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My Step 2 CK > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is considered mild mental retardation?

A

IQ btw 50-70

6th grade level functioning, can work & live independently but need help in stressful imes

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2
Q

What is considered moderate mental retardation?

A

IQ btw 30-50

2nd grade level functioning, require supervision & support

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3
Q

What is considered severe mental retardation?

A

IQ 20-40

little/no speech, limited self care

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4
Q

What is considered profound severe mental retardation?

A

IQ < 20

needs continuous care & supervision

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5
Q

What is treatment for mental retardation? (4)

A
  1. preventation: genetic counseling, prenatal care, safe environment
  2. treat underlying disorder (PKU, etc)
  3. special education to improve functioning
  4. behavioral therapy to reduce negative behaviors
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6
Q

What are the childhood developmental disorders that involve social, behavioral, and language problems that occurs before 3 years old? (4)

A
  1. Autism
  2. Rett disorder
  3. Childhood disintegrative disorder
  4. Asperger disorder
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7
Q

A boy who lacks peer relationships (w/ peers and parents), poor eye contact, lack social smile, absent/ bizarre speech, repetitive behaviors (spinning, banging head, stacking), easily agitated resulting in injury of self and others presenting before 3 years old most likely suffers from …

A

Autism Disorder

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8
Q

What is the treatment for the aggressive behavior of Autistic children?

A

Antipsychotic medications

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9
Q

A girl presents with microcephaly, hand wringing, loss of speech, ataxia, progressive loss of muscle function, progressive encephalopathy and psychomotor retardation most likely suffers from ….

A

Rett Syndrome

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10
Q

A boy presents with normal development for 2 years followed by marked functional regression (loss of language, motor function, bladder function) and repetitive/ stereotyped behavior most likely suffers from ….

A

Childhood disintegrative disorder

need to rule out infectious causes

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11
Q

A boy presents with social and behavioral problems (lack peer relationships, poor eye contact, repetitive behaviors) and preoccupied with rules without language or intellectual deficits most likely suffers from ….

A

Asperger Disorder

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12
Q

A child presents with history of interrupting others, fidgeting in chair, running/ climbing excessively, and unable to engage in leisure activities at home while at school, inattentive, make careless mistakes in work, doesnt follow thru with instructions, has difficulties organizing tasks and easily distracted; these symptoms have been present for at least 6 months with onset before 7 years old most likely suffers from …

A

ADHD (attention deficit hyperactivity disorder)

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13
Q

What is the best initial treatment for ADHD (attention deficit hyperactivity disorder)?

A

Methylphenidate or dextroamphetamine

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14
Q

What are common side effects associated with stimulant medication used for ADHD (methylphenidate, dextroamphetamine)?

A
  1. insomnia
  2. decreased appetite
  3. headache
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15
Q

what is second line treatment for ADHD (attention deficit hyperactivity disorder)?

A

atomoxetine (NE reuptake inhibitor)

usually chosen over stimulant medication b/c low side effect profile

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16
Q

A child presents around age 8 years old and argues often, loses temper easily, easily annoyed, blames others for their mistakes, have problems with authority figures (teachers, parents), justifies behavior as response to other’s actions that interrupts with functioning in school/ home/ work most likely suffers from …

A

Oppositional Defiant Disorder

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17
Q

What is treatment for oppositional defiant disorder?

A

teach parents appropriate child management skills

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18
Q

A boy presents with persistent behavior that breaks rules, aggressive to others, bullying, cruelty to animals, fighting, use weapons, vandalize and destroy property, set fires, steal items from others, and lie to obtain good from others, and get in trouble with law (truancy, running away, breaking curfew) most likely suffers from ….

A

Conduct disorder

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19
Q

What is the treatment for aggressive behavior of children with Conduct disorder?

A

antipsychotic medication

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20
Q

A pt presents with multiple tics that have lasted for longer than 1 year with onset before 18 y/o, tics can be motor (facial, neck muscle twitching like head shaking or blinking) or vocal (grunting, coughin, throat clearing) that is uncontrollable most likely suffers from …

A

Tourette Disorder

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21
Q

What is the treatment for Tourette Disorder?

A

Dopamine antagonist (risperidone)

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22
Q

A pt presents with at least 2 weeks of having at least 4 of the SMIGECAPS symptoms without a medical or neuological and causing impairment of functioning most likely suffers from …

A

Major depression

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23
Q

What are the SMIGECAPS symptoms associated with depression?

