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Psychiatry > Diagnosis > Flashcards

Diagnosis Flashcards

1
Q

Diagnosis of GAD

Duration of anxiety?
Other symptoms?
BE SKIM (3+)

A

Excessive anxiety/worry for 6+ months

Other symptoms:
Blank mind/difficulty concentrating
Easily fatigued
Sleep disturbance
Keyed up/restless
Irritable
Muscle tension

Tx: relaxation therapy + Buspirone

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2
Q

Anorexia Nervosa versus Bulimia Nervosa?

Shared symptoms include: dental caries, periodontal disease, pharyngeal abrasions, nail changes, hypokalemia, metabolic alkalosis

A 
Anorexia
-grossly underweight
-intense fear of gaining weight
-signs of hormonal imbalance
(eg, amenorrhea, osteoporosis, hair loss)

Bulimia

  • binge/purge behavior at least 1x/wk for 3+ mo
  • sense of lack of control during binge eating
  • weight is usually normal or slightly above average
  • no hormonal imbalance
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3
Q

Diagnosis of schizophrenia requires:

a) 2+ of what 5 symptoms for at least a month?
b) social/occupational dysfunction
c) some symptoms present for at least how many months?
d) rule out which 2 disorders?
e) rule out substance abuse/medical cause

A

Diagnosis of Schizophrenia:

a) 2+ of the following for at least a month: delusions, hallucinations, disorganized speech, disorganized/catatonic behavior; negative symptoms
b) social/occupational dysfunction
c) some symptoms present for at least 6 months
d) rule out schizoaffective and mood disorder with psychotic features
e) rule out substance abuse/medical cause

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4
Q

What are the 5 subtypes of schizophrenia?

A

Paranoid: delusions, auditory hallucinations

Disorganized: flat or inappropriate affect, disorganized speech/behavior

Catatonic: motor immobility, purposeless motor activity, negativisim (rigid posture) or mutism, peculiar voluntary movements, echolalia/echopraxia

Undifferentiated

Residual: negative symptoms; absence of prominent delusions, hallucinations, disorganized speech, or disorganized/catatonic behavior

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5
Q

What are 4 medical conditions that can mimic schizophrenia?

Abuse of what substance often most closely mimics schizophrenia?

What 2 types of medications most frequently cause psychotic states?

A

Medical conditions: delirium, dementia, severe hypothyroidism, hypercalcemia

Substance abuse: phencyclidine (PCP)

Medications: steroids, anticholinergics

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6
Q

Schizophrenia versus Schizoaffective?

A

Psychotic symptoms prominent in both.

Schizoaffective: involves a mood episode (mania, major depressive, or mixed)

  • -mood episode occurs only concurrently with psychotic symptoms
  • -psychotic symptoms present even in absence of mood episode

Schizophrenia: brief duration of mood symptoms

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7
Q

Schizoaffective versus Mood disorder with psychotic features?

Discuss in terms of relative timing of psychotic and mood episodes.

A

Mood Disorder with Psychotic Features

  • -psychotic features present only during mood disorder
  • -mood disorder present even in absence of psychotic features

Schizoaffective Disorder

  • -psychotic features present even in absence of mood symptoms
  • -mood episodes present only with psychotic features
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8
Q

Conversion Disorder

A psychological stressor causes what type of physical symptoms?

What feature can often be observed in patients as they describe their symptoms?

A

Conversion Disorder

psychologic stressor –> 1+ neurologic symptoms (sensory or motor, eg blindness, paralysis, paresthesia)

La belle indifference: calm; unconcerned

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9
Q

Bipolar I versus Bipolar II?

Dx criteria re: mania
Dx criteria re: mood

A

Bipolar I

  • hx of at least 1 manic or mixed episode
  • may or may not have any mood issues

Bipolar II

  • hx of at least 1 hypomanic episode
  • hx of at least 1 major depressive episode
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10
Q

Symptoms of mania?

