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
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
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
4
Q
Teratogenicity of Lithium?
A
Ebsteins anomaly
5
Q
preferred tx for bipolar in preggos?
A
clonazepam, esp 1st tri
6
Q
bipolar + elevated LFTs and hepatitis?
A
Valproate. Also can cause n/v/d, skin rash
7
Q
bipolar + SJS?
A
Lamotrigine
8
Q
Bipolar + Agranulocytosis?
A
carbamazepine. Check CBC regularly
9
Q
Bipolar + increased AFP in a 20 wk preggo?
A
valproate or carbamazepine
10
Q
MC complication of carbamazepine? Therapeutic levels?
A
rash
60-120
11
Q
therapeutic levels of valproate?
A
6-12
12
Q
most important question to ask for someone with MDD?
A
assess for SI
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
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
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
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
17
Q
which SSRI do you not have to taper when stopping?
A
Fluoxetine
18
Q
HA, n/v/d, dizziness and fatigue when stopping SSRI suddenly?
A
5HT discontinuation syndrome. MC with sertraline and fluvoxamine
19
Q
Myoclonic jerks, tachycardia, high BP, hyperreflexia, n/v/d in pt being tx for MDD?
A
5HT syndrome. If SSRI + MAOI
20
Q
Tx for MDD if loss of erection, ejaculation?
A
switch to bupropion
NET DAT Ball Pro
21
Q
Tx for MDD and boner for > 3 hrs, what drug?
Tx for MDD for old, skinny, sad ladies?
A
Trazodone
Mirtazepine
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
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
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
25
Pt has delusions, hallucinations, and flattened affect for 3 wks? for 3 mos?
- Brief psychotic d/o= >1 wk, <1 mo
| - Schizophreniform d/o= >1 mo, <6 mo
26
Pt has had persecutory delusions for the past 3 yrs. 6 mo ago he started having sadness, guilt, insomnia, decreased concentration and SI?
Schizoaffective d/o --> hallucinations/delusions for >2 wks in absence of mood sx
Tx with atypical antipsychotics + SSRI if depression and + Lithium if manic
27
a pt has had MDD for 3 yrs and reports hearing voices telling him he is worthless and to kill himself
MDD with psychotic features --> Delusions are typically mood congruent
Tx with atypical antipsychotic + SSRI or ECT (esp preggos)
28
Man is convinced Miley Cyrus is in love with him but otherwise functional
delusional d/o
29
DOC for acute agitation or psychosis?
IM haloperidol
30
Low potency 1st gen antipsychotics? High potency?
low=Chlorpromazine and Thioridazine --> Less EPS, more Anticholinergic, Antihistamine, and alpha1 antagonism
High=Haloperidol and Fluphenazine --> More EPS
31
Antipsychotic drugs:
-Purple grey metallic rash over sun-exposed areas and jaundice?
-Prolonged QTc and pigmentary retinopathy?
chlorpromazine
thiodridazine
32
Pt wakes up with eyes "stuck" looking up or head "stuck" turned to the side?
Acute dystonia (<12 hrs)
tx w/ benztropine or diphenhydramine
33
pt report feeling like they "always have to move"?
Akathesia (30-90 days)
tx w/propanolol (1st line) or Benzo
34
Coarse resting tremor, masked facies, unsteady gait, bradykinesia?
Parkinsonism (>6 mo)
tx w/ benztropine/diphenhydramine, amantidine, or bromocriptine. NOT L-DOPA!!
35
After 10 yrs on fluphenazine, tongue movement, and grimacing?
Tardive dyskinesia (> years)
Tx by stopping antipsychotic and switch to atypical or clozapine
36
w/in hrs of a haloperidol injx, pt has increased CPK, T=103F, autonomic instability, and delirium?
NMS
1st-D/c med
2nd-Cooling blankets and dantroline
37
Atypical agent w/ highest risk for EPS and increased prolactin?
Risperidone (depot shot)
38
atypical agent weight neutral but prolongs QTc? weight neutral but increases akathisia?
ziprazodone
aripiprazole
39
atypical agent most assoc with weight gain? orthostasis and cataracts?
olanzapine
quetiapine
40
atypical agent good for tx-refractory schizophrenia?
clozapine
41
MC SE of clozapine? Most dangerous? How to monitor?
