Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Step 2 > Psychiatry 3 > Flashcards

Psychiatry 3 Flashcards

1
Q

Presentation of Parkinson disease dementia?

A

Executive and visuospatial dysfunction (eg, impaired attention and planning, inability to recognize grandchildren, getting lost in familiar locations) with only mild memory impairment early on; visual hallucinations, delusions, sleep disorders (occur at higher rates in PDD, though may occur in Parkinson disease without dementia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Rx Parkinson Disease Dementia?

A

Cholinesterase inhibitors (eg, donepezil)

Psychotic symptoms - dose reduction of antiparkinsonian agents and/or low-potency antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

About ___ of patients with Parkinson disease have evidence of PDD.

A

1/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Clinical features of Alzheimer disease?

A

Early, prominent memory impairment accompanied by executive and visuospatial dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Differentiate between Dementia with Lewy Bodies and PDD?

A

PDD is diagnosed when parkinsonism predates cognitive impairment by >1 year

In DLB, cognitive impairment would develop before or at the same time as parkinsonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Progressive supranuclear palsy is a rare syndrome that presents with what symptoms?

A

Falls, impaired vertical gaze, parkinsonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Presentation of vascular dementia?

A

Mild memory impairments, prominent executive dysfunction, and focal neurologic deficits corresponding to cerebrovascular pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Seizures are a potential dose-dependent side effect of dopamine/norepinephrine reuptake inhibitor ___ and ___. They are more likely to be seen in patients susceptible to seizures.

A

Bupropion; TCAs (such as clomipramine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MOA of mirtazapine?

A

Alpha-2 receptor antagonist (antidepressant)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Abrupt discontinuation of what 2 medications has been associated with antidepressant discontinuation syndrome (acute of dysphoria, fatigue, dizziness, GI distress, flu-like symptoms)?

A

Paroxetine and venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Patients with depression or underlying psychiatric issues frequently come to their primary care physician with ___ symptoms.

A

Physical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Characteristics of delirium?

A

Fluctuating disturbance in attention and arousal that can develop acutely in the context of an underlying medical illness

May be associated with psychotic symptoms, particularly visual hallucinations, in addition to sleep and behavioral changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Common causes of delirium?

A

Postoperatively
New or worsening infections
New medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

To diagnose psychotic disorder due to a medical condition, ___ must be absent. In addition, there must be a ___ link between psychotic symptoms and a medical condition, and the psychosis cannot be better explained by another condition.

A

Delirium; causal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Presentation of OSA with depressive symptoms?

A

Fatigue, sleep disturbance with multiple awakenings, impaired concentration, irritability, and low mood

Excessive daytime sleepiness, snoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Risk factors for OSA?

A

Male gender, obesity, HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Following abrupt discontinuation of benzos, early rebound effects of ___ and increased ___ are common.

A

Insomnia; anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Characteristics of malingering?

A

Feigned or grossly exaggerated physical or psychological symptoms with the intention of obtaining secondary gain (financial compensation, leave from work, narcotics, etc.)

Usually a marked disparity between the patient’s disability and the objective findings

Should be suspected when the patient is reluctant to be examined or treated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Characteristics of conversion disorder?

A

Typically preceded by an emotional trigger

Unexplained neurological symptoms that are incompatible with recognized neurological conditions

No external incentive

Symptoms not intentionally produced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Characteristics of factitious disorder?

A

Intentional production of false physical or physiological signs or symptoms to assume the sick role

No secondary gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

3 causes of lithium toxicity?

A
  1. OD
  2. Volume depletion (decreased GFR)
  3. Drug interactions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

4 drugs that can cause lithium toxicity?

A
  1. Thiazide diuretics (decreased renal clearance)
  2. NSAIDs (not aspirin)
  3. ACEIs
  4. Tetracyclines, metronidazole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Features of acute lithium toxicity?

A

GI - NV/, diarrhea

Late neurologic sequelae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Features of chronic lithium toxicity?

A

Confusion, agitation, ataxia, tremors/fasciculations, seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Management of lithium toxicity?

A

Hemodialysis for severe cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Major AE of lamotrigine?

A

SJS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Major AEs of valproic acid?

A

GI symptoms, hepatitis, pancreatitis, hepatic encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Clinical features of anorexia nervosa?

A
  1. Significantly low weight
  2. Intense fear of weight gain
  3. Distorted views of body weight/shape
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Subtypes of anorexia nervosa?

