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USMLE: step 1 > Psych > Flashcards

Psych Flashcards

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USMLE® Step 1 flashcards
1
Q

What is classical conditioning using an example and naming the stimuli and responses?

A
  • Steak (UNCONDITIONED stimulus) makes a dog drool (NATURAL response).
  • Associating a bell (CODITIONAL stimulus) with a steak makes dog drooln absence of steak: the bell has become the CONDITIONED stimulus and drooling at it is the CONDITIONED RESPONSE
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2
Q

How are natural and conditioned response different?

A

The response is the same, it is just called the conditioned response when it occurs in response to the conditioned stimulus

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3
Q

What are consequences and in what model are they seen?

A

Outcomes of a behavior influencing the likelihood it will happen again

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4
Q

Difference between stimulus in classical and operant conditioning?

A

Classical: stimulus is presented before behaviour
Operant: consequence given after behavior to increase or decrease its likelihood

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5
Q

What are positive and negative consequences?

A

**Remember, a consequence can be a punishment, or a reinforcement:
Positive consequences: involves DOING something
Negative consequences: involve stopping or withholding something

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6
Q

What are reinforcement and punishment?

A

*Both are consequences to a certain behavior:
Reinforcement: makes behavior more likely
Punishment: makes behavior it less likely

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7
Q

What is negative reinforcement?

A

Temporarily removing adverse condition when behavior is performed

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8
Q

What is negative punishment?

A

Temporarily removing a non adverse condition when a behavior is performed
***Taking away a kids toys when they bite you

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9
Q

What is extinction?

A

Loss of a trained behavior after the stimulus is removed

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10
Q

What is transference?

A

PATIENT is projecting a past relationship onto the clinician

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11
Q

What is COUNTERtransference?

A

CLINICIAN is transferring past relationship onto patient

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12
Q

What is the isolation defense?

A

“Think isolation of affect”

- You are isolating your emotions even when talking about a terrible event

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13
Q

What is identification?

A

Modeling your identity on someone more powerful?

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14
Q

What is splitting?

A

Dividing the world into absolutes: everything is either all good, or all bad
**Characteristic of borderline personality disorder

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15
Q

What is splitting characteristic of?

A

Borderline personality disorder

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16
Q

What is SUBconsciously blocking a painful memory?

A

Repression

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17
Q

What is repression?

A

SUBconsciously blocking a painful memory

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18
Q

What is consciously blocking a painful memory?

A

Suppression

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19
Q

What is suppression?

A

Consciously blocking a painful memory

  • Aware it is going on but you choose not to think about it
  • Choosing not to worry about something for now
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20
Q

Most mature of suppression, repression, and denial?

A

Suppression

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21
Q

What is denial?

A

You are consciously aware of bad new but you are subconsciously unable to accept

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22
Q

What is projection?

A

Seeing your shitty qualities in someone else

- Think of a projector machine projecting them onto the wall or someone else

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23
Q

What is displacement?

A

Taking your anger from one person and acting it out on another person - think, your anger is misplaced!

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24
Q

What is fixation?

A

Never growing up

- Adults who have been doing something childish for a while such as video games

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25
Q

What is regression?

A

Have grown up but revert back to old behavior

- Starting to wet bed or such thumb in response to a stressor

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26
Q

What is reaction formation?

A

Instead of performing and unacceptable action, you perform the exact opposite
- Obsessed with sex so you become a celibate priest

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27
Q

What is sublimation?

A

Aware of anger but you channel it to something similar but safer:
- I want to punch someone but I am going to play hockey instead

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28
Q

Rates and genetics of schizophrenia?

A

General population: 1%
First degree relative: 10%
Monozygotic Twin: 50%

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29
Q

Effects of infant deprivation of care?

A

“Weak, wordless, wary, wanting”

  • Failure to thrive
  • Low verbal scores
  • Difficulty trusting others
  • Poor social development
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30
Q

What is reactive attachment disorder?

A
  • Lack of social stimulation causing unresponsiveness and physical decline
  • Can lead to coma and death
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31
Q

What do spiral fractures indicated?

A

Child abuse from grabbing and twisting long bones

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32
Q

Signs of shaken baby?

A
  1. Rib bruise and fracture
  2. Cervical spine fracture
  3. Retinal hemorrhage and detachment
  4. Subdural hematoma w/o external trauma
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33
Q

Who usually commits physical child abuse?

