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Shelf Exams/USMLE Step 2 CK ❄️ > Psych - Case Files, UW, etc. > Flashcards

Psych - Case Files, UW, etc. Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the risk of recurrence of a major depressive episode if SSRIs or other treatments are discontinued?

A

50-85%

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2
Q

What are the major side effects of SSRIs?

A

GI sx (pain, nausea, diarrhea), sleep disturb (sedation or insomnia), tremor, dizzy, sex dysfunction

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3
Q

What is retinitis pigmentosa, and which psychiatric medication can cause this disorder?

A

Pigmentation of retina that may cause poor night vision

Side effect of first generation AP Thioridazine

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4
Q

What is an appropriate treatment of priapism from Trazadone?

A

Epinephrine injection into corpus of penis

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5
Q

What are contraindications for using bupropion?

A

Patients with eating or seizure disorder

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6
Q

What are symptoms of life threatening lithium overdose, and how do you best treat?

A

Seizures and coma

Dialysis to treat

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7
Q

What can be useful for excessive daytime sleepiness in shift workers?

A

Modafinil

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8
Q

What must be ruled out to make a diagnosis of schizophrenia?

A

Psychosis secondary to substance abuse and or general medical conditions

Schizoaffective DO and mood DO must be R/O

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9
Q

What symptom is most specific to a diagnosis of schizophrenia?

A

Bizarre delusions

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10
Q

What symptom is most specific to a diagnosis of schizophrenia?

A

Bizarre delusions

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11
Q

What is the immediate treatment for panic attacks? Long term treatment for panic disorder?

A
  1. Short acting benzo (alprazolam) - discontinue after initial few weeks
  2. SSRI + CBT
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12
Q

What is the definition of agoraphobia?

A

Anxiety about being in situations or places from which escape will be difficult, or in which help may not come if panic attack occurs

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13
Q

What differentiates social phobia vs. specific phobia?

A

Social phobia involves social or performance situations while specific involves a specific object or situation

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14
Q

How can ADHD be differentiated from hypo mania?

A

ADHD has distractibility, impulsivity and hyperactivity present on daily basis since age 7 (also look for preschool age sx)

And often oppositional defiant disorder and conduct disorder present

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15
Q

What needs to be monitored closely in patients taking lithium or carbamazepine?

A

Li - thyroid and kidney fxn

Carba - aplastic anemia or agranulocytosis

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16
Q

What mood stabilizers are a better option in young women of child bearing age?

A

Atypical APs - olanzapine risperidone seroquel

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17
Q

How can one differentiate schizoid PD from avoidant?

A

Avoidant find loneliness as ego-dystonic and strongly wish for relationships with others

Schizoid do not feel need for relationships at all

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18
Q

What defense mechanism is frequently seen in schizoid PD?

A

Intellectualization

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19
Q

What is the best course of therapy for major depression with psychotic features? (Especially in elderly with SI)

A

ECT

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20
Q

What medical conditions should raise caution before doing ECT?

A

Raised ICP, unstable angina, recent MI, electrolyte imbalance

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21
Q

What pharma tx can be given for anxiety associated with performance situation just before the feared situation?

A

Beta blockers - atenolol and propranolol

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22
Q

What are typical exam findings of PCP intoxication?

A

Angry, belligerent, dysarthria, vertical nystagmus

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23
Q

How does treatment for PCP intoxication vary based on the symptoms?

A

Benzodiazepines if psychotic symptoms not present

Haldol if severe psychosis but this may worsen anti-cholinergic side effects, hyperthermia, dystonia

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24
Q

What should be avoided in patients with generalized anxiety disorder?

A

Benzodiazepines, because habit forming and will make buspirone and to lesser extent SSRIs less effective

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25
Q

What are PANDAS?

A

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections

Include OCD and other disorders

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26
Q

What is the triad of wernicke encephalopathy?

A

Acute reversible triad of delirium, 6th nerve palsy, ataxia, caused by thiamine deficiency

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27
Q

What are the CAGE questions?

A

Have you attempted to Cut down on drinking, Annoyed by criticism, Guilty for drinking,Eye opener

Yes to 2 or more is sensitive for EtOh dependence

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28
Q

What is the most sensitive test for delirium and what will it show?

A

EEG, generalized slowing

If delirium by EtOH or sedative hypnotic withdrawal, can show fast low voltage activity

Hepatic encephalopathy - triphasic delta waves

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29
Q

How do depressed youth often present to their pediatrician?