DIGFAST

A 
Mania:
Distractability
Indiscretion
Grandiosity
Flight of ideas
Activities/Agitation
Speedy thoughts
Talkative
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11
Q

Panic Disorder
Attack = 4+ of PANICS?
Recurrent, UNEXPECTED attacks
Worrying/fear about having additional attacks (not a fear of a specific situation)
Attacks not caused by SUD, medical condition, or other mental illness

A

Panic Disorder

Palpitations
Abdominal Distress
Nausea, Numbness
Intense fear of dying
Choking, Chills, Chest Pain
Sweating, Shaking, SOB
(also dizziness)

Attacks are UNEXPECTED, and not provoked by any particular stimulus!

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12
Q

Panic attacks

Distinguish...
Panic Disorder
Social Phobia
Specific Phobia
GAD
A

Panic Disorder - unprovoked attacks

Social phobia - attacks provoked by social or performance situation

Specific phobia - excessive fear cued by presence/anticipation of specific object/situation

GAD - anxiety; worry about a number of events or activities

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13
Q

Autism versus Asperger?

A

Asperger: no significant delays in language, cognitive development, self-help skills, or curiosity about the environment

NB: To dx autism,

  • -symptoms must be present by age 3
  • -problems with social interaction
  • -impairments in communication
  • -repetitive and stereotyped patterns of behavior and activities
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14
Q

PTSD v Acute Stress Disorder

  • -time of event?
  • -duration of symptoms?

PTSD Dx:

  • -Traumatic, potentially harmful event
  • -Reexperiencing
  • -Avoidance of stimuli associated with trauma
  • -Unable to function
  • -Numbing
  • -Arousal(hyper)
A

PTSD

  • -event occurred at any time in past
  • -symptoms last > 1 mo

Acute Stress Disorder

  • -event occurred less than 1 mo ago
  • -symptoms last less than 1 mo
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15
Q

Adjustment Disorders
Types: depression, anxiety, disturbance of conduct

–emotional or behavioral symptoms after a stressful life event; distress in excess of what’s expected

Symptoms begin within ? months after the event
Symptoms resolve within ? months after stressor has terminated.

A

Adjustment Disorders
Types: depression, anxiety, disturbance of conduct

–emotional or behavioral symptoms after a stressful life event; distress in excess of what’s expected

Symptoms begin within 3 months after the event
Symptoms resolve within 6 months after stressor has terminated.

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16
Q

In a child, symptoms include physical complaints, nightmares, excessive worry/fear about being separated from major attachment figures. Symptoms present at least 4 weeks.

A

Separation Anxiety Disorder

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17
Q

Excessive daytime sleepiness; irresistible attacks of refreshing sleep that occur daily for 3+ mo; cataplexy; hypnopompic and hypnogogic hallucinations

Dx?
3 non-apmphetamine tx? (M, M, S)

A

Narcolepsy

Methylphenidate, Modafinil, Sodium oxybate

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18
Q

Dementia DDx

Dementia + …..

1) cogwheel rigidity, resting tremor
2) gait apraxia, urinary incontinence
3) obesity, coarse hair, constipation, cold intolerance
4) stepwise increase in severity; focal neuro signs
5) diminished position/vibration sensation; megaloblasts on CBC

A

Dementia DDx

1) Parkinson Disease, Lewy Body dementia
- -cogwheel rigidity, resting tremor

2) Normal Pressure Hydrocephalus
- -gait apraxia, urinary incontinence (wet, wacky, wobbly)

3) Hypothyroidism
- -obesity, coarse hair, constipation, cold intolerance

4) Vascular Dementia
- -stepwise increase in severity; focal neuro signs

5) Vitamin B12 Deficiency
- -diminished position/vibration sensation; megaloblasts on CBC

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19
Q

alternating periods of hypomanic symptoms and mild/moderate depressive symptoms for at least 2 years

  • no hx of major depressive episode or manic episode
  • never symptom free for more than 2 mo
A

Cyclothymic Disorder

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20
Q

Bipolar I versus Bipolar II?

