Psych Exam Questions Flashcards by John Breneman

What age range has the highest incidence of alcoholism?

18-29 year olds

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What laboratory changes are suggestive of alcoholism?

Increase in ALT, AST, alk phos, amylase, bilirubin, cholesterol, GGT, LDH, MCV, prothrombin time, triglycerides, and uric acid.

Decrease in BUN, Calcium, hematocrit, magnesium, phosphorus, platelet count, and protein.

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What is the difference in treatment methods between alcohol withdrawal compared to sedative hypnotic withdrawal?

ETOH withdrawal is treated with benzodiazepines, carbamazepine, or paraldehyde.

Sedative hypnotic withdrawal is usually treated with long acting barbiturates.

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A patient presents with tearing eyes, a runny nose, tachycardia, hair on end, abdominal pain, nausea, vomiting, diarrhea, insomnia, pupillary dilation, and leukocytosis. What is the diagnosis and treatment?

Opiate/Opioid withdrawal.

Treat with methadone or dolphin.
Clonidine may blunt some side effects.

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What chromosomal abnormality do autistic patients generally have?

Fragile X syndrome

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Which has an earlier onset: Bipolar or unipolar disorder?

Bipolar (20s-30s)

Unipolar is usually between 35 and 50 yrs.

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Differentiate between bipolar I, bipolar II and hypomania.

Bipolar I: Mania and major depression
Bipolar II: Hypomania and major depression
Hypomania: Mania without severe impairment or psychotic features.

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Other than classic mania, what else can lithium be used to treat?

Bulimia, anorexia nervosa, alcoholism in patients with mood disorders, leukocytosis in patients on antineoplastic medication, cluster headaches, and migraine headaches.

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Postural tremor is a major side effect of lithium. How is this controlled?

Minimize the dose during the workday and supplement with low dose beta blockers.

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Should athletic patients be on a higher or lower dose of lithium?

Higher.

Lithium is excreted in high amounts in sweat.

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What is the potential complication of treating manic depression and CHF simultaneously?

Lithium toxicity.

A low salt diet and/or sodium-losing diuretics can cause lithium retention and toxicity.

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At what level does lithium toxicity occur and what are the symptoms?

14mg/L

Symptoms include: nausea, diarrhea, vomiting, rigidity, tremor, ataxia, seizures, delirium, coma, and death.

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What is the most common symptom of a patient with borderline personality disorder?

Chronic boredom.
Other symptoms include severe mood swings, volatile relationships, continuous and uncontrollable anger, and impulsiveness.

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What other findings might you expect in a patient with parotid gland swelling and eroding tooth enamel?

Bulimic patients often have elevated serum amylase and hypokalemia.

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What is the most common cause of catatonia?

Affective disorder.

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The pleasurable effects of cocaine are due to its effect on what?

DA2 receptors

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What is the treatment for cocaine toxicity?

Acidify the urine and administer neuroleptics and phentolamine.

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Children with conduct disorders will most likely develop which adult disorder?

Antisocial personality disorder (40%)

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What is dysthymia?

A chronic disorder that lasts for more than two years. Severe symptoms of depression such as delusions and hallucinations are absent.

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What are the symptoms of antidepressant withdrawal?

Wild and frequent dreams, anxiety, akathisia, bradykinesia, mania, malaise.

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What is a distonic reaction and what is the treatment?

A common side effect of neuroleptics. It involves muscle spasms of the tongue, face, neck, and back.

Treat with H1 blockers such as Diphenhydramine (Benadryl) or Benztropine (Cogentin)

What is Folio `a Deux?

An induced psychotic disorder. A patient who has a close relationship with another patient begins forming the same delusions as that patient.

A 20 year old male is brought to your office by a concerned friend. It appears the patient sleeps excessively, has been inhaling his food like there is no tomorrow, and is getting into fights at bars. He also has been hypersexual, pursuing every female within a 5-mile radius. What is the diagnosis and treatment?

Kleine-Levin syndrome. It can be treated with stimulants.

A 24 year old male presents complaining of pleuritic pain, palpitations, dyspnea, dizziness, and tingling in his arms/legs/lips. What is the dx?

Hyperventilation syndrome.

