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UWorld > Psych/behavior & Substance Abuse > Flashcards

Psych/behavior & Substance Abuse Flashcards

1
Q

Alpha ketogluarate dehydrogenase requires thiamine as a cofactor to convert alpha ketoglutarate to what

A

Succinyl co A

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2
Q

What ratio of metabolic biproducts is increased during alohol consumption

A

NADH to NAD +

NAD+ is used up

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3
Q

The tuberoinfundibular pathway connects the hypothalamus to the ____

A

Pituitary gland

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4
Q

The uberoinfundibular pathway is responsible for the tonic inhiition of _______

A

Prolactin secretion

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5
Q

How may antipsychotics cause a patient to have amenorrhea and galactorrhea

A

Blockade of dopamine 2 receptors –> inhibiting tuberoinfundibular pathway –> loss of prolactin secretion inhibition

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6
Q

Haloperidol MOA

A

First generation antipsychotic

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7
Q

Function of the orbitofrontal cortex

A

Modulatory connections to the limbic system (emotions)

Involved in behavioral and emotional regulation

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8
Q

Function of the lateral prefrontal cortex

A

Executive functioning (includes motivation, organization, planning, and purposeful action)

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9
Q

What is an impulse disorder that is specific to repetitive outbursts of impulsive aggression that is grossly disproportionate to the situation

A

Intermittent explosive disorder

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10
Q

Treatment for anorexia nervosa

A

Cognititve behavioral therapy
Nutritional rehabilitation
Olazapine if no response to other 2 treatments

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11
Q

Bulimia nervosa treatment

A

Cognititve behavorial therapy
Nutritional rehabitlitation
SSRI (fluoxetine) (often in combo with above)

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12
Q

Binge eating disorder treatment

A

Cognitive behavioral therapy
Behavioral weight loss therapy
SSRI
Lisdexamfetamine

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13
Q

Anorexia nervosa is defined as a BMI < ____

A

18.5 kg/m^2

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14
Q

Bulimia nervosa clinical features

A

Recurrent episodes of bings eating
Binge eating and inappropriate compensatory behavior to prevent weight gain
Excess worrying about body shape/weight

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15
Q

Binge eating disorder clinical features

A

Recurrent episodes of binge ating
Lack of control during eating
(No inappropriate compensatory behaviors as seen in bulimia)

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16
Q

What are the common side effects seen in high potency (haloperidol) first generation antipsychotics

A 
Extrapyramidal symptoms (acute dystonia, akathisia, parkinsonism)
Tardive dyskinesia
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17
Q

What are the common side effects seen in low potency (chlorpromazine) first generation antipsychotics

A

Sedation
Cholinergic blockade
Orthostatic hypotension
Weight gain

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18
Q

What are the common side effects seen in second generation antipsychotics

A

Metabolic syndrome
Weight gain
Extrapyramidal symptoms (less common than first generation antipsychotics though)

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19
Q

As a class, first generation antipsychotics are assciated with a high risk of extrapyramidal symptoms due to their potent ____ antagonism

A

D2

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20
Q

Define akathisia

A

Inner restlessness and inability to sit still

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21
Q

Tricyclic antidepresants’ inhibitory affects on ___ receptors can cause tachycardia, delirium, dilated pupils, flushing, decreased sweating, hyperthermia, ileus, and urinary retention

A

Muscarinic acetylcholine

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22
Q

Tricyclic antidepressants’ inhibition of ____ receptorscan lead to peripheral vasodilation (orthostatic hypotension)

A

Alpha 1 adrenergic

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23
Q

Tricyclic antidepressants’ inhibition of ____ can lead to conduction defects and arrhythmias

A

Cardiac fast sodium channels

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24
Q

Tricyclic antidepressants’ inhibition of presynaptic NE and serotonin reuptake can cause what adverse effects

A

Seizures

Tremors

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25
Q

Tricyclic antidepressants’ inhibition of ____ receptors can lead to desation and increased appetite

A

Histamine (H1)

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26
Q

Most deaths from tricyclic antidepressant overdose is due to ____ and ____

A

Cardiac arrhythmias

Refractory hypotension

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27
Q

TCA overdose is treated with ____ which increases serum pH and promotes TCA dissociation from sodium channels

A

Sodium bicarbonate (NaHCO3)

