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Psychiatrics 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
grandiose delusion
belief of great talent insights or achievements
26
Jealous delusion
unfaithful partners
27
somatic delusion
belief of bodily functions and sensation
28
how to differentiate delusion from schizophrenia(2)
you need symptoms for at least 6 months to dx schizophrenia | additional psychotic symptom in schizophrenia
29
psychotic symptom in schizophrenia(3)
hallucinations disorganisation negative symptom
30
clue for delusion
patient is highly functionnal
31
rx of obsessive compulsive disrder will target which substance
serotonin
32
drugs used in OCD(5)
``` clomipramine fluoxetine fluvoxamine paroxetine sertraline ```
33
class of drug for clomipramine
TCA
34
RX of choice of OCD
paroxetine
35
which neurotransmetter has altered level in OCD
serotonin
36
quid of bereavment
normal reaction to the loss of loved one
37
persistent complex bereavement syndrome
persistence of symptom at leats one year after the loss of loved one
38
dx of major depression(2)
4 symptoms in SIGECAPs plus mood depressed or loss of interest
39
cancer patient is at risk of what psychiatric disease
major depression
40
rx of patient with cancer and major depression
SSRI
41
can you have bereavement from cancer
yes you can
42
how a patient with bipolar will take lithium
it depends on the number of relapses
43
first episosde of bipolar rx duration
lithium for at least one year
44
second episode of bipolar
lithium for years
45
indication of lithium for many years(3)
2 episodes severe episode family history
46
rx of more than 3 episodes of bipolar
lithium for lifetime
47
patient taking fluoxatine for depression after 2 weeks he comes back to say there's no improvement what to do?
continue fluoxatine at the same dose
48
when a patient taking SSRI will start having improvement
in 4 -6 weeks
49
mechanism of action of risperidone
blocking dopamine D2 receptor
50
what a clinician should do in case of mistake(2)
facts should be clarified | truth told to the patient
51
patient leaves home to live on university campus weeks later develops anxiety that someone is going to break the house dx
adjustment disorder with anxiety
52
quid of adjustment diosorder with anxiety
development of emotionnal or behavioral symptom in response to an identifiable stressor within 3 months of the onset of the stressor
53
quid of acute stress disorder
anxiety developing after experiencing or whitnessing an event
54
acute stress disorder and PTSD
PTSD last more than one month
55
generalized anxiety disorder GAD
excessive worry on many aspects of life including work,family, finance etc...
56
patient starting new job worry in asking if children are safe at school, has difficulty sleeping etc...
GAD
57
what's the most important factor to determine a psychiatric disorder
the level of functionning at work
58
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
normal human experience
59
immature mechanism of defense in which individual expresses his aggresion toward another person with repeated passive failure to meet the other person
passive agressive behavior
60
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
passive agressive behavior
61
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
alprazolam
62
abrupt cessation of this drug cause seizure
alprazolam
63
example of catatony
patient repeats only with monosyllables and refused to make eye contact
64
symptoms of schizophrenia(5)
``` delusions hallucinations disorganised speech catatony negative symptom ```
65
patietn presenting with all symptoms of schizophrenia but depuis moins de 6 mois dx
schizophreniform disorder
66
quid of brief psychotic disorder
symptom lasting more than 1 day but less than 1 month
67
qid of chizoaffective disorder
mood disorder with active symptom of schizophrenia lasting at least 2 weeks
68
quid of delusionnal disorder(3)
delusions lasting more than 1 month normal functionning no psychotic symptom
69
person who is splitting people as good or bad
