Behavioral Flashcards
1
Q
The major inhibitory neurotransmitter in CNS
A
GABA
2
Q
Drugs potentiating GABA
A
Benzodiazepines
3
Q
Receptor for 1st generation antipsychotics
A
D2
4
Q
Receptor of 2nd generation antipsychotics
A
5HT2
5
Q
Carbamazepine mechanism of action
A
Blockade of Na channels
6
Q
Advance care planning time
A
Should begin in the outpatient setting as a conversation between the patient and the primary care provider.
When a patient is hospitalized it is essential to inquire about advance directives in the event that the patient becomes unable to make decisions.
7
Q
Effective discharge planning requirement
A
Collaboration of physician, nurse, social worker
8
Q
How much information can be shared if a patient is incapacitated to not present?
A
Basic/minimal information if it’s in the Patient’s best interest
9
Q
Cardiac complications of anorexia nervosa
A
Cardiac atrophy
cardiomyopathy
arrhythmias
10
Q
Clues to low level of literacy
A
Fewer years of education
Impaired cognitive function
History of incarceration
Poor or near poor income status
11
Q
Ephedra: use, side effects, interactions
A
Use: diet pill, energy booster
Adverse effect: increased BP, MI, CVA
Interaction: caffeine
12
Q
Appropriate question at the start of Hx taking?
A
Open-ended questions: What brings you in today? How can I help you? Tell me more about your condition/pain Please continue
13
Q
Signs of medication misuse
A
Not taking medication as prescribed, early refill requests, accessing drugs from multiple doctors or illicit sources, requesting higher doses and refusing alternate pain management strategies.
14
Q
How to inquire about the patient’s sexual partners?
A
Be neutral, open, non-judgmental
Ask direct and specific questions
15
Q
Emancipated minor
A
Homeless Parent Married Military Financially independent High school graduate
16
Q
SPIKES Protocol for delivering bad news
A
Set the stage Perception Invitation knowledge Empathy Summary and strategy
17
Q
Effects of alcohol on neurotransmitters
A
Potentiates the effects of GABA leading to sedation
Inhibit excitatory NMDA receptors in the brain
18
Q
The most common initial finding of alcohol withdrawal
A
Tremor
19
Q
Goal of therapy for somatic symptom disorder
A
Functional improvements rather than symptom elimination by promoting stress reduction and healthy behaviors Such as diet, exercise, return to productive activities
20
Q
PCP receptor
A
NMDA receptor antagonist
Secondary mechanism of action: inhibit re-uptake if NE, Dopamine, serotonin
21
Q
Receptor for analgesic affect of opioids
A
Mu
22
Q
PCP effects
A
Psychosis, severe agitation, violent behavior, ataxia, horizontal and vertical nystagmus, delirium
23
Q
The first step in root cause analysis
A
Collecting data mainly through interviewing multiple individuals involved in the steps leading to the outcome
24
Q
Social anxiety in schizotypal personality versus avoidant personality
A
Individuals with avoidant personality disorder desire relationships but fear rejection and do not exhibit eccentric behaviors of schizotypal personality disorder l.
People with schizotypal personality have social anxiety despite familiarity.
25
Functional/social status in adjustment disorder
Impaired
26
First line medications for bipolar maintenance treatment
Lithium valproate quetiapine
27
Triazolam Duration of action
Short
28
Lorazepam Duration of action
Intermediate
29
Symptoms that might occur initially when an SSRI is prescribed
Increased agitation and anxiety
| Treatment: Benzodiazepine
30
The strongest single risk factor for suicide
Previous suicide attempts
31
Negative symptoms
```
Affective flattening
Avolition
Alogia
Anhedonia
Asociallity
```
32
Factors associated with better treatment adherence rates among adolescents
Close peers with complementary behavioral practices
Positive family functioning
Physician empathy
Immediate benefits of treatment
33
Buspirone onset of action
Slow onset
Up to 2 weeks
Agonist of the 5HT
34
Tolerance dependence withdrawal with buspirone
None
35
Who uses undoing defense mechanism?
OCDs
36
Methylphenidate Onset of action
Rapid
37
The most common adverse effect of methylphenidate
Decreased appetite, weight-loss and insomnia
38
Panic attack management
If vital signs are stable/no symptom: SSRI, SNRI
If symptomatic/abnormal vital signs: benzodiazepine
39
Panic attack DDx
```
Arrhythmia
Hyperthyroidism
Hyperparathyroidism
Pheo
COPD
Pulmonary embolus
Vestibular dysfunction
Seizure disorders
```
40
Criteria for narcolepsy
Recurrent lapses into sleep or napping multiple times within the same day occurring at least three times weekly for three months.
