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Psychiatry MOC Review > MOC Exam#6 > Flashcards

MOC Exam#6 Flashcards

1
Q

When should buprenorphine be started

A
  • only when objective evidence of opiate withdrawal is present
  • B can precipitate acute withdrawal symptoms when pt is intoxicated
  • then prescribe ONCE daily (Long half life)
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2
Q

What is the association between Antisocial Personality Disorder and co-morbid substance use disorder?

A

-35%-60% of pts with SUD also meet criteria for ASPD

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3
Q

What is the prognosis for the association between ASPD and SUD

A

Compared to ASPD without SUD

  • increased likelihood of using illicit substances
  • greater psychopathology
  • more depression, isolation
  • mores impulsivity
  • lessened life satisfaction
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4
Q

What are the symptoms of Organophosphate poisoning?

A

organophosphates cause excessive cholinergic activity (blocks acetylcholinesterase)

  • SLUDGE
  • salivation, lacrimation, urination, diaphoreses(defecation), gastrointestinal motility, emesis
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5
Q

What is antidote for organophosphate poisoning?

A

ATROPINE- muscarinic recepter BLOCKER

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6
Q

What is the difference between ATROPINE and PHYSOSTIGMINE?

A

PHYSOSTIGMINE is a cholinergic AGONIST

ATROPINE is a cholinergic ANTAGONIST, ANTI-CHOLINERGIC

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7
Q

Seizure risk in pts taking antidepressants

A
  • overall incidence of seizures in pts taking antidepressants at therapeutic doses 0.1%-4%
  • Clomipramine has highest seizure risk in this category at doses higher than 350 mg (among the TCA’s)
  • risk of seizure after antidepressant overdose is high
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8
Q

Risk of suicide patients among pts with borderline personality disorder

A

-10%

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9
Q

Risk factors for suicide in pts with BPD

A
  • high current and life time psychiatric comorbidity
  • novelty seeking, impulsivity
  • co-morbid personality disorders
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10
Q

What is hallucinogen persisting perception disorder?

A
  • spontaneous, transitory recurrences of the hallucinogen experience
  • visual distortions, AH, VH, visual “trails” behind moving objects
  • occurs in 15%-80% of users of hallucinogens
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11
Q

Physical milestones of child development

A
  • 4 months: hold and balance head, lift head 90 degrees from proned position
  • 6 months: sit steadily and independently, and bounce actively when placed in standing position
  • 8 months: crawl on hands and knees
  • 12 months: walking (independently or one hand held)
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12
Q

Characteristics of somnambulism

A
  • occurs during NREM (stage III-IV) deep sleep
  • more common in boys
  • runs in families
  • at least 15% of children do it
  • onset between 4 and 8 y of age (peak prevalence 12y)
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13
Q

What happens with deep (delta) sleep with age?

A

declines with age and can be almost absent in older people, AND
THERE ARE NO MEDICATIONS THAT RESTORE THIS!!

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14
Q

Symptom that distinguish amphetamine induced toxic psychosis from schizophrenia

A
  • visual or tactile hallucinations (chronic meth use)
  • disordered thinking (schizophrenia)
  • affect flattening and alogia (schizophrenia)
  • hyperactivity, hypersexuality, incoherence, confusion (meth use)
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15
Q

How long after single major depressive episode with remission should antidepressant be continued?

A

2 years at same dose

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16
Q

Indications prophylactic treatment with antidepressants in pts with MDD

A
  • 3 or more episodes

- age >= 45 y

17
Q

Characteristics of paraphillias

A
  • practically all cases occur in males
  • more than 50% have age of onset before age 18y
  • pts usually meet criteria for 3-5 paraphilias, concurrently or at different times of life
  • chronic, with peak paraphillic behavior between ages 15y-25y then declining
18
Q

Treatment of paraphillias

A
  • for non-violent (or other personal risk) SSRI SNRI
  • for violent/high risk antiandrogen hormone treatments
  • CBT & skills training
19
Q

First line treatment for suspected TCA over dose

A

-gastric lavage with activated charcoal

20
Q

Describe Wilson’s Disease

A
  • hepatolenticular degeneration
  • involves the liver and the brain
  • disorder due to excessive copper accumulation
  • Parkinsonism is present (masked facies, tremor, righdity)
  • Ataxia, dystonia, dysarthria
  • Kayser-Fleischer ring around iris present only in 2/3 of pts
21
Q

Causes of neurocognitive disorders

A
  • Alzheimer’s disease: 50%-60% of cases
  • Vascular NCD: 10%-20%
  • Parkinson’s Disease: 5%
  • Huntington’s Disease: 5%
22
Q

Distinguishing physiologic change characteristic of males, but not females, in the sexual response cycle

A

-men have refractory period after orgasm, women do not, allowing for multiple and successive orgasms

23
Q

What percent of pts on Lammotrigine with develop a benign rash?

A
  • 10%

- non-confluent, non-tender, spotty, and usually resolves in 10-14 days

24
Q

The presence of tics is an absolute contraindication to use of stimulant medications for ADHA. TRUE or FALSE

A

FALSE

25
Q

Characteristics of paranoid personality disorder

A
  • suspicious, litigious, unable to accept their own feelings, engage in projection
  • on guard and hypervigilant on being exploited, betrayed, deceived, harmed
26
Q

Consequences of longterm sedative/hypnotic use on EEG

A
  • decreased deep sleep
  • increases in Stage 1 and Stage 2 sleep
  • fragmented sleep
27
Q

Typical age pattern of inhalant abuse

A
  • peak age of use 14y-15y, declines by 17y-19y
  • prevalence rates similar between male and female in 12y-17y range
  • but sustained use after age 17y more common in males
28
Q

Personality disorder that often co-exists in pts with bulimia

A

Borderline Personality Disorder

29
Q

Risks of valproic acid in pregnancy

A
  • spina bifida, and other neural tube defects

- development of autism spectrum disorder in child

30
Q

The 2 drugs approved by the FDA for treatment of eating disorders

A
  • Fluoxetine for moderate to severe bulimia, reducing binge-eating and purging behavior, reducing relapse in adolescents
  • Lisdexamphetamine for severe binge-eating disorder in adults, reducing the number of binge days
31
Q

Describe the following:

  • Derailment
  • Loose associations
  • Perseveration
  • Poverty of thought content
  • Thought blocking
A
  • derailment: sudden or gradual deviation from train of thought without blocking, synonymous with loose associations
  • perseveration: the persistence of a response to a previous stimulus even though a new stimulus is presented
  • poverty of thought content: thought that gives little information
  • thought blocking: abrupt interruption and after brief pause, no recollection of previous train of thought
32
Q

FDA Black Box warning for Atomoxetine for:

A

suicidal thoughts

-risk 4/1000 pts treated compared to placebo

33
Q

Most common psychiatric disorder among pts with heart disease?

A

Major Depressive Disorder

34
Q

Phase I clinical trials are conducted to:

A

-collection of safety and efficacy data

35
Q

Phases of Clinical Trials

A

Phase I- collection of safety and efficacy data
Phase II-
Phase III- compare the results of people taking the new treatment with those taking standard treatment; determine if treatment results in fewer or more side effects
Phase IV- evaluate side effects of a new treatment that were not apparent before; determine the effects of drugs in populations which were not originally tested

36
Q

Characteristics of melancholic depression

A
  • anhedonia or depressed mood
  • depressed mood regularly worse in the morning
  • early morning waking
  • marked psychomotor retardation OR agitation
  • significant anorexia or weight loss
  • excessive and inappropriate guilt

Psychiatry MOC Review (60 decks)

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