Psychiatry Flashcards
Young female BMI 16bcoming to you with 1ry amenorrhea first inv…
US
Female BMI 16 with bony pain first inv
DEXA scan ..osteoporosis
Priority in anorexia nervosa
electrolytes (hypo K)
Most common:
Effect of anorexia nervosa on pregnancy
…Low birth weight
Effect of malaria on pregnancy
.low birth weight
Effect of cocaine on pregnancy
low birth weight
Effect of smoking on pregnancy
low birth weight
Main difference bet bulimia and anorexia nervosa
…normal weigh
Long term prognosis of bulimia nervosa
depression
Long term prognosis of OCD
..PSYCHOSIS
Long term prognosis of borderline personality disorder…
PSYCHOSIS
Long term prognosis of generalized anxiety
depression
Long term prognosis of panic attack……
depression
Psychiatric disorder causing highest rate of death
anorexia nervosa
Female always feel that she is overweight although normal BMI
.body dysmorphic disorder
Causes of body dysmorphic disorder?
2-anorexia nervosa
3-amputated limb
4-acromegaly
5- neglect syndrome
Distrustful suspicious person
paranoid
Female with history of crimes, drug abuse, sexual troubles, left her family and lives alone
borderline
Male with history of crimes, drug abuse, sexual troubles, left his family and lives alone more than 18 yrs
antisocial
Most risk with borderline
…suicide
Psychotherapy for borderline
dialectal
Psychotherapy for trichillomania
…..aversion
Male lives alone does not care about people
…schizoid
Male lives alone feels being rejected
..avoidant
Male lives alone with ideas of reference
…schizotypal
Male with high self esteem does not show empathy
.narcissitic
Female being abused by her boy friend but still feels as if she can never live without him…
dependent
Female gives great care to the order of furniture in her home and has a strict schedule of her life routine.
Obsessive compulsive
Female during interview wear sexy clothes and tries to seduce the employer to get the job
…histrionic
Child 5 yrs his mother complains of his overactivity and that he does not listen to what she says
.ADHD
First step to confirm ADHD
call the teacher and ask for his grades
Drug of choice for ADHD
.methyphenidate
Most imp test for ADHD………
..hearing test
Boy 4 yrs old with low IQ limited social activity, limited language development , fascinating with certain toys…..
AUTISM
Boy 4 ys old with normal IQ , limited social activity, normal language development , fascinating with certaing toys
.asperger
8 yrs child doing recurrent grimacing and recurrent strange sounds….
.Tourret’s
Most common association with Tourret’s……
OCD
Drug of choice for tourret’s
…antipsychotic
Child 14 yrs with history of drinking alcohol and recurrent fighting with his peers in school
Conduct
Is masturbation normal act?
..yesssssss
Is being Gay or lesbian normal act ?….
yesssssss
TTT of choice for :
Anorgasm
.self stimulation
Premature ejaculation, what to do?
….squeeze technique
Vaginismus
…vaginal dilators
Male feels orgasm by wearing his girlfriend underwear
.transvestism
Male feels orgasm by rubbing his body against clothed females in crowded places
……frotteurism
Male feels orgasm by having sex with kids….
pedophilia
Male feels that he is a woman in male’s body and asking for plastic surgeries to change his sex
transsexualism
Young females with recurrent attacks of hyperventilation, palpitations and feeling as if she will die…
panic
Long term prognosis of panic
depression
Most common association with panic
…agoraphobia
TTT of acute attack of panic……
benzodiazepine
Lab of panic
alkalosis, hypocapnia and increased O2
Woman with marked fear each time she has to give public speaking
social phobia
Best ttt for specific phobia
gradual exposure
Imp test for dementia
MMSE test|( less than 24)
There is no definitive investigation for Alzheimer
Alzheimer is not preventable nor curable
First to be affected in Alzheimer
memory
Least likely to be affected with Alzheimer is?