A

Bipolar I

  • -only requirement for dx is at least one manic or mixed episode
  • -involves episodes of mania and of major depression

Bipolar II

  • -hx of at least one major depressive episode and at least one hypomanic episode
  • -hypomanic: symptoms of mania not severe enough to cause significant impairment in social/occupational function
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21
Q

Schizophrenia = lifelong psychotic disorder

  1. Schizophreniform = ?
  2. Schizoaffective = schizophrenia + ?
  3. Schizotypal PD = paranoid, odd beliefs; lack of friends; social anxiety; but no ?

Schizoid PD = withdrawn; no desire for relationships/intimacy; emotionally restricted

A

Schizophrenia = lifelong psychotic disorder

  1. Schizophreniform = schizophrenia for less than 6 months
  2. Schizoaffective = schizophrenia + mood disorder
  3. Shizotypal PD = paranoid, odd; magical beliefs; lack of friends; social anxiety; but no true psychosis

Schizoid PD = withdrawn; no desire for relationships/intimacy; emotionally restricted

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22
Q

Delusional Disorder

  • -nonbizarre, fixed delusions for at least 1 mo
  • -not schizophrenia
  • -life functioning not significantly impaired

Types of delusions: erotomanic; grandiose; somatic; persecutory; jealous; mixed

Two key differences with schizophrenia? re: hallucinations? functioning?

A

Delusional Disorder vs. Schizophrenia

  • -no hallucinations (there might be tactile/olfactory hallucinations, but not auditory)
  • -daily life functioning not significantly impaired
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23
Q
  • prolonged, severe pain without adequate medical explanation
  • causes significant distress/impairment
  • not intentionally produced

Dx?
Tx?
Are analgesics helpful?

A

Pain Disorder

  • prolonged, severe pain without adequate medical explanation
  • causes significant distress/impairment
  • not intentionally produced

Tx: SSRIs
Analgesics not helpful

24
Q

How can ADHD in children be differentiated from hypomania?

Think re: age of onset; frequency of symptoms

A

ADHD: onset since 7 years old; consistent/daily basis

-Bipolar is extremely rare in the preschool age

25
Q

Oppositional Defiant Disorder (ODD)
–at least 6 months of behavior such as loss of temper, arguments with adults, deliberately annoying people, blaming others, anger/resentment

Name two ways of distinguishing ODD versus Conduct Disorder with regards to

  1. physical aggression
  2. relationships with peers, teachers, parents
A

ODD versus CD

  1. ODD - no physical aggression or violation of the basic rights of others
  2. ODD - can get along with peers, but struggle with parents/teachers
26
Q

Brief Psychotic Disorder, Schizophreniform, Schizophrenia.

Same symptoms; different durations.

A

Brief Psychotic Disorder: 1 day - 1 month

Schizophreniform: 1 month - 6 month

Schizophrenia: 6+ months

27
Q

Diagnose the intoxication/withdrawal:

  • -euphoria
  • -anxiety
  • -impaired motor coordination
  • -sensation of slowed time
  • -mild tachycardia
  • -conjunctival injection
  • -dry mouth
  • -increased appetite
A

Marijuana/THC

28
Q

Diagnose the intoxication/withdrawal:

  • -illusions/hallucinations
  • -labile affect
  • -dilated pupils
  • -tachycardia/HTN/palpitations
  • -hyperthermia
  • -tremors
  • -incoordination
  • -sweating
  • -“bad trip”: anxiety, panic, paranoia
A

Hallucinogens: psilocybin, LSD

29
Q

Diagnose the intoxication/withdrawal:

  • -drowsiness
  • -n/v
  • -constipation
  • -slurred speech
  • -constricted pupils
  • -respiratory depression

Tx?

A

Opioids Intoxication

Tx for opioid overdose: naloxone, naltrexone
*may cause severe withdrawal in opiate-dependent patient

30
Q

Diagnose the intoxication/withdrawal:

  • -dysphoria
  • -insomnia
  • -lacrimation
  • -rhinorrhea
  • -sweating
  • -piloerection
  • -dilated pupils
  • -abdominal cramps
  • -arthralgia/myalgia

Tx?

