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Psychiatry Clerkship > High Yield-Emma Holliday > Flashcards

High Yield-Emma Holliday Flashcards

1
Q

medications to avoid in a manic pt?

A

-SSRIs and TCAs (can trigger mania)

-Haloperidol or clonazepam for acute agitations or delusions
AND
Lithium, valproic acid or carbamazepine for maintenance

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2
Q

pt takes Advil and develops n/v/d, coarse tremor, ataxia, confusion, slurred speech. What drug toxicity?

A

lithium –> precipitated by nsaids. Better pain meds are aspirin or sulindac

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3
Q

major SEs of Lithium? Therapeutic levels? What should you monitor?

A
  • Weigh gain and acne, GI irritation, cramps
  • 0.6-1.2
  • Monitor Li levels q4-8 wks, TFTs q6mo, Cr, UA, CBC, EKG
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4
Q

Teratogenicity of Lithium?

A

Ebsteins anomaly

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5
Q

preferred tx for bipolar in preggos?

A

clonazepam, esp 1st tri

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6
Q

bipolar + elevated LFTs and hepatitis?

A

Valproate. Also can cause n/v/d, skin rash

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7
Q

bipolar + SJS?

A

Lamotrigine

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8
Q

Bipolar + Agranulocytosis?

A

carbamazepine. Check CBC regularly

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9
Q

Bipolar + increased AFP in a 20 wk preggo?

A

valproate or carbamazepine

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10
Q

MC complication of carbamazepine? Therapeutic levels?

A

rash

60-120

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11
Q

therapeutic levels of valproate?

A

6-12

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12
Q

most important question to ask for someone with MDD?

A

assess for SI

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13
Q

RF’s for suicide?

A 
Prior attempt
> 45 y/o
White male
serious illness
detailed plan
no support/lack of support
ethos/drugs
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14
Q

Pt who is eating more, gaining weight, sleeping more and has leaden paralysis in the morning?

A

atypical depression –> hypersensitive to rejection, can affect social fxning
Tx with MAOIs

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15
Q

1 mo after death of her child, mom feels guilty, can’t sleep, concentrate, eat, or enjoy interests?

A

uncomplicated bereavement –> No SI, no psychosis, rarely tx w/antidepressants for sxs

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16
Q

4 mos after death of her dog, a woman still feels guilt, can’t sleep, concentrate, or enjoy her interests?

A

adjustment d/o –> sxs within 3 mo of stressor out of proportion. can’t persist longer than 6 mo. best tx with psychotherapy

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17
Q

which SSRI do you not have to taper when stopping?

A

Fluoxetine

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18
Q

HA, n/v/d, dizziness and fatigue when stopping SSRI suddenly?

A

5HT discontinuation syndrome. MC with sertraline and fluvoxamine

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19
Q

Myoclonic jerks, tachycardia, high BP, hyperreflexia, n/v/d in pt being tx for MDD?

A

5HT syndrome. If SSRI + MAOI

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20
Q

Tx for MDD if loss of erection, ejaculation?

A

switch to bupropion

NET DAT Ball Pro

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21
Q

Tx for MDD and boner for > 3 hrs, what drug?

Tx for MDD for old, skinny, sad ladies?

A

Trazodone

Mirtazepine

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22
Q

Pounding head, flushing, nausea, myoclonus after eating cheese, drinking red wine, taking decongestant or meperidine?

A

Hypertensive crisis w/ MAOI. Tx w/ 5 mg IV phentolamine

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23
Q

mc cause of death in someone who ODs on TCAs? Tx for reversal?

A

Arrhythmia –> torsades, v-fib, death

Activated charcoal if ingested w/in 1-2 hrs

Give IV NaHCO3

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24
Q

Patholophys of + sx in schizophrenia?

Pathophys of - sx in schizophrenia?

A

+ –> Excess DA in limbic area binding D2 receptors

  • –> decreased DA in prefrontal cx/mesocortical tract this is why typical antipsychotics make - sxs worse
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25
Q

Pt has delusions, hallucinations, and flattened affect for 3 wks? for 3 mos?

A
  • Brief psychotic d/o= >1 wk, <1 mo

- Schizophreniform d/o= >1 mo, <6 mo

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26
Q

Pt has had persecutory delusions for the past 3 yrs. 6 mo ago he started having sadness, guilt, insomnia, decreased concentration and SI?

