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Psychiatry 200 > General > Flashcards

General Flashcards

1
Q

Workup for dementia

A

CBC w/ diff; electrolytes; BUN; creatinine; B12; folate; VDRL; calcium, magneisium, phosphorus; UA; ESR; urine tox; TSH; LFTs; ECG; chest xray

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2
Q

Focal neurologic deficits found, you then do

A

Noncontrast head CT

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3
Q

Most common forms of dementia

A
  1. Alzheimer’s
  2. Vascular

Both account for 70-80% of all dementias

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4
Q

MDD w/ psychotic features

A

> 2 weeks depressive symptoms + psychosis (delusions)

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5
Q

Somatization disorder characterized by

A

Somatic complaints as well as least one neurologic and pain symptoms

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6
Q

Drugs mimicking SCZ

A

cocaine, PCP, or amphetamines

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7
Q

SSRI side effects

A

diarrhea, constipation, insomnia, nausea, headache, sexual dysufnciton, and agitation

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8
Q

Adjustment disorder

A

Onset of emotional or behavioral disturbances within 3 mos. of a significant life event. Disturbances are not as severe as MDD. Typically doesn’t have the neurovegetative signs of depression.

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9
Q

Acute stress disorder

A

Diagnosed when a patient has dissociative experiences and anxities. PTSD has rexperiencing

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10
Q

First line agent for panic disorder

A

SSRIs

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11
Q

Propranolol for what anxiety disorder

A

Social phobia

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12
Q

Mild mental retardation IQ

A

50-70

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13
Q

Moderate MR IQ

A

35-49

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14
Q

Severe MR IQ

A

20-34

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15
Q

Profound MR IQ

A

<20

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16
Q

Test what before starting Pimozide

A

ECG: can lengthen QT interval and lead to vent. arrythmias

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17
Q

Neurologic disease that can cause stereotypies

A

Epilepsy during complex partial seizures

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18
Q

Amphetamine toxicosis

A

Seizures…but possibly stereotypies

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19
Q

Neurosyphilis symptoms

A

Tabes dorslis and general paresis: wide based gait, positive Rombergs, loss of vibratory and proprioceptive senses initially in lower extremities.

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20
Q

Argyll-Robertson pupil

A

Accomodate but don’t react: Prost Pupils

Neurosyphilis

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21
Q

Syphilis tests

A

VDRL

Fluorescent treponemal antibody absorption test (FTA-ABS)

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22
Q

Hyperthyroidism

A

Depressive, hypomanic, and cognitive features:

Fine 8-12 Hz tremor
Lid lag, brisk deep tendon reflexes, proximal myopathy with muscle wasting, myalgias, hot flashes, insensitivity to heat

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23
Q

Hypoglycemia delirium

A

tachycardia, tremor, hypertension, and seizure

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24
Q

Workout up delirium

A

Same as for dementia +peripheral O2 sat, and mental status and physical exam

Dementia: CBC w/ diff; electrolytes; BUN; creatinine; B12; folate; VDRL; calcium, magneisium, phosphorus; UA; ESR; urine tox; TSH; LFTs; ECG; chest xray

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25
Q

Cocaine withdrawal

A

Fatigue, dysphoric mood with SI, increased appetite, insomnia or hypersomnia, unpleasant dreams, psychomotor agitation or retardation

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26
Q

MDMA effects

A

Enhanced perception/sensation, increased HR, hypertension, dilated pupils, trismus, bruxism, hyperthermia, diaphoresis

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27
Q

Best way to ascertain alcoholism

A

Ask family and friends

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28
Q

GAD definition

A

Excessive anxiety or worry for >6 months

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29
Q

GAD symptoms

A

Restless, fatigue, irritable, muscle tension, difficulty concentrating, sleep disturbance

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30
Q

Panic vs. GAD

A

Panic comes in earlier b/c they think they’re going to die or choke

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31
Q

Separation anxiety onset

A

before age 18

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32
Q

Wernicke encephalitis

A

ACE: Ataxia, Confusion, and Eye movement findings

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33
Q

Alcoholic cerebellar degeneration

A

Gait and stance problems but no arm ataxia or nystagmus

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34
Q

Subacute combined degeneration

A

B12 deficiency
Demyelination and axonal degeneration of the peripheral nerves, posterior and lateral columns, and cerebrum
Cognitive impairment, diminished position and vibration sense, and abnormal gait

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35
Q

Alcoholic peripheral neuropathy

A

Sensory peripheral neuropathy: alcohol directly causes axonal damage

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36
Q

NPH

A

Classic triad: Incontinence, dementia (confusion), gait ataxia

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37
Q

Can dysthymia and adjustment disorder have delusions

A

NO, they don’t get as intense as MDD

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38
Q

Heritability of BAD

A

Mono twin has 80-90% risk

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39
Q

Cataplexy

A

Sudden dramatic loss of muscle tone following an intense emotional reaction

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40
Q

Narcolepsy vs. Idiopathic hypersomnolence

A

Naps in narcolepsy are short and refreshing, unlike in IH

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41
Q

Thioridazine

A

Atypical typical, watch out for delirium due to ACh effects, you’d get less EPS than Haldol

Can lead to retinopathy

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42
Q

Kluver-Bucy Syndrome

A

syndrome resulting from bilateral lesions of the anterior temporal lobe (including amygdaloid nucleus).[1] Klüver–Bucy syndrome may present with hyperphagia, hypersexuality, hyperorality, visual agnosia, and docility.