A

Opioid Withdrawal

Tx: buprenorphine, methadone

31
Q

Diagnose the intoxication/withdrawal:

  • -euphoria
  • -dilated pupils
  • -fight or flight response
  • -seizures
  • -arrhythmias
  • -tactile hallucinations
  • -MI/stroke
A

Cocaine OR Amphetamine Intoxication

–MI/stroke more specific for cocaine

32
Q

Diagnose the intoxication/withdrawal:

  • -agitation/rage
  • -erythema
  • -dilated pupils
  • -delusions/hallucinations/depersonalization
  • -amnesia
  • -nystagmus (especially rotary)
  • -excitation
  • -skin dryness
A

PCP Intoxication

–Ketamine can produce amnesia

–PCP intoxication results in violence more often than other drugs

33
Q

Diagnose the intoxication/withdrawal:

  • -drowsiness, confusion
  • -hypotension
  • -slurred speech, incoordination
  • -respiratory depression
  • -mood lability
A

Benzodiazapenes, Barbiturates

*Seizures - benzodiazapenes

34
Q

ADHD versus a normal hyperactive child?

  • -number of settings
  • -age of onset
  • -behavior at TV/meal?
A

ADHD

  • -two or more settings
  • -onset prior to age 7
  • -ADHD: can’t sit through TV show or meal
35
Q

Delirium versus Dementia

  • -onset?
  • -level of consciousness?
  • -symptom stability?
  • -EEG?
A

Delirium

  • -acute onset
  • -waxing/waning LOC
  • -fluctuating symptoms; often worse at night
  • -EEG changes

Dementia

  • -insidious onset
  • -symptoms stable throughout day
  • -no EEG changes
36
Q
  • Sudden, unexpected travel away from home/work, plus inability to recall one’s past
  • Confusion about identity or formation of new identity
  • Often associated with stressful life event
  • Patients are NOT aware they’ve forgotten anything
A

Dissociative Fugue

37
Q
  • At least one episode of inability to recall important personal information; often involving traumatic/stressful event
  • Patient is aware that they have a gap in memory
  • Often experience flashbacks, nightmares
A

Dissociative Amnesia

38
Q
  • -recurrent outbursts of aggression that result in assault against people/property
  • -outbursts/aggression disproportionate to the triggering event
  • -episode remits quickly, leaving patient feeling remorseful; distressed
A

Intermittent Explosive Disorder

39
Q

1) sexual pleasure from touching or rubbing against a non-consenting person
2) sexual excitement from hurting or humiliating others
3) sexual excitement from being humiliated or beaten

A

1) Frotteurism
2) Sadism
3) Masochism

40
Q

Alzheimer Disease versus Pseudodementia
(Pseudodementia = MDD in elderly)

…effort during cognitive testing?
…insight into intellectual difficulties?

A

Pseudodementia

  • -little effort during cognitive testing
  • -have insight

Alzheimer

  • -make a greater effort
  • -lack insight
41
Q

Symptoms: polyuria, vomiting, diarrhea, difficulty concentrating, confusion, lethargy

Pt has psychiatric disorder.
Symptoms not due to meds.

Dx?

A

Psychogenic Polydipsia: excessive water intake due to psychiatric disorder

polyuria, vomiting, diarrhea, difficulty concentrating, confusion, lethargy

42
Q

4 features of atypical depression with regards to:

  • -sleep
  • -weight
  • -fatigue
  • -sensitivity
A

4 features of atypical depression:

  • -hypersomnia
  • -weight gain
  • -leaden paralysis
  • -increased sensitivity to interpersonal rejection
43
Q

Diagnose the intoxication/withdrawal:

  • -dysphoria
  • -insomnia
  • -lacrimation
  • -rhinorrhea
  • -yawning
  • -sweating
  • -piloerection
  • -n/v, abdominal cramping
  • -dilated pupils (miosis)
  • -arthralgia/myalgia

Tx?

  • -autonomic symptoms?
  • -pain symptoms?
  • -abdominal cramps?
A

Opioid Withdrawal

Tx

  • -autonomic symptoms: Clonidine
  • -pain symptoms: NSAID
  • -abdominal cramps: dicyclomine

Detox with buprenorphine or methadone

44
Q
  • choreoathoid movements
  • jerkiness, fidgetiness
  • dementia
  • depression, psychosis, irritability, paranoia
  • CT/MRI: atrophy of caudate nucleus
A

Huntington Disease (AD)

45
Q
  • resting tremor
  • bradykinesia
  • cogwheel rigidity
  • loss of dopaminergic neurons in the substantia nigra
A

Parkinson Disease

46
Q
  • depressed mood for majority of time, most days for 2+ years
  • at least 2 symptoms from SIGECAPS
  • no major depressive episode
  • no manic or hypomanic episodes
A

Dysthymic Disorder

47
Q

Normal Grief versus Depression re:

  • -duration of symptoms
  • -presence of suicidal thoughts
  • -illusions/delusions/hallucinations
A

Normal Grief

  • -usually less than 2 mo
  • -not usually suicidal
  • -illusions are common
  • not pathologic unless > 1 yr

Depression

  • -greater than 2 mo
  • -suicidal thoughts may be present
  • -delusions/hallucinations are common
48
Q

Alcoholic Hallucinosis versus Delirium Tremens

re: timing of onset since last drink?
re: vital signs?
re: sensorium?

A

Alcoholic Hallucinosis

  • 12-24 hrs since last drink
  • normal vital signs
  • intact sensorium with hallucinations

Delirium Tremens

  • 48-96 hrs since last drink
  • fever, tachycardia, HTN, diaphoresis
  • hallucinations, disorientation
49
Q

conscious production of s/s of medical/metal disorders with goal to assume the sick role

A

Factitious Disorder

Factitious Disorder by Proxy if s/s are faked for another person

50
Q

prolonged fear of getting or having a disease with no or minimal actual physical s/s

A

Illness Anxiety Disorder (Hypochondriasis)

51
Q

excessive distress caused by 1+ minor physical s/s; > 6 months

A

Somatic Symptom Disorder

52
Q 
Tourette Disorder
Dx:
1) Multiple motor tics and 1+ vocal tics
2) Onset prior to 18
3) Tics occur daily for 1 year; no tic free period for greater than ? months
A 
Tourette Disorder
Dx:
1) Multiple motor tics and 1+ vocal tics
2) Onset prior to 18
3) Tics occur daily for 1 year; no tic free period for greater than 3 months
53
Q

Learning Disorders
–reading, mathematics, verbal expression

Achievement that is significantly lower than expected for chronological age, level of education, and what other factor?

A

Learning Disorders
–reading, mathematics, verbal expression

Achievement that is significantly lower than expected for chronological age, level of education, and level of intelligence (IQ).

*Look for disparity between achievement and IQ.

54
Q

Autism Dx
–at least six symptoms present before age 3

  • -at least 2 symptoms related to impairment in ?
  • -at least 1 symptom related to impairment in ?
  • -at least 1 symptom related to repetitive and stereotyped patterns of behavior/activities
A

Autism Dx
–at least six symptoms present before age 3

–2+ symptoms: impaired social interaction
(eg, nonverbal behavior, lack of relationships)

–1+ symptom: impaired communication
(eg, delayed speech, inability to hold conversation)

–1 symptom: repetitive and stereotyped patterns of behavior/activities
(eg, narrowed interests, hand flapping, rituals)

55
Q

Common lab findings in anorexia nervosa:

  • -bradycardia
  • -hypotension
  • -hypokalemia
  • -leukopenia

Cholesterol?
Arrhythmia?
Anemia?

A

Common lab findings in anorexia nervosa:

  • -bradycardia
  • -hypotension
  • -hypokalemia
  • -leukopenia
  • -hypercholesterolemia
  • -QTc prolongation
  • -normocytic, normochromic anemia
56
Q

Dx criteria for mental retardation:

  1. IQ less than ?
  2. Deficits in ?
A

Dx criteria for mental retardation:
1. IQ less than 70
2. Deficits in adaptive functioning
(eg, communication, self-care, social skills, etc.)

Psychiatry (6 decks)

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