Ethics/Radiology/Psychiatry Flashcards

1
Q

What is one exception to partial emancipation of minors to make their own medical decisions (e.g. sex, reproductive health, substance abuse)?

A

Abortion needs to be disclosed to parents in 36 states

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2
Q

If the parents of a child are Jehoviah’s Witness can they deny life-saving therapy for their child?

A

No

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3
Q

Can a pregnant women refuse therapies which would assist the fetus while pregnant?

A

Yes. But once the fetus is out then she can’t refuse life-sustaining treatment for it

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4
Q

True/False

To be useful a living will needs to be clear and precise

A

True

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5
Q

When is a court order an acceptable tool?

A

After all other options have been exhausted, including an ethics consultation

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6
Q

Is physician-assisted suicide and euthanasia ever the right answer (that is the intent to end life)?

A

No

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7
Q

Do you need the consent of the father for an abortion?

A

No

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8
Q

When can you break patient confidentiality?

A

When there is direct harm to others (e.g. physical harm in setting of psychiatric patient or communicable diseases like HIV)

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9
Q

Can physicians refuse to treat certain patients?

A

It is legal for them to do so but not always ethical

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10
Q

Lytic bone lesions may be caused by what cancer?

A

Multiple myeloma
Primary bone cancer
Lung, renal, thyroid, or breast mets

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11
Q

Blastic bone lesions may be caused by what cancer?

A

Breast, prostate, or lymphoma mets
Paget’s Disease
Medulloblastoma in peds

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12
Q

What is the preferred therapy for delusional disorders and personality disorders?

A

Psychotherapy

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13
Q

What are other tests which should be included your diagnostic work-up to rule out non-psych related diagnoses?

A
TSH
VDRL/RPR
HIV
BMP (Calcium and other metabolic disorders)
Temporal lobe epilepsy hx
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14
Q

Besides psychosis, what are two other indications for the use of antipsychotics?

A

1) Sedating effect when BZDs contra-indicated

2) Huntington’s Disease or Tourette’s

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15
Q

Major side effect of clozapine

A

Agranulocytosis (Check a CBC once/week)

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16
Q

What are adverse effects seen with low-potency antipsychotics?

A
Orthostatic hypotension (from alpha blockade effect)
Dry mouth, urinary retention, blurry vision, delirium (anticholinergic effect)
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17
Q

Adverse effects of thioridazine

A

Prolongs QT and arrhythmias

Abnormal retinal pigmentation

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18
Q

What are adverse effects of some antipsychotics which are a major reason for male non-compliance?

A

Impotence and inhibition of ejaculation

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19
Q

What is the major advantage and disadvantage of use of typical high-potency antipsychotics (e.g. haloperidol and fluphenazine)?

A

Advantage: fewer side effects related to alpha blockade and anticholinergic effect; higher potency

Disadvantage: higher association with EPS symptoms

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20
Q

What is the major advantage and disadvantage of low-potency typical antipsychotics (e.g. thioridazine, chlorpromazine)?

A

Advantage: Less likely to cause EPS symptoms

Disadvantage: Greater sedating effect and risk of orthostatic hypotension and anticholinergic effects

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21
Q

What is the major benefit of atypical antipsychotics such as risperidone, quetiapine, olanzapine, and clozapiine?

A

Greater effect on negative symptoms and has less risk of EPS

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22
Q

Which antipsychotic has the greatest risk of weight gain?

A

Olanzapine

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23
Q

How do you treat acute dystonic reactions or bradykinesia which occurs while on antipsychotics?

A

Reduce dose

Anticholinergics (i.e. benztropine, diphenhydramine, trihexyphenidyl)

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24
Q

How do you manage akathisia which may result from antipsychotics?

A

Reduce dose
BZD may help
Switch to a newer antispsychotic (e.g. risperidone)

25
Q

How do you manage tardive dyskinesia?

A

Stop the old antipsychotic and start a new one

26
Q

T/F

After discontinuing an old antipsychotic symptoms of tardive dyskinesia improve

A

False

Symptoms worsen first

27
Q

What are non-antipsychotic meds which may also cause EPS symptoms?

