EH - Psychiatry Flashcards
1
Q
Timing criteria for schizophrenia?
A
6+ months; Any symptoms (negative)
2
Q
Timing criteria for schizophreniform disease?
A
1-6 months
3
Q
Prevalence of schizophrenia?
A
0.5 – 1.0%
4
Q
Risk for schizophrenia in twin brother?
A
50%
5
Q
Risk for schizophrenia in sibling?
A
10%
6
Q
Origin of (+) symptoms in schizophrenia?
A
Excess dopamine in mesolimbic tract
7
Q
Origin of (–) symptoms in schizophrenia?
A
Deficient dopamine in mesocortical tract
8
Q
Patient presents with delusions, hallucinations, flattened affect for past 3 weeks – diagnosis?
A
Brief psychotic disorder
9
Q
Timing criteria for Brief psychotic disorder?
A
Between 1 week and 1 month
10
Q
Best treatment for Brief psychotic disorder?
A
1st generation antipsychotics
11
Q
Benefit of 1st generation antipsychotics in treatment of schizophreniform disease and Brief psychotic disorder?
A
Alleviates (+) symptoms; Does not alter course of disease
12
Q
Pt presents with 3 years of persecutory delusions; 6 months ago began experiencing increased guilt, sleep disturbance, sadness, SI – diagnosis?
A
Schizoaffective disease … psychotic symptoms are present in the absence of depression
13
Q
Best treatment for Schizoaffective disease?
A
Antipsychotic + Antidepressant
14
Q
Treatment for psychotic depression?
A
ECT
15
Q
Patient is convinced that celebrity is in love with him; Otherwise functional in daily life – diagnosis?
A
Delusional disorder
16
Q
MOA of haloperidol?
A
Inhibits D2 dopamine receptor
17
Q
2 AEs of haloperidol?
A
Galactorrhea, Extra-pyramidal symptoms
18
Q
What accounts for galactorrhea in setting of haloperidol use?
A
Inhibition of dopamine release in tubuloinfundibular tract
19
Q
What accounts for extra-pyramidal symptoms in setting of haloperidol use?
A
Inhibition of dopamine release in nigrostriatal tract
20
Q
High potency anti-psychotics?
A
Haloperidol, Fluphenazine
21
Q
Low potency anti-psychotics?
A
Chlorpromazine, Thioridazine, Levomepromazine
22
Q
AE of low potency anti-psychotics?
A
Greater anticholinergic AEs
23
Q
Benefit of low potency anti-psychotics?
A
Fewer extra-pyramidal symptoms
24
Q
Which medication is responsible for purple-grey metallic rash over sun-exposed skin + jaundice?
A
Chlorpromazine
… (colorful)
25
Which medication is responsible for prolonged QTC and pigmented retinopathy?
Thioridazine
26
Best treatment for dystonic reactions in setting of antipsychotic medications?
Benztropine, Diphenhydramine
27
Best treatment for akanthasia in setting of antipsychotic medications?
Benzodiazepine, Propranolol
28
Best treatment for Parkinsonian features in setting of antipsychotic medications?
Benztropine, Diphenhydramine
29
Best treatment for tardive dyskinesia in setting of antipsychotic medications?
No treatment … need to discontinue anti-psychotic
30
2 other DOCs used to treat Neuroleptic Malignant Syndrome (not dantrolene)?
Bromocriptine, Metoclopramide
31
Which atypical anti-psychotic has highest risk of EPS and galactorrhea?
Risperidone
32
Which anti-psychotic is weight-neutral, but prolongs QTC?
Ziprasidone
33
Which anti-psychotic is weight-neutral, but causes akanthasia?
Aripiprazole
34
Which 2 anti-psychotics are weight-neutral?
Ziprasidone, Aripiprazole
35
Which atypical anti-psychotic causes weight gain?
Olanzapine
... Olanzapine = Obesity
36
Which atypical anti-psychotic causes Orthostasis?
