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EH Reviews > EH - Psychiatry > Flashcards

EH - Psychiatry Flashcards

1
Q

Timing criteria for schizophrenia?

A

6+ months; Any symptoms (negative)

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2
Q

Timing criteria for schizophreniform disease?

A

1-6 months

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3
Q

Prevalence of schizophrenia?

A

0.5 – 1.0%

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4
Q

Risk for schizophrenia in twin brother?

A

50%

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5
Q

Risk for schizophrenia in sibling?

A

10%

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6
Q

Origin of (+) symptoms in schizophrenia?

A

Excess dopamine in mesolimbic tract

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7
Q

Origin of (–) symptoms in schizophrenia?

A

Deficient dopamine in mesocortical tract

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8
Q

Patient presents with delusions, hallucinations, flattened affect for past 3 weeks – diagnosis?

A

Brief psychotic disorder

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9
Q

Timing criteria for Brief psychotic disorder?

A

Between 1 week and 1 month

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10
Q

Best treatment for Brief psychotic disorder?

A

1st generation antipsychotics

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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

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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

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13
Q

Best treatment for Schizoaffective disease?

A

Antipsychotic + Antidepressant

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14
Q

Treatment for psychotic depression?

A

ECT

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15
Q

Patient is convinced that celebrity is in love with him; Otherwise functional in daily life – diagnosis?

A

Delusional disorder

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16
Q

MOA of haloperidol?

A

Inhibits D2 dopamine receptor

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17
Q

2 AEs of haloperidol?

A

Galactorrhea, Extra-pyramidal symptoms

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18
Q

What accounts for galactorrhea in setting of haloperidol use?

A

Inhibition of dopamine release in tubuloinfundibular tract

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19
Q

What accounts for extra-pyramidal symptoms in setting of haloperidol use?

A

Inhibition of dopamine release in nigrostriatal tract

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20
Q

High potency anti-psychotics?

A

Haloperidol, Fluphenazine

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21
Q

Low potency anti-psychotics?

A

Chlorpromazine, Thioridazine, Levomepromazine

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22
Q

AE of low potency anti-psychotics?

A

Greater anticholinergic AEs

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23
Q

Benefit of low potency anti-psychotics?

A

Fewer extra-pyramidal symptoms

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24
Q

Which medication is responsible for purple-grey metallic rash over sun-exposed skin + jaundice?

A

Chlorpromazine

… (colorful)

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25
Q

Which medication is responsible for prolonged QTC and pigmented retinopathy?

A

Thioridazine

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26
Q

Best treatment for dystonic reactions in setting of antipsychotic medications?

A

Benztropine, Diphenhydramine

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27
Q

Best treatment for akanthasia in setting of antipsychotic medications?

A

Benzodiazepine, Propranolol

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28
Q

Best treatment for Parkinsonian features in setting of antipsychotic medications?

A

Benztropine, Diphenhydramine

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29
Q

Best treatment for tardive dyskinesia in setting of antipsychotic medications?

A

No treatment … need to discontinue anti-psychotic

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30
Q

2 other DOCs used to treat Neuroleptic Malignant Syndrome (not dantrolene)?

A

Bromocriptine, Metoclopramide

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31
Q

Which atypical anti-psychotic has highest risk of EPS and galactorrhea?

A

Risperidone

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32
Q

Which anti-psychotic is weight-neutral, but prolongs QTC?

A

Ziprasidone

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33
Q

Which anti-psychotic is weight-neutral, but causes akanthasia?

A

Aripiprazole

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34
Q

Which 2 anti-psychotics are weight-neutral?

A

Ziprasidone, Aripiprazole

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35
Q

Which atypical anti-psychotic causes weight gain?

A

Olanzapine

… Olanzapine = Obesity

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36
Q

Which atypical anti-psychotic causes Orthostasis?

A

Quetiapine

… (you’re quiet when you faint)

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37
Q

Why does quetiapine cause orthostasis?

A

Blocks alpha-1 receptors

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38
Q

Which atypical anti-psychotic is effective for treatment of refractory schizophrenia?

A

Clozapine

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39
Q

Most common AE of Clozapine?

A

Weight gain, sedation, Metabolic syndrome

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40
Q

Most dangerous AE of Clozapine?