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28
Q

Indications for lithium in bipolar disorder

A

Manic and depressive features

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29
Q

Indications for valproate in bipolar disorder

A

Manic features

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30
Q

Indication for carbamazepine in bipolar disorder

A

Manic features

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31
Q

Indication for lamotrigine in bipolar disorder

A

Depressive features

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32
Q

Duration of symptoms in brief psychotic disorder

A

> 1 day, < 1 month

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33
Q

Duration of symptoms in schizophreniform disorder

A

> 1 month <6 months

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34
Q

Duration of symptoms in schizophrenia

A

> 6 months

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35
Q

A patient found to be lethargic, ataxic, disoriented and have slurred speech followed by rapid improvement and a parioral and perinasal rash indicates what type of substance use

A

Inhalants

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36
Q

Inhalation/misuse of nitrous oxide is associated with ____ deficiency and resultant symptoms of polyneuropathy (symmetric numbness, gait abnormalities)

A

B12

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37
Q

frontotemporal dementia microscopic features includes initial neuronal loss in the frontotemporal lobes with ___ and ___ inclusions

A 
Tau protein (neurofibrillary tangles, pick bodies)
TDP-43 protein
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38
Q

____ protein is involved in DNA repair and transcription and it becomes abnormally ubiquinted in frontotemporal dementia

A

TDP-43

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39
Q

Pathologically ubiquitinated TDP-43 is seen in what two diseases

A

Frontotemporal dementia

Amyotrophi lateral sclerosis

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40
Q

What abnormal labrotory findings are seen in bulimia nervosa

A

Hypokalemia

Metabolic alkalosis

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41
Q

Treatment for social anxiety disorder (social phobia)

A

SSRI/SNRI
Cognitive behavioral therapy
Beta blocker or benzo for performance-only subtype

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42
Q

Duration of symptoms in post traumatic stress disorder

A

> 1 month

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43
Q

First line treatment PTSD

A

SSRI/SNRI

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44
Q

Phenelzine MOA

A

MAO inhibitor

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45
Q

If antipsychotic medication cannot be reduced or discontinued, drug induced parkinsonism is best treated with _____

A

Centrally acting anticholinergic agent (benztropine)

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46
Q

Why should levadopa not be used for treating drug induced parkinsonism in a patient being treated with antipsychotics

A

Levadopa can exacerbate or even precepitate psychosis (use anticholinergic instead)

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47
Q

_____ disorder is characterized by a pattern of behaviors that violate major societal norms or rights of others. Behaviors seen in this disorder include byllying, frequent fights, using weapons, torturing animals, breaking into houses, and sexual coercion. It generally presents in middle childhood to adolescence and is more common in boys

A

Conduct

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48
Q

What are the first line drug treeatments for school-age children with ADHD

A

Stimulant drugs including methylphenidate and amphetamines

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49
Q

Which cluter A personality disorder is described as a person who prefers to be a loner and is detatched and unemotional

A

Schizoid

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50
Q

What cluster C personality disorder is described as avdance due to fears of criticism and rejection

A

Avoidant

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51
Q

A patient with normal development through age 10 months followed by regression and development of hand wringing likely has what diagnosis (other features include seizures, intellectual disability, autistic features, breathing abnormalities, and deceleration of head growth)

A

Rett Syndrome

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52
Q

Rett syndrome is caused by a de novo mutation in the X-linked _____ gene

A

MECP2

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53
Q

Treatment for akathisia, an extrapyramidal side effect of antipsycotic medication

A

Reduction of antipsychotic dose, if possible, or the addition of beta blocker or a benzodiazepine

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54
Q

Decreased renal perfusion due to what medications can cause decreased lithium clearance and therefore toxicity

A

Thiazide diuretics
NSAIDs
ACE inhibitors

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55
Q

Positive psychotic symptoms are thought to be caused by an excess of dopamine in the ____ pathway

A

Mesolimbic

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56
Q

____ is the compulsive consumption of nonstaple food or non nutritive substance for > 1 month

A

Pica

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57
Q

Pica is most commonly seen in what 2 populations

A

Pregnant women

Schoolchildren

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58
Q

What is the term for involuntary movements after chronic use of antipsychotics which typically involves lip smacking or choreoathetoid movements

A

Tardive dyskinesia

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59
Q

Lacrimation and yawning are specific findings for what drug withdrawal

A

Opiod

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60
Q

What is the term for the mature defense mechanism inwhich someone puts unwanted feeligns aside to cope with reality

