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100 Cards in this Set

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  • Back
How is anorexia nervosa tx?

How is bulimia nervosa tx?
Anorexia - supportive/counseling (SSRI's DO NOT work!)

Bulimia - SSRI's DO work..(Fluoxitene)
What kind of acid-base disturbance occurs in bulimia nervosa?
Hypochloremic, hypokalemic, metabolic alkalosis
Difference between retrograde and anterograde amnesia
Retrograde amnesia - inability to remember things that occurred BEFORE a CNS insult

Anterograde amnesia - inability to remember things that occurred AFTER a CNS injury (no new memory)
Korsakoff's amnesia

D/t deficiency in _______

What is the damage to the brain?
Thiamine deficiency...commonly seen in alcoholics

bilateral destruction of mammillary bodies

presents with confabulations (making up memories which don't exist)
What is dissociative amnesia?
inability to recall important personal information, usually subsequent to severe trauma or stress
What are the two more common causes of delirium?
Drugs (mc are anticholinergic drugs = "mad as a hatter")

UTI's
What is "pseudodementia"?
Despression in the elderly, which may present like dementia.
- they may lose things, or forget things, BUT they know that they are doing these things and aware of them....in true dementia, the pt is not aware that they are forgetting things!
What are the two main histological findings in Alzheimer's dz?
Senile plaques (beta-amyloid core...may cause intracranial hemorrhage)

Neurofibrillary tangles --> intracellular abnormally phosphorylated tau protein! (amount of tangles correlates with degree of dementia!!)
This type of dementia starts out as a change in personality, leading to dementia, aphasia and parkinsonian features.
Picks dz
Which dementia:

intracellular, aggregated tau protein
Pick's disease
Which dementia:

parkinsoniusm with dementia and VISUAL hallucinations
Lewy body dementia
Which dementia:

repeated falls & syncope
Lewy body dementia
What are the other disease that can cause dementia (other than alzheimers, pick's dz, etc)?
Multi-infarct (2nd mc in elderly)
syphilis
HIV
Vitamin B12 def
Wilson's dz
Which one of these (hallucinations, illusions, delusions, loose associations):

perception in the absence of external stimuli
hallucinations
- ie. seeing a light that is not actually present
- can be tactile (EtOH), visual (Lewy body dementia) or auditory (schizophrenia)
Which one of these (hallucinations, illusions, delusions, loose associations):

misinterpretations of actual external stimuli
Illusions
- ie. seeing a light and thinking that it is the sub
- ie. seeing a person in the arm but it's actually a coat rack
- ie. seeing an arm outside the window that's actually a tree branch
Which one of these (hallucinations, illusions, delusions, loose associations):

False beliefs not shared with other members of culture/subculture that are firmly maintained in spite of obvious proof to the contrary
Delusions
- ie. thinking the CIA is spying on you
- ie. thinking the TV is talking to you
Which one of these (hallucinations, illusions, delusions, loose associations):

Disorders in the form of though
Loose associations
- the way ideas are tied together
Tactile hallucinations are seen in what two drug uses?
alcohol
cocaine
Tourett's syndrome pt's have hypnogogic or hypnopompic hallucinations?
hypnagogic (occurs when going to sleep)
What is the DSM for schizophrenia?
decline in functioning that lasts >6mo

Dx requres 2 or more of these:
-Delusions
-Hallucinations
-Disorganized speech (loose associations)
-Disorganized or catatonic behavior
-"Negative sx" = flat affect, social withdrawal, lack of motivation, lack of speech or though (alosia)
What is this called?

Pt keeps answering "I'm fine" to all your questions...and in absence of stimulus
Perseveration
How do schizophrenia, brief psychotic disorder and schizophreniform disorder differ?
TIME!
<1 mo = brief psychotic disorder
1-6 mo = schizophreniform disorder
>6 mo = schizophrenia
What is schizoaffective disorder?
at least 2 WEEKS of STABLE mood with psychotic sx, plus a major depressive episode, manic or mixed episode (bipolar or depressive)

(so it's schizophrenia + bipolar or depressive mood disorder)
What is stereotyped & meaningless repetition of words & phrases?
verbigeration
What is the consequence of long-term antipsychotic drug use?
tardive dyskinesia (esp with haloperidol, fluphenazine & trifluoperazine)
= stereotypic oral-facial movements
What group of drugs can cause neuroleptic malignant syndrome?

What is the tx for NMS?
Antipsychotics (haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine)

-excess muscle contraction => breakdown of muscles and increased body temp => myoglobin spills out into blood stream => can clog up kidneys & cause ARF

= rhabdomyolysis!

