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MVU Adult 2 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What is the most common psychiatric disorder in the US?

A

Anxiety

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2
Q

What is are the DSM-5 symptom criteria for diagnosis of GAD?

A

A. Excessive anxiety and worry predominating for at least 6 months
B. Patient finds it difficult to manage the worry
C. 3/6 Anxiety Physical symptoms present most days
D. The disturbance is not due to a medication or other diagnosis

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3
Q

What are the six physical symptoms listed in the DSM-5 as associated with GAD?

A

-Restlessness
-Easily fatigued
-Difficulty concentrating or mind going blank
-Irritability
-Muscle tension
-Sleep disturbance

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4
Q

What are the DSM-5 symptom criteria for major depressive disorder?

A

Five or more symptoms present during the same 2 weeks period and represent a change from previous functioning. Symptoms: depressed mood, anhedonia (loss of interest or pleasure), weight loss or gain, insomnia or hypersomnia, psychomotor agitation, fatigue, feeling worthless or guilty, decreased concentration, suicidal ideation

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5
Q

What are the risk factors for major depression?

A

-Adolescent or older adult
-Female gender
-Family Hx
-Hx of migraines, pain, recent MI, peptic ulcer disease
-Medical conditions: chronic disease or insomnia
-Lifestyle: stress, poverty, lack of education, trauma

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6
Q

What are the common presenting symptoms of depression in the geriatric patient?

A

-Poor appetite, disrupted sleep, pain, feelings of guilt and worry, suicidal ideation, memory problems, psychomotor agitation

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7
Q

What are the first line pharmacologic treatment options for major depressive disorder?

A

SSRIs, SNRIs, TCAs, bupropion (a norepinephrine dopamine reuptake inhibitor)

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8
Q

What are the concerns about pharmacological treatment for major depression in the elderly?

A

-SSRI- increased risk for development of SIADH in elderly
-Increased risk for falls, osteoporosis, and fractures
-Generally the elderly are more sensitive to side effects of medications, have decreased drug metabolism, multiple medical morbidities, and polypharmacy

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9
Q

What are the nonpharmacological treatment options for major depressive disorder?

A

-Interpersonal and cognitive behavioral therapy
-Support group, counseling
-Establish a routine, increase activities, relaxation, massage, exercise, good nutrition

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10
Q

What are the pharmacological treatment options for GAD?

A

First line- SSRIs (escitalopram, paroxetine, sertraline),
Acute treatment: SNRIs (Buspirone, venlafaxine)
If needing sedation- TCAs (imipramine)
Antihistamines- hydroxyzine

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11
Q

What are the nonpharmacological treatment options for GAD?

A

-Cognitive-behavioral therapy/Counseling
-Patient education: symptom recognition, interpretation, decrease intake of stimulants (caffeine/nicotine), relaxation skills

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12
Q

What is the difference between major mood disorders (unipolar) and bipolar disorders I and II?

A

Unipolar: another name for major depressive disorder, unipolar meaning without mania
Bipolar I: at least one episode of reported mania with or without depression episode; essential feature is mania
Bipolar II: recurrent moods of hypomania and depression

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13
Q

Mnemonic DIGFAST for manic episode

A

Distractibility
Insomnia
Grandiosity (inflated self-esteem)
Flight of ideas (racing thoughts)
Activities (increased, goal-directed)
Speech (increased)
Thoughtlessness (poor judgement)

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14
Q

How do you assess suicide risk?

A

Mnemonic SAD PERSONS;
S- Male Sex
A- <19, >45yrs
D- Depression
P- Previous attempts
E- Excessive alcohol/substance use
R- Rational thinking loss
S- Social supports lacking
O- Organized plan
N- No spouse
S- Sickness

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15
Q

What are the stages of grieving?

A

-Denial
-Anger
-Bargaining
-Depression
-Acceptance

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16
Q

What are the phases of grief?

A

-Avoidance
-Confrontation
-Accommodation

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17
Q

How would you identify intimate partner violence?