A

Supression

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61
Q

What is the mature defense mechanism in which someone chanels impulses into socially acceptable behaviors

A

Sublimation

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62
Q

What is the best approach when treating a patient with somatic symptom disorder

A

Schedule regular visits with their primary care provider who can monitor them and avoid unnecessary diagnostic testing and specialist referals

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63
Q

What are the signs and symptoms of neuroleptic malignant syndrome

A

Fever
Altered mental status
Generalized muscle rigidity (lead pipe rigidity)
Autonomic instability

64
Q

Neuroleptic malignant syndrome is thought to be primarily ue to dysregulation of ______

A

Dopamine

65
Q

During alcohol withdrawal, symtpoms are due to increased activity of what receptors

A

NMDA glutamate

66
Q

Chronic alcohol exposure leads to the downregulation of what receptors

A

GABA A

67
Q

How is methadone metabolized

A

P450 system, specifically the CYP3A4

68
Q

Fluconazole, voriconazole, ketoconazole, ciprofloxacin, clarithromycin, cimetidine,, and fluvoxamine all inhibit_____ which prrolongs the effects of methadone

A

P450 3A4

69
Q

Clozapine drug class

A

Atypical antipsychotic (used in treatment resistant schizophrenia)

70
Q

Adverse effects of clozapine

A

Agranulocytosis
Seizures
Myocarditis
Metbolic syndrome

71
Q

What is the diagnosis of someone who has mood episoides with concurrent active phase symptoms of schizophrenia with more than 2 weeks of delusions or hallucinations inthe absence of prominent mood symptoms

A

Schizoaffective disorder

72
Q

Which first generation antipsychotics are more likely to precipitate extrapyramidal symptoms such as acute dystonia, akathisia, and parkinsonism

A

High potency (haloperidol, fluphenazine)

73
Q

What personality disorder may lead to maladaptive pattern of behavior characterized by social inhibition, feelings of inadequacy, andfear of embarrassment and rejection

A

Avoidant

74
Q

Moa buspirone

A

Partial agonist f 5HT1a receptor

75
Q

Does buspirone carry a risk of dependence

A

No (slow onset of action, lacks muscle relaxnt or anticonvulsant properties)

76
Q

What asepct of an ADHD diagnosis may require a teacher’s evaluation

A

The symptoms aer present in 2 or more settings (home and school for example)

77
Q

Phenelzine MOA

A

Monoamine oxidase inhibitor

78
Q

Monoamine oxidase inhibitors work by inhibitig oxidtive deamination, thereby increasing the presynaptic availibility of _____, _____, and _____

A

Serotonin
Norepinephrine
Dopamine

79
Q

MAOIs are supperior to other antidepressants in treating what type of depression

A

Major depressive disorder with atypical features

80
Q

Major depressive disorder with atypical feactures is characteriezed by ______ (mood improve in response to positive events), ______ (patients arms and legs feel extremely heavy), ______ (overly sensitive to slight criticism) and the reversed vegatiative signs of incerased sleep and appetite

A

Mood reactivity
Leaden paralysis
Rejection sensitivity

81
Q

At age 2, a child should have a vocabulary of __-___ words and be able to use 2 word phrases

A

50-200

82
Q

What is the most commonly delayed milestone and an isolatd delay in this milestone with usually catch up in preschool

A

Language

83
Q

What disease may present in an adolescent patient as postural tremor on extension of the arms, broad based gait, slurred speech, sad mood, distractibility, and elevated serum transaminases

A

Wilsons disease

84
Q

Wilsons disease is an autosomal recessive mutation in what gene

A

ATP7B

85
Q

Wilsons disease is an autosomal recessive mutation of ATP7B that causes a hepatic accumulation of ____

A

Copper

86
Q

Mehanism of action: citalopram

A

SSRI

87
Q

What disorder presents with repeated nocturnal episodes of violent motor behaviors reflecting dream enactment

A

REM sleep behavior disorder

88
Q

What are the primary mecahnisms of action for second generation antipsychotics

A

Dopamine D2 receptor antagonism

Serotonin 2A receptor antagonism

89
Q

Drug class: quetiapine

A

Second generation antipsychotiv

90
Q

______ is an immature defense mechanism where the patient will attribute their own feelings to others

A

Projection

91
Q

_____ is an immature defense mechanism where a patient transfers their feelings to less threatening object/person

A

Displacement

92
Q

______ disorder is characterized by 1 or more delusions for 1 or more months in the abence of other psychotic symptoms

A

Delusional

93
Q

____ is a full mu-opiod receptor agonist used for withdrawal and maintenance treatment for opiod use disorders. Its long half life allows it to effectively supress cravings and withdrawal symptoms

