PRITE-Style ?s Flashcards
On the expressive-supportive spectrum of interventions, which of the following is considered to be the most supportive therapist intervention?
- confronting
- observing
- interpreting
- clarifying
- advising
advising
Which of the following statistical measures could be used to determine how two independent variables in a study, such as depression and EtOH dependence, affect the frequency of the occurrence event, such as suicide?
- T test
- survival
- odds ratio
- relative risk
- regression analysis
- T test: inferential statistic used when there are two levels of independent variable; it involves using the null hypothesis
- survival
- odds ratio:
- relative risk:
- regression analysis:
Explain the null-hypothesis.
Used to determine if an independent variable has produced an effect in an experiment. Null-hypothesis begins with the assumption that an independent variable has NO effect. By assuming the null is true, we can use probability theory to determine the likelihood that any difference(s) we observed in any given study would occur “by chance”. When we say that there is a statistically significant outcome, we mean there is only a very small likelihood that this would occur if the null hypothesis were true. Another way of thinking about this is that the difference we obtained in our study is larger than would be expected by chance (error variation) alone.
When are f-tests used?
When there are 3 or more levels of independent variables.
Which of the following NTs is reduced in quantity, uptake, and turnover in spasticity?
- glycine
- serotonin
- dopamine
- NE
- GABA
*Glycine:
Childhood physical and sexual abuse has been shown to be a risk factor for which of the following? social phobia specific phobia panic disorder generalized anxiety disorder OCD
panic disorder
The capacity to set reasonable goals for one's self and to accept one's imperfections and other limitations is typically realized during which developmental stage? toddlerhood early childhood late childhood adolescence adulthoo
adolescence
A 65 year old patient presents with insidious onset of weakness when rising from low chairs or squatting position and using stairs. Pt complains of lack of strength in R hand. Has prominent weakness of quads bilat, and on opposition of the thumb in R hand. Atrophy in forearm muscles with nl DTRs; other muscles normal strength. Sensory exam is nl. ROS is negative. Labs: nl CK, no anti-transfer RNA synthase antibodies (Jo1). What is the most likely dx?
dermatomyositis, myotonic dystrophy, desmin myopathy, inclusion body myositis, limb-girdle muscular dystrophy
-Inclusion body myositis: is a T-cell mediated inflammatory muscle disease, characterized by slowly progressive weakness and wasting of both distal and proximal muscles, most apparent in the muscles of the arms and legs; CK is usually elevated, EMGs usually abnl. Treatment is symptom mgmt, no cure. If dysphagia develops, can be fatal, usually from aspiration PNA.
Describe dermatomyositis.
(DM) is a connective-tissue disease related to polymyositis (PM) that is characterized by inflammation of the muscles and the skin. While DM most frequently affects the skin and muscles, it is a systemic disorder that may also affect the joints, the esophagus, the lungs, and, less commonly, the heart.
What is thought to cause dermatomyositis?
The cause is unknown, but it may result from either a viral infection or an autoimmune reaction. In the latter case it is a systemic autoimmune disease. Many people diagnosed with dermatomyositis were previously diagnosed with infectious mononucleosis and Epstein-Barr virus.
What conditions does dermatomyositis “overlap” with sometimes?
Some cases of dermatomyositis actually “overlap” other autoimmune diseases such as Sjögren’s syndrome, lupus, scleroderma, or vasculitis.
What class of medications may contribute to both dermatomyositis and polymyositis?
Several cases of polymyositis and dermatomyositis were reported as being triggered by the use of various statin drugs used to control blood cholesterol. Muscle biopsies of these patients showed rhabdomyolysis, and degeneration and regeneration of muscle tissue.
What are the main skin findings dermatomyositis?
Skin lesions: Gottron lesions, scaly erythematous eruptions or red patches overlying the knuckles, elbows, and knees, also periungual telangiectasias and a heliotropic (purple) rash over the upper eyelids; Mechanic’s hands refers to rough, cracked skin at the tips and lateral aspects of the fingers forming irregular dirty-appearing lines that resemble those seen in a laborer
What are the MSK findings in dermatomyositis?
Symmetric proximal muscle weakness which may be accompanied by pain. The pain may resemble the type experienced after strenuous exercise; Patients find it hard to raise their arms to comb their hair or walk up the stairs due to the proximal muscle weakness; Calcinosis can occur in the skin, joints and tissues
What objective findings would be abnormal in dermatomyositis (i.e. labs, other studies)
. Upon investigation, characteristically one would find an elevated ESR and CPK along with typical EMG findings of spontaneous muscle fibrillation and short polyphasic muscle potentials
What is the treatment for dermatomyositis?