A

Agranulocytosis, Seizures

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41
Q

Timing criteria for major depressive disorder?

A

2 weeks

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42
Q

Most important risk factor for suicide?

A

Prior attempt

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43
Q

Change to sleep in setting of MDD?

A

Decreased stage ¾ sleep, Shortened REM latency, More frequent REM

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44
Q

Atypical lab test in patients with MDD?

A

Cortisol … unaffected by dexamethasone suppression test

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45
Q

3 medications that may lead to depression?

A

B blockers, IFN-gamma, alpha methyldopa

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46
Q

Which type of CVA can cause depression?

A

L MCA

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47
Q

Which SSRI has most drug-drug interactions?

A

Paroxetine … CYP450

(Paroxetine works in Pairs)

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48
Q

Which SSRI does not require tapering?

A

Fluoxetine

Fluoxetine 1/2 life = Forever

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49
Q

Why does fluoxetine not require tapering?

A

Longest half life

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50
Q

Which SSRI has fewest drug-drug interactions?

A

Citalopram

Citalopram … sits by itself

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51
Q

Which SSRI is most likely to cause Serotonin Discontinuation Syndrome if stopped suddenly?

A

Sertraline

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52
Q

Clinical presentation of Serotonin Discontinuation Syndrome?

A

Flu-like symptoms

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53
Q

Which anti-depressant is indicated for patient who experiences sexual dysfunction while taking SSRI?

A

Bupropion

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54
Q

MOA of Bupropion?

A

Inhibition of NET and DAT

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55
Q

CI to Bupropion?

A

Seizures, ETOH abuse, Bulimia

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56
Q

Which anti-depressant should be avoided in HTN patients?

A

Venlafaxine

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57
Q

SNRIs + ___ may result in HTN crisis?

A

St. John’s Wort

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58
Q

Best treatment for HTN crisis in patients taking MAOI?

A

Alpha blocker

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59
Q

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?

A

TCA

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60
Q

Best treatment for TCA overdose?

A

Sodium bicarbonate

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61
Q

Patient with signs of MDD also experiences leaden paralysis in AM – diagnosis?

A

Atypical depression

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62
Q

2 other symptoms of Atypical depression?

A

Increased sleep, increased appetite

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63
Q

DOC for Atypical depression?

A

MAOIs

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64
Q

2 clinical symptoms of complicated bereavement?

A

Psychosis, Suicidal thoughts

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65
Q

Timing criteria for adjustment disorder?

A

Must begin within 3 months of stressor; Can’t last longer than 6 months of stressor

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66
Q

Best treatment for adjustment disorder?

A

Psychotherapy

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67
Q

Incidence of Bipolar Disorder in general population?

A

1%

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68
Q

Risk for Bipolar Disorder in identical twin?

A

90%

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69
Q

Which type of CVA may result in symptoms of mania?

A

R MCA

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70
Q

Which medications should be avoided in patients with Bipolar Disorder?

A

SSRIs, TCA

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71
Q

3 DOCs for Bipolar Disorder?

A

Lithium, Valproic Acid, Carbamazepine

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72
Q

DOC for agitation in patient with Bipolar Disorder?

A

Haloperidol

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73
Q

Pt with PMHX of bipolar disorder presents with NVD, coarse tremor, ataxia, slurred speech – diagnosis?

A

Lithium toxicity

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74
Q

Which class of medications are notorious for precipitating Lithium toxicity?

A

NSAIDs

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75
Q

Which 2 NSAIDs are least likely to precipitate Lithium toxicity?

A

ASA, Sulendac

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76
Q

2 EKG findings associated with Lithium toxicity?

A

Flattened T waves, U waves

… (EKG does down)

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77
Q

Best treatment for Lithium overdose?

A

Dialysis

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78
Q

Major AEs of Lithium?

A

Nephrogenic DI, GI upset, Hypothyroidism

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79
Q

MOA of Lithium?

A

Inhibition of inostotrol triphosphate

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80
Q

Which lab tests are essential for monitoring of Lithium?

A

Renal function, Thyroid function

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81
Q

CI to use of Lithium?

A

CKD (precipitates toxicity due to inability to clear Lithium renally), Pregnancy

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82
Q

Problems that Lithium causes during pregnancy?

