treat primary and medication- induced Parkinsonism

Back 954

A954. Trihexyphenidyl

Front 955

Q955. First line of Tx for Post traumatic Stress Disorder

Back 955

A955. SSRI

Front 956

Q956. low levels of what NT are shown to be assoc with impulsiveness and aggression?

Back 956

A956. Serotonin

Front 957

Q957. what is a common comorbid disorder with Bulimia?

Back 957

A957. Kleptomania

Front 958

Q958. a 40yo businessman states that over the past 2 years he has had trouble staying awake for more then 2 hours before falling asleep. He has a hard time sleeping through the night. Meanwhile his work is suffering. Dx?; Tx? (3 possible drugs)

Back 958

A958. Dx: Primary Insomnia; Tx:; 1. Zolpidem (Ambien); 2. Zaleplon (Sonata); 2. Trazodone (Desyrel)

Front 959

Q959. another name for Sleepwalking disorder

Back 959

A959. Somnambulism

Front 960

Q960. what NT enhances libido?; what NT inhibits libido?

Back 960

A960. Enhances: Dopamine; Inhibits: Serotonin

Front 961

Q961. Dx:; genital pain before, during or after sexual intercourse

Back 961

A961. Dyspareunia

Front 962

Q962. Dx:; involuntary muscle contraction of the outer third of the vagina during insertion of the penis or object

Back 962

A962. Vaginismus

Front 963

Q963. Conditioning type:; Drugs serve as reinforcers to increase frequency

Back 963

A963. Operant conditioning; (behaviors can be learned when followed by positive or negative reinforcement)

Front 964

Q964. Conditioning type:; Drugs play a major role in relapse

Back 964

A964. Classical conditioning; (a stimuli evokes a conditioned response)

Front 965

Q965. Behavioral therapy technique:; a patient who is afraid of flying is made to fly on a plane

Back 965

A965. Flooding

Front 966

Q966. Behavioral therapy technique:; a patient who is afraid of flying is made to imagine flying

Back 966

A966. Implosion

Front 967

Q967. Behavioral therapy technique:; an alcoholic is given Antabuse which makes him ill every time he drinks alcohol; aside from addictions, what else is this therapy used to treat?

Back 967

A967. Aversion therapy; also Tx: Paraphilias (necrophilia, S&M, etc)

Front 968

Q968. Aside from Depression, what other disorders use SSRIs as the first drug treatment?; (10)*

Back 968

A968. A Bad PMS In A PP Organ:; Anorexia,; Body Dysmorphic Disorder,; Panic Disorder,; Migraines,; Social Phobia,; IBS,; Autism,; PTSD,; Premenstrual Dysphoric disorder,; OCD

Front 969

Q969. Aside from Depression, what other disorders use TCAs as a main treatment?; (3)

Back 969

A969. Enuresis,; Neuropathic Pain,; Insomnia

Front 970

Q970. Most life-threatening adverse effect of TCA

Back 970

A970. Orthostatic Hypotension

Front 971

Q971. What is the first step when suspecting serotonin syndrome?

Back 971

A971. Discontinue Medication

Front 972

Q972. MOA of Mirtazepine; common AE?

Back 972

A972. NASA: NE and Serotonin Antagonist; common AE: Weight Gain

Front 973

Q973. What drugs cause Anti-HAM effects?; (2)

Back 973

A973. Antipsychotics,; TCAs; (anti-HAM = antiHistamine - sedation; antiAdrenergic - Hypotension; antiMuscarinic - dry mouth, blurred vision, urinary retention)

Front 974

Q974. What can be used in a patient with Generalized Anxiety Disorder if he is an alcoholic with HTN?

Back 974

A974. Buspirone; (Benzos are contraindicated in alcoholics and Venlafaxine is contraindicated in HTN patients)

Front 975

Q975. what are the (3) main uses of Benzodiazepines?

Back 975

A975. PIA:; Panic Attacks / Anxiety,; Insomnia,; Alcohol withdrawal/detox

Front 976

Q976. difference between Dystonia and Tardive Dyskinesia symptoms around the head?

Back 976

A976. Dystonia:; sustained Contraction of muscles of neck and tongue; TD:; Choreoathetoid (writhing) movements of mouth and tongue

Front 977

Q977. what (2) atypical antipsychotics also have FDA approval for Tx of Mania?

Back 977

A977. Quetiapine,; Ziprasidone

Front 978

Q978. a 20yo woman comes to see you because her mother says she isnt herself. The patient is dressed in brightly colored clothing and has worn a large amount of makeup for the past 3 weeks. She acts overtly seductive toward her colleagues at work, is more distractible and is easily irritated. She also sleeps less, claiming she no longer needs the sleep. Dx?

