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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
Drug to decrease autonomic symptoms of opioid withdrawal? other drugs for what symptoms
Clonidine | Also Loperamide for loose stools, promethazine for nausea, and ibuprofen for muscle pain
26
What will happen if a patient is on bupenorphine and opioids
They will go into withdrawal
27
Drug for folks on PCP
Benzos for agitation
28
Alcohol withdrawal stages
6-8 hours: Tremulousness and jitteriness 8-12 hours: psychosis and perceptual symptoms 12-24 hours: seizures 24-72: DTs
29
Benzo for alcohol withdrawal in patients with bad livers
Lorazepam
30
Benzo withdrawal features
Anxiety, sweating, intolerance of loud noises or lights, muscle twitching, seizures
31
Drug for Benzo OD
Flumazenil (but can precipitate severe withdrawal)
32
Benzos alter what ion influx
Chloride (on GABA-A receptors)
33
Short acting benzo
Alprazolam (short actings more likely to cause seizures)
34
What is unique about Lorazepam's metabolism
Directly conjugated to inactive glucuronide metabolite that is excreted by the kidneys
35
Crack vs Meth differentiation
Meth people with have "meth mouth" or extremely poor dentition
36
Key features of delerium
Waxing and waning of consciousness and disorientation (fluctuation in the level of attention and awareness)
37
Delirium associated with alcohol withdrawal shows what in EEG
Increased fast waves
38
Class of Ab to worry about with delerium
Floroquinolones
39
ICU triad of delerium
Pain, agitation, and delirium
40
What is agnosia
Loss of ability to recognize or identify objects/people despite intact sensory function
41
IADLs vs ADLs
IADLs what needed to function in society | ADLs what needed to function
42
NSME score more major neurcognitive disorder? significant cognitive impairment
43
When to get head CT or MRI for NCD
Onset prior to age 65, recent onset of symptoms with rapid deadline, focal neurologic findings, history of head injury
44
Ach inhibitors used in Alzheimers
Donepezil, galantamine, rivastigmine
45
Patient's with lewy body dementia at risk for what when given 1st gen antipsychotics
Dystonic reaction
46
Treating older demented patients with antipsychotics increases risk of what
Stroke
47
Why should Benzos be avoided in the elderly
May cause paradoxical disinhibition, over sedation, unsteadiness, and falls in elderly
48
Displacement
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
Projection
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
Avoiding vs Schizoid personality disorder
Avoidant wants to have friends super bad
51
How do avoidant personality disorder patients often view people
As critiquing and rejecting
52
Two defense mechs used in avoidant personality disorder
Displacement and Projection
53
What are patients with dependent personality disorder afraid of
Afraid of being left alone to fend for themselves
54
What is ego-syntonic
When a patient does not recognize problems as originating from him, but rather blames them on others in the outside world
55
Intellectualization
Defense mech using excessive use of abstract thinking to control or minimize disturbing feelings *obsessing over details without showing emotion*
56
Isolation of affect
Defense mech by which an individual deals with emotional conflict or stressors by separating ideas from the feelings originally associated with them
57
Undoing
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
OCPD folks
Pervasive pattern of perfectionism and inflexibility, emotional constriction Orderly and stubborn, often have trouble meeting deadlines and work and making choices
59
Cluster C disorders
Avoidant, OCPD, Dependent
60
Personality disorder with theatrical and overblown speech with seductive manner? approach to take with them?
Histrionic personality disorder | Be very attentive to clear professional boundaries
61
Most common defense mechs in histrionic patients
Dissociation and repression
62
Reaction formation
Defense mech when a person deals with bad things by substituting for diametrically opposed thoughts or feelings
63
What can happen to schizotypal personality disorder people under stress
They can become transiently psychotic
64
% of psyche patients that also have a personality disorder
30-50%
65
Current conceptualization of schizotypal personality disorder
Biologically related to schizophrenia but is a milder disorder on the schizophrenia spectrum
66
Devaluation
Defense mech where an individual deals with emotional conflict by attributing exaggerated negative qualities to themselves or to others *opposites is idealization*
67
When do patients with narcissistic personality disorder usually present for treatment
Due to underlying anger or depression resulting from being belittled or not receiving the admiration to which they feel entitled
68
Paranoid ideations vs delusions
Ideation is mere suspiciousness or worry | Delusions are fixed false beliefs - i.e. actually acting out on them
69
CBT specifically designed for borderline patients
Dialectal behavioral therapy
70
What should you ask a patient with a paraphilia about
If they have any others
71
What is vaginismus
Involuntary contraction of vaginal musculature that prevents intercourse Best treated with behavioral therapy
72
Dystonia tx
Benztropine or diphenhydramine
73
Dopa blocking where causes EPS
Nigrostriatal pathway
74
Drug induced parkinsonism triad
Resting "pill rolling" tremor Muscular rigidity Bradykinesia
75
EPS timlines
``` Dystonia - hours to days Parkinsonism - day to weeks Akathisia- days to weeks TD - years NMS - ANY TIME ```
76
Facetious disorder motivation
Assumption of the sick role
77
Features of somatic symptom disorder
Distressing somatic symptom which disrupts normal life routines, excessive thoughts about physical condition, and persistent anxiety

Psychiatry (6 decks)

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