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
drug regimen of choice for panic attacks?
Alprazolam or clonazepam low dose PRN short term, but SSRIs are preferred drug
*dont give benzos to addicts, COPDers, or restrictive lung disease*
43
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.
Acute bzd withdrawal rxn. Similar to DTs
Tx w/diazepam or chlordiazepoxide + haloperidol if psychotic
44
best tx for specific phobia?
Best tx is CBT w/ flooding or exposure/extinction. Can give bzd for situational use
45
best tx for social phobia or fear of public speaking?
Best tx is propanolol to stop hyperarousal and benzo
46
Gold standard tx for OCD?
Clomipramine is gold standard
| SSRIs are 1st line
47
tx for PTSD?
Sertraline or paroxetine. Combo w/ CBT. Prazosin for nightmares
48
Time frame for PTSD? Acute stress rxn? What if similar sx to ASD but in response to a bad breakup?
PTSD= > 1 mo
ASD= 3 d-1 mo
Bad break up=Adjustment d/o
49
```
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?
```
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
what stage of sleep do you find sleep walking/talking/night terrors? Sk m paralysis?
stage 3-sleep walk/talk/night terrors
REM-sk m paralysis
51
daytime sleepiness and depression in a big fat guy with a big neck?
obstructive sleep apnea. Dx with polysomnogram. Tx with CPAP to reduce pulm HTN
52
Tx for narcolepsy?
scheduled naps and modafinil
53
78 y/o F presents with memory loss...aphasia, apraxia, lost while driving? Pathology? Genes? Tx?
Alzheimers dementia
Global brain atrophy. B amyloid plaques or tau tangles
APP (chr 21), ApoE2
Tx with donepezil, rivastigmine, galantine, Memantine
54
78 y/o F presents with memory loss..becomes more sexually explicit, apathetic? Pathology? Tx?
Frontotemporal dementia
Lobar atrophy. Intra-neuronal silver staining inclusions
Tx-olanzepine for severe disinhibition
55
78 y/o F with memory loss...fluctuation in consciousness, visual hallucinations, and shuffling gait? Pathology? Tx?
lewy body dementia
Intra cytoplasmic a-synuclein inclusions in neocortex
Tx-AchEsterase inhibitors, not L-Dopa, avoid neuroleptics
56
78 y/o F presents with memory loss...sudden stepwise decrease in memory/cognition?
vascular dementia
57
78 y/o F presents with memory loss...loss of vibration sense, labile affect. pupils accommodate but don't react? Dx? Tx?
tertiary syphilis
Dx=+ RPR, VDRL. Do spinal tap to look for spirochetes
Tx=IV penicillin
58
78 y/o F with memory loss...myoclonus, startle response, seizures. Recently had a corneal transplant? Pathology? EEG findings?
CJD
Path-Spongiform encephalopathy
EEG-Triphasic bursts
59
78 y/o F with memory loss...incontinence, gait disturbance/frequent falls, and rapidly developing dementia? Dx? Tx?
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
best initial tx for etoh withdrawal pt?
diazepam or chlordiazepoxide b/c they have 80 and 120 hr 1/2 lives, respectively
61
best tx for etoh witihdrawal in a pt wiho is cirrhotic?
Lorazepam, Oxazepam, or Temazepam (LOT)
62
tx for wernicke encephalopathy?
thiamine 1st then glucose containing fluids
63
best 1st step to tx a pt with heroin OD?
intubate pt. then give IV or IM naloxone
64
What sxs in a pt withdrawing from heroin?
joint and muscle pain, photophobia, goosebumps, diarrhea, tachycardia, HTN, GI cramps, dilated pupils, anxiety/depression
65
Pt presents with horizontal nystagmus, dilated pupils, ataxia, and acute psychosis?