A
  1. sleep changes
  2. mood (depressed)
  3. interest loss (anhedonia)
  4. guilty
  5. energy loss (fatigue)
  6. concentration poor
  7. appetite changes
  8. psychomotor agitation/ depression
  9. suicidal ideation
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24
Q

What is the most common medical cause of depressed mood?

A

Hypothyroidism

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25
Q

What is the first line treatment for depression?

A

SSRIs (fluoxetine, paroxetine, sertraline, citalopram, escitalopram)

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26
Q

How long does it take for SSRIs to become effective?

A

4-6 weeks

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27
Q

What is the next best step in management if a pt with depression has some improvement but not a full response to an SSRI?

A
  1. increase dose of SSRI

2. add psychotherapy (cognitive therapy to identify negative thoughts and develop positive ways of thinking)

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28
Q

What disorder is associated with SSRIs being used with MAO inhibitors?

A

Serotonin syndrome

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29
Q

What is the best treatment for a pt with depression and neuropathic pain?

A

Desvenlafaxine

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30
Q

What is the best treatment for a pt with depression who is fearful of weight gain or sexual side effects?

A

Bupropion

used as adjunct treatment for SSRI induced sexual side effects

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31
Q

A pt presents with elevated mood along with at least 3 DIGFAST symptoms that last at least 1 week that causes significant distress in level of functioning and may have associated depression episodes most likely suffers from ….

A

Bipolar 1 Disorder

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32
Q

What are the DIGFAST symptoms associated with maniac disorder?

A 
D: distractibilty
I: insomnia (decreased need for sleep)
G: grandiosity
F: flight of ideas
A: activities (increased goal directed and pleasurable)
S: pressured speech
T: thoughtlessness
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33
Q

What is a common medical cause of manic episodes?

A

Cocaine/ amphetamine use

obtain urine drug screen

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34
Q

What is the difference between mania and hypomania?

A

mania: severe impairment of functioning, last 1 week
hypomania: mild impairment, lasts less than 1 week

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35
Q

A pt presenting with hypomania and major depression most likely suffers from …

A

Bipolar 2 disorder

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36
Q

What is the treatment for acute manic episode?

A
  1. lithium
  2. valproic acid
  3. atypical antipsychotics (olanzapine, especially if severe)
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37
Q

What is the treatment for bipolar depression?

A
  1. lithium

2. lamotrigine

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38
Q

What patients should not be given lithium for bipolar disorder? (2)

A
  1. kidney dysfunction

2. pregnant

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39
Q

A pt presents with depressed mood that lasts most of the day and is present almost continuously for at least 2 years with minimal impairment of functioning most likely suffers from….

A

Dysthymia

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40
Q

A pt presents with hypomanic episodes and mild depression for at least 2 years with minimal impairment of functioning most likely suffers from …

A

Cyclothymia

tx: lithium, valproic acid, carbamazepine, and psychotherapy

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41
Q

A pt presents with depressed mood, increased sleep, increased weight and increased appetite with mood worse in the evening and complain of extremities feeling heavy most likely suffers from …

A

Atypical depression

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42
Q

What is the treatment atypical depression?

A
  1. SSRIs

2. MAO inhibitors

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43
Q

A pt presents with depressed mood that usually occurs in fall and winter yearly with associated weight gain, increased sleep, and fatigue most likely suffers from …

A

Seasonal Affective Disorder

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44
Q

What is the treatment for seasonal affective disorder?

A
  1. phototherapy

2. bupropion

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45
Q

A post-partum women develops sadness, mood lability, tearfulness that starts immediately after birth lasting up to 2 weeks and lack negative feelings toward their baby most likely suffers from ….

A

Postpartum blues (“baby blues”)

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46
Q

What is the treatment for postpartum blues (baby blues)?

A

Supportive (usually self limited)

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47
Q

A post-partum women presents with depressed mood, weight changes, sleep disturbances and excessive anxiety that started withing 1-3 months after giving birth and may have negative feelings toward baby and feels guilty about the feelings most likely suffers from …

A

Post-partum depression

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48
Q

A post-partum women presents with depression, delusions, and thoughts of harming the baby that starts within 2-3 weeks after birth most likely suffers from …

A

Postpartum psychosis

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49
Q

What is the treatment for postpartum psychosis?

A
  1. antipsychotic medication
  2. lithium
    (with antidepressants)
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50
Q

What is the treatment for postpartum depression?

A

antidepressant medication

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51
Q

A pt presents with feelings of sadness, worrying, irritability, sleep difficulties, poor concentration and tearfulness after the death of a loved one that usually last less than 6 months most likely suffers from …

A

Bereavement (Grief)

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52
Q

What is the treatment for bereavement (grief)?