A

Epstein Syndrome … atrialization of RV

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83
Q

DOC for treatment of Bipolar Disorder in pregnancy?

A

Benzodiazepine

84
Q

Which bipolar disorder medication causes LFTs and hepatitis?

A

Valproic acid

85
Q

Which bipolar disorder medication causes Stevens Johnson Syndrome?

A

Lamotrigine

86
Q

Which bipolar disorder medication causes agranulocytosis?

A

Carbamazepine

87
Q

Female becomes pregnant while taking medications for Bipolar Disorder; Labs show increased AFP – which drug is responsible?

A

Valproic acid, Carbamazepine … (AFP = neural tube defect)

88
Q

Most common complication of Carbamazepine?

A

Rash

89
Q

28 yo female presents with CP, SOB, palpitations; Smokes 1PPD, currently on OCPs; Rarely leaves house because worried about having another episode – diagnosis?

A

Panic disorder with agoraphobia

90
Q

Best treatment for Panic disorder?

A

Medical workup first!

91
Q

DOC for Panic disorder?

A

SSRI + Benzodiazepine (short-term)

92
Q

CI for Benzodiazepine?

A

HX of addiction, COPD, ILD

93
Q

Why are Benzodiazepines contraindicated in COPD, ILD?

A

Benzodiazepines suppress the respiratory drive

94
Q

Clinical presentation of Benzodiazepine withdrawal?

A

Autonomic instability, Seizures, Hallucinations

95
Q

DOC for treatment of Benzodiazepine withdrawal?

A

Diazepam, Chlorodiazepoxide

96
Q

Best treatment for Specific phobia?

A

CBT, small prescription for Benzodiazepine

97
Q

DOC for social anxiety disorder?

A

Propranolol

98
Q

Definition of Avoidant personality disorder?

A

Want to interact with peers, but afraid of rejection

99
Q

Best treatment for Avoidant personality disorder?

A

CBT

100
Q

Comorbid condition for OCD?

A

Tourette’s Disorder

101
Q

DOC for OCD?

A

SSRIs

102
Q

Best treatment for PTSD?

A

SSRI

103
Q

Best treatment for nightmares in PTSD?

A

Alpha blockers … (prazosin, terazosin)

104
Q

Timing criteria for PTSD?

A

> 1 month

105
Q

Timing criteria for Acute stress reaction?

A

Less than 1 month

106
Q

3 comorbid conditions with Somatization disorder?

A

MDD, Personality Disorder, Anxiety

107
Q

Pseudoseizure represents a type of …

A

Conversion disorder

108
Q

Definition of malingering?

A

Need to have evidence of secondary gain

Malingering = looking for More

109
Q

3 changes to vital signs in patient with bulimia?

A

Bradycardia, Hypothermia, Hypotensive

110
Q

Metabolic abnormality expected in patients with bulimia?

A

Hypokalemic, Hypochloric, Metabolic alkalosis (high HCO3-)

111
Q

3 additional lab changes seen in patients with bulimia?

A

High amylase, High LFTs, High carotene

112
Q

What accounts for high LFTs in setting of anorexia?

A

Liver becomes stressed in an attempt to produce glycogen

113
Q

Change to CBC in patients with anorexia?

A

Leukopenia

114
Q

Change to thyroid function testing in anorexia?

A

NML

115
Q

Change to lipid levels in anorexia?

A

Hypercholesterolemia

116
Q

Change to cortisol in setting of anorexia?

A

High

117
Q

Change to estrogen in setting of anorexia?

A

Low

118
Q

Change to LH, FSH in setting of anorexia?

A

Low

119
Q

Most common cause of death in patients with anorexia?

A

Arrhythmia

120
Q

2nd most common cause of death in patients with anorexia?

A

Suicide

121
Q

Complication of TPN provided to patient with anorexia?

A

Refeeding Syndrome

122
Q

Description of Refeeding Syndrome seen after TPN?

A

Fluid retention that causes hypokalemia, hypocalcemia, hypomagnesemia

123
Q

Complication of Refeeding Syndrome?

A

Arrhythmias

124
Q

Which sleep stage is characterized by theta waves?

A

Stage NREM 1

Awake = B

Sleepy = A

NREM 1 = T

NREM 2 = S (K)

NREM 3/4 = D

REM = B

125
Q

Which sleep stage is characterized by sleep spindles and K complexes?