A

Caregiver, females for often

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34
Q

Who usually commits sexual abuse?

A

Not the caregiver but a male the child knows

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35
Q

Signs of child abuse?

A
  1. Sexually precocious: outside normal body curiosity
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36
Q

Signs of osteogenesis imperfecta?

A
  1. Blue sclera
  2. Multiple fractures
  3. Hearing loss
  4. Opalescent teeth
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37
Q

What to do when you expect child neglect?

A

Call CPS

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38
Q

What is vulnerable child syndrome?

A
  • Parents believe child is vulnerable to harm following serious illness or accident
  • Leads to missed school or overuse of medical system
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39
Q

What is only non stimulant non habit forming medicine for ADHD?

A

Atomoxetine

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40
Q

What is oppositional defiant disorder? Conduct?

A

Oppositional: Consistent defiance and hostility to authority figures
Conduct: defiant but consistently are violating rights of others with criminal behavior common
*Start fires, steal, violent

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41
Q

Difference between conduct disorder and antisocial personality disorder

A

Same thing but:

Conduct disorder: 18 yo

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42
Q

Presentation of tourettes?

A
  1. Vocal tics

2. Motor tics

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43
Q

2 associated diseases with tourettes?

A
  1. OCD

2. ADHD

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44
Q

Characteristics of autism spectrum?

A
  1. Fixated and repetitive behavior
  2. Social disability
  3. Communication disability
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45
Q

What is Rett syndrome?

A
  • Only disease of autism spectrum with known cause
  • X linked recessive seen only in girls
  • If you dont have 1 normal X chromosome disease is deadly
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46
Q

Diagnosis with autistic girl hand wringing?

A

Rett syndrome

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47
Q

Presentation of Rett?

A
  1. Hand wringing
  2. Regression of verbal abilities
  3. Autism spectrum
  4. Only females
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48
Q

2 Comorbidities of ADHD?

A
  1. Tourette
  2. Conduct disorder
  3. Oppositional defiant
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49
Q

Movement effect of ACH and dopamine?

A

ACH: anti movement
De: pro movement

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50
Q

De pro or anti psychotic?

A

Pro “Dont act DOPEY”

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51
Q

Disease in which glutamate is high?

A

Alzheimers

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52
Q

NTs in alzheimer’s?

A
  1. Increased glutamate

2. Decreased ACH

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53
Q

Which NT is pro memory?

A

ACH

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54
Q

NTs in anxiety?

A
  1. High NE
  2. Low 5HT
  3. Low GABA
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55
Q

NTs in depression?

A
  1. Low NE
  2. Low 5ht
  3. Low DE
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56
Q

NTs in huntington’s?

A
  1. Increased DE
  2. Decreased ACH
  3. Low GABA
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57
Q

NTs in parkinson’s?

A

Opposite huntingtons

  1. Low DE
  2. Increased ACH
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58
Q

NTs in schizo?

A
  1. High DE
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59
Q

In which order do you lose your orientations?

A
  1. Time
  2. Place
  3. Person
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60
Q

What causes korsakoff syndrome? Signs?

A
  • Mamillary body destruction from thiamine deficiency
  • Leads to anterograde amnesia
  • Confabulation seen
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61
Q

What is dissociative amnesia?

A

Retrograde amnesia secondary to emotional trauma

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62
Q

What is dissociative amnesia?

A

Trauma causing inability to remember personal info

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63
Q

What is dissociative fugue?

A

SEVERE loss of identity: wondering off to somewhere random sometimes even developing a new identity

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64
Q

What is dissociated identity disorder?

A

Psychological trauma causing multiple personalities

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65
Q

What is depersonalization disorder?

A

Feeling disconnected with interactions with world around you

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66
Q

What is delirium?

A
  • Acute onset, waxing and waning altered mental status

- Usually result of medical issues

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67
Q

What is dementia?

A
  • Chronic, progressive decline of mental status

- Usually in elderly

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68
Q

Common symptoms of delirium and dementia?

A 
Delerium:
1. Lapse in consciousness and focus
2. Hallucinations
Dementia:
1. Gradual memory loss
2. Loss of language skills
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69
Q

Delirium of dementia reversible?

A

Delerium will reverse once underlying cause is treated

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70
Q

Reversible causes of dementia that need to be ruled out?

A
  1. Thyroid
  2. B12
  3. Depression
  4. Normal pressure hydrocephalus
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71
Q

In which dementia are hallucinations seen?