A

Methadone

94
Q

____ is an immature defense mechanism in which a patient will experience a person or situation as all positive or all negative

A

Splitting

95
Q

Splitting is commonly seen in people with ____ disorder which contributes to unstable relationships and mood instability that exemplify this disorder

A

Borderline personality

96
Q

The most common adverse affects of methylphenidate are what?

A

Decreases appetite
Weight loss
Insomnia

97
Q

_____ disorder is defined as 1 or more unexplained symtpomswth excessive thoughts, anxiety, and behaviors in response to symptoms

A

Somatic symptom disorder

98
Q

_____ disorder hasminimal to no symptoms and preocupation with the idea of having a serious illness

A

Illness anxiety disorder

99
Q

______ disorder presents with neurologic symptoms incompatible with anatomy or pathophysiology

A

Conversion disorder (functional neurologic symptom disorder)

100
Q

_______ disorder is falsification of symptoms/inducing inury in the absence of obvious external rewards

A

Factitious disorder

101
Q

_____ is falsification of illness for obvious external rewards

A

Malingering

102
Q

The stages of change include precontemplation, contemplation, ______, action, maintenance

A

Preparation

103
Q

How might lithium use cause weight gain, hair loss, and bradycardia

A

Lithium induced hypothyroidism

104
Q

What differentiates adjustment disorder fom normal sadness

A

Impaired social and/or occupational functioning

105
Q

How is opiod overdose treated

A

Naloxone

106
Q

How does naloxone treat opiod overdose (MOA)

A

Antagonizes opiod receptors (competes with opiod medications and displaces them)

107
Q

Adverse affects of clozapine treatment (4)

A

Agranulocytosis
Seizures
Myocarditis
Metabolic syndrome

108
Q

Why might a patient on resperidone present with amenorrhea and breast tenderness

A

Hyperprolactinemia due to ihibition of D2 receptors which normally inhibit prolactin release

109
Q

First line treatment for specific phobia

A

Cognitive behavioral therapy

110
Q

What is the first line pharmacotherapy for moderate to severe alcohol use disorder

A

Opiod antagonist naltrexone

111
Q

What is the second line pharmacotherapy for alcohol use disorder

A

Aldehyde dehydrogenase inhibitor

112
Q

Clinical features of tourette syndrome include ____ and ____ with an onset of <18 (usually 6-15)

A

Motor tics

Vocal tics

113
Q

Treatment for a patient with panic disorder presenting with acute distress

A

Benzodiazepine

SSRI/SNRI and or CBT are first line but would not produce relief of symptoms acutely

114
Q

Substance induced psycotic disorder may present similarly to schizophrenia but with an acute onset corilating to stimulant use as well as physical signs such as tachycardia, diaphoresis, hypertension and what other finding in the eyes

A

Mydriasis

115
Q

When individuals with conduct disorder continue to display a pattern of violating th rights of others into adulthood, they are diagnosed with ______

A

Antisocial personality disorder

116
Q

Define conjunctival injection

A

Red eyes

117
Q

The most characteristic physiological signs of _____ intoxication are conjunctival injection, tachycardia, increased appetite, and dry mouth

A

Marijuana

118
Q

BMI < _____ is consistant with anorexia nervosa diagnosis

A

18.5

119
Q

Describe the restricting subtype of anorexia nervosa

A

Patients fast and exercise excessively but do not purge

120
Q

Describe the binge eating/purging subtype of anorexia nervosa

A

Patients engage in vomiting and/or use substances (laxative, enemas, or diuretics) to avoid weight gain

121
Q

How do opiods cause central sensitization (3)

A 
Opiod receptor down regulation
Recetor decoupling (from second messengers)
Upregulation of excitatory NMDA receptors
122
Q

What is a partial opioid receptor agonist that binds with high affinity but has has low intrinsic activity which may precipitate withdrawal in long term opiod users

A

Buprenorphine

123
Q

First line treatment for OCD

A

SSRI

124
Q

REM sleep behavior disorder is strongly associated with neurodegeneration due to accumulation of _____