bordeline personnality disorder type B
70
risk of boderline personality disorder
risk of suicide | angry outburst
71
disorganized speech in schizophrenia ,quid of of circumstantiality(3)
stand around you give detailed to a specific question but irrelevat responses patietn deviates from the original subject but eventually return to it
72
tangential thought
patietn druft away from the subject but never return to it
73
quid of conficdentiality in medical sciences
don't discuss thing about a patient with somebody or physician directly relaled to his care
74
what to monitor in patietn taking olanzapine and clozapine(2)
fasting glucose | lipids
75
pathologic gambling
pathologic history of gambling and inability to stop
76
how to deal with angry patient
start a discussion with open ended question and let the patietn talk about the emotion and problem
77
different classes of antidepressant drugs(4)
SSRI=selective serotonin reuptake inhibitor SNRI=serotonin norepinephrine reuptake inhibitor TCA=tricyclic antidepressant MAOI=mono amine oxydase inhibitor atypical antidepressant
78
name atypical antidepressant(3)
bupropion mirtazapine trazodone
79
TCA(4)
amitryptiline clomipramine doxepin nortryptiline
80
name SNRI(3)
duloxetin venlafaxine Pesvenlafaxine
81
Name MAOI (2)
phenelzine | tranylcipromine
82
when to change class of anti depressor during rx
when two trials of SSRI are inneficient
83
first line rx of GAD(2)
cognitive behavioral therapy | SSRI or SNRI
84
second line of GAD(2)
benzodiapine | buspirone
85
quid of GAD(6)
``` multiple wory or anxiety > ou egal a 6 months plus 3 or more of this restlessness fatigue difficulty concentrating irritability Mx tension sleep disturbance ```
86
quid of folie a deux
psychaitric disorder a delusion or set of delusion is shared simultaneously by individuals who dshared a close relationship
87
what to do in case folie a deux interview(2)
interview the two people separately | rx the one who first has the delusion
88
person always alone ,demonstrate interst in magical thing
schysotypal personality disorder
89
shizoid personality disorder
they don't have friends
90
avoidant personality disorder
they want friends but fear ridicule
91
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
the patietn as long as her jugment and decision making ability are not affected
92
who can give consent for intervention surgical in minor
patient's parent
93
minor less than 18 ans who don't require parental consent(5)
``` homeless live alone financially independent married military ```
94
minor wo dont dont need consent (6)
emergent care
95
jehovah witnesses with no advanced directives on him and requires blod transfusion but unconscious
transfusion can be done
96
quid of advance directive or card
instruction saying you want something or not during critical care
97
if the jehovah witness is conscious what can be done
he can refuse or accept the blod transfusion
98
patient found in airport or terminal bus with dissociation forgetfulness of name and adress
dissociative fugue
99
what 's the best answer to give to the parent of a kid with kleptomania
it's a mental disorder that can be treated with psychotherapy
100
rx of kleptomania
cognitive behavioral therapy
101
quid of kleptomania
impulsive control disorder
102
dx differential of kleptomania(4)
shoplifting antisocial behavior disorder bipolar manic episode(impaired jugment) psychotic disorder vol because of hallucinations
103
kid with ALL but parent refuse chimio next step
obtain a court order for chemo
104
why you should obtain a court order for chemo in patient with ALL but parent refusing rx
50% des cas ALL is treated with chemo
105
straight A student 16 yo become suddenly to develop odd bahavior missed class failing in math ,what the best next thing to do
obtain urine toxicolog screening
106
any changes in adolecent behavior what to check(5)
``` check drug use partner violence date rape pregnancy sexual or physical abuse ```
107
patient on antipsychotics develops milky discharge in nipple cause?