A

Schizoaffective d/o –> hallucinations/delusions for >2 wks in absence of mood sx

Tx with atypical antipsychotics + SSRI if depression and + Lithium if manic

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27
Q

a pt has had MDD for 3 yrs and reports hearing voices telling him he is worthless and to kill himself

A

MDD with psychotic features –> Delusions are typically mood congruent

Tx with atypical antipsychotic + SSRI or ECT (esp preggos)

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28
Q

Man is convinced Miley Cyrus is in love with him but otherwise functional

A

delusional d/o

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29
Q

DOC for acute agitation or psychosis?

A

IM haloperidol

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30
Q

Low potency 1st gen antipsychotics? High potency?

A

low=Chlorpromazine and Thioridazine –> Less EPS, more Anticholinergic, Antihistamine, and alpha1 antagonism

High=Haloperidol and Fluphenazine –> More EPS

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31
Q

Antipsychotic drugs:
-Purple grey metallic rash over sun-exposed areas and jaundice?

-Prolonged QTc and pigmentary retinopathy?

A

chlorpromazine

thiodridazine

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32
Q

Pt wakes up with eyes “stuck” looking up or head “stuck” turned to the side?

A

Acute dystonia (<12 hrs)

tx w/ benztropine or diphenhydramine

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33
Q

pt report feeling like they “always have to move”?

A

Akathesia (30-90 days)

tx w/propanolol (1st line) or Benzo

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34
Q

Coarse resting tremor, masked facies, unsteady gait, bradykinesia?

A

Parkinsonism (>6 mo)

tx w/ benztropine/diphenhydramine, amantidine, or bromocriptine. NOT L-DOPA!!

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35
Q

After 10 yrs on fluphenazine, tongue movement, and grimacing?

A

Tardive dyskinesia (> years)

Tx by stopping antipsychotic and switch to atypical or clozapine

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36
Q

w/in hrs of a haloperidol injx, pt has increased CPK, T=103F, autonomic instability, and delirium?

A

NMS
1st-D/c med
2nd-Cooling blankets and dantroline

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37
Q

Atypical agent w/ highest risk for EPS and increased prolactin?

A

Risperidone (depot shot)

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38
Q

atypical agent weight neutral but prolongs QTc? weight neutral but increases akathisia?

A

ziprazodone

aripiprazole

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39
Q

atypical agent most assoc with weight gain? orthostasis and cataracts?

A

olanzapine

quetiapine

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40
Q

atypical agent good for tx-refractory schizophrenia?

A

clozapine

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41
Q

MC SE of clozapine? Most dangerous? How to monitor?

A

MC=Sedation, weight gain, increased blood sugar and lipids

Most dangerous=Agranulocytsosis, decrease seizure threshold

Monitor=CBC –> ANC q week for 6 mo and x2 wks for next 6 mo; D/c drug if ANC < 1500

42
Q

drug regimen of choice for panic attacks?

A

Alprazolam or clonazepam low dose PRN short term, but SSRIs are preferred drug
dont give benzos to addicts, COPDers, or restrictive lung disease

43
Q

A pt being tx for panic attack is brought in 3 mo after beginning tx with temp of 101, convulsions, confusion, and HTN. She recently lost her rx drug coverage.

A

Acute bzd withdrawal rxn. Similar to DTs

Tx w/diazepam or chlordiazepoxide + haloperidol if psychotic

44
Q

best tx for specific phobia?

A

Best tx is CBT w/ flooding or exposure/extinction. Can give bzd for situational use

45
Q

best tx for social phobia or fear of public speaking?

A

Best tx is propanolol to stop hyperarousal and benzo

46
Q

Gold standard tx for OCD?

A

Clomipramine is gold standard

SSRIs are 1st line

47
Q

tx for PTSD?

A

Sertraline or paroxetine. Combo w/ CBT. Prazosin for nightmares

48
Q

Time frame for PTSD? Acute stress rxn? What if similar sx to ASD but in response to a bad breakup?

A

PTSD= > 1 mo

ASD= 3 d-1 mo

Bad break up=Adjustment d/o

49
Q 
what lab abnormalities below in anorexia nervosa pt?
Vitals? 
CBC? 
Chemistry? 
Fasting lipid profile?
Hormones? 
Long term complications?
MC cause of death?
Tx? 
Complications of tx?
A

vitals=Hypotension, bradycarida, hypothermia
CBC=leukopenia
Chem=High HCO3, low Cl, low K, high carotene, high LFTs and amylase
Lipid=High cholesterol
Hormones=High cortisol, low LH/FSH, low estrogen
Long term comp=Osteoporosis
MC cause death=Heart disease then suicide
Tx=Admit them to max nutrition. SSRIs for bulimia but intensive counseling for anorexia
Complications=Re-feeding sx –> low PO4, low Mg, low Ca, and fluid retention

50
Q

what stage of sleep do you find sleep walking/talking/night terrors? Sk m paralysis?

