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usmle step 2 > Psychiatrics > Flashcards

Psychiatrics Flashcards

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USMLE® Step 1 flashcards
1
Q

quid of alternative treatment(2)

A

yoga

acupuncture

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2
Q

what to do if a patient is intereted in alternative treatment

A

physician should inquire as to why

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3
Q

how to dx major depressive episode(8)

A 
Sleep proble
Interest low
Guilt
Energu is low
Concentration
Appetite is low
Psychomotor ...
Suicidability
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4
Q

First line treatment of schizophrenia(8)

A 
Aripiprzole
Asenapine
iloperidone
olanzapine
quetiapine
paliperidone
risperidone
ziprasidone
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5
Q

best btolerated drug in patient with psychosis

A

Olanzapine

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6
Q

when using injectable products in schizophrenia

A

non compliant patient to oral medication

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7
Q

what injectable medication can be used in schizophrenia(4)

A

haloperidol decanoate
fluphenazine decanoate
risperidone depot
paliperidone

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8
Q

posologie of haloperidol injectable in the rx of schizophrenia

A

once a month

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9
Q

posologie of fluphenazine injectable in the rx of schizophrenia

A

twice a month

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10
Q

posologie of risperidone injectable in the rx of schizophrenia

A

twice a month

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11
Q

posologie of paliperidone injectable in the rx of schizophrenia

A

1 a 2 fois par mois

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12
Q

best long term rx of schizophrenia

A

paliperidone

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13
Q

quid of bipolar(2)

A

lot of energy

megalomaniac

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14
Q

do you need depression to DX bipolar

A

no

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15
Q

rx of bipolar (3)

A

mood stabiliser
plus
atypical antipsychotics
atipical antipsychotics as montherapy

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16
Q

quid of mood stabiliser(3)

A

lithium
lamotrigine
acid valproic

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17
Q

quid of atypical antipsychotics used in bipolar(5)

A 
risperidone
olanzapine
quetiapine
aripiprazole
ziprasidone
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18
Q

first line regimen for mild to moderate bipolar

A

atypical antipsychotics

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19
Q

rx of severe episodes of bipolar

A

mood stabiliser plus atypical anti psychotics

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20
Q

patient presenting with many symptoms has seen many doctors asking for CT even if the prior CT was normal

A

somatisation

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21
Q

what to do in patient with somatisation

A

scheduled appointment intended to reduce underlying psychological distress

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22
Q

in vignette patietn patietn with thought of being poisonned depuis 3 mois

A

delusionnal disorder

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23
Q

type of delusion(5)

A 
persecutory
erotomanic
grandiose
jealous
somatic
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24
Q

erotomanic delusion

A

you think someone of higher status is in love with you

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25
Q

grandiose delusion

A

belief of great talent insights or achievements

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26
Q

Jealous delusion

A

unfaithful partners

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27
Q

somatic delusion

A

belief of bodily functions and sensation

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28
Q

how to differentiate delusion from schizophrenia(2)

A

you need symptoms for at least 6 months to dx schizophrenia

additional psychotic symptom in schizophrenia

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29
Q

psychotic symptom in schizophrenia(3)

A

hallucinations
disorganisation
negative symptom

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30
Q

clue for delusion

A

patient is highly functionnal

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31
Q

rx of obsessive compulsive disrder will target which substance

A

serotonin

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32
Q

drugs used in OCD(5)

A 
clomipramine
fluoxetine
fluvoxamine
paroxetine
sertraline
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33
Q

class of drug for clomipramine

A

TCA

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34
Q

RX of choice of OCD

A

paroxetine

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35
Q

which neurotransmetter has altered level in OCD

A

serotonin

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36
Q

quid of bereavment

A

normal reaction to the loss of loved one

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37
Q

persistent complex bereavement syndrome

A

persistence of symptom at leats one year after the loss of loved one

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38
Q

dx of major depression(2)

A

4 symptoms in SIGECAPs
plus
mood depressed or loss of interest

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39
Q

cancer patient is at risk of what psychiatric disease

A

major depression

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40
Q

rx of patient with cancer and major depression

A

SSRI

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41
Q

can you have bereavement from cancer

A

yes you can

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42
Q

how a patient with bipolar will take lithium

A

it depends on the number of relapses

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43
Q

first episosde of bipolar rx duration

A

lithium for at least one year

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44
Q

second episode of bipolar

A

lithium for years

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45
Q

indication of lithium for many years(3)

A

2 episodes
severe episode
family history

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46
Q

rx of more than 3 episodes of bipolar

A

lithium for lifetime

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47
Q

patient taking fluoxatine for depression after 2 weeks he comes back to say there’s no improvement what to do?

A

continue fluoxatine at the same dose

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48
Q

when a patient taking SSRI will start having improvement

A

in 4 -6 weeks

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49
Q

mechanism of action of risperidone

A

blocking dopamine D2 receptor

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50
Q

what a clinician should do in case of mistake(2)

A

facts should be clarified

truth told to the patient

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51
Q

patient leaves home to live on university campus weeks later develops anxiety that someone is going to break the house dx

A

adjustment disorder with anxiety

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52
Q

quid of adjustment diosorder with anxiety

A

development of emotionnal or behavioral symptom in response to an identifiable stressor within 3 months of the onset of the stressor

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53
Q

quid of acute stress disorder

A

anxiety developing after experiencing or whitnessing an event

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54
Q

acute stress disorder and PTSD

A

PTSD last more than one month

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55
Q

generalized anxiety disorder GAD

A

excessive worry on many aspects of life including work,family, finance etc…

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56
Q

patient starting new job worry in asking if children are safe at school, has difficulty sleeping etc…