A

supportive therapy

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53
Q

What are red flags that a pt has depression instead of bereavement? (6)

A
  1. weight loss
  2. feeling of worthlessness
  3. symptoms last longer than 2 months
  4. prolonged functional impairment
  5. suicidal ideation
  6. psychosis
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54
Q

What are the side effects of TCAs (amitriptyline, notriptyline, imipramine)? (9)

A
  1. hypotension
  2. dry mouth
  3. constipation
  4. confusion
  5. arrhythmias
  6. sexual side effects
  7. weight gain
  8. GI distress
  9. toxic
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55
Q

What are the major side effects of MAO inhibitors (phenelzine, isocarboxazid, tranylcypromine)?

A 
Hypertensive crisis (w/ aged cheese, red wine, chocolate)
2. Serotonin syndrome (if given with SSRIs)
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56
Q

What are the side effects of SSRIs (fluoxetine, paroxetine, sertraline, citalopram, escitalopram, fluoxamine)? (5)

A
  1. headaches
  2. weight changes
  3. sexual side effects
  4. GI distress
  5. Serotonin syndrome (if given w/ MAO inhibitor)
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57
Q

What are the side effects of SNRIs (venlafaxine, duloxetine, desvenlafaxine)?

A
  1. hypertension
  2. blurry vision
  3. weight changes
  4. sexual side effects
  5. GI distress
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58
Q

What are the side effects of buproprion?

A

increased risk of seizures (lowers threshold for seizures)

avoid in anorexic

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59
Q

What is the side effect of trazadone?

A

Priapism

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60
Q

What are the side effects of mirtazapine? (2)

A
  1. weight gain

2. sedation

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61
Q

What antidepressant medication can be helpful in smoking cesstion?

A

Bupropion

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62
Q

What are the side effects associated with lithium? (7)

A
  1. tremors
  2. weight gain
  3. GI distress
  4. nephrotoxic (diabetes insipidus)
  5. teratogenic (Ebstein’s anomaly)
  6. leukocytosis
  7. toxicity (confusions, ataxia, lethargy, abnormal reflexes)
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63
Q

What are the side effects associated with valproic acid? (7)

A
  1. tremors
  2. weight gain
  3. Gi distress
  4. alopecia
  5. teratogenis
  6. hepatotoxic
  7. toxicity (coma, hyponatremia, death)
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64
Q

What is the side effect associated with lamotrigine?

A

Stevens- Johnson syndrome

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65
Q

What are the side effects associated with ECT (electroconvulsive therapy)?

A
  1. headache

2. transient memory loss

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66
Q

What is the most effective treatment for depression?

A

ECT (electroconvulsive therapy)

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67
Q

When should ECT be used for depression?

A
  1. no response to medical treatment

2. suicidal patient

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68
Q

A pt presents with agitation, confusion, hallucinations, hypomania, sweating, fever, tachycardia, tremors and myoclonus while on antidepressant medication most likely suffers from …

A

Serotonin Syndrome

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69
Q

What is treatment for Serotonin syndrome?

A
  1. stop SSRI (offending medication)
  2. symptomatic treatment of fever, diarrhea, HTN
  3. cyproheptadine (serotonin antagonist)
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70
Q

A pt presents with with delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior that has been going on for more than 1 day but less than 1 month most likely suffers from…

A

Brief Psychotic Disorder

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71
Q

A pt presents with with delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior and negative symptoms (flat affect, poor grooming, social withdrawal) that has been going for at least 1 month but less than 6 months most likely suffers from …

A

Schizophreniform

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72
Q

A pt presents with with delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior and negative symptoms (flat affect, poor grooming, social withdrawal) that severely affects level of functioning that has been going for longer than 6 months most likely suffers from …

A

Schizophrenia

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73
Q

A pt presenting with signs and symptoms of schizophrenia, what test should be performed to rule out other causes of similar symptoms?

A

Urine drug screen (rule out LSD, mushrooms, cocaine, amphetamine, etc)

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74
Q

What type of schizophrenia is characterized by delusions or hallucinations mostly of persecutory or grandiose type?

A

Paranoid Schizophrenia

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75
Q

What type of schizophrenia is characterized by psychomotor disturbances (retardation or excitation) that include stupor, rigidity, posturing and mutism?

A

Catatonic Schizophrenia

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76
Q

What type of schizophrenia is characterized by marked regression to disinhibited behavior with little contact with reality, appear disheveled and have bizarre emotional responses, and wearing something weird on head?