Quetiapine
... (you're quiet when you faint)
37
Why does quetiapine cause orthostasis?
Blocks alpha-1 receptors
38
Which atypical anti-psychotic is effective for treatment of refractory schizophrenia?
Clozapine
39
Most common AE of Clozapine?
Weight gain, sedation, Metabolic syndrome
40
Most dangerous AE of Clozapine?
Agranulocytosis, Seizures
41
Timing criteria for major depressive disorder?
2 weeks
42
Most important risk factor for suicide?
Prior attempt
43
Change to sleep in setting of MDD?
Decreased stage ¾ sleep, Shortened REM latency, More frequent REM
44
Atypical lab test in patients with MDD?
Cortisol … unaffected by dexamethasone suppression test
45
3 medications that may lead to depression?
B blockers, IFN-gamma, alpha methyldopa
46
Which type of CVA can cause depression?
L MCA
47
Which SSRI has most drug-drug interactions?
Paroxetine … CYP450
(Paroxetine works in Pairs)
48
Which SSRI does not require tapering?
Fluoxetine
Fluoxetine 1/2 life = Forever
49
Why does fluoxetine not require tapering?
Longest half life
50
Which SSRI has fewest drug-drug interactions?
Citalopram
Citalopram ... sits by itself
51
Which SSRI is most likely to cause Serotonin Discontinuation Syndrome if stopped suddenly?
Sertraline
52
Clinical presentation of Serotonin Discontinuation Syndrome?
Flu-like symptoms
53
Which anti-depressant is indicated for patient who experiences sexual dysfunction while taking SSRI?
Bupropion
54
MOA of Bupropion?
Inhibition of NET and DAT
55
CI to Bupropion?
Seizures, ETOH abuse, Bulimia
56
Which anti-depressant should be avoided in HTN patients?
Venlafaxine
57
SNRIs + ___ may result in HTN crisis?
St. John’s Wort
58
Best treatment for HTN crisis in patients taking MAOI?
Alpha blocker
59
Young male eats pills from grandmother’s purse; Develops dry mouth, tachycardia, seizures, urinary retention; EKG shows widened QRS complexes and prolonged QT interval – which medication did the patient ingest?
TCA
60
Best treatment for TCA overdose?
Sodium bicarbonate
61
Patient with signs of MDD also experiences leaden paralysis in AM – diagnosis?
Atypical depression
62
2 other symptoms of Atypical depression?
Increased sleep, increased appetite
63
DOC for Atypical depression?
MAOIs
64
2 clinical symptoms of complicated bereavement?
Psychosis, Suicidal thoughts
65
Timing criteria for adjustment disorder?
Must begin within 3 months of stressor; Can’t last longer than 6 months of stressor
66
Best treatment for adjustment disorder?
Psychotherapy
67
Incidence of Bipolar Disorder in general population?
1%
68
Risk for Bipolar Disorder in identical twin?
90%
69
Which type of CVA may result in symptoms of mania?
R MCA
70
Which medications should be avoided in patients with Bipolar Disorder?
SSRIs, TCA
71
3 DOCs for Bipolar Disorder?
Lithium, Valproic Acid, Carbamazepine
72
DOC for agitation in patient with Bipolar Disorder?
Haloperidol
73
Pt with PMHX of bipolar disorder presents with NVD, coarse tremor, ataxia, slurred speech – diagnosis?
Lithium toxicity
74
Which class of medications are notorious for precipitating Lithium toxicity?
NSAIDs
75
Which 2 NSAIDs are least likely to precipitate Lithium toxicity?
ASA, Sulendac
76
2 EKG findings associated with Lithium toxicity?
Flattened T waves, U waves
... (EKG does down)
77
Best treatment for Lithium overdose?
Dialysis
78
Major AEs of Lithium?
Nephrogenic DI, GI upset, Hypothyroidism
79
MOA of Lithium?