risperidone
108
clue for prolactinoma
prolactinemia > 200 ng /ml
109
clue ofr dependent personnality disorder(3)
partner physically abusive but wife can leave him avoid arguments whenever possible to be pleasant to others fear of being alone
110
clue for bulimia nervosa(3)
patient eats a lot and sometime vomit(throw up) tends to fast or exercicie to compensate BMI is normal or slighlty above
111
clue for anorexia nervosa(2)
patient with low BMI | amenorrheic
112
BMI in bulimia nervosa(2)
normal or slightly elevated
113
clue for persistent depressive disorder
dysthimia ,chronic low grade depression that last 2 years or more
114
how to differentiate major depressive disorder and persistent depressive disorder
you don't have all 5 crtieria in SIGECAP in persistent depressive disorder
115
symptom in persistent depressive disorder(2)
sadness | low energy for years
116
pain during sexual intercourse or when attempting penetration
genito pelvic pain penetration disorder
117
quid of alcohol hallucinosis
alcohol withdrawal syndrome occurring 12-24 h after the last drink and resolves within 24-48 h
118
patient with history of 6-8 beers /day develops auditory hallucination after an accident
alcohol hallucinosis
119
quid of delirium tremens
fever HTA tachycardia occuring 48-96 hr after stopping alcohol
120
quid of withdrawal seizures
alcohol withdrawal causing seizures
121
quid of mild withdrawal alcohol(2)
palpitation or tremulation
122
complication of mild withdrawal or alcohol withdrawal seizures
Delirium tremens
123
differentiate alcohol hallucinosis and DT
vitals are normal in alcohol hallucinosis
124
quid of pyromania
intentionnal and repeated fire setting with no obvious motive
125
immature mechanism of defense in which individuals displace negative feelings associated with an unacceptable object or situation ob a safer object or situation
displacement | dan pouri gen fos sou bannann mu
126
side effct most commonly seen with olanzapine
weight gain
127
cause of acute dystonic reaction(2)
haloperidol | metochlopramine
128
rx of acute dystonic reaction
benztropine or antihistaminics(diphenidramine)
129
quid of bereavment
sadness after a bad event
130
patietn with cancer can develop what disease
major depression
131
rx of bereavment
SSRI
132
drug used in NMS
dantrolene
133
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)
intellectualisation | an immature mechanism of defense
134
difference between boulimia nervosa and binge eating disorder
in binge eating disorger no compensatory behavior
135
rx of binge eating disorder(2)
SSRI and CBT
136
first line rx in boulimia nervosa and anorexia nervosa
CBT | nutritionnal rehab
137
when use pharmacologic rx in boulimia nervosa and anorexia nervosa
when first line regimen fails
138
clue for inducing vomiting(surreptitious vomiting)(4)
parotid gland hypertrophy dental caries halithosis scars and calluses over hand
139
quid of hoarding disorder
difficulty discarding possessions regardless of their actual values
140
first line rx of hoarding disorder(2)
CBT | SSRI
141
patient with history of dependence of opiod develops false symptom of back pain to get morphine dx
malingering
142
what's the deadline for a physician to give a copy of medical record on patient's request
30 jours
143
what to do if relatives or patient want to get a copy of dossier
patient must request a copy of medical record
144
pregnant woman with clear indication of CS refuses it what to do
respect the patient decision and proceed with vaginal delivery
145
why respect the patient decision and proceed with vaginal delivery in case of refusal of CS
pregnant women have the right to refuse rx even if it places her unborn child at risk
146
mother refuses to vaccinate children next step
document in the medical chart that the risks and benefits of vaccination have been explained
147
quid of advance directives
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
148
what to do if patient's healthcare proxy disagrees with a living will and demands care that contradicts the patietn written wishes
discuss the matter with the proxy and other family member
149
what if the family members fails to resolve the problem
the hospital ethics commmitee shold be consulted
150
why you shoul not give bupropion to patient with eating disorder
risk for seizures
151
why can you have seizures with bupropion in patient with eating disorder
electrolytes disturbance
152
why bupropion is contrindicated in epilepsy
it's decreases the tresholf of seizure
153
why patient snorting cocaine tends to lose weight
because they have decreased appetite
154
when using haloperidol in patient with manic episodes
extreme agitation
155
some clue for manic episode(7)
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)
156
