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Primary Care III > Module 6 > Flashcards

Module 6 Flashcards

1
Q

Psychotic disorders are

A

disturbances of thought content and/or process and signal a departure from reality, often accompanied by a combination of hallucinations and delusions, disorganized thinking (speech), disorganized or abnormal motor behavior (including catatonia), and negative symptoms

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2
Q

annual health-related expenses of someone with chronic schizophrenia averaged more

A

than $15,000

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3
Q

schizophrenia

A

acute or insidious onset
symptoms for six months, at least 2 or more positive or negative symptoms for 1 month. one positive symptom must be delusion, hallucination, disorganized speech

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4
Q

schizoaffective disorder

A

2 weeks or longer with psychotic symptoms in absence of mood symptoms, negative symptoms less severe

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5
Q

schizophrenia age of onset

A

typically during adolescence or early 20s, earlier in men than women

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6
Q

teens with schizophrenia have this risk of attempted suicide

A

50%

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7
Q

plays role in poor health outcomes with schizophrenia

A

poor engagement in health maintenance initiatives such as cancer screenings, exercise, nutrition, tobacco cessation, and identification of other comorbid chronic medical diseases

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8
Q

risk factors schizophrenia

A

immigration, living in an urban area, OB complications, late winter/ early spring births, advanced paternal age

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9
Q

transmitter systems that are likely involved in patho of schizophrenia

A

dopamine
glutamate
GABA
acetylcholine

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10
Q

4 symptom clusters in schizophrenia

A

positive symptoms
negative symptoms
cognitive impairments
affective disturbances

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11
Q

Positive symptoms refer to

A

the “active” qualities of these symptoms that are abnormal and are synonymous with psychosis. Positive symptoms include delusions, hallucinations, disorganized thinking (speech), and grossly disorganized or abnormal behavior (catatonia). Delusions are the hallmark of positive symptoms,

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12
Q

Delusions are

A

fixed beliefs that are not amenable to change despite conflicting evidence. They can include persecutory, referential, somatic, religious, or grandiose themes.

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13
Q

Hallucinations are

A

sensory impressions without basis of reality. They can be vivid and clear to the individual experiencing them and may occur in any sensory modality such as auditory, visual, somatic, olfactory, or gustatory, with auditory followed by visual hallucinations most common.

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14
Q

Tangentiality

A

—getting off topic without answering questions appropriately

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15
Q

Circumstantiality

A

—will answer question in markedly roundabout manner

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16
Q

Derailment

A

—switching topics without a logic sequence

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17
Q

Neologisms

A

—creation of new, idiosyncratic words

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18
Q

Word salad—

A

words are placed together without any sensible meaning

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19
Q

Negative symptoms represent

A

diminished or a lack of normal characteristics—diminished emotional expression and avolition

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20
Q

Avolition represents

A

decline in motivated self-initiated purposeful activities. This encompasses loss of affective responsiveness, verbal expression, and communication, personal and social motivation, and enjoyment

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21
Q

Cognitive impairments include

A

difficulties with memory, attention, psychomotor speed, and executive function. Cognitive impairments, along with negative symptoms, are the most common contributors to disability in schizophrenia.

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22
Q

Affective disturbances

A

, which are difficulties with mood and affect, are seen with schizophrenia. Depression and anxiety can be detected before, during or after a psychotic episode, and providers must be alert for risk of suicide

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23
Q

pharm therapy schizophrenia

A

antipsychotics, early intervention is key. effective in addressing positive symptoms but not negative and cognitive symptoms

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24
Q

best way to treat negative and cognitive symptoms

A

CBT in combo with meds

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25
Q

pts with first episode of schizophrenia

A

typically more responsive to meds than multiple episodes

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26
Q

typical antipsychotics

A

effective, but have more motor system side effects

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27
Q

atypical antipsychotics

A

equally effective to typical
reduce positive symptoms
less likely to have motor side effects
associated with weight gain, metabolic disturbance

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28
Q

Extrapyramidal symptoms (EPS)

A

are potentially troubling side effects of antipsychotics and include Parkinson-like symptoms, akathisia (an inability to sit still), and dystonia (akin to muscle cramps). In some cases, tardive dyskinesia develops

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29
Q

Persons experiencing a first episode should remain on the antipsychotic medication for at least

A

18 months.

