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EOR Exam - Family Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Differentiate anorexia nervosa from bullimia nervosa.

A

Anorexia: Distorted body image with self-imposed starvation. Characterized by weight loss of at least 15% of ideal body weight.
Bullimia: Binge eating + vomiting/laxatives/diuretics/exercise to extreme to lose weight. Patients tend to maintain weight near ideal range.

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2
Q

Define anorexia.

A

Lack or loss of appetite for food

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3
Q

Define classifications of anorexia nervosa from mild to extreme.

A

Mild: BMI = 17+
Mod: BMI = 16-16.9
Severe: BMI = 15 - 15.9
Extreme: BMI < 15

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4
Q

What is the diagnostic criteria for bulimia nervosa?

A

At least 1 binge/purge episode per week for 3 mos

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5
Q

Define classifications of bulimia nervosa from mild to extreme.

A

Mild: 1-3 episodes per week
Mod: 4-7 episodes per week
Severe: 8-13 episodes per week
Extreme: 14+ episodes per week

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6
Q

What are some common S/S associated with anorexia nervosa?

A

Emaciated, lanugo (soft/thin hair), bradycardia, amenorrhea/delayed menarche, osteoporosis

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7
Q

What lab abnormalities are common in anorexia nervosa?

A

Leukopenia, HypoK, HypoPhos, HypoCl, HypoCa, dec vitamin D, inc BUN, metabolic alkalosis, dec estrogen, inc cortisol, inc total cholesterol s/p inc HDL.

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8
Q

What is the primary goal in the treatment of anorexia nervosa?

A

Restore nutrition –> may require hospitalization if body weight < 20% expected.

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9
Q

What specialty typically manages treatment of anorexia nervosa?

A

Requires multi-disciplinary approach.

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10
Q

What medications may be used in the treatment of anorexia nervosa?

A

Anti-dep: amitryptaline, paroxetine, mirtazapine

Weight gain: olanzapine

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11
Q

What anti-depressant is contraindicated in the management of anorexia nervosa and why?

A

Bupropion –> dec seizure threshold

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12
Q

What ECG arrhythmia is most common in anorexia nervosa?

A

sinus bradycardia

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13
Q

Describe refeeding syndrome associated with anorexia nervosa and state which electrolyte abnormality is responsible.

A

Def: eintroducing nutrition too quickly

Caused by hypophosphatemia

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14
Q

What are common S/S associated with bulimia nervosa?

A

dental erosion, esophagitis, HypoCl, HypoK, HypoMg, HypoCa, metabolic alkalosis, salivary gland hypertrophy, elevated amylase, gastric distention

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15
Q

What is first line therapy in bulimia nervosa?

A

CBT

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16
Q

Which eating disorder is more likely to require hospitalization?

A

Anorexia

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17
Q

Which SSRI is approved for the treatment of bulimia nervosa?

A

Fluoxetine (Prozac)

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18
Q

T/F: Due to its severity, anorexia nervosa patients typically seek treatment more commonly than bulimia nervosa patients?

A

False: Bulimia seeks treatment more commonly

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19
Q

Describe the diagnostic criteria for major depressive disorder.

A

Depressed mood + anhedonia (inability to feel pleasure) with 5 or more assoc symptoms almost every day for 2 weeks

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20
Q

State the associated symptoms that are part of the diagnosis of major depressive disorder.

A
  • Change in weight or appetite
  • Change in sleep
  • Change in psychomotor activity (agitation)
  • Decreased energy
  • Felling worthless, guilt
  • Difficulty thinking or concentrating
  • Recurrent thoughts of death/suicide
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21
Q

What treatment options are considered for major depressive disorder?

A

1st line: Psychotherapy
2nd line: SSRIs/SNRIs/TCAs, CBT
Last line: ECT

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22
Q

What are some risk factors for suicide?

A

Psychiatric illness, previous suicide attempts, never been married, military service, childhood abuse, family history of suicide, and access to weapons.

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23
Q

T/F: Men are more likely to attempt suicide.

