psych Flashcards
How should you confirm positive urine drug screens?
Gas chromatography and mass spectrometry
How would you monitor for discontinuation of marijuana use ?
Serial urine THC:creatinine ratio
What is the most common fatal complication with use of inhalants in teenagers ?
Cardiac arrhythmias
What diagnosis should you consider in a patient with agitation and ataxia who has hydrocarbon smell on breath, but urine tox screen is negative?
Inhalant use
What can occur with chronic use of inhalants?
Encephalopathy
What type of drug use should you consider in a patient who is combative with muscle rigidity, vertical & horizontal nystagmus? What would you expect the pupils to be like?
PCP - normal pupils
What type of drug use should you expect in a combative patient with tachycardia, tremors, HTN and dilated pupils? (2 answers)
Cocaine
Amphetamines
What type of drug use should you consider in a combative and agitated patient without tremors and with a normal heart rate? (2 answers)
Opiates
Alcohol
What are 4 psychological consequences with marijuana use?
Learning problems
Poor problem solving skills
Memory impairment
Worsening anxiety/depression
what are 4 acute physical signs of marijuana use?
Dry mouth
Dilated pupils
Drowsiness
Distortion of time
What are 3 chronic effects of marijuana use?
Pulmonary compromise
Tachycardia
Gynecomastia
What are 4 additional signs you may find in a teenage patient who presents with ataxia, slurred speech, visual disturbance and vomiting ? What is the likely diagnosis ?
Sluggish pupils Excessive sweating Flushed skin Hypoglycemia *alcohol toxicity*
What symptoms occur with opiate overdose in regards to 1. Breathing, 2. Blood pressure, 3. Temperature, 4. Stooling/urination, 5. Pupils?
- Respiration depression/arrest
- Hypotension
- Hypothermia
- Constipation/urinary retention
- Miosis
What are the possible causes of death in patients with severe opioid overdose? (3 answers)
Respiratory arrest
Circulatory collapse
Seizures
What should you suspect in a patient with anxiety, rhinorrhea, insomnia and stomach cramps?
Opioid withdrawal
What are the signs of amphetamine abuse in regards to vitals and pupils? What psych finding is specific to amphetamine use?
Tachycardia Hypertension Hyperthermia Sluggish dilated pupils *feeling insects crawling on skin
What are the signs of barbituate overdose in regards to vital signs, bowel sounds and pupils?
Bradycardia Bradypnea Hypotension Hypothermia Hypoactive bowel sounds Normal pupils with slow pupillary reflex
What drug would you expect to be the cause of paranoia, agitation, hallucinations and distorted body image?
Pcp
What are the affects on HR, BP, reflexes and the pupils in a patient using PCP?
Tachycardia
HTN
Increased reflexes
Miosis
What are two things that should not be done in a patient suspected of PCP intoxication and why?
Do not acidify urine (precipitates myoglobin)
Do not use restraints (rhabdomyolysis)
What happens to HR and BP in patients using cocaine and how would you treat these patients ?
Hypertension & tachycardia - nitroprusside
What are 4 serious complications of cocaine abuse ?
Myocardial infarction
Stroke
Rhabdomyolysis
Renal failure
What is a sign of chronic cocaine abuse?
Choreoathetotic movements due to dopamine depletion
What are 5 organic causes of enuresis ?
Sickle cell trait UTI Diabetes Seizure Sacral simple? (tethered cord)
What is the appropriate short term treatment for nocturnal enuresis? Why is imipramine no longer used?
Intranasal desmopressin
*imipramine associated with overdose
What are 4 possible organic causes of daytime enuresis after age 3?
UTI
Diabetes mellitus
Diabetes insipidus
Kidney disease
What is the condition in with symptoms are not compatible with any medical cause but symptoms are not faked ?
Conversion disorder
What is the belief that something is wrong with oneself but takes on psychotic dimensions (such as “my pancreas has wings”)?
Somatic delusions
By what age should infants be able to sleep through the night?
4 months
What condition causes children to awaken during the first 1/3 of the night with sweating, tachycardia and tachyons but they are disoriented and don’t recall what occurred? What should be done in this situation ?
Night terrors - do not intervene. Make sure the environment if safe to prevent injury to self. Benzodiazepines may be used to decrease slow wave sleep frequency
What are some things a pediatrician must do after an international adoption?
Verify vaccines TB screening CBC, lead ?hep B, HIV, syphilis, hep C Vision/hearing screen Developmental assessment Q3 months