A

Alpha-synuclein

125
Q

What is the unconscious shifting of emotions or desires associated wth a person from the past to another person in the present

A

Transference

126
Q

What immature defense mechanism is transforming unacceptable feelings/impulses into the extreme opposite

A

Reaction formation

127
Q

Of the risk factors for suicide what is the strongest single factor thatis most predictive of completed suicide

A

Past suicde attempt

128
Q

Why might lorazepam, oxazepam, clonazepam be better choices for sleep aid than diazepam, chordiazepoxide, or flurazepam

A

Lorazepam has an intermediate duration of action so has less of a chance to precipitate adverse ideeffects of sedation and fatigue when the patient wakes up as the medications with long durations of action

129
Q

What drug class is first line therapy for psychomotor agitation associated with alcohol withdrawal and to prevent progression to seizures and delirium

A

Benzodiazepines

130
Q

Chlorodiazepoxide MOA

A

Benzodiazepine

131
Q

Mecanism of action of antipsychotics

A

Antagonism of postsynaptic dopamine D2 receptors

132
Q

Withdrawal from what drug is characterized by anxiety, tremor, insomnia, and sympathetic hyperactivity and can also be accompanied by psychosis, seizures, or death

A

Benzodiazepines

133
Q

What immature defense mechanism is transferring feelingsto less threatening object/person

A

Displacement

134
Q

A patient using what substance may present with violent behavior, dissociation, hallucinations, amnesia, nystagmus, and/or ataxia

A

PCP (phencyclidine)

135
Q

PCP (phencyclidine) is a hallucinogen that works primaritly as a _____ receptor antagonist as well as a monoamine reuptake inhibitor

A

NMDA

136
Q

A patient that deliberately induces an infection in the absence of obvious external rewards is consistent with ____ disorder

A

Factitious

137
Q

side effects frome what medication can include the following: confusion, constipation, acute urinary retention, hypotension, and sedation

A

Tricyclic antidepressants

138
Q

Describe schizotypal personality disorder

A

Unusual thoughts, perceptions, and behaviors

139
Q

Postpartum blues is a normal, self-limiting condition that occurswihtin a few days postpartum, the symtpoms typically peak at 5 days and resolve within __ days

A

14

140
Q

Postpartum depression typically presents within 4-6 ___folowing delivery

A

Weeks

141
Q

Discribe a learning disorder

A

Difficulties with key academic skills (reading, writing, or mathematics)

142
Q

Patient presening with anxiety, weight loss without trying, tachycardia, warm moist skin, tremor, frightened stare and restlessness are consistent with what diagnosis

A

Hyperthyroidism

143
Q

____ disorderis characterized by excessive concern about having a serious, undiagnosed disease, despite few or no symptoms and negative medical workup

A

Illness anxiety disorder

144
Q

In acute distress disorder, syptoms usually develop directly following the trauma and last from 3 days to _______. When symptoms persist long, the diagnosis is changed to post-traumatic stress disoder

A

1 mont

145
Q

How does transference differ from countertransference

A

Transference: patient’s reactions towards a provider
Contertransference: provider’s reaction to a patient

146
Q

Bipolar II characteristics

A

Hypomanic episodes

1 or more depressive episodes

147
Q

Bipolar I characteristics

A

Manic episodes

Depressive episodes common but not required for diagnosis

148
Q

Dx of persistent depressive disorder requires depressed mood more days than not for more than _____ and at least 2 other depressive symptoms

A

2 years

149
Q

Pure dysthymic syndrome is a subset of persistent depressive disorder with what characteristics

A

Someone who has never met the criteria fo a major depressive episode

150
Q

Attention deficit hyperactivity disorder should not be diagnosed until what age

A

4-5

151
Q

In cognitive testing, what does reciting months of the year backwards test for

A

Concentration

152
Q

Name an antidepressant that does not cause sexual dysfunction

A

Buprpion

153
Q

What isbthe process of a previously neutral stimulus eliciting a response after association with a natural, unlearned stimulus

A

Classical conditioning

154
Q

What is the process of a behavior becoming associated with an environmental consequence

A

Operant conditioning

155
Q

What diagnosis is described by angry/irritable mood, argumentative/defiant behavior, or vendictiveness for 6 months oor more

A

Oppositional defiant disorder

UWorld (19 decks)

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