Psychiatry Flashcards
1
Q
Defense mechanism utilized by pts with paranoid personality disorder?
A
Projection
2
Q
How do you treat anti-social personality disorder?
A
limit setting, psychotherapy, group therapy
3
Q
Diagnosis (personality disorder): loner, lives in a basement, programs from home
A
Schizoid personality disorder
4
Q
Defense mechanism utilized by patients with borderline personality disorder?
A
Splitting
5
Q
Diagnosis (personality disorder): woman stays with abusive alcoholic husband for years
A
dependent personality disorder
6
Q
Separate narcissistic from histrionic personality disorder?
A
Histrionic: woman, sexual
Narcissistic: man, demands the best
7
Q
Diagnosis (personality disorder): a medical student spends hours editing their notes until there are only 20 words per line because “it’s the right way.” They aren’t able to get through all the relevant material in time for the exam so they fail.
A
Obsessive-compulsive personality disorder
8
Q
Diagnosis (personality disorder): person who works the night shift toll booth
A
schizoid personality disorder
9
Q
Diagnosis (personality disorder): Person who fears rejection and criticism, wants relationships, but does not pursue them
A
Avoidant personality disorder
10
Q
Diagnosis (personality disorder): Person with thinking that borders on psychosis, bizarre thoughts, behavior, and dress
A
Schizotypal personality disorder
11
Q
Diagnosis (personality disorder): Person who is unable to control rapid changes in mood, suicidal gestures, promiscuous
A
borderline personality disorder
12
Q
The diagnosis is CLEARLY PTSD and the event happened 2 weeks ago; what’s the diagnosis?
A
Acute stress disorder (up to 1 mo after traumatic event)
13
Q
A person has a fear of spiders but needs to do a photoshoot of spiders in the Amazon next month. What’s the best treatment?
A
Exposure therapy/CBT
14
Q
How do you treat PTSD?
A
CBT with exposure + SSRI
15
Q
Medical therapy to abort a panic attack?
A
Benzo
16
Q
A 20 yo woman with crushing substernal chest pain, dyspnea, and diaphoresis. What’s the next step?
A
Rule out MI (ECG, troponin) though this is probably a panic attack
17
Q
Treatment for anxiety of public speaking?
A
Beta blockers (eg propranolol, atenolol)
18
Q
The diagnosis is CLEARLY PTSD and the event happened 8 weeks ago; what’s the diagnosis?
A
PTSD (more than 1 month of symptoms)
19
Q
Substernal chest pain, dyspnea, diaphoresis, and sense of impending doom in a 23 yo woman: diagnosis?
A
Panic attack
20
Q
The fear of avoidance of public areas, crowds, or public transit is __.
A
agoraphobia
21
Q
A pilot develops a fear of flying, but wants to keep his job. What type of CBT does he need?
A
Desensitization
22
Q
If you had to pick between therapy or medications for Generalized Anxiety Disorder, which do you go with?
A
Therapy (but SSRIs work too)
23
Q
The patient is in a constant state of worry about most things on most days. Diagnosis?
A
GAD
24
Q
What’s the treatment for generalized anxiety disorder?
A
Psychotherapy > SSRIs. Benzos are the wrong answer (can also use buspirone)
25
Generalized anxiety disorder requires what for diagnosis?
Worry about most things on most days of most months for greater than or equal to 6 months with greater than or equal to 3 somatic complaints
26
A child has many outbursts in class, is started on stimulants for ADHD, and the outbursts get worse, dx?
Tic disorder (Tourette's)
27
A child misbehaves at school, appears easily distracted. They're able to sit quietly at home and watch TV, dx?
troublemaker (not ADHD)
28
Treatment: child is fidgety, interrupts others, is easily distracted, has poor grades, and can't follow instructions at home
stimulant medication (ie methylphenidate or dextroamphetamine)
29
Child has impaired speech, poor social function, repetitive behaviors, and rocks back and forth, dx?
Autism spectrum disorder
30
Child risk factors for intellectual disability disorders?
lead poisoning, trauma, cerebral palsy
31
A child lacks a social smile, lacks eye contact, dx?
Autism
32
How do you treat a tic disorder?
dopamine antagonists (this doesn't make intuitive sense so it's great board fodder)
33
Maternal risk factors for intellectual disability disorders?
hypothyroid in utero, alcohol in utero
34
How do you grade an intellectual disability disorder?
Adaptive functioning (not IQ)
35
What does an IQ less than 70 mean?
That the person is below three standard deviations from the mean
36
When assessing neurodevelopmental disorders, when is an IQ test the right answer?
never
37
Child must stack a set of cars in the same way every day; deviating causes a tantrum. Diagnosis?
Autism
38
A 6 mo old girl has normal developmental progress, but then regresses. Dx?
Rett syndrome
39
Mom wants prenatal screening for intellectual disability disorder, which should you check first?
That she's willing to terminate (there's risk to procedures and nothing to do if she isn't going to terminate)
40
What are the two main symptoms of Autism spectrum disorder?
Impaired social communication and repetitive behaviors
41
Chromosomal causes of intellectual disability disorders?
Fragile X, down syndrome, Cri-du-chat
42
What is required for ADHD (6)?
6/9 inattention AND/OR 6/9 impulsivity in greater than 2 settings, onset before 12, and duration gt/= 6 months, and not better explained by something else
43
A child who was previously dry starts wetting the bed. Also has urgency, frequency, dysuria. Diagnosis and next step?
UTI; 1) Urinalysis, 2) Renal Ultrasound, 3) assess for stressors
44
Lying, cheating, hurts animals, less than 18 yo. Dx?
Conduct disorder
45
Child yells, talks back to teachers and parents, but isn't aggressive with peers or animals. Dx?
Oppositional defiant disorder
46
A 6 yo is wetting the bed. He has good self esteem and friends. How do you treat?
Nothing (normal); child isn't showing impairment
47
Older than 7 years old, still bed wetting, frequently cries from embarrassment. Tx?
Positive reinforcement, alarm blankets, water restriction. Medication treatment = DDAVP (TCAs are ok answers)
48
Lying, cheating, hurts animals, greater than 18 years old, dx?
Anti social personality disorder
49
What's the tx for oppositional defiant disorder?
Better parenting
50
UTI in a young girl - dx?
If STI, abuse. If not, then poor hygiene. Girls need education not to "wipe up"
51
What is the major action or concept that separates conduct disorder from oppositional defiant disorder?
HARMING peers: using cruelty/torture on animals, forced sex
52
Treatment for conduct disorder?
Juvenile detention
53
Diagnosis if you see an STI in a child?
Abuse
54
Schizophrenia with a mood disorder = ?
Schizoaffective
55
College freshman gets distracted, loses track of school work, and starts to fail. What's the next step?
Urine toxicology to rule out drugs and alcohol (always think drugs for acute change in mental status!)
56
How do you treat brief psychotic disorder?
antipsychotics
57
What is the timeline for brief psychotic disorder?
less than 1 month
58
Treatment for delusional disorder?
Gentle confrontation
59
A man believes his neighbors found a way to spy on him in his own home. He has a job, is married, and everything else seems fine. Diagnosis?
Delusional disorder
60
Psychotic symptoms with overlapping mood symptoms most of the time; no mood symptoms without psychosis. Diagnosis?
Schizoaffective disorder
61
Duration that defines schizophrenia?
gt 6 months
62
What is the criteria for schizophrenia diagnosis (the symptom part)?
2 or more of the following must be present for at least 1 month and at least one must be 1-3
1. delusions; 2. hallucinations; 3. disorganized speech; 4. grossly disorganized or catatonic behavior; 5. Negative symptoms (flat affect, anhedonia, cognitive defects, poverty of speech)
63
What are the 5 A's of schizophrenia negative symptoms
Anhedonia, Affect (flat), Alogia (poverty of speech), Avolition (apathy), Attention (poor)
64
Explosive outbursts twice a week for 3 months but without ever actually harming anyone - dx?
Intermittent explosive disorder
65
How do you treat someone who sets fires for money?
Arson - jail
66
How do you treat someone who sets fires for pleasure?
pyromania - jail
67
What elements of stealing help differentiate kleptomania from the crime of theft (3)?
Kleptos CAN afford
the action is SPONTANEOUS
they have REMORSE after stealing
68
What medical therapy is effective in treating any and all impulse control disorders?
none (it's the only set of anxiety disorders that DOES NOT respond to SSRIs)
69
What medical therapy is effective in treating intermittent explosive disorder?
None
| same for klepto and pyro
70
Explosive outbursts three times this year, one of which caused a man to be treated for lacerations and a broken arm - dx?
intermittent explosive disorder
71
What are the comorbid disorders commonly associated with PTSD?
Substance abuse (alcohol most often) and mood disorders (depression, anxiety)
72
If you think reactive attachment disorder, what must be in vignette?
Neglect or abuse in infancy, too little attachment to others later in life
73
If you think Disinhibited Social Engagement Disorder, what must be in vignette?
Neglect or abuse in infancy, too much attachment to others later in life
74
What's the difference btwn PTSD and adjustment disorder?
Everything - adjustment disorder has a mild stressor, mild mood change, and requires little or no treatment
75
What is the best treatment for PTSD?
psychotherapy (group classes)
76
What's the difference between PTSD and acute stress disorder?
Timing (ASD is greater than 3 days, less than 1 mo, and PTSD is greater than 1 mo)
77
What's the timing for an event to be called PTSD?
greater than 1 month duration
78
When do you use benzos in PTSD?
Only to abort panic attacks, never chronically
79
What's the timing for a PTSD-type event to be called acute stress disorder?
gt 3 days from event AND less than 1 month duration
80
What is the medication of choice for PTSD?
SSRIs
81
What are the five categories of symptoms needed in PTSD?
Intrusion, negative mood, dissociation, avoidance, arousal
(also need to have exposure to actual or threatened death, serious injury, or sexual violence by directly experiencing or witnessing the trauma)
82
What drug can be used to stop nightmares in PTSD?
Prazosin
83
Alopecia in a woman with hair at different lengths - diagnosis?
Trichotillomania
84
What is the preferred treatment for obsessive compulsive disorder?
CBT
85
What medications can be used to tx OCD?
SSRIs (or clomipramine = TCA)
86
The patient has a house full of trash and the inability to throw anything way - dx?
Hoarding disorder
87
A woman insists a surgeon perform a surgery to cosmetically correct her nose. It's her third surgery; there appears to be nothing wrong with her nose; dx?
Body dysmorphic disorder (don't do the surgery!)
88
Psych question about anxiety with a small bowel obstruction = ?
Trichotillomania with bezoar (picks the hair and eats it)
89
You see alopecia in a woman with hair at different lengths - next step?
r/o fungus (KOH prep)
90
There's a woman in a question about a defect in a particular body part (not her weight) - dx?
body dysmorphic disorder
91
You think it's a body dysmorphic disorder question but there's emphasis on weight or weight controlling strategies, dx?
Eating disorder (anorexia or bulimia)
92
Man in a question about muscle size - dx?
Muscle dysmorphic disorder (or muscle dysphoria)
93
A vignette says something about copper and it's a psych question - dx?
muscle dysphoria (testosterone abuse)
94
Which gender experiences OCD more often?
No gender difference in prevalence!
95
What is required for the diagnosis of OCD?
Experiencing obsessions and/or compulsions that are time consuming (gt 1 hr/day) or cause significant distress or dysfunction
96
Suicidal ideations with a plan, what's the next step?
Hospitalize
97
Talkative, agitated, pressured speech, flight of ideas, what's the tx?
Lithium
98
Suicidal ideations without a plan, what's the next step?
Antidepressants
99
Vignette sounds like depression, but it's been there for more than 2 years and isn't that bad. Diagnosis?
Dysthymic disorder
100
You diagnose major depressive disorder and start an SSRI. Then the patient starts spending money and having sex with everyone. What's the diagnosis?
Acute mania, bipolar I (SSRI reveals mania)
101
A woman wants to get pregnant but is bipolar. What medication should you use?
Lamotrigine
102
Mania is present, but the pt has had lithium toxicity twice. What medications should you use?
Valproic acid
103
What is the ultimate treatment for refractory depression?
Electroconvulsive therapy (ECT)
104
What is the best initial treatment for major depressive disorder?
A combination of psychotherapy and SSRI
105
Vignette looks like mania but is just not as severe. Diagnosis?
Bipolar II
106
SIGECAPS and what is required for depression?
Sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicidal (pt must also have decreased mood OR anhedonia AND 5 of sigecaps) with a duration gt/= 2 wks
107
DIGFAST and what is required for manic episode?
Distractibility, Insomnia/Impulsive, Grandiosity, Flight of ideas/racing thoughts, Activity/Agitation, Speech (pressured)/Sexual exploits), Thoughtlessness/Talkative lasting at least 1 week (or any duration if hospitalization is necessary) and including at least 3 of DIGFAST
108
What's the timeline for a hypomanic episode?
At least 4 consecutive days that includes at least 3 DIGFAST; no marked impairment in social or occupational functioning and no psychotic features
109
In days after giving birth, mom feels sad, can't motivate herself, and feels sluggish. Diagnosis and treatment?
Post-partum depression, use anti depressants (SSRIs)
110
At what duration is grief no longer grief?
12 months; it becomes PCBD (persistent complex bereavement disorder) if it doesn't meet criteria for depression
111
How do you treat uncomplicated grief?
Time and an open mind (no intervention required)
112
Mom has a baby and at the next well child visit complains how hard it was/how depressed she felt when she got home. She asks if this is normal. Diagnosis and treatment?
Baby blues. While pathologic ("not normal"), only reassurance is required
113
In days after giving birth, mom hears voices telling her to kill baby. Diagnosis?
Post partum psychosis
114
A son doesn't go to soccer practice, is easily distracted in class, and breaks up with his girlfriend after the death of his mother. What stage of death and dying is he in?
Depression
115
How do you treat depression after the loss of a loved one?
SSRI or SnRI
116
A man sips on his diet coke, takes his oxycodone and his valium, and closes his eyes, with his family surrounding him in a circle of prayer. What stage of death and dying is this?
Acceptance
117
A woman gets a third opinion on her metastatic ovarian cancer, insisting the doctors must be wrong. What stage of death and dying is she in?
Denial
118
How do you treat persistent complex bereavement disorder?
SSRI or SnRI
119
A mother strikes a physician in the face with an open palm after being informed her son was shot and killed. What stage of death and dying is this?
Anger
120
People may feel down after the loss of a loved one. What is it about their depressed mood that makes it grief (normal)?
Grief has periods of happiness or at least an imagined future of happiness, and when not considering the deceased, mood can be elated
121
A father asks if there is anything more he can do - transplant his kidney or his liver - or whatever it takes, if you can just save his son. What stage of death and dying is this?
Bargaining
122
Someone with bulimia is having seizures. What should you look out for?
buproprion
123
A woman has a BMI of 14 and has stopped menstruating, but thinks she's fat. What do you do?
medical hospitalization and refeeding
124
What is someone with bulimia at risk for if they take bupropion?
Seizures
125
What eating disorder behavior is commonly associated with anorexia nervosa?
restriction
126
A girl has a BMI of 18, works out 3 hours a day, eats very little, but thinks she's fat. What do you do?
Psychotherapy (NO indication for hospitalization) (and antipsychotic?)
127
What eating disorder behavior is commonly associated with bulimia nervosa?
Binge purge
128
What is the source of anxiety in bulimia?
The binge
129
What's the epidemiology of eating disorders, primarily?
females teens to twenties (10:1 F:M ratio)
130
What is the source of anxiety in anorexia?
Fear of being or becoming obese (even if the pt is extremely thin)
131
Why is the F:M ratio so high in eating disorders?
men report eating disorders less and are less likely to seek help
132
What is the most common cause of death from anorexia?
suicide, then medical conditions (malnutrition predisposes to infection)
133
When do you hospitalize an anorexia pt (3)?
When severe (BMI lt 16), when there are hemodynamic changes (BP, bradycardia), or when there are electrolyte abnormalities
134
What other findings would you look for in a Binge-Purge eating disorder with metabolic alkalosis (4)?
dorsal hand scars, dental erosion, and parotid swelling (also low K and low Mg)
135
What does binge mean in the eating disorders that cause binge purge?
inability to control eating habits; eating too much at once
136
Patient has difficulty remembering traumatic/stressful event. Diagnosis?
dissociative amnesia
137
The feeling of seeing a procedure being performed to you as though you are somewhere else is ___
depersonalization
138
Following traumatic/stressful event, a person goes missing, is found 200 miles away and doesn't remember important details about themselves. Diagnosis?
dissociative fugue
139
How do you treat dissociative identity disorder?
psychotherapy
140
An altered state of affect/behavior/consciousness; pt returns to normal state without knowledge of related events. Diagnosis?
dissociative identity disorder
141
Lead pipe rigidity, fever, altered mental status, and mention of an atypical psychotic; diagnosis?
neuroleptic malignant hyperthermia
142
How do you treat malignant catatonia?
Benzos
143
Diagnosis and treatment: altered mental status, hyperthermia, lead pipe rigidity, anesthesia
Malignant hyperthermia; tx with dantrolene
144
Passive resistance to movement during catatonia is?
cata-lepsy
145
Diagnosis: altered mental status, hyperthermia, lead pipe rigidity, SSRI
Serotonin syndrome (cyrpoheptadine and IVF!)
146
What do you treat catatonia with?
benzos
147
A catatonic pt that can be placed into any position and stay there has what's called ___
waxy flexibility
148
Diagnosis: delirium, tachycardia, HTN, diaphoresis, 2 days post-op
Alcohol or benzodiazepine withdrawal (vital sign instability is among the last symptoms to show up)
149
How do you treat neuroleptic malignant syndrome?
dantrolene (or bromocriptine if refractory)
150
How do you abort a panic attack?
benzo
151
What is the mainstay medication class for depression?
SSRI
152
Diagnosis: AMS, fever, increased CK, rigidity; not in the context of anesthesia
NMS (neuroleptic malignant syndrome)
153
What potentially lethal side effect do TCAs cause?
cardiac arrythmia
154
If you can't use lithium, what do you use?
Valproate (except during pregnancy)
155
Don't use buproprion with bulimia because it causes ___
seizures
156
What drug causes hypertension when you eat cheese or red wine?
MAOI (eg phenelzine), caused by tyramine containing foods
157
Name 3 MAOIs
phenelzine, selegiline, tranylcypromine
158
What is the first line medication for mania/bipolar?
lithium
159
Pharmacotherapy for both smoking cessation and depression?
buproprion
160
How long do you need for washout between anti-depression medications?
"6 weeks" (really 3, but really really 3-6)
161
How long do you treat depression for once you've found the maximal tolerable dose?
6 months
162
What are backup medications for mood stabilization if Li and valproate can't be used?
Lamotrigine and quetiapine (carbamezapine losing favor)
163
What does trazodone do?
works as a sleep aid
164
What medications, originally designed for depression, treat neuropathic pain?
tricyclics
165
What does mirtazapine do?
treats depression and stimulates appetite
166
What mood stabilizer causes nephrogenic diabetes insipidus?
lithium
167
In pregnant woman, which mood stabilizers can you NOT use?
lithium and valproate
168
Valproic acid teratogenicity can lead to?
Spina bifida
169
How long do you give an SSRI before increasing the dose?
6 weeks
170
When can quetiapine be used to treat bipolar?
Can be given in all phases, used as an adjunct to Li or valproate
171
What are the side effects of SSRIs?
decreased libido, delayed ejaculation, GI, insomnia
172
Pharmacotherapy for chronic anxiety?
SSRI
173
Treatment for performance anxiety?
beta blockers (eg propranolol)
174
Pt has been tried on 14 different antipsychotics, symptoms persist, tx?
clozapine (be aware of agranulocytosis side effect)
175
Blocking dopamine in the tuberoinfundibulnar tract causes what?
Prolactin disinhibition = gynecomastia (men) or amenorrhea, galactorrhea (women)
176
What medications come in a Depot for long term use in non compliant pts?
Olanzapine, risperidone, and haloperidol
177
Positive symptoms of schizophrenia are caused by what? Where are they found?
D2C dopamine receptor in the mesolimbic tract
178
What's the potency of haloperidol?
high potency - it has many EPS side effects
179
You want to start an atypical (SGA) antipsychotic. What do you need first?
ECG for QTc assessment
180
Olanzapine is associated with what side effects (3)?
diabetes, weight gain, metabolic syndrome
181
Repetitive involuntary facial muscle mvmt on an antipsychotic - diagnosis and treatment?
tardive dyskinesia; stop the medication
182
Blocking dopamine in the nigrostriatal tract causes what?
Parkinsonism
183
Treat acute dystonia with?
benztropine (diphenhydramine is ok)
184
What anti-psychotic medications come in rapid IM form for combative pts?
Haloperidol
185
Pt's eyes are locked in an upward gaze yet she is still fully cognizant of her inability to look down, dx?
Oculogyric crisis, acute dystonia
186
Negative symptoms of schizophrenia are caused by what?
5-HT1 serotonin receptor activation
187
Additional side effect (potentially a benefit) of quetiapine?
drowsiness (used in manic pts with trouble sleeping)
188
What medications come in ODT for mild control of combative patients?
Olanzapine and risperidone (ODT = orally disintegrating tablet)
189
Treatment of dyskinesia from antipsychotic use?
Benztropine (amantadine is ok); any dopamine agonist would be WRONG here
190
Physical symptoms associated with stopping a substance is ___
Withdrawal
191
Needing more of a substance to feel the same effect is ___.
tolerance
192
An adolescent experiments with EtOH with his peer group but never uses it alone, dx?
normal behavior
193
What are the biggest risk factors for addiction (2)?
Hereditary (genes), early access to gateway drugs (alcohol, marijuana, etc)
194
What is CAGE, and how does a person screen positive?
Cut down, Anger, Guilt, Eye Opener; any 1 positive counts
195
Altered mental status, ataxia, opthalmoplegia: cause?
Wernicke's encephalopathy, due to thiamine deficinecy. Common in alcoholics due to malnutrition. Chronic condition, but reversible
196
What is the most effective means of treating substance abuse disorder?
Group therapy (i.e. AA) but ultimately whatever works for the patient
197
Paranoid delusions, auditory/visual/tactile hallucinations. Intoxication with?
stimulants (cocaine, amphetamines) = stimulant induced psychotic disorder (bugs crawling under the skin aka "coke bugs" are classically associated with cocaine, but caused by other stimulants as well)
198
Psychosis, nystagmus, agitation, superhuman strength. Intoxication with?
PCP
199
Conjunctivitis, dry mouth, delayed cognition, slowed reflexes. Intoxication with?
marijuana (THC)
200
Patient presents with slurred speech, ataxic gait, and cerebellar dysfunction. Best test?
blood alcohol level
201
In a benzodiazepine overdose, what are you giving for the antidote and what do you need to watch for?
flumazenil (causes seizure)
202
Pinpoint pupils, respiratory depression, and track marks. Intoxication with?
Opiates (heroin)
203
Water intoxication (hypoNa), overheating, and pupillary dilation suggests intoxication with?
MDMA (Ecstasy)
204
Treatment for EtOH withdrawal?
long acting benzo taper with short acting benzo prn
205
Diastolic HTN, tachycardia, tremor, and diaphoresis suggests withdrawal to what?
EtOH (also benzos!)
206
What is the antidote for an opiate overdose?
naloxone
207
What treatment should you use for an opiate addiction?
Naltrexone, suboxone, or methadone (they're all = to each other)
208
Yawning, lacrimation, nausea, vomiting, diarrhea, and intense pain suggests __ withdrawal.
opiate
209
Name two rapid acting benzos. Name 2 long acting.
alprazolam and lorazepam; diazepam and chlordiazepoxide
210
What happens to sleep latency when you've been sleep deprived (ie on a 30 hour call)?
decreases (you enter deep sleep faster!)
211
Child is upright, screaming in bed, inconsolable, and doesn't remember the event (parents tell you about it). Diagnosis?
Night terror
212
When you've been waking up for 48 hours taking 30 minute naps here and there, what happens to REM latency?
goes down (you get to REM faster)
213
Theta waves and absent alpha waves are indicative of which sleep stage?
Stage I
214
What do alcohol and benzodiazepines do to sleep architecture?
suppress REM
215
K-complexes and sleep spindles are in what stage of sleep?
Stage II
216
Which medications can cause sleepwalking?
BZD1 (ambien)
217
What does an EEG of REM resemble?
awake state
218
What happens to tone during non-rem sleep?
it's maintained
219
A pt mumbles incessantly each night they are asleep. The spouse wants it to stop. What do you do?
reassurance (sleep talking)
220
What happens to tone during REM?
atony
221
__ is when a person harms themselves to be admitted as a pt
Factitious disorder
222
Harming a child or elderly dependent in order to be a patient or care for their injury, diagnosis?
factitious disorder by proxy (Munchausen)
223
A pt loses use of his arm after striking wife. There is no evidence of stroke or cord lesion. Diagnosis?
Conversion (functional neurologic symptom disorder)
224
What boundaries should be set when dealing with a somatic symptom disorder pt (2)?
One physician + regularly scheduled appointments, but no more than that
225
A pt with somatic symptom disorder has various somatic complaints. Today, there is crushing sternal chest pain with diaphoresis, dyspnea, and presyncope. What do you do?
Treat like MI
226
Harming oneself or lying to get money or freedom is __.
malingering
227
A pt is preoccupied with getting sick despite reassurance that he is medically well. Diagnosis?
Illness anxiety disorder (hypochondriasis)
228
How do you diagnose obstructive sleep apnea?
polysomnography (sleep study)
229
Pt can't fall asleep or stay asleep, and feels tired during the day. Next step (2 and 1 don't)?
investigate: rule out mood disorders (MDD, bipolar disorder), drugs, medical causes. Evaluate sleep hygiene. DO NOT give sleep aid.
230
Tx for OSA?
CPAP (=PEEP) and weight loss
231
Diagnosis: pt is overweight, sleepy during the day, and snoring at night
Obstructive sleep apnea
232
What is it called when a loud bang causes a pt to lose all tone, fall to the floor, and fall asleep?
cataplexy (sx of narcolepsy)
233
Treat narcolepsy with?
scheduled naps, stimulants (modafinil, methylphenidate, amphetamine)
234
Pt falls asleep spontaneously during the day and feels well rested upon waking, dx?
narcolepsy
235
What's the diagnostic step for narcolepsy (2)?
CSF-Hypocretin-1 and narcolepsy
236
Pt sleeps 6 hrs/day and reports difficulty falling asleep at night, feels tired. Diagnosis?
insomnia
237
Define good sleep hygiene (6)
```
bed is for sex and sleep only
lights off = sleep time
avoid stimulants
avoid exercise
avoid EtOH
avoid fluids (all before sleep)
```
238
Exposing one's genitals to strangers is an example of what paraphilia?
Exhibitionism
239
A man believes he is a woman trapped in a man's body. What is this?
Transgendered
240
Who is most likely to be molested?
female children (by adult males) - homosexuality is much less common
241
A man on a crowded subway grabs woman's legs and buttocks in the crowd. Paraphilia?
Frotteurism (touching, rubbing on a non-consenting person)
242
A person who gets pleasure from watching unknowing people undress. Paraphilia?
voyeurism
243
What is the single greatest risk for becoming a child molester?
being molested
244
Treatment for akathisia?
beta blocker (propranolol) or benzo (lorazepam)