patient with presenting with mx pain diarrhea abdominal cramps sweating and HTA abd dilated pupils what drugs can cause that
heroin withdrawal
157
action of heroin
everything is high
158
1 cause of NMS
haloperidol
159
clue for major depression with psychotic symptom(2)
when the patient is depressed psychotic event occurs | when the patietn is euthymic no psychotic symptom
160
quid of schizoaffective disorder
at least > ou egal a 2 weeks of delusions or hallucinations in absence of mood depression and than mood depression occurs with psychotic symptom
161
bipolar with psychotic features(2)
when the patient is manic ,psychotic features occur | when the patient is ok no psychotic features
162
quid of autism(3)
children perform stereotyped behavior no emotionnla bonds with others participation in restricted activities
163
age of onset of autism
before 3 yo
164
patient thinking he has special power
grandiose delusion
165
dx of bipolar
elevated or irritable mood with 3 or more of this | DIGFAST
166
quid of DIGFAST in bipolar disorder
``` D=distractibility I=impulsivity G=grandiosity F=flight of ideas A=activity S=sleep need decreased T=talktiveness or pressured speech ```
167
quid of hypomanic episode(3)
less severe than bipolar symptoms > ou egal a 4 consecutives days no psychotic features
168
can you have psychotic features in bipolar
yes
169
quid of bipolar type 1
manic episode plus depressive episode
170
do you require depressive episode in bipolar type 1
no
171
quid of bipolar type 2(2)
hypomanic episodes | you must have 1 day or more of depressive episodes
172
differenciate type 1 bipolar from type 2(2)
in type 1 no depressive episode is needed | in type 2 you need at one episode at major depression
173
quid of cyclothymic disorder
2 years of fluctuating mild hypomanic and depressive symptom
174
what to suspect in children with sudden behaviral changes
physical or sexual abuse
175
risk factor of sexual abuse or physical abus(2)
parent with unstable economic backgrounds | parent with history of drugs or alcohol abuse
176
quid of response during rx in psychiatry
50% reduction in the baseline level of severity
177
quid of remission during rx in psychiatry
absence of Symptom or minimal symptom
178
quid of sustained remission during rx in psychiatry
stabilisation of patient's symptom
179
quid of recovery during rx in psychiatry
episode is over
180
quid of reccurence during rx in psychiatry
after recovery symptom reappears
181
quid of relapse during rx in psychiatry
during sustained remission symptoms reappears
182
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
hospitalise the patient involuntarily
183
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
he is a danger for himself and other
184
what medication ingestion contrindicated consumption of meat and aged cheese and why(2)
phenelzine | risk of icrease of blood presure
185
quid of phenelzine
monoamine oxydase inhibitor
186
patiet 16 yo with attempted suicide next step
hospitalisation
187
anxiety restricted to social or performance situations
social anxiety
188
young girl with no close friend during interview the patient says nobody wants to be friend of someone ugly and stupid like me dx
avoidant pesonality disorder
189
quid of body dismorphic disorder
it's an obsessive compulsive disorder
190
what to in case of body dismorphic disorder(4)
continue to meet regularly to discuss concerns of the patient psychoterapy SSRI referral to a psychiatrist
191
Quid of body dismorphic disorder
preoccupation with at least one perceived physical detect
192
quid of most likely cause of tardive dyskinesia
risperidone
193
common manif of tardive dyskinesia(9)
``` face grimacing chewing biting tongue protrusion torticolis shoulder shruugging respiratory grunting noises rocking and swaying rotary hip movements ```
194
limb abnormality in tardive dyskinesia(4)
limb twisting and spreading piano playing finger foot tapping dystonic extension of the toe
195
next step in rx tardive dyskinesia
stop risperidone | begin clozapine
196
side effect of clozapine
agranulocytoiss
197
in cae of suicidability what patient should be hospitalised(2)
patient with ideation | intent and plan
198
suicidability with no plan next step(3)
rx underlying depression family support reduce access to potential means
199
rx of performance only social anxiety(2)SAD
Bblocker or benzodiapines
200
rx used in Generalised social AD and SAD
CBT
201
how to give propranolol in anxiety provoking situation
30-60 mn before the act
202
quid of generalised social anxiety disorder
anxiety in meeting new people | initiating or maintaining conversation
203
rx of generalised social anxiety disorder (2)
CBT | SSRI
204
2 types of social anxiety
performance only | generalised
205
indication of buspirone
generalised anxiety social disorder
206