A

Lewy body disorder

72
Q

What is psychosis?

A

Inability to experience reality normally

73
Q

Main signs of psychosis? and criteria?

A

At least two symptoms present for > 1 month during a 6 month period and one must be:

  1. Hallucinations
  2. Delusions
  3. Disorganized speech
74
Q

What is disorganized speech?

A

Speech that doesn’t make logical sense

75
Q

Non psychotic causes of hallucinations?

A
  1. Narcolepsy
  2. Drugs
  3. Alcohol withdrawal
76
Q

What are hypnogogic and hypnopompic hallucinations?

A

Both seen in narcolepsy

  • Hypnopompic: when you POP out of bed
  • Hypnogogic: when you GO to bed
77
Q

Normal hallucination in psychotic folks?

A

Auditory

78
Q

When are olfactory and gustatory hallucinations often seen?

A

Epileptic aura

79
Q

What are tactile hallucinations associated with?

A

Alcohol and drug withdrawal

80
Q

Negative symptoms mean better or worse prognosis in schizo?

A

Worse

81
Q

Time requirement for schizophrenia?

A

6 months from start of symptoms

- Starts at the prodrome, not at the break

82
Q

Break out the psychotic disorders by time?

A
  1. Schizophrenia: > 6 months
  2. Schizophreniform: 1 - 6 months
  3. Brief psychotic disorder:
83
Q

What is schizoaffective disorder?

A
  • Psychotic disorder leading to mood symptoms
84
Q

How to tell schizoaffective vs. MDD with psychosis, vs. Bi polar with psychosis?

A

Affective: Mood symptoms must overlap psychosis
- Psychosis can occur independently
**Must be 2 weeks of psychosis sans mood
MDD:
- Psychosis only seen alongside mood symptoms
BP:
- Psychosis only seen alongside mood symptoms

85
Q

If you are grieving and hallucinating are you psychotic?

A

No, falls under normal bereavement

86
Q

Imaging of schizophrenia?

A

Enlarged ventricles

87
Q

What is delusional disorder?

A
  • Only psychotic symptom is delusions
  • Must be > 1 month
  • Delusion is non bizarre: could happen but not true
  • Function normally not lost
88
Q

What are the two down disorders?

A
  1. MDD

2. Dysthymia

89
Q

Why are the up and down disorders?

A
  1. BP1
  2. BP2
  3. Cyclothymia
90
Q

What is a manic episode?

A 
Abnormally elevated OR irritable mood + 3 of "DIG FAST"
Distractibility 
Irresponsibility 
Grandiosity 
Flight of ideas
Agitation / activity 
Sleeplessness
Talkative
91
Q

Signs to distinguish stimulant OD from mania?

A
  1. Tachycardia
  2. Dilated pupils
    * **Urine toxicology for definitive diagnosis
92
Q

What is a hypomanic episode?

A

Like a manic episode but:

  1. Does not significantly impair function
    - Can actually increase
  2. There is no psychosis
93
Q

Definition of Bipolar I and II?

A

Bipolar I: 1 episode mania and usually MDD as well

Bipolar II: 1 episode HYPOmania + 1 episode MDD

94
Q

Bipolar I or II considered more severe and why?

A

II - mania is milder but the lows tend to be much lower and cycle faster
***Suicide risk is also higher

95
Q

What happen in BP patient given only antidepressant without mood stabilizer?

A

Catapult them into mania

96
Q

What is cyclothymia?

A
  • Mood episodes are not distinct, constantly cycling but at a milder level
  • Must occur for AT LEAST 2 years
  • Subclinical depression and hypomania
  • **
97
Q

2 mood that can define MDD? Time criteria?

A

At least two weeks of either:

  1. Depressed mood
  2. Anhedonia: can’t find pleasure in normal things
98
Q

What is the MDD pneumonic?

A

“SIG E CAPS”
Sleep changes
Interest decrease
Guilt

Energy decrease

Concentration decrease
Appetite changes
Psychomotor changes
Suicidality 
\++++Depressed mood counts as no as well
99
Q

Diagnostic criteria for MDD?

A
  • 5 SIGECAPS
  • > 2 weeks
  • 1 Lifetime episode with no history of mania
100
Q

What is dysthymia?

A
  • Milder form of MDD
  • > 2 years symptoms
  • Don’t meet all 5 MMD criteria
  • No periods > 2 months normal
101
Q

Signs of melancholic depression?