face recognition
Psychiatric illness increases in incidence
dementia
Memory affection with normal aging sometimes very similar to Alzheimer except that there is no impairment of normal function
he lives independently
CT of Alzheimer
brain atrophy with ventricular enlargement
Drug of choice for alzheimer
donepezil, tacrine
Best drug for alzheimer with heart disease
memantine
Dementia + visual hallucinations + parkinsonism
.lewy body
Dementia+personality changes+abnormal movements
Huntington
Dementia+urine incontinence+abnormal gait
normal pressure hydrocephalus
Dementia+young aged male with uncontrolled HTN
Vascular
Short history of dementia+sleeping troubles
depression
Old age in the hospital sleeping during the day, agitated
delirium
Most imp inv for delirium
urine analysis
Most imp drug to control agitation in delerium
.antipsychotic
Agitation in admitted person
think of alcohol withdrawal
TTT of alcohol withdrawal
diazepam
Female being raped now complains of flashbacks and troubles in sleeping
PTSD
Most effective ttt in PTSD
group counseling
Drug of choice for PTSD
SSRI
Drug of choice for OCD
SSRI
Drug of choice for depression
SSRI
Drug of choice for GAD
SSRI
Long term ttt for panic
.SSRI
Female patients with a long history of hospital admissions with many procedures and surgeries done
factitious
Kid admitted hospital becomes sick only when his mom visits him
munchausen syndrome by proxy
Male patient comes to the clinic with severe renal colic asking for strong analgesics, his investigations normal
malingering
First step in this patient of malingering
urine sampling in front of you
Male patient alcoholic now complains of nystagmus, gait instability and drowsy
wernicke’s encephalopathy
Main cause of wernicke’s encephalopathy
thiamine deficiency
TTT of wernicke’s encephalopathy
THIAMINE then GLUCOSE
Police brings to you male confused doesn’t know his name , you found airline ticket in his pocket….
dissociative fugue
Causes of IMPULSE CONTROL DISORDER?
1-KLEPTOMANIA
2-PYROMANIA
3-TRICHOTILLOMANIA
4-PATHOLOGICAL GAMBLING
Female patient with recurrent acts of stealing of stuff she does not really needs
KLEPTOMANIA
Main ttt of kleptomania
aversion
Male patient with recurrent episodes of doing firing in home and school
pyromania
Why pyromaniacs do firing……
satisfaction
Female patient with no hair on half of her scalp
TRICHOTILLOMANIA
Main ttt of grief
support
TTT of grief and depression
SSRI
Most imp to depression with grief
suicidal ideation
Grief + visual hallucination
abnormal grief
Imp question to patient with postpartum
if she has any feeling of hurting herself or her baby
Main risk factor for postpartum psychosis
….primipara
Important steps for mild postpartum blue
family involvement and continue breastfeeding
Treatment of cases of postpartum psychosis
…involuntary admission and .ECT
Inability to answer a question without giving excessive, unnecessary detail.. but eventually will answer the question
.Circumstantiality
if does not answer the question
tangentiality
feeling that you saw this situation before
.deja vu
Female patient told you that a very famous celebrity loves her
…delusion of erotomania
Male patient came to told shouting that he is God and should be followed
..delusion of grandiosity
Old age patient anxious telling you his neighbors trying to kill him by putting poisons in his food
.delusion of persecution
Patient feels that the people are talking about him
.delusions of reference
2 sisters sharing the same psychotic symptoms
folie a deux
Female patient with recurrent thoughts of cleaning her hands
OCD
Long term prognosis of OCD
……psychosis
Female patient worries about her financial condition and also about her husband’s work ……
GAD
Main ttt of GAD
.SSRI
Long term prognosis of GAD……
depression
Female patient with recurrent thoughts of washing her hands
OCD
Young boy taking more than 10 showers per day…
OCD
Drug of choice for OCD in kids……
SSRI
Young male with recurrent attacks of sleeping per day that are accompanied with hallucinations
…narcolepsy
Main ttt of narcolepsy
…psychostimulant
Middle age male obese with recurrent attacks of sleeping and his wife complains of his snoring
…Obstructive sleep apnea
Inv of choic for OSA….
polysomonography
First advice for this patient OSA
loss weight
TTT of choice of OSA
…CPAP
What does insomnia means
…bad quality of sleep
Main ttt of insomnia
……non pharmacological
Drug of choice for insomnia
.short acting benzodiazepine
Duration to diagnose depression
2 weeks
Duration to diagnose schizophrenia……
6 months
Duration to diagnose schizophreniform
.1-6 months
Duration to diagnose brief psychotic disorder.
less than I month
Duration to diagnose PTSD
.more than 1 month
Drug of choice for depression
SSRI
No effect after usage of SSRI for 1 week….
just continue
Effect of SSRI appears after……
2-6 weeks
When to shift to another drug…..
no effect after 2 months
How long to use SSRI
at least 6 months
How long to use SSRI in suicidal patient….