Inhibition of inostotrol triphosphate
80
Which lab tests are essential for monitoring of Lithium?
Renal function, Thyroid function
81
CI to use of Lithium?
CKD (precipitates toxicity due to inability to clear Lithium renally), Pregnancy
82
Problems that Lithium causes during pregnancy?
Epstein Syndrome … atrialization of RV
83
DOC for treatment of Bipolar Disorder in pregnancy?
Benzodiazepine
84
Which bipolar disorder medication causes LFTs and hepatitis?
Valproic acid
85
Which bipolar disorder medication causes Stevens Johnson Syndrome?
Lamotrigine
86
Which bipolar disorder medication causes agranulocytosis?
Carbamazepine
87
Female becomes pregnant while taking medications for Bipolar Disorder; Labs show increased AFP – which drug is responsible?
Valproic acid, Carbamazepine … (AFP = neural tube defect)
88
Most common complication of Carbamazepine?
Rash
89
28 yo female presents with CP, SOB, palpitations; Smokes 1PPD, currently on OCPs; Rarely leaves house because worried about having another episode – diagnosis?
Panic disorder with agoraphobia
90
Best treatment for Panic disorder?
Medical workup first!
91
DOC for Panic disorder?
SSRI + Benzodiazepine (short-term)
92
CI for Benzodiazepine?
HX of addiction, COPD, ILD
93
Why are Benzodiazepines contraindicated in COPD, ILD?
Benzodiazepines suppress the respiratory drive
94
Clinical presentation of Benzodiazepine withdrawal?
Autonomic instability, Seizures, Hallucinations
95
DOC for treatment of Benzodiazepine withdrawal?
Diazepam, Chlorodiazepoxide
96
Best treatment for Specific phobia?
CBT, small prescription for Benzodiazepine
97
DOC for social anxiety disorder?
Propranolol
98
Definition of Avoidant personality disorder?
Want to interact with peers, but afraid of rejection
99
Best treatment for Avoidant personality disorder?
CBT
100
Comorbid condition for OCD?
Tourette’s Disorder
101
DOC for OCD?
SSRIs
102
Best treatment for PTSD?
SSRI
103
Best treatment for nightmares in PTSD?
Alpha blockers … (prazosin, terazosin)
104
Timing criteria for PTSD?
\> 1 month
105
Timing criteria for Acute stress reaction?
Less than 1 month
106
3 comorbid conditions with Somatization disorder?
MDD, Personality Disorder, Anxiety
107
Pseudoseizure represents a type of …
Conversion disorder
108
Definition of malingering?
Need to have evidence of secondary gain
Malingering = looking for More
109
3 changes to vital signs in patient with bulimia?
Bradycardia, Hypothermia, Hypotensive
110
Metabolic abnormality expected in patients with bulimia?
Hypokalemic, Hypochloric, Metabolic alkalosis (high HCO3-)
111
3 additional lab changes seen in patients with bulimia?
High amylase, High LFTs, High carotene
112
What accounts for high LFTs in setting of anorexia?
Liver becomes stressed in an attempt to produce glycogen
113
Change to CBC in patients with anorexia?
Leukopenia
114
Change to thyroid function testing in anorexia?
NML
115
Change to lipid levels in anorexia?
Hypercholesterolemia
116
Change to cortisol in setting of anorexia?
High
117
Change to estrogen in setting of anorexia?
Low
118
Change to LH, FSH in setting of anorexia?
Low
119
Most common cause of death in patients with anorexia?
Arrhythmia
120
2nd most common cause of death in patients with anorexia?
Suicide
121
Complication of TPN provided to patient with anorexia?
Refeeding Syndrome
122
Description of Refeeding Syndrome seen after TPN?
Fluid retention that causes hypokalemia, hypocalcemia, hypomagnesemia
123
Complication of Refeeding Syndrome?
