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Psychiatry > High Yield Psych-MSE changes, drug abuse, MR, child > Flashcards

High Yield Psych-MSE changes, drug abuse, MR, child Flashcards

1
Q

Elderly woman w/ AMS and sundowning. Explain her lab workup; which meds to avoid

A

UA, glucose, Na, blood cultures, B12, RPR; benadryl, opiates, benzos

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2
Q

Alzheimer: On MMSE, prompting does not increase ____. Due to global brain path with ___ plaques and ___ tangles

A

recall; ßamyloid; tau

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3
Q

Frontotemporal dementia: tx w/ ___ for severe disinhibition

A

olanzepine

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4
Q

Lewy Body Dementia: ____ inclusions in neocortex; give ______ [class of drugs]

A

∂synuclien; AChE inhibitors

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5
Q

Creutzfeldt Jacob [myoclonus, startle response, seizures and recent corneal transplant]: EEG findings

A

triphasic bursts

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6
Q

Normal pressure hydrocephalus: VP shunt improves cognitive fxn in ____ of patients

A

50-66%

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7
Q

Alcoholism: seizures can occur ____ since last drink

A

12-24hrs

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8
Q

Alcoholism: tactile hallucinations can occur _____, usually when DTs start

A

48-72hrs since last drink

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9
Q

Alcohol is metabolized by _____ kinetics.

A

25mg/hr [if pt BAL 0.225 mg/ml, will take 9 hours to get rid of]

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10
Q

Alcoholism w/dwl: ___ can mask the signs of autonomic hyperactivity, except for ____, which is used to dose benzos during withdrawal

A

ßblockers; hyperreflexia

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11
Q

Alcoholism: best initial tx current tonic/clonic seizures from w/dwl; tx if liver disease

A

diazepam/clordiazepoxide (long half lives); lorazepam, oxazepam (glucuronidated prior to elimination)

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12
Q

Most specific test for ETOH consumption in the past 10 days?

A

Carbohydrate-deficient transferrin. Less specific- elevated GGT and AST more than twice ALT

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13
Q

Abuse/Wdwl: diagnose pt w/ confusion, ataxia and constricted pupils; tx

A

Wernicke Encephalopathy (thiamine def); give thiamine first then glucose

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14
Q

Abuse/Wdwl diagnosis: apathy, anter/retrograde amnesia and confabulation, can see MB atrophy on MRI

A

Korsakoff’s syndrome (irreversible damage to mamillary bodies)

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15
Q

Diagnose: ER pt is in a non- responsive state. His BP is 100/60, HR is 50, RR is 6. He has multiple track marks on his arm; what if pupils dilated?

A

opioid OD; same diagnosis (hypoxia secondary to respiratory depression can cause mydrasis)

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16
Q

Opioid wdwl sxs

A

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

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17
Q

Opioid OD: tx

A

IM/IV naloxone [full mu-opioid antagonist]

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18
Q

Opioid wdwl tx short term; long-term dependence

A

Clonidine for autonomic sxs; methadone, buprenorphrine or naltrexone

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19
Q

Diagnose drug/wdwl: Pt presents with horizontal nystagmus, dilated pupils, ataxia and acute psychosis

A

PCP

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20
Q

Diagnose drug/wdwl: Pt presents s/p MVC with injected conjunctiva, sedation and is asking for Doritos (cool ranch plz)

A

MJ

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21
Q

Diagnose drug/wdwl: Pt presents with SI, hypersomnia, depression and anergia

A

cocaine/amphetamine wdwl

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22
Q

Diagnose drug/wdwl: Pt presents with dilated pupils, seizure, tachycardia and HTN

A

cocaine/amphetamine

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23
Q

Cocaine/amphetamine intoxication w/ HTN and tachycardia, tx with ____

A

CCBs [ßblockers contraindicated]

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24
Q

Diagnose: 11yo boy evaluated for developmental delay, poor school and social performance. IQ 50. He has a macrocephaly,
long face and macroorchidism

A

Fragile X [CGG repeats w/ anticipation; Cx = Seizures, MVP, dilation of the aorta, tremors, ataxia, ADHD-like behavior.
MC cause of INHERITED MR]

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25
Q

MR: IQ of ___ is mild.

A

55-70

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26
Q

MR: IQ of ___ is moderate.

A

40-55

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27
Q

MR: IQ of ___ is severe.

A

25-40

28
Q

MR: IQ of ___ is profound.

A
29
Q

Average IQ is ___ with std of ___; MR is categorized under Axis ___

A

100; 15; Axis II

30
Q

MR: For pts w/ Down Syndrome, will most likely have _____ MR, speech and gross/fine motor skill delay

A

mild to moderate

31
Q

MR diagnoses: Café-au-lait spots, seizures large head. Autosomal dominant

A

NF 1

32
Q

MR diagnoses: Coarse facies, short stature, cloudy cornea. Autosomal recessive

A

Hurler syndrome

33
Q

MR diagnoses: Broad, square face, short stature, self- injurious behavior. Deletion on Chr17

A

Smith Magenis

34
Q

MR diagnoses: Hypotonia, hypogonadism, hyperphagia, skin picking, agression. Deletion on paternal Chr15.