A

stage 3-sleep walk/talk/night terrors

REM-sk m paralysis

51
Q

daytime sleepiness and depression in a big fat guy with a big neck?

A

obstructive sleep apnea. Dx with polysomnogram. Tx with CPAP to reduce pulm HTN

52
Q

Tx for narcolepsy?

A

scheduled naps and modafinil

53
Q

78 y/o F presents with memory loss…aphasia, apraxia, lost while driving? Pathology? Genes? Tx?

A

Alzheimers dementia
Global brain atrophy. B amyloid plaques or tau tangles
APP (chr 21), ApoE2
Tx with donepezil, rivastigmine, galantine, Memantine

54
Q

78 y/o F presents with memory loss..becomes more sexually explicit, apathetic? Pathology? Tx?

A

Frontotemporal dementia
Lobar atrophy. Intra-neuronal silver staining inclusions
Tx-olanzepine for severe disinhibition

55
Q

78 y/o F with memory loss…fluctuation in consciousness, visual hallucinations, and shuffling gait? Pathology? Tx?

A

lewy body dementia
Intra cytoplasmic a-synuclein inclusions in neocortex
Tx-AchEsterase inhibitors, not L-Dopa, avoid neuroleptics

56
Q

78 y/o F presents with memory loss…sudden stepwise decrease in memory/cognition?

A

vascular dementia

57
Q

78 y/o F presents with memory loss…loss of vibration sense, labile affect. pupils accommodate but don’t react? Dx? Tx?

A

tertiary syphilis

Dx=+ RPR, VDRL. Do spinal tap to look for spirochetes

Tx=IV penicillin

58
Q

78 y/o F with memory loss…myoclonus, startle response, seizures. Recently had a corneal transplant? Pathology? EEG findings?

A

CJD

Path-Spongiform encephalopathy

EEG-Triphasic bursts

59
Q

78 y/o F with memory loss…incontinence, gait disturbance/frequent falls, and rapidly developing dementia? Dx? Tx?

A

Normal pressure hydrocephalus

dx-CT/MRI shows hydrocephalus, spinal tap shows nl opening pressure

tx-Ventriculoperitoneal shunt improves cognitive fxn in 50-67% of pts

60
Q

best initial tx for etoh withdrawal pt?

A

diazepam or chlordiazepoxide b/c they have 80 and 120 hr 1/2 lives, respectively

61
Q

best tx for etoh witihdrawal in a pt wiho is cirrhotic?

A

Lorazepam, Oxazepam, or Temazepam (LOT)

62
Q

tx for wernicke encephalopathy?

A

thiamine 1st then glucose containing fluids

63
Q

best 1st step to tx a pt with heroin OD?

A

intubate pt. then give IV or IM naloxone

64
Q

What sxs in a pt withdrawing from heroin?

A

joint and muscle pain, photophobia, goosebumps, diarrhea, tachycardia, HTN, GI cramps, dilated pupils, anxiety/depression

65
Q

Pt presents with horizontal nystagmus, dilated pupils, ataxia, and acute psychosis?

A

PCP intoxication. Can use haloperidol for acute psychosis

66
Q

pt presents s/p MVC with injected conjunctiva, sedation, and asking for Doritos?

A

cannabis intox

67
Q

Pt presents with SI, hypersomnia, depression, and anergia (abnormal lack of energy)? Best 1st test? Tx of HTN and tachycardia?

A

cocaine/amphetamine intoxication

EKG then urine tox screen. Tx seizure with lorazepam

HTN and tachy-tx with CCB; B blockers contraindicated

68
Q

11 y/o boy with developmental delay, poor school and social performance, iq of 50, macrocephaly and macroorchidism?

A

Fragile X syndrom
X linked dominant
CGG repeats w/ anticipation
Cx=seizures, MVP, dilation of aorta, tremors, ataxia, ADHD-like behavior

MC cause of inherited MR

69
Q

Newborn baby with decreased tone, oblique palpebral fissures, simian crease, big tongue, white spots on iris? MC med complications?

A

Downs syndrome

Heart-VSD, endocardial cushion defects
GI-Hirschsprungs, intestinal atresia, imperforate anus, annular pancreas
Endocrine-Hypothyroidism
MSK-AA instability
Neuro-Incr risk of Alzheimers by 30-35 (APP on Chr 21)
Cancer-Incr risk of ALL

70
Q

Cafe au last spots, seizures, large head, AD?

A

neurofibromatosis

71
Q

Coarse facies, short stature, cloudy cornea. AR?