Tx: Dantrolene (block Ca. release from SR) OR can use a Dopa agonist like bromocriptine to prevent the blockage of Dopa!)
Dantrolene can be used to treat which TWO serious problems?
Malignant hyperthermia (d/t inhalation anesthetics & succinylcholine)

Neuroleptic malignant syndrome (tox. of antipsychotic drugs..ie. haloperidol or "-azine")
Genetic mutation in the RyR1 gene predisposes you to what problem?
Malignant hyperthermia when you receive inhalation anesthetics (except N2O) and succinylcholine)
Some of the atypical antipsychotics have been linked to DM. WHY?
Quetiapine, Olanzapine, clozapine may cause significant WEIGHT GAIN = DM!!!
Which atypical antipsychotic may cause AGRANULOCYTOSIS??
Clozapine!
(will see decreased WBC, etc)
- drug is used to treat + AND - sx associated with schizophrenia!

"must watch clozapine clozely!"
Dissociative identify disorder is formerly known as what?
multiple personality disorder (2 or more distinct identities or personality states)
Persistent feelings of detachment or estrangement from one's own body, a social situation or the environment.

What disorder?
Depersonalization disorder
Abrupt change in geographic location with inability to recall past, confusion about personal identity or assumption of a new identity.
Dissociative fugue = associated with traumatic circumstances (natural disasters, wartime, trauma). Leads to significant distress or impairment. Not the result of a substance abuse or general medical condition.
Distinct period of abnormally and persistently ELEVATED, expansive or irritable mood lasting at least ____ week.
Manic episode

1 week!!!
What is the mnemonic DIG FAST used for and what does it mean?
"Manics DIG FAST"..used for manic episodes

Distractibility
Irresponsibility - seeks pleasure w/o regard to consequences
Grandiosity
Flight of ideas
Activity (increase in goal-directed) and Agitation
Sleep is decreased
Talkative/pressured speech
What's the difference between Bipolar I and Bipolar II?
Bipolar I = at least 1 MANIC episode, with or without a MDE

Bipolar II = at least 1 HYPOMANIC episode and at least 1 MDE (but never a manic episode!)
DOC for chronic tx of bipolar disorder
Lithium
This drug used to tx bipolar disorder can cause HYPOTHYROIDISM!
Lithium
This drug can cause "Ebstein anomaly"
Lithium
Is lithium used to tx SIADH or causes SIADH?
It's used to TX SIADH...since it causes nephrogenic diabetes insipidus!
What is cyclothymic disorder?
Dysthymia + hypomania

it's a MILDER form of bipolar disorder that lasts AT LEAST 2 YEARS! (hypomania + mild depression (dysthymia))
How are manic and major depressive episode differ in terms of time?
Manic episode is at least 1 week of sx

Major depressive episode is at least 2 weeks of sx
What is anhedonia and which disorder is it seen in?
Not receiving pleasure from things that used to give you pleasure

seen in MDE!
What are the criteria for "recurrent MDD"?
2 or more MDE with a SX-free interval of 2 months
Milder form of depression lasting at least 2 years?

Dysthymia + hypomania lasting at least 2 years?
dysthymia (a milder form of depression)

cyclothymia (a milder form of bipolar)
What is the mnemonic SIG E CAPS and what is it for?
MDE

Sleep disturbance
Interest lost (ANHEDONIA)
Guilt or feelings of worthlessness
Energy loss
Concentration loss
Appetite/weight changes
Psychomotor retardation & agitation (lead limbs = don't want to move)
Suicidal ideations
This type of depression is characterized by:
hypersomnia (a lot of sleep)
Hyperphagia (overeat)
Mood reactivity (very sensitive to criticism)

Which drugs are used to tx this?
Atypical depression

Tx: MAOI & SSRI
How are maternal/postpartum blues & postpartum depression & postpartum psychosis differ?
maternal/postpartum blues = resolves w/in 2 weeks (tx: supportive)

postpartum depression = lasts 2 weeks to >1yr! (tx: antidepressants, psychotherapy)

postpartum psychosis - delusions, confusions and possibly killing baby or commiting suicide (Tx: antipsychotics, antidepressants, possibly admit to hospital)
When is electroconvulsive therapy usually used?
when refractory to other antidepressants (often for MDD!)
What does the mnemonic SAD PERSONS mean?
Risk factors for suicide completion:

Sex (male)
Age (teens or elderly)
Depression

Previous suicide attempt
Ethanol/drug use
Rational thinking is lost
Sickness (medical illness or 3 or more meds)
Organized plan**
No spouse (divorced, widowed, single, childless**)
Social support lacking
Which is better for elderly pt's in need of sleep....nortriptyline or amytriptyline?
nortriptyline...since it has less AntiACh effects (less chance of confusion and hallucinations in the elderly = delirium!!!!)
What are the Tri-C's (for toxicity) of TCA's?