A

Sudden onset anger and irritability, lack of interest in fun activities, low E, poor grades

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30
Q

What are the key features of OCPD and how do you differentiate from OCD?

A

INFLEXIBLE THINKING AND BEHAVIOR - Difficulty making decisions and finishing work, blames others for problems (egosyntonic), rigid and stubborn manner

w/ OCPD there are no intrusive repetitive thoughts or ritualistic behaviors as with OCD

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31
Q

What are the preferred treatments for OCD?

A

SSRI or clomipramine are first line pharma

CBT-evoked response prevention taught to manage anxiety

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32
Q

What are the features of somatization disorder?

A

Numerous somatic complaints related to several body areas, not full explained by medical cause.

Focus is on symptoms themselves not fear of specific disease or defect

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33
Q

What is the best treatment for Schizoaffective DO depressive subtype?

A

2nd gen AP

Add SSRI only if mood sx don’t improve with AP

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34
Q

What should be used for treating ADHD when there are concurrent substance abuse problems? What if main meds are ineffective?

A

Atomoxetine

Bupropion, imipramine, nortriptyline, pemoline

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35
Q

What are the 5 axis’ of psychiatric diagnosis?

A

Axis 1: Clinical disorders (schizo, MDD)
Axis 2: Personality DO and Mental retardation
Axis 3: Physical disorders and other Gen Med conditions
Axis 4: Psychosocial problems contributing to psych prob
Axis 5: Global Assessment of Functioning

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36
Q

What is formication and how does it usually develop?

A

Hallucinated sensation that insects/snakes crawling over skin

Common SE of extensive cocaine/amphetamine use

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37
Q

What must be monitored in patients being treated with stimulants or atomoxetine?

A

Follow appetite, and monitor height and weight, because of risk of medication related growth rate changes

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38
Q

What is the advantage of using atomoxetine over Ritalin for ADHD? What should be avoided with Atom?

A

Atomoxetine begins working immediately to reduce symptoms and has longer onset of action

Don’t take on empty stomach, can cause N/V

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39
Q

What meds are most helpful for patients with ASD?

A

Hypnotics and anxiolytics in short term (beta blockers may prevent development of PTSD)

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40
Q

What is the defense mechanism sublimation?

A

Mature DM - involves satisfying socially objectionable manners in an acceptable manner (e.g. person who enjoys exerting dominance over others, becomes prison guard)

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41
Q

What is the difference between suppression and repression?

A

Suppression is a mature defensive mech and involves conscious avoidance of particular emotion/thought

Repression is immature DM and is unconscious

42
Q

What are ideal characteristics for patients who are to undergo psychoanalysis?

A

-Age under 40, not psychotic, intelligent, stable in relationships and ADLs

43
Q

What is interpersonal therapy and how is it used?

A
  • type of psychotherapy used for Tx of depression
  • focus is on the present, and specific problem areas that may interfere w/ pt self esteem and interpersonal relationships
44
Q

What is the basis of the central idea behind cognitive behavioral therapy?

A
  • Our emotions are due to our thinking (cognition)

- we may get rewarded for how we act, contributing into increase of these thoughts and actions (behavior)

45
Q

What are the best treatment modalities for bulimia nervosa?

A
  1. Nutritional rehab
  2. CBT
  3. Antidepressant - SSRI (fluoxetine first, then sertraline)
46
Q

What may be used by patients with bulimia to induce vomiting and what should patients be checked for?

A

Ipecac - can cause ipecac intoxication w/ pericardial pain, dyspnea, generalized muscle weakness; which are associated w/ HoTN, tachycardia, and ECG abnormalities
-Risk of toxic cardiomyopathy and death

47
Q

What differentiates bulimia from anorexia?

A

Bulimia pts are less resistant to getting help, have more alcohol abuse, and have more emotional lability
-Bulimia has later onset

48
Q

What drug can decrease autonomic and other sx of oops of withdrawal? MoA?

A

Clonidine, blocks NE neurons of locus ceruleus

49
Q

What can treat sx of opioid withdrawal for patients who don’t want prescription meds?

A

NSAID like ibuprofen for muscle aches

Loperamide for loose stools

(Promethazine for N/V, but need script)

50
Q

What are the diagnostic criteria for pain DO?

A
  • severe distressing pain at 1 or more sites, causing fxnal impairment
  • psychological factors play important part in pain
  • not explained by another axis 1 DO
51
Q

How can you treat patient who has overdosed on TCA?