2 YEARS
ld age + severe depression
ECT
Depression+smoker
…..bupropion
Depression+insomnia……..
mirtazapine
Depression + decreased appetite……….
mirtazapine
Most common season for depression
Winter
Most common season for suicide……………
Spring
Most common season for SIDS
Winter
Depression memory impairement
……pseudodementia
Depression and suicide
when is the Highest risk of suicide
first two weeks after leaving hospital
Most important question to depressed patient……..
suicidal thoughts
Highest probability of suicide
..history of previous suicidal attempt
Once you discover suicidal thoughts
…involuntary admission
Most risky patients
have a plan of suicide
SSRI + Ecstasy…….lead to?
serotonin syndrome
First step in serotonin syndrome
..stop both drugs
Food should be avoided in patient taking MAOI….
cheese and wine
What should be screened in patient taking MAOI
.blood pressure
Patient on SSRI comes back to you complaining that there is no improvement………
….just.continue the medications
how to stop SSRI ?
.TAPPERING SHOULD BE DONE FOR 2_4 WEEKs
Effect of overdose of TCA
…arrhythmia
Most imp Inv in TCA overdose?
ECG
How to assess severitty of TCA overdose
…….duration of QRS complex
Antidote for TCA overdose……
NaHco3
Tests should be done in patient on lithium
.TSH and RFTs (thyroid and Kidneys)
Main SE of lithium toxicity…..
ataxia, dysarthria delirium
TTT of lithium toxicity
…dialysis
Main SE of carbamazepine
……leucopenia
Main SE of lamotrigine
…rash
Patient coming to ER with neck contracted to one side
…dystonia
TTT of acute dystonia
…diphenhydramine and benztropine
Main 2 categories of drugs causing extrapyramidal symptoms
…antipsychotic and anti emetics drugs
Patient on antipsychotic with continuous urge to move around the room……
akathisia
Patient on antipsychotic with twitching of his face, tongue and hand
.tardive dyskinesia
Patient on antipsychotic coming to ER with high fever, high blood pressure…….
neuroleptic malignant syndrome
Risk with neuroleptic malignant syndrome
…rhabdomyolosis….acute renal failure
TTT of choice for neuroleptic malignant syndrome…
dantrolene or bromocriptine
Monitor of clozapine for? with?
CBC( AGRANULOCYTOSIS)
Monitor of olanzapine
…FBS and lipid profile
First line therapy for schizophrenia
olanzapine
schizophrenia + insomnia
olanzapine
drug with the least side effects
quitiapine
schizophrenia+ oversleeping…
respiridone
Most important step in psychotherapy
establish good relationship with the patient
Main SE of ECT
Transient memory disturbance
Schizophrenic patient taking marijuana first step
.stop marijuana
Duration of usage of SSRI in suicidal patients……
2 yrs
Type of SSRI in kids
.fluvoxamine
Most imp to monitor in venalfaxine
…blood pressure
Patient with pin point pupil and RR 6/min
.morphine toxicity
TTT of morphine toxicity,…… (opiod)
naloxone
Patient with pinpoint pupil, diarrhea and marked crepitation heared on the lung……
organophosphorus poisoning
TTT organophosphorus….
atropine and oxime
Patient with piloerection, yawning, rhinorrhea and myalgia…
.morphine withdrawal
TTT of morphine withdrawal…..
methadone
Main SE of benzodiazepine withdrawal….
agitation
Type of benzodiazepine causing withdrawal symptoms…
short acting
TTT of benzodiazepine overdose
Flumazenil
Effect of cocaine on brain
stroke
Effect of cocaine on nose
septal perforation
Effect of cocaine on heart
MI
Effect of cocaine on skin
bugs under skin
Effect of cocaine on placenta
.abruptio placenta
Effect of cocaine on fetus
low birth weight.
Effect of cocaine on fetus
teratogenic
Most common teratogenic substance
alcohol followed by cocaine
Main SE of cocaine withdrawal
skin bugs
Main SE of PCP toxicity
vertical/horizontal nystagmus
Main SE of LSD toxicity…
hallucination
Main SE of cannabis toxicity
increased appetite, dry mouth, conjunctival injection
Active form of cannabis
etra hydro cannabinoid
Main TTT to help patient stop smoking
nicotine patch
alcohol questionnaire
CAGE
- Have you ever felt the need to Cut down on your drinking?
- Have you ever felt Annoyed by criticism of your drinking?
- Have you ever felt Guilty about drinking?
- Have you ever had to take a morning Eye opener?
Most imp question to detect alcohol addiction
….morning eye opener
Most important risk factor for:
Anorexia nervosa.
family history of athleticism
Bulimia nervosa
history of child abuse
Binge eating
family history of obesity
Weight loss in young female without others symptoms except psychic problems
drug or alcohol abuse
Drug of choice for catatonic schizophrenia
..benzodiazepine
Most common drug used in parties
Ecstasy (MDMA)
Most important sign of amphetamine withdrawal
paranoia
Most important sign of amphetamine toxicity
…psychosis followed by hallucinations
Drug of choice for agitation of drugs
antipsychotic
Patient on SSRI comes back to you complaining that there is no improvement
just continue the medications
Patient on SSRI still have symptoms first step
increase dose
Patient on SSRI developed side effects
..shift to another SSRI
Most common side effect of SSRI
.abdominal pain and agitation
Patient on SSRI after taking tramadol developed serotonin syndromes first step
….stop both of them
Donepezil and SSRIs
Synergistic effect
First step
.stop both of them
Police brings to you homeless psychotic patient :
First step
.collateral history from the police
If agitated
…antipsychotic then admission
If not agitated……
admission
Where to admit
.psychiatric unit
DD of sudden withdrawal manifestation in teenagers??
1-drug abuse……..need to be excluded first
2-depression…..associated with decreased appetite, enegery, sleep and suicisal thoughts
3-prodrome of schizophrenia……associated with delusions and hallucinations
Delusion with pregnancy…………
clozapine
Drug causing teratogenicity in first trimester
..anticonvulsant
Drug causing teratogenicity in last trimester
..antipsychotic
First step if mom complains of behaviouir of her son …..
interview with the son
Currently ttt of choice in agitated person if:
Psychotic patient
..antipsychotic medications
Delirious patient
..antipsychotic medications
Postoperative……………..
antipsychotic medications
Amphetamine toxicity…………………
antipsychotics
Alcoholic………
diazepam
Alcoholic and liver impairment…….
.lorazepam
Selective Mutism
where children will speak freely in somesettings (usually at home) but not in others
Patient with dementia needs urgent surgery first step
.ask for advanced directive
Serious complication of amphetamine poisioning?
MI
Least common side effect of lithium?
Renal impairment
Motor restlessness of feet and legs is termed?
Akathisia
Muscle spasm of neck, face tongue and trunk is termed?
Dystonia
Tx of Hoarding disorder?
CBT
what is LESS common presentation in bipolar vs unipolar depression?
Decreased appetite
In eating disorder, expect family history of what?
Obesity
What is not a key diagnostic feature of eating disorder?
Hirsutism
Believes that someone replaces your loved one is called?
Capgrass syndrome (dilusional misidentifivation syndrome)
MCC of death in TCA overdose?
Arrhythmias
Pt develops lethergy while on long term Lithium therapy, Check what?
Thyroid function
flight of ideas is a feature of?
not?
Bipolar
not schizophrenia
What is clock drawing test used for?
Access severity of dementia
which antipsychotics protect against depression in a pt with Bipolar disorder?
Olanzapine and quetiepine
only effective ssri for kids?
fluoexetine