A

Disorganized Schizophrenia

worse prognosis and earliest onset

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77
Q

What type of Schizophrenia is characterized by lack of positive symptoms (hallucinations, delusions) but the presence of negative symptoms (flat affect, poor grooming, social withdrawal)?

A

Residual Schizophrenia

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78
Q

What is the treatment for brief psychotic disorder, schizophreniform, and schizophrenia?

A
  1. hospitalize if acutely psychotic

2. atypical antipsychotic (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, paliperidone)

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79
Q

What is the treatment for a psychotic patient in the emergency situation where intramuscular medication is needed?

A
  1. Olanzapine
  2. Ziprasidone

(haloperidol has more side effects)

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80
Q

When treating a psychotic pt who is noncompliant, what medication is used?

A

Risperidone (long acting)

haloperidol has more side effects

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81
Q

What is the last line anti-psychotic medication for a pt who does not respond to an adequate trial of typical and atypical antipsychotics?

A

Clozapine

side effect of agranulocytosis

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82
Q

What is the most common side effects for olanzipine?

A
  1. diabetes
  2. weight gain

(avoid in diabetics and obese)

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83
Q

What is the most common side effects for risperidone?

A
  1. movement disorders

2. gynecomastia

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84
Q

What is the most common side effects for quetiapine?

A

Less incidence of movement disorders

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85
Q

What is the msot common side effect for ziprasidone?

A 
QT prolongation
(avoid in pts with conduction defects)
86
Q

What is the most common side effect for clozapine?

A

agranulocytosis

monitor CBC

87
Q

What are the two atypical antipsychotics that are less likely to cause weight gain, diabetes and metabolic syndrome?

A
  1. aripiprazole

2. ziprasidone

88
Q

….is muscle spasms such as torticollis, laryngeal spasms and occulogyric crisis that occurs hours to days after initiating an antipsychotic medication

A

Acute dystonia

89
Q

What is the treatment for acute dystonia?

A
  1. benzotropine
  2. trihexyphenidyl
  3. diphenhydramine
    (stop offending medication)
90
Q

…. is generalized restlessness, pacing, rocking, and inability to relax that occurs weeks after initiating an antipsychotic medication

A

Akathisia

91
Q

What is the treatment for Akathisia?

A
  1. reduce dose of antipsychotic
  2. beta blockers
  3. switch to atypical antipsychotic
92
Q

….is characterized by abnormal involuntary movements of head, limb and trunk with perioral movements being common, occurs after 6 months of use of antipsychotic medication

A

Tardive dyskinesia

93
Q

What is the treatment for tardive dyskinesia?

A
  1. switch to atypical

once occurs, it is irreversible

94
Q

What antipsychotic medication has the least likelihood of tardive dyskinesia developing?

A

Clozapine

95
Q

A pt presents with muscular rigidity, fever, autonomic changes, agitation and altered mental status while being treated with anantipsychotic most likely suffers from …

A

Neuroleptic Malignant Syndrome

96
Q

What is the treatment for Neuroleptic Malignant Syndrome?

A
  1. dantrolene

2. bromocriptine

97
Q

A pt presents with prominent non-bizarre delusions (neighbor stealing from them, etc) for greater than 1 month and without impairment in functioning most likely suffers from ….

A

Delusional Disorder

tx: atypical antipsychotic and psychotherapy

98
Q

A pt presents with sudden episodes of feeling intense anxiety and feelings of dread and doom with at least 4 associated symptoms (diaphoresis, trembling, chest pain, fear of dying, chills, palpitations, SOB, nausea, dizziness, paresthesias, dissociative symptoms) that last less 30 minutes most likely suffers from ….

A

Panic Disorders

rule out thryoid, hypoglycemia and cardiac

99
Q

What is agoraphobia?

A

fear of places that escape is felt to be difficult

100
Q

What is the treatment for panic disorder?

A

SSRIs (fluoxetine, paroxetine, sertraline)

can start with benzo that is tapered down once SSRI is therapeutic

101
Q

What is the treatment for a single panic attack?

A

Benzo

102
Q

…. is the fear of an object or situation and the need to avoid it

A

Phobias

103
Q

What type of phobia is characterized by fear of an object such as animals, heights or cars?

A

Specific Phobia

104
Q

What type of phobia is fear of a situation where something potentially embarassing may happen such as public restrooms, eating in public, or public speaking?

A

Social Phobia

105
Q

What is the treatment for specific phobia?