This disease has no known cure. Specialized exercise therapy may supplement treatment to enhance quality of life. Medications to help relieve symptoms include:
- Prednisolone
- Methotrexate
- Mycophenolate (CellCept / Myfortic)
- IVIG
- Azathioprine (Imuran)
- Cyclophosphamide
- Rituximab[11]
- Acthar Gel
Describe myotonic dystrophy
A chronic, slowly progressing, highly variable, inherited multisystemic disease, characterized by wasting of the muscles (muscular dystrophy), cataracts, heart conduction defects, endocrine changes, and myotonia
Describe the two types of myotonic dystrophy
Both are atuosomal dominant.
DM1 (Steinhart disease): more severe, usually childhood onset
DM2: (PROMM Proximal Myotonic Myopathy) rarer form also milder
Aside from the MSK findings, what are some common symptoms of myotonic dystrophy?
Problems with executive function (e.g., organization, concentration, word-finding) and hypersomnia. Conduction abnormalities: all patients are advised to have an annual ECG; insulin resistance, cortical cataract with a blue dot appearance
How do you diagnose and treat myotonic dystrophy?
Molecular testing is considered the gold standard of diagnosis; diagnosis of DM1 and DM2 can be difficult due to the large number of neuromuscular disorders, most of which are very rare; patients may be referred to many specialists including neurology, cardiology, ophthalmology, endocrinology, and rheumatology.
Treatment is symptom mgmt: PT, orthotics, mobility aids, adaptive equipment.
What is desmin myopathy?
Desmin myopathy is associated with mutations in desmin or alphaB-crystallin. Typically, the illness presents with lower limb muscle weakness slowly spreading to involve truncal, neck-flexor, facial, bulbar and respiratory muscles. Skeletal myopathy is often combined with cardiomyopathy manifested by conduction blocks and arrhythmias resulting in premature sudden death.
Which of the following is the most common pattern of obsessions in patients with OCD? hoarding counting agression contamination need for symmetry
contamination
Which of the following is useful for mgmt of orthostatic hypotension in PD? prednisone levodopa entacapone pramipexole fludrocortisone
fludrocortisone
Semiconsciously diverting attention from a conflict in order to minimize discomfort is an example of : repression rationalization suppression intellectualization reaction formation
Supression:
repression:
rationalization:
intellectualization:
reaction formation:
How do antipsychotics elevate prolactin?
Prolactin is under tonic inhibitory control of dopamine. Block dopamine and you inhibit the inhibitor of prolactin, thus prolactin will increase.
What is the most frequent manifestation of acute neurosyphilis? stroke dementia tabes dorsalis optic nerve atrophy deafness and vestibulopathy
stroke
A pt with known EtOH dependence presents to the ED with confusion, ataxia, nystagmus, and ophthalmoplegia. What does he have, and how might it have been prevented?
Wernicke’s encephalopathy (3/3 of these sx present in only ~10% of pts). Caused by B1 (thiamine) deficiency, thus aggressive supplementation of this vitamin (or cessation of drinking) might have prevented it.
What are the thiamine (B1) deficiency syndromes?
Beriberi
Wernicke’s encephalopathy
Korsakoff syndrome
Describe Korsakoff syndrome
characterised by memory impairment, confabulation, confusion and personality changes, has a strong and recognised link with WE. A high % of patients with Wernicke-Korsakoff syndrome also have peripheral neuropathy, and many alcoholics have this neuropathy without other neurologic signs or symptoms. Korsakoff´s occurs much more frequently in WE due to chronic alcoholism. It is uncommon among those who do not consume alcohol abusively. Up to 80% of WE patients who abuse alcohol develop Korsakoff’s syndrome
What does thiamine do?
.Thiamine helps to breakdown glucose by acting as a coenzyme in the TCA cycle and the pentose phosphate shunt. The body only has 2–3 weeks of thiamine reserves, which are readily exhausted without intake, or if depletion occurs rapidly, such as in chronic inflammatory states or in diabetes.
B1 is involved in:
- Metabolism of carbohydrates, creating energy
- Production of neurotransmitters including glutamic acid and GABA.
- Lipid metabolism, necessary for myelin production.
- Amino acid modification.
- Neuromodulation
Polyneuropathy can be caused by either deficiency or extreme excess of which of the following B vitamins?
B6 (Pyridoxine); Pyridoxal phosphate is the metabolically active form involved in: many aspects of macronutrient metabolism, neurotransmitter synthesis (5HT, DA, epi, NE, GABA), histamine synthesis, hemoglobin synthesis and function and gene expression coenzyme for many reactions. Absorbed in the ileum and jejunum and metabolized in the liver.
According to standard DBT approach, which skill should be taught early and practiced often to facilitate learning of other skills? mindfulness self-management distress tolerance emotion regulation interpersonal effectiveness
mindfulness
Cigarette smoker with 1 ppd habit recognizes the need to quit smoking "I know it's bad for me, I'll feel better once I quit, I'll probably get serious about it next year. Which stage of change? precontemplation contemplation preparation action maintenance
contemplation:
precontemplation:
preparation:
action:
maintenance