Back 978

A978. Bipolar Disorder, Mania

Front 979

Q979. What is a good behavioral treatment for insomnia?

Back 979

A979. De-conditioning; (using the bed only for sleep; get up if not able to sleep in a short period of time)

Front 980

Q980. (3) meds used to reduce Sx of flashbacks

Back 980

A980. CVC:; 1. Clonazepam; 2. Valproic Acid; 3. Carbamazepine

Front 981

Q981. What pathology would be most important to rule out before starting treatment of Tourette's disorder?

Back 981

A981. Environmental Allergies; (they have a presentation most resembling Tourette's disorder)

Front 982

Q982. What lab test is most helpful in assessing the severity of starvation in anorexia?

Back 982

A982. Albumin levels

Front 983

Q983. what psychiatric disorder is seen in people with Graves Disease?

Back 983

A983. Generalized Anxiety Disorder; (criteria for GAD are met in up to 60% of those with Graves)

Front 984

Q984. What are the (2) common defense mechanisms of Avoidant Personality disorder?

Back 984

A984. 1. Displacement; 2. Projection

Front 985

Q985. A 30yo woman presents with a chief complaint of being unable to finish a project. She had difficulty finishing college in 4 years as well. She is cannot pinpoint what is wrong with her. She has no long-term love relationship, although she would like to have one. Otherwise the patient has no psychiatric signs or symptoms. She has no psych History and her only medical problem is well-controlled HTN. She has no History of drug or ETOH use. Dx?; Tx?

Back 985

A985. Dx: Neurosis; (not a DSM-IV Dx, "trouble working and loving"); Tx: Insight-oriented Psychotherapy

Front 986

Q986. A 24yo man gets excited about sex but has a problem performing sexually. He can have an erection, but it is not maintained when the time for intercourse occurs. There is nothing physically wrong. He seems to be struggling with abandonment issues with his father. Tx?

Back 986

A986. Tx: Psychodynamic Psychotherapy; (CBT is not likely to elicit the unconscious conflict troubling him)

Front 987

Q987. What BT type is best suited for someone with Borderline Personality Disorder?

Back 987

A987. Dialectical BT; (patients learn skills to confront and manage the volatile emotions and impulses they are feeling)

Front 988

Q988. In what (2) types of psychiatric disorders will you see cognitive thinking?

Back 988

A988. 1. Schizophrenia; 2. Cognitive disorder (dementia; MR)

Front 989

Q989. Hyperarousal symptoms seen in PTSD are thought to be due to a stress-induced, chronic hyperactivity of what area of the brain?

Back 989

A989. Locus Ceruleus; (main noradrenergic nucleus of the brain)

Front 990

Q990. what nucleus of the brain degenerates in Alzheimers dementia?

Back 990

A990. nucleus basalis of Meynert

Front 991

Q991. A young woman with a history of cutting states that the act calms her and she feels no pain. Self-injury can have this effect b/c it triggers the release of what?

Back 991

A991. Endorphins; (body's defense mechanism to deal with pain)

Front 992

Q992. After being struck in the head with a bat, a patient's personality changes. What part of the brain was affected?

Back 992

A992. Frontal lobes

Front 993

Q993. A little girl who was underweight and hypotonic at infancy is obsessed with food, eats compulsively and at age 4 is already grossly overweight. She is also argumentative, oppositional and rigid. She has a narrow face, almond- shaped eyes and a small mouth. Dx?

Back 993

A993. Prader-Willi syndrome

Front 994

Q994. what NT regulates mood, sleep, pain and aggression?; what nuclei?

Back 994

A994. Serotonin; Raphe Nuclei

Front 995

Q995. An elderly man awakes in a state of aggitation. Although he appears that he wants to communicate, he can only state "See you later" over and over. The right side of his face droops and he seems to have difficulty moving his right arm. A CAT scan shows a recent brain infarct. Where is the lesion (specifically)?; What vessel?

Back 995

A995. Left Frontal Lobe; (at Broca's area, which presents with nonfluent aphasia and can cause one to repeat); Middle Cerebral Artery

Front 996

Q996. Aggressive behavior is assoc with an increase or decrease in what NT?

Back 996

A996. Decrease in Serotonin

Front 997

Q997. Where is the brain lesion:; a 22yo woman with an inoperable craniopharyngioma has become grossly obese and experiences rapid fluctuation of body temperature.