A

Stage NREM 2

Awake = B

Sleepy = A

NREM 1 = T

NREM 2 = S (K)

NREM 3 = D

REM = B

126
Q

Which sleep stage is characterized by delta waves?

A

Stage NREM 3+4

Awake = B

Sleepy = A

NREM 1 = T

NREM 2 = S (K)

NREM 3/4 = D

REM = B

127
Q

Sleep walking, sleep talking, and night terrors all occur during which stage of sleep?

A

NREM 3+4 … (delta waves)

128
Q

Which sleep stage is characterized by sawtooth waves, appears like awake?

A

REM

129
Q

MSK characteristic of REM?

A

Skeletal muscle paralysis, except for EOM

130
Q

Change to sleep EEG in depression?

A

Increased time in REM, Decreased REM latency

131
Q

Change to NML sleep behavior in elderly people?

A

Decreased sleep time at night, but unchanged total sleep during 24-hour period

132
Q

Patient presents with difficulty falling and staying asleep, causing functional impairment; Symptoms have lasted 1+ months – diagnosis?

A

Insomnia

133
Q

Axis I diagnosis of Restless Leg Syndrome?

A

Dyssomnia

134
Q

First step of workup for patient with Restless Leg Syndrome?

A

Iron panel, Creatinine

135
Q

DOC for Restless Leg Syndrome?

A

Dopamine agonists

136
Q

Major complication of Obstructive Sleep Apnea?

A

Pulmonary HTN

137
Q

Best treatment for paranoid personality disorder?

A

Antipsychotics

138
Q

Most common comorbid condition in antisocial disorder?

A

Substance abuse

139
Q

Most common defense mechanism employed by patients with borderline personality disorder?

A

Splitting

140
Q

2 most common comorbid conditions in antisocial disorder?

A

Substance abuse, Eating disorder

141
Q

2 most common comorbid conditions in dependent disorder?

A

Depression, Anxiety

142
Q

Major distinguishing factor between OCD and OCPD?

A

OCPD doesn’t believe that it’s a problem

143
Q

Most significant risk factor for delirium?

A

Age

144
Q

EEG findings associated with delirium?

A

EEG shows diffuse background slow waves

145
Q

Elderly woman presents with aphasia, ataxia, becomes lost while driving – diagnosis?

A

Alzheimer’s Disease

146
Q

Appearance of Alzheimer’s Disease on MRI?

A

Diffuse cortical atrophy

147
Q

Histologic finding associated with Alzheimer’s Disease?

A

Tau bodies, Beta amyloid plaques

148
Q

APP in Alzheimer Disease is located on Chromosome ___

A

21

149
Q

MAO of memantine in treatment of Alzheimer Disease?

A

NMDA inhibitor

150
Q

Appearance of Frontotemporal Disease on MRI?

A

Frontotemporal atrophy

151
Q

Histologic finding associated with Frontotemporal Disease?

A

Pick inclusions within neurons

152
Q

Best treatment for Frontotemporal Disease?

A

Treat behavioral problems with olanzapine

153
Q

Which medication should be avoided in Lewy Body Dementia?

A

Typical antipsychotics, Levodopa

154
Q

Best treatment for Lewy Body Dementia?

A

ACH-E inhibitors … same used for Alzheimer Disease

155
Q

EEG findings associated with Creutzfeldt-Jakob Disease?

A

Triphasic burst

156
Q

MSK symptom associated with Creutzfeldt-Jakob Disease?

A

Myoclonus

157
Q

2 essential components of workup for Normal Pressure Hydrocephalus?

A

MRI, LP

158
Q

Best treatment for Normal Pressure Hydrocephalus?

A

Shunt

159
Q

50 yo ETOH male presents to ER with tonic-clonic seizures; PE shows HTN, hyperthermia, tachycardia – how long since last drink?

A

12-24 hours

160
Q

50 yo ETOH male presents to ER with confusion, delusions – how long since last drink?

A

48-96 hours

161
Q

ETOH metabolism follows ___ order kinetics

A

Zero … certain AMOUNT metabolized per unit time

162
Q

First order kinetics involves metabolism of …

A

Certain PROPORTION metabolized per unit time

163
Q

50 yo ETOH male presents to ER; Also taking propranolol, allopurinol, lactulose – what should be monitored to measure withdrawals?