A
  1. Depressed mood AND anhedonia
  2. Sleep loss
  3. Weight loss
  4. Increased REM
  5. Nighttime awakeness
  6. Wake early in morning
102
Q

What is atypical depression?

A
  1. Depressed mood can be fixed by positive events
  2. Eat more
  3. Sleep more
  4. Sensitive to rejection
103
Q

Best drug for atypical depression?

A

MAOIs

104
Q

Normal postpartum blues descriptors?

A
  1. Not suicidal

2.

105
Q

What is normal bereavement?

A

1.

106
Q

Most common means of suicide?

A

Guns

107
Q

Panic disorder diagnostics?

A
  1. 1 panic attack

2. 1 month preoccupation with attack

108
Q

How to treat panic attack?

A

Benzo

109
Q

What is specific phobia?

A

Fear of specific:

  1. Thing
  2. Situation (social anxiety)
  3. Environment (agoraphobia)
110
Q

What is agoraphobia?

A

Excessive fear of uncontrollable environments:

  1. Open spaces
  2. Public transport
  3. Crowded spaces
111
Q

What phobia associated with panic attacks?

A

Agoraphobia

112
Q

Treatment for specific phobia?

A

Systematic desensitization

113
Q

What is generalized anxiety disorder?

A
  1. > 6 months anxiety
  2. Not related to specific trigger
  3. Psychosomatic symptoms
114
Q

What drug has side effect of seizures?

A

Benzons

115
Q

Time criteria for adjustment disorder?

A

Ends within 6 months of removal of stressor

- Could persist indefinitely if not removed

116
Q

What is a compulsion?

A

Repetitive action that temporarily relieves anxiety of obsession

117
Q

Difference between OCD and obsessive compulsive personality disorder (OCPD)?

A
  • OCD, you know your obsession are nuts (ego dystonic)

- OCPD you do not (ego syntonic)

118
Q

Which childhood disorder is OCD associated with?

A

Tourettes

119
Q

What is body dysmorphic disorder?

A

Obsession with perceived physical imperfection

- Look for lots of plastic surgery

120
Q

Who is looking for lots of plastic surgery?

A

Body dysmorphic disorder

121
Q

Trauma criteria for PTSD?

A
  1. Death
  2. Serious injury
  3. Sexual violence
    * Must have experienced or witnessed this
122
Q

Symptoms of PTSD?

A
  1. Flashbacks
  2. Nightmares
  3. Avoidance of stimuli
  4. Hypervigilance
    * **Must last at least one month
123
Q

What is acute stress disorder?

A

Symptoms of PTSD but last

124
Q

What is malingering?

A

Lying for gain to medical professional: get out of work or for narcotics for example

125
Q

What is factitious disorder?

A

Faking medical condition for no real reason other than craving the attention or something

126
Q

What is munchausen by proxy?

A

Caregiver forces child or elderly to act sick because they receive gratification for some sick reason

127
Q

What are somatoform disorder? 2 types?

A

Being obsessed with thinking you are sick when you really are not

  1. Illness anxiety: FEAR of serious illness
    - Have stomach but but think they have AAA
  2. Somatic symptom disorder: multiple unexplained complaints
    - Psychogenic problem is causing the pain
128
Q

What is conversion disorder?

A

Stressor leading to specific sensory or motor loss and person doesn’t seem to really care

129
Q

How to treat somatic symptoms?

A
  1. Dont tell them they aren’t really sick

2. Schedule regular follow ups

130
Q

What do clusters A B and C share characteristics with?

A

“Weird, Wild, worried”
A: psychotic
B: Bipolar
C: anxiety

131
Q

What is paranoid PD?

A
  • Everyone out to get you
132
Q

Schizoid PD?

A

“Remember the ‘D’ for distant”

  • Blunted emotional range
  • Not interested in social interactions
133
Q

Schizotypal PD?

A
  • Unusual beliefs and magical thinking
  • Eccentric dress and appearance
  • Socially awkward
134
Q

What is schizoaffective?

A

Schizophrenia with the personality issues of PDs as well

135
Q

Borderline PD?

A
  • Emotionally very high and low
  • Unstable relationships
  • Use splitting often
136
Q

Histrionic PD?

A
  • Outgoing

- Sexually provocative

137
Q

Narcissistic PD?