what about CBT in social anxiety compared to drug
equally efficace
207
tetrad of alzheimer(5)
``` memory impairment apraxia aphasia or language dysfunction agnosia you can have 2 of them ```
208
quid of agnosia
difficulty recognizing object
209
quid of apraxia
difficulty carrying out activities
210
what should be done before making the dx of alzheimer
rule out any medical causes of cognitive decline
211
the best way to break bad news(2)
use a symptom to ask the question | what do you think is going on with your back pain for example
212
steps to prepare meeting with family to break bad news
SPIKES
213
quid of SPIKES(6)
``` 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
clue for panic attack(4)
suddeny you have a patient with palpitation chest pain and diaphoresis
215
first thing to do in patient with palpitation chest pain and diaphoresis(2)
EKG | drug screening
216
acute rx of panic attack
benzodiazepine
217
long term rx of panic attack
SSRI
218
gender involved in panic attack
woman
219
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
is there a specific reason you don't want your mother to know the DX
220
quid of trichotillomania
it's an OCD
221
rx of trichotillomania
CBT
222
reaction of pain ,distress after the loss of a close relationship pendant < 6 months
greaf of bereavement
223
normal laps of time to speak of greaf bereavment
about 6 months
224
complication of greaf bereavment
major depression
225
rx of greaf bereavment(2)
SSRI plus psychoterapy
226
first line rx of OCD(2)
SSRI or clomipramine
227
patient with bruises on body come to clinic when physicians saks on bruises patient start crying dx and next step(2)
tell me more about the bruises on your body | physical abuse
228
rx of withdrawal alcohol seizures
long acting benzodiapines
229
quid of long acting benzodiapines(3)
diazepam lorazepam chlordiazepoxide
230
action of long acting benzodiazepines in rx withdrawal seizures
stimulate gamma aminobutyric acid receptor causing sedation
231
quid of alcoholic in USMLE
6-10 beers /day
232
indication of disulfuram (antabuse)
to maintem long term abstinenece in alcoholic patients
233
rx of alzheimer dementia
initiate cholinesterase inhibitor
234
example of cholinesterase inhibitor(3)
donepezil galantamine rivastigmine
235
children with motor tick =grimacing,blinking shouldeer shrugging vocal tick barking grunting coughing and throat clearance dx
tourette syndrome
236
complication of tourette(2)
hyperactivity disorder | OCD
237
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
poor sleep hygiene
238
risk for survivor of sexual assault(3)
PTSD depression suicidability
239
quid of narcolepsy(2)
daytime drowsiness plus cataplexy
240
quid of cataplexy
sudden loss of mx tone triggered by strong emotions
241
rx of narcolepsy
modafinil or amphetamine stimulants
242
preferred drug in narcoplepsy
modafinil also called provigil
243
measure in narcolepsy(3)
avoid alcohol maintain proper sleep schedules avoid drugs causing drowsiness
244
what to do if an employer asks to hospital information on hospitalised patient what you need to do that
verbal or written autorization from patient
245
what to do if an employer asks to hospital information on hospitalised patient with patient's autorization(2)
disclose only minimal necessary information | i can confirm the patietn is hospitalised and i anticipate he will be able to return to work
246
indication of methylphenidate
hyperactivity disorder
247
side effect # 1 of methylphenidate
decreased appetite
248
contrindication of methylphenidate
children less than 6 years
249
common side effect of methylphenidate(3)
abdominal pain insomnia nervousness
250
quid of dysthimia
depressed mood for at least 2 years
251
differenciation between dysthimia and major depression
in dysthimia you have the same symptom than major depression but less severe and longer duration
252
patient rx with sertraline for major depression accuses improvement next step?
continue medication for 6 months
253
rx of simple episode of depression duration
6 mois rx
254
in multiple episode of major depression duration of rx
continue maintenance rx for a long time
255
patient with manic episode has been on rx for 6 months for a prior manic episode develops manic episode next step(2)
initiate antipsychotic | recommend hospitalisation
256
any patient on lithium and develops manic episode next step(4)
hospitalisation antipsychotic plus moodstabilizer urine toxicology mood stabilizer drug levels
257
patient 60 ans with colon cancer refuses rx next step
ask the patient why he doesn't want rx and intervention of any kind
258
what to do if a patient refuses rx
it's important to fully discuss the specific reasons for the decision before honoring it
259
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 ?
