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Year 3 > COMBANK Psych COMAT > Flashcards

COMBANK Psych COMAT Flashcards

1
Q

symptoms of tricyclic antidepressant (TCA) overdose

A

wide complex tachycardia, hyperthermia, hypotension, flushed and dry skin, hypoventilation
confusion, agitation

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2
Q

Tx of TCA overdose

A

Sodium bicarbonate as soon as IV access is obtained

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3
Q

factitious disorder

A

intentionally feigning of sx for secondary gain of assuming the sick role

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4
Q

malingering disorder

A

intentionally feigned s/sx for primary gain (benefit to self - ex/ money, housing, obtaining drugs).

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5
Q

functional neurological sx disorder

A
  • aka conversion disorder
  • voluntary motor or sensory sx that suggest neuro illness
  • not intentionally produced but can’t be explained by med condition, substance effect, cultural behavior, or experience
  • sx often preceded by stress
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6
Q

bulimia nervosa dx

A
  • binging + purging

- normal weight

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7
Q

bulimia tx

A

CBT > ssri/snri

both better

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8
Q

repression defense mechanism

A

unconscious prevention of an undesirable thought or feeling from reaching consciousness

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9
Q

suppression defense mechanism

A

consciously ignores unacceptable impulses or emotions in order to achieve a desired outcome
- mature defense mechanism

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10
Q

isolation of affect defense mechanism

A

unconscious limitation of the feeling of emotion associated with a stressful life event
– but still consciously aware the feeling exists

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11
Q

MDD SIGECAPS

A 
S = decreased or increased sleep
*I = decreased interest in most activities
G = increased feelings of worthlessness or guilt
E = decreased energy or fatigue
C = decreased concentration on tasks or activities or in decision-making
A = decreased or increased appetite and weight loss or weight gain
P = psychomotor agitation or retardation
S = recurrent thoughts of death or SI

*Have to have I or depressed mood as one of the sx to make dx

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12
Q

PTSD dx timeline

A

sx > 1 month

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13
Q

Ganser’s syndrome

A
  • *- approximate answers to questions (paralogia)
  • may have pseudohallucinations, clouded consciousness, and somatic complaints
  • Ganser so close to answer but not quite.
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14
Q

Briquet’s syndrome

A
  • aka somatization disorder

- throw a brick at em and they’ll think it hurts

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15
Q

Munchausen syndrome

A
  • sub-type of factitious disorder
  • involves traveling from hospital/clinic to hospital/clinic
  • habitual lying about extensive histories
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16
Q

Munchausen syndrome by proxy

A
  • aka factitious disorder by proxy

- individual intentionally produces physical s/sx in someone under their own care

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17
Q

Wernicke’s encephalopathy sx

A

nystagmus
ataxia
ophthalmoplegia (ex/ horizontal nystagmus, lateral orbital palsy, gaze palsy)
confusion

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18
Q

difference between conduct disorder and antisocial personality disorder

A
  • antisocial PD is the progression of conduct disorder as pt ages. It is dx’d at or above 18yo
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19
Q

distinguishing features of sleep terror disorder

A
  • unresponsiveness during the event
  • amnesia after the event
  • occurs during NREM sleep (stage III or IV)
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20
Q

Danger of TCA overdose

A

may cause QTc prolongation and widened QRS complexes, leading to possibly fatal arrhtyhmias.

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21
Q

tx of TCA overdose

A

sodium bicarb (anti-arrhythmic)

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22
Q

schizotypal personality disorder

A
  • magical thinking, bizarre, borders on psychosis (ex/ Lady Gaga)
  • eccentric behavior
  • social and interpersonal deficits
  • – impairment in self function (confused boundaries, distorted self concept, emotional expression off, unrealistic goals)
  • – impairment in interpersonal functioning (misinterpretations, can’t develop closer relationships)
  • some typa lady
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23
Q

schizoid personality disorder

A
  • loner, happy that way (ex/ night shift toll booth worker)
  • social withdrawal, reduced range of affect, no interest in sexual relationships
  • schizoid like an android
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24
Q

paranoid personality disorder

A
  • distrustful, suspicious

- interprets others as malicious

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25
Q

histrionic personality disorder

A
  • theatrical, attention-seeking, uses physical appearance
  • dramatic, flamboyant
  • shallow expression of emotions that can be rapidly shifting (similar to borderline)
  • usually women
  • Ex/ marilyn monroe
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26
Q

borderline personality disorder

A
  • unstable, rapid changes in mood, suicidal gestures
  • impulsive, promiscuous, emotional emptiness
  • usually women
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27
Q

anti-social personality disorder

A
  • criminal, lacks remorse
  • must be >18yo (otherwise is conduct disorder)
  • manipulative, impulsive, no regard for rights of others
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28
Q