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30
Q

Currently the manufacturer recommends evaluation of cataracts at baseline and every 6 months for patients taking

A

quetiapine (Seroquel

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31
Q

Patients with schizophrenia have an average life span that is reduced by

A

20 years compared with population norms,

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32
Q

OCD

A

OCD is characterized by the presence of obsessions, compulsions, or both. Only one category of symptoms is required for diagnosis. Distress is present or acts are time consuming or significantly affects normal routine

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33
Q

Obsessions are

A

recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted.

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34
Q

Compulsions are

A

repetitive behaviors or mental acts that an individual feels forced to perform due to either an obsession or strict rules of conduct. Compulsions help to temporarily decrease anxiety from obsessions and thus, over time become reinforced

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35
Q

OCD onset

A

acute, typically after significant stressful event

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36
Q

pediatric autoimmune neuropsychiatric disorders associated with group A beta-hemolytic streptococcal infection (PANDAS)

A

haracterized by rapid onset and other neuropsychiatric symptoms, including tics, restricted eating, anxiety, and/or irritability. It is thought to be triggered by a throat infection or other illness, leading to the production of autoimmune antibodies against streptococci, which also cross-react with the basal ganglia. This cross-reaction is thought to result in neuropsychiatric symptoms

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37
Q

OCD most common obsessions

A

The most common obsessions are fears of contamination, pathological self-doubt, intrusive thoughts, and symmetry.

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38
Q

1st line treatment OCD

A

SSRI, higher doses and trials (12 weeks) required
CBT

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39
Q

Body dysmorphic disorder

A

Preoccupation with perceived defects or flaws in physical appearance, leading to repetitive behaviors or mental acts.

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40
Q

Excoriation (skin-picking) disorder

A

Repeated skin picking results in skin lesions. The most common areas impacted are the face, arms, and hands

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41
Q

Hoarding disorder

A

Persistent difficulty discarding or parting with objects, regardless of their actual value or importance, due to a perceived need to save them and distress associated with discarding them.

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42
Q

Trichotillomania (hair-pulling) disorder

A

Recurrent hair-pulling from any part of the body resulting in hair loss. There are repeated attempts to stop or decrease the hair pulling.

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43
Q

OCD treatment as last resort

A

DBS, must be chronic severe and treatment resistant

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44
Q

Body dysmorphia disorder typically presents as

A

pt requesting referrals for perceived imperfection

45
Q

1st line treatment BDD

A

no FDA approved treatment, first line is SSRI
CBT

46
Q

hoarding prevalence

A

increased among unmarried or divorced individuals

47
Q

risk factors for developing an eating disorder include

A

female sex, a family history of an eating disorder, perfectionism, obsessive personality traits, and susceptibility to societal pressures for thinness.

48
Q

anorexia nervosa

A

AN is characterized by a refusal to maintain a minimally normal body weight and an intense fear of gaining weight due to a body image disturbance.

49
Q

two types of anorexia nervosa

A

restricting
binge eating/purging

50
Q

One in 10 patients with AN

A

die suddenly from starvation, cardiac arrest, or suicide

51
Q

Binge eating is characterized by

A

eating an excessive amount of food within a 2-hour period. Persons with BN undergo feelings of loss of control during bingeing episodes, and their self-esteem is excessively influenced by their body shape and weight.

52
Q

most pts with bulimia nervosa are

A

normal weight or overweight

53
Q

eating disorder risk between women and men

A

10x higher in women

54
Q

Diagnostics with eating disorders

A

CBC
ESR
CMP
UA
EKG

55
Q

outpatient management eating disorder

A

weight pt weekly, then monthly
provide symptom relief
CBT
SSRI (fluoxetine is FDA approved)

56
Q

The primary consequences of acute insomnia are

A

sleepiness, negative mood, and impairment of performance, with severity related to the amount of sleep lost on one or more nights

57
Q

insomnia medications

A

benzo or benzo receptor agonist meds
all have potential for dependence

58
Q

RLS is

A

a neurological, sensorimotor condition that is typified by uncomfortable sensations in the lower extremities, such as burning, tingling, crawling, or itching, and an uncontrollable desire to move the legs, with associated sleep disturbance. Relief of symptoms is usually obtained once the individual moves his or her legs

59
Q

RLS treatment

A

baths, massage, exercise
relaxis (vibrating pad)
pramipexole, ropinirole

60
Q

percentage of accidents with poisoning that occur involving children

A

46%

61
Q

TCA overdose risk

A

toxic cardiovascular and CNS effects
similar to anticholinergic med effects
QTc prolongation