A

a pattern of assaultive and coervice behaviors that my include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation, and threats by an intimate partner

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18
Q

What is the clinical presentation of PTSD?

A

Patient would describe reexperiencing of the event, a pattern of avoidance, and emotional numbing (negative thoughts or feelings, hyperarousal symptoms such as jumpiness)

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19
Q

What are some screening tools for PTSD?

A

Primary care PTSD Screen for DSM-5 (PC-PTSD-5), Trauma Screening Questionnaire (TSQ)

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20
Q

What are the DSM-5 criteria for a diagnosis of PTSD?

A

Traumatic or threatened event results in symptoms of re-experiencing the trauma, avoidance, and cognitive mood changes that last greater than a month and cause active distress

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21
Q

What is the pharmacological management for PTSD?

A

SSRIs- paroxetine, sertraline
TCAs
Anxiolytics- Buspirone to reduce intrusive sx

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22
Q

What is the nonpharmacological management for PTSD?

A

Safety assessment, trauma-focused psychotherapy, CBT, written narrative exposure

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23
Q

S&S of anorexia nervosa

A

Hypothermia, constipation, lethargy, nervous energy, hypotension, dehydration, dry skin, hypertrophy of salivary glands

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24
Q

S&S of bulimia nervosa

A

Tooth erosion, periodontal disease, swollen salivary glands, esophageal irritation, GERD, calluses on the back of hands, abdominal pain, irregular menses

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25
Q

What are the warning signs that a patient might have an eating disorder?

A

-Weight loss
-Depression/mood swings
-Preoccupation with weight, calories, and food
-Wears baggy clothes
-Excessive exercise
-Hypotension, bradycardia
-Amenorrhea

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26
Q

What are some sleep hygiene strategies for a patient complaining of insomnia?

A

-Maintain a regular sleep/wake schedule
-Eat regular meals
-Develop a relaxing bedtime routine
-Avoid consuming liquids/caffeine/tobacco/alcohol later in the day and evening
-Avoid naps
-Exercise
-Limit exposure to light in the evenings
-Attempt a quiet activity after 20 minutes of failed sleep attempt

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27
Q

What is the first-line treatment for chronic insomnia?

A

CBT

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28
Q

How long can benadryl be taken for insomnia?

A

Short-term: less than 2 weeks

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29
Q

Which is the most energizing SSRI?

A

Fluoxetine

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30
Q

Which is the most sedating SSRI?

A

Paroxetine

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31
Q

Which SSRI has a dose limitations due to potential QT prolongation?

A

Citalopram

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32
Q

Which SSRI has the least drug interaction potential?

A

Escitalopram

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33
Q

Which SSRI has the longest 1/2 life?

A

Fluoxetine

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34
Q

Which SSRI has the most drug interaction potential?

A

Fluoxetine

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35
Q

A patient that was recently started on an SSRI presents to the clinic 2 weeks later with complaint that the medication is not working and is causing frontal headache. What do you do?

A

-Educate her that the lag of a number of weeks in the onset of SSRI therapeutic effect is expected; these meds need 4-6 weeks of continued use before benefits are seen
-Frontal headache is a common short-term problem with early SSRI use

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36
Q

What are some signs of antidepressant discontinuation syndrome?

A

Nausea, Flu-like symptoms, anxiety, headaches

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37
Q

Which SSRI is the best choice for a 67-yr-old female patient with multiple comorbidities?

A

Escitalopram- less risk for drug interactions

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38
Q

Which blood test should be periodically checked while on olanzapine (zyprexa)?

A

Blood sugar and lipid profile- risk for weight gain and metabolic problems

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39
Q

What would indicate a positive screening for substance abuse?

A

Positive response to two items on the CAGE questionnaire

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40
Q

What are some symptoms of alcohol withdrawal?

A

Irritability, tremors, insomnia, seizures, delirium tremens, death

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41
Q

What are some pharmacological treatment options for alcohol withdrawal?