A

Sodium Bicarbonate, helps with ECG abnormalities

52
Q

What medication is preferred for patient with bipolar 2?

A

Lamotrigine - helps with depression (make sure NO mania Hx)

53
Q

What antipsychotic decreases suicide risk in schizophrenia?

A

Clozapine

54
Q

What are the signs associated with adjustment disorder?

A

Emotional response to specific stressor w/in 3 mo, clinically significant somatic sx, and some mood disorders (depression, anxiety, mixed, conduct DO)

55
Q

What aspect of the presentation differs most with depression in adults vs Peds?

A

Child and adolescents more often have irritability or short temper, than sadness with depression

56
Q

What other disorders occurs most along with sleep terrors?

A

Restless leg syndrome and sleep disordered breathing

57
Q

Which medications are useful sleeping aids and how long should they be used for?

A

Ramelteon, Trazodone and Z-drugs

don’t use z-drugs longer than 2 weeks bc of tolerance and withdrawal symptoms

58
Q

What should be the first step if seeing a new patient and suspecting somatization disorder?

A

Get thorough H&P and complete labs w/ blood work to r/o medical causes

59
Q

What is the immediate treatment of an acute dystonic reaction?

A

Benztropine 2mg IM w/ repeat dose in 30min if no improvement

60
Q

What is the difference between somatization and conversion DOs?

A

Somatization - multiple physical symptoms present for chronic length, before age of 30, not explained by any medical cause

Conversion - sx of neurologic DO w/o obvious cause or trauma (unconscious, not for external gain, internal conflict)

61
Q

How can you differentiate autism spectrum DOs from Rett DO?

A

In Rett there is a period of normal development early on then gradual decline and loss of skills

In ASD there is evidence of disorder early on

62
Q

What should be done in causes where early autism is suspected?

A

Full medical workup to rule out hearing/vision difficulties that may be causing poor language development

63
Q

What can help to relieve some of the anxiety associated with avoidant personality DO?

A

Mainly CBT for APD, but SSRIs and beta-blockers can be given for anxiety

64
Q

How can you differentiate autism spectrum DOs from Rett DO?

A

In Rett there is a period of normal development early on then gradual decline and loss of skills

In ASD there is evidence of disorder early on

65
Q

What should be done in causes where early autism is suspected?

A

Full medical workup to rule out hearing/vision difficulties that may be causing poor language development

66
Q

What can help to relieve some of the anxiety associated with avoidant personality DO?

A

Mainly CBT for APD, but SSRIs and beta-blockers can be given for anxiety

67
Q

What is dissociative fugue?

A

Unexpected sudden departure from home and pt cannot recall past or identity, forges new identity; lasts hours to days, sometimes months

In setting of severe trauma or life stressor

68
Q

What are predisposing factors to dissociative fugue?

A

Alcohol abuse, certain mood DOs, personality DOs, Hx of head trauma

69
Q

What are the symptoms and time course of alcohol withdrawal?

A

6-8hrs: jittery and tremulous
8-12hrs: psychosis and perceptual sx
12-24hrs: seizures
24-72hrs to 1 week: DTs

70
Q

What drug should be avoided in EtOH withdrawal and why?

A

Antipsychotics -> lower seizure threshold

71
Q

What medication is preferred in the treatment of alcohol withdrawal in a patient who demonstrates poor liver function?

A

Lorazepam, bc metabolized solely by glucoronidation, less dependent on liver function

72
Q

How can you differentiate paranoid delusions from ideations?

A

PD = fixed false beliefs, psychosis, require tx w/ APs

PI = paranoid personality disorder, suspiciousness NOT a Del, can be tx with reassurance

73
Q

What medication can be helpful to prevent benzo withdrawal seizures in individuals prone to it?

A

Carbamazepine in conjunction with the benzo taper

74
Q

Which benzos are more likely to cause withdrawal syndrome?

A

Those with shorter half lives: Alprazolam (Xanax), oxazepam, temazepam, versed

75
Q

What may be a cause for anger and self destructive behavior in mentally retarded individuals?

A

Underlying medical condition that is causing pain

Also look for concurrent psychotic disorder that is separate from mental deficit

76
Q

What two pieces of info are key in diagnosing mental retardation?

A

IQ score and evidence of deficits in adaptive functioning (conceptual skills, social skills, practical skills)

77
Q

What is the most common cause of mental retardation?

A

Idiopathic or unknown

78
Q

Which medications work best for agitation and psychosis from illicit drug intoxication?