A

False: Women are 2x more likely to attempt suicide but men are 3x more likely to be successful.

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24
Q

What should be included in the assessment of a person with SI?

A

Lethality of the patient’s medication regimen –> SSRIs are preferred in patients with depression and suicide risk s/p their low lethality in overdose.

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25
Q

Describe the diagnostic criteria for generalized anxiety disorder.

A

Excessive anxiety or worry more days than not in a 6 month period plus 3 or more associated symptoms.

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26
Q

State the associated symptoms that are part of the diagnosis of generalized anxiety disorder.

A

Fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, HA

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27
Q

What options may be considered in the management of generalized anxiety disorder?

A
  1. SSRIs (paroxetine and escitalopram( or SNRIs
  2. Buspirone - no sedation, takes weeks for effect
  3. BZDs, BBs for short term effect
  4. Psychotherapy
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28
Q

Describe the diagnostic criteria for panic disorder.

A

Recurrent, unexpected attacks (at least 2) not related to trigger. Panic attack followed by concern of more attacks, worry about implication of attacks, or significant change in behavior related to attacks

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29
Q

What is required to make a diagnosis of panic attack?

A

At least 4 of –> palpitations, trembling, sweating, choking, SOB, chills, dizzy, nausea, hot flashes, paresthesias, fear of dying, losing control.

30
Q

What is used in the management of a panic attack?

A

BZD

31
Q

What is used in the long term management of panic disorder?

A

SSRIs and CBT

32
Q

What lab values must be evaluated before making a diagnosis of panic disorder?

A

TSH, CBC, CMP

33
Q

What substance use disorder is most often associated with panic disorder?

A

Alcohol Use Disorder

34
Q

Describe general characteristics of phobic disorders.

A

Irrational fear that is known to patient and causes an immediate response upon exposure and may even result in a panic attack.

35
Q

What is required to diagnose a phobic disorder?

A

Response to stimuli interferes with daily routine, social functioning, or occupational functioning and is present for at least 6 months.

36
Q

Define agoraphobia.

A

Fear of places and situations that might cause panic, helplessness, or embarrassment.

37
Q

What are treatment options for phobic disorders?

A

SSRIs (1st line pharm), BZDs, TCAs, BBs

Best therapy –> systemic desensitization through exposure therapy.

38
Q

Describe the criteria required to doagnose PTSD.

A

Traumatic event that is directly experienced or learned event of close friend/family. Symptoms for 1+ month in each of the following –> 1+ intrusive symptom, 1+ avoidance, 2+ negative alterations in cognition/mood, and 2+ changes in arousal/reactivity related to event.

39
Q

Give examples of intrusive symptoms, avoidance symptoms, negative alterations, and arousal/reactivity changes related to PTSD.

A

Intrusive: dreams, flashbacks, psych/phys response to stimuli related to the event.
Avoid: Memories, thoughts, feelings, external reminders
Neg Alt: Can’t remember pieces of event, distorted blame about event, detachment, inability to experience positive emotions, etc.
Arousal: irritability, self-destructive behavior, hypervigilence, difficulty concentrating, insomnia

40
Q

What is used in the treatment of PTSD?

A

SSRIs first line, other –> MAOIs, TCAs, CBT

41
Q

Differentiate acute stress disorder from PTSD.

A

Similar S/S but occur within one month of event. 1st line Tx is psychotherapy/CBT

42
Q

Define Bipolar I disorder.

A

Occasional major depressive episodes with at least 1 manic episode.

43
Q

Define a manic episode.

A

Marked by grandiosity, decreased need for sleep, pressured speech, flight of ideas, easily distracted, risk taking behavior, increased goal directed activity or psychomotor agitation lasting at least 1 week.

44
Q

What is the biggest risk factor for bipolar I disorder?

A

Family Hx

45
Q

What is the treatment for bipolar I disorder?

A

Lithium or 1st/2nd generation anti-psychotic.

46
Q

Define bipolar II disorder.

