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Med > Behavioral > Flashcards

Behavioral Flashcards

1
Q

The major inhibitory neurotransmitter in CNS

A

GABA

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2
Q

Drugs potentiating GABA

A

Benzodiazepines

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3
Q

Receptor for 1st generation antipsychotics

A

D2

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4
Q

Receptor of 2nd generation antipsychotics

A

5HT2

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5
Q

Carbamazepine mechanism of action

A

Blockade of Na channels

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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.

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7
Q

Effective discharge planning requirement

A

Collaboration of physician, nurse, social worker

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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

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9
Q

Cardiac complications of anorexia nervosa

A

Cardiac atrophy
cardiomyopathy
arrhythmias

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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

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11
Q

Ephedra: use, side effects, interactions

A

Use: diet pill, energy booster
Adverse effect: increased BP, MI, CVA
Interaction: caffeine

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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
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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.

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14
Q

How to inquire about the patient’s sexual partners?

A

Be neutral, open, non-judgmental

Ask direct and specific questions

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15
Q

Emancipated minor

A 
Homeless
Parent
Married
Military
Financially independent 
High school graduate
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16
Q

SPIKES Protocol for delivering bad news

A 
Set the stage
Perception
Invitation 
knowledge
Empathy
Summary and strategy
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17
Q

Effects of alcohol on neurotransmitters

A

Potentiates the effects of GABA leading to sedation

Inhibit excitatory NMDA receptors in the brain

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18
Q

The most common initial finding of alcohol withdrawal

A

Tremor

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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

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20
Q

PCP receptor

A

NMDA receptor antagonist

Secondary mechanism of action: inhibit re-uptake if NE, Dopamine, serotonin

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21
Q

Receptor for analgesic affect of opioids

A

Mu

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22
Q

PCP effects

A

Psychosis, severe agitation, violent behavior, ataxia, horizontal and vertical nystagmus, delirium

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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

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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.

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25
Q

Functional/social status in adjustment disorder

A

Impaired

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26
Q

First line medications for bipolar maintenance treatment

A

Lithium valproate quetiapine

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27
Q

Triazolam Duration of action

A

Short

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28
Q

Lorazepam Duration of action

A

Intermediate

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29
Q

Symptoms that might occur initially when an SSRI is prescribed

A

Increased agitation and anxiety

Treatment: Benzodiazepine

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30
Q

The strongest single risk factor for suicide

A

Previous suicide attempts

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31
Q

Negative symptoms

A 
Affective flattening
Avolition
Alogia
Anhedonia
Asociallity
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32
Q

Factors associated with better treatment adherence rates among adolescents

A

Close peers with complementary behavioral practices
Positive family functioning
Physician empathy
Immediate benefits of treatment

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33
Q

Buspirone onset of action

A

Slow onset
Up to 2 weeks

Agonist of the 5HT

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34
Q

Tolerance dependence withdrawal with buspirone

A

None

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35
Q

Who uses undoing defense mechanism?

A

OCDs

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36
Q

Methylphenidate Onset of action

A

Rapid

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37
Q

The most common adverse effect of methylphenidate

A

Decreased appetite, weight-loss and insomnia

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38
Q

Panic attack management

A

If vital signs are stable/no symptom: SSRI, SNRI

If symptomatic/abnormal vital signs: benzodiazepine

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39
Q

Panic attack DDx

A 
Arrhythmia
Hyperthyroidism
Hyperparathyroidism
Pheo
COPD
Pulmonary embolus
Vestibular dysfunction
Seizure disorders
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40
Q

Criteria for narcolepsy

A

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.