A

Prader-Willi

35
Q

MR diagnoses: Seizures, strabismus, sociable w/ episodic laughter. Deletion on maternal Chr15

A

Angelman

36
Q

MR diagnoses: Elfin-appearance, friendly, increased empathy and verbal reasoning ability. Deletion on Chr7

A

Williams

37
Q

MR diagnoses: ADHD-like sxs, microcephaly, smooth philtrum. Most common cause of mental retardation

A

FAS

38
Q

MR diagnoses: Seizures, chorioretinitis, hearing impairments, periventricular calcifications, petechiae @ birth, hepatitis

A

congenital CMV infection

39
Q

MR diagnoses: Seizures, hearing impairments, cloudy cornea/retinitis, heart defects, low birth weight

A

congenital rubella syndrome

40
Q

MR diagnoses: Abnormal muscle tone, unsteady gait, seizures, mental retardation or learning disability

A

cerebral palsy from birth asphyxia

41
Q

MR diagnoses: IUGR, hypertonia, distinctive facies, limb malformation, self-injurious behavior, hyperactive

A

Cornelia de Lange

42
Q

MR diagnoses: Coloboma, heart defects, choanal

atresia, growth retardation, GU anomalies, ear deformity and deafness. Chr 8

A

CHARGE

43
Q

MR diagnoses: Autism spectrum sxs, heart disease, palate defects, hypopastic thymus, hypoCa. Chr 22 deletion

A

DiGeorge

44
Q

MR diagnoses: Vomiting, seizures, lethargy, coma. Acidosis w/ stress, illness. Causes neurological damage

A

Maple Syrup Urine dz

45
Q

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

A

Rett syndrome

46
Q

MR diagnoses: Normal development until age 2 then major loss of verbal, social skills w/ autistic like behavior.

A

Childhood disintegrative disorder

47
Q

MR diagnoses: Lack of mother-child eye contact, language delay/repetitive language, peroccupation w/ “parts of toys” before age 3

A

Autism

48
Q

MR diagnoses: Problems with social skills (usually recognized in preschool) w/ reserved verbal ability

A

Asperger

49
Q

ADHD: ___ heritability; low birth weight, ____ exposure

A

77%; AODA

50
Q

ADHD: comorbid ODD/CD in _____ cases

A

30-50%

51
Q

ADHD: tx

A

methylphenidate, amphetamine, atomoxetine, others [clonidine, guanfacine, SNRIs, TCAs, MAOIs]

52
Q

ADHD: major SEs for methylphenidate/amphetamine

A

dec appetite, nausea, HTN, tachycardia, stunted growth

53
Q

Methylphenidate blocks ___ where amphetamine blocks ____ and stimulates ____

A

dopamine reuptake; DA/NE reuptake; DA/NE release

54
Q

Diagnose: 14 yo boy stole his neighbor’s lawn mower and then set fire to his tool shed. He has a 5 year history of truancy from school and assaulted a 13 year old school mate

A

conduct disorder

55
Q

Conduct Disorder: sxs for at least ____; comorbidity _____; may progress to ____

A

6mo; substance abuse; anti-social PD

56
Q

Diagnose: 14 yo boy has been getting in trouble at school for being argumentative and disrespectful to his teachers (for over 1 yr); defies rules and often deliberately annoys her

A

Oppositional defiant disorder

57
Q

ODD: need sxs for at least ___

A

1 year

58
Q

Diagnose: 9 year old boy is sent to counseling b/c at least once a day he makes loud grunting noises and hand movements that are disruptive to the class

A

Tourette’s

59
Q

Tourettes: tics must occur _____ for ____ in order to diagnose

A

at least once per day; 1 year

60
Q

Tourettes: comorbidity ____; tx first line ____ and most effective _____

A

clonidine/carbamazepine (b/c benign SE profile); haloperidol/pimozide

61
Q

Diagnose: 7 year old 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 disorder

62
Q

Diagnose: 6 year old adopted child is brought in because she has not formed a relationship with her adoptive parents. She is inhibited and hyper vigilant

A

Reactive attachment disorder

63
Q

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

A

Rumination disorder [check lead levels!]

64
Q

Tx of 6y/o stools in her clothes once every 2 weeks w/ normal fecal retention

A

behavioral modification that only rewards

65
Q

Tx of 6 y/o urinates in her clothes once a day w/ normal UA/urine culture

A

(1) Alarm and pad for 6wks (2) imipramine/DDAVP, but relapse is common

66
Q

MC SEs of DDAVP for childhood urinary incontinence

A

headaches, nausea, hyponatremia

Psychiatry (2 decks)

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