Back 997

A997. Hypothalamus; (expansion of the tumor)

Front 998

Q998. Where is the brain lesion:; an 82yo woman at the late stages of a dementing disorder roams her nursing home touching and licking everything she passes. She is placcid and nothing frightens her.

Back 998

A998. Amygdala; (behavior and personality changes including hypersexuality, placcidity and lack of fear = Kluver-Bucy syndrome)

Front 999

Q999. Where is the brain lesion:; a 34yo homeless man with a chronic psychiatric disorder hears the voices of angels and believes he is the new savior

Back 999

A999. Mesolimbic circuit; (pathway of positive and negative Sx of schizophrenia)

Front 1000

Q1000. Where is the brain lesion:; a 17yo male cannot remember anything that happened after he had a bout of encephalitis, but he has no difficulty with remote memories

Back 1000

A1000. Hippocampus; (Herpes encephalitis causes bilateral lesions in the hippocampus causing anterograde amnesia and damages the amygdala causing Kluver-Bucy syndrome)

Front 1001

Q1001. A patient is diagnosed with Wernicke-Korsakoff's syndrome. What part of the brain is affected?

Back 1001

A1001. Mammillary bodies; (dependent on Thiamine)

Front 1002

Q1002. Stimulation of what nucleus reduces appetite?; A dysfunction in this nucleus, causing hyperphagia, is seen in what syndrome?; Which nucleus stimulates appetite?; A dysfunction or ablation of this nucleus can lead to what?

Back 1002

A1002. Reduces eating: Ventromedial nuclei; dysfunction = Prader-willi; Increases eating: Lateral nuclei; dysfunction = fatal Anorexia

Front 1003

Q1003. A 70yo with a dementing disorder dies in a car accident. During the last 5 years his personality changed dramatically. Path exam of the brain shows frontal-temporal atrophy, gliosis of frontal lobe white matter, intracellular inclusions and swollen neurons. Dx?

Back 1003

A1003. Pick's Disease

Front 1004

Q1004. A young man smells burnt rubber, then turns his head and upper body to the right, makes chewing movements and fumbles with his clothes. This lasts one minute and he appears dazed. Dx?; where is the problem?

Back 1004

A1004. Partial Complex Seizure; Location: Temporal lobe

Front 1005

Q1005. What psychiatric disorder is assoc with Cushing's syndrome?

Back 1005

A1005. Depression

Front 1006

Q1006. a 40yo cognitive functions have deteriorated in the past couple years to the point that she needs a nursing home. Since this began she has become depressed, irritated and is prone to aggressive outbursts. She also has irregular, purposeless and asymmetrical movements of her face, limbs and trunk which get worse when she is upset. Her MRI shows atrophy of the caudal nuclei and putamen. Dx?

Back 1006

A1006. Huntington's Disease

Front 1007

Q1007. A healthy 62yo male undergoes a corneal transplant. Three months later he is profoundly demented and his EEG shows periodic bursts of electrical activity superimposed on a slow background. Dx?

Back 1007

A1007. Creutzfeldt-Jakob Disease

Front 1008

Q1008. A 64yo man completely ignores the left side of his body. He also has difficulty with simple calculations. Where is the lesion?

Back 1008

A1008. Parietal Lobe

Front 1009

Q1009. What Drug:; A woman who is treated with an antipsychotic develops an uneven pigmentation over her arms, shoulders and face with a trip to the beach

Back 1009

A1009. Chlorpromazine; (side effect of low-potency neuroleptics)

Front 1010

Q1010. Drug of Choice:; a patient with schizophrenia has multiple relapse due to non-compliance

Back 1010

A1010. Haloperidol decanoate; (injectable medications are effective in decreasing the rate of relapse)

Front 1011

Q1011. what are the (2) atypical antipsychotics that are proven to be useful for the negative symptoms?

Back 1011

A1011. Clozapine; Olanzepine

Front 1012

Q1012. Dx:; A delusional disorder that develops in a person who is in a close relationship with another person that has a psychotic disorder with delusions

Back 1012

A1012. Shared Psychotic disorder

Front 1013

Q1013. Dx:; Atrophy of the Caudate

Back 1013

A1013. Huntington's Disease

Front 1014

Q1014. DOC:; 1. Melancholic Depression; 2. Atypical Depression

Back 1014

A1014. 1. TCAs; 2. MAOIs

Front 1015

Q1015. (2) drugs used to Tx hyperarousal Sx of PTSD

Back 1015

A1015. 1. Clonidine (alpha-2-agonist); 2. Beta-blocker

Front 1016

Q1016. What medical condition is commonly confused with Conversion disorder?