A

-Benzos: lorazepam, diazepam, carbamazepine
-Antipsychotics: haldol
-Beta blockers, clonidine, phenytoin

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42
Q

What are some non-pharmacological interventions for substance use disorder?

A

-Motivational interviewing
-Education of effects of drugs
-Inpatient rehab

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43
Q

Symptom criteria for diagnosis of schizophrenia:

A

-Onset acute or insidious
-Symptoms present for at least 6 months with 2+ positive or negative sx present for at least 1 month
-Social, employment, or self-care impairment

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44
Q

What are the positive symptoms of schizophrenia?

A

-delusions, hallucinations, disorganized speech

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45
Q

How would you differentiate between a diagnosis of gastroenteritis and irritable bowel syndrome?

A

Gastroenteritis would likely present with sudden onset and nausea/vomiting/fever; for IBS diagnosis symptoms must be present for at least 3 months continuously or recurrently and no symptoms of systemic disease

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46
Q

What are the negative symptoms of schizophrenia?

A

-Flat affect
-Alogia- poverty of speech
-Asociality- lack of pleasure in acts that are normally pleasurable
-Apathy

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47
Q

What are the goals of therapy for schizophrenia?

A

-Management of symptoms, evaluation of community issues such as housing, employment, and association of other illnesses such as PTSD, substance use

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48
Q

Pharmacological intervention for schizophrenia targets what symptoms?

A

Positive symptoms

49
Q

Which antipsychotic medication has the lowest risk of causing extrapyramidal symptoms?

A

Clozapine (but increased risk for agranulocytosis- check CBC)

50
Q

What are the common side effects to anticipate when prescribing atypical antipsychotics for schizophrenia?

A

Antcholinergic (dizziness/hypotension)
Metabolic effects- increased lipids, weight gain
Prolonged QT interval
Agranulocytosis (Check CBC)
EPS

51
Q

Which class of medications for schizophrenia is least likely to cause motor symptoms?

A

Atypical antipsychotics- equally as effective as typical antipsychotics

52
Q

Name some atypical antipsychotics

A

Clozapine, olanzapine (Zyprexa), Quetiapine (Seroquel), Risperidone

53
Q

What is the only drug approved for treatment of bulimia nervosa?

A

fluoxetine

54
Q

What is the difference in the mode of transmission for Hep A, Hep B, and Hep C?

A

Hepatitis A- contaminated food or water (fecal-oral route_
Hepatitis B- direct contact with infected blood/blood products or sex
Hep C- percutaneous exposure to blood and blood products (most commonly injected drugs)

55
Q

Describe the clinical presentation of appendicitis

A

-Acute onset mild-severe epigastric or periumbilical pain; localizes to RUQ in first 24 hours and exacerbated by walking/coughing
-N/V/D or constipation
-Fever/chills
-HTN
-tachycardia, fever
-Flexed knees when lying on side
-Rebound tenderness
-Signs: Rovsing’s, Psoas, obturator

56
Q

Describe Rovsing’s sign for appendicitis

A

Deep palpation over the LLQ with sudden, unexpected release of pressure- + if this causes rebound tenderness over RLQ

57
Q

Describe the Psoas sign for appendicitis

A

Patient should lift the right leg against gentle pressure applied by the examiner or extend the right leg while in the left lateral decubitus position- increased pain is +

58
Q

Describe the obturator signs for appendicitis

A

Right hip and knee flexed, examiner rotates right leg internally; pain in RLQ is +

59
Q

Describe the McBurney’s sign for appendicitis

A

Pressure is applied to McBurney’s point (halfway b/w the umbilicus and the anterior spine. of the ilium); + if causes pain

60
Q

Describe the clinical presentation for GERD

A

S- hearburn, regurgitation, reflex salivation, dysphagia, sour taste in mouth in the morning, belching, coughing, hoarsness, wheezing
O- PE is usually normal, possible occult blood in stool

61
Q

How is GERD diagnosed?

A

Usually by history alone which has a sensitivity of 80%

62
Q

When should you refer someone with GERD to GI specialist?