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43
Q

Anticonvulsants and Blood Dyscrasias

A

Lithium isn’t really associated, can cause a benign leukocytosis

Carbamazepine: Commonly reduces WBCs, can cause agranulocytosis 1 in 10000

Depakote: Agranulocytosis can happen but rare. More common thrombocytopenia

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44
Q

Antipsychotics and Blood Cells

A

Can cause a decrease in leukopoeisis which normalizes.

Agranulocytosis 1 in 10,000, more for clozapine

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45
Q

Somatization disorder and Gender

A

Women get it 20:1 over men

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46
Q

Strongest cause of relapse into psychosis

A

Medication noncompliance….then stress or viral illness

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47
Q

Alcoholic hepatitis liver enzyme ratio

A

AST:ALT >2:1

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48
Q

Buspirone MOA

A

5HT1a partial agonist with anxiolytic effects

49
Q

Mortality rate for anorexia

A

5-20%

50
Q

How long before getting diagnosed with dysthymia?

A

2 years

51
Q

Anticholinergic toxicity caused most by….

A

Low potency agents like Chlorpromazine and thioridazine and TCAs amitriptyline and imipramine

52
Q

Atropine MOA

A

antimuscarinic

53
Q

Anticholinesterase toxicity

A

N/V, bradycardia, seizures

54
Q

AChE toxicity tx

A

Atropine

55
Q

Do antipsychotics lower the seizure threshold?

A

yes they can

56
Q

Tertiary amine TCAs and MOA

A

Amitriptyline, chlomipramine, doxepin, imipramine, trimipramine.

5HT reuptake blocking more than NE

57
Q

Secondary amine TCAs and MOA

A

Desipramine, nortriptyline, and protriptyline

NE primarily

58
Q

Inhalant Intoxication signs

A

Visual disturbances, dyscoordination, depressed relfexes, euphoria, and nystagmus

59
Q

Staring into space and euphoria…what drug?

A

PCP

60
Q

Hair loss for what anticonvulsant?

A

Depakote

61
Q

Common side effects of Depakote?

A

N/V, indigestion

Sedation
Mildly elevated LFTs

62
Q

Hair loss with carbamazepine, clozapine, olanzapine, or geodon?

A

nope!

63
Q

If a young guy is having delusions/hallucinations for at least a month, they have…

A

SCZ

64
Q

Nicotine toxicity sxs

A

Confusion, muscle twitching, weakness, abdominal cramps, depression, palpitations, coma, and respiratory failure.

65
Q

Hallucinogens are more stimulant or depressant like?

A

Stimulant-like, elevated vital signs and increased activity

66
Q

Tx for hypertensive crisis with MAOI

A

Alpha-blocker: e.g. prazosin

more effective than beta-blockers or CCBs

67
Q

Seizures and Galactorrhea and Clozapine

A

Increased seizure risk

No effect on prolactin so no galactorrhea

68
Q

Phenytoin oral symptom

A

Gingival hyperplasia

69
Q

Phenytoin Side effects

A

Nystagmus, dizziness, slurred speech, ataxia, mental confusion, decreased coordination

70
Q

Lithium birth defect

A

Ebstein Anomaly: 7.7%

71
Q

Attention vs. Concentration and examples of tests

A

Attention is the ability to focus one’s perception on an outside or inside stimulus.
e.g. Spelling word backwards

Concentration is sustained attention to an internal thought process.
e.g. Serial 7s

72
Q

amok

A

Malay Man starts attacking people for no reason, likely wants to be killed since Islam forbids suicide

73
Q

Four types of EPS effects

A

Acute dystonic reactions, akathisia, pseudoparkinsonism, and TD

74
Q

How to treat EPS

A

Reducing Dose
Try a low-potency agent
Add antiparkinsonian drug

75
Q

Amantadine’s use in psychiatry?

A

Can help relieve EPS sxs

76
Q

Ganser syndrome

A

Patient answers are approximate or ridiculous

Often confused with malingering

Primarily in the prison population

77
Q

Tx for Elderly person with high risk of suicide from MDD and medical contraindications to medicine

A

ECT

78
Q

Atypical Depressive Symptoms

A

Mood Reactivity

AND

2/4 features: increased appetite or weight gain, hypersomnia, leaden paralysis, and rejection sensitivity

79
Q

Melancholic depression features

A

Loss of interest or pleasure in all or almost all activities or a lack of reactivity to usually pleasurable stimuli

80
Q

What is Catalepsy?