A

GAD

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57
Q

what’s the most important factor to determine a psychiatric disorder

A

the level of functionning at work

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58
Q

patient with lot of stress at work because colleague quit and has more workload,sleep poorly but keep on doing well in his job dx

A

normal human experience

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59
Q

immature mechanism of defense in which individual expresses his aggresion toward another person with repeated passive failure to meet the other person

A

passive agressive behavior

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60
Q

patient after having a warm argumetn with the receptionnist called the physicyan office for a new appointment.Everytime patient calls up receptionnist says i am sorry the appointment is full what type od mechanism of defense is used by the receptionnist

A

passive agressive behavior

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61
Q

patient develops tonic clonic seizures , she used to take a drug for anxiety but stops taking it and suddenly develops seizure what drug she was taking

A

alprazolam

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62
Q

abrupt cessation of this drug cause seizure

A

alprazolam

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63
Q

example of catatony

A

patient repeats only with monosyllables and refused to make eye contact

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64
Q

symptoms of schizophrenia(5)

A 
delusions
hallucinations
disorganised speech
catatony
negative symptom
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65
Q

patietn presenting with all symptoms of schizophrenia but depuis moins de 6 mois dx

A

schizophreniform disorder

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66
Q

quid of brief psychotic disorder

A

symptom lasting more than 1 day but less than 1 month

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67
Q

qid of chizoaffective disorder

A

mood disorder with active symptom of schizophrenia lasting at least 2 weeks

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68
Q

quid of delusionnal disorder(3)

A

delusions lasting more than 1 month
normal functionning
no psychotic symptom

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69
Q

person who is splitting people as good or bad

A

bordeline personnality disorder type B

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70
Q

risk of boderline personality disorder

A

risk of suicide

angry outburst

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71
Q

disorganized speech in schizophrenia ,quid of of circumstantiality(3)

A

stand around
you give detailed to a specific question but irrelevat responses
patietn deviates from the original subject but eventually return to it

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72
Q

tangential thought

A

patietn druft away from the subject but never return to it

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73
Q

quid of conficdentiality in medical sciences

A

don’t discuss thing about a patient with somebody or physician directly relaled to his care

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74
Q

what to monitor in patietn taking olanzapine and clozapine(2)

A

fasting glucose

lipids

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75
Q

pathologic gambling

A

pathologic history of gambling and inability to stop

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76
Q

how to deal with angry patient

A

start a discussion with open ended question and let the patietn talk about the emotion and problem

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77
Q

different classes of antidepressant drugs(4)

A

SSRI=selective serotonin reuptake inhibitor
SNRI=serotonin norepinephrine reuptake inhibitor
TCA=tricyclic antidepressant
MAOI=mono amine oxydase inhibitor
atypical antidepressant

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78
Q

name atypical antidepressant(3)

A

bupropion
mirtazapine
trazodone

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79
Q

TCA(4)

A

amitryptiline
clomipramine
doxepin
nortryptiline

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80
Q

name SNRI(3)

A

duloxetin
venlafaxine
Pesvenlafaxine

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81
Q

Name MAOI (2)

A

phenelzine

tranylcipromine

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82
Q

when to change class of anti depressor during rx

A

when two trials of SSRI are inneficient

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83
Q

first line rx of GAD(2)

A

cognitive behavioral therapy

SSRI or SNRI

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84
Q

second line of GAD(2)

A

benzodiapine

buspirone

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85
Q

quid of GAD(6)

A 
multiple wory or anxiety > ou egal a 6 months plus 3 or more of this
restlessness
fatigue
difficulty concentrating
irritability
Mx tension
sleep disturbance
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86
Q

quid of folie a deux

A

psychaitric disorder a delusion or set of delusion is shared simultaneously by individuals who dshared a close relationship

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87
Q

what to do in case folie a deux interview(2)

A

interview the two people separately

rx the one who first has the delusion

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88
Q

person always alone ,demonstrate interst in magical thing

A

schysotypal personality disorder

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89
Q

shizoid personality disorder

A

they don’t have friends

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90
Q

avoidant personality disorder

A

they want friends but fear ridicule

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91
Q

patient major with paranoid schizphrenia compliant to meds come to the emergency with dx of ruptured ectopic pregnancy.patient is conscious ,whi can give the consent for her

A

the patietn as long as her jugment and decision making ability are not affected

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92
Q

who can give consent for intervention surgical in minor

A

patient’s parent

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93
Q

minor less than 18 ans who don’t require parental consent(5)

A 
homeless
live alone
financially independent
married
military
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94
Q

minor wo dont dont need consent (6)

A

emergent care

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95
Q

jehovah witnesses with no advanced directives on him and requires blod transfusion but unconscious

A

transfusion can be done

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96
Q

quid of advance directive or card

A

instruction saying you want something or not during critical care

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97
Q

if the jehovah witness is conscious what can be done

A

he can refuse or accept the blod transfusion

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98
Q

patient found in airport or terminal bus with dissociation forgetfulness of name and adress

A

dissociative fugue

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99
Q

what ‘s the best answer to give to the parent of a kid with kleptomania

A

it’s a mental disorder that can be treated with psychotherapy

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100
Q

rx of kleptomania

A

cognitive behavioral therapy

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101
Q

quid of kleptomania

A

impulsive control disorder

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102
Q

dx differential of kleptomania(4)

A

shoplifting
antisocial behavior disorder
bipolar manic episode(impaired jugment)
psychotic disorder vol because of hallucinations

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103
Q

kid with ALL but parent refuse chimio next step

A

obtain a court order for chemo

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104
Q

why you should obtain a court order for chemo in patient with ALL but parent refusing rx

A

50% des cas ALL is treated with chemo

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105
Q

straight A student 16 yo become suddenly to develop odd bahavior missed class failing in math ,what the best next thing to do

A

obtain urine toxicolog screening

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106
Q

any changes in adolecent behavior what to check(5)

A 
check drug use
partner violence
date rape
pregnancy
sexual or physical abuse
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107
Q

patient on antipsychotics develops milky discharge in nipple cause?