A

Hyperactive reflexes … Propranolol blunts tachycardia

164
Q

Best initial treatment for delirious patient?

A

Benzodiazepine … Chlorodiazepoxide, Diazepam

165
Q

Chlorodiazepoxide, Diazepam represents types of ___-acting benzodiazepines

A

Long

166
Q

Most specific test to measure ETOH consumption in past 10 days?

A

GGT

167
Q

3 aspects of clinical presentation for Wernicke encephalopathy?

A

CAN – Confusion, Ataxia, Nystagmus

168
Q

Difference between Wernicke Encephalopathy and Korsakoff Syndrome?

A

Wernicke = reversible, Korsakoff = irreversible

169
Q

Pt presents with hypotension, bradycardia, RR = 6; PE shows track marks on arms – diagnosis?

A

Heroin OD

170
Q

Best first step of heroin OD?

A

Intubation, then Naloxone

171
Q

Expected symptoms during withdrawal from heroin?

A

Diarrhea, Mydriasis, Rhinorrhea, Sweating

172
Q

Best treatment for heroin withdrawal?

A

Clonidine

173
Q

Nystagmus is a sign of ___ intoxication

A

PCP

174
Q

Best first test for cocaine, amphetamine intoxication?

A

EKG

175
Q

Best treatment for HTN in setting of cocaine use?

A

Avoid B blockers

176
Q

At what age does death become permanent?

A

6-7 yo

177
Q

Which phase in child development begins at about 6-7 yo?

A

Concrete operational phase

178
Q

At what age does ability to think abstractly arise?

A

11 yo

179
Q

Which phase in child development begins at about 11 yo?

A

Formal operational phase

180
Q

Average IQ?

A

100

181
Q

IQ standard deviation?

A

15

182
Q

Mild mental retardation?

A

55 – 70

183
Q

Moderate mental retardation?

A

40 – 55

184
Q

Severe mental retardation?

A

25 – 40

185
Q

Profound mental retardation?

A

< 25

186
Q

Most common cause of inherited mental retardation?

A

Fragile X Syndrome

187
Q

Typical range of mental retardation seen in Fragile X Syndrome?

A

Moderate … 40 – 55

188
Q

___ refers to white spots on iris seen in setting of Down Syndrome

A

Brushfield spots

189
Q

Typical range of mental retardation seen in Down Syndrome?

A

Mild – Moderate

190
Q

Common endocrine complication of Down Syndrome?

A

Hypothyroidism

191
Q

Common GI complication of Down Syndrome?

A

Duodenal atresia, Hirschsprung Disease, Omphalocele, Annular pancreas

192
Q

Common MSK complication of Down Syndrome?

A

AA instability

193
Q

Down Syndrome results in increased risk of which CA type?

A

ALL

194
Q

Patient presents with macrocephaly, seizures, mental retardation, Café au Lait spots – diagnosis?

A

Neurofibromatosis

195
Q

Patient presents with short stature, cloudy cornea, coarse facies – diagnosis?

A

Hurler Syndrome

196
Q

Patient presents with broad/square face, short stature, self-injurious behavior – diagnosis?

A

Smith McGuinness

197
Q

Smith McGuiness Syndrome results from deletion of Chromosome …

A

17

198
Q

Patient presents with hypogonadism, skin picking, aggression, hyperphagia; Deletion on paternal Chromosome 15 – diagnosis?

A

Prader-Willi

199
Q

Patient presents with seizure, strabismus, sociable, episodic laughter; Deletion on maternal Chromosome 15 – diagnosis?

A

Angelman Syndrome

200
Q

Williams Syndrome results from deletion on chromosome …

A

7

201
Q

Most common cause of mental retardation?

A

Fetal ETOH Syndrome

202
Q

Patient presents with petechiae, periventricular calcifications, hearing loss, hepatitis, chorioretinitis – diagnosis?

A

CMV

203
Q

Patient presents with seizures, cloudy cornea, retinitis, hearing impairment, low birth weight – diagnosis?

A

Rubella

204
Q

Most effective treatment for Tourette Syndrome?

A

Haloperidol

205
Q

First-line treatment for Tourette Syndrome?

A

Clonidine

EH Reviews (4 decks)

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