A

Metoclopramide and prochlorperazine (antiemetics)

28
Q

Mgmt of panic disorder

A

Cognitive behavioral therapy and relaxation training

SSRIs, BZD, imipramine, MAOI

29
Q

Treatment of phobia disorders

A

Exposure therapy

BZD and Beta Blockers may be helpful when given prior to the exposure

30
Q

Place these benzodiazepines in order of shortest to longest half-life:

Diazepam (Valium)
Alprazolam (Xanax)
Lorazepam (Ativan)

A

Alprazolam (Xanax)

31
Q

What is a major benefit of buspirone compared to other anxiolytic effects?

A

No sedating effects

32
Q

Major depressive disorder requires symptoms to last for how long?

A

2 weeks

33
Q

In patients with newly diagnosed depression who are acutely suicidal what is an appropriate therapy?

A

ECT, which reduces risk of suicidality quicker than antidepressants would

34
Q

Describe dysthymic disorder. What is mgmt?

A

Low level depression symptoms lasting 2 yrs

Individual psychotherapy is the best initial treatment, SSRIs can be used if that doesn’t help

35
Q

How is seasonal affective disorder managed?

A

Phototherapy and sleep deprivation

36
Q

What is rapidly cycling bipolar disorder?

A

Greater than 4 manic episodes per year

37
Q

How do you managed a bipolar patient who is well maintained on Li but becomes pregnant?

A

Stop Li

Use ECT in first trimester and Lamictal in 2nd and 3rd trimester

38
Q

What is appropriate management of acute mania?

A

1) Mood stabilizing medicine to induce remission (e.g. Lithium)
2) Antipsychotic to control the acute mania (e.g. Risperidone)
3) IM Depot Phenothiazine in noncompliant and severely manic patients

39
Q

What are second-line options for treatment of bipolar disorder?

A

Aripiprazole, quetiapine, olanzapine, divalproex

40
Q

Describe cyclothymia and its mgmt

A

Recurrent episodes of depressed mood and hypomania over 2 years.

Psychotherapy is first and then if patients still need assistance may give Divalproex

41
Q

What is appropriate treatment for a grief reaction?

A

Supportive therapy

42
Q

What type of depression are MAOIs useful for?

A

Atypical Depression

43
Q

How long should you keep a pt on an antidepressant before considering switching if it doesn’t work?

A

8 weeks

44
Q

Mirtazapine is a good antidepressant to use if patients have what additional symptoms to their depression?

A

Poor appetite, insomnia, weight loss

45
Q

In which situations is trazodone a helpful antidepressant?

A

Patients with severe insomnia because of its sedating effect

46
Q

What is the one SSRI not safe in pregnancy?

A

Paroxetine

47
Q

Which antidepressive medication should be avoided in patients with history of seizures?

A

Bupropion

48
Q

What is the first line choice for rapidly cycling bipolar disorder?

A

Divalproex

49
Q

What are serious side effects of carbamazepine?

A

Agranulocytosis and sedation

*CYP450 Inducer so increases clearance of warfarin, phenytoin, theophyllilne, valproic acid

50
Q

What should you always discuss with a patient prior to starting an antidepressant medication?

A

If they have had suicidal ideations because some patients have increases thoughts of over the first 2 weeks

51
Q

What medications assist with anorexia and bulimia?

A

Olanzapine (promotes weight gain)

SSRI antidepressants

52
Q

What is appropriate treatment of body dysmorphic disorder?

A

SSRI

53
Q

How is intermittent explosive disorder managed?

A

Aggression out of proportion to stressor

54
Q

Do you have to report spousal abuse?

A

No, its not indicated

55
Q

Which is the one with weird thoughts and magical thinking, schizoid or schizotypal personality disorder?

A

Schizotypal

56
Q

What are characteristics of histrionic PD?

A

Exaggerated behaviors to draw attention to oneself, often through sexual means

57
Q

What are characteristics of borderline PD?

A

Unstable affect with mood swings. Often can be suicidal and have chronic feelings of emptiness, identity disturbance, and inappropriate anger

58
Q

What are potential treatments for opiate withdrawal?

A

Clonidine and/or methadone

59
Q

What is appropriate management of paraphillic disorders (recurrent, sexually arousing preoccupations)?

A

Individual psychotherapy and aversive conditioning