A

Assuming an immobile position that is constantly maintained.

81
Q

Pregnancy antidepressants

A

Fluoxentine can be used…anything else?

82
Q

Most important step in treating NMS

A

Discontinue the offending med

83
Q

Tests before Lithium

A

TSH, CBC, electrolytes, ECG, renal function studies….

84
Q

Lithium-induced polyuria is from

A

Inhibition of ADH

85
Q

Serotonin Syndrome Features

A

Abdominal Pain, diarrhea, diaphoresis, hyperpyrexia, tachycardia, hypertension, myoclonus, irritability, agitation, seziures, delirium

86
Q

Fluoxetine clearance time

A

Up to 6 weeks

87
Q

Bereavement

A

MDD symptoms that begin within 2 months of the loss and do not persist beyond the 2-month period

88
Q

Complicated bereavement

A

Chronic and Unremitting distress

89
Q

Bereavement tx

A

Don’t give them anything, it won’t make the pain go away any earlier

90
Q

Purest Serotonin Antidepressant

A

Citalopram

91
Q

Fluoxetine half-life

A

7 Days

92
Q

What is Hallucinosis?

A

Hallucination in a patient who is completely alert and oriented

93
Q

Where you do most commonly see Hallucinosis?

A

Alcohol withdrawal or chronic alcohol abuse.

94
Q

How do dysthymia and MDD differ?

A

Dysthymia will have similar neurovegetative symptoms, but it is just less in severity and must be for >2 years.

95
Q

What is Palilalia?

A

When you repeat your own word because you are stuck on it.

96
Q

What is Parapraxis?

A

A slip of the tongue

97
Q

Choreiform movements are…

A

Involuntary, irregular, and jerky but lack the ballistic-like nature of hemiballismus

98
Q

Hemiballismus is…

A

Uncontrolled swinging of an extremity. usually sudden, and once initiated it cannot be controlled

99
Q

Athetoid movements are…

A

Slow, snake-like movements of the fingers and hands

100
Q

Testamentary capacity requires ALL 5 of the following…

A

1) Understanding the nature of the will
2) Knowledge of one’s assets
3) Knowledge of natural heirs
4) Absence of acute psychosis which might compromise rational decision making
5) Freedom from undue influence or coercion

101
Q

3 exceptions to informed consent

A

1) Emergency situations
2) Waiver of informed consent
3) Situations where disclosure would harm the patient (seldom used)`

102
Q

Memantine is a…

A

NMDA receptor antagonist, used for Alzheimer

103
Q

Galantamine is a…

A

AChE inhibitor for Alzheimer

104
Q

First thing to use for atypical depression…

A

Try an SSRI first, if that doesn’t work then move to an MAOI (because of side effect profiles)

105
Q

First thing to do when someone comes in Crazy

A

Get a Urine Tox Screen to look for an exogenous cause

106
Q

A recovering alcoholic needs something to sleep, give him…

A

Trazodone, don’t want something that touches his GABA receptors

107
Q

Three components of Pervasive Developmental Disorders

A

1) Language
2) Social Interaction
3) Stereotypical behaviors

108
Q

Worst/Best Predictor for Suicidality

A

Prior suicide attempts???

Patients with past attempts are the worst risk factor, those with no prior attempts are good sign.

109
Q

Primary Vs. Secondary Enuresis

A

Primary enuresis means the patient has never achieved complete continence.

Secondary means the child had continence for over a year and then lose it.

110
Q

Encopresis is…

A

Voluntarily or Involuntarily shitting yourself when you were once continent

111
Q

Facies of Fetal Alcohol Syndrome

A

Microcephaly, short palpebral fissures, flat midface, and thin upper lip`

112
Q

Atypical depression symptoms

A

1) Mood Reactivity
2) Rejection Hypersensitivity
3) Hypersomnolence
4) Increased Appetite
5) Lead Pipe Psychomotor retardation

113
Q

Personality disorder NOS is…

A

When you have traits from numerous syndromes and don’t fit into one perfectly, commonly seen in clinical practice

114
Q

Required for SAD diagnosis

A

Period of 2 weeks of psychotic symptoms w/o affective symptoms

115
Q

Definitions:

  1. Type I Error
  2. Type II Error
  3. Standard Error
  4. Positive predictive value
  5. Negative predictive value
A
  1. Type 1: False positive
  2. Type 2: False negative
  3. Degree to which the means of several different samples would vary if they were taken repeatedly from the same population
  4. Proportion of abnormal test results that are true positive
  5. Proportion of normal test results that are true negative
116
Q

Describe Tardive Dyskinesia

A

Perioral or limb musculature Choreiform movements

117
Q

Personality disorders and PTSD

A

Increase the risk of acquiring PTSD

118
Q

Complex Partial Epilepsy and Psychosis

A

20% with complex partial epilepsy experience psychotic features at some time

Psychiatry 200 (5 decks)

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