A

Hurler syndrome

72
Q

Broad, square face, short stature, self-injurious behavior. Deletion on Chr 17?

A

Smith Magenis

73
Q

Hypotonia, hypogonadism, hyperphagia, skin picking, aggression, Deletion on paternal Chr 15?

A

Prader-willi

74
Q

Seizures, strabismus, sociable w/episodic laughter, deletion on maternal chr 15?

A

Angelman

75
Q

Elfin-appearance, friendly, increased empathy and verbal reasoning ability, deletion on Chr 7

A

Williams

76
Q

ADHD-like sxs, microcephaly, smooth philtrum. MC cause of MR?

A

Fetal alcohol syndrome

77
Q

Seizures, chorioretinits, hearing impairments, periventricular calcifications, petechiae at birth, hepatitis?

A

Congenital CMV infx

78
Q

Seizures, hearing impairments, cloudy cornea/retinitis, heart defects, low birth weight?

A

congenital rubella syndrome

79
Q

abnormal muscle tone, unsteady gait, seizures, MR or learning disability

A

cerebral palsy from birth asphyxia

80
Q

IUGR, hypertonia, distinctive facies, limb malformation, self-injurious behavior, hyperactive?

A

Cornelia de lange

81
Q

Coloboma, heart defects, choanal atresia, growth retardation, GU anomalies, ear deformity and deafness, Chr 8?

A

CHARGE

82
Q

autism spectrum sxs, heart disease, palate defects, hypo plastic thymus, hypo-Ca, Chr 22 deletion?

A

DiGeorge

83
Q

Vomiting, seizures, lethargy, coma. Acidosis w/stress, illness. Causes neurological damage?

A

Maple syrup urine disease

84
Q

Exclusively in girls, normal development for 6-8 pos, then regression, handwringing, loss of speech and use of hands. X-linked dominant deletion of MECP2?

A

Rett syndrome

85
Q

Normal development until age 2 then major loss of verbal, social skills w/autistic-like behavior

A

Childhood disintegrative behavior

86
Q

lack of mother-child eye contact, language delay/repetitive language, preoccupation with “parts of toys” before age 3?

A

Autism

87
Q

Problems with social skills (usually recognized in preschool) w/reserved verbal ability?

A

aspergers

88
Q

risk factors for ADHD? comorbid conditions?

A

Low birth weight, tobacco/etoh exposure

OCD/tic disorder

89
Q

MOA of methylphenidate?

A

Blocks DA reuptake

90
Q

MOA of amphetamine?

A

Blocks DA/NE reuptake and stimulates release

91
Q

MOA of atomoxetine?

A

NE reuptake inhibitor. Non stimulant

92
Q

MOA of clonidine, guanfacine?

A

a2 agonists, reduce peripheral SNS

93
Q

14 y/o boy sent for court mandated counseling. Stole neighbors lawn more and then set fire to his tool shed. has a 5 y hx of truancy from school and assaulted a 13 y/o school mate?

A

conduct d/o

Need sxs for 6 mo
Comorbid substance abuse
May progress to anti social PD

94
Q

14 y/o boy brought in by mom. For past year, getting in trouble at school for being argumentative and disrespectful to teachers. he defies rules she sets for house and often deliberately annoys her?

A

ODD
Need sxs for 12 mos

Stops just short of breaking the law or physically harming others

95
Q

Timeline for dx tourettes?

A

tics must occur at least 1x/day for 1 yr w/o a tic-free period longer than 3 mo

96
Q

comorbid conditions for Tourettes?

A

Look for the compulsions of OCD. Can have ADHD as well

97
Q

1st line tx for Tourettes? Most effective?

A

Clonidine

Haloperidol or pimozide –> DA receptor antagonists

98
Q

7 y/o boy complains of frequent abdominal pain resulting in many missed school days. He never gets the pain on the weekends or in the summer?

A

Separation anxiety d/o

99
Q

6 y/o adopted child brought in b.c she has not formed a relationship with her adoptive parents. She is inhibited and hypervigilant?

A

Reactive attachment d/o

100
Q

18 mo old baby has recently been regurgitating and re-chewing her food. She had previously been eating normally?

A

Rumination d/o
Check Pb levels

Next best test=Check for fecal retention

Tx=Behavior modification that only rewards

101
Q

6 y/o urinates in her clothes once a day. Next best test? Tx?

A

UA and urine culture

Alarm and pad for 6 wks. TCAs reduce bed wetting but relapse is common. DDAVP has same prob + S/E=HA’s, nausea, hyponatremia

Psychiatry Clerkship (4 decks)

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