A

If a patient is being treated with a PPI BID without improvement of symptoms in 8 weeks

63
Q

Describe lifestyle changes recommended for patients with GERD

A

-Weight loss
-Avoid eating large meals, tight clothing, or bending and straining
-Eat small, frequent meals
-Don’t eat within 4 hours of bedtime
-Avoid smoking

64
Q

Describe medical management of GERD

A

Initial: Weight loss, elevate HOB 6-8 in., avoid meals 2-3 hours before bedtime, avoid food irritants, PPI once daily for 8 weeks–> move to twice daily if needed
-After 8 weeks with no response: if EGD shows Barrett’s esophagus, chronic PPI

65
Q

Monitoring and adverse effects for patients with chronic PPI use

A

Every 6 months- Vitamin B12, osteoporosis, c.diff, pneumonia are common adverse effects

66
Q

Differentiate between management of GERD and peptic ulcer disease

A

GERD- PPI, lifestyle modifications
PUD- PPIs are drug of choice; TUMS or antacids with calcium SHOULD NOT be used, Sucralfate, bismuth preparations, or misoprostol to promote ulcer healing

67
Q

Describe the diagnosis criteria for IBS

A

Two of the following must be present for 3 or more months:
-abdominal pain relieved by defecation
-change in frequency in stool
-change in the appearance of the stool

68
Q

What is the pharmacological management for IBS?

A

-Anti-diarrheal (Ioperamide, diphenoxylate)
-Antispasmodics- dicyclomine, hyoscyamine
-TCA/SSRI

69
Q

What is the non-pharmacological management for IBS?

A

-Identify and eliminate IBS triggering foods
-High fiber diet with at least 8 8-oz glasses of water per day, probiotics

70
Q

What are the risk factors for cholelithiasis?

A

-Female
-Obesity
-Pregnancy
-Increased age
-Drugs (BC)
-Cystic fibrosis
-DM
-Sickle cell anemia

71
Q

What is the clinical presentation of cholecystitis?

A

S- indigestion, nausea, vomiting, acute colicky pain in RUQ or epigastric area exacerbation after a meal high in fat
O- guarding as pain becomes severe, + Murphy’s sign (severe pain with deep inspiration at the right subcostal region), may have fever and diminished bowel sounds

72
Q

What lab findings would you expect to see with acute cholecystitis?

A

-Elevated WBC- up to 15,000
-Alkaline phosphatase elevated
-Elevated bilirubin

73
Q

What is the gold standard lab test for diagnosis of pancreatitis? What other labs would be elevated on the first day of acute symptoms?

A

-Elevated serum amylase level, also lipase would be elevated

74
Q

What lab diagnostics can be used for pancreatitis?

A

-Amylase (gold standard)
-Lipase level- also elevated
-WBC between 12000-20,000

75
Q

What is the clinical presentation of chronic pancreatitis?

A

S- abdominal pain in left epgastric area or LUQ, weight loss, diarrhea, indigestion, nausea, vomiting, pain is exacerbated by food or alcohol
O- mild-moderate epigastric tenderness with no rebound tenderness or guarding

76
Q

What are the guidelines for colon cancer screening?

A

If average risk: Starting at age 45 - Colonoscopy every 10 years (gold standard), FIT annually if they decline, or flex sig every 5-10 years, CT colon every 5 years, hemmocult every 3 years
If high risk (close family relative with colerectal CA before age 60)- colonoscopy every 5 years starting at age 40

77
Q

What is the clinical presentation for diverticular disease?

A

S- LLQ pain, pain is worse after eating, pain relieved with BM or flatus, fever/chills/tachycardia if inflamed
O- LLQ tenderness, possible firm mass, guarding, rigidity

78
Q

How would you manage a patient with an incidental finding of uncomplicated diverticular disease?

A

No further intervention but can be managed with a high-fiber diet or daily fiber supplements with psyllium

79
Q

Should a patient with ulcerative colitis be encouraged to eat high fiber foods such as raw fruit and veggies?