A
  1. Binge/purge

2. Restricting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Clinical features of bulimia nervosa?

A
  1. Recurrent episodes of binge eating
  2. Compensatory behavior (vomiting, exercise, fasting, misuse of laxatives, enemas, diuretics, diet pills) to prevent weight gain
  3. Excessive worry about body shape and weight
  4. Maintains normal body weight

Binges and inappropriate compensatory behaviors must occur at least once a week for 3 months for the diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Clinical features of binge eating disorder?

A
  1. Recurrent binge eating with lack of control

2. No compensatory bheaviors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

True or false - self-induced vomiting is necessary for the diagnosis of bulimia nervosa.

A

False

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Signs of bulimia?

A
  1. Hypotension
  2. Tachycardia
  3. Dry skin
  4. Menstrual irregularities

If vomiting regularly: electrolyte abnormalities (hypokalemia, hypochloremia, metabolic alkalosis), erosion of dental enamel, parotid hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Treatment of bulimia?

A

Nutritional rehabilitation
CBT
Pharamcotherapy with fluoxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the key distinction between anorexia and bulimia nervosa?

A

Patients with bulimia nervosa have normal to increased weight; those with anorexia nervosa have significantly low body weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Clinical features of avoidant/restrictive food intake disorder?

A

Typically begins in infancy or early childhood

Characterized by food avoidance due to a dislike of the sensory components of certain foods or the experience of eating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Clinical features of BDD?

A

Intense preoccupation with a perceived defect in physical appearance

Patient does not meet the criteria for an eating disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Characteristics of OCPD?

A

Pervasive pattern of preoccupation with orderliness, perfectionism, and control present in a variety of contexts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Clinical features of autism spectrum disorder?

A
  1. Deficits in social communication and interactions with onset in early development (sharing of emotions or interests, non-verbal communication, developing and understanding relationships)
  2. Restricted, repetitive patterns of behavior (repetitive movements or speech, insistence on sameness/routines, intense fixated interests, adverse responses to sensory input)
  3. May occur with or without language and intellectual impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Assessment and management of autism spectrum disorder?

A
  1. Early diagnosis and intervention
  2. Comprehensive, multimodal treatment (speech, behavioral therapy, educational services)
  3. Adjunctive pharmacotherapy for psychiatric comorbidities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

True or false - ADHD frequently persists into adulthood.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Most effective treatment for adult ADHD? Contraindication?

A

Stimulants (amphetamines, methylphenidate); patients with a history of SUD due to potential for misuse or addiction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the treatment of choice among nonstimulant options for adult ADHD?

A

Atomoxetine (norepinephrine reuptake inhibitor)

Other options - bupropion, TCAs

44
Q

Nonstimulant treatment options for children and adolescents with ADHD?

A

Alpha-2 adrenergic agonists (clonidine, guanfacine)

45
Q

Rx opioid withdrawal?

A

Supportive care and medications (alpha-2 adrenergic agonists, methadone, or buprenoprine)

46
Q

What are the 3 mature defense mechanisms?

A

Altruism, Sublimation, Suppression

47
Q

Defense mechanism - expressing unacceptable feelings through actions

A

Acting out

48
Q

Defense mechanism - behaving as if an aspect of reality does not exist

A

Denial

49
Q

Defense mechanism - putting unwanted feelings aside to cope with reality

A

Suppression

50
Q

Defense mechanism - sublimation

A

Channeling impulses into socially acceptable behaviors

51
Q

Defense mechanism - transferring feeling to less threatening object/person

A

Displacement

52
Q

Defense mechanism - experiencing a person/situation as either all positive or all negative

A

Splitting

53
Q

Defense mechanism - focusing on non-emotional aspects to avoid distressing feelings

A

Intellectualization

54
Q

Defense mechanism - reverting to earlier developmental stage

A

Regression

55
Q

Defense mechanism - avoiding conflict by expressing hostility covertly

A

Passive aggression

56
Q

Defense mechanism - transforming unacceptable feelings/impulses/desires into their extreme opposite

A

Reaction formation

57
Q

Defense mechanism - attributing one’s own feelings to others

A

Projection

58
Q

Defense mechanism - justifying behavior to avoid difficult truths

A

Rationalization

59
Q

___ are normal features of human behavior that enable individuals to navigate social relationships in a way that preserves self-esteem, limits anxiety, and creates a feeling of control. They can be pathological if they become ___ or interfere with ___.