Back 1016

A1016. Multiple Sclerosis

Front 1017

Q1017. For a Dx of Hypochondriasis, how long do the Sx need to be present?

Back 1017

A1017. 6 months

Front 1018

Q1018. what medication that helps with anxiety can lead to sexual dysfunction?; (2)

Back 1018

A1018. 1. Propanolol; 2. SSRI

Front 1019

Q1019. A 27yo female with a history of bipolar disorder is admitted to the hospital in a manic state. She is 4 weeks pregnant and refuses to take any medication associated with birth deformities in humans. Which medication is appropriate?

Back 1019

A1019. Olanzapine; (atypical antipsychotic approved for short-term mania use)

Front 1020

Q1020. Neuro Dx:; Hippocampal atrophy

Back 1020

A1020. Alzheimer's Disease

Front 1021

Q1021. Neuro Dx:; Occipital Hypoprofusion

Back 1021

A1021. Lewey Body Disease

Front 1022

Q1022. A 19-year-old man is brought to the emergency room by his distraught parents, worried about his vomiting and profuse diarrhea. On arrival, his pupils are dilated, his blood pressure is 175/105, and his muscles are twitching. His parents report that these symptoms started two hours earlier. For the past couple of days he has been home-bound due to a sprained ankle and, during this time, he has been increasingly anxious and restless, has been yawning incessantly and has had a runny nose. Dx?

Back 1022

A1022. Heroin withdrawal

Front 1023

Q1023. Tx for mild Opioid withdrawal Sx?; for general Opioid withdrawal?

Back 1023

A1023. mild Sx: Clonidine; normal Sx: Naloxone

Front 1024

Q1024. Tx for Alcohol withdrawal

Back 1024

A1024. Diazepam

Front 1025

Q1025. MOA of cocaine

Back 1025

A1025. inhibits the reuptake of NT in the synapse

Front 1026

Q1026. what is the therapeutic intervention most likely to be effective in PCP intoxication?

Back 1026

A1026. Isolate patient in a quiet, dimly lit room to minimize sensory input

Front 1027

Q1027. According to the cognitive model Depression is a consequence of what?

Back 1027

A1027. Maladaptive negative beliefs

Front 1028

Q1028. What does Cognitive psychotherapy focus on?

Back 1028

A1028. Faulty ideas and beliefs

Front 1029

Q1029. The parents of a 20-year-old man recently diagnosed with paranoid schizophrenia are having difficulty dealing with their son’s decline in function. Once an honor student with many friends and an active social life, he now spends his days barricaded in his room, surveying the street with binoculars, watching out for his “enemies.”; What is a helpful family therapy intervention?

Back 1029

A1029. Teaching the parents about the importance of reducing expressed emotions in the family transactions

Front 1030

Q1030. A 34-year-old mathematician; is in psychoanalytic psychotherapy because of anxiety, depression, and marital problems, which seemed to begin shortly after the death of his mother. They had an intensely dependent and ambivalent relationship with each other. When the patient discusses his mother and her death, he is unemotional and detached. This is an example of what defense mechanism?

Back 1030

A1030. Isolation of Affect; (splitting off the affective component, usually unpleasant, from an idea or thought)

Front 1031

Q1031. Defense mechanism:; A man visits his domineering and demanding elderly mother at her nursing home. When she starts browbeating him for his “lack of devotion,” he has a sudden urge to shout at her. The next day, when he talks with his therapist about his visit, he minimizes the impact of his mother’s constant badgering and has no memory of his brief moment of rebellion.

Back 1031

A1031. Repression

Front 1032

Q1032. Defense Mechanism:; A 34-year-old auto mechanic has a lifelong grudge against his more successful older brother, who, in his eyes, was their parents’ favorite, but he has a hard time admitting it even to himself. Instead, he tells his friends that his brother envies his good looks and his success with women.

Back 1032

A1032. Projection; (the attribution of one person's unacceptable impulses or feelings to others; in this case it is Jealousy)

Front 1033

Q1033. A man who has psychotic depression is placed on imipramine and perphenazine. When he develops Parkinsonian symptoms, benztropine mesylate 2 mg per day is added to the medications he already receives. One week later, his wife reports that the patient has become unusually forgetful and that he appears disoriented when he gets up during the night to use the bathroom. On physical examination, the man appears slightly flushed, his skin and palms are dry, and he is tachycardic. He cannot remember the date and has trouble concentrating. Dx?