Arrhythmias
124
Which sleep stage is characterized by theta waves?
Stage NREM 1
Awake = B
Sleepy = A
NREM 1 = T
NREM 2 = S (K)
NREM 3/4 = D
REM = B
125
Which sleep stage is characterized by sleep spindles and K complexes?
Stage NREM 2
Awake = B
Sleepy = A
NREM 1 = T
NREM 2 = S (K)
NREM 3 = D
REM = B
126
Which sleep stage is characterized by delta waves?
Stage NREM 3+4
Awake = B
Sleepy = A
NREM 1 = T
NREM 2 = S (K)
NREM 3/4 = D
REM = B
127
Sleep walking, sleep talking, and night terrors all occur during which stage of sleep?
NREM 3+4 … (delta waves)
128
Which sleep stage is characterized by sawtooth waves, appears like awake?
REM
129
MSK characteristic of REM?
Skeletal muscle paralysis, except for EOM
130
Change to sleep EEG in depression?
Increased time in REM, Decreased REM latency
131
Change to NML sleep behavior in elderly people?
Decreased sleep time at night, but unchanged total sleep during 24-hour period
132
Patient presents with difficulty falling and staying asleep, causing functional impairment; Symptoms have lasted 1+ months – diagnosis?
Insomnia
133
Axis I diagnosis of Restless Leg Syndrome?
Dyssomnia
134
First step of workup for patient with Restless Leg Syndrome?
Iron panel, Creatinine
135
DOC for Restless Leg Syndrome?
Dopamine agonists
136
Major complication of Obstructive Sleep Apnea?
Pulmonary HTN
137
Best treatment for paranoid personality disorder?
Antipsychotics
138
Most common comorbid condition in antisocial disorder?
Substance abuse
139
Most common defense mechanism employed by patients with borderline personality disorder?
Splitting
140
2 most common comorbid conditions in antisocial disorder?
Substance abuse, Eating disorder
141
2 most common comorbid conditions in dependent disorder?
Depression, Anxiety
142
Major distinguishing factor between OCD and OCPD?
OCPD doesn’t believe that it’s a problem
143
Most significant risk factor for delirium?
Age
144
EEG findings associated with delirium?
EEG shows diffuse background slow waves
145
Elderly woman presents with aphasia, ataxia, becomes lost while driving – diagnosis?
Alzheimer’s Disease
146
Appearance of Alzheimer’s Disease on MRI?
Diffuse cortical atrophy
147
Histologic finding associated with Alzheimer’s Disease?
Tau bodies, Beta amyloid plaques
148
APP in Alzheimer Disease is located on Chromosome \_\_\_
21
149
MAO of memantine in treatment of Alzheimer Disease?
NMDA inhibitor
150
Appearance of Frontotemporal Disease on MRI?
Frontotemporal atrophy
151
Histologic finding associated with Frontotemporal Disease?
Pick inclusions within neurons
152
Best treatment for Frontotemporal Disease?
Treat behavioral problems with olanzapine
153
Which medication should be avoided in Lewy Body Dementia?
Typical antipsychotics, Levodopa
154
Best treatment for Lewy Body Dementia?
ACH-E inhibitors … same used for Alzheimer Disease
155
EEG findings associated with Creutzfeldt-Jakob Disease?
Triphasic burst
156
MSK symptom associated with Creutzfeldt-Jakob Disease?
Myoclonus
157
2 essential components of workup for Normal Pressure Hydrocephalus?
MRI, LP
158
Best treatment for Normal Pressure Hydrocephalus?
Shunt
159
50 yo ETOH male presents to ER with tonic-clonic seizures; PE shows HTN, hyperthermia, tachycardia – how long since last drink?
12-24 hours
160
50 yo ETOH male presents to ER with confusion, delusions – how long since last drink?
48-96 hours
161
ETOH metabolism follows ___ order kinetics
Zero … certain AMOUNT metabolized per unit time
162
First order kinetics involves metabolism of …
Certain PROPORTION metabolized per unit time
163
50 yo ETOH male presents to ER; Also taking propranolol, allopurinol, lactulose – what should be monitored to measure withdrawals?
Hyperactive reflexes … Propranolol blunts tachycardia
164
Best initial treatment for delirious patient?
Benzodiazepine … Chlorodiazepoxide, Diazepam
165
Chlorodiazepoxide, Diazepam represents types of \_\_\_-acting benzodiazepines
Long
166
Most specific test to measure ETOH consumption in past 10 days?
GGT
167
3 aspects of clinical presentation for Wernicke encephalopathy?
CAN – Confusion, Ataxia, Nystagmus
168
Difference between Wernicke Encephalopathy and Korsakoff Syndrome?
Wernicke = reversible, Korsakoff = irreversible
169
Pt presents with hypotension, bradycardia, RR = 6; PE shows track marks on arms – diagnosis?
Heroin OD
170
Best first step of heroin OD?
Intubation, then Naloxone
171
Expected symptoms during withdrawal from heroin?
Diarrhea, Mydriasis, Rhinorrhea, Sweating
172
Best treatment for heroin withdrawal?
Clonidine
173
Nystagmus is a sign of ___ intoxication
PCP
174
Best first test for cocaine, amphetamine intoxication?
EKG
175
Best treatment for HTN in setting of cocaine use?
Avoid B blockers
176
At what age does death become permanent?
6-7 yo
177
Which phase in child development begins at about 6-7 yo?
Concrete operational phase
178
At what age does ability to think abstractly arise?
11 yo
179
Which phase in child development begins at about 11 yo?
Formal operational phase
180
Average IQ?
100
181
IQ standard deviation?
15
182
Mild mental retardation?
55 – 70
183
Moderate mental retardation?
40 – 55
184
Severe mental retardation?
25 – 40
185
Profound mental retardation?
\< 25
186
Most common cause of inherited mental retardation?
Fragile X Syndrome
187
Typical range of mental retardation seen in Fragile X Syndrome?
Moderate … 40 – 55
188
\_\_\_ refers to white spots on iris seen in setting of Down Syndrome
Brushfield spots
189
Typical range of mental retardation seen in Down Syndrome?
Mild – Moderate
190
Common endocrine complication of Down Syndrome?
Hypothyroidism
191
Common GI complication of Down Syndrome?
Duodenal atresia, Hirschsprung Disease, Omphalocele, Annular pancreas
192
Common MSK complication of Down Syndrome?
AA instability
193
Down Syndrome results in increased risk of which CA type?
ALL
194
Patient presents with macrocephaly, seizures, mental retardation, Café au Lait spots – diagnosis?
Neurofibromatosis
195
Patient presents with short stature, cloudy cornea, coarse facies – diagnosis?
Hurler Syndrome
196
Patient presents with broad/square face, short stature, self-injurious behavior – diagnosis?
Smith McGuinness
197
Smith McGuiness Syndrome results from deletion of Chromosome …
17
198
Patient presents with hypogonadism, skin picking, aggression, hyperphagia; Deletion on paternal Chromosome 15 – diagnosis?
Prader-Willi
199
Patient presents with seizure, strabismus, sociable, episodic laughter; Deletion on maternal Chromosome 15 – diagnosis?
Angelman Syndrome
200
Williams Syndrome results from deletion on chromosome …
7
201
Most common cause of mental retardation?
Fetal ETOH Syndrome
202
Patient presents with petechiae, periventricular calcifications, hearing loss, hepatitis, chorioretinitis – diagnosis?
CMV
203
Patient presents with seizures, cloudy cornea, retinitis, hearing impairment, low birth weight – diagnosis?
Rubella
204
Most effective treatment for Tourette Syndrome?
Haloperidol
205
First-line treatment for Tourette Syndrome?
Clonidine
