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Psychiatry > Case Files 2 > Flashcards

Case Files 2 Flashcards

1
Q

Two low electrolytes in bulimia

A

Hypochloremic-hypokalemic alkalosis

can see elevated amylase

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2
Q

3 prong treatment for bulimia

A

Nutritional counseling, CBT, and SSRI (Fluoxetine is best)

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3
Q

Bulimia vs Anorexia odd features

A

Bulimia more likely to accept treatment, have more alcohol abuse, and more likely to be emotionally labile than those with anorexia

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4
Q

First step to dx anorexia

A

Calculation of BMI

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5
Q

Odd positive prognostic factor for recovery in anorexia

A

Greater impulsivity

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6
Q

Desmopressin for wetting the bed after what age

A

Reserved for those over 7 years old

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7
Q

What is it called when a kid pees himself during the day

A

Diurnal enuresis

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8
Q

Most important treatment for enuresis

A

Psychoeducation (for patients and caretakers)

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9
Q

Insomnia diagnostic criteria

A

Problems for at least 3 months and cause significant distress or impairment
diagnosis of exclusion

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10
Q

Narcolepsy druge

A

Ramelteon (melatonin receptor agonist)

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11
Q

What to do for sleep terror disorder

A

Protect the child from injury

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12
Q

When do sleep terrors occur? what makes worse

A 
During delta (slow wave) sleep
Fever, sleep deprivation, and and CNS depressants may worsen
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13
Q

Dyssomnias vs Parasomnias

A

Dysomnias: Sleep difficulties associated with duration and type of sleep (excessive sleepiness or diff starting/maintaining sleep)
Parasomnias: sleep disorders associated with problems during stages of sleep

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14
Q

Protocol for gender dysphoria treatment

A

3 months as other sex in society for hormones

12 months as other sex in society for surgery

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15
Q

Gender dysphoria vs Delusions

A

Gender dysphoria feels like they were born in the wrong body, delusional people actually think they are the other sex

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16
Q

Drug shown to be helpful in conduct disorder

A

Risperidone (or other atypical)

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17
Q

CD diagnostic criteria

A

Three of criteria in 12 months with at least one in the last 6 months
Aggression towards people or animals, Destruction of property, Deceitfulness or threat, serious rule violation
Before age of 18

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18
Q

CD commonly seen with what in boys

A

ADHD

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19
Q

ODD vs CD

A

ODD patients do not typically cause significant harm to others or violate social norms

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20
Q

ODD worsening history

A

ODD can be predecessor to CD

CD can be predecessor to ASD

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21
Q

Wernicke triad

A

Delirium, ophthalmoplegia (CN 6), and ataxia

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22
Q

Two alcohol abuse drugs

A

Naltrexone (opioid antagonist)

Acamprosate (stabilizes gluatminergic functioning)

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23
Q

What in confabulation

A

Filling in missing memories with false information (often seen in Korsakoff syndrome)

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24
Q

How long to have a negative UDS for coke

A

3 days

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25
Q

Drug to decrease autonomic symptoms of opioid withdrawal? other drugs for what symptoms

A

Clonidine

Also Loperamide for loose stools, promethazine for nausea, and ibuprofen for muscle pain

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26
Q

What will happen if a patient is on bupenorphine and opioids

A

They will go into withdrawal

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27
Q

Drug for folks on PCP

A

Benzos for agitation

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28
Q

Alcohol withdrawal stages

A

6-8 hours: Tremulousness and jitteriness
8-12 hours: psychosis and perceptual symptoms
12-24 hours: seizures
24-72: DTs

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29
Q

Benzo for alcohol withdrawal in patients with bad livers

A

Lorazepam

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30
Q

Benzo withdrawal features

A

Anxiety, sweating, intolerance of loud noises or lights, muscle twitching, seizures

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31
Q

Drug for Benzo OD

A

Flumazenil (but can precipitate severe withdrawal)

32
Q

Benzos alter what ion influx

A

Chloride (on GABA-A receptors)

33
Q

Short acting benzo

A

Alprazolam (short actings more likely to cause seizures)

34
Q

What is unique about Lorazepam’s metabolism

A

Directly conjugated to inactive glucuronide metabolite that is excreted by the kidneys

35
Q

Crack vs Meth differentiation

A

Meth people with have “meth mouth” or extremely poor dentition

36
Q

Key features of delerium

A

Waxing and waning of consciousness and disorientation (fluctuation in the level of attention and awareness)

37
Q

Delirium associated with alcohol withdrawal shows what in EEG

A

Increased fast waves

38
Q

Class of Ab to worry about with delerium

A

Floroquinolones

39
Q

ICU triad of delerium

A

Pain, agitation, and delirium

40
Q

What is agnosia

A

Loss of ability to recognize or identify objects/people despite intact sensory function

