Psychiatry Flashcards
quid of alternative treatment(2)
yoga
acupuncture
what to do if a patient is intereted in alternative treatment
physician should inquire as to why
how to dx major depressive episode(8)
Sleep proble Interest low Guilt Energu is low Concentration Appetite is low Psychomotor ... Suicidability
First line treatment of schizophrenia(8)
Aripiprzole Asenapine iloperidone olanzapine quetiapine paliperidone risperidone ziprasidone
best btolerated drug in patient with psychosis
Olanzapine
when using injectable products in schizophrenia
non compliant patient to oral medication
what injectable medication can be used in schizophrenia(4)
haloperidol decanoate
fluphenazine decanoate
risperidone depot
paliperidone
posologie of haloperidol injectable in the rx of schizophrenia
once a month
posologie of fluphenazine injectable in the rx of schizophrenia
twice a month
posologie of risperidone injectable in the rx of schizophrenia
twice a month
posologie of paliperidone injectable in the rx of schizophrenia
1 a 2 fois par mois
best long term rx of schizophrenia
paliperidone
quid of bipolar(2)
lot of energy
megalomaniac
do you need depression to DX bipolar
no
rx of bipolar (3)
mood stabiliser
plus
atypical antipsychotics
atipical antipsychotics as montherapy
quid of mood stabiliser(3)
lithium
lamotrigine
acid valproic
quid of atypical antipsychotics used in bipolar(5)
risperidone olanzapine quetiapine aripiprazole ziprasidone
first line regimen for mild to moderate bipolar
atypical antipsychotics
rx of severe episodes of bipolar
mood stabiliser plus atypical anti psychotics
patient presenting with many symptoms has seen many doctors asking for CT even if the prior CT was normal
somatisation
what to do in patient with somatisation
scheduled appointment intended to reduce underlying psychological distress
in vignette patietn patietn with thought of being poisonned depuis 3 mois
delusionnal disorder
type of delusion(5)
persecutory erotomanic grandiose jealous somatic
erotomanic delusion
you think someone of higher status is in love with you
grandiose delusion
belief of great talent insights or achievements
Jealous delusion
unfaithful partners
somatic delusion
belief of bodily functions and sensation
how to differentiate delusion from schizophrenia(2)
you need symptoms for at least 6 months to dx schizophrenia
additional psychotic symptom in schizophrenia
psychotic symptom in schizophrenia(3)
hallucinations
disorganisation
negative symptom
clue for delusion
patient is highly functionnal
rx of obsessive compulsive disrder will target which substance
serotonin
drugs used in OCD(5)
clomipramine fluoxetine fluvoxamine paroxetine sertraline
class of drug for clomipramine
TCA
RX of choice of OCD
paroxetine
which neurotransmetter has altered level in OCD
serotonin
quid of bereavment
normal reaction to the loss of loved one
persistent complex bereavement syndrome
persistence of symptom at leats one year after the loss of loved one
dx of major depression(2)
4 symptoms in SIGECAPs
plus
mood depressed or loss of interest
cancer patient is at risk of what psychiatric disease
major depression
rx of patient with cancer and major depression
SSRI
can you have bereavement from cancer
yes you can
how a patient with bipolar will take lithium
it depends on the number of relapses
first episosde of bipolar rx duration
lithium for at least one year
second episode of bipolar
lithium for years
indication of lithium for many years(3)
2 episodes
severe episode
family history
rx of more than 3 episodes of bipolar
lithium for lifetime
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
when a patient taking SSRI will start having improvement
in 4 -6 weeks
mechanism of action of risperidone
blocking dopamine D2 receptor
what a clinician should do in case of mistake(2)
facts should be clarified
truth told to the patient
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
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
quid of acute stress disorder
anxiety developing after experiencing or whitnessing an event
acute stress disorder and PTSD
PTSD last more than one month
generalized anxiety disorder GAD
excessive worry on many aspects of life including work,family, finance etc…