i would like to see you at a follow up visit to evaluate your symptom again before deciding the ct scan
260
why patient with somatisation should be seen at follow up visit for further evaluation
because they have to be seen in regular scheduled visits that focus on psychological distress associated with their symptoms
261
patient comes to the hospital for severe haeadache despite of extensive follow up he is sure he has cerebral hemmorrage dx
hypochondriasis
262
next step after dx hypochondriasis
initiate discussion about current emotionnal stressors
263
why you shoud initiate discussion about current emotionnal stressors in case of hypochondriasis
because the symptom will develop in stressfull period
264
rx of hypochondriasis
brief psychotherapy
265
clue for amphetamine intox(8)
``` agitation excitability delirium paranoia tachycardia hta mydriasis diaphoresis ```
266
complication of amphetamine intox(4)
cardiac arythmia seizures hyper thermia intracerebral hemorrage
267
what differentiate amphetamine intox from anticholinergic poisonning intox(5)
``` same symptom sauf dry skin and mucous membranes ileus retention d'urine tremor and myoclonic jerk favors anticholinergic ```
268
patient with low mood but no impairement of daily functionning dx
normal stress response
269
conversion disorder quid
neurologic symptom after a stressor event
270
most common presentation of conversion(4)
weakness paralysis seizures but normal neurologic exam
271
first line rx in conversion
education
272
second line rx in conversion
CBT
273
2 ways of presentation of conversion
hysterical | indifferent
274
sleep pattern in older people
they tend to frequently awaken from sleep and spend less time sleeping overall
275
persistent complex bereavment syndrome
symptom last more than 12 months followiing the loss
276
In USMLE anytime you see death what to rule out
breavement syndrome
277
exposure to lithium during first trimester of pregnancy
cardiac malformation
278
what are the 2 cardiac abnormalities seen in litium during pregnancy(2)
septal defect | ebstein anomaly
279
quid of ebstein anomaly
malformed and inferiorly atached tricuspid valve causing a part of the right ventricle to become part of the right atrium
280
Ebstein
atrialisation of the right ventricle
281
complication of lithium on baby during 3 e trimestre de la grossesse(2)
goiter | transient neuromxar dysfunction
282
rx of tourette(3)
first generation antipsychotics pimozide haloperidol fluphenazine
283
second line rx of tourette(2)
atypical antipsychotics | risperidone
284
quid of tourette syndrome
multiple motor and vocal ticks for 1 yaer
285
should you have vocal ticks and motor ticks together for tourette
no you can them separately
286
first rx for tourette
risperidone
287
quid of narcistic personality disorder
exaggerated senseof self importance feelings and entitlement egocentrism and lack of empathy to others
288
indication of electroconvulsive rx(5)
``` severe depression depression in pregnancy refractory mania NMS catatnic schizophrenia ```
289
adverse effect of electroconvulsive rx(6)
``` prolonged seizures delirium skin burns amnesia headache nausea ```
290
most common side effect of electroconvulsive rx
amnesia
291
quid of factitious disorder
patient induces symptom to play the sick role
292
example of factitious disorder
patient taking insulin
293
munchausen syndrome
patient playing the sick role in order to get surgery
294
complication in baby with mother suffering from anorexia nervosa
small of gestationnal age baby
295
anomaly in anorexia nervosa in patient(6)
``` osteoporosis increase cholesterol and carotene levels cardiac arythmia euthyroid sick syndrome hyponatremia hypothalamic pituitary axis dysfunction ```
296
cardiac arythmia seen in anorexia nervosa
prolonged QT syndrome
297
anorexia nervosa and hypothalamic pituitary axis dysfunction(3)
amenorrhea anovulation estrogen deficiency
298
why hyponatremia in anorexia nervosa
excess of water drinking
299
why you can have many electrolytes disturbances in anorexia nervosa
because of purging behavior
300
complication of pregnancy in anorexia nervosa(6)
``` miscarriage intrauterine growth retardation hyperemesis premature birth cesarean section post partum depression ```
301
quid of antisocial personnality disorder
patient 18 ou plus engages in illegal activities and disregard rights of others
302
what to monitor in all patietns taking clozapine
WBC
303
why monitor WBC in patient taking clozapine
to rule out agranulocytosis
304
other side effect of clozapine
lower seizure treshold
305
rs of alcohol withdrawal syndrome
diazepam
306
patietn asking to see doctor after time of closing office for sore in the mouth what to do(2)
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
quid of somatisation
symptom more than 6 months with disruption of daily life
308
quid of illness anxiety disorder
prolonged fear and concern about getting or having a disease but with minimal or no actual physical symptom
309
children verbal and talkative at home but refuses to speak in specific settings generally at school dx
selective mutism
310
