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USMLE Step 1 Systems > Psych > Flashcards

Psych Flashcards

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USMLE® Step 1 flashcards
1
Q

Time course difference in schizo, schizophreniform, brief psychotic.*

A

Brief Psychotic: present < 1 mo
Schizophreniform: 1-6 mo
Schizophrenia: 6 mo

Schizoaffective: 2 wks of just psychosis

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2
Q

Difference between conversion vs. somatization disorder

A

Conversion: unconscious NEURO sx after a life stressor, la belle indifference

Somatization: 4 pain, 2 GI, 1 sex, 1 neuro “so many probs”

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3
Q

What benzodiazepine has a short half life?

A

Triazolam

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4
Q

Acute Stress vs. PTSD time frame?*

A

Acute Stress: < 4 wks

PTSD: >/= 4 wks

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5
Q

Time course for postpartum blues, depression, psychosis.

A

Blues: 2-3 days up to 10 days
Depression: > 2 wks; antidepressants
Psychosis: typically days - 4-6wks postpartum; antipsychotics

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6
Q

In what cases are MAOI particularly useful?

A

Atypical depression (mood reactivity, leaden paralysis, increased sleep and appetite, rejection sensitivity)

Treatment resistant depression

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7
Q

Narcolepsy - Mech and Tx

A

Sx: excessive daytime sleepiness, cataplexy, hypnogogic, hypnopompic hallucinations

Mech:
Dec. hypocretin-1 secretion by lateral hypothalamus

Tx:

  1. Daytime stimulants (modafinil, amphetamine)
  2. PM sodium oxybate (GHB)
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8
Q

What is the “on-off” vs. “wearing off” phenomenon of Parkinson’s tx?

A

“On-off” = UNPREDICTABLE, dose-independent.
- sudden loss of anti-parkinson effects of L dopa, and can be worse than pt’s original symptoms

“Wearing off” = more predictable
- progressive destruction of nigrastriatal dominergic neurons.

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9
Q

What is common adverse effect in SSRI?

A

sexual dysfxn.

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10
Q

Globus Hystericus Vs. Pseudobulbar Paresis

A

Globus Hystericus: “lump in the throat” without accompanying physical, endoscopic, radiographic, or esophageal findings of obstruction. Emotions trigger it.

Pseudobulbar Paresis: dysarthria, dysphagia, dysphonia, impaired movement of the tongue and facial muscles. Caused by conditions such as multiple sclerosis.

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11
Q

Most common cause of death with TCA? Mech?

A

Cardiac Arrhythmia (prolongation of QRS, neg inotrope) and Refractory Hypotension (due to dec. contractility, direct anti-alpha1 effect)

Blocks Cardiac Fast Na channels!

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12
Q

Lithium Side Effects. Toxicity increased with what drugs?

A 
LMNOP: Lithium Side effects: 
Movement (tremor)
Nephrogenic Diabetes Insipidous 
HypOthyroidism 
Pregnancy Probs - Ebstein's Anomaly.

Increased Toxicity with

  • HCTZ
  • ACEi
  • NSAIDS
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13
Q

Tx of Serotonin Syndrome

A

Cyproheptadine - 1st generation antihistamine with nonspecific 5HT-R antagonist properties

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14
Q

HTN crisis after a wine and cheese party - what med is he on?

A

MAOI

Tyramine containing foods = wine, cheese, sausage.

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15
Q

EPS side effects in terms of time frame

A

4 hr acute dystonia
4 day akathisia
4 wk bradykinesia/parkinson
4 mo tardive dyskinesia.

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16
Q

High Potency vs. Low Potency antipsychotics

A

High: “try to fly high”

trifluoperazine
fluphenazine
haloperidol

Low: “cheating thieves are low”

chlorpromazine - Corneal deposits
thioridazine - reTinal deposits

17
Q

Impt side effects for atypical antipsychotics

A

Olanzapine/Clozapine = weight gain

Clozapine = agranulocytosis

Risperidone = increase prolactin - irregular menstruation, fertility issues.

Ziprasidone = prolong QT

18
Q

Side effects of Lithium

A 
LMNOP: Li side effects: 
Movement (tremor)
Nephrogenic Diabetes Insipidous
HypOthyroidism
Preg probs - Ebsteins.

Excreted by kidneys.

Increased toxicity with:

  • HCTZ
  • ACEi
  • NSAIDS
19
Q

How to treat serotonin syndrome?

A

Cyproheptadine 5HT2-R antagonist.

20
Q

TCA side effects

A

Tri-C:
Convulsions
Coma
Cardiotoxicity

Tx: NaHCO3

21
Q

What are the MAOIs?

A

MAO Takes Pride In Shanghai

Tranylcypromine
Phenelzine
Isocarboxazid
Seleginine

22
Q

Bupropion

A

DNRI
Smoking cessation

No sexual side effects

Tox:
stimulatory effects
seizure in bulimics

23
Q

Mirtazapine

A

alpha2 antagonist - Inc. NE and 5HT

Tox:
sedation - good for depressed with insomnia
inc. appetite
weight gain - good in old, anorexic peeps
dry mouth

24
Q

Trazodone

A

blocks 5HT2 and a1-R

Insomnia

Tox:
priapism, hypotension.

25
Q

Buspirone

A

5HT1a receptors

For GAD

No sedation, addiction, tolerance.

26
Q

Short half life benzos

A

AOT
Alprazolam
Oxazepam
Triazolam

Decreased drowsiness
Increased risk of withdrawal, addiction

27
Q

Longer half life benzos

A

Chlordiazepoxide
Chlorazepate
Diazepam
Flurazepam

increased drowsiness
Decreased withdrawal, addiction

28
Q

Postpartum time frame

A

onset within 4 wks of delivery

blue: resolves in 10d
depression: lasts 2 wks - 1 year
psychosis: 4-6 wks

29
Q

Pathologic grief

A

> 6-12 months

30
Q

GAD vs. adjustment

A

> 6 months

Adjustment < 6 mo

USMLE Step 1 Systems (11 decks)

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