A
  1. behavioral modification (systematic desesitization)

2. relaxation techniques (breathing, guided imagery)

106
Q

What is systematic desensitization?

A

expose individuals to their feared objects, moving from the least anxiety provoking to the most anxiety-provoking

107
Q

What is the treatment for performance anxiety?

A

beta blockers

108
Q

A pt presents with thoughts that are intrusive, senseless, and distressing to the pt that increases anxiety (ie fear of contamination) and rituals that are done to neutralize thoughts (ie counting, checking) that consume time and lower anxiety, these thoughts and rituals affect the pt’s level of functioning most likely suffers from …

A

Obsessive Compulsive Disorder

109
Q

What is the treatment for obsessive compulsive disorder? (20

A
  1. SSRI (fluoxetine, paroxetine, sertraline, citalopram, fluvoxamine)
  2. exposure and response prevention
110
Q

What disease can co-exist with compulsive disorder?

A

Tourette’s syndrome

111
Q

A pt who has been exposed to a stressor that was a near death experience that continually relive the event, avoid anything that reminds them of the event and these symptoms (increased startle response, hypervigilance, sleep disturbances, anger outbursts, poor concentration) affect their functioning and have been going on for at least 1 month most likely suffers from …

A

Post Traumatic Stress Disorder

112
Q

A pt who has been exposed to a stressor that was a near death experience that occurred that continually relive the event, avoid anything that reminds them of the event and these symptoms (increased startle response, hypervigilance, sleep disturbances, anger outbursts, poor concentration) affect their functioning and started within 1 month of event and have been going on for less than 1 month most likely suffers from …

A

Acute Stress Disorder

113
Q

What is the treatment for PTSD and acute stress disorder?

A
  1. SSRIs (paroxetine, sertraline)
  2. relaxation techniques
  3. Psychotherapy
114
Q

A pt presenting with excessive anxiety and worries about most things for at least 6 months, the anxiety is out of proportion of the event, and has associated symptoms (fatigue, poor concentration, sleep problems, muscle tension, restlessness) most likely suffers from …

A

Generalized Anxiety Disorder

115
Q

What is the treatment for Generalized Anxiety Disorder?

A
  1. SSRIs (fluoxetine, paroxetine,sertraline, citalopram)
  2. Venlafaxine and buspirone
  3. psychotherapy and behavioral therapy
116
Q

What are the side effects associated with benzos (diazepam, lorazepam, clonazepam, alprazolam, oxazepam, chlordiazepoxide, temazepam, flurazepam)?

A
  1. sedation
  2. confusion
  3. memory deficits
  4. respiratory depression
  5. addiction
117
Q

What are the side effects associated with buspirone?

A
  1. headache
  2. nausea
  3. dizziness
118
Q

When is lorazepam used?

A

emergency situations (b/c can be given IM)

119
Q

When is clonazepam used?

A

if addiction is concerned (has longer half-life)

120
Q

What benzo’s are used for alcohol withdrawal?

A
  1. chlordiazepoxide
  2. oxazepam
  3. lorazepam
121
Q

When is alprazolam used?

A

panic disorder

122
Q

When is flumazenil (benzo antagonist) used?

A

acute benzo overdose in which pt is not chronically dependent

123
Q

What are side effects associated with flumazenil use?

A
  1. seizures (in benzo dependent pt)

2. withdrawal (tremor, seizures)

124
Q

… is maladaptive pattern of use of a substance that leads to engaging in hazardous situations, legal problems, inability to fulfill obligations and continued use despite adverse consequences

A

Substance Abuse

125
Q

… is maladaptive pattern of use of substances that leads to tolerance, withdrawal when trying to cut down, great deal of time engaging in drug use, continued use despite adverse consequence

A

Substance Dependence

126
Q

A pt presenting with talkativeness, sullen/ remorseful, sociable, moody and disinhibited most likely suffers from …

A

Alcohol intoxication

127
Q

A pt presenting with tremors, hallucinations (tactile), seizures, and delirium tremens most likely suffers from ..

A

Alcohol withdrawal

128
Q

What is the treatment for alcohol withdrawal?

A
  1. benzos

2. thiamine, multivitamins, folic acid

129
Q

A pt presenting with euphoria, hypervigilence, autonomic hyperactivity, weight loss, pupillary dilation and perceptual disturbances most likely suffers from …

A

Amphetamine/ Cocaine intoxication

130
Q

A pt presents with anxiety, tremulousness, headache, increased appetite, depression, and suicidal risk most likely suffers from …

A

Amphetamine/ Cocaine Withdrawal

131
Q

What is the treatment for amphetamine/ cocaine withdrawal?

A
  1. bupropion

2. bromocriptine

132
Q

A pt presents with impaired motor coordination, slowed sense of time, social withdrawal, increases appetite, and conjunctival injection most likely suffers from …

A

Cannabis/ Marijuana intoxication

133
Q

A pt presents with ideas of reference, perceptual disturbances, impaired judgment, tremors, incoordination, and dissociative symptoms most likely suffers from …

A

Hallucinogen Intoxication

134
Q

What is the treatment for hallucinogen intoxication?

A
  1. antipsychotics
  2. benzos
  3. talk down
135
Q

A pt presents with belligerence, apathy, aggression, impaired judgement, stupor, or coma most likely suffers from …

A

Inhalants Intoxication

136
Q

What is the treatment for inhalant intoxication?

A

Antipsychotics

137
Q

A pt presents with apathy, dysphora, pupillary constriction, drowsiness, slurred speech, respiratory depression and coma/death most likely suffers from ..

A

Opioid Intoxication

138
Q

What is the treatment for opioid intoxication?

A

Naloxone

139
Q

A pt presents with fever, chills, lacrimation, abdominal cramps, muscle spasms, and diarrhea most likely suffers from …

A

Opiate Withdrawal

140
Q

What is treatment for opiate withdrawal?

A
  1. clonidine

2. metadone or burprenorphine

141
Q

A pt presents with belligerence, psychomotor agitation, violence, nystagmus, hypertension and seizures most likely suffers from …

A 
PCP intoxication
(phencyclidine)
142
Q

What is the treatment for PCP (phencyclidine) intoxication?

A
  1. antipsychotics
  2. benzo
  3. talking down
143
Q

An athlete who is large for his age who presents with irritability, aggression, mania and psychosis most likely suffers from …

A

Anabolic Steroid Intoxication

144
Q

What is the treatment for anabolic steroid intoxication?

A

Antipsychotics

145
Q

An athlete who presents with depression, headaches, anxiety, and increased concern over their body’s physical state most likely suffers from …

A

Anabolic steroid withdrawal

146
Q

What is the treatment for anabolic steroid withdrawal?

A

SSRIs

147
Q

What are the CAGE questions used to assess for alcohol abuse/ dependence?

A

C: cut down
A: annoyed by criticism
G: guilty about drinking
E: eye opener (need drink first thing in morning)

(2 or more is positive test)

148
Q

What are pharmacologic agents used for substance dependence treatment?

A
  1. disulfram (aversion therapy for alcohol)
  2. naltrexone (opioid antagonist)
  3. acamprosate
149
Q

A pt presents with 4 pain symptoms, 2 GI symptoms, 1 sexual symptom and 1 pseudoneurological symptoms that has no medical explanation most likely suffers from…

A

Somatization disorder

150
Q

A pt presents with belief that they have some specific disease despite constant reassurance with no medical explanation most likely suffers from …

A

Hypochondriasis

151
Q

A pt presents with a voluntary motor or sensory functions that are indicative of a medical condition but are not concerned about his/her impairment (la belle indifference) most likely suffers from …

A

Conversion Disorder

152
Q

A pt presents with belief that some part of the body is abnormal, misshapen and defective, usually wants cosmetic surgery constantly most likely suffers from …

A

Body Dysmorphic Disorder

153
Q

A pt presents with the presence of pain as the main complaint and have psychological factors associated with pain most likely suffers from …

A

Pain disorder

154
Q

What is the treatment for somatoform disorders (somatization, hypochondriasis, conversion, body dysmorphic, pain disorders)?

A

Psychotherapy

155
Q

… is characterized by a pt (usually women in healthcare profession) faking a illness (hallucinations, delusions, depression, abdominal pain, etc) in order to get attention and emotional support by assuming the pt role

A

Factitious Disorder

156
Q

…. is characterized by a caretaker faking signs and symptoms in another person (usually kid) in order to have kid admitted so parent can be in hospital.

A

Munchausen by proxy

157
Q

What is the next best step in management for Munchausen by proxy?

A

child protection services

158
Q

…. is characterized by conscious production of signs and symptoms for an obvious gain, such as avoiding work/ evading criminal prosecution/ achieve financial gain; best diagnosed when there is discrepancy between the pt’s complaints and the actual physcial or lab findings and pt will usually not cooperate

A

Malingering

common in prisoners and military

159
Q

What is the next best step in management if patient is found to be malingering?

A

confront patient with outcome

160
Q

A pt presents with maladaptive reaction (anxiety, depression, conduct disturbances) to a non-life threatening stressor (loss of job, divorce, failed school) within 3 months of stressor and remits within 6 months of removing stressor, and symptoms cause functional impairment most likely suffers from …

A

Adjustment Disorder

161
Q

What is the treatment for Adjustment Disorder?

A

Psychotherapy

162
Q

A pt is constantly suspicious, mistrustful, secretive, isolated, and questioning the loyalty of family and friends most likely suffers from…

A

Paranoid personality disorder

cluster A

163
Q

A pt constantly chooses solitary activities, lack close friends, emotional cold and has no desire for close relationship most likely suffers from …

A

Schizoid personality disorder

cluster A

164
Q

A pt that constantly have ideas of reference, magical thinking, odd thinking, eccentric behavior, increased social anxiety and brief psychotic episodes most likely suffers from …

A

Schizotypal personality disorder

cluster A

165
Q

A pt who constantly must be center of attention, have inappropriate sexual behavior, self dramatization, and use physical appearance to draw attention to themself most likely suffers from …

A

Histrionic personality disorder

cluster B

166
Q

A pt (older than 18 y/o) who constantly fails to conform to social rules, deceitful, lack remorse, impulsive, aggressive towards others, irresponsible and usually have history of conduct disorder most likely suffers from …

A

Antisocial Personality Disorder

cluster B

167
Q

A pt who is constantly in unstable relationships, impulsive, has recurrent suicidal behaviors (cutting, etc), have chronic feelings of emptiness, inappropriate anger, and can occasionally have dissociative symptoms and brief psychotic episodes when severely stressed most likely suffers from …

A

Borderline Personality Disorder

cluster B

168
Q

What is the most common defense mechanism used by pts with borderline personality disorder?

A

Splitting

169
Q

A pt who constantly has grandiose sense of self, belief that they are special, lack empathy, have sense of entitlement, and require excessive admiration most likely suffers from …

A

Narcissistic Personality Disorder

cluster B

170
Q

A pt that is constantly unwilling to get involved with people, views self as socially inept, reluctant to take risks, have feeling of inadequacy, and dont have friends but want friends most likely suffers from …

A

Avoidant Personality Disorder

Cluster C

171
Q

A pt who is constantly has difficulty making day-to day decisions, unable to assume responsibility, unable to express disagreement, fear of being alone, and seeks relationship as a source of care most likely suffers from …

A

Dependent Personality Disorder

Cluster C

172
Q

A pt who is constantly preoccupied with details, rigid, orderly, perfectionistic, excessively devoted to work and inflexible most likely suffers from …

A

Obsessive compulsive personality disorder

Cluster C

173
Q

What is treatment for personality disorders?

A

Individual Psychotherapy

174
Q

A pt who fails to maintain normal body weight (BMI

A

Anorexia Nervosa

175
Q

What are associated signs and symptoms associated with anorexia nervosa?

A
  1. calluses on hand
  2. cavities
  3. arrhythmias
  4. lanugo hair
  5. amenorrhea
  6. electrolyte disturbances
176
Q

What is the treatment for anorexia nervosa?

A
  1. hospitalization (tx dehydration, starvation, electrolyte imbalance)
  2. psychotherapy and behavioral therapy
  3. SSRIs (to promote weight gain)
177
Q

A pt presents with frequenct binge eating (large amounts of food in discrete time) and lack of control overeating episodes with associated compensatory behavior (purging, miuse of laxatives/ diuretics, fasting, excessive exercise) to prevent weight gain, have poor body image but have normal BMI/ weight most likely suffers from …

A

Bulimia Nervosa

178
Q

What is treatment for bulimia nervosa?

A
  1. Psychotherapy

2. SSRIs

179
Q

A pt presents with excessive daytime sleepiness, abnormal REM sleep, have sleep attacks (episodes of irresistible sleepiness and feel refreshed upon awakening), cataplexy, hypnogogic/ hypnopompic hallucinations, and sleep paralysis most likely suffers from …

A

Narcolepsy

180
Q

What is cataplexy?

A

sudden loss of muscle tone usually precipitated by loud noise or emotions
(pathognomonic for narcolepsy)

181
Q

What is hypnogogic hallucinations and what disorder is it associated with?

A

hallucinations as the pt is going to sleep; Narcolepsy

182
Q

What is hypnopompic hallucinations and what disorder is it associated with?

A

hallucinations as the pt awakens from sleep; Narcolepsy

183
Q

What is sleep paralysis and what disorder is it associated with?

A

patient awakens but is unable to move; Narcolepsy

184
Q

What is the treatment for Narcolepsy?

A
  1. forced naps during fay
  2. Modafinil (maintain alertness)
  3. methylphenidate, dextroamphetamine GHB
185
Q

What is the diagnostic test of choice for narcolepsy?

A

Sleep study

186
Q

A pt presents with inability to initiate or maintain sleep and it adversely affects level functioning, may have associated fatigue, increased yawning and increased appetite most likely suffers from ..

A

Insomnia

187
Q

What is the treatment for insomnia?

A
  1. sleep hygiene (go to bed and wake up at same time each day, avoid caffeine, avoid daytime naps)
  2. behavioral modification (only use bed for sleep)
  3. Zolpidem, eszopiclone, zaleplon
188
Q

…. is a person’s secondary sexual characteristics

A

Sexual identity

189
Q

… is one’s sense of maleness or femaleness that is established by 3 years old

A

Gender Identity

190
Q

…. is external patterns of behavior that reflect inner sense of gender identity

A

Gender Role

191
Q

… is person’s choice of love object; may be heterosexual, homosexual, bisexual, asexual

A

Sexual orientation

192
Q

…. is the persistent or recurrent inability to attain/ maintain an erection until completion of the sexual act

A

Impotence

193
Q

… is ejaculation before penetration or just after penetration usually due to anxiety

A

Premature Ejaculation

194
Q

What is treatment for premature ejaculation?

A
  1. psychotherapy
  2. behaviroal modification (stop, go, squeeze)
  3. SSRI
195
Q

… is pain associated with sexual intercourse

A

Dyspareunia

196
Q

what is treatment of dyspareunia not due to medical condition?

A

Psychotherapy

197
Q

… is involuntary constriction of the outer third of the vagina preventing penile insertion

A

Vaginismus

198
Q

What is the treatment for vaginismus?

A
  1. psychotherapy

2. dilator therapy

199
Q

A pt who has recurrent urge to expose oneself to strangers for more than 6 months and causes significant distress and impairment of functioning most likely suffers from ..

A

Exhibitionism

200
Q

A pt who suffers from recurrent use of nonliving objects to achieve sexual pleasure for more than 6 months and causes significant distress and impairment of functioning most likely suffers from …

A

Fetishism

201
Q

A pt who suffers from recurrent urges or arousal toward prepubescent children for more than 6 months and causes significant distress and impairment of functioning most likely suffers from …

A

Pedophila

202
Q

A pt who suffers from recurrent urges or behavior involving the act of humiliation for more than 6 months and causes significant distress and impairment of functioning most likely suffers from …

A

Masochism

203
Q

A pt who suffers from recurrent urges or behaviors involving acts in which physical or psychological suffering of a victim is exciting for more than 6 months and causes significant distress and impairment of functioning most likely suffers from …

A

Sadism

want to be the dominator with clamps, whips, etc

204
Q

A pt who suffers from recurrent urge or behavior involving cross dressing for sexual gratification (usually found in heterosexual men) for more than 6 months and causes significant distress and impairment of functioning most likely suffers from …

A

Transvestic fetishism

205
Q

A pt who suffers from rubbing their pelvis or erect penis against a nonconsenting person for sexual gratification for more than 6 months and causes significant distress and impairment of functioning most likely suffers from …

A

Frotteurism

206
Q

What is the treatment for paraphilias (exhibitionism, fetishism, pedophilia, masochism, sadism, transvestic fetishism, frotteurism)?

A
  1. individual psychotherapy
  2. behavioral modification (aversive conditioning)
  3. antiandrogens or SSRIs (to control sexual drive)
207
Q

… is characterized by the persistent discomfort and sense of inappropriateness regarding their assigned sex, usually associated with wearing opposite gender’s clothes, use toys of opposite sex, play with opposite sex kids, taking hormones to deepen/ soften voice, breast binding, or hiding of penis/ testicles

A

Gender Identity Disorder

208
Q

What is the treament for Gender Identity Disorder?

A
  1. sexaul reassignment surgery (need approval)

2. individual psychotherapy

209
Q

What are the risk factors for suicide in a pt with suicidal ideation? (7)

A
  1. men
  2. elderly
  3. social isolation
  4. presence of psychiatric illness/ drug abuse
  5. perceived hopelessness
  6. previous attempts
  7. suicidal behaviros (buying weapons, giving away possessions, writing wills)
210
Q

What is the treatment for suspected suicide?

A

admit (to psychiatric unit)

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