patient presenting with sudden palpitations sweating trembling or shaking shortness of breath and hot and cold sensations dx
panic disorder
311
disease associated with panic disorder(4)
major depression agoraphobia bipolar substance abuse
312
risk in patient with panic attack
suicide
313
abnormal imaging associated with schizophrenia
enlargement of cerebral ventricles
314
abnormal imaging associated with autism
increase total brain volume
315
abnormal imaging associated with OCD
abnormalities in orbitofrontal cortex and striatum
316
abnormal imaging associated with PTSD
decrease volume of amygdala
317
which ventricle is enlarged in schizophrenia
lateral ventricle
318
hiv positive woman is terrified by her lab result she has trouble telling that to her husband what to say
encourage the patient to tell her husband but tell her you to inform the local health department
319
what will do the local health department in hiv case
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
patietn with caught his girlfriend cheating on him he develops worthless,sleep problem all began 2 months after the rupture dx(2)
adjustement disorder | it's not depression
321
rx of adjustment disorder(2)
psychodynamic psychotherapy | brief cognitive psychotherapy
322
quid of adjustment disorder
emotionnal or behavioral symptom that develops within 3 months of exposure to an identifiable stressor
323
quid of rationalisation
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
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
rationalisation
325
clue for EPS type parkinsonian(4)
walk much slower not swinging arms facial expressions flat ,unchanged micrographia
326
rx for EPS
benztropine
327
indication of CBT(3)
overgeneralisation of negative events catastrophising maximizing negative events
328
when CBT can be used(5)
``` anxiety mood problem personality problem somatic symptom eating disorder ```
329
how many sessions of CBT is recommnaded
12
330
indication to place a patient in a hospice care
patient with prognosis less than 6 months
331
what are the focus in hospice care(5)
``` symptom control quality of life psychosocial spiritual bereavment care ```
332
rx of meningococcemia(3)
isolation IV antibiotics supportive care
333
can a patient refuse the rx of meningococcemiaand why(2)
no | because he could be pose a threat to the health and welfare of others
334
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
ask the receptionnist instruct the patient to shedule an appointment during normal office hours
335
rx of specific phobia first line
CBT
336
second line rx of specific phobia
benzodiazepines
337
what they do during CBT
exposure technique
338
quid of phobia
fear of specific object or situation
339
strongest indication for a future suicide in patient with psychiatric disorder
previous suicide attempt
340
indication for suicide(8)
``` preexisting psychiatric disorder hopelessness impulsivity never married elderly white men unemployed or unskilled physical illness family history or genetics family discord ```
341
protective fgactors against suicide(4)
social support/family connectedness pregnancy parenthood religion and participation in religious activities
342
the greatest risk to attempt suicide in future
past history of suicide attempt
343
what must be present for the dx of major depression(2)
low mood or anhedonia plus SIGECAPS
344
duration of symptom to dx major depression
two weeks or more
345
what the most important element to dx grief(2)
loss | emptyness
346
dx depression
5 on 9 depressive symptoms which at least 2 weeks | at least one is depressed mood or looss of interest/pleasure
347
reaction formation
transformation of an unwanted thought or feeling into it's opposite
348
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
reaction formation
349
patient with creat 1,9 and bipolar what medication can be given in long term rx (as mood stabiliser )of the patient
acid valproic
350
bipolar and renal failure
no lithium
351
in major depression evaluation what should be screened
suicidal ideation
352
if suicidal ideation is present during major depression evaluation what should be done
hospitalisation
353
helpful measure in schizophrenia
keep family stresses and conflicts to a minimum
354
what about school during schizophrenia
gradual return with a reduced schedule would be more appropriate
355
patient seen in clinics but refuses to speak,her husband is with her but replies to all the question during interview next step
ask the husband to step out the room and then try to speak to the patient
356
what types of question patient can have difficulty to answer in front of family members(3)
question regarding drug use sexual history domestic violence
357
clue for marijuana intox(3)
increased appetite impaired perception conjunctival injection
358
clue for PCP intox
nystagmus
359
type of drug PCP is
hallucinogen
360
clue for LSD intox
visual halucinations
361
complication of cocaine(2)
chest pain | seizures
362
clue heroin intox(3)
deressed mental status miosis respiratory depression
363
what type of drug is heroin
opioid
364
type of drug is marijuana
psychoactive drugs
365
gynecomastia in use of cannabis meaning?
