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Emergency Medicine > Psych > Flashcards

Psych Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

age that most psych illnesses are diagnosed by

A

45 years

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2
Q

most common psych illness

A

anxiety

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3
Q

PE, ACS, Aortic Dissection, Thyroid disfunction, Arrythmias, Hypoglycemia, Elicit Drugs, EtOH withdrawal, caffeine/energy drinks, marijuana, phobia, PTSD, OCD

A

differentials for anxiety

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4
Q

intense fear + tension + restlessness + palpitations + SOB + hyperventilation + paresthesisa + carpal/pedal spasm + dizziness + agitation

A

anxiety

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5
Q

Management of acute anxiety reaction

A

benzodiazepine → NOT in the ED

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6
Q

MC diagnose in the ED for combative patients

A

drug and alcohol withdrawal

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7
Q

What should you obtain in all patients

A

rapid serum glucose
pulse ox
complete set of vitals

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8
Q

Accronym for causes of agitation

A

FIND ME

[Functional, Infectious, Neurologic, Drugs, Metabolic, Endocrine]

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9
Q

first step in evaluating combative patient

A

risk assessment and attention to safety

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10
Q

what should you never do to an agitated patient?

A

lie to them

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11
Q

which patients require immediate restraint

A

actively violent
severely agitated
those who exhibit signs of impending violence

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12
Q

Physical restraints

A

4 point restraints on extremities + one arm up/down + HOB elevated + padding to prevent neurovascular injury

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13
Q

How often do you check for neurovascular injury on patient with physical restraint

A

q 15 - 30 min

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14
Q

What do you always have to do for patient with physical restraints

A

document reason
which limbs are restrained
frequency of NV checks
review the need every 12 hours

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15
Q

types of chemical restraints

A

IM, IV, or SubQ Benzo or Antipsychotic

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16
Q

what do you need to be on the lookout for with Benzo?

A

decreased respiratory drive

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17
Q

MC chemical restraint ?

What is it good especially for?

A

Lorazepam (Ativan)

excellent for EtOH withdrawal

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18
Q

Preferred chemical restraint agents in pediatrics?

A

haloperidol and lorazepam

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19
Q

disturbance in cognition that impairs memory, judgement, personality, higher critical function and abstract thought process

A

dementia

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20
Q

How does dementia start and how is level of consciousness?

A

gradual onset

level of consciousness maintained

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21
Q

How does delerium differ from dementia?

A

Delirium → acute impairment of cognitive function and decreased LOC, Visual hallucinations are common

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22
Q

MC cause of delirium

A

infection → UTI, meningitis, pneumonia, electrolyte abnormalities

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23
Q

persistent dysphoric mood or loss of interest and please in usual activities (anehedonia)
feeling guilty or worthless
hopeless, thoughts of death/suicide
weight loss, decreased appetite, insomnia/hypersomnia, decreased concentration, flat affect, decreased hygeine

A

depression

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24
Q

Red flag for depression

A

giving away possessions

25
Q

What must you do with depressed patients?

A

ask all about suicidal ideation

26
Q

Job with handling Depression in the ED

A

rule out organic causes first → CBC, TSH, HIV, RPR, CMP, EtOH, UDS, Ammonia, CT of head

27
Q

what do you never do with depressed patient in ED?

A

Never give new or previous diagnosis of depression in the ED → ALWAYS consult psych

28
Q

risk factors for suicide

A

caucasian/native american, family history, male, >65 years, unmarried, lives alone, recent stressor, substance abuse, TMI, MH disorder, prior attempt/plan, access to carry out plan

29
Q

If your patient in the ED had a suicide attempt, what should you do ?

A

place in safe rom 1:1 with sitter → paper gowns and no ties/strings

30
Q

unnatural shifts in mood, energy acitivty levels

A

Bipolar Disorder

31
Q

Three types of Bipolar Disorder

A

Manic Depressive
Bipolar Affective
Cyclothymic

32
Q

Described manic phase of bipolar disorder

A 
grandiosity 
easily distracted 
pressured speech 
insomnia 
racing thoughts/flight of ideas 
increased focus on activity 
excessive pleasurable activities 
poor judgement
33
Q

depressed phase of Bipolar Disorder

A

Suicidal Ideation

feeling worthless

34
Q

Which phase of bipolar episode with have delusions/hallucinations?

A

either phase

35
Q

potential causes of bipolar episode that you must rule out

A 
infection 
HIV 
syphilis 
head injury 
thyroid dysfunction 
schizophrenia
36
Q

bizarre hallucinations + paranoia + social withdrawal + delusions + distrubed thinking processes + flat affect + abnormal behavior

A

Schizophrenia

37
Q

when does the onset of schizophrenia usually occur?

A

late teens and mid 30s

38
Q

major symptoms of schizophrenia

A

psychosis

39
Q

when are most schizophrenic patients seen in the ED?

A

first psychotic break or acute flares (due to noncompliance of meds)

40
Q

How does psychosis differ from schizophrenia?

A

psychosis symptoms include delusions + hallucinations + impaired relationship with reality + short lasting

41
Q

what is schizophrenia?

A

disorder of thinking and perception → information processing and reality testing are impaired → unable to distinguish fantasy and reality [delusions and hallucinations]

42
Q

four categories of schizophrenia symptoms

A

positive
negative
cognitive
mood

43
Q

four types of positive symptoms in schizophrenia

A

hallucinations
delusions
disorganized speech
behavior

44
Q

Types of hallucinations seen in schizophrenia

A

auditory (if visual or tactile think organic etiology)

45
Q

types of delusions seen in schizophrenia

A

bizarre or illogical false beliefs, often paranoids, grandoise, persecutory, or religious
false interpretation of normal perceptions, taunting voices, 2 or more discussing or arguing with eachother

46
Q

How will the speech be in a patient with schizophrenia?

A

disorganized → tangential, incoherent, rambling speech, neologisms

47
Q

Negative symptoms seen in shcizophrenia

A

decrease in emotion
poverty of speech
loss of interest and drive

48
Q

cognitive symptoms seen in schizophrenia

A 
neurocognitive deficits (memory, attention, executive funcitons)
difficulty understanding subtle interpersonal cues/relationships
49
Q

Mood symptoms in schizophrenia

A

labile, anxious, depressed, suspicious, angry, cheerful

50
Q

ED management for schizophrenic patient

A

haldol, risperdal, olanzapine
treat agitation
psych consult

51
Q

assault by forcible, inappropriate sexual behavior

A

sexual assault

52
Q

What should you include in history of patient who was sexually assaulted?

A 
brief description of incident 
time it occurred 
location of assault 
weapon/drugs 
changed clothes, showered, douched since incident?
53
Q

when would you do GU exam in sexual asault patient?

A

concern for life thretening injury (hemorrhaging)

54
Q

When can you have evaluation from specially sexual assault trained RN?

A

assault must be within 3 days

55
Q

labs you may want to order for sexual assault patient

A

UA/UPT, GC/Chlamydia, Wet Prep, HIV, Hep B, Syphilis

56
Q

Sign of child abuse in infants

A

failure to thrive without underlying cause

57
Q

Where are unusual fracture sites or injuries that may indicate child abuse ?

A 
clavicle 
ribs 
arms 
seizures 
retinal hemorrhages
58
Q

What is most often the indication of a presenting child that child abuse is going on?

A

inappropriate delay in seeking care

Emergency Medicine (6 decks)

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