Plus one of :cataplexy, hypocretin-1 deficiency in CSF, REM latency less than 15 minutes.
41
Neuropeptides lacking in narcolepsy with cataplexy
```
Hypocretin 1 (orexin-A)
Hypocretin 2 (orexin-B)
```
They promote wakefulness and inhibit REM sleep-related phenomena
42
Neurotransmitter associated with impulsive distractive behavior particularly aggression suicide and violence
Low CSF 5-HIAA
43
CSF protein in Creutzfeldt-Jakob
14-3-3 protein
44
Homovanillic acid
Metabolite of dopamine
Altered levels in CSF of: Substance use disorders psychosis mood disorders
Decreased level in CSF of Parkinson’s disease
45
Melatonin levels in CSF decreased in
Alzheimer’s disease
46
Disruptive mood dysregulation disorder
Characterized by persistent irritability and frequent developmentally inappropriate temper outbursts
47
Pica
Compulsive consumption of a non-food and/or non-staple food source for one months or longer
Often associated with nutritional deficiencies including Iran, zinc deficiencies and anemia of any etiology
48
The most ingested substance in pica
Ice
Others: earth/soil, raw starch
49
Mature defense mechanisms
Suppression
Sublimation
Humor
Altruism
50
Suppression versus repression
In suppression the individual is aware of the emotion but decided not to attend to it. In repression unacceptable thoughts or feelings are blocked from entering conscious awareness.
51
Symptoms of frontal lobe syndrome
Disorganized
Disinhibited
Apathetic
52
Damage to parietal lobe
Difficulties with spatial and visual perception, writing and calculation, left-right differentiation, object identification.
53
Temporal lobe injury
Language problems, difficulty with sensory interpretation, impaired memory, behavioral changes (hyperorality, hypersexuality)
54
Medical conditions capable of producing depression symptoms
```
Hypothyroidism
Parkinson disease
OSA
MS
Mononucleosis
```
55
Reason for not drinking alcohol near bedtime
Alcohol is disruptive to sleep in the second half of the night
56
Rett syndrome
```
X-linked
Occurs mainly in girls
Normal development until age 5 to 18 months
A loss of motor and language skills
Development of stereotypic hand movements
Deceleration of head growth
Seizures
Intellectual disability
Autistic features
Breathing abnormalities
```
57
Lesch-Nyhan
```
X-linked recessive
HPRT deficiency
Increased uric acid levels
Gout
Poor muscle control
Intellectual disability
Writhing or repetitive involuntary movements
Self mutilation
```
58
Identification defense mechanism
Modeling one’s behavior after someone who is perceived to be more powerful or prestigious. a classic example is the child of an abusive father who becomes a child abuser himself
59
Serotonergic neurons in brain stem
Raphe nuclei
Role: sleep-wake cycle, level of arousal
Dysfunction: insomnia, depression
60
Norepinephrine neurons in dorsal pons
Nucleus ceroleus
| Role: activation of the “fight or flight” response
61
Cholinergic neurons
Nucleus basalis of Meynert
| Inadequate production of acetylcholine in Alzheimer
62
Red nucleus
Anterior midbrain
| Motor coordination of upper extremities
63
Caudate and putamen in striatum
Function in motor activity
| Loss of cholinergic and GABA releasing neurons of striatum in Hantington
64
Dopaminergic neurons
Substantia nigra
| Depleted in Parkinson
65
The second generation antipsychotic most often associated with prolongation of QT interval
Ziprasidone
66
Second generation antipsychotic associate with a greater risk of prolactin elevation
Risperidone
67
Ethics of treatment of friends
Limited to emergency situations when no other physician is available
68
Agents associated with increased risk of fall
```
Antipsychotics
Benzodiazepine
Antidepressants
NSAIDs
Anti-hypertensive
```
69
Transference defense mechanic
Unconscious shifting of emotions or desires associated with a person from the past to another person in the present
70
Methadone receptor
Mu-opioid agonist
71
Methadone characteristics
```
Long half-life (suppresses craving and withdrawal for >24h)
Good bioavailability
Potent agonist, high affinity
Blocks euphoric effect of other opioids
Potent analgesic effect
```
72
Methadone adverse effects
QT prolongation
Respiratory depression
Lethality in overdose
Abrupt discontinuation causes withdrawal
73
Buprenorphine vs methadone
Buprenorphine less likely to cause respiratory depression and mortality in overdose
Methadone is drug of choice for maintenance treatment of opioid abuse
74
Which drugs are rarely lethal if overdosed?