A

risperidone

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108
Q

clue for prolactinoma

A

prolactinemia > 200 ng /ml

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109
Q

clue ofr dependent personnality disorder(3)

A

partner physically abusive but wife can leave him
avoid arguments whenever possible to be pleasant to others
fear of being alone

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110
Q

clue for bulimia nervosa(3)

A

patient eats a lot and sometime vomit(throw up)
tends to fast or exercicie to compensate
BMI is normal or slighlty above

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111
Q

clue for anorexia nervosa(2)

A

patient with low BMI

amenorrheic

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112
Q

BMI in bulimia nervosa(2)

A

normal
or
slightly elevated

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113
Q

clue for persistent depressive disorder

A

dysthimia ,chronic low grade depression that last 2 years or more

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114
Q

how to differentiate major depressive disorder and persistent depressive disorder

A

you don’t have all 5 crtieria in SIGECAP in persistent depressive disorder

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115
Q

symptom in persistent depressive disorder(2)

A

sadness

low energy for years

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116
Q

pain during sexual intercourse or when attempting penetration

A

genito pelvic pain penetration disorder

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117
Q

quid of alcohol hallucinosis

A

alcohol withdrawal syndrome occurring 12-24 h after the last drink and resolves within 24-48 h

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118
Q

patient with history of 6-8 beers /day develops auditory hallucination after an accident

A

alcohol hallucinosis

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119
Q

quid of delirium tremens

A

fever
HTA
tachycardia
occuring 48-96 hr after stopping alcohol

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120
Q

quid of withdrawal seizures

A

alcohol withdrawal causing seizures

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121
Q

quid of mild withdrawal alcohol(2)

A

palpitation
or
tremulation

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122
Q

complication of mild withdrawal or alcohol withdrawal seizures

A

Delirium tremens

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123
Q

differentiate alcohol hallucinosis and DT

A

vitals are normal in alcohol hallucinosis

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124
Q

quid of pyromania

A

intentionnal and repeated fire setting with no obvious motive

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125
Q

immature mechanism of defense in which individuals displace negative feelings associated with an unacceptable object or situation ob a safer object or situation

A

displacement

dan pouri gen fos sou bannann mu

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126
Q

side effct most commonly seen with olanzapine

A

weight gain

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127
Q

cause of acute dystonic reaction(2)

A

haloperidol

metochlopramine

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128
Q

rx of acute dystonic reaction

A

benztropine
or
antihistaminics(diphenidramine)

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129
Q

quid of bereavment

A

sadness after a bad event

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130
Q

patietn with cancer can develop what disease

A

major depression

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131
Q

rx of bereavment

A

SSRI

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132
Q

drug used in NMS

A

dantrolene

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133
Q

after a dx of cancer patient goes on internet to search for data on his disease waht mechanism of defense used by the patient(2)

A

intellectualisation

an immature mechanism of defense

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134
Q

difference between boulimia nervosa and binge eating disorder

A

in binge eating disorger no compensatory behavior

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135
Q

rx of binge eating disorder(2)

A

SSRI
and
CBT

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136
Q

first line rx in boulimia nervosa and anorexia nervosa

A

CBT

nutritionnal rehab

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137
Q

when use pharmacologic rx in boulimia nervosa and anorexia nervosa

A

when first line regimen fails

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138
Q

clue for inducing vomiting(surreptitious vomiting)(4)

A

parotid gland hypertrophy
dental caries
halithosis
scars and calluses over hand

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139
Q

quid of hoarding disorder

A

difficulty discarding possessions regardless of their actual values

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140
Q

first line rx of hoarding disorder(2)

A

CBT

SSRI

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141
Q

patient with history of dependence of opiod develops false symptom of back pain to get morphine dx

A

malingering

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142
Q

what’s the deadline for a physician to give a copy of medical record on patient’s request

A

30 jours

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143
Q

what to do if relatives or patient want to get a copy of dossier

A

patient must request a copy of medical record

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144
Q

pregnant woman with clear indication of CS refuses it what to do

A

respect the patient decision and proceed with vaginal delivery

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145
Q

why respect the patient decision and proceed with vaginal delivery in case of refusal of CS

A

pregnant women have the right to refuse rx even if it places her unborn child at risk

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146
Q

mother refuses to vaccinate children next step

A

document in the medical chart that the risks and benefits of vaccination have been explained

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147
Q

quid of advance directives

A

document completed while patietn have decision making capacity to ensure that decisions are made according to his wishes in the event that they lose decision making capacity

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148
Q

what to do if patient’s healthcare proxy disagrees with a living will and demands care that contradicts the patietn written wishes

A

discuss the matter with the proxy and other family member

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149
Q

what if the family members fails to resolve the problem

A

the hospital ethics commmitee shold be consulted

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150
Q

why you shoul not give bupropion to patient with eating disorder

A

risk for seizures

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151
Q

why can you have seizures with bupropion in patient with eating disorder

A

electrolytes disturbance

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152
Q

why bupropion is contrindicated in epilepsy

A

it’s decreases the tresholf of seizure

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153
Q

why patient snorting cocaine tends to lose weight

A

because they have decreased appetite

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154
Q

when using haloperidol in patient with manic episodes

A

extreme agitation

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155
Q

some clue for manic episode(7)

A

inflated self esteem or grandiosity
decreaased need for sleep
increase talktiveness or pressured speech
flight of ideas
distractibility or irritability
increase goal directed activity or psychomotor agiatation
increasse involvement in pleasurable activities (sex,gambling,purchasing)

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156
Q

patient with presenting with mx pain diarrhea abdominal cramps sweating and HTA abd dilated pupils what drugs can cause that

A

heroin withdrawal

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157
Q

action of heroin

A

everything is high

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158
Q

1 cause of NMS

A

haloperidol

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159
Q

clue for major depression with psychotic symptom(2)

A

when the patient is depressed psychotic event occurs

when the patietn is euthymic no psychotic symptom

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160
Q

quid of schizoaffective disorder

A

at least > ou egal a 2 weeks of delusions or hallucinations in absence of mood depression and than mood depression occurs with psychotic symptom

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161
Q

bipolar with psychotic features(2)

A

when the patient is manic ,psychotic features occur

when the patient is ok no psychotic features

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162
Q

quid of autism(3)

A

children perform stereotyped behavior
no emotionnla bonds with others
participation in restricted activities

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163
Q

age of onset of autism

A

before 3 yo

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164
Q

patient thinking he has special power

A

grandiose delusion

165
Q

dx of bipolar

A

elevated or irritable mood with 3 or more of this

DIGFAST

166
Q

quid of DIGFAST in bipolar disorder

A 
D=distractibility
I=impulsivity
G=grandiosity
F=flight of ideas
A=activity
S=sleep need decreased
T=talktiveness or pressured speech
167
Q

quid of hypomanic episode(3)

A

less severe than bipolar
symptoms > ou egal a 4 consecutives days
no psychotic features

168
Q

can you have psychotic features in bipolar

A

yes

169
Q

quid of bipolar type 1

A

manic episode
plus
depressive episode

170
Q

do you require depressive episode in bipolar type 1

A

no

171
Q

quid of bipolar type 2(2)

A

hypomanic episodes

you must have 1 day or more of depressive episodes

172
Q

differenciate type 1 bipolar from type 2(2)

A

in type 1 no depressive episode is needed

in type 2 you need at one episode at major depression

173
Q

quid of cyclothymic disorder

A

2 years of fluctuating mild hypomanic and depressive symptom

174
Q

what to suspect in children with sudden behaviral changes

A

physical or sexual abuse

175
Q

risk factor of sexual abuse or physical abus(2)

A

parent with unstable economic backgrounds

parent with history of drugs or alcohol abuse

176
Q

quid of response during rx in psychiatry

A

50% reduction in the baseline level of severity

177
Q

quid of remission during rx in psychiatry

A

absence of Symptom or minimal symptom

178
Q

quid of sustained remission during rx in psychiatry

A

stabilisation of patient’s symptom

179
Q

quid of recovery during rx in psychiatry

A

episode is over

180
Q

quid of reccurence during rx in psychiatry

A

after recovery symptom reappears

181
Q

quid of relapse during rx in psychiatry

A

during sustained remission symptoms reappears

182
Q

patient with schizophrenia says he is hearing voice telling her to do bad thing.he has a history of suicide attempt 10 years ago ,the patietn refuses to be hospitalised next step

A

hospitalise the patient involuntarily

183
Q

telling her to do bad thing.he has a history of suicide attempt 10 years ago ,the patietn refuses to be hospitalised ,why you should hospitalise this patient involuntarily

A

he is a danger for himself and other

184
Q

what medication ingestion contrindicated consumption of meat and aged cheese and why(2)

A

phenelzine

risk of icrease of blood presure

185
Q

quid of phenelzine

A

monoamine oxydase inhibitor

186
Q

patiet 16 yo with attempted suicide next step

A

hospitalisation

187
Q

anxiety restricted to social or performance situations

A

social anxiety

188
Q

young girl with no close friend during interview the patient says nobody wants to be friend of someone ugly and stupid like me dx

A

avoidant pesonality disorder

189
Q

quid of body dismorphic disorder

A

it’s an obsessive compulsive disorder

190
Q

what to in case of body dismorphic disorder(4)

A

continue to meet regularly to discuss concerns of the patient
psychoterapy
SSRI
referral to a psychiatrist

191
Q

Quid of body dismorphic disorder

A

preoccupation with at least one perceived physical detect

192
Q

quid of most likely cause of tardive dyskinesia

A

risperidone

193
Q

common manif of tardive dyskinesia(9)

A 
face grimacing
chewing
biting 
tongue protrusion
torticolis
shoulder shruugging
respiratory grunting noises
rocking and swaying
rotary hip movements
194
Q

limb abnormality in tardive dyskinesia(4)

A

limb twisting and spreading
piano playing finger
foot tapping
dystonic extension of the toe

195
Q

next step in rx tardive dyskinesia

A

stop risperidone

begin clozapine

196
Q

side effect of clozapine

A

agranulocytoiss

197
Q

in cae of suicidability what patient should be hospitalised(2)

A

patient with ideation

intent and plan

198
Q

suicidability with no plan next step(3)

A

rx underlying depression
family support
reduce access to potential means

199
Q

rx of performance only social anxiety(2)SAD

A

Bblocker
or
benzodiapines

200
Q

rx used in Generalised social AD and SAD

A

CBT

201
Q

how to give propranolol in anxiety provoking situation

A

30-60 mn before the act

202
Q

quid of generalised social anxiety disorder

A

anxiety in meeting new people

initiating or maintaining conversation

203
Q

rx of generalised social anxiety disorder (2)

A

CBT

SSRI

204
Q

2 types of social anxiety

A

performance only

generalised

205
Q

indication of buspirone

A

generalised anxiety social disorder

206
Q

what about CBT in social anxiety compared to drug

A

equally efficace

207
Q

tetrad of alzheimer(5)

A 
memory impairment
apraxia
aphasia or language dysfunction
agnosia
you can have 2 of them
208
Q

quid of agnosia

A

difficulty recognizing object

209
Q

quid of apraxia

A

difficulty carrying out activities

210
Q

what should be done before making the dx of alzheimer

A

rule out any medical causes of cognitive decline

211
Q

the best way to break bad news(2)

A

use a symptom to ask the question

what do you think is going on with your back pain for example

212
Q

steps to prepare meeting with family to break bad news

A

SPIKES

213
Q

quid of SPIKES(6)

A 
S=set up situation
P=perception of the family is assessed
I=obtain family Invitation,how much info they need to know
K=give knowledge and information
E=use empathic statements
S=staregy and summary
214
Q

clue for panic attack(4)

A

suddeny you have a patient with
palpitation
chest pain and
diaphoresis

215
Q

first thing to do in patient with palpitation chest pain and diaphoresis(2)

A

EKG

drug screening

216
Q

acute rx of panic attack

A

benzodiazepine

217
Q

long term rx of panic attack

A

SSRI

218
Q

gender involved in panic attack

A

woman

219
Q

you receive le fils d’une femme avec dx of de cancer .Le fils vous demande to withhold the dx to his mother what to do

A

is there a specific reason you don’t want your mother to know the DX

220
Q

quid of trichotillomania

A

it’s an OCD

221
Q

rx of trichotillomania

A

CBT

222
Q

reaction of pain ,distress after the loss of a close relationship pendant < 6 months

A

greaf of bereavement

223
Q

normal laps of time to speak of greaf bereavment

A

about 6 months

224
Q

complication of greaf bereavment

A

major depression

225
Q

rx of greaf bereavment(2)

A

SSRI
plus
psychoterapy

226
Q

first line rx of OCD(2)

A

SSRI
or
clomipramine

227
Q

patient with bruises on body come to clinic when physicians saks on bruises patient start crying dx and next step(2)

A

tell me more about the bruises on your body

physical abuse

228
Q

rx of withdrawal alcohol seizures

A

long acting benzodiapines

229
Q

quid of long acting benzodiapines(3)

A

diazepam
lorazepam
chlordiazepoxide

230
Q

action of long acting benzodiazepines in rx withdrawal seizures

A

stimulate gamma aminobutyric acid receptor causing sedation

231
Q

quid of alcoholic in USMLE

A

6-10 beers /day

232
Q

indication of disulfuram (antabuse)

A

to maintem long term abstinenece in alcoholic patients

233
Q

rx of alzheimer dementia

A

initiate cholinesterase inhibitor

234
Q

example of cholinesterase inhibitor(3)

A

donepezil
galantamine
rivastigmine

235
Q

children with motor tick =grimacing,blinking shouldeer shrugging
vocal tick barking grunting coughing and throat clearance dx

A

tourette syndrome

236
Q

complication of tourette(2)

A

hyperactivity disorder

OCD

237
Q

patient with insomnia and use of caffeine alcohol and nicotine especially at the period preceding sleep,engaging to activities too close to bed time ,use of the bed for other activities cause of imsomnia

A

poor sleep hygiene

238
Q

risk for survivor of sexual assault(3)

A

PTSD
depression
suicidability

239
Q

quid of narcolepsy(2)

A

daytime drowsiness
plus
cataplexy

240
Q

quid of cataplexy

A

sudden loss of mx tone triggered by strong emotions

241
Q

rx of narcolepsy

A

modafinil
or
amphetamine stimulants

242
Q

preferred drug in narcoplepsy

A

modafinil also called provigil

243
Q

measure in narcolepsy(3)

A

avoid alcohol
maintain proper sleep schedules
avoid drugs causing drowsiness

244
Q

what to do if an employer asks to hospital information on hospitalised patient what you need to do that

A

verbal or written autorization from patient

245
Q

what to do if an employer asks to hospital information on hospitalised patient with patient’s autorization(2)

A

disclose only minimal necessary information

i can confirm the patietn is hospitalised and i anticipate he will be able to return to work

246
Q

indication of methylphenidate

A

hyperactivity disorder

247
Q

side effect # 1 of methylphenidate

A

decreased appetite

248
Q

contrindication of methylphenidate

A

children less than 6 years

249
Q

common side effect of methylphenidate(3)

A

abdominal pain
insomnia
nervousness

250
Q

quid of dysthimia

A

depressed mood for at least 2 years

251
Q

differenciation between dysthimia and major depression

A

in dysthimia you have the same symptom than major depression but less severe and longer duration

252
Q

patient rx with sertraline for major depression accuses improvement next step?

A

continue medication for 6 months

253
Q

rx of simple episode of depression duration

A

6 mois rx

254
Q

in multiple episode of major depression duration of rx

A

continue maintenance rx for a long time

255
Q

patient with manic episode has been on rx for 6 months for a prior manic episode develops manic episode next step(2)

A

initiate antipsychotic

recommend hospitalisation

256
Q

any patient on lithium and develops manic episode next step(4)

A

hospitalisation
antipsychotic plus moodstabilizer
urine toxicology
mood stabilizer drug levels

257
Q

patient 60 ans with colon cancer refuses rx next step

A

ask the patient why he doesn’t want rx and intervention of any kind

258
Q

what to do if a patient refuses rx

A

it’s important to fully discuss the specific reasons for the decision before honoring it

259
Q

patient has seen many doctors for symptoms but all tests are negative ,she comes to you and asks for CT abdominal scan what to answer ?

A

i would like to see you at a follow up visit to evaluate your symptom again before deciding the ct scan

260
Q

why patient with somatisation should be seen at follow up visit for further evaluation

A

because they have to be seen in regular scheduled visits that focus on psychological distress associated with their symptoms

261
Q

patient comes to the hospital for severe haeadache despite of extensive follow up he is sure he has cerebral hemmorrage dx

A

hypochondriasis

262
Q

next step after dx hypochondriasis

A

initiate discussion about current emotionnal stressors

263
Q

why you shoud initiate discussion about current emotionnal stressors in case of hypochondriasis

A

because the symptom will develop in stressfull period

264
Q

rx of hypochondriasis

A

brief psychotherapy

265
Q

clue for amphetamine intox(8)

A 
agitation
excitability
delirium 
paranoia
tachycardia
hta
mydriasis
diaphoresis
266
Q

complication of amphetamine intox(4)

A

cardiac arythmia
seizures
hyper thermia
intracerebral hemorrage

267
Q

what differentiate amphetamine intox from anticholinergic poisonning intox(5)

A 
same symptom sauf
dry skin and mucous membranes
ileus
retention d'urine 
tremor and myoclonic jerk favors anticholinergic
268
Q

patient with low mood but no impairement of daily functionning dx

A

normal stress response

269
Q

conversion disorder quid

A

neurologic symptom after a stressor event

270
Q

most common presentation of conversion(4)

A

weakness
paralysis
seizures
but normal neurologic exam

271
Q

first line rx in conversion

A

education

272
Q

second line rx in conversion

A

CBT

273
Q

2 ways of presentation of conversion

A

hysterical

indifferent

274
Q

sleep pattern in older people

A

they tend to frequently awaken from sleep and spend less time sleeping overall

275
Q

persistent complex bereavment syndrome

A

symptom last more than 12 months followiing the loss

276
Q

In USMLE anytime you see death what to rule out

A

breavement syndrome

277
Q

exposure to lithium during first trimester of pregnancy

A

cardiac malformation

278
Q

what are the 2 cardiac abnormalities seen in litium during pregnancy(2)

A

septal defect

ebstein anomaly

279
Q

quid of ebstein anomaly

A

malformed and inferiorly atached tricuspid valve causing a part of the right ventricle to become part of the right atrium

280
Q

Ebstein

A

atrialisation of the right ventricle

281
Q

complication of lithium on baby during 3 e trimestre de la grossesse(2)

A

goiter

transient neuromxar dysfunction

282
Q

rx of tourette(3)

A

first generation antipsychotics
pimozide
haloperidol
fluphenazine

283
Q

second line rx of tourette(2)

A

atypical antipsychotics

risperidone

284
Q

quid of tourette syndrome

A

multiple motor and vocal ticks for 1 yaer

285
Q

should you have vocal ticks and motor ticks together for tourette

A

no you can them separately

286
Q

first rx for tourette

A

risperidone

287
Q

quid of narcistic personality disorder

A

exaggerated senseof self importance feelings and entitlement egocentrism and lack of empathy to others

288
Q

indication of electroconvulsive rx(5)

A 
severe  depression
depression in pregnancy
refractory mania
NMS
catatnic schizophrenia
289
Q

adverse effect of electroconvulsive rx(6)

A 
prolonged seizures
delirium
skin burns
amnesia
headache
nausea
290
Q

most common side effect of electroconvulsive rx

A

amnesia

291
Q

quid of factitious disorder

A

patient induces symptom to play the sick role

292
Q

example of factitious disorder

A

patient taking insulin

293
Q

munchausen syndrome

A

patient playing the sick role in order to get surgery

294
Q

complication in baby with mother suffering from anorexia nervosa

A

small of gestationnal age baby

295
Q

anomaly in anorexia nervosa in patient(6)

A 
osteoporosis
increase cholesterol and carotene levels
cardiac arythmia
euthyroid sick syndrome
hyponatremia
hypothalamic pituitary axis dysfunction
296
Q

cardiac arythmia seen in anorexia nervosa

A

prolonged QT syndrome

297
Q

anorexia nervosa and hypothalamic pituitary axis dysfunction(3)

A

amenorrhea
anovulation
estrogen deficiency

298
Q

why hyponatremia in anorexia nervosa

A

excess of water drinking

299
Q

why you can have many electrolytes disturbances in anorexia nervosa

A

because of purging behavior

300
Q

complication of pregnancy in anorexia nervosa(6)

A 
miscarriage
intrauterine growth retardation
hyperemesis
premature birth
cesarean section
post partum depression
301
Q

quid of antisocial personnality disorder

A

patient 18 ou plus engages in illegal activities and disregard rights of others

302
Q

what to monitor in all patietns taking clozapine

A

WBC

303
Q

why monitor WBC in patient taking clozapine

A

to rule out agranulocytosis

304
Q

other side effect of clozapine

A

lower seizure treshold

305
Q

rs of alcohol withdrawal syndrome

A

diazepam

306
Q

patietn asking to see doctor after time of closing office for sore in the mouth what to do(2)

A

politely and firmly refuses to see the patient and schedules her for tomorrow
although i undestood your concern we should address the issue tomorrow because it’s not an emergency

307
Q

quid of somatisation

A

symptom more than 6 months with disruption of daily life

308
Q

quid of illness anxiety disorder

A

prolonged fear and concern about getting or having a disease but with minimal or no actual physical symptom

309
Q

children verbal and talkative at home but refuses to speak in specific settings generally at school dx

A

selective mutism

310
Q

patient presenting with sudden palpitations sweating trembling or shaking shortness of breath and hot and cold sensations dx

A

panic disorder

311
Q

disease associated with panic disorder(4)

A

major depression
agoraphobia
bipolar
substance abuse

312
Q

risk in patient with panic attack

A

suicide

313
Q

abnormal imaging associated with schizophrenia

A

enlargement of cerebral ventricles

314
Q

abnormal imaging associated with autism

A

increase total brain volume

315
Q

abnormal imaging associated with OCD

A

abnormalities in orbitofrontal cortex and striatum

316
Q

abnormal imaging associated with PTSD

A

decrease volume of amygdala

317
Q

which ventricle is enlarged in schizophrenia

A

lateral ventricle

318
Q

hiv positive woman is terrified by her lab result she has trouble telling that to her husband what to say

A

encourage the patient to tell her husband but tell her you to inform the local health department

319
Q

what will do the local health department in hiv case

A

departement health will call the husband to him he is at risk of hiv without telling him about the person who placed him at risk

320
Q

patietn with caught his girlfriend cheating on him he develops worthless,sleep problem all began 2 months after the rupture dx(2)

A

adjustement disorder

it’s not depression

321
Q

rx of adjustment disorder(2)

A

psychodynamic psychotherapy

brief cognitive psychotherapy

322
Q

quid of adjustment disorder

A

emotionnal or behavioral symptom that develops within 3 months of exposure to an identifiable stressor

323
Q

quid of rationalisation

A

an immatire defense mechanism characterised by excusing an unacceptable behavior in a false but logical way to avoid the true reasons for the behavior

324
Q

a woman noticed a mass in a breast but resolved not to see a doctor.when asked why she made this decision she replies:i didn’t want to have a bunch of appointment when i should be helping my children with homeworkwhat mechanism is used to explain why she didn’t come to see doctors

A

rationalisation

325
Q

clue for EPS type parkinsonian(4)

A

walk much slower
not swinging arms
facial expressions flat ,unchanged
micrographia

326
Q

rx for EPS

A

benztropine

327
Q

indication of CBT(3)

A

overgeneralisation of negative events
catastrophising
maximizing negative events

328
Q

when CBT can be used(5)

A 
anxiety
mood problem
personality problem
somatic symptom
eating disorder
329
Q

how many sessions of CBT is recommnaded

A

12

330
Q

indication to place a patient in a hospice care

A

patient with prognosis less than 6 months

331
Q

what are the focus in hospice care(5)

A 
symptom control
quality of life
psychosocial
spiritual
bereavment care
332
Q

rx of meningococcemia(3)

A

isolation
IV antibiotics
supportive care

333
Q

can a patient refuse the rx of meningococcemiaand why(2)

A

no

because he could be pose a threat to the health and welfare of others

334
Q

patient comes in hospital for symptom she has last week and asked to see the same doctor in private without the nurse,she comes with no appointment what to do

A

ask the receptionnist instruct the patient to shedule an appointment during normal office hours

335
Q

rx of specific phobia first line

A

CBT

336
Q

second line rx of specific phobia

A

benzodiazepines

337
Q

what they do during CBT

A

exposure technique

338
Q

quid of phobia

A

fear of specific object or situation

339
Q

strongest indication for a future suicide in patient with psychiatric disorder

A

previous suicide attempt

340
Q

indication for suicide(8)

A 
preexisting psychiatric disorder
hopelessness impulsivity
never married
elderly white men
unemployed or unskilled
physical illness
family history or genetics
family discord
341
Q

protective fgactors against suicide(4)

A

social support/family connectedness
pregnancy
parenthood
religion and participation in religious activities

342
Q

the greatest risk to attempt suicide in future

A

past history of suicide attempt

343
Q

what must be present for the dx of major depression(2)

A

low mood or anhedonia
plus
SIGECAPS

344
Q

duration of symptom to dx major depression

A

two weeks or more

345
Q

what the most important element to dx grief(2)

A

loss

emptyness

346
Q

dx depression

A

5 on 9 depressive symptoms which at least 2 weeks

at least one is depressed mood or looss of interest/pleasure

347
Q

reaction formation

A

transformation of an unwanted thought or feeling into it’s opposite

348
Q

woman is angry because of increasing number of immigrants asking for job,he volunteers to help immigrant families by offering vocationnal guidance to find job DX

A

reaction formation

349
Q

patient with creat 1,9 and bipolar what medication can be given in long term rx (as mood stabiliser )of the patient

A

acid valproic

350
Q

bipolar and renal failure

A

no lithium

351
Q

in major depression evaluation what should be screened

A

suicidal ideation

352
Q

if suicidal ideation is present during major depression evaluation what should be done