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41
Q

Neuropeptides lacking in narcolepsy with cataplexy

A 
Hypocretin 1 (orexin-A)
Hypocretin 2 (orexin-B)

They promote wakefulness and inhibit REM sleep-related phenomena

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42
Q

Neurotransmitter associated with impulsive distractive behavior particularly aggression suicide and violence

A

Low CSF 5-HIAA

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43
Q

CSF protein in Creutzfeldt-Jakob

A

14-3-3 protein

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44
Q

Homovanillic acid

A

Metabolite of dopamine
Altered levels in CSF of: Substance use disorders psychosis mood disorders
Decreased level in CSF of Parkinson’s disease

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45
Q

Melatonin levels in CSF decreased in

A

Alzheimer’s disease

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46
Q

Disruptive mood dysregulation disorder

A

Characterized by persistent irritability and frequent developmentally inappropriate temper outbursts

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47
Q

Pica

A

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

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48
Q

The most ingested substance in pica

A

Ice

Others: earth/soil, raw starch

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49
Q

Mature defense mechanisms

A

Suppression
Sublimation
Humor
Altruism

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50
Q

Suppression versus repression

A

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
Q

Symptoms of frontal lobe syndrome

A

Disorganized
Disinhibited
Apathetic

52
Q

Damage to parietal lobe

A

Difficulties with spatial and visual perception, writing and calculation, left-right differentiation, object identification.

53
Q

Temporal lobe injury

A

Language problems, difficulty with sensory interpretation, impaired memory, behavioral changes (hyperorality, hypersexuality)

54
Q

Medical conditions capable of producing depression symptoms

A 
Hypothyroidism
Parkinson disease
OSA
MS
Mononucleosis
55
Q

Reason for not drinking alcohol near bedtime

A

Alcohol is disruptive to sleep in the second half of the night

56
Q

Rett syndrome

A 
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
Q

Lesch-Nyhan

A 
X-linked recessive
HPRT deficiency
Increased uric acid levels
Gout
Poor muscle control
Intellectual disability
Writhing or repetitive involuntary movements
Self mutilation
58
Q

Identification defense mechanism

A

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
Q

Serotonergic neurons in brain stem

A

Raphe nuclei
Role: sleep-wake cycle, level of arousal
Dysfunction: insomnia, depression

60
Q

Norepinephrine neurons in dorsal pons

A

Nucleus ceroleus

Role: activation of the “fight or flight” response

61
Q

Cholinergic neurons

A

Nucleus basalis of Meynert

Inadequate production of acetylcholine in Alzheimer

62
Q

Red nucleus

A

Anterior midbrain

Motor coordination of upper extremities

63
Q

Caudate and putamen in striatum

A

Function in motor activity

Loss of cholinergic and GABA releasing neurons of striatum in Hantington

64
Q

Dopaminergic neurons

A

Substantia nigra

Depleted in Parkinson

65
Q

The second generation antipsychotic most often associated with prolongation of QT interval

A

Ziprasidone

66
Q

Second generation antipsychotic associate with a greater risk of prolactin elevation

A

Risperidone

67
Q

Ethics of treatment of friends

A

Limited to emergency situations when no other physician is available

68
Q

Agents associated with increased risk of fall

A 
Antipsychotics
Benzodiazepine
Antidepressants
NSAIDs
Anti-hypertensive
69
Q

Transference defense mechanic

A

Unconscious shifting of emotions or desires associated with a person from the past to another person in the present

70
Q

Methadone receptor

A

Mu-opioid agonist

71
Q

Methadone characteristics

A 
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
Q

Methadone adverse effects

A

QT prolongation
Respiratory depression
Lethality in overdose
Abrupt discontinuation causes withdrawal

73
Q

Buprenorphine vs methadone

A

Buprenorphine less likely to cause respiratory depression and mortality in overdose

Methadone is drug of choice for maintenance treatment of opioid abuse

74
Q

Which drugs are rarely lethal if overdosed?

A

Benzodiazepine

Marijuana

75
Q

Substance with conjunctival injection

A

Marijuana

76
Q

Substance with inappropriate laughter

A

Marijuana

77
Q

Marijuana metabolism

A

Liver
Remains in body for a long time
Can be detected in urine up to 3 days after daily use has ceased

78
Q

Substances causing bradycardia

A

GHB
benzodiazepine
OpIate

79
Q

Evaluation is when language milestone is delayed

A

Hearing examination

Speech and language evaluation

80
Q

Red flags of prescription drugs missuse

A

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
Q

Treatment of specific phobia

A

Exposure-based behavioral therapy
Short-acting benzodiazepines may help acutely but have a limited role. for example therapist unavailable or insufficient time