A
  • Grandiosity
  • React horribly to criticism
  • Lack of empathy
  • Arrogant
138
Q

Antisocial PD

A
  • Conduct disorder in person > 18 yo
  • Lack of empathy
  • Arrogant
  • Criminal behavior
139
Q

Which cluster B responds best to treatment?

A

Borderline to dialectic behavioral therapy

140
Q

Avoidant PD?

A
  • Avoid social interaction
  • Low self esteem / inadequacy
  • Hypersensitive to rejection
141
Q

Rule for diagnosing eating disorder?

A
  1. If underweight = anorexia, BMI
142
Q

Definition of purging?

A
  1. Vomit
  2. Exercise
  3. Laxatives
  4. Diuretics
143
Q

What is binge eating disorder?

A
  • Binge phase of bulimia with not purge
  • No preoccupation with weight
  • Obesity and type II rampant
144
Q

Transgender, transexual, Transvestite?

A

Genger: want to live as no biologic gender
Sexual: Same as above + Change body
Vest: sexual pleasure from dressing as other genger

145
Q

Who do antipsychotics cause ED?

A

Suppress DE, disinhibiting prolactin which suppresses the axis

146
Q

When do nightmares occur?

A

REM

147
Q

When to sleep terrors occur?

A

Slow wave

- Thrash and scream but have no memory

148
Q

What is the issue with narcolepsy?

A

Orexin AKA hypocretin

149
Q

What is cataplexy?

A

Dropping to ground when feel strong emotion, indicative of narcolepsy

150
Q

Depressant withdrawal symptoms?

A
  1. Anxiety
  2. WIthdrawal
  3. Tremmor
151
Q

Stimulant withdrawal symptoms?

A
  1. Depression
  2. Lethargy
  3. Headache
  4. Weight gain
152
Q

When are goosebumps, yawning, and pinpoint pupils seen?

A

Opioids withdrawal

153
Q

Depressant with highest risk of repiratory collapse?

A

Barbiturates

154
Q

Treatment of opioid OD?

A

Naloxone: mu antagonist

155
Q

Drugs leading to dilated pupils?

A
  1. Amphetamines

2. Cocaine

156
Q

Treatment of Cocaine withdrawal?

A
  1. Benzo
  2. A1 blocker for coronary vasoconstriction
    * ***Never use BB, will drop CO too low when cardiac vessels are already over dilated
157
Q

Non nicotinic agents approved for smoking cessation?

A
  1. Bupropion

2. Varenicline

158
Q

What is good about LSD?

A
  1. No withdrawal

2. Is not habit forming

159
Q

What is phencyclidine?

A

PCP

160
Q

What does PCP intoxication look like?

A
  1. BELLIGERENCE
  2. Stimulated
  3. Analgesia
  4. Hallucinations
    5 NYSTAGMUS
161
Q

Signs of wernicke’s encephalopathy?

A

From Thiamin deficiency / booze:
1. Ophthalmoplegie
2. Ataxia
3 Confusion

162
Q

What is B1?

A

Thiamin

163
Q

First line for depression?

A

SSRIs

164
Q

Goal of stimulus control therapy for insomnia?

A

Disassociate bedroom with stimulating activities:

  1. Reading
  2. TV
  3. Eating
  4. Fear of sleep
165
Q

What is priapism? What drug can cause it?

A

Persistent erection > 4 hours

- Can be caused by TRAZODONE

166
Q

Time place and age requirement for ADHD?

A
  • Must occur before 12 yo

- Must occur in > 1 setting

167
Q

What causes drug induced parkinsonism?

A

Blockage of D2 receptors

168
Q

Drugs good to treat drug induced parkinsonism?

A
  1. Benzotropine

2. Trihexyphenidyl

169
Q

What is gender?

A

Innate feeling of being male or female developed by age 3 -4

170
Q

Best treatment for specific phobia?

A

Behavioral therapy

171
Q

Does OCD involve compulsions?

A

NO

172
Q

Who displays patterns of unstable relationships beginning in childhood and leading to adulthood?

A

Borderline personality disorder

173
Q

Treatment for bulimia nervosa?

A

SSRIs: fluoxetine is #1

174
Q

Benzons good in liver failure?

A
  1. Lorazepam
  2. Oxazepam
  3. Temazepam
175
Q

Mechanism of PCP?

A

NMDA antagonism

176
Q

Is suppression or repression a conscious decision?

A

Suppression, it is “what you are SUPPOSED to do”

USMLE: step 1 (15 decks)

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