avoidant personality disorder

A
  • wants relationships but doesn’t pursue them out of fear of rejection and criticism
  • passes on promotions
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29
Q

countertransference

A
  • rxn the provider has towards the dr-pt relationship

- can be positive or negative

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30
Q

pseudocyesis

A

false pregnancy

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31
Q

reaction formation defense mechanism

A
  • pt develops a socialized attitude or an interest that is the direct antithesis of an infantile wish, desire, or impulse that is harbored consciously or unconsciously
  • ex/ businessman engaged in fraud to earn money and then donates large sum of money to charity (unconsciously to avoid guilt)
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32
Q

sublimation defense mechanism

A
  • energy associated with unacceptable impulses or drives is diverted into personally and socially acceptable channels
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33
Q

tx of status epilepticus (sz state over 30min)

A
  • initially benzos: lorazepam, diazepam, midazolam
  • second line = phenytoin then phenobarbital
  • if still no relief then pentobarbital, midazolam, or propofol
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34
Q

Capgras syndrome

A

illusion of doubles

  • delusion of misidentification that a familiar person has been replaced by an imposter
  • seen after sudden brain damage
  • is it a cap, is it gras? its two things! but not really…
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35
Q

Cotard syndrome

A
  • aka nihilistic delusional disorders
  • believe the world around them has been reduced to nothingness and that they’ve lost everything (including their own organs)
  • precursor to schizophrenic or depressive episode
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36
Q

serotonin syndrome sx

A 
hyperthermia
muscle rigidity
tremors
altered mental status
fever
autonomic instability
hyperreflexia
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37
Q

frotterism

A
  • recurrent and intense sexual fantasies, urges or behaviors that involve rubbing against or touching a non-consenting person
  • frotternizes (fraternizes) up against ppl
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38
Q

fetishism

A
  • sexual fantasies, urges, or behaviors focused on nonliving objects such as shoes, stockings, or gloves
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39
Q

voyeurism

A

recurrent and intense preoccupation with observing an unsuspecting person who is disrobing, naked, or engaged in sexual activity

  • aka scopophilia
  • voyages to spy on naked ppl
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40
Q

psych meds where you often see anticholinergic toxicity with overdose

A

atypical antipsychotics&raquo_space; typical antipsychotics (according to combank but not actually)

also TCAs

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41
Q

s/sx anticholinergic toxicity

A 
red as a beet
dry as a bone
hot as a hare
blind as a bat
mad as a hatter
full as a flask
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42
Q

haloperidol overdose s/sx

A

lethargy
tremors
dystonia
(mayyy cause anticholinergic toxicity)

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43
Q

lithium overdose s/sx

A 
nephrogenic DI
hyperreflexia
tremor
ataxia
nystagmus
SZs
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44
Q

Can you switch immediately from MAOi to SSRI?

A

No, have to wait at least 14d after stopping MAOi to avoid serotonin syndrome

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45
Q

s/sx of narcolepsy

A
  • cataplexy (sudden, transient, bilateral weakness or paralysis. usually triggered by strong emotions… perplexed cat)
  • sleep paralysis (on falling asleep or waking up)
  • sleep-onset REM sleep attacks
  • hypnagogic hallucinations
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46
Q

common laxatives

A

bisacodyl
cascara
senna
high fiber supplements

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47
Q

Russell sign

A

bulimia nervosa
= callus formation on the back of the index and long fingers
– occurs secondary to self-inflicted vomiting

48
Q

Waddell signs

A

malingering

49
Q

brain area associated with anxiety

A
  1. amygdala - increased activity
  2. anterior cingulate cortex
  3. insula
50
Q

neuroleptic malignant syndrome s/sx

A 
severe muscular rigidity
hyperthermia
AMS
tachyC
HTN
51
Q

neuroleptic malignant syndrome labs

A 
elevated CK
metabolic acidosis
hyperkalemia
leukocytosis
myoglobinuria
52
Q

NMS tx

A
  • supportive care
  • dantrolene (muscle relaxant. for muslce rigidity and hyperthermia)
  • bromocriptine (reverse loss of dopaminergic tone)
53
Q

Calcium channel blocker overdose sx

A

profound bradycardia
hypotension
preserved or mildly depressed mentation

54
Q

opioid/narcotic OD sx

A 
AMS
bradycardia
miosis
respiratory depression
hypotension
hypothermia
ithcing, nausea, constipation
55
Q

EtOH intoxication sx

A

hypotension (due to vasodilation) with reflex tachycardia

56
Q

Bupropion OD sx

A

HTN
TachyC
SZ

57
Q

tx of acute bipolar mania

A

valproate, lithium, antipsychotics (haloperidol, olanzapine)
- benzos if particularly agitated

58
Q

illness anxiety disorder

A
  • aka hypochondriasis
  • disease preoccupation and conviction despite medical reassurance
  • > = 6mo
59
Q

MAOi’s MOA

A

prevent breakdown of dopamine but also of tyramine, which acts as an indirect sympathomimetic, causing increased release of endogenous catecholamines

60
Q

biggest distinction between schizotypal PD and schizoid

A

schizotypal has MAGICAL thinking/odd beliefs. Schizoid is just weird by society standards

61
Q

best option for maintenance tx for bipolar

A

quetiapine + lithium or valproate

sometimes use olanzapine

62
Q

Tourette’s disorder

A
  • onset before age 18
  • motor and vocal tics
  • – tic = sudden, rapid, recurrent, non-rhythmic, sterotypic motor movement or vocalization
  • ex/ repetitive eye blinking, facial grimacing, shoulder shrugging, and head jerking
  • sx waxes and wanes
63
Q

Huntington’s chorea

A
  • genetic movement disorder, AD
  • appears in adulthood
  • choreiform movements (rapid, involuntary, non-repetitive or arrhythmic movement), cognitive decline (dementia), neuropsych sx (attention, judgment, depression, apathy, social withdrawal, irritability)
64
Q

Tardive dyskinesia

A
  • movement disorder seen in older adults chronically on anti-psychotics
  • mainly mouth and tongue
  • blepharospasm, lip smacking, sucking, facial grimacing
  • axial or tuncal choreoathetosis or dystonia
65
Q

Wilson’s disease

A
  • error of copper metabolism
  • dystonias (ex/ torticollis, blepharospasm, cramps), chorea, ataxias, wing-beating tremors, mood disorders, psychosis, intellectual decline
  • Keyser Fleischer rings, liver dysfunction
66
Q

Sydenham’s chorea

A
  • self-limited consequence of strep infection or ARF
  • childhood
  • choreiform movements (involuntary brief, random and irregular movements of limbs and face)
  • emotional lability, hypotonia, muscle weakness, loss of fine motor control
67
Q

Common SSRI side effects

A
  • abnormal bleeding -> acute microcytic hypochromic anemia
  • sexual disturbances, GI, agitations, insomnia, tremor
  • beware serotonin syndrome
68
Q

most common OCD compulsion

A

excessive grooming, hand washing, tooth brushing, etc

60% pts

69
Q

loose associations

A
  • disruption of logical connection between thoughts expressed sequentially
  • pt unaware
  • thoughts difficult to understand
70
Q

Tangentiality

A
  • extra ideas are included, never actually answering a question
  • logical connections between thoughts remain
71
Q

word salad

A
  • incoherent illogical speech that lacks meaningful connection between words
  • extreme form of loose association
72
Q

circumstantiality

A
  • extra and unnecessary details included before ultimately answering a question
  • clear link between ideas expressed
73
Q

circumstantiality vs tangentiality

A
  • C answers the question, T does not

- both have logical connections

74
Q

loose associations vs tangentiality

A

T still has logical connections, L doesn’t

- neither answers the question

75
Q

tx for dissociative fugue

A
  • psychodynamic psychotherapy (to deal with stressor and minimize recurrence risk)
  • supportive care
76
Q

what is interpersonal therapy used for

A
  • focuses on 4 main areas:
    1. grief over loss
    2. interpersonal disputes
    3. role transitions
    4. interpesronal skill deficits
77
Q

sympathetic viscerosomatic reflex for thyroid gland

A

T2

- associated with an upper thoracic flexion hump

78
Q

cyclothymic disorder dx

A

hypomania + dysthymia

79
Q

PCP intox sx

A 
psychosis
unpredictable violent behavior
horizontal and vertical nystagmus
pupillary constriction (miosis)
tachyC
80
Q

LSD intoxication sx

A

anx, depression
pupillary dilation
delusions, visual hallucinations, flashbacks
synesthesias (haering colors, seeing sounds)
panic

81
Q

methamphetamine intox sx

A

fatigue, apprehension, trouble with concentration
HTN
pupillary dilation
fever
euphoria
possible psychosis, restlessness, irritability
prolonged wakefulness

82
Q

salvia intox sx

A

hallucinations
euphoria
perceptual distortions
lasts 1-2hrs

83
Q

CAGE scoring

A

1 point - at risk for dependency
2-3 = highly suspicious
4 = diagnostic for alcohol abuse disorder

84
Q

borderline tx

A

dialectical behavioral therapy with adjuvant meds

85
Q

best tx for alcohol abuse

A

brief intervention with follow-up visits (motivational enhancement therapy)

86
Q

delerium tremens sx

A 
tachyC
psychomotor agitation
combativeness
HTN
fever
87
Q

meds with greatest risk for serotonin syndrome

A

MAO-Is when taken with other serotonergic meds, herbal supplements, or tyramine- and tryptophan-containing drinks/food

88
Q

childhood disintegrative disorder

A
  • normal development until age 2 then loss of previously acquired skills
  • onset between 2-10
  • boys > girls
89
Q

Rett’s disorder

A
  • normal dev until age 5mo
  • disintegration in previously acquired milestones onset between 5mo-48mo
  • girls only
90
Q

drugs with pupillary constriction (miosis)

A

opiates intox

PCP intox

91
Q

drugs with pupillary dilation (mydriasis)

A

cocaine intox
amphetamine intox
LSD intox

opiate withdrawal

92
Q

cocaine intox sx

A

agitation
autonomic hyperactivity
pupillary dilation (mydriasis)
psychosis

  • exact same as amphetamines so differentiate via urine drug screen
93
Q

neurotransmitter that promotes REM sleep

A

acetylcholine

94
Q

sx of vascular dementia

A
  • manifest cognitive impairments and memory problems in a step-wise, progressivev way
  • focal sensory or motor deficits
95
Q

normal pressure hydrocephalus (NPH) sx

A

wet wacky wobbly
urinary incontinence
dementia
“magnetic gait”

96
Q

Sx of alzheimer’s dementia

A

memory impairment + cognitive disturbance

  • aphasia
  • apraxia (inability to execute learned purposeful movements)
  • agnosia (inability to recognize objects)
  • disturbance in executive functioning
97
Q

wernicke-korsakoff syndrome sx

A 
confusion
ataxia
ophthalmoplegia
vestibular problems
confabulation
anterograde amnesia
98
Q

cri-du-chat sx

A 
high-pitched cat-like crying
low birth weight
FTT
hypotonia
psychomotor retardation
severe intellectual disabilities 
microcephaly
hypertelorism
99
Q

prader-willi syndrome sx

A 
upslanting, almond-shaped eyes
thin upper lips
down-turned mouth
light skin
small hands and feet
hypogonadism
prominent low tone
FTT in infancy
hyperphagia -> obesity
high pain threshold
psych: obsessions, compulsions, temper tantrums, skin-picking, anx, depr, psychosis
100
Q

angelman syndrome sx

A 
severe intellectual disabilites
postnatal microcephaly
SZ
frequent laughter and smiling
excitable personalities
hypermotoric behaviors
attention problems
decreased speech or absence of speech output
ataxia
101
Q

fragile x syndrome sx

A

large head with long face, prominent jaw and forhead, large ears
large-sized testes
Connective tissue dz
hypotonia
Psych: mod-sev mental retardation, pervasive developmental disorder, ADHD, mood lability

102
Q

alcohol withdrawal timeline

A
  • early: 8-9h after last drink, tremulousness, face flushed, mild anx, HA, GI upset, insomnia, hallucinations, diaphoresis, grand mal SZ, mild disorientation
  • late/acute: 48-96h after last drink. Delirium tremens
103
Q

SI tx for pregnant pt

A

ECT very effective for acute tx of depressive episode

104
Q

anti-depressants assoc with orthostatic hypoT

A

TCAs - mainly Imipramine

105
Q

adverse effects of trazodone

A

hypotension
sedation
priapism

106
Q

adjustment disorder timeline

A

sx begin within 3mo of the change and stop w/in 6mo

107
Q

concrete thinking

A
  • age 7-11
  • characterized by actual things, events, and immediate experience, rather than by abstractions
    • seen in young children and ppl who can’t generalize (schizophrenia, and certain cognitive disorders)
108
Q

formal operation

A
  • age 12-adulthood

- deductive logic and emergence of ability to use abstrct thought for hypothetical situations

109
Q

sleep-related eating disorder can be caused by …

A

hypnotics, ex/ zolpidem

110
Q

Charles Bonnet Syndrome

A
  • onset of complex visual hallucinations in an otherwise health blind pt with no psych hx and no other evidence or psych or mood disorder
  • pts know hallucinations aren’t real
111
Q

narcolepsy tx

A
  • maintain regular sleep schedule
  • timed daily naps
  • moderate exercise
  • emotional support
  • stimulant drugs if needed
112
Q

benzo withdrawal sx

A

*HTN
*TachyC
anxiety
SZ
aud or vis hallucinations
insomnia

113
Q

PCP intox tx

A

Diazepam or lorazepam

- then haloperidol or risperidone if sx don’t improve

114
Q

ADHD associated with development of

A

conduct disorder -> antisocial personality disorder

115
Q

absolute contraindication to bupropion use

A
  • SZ disorder (b/c lowers sz threshold)
  • MAOi use w/in 14d
  • anorexia or bulimia
  • linezolid or IV methylene blue use
116
Q

bupropion common adverse effects

A

tachyC
insomnia
headaches

Year 3 (15 decks)

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