Back 1033

A1033. Anticholinergic syndrome; (Phenothiazides, TCAs and anti-parkinson agents all have anticholinergic properties; the acton becomes additive when administered together)

Front 1034

Q1034. A middle-aged man with depression takes daily doses of warfarin as prophylaxis for pulmonary embolism. His doctor is baffled because the patient’s warfarin dose needs to be readjusted almost every week to maintain an optimal level of anticoagulation. What antidepressant can cause this effect on Warfarin?

Back 1034

A1034. SSRIs; (specifically Sertraline, Paroxetine, and Fluvoxamine); (they can displace warfarin from their binding sites, increasing the levels of biologically active warfarin)

Front 1035

Q1035. An 8-year-old boy with ADHD has been constantly clearing his throat and blinking his eyes for the past three weeks, since he was placed on methylphenidate. These symptoms have been present, on and off, for several years, but they have been greatly worsened by the stimulant. What medication can be used to treat both ADHD symptoms and tics?

Back 1035

A1035. Clonidine; (Alpha-2 adrenergic agonist that is helpful in the treatment of Tourette's disorder and in the Tx for kids that develop ADHD with tics from other stimulants)

Front 1036

Q1036. For several weeks, a 72yo retired physician with Parkinson’s disease and mild dementia has been talking about “those horrible people that come to bother me every night.” He is convinced that someone is plotting against him and has nailed his window shut for fear of intruders. More recently he has started showing signs of thought disorder, mostly in the evening and at night. What antipsychotic med is least likely to worsen; the patient’s Parkinsonism?

Back 1036

A1036. Clozapine; (preferred Tx for psychotic Sx in a person with Parkinsons)

Front 1037

Q1037. A 72-year-old man with a long history of recurrent psychotic depression is hospitalized during a relapse. He has prostatic hypertrophy coronary heart disease, and recurrent orthostatic hypotension. Which is the most appropriate antipsychotic medication for this patient?

Back 1037

A1037. Haloperidol; (high-potency neuroleptics have low anticholinergic side effects)

Front 1038

Q1038. what medication class can be a sedative, but actually supresses REM?

Back 1038

A1038. TCAs

Front 1039

Q1039. what OTC med can cause severe HTN crisis in someone taking a MAOI?

Back 1039

A1039. Pseudoephedrine; (a synpathomimetic agent)

Front 1040

Q1040. what is the most worrisome cardiovascular AE of a TCA?

Back 1040

A1040. Slowing of cardiac conduction

Front 1041

Q1041. what do Cyproeptadine, Bethanecol, Amantidine, Bupropion and Yohimbine have in common with relation to an SSRI side effect?

Back 1041

A1041. all reverse the effects of SSRI Sexual Dysfunction

Front 1042

Q1042. Tx for Serotonin Syndrome

Back 1042

A1042. Stop medications

Front 1043

Q1043. a 61yo male is broght to the ED b/c his family states that he has been yelling, spitting and pulling other peoples noses and ears unexpectedly. He also began using foul language and is openly promiscuous. He has no medical or psych Hx. The patient's uncle had similar behavior and died shortly after being placed in a nursing home. During the exam the patient has trouble finding his words and keeps repeating the doctors commands while giggling inappropriately. Dx?

Back 1043

A1043. Pick's Disease; (a frontotemporal dementia that presents with behavioral changes initially)

Front 1044

Q1044. Thought disturbance example after being asked how the patient got to the hospital:; "I was reading a great book at home and after I finished it I drove myself to the hospital"

Back 1044

A1044. Circumstantiality

Front 1045

Q1045. Thought disturbance example after being asked how the patient got to the hospital:; "I started driving but I was thinking about my history. History books are great. I once wrote a paper on Alexander the Great. I do well in college."

Back 1045

A1045. Flight of Ideas

Front 1046

Q1046. Thought disturbance example after being asked how the patient got to the hospital:; "I really like history books and I was reading one at home today while eating tuna fish."

Back 1046

A1046. Tangentiality

Front 1047

Q1047. Thought disturbance example after being asked how the patient got to the hospital:; "The spy in the book I was reading was real, and he was watching me through the pages. He knew who I was."

Back 1047

A1047. Loose Associations

Front 1048

Q1048. MC side effect of Olanzapine

Back 1048

A1048. Sedation (30%)

Front 1049

Q1049. In what psychiatric disorder will you find "Leaden Paralysis"?; Drug class of choice?

Back 1049

A1049. Major Depressive disorder with Atypical features; DOC: MAOIs

Front 1050

Q1050. when does Stranger anxiety develop fully in infants?

Back 1050

A1050. 8 months (32 weeks)

Front 1051

Q1051. A 35yo woman with bipolar disorder has noticed an increase in appetite with significant weight gain as well as hair loss. Her thyroid panel is normal. What bipolar medication was she prescribed?

