Behavioral Flashcards
Requirement to refer a patient for a hospice care
Survival prognosis of ≤ 6 months
Which compound is likely to be low at CSF in Narcolepsy? is associated with what symptom?
Hypocretin-1 (orexyn-A) - Narcolepsy with cataplexy - undetectable levels
*Hypocretin-1 (orexyn-A), Hypocretin-2 (orexyn-B) - promote wakefulness and inhibit REM sleep-related phenomena.
How do you identity and distinguish a conversion disorder?
- Neurological symptoms incompatible with any known neurologic disease
- Acute onset after stressful event
- La belle indifferénce
How do you detect a passive aggression defense mechanism?
- Passively resist perform a expected task (first agree to do it), procrastination, forgetfulness, purposeful inefficiency
- backhanded compliments, sarcasm, denial of being angry
Order of next of kin of a non comunicable patient and when yo should identify?
- Usual order ▶️ proximity of relationship and age ▶️ spouse, adult children, parents, adult siblings
- Making decisions based what patient would want (NOT what next of kin want) ▶️ patient unable to make their wishes known and there is no written documentation
Health insurance plan recommended for a diabetic type 1 patient that want to pay low cost premium.
Health Maintenance Organization (HMO)
*If is willing to the limited network of providers is the best for low cost in patient with chronic medication and risk of complications.
What is a preventable medical error or adverse event?
Injury to the patient due to failure to follow evidence-based guidelines
Which are the mature mechanisms of defense? Describe them.
- Sublimation ▶️ transform impulse into socially acceptable behavior
- Suppression ▶️ put aside unwanted feelings, being aware of them to cope reality
What is an outlier, probably cause and what can affect? What measure in a study is the less affected?
- Extreme and unusual value in a dataset ▶️ error in measurement or recording, natural phenomenom
- Central tendency (median, mode, media) and dispersion measures (variance and standard deviation), and range ⏭ Mode the less affected
Key to identify cocaine withdrawal. Others features and treatment.
- “Crash”→acute depression symptoms with suicide ideas
- Hypersomnia, fatigue, hyperphagia, pronunced lassitude, vivid nightmares, psychomotor retardation. Minor physical signs and symptoms.
- Tx: supportive only
Which factor mainly affect the negative predictive value? How does it affect NPV?
- Pre-test probability
- High pre-test probability→↓NPV
- Low pre-test probability→↑NPV
*Prevalence is directly related with pre-test probability (high prevalente→↑pre-test probability, and viceversa)
Medical conditions associated with premature ejaculation. Treatment.
- Prostatitis, thyroid disease
- Medications ▶️ SSRIs, topical anesthetics. Psychotherapy ▶️ address psychogenic and relation ship factors
How do you assess the attention and concentration?
Tasks requiring prolonged, continuous thinking ▶️ counting down from 100 by 3 or 7, reciting the months in reverse order, spelling “world” backward
*may be impaired in dementia, head injury, depression
Ranges and uses of the correlation coeficient.
- Ranges from -1 to +1
- Describes strength and polarity of a linear association
Next step on evaluation when hace suspicious of child abuse.
- Complete full history→physical exam looking for signs suggesting child abuse
- Ask permission to the parents to interview the child alone→if they refuse to it, consider concerning for abuse (full history complete)→legally obligated to report suspected child abuse→contact child protective services (CPS)
What findings in physical examination do you look for when suspect child abuse?
- Skin lesions
- Signs of swelling
- Bony tenderness and unwillingness to use an extremity
- Retinal hemorrhages
- Genital trauma
- Signs of neglect→uncleanliness, malnourishment
- Strongly concerning→multiple injuries in different stages of healing and different types, pathognomonic injuries (cigarette burns), significant behavioral disturbances (excessive compliance, pseudo-maturity)
What is an attrition bias? what is the consequence to have it? Most common type of studies where it can occur.
- Type of selection bias→Loss of follow-up disproportionately between the exposed and unexposed groups→lost subjects differ in their risk of developing the outcome compared with the remaining subjects
- Ex→if selective loss of high risk subjects has occured→understimate the association
- Prospective studies
Best evidence for treatment of post-traumatic stress disorder
- Antidepressants→SSRI, SNRI
- Trauma focused cognitive behavioral therapy
What is the next step when you suspect elder abuse, neglect or explotation after talk with caregiver and make a full physical examination?
Interview patient alone: 3 questions as brief screen
- Dou you feel safe where you live?
- Who prepares your meals?
- Who handles your checkbook?
How is selected the control group of a case-control study?