PCP intoxication. Can use haloperidol for acute psychosis
66
pt presents s/p MVC with injected conjunctiva, sedation, and asking for Doritos?
cannabis intox
67
Pt presents with SI, hypersomnia, depression, and anergia (abnormal lack of energy)? Best 1st test? Tx of HTN and tachycardia?
cocaine/amphetamine intoxication
EKG then urine tox screen. Tx seizure with lorazepam
HTN and tachy-tx with CCB; B blockers contraindicated
68
11 y/o boy with developmental delay, poor school and social performance, iq of 50, macrocephaly and macroorchidism?
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
Newborn baby with decreased tone, oblique palpebral fissures, simian crease, big tongue, white spots on iris? MC med complications?
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
Cafe au last spots, seizures, large head, AD?
neurofibromatosis
71
Coarse facies, short stature, cloudy cornea. AR?
Hurler syndrome
72
Broad, square face, short stature, self-injurious behavior. Deletion on Chr 17?
Smith Magenis
73
Hypotonia, hypogonadism, hyperphagia, skin picking, aggression, Deletion on paternal Chr 15?
Prader-willi
74
Seizures, strabismus, sociable w/episodic laughter, deletion on maternal chr 15?
Angelman
75
Elfin-appearance, friendly, increased empathy and verbal reasoning ability, deletion on Chr 7
Williams
76
ADHD-like sxs, microcephaly, smooth philtrum. MC cause of MR?
Fetal alcohol syndrome
77
Seizures, chorioretinits, hearing impairments, periventricular calcifications, petechiae at birth, hepatitis?
Congenital CMV infx
78
Seizures, hearing impairments, cloudy cornea/retinitis, heart defects, low birth weight?
congenital rubella syndrome
79
abnormal muscle tone, unsteady gait, seizures, MR or learning disability
cerebral palsy from birth asphyxia
80
IUGR, hypertonia, distinctive facies, limb malformation, self-injurious behavior, hyperactive?
Cornelia de lange
81
Coloboma, heart defects, choanal atresia, growth retardation, GU anomalies, ear deformity and deafness, Chr 8?
CHARGE
82
autism spectrum sxs, heart disease, palate defects, hypo plastic thymus, hypo-Ca, Chr 22 deletion?
DiGeorge
83
Vomiting, seizures, lethargy, coma. Acidosis w/stress, illness. Causes neurological damage?
Maple syrup urine disease
84
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?
Rett syndrome
85
Normal development until age 2 then major loss of verbal, social skills w/autistic-like behavior
Childhood disintegrative behavior
86
lack of mother-child eye contact, language delay/repetitive language, preoccupation with "parts of toys" before age 3?
Autism
87
Problems with social skills (usually recognized in preschool) w/reserved verbal ability?
aspergers
88
risk factors for ADHD? comorbid conditions?
Low birth weight, tobacco/etoh exposure
OCD/tic disorder
89
MOA of methylphenidate?
Blocks DA reuptake
90
MOA of amphetamine?
Blocks DA/NE reuptake and stimulates release
91
MOA of atomoxetine?
NE reuptake inhibitor. Non stimulant
92
MOA of clonidine, guanfacine?
a2 agonists, reduce peripheral SNS
93
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?
conduct d/o
Need sxs for 6 mo
Comorbid substance abuse
May progress to anti social PD
94
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?
ODD
Need sxs for 12 mos
Stops just short of breaking the law or physically harming others
95
Timeline for dx tourettes?
tics must occur at least 1x/day for 1 yr w/o a tic-free period longer than 3 mo
96
comorbid conditions for Tourettes?
Look for the compulsions of OCD. Can have ADHD as well
97
1st line tx for Tourettes? Most effective?
Clonidine
Haloperidol or pimozide --> DA receptor antagonists
98
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?
Separation anxiety d/o
99
6 y/o adopted child brought in b.c she has not formed a relationship with her adoptive parents. She is inhibited and hypervigilant?
Reactive attachment d/o
100
18 mo old baby has recently been regurgitating and re-chewing her food. She had previously been eating normally?
Rumination d/o
Check Pb levels
Next best test=Check for fecal retention
Tx=Behavior modification that only rewards
101
6 y/o urinates in her clothes once a day. Next best test? Tx?
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
