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
2
Q
Focal neurologic deficits found, you then do
A
Noncontrast head CT
3
Q
Most common forms of dementia
A
- Alzheimer’s
- Vascular
Both account for 70-80% of all dementias
4
Q
MDD w/ psychotic features
A
> 2 weeks depressive symptoms + psychosis (delusions)
5
Q
Somatization disorder characterized by
A
Somatic complaints as well as least one neurologic and pain symptoms
6
Q
Drugs mimicking SCZ
A
cocaine, PCP, or amphetamines
7
Q
SSRI side effects
A
diarrhea, constipation, insomnia, nausea, headache, sexual dysufnciton, and agitation
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.
9
Q
Acute stress disorder
A
Diagnosed when a patient has dissociative experiences and anxities. PTSD has rexperiencing
10
Q
First line agent for panic disorder
A
SSRIs
11
Q
Propranolol for what anxiety disorder
A
Social phobia
12
Q
Mild mental retardation IQ
A
50-70
13
Q
Moderate MR IQ
A
35-49
14
Q
Severe MR IQ
A
20-34
15
Q
Profound MR IQ
A
<20
16
Q
Test what before starting Pimozide
A
ECG: can lengthen QT interval and lead to vent. arrythmias
17
Q
Neurologic disease that can cause stereotypies
A
Epilepsy during complex partial seizures
18
Q
Amphetamine toxicosis
A
Seizures…but possibly stereotypies
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.
20
Q
Argyll-Robertson pupil
A
Accomodate but don’t react: Prost Pupils
Neurosyphilis
21
Q
Syphilis tests
A
VDRL
Fluorescent treponemal antibody absorption test (FTA-ABS)
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
23
Q
Hypoglycemia delirium
A
tachycardia, tremor, hypertension, and seizure
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
25
Cocaine withdrawal
Fatigue, dysphoric mood with SI, increased appetite, insomnia or hypersomnia, unpleasant dreams, psychomotor agitation or retardation
26
MDMA effects
Enhanced perception/sensation, increased HR, hypertension, dilated pupils, trismus, bruxism, hyperthermia, diaphoresis
27
Best way to ascertain alcoholism
Ask family and friends
28
GAD definition
Excessive anxiety or worry for >6 months
29
GAD symptoms
Restless, fatigue, irritable, muscle tension, difficulty concentrating, sleep disturbance
30
Panic vs. GAD
Panic comes in earlier b/c they think they're going to die or choke
31
Separation anxiety onset
before age 18
32
Wernicke encephalitis
ACE: Ataxia, Confusion, and Eye movement findings
33
Alcoholic cerebellar degeneration
Gait and stance problems but no arm ataxia or nystagmus
34
Subacute combined degeneration
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
35
Alcoholic peripheral neuropathy
Sensory peripheral neuropathy: alcohol directly causes axonal damage
36
NPH
Classic triad: Incontinence, dementia (confusion), gait ataxia
37
Can dysthymia and adjustment disorder have delusions
NO, they don't get as intense as MDD
38
Heritability of BAD
Mono twin has 80-90% risk
39
Cataplexy
Sudden dramatic loss of muscle tone following an intense emotional reaction
40
Narcolepsy vs. Idiopathic hypersomnolence
Naps in narcolepsy are short and refreshing, unlike in IH
41
Thioridazine
Atypical typical, watch out for delirium due to ACh effects, you'd get less EPS than Haldol
Can lead to retinopathy
42
Kluver-Bucy Syndrome
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.
43
Anticonvulsants and Blood Dyscrasias
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
44
Antipsychotics and Blood Cells
Can cause a decrease in leukopoeisis which normalizes.
Agranulocytosis 1 in 10,000, more for clozapine
45
Somatization disorder and Gender
Women get it 20:1 over men
46
Strongest cause of relapse into psychosis
Medication noncompliance....then stress or viral illness
47
Alcoholic hepatitis liver enzyme ratio
AST:ALT >2:1
48
Buspirone MOA
5HT1a partial agonist with anxiolytic effects
49
Mortality rate for anorexia
5-20%
50
How long before getting diagnosed with dysthymia?
2 years
51
Anticholinergic toxicity caused most by....
Low potency agents like Chlorpromazine and thioridazine and TCAs amitriptyline and imipramine
52
Atropine MOA
antimuscarinic
53
Anticholinesterase toxicity
N/V, bradycardia, seizures
54
AChE toxicity tx
Atropine
55
Do antipsychotics lower the seizure threshold?
yes they can
56
Tertiary amine TCAs and MOA
Amitriptyline, chlomipramine, doxepin, imipramine, trimipramine.
5HT reuptake blocking more than NE
57
Secondary amine TCAs and MOA
Desipramine, nortriptyline, and protriptyline
NE primarily
58
Inhalant Intoxication signs
Visual disturbances, dyscoordination, depressed relfexes, euphoria, and nystagmus
59
Staring into space and euphoria...what drug?
PCP
60
Hair loss for what anticonvulsant?
Depakote
61
Common side effects of Depakote?
N/V, indigestion
Sedation
Mildly elevated LFTs
62
Hair loss with carbamazepine, clozapine, olanzapine, or geodon?
nope!
63
If a young guy is having delusions/hallucinations for at least a month, they have...
SCZ
64
Nicotine toxicity sxs
Confusion, muscle twitching, weakness, abdominal cramps, depression, palpitations, coma, and respiratory failure.