Back 1051

A1051. Valproic Acid; (common AE are nausea, sedation, weight gain, transient hair loss and increased LFTs; rare AE are hepatitis, pancreatitis, and decreased platelets and platelet functions)

Front 1052

Q1052. What are the (8)* stages and ages of Erikson's stages of Ego development?

Back 1052

A1052. TAG It RISE:; 0 - 18 months: Trust vs. Mistrust; 18m - 3 years: Autonomy vs. Shame; 3 - 5 years: Initiative vs. Guilt; 5 - 13 years: Industry vs. Inferiority; 13 - 21 years: Identity vs. Role Confusion; 21 - 35 years: Intimacy vs. Isolation; 35 - 60 years: Generativity vs. Stagnation; 60+ years: Ego Integrity vs. Despair

Front 1053

Q1053. a 22yo woman with a history of depression is found groggy and minimally responsive in her home. On exam she is obtunded and complains of blurry vision. She has enlarged pupils and PVCs with a rate of 120. A Foley is placed and yields 800ml of urine. An overdose is presumed. What drug did she take?

Back 1053

A1053. TCA; (prominent anticholinergic properties - mydriasis, urinary retention and tachycardia; also TCAs cause arrhythmias)

Front 1054

Q1054. What is the initial step in management of a patient with delirium?

Back 1054

A1054. Protect the patient from unintentional harm

Front 1055

Q1055. A 52yo woman with a history of mitral valve prolapse, MI and DM has been recently Dx with panic disorder. She is obese, has a history of alcohol dependence and frequent history of Hypoglycemia due to poor control of blood sugar. What condition has a demonstrated association with panic disorder?

Back 1055

A1055. Alcohol Dependence; (ETOH and substance dependence occurs in about 20 - 40% of all patients with panic disorder)

Front 1056

Q1056. A 50yo woman presents with paresthesias, gait disturbance, motor weakness and visual defects. Dx?; What is affected in the Brain?

Back 1056

A1056. Multiple Sclerosis; brain: Focal demyelination and Gliosis of Periventricular white matter; (generally begins before age 55 and more common in females)

Front 1057

Q1057. A 25yo attempted to OD on sleeping pills after her boyfriend broke up with her. She tells the intern that he is so caring and competent and that she has never met such a doctor. She complains that no one understands her and that the only one who can really help her is the intern. What defense mechanism is this?

Back 1057

A1057. Primitive Idealization; (external objects are unrealistically endowed with great power and are either "all good" or "all bad." All good objects are ideal and omnipotent; the badness of the others are also greatly inflated. Splitting difference has the abrupt shifting of an object from good to bad or visa-versa)

Front 1058

Q1058. What (2) types of disorders use Hypnosis as a form of treatment?

Back 1058

A1058. 1. Conversion disorder; 2. Dissociative disorder

Front 1059

Q1059. Another name for Childhood Disintegrative disorder?

Back 1059

A1059. Heller Syndrome

Front 1060

Q1060. An adolescent male presents with hypersomnia, hyperphagia, sexual disinhibition and some psychosis. Dx?

Back 1060

A1060. Kleine-Levin syndrome; remember: Calvin KLEIN's male models like sex, sleep and food)

Front 1061

Q1061. What chromosome is Wilson’s Disease?

Back 1061

A1061. Chromosome 13

Front 1062

Q1062. Which medication that begins with the letter "P" is for ADHD and contra-indicated in Tourettes?; Which with the letter "P" is for Tourettes and contra- indicated in ADHD?

Back 1062

A1062. ADHD: Pimoline; Tourettes: Pimozide; (Alphabetical)

Front 1063

Q1063. what are the only (2) meds can be used in both ADHD and Tourettes?; (MOA)

Back 1063

A1063. 1. Clonidine; 2. Guanfacine; (both are alpha-2-agonists)

Front 1064

Q1064. Dx:; A child with hyperactivity, poor attention, depression, irritability, seizures and a severe language disorder.

Back 1064

A1064. Landau-Kleffner syndrome (LKS); (rare childhood epilepsy that results in severe language disorder); [LKS = Language-Killing and Seizures]

Front 1065

Q1065. Dx:; mental retardation, aggression, impulsivity, possible seizures and hamartomas in the brain, kidney, heart and skin

Back 1065

A1065. Tuberous Sclerosis; (autosomal dominant)

Front 1066

Q1066. what is the only FDA approved SSRI Tx for depression in kids?

Back 1066

A1066. Fluoxetine

Front 1067

Q1067. what SSRI has the greatest increase in suicidal rates in kids?

