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Last minute things Flashcards

1
Q

Self- harm (cutting) may indicate what

A

Borderline Personality disorder

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2
Q 
In OCD thoughts must be recurrent & 
time consuming (≥1hr), \_\_\_\_, OR \_\_\_\_
A

distressing

impairing

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3
Q

Impressionable, considers relationships more intimate than they are, inappropriate sexual/seductive behavior, uses appearance to draw attention, dramatic displays of emotion

A

Histrionic

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4
Q

Blames others for mistakes
Deliberately annoys others
Short tempered, irritable, argumentative, defiant, OR vindictive

A

Oppositional Defiant

≥6m

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5
Q

ODD and Conduct disorder treated with

A

Parent Management Training

Psychotherapy & CBT, respectively

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6
Q

Dissociative amnesia/fugue triggered by

A

an emotionally stressful event

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7
Q

The depressive and hypomanic episodes in bipolar II disorder may resemble borderline personality disorder. However, the labile mood states in borderline personality disorder are

A

brief, typically lasting hours to days (rather than weeks to months).

and come with other Borderline symptoms

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8
Q

Insecure attachment to the primary caregiver may underlie the unstable relationships and fears of abandonment commonly seen in the disorder.

A

Borderline Personality disorder

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9
Q

Poor social responsiveness, limited affect, does not seek/respond to comfort, unexplained irritability/sadness/ fear, +/- toileting problems, anxiety, aggression, sleep problems

A

Reactive Attachment Disorder

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10
Q

Describe delusional disorder
time frame
Treatment

A

≥1 delusion
≥1 month
no functional impairment

Antipsychotic or CBT

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11
Q

Hoarding → treat with

A

CBT, if persistent use SSRI (off label)

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12
Q

OCPD obsessed with

A

Details, Control, Perfectionism

NO Rituals/Compulsions
NO Feared thoughts

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13
Q

Fear of Scrutiny and embarrassment

A

SAD

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14
Q

GAD causes significant distress or impairment due to chronic worries ≤6m
Must have 3+ of the following symptoms (7)

A 
Fatigue
impaired concentration
irritability
Tension (muscles)
On edge
Restless
Sleep disturbances

FiiTORS

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15
Q

Panic disorder has ≥4 of the following symptoms (15)

A 
SOB
Trembling
Upset stomach
Dizziness
Derealization/Depersonalization
Numbness
Tingly/Paresthesia 
Sweating
Palpitations
Avoidance behaviors
Nausea
Intense Fear of dying
Chest pain/Choking

STUDDNTS PANIC

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16
Q

Symptoms of PTSD (9)

A 
Flashbacks
Irritability
Nightmares
Negative mood
Dissociation
Avoidance (of reminders)
Amnesia (of event)
Hyper-vigilance

FINNDAAH

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17
Q

First-line treatment of specific phobia

A

Exposure therapy & CBT

Benzos for acute settings

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18
Q

Is conversion disorder intentional?

A

No

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19
Q

1st line treatment for conversion disorder

A

Pt education/self-help

(2nd line) CBT

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20
Q

List all the things that can cause Serotonin Syndrome

10

A 
SSRI
SNRI
TCA
MAO-I
Tramadol
Linezolid
Dextromethorphan
MDMA
Ondansetron
Meperidine (opioid for acute pain)
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21
Q

Treatment of Genito-pelvic pain disorder

A

Desensitization therapy

Kegel pelvic floor exercises

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22
Q

5HT-1A partial agonist. Inhibits serotonin reuptake

A

Vilazodone

atypical antidepressant

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23
Q

5HT-1A agonist.
5HT-3 antagonist.
Inhibits serotonin reuptake

A

Vortioxetine

atypical antidepressant

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24
Q

Indications for ECT (5)

A 
Treatment Resistance
MMD w/Psychotic features
Pregnancy
Refusal to eat/drink
Suicidal
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25
Q

List 3 protective factors for suicide

A

Pregnancy
Parenthood
Religion
Social/family support

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26
Q

Depressed new mother for:
__ weeks → Blues
__ weeks → MDD

A

≤2 (reassurance)

≤ 2 (CBT + SSRI)

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27
Q

Adjustment disorder treatment

A

Psychotherapy

w/ adjunctive sleep aid like Zolpidem or anxiolytic if needed.

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28
Q

Peripheral alpha 1 antagonism causes

A

vasodilation (orthostatic hypotension)

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29
Q

Discontinuation of SSRI may cause

A 
Flu like
Insomnia
Nausea/Vomit/Diarrhea
Instability (Dizziness)
Sore muscles (myalgias)
Headache
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30
Q

Treatment of lithium toxicity (2)

A

IV hydration

Dialysis (if severe)

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31
Q

4 contraindications for Lithium

A

CKD
Heart disease
Hyponatremia
Diuretic use

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32
Q

Lithium may cause

A

Polyuria/Polydipsia

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33
Q

List 7 psychiatric medical emergencies

A 
NMS
Serotonin Syndrome
TCA overdose
Tyramine HTN crisis
Acute Dystonia
Delirium Tremens
Lithium Toxicities
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34
Q

Patient with Parkinson or DLB can be given what antipsychotic?

