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Clerckship_USMLE > chapter_2 _Q&A > Flashcards

chapter_2 _Q&A Flashcards

1
Q

What are the key components of a psychiatric interview?

A
  1. Establish rapport
  2. Gather history
  3. Perform mental status exam (MSE)
  4. Assess risk factors
  5. Consider differential diagnosis
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2
Q

What are the major components of a psychiatric history?

A
  1. Identifying data
  2. Chief complaint
  3. History of present illness (HPI)
  4. Past psychiatric history
  5. Substance history
  6. Medical history
  7. Family history
  8. Social/developmental history
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3
Q

What are the essential components of the Mental Status Examination (MSE)?

A
  1. Appearance/Behavior
  2. Speech
  3. Mood/Affect
  4. Thought process
  5. Thought content
  6. Perceptual disturbances
  7. Cognition
  8. Insight
  9. Judgment
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4
Q

How is mood assessed in the MSE?

A

Ask the patient how they feel and record their subjective response.

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5
Q

What is the difference between mood and affect?

A

Mood: Patient’s subjective emotional state
Affect: Examiner’s observation of emotional expression

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6
Q

What are the types of affect?

A
  1. Full (normal)
  2. Constricted
  3. Blunted
  4. Flat
  5. Labile
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7
Q

Define circumstantial thought process.

A

Patient provides unnecessary details but eventually answers the question.

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8
Q

What is tangential thought process?

A

Patient never reaches the point or answers the question.

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9
Q

What is thought blocking?

A

Sudden cessation of thought, often seen in schizophrenia.

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10
Q

What is a delusion?

A

A fixed, false belief that persists despite contrary evidence.

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11
Q

What are examples of delusions?

A
  1. Persecutory (paranoia)
  2. Grandiose
  3. Religious
  4. Somatic
  5. Thought broadcasting
  6. Thought insertion + withdrawal
  7. Eratomanic
  8. infidelity (jealousy)
  9. Reference
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12
Q

What is the most common type of hallucination in schizophrenia?

A

Auditory hallucinations

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13
Q

What are the different types of hallucinations?

A
  1. Auditory
  2. Visual
  3. Olfactory
  4. Tactile
  5. Gustatory
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14
Q

What are two common bedside cognitive tests?

A
  1. Mini-Mental State Examination (MMSE)
  2. Montreal Cognitive Assessment (MoCA)
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15
Q

What does the MMSE assess?

A
  1. Orientation
  2. Attention
  3. Memory
  4. Language
  5. Visuospatial skills
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16
Q

What are key components of the MoCA?

A
  1. Orientation
  2. Memory
  3. Attention
  4. Language
  5. Abstraction
  6. Executive function
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17
Q

What are key suicide risk factors?

A

SAD PERSONS

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18
Q

How do you assess homicidal risk?

A
  1. Ask about intent
  2. Ask about access to weapons
  3. Ask about past violent behavior
  4. Identify specific targets
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19
Q

What are the most commonly used intelligence tests?

A
  1. Wechsler Adult Intelligence Scale (WAIS)
  2. Wechsler Intelligence Scale for Children (WISC)
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20
Q

What is an IQ of 70 or below classified as?

A

Intellectual disability

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21
Q

What are examples of objective personality tests?

A
  1. Minnesota Multiphasic Personality Inventory (MMPI)
  2. Millon Clinical Multiaxial Inventory (MCMI)
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22
Q

What are projective personality tests?

A
  1. Rorschach Inkblot Test
  2. Thematic Apperception Test (TAT)
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23
Q

What is the Tarasoff Rule?

A

A psychiatrist has a duty to warn and protect individuals who are at risk from a patient.

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24
Q

What are key considerations when interviewing a violent patient?

A
  1. Never interview alone
  2. Be aware of exits
  3. Ask about homicidal thoughts
  4. Consider hospital security presence
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25
Q

What is the best approach when interviewing a delusional patient?

A

Do not confront the delusion directly; instead, acknowledge the patient’s experience without reinforcing the false belief.

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26
Q

What is the first step in assessing a psychiatric patient?

A

Establish rapport and ensure patient safety.

27
Q

What is the most important predictor of future violence?

A

A prior history of violence.

28
Q

What are the key features of delirium?

A
  1. Acute onset
  2. Waxing and waning course
  3. Inattention
  4. Altered level of consciousness
29
Q

How do you differentiate between delirium and dementia?

A

Delirium is acute and fluctuating, while dementia is chronic and progressive.

30
Q

What is the difference between illusion and hallucination?

A

Illusion: Misinterpretation of real external stimuli.
Hallucination: Perception without external stimuli.

31
Q

What are the DSM-5 criteria for schizophrenia?

A

At least 2 of the following for 1 month: 1. Delusions, 2. Hallucinations, 3. Disorganized speech, 4. Disorganized behavior, 5. Negative symptoms. Duration must be 6+ months.

32
Q

What are the core symptoms of major depressive disorder (SIG E CAPS)?

A
  1. Sleep changes
  2. Interest loss
  3. Guilt
  4. Energy loss
  5. Concentration issues
  6. Appetite changes
  7. Psychomotor changes
  8. Suicidal ideation
33
Q

What is the best initial treatment for acute mania?