A

Haldol and other APs

79
Q

What is a patient on MAOIs consuming tyramine rich foods at risk for and what should be monitored?

A

Hypertensive crisis, monitor blood pressure closely

80
Q

What is the treatment of akathisia?

A

Beta blocker or benzo

81
Q

Which drugs may decrease suicidality?

A

Lithium and clozapine

82
Q

Why do you titrate clozapine slowly?

A

Prevent agranulocytosis and seizures

83
Q

What are the manifestations of ecstasy intoxication? What is a potentially dangerous drug interaction?

A

Hypertension, tachycardia, hyperthermia, hyponatremia

Can develop serotonin syndrome - autonomic dysregulation, AMS, high fever, neuromuscular irritability, and seizures (especially if pt on SSRI, MAOI, TCA etc.)

84
Q

What psychological reactions do patients who ingested bath salts present with?

A

Amphetamine analogs - hyperactivity, combativeness, severe agitation, hyperthermia

85
Q

What type of defensive mech is rationalization and what is it’s definition?

A

Immature - excusing an unacceptable behavior in a false but logical way, usually to avoid difficult truths

86
Q

What are the main impairments present in Asperger’s syndrome?

A

Impairment in reciprocal social interactions and restricted interests. Desire relationships, lack awareness of social conventions. Normal language development

87
Q

What are the major needs of people with OCPD?

A

Need for order and perfection, and to carry out activities in a extremely methodical way (usually before adulthood). These methods can severely impact life and work, resulting in missed deadlines, etc. Ego-syntonic

88
Q

How can you distinguish paranoid personality disorder from delusional disorder?

A

PPD is characterized by a pervasive pattern of distrust and suspicion (interpersonal problems), but no persistent delusions or other psychotic symptoms

DD is >= 1 delusion for at least 1 month, can involve erotomanic, grandiose, jealous, persecutory and somatic subtypes

89
Q

Which AP is least likely to cause weight gain?

A

Abilify

90
Q

What medications are preferred for EtOH detox in patient with liver cirrhosis?

A

LOT - lorazepam, oxazepam, tonozepam

These are Not fully metabolized by liver

91
Q

What are the main tx from dystonia side effects of APs?

A

AntiAch - benztropine

Anti-histamine - diphenhydramine

92
Q

What drugs can interact with lithium?

A

Diuretics, NSAIDA besides aspirin, SSRIs, ACEI/ARB, antiepileptics

93
Q

What is the preferred treatment for patient’s with mild-moderate bipolar disorder? Severe?

A

Atypical antipsychotics

Combo therapy with lithium/valproate + atypical AP

94
Q

What’s the risk of developing bipolar d/o in pt with single parent who has bipolar? Both parents? Monozygotic twin?

A

10%, 60%, 70%

95
Q

What is the preferred therapy for specific phobia?

A

Behavior therapy (exposure, systematic desensitization etc.)

96
Q

What are Zuprasidone (Geodon) and Lurasidone (Latuda)? What can they be used to treat?

A

Z - (atypical AP) adjunct to Li or Valproate in maintenance treatment of bipolar

L - (atypical AP) treats depressive episodes of bipolar depression alone or with Li/Val

97
Q

What is introjection?

A

immature DM, that involves incorporating another’s attitudes into one’s own perspective (victim of DM, blames partner’s aggression on themselves)

98
Q

What is the best method of treatment for hypochondriasis?

A

Hypochondriasis occurs more commonly during times of psychological stress, therefore inquire about recent/current emotional stressors and provide brief psychotherapy

99
Q

What are the order of treatments for conversion disorder?

A
  1. Education and self-help techniques to pt and family
  2. CBT
  3. Physical therapy for motor symptoms
100
Q

How long should a patient who is tolerating an SSRI, but not noticing improvements, c/w the dose before considering raising it?

A

Go for at least 4 weeks, and if no improvement then consider increasing dose

101
Q

What common side effects are seen commonly with Clozapine and Olanzapine, and what should be checked frequently?

A

Metabolic adverse effects - weight gain, dyslipidemia, hyperglycemia

Check fasting blood sugar and lipids, and get regular BMI, BP and waist circumference checks

102
Q

What neuroimaging findings are present in schizophrenia? PTSD? OCD? Autism?

A

Schizo - enlargement of cerebral vesicles
PTSD - decreased hippocampal volume
OCD - orbitofrontal cortex and striatum abnormal
Autism - increased total brain volume

Shelf Exams/USMLE Step 2 CK ❄️ (21 decks)

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