A

Defense mechanisms; fixed; self-development

60
Q

Defense mechanism - managing unpleasant emotions through service to others, which provides gratification

A

Altriusm

61
Q

Patients with panic attacks frequency develop agoraphobia - clinical features?

A

Anxiety and avoidance of 2+ situations in which it may be difficult to escape or get help in the event of a panic attack

62
Q

Rx - agoraphobia?

A

CBT

63
Q

What is a shared psychotic disorder (aka folie a deux)?

A

Rare manifestation of delusional disorder in which the same delusion is present in individuals who share a close relationship; usually the dominant individual becomes delusional and transfers the delusion onto the second, more submissive person, who may or may not meet full criteria for delusional disorder

64
Q

What is the first step in addressing shared psychotic disorder?

A

Separate the pair to disrupt the mutually reinforcing nature of the shared delusion and to enable a more careful assessment of each individual’s pathology; the dominant individual typically requires psychiatry treatment, whereas the more submissive individual less frequently requires formal treatment

65
Q

Which SGA is most likely to cause EPS?

A

Risperidone

66
Q

Mechanism of benztropine?

A

Anticholinergic

67
Q

Mechanism of amantadine?

A

Dopaminergic, weak NMDA antagonist

68
Q

When dopamine is blocked in the ___ pathway, the production of prolactin increases, which can result in ___, ___, and ___.

A

Tuberoinfundibular; galactorrhea; menstrual irregularities; infertility

69
Q

Which two SGAs are least likely to cause hyperprolactinemia?

A

Aripiprazole (partial D2R agonist) and quetiapine (low-potency D2R antagonist)

70
Q

AE of carbamazepine?

A

Aplastic anemia

SIADH

71
Q

How can concurrent use of NSAIDs cause lithium toxicity?

A

Decreased renal clearance of lithium

72
Q

DDx - dementia subtypes (6)?

A
  1. Alzheimer disease
  2. Vascular dementia
  3. Frontotemporal dementia
  4. Dementia with Lewy bodies
  5. Normal pressure hydrocephalus
  6. Prion disease
73
Q

DDx features of Alzheimer disease?

A

Early, insidious short-term memory loss
Language deficits and spatial disorientation
Later personality changes

74
Q

DDx features of vascular dementia?

A

Stepwise decline
Mild memory impairments
Early, prominent executive dysfunction
Focal neurologic deficits corresponding to cerebrovascular pathology
Cerebral infarction and/or deep white matter changes on neuroimaging

75
Q

DDx features of frontotemporal dementia?

A

Early personality changes
Memory impairment is generally mild in early FTD
Apathy, disinhibition, compulsive behavior, hyperorality, lack of insight, executive dysfunction
Frontotemporal atrophy on neuroimaging

76
Q

DDx features of dementia with Lewy bodies?

A

Visual hallucinations
Spontaneous parkinsonism
Fluctuating cognition
REM sleep behavior disorder

77
Q

DDx features of normal pressure hydrocephalus?

A

Ataxia early in disease
Urinary incontinence
Dilated ventricles on neuroimaging

78
Q

DDx features of prion disease?

A 
Behavioral changes
Rapid progression
Myoclonus and/or seizures
Hypokinesia
Cerebellar dysfunction
79
Q

FTD typically presents around age ___, affects males and females at ___ (rate?), and follows an ___ pattern of inheritance in up to 25% of cases.

A

60; equal rates; AD

80
Q

Average length of survival following diagnosis of FTD?

A

5-10 years

81
Q

Behavioral variant FTD is associated with the accumulation of ___ in the hippocampi, temporal lobes, and frontal lobes.

A

Tau protein inclusions known as Pick bodies

82
Q

What medications have demonstrated some benefit in the management of neuropsychiatric symptoms of FTD?

A

SSRIs, trazodone

83
Q

Presentation of behavioral variant FTD?

A

Compulsive behavior, hyperorality, apathy, executive dysfunction, disinhibition

84
Q

Clinical features of acute mania?

A

Elevated, irritable, labile mood
Increased energy and activity, decreased need for sleep
Pressured speech, racing thoughts, distractibility
Grandiosity, risky behavior
Marked impairment, may have psychotic symptoms

85
Q

Management of acut emania?

A

Antipsychotics
Lithium (avoid in renal disease)
Valproate (avoid in liver disease)
Combinations in severe mania (eg, antipsychotic + Lithium or valproate)
Adjunctive benzos for insomnia, agitation

86
Q

Management of agitated patients with acute mania consists of ___ to control behavioral disturbances.