A

Atypical antipsychotics (e.g., olanzapine, risperidone) or mood stabilizers (e.g., lithium, valproate).

34
Q

What is the first-line treatment for generalized anxiety disorder?

A

SSRIs or SNRIs, plus cognitive-behavioral therapy (CBT).

35
Q

What is the mechanism of action of benzodiazepines?

A

Enhance GABA-A receptor activity, increasing chloride channel opening frequency.

36
Q

What are the types of thought process abnormalities?

A
  1. Tangentiality
  2. Circumstantiality
  3. Loosening of associations
  4. Flight of ideas
  5. Thought blocking
  6. Word salad
  7. Clang associations
  8. Neologisms
  9. incoherent
37
Q

What are command hallucinations and why are they important?

A

Hallucinations instructing the patient to perform actions; they increase the risk of suicide or homicide.

38
Q

How do you assess insight in a psychiatric patient?

A

Ask the patient if they understand their illness and need for treatment; responses range from full to poor insight.

39
Q

What is the most sensitive test for detecting cognitive impairment?

A

Montreal Cognitive Assessment (MoCA), as it better detects mild cognitive impairment than MMSE.

40
Q

How is judgment assessed in the MSE?

A

Ask how a patient would respond to hypothetical situations (e.g., ‘What would you do if you found a wallet on the ground?’).

41
Q

What is the importance of asking about alcohol or drug use in psychiatric evaluations?

A

Substance use can mimic or exacerbate psychiatric disorders and is crucial in differentiating primary vs. secondary psychiatric conditions.

42
Q

How do you approach a patient with suspected malingering?

A

Assess for inconsistency in symptoms, lack of distress, external incentives (e.g., avoiding jail, obtaining medication).

43
Q

What is a major difference between delirium and psychotic disorders?

A

Delirium is associated with fluctuating consciousness and inattention, while primary psychotic disorders have a clear sensorium.

44
Q

Which conditions must be ruled out before diagnosing primary psychiatric illness?

A
  1. Neurological disorders (e.g., stroke, tumor, epilepsy)
  2. Endocrine abnormalities (e.g., thyroid disorders)
  3. Substance intoxication/withdrawal
  4. Infectious diseases (e.g., syphilis, HIV, meningitis)
45
Q

What is a major risk factor for developing delirium in hospitalized patients?

A

Older age, baseline cognitive impairment, polypharmacy, infection, ICU admission, sensory deprivation (e.g., hearing/vision impairment).

46
Q

What is the average IQ score in the general population?

A

100, with a standard deviation of 15.

47
Q

What is the cutoff for intellectual disability?

A

IQ < 70, along with deficits in adaptive functioning.

48
Q

What is the IQ range for borderline intellectual functioning?

A

IQ 70–79.

49
Q

What are the IQ classifications for intellectual disability?

A
  1. Mild: 50–69
  2. Moderate: 35–49
  3. Severe: 20–34
  4. Profound: <20.
50
Q

Which test is the most commonly used for measuring intelligence in adults?

A

Wechsler Adult Intelligence Scale (WAIS).

51
Q

Which intelligence test is used for children?

A

Wechsler Intelligence Scale for Children (WISC).

52
Q

What are the four index scores assessed in the WAIS?

A
  1. Verbal comprehension
  2. Perceptual reasoning
  3. Working memory
  4. Processing speed.
53
Q

What is the difference between crystallized and fluid intelligence?

A

Crystallized intelligence: Knowledge accumulated over time.
Fluid intelligence: Ability to solve new problems without prior knowledge.

54
Q

Which factors can influence IQ scores?

A
  1. Genetics
  2. Environment (education, socioeconomic status)
  3. Nutrition
  4. Health conditions (e.g., lead exposure, prenatal factors).
55
Q

What is the Flynn effect?

A

The phenomenon of rising IQ scores over generations due to improved education, nutrition, and living conditions.

56
Q

What are the main types of perceptual disturbances?

A
  1. Hallucinations
  2. Illusions
  3. Derealization
  4. Depersonalization
57
Q

What is the difference between a hallucination and an illusion?

A

Hallucination: Perception without an external stimulus.
Illusion: Misinterpretation of a real external stimulus.

58
Q

What is the most common type of hallucination in schizophrenia?

A

Auditory hallucinations.

59
Q

Which type of hallucination is most commonly associated with delirium?

A

Visual hallucinations.

60
Q

What are hypnagogic and hypnopompic hallucinations?

A

Hypnagogic: Occur while falling asleep.
Hypnopompic: Occur while waking up.

61
Q

What is depersonalization?

A

A feeling of detachment from oneself, as if watching oneself from the outside.

62
Q

What is derealization?

A

A feeling that the external world is unreal or distorted.

63
Q

Which psychiatric disorders commonly present with perceptual disturbances?

A
  1. Schizophrenia (hallucinations)
  2. Delirium (visual hallucinations)
  3. PTSD (flashbacks)
  4. Depersonalization/Derealization disorder

Clerckship_USMLE (8 decks)

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