What is the treatment for the toxicity?
Convulsions (causes hyperpyrexia!)
Coma
CARDIOTOXICITY!

Treat the cardiotoxicity (not others) with sodium bicarb (NaHCO3)
Which antidepressants can be used for neuropathic pain & fibromyalgia?
TCA's (-pramine's & -tyline)

Although duloxetine (an SNRI) is the DOC for peripheral neuropathy!
What drugs are associated with seratonin syndrome?
SSRI's, SNRI's, MAOI
St. Johns Wort (taken for mild depression)
Kava Kava (taken for anxiety)
Sibutramine (SNRI for weight loss..no longer available in US)
Tryptophan
Cocaine, amphetamines
What is the DOC for Serotonin Syndrome?
cyproheptadine, which is a 5-HT2 receptor blocker
This drug is the DOC for diabetic (or general) peripheral neuropathy
Duloxetine (an SNRI)
What is the 1st treatment of panic disorder?

What about the other possible tx?
1st tx = cognitive behavioral therapy (CBT)

other tx = SSRI's, TCA's (these are for prophyplaxis), benzo's (for acute)
How do you treat specific phobia?

How do you treat social phobia?
desensitization

SSRI, or beta-blockers if you have performance phobia
How can you treat OCD?
SSRI's..ie. fluoxetine
clomimpramine (TCA)
OCD is associated with what other disorder?
Tourrett's syndrome!
How do you differentiate between Acute Stress Disorder and PTSD?
Acute Stress Disorder = lasts between 2 days and 1 month

PTSD = lasts > 1 month!!!
What is the DOC for PTSD?
SSRI = peroxetine

(can also try psychotherapy!)
What is the time requirement for generalized anxiety disorder?

What is the tx?
anxiety for at least 6 months

- associated with sleep disturbance, fatigue, GI disturbance and difficulty concentration

Tx for GAD: Benzodiazepines (diazepam!), Buspirone, SSRI's
What is the ONLY use for the drug Buspirone?

What is its MOA?

Why is this drug BETTER than most of the other ones out there?
Generalized anxiety disorder (anxiety for at least 6 mo)

stimulates 5-HT(1A) receptors

Does not cause sedation, addiction, tolerance, & doesn't interact with alcohol like benzo's do!
Adjustment disorder
usually <6 months but can be >6 months in presence of chronic stressors
A pt is a frequent flyer at the ER and has been admitted every week for the past two months. Today, they came in because they've injected fecal matter under the skin and complain of a painful abscess.

Dx?
Munchausen's syndrome (it's a CHRONIC factitious disorder)
A pt comes in one time with diarrhea, but you can't figure out what's wrong. 5 months later they come back with paresthesias in the hands. You can't figure out what's wrong. They then come back in a couple months and have sexual problems.

Dx?
Probably somatization disorder (at least 4 areas of pain, 2 GI, 1 sexual and 1 pseudoneurologic areas affected) over a period of YEARS!
Pt has sudden loss of sensory or motor function (ie. paralysis, blindness, mutism...often following an acute stressor. Dx?
Conversion disorder (a type of somatoform disorder)
Pt has prolonged pain with no physical findings. Dx?
Pain disorder (pain is the predominant focus of clinical presentation and psychological factors play an important role in severity, exacerbation or maintenance of pain)
What are the Cluster A personality disorders?
Cluster A = "odd & eccentric"

Paranoid
SchizoiD = "Distant"
SchizoTypal = magical Thinking
What are the Cluster B personality disorders?
Cluster B = "bad to the bone"

Antisocial
Borderline
Histrionic
Narcissistic
What are the Cluster C personality disorders
Cluster C = worried; cowardly, compulsive, clingy

Avoidant
Obsessive-compulsive
Dependent
Paranoid is which cluster personality disorder?

What is the major defense mechanism?
Cluster A

projection = internal impulse attributed to an external source (ie...man wants another woman to think his wife is cheating on him)
How do conduct disorder and antisocial disorder differ?
conduct disorder = must be <18yo

antisocial disorder = 18 yo or older

Both have the same sx = disregard for and violation of rights of others, criminality
Pt had permiscuity, self-mutilation, and unstable mood and interpersonal relationship. They often have thoughts of suicide.