A

Qutiapine (which binds D2 loosely)
or
Pimvaserin

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35
Q

Antipsychotics causing orthostatic hypotension like _______ not good for elderly. Not good at all for parkinsonism.

A

Risperidone

but still can be used

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36
Q

Low potency typicals do not

A

bind D2 very tightly

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37
Q

2nd Gen antipsychotics can cause weight gain and (2)

A

Dyslipidemia
Hyperglycemia

(monitor lipids & A1C)

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38
Q

Which antipsychotic causes
Metabolic syndromes/weight gain
EPS &
Prolonged Qtc

A

Risperidone

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39
Q

Which 2 antipsychotics cause Prolonged Qtc

A

Risperidone

Ziprasidone

40
Q

List 3 overlapping features of NMS & SS

A

Fever
Autonomic Instability (sweats, tachycardia, HTN)
Mental status altered
(FAM)

NMS: muscle rigidity
SS: Myoclonus/hyper-reflexia

41
Q

Schizophrenia must have 1 of the following 3 symptoms:
&
have either of the following 3 symptoms:

A

Hallucinations, Delusions, Disorganized speech

Negative symptoms, Bizarre behavior, Catatonia

42
Q

What are the 5 As of negative symptoms in Schizophrenia?

A 
Alogia (brief answers/ speaking little)
Anhedonia
Affect (flat)
Avolition (apathy)
Attention (poor)
43
Q

In Wilson’s disease the Basal Ganglia gets deposits of copper. Neurologic findings can include (4)
& come before obvious hepatic symptoms in teenagers with acute psychosis.

A

dysarthria
dystonia
tremor
pooling saliva

44
Q

Patient has overdosed on Heroin and has a RR<8 what do you do next?

A

Intubate then give IM Naloxone

45
Q

With opioid intoxication what do you expect to find in ABG and finger glucose stick?

A

Respiratory Acidosis

Hypoglycemia

46
Q

What is a normal pupil size?

A

Normal Pupils in
LIGHT (2-4mm)
DARK (4-8mm)

Pupils <1mm = intoxication

47
Q

What are some opioid withdrawal symptoms you can ask (8)

A 
Stomach Cramps
Diarrhea
Piloerection
Insomnia
Yawning
Rhinorrhea
Lacrimation
Muscle/joint aches
48
Q

What can you give for opioid withdrawal diarrhea

A

Loperamide

49
Q

List 3 complications of cocaine use

A

Myocardial ischemia or MI
Aortic Dissection
Intracranial Hemorrhage

50
Q

Beta 1 stimulation causes cardiac

A

contractility increase

51
Q

Alpha 1 stimulation causes peripheral

A

vasoconstriction (HTN)

52
Q

Beta 2 stimulation causes bronchial ____

& peripheral _____

A

Dilation

Vasodilation

53
Q

Why are Beta Blockers contraindicated in cocaine use?

A

Cocaine stimulates Alpha 1 vasoconstriction & Beta 2 vasodilation and blocking B1 & B2 will lower the heart contractility and the vasodilation of B2 but leave the alpha 1 vasoconstriction unopposed causing a HTN crisis possibly.

54
Q

Alcohol withdrawal seizures &/or Hallucinosis occurs when

A

within 12 hours to 2 days

55
Q

Delirium tremens occurs when

A

2-4 days

after last drink

56
Q

Alcohol withdrawal shakes, anxiety, insomnia, and GI upset occur when

A

6 hours to 1 day

after last drink

57
Q

skin picking, teeth grinding and dental decay indicate what use disorder

58
Q

Methadone opioid intoxication can be caused by

A

Cimetidine (for GERD)
Fluconazole etc. (fungal infection)
Clarithromycin (antibiotic
Fluvoxamine (SSRI)

WHAT OUT for these CYP P450 inhibitors increasing Methadone levels in the body

59
Q

Non-selective (O-Z) Beta Blockers can cause what sexual symptom?

A

erectile dysfunction

60
Q

Anticholinergic toxicity can cause (5)

A 
Mydriasis (blind as a bat)
Tachycardia (fast as a fiddle)
Dry skin/mucous memb. (Dry as a bone)
Flushing (red as a beet)
Urinary retention (full as a flask)
Delirium (mad as a hatter)
Treat with Physostigmine
61
Q

Marijuana causes dry mouth, red eyes and what cardio effect?