41
Q

IADLs vs ADLs

A

IADLs what needed to function in society

ADLs what needed to function

42
Q

NSME score more major neurcognitive disorder? significant cognitive impairment

A
43
Q

When to get head CT or MRI for NCD

A

Onset prior to age 65, recent onset of symptoms with rapid deadline, focal neurologic findings, history of head injury

44
Q

Ach inhibitors used in Alzheimers

A

Donepezil, galantamine, rivastigmine

45
Q

Patient’s with lewy body dementia at risk for what when given 1st gen antipsychotics

A

Dystonic reaction

46
Q

Treating older demented patients with antipsychotics increases risk of what

A

Stroke

47
Q

Why should Benzos be avoided in the elderly

A

May cause paradoxical disinhibition, over sedation, unsteadiness, and falls in elderly

48
Q

Displacement

A

defense mechanism is when an individual avoids emotional conflict by transferring a feeling to a less threatening one
(yelling at your kids after your boss yells at you)

49
Q

Projection

A

Defense mechanism in which individuals attribute feelings they have about themselves or the worlds to others
(I hate you so I think you hate me)

50
Q

Avoiding vs Schizoid personality disorder

A

Avoidant wants to have friends super bad

51
Q

How do avoidant personality disorder patients often view people

A

As critiquing and rejecting

52
Q

Two defense mechs used in avoidant personality disorder

A

Displacement and Projection

53
Q

What are patients with dependent personality disorder afraid of

A

Afraid of being left alone to fend for themselves

54
Q

What is ego-syntonic

A

When a patient does not recognize problems as originating from him, but rather blames them on others in the outside world

55
Q

Intellectualization

A

Defense mech using excessive use of abstract thinking to control or minimize disturbing feelings
obsessing over details without showing emotion

56
Q

Isolation of affect

A

Defense mech by which an individual deals with emotional conflict or stressors by separating ideas from the feelings originally associated with them

57
Q

Undoing

A

Defense mech by which an individual deals with emotional conflict or stressors with words or behavior designed to negative or symbolically make amends for unacceptable thoughts, feelings, or actions

58
Q

OCPD folks

A

Pervasive pattern of perfectionism and inflexibility, emotional constriction
Orderly and stubborn, often have trouble meeting deadlines and work and making choices

59
Q

Cluster C disorders

A

Avoidant, OCPD, Dependent

60
Q

Personality disorder with theatrical and overblown speech with seductive manner? approach to take with them?

A

Histrionic personality disorder

Be very attentive to clear professional boundaries

61
Q

Most common defense mechs in histrionic patients

A

Dissociation and repression

62
Q

Reaction formation

A

Defense mech when a person deals with bad things by substituting for diametrically opposed thoughts or feelings

63
Q

What can happen to schizotypal personality disorder people under stress

A

They can become transiently psychotic

64
Q

% of psyche patients that also have a personality disorder

A

30-50%

65
Q

Current conceptualization of schizotypal personality disorder

A

Biologically related to schizophrenia but is a milder disorder on the schizophrenia spectrum

66
Q

Devaluation

A

Defense mech where an individual deals with emotional conflict by attributing exaggerated negative qualities to themselves or to others
opposites is idealization

67
Q

When do patients with narcissistic personality disorder usually present for treatment

A

Due to underlying anger or depression resulting from being belittled or not receiving the admiration to which they feel entitled

68
Q

Paranoid ideations vs delusions

A

Ideation is mere suspiciousness or worry

Delusions are fixed false beliefs - i.e. actually acting out on them

69
Q

CBT specifically designed for borderline patients

A

Dialectal behavioral therapy

70
Q

What should you ask a patient with a paraphilia about

A

If they have any others

71
Q

What is vaginismus

A

Involuntary contraction of vaginal musculature that prevents intercourse
Best treated with behavioral therapy

72
Q

Dystonia tx

A

Benztropine or diphenhydramine

73
Q

Dopa blocking where causes EPS

A

Nigrostriatal pathway

74
Q

Drug induced parkinsonism triad

A

Resting “pill rolling” tremor
Muscular rigidity
Bradykinesia

75
Q

EPS timlines

A 
Dystonia - hours to days
Parkinsonism - day to weeks
Akathisia- days to weeks
TD - years 
NMS - ANY TIME
76
Q

Facetious disorder motivation

A

Assumption of the sick role

77
Q

Features of somatic symptom disorder

A

Distressing somatic symptom which disrupts normal life routines, excessive thoughts about physical condition, and persistent anxiety

Psychiatry (6 decks)

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