62
Q

barbiturate overdose

A

depressed CNS tone, inhibition of cardiac contractibility

63
Q

Diagnostic tests for poisoning

A

BMP
coag profile
acetaminophen level
ASA level
UA

64
Q

The most common form of GI decontamination is the use of

A

activated charcoal. best if used within 1 hour of ingestion

65
Q

bee and wasp stings cause more deaths annually than

A

any other venomous animal

66
Q

brown recluse bite

A

spider has “fiddleback” marking on back
causes local tissue destruction

67
Q

black widow bite

A

orange red hourglass shaped marking on abdomen
neurotoxin

68
Q

The normal or usual reaction following an insect sting is

A

local erythema, pain, pruritus, and swelling. Insect stings almost always cause pain. This initial reaction should subside in 1 to 2 hours

69
Q

large local reaction

A

can spread more than 6 inches beyond the sting and is characterized by prolonged and marked edema at the site of the sting injury, peaking at 48 hours and lasting as long as 1 week. This reaction may be accompanied by nausea, vomiting, and fatigue. A large local reaction can involve one or more neighboring joints and may even produce airway obstruction due to tissue swelling if the sting occurs in the mouth or throat

70
Q

toxic reaction occurs when

A

there is a history of multiple stings, often more than 10 in number. Toxic reactions are caused by nonantigenic properties of Hymenoptera venom. They resemble systemic reactions but have a greater frequency of GI disturbances. Diarrhea, nausea, vomiting, light-headedness, and syncope are common signs. The patient may also have headache, drowsiness, fever, involuntary muscle spasms, edema without urticaria, and occasionally seizures. Urticaria and bronchospasm are not present, and symptoms usually subside within 48 hours

71
Q

The shorter the interval between the sting and the onset of symptoms,

A

the more severe the reaction

72
Q

Hymenoptera (bee and wasp) stings produce

A

immediate pain and a red papule surrounded by a pale zone of edema, with varying amounts of local swelling

73
Q

Fire ant stings produce

A

vesicles that become sterile pustules; these pustules subsequently become necrotic within several hours and may take up to 10 days to heal

74
Q

Brown recluse spider bites are

A

unusual in that persons bitten usually do not feel pain for 2 to 3 hours. A single necrotic lesion occurs, usually measuring 0.5 to 2 cm in size, self-limited in spread, and lacking adenopathy or sustained general toxicity. The typical bull’s-eye lesion is created when the red blister is encircled by a pale, irregularly shaped and ischemic halo, which in turn is surrounded by extravasated blood. The pustule may gradually grow to form a crater-like lesion over 3 to 4 days, with associated lymphadenopathy and low-grade fever

75
Q

Black widow spider bites create

A

an initial puncture wound that disappears rapidly, leaving a local swelling where tiny red spots appear. Symptoms of envenomation occur within 10 to 60 minutes, including severe pain in the bitten extremity and muscle spasms of the abdomen and trunk. Diffuse paresthesias, ptosis, and hyperactive deep tendon reflexes may be noted. Victims experience agonizing pain and may develop hypertension, headache, muscular rigidity and spasm, hyperreflexia, vomiting, abdominal pain, agitation, or psychosis. Symptoms peak at 2 to 3 hours after the bite and may last up to 24 hours.

76
Q

Scorpion stings are

A

immediately intensely painful, with little or no erythema or swelling. Generalized reactions may occur within 1 hour and progress to maximum severity in 5 hours

77
Q

Tick bites can

A

produce lesions that vary from small pruritic nodules to extensive ulceration, induration, and erythema. The lesions may be accompanied by malaise, fever, and chills

78
Q

Flea bites produce

A

lesions that are so similar to those of lice and scabies that diagnosis is often difficult. Flea bites produce itching papules, found in zigzag lines, especially on the legs and in the waist area. The lesions present as central hemorrhagic puncta surrounded by erythematous and urticarial patches. Pruritus is intense

79
Q

chigger bites is

A

usually noticed 4 to 8 hours after chiggers have attached or have been removed. Initially, a papule develops and ultimately enlarges over 24 to 48 hours to form a nodule. Pruritus peaks on the second day. The fluid injection causes nodules to appear, which may last for 2 weeks.

80
Q

puss caterpillar’s sting causes

A

intense, immediate pain, often in spasms. This is followed by local edema, pruritus, and a rash of red blotches and ridges. The lesions consist of red or white papules and vesicles, often forming perfect gridlike markings where the caterpillar made contact

81
Q

mosquito bites includes

A

erythema, wheal formation, and severe pruritus. A delayed reaction 12 to 24 hours later consists of more intense redness, edema, and a burning pruritus. Blistering and necrosis can also occur.