patient starting new job worry in asking if children are safe at school, has difficulty sleeping etc…
GAD
what’s the most important factor to determine a psychiatric disorder
the level of functionning at work
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
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
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
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
abrupt cessation of this drug cause seizure
alprazolam
example of catatony
patient repeats only with monosyllables and refused to make eye contact
symptoms of schizophrenia(5)
delusions hallucinations disorganised speech catatony negative symptom
patietn presenting with all symptoms of schizophrenia but depuis moins de 6 mois dx
schizophreniform disorder
quid of brief psychotic disorder
symptom lasting more than 1 day but less than 1 month
qid of chizoaffective disorder
mood disorder with active symptom of schizophrenia lasting at least 2 weeks
quid of delusionnal disorder(3)
delusions lasting more than 1 month
normal functionning
no psychotic symptom
person who is splitting people as good or bad
bordeline personnality disorder type B
risk of boderline personality disorder
risk of suicide
angry outburst
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
tangential thought
patietn druft away from the subject but never return to it
quid of conficdentiality in medical sciences
don’t discuss thing about a patient with somebody or physician directly relaled to his care
what to monitor in patietn taking olanzapine and clozapine(2)
fasting glucose
lipids
pathologic gambling
pathologic history of gambling and inability to stop
how to deal with angry patient
start a discussion with open ended question and let the patietn talk about the emotion and problem
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
name atypical antidepressant(3)
bupropion
mirtazapine
trazodone
TCA(4)
amitryptiline
clomipramine
doxepin
nortryptiline
name SNRI(3)
duloxetin
venlafaxine
Pesvenlafaxine
Name MAOI (2)
phenelzine
tranylcipromine
when to change class of anti depressor during rx
when two trials of SSRI are inneficient
first line rx of GAD(2)
cognitive behavioral therapy
SSRI or SNRI
second line of GAD(2)
benzodiapine
buspirone
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
quid of folie a deux
psychaitric disorder a delusion or set of delusion is shared simultaneously by individuals who dshared a close relationship
what to do in case folie a deux interview(2)
interview the two people separately
rx the one who first has the delusion
person always alone ,demonstrate interst in magical thing
schysotypal personality disorder
shizoid personality disorder
they don’t have friends
avoidant personality disorder
they want friends but fear ridicule
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
who can give consent for intervention surgical in minor
patient’s parent
minor less than 18 ans who don’t require parental consent(5)
homeless live alone financially independent married military
minor wo dont dont need consent (6)
emergent care
jehovah witnesses with no advanced directives on him and requires blod transfusion but unconscious
transfusion can be done
quid of advance directive or card
instruction saying you want something or not during critical care
if the jehovah witness is conscious what can be done
he can refuse or accept the blod transfusion
patient found in airport or terminal bus with dissociation forgetfulness of name and adress
dissociative fugue
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
rx of kleptomania
cognitive behavioral therapy
quid of kleptomania
impulsive control disorder
dx differential of kleptomania(4)
shoplifting
antisocial behavior disorder
bipolar manic episode(impaired jugment)
psychotic disorder vol because of hallucinations
kid with ALL but parent refuse chimio next step
obtain a court order for chemo
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
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
any changes in adolecent behavior what to check(5)
check drug use partner violence date rape pregnancy sexual or physical abuse
patient on antipsychotics develops milky discharge in nipple cause?