Always a dx of exclusion

Hallucinations effect which neurotransmitter?

Serotonin

What is a previously healthy patient most likely suffering from when he becomes suddenly and intensely excited, goes into a delirious mania, develops catatonic features, and has a high fever?

Lethal catatonia. Treat with electroconvulsive therapy.

What labs would be elevated with Neuroleptic Malignant Syndrome and what is the treatment?

CPK, serum alk phos, and serum aminotransferases are elevated. Leukocytosis with a left shift, hyponatremia, and hypokalemia are also present. Treat with dopaminergic agents and muscle relaxants. (Obviously stop the neuroleptics)

Why shouldn't you exceed 600 mg/day of thioridazine (Mellaril)?

Retinitis Pigmentosa | Extrapyramidal symptoms are of low concern with this drug

What psychiatric disorder is associated with carcinoma of the pancreas?

Depression

What is the only neuroleptic with tardive dyskinesia as a side effect?

Clozapine

Why should ETOH be avoided with benzodiazepines?

Severe respiratory depression can result in death.

What are contraindications for Benzodiazepines?

Acute narrow angle glaucoma, pregnancy

What should be used to treat hypertensive crisis caused by the combination of MAO inhibitors with a known toxin?

Alpha and Beta adrengeric antagonist such as labetalol. Also consider nifedipine or nitroglycerine. If unsuccessful, consider IV phentolamine or sodium nitroprusside.

What are the three most common MAO inhibitors?

Phenelzine (Nardil) Isocarboxazid (Marplan) Tranylcypromine (Parnate)

How is PCP overdose treated?

Acidify the urine Give Benzodiazepines Restrain the patient

A patient perceives a kitten to be a dragon. This is an example of a...

Illusion

The patient hears voices when no one is talking. This is an example of a...

Complete auditory hallucination.

The patient hears voices only when cars honk their horns. This is an example of a...

Functional hallucination. | These occur only with a stimulus

The patient perceives people waving to him from the Eiffel tower while in Chicago. This is an example of a...

Extracampine Hallucination | Hallucination external to normal sensory range.

What brain lesion sites are most commonly associated with psychosis?

Temporolimbic system Caudate Nucleus Frontal lobes

What are some life threatening causes of acute psychosis?

``` (WHHHIMP) Wernicke's encephalopathy Hypoxia Hypoglycemia Hypertensive encephalopathy Intracerebral hemorrhage Meningitis/encephalitis Poisining ```

When does postpartum psychosis begin?

Usually within ten days of delivery.

What are the five criteria for diagnosing schizophrenia?

Psychosis Emotional Blunting Absence of affective features or episodes Clear Consciousness Absence of coarse brain disease, systemic illness, and drug use.

At what age is schizophrenia generally diagnosed?

80% before early twenties. | Very rare after age 40.

How does the insomnia differ between patients with melancholia vs dysthymia?

Melancholics have difficulty staying asleep and wake early. Dysthymics have trouble falling asleep and have a tendency to oversleep.

In which stage of sleep do we spend the most time?

``` Stage 2 (50% of sleep) Characterized by sleep spindles and K complexes on EEG. ```

Sleepwalking and pavor nocturnus (night terrors) occur during which stage of sleep? What is the treatment?

Stage 4 | A stage 4 sleep depressant such as a long acting benzo (eg. Clonazepam) is good for treatment.

Narcolepsy is a disorder of which sleep cycle? | What is the treatment?

REM | Attacks of sleep, dreams, and paralysis last from ten minutes to an hour. Treat with amphetamines and planned naps.

The patient states, "I've been wondering if the mechanical mechanisms of this machine are mechanically sound. mechanically speaking, I must understand the mechanisms." This is an example of what?

Perseveration | Repetition of certain words or phrases

How might you clinically distinguish serotonin syndrome from neuroleptic malignant syndrome?

Typical features in these patients that are not often seen in NMS patients are shivering, hyperreflexia, myoclonus, and ataxia. Nausea, vomiting, and diarrhea are also a common part of the prodrome in serotonin syndrome and are rarely described in NMS. Rigidity and hyperthermia, when present, are less severe than in patients with NMS.