A

Major depressive episodes with HYPOMANIA

47
Q

Define hypomania.

A

Similar to mania but less severe (society may perceive hypomania to be beneficial) and needed to only be present for 4 days.

48
Q

T/F: Patients with bipolar I disorder are at higher risk of suicide.

A

False: Bipolar II carries higher risk of suicide attempts and greater lethality per attempt.

49
Q

What is the treatment for bipolar II disorder?

A

Same as bipolar I –> lithium or anti-psychotic.

50
Q

Describe S/S associated with chronic alcohol abuse.

A 
acne rosacea, palmar erythema, hepatomegaly, 
dupuytren contracture (thickened skin at base of fingers), testicular atrophy, gynecomastia
51
Q

What serum lab changes are seen in AUD and which is the earliest change?

A

Inc: GGT (earliest), AST, ALT, LDH, MCV
Dec: RBC volume, LDL, BUN

52
Q

Describe the progression of alcohol withdrawal over time.

A

8-18 hours: shakes and jitters
24-48 hours: seizures
48-96 hours: DTs –> disorientation, agitation, hyperthermia

53
Q

What is the treatment for severe alcohol withdrawal?

A

BZDs, antipsychotics, glucose, thiamine, fluids

54
Q

What pharmacologic options are available to treat AUD?

A

Disulfiram and naltrexone

55
Q

What is the risk of treating AUD with disulfiram?

A

Intake of any alcohol on this medication will cause severe illness.

56
Q

What determines the potency of cannabis products.

A

Ratio of THC to cannabidiol in the substance

57
Q

How long after use does THC remain detectable in urine?

A

1 month

58
Q

When does the withdrawal period start and stop for THC?

A

Starts within 24-48 hours after last use and peaks on day 4.

59
Q

Describe S/S of THC withdrawal and state how it is treated.

A

S/S: malaise, irritability, insomnia, night sweats, GI

Tx: usually not needed –> may use anxiolytics

60
Q

Describe the S/S of severe PCP intoxication and state the first line treatment.

A

S/S: violent behavior, horizontal and vertical nystagmus, auditory hallucinations.
Tx: BZDs

61
Q

What is a common sequelae of inhalant use disorder and what S/S is seen to indicate it?

A

Often see an erythematous rash around the mouth s/p contact dermatitis to the chemicals in the inhalant. May lead to a secondary bacterial infection.

62
Q

State some common S/S of inhlant use other than infectious sequelae.

A

Mood swings, HA, facial flushing, N/V, anorexia, cough, unusual breath or body odor, tachycardia, slurred speech.

63
Q

What are the long term effects of inhalant use?

A

kidney, liver, and neurological degeneration

64
Q

What are the classic S/S of opioid intoxication?

A

Miosis, respiratory depression, CNS depression

65
Q

Name and describe treatment options to manage opioid dependence.

A

Methadone: ultra-long acting opioid agonist
Naltrexone: long acting opioid antagonist
Buprenorphine: mixed partial agonist and antagonist

66
Q

What complications are associated with BZD withdrawal and what is the treatment:

A

S/S: seizure, cardiovascular collapse, death

Tx: long acting barb or BZD

67
Q

What is the treatment for severe stimulant intoxication?

A

BZD and antipsychotic

68
Q

What are the S/S associated with stimulant withdrawal.

A

Fatigue, depression, HA, profuse sweating, muscle cramps, hunger

69
Q

What is the most common SUD in the US?

A

tobacco/nicotine

70
Q

What comorbid conditions decrease the success rate of smoke cessation?

A

Alcohol or other SUD

71
Q

Describe pharmacologic options available in the treatment of nicotine dependence.

A

NRT: patch, gum, lozenge –> cheap but less effective
Buproprion: anti-depressant that blocks DA reuptake
Varenicline (Chantix): dec cravings as partial alpha-2 agonist –> recently pulled from market
Nortriptyline (TCA: 2nd line pharm therapy

EOR Exam - Family Medicine (15 decks)

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