A

Antipsychotic medication (administered IM if needed)

87
Q

Separation anxiety disorder is more common in children under age ___ but can occur at any age.

A

12

88
Q

First-line treatment of PTSD?

A

Trauma-focused CBT and SSRIs/SNRIs

89
Q

List the 6 common SGAs.

A 
Aripiprazole
Olanzapine
Risperidone
Ziprasidone
Clozapine
Quetiapine
90
Q

Compare the risk of weight gain/metabolic syndrome in the 6 common SGAs.

A 
Aripiprazole - Low
Olanzapine - VERY HIGH
Risperidone - High
Ziprasidone - Low
Clozapine - VERY HIGH
Quetiapine - High
91
Q

Compare the risk of EPS in the 6 common SGAs.

A

All low except for Risperidone (High)

92
Q

Compare the risk of prolonged QTc in the 6 common SGAs.

A

All low except for Risperidone and Ziprasidone (High)

93
Q

Rx - GAD?

A

CBT

SSRIs or SNRIs

94
Q

DDx - anxiety disorders

A
  1. Social anxiety disorder (social phobia) - anxiety restricted to social and performance situations, fear of scrutiny and embarrassment
  2. Panic disorder - recurrent, unexpected panic attacks
  3. Specific phobia - excessive anxiety about a specific object or situation (phobic stimulus)
  4. GAD - chronic multiple worries, anxiety, tension
95
Q

Onset of narcolepsy typically occurs around what ages?

A

Adolescence or the early 20’s

96
Q

Diagnostic evaluation of narcolepsy?

A

Polysomnography (r/o other sleep disorders)
Multiple sleep latency test that demonstrates decreased sleep latency and sleep-onset REM periods
Rule out other sleep disorders that can present with excessive daytime sleepiness

97
Q

Clinical features of circadian rhythm sleep-wake disorder with delayed sleep phases?

A

Inability to fall asleep for 2+ hours and awakening later than the desired time

98
Q

List the 3 clusters of personality disorders and a brief descriptor.

A

Cluster A - odd/eccentric
Cluster B - dramatic/erratic
Cluster C - anxious/fearful

99
Q

List the Cluster A personality disorders and compare them briefly.

A
  1. Paranoid - suspicious, distrustful, hypervigilant
  2. Schizoid - prefers to be a loner; detached, unemotional
  3. Schizotypal - unusual thoughts, perceptions, and behaviors
100
Q

List the Cluster B personality disorders and compare them briefly.

A
  1. Antisocial - disregard and violation of the rights of others, lack of remorse
  2. Borderline - chaotic relationships, abandonment fears, labile mood, impulsivity, inner emptiness, self-harm
  3. Histrionic - superficial, theatrical, attention-seeking
  4. Narcissistic - grandiosity, lack of empathy
101
Q

List the Cluster C personality disorders and compare them briefly.

A
  1. Avoidant - avoidance due to fears of criticism and rejection
  2. Dependent - submissive, clingy, needs to be taken care of
  3. Obsessive-compulsive - rigid, controlling, perfectionistic
102
Q

Clinical features of schizoid personality disorder?

A

Lack of desire for close relationships
Preference for solitary activities
Few friends by choice
Show little interest in intimacy or sexual experiences
Emotionally detached
Flat affect
Apparent indifference to praise or criticism

103
Q

Patients with minimal to no improvement with initial antidepressant treatment can be… (pharmacologic management)?

A

Switched to another antidepressant

104
Q

What antidepressant is contraindicated in a patient with (or with a history of) bulimia nervosa?

A

Bupropion

105
Q

What is MDMA?

A

Synthetic amphetamine with mild hallucinogenic properties that causes an increase in synaptic NE, DA, and 5-HT.

Causes euphoria, increases sociability, empathy, and sexual desire

Also known as ecstasy or molly

106
Q

Intoxication with MDMA?

A
  1. Amphetamine toxicity (HTN, tachycardia, hyperthermia)
  2. Serotonin toxicity (Serotonin syndrome = autonomic dysregulation, high fever, altered mental status, neuromuscular irritability, seizures; hyponatremia)
107
Q

Compare MDMA to bath salts.

A

Bath salts are amphetamine analogs; may cause serotonin syndrome

More likely to cause agitation, combativeness, and acute psychosis

Less likely to be associated with hyponatremia

Step 2 (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions