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USMLE Rapid Review > Psychiatry > Flashcards

Psychiatry Flashcards

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USMLE® Step 1 flashcards
1
Q

fear of having a serious illness despite few or no symptoms and consistently negative evaluations

A

illness anxiety disorder

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2
Q

neurologic symptoms incompatible w/ any known neurologic dz, often acute onset associated w/ stress

A

conversion disorder (functional neurologic symptom disorder)

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3
Q

intentional falsification or inducement of symptoms w/ goal to assume sick role

A

factitious disorder

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4
Q

falsification or exaggeration of symptoms to obtain external incentives (secondary gain)

A

malingering

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5
Q

excessive anxiety and preoccupation w/ ≥ 1 unexplained symptoms

A

somatic symptom disorder

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6
Q

first line tx for depression

A

SSRI

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7
Q

anti-depressants associated w/ HTN crisis

A

MAO-I

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8
Q

s/e include galactorrhea, impotence, menstrual dysfunction, and decreased libido

A

dopamine antagonists (anti-psychotics)

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9
Q

life-threatening muscle rigidity, high fever, and rhabdomyolysis

A

NMS

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10
Q

amenorrhea, low body weight, bradycardia, fine body hair, and abnormal body image in young woman. Dx?

A

anorexia

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11
Q

most serious s/e of clozapine

A

agranulocytosis

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12
Q

key s/e of atypical antipsychotics

A

weight gain, type II DM, QT-segment prolongation

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13
Q

violent pt w/ horizontal nystagmus

A

PCP intoxication

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14
Q

pt w/ AMS, fever, agitation, tremor, myoclonus, hyperreflexia, ataxia, diaphoresis, flushing, and diarrhea. Dx? Tx?

A

serotonin syndrome. d/c offending agents and consider cyproheptadine

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15
Q

pt eats tyramine containing food while taking MAO-I and becomes hypertensive w/ HA, sweating, N/V. Dx? Tx?

A

tyramine rxn/hypertensive crisis. tx w/ phenotolamine

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16
Q

pt overdoses on unknown anti-depressant presents w/ dry mouth, mydriasis (pupil dilation), fever, cardiac conduction disturbances, hypotension, respiratory depression, agitation/AMS. drug? tx?

A

TCA. sodium bicarbonate

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17
Q

time course for psychotic disorders…

A

brief psychotic disorder = 6 months

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18
Q

symptoms of MDD? requirements for diagnosis?

A

SIGECAPS - sleep, interest, guilt, energy, concentration, appetite, pyschomotor retardation, and suicide ideation
must have at least 5 symptoms for 2 weeks (1 of the symptoms must be either depressed mood or anhedonia)

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19
Q

symptoms of mania?

A

DIGFAST - distractability, insomnia/impulsive behavior, grandiosity, flight of ideas/racing thoughts, activity/agitation, speech (pressured), and thoughtlessness

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20
Q

differences between bipolar 1 and bipolar 2

A

bipolar 1 = major depression + manic episodes

bipolar 2 = major depression + hypomanic episodes

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21
Q

symptoms of panic attacks? requirements for diagnosis?

A

PANICS - palpitations, abdominal distress, numbness, intense fear of death, choking/chills/chest pain, and sweating/shaking/SOB.
requirements include symptoms + persistent concern for additional attacks or worry about implications of attack or change in behavior/avoidance of situations

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22
Q

social phobia vs panic w/ agoraphobia

A

social phobia = pt avoids social situation because of feelings of inadequacy, he feels he is going to be humiliated

panic w/ agoraphobia = pt avoids places where escape is difficult in case he gets a panic attack

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23
Q

important complication of anorexia

A

osteoporosis

24
Q

poor sleep hygiene practices…?

A

poor sleep scheduling w/ variable wake and sleep times, frequent daytime napping, routine use of caffeine, alcohol, or nicotine esp in the period preceding sleep, engaging in mentally or physically stimulating activities before sleep, frequent use of the bed for activities other than sleep (watching tv, reading, etc)

25
Q

pt develops emotional or behavioral symptoms in response to an identifiable stressor that occurred w/in 3 months of the stressor. dx? tx?

A

adjustment disorder. tx of choice is cognitive or pscyhodynamic psychotherapy

26
Q

evolution of EPS symptoms and tx?

A
  1. acute dystonia (prolonged, painful tonic muscle contractions/spasms) w/in hours. tx w/ anticholinergics (benztropine or diphenhydramine)
  2. akinesia (shuffling gait, cogwheel rigidity) w/in days. tx w/ anticholinergics or dopamine agonist (amantadine) or decrease dose.
  3. akathisia (subjective/objective restlessness) w/in weeks. tx w/ decreased neuroleptics or beta-blockers
  4. tardive dyskinesia (involuntary, painless, oral-facial mvmts) w/in months. tx w/ dc of drug (note giving anticholinergics or decreasing dose may initially worsen tardive dyskinesia)
27
Q

pt w/ weight loss, behavioral changes, and erythema of the turbinates and nasal septum

A

cocaine abuse

28
Q

pt w/ excessive anxiety about multiple events + 3 of the following: impaired sleep, poor concentration, easy fatigue, irritability, muscle tension, and restlessness. dx? tx?

A

GAD. tx short term = BZD; long term = psychotherapy and meds (SSRI, venlafaxine, or buspirone)

29
Q

tx MDD w/ anti-depressant for how long?

A

first episode - 6 months; recurrent episodes - longer

30
Q

who is considered high imminent risk of suicide? tx?

A

high risk = ideation, intent, and plan –> tx by hospitalization against will
non-high risk = ideation, intent, but no plan –> tx symptoms, recruit family/friends, reduce access to potential harms

31
Q

pt w/ excessive preoccupation w/ a slight or imagined bodily defect. dx? tx?