A

No, raw fruit and veggies or foods high fiber can cause trauma to the already inflamed mucosal surface

80
Q

Should a patient with Crohn’s disease be encouraged to eat high fiber foods such as whole grain bread and pumpkin seeds?

A

No, a patient with Crohn’s should be encouraged to eat a low-residue diet and avoids foods high in fiber; patient should consume canned fruit and vegetables and only white breads

81
Q

Should a person with IBS slowly increase their fiber intake to 20-30 g/day?

A

Yes, fiber helps to prevent excessive hydration or dehydration of stool

82
Q

Clinical presentation of ulcerative colitis

A

S: Mild case- 4 or less loose stools per day associated with abdominal cramps relieved by defecation; stools may have small amount of blood and mucous present, tenesmus also present
More severe cases- 6 or more loos stools a day that contain blood and mucus; also may have systemic symptoms such as tachycardia, fever, weight loss, and edema
O- tenderness in LLQ or diffuse with guarding and abdominal distention

83
Q

Pharmacological treatment for ulcerative colitis

A

-Anti-diarrheals for more mild cases (Lomotil/Imodium)
-Topical mesalamine for disease limited to rectosigmoid area
-Steroid enemas at night for 2 weeks
-PO 5-ASA medications (Azulfidine) can help to maintain remission

84
Q

Non-pharmacological treatments for ulcerative colitis

A

-Nutrition counseling: avoid caffeine, raw fruits and vegetables, and other foods high in fiber
-Lactose-free diet for some patients
-Bland diet high in calories and protein but low in fat to help prevent diarrhea

85
Q

Clinical presentation for Crohn’s disease

A

S- abdominal cramping and tenderness, fever, anorexia, weight loss, flatulence, RLQ pain or mass; increased Sx when stressed; sometimes has blood in the stool and stools are frequently soft or semi-liquid
O- abdominal tenderness with tubular, tender mass in the RLQ, perianal fissures

86
Q

Pharmacological treatment for Crohn’s disease

A

-Sulfasalazine (Azulfidine)- this has many side effects and efficacy is questionable
-Glucocorticoids- prednisone 40-60 mg /day for initial treatment
-Metronidazole for treatment if intolerant to azulfidine
-Immunomodulating agents such as Humira/Remicade

87
Q

Non-pharmacological treatment for Crohn’s disease

A

-Low residue diet and avoid foods high in fiber, including whole grain bread and fresh fruit and vegetables, seeds, and nuts

88
Q

What medications should NOT be used in the treatment of Crohns or severe UC?

A

Anticholinergics and antidiarrheal medications due to the risk of ileus or megacolon; antidiarrheals are OK with caution in more mild cases of UC

89
Q

Differentiate between the different GI diagnosis: IBS, Crohn’s, Ulcerative Colitis, and Diverticulosis

A

IBS- a functional GI disorder, characterized by abdominal pain and change in bowel habit that is either diarrhea alone or diarrhea with constipation
Crohn’s- patchy inflammation of the bowel wall involving any portion of the GI tract from mouth to anus; abdominal cramping and tenderness, fever, anorexia, weight lloss, flatulance, RLQ mass
UC- involves inflammation and infiltration of WBCs of only the mucosal surface of the colon which results in bleeding and erosions; loose bowel movements and pain relieved by defecation
Diverticulitis- when the outpouchings of the intestinal wall become inflamed or bleed; patients can be febrile with chills, tachycardia, nausea, vomiting

90
Q

What is a direct inguinal hernia?

A

when the transversus abdominis & internal oblique muscles are attached, caused by increased abdominal pressure to the area; 25% of hernias are this

91
Q

What is an indirect inguinal hernia?

A

The tissue herniates through the internal inguinal ring, which in men extends the length of the spermatic cord

92
Q

What is a femoral hernia?

A

Hernia that occurs at the fossa ovalis where the femoral artery exits from the abdomen

93
Q

Clinical presentation for direct inguinal hernia

A

-Many are asymptomatic
Painless and easily reducible
-Hernia bulges anteriorly during examination

94
Q

Clinical presentation for inguinal hernia

A

May have pain or bulge; Soft swelling within the internal ring that often descends within the scrotum

95
Q

What type of abdominal hernia is the most common?

A

Indirect inguinal hernia

96
Q

What does the DSM V criteria for major depressive disorder require?

A

Five or more symptoms including at least one depressed mood or loss of interest present in the same two weeks and present nearly everyday

97
Q

Which treatment option for major depressive disorder has fewer sexual side effects?

A

Buproprion

98
Q

A 45-yr-old obese woman presents with severe pain and tenderness in the RUQ with nausea, vomiting, and a fever. + Murphy’s sign. What is the most likely diagnosis?

A

Cholecystitis

99
Q

A 46-yr-old M complains of dysphagia, hoarseness, and a cough. He states he wakes up with a sour taste in his mouth. What is the most likely diagnosis?

A

GERD

100
Q

What is the best recommendation to reduce the incidence of diverticular disease?

A

Increase amount of fiber in diet

101
Q

What is chronic hepatitis?

A

elevation in AST and ALT levels for more than 6 months; occurs frequently in infants with HBV

102
Q

What are the symptoms of hepatitis?

A

Abrupt or insidious onset: anorexia, N/V, malaise, URI, fever, abdominal pain
Later- jaundice, dark urine, light-colored stools

103
Q

What is the gold standard lab test for diagnosis of acute Hepatitis A?

A

detection of IgM

104
Q

Lab tests to draw if expecting cirrhosis or hepatitis?

A

AST/ALT, bilirubin, alkaline phosphatase (elevated), WBC (normal or low)

105
Q

What is the DSM-5?

A

A descriptive manual of mental health disorders authorized by the American Psychiatric Association; it provides the diagnostic criteria for each mental disorder

106
Q

What symptom would you not expect from a patient with typical GERD symptoms? What are some expected symptoms?

A

Weight loss; expected findings are hoarseness, cough, chronic pharyngitis

107
Q

Lab tests to draw if expecting cirrhosis or hepatitis?

A

AST/ALT, bilirubin, alkaline phosphatase (elevated), WBC (normal or low)

108
Q

What are some differential diagnosis for partial esophageal obstruction?

A

Esophageal cancer, esophageal stricture, esophagitis

109
Q

What symptom would you not expect from a patient with typical GERD symptoms? What are some expected symptoms?

A

Weight loss; expected findings are hoarseness, cough, chronic pharyngitis

110
Q

What are some anticipated clinical findings for a patient with acute appendicitis?

A

2-hour history of sudden onset vomiting and generalized abdominal pain accompanied by. a fever

111
Q

What is the most helpful imaging study for a diagnosis of appendicitis?

A

Abdominal CT with contrast

112
Q

Patient has the following lab results: HBsAg= +, Anti-HAV= positive, Anti-HCV= negative, AST 56, ALT 98. What is the likely diagnosis?

A

Chronic hepatitis B due to positive HBsAG and mildly elevated liver function tests (these would be very elevated if acute); patient has evidence of hepatitis A immunity

113
Q

What is the recommended screening guidelines for Hep C?

A

All adults 18-79 should be screened regardless of risk factors

114
Q

What is the most common diagnostic screening tool used for anxiety?

A

GAD-7 from Pfizer

115
Q

What is the most common diagnostic screening tool used for depression?

A

PHQ-9 from Pfizer

116
Q

When should you do a stool culture on someone that presents with gastroenteritis

A

If the patient has severe diarrhea, a fever of 101.3 or higher, bloody stools, or stools that test positive for leukocytes or occult blood

117
Q

Medications that treat diarrhea

A

Pepto-Bismol, loperamide (Imodium), and diphenoxylate with atropine (Lomotil)

118
Q

When should a patient with hepatitis follow up?

A

If HCV- refer to hepatology due to high risk of chronic infection
HAV- often no follow-up needed
HBV- 1 month and blood draw for HBsAg after 6 months; if elevation is persistent– refer to hepatology

MVU Adult 2 (4 decks)

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