Back 1067

A1067. Paroxetine

Front 1068

Q1068. Dx:; repeated regurgitation and rechewing of the regurgitated food; How long must it be present?

Back 1068

A1068. Rumination; (present for 1 month)

Front 1069

Q1069. Dx:; a hereditary disease with the onset in childhood, characterized by dystonia, rigidity, difficulty with gait and speech, seizures and retinitis pigmentosa. Iron deposits are seen in the globus pallidus.

Back 1069

A1069. Hallervorden-Spatz

Front 1070

Q1070. What is the number 1 predisposing factor of Narcolepsy?; what HLA is it associated with?

Back 1070

A1070. #1 factor: Dx in a first-degree relative; HLA-DR2

Front 1071

Q1071. Drug that treats Tourettes, Schizophrenia and Chronic Psychosis and has the AE of prolongation of QT intervals; (as well as TD and EPS)

Back 1071

A1071. Pimozide

Front 1072

Q1072. A 53yo man admitted to the inpatient psych unit for Tx of Bipolar disorder was found lying in the hallway. He is conscious but confused and the staff said has been sedated and confused for the past 24 hours. He was admitted one week ago and restarted on a bipolar med. Then 3 days ago he developed an upper respiratory infection and was treated with an Abx. Dx?

Back 1072

A1072. Carbamazepine Toxicity; (the antibiotic inhibited the metabolism causing patient's Sx)

Front 1073

Q1073. How is Psychoanalytic Psychotherapy different from other forms of BT with respect to focus and time?; (2)

Back 1073

A1073. Focus: the Past (ex: early childhood); Time: Multiple sessions per week are common

Front 1074

Q1074. What drug withdrawal necessitates admission to the hospital (more then any other street drug)?

Back 1074

A1074. Barbiturates; (withdrawal can lead to death)

Front 1075

Q1075. Fluoxetine

Back 1075

A1075. SSRI; decrease appetite, insomnia headache tremor Serotonin Syndrome (fever, myoclonus, mental status change, arrhythmia) used with MAOI

Front 1076

Q1076. Sertraline

Back 1076

A1076. SSRI; decrease appetite, insomnia headache tremor Serotonin Syndrome (fever, myoclonus, mental status change, arrhythmia) used with MAOI

Front 1077

Q1077. Paroxetine

Back 1077

A1077. SSRI; decrease appetite, insomnia headache tremor Serotonin Syndrome (fever, myoclonus, mental status change, arrhythmia) used with MAOI

Front 1078

Q1078. Citalopram

Back 1078

A1078. SSRI; decrease appetite, insomnia headache tremor Serotonin Syndrome (fever, myoclonus, mental status change, arrhythmia) used with MAOI

Front 1079

Q1079. Escitalopram

Back 1079

A1079. SSRI; decrease appetite, insomnia headache tremor Serotonin Syndrome (fever, myoclonus, mental status change, arrhythmia) used with MAOI

Front 1080

Q1080. Buproprion

Back 1080

A1080. Atypical Antidepressants; treat OCD, pain, migraine; risk of seizures,; no sex side effect

Front 1081

Q1081. Venlafaxine

Back 1081

A1081. Atypical Antidepressant. for OCD, migraine; side: diastolic HTN

Front 1082

Q1082. Mirtazapine

Back 1082

A1082. Atypical Antidepressants; treat OCD pain migraine; Side: Weight gain, sedation

Front 1083

Q1083. Nefazodone

Back 1083

A1083. Atypical Antidepressants; treat OCD pain migraine; Side: sedation, headache, dry mouth

Front 1084

Q1084. Trazodone

Back 1084

A1084. Atypical Antidepressants; treat OCD, pain, migraine; Sleep and erectile dysfunction. Side: sedating, priapism

Front 1085

Q1085. Nortriptyline

Back 1085

A1085. TCA; Lethal with overdose owing to cardiac conduction arrhythmias (QT); Anticholinergic effects (dry mouth, constipation, urinary retention)

Front 1086

Q1086. Despiramine

Back 1086

A1086. TCA; Lethal with overdose owing to cardiac conduction arrhythmias (QT); Anticholinergic effects (dry mouth, constipation, urinary retention)

Front 1087

Q1087. Amitriptyline

Back 1087

A1087. TCA; Lethal with overdose owing to cardiac conduction arrhythmias (QT); Anticholinergic effects (dry mouth, constipation, urinary retention)

Front 1088

Q1088. Imipramine

Back 1088

A1088. TCA; Lethal with overdose owing to cardiac conduction arrhythmias (QT); Anticholinergic effects (dry mouth, constipation, urinary retention)