A

Tachycardia

62
Q

List the Neuroleptic Malignant Syndrome mnemonic

M-FEVER

A 
Myoglobinuria (RBCs on UA)
Fever
Elevated Enzymes (CK & leukocytosis)
Vital Unstable 
Encephalopathy (Delirium)
Rigidity lead pipe
63
Q

Meperidine (opioid) + MOI can cause

A

Serotonin Syndrome

64
Q 
Meperidine (opioid)
Triptans (migraines)
Ondansetron (anti-emetic)
Dextromethorphan (cough syrup)
MDMA (Ecstasy/ Molly)
Tramadol (analgesic)
MAOI
TCAs/SNRIs/SSRIs

can be combined to cause

A

Serotonin Syndrome

65
Q

Slow wave sleep is what phase

66
Q

N3 slow wave sleep is characterized by what waves, frequency, and amplitude?

A

Delta (low frequency, high amplitude)

67
Q

Sleep apnea may cause an increase in what hormone?

A

EPO (erythropoiesis; high RBC count)

68
Q

What 2 lab findings are seen in Bulimia

A 
Hypokalemia
Metabolic Alkalosis (High bicarb)
69
Q

How to tell apart
NPH vs
Alzheimer’s MSA

A

MUD DUM
Motor > Urinary> Dementia = NPH
Dementia > Urinary > Motor = MSA

70
Q

Tetrabenazine (for Tourette’s) is a

A

dopamine depleter

71
Q

List the OARS technique for motivational interviewing

A

Open ended questions
Affirmation of Positives
Reflect on how it might feel in the Positive
Summarize

72
Q

Fragile X Syndrome is often associated with what learning/psych problems?

A

Intellectual disability
ADHD
Autism
Anxiety

73
Q

Self- injurious behavior is associated with what 2 congenital illnesses?

A

Fragile X

Lesch Nyan

74
Q

Long face
Protruding ears
Hypermobility of joints
intellectual/developmental delay

75
Q

In Alzheimer’s what neurotransmittor is affected

76
Q

In parkinson what neurotransmittor(s) are affected

A

↑ ACH
↓ Dopamine
↓ Serotonin

77
Q

In Anxiety what neurotransmittor(s) are affected

A

↓ Serotonin
↓ GABA
↑ NE

78
Q

In Huntington what neurotransmittor(s) are affected

A

↓ ACH
↓ GABA
↑ Dopamine

79
Q

What is a U-wave on ECG?

A

A little hill after T wave (the last wave in 1 ECG cycle)

80
Q

Lithium causes what 2 possible changes on ECG

due to HYPOKALEMIA?

A 
U waves (after T wave)
Flat/upside down T waves
81
Q

List 5 MOAI

A 
Tranyl-cypro-mine
Rasagiline
Isocarboxazid
Phenelzine
Selegiline
(TRIPS)
82
Q

List 6 TCAs

A 
Amoxapin
Desipramine
Amyltriptyline
Nortriptyline
Doxepin
Imipramine
(A DANDI)
*Timipramine
83
Q

List 5 SNRIs

A 
Desvenlafaxine 
Levomilnacipran
Duloxetine 
Milnacipran 
Venlafaxine 
(Don't Lose DMV)
84
Q

List 3 Antiemetics

A

Metoclopramide 5HT3 & D2 antagonist

Ondansetron (Zofran) 5HT3 antagonist

Prochlorperazine (Compazine) D2 antagonist

(MOP vomit)

85
Q

Absent DTRs
+ Romberg
Ataxia
Shooting pain

A

tertiary syphilis

86
Q

Enuresis/Encopresis can be associated with what 3 psychiatric conditions?

A

Autism
ADHD
Conduct Disorder

87
Q

Triptans (anti-migraine meds) can cause

A

Serotonin Syndrome

88
Q

Phenobarbital is a ____ acting barbituate

A

Long

*so is Barbitone/Mephobarbitone

89
Q

PENTObarbital is a ____ acting barbituate

90
Q

Thiopental is a ____ acting barbituate

91
Q

Huntington chorea/ tardive dyskinesia can be treated with

A

Tetrabenazine (for Tourettes too)

VMAT-I for ↓ Dopamine release

92
Q

Alzheimers progression can be hindered with what drugs

A

Ach-Esterase Inhibitors
(Donepezil, Rivastigmine, Galantamine)

NMDA receptor antagonist (Ca2+ excitotox)
(Memantine)

*Of note: Amantadine is a weak, non-competitive NMDA receptor antagonist for DI-Parkinsonism

93
Q

Trihexyphenidyl is used for

A

DI-Parkinsonism

*same MOA as Benzotropine (antimuscarinic curbs excess cholinergic activity in parkinson)

94
Q

For treatment of Parkinson disease first line is ____ or ____

A

carbidopa-levodopa
or (or as adjunctive)
Dopamine receptor agonist (Pramipexole/Ropinirole/Bromocriptine 3rd choice)

*If it doesn’t respond to one it won’t respond to the other option.

95
Q

Other second line treatments for Parkinson disease
are (

*(aside from carbidopa-levodopa & Dopamine receptor agonist )

A 
COMT inhibitors (Encapone/Talcopone) + Carbi/Levo
NMDA antagonist (Amantadine - for Akinesia)
MAO-B Inhibitors (Rasagiline, Selegiline) + Carbi/Levo

Psych Rotation (7 decks)

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