82
Q

large local reaction treatment

A

antihistamine
corticosteroids over 5 days
if needed, nerve block anesthesia

83
Q

delayed serum sickness reaction treatment

A

prednisone tapered over 2 weeks
hydroxyzine
topical corticosteroids

84
Q

remover stinger by

A

scraping it away from skill with dull object (not grasped and pulled)

85
Q

brown recluse spider bite treatment

A

ice intermittently x4 days over sterile dressing
oral abx
elevation of affected body part

86
Q

black widow spider bite treatment

A

ice to bite wound
narcotic analgesic if needed
monitor for htn

87
Q
A
88
Q

Heat rash

A

, also known as prickly heat or miliaria, is a group of skin conditions caused by environmental heat and excessive perspiration. The condition occurs when sweat is trapped under the skin due to closed pores. This forms an uncomfortable and often pruritic rash ranging from pinpoint to small, clear to red vesicles. The rash usually occurs on the face and neck. It is more common in the elderly, overweight persons, and infants.

89
Q

Heat cramps are

A

muscle spasms that usually occur in large muscle groups like the calves, abdomen, thighs and shoulders, during or shortly after exercising in the heat

90
Q

Heat syncope is

A

a heat-related fainting episode. It may occur because of vasodilation and peripheral pooling of blood to release body heat, volume deficits, or sluggish vasomotor tone. Syncope occurs when the venous return of blood flow does not support the required cardiac output. Thus, heat syncope can result from inadequate cardiac output and postural hypotension. Typically, recovery is immediate once the patient lies flat.

91
Q

Heat exhaustion occurs when

A

the body overheats and is unable to maintain a normal core temperature. Symptoms may include thirst, heavy sweating, tachycardia, dizziness, nausea, vomiting, and weakness. Heat exhaustion is usually caused by strenuous work in hot and/or humid environments. Treatment includes rest, moving to a cooler environment, removal of clothing that prevents evaporative cooling, and hydration

92
Q

Risk factors for heat exhaustion include

A

the use of alcohol, dehydration, advanced age, and age younger than 5 years.

93
Q

Heat stroke or sunstroke is characterized by

A

a core body temperature of 104°F (40°C) or higher, mental confusion, and more severe clinical manifestations that go beyond the symptoms of heat exhaustion. Heat stroke occurs when heat production is greater than heat loss. There may be damage to multiple organ systems and breakdown of muscle tissue (rhabdomyolysis), and mortality may be as high as 10%.

94
Q

acclimatization

A

is a term that refers to the body’s ability to adapt to heat stress. This adaptation primarily involves the sweating mechanism.

95
Q

safest, most practical method to cool patient

A

remove all clothing
spray warm water over patients entire body surface area

96
Q

goal for heat stroke treatment

A

reduce temp to 102 in the first hour
further active cooling cease when core temp reaches 101

97
Q

Hypothermia

A

is a medical emergency that can threaten life and limb and is defined by a core temperature of less than 95°F

98
Q

risk factor hypothermia

A

older
uninsured
use more critical care than most pts in ED
problems with alcoholism, homelessness, mental illness

99
Q

mild hypothermia

A

tempt 89.6-95

100
Q

moderate hypothermia

A

temp 82.4-89.6

101
Q

severe hypothermia

A

temp less than 82.4

102
Q

hypothermia is a

A

medical emergency

103
Q

individuals at greatest risk for frostbite

A

age 30-49

104
Q

First-degree frostbite (partial skin freezing)

A

: Erythema, edema, hyperemia, no blisters or necrosis, occasional skin desquamation (5–10 days later), transient stinging and burning, and possible throbbing and aching; the patient may also have hyperhidrosis (excessive sweating)

105
Q

Second-degree frostbite (full-thickness injury)

A

: Erythema, substantial edema, vesicles with clear fluid, blisters that desquamate and form blackened eschar, numbness, and vasomotor disturbances in severe cases.

106
Q

Third-degree frostbite (full-thickness injury and subcutaneous freezing)

A

: Violaceous/hemorrhagic blisters, skin necrosis, and blue-gray discoloration; initially, no sensation (tissue feels like a block of wood), but shooting pains, burning, throbbing, and aching develop later.

107
Q

Fourth-degree frostbite (full-thickness injury and subcutaneous tissue, muscle, tendon, and bone freezing)

A

: Initially, skin is mottled, deep red, or cyanotic; later, skin becomes dry, black, and mummified. Minimal edema is present, with possible joint discomfort

108
Q

treatment frostbite

A

rewarm affected area with warm water, do not rub affected area
give narcotics (painful)

Primary Care III (7 decks)

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