Patientst who don’t have the disease, regardless of exposure status
Physical signs that can suggest bulimia nervosa. Laboratories alteration that you may find.
- Bilateral parotid gland enlargement and erosion of dental enamel→self-induced vomiting; hypotension, ↑HR, dry skin, menstrual irregularities, calluses on dorsum of hands (Russell sign)
- Electrolyte disturbances (Hypokalemia, hypochloremia, metabolic alkalosis), ↑salivary amylase
How can you distinguish anorexia vs bulimia?
- Bulimia→normal or overweight
- Anorexia→low weight
Treatment of specific fobia
- Behavioral therapy→systematic, repeated exposure to the phobic stimulus (most effective)
- Short-acting benzodiazepines (acutely), limited role
Majority of drug overdose death in US
Opioid in isolation or co-ingestants▶️abuse and addiction of prescription and heroin
How do you identify effect modification in a study?
Effect of a exposure on a outcome is modified by another variable
*Is not a bias. Is a natural phenomenon - describe, not correct.
How can you differentiate effect modification and confounding in a study?
Stratified analysis▶️analyzing the cohort as different groups
- Effect modification▶️allways significant difference between the strata (groups)▶️different measures of association
- Confounding▶️Not significant difference between the strata
Treatment of bulimia nervosa
- SSRI
- Cognitive behavioral therapy
- Nutritional rehabilitation
Pharmacotherapy for anorexia nervosa
Olanzapine (antipsychotic associated with weight gain), associated with psycotherapy
Best test to assess the association between 2 categorical variables
Chi-square
Utility of two-sample z test and two-sample t test.
Compare 2 group means, no categorical variables
Which test do you use to compare the means of 2 or more groups?
Analysis of variance (ANOVA)
What are you looking for when use matching method to compare data between 2 gropus? in which studies is most used?
- Control confounding bias→match by common or potential variables confounders►age, race, gender, smoking status, etc
- Case-control studies
Pathophysiology of ADHD symptoms. Treatment.
- ⬇️ NE and DA in prefrontal cortex
- Methylphenidate and amphetamines▶️⬆️release of NE and DA from vesicles and 🚫reuptake at synapses
How can you differentiate the derealization and depersonalization of depersonalization/derealization disorder from psychotic disorders?
Reality testing
- Intact in depersonalization/derealization disorder
What is a key feature of panic attacks, how may you identify them?
- At least some of the attacks are spontaneous with no obvious trigger (ex, relaxing at home or emerging from sleep)
- Acute onset anxiety with physical symptoms (shaking, dizziness, nausea, sweating)►recurrent and unexpected, concern about additional attacks→Panic disorder
What can you use to treat generalized anxiety disorder without dependence, tolerance and sexual dysfunction? Mechanism of action.
Buspirone (2nd line Tx)→Stimulates 5-HT1A receptors
*Does not interact with alcohol (vs barbiturates, benzodiazepines)
Risk factors for neonatal abstinence syndrome
Mothers with poor mental health, no prenatal care, hepatitis C infection (
Treatment and possible cause of neonatal abstinence syndrome
- Withdrawal from transplacental opiates due to maternal drug use
- Opioid replacement therapy→morphine, metahodone
Symptoms of neonatal abstinence syndrome
- Neurologic→irritability, hypertonia, jittery movements, seizures (rare)
- Gastrointestinal→diarrhea, vomiting, feeding intolerance
- Autonomic→sweating, sneezing, pupillary dilation
Pharmacology treatment of behavioral and psychotic manifestations of delirium.
Low-dose of antipsychotics (Haloperidol and some 2nd generation)
*Benzodiazepines can worsen confusional state→only delirium due alcohol and benzo withdrawal
Mechanism of action of phencyclidine (PCP). Most important clinical features of intoxication.
- N-methyl-D-aspartate (NMDA) receptor antagonist
- Secondarily inhibit reuptake of norepinephrine, DA, 5HT; sigma opioid receptor
- Agitation, hallucinations (substance-induced psychosis), violent behavior, loss coordination, horizontal and vertical nystagmus, memory loss, ataxia
Indications of use of MAOI’s
- Treatment-resistant depression
- Atypical depression
What is a atypical depression?
- Mood reactivity→ex, feeling better in response to positive events
- Leaden paralysis→arms and legs extremely heavy
- Recjection sensitivity→overly sensitive to slight criticism
- ↑sleep and appetite
How do you identify tourette syndrome?
- Both vocal (at least one) and multiple motor tics
- Tics preceded by urge and followed by relief. Can be supressed temporarily
- Common in boys 6-15 age