82
Q

Treatment of social anxiety disorder

A

SSRI or SNRI
CBT
BB or benzodiazepine for performance-only subtype

83
Q

Confronting people with factitious diseases with the possibility of feigning or producing symptoms

A

Respond with denial

May reject medical or psychiatric care

84
Q

Compensatory behaviors in bulimia

A

Self-induced vomiting
Fasting
Excessive exercise
Miss use of laxatives, enemas, diuretics and diet pills

85
Q

Compensatory behavior in binge eating disorder

A

None

86
Q

Management of hypothyroidism due to lithium consumption

A

T4

Not necessary to discontinue lithium

87
Q

Closed loop communication

A

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
Q

Separation anxiety duration for diagnosis

A

At least 4 wk in children and 6 mo in adults

89
Q

Sedating antidepressant associated with priapism

A

Trazodome

90
Q

Trazodone not to be prescribed in:

A

Sickle cell disease, multiple myeloma

91
Q

Trazodone side effects

A

Antagonizes post-synaptic serotonin receptors and inhibits serotonin reuptake
Minimal effects on norepinephrine and dopamine
Alpha adrenergic blockade
Histamine H1 receptor antagonism

92
Q

Substance use with dental decay

A

Methamphetamine

93
Q

Substance with impaired time perception

A

Marijuana

94
Q

Substance with conjunctival injection

A

Marijuana

95
Q

Substance with nystagmus

A

PCP

96
Q

Substance with visual hallucination

A

LSD

97
Q

Substances with violent behavior

A

PCP

Methamphetamine

98
Q

Substance which is NMDA receptor antagonist

A

PCP

99
Q

Substance with an anesthetic properties

A

PCP

100
Q

Substances that increased appetite

A

Marijuana toxicity and cocaine withdrawal and nicotine withdrawal

101
Q

Substance with ischemic effects

A

Cocaine

102
Q

Substance causing depersonalization

A

LSD

103
Q

Duration of intoxication with methamphetamine

A

Up to 20 hours

104
Q

Duration of intoxication with cocaine

A

Up to one hour

105
Q

Denial of the problem in the stage of change model

Blaming external circumstances

A

Precontemplation

106
Q

Acceptance of the problem in stage of change model

Not ready to make changes

A

Contemplation

107
Q

Planning to change the behavior in stage of change model

A

Preparation

108
Q

Hypersomnolence disorder versus narcolepsy

A

Persistent excessive and impairing daytime sleepiness rather than sleep attacks

They do not feel refreshed after naps

109
Q

REM sleep related phenomena

A

Hypnagogic/hypnopompic hallucinations

Sleep paralysis

110
Q

The key neurotransmitters involved in pathophysiology of ADHD

A

Norepinephrine
Dopamine
Reduce levels in prefrontal cortex

111
Q

Methylphenidate and amphetamine mechanism of action

A

Increase release and black reuptake of NE and Dopamine neurotransmitters in prefrontal cortex

112
Q

Acute dystonic reaction mechanism of action

A

D2 antagonism in nigrosriatal pathway

113
Q

Flumazenil Mechanism of action

A

GABA antagonist

114
Q

Leaving the mother alone with the infant in postpartum psychosis

A

Not allowed

115
Q

Receptor responsible for drug-induced parkinsonism

A

D2 blockade in nigrostriatal pathway
Antipsychotics
Gastric motility Agents/ antiemetics

116
Q

Trihexyphenidil Mechanism of action

A

Anticholinergic

117
Q

Benztropine Mechanism of action

A

Anticholinergic

118
Q

The best approach to a patient in denial

A

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
Q

Tardive dyskinesia mechanism

A

Development of supersensitivity of post synaptic D2 receptors following prolonged D2 blockade and any balance between D1 and D2 receptor mediated effects

120
Q

Aggravating factors for tardive dyskinesia

A

Emotional stress and fatigue

121
Q

Hypo or hyper reactivity to sensory input seen in:

A

Autism

For example extreme response to sounds or textures, indifference to pain

122
Q

White coat hypertension mechanism

A

Classical conditioning

123
Q

Eye signs of marijuana

A

Conjunctival injection

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