65
Hallucinogens are more stimulant or depressant like?
Stimulant-like, elevated vital signs and increased activity
66
Tx for hypertensive crisis with MAOI
Alpha-blocker: e.g. prazosin
more effective than beta-blockers or CCBs
67
Seizures and Galactorrhea and Clozapine
Increased seizure risk
No effect on prolactin so no galactorrhea
68
Phenytoin oral symptom
Gingival hyperplasia
69
Phenytoin Side effects
Nystagmus, dizziness, slurred speech, ataxia, mental confusion, decreased coordination
70
Lithium birth defect
Ebstein Anomaly: 7.7%
71
Attention vs. Concentration and examples of tests
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
amok
Malay Man starts attacking people for no reason, likely wants to be killed since Islam forbids suicide
73
Four types of EPS effects
Acute dystonic reactions, akathisia, pseudoparkinsonism, and TD
74
How to treat EPS
Reducing Dose
Try a low-potency agent
Add antiparkinsonian drug
75
Amantadine's use in psychiatry?
Can help relieve EPS sxs
76
Ganser syndrome
Patient answers are approximate or ridiculous
Often confused with malingering
Primarily in the prison population
77
Tx for Elderly person with high risk of suicide from MDD and medical contraindications to medicine
ECT
78
Atypical Depressive Symptoms
Mood Reactivity
AND
2/4 features: increased appetite or weight gain, hypersomnia, leaden paralysis, and rejection sensitivity
79
Melancholic depression features
Loss of interest or pleasure in all or almost all activities or a lack of reactivity to usually pleasurable stimuli
80
What is Catalepsy?
Assuming an immobile position that is constantly maintained.
81
Pregnancy antidepressants
Fluoxentine can be used...anything else?
82
Most important step in treating NMS
Discontinue the offending med
83
Tests before Lithium
TSH, CBC, electrolytes, ECG, renal function studies....
84
Lithium-induced polyuria is from
Inhibition of ADH
85
Serotonin Syndrome Features
Abdominal Pain, diarrhea, diaphoresis, hyperpyrexia, tachycardia, hypertension, myoclonus, irritability, agitation, seziures, delirium
86
Fluoxetine clearance time
Up to 6 weeks
87
Bereavement
MDD symptoms that begin within 2 months of the loss and do not persist beyond the 2-month period
88
Complicated bereavement
Chronic and Unremitting distress
89
Bereavement tx
Don't give them anything, it won't make the pain go away any earlier
90
Purest Serotonin Antidepressant
Citalopram
91
Fluoxetine half-life
7 Days
92
What is Hallucinosis?
Hallucination in a patient who is completely alert and oriented
93
Where you do most commonly see Hallucinosis?
Alcohol withdrawal or chronic alcohol abuse.
94
How do dysthymia and MDD differ?
Dysthymia will have similar neurovegetative symptoms, but it is just less in severity and must be for >2 years.
95
What is Palilalia?
When you repeat your own word because you are stuck on it.
96
What is Parapraxis?
A slip of the tongue
97
Choreiform movements are...
Involuntary, irregular, and jerky but lack the ballistic-like nature of hemiballismus
98
Hemiballismus is...
Uncontrolled swinging of an extremity. usually sudden, and once initiated it cannot be controlled
99
Athetoid movements are...
Slow, snake-like movements of the fingers and hands
100
Testamentary capacity requires ALL 5 of the following...
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
3 exceptions to informed consent
1) Emergency situations
2) Waiver of informed consent
3) Situations where disclosure would harm the patient (seldom used)`
102
Memantine is a...
NMDA receptor antagonist, used for Alzheimer
103
Galantamine is a...
AChE inhibitor for Alzheimer
104
First thing to use for atypical depression...
Try an SSRI first, if that doesn't work then move to an MAOI (because of side effect profiles)
105
First thing to do when someone comes in Crazy
Get a Urine Tox Screen to look for an exogenous cause
106
A recovering alcoholic needs something to sleep, give him...
Trazodone, don't want something that touches his GABA receptors
107
Three components of Pervasive Developmental Disorders
1) Language
2) Social Interaction
3) Stereotypical behaviors
108
Worst/Best Predictor for Suicidality
Prior suicide attempts???
Patients with past attempts are the worst risk factor, those with no prior attempts are good sign.
109
Primary Vs. Secondary Enuresis
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
Encopresis is...
Voluntarily or Involuntarily shitting yourself when you were once continent
111
Facies of Fetal Alcohol Syndrome
Microcephaly, short palpebral fissures, flat midface, and thin upper lip`
112
Atypical depression symptoms
1) Mood Reactivity
2) Rejection Hypersensitivity
3) Hypersomnolence
4) Increased Appetite
5) Lead Pipe Psychomotor retardation
113
Personality disorder NOS is...
When you have traits from numerous syndromes and don't fit into one perfectly, commonly seen in clinical practice
114
Required for SAD diagnosis
Period of 2 weeks of psychotic symptoms w/o affective symptoms
115
Definitions:
1. Type I Error
2. Type II Error
3. Standard Error
4. Positive predictive value
5. Negative predictive value
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
Describe Tardive Dyskinesia
Perioral or limb musculature Choreiform movements
117
Personality disorders and PTSD
Increase the risk of acquiring PTSD
118
Complex Partial Epilepsy and Psychosis
20% with complex partial epilepsy experience psychotic features at some time