risperidone
clue for prolactinoma
prolactinemia > 200 ng /ml
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
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
clue for anorexia nervosa(2)
patient with low BMI
amenorrheic
BMI in bulimia nervosa(2)
normal
or
slightly elevated
clue for persistent depressive disorder
dysthimia ,chronic low grade depression that last 2 years or more
how to differentiate major depressive disorder and persistent depressive disorder
you don’t have all 5 crtieria in SIGECAP in persistent depressive disorder
symptom in persistent depressive disorder(2)
sadness
low energy for years
pain during sexual intercourse or when attempting penetration
genito pelvic pain penetration disorder
quid of alcohol hallucinosis
alcohol withdrawal syndrome occurring 12-24 h after the last drink and resolves within 24-48 h
patient with history of 6-8 beers /day develops auditory hallucination after an accident
alcohol hallucinosis
quid of delirium tremens
fever
HTA
tachycardia
occuring 48-96 hr after stopping alcohol
quid of withdrawal seizures
alcohol withdrawal causing seizures
quid of mild withdrawal alcohol(2)
palpitation
or
tremulation
complication of mild withdrawal or alcohol withdrawal seizures
Delirium tremens
differentiate alcohol hallucinosis and DT
vitals are normal in alcohol hallucinosis
quid of pyromania
intentionnal and repeated fire setting with no obvious motive
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
side effct most commonly seen with olanzapine
weight gain
cause of acute dystonic reaction(2)
haloperidol
metochlopramine
rx of acute dystonic reaction
benztropine
or
antihistaminics(diphenidramine)
quid of bereavment
sadness after a bad event
patietn with cancer can develop what disease
major depression
rx of bereavment
SSRI
drug used in NMS
dantrolene
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
difference between boulimia nervosa and binge eating disorder
in binge eating disorger no compensatory behavior
rx of binge eating disorder(2)
SSRI
and
CBT
first line rx in boulimia nervosa and anorexia nervosa
CBT
nutritionnal rehab
when use pharmacologic rx in boulimia nervosa and anorexia nervosa
when first line regimen fails
clue for inducing vomiting(surreptitious vomiting)(4)
parotid gland hypertrophy
dental caries
halithosis
scars and calluses over hand
quid of hoarding disorder
difficulty discarding possessions regardless of their actual values
first line rx of hoarding disorder(2)
CBT
SSRI
patient with history of dependence of opiod develops false symptom of back pain to get morphine dx
malingering
what’s the deadline for a physician to give a copy of medical record on patient’s request
30 jours
what to do if relatives or patient want to get a copy of dossier
patient must request a copy of medical record
pregnant woman with clear indication of CS refuses it what to do
respect the patient decision and proceed with vaginal delivery
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
mother refuses to vaccinate children next step
document in the medical chart that the risks and benefits of vaccination have been explained
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
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
what if the family members fails to resolve the problem
the hospital ethics commmitee shold be consulted
why you shoul not give bupropion to patient with eating disorder
risk for seizures
why can you have seizures with bupropion in patient with eating disorder
electrolytes disturbance
why bupropion is contrindicated in epilepsy
it’s decreases the tresholf of seizure
why patient snorting cocaine tends to lose weight
because they have decreased appetite
when using haloperidol in patient with manic episodes
extreme agitation
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)
patient with presenting with mx pain diarrhea abdominal cramps sweating and HTA abd dilated pupils what drugs can cause that
heroin withdrawal
action of heroin
everything is high
1 cause of NMS
haloperidol
clue for major depression with psychotic symptom(2)
when the patient is depressed psychotic event occurs
when the patietn is euthymic no psychotic symptom
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
bipolar with psychotic features(2)
when the patient is manic ,psychotic features occur
when the patient is ok no psychotic features
quid of autism(3)
children perform stereotyped behavior
no emotionnla bonds with others
participation in restricted activities
age of onset of autism
before 3 yo
patient thinking he has special power
grandiose delusion
dx of bipolar
elevated or irritable mood with 3 or more of this
DIGFAST
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
quid of hypomanic episode(3)
less severe than bipolar
symptoms > ou egal a 4 consecutives days
no psychotic features
can you have psychotic features in bipolar
yes
quid of bipolar type 1
manic episode
plus
depressive episode
do you require depressive episode in bipolar type 1
no
quid of bipolar type 2(2)
hypomanic episodes
you must have 1 day or more of depressive episodes
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
quid of cyclothymic disorder
2 years of fluctuating mild hypomanic and depressive symptom
what to suspect in children with sudden behaviral changes
physical or sexual abuse
risk factor of sexual abuse or physical abus(2)
parent with unstable economic backgrounds
parent with history of drugs or alcohol abuse
quid of response during rx in psychiatry