Benzodiazepine
| Marijuana
75
Substance with conjunctival injection
Marijuana
76
Substance with inappropriate laughter
Marijuana
77
Marijuana metabolism
Liver
Remains in body for a long time
Can be detected in urine up to 3 days after daily use has ceased
78
Substances causing bradycardia
GHB
benzodiazepine
OpIate
79
Evaluation is when language milestone is delayed
Hearing examination
| Speech and language evaluation
80
Red flags of prescription drugs missuse
Lost or stolen medication
Pain in consistent with physical examination
Requesting a specific medication my name
Running out of medication
Obtaining multiple opioid prescriptions from different providers
81
Treatment of specific phobia
Exposure-based behavioral therapy
Short-acting benzodiazepines may help acutely but have a limited role. for example therapist unavailable or insufficient time
82
Treatment of social anxiety disorder
SSRI or SNRI
CBT
BB or benzodiazepine for performance-only subtype
83
Confronting people with factitious diseases with the possibility of feigning or producing symptoms
Respond with denial
| May reject medical or psychiatric care
84
Compensatory behaviors in bulimia
Self-induced vomiting
Fasting
Excessive exercise
Miss use of laxatives, enemas, diuretics and diet pills
85
Compensatory behavior in binge eating disorder
None
86
Management of hypothyroidism due to lithium consumption
T4
| Not necessary to discontinue lithium
87
Closed loop communication
The sender transmitting a message to another individual who is the receiver who then repeats the message back to the sender. Sebder typically will confirm the message by saying yes
88
Separation anxiety duration for diagnosis
At least 4 wk in children and 6 mo in adults
89
Sedating antidepressant associated with priapism
Trazodome
90
Trazodone not to be prescribed in:
Sickle cell disease, multiple myeloma
91
Trazodone side effects
Antagonizes post-synaptic serotonin receptors and inhibits serotonin reuptake
Minimal effects on norepinephrine and dopamine
Alpha adrenergic blockade
Histamine H1 receptor antagonism
92
Substance use with dental decay
Methamphetamine
93
Substance with impaired time perception
Marijuana
94
Substance with conjunctival injection
Marijuana
95
Substance with nystagmus
PCP
96
Substance with visual hallucination
LSD
97
Substances with violent behavior
PCP
| Methamphetamine
98
Substance which is NMDA receptor antagonist
PCP
99
Substance with an anesthetic properties
PCP
100
Substances that increased appetite
Marijuana toxicity and cocaine withdrawal and nicotine withdrawal
101
Substance with ischemic effects
Cocaine
102
Substance causing depersonalization
LSD
103
Duration of intoxication with methamphetamine
Up to 20 hours
104
Duration of intoxication with cocaine
Up to one hour
105
Denial of the problem in the stage of change model
| Blaming external circumstances
Precontemplation
106
Acceptance of the problem in stage of change model
| Not ready to make changes
Contemplation
107
Planning to change the behavior in stage of change model
Preparation
108
Hypersomnolence disorder versus narcolepsy
Persistent excessive and impairing daytime sleepiness rather than sleep attacks
They do not feel refreshed after naps
109
REM sleep related phenomena
Hypnagogic/hypnopompic hallucinations
| Sleep paralysis
110
The key neurotransmitters involved in pathophysiology of ADHD
Norepinephrine
Dopamine
Reduce levels in prefrontal cortex
111
Methylphenidate and amphetamine mechanism of action
Increase release and black reuptake of NE and Dopamine neurotransmitters in prefrontal cortex
112
Acute dystonic reaction mechanism of action
D2 antagonism in nigrosriatal pathway
113
Flumazenil Mechanism of action
GABA antagonist
114
Leaving the mother alone with the infant in postpartum psychosis
Not allowed
115
Receptor responsible for drug-induced parkinsonism
D2 blockade in nigrostriatal pathway
Antipsychotics
Gastric motility Agents/ antiemetics
116
Trihexyphenidil Mechanism of action
Anticholinergic
117
Benztropine Mechanism of action
Anticholinergic
118
The best approach to a patient in denial
Determine whether the denial is interfering with medical care or significant relationships. If it is not the denial should not be confronted.
Validated patients hope, but encourage him to focus on short-term plans to maximize his participation in areas that give meaning to his life
119
Tardive dyskinesia mechanism
Development of supersensitivity of post synaptic D2 receptors following prolonged D2 blockade and any balance between D1 and D2 receptor mediated effects
120
Aggravating factors for tardive dyskinesia
Emotional stress and fatigue
121
Hypo or hyper reactivity to sensory input seen in:
Autism
| For example extreme response to sounds or textures, indifference to pain
122
White coat hypertension mechanism
Classical conditioning
123
Eye signs of marijuana
Conjunctival injection
| NO PUPILLARY DILATION