A

body dismorphic diosrder. tx w/ medication and psychotherapy (NOT SURGERY)

32
Q

pt w/ sudden onset of neurological symptoms and clinical findings that are incompatible w/ recognized neurological conditions. may be precipitated by stress. may present as hysterical or strangely indifferent about their symptoms

A

conversion disorder

33
Q

absolute contraindication to use of bupropion

A

pts w/ hx of seizure disorders or people w/ electrolyte abnormalities (which predisposes to seizures) such as pts w/ anorexia or bulimia

34
Q

pts have to right to refuse tx except when?

A

except when it poses a serious threat to public health

35
Q

4 findings of nacrolepsy? tx?

A
  1. excessive daytime sleepiness
  2. cataplexy (sudden loss of muscle tone that leads to collapse)
  3. hypnagogic or hypnopompic hallucinations (hallucinations upon falling asleep or upon awakening, respectively)
  4. sleep paralysis
    tx includes proper sleep scheuldes, avoidance of alcohol or drugs that cause drowsiness, and lastly stimulants such as modafinial (provigil) to reduce daytime sleepiness
36
Q

tx of tourette disorder?

A

anti-psychotic meds - haloperidol is approved, but second generation are becoming more favorable due to less s/e

37
Q

PCP and LSD intoxication present similarly. what distinguishes?

A

PCP - pt is more agitated and aggressive

LSD - pt has more visual hallucinations and intensified perceptions

38
Q

malingering vs factitious disorder

A

malingering always has a secondary gain vs factitious disorder is to assume to sick role

39
Q

avoidant vs schizoid personality disorder

A

avoidant pts want to be with others, but are too scared of rejection vs schizoid pts prefer to be alone

40
Q

borderline personality disorder - IMPULSIVE mneumonic

A

impulsive, moody, paranoid, unstable self-image, labile, suicidal/splitting, inappropriate ange, vulnerable, emptiness

41
Q 
differentating the schizos...
schizophreniform
schizophrenia
schizoaffective
schizotpyical
schizoid
A

schizophreniform - psychotic - > 1 mon - 6 mon
schizoaffective - psychotic - schizophrenia + MDD
schizotpyical - personality - magical thinker
schizoid - personality - loners

42
Q

mechanism of action of anti-psychotics

A

dopamine D2 receptor blocker (atypicals have some serotonin receptor binding which leads to less EPS effects)

43
Q

OCD vs OCPD

A

OCD pts recognize the obsessions/compulsions and want to be rid of them (ego dystonic)

OCPD pts do not recognize their behavior as problematic (ego syntonic)

44
Q

4 features of PTSD

A

symptoms greater than 1 month following traumatic event including:

  1. re-experiencing the event
  2. avoidance of stimuli associated w/ the event
  3. numbed responsiveness
  4. increased arousal
45
Q

delirium vs dementia

onset, course, hallucinations, prognosis, tx

A

delirium - acute onset, fluctuating course, + hallucinations, reversible, tx underlying cause and low dose anti-psychotics
dementia - gradual onset, progressive course, + hallucinations in advanced dz, mostly irreversible, tx w/ cholinesterase inhibitors and low dose anti-psychotics

46
Q

TCA toxicity - tri Cs

A

convulsions, cardiac arrhythmia, coma

47
Q

ddx of postpartum disorders

  1. postpartum blues
  2. postpartum psychosis
  3. postpartum depression
A
  1. postpartum blues - w/in 2 wks w/ sadness, moodiness, emotional lability, no thoughts of harming baby
  2. postpartum psychosis - w/in 2-3 wks, delusions and depression, may have thoughts of harming baby
  3. postpartum depression - w/in 1-3 months, delusions and depression, plus sleep distrubanes and anxiety, may have thoughts about hurting baby
48
Q

s/e of mirtazapine

A

weight gain and sedation

49
Q

s/e of trazodone

A

sedation and priapism

50
Q

s/s of serotonin syndrome

A

fever, myoclonus, mental status changes, cardiovascular collapse

51
Q

findings consistent w/ schizophrenia…

A

two or more of the following for > 6 months w/ social or occupational dysfunction:
1. + symptoms = hallucinations (usually auditory), delusions, disorganized speech, bizarre behavior, and thought disorder
or
2. - symptoms = flat affect, decreased emotion, poverty of speech, anhedonia

52
Q

anorexia vs bullimia

A

anorexic pts are underweight (> 15% BMI) and not distressed by illness
bullimic pts are normal weight to overweight and distressed by symptoms

53
Q

anti-psychotic effects vs prolactinoma

A

both can cause hyperprolactinemia secondary to their DA blockade effect, but prolactinomas tend to produce very high levels of prolactin (> 200)

54
Q

conduct vs anti-social disorder

A

conduct disorder is characterized by disruptive behavioral patterns that violate basic social norms for at least one year in pts 18 y/o

55
Q

normal bereavement vs MDD

A

normal bereavement occurs after the loss of a loved one, involves no severe impairment/suicidality, usually last

56
Q

anti-pyschotic DA blockade effects in DA pathways:
mesolimbic - ?
nigrostriatal - ?
tuberoinfundibular - ?

A

DA pathways:
mesolimbic - anti-pyschotic effects
nigrostriatal - EPS effects (acute dystonia, akinesia, akathisia, and tardive dyskinesia)
tuberoinfundibular - hyperprolactinemia effects (high prolactin –> amenorrhea, galactorrhea, gynecomastia, and sexual dysfunction)

USMLE Rapid Review (16 decks)

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