50% reduction in the baseline level of severity
quid of remission during rx in psychiatry
absence of Symptom or minimal symptom
quid of sustained remission during rx in psychiatry
stabilisation of patient’s symptom
quid of recovery during rx in psychiatry
episode is over
quid of reccurence during rx in psychiatry
after recovery symptom reappears
quid of relapse during rx in psychiatry
during sustained remission symptoms reappears
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
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
what medication ingestion contrindicated consumption of meat and aged cheese and why(2)
phenelzine
risk of icrease of blood presure
quid of phenelzine
monoamine oxydase inhibitor
patiet 16 yo with attempted suicide next step
hospitalisation
anxiety restricted to social or performance situations
social anxiety
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
quid of body dismorphic disorder
it’s an obsessive compulsive disorder
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
Quid of body dismorphic disorder
preoccupation with at least one perceived physical detect
quid of most likely cause of tardive dyskinesia
risperidone
common manif of tardive dyskinesia(9)
face grimacing chewing biting tongue protrusion torticolis shoulder shruugging respiratory grunting noises rocking and swaying rotary hip movements
limb abnormality in tardive dyskinesia(4)
limb twisting and spreading
piano playing finger
foot tapping
dystonic extension of the toe
next step in rx tardive dyskinesia
stop risperidone
begin clozapine
side effect of clozapine
agranulocytoiss
in cae of suicidability what patient should be hospitalised(2)
patient with ideation
intent and plan
suicidability with no plan next step(3)
rx underlying depression
family support
reduce access to potential means
rx of performance only social anxiety(2)SAD
Bblocker
or
benzodiapines
rx used in Generalised social AD and SAD
CBT
how to give propranolol in anxiety provoking situation
30-60 mn before the act
quid of generalised social anxiety disorder
anxiety in meeting new people
initiating or maintaining conversation
rx of generalised social anxiety disorder (2)
CBT
SSRI
2 types of social anxiety
performance only
generalised
indication of buspirone
generalised anxiety social disorder
what about CBT in social anxiety compared to drug
equally efficace
tetrad of alzheimer(5)
memory impairment apraxia aphasia or language dysfunction agnosia you can have 2 of them
quid of agnosia
difficulty recognizing object
quid of apraxia
difficulty carrying out activities
what should be done before making the dx of alzheimer
rule out any medical causes of cognitive decline
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
steps to prepare meeting with family to break bad news
SPIKES
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
clue for panic attack(4)
suddeny you have a patient with
palpitation
chest pain and
diaphoresis
first thing to do in patient with palpitation chest pain and diaphoresis(2)
EKG
drug screening
acute rx of panic attack
benzodiazepine
long term rx of panic attack
SSRI
gender involved in panic attack
woman
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
quid of trichotillomania
it’s an OCD
rx of trichotillomania
CBT
reaction of pain ,distress after the loss of a close relationship pendant
greaf of bereavement
normal laps of time to speak of greaf bereavment
about 6 months
complication of greaf bereavment
major depression
rx of greaf bereavment(2)
SSRI
plus
psychoterapy
first line rx of OCD(2)
SSRI
or
clomipramine
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
rx of withdrawal alcohol seizures
long acting benzodiapines
quid of long acting benzodiapines(3)
diazepam
lorazepam
chlordiazepoxide
action of long acting benzodiazepines in rx withdrawal seizures
stimulate gamma aminobutyric acid receptor causing sedation
quid of alcoholic in USMLE
6-10 beers /day
indication of disulfuram (antabuse)
to maintem long term abstinenece in alcoholic patients
rx of alzheimer dementia
initiate cholinesterase inhibitor
example of cholinesterase inhibitor(3)
donepezil
galantamine
rivastigmine
children with motor tick =grimacing,blinking shouldeer shrugging
vocal tick barking grunting coughing and throat clearance dx
tourette syndrome
complication of tourette(2)
hyperactivity disorder
OCD
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
risk for survivor of sexual assault(3)
PTSD
depression
suicidability
quid of narcolepsy(2)
daytime drowsiness
plus
cataplexy
quid of cataplexy
sudden loss of mx tone triggered by strong emotions
rx of narcolepsy
modafinil
or
amphetamine stimulants
preferred drug in narcoplepsy
modafinil also called provigil
measure in narcolepsy(3)
avoid alcohol
maintain proper sleep schedules
avoid drugs causing drowsiness
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
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
indication of methylphenidate
hyperactivity disorder
side effect # 1 of methylphenidate
decreased appetite
contrindication of methylphenidate
children less than 6 years
common side effect of methylphenidate(3)
abdominal pain
insomnia
nervousness
quid of dysthimia
depressed mood for at least 2 years
differenciation between dysthimia and major depression
in dysthimia you have the same symptom than major depression but less severe and longer duration
patient rx with sertraline for major depression accuses improvement next step?
continue medication for 6 months
rx of simple episode of depression duration
6 mois rx
in multiple episode of major depression duration of rx
continue maintenance rx for a long time
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
any patient on lithium and develops manic episode next step(4)
hospitalisation
antipsychotic plus moodstabilizer
urine toxicology
mood stabilizer drug levels
patient 60 ans with colon cancer refuses rx next step
ask the patient why he doesn’t want rx and intervention of any kind
what to do if a patient refuses rx
it’s important to fully discuss the specific reasons for the decision before honoring it
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
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
patient comes to the hospital for severe haeadache despite of extensive follow up he is sure he has cerebral hemmorrage dx
hypochondriasis
next step after dx hypochondriasis
initiate discussion about current emotionnal stressors
why you shoud initiate discussion about current emotionnal stressors in case of hypochondriasis
because the symptom will develop in stressfull period
rx of hypochondriasis
brief psychotherapy
clue for amphetamine intox(8)
agitation excitability delirium paranoia tachycardia hta mydriasis diaphoresis
complication of amphetamine intox(4)
cardiac arythmia
seizures
hyper thermia
intracerebral hemorrage
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
patient with low mood but no impairement of daily functionning dx
normal stress response
conversion disorder quid
neurologic symptom after a stressor event
most common presentation of conversion(4)
weakness
paralysis
seizures
but normal neurologic exam
first line rx in conversion
education
second line rx in conversion
CBT
2 ways of presentation of conversion
hysterical
indifferent
sleep pattern in older people
they tend to frequently awaken from sleep and spend less time sleeping overall
persistent complex bereavment syndrome
symptom last more than 12 months followiing the loss
In USMLE anytime you see death what to rule out
breavement syndrome
exposure to lithium during first trimester of pregnancy
cardiac malformation
what are the 2 cardiac abnormalities seen in litium during pregnancy(2)
septal defect
ebstein anomaly
quid of ebstein anomaly
malformed and inferiorly atached tricuspid valve causing a part of the right ventricle to become part of the right atrium
Ebstein
atrialisation of the right ventricle
complication of lithium on baby during 3 e trimestre de la grossesse(2)
goiter
transient neuromxar dysfunction
rx of tourette(3)
first generation antipsychotics
pimozide
haloperidol
fluphenazine
second line rx of tourette(2)
atypical antipsychotics
risperidone
quid of tourette syndrome
multiple motor and vocal ticks for 1 yaer
should you have vocal ticks and motor ticks together for tourette
no you can them separately
first rx for tourette
risperidone
quid of narcistic personality disorder
exaggerated senseof self importance feelings and entitlement egocentrism and lack of empathy to others
indication of electroconvulsive rx(5)
severe depression depression in pregnancy refractory mania NMS catatnic schizophrenia
adverse effect of electroconvulsive rx(6)
prolonged seizures delirium skin burns amnesia headache nausea
most common side effect of electroconvulsive rx
amnesia
quid of factitious disorder
patient induces symptom to play the sick role
example of factitious disorder
patient taking insulin
munchausen syndrome
patient playing the sick role in order to get surgery
complication in baby with mother suffering from anorexia nervosa
small of gestationnal age baby
anomaly in anorexia nervosa in patient(6)
osteoporosis increase cholesterol and carotene levels cardiac arythmia euthyroid sick syndrome hyponatremia hypothalamic pituitary axis dysfunction
cardiac arythmia seen in anorexia nervosa
prolonged QT syndrome
anorexia nervosa and hypothalamic pituitary axis dysfunction(3)
amenorrhea
anovulation
estrogen deficiency
why hyponatremia in anorexia nervosa
excess of water drinking
why you can have many electrolytes disturbances in anorexia nervosa
because of purging behavior
complication of pregnancy in anorexia nervosa(6)
miscarriage intrauterine growth retardation hyperemesis premature birth cesarean section post partum depression
quid of antisocial personnality disorder
patient 18 ou plus engages in illegal activities and disregard rights of others
what to monitor in all patietns taking clozapine
WBC
why monitor WBC in patient taking clozapine
to rule out agranulocytosis
other side effect of clozapine
lower seizure treshold
rs of alcohol withdrawal syndrome
diazepam
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
quid of somatisation
symptom more than 6 months with disruption of daily life
quid of illness anxiety disorder
prolonged fear and concern about getting or having a disease but with minimal or no actual physical symptom
children verbal and talkative at home but refuses to speak in specific settings generally at school dx
selective mutism
patient presenting with sudden palpitations sweating trembling or shaking shortness of breath and hot and cold sensations dx
panic disorder
disease associated with panic disorder(4)
major depression
agoraphobia
bipolar
substance abuse
risk in patient with panic attack
suicide
abnormal imaging associated with schizophrenia
enlargement of cerebral ventricles
abnormal imaging associated with autism
increase total brain volume
abnormal imaging associated with OCD
abnormalities in orbitofrontal cortex and striatum
abnormal imaging associated with PTSD
decrease volume of amygdala
which ventricle is enlarged in schizophrenia
lateral ventricle
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
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
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
rx of adjustment disorder(2)
psychodynamic psychotherapy
brief cognitive psychotherapy
quid of adjustment disorder
emotionnal or behavioral symptom that develops within 3 months of exposure to an identifiable stressor
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
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
clue for EPS type parkinsonian(4)
walk much slower
not swinging arms
facial expressions flat ,unchanged
micrographia
rx for EPS
benztropine
indication of CBT(3)
overgeneralisation of negative events
catastrophising
maximizing negative events
when CBT can be used(5)
anxiety mood problem personality problem somatic symptom eating disorder
how many sessions of CBT is recommnaded
12
indication to place a patient in a hospice care
patient with prognosis less than 6 months
what are the focus in hospice care(5)
symptom control quality of life psychosocial spiritual bereavment care
rx of meningococcemia(3)
isolation
IV antibiotics
supportive care
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
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
rx of specific phobia first line
CBT
second line rx of specific phobia
benzodiazepines
what they do during CBT
exposure technique
quid of phobia
fear of specific object or situation
strongest indication for a future suicide in patient with psychiatric disorder
previous suicide attempt
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
protective fgactors against suicide(4)
social support/family connectedness
pregnancy
parenthood
religion and participation in religious activities
the greatest risk to attempt suicide in future
past history of suicide attempt
what must be present for the dx of major depression(2)
low mood or anhedonia
plus
SIGECAPS
duration of symptom to dx major depression
two weeks or more
what the most important element to dx grief(2)
loss
emptyness
dx depression
5 on 9 depressive symptoms which at least 2 weeks
at least one is depressed mood or looss of interest/pleasure
reaction formation
transformation of an unwanted thought or feeling into it’s opposite
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
patient with creat 1,9 and bipolar what medication can be given in long term rx (as mood stabiliser )of the patient
acid valproic
bipolar and renal failure
no lithium
in major depression evaluation what should be screened
suicidal ideation
if suicidal ideation is present during major depression evaluation what should be done
hospitalisation
helpful measure in schizophrenia
keep family stresses and conflicts to a minimum
what about school during schizophrenia
gradual return with a reduced schedule would be more appropriate
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
what types of question patient can have difficulty to answer in front of family members(3)
question regarding
drug use
sexual history
domestic violence
clue for marijuana intox(3)
increased appetite
impaired perception
conjunctival injection
clue for PCP intox
nystagmus
type of drug PCP is
hallucinogen
clue for LSD intox
visual halucinations
complication of cocaine(2)
chest pain
seizures
clue heroin intox(3)
deressed mental status
miosis
respiratory depression
what type of drug is heroin
opioid
type of drug is marijuana
psychoactive drugs
gynecomastia in use of cannabis meaning?
chronic use
what test shold be done before initiating lithium rx(2)
creatinine
thyroid function
complication of lithium(3)
nephrogenic insipidus diabetes
hypothyroidism
ebstein anomaly in fetus
neurologic action of lithium
inhibit inositol 1 phosphatase in neuron
why headache is important in psychiatry
could be indicative of depression in elderly
can you physical symptom in depression
sometimes patient with depression comes to see you with physical symptom
drugs causing halluciantions and combative behavior
Phenylcyclidine
drugs causing hallucinations and intensified perceptions
PCP and LSD
what are the 3 A for negative symptoms(3)
asociability
alogia
affective flattening
SIGECAPS
S=sleep I=interst G=guilt E=energy C=concentration A=appetite P=psychomotor S=suicidability
teens you can rx without parents consent(4)
contraception
prenatal care
substance abuse
STD
drugs used in depression and smoking cessation
bupropion
druds used to rx all forms of anxiety and fright disorder
SSRI
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 %
twin monozygotic has schizophrenia what the probility of having it in other twin
70%
a child with both parents schizophrenic what the probability for the child to have it
60%
schizophrenia probability in the general population
1%
the 3 manif of extra pyramidal syndrome
acute dystonic reaction
akathisia
parkinsonism
symptom in acute dystonic reaction
neck rigidity
symptom in acute akathisia
restlessness
rx of akathisia
propranolol
rx of parkinsonism(2)
amantadine
or
anticholinergic
hallmark of NMS(3)
hyperthermia
rigidity
autonomic instability
complication of NMS
rhabdomyolysis
rx of NMS(3)
dantrolene
or
amantadine
or/and dopamine agonist
rx of anorexia nervosa
olanzapine
rx of bulimia
SSRI
quid of russel’s sign(2)
cicatrices and calluses over the hand
seen in anorexia nervosa
triad of anorexia nervosa(3)
low BMI
first thing to do if child abuse is suspected
complete physical examination
second thing to do if child abuse is suspected
skeletal survey
third thing to do if child abuse is suspected
coagulation profile
4e thing to do if child abuse is suspected
child protective services
5e et 6 e thing to do if child abuse is suspected(2)
hospitalisation if necessary
consultation with a psychiatrist
patient with depression develops HTA crisis while eating cheese what drug is he on
phenelzine
substance containing tyramine and hta crisis during depression if patient is taking phenelzine(2)
meat
cheese
indication of cl0zapine in hospiatalised patietn with schizophrenia(2)
treatment resistant schizophrenia
schizophrenia associated with suicidability
adverses effect of clozapine(4)
agranulocytosis
seizures
myocarditis
metabolic syndrome
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
approach the patient with delusions(2)
acknowledge the patient distress
without endorsing specific delusions or halucinations
first line regimen in psychosis
second generation anitpsyhotics
patient foud by police wandering in the street .whe askin what she fels she answers”jingle jangle “ doctor dx
psychosis
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
kid 5 yo talking to herself.She says she has a friend called Mindy dx
imaginary friends
what to do in case of imaginary friends(2)
nothing
imaginary friend is outgrown by the early elementary school years