A

hospitalisation

353
Q

helpful measure in schizophrenia

A

keep family stresses and conflicts to a minimum

354
Q

what about school during schizophrenia

A

gradual return with a reduced schedule would be more appropriate

355
Q

patient seen in clinics but refuses to speak,her husband is with her but replies to all the question during interview next step

A

ask the husband to step out the room and then try to speak to the patient

356
Q

what types of question patient can have difficulty to answer in front of family members(3)

A

question regarding
drug use
sexual history
domestic violence

357
Q

clue for marijuana intox(3)

A

increased appetite
impaired perception
conjunctival injection

358
Q

clue for PCP intox

A

nystagmus

359
Q

type of drug PCP is

A

hallucinogen

360
Q

clue for LSD intox

A

visual halucinations

361
Q

complication of cocaine(2)

A

chest pain

seizures

362
Q

clue heroin intox(3)

A

deressed mental status
miosis
respiratory depression

363
Q

what type of drug is heroin

A

opioid

364
Q

type of drug is marijuana

A

psychoactive drugs

365
Q

gynecomastia in use of cannabis meaning?

A

chronic use

366
Q

what test shold be done before initiating lithium rx(2)

A

creatinine

thyroid function

367
Q

complication of lithium(3)

A

nephrogenic insipidus diabetes
hypothyroidism
ebstein anomaly in fetus

368
Q

neurologic action of lithium

A

inhibit inositol 1 phosphatase in neuron

369
Q

why headache is important in psychiatry

A

could be indicative of depression in elderly

370
Q

can you physical symptom in depression

A

sometimes patient with depression comes to see you with physical symptom

371
Q

drugs causing halluciantions and combative behavior

A

Phenylcyclidine

372
Q

drugs causing hallucinations and intensified perceptions

A

PCP and LSD

373
Q

what are the 3 A for negative symptoms(3)

A

asociability
alogia
affective flattening

374
Q

SIGECAPS

A 
S=sleep
I=interst
G=guilt
E=energy
C=concentration
A=appetite
P=psychomotor
S=suicidability
375
Q

teens you can rx without parents consent(4)

A

contraception
prenatal care
substance abuse
STD

376
Q

drugs used in depression and smoking cessation

A

bupropion

377
Q

druds used to rx all forms of anxiety and fright disorder

A

SSRI

378
Q

if father ,or sibling or dizygotic tween or first degree relative twin has schizophrenia what’s the probability to progeniture to have it

A

5 a 10 %

379
Q

twin monozygotic has schizophrenia what the probility of having it in other twin

A

70%

380
Q

a child with both parents schizophrenic what the probability for the child to have it

A

60%

381
Q

schizophrenia probability in the general population

A

1%

382
Q

the 3 manif of extra pyramidal syndrome

A

acute dystonic reaction
akathisia
parkinsonism

383
Q

symptom in acute dystonic reaction

A

neck rigidity

384
Q

symptom in acute akathisia

A

restlessness

385
Q

rx of akathisia

A

propranolol

386
Q

rx of parkinsonism(2)

A

amantadine
or
anticholinergic

387
Q

hallmark of NMS(3)

A

hyperthermia
rigidity
autonomic instability

388
Q

complication of NMS

A

rhabdomyolysis

389
Q

rx of NMS(3)

A

dantrolene
or
amantadine
or/and dopamine agonist

390
Q

rx of anorexia nervosa

A

olanzapine

391
Q

rx of bulimia

A

SSRI

392
Q

quid of russel’s sign(2)

A

cicatrices and calluses over the hand

seen in anorexia nervosa

393
Q

triad of anorexia nervosa(3)

A

low BMI<18
amenorrhea
vomiting

394
Q

first thing to do if child abuse is suspected

A

complete physical examination

395
Q

second thing to do if child abuse is suspected

A

skeletal survey

396
Q

third thing to do if child abuse is suspected

A

coagulation profile

397
Q

4e thing to do if child abuse is suspected

A

child protective services

398
Q

5e et 6 e thing to do if child abuse is suspected(2)

A

hospitalisation if necessary

consultation with a psychiatrist

399
Q

patient with depression develops HTA crisis while eating cheese what drug is he on

A

phenelzine

400
Q

substance containing tyramine and hta crisis during depression if patient is taking phenelzine(2)

A

meat

cheese

401
Q

indication of cl0zapine in hospiatalised patietn with schizophrenia(2)

A

treatment resistant schizophrenia

schizophrenia associated with suicidability

402
Q

adverses effect of clozapine(4)

A

agranulocytosis
seizures
myocarditis
metabolic syndrome

403
Q

patient with delusion or hallucinations ask you if you believe him the best answer to give him

A

i know your experienc ehas been difficult for yo.Let’s see what we can do to help u

404
Q

approach the patient with delusions(2)

A

acknowledge the patient distress

without endorsing specific delusions or halucinations

405
Q

first line regimen in psychosis

A

second generation anitpsyhotics

406
Q

patient foud by police wandering in the street .whe askin what she fels she answers”jingle jangle “ doctor dx

A

psychosis

407
Q

patient hospitalised three months later for psychosis come to see you with erectile dysfunction and gynecomastia what cause that and physiopatho

A

hyperprolactinemia caused by antopsychotics

reason=decreased or blackade of dopamine activity in the tuberoinfundibular pathway

408
Q

kid 5 yo talking to herself.She says she has a friend called Mindy dx

A

imaginary friends

409
Q

what to do in case of imaginary friends(2)

A

nothing

imaginary friend is outgrown by the early elementary school years

usmle step 2 (22 decks)

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