chronic use
366
what test shold be done before initiating lithium rx(2)
creatinine | thyroid function
367
complication of lithium(3)
nephrogenic insipidus diabetes hypothyroidism ebstein anomaly in fetus
368
neurologic action of lithium
inhibit inositol 1 phosphatase in neuron
369
why headache is important in psychiatry
could be indicative of depression in elderly
370
can you physical symptom in depression
sometimes patient with depression comes to see you with physical symptom
371
drugs causing halluciantions and combative behavior
Phenylcyclidine
372
drugs causing hallucinations and intensified perceptions
PCP and LSD
373
what are the 3 A for negative symptoms(3)
asociability alogia affective flattening
374
SIGECAPS
``` S=sleep I=interst G=guilt E=energy C=concentration A=appetite P=psychomotor S=suicidability ```
375
teens you can rx without parents consent(4)
contraception prenatal care substance abuse STD
376
drugs used in depression and smoking cessation
bupropion
377
druds used to rx all forms of anxiety and fright disorder
SSRI
378
if father ,or sibling or dizygotic tween or first degree relative twin has schizophrenia what's the probability to progeniture to have it
5 a 10 %
379
twin monozygotic has schizophrenia what the probility of having it in other twin
70%
380
a child with both parents schizophrenic what the probability for the child to have it
60%
381
schizophrenia probability in the general population
1%
382
the 3 manif of extra pyramidal syndrome
acute dystonic reaction akathisia parkinsonism
383
symptom in acute dystonic reaction
neck rigidity
384
symptom in acute akathisia
restlessness
385
rx of akathisia
propranolol
386
rx of parkinsonism(2)
amantadine or anticholinergic
387
hallmark of NMS(3)
hyperthermia rigidity autonomic instability
388
complication of NMS
rhabdomyolysis
389
rx of NMS(3)
dantrolene or amantadine or/and dopamine agonist
390
rx of anorexia nervosa
olanzapine
391
rx of bulimia
SSRI
392
quid of russel's sign(2)
cicatrices and calluses over the hand | seen in anorexia nervosa
393
triad of anorexia nervosa(3)
low BMI<18 amenorrhea vomiting
394
first thing to do if child abuse is suspected
complete physical examination
395
second thing to do if child abuse is suspected
skeletal survey
396
third thing to do if child abuse is suspected
coagulation profile
397
4e thing to do if child abuse is suspected
child protective services
398
5e et 6 e thing to do if child abuse is suspected(2)
hospitalisation if necessary | consultation with a psychiatrist
399
patient with depression develops HTA crisis while eating cheese what drug is he on
phenelzine
400
substance containing tyramine and hta crisis during depression if patient is taking phenelzine(2)
meat | cheese
401
indication of cl0zapine in hospiatalised patietn with schizophrenia(2)
treatment resistant schizophrenia | schizophrenia associated with suicidability
402
adverses effect of clozapine(4)
agranulocytosis seizures myocarditis metabolic syndrome
403
patient with delusion or hallucinations ask you if you believe him the best answer to give him
i know your experienc ehas been difficult for yo.Let's see what we can do to help u
404
approach the patient with delusions(2)
acknowledge the patient distress | without endorsing specific delusions or halucinations
405
first line regimen in psychosis
second generation anitpsyhotics
406
patient foud by police wandering in the street .whe askin what she fels she answers"jingle jangle " doctor dx
psychosis
407
patient hospitalised three months later for psychosis come to see you with erectile dysfunction and gynecomastia what cause that and physiopatho
hyperprolactinemia caused by antopsychotics | reason=decreased or blackade of dopamine activity in the tuberoinfundibular pathway
408
kid 5 yo talking to herself.She says she has a friend called Mindy dx
imaginary friends
409
what to do in case of imaginary friends(2)
nothing | imaginary friend is outgrown by the early elementary school years

usmle step 2 (22 decks)

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