Front 1089

Q1089. Tranylcypromine

Back 1089

A1089. Depression MAOI; hypertensive crisis if taken with high Tyramine foods (cheese wine); Sexual side effects

Front 1090

Q1090. Phenelzine

Back 1090

A1090. MAOI; Hypertensive crisis with high tyramine; Sexual side effects

Front 1091

Q1091. TCA side effects

Back 1091

A1091. Convulsions, Coma Cardiac Arrhythmias

Front 1092

Q1092. Haloperidol

Back 1092

A1092. typical antipsychotics; Extrapyramidal symptoms (EPS); Hyperprolactinemia; Anticholinergic Effects( DRY mouth, urine, constipation); Neuroleptic malignant syndrome (fever, muscle rigid, autonomic instability, clouded consciousness)

Front 1093

Q1093. Droperidol

Back 1093

A1093. typical antipsychotics; Extrapyramidal symp (EPS); Hyperprolactinemia; Anticholinergic Effects( DRY mouth, urine, constipation); Neuroleptic malignant syndrome (fever, muscle rigid, autonomic instability, clouded consciousness)

Front 1094

Q1094. Fluphenazine

Back 1094

A1094. typical antipsychotics; Extrapyramidal symp (EPS); Hyperprolactinemia; Anticholinergic Effects( DRY mouth, urine, constipation); Neuroleptic malignant syndrome (fever, muscle rigid, autonomic instability, clouded consciousness)

Front 1095

Q1095. Quetiapine

Back 1095

A1095. typical antipsychotics; Extrapyramidal symp (EPS); Hyperprolactinemia; Anticholinergic Effects( DRY mouth, urine, constipation); Neuroleptic malignant syndrome (fever, muscle rigid, autonomic instability, clouded consciousness)

Front 1096

Q1096. Olanzapine

Back 1096

A1096. typical antipsychotics; Extrapyramidal symp (EPS); Hyperprolactinemia; Anticholinergic Effects( DRY mouth, urine, constipation); Neuroleptic malignant syndrome (fever, muscle rigid, autonomic instability, clouded consciousness)

Front 1097

Q1097. Ziprasidone

Back 1097

A1097. typical antipsychotics; Extrapyramidal symp (EPS); Hyperprolactinemia; Anticholinergic Effects( DRY mouth, urine, constipation); Neuroleptic malignant syndrome (fever, muscle rigid, autonomic instability, clouded consciousness)

Front 1098

Q1098. Aripiprazole

Back 1098

A1098. typical antipsychotics; Extrapyramidal symp (EPS); Hyperprolactinemia; Anticholinergic Effects( DRY mouth, urine, constipation); Neuroleptic malignant syndrome (fever, muscle rigid, autonomic instability, clouded consciousness)

Front 1099

Q1099. Clozapine use

Back 1099

A1099. reserved for treatment of resistance and severe tardive dyskinesia

Front 1100

Q1100. Lithium

Back 1100

A1100. Mood Stabilizer; acute mania; prophylaxis of mania and depression in bipolar; augmentation of depression treatment

Front 1101

Q1101. Lithium Side

Back 1101

A1101. Thirs polyuria tremor weight gain hypothyroidism, nephrotoxicity, ataxia, dysarthria, delirium, nausea diarrhea, seizures. Narrow therapeutic window.

Front 1102

Q1102. Carbamazepine

Back 1102

A1102. second line mood stabilizer, anticonvulsant; Side: Skin rash, leukopenia, AV block, Aplastic anemia, Stevens-Johnson syndrome

Front 1103

Q1103. Valproic acid

Back 1103

A1103. most widely used drug for bipolar and acute mania; side: Tremor, sedation, ataxia, alopecia, weight grain, thrombocytopenia, hepatotoxicity, agranulocytosis

Front 1104

Q1104. Lamotrigine

Back 1104

A1104. Mood stabilizer for treatment refractory patient; side: ataxia, blurred vision, GI distress, Steven Johnson syndrome

Front 1105

Q1105. Buspirone

Back 1105

A1105. generalized anxiety disorder OCD PTSD; side: seizures with chronic use. No tolerance, dependence or withdrawal.

Front 1106

Q1106. general anxiety disorder treatment

Back 1106

A1106. Buspirone, SSRI

Front 1107

Q1107. Performance anxiety treatment

Back 1107

A1107. B-blockers

Front 1108

Q1108. FLumazenil

Back 1108

A1108. Antidote to benzodiazepine intoxication; side: sedation, nausea, dizziness, vomiting, pain