What is the major defense mechanism?
Borderline personality disorder (cluster B pd)

Major defense mech = SPLITTING!
Pt has grandiosity, sense of entitlement, lacks empathy and requires excessive admiration; often demands the "best" and reacts to criticism with RAGE
Narcissistic personality disorder (cluster C pd)
Pt has excessive emotionality and excitability; often attention seeking and sexually provocative.
Histrionic
How is OCD different from Obsessive Compulsive Personality Disorder?
OCD = pt's do not like their disorder. They are aware of it, but don't like/want to wash their hands 50 times a day

Obsessive-compulsive personality disorder = pt's aren't aware of the problem; they may be perfectionist & may think that it's fine to be that way.
What's the name of this = false belief of being pregnant?
pseudocyesis
Maladaptive pattern leading to clinically significant impairment or distress.

Is this substance dependence or substance abuse?
Substance ABUSE....must lead to significant impairment or distress!
Which serum markers are sensitive indicators of alcohol use?
Serum gamma-glutamyltransferase (GGT)

Lab AST values are twice ALT values ("Alcohol for Scotch and Tonic" = AST!)
What is the treatment for acute alcohol intoxication?

How about for alcohol abuse PREVENTION?
Time

BEST ONE: Alcoholics anonymous! Next: naltrexone
What is the tx for delirium tremens?
benzo's or alcohol
Which two signs or sx can you not develop tolerance against in opioid intoxication?
miosis
constipation
If you see a pt that is sick at the hospital and he has pinpoint pupils, what two things do you think of?
cholinergic agonists or organophosphates

Opioids
Pt presents with these sx: sweating, dilated pupils, piloerection, fever, rhinorhea, stomach cramps and diarrhea.
Opioid WITHDRAWAL!
- esp if runny nose, goodbumps and dilated pupils
What two drugs can you use to help heroin addicts?
methadone

Suboxone - naloxone + buprenorphine (partial agonist) - withdrawal sx occur only when injection occurs (like disulfiram)
What is the tx for barbiturate and benzo intoxication?
barbiturate = sx management (assist respirations, increase BP)

Benzo's = flumazenil (comp. GABA blocker)
What are the main withdrawal sx seen in alcohol, barb's and benzo's?
delirium, CARDIOVASCULAR COLLAPSE (autonomic instability), seizures

Tx is the same for all: long acting benzo's are good (diazepam!)
Pt has overdoses on cocaine. If he has agitation sx, what's the tx? If he has psychosis sx (delusions, hallucinations, etc)..which are common...what tx?
agitation sx = benzo's

psychosis sx = haloperidol (typical antipsychotic)..if pt has delusion/hallucination sx!
What are some methods of tx nicotine withdrawal sx?
Withdrawal sx: nicotine patch, gum, or lozenges

For relapse prevention: buproprion or varenicline (chantix)
A pt is brought into the ER. He is young and appears to be violent around others. You suspect he's high. Which drug causes you to be violent & belligerent?
PCP
If a pt that is either intoxicated or in withdrawal and has signs of agitation, what can you give?

What if they have signs of psychosis?
Treat as if that's the main problem they have!

Agitation = give benzo's

Psychosis = give antipsychotics such as haloperidol!
Pt has marked anxiety (or depression), delusions, VISUAL hallucinations, FLASHBACKS, pupillary dilation. What drug are they on?
LSD - flashbacks and pupillary dilation!
Teens who use marijuana have increased risk of developing what?
Schizophrenia
A chronic alcoholic has confusion, opthalmoplegia and ataxia. What does he have?

He then progresses to irreversible memory loss, confabulation (production of false memories) and personality changes. What is this called?
Wernicke's encephalopathy

Korsakoff's psychosis

Together: Wernicke-Korsakoff syndrome..all d/t thiamine deficiency, which causes BILATERAL hemorrhage/necrosis of the mammillary bodies.

Tx: IV Vit B1 replacement (thiamine)
An alcoholic is at the ER. He has "coffee-ground emesis." Dx?

What if he had hematemesis?
Coffee-ground emesis = esophageal varices (d/t portal hypertension from liver cirrhosis)

Hematemesis is bright red vomit d/t Mallory-Weiss tears.
What is the "CAGE" questionnaire and what does it help to screen for?
It helps to screen for alcoholism
"CAGE"

C = Cut back? (have felt the need?)
A = Annoyed when others ask you about your alcohol use?
G = Guilt about use?
E = Eye-opener (do you need a drink in the morning?)
What's the drug name for PCP?
Phencyclidine = belligerence, combative, assaulting, vertical or horizontal NYSTAGMUS!!!
What is the street name for Methylenedioxymethamphetamine?

What are the sx of intox?
intoxication may present with increased feelings of intimacy and empathy, decreased appetite, urinary retention and hyponatremia, mydriasis, increased heart rate and blood pressure, increased body temperature, clenched masseter muscles, grinding teeth, and nystagmus.