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STEP 2 > Psychiatry (Boards and Wards) > Flashcards

Psychiatry (Boards and Wards) Flashcards

1
Q

What is a common side effect that SSRIs DONT have?

A

impotence (rare)

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2
Q

What are the more severe side efffects of TCAs?

A

confusionsedation (good for people with insomnia at night)

orthostatic hypotension prolonged QRS

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3
Q

What are the common side effects with MAOIs

A 
Serotonin syndrome (interaction with SSI, meperidine (demerol), pseudoephedrine)--> hyperthermia, muscle rigidity and altered mental status
Hypertensive crisis--malignant hyperthermia when ingested with foods rich in tyramine (wine and cheese)
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4
Q

What are the SNRIs

A

Mirtazapine and Duloxetine

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5
Q

What is a side effect associated with Mirtazapine?

A

agranulocytosis

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6
Q

what is required to diagnose MDD?

A

two depressive episodes >2 weeks each, separated by 2 months

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7
Q

What is dysthymic disorder?

A

steady depressive sx for at least 2 years (if major depressive episode occurs during the 2 yrs, then the Dx is MDD rather than dysthymic disorder

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8
Q

What is the treatment for dysthymic disorder?

A

Same as MDD

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9
Q

What drug toxicities should you consider in a patient who may have bipolar disorder?

A

cocaine, amphetamine

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10
Q

What is the difference between a manic episode and a hypomanic episode?

A

manic cause significant disability, hypomanic have the same sx but do not cause a significant disability

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11
Q

What are the diagnostic clues for bipolar disorder

A
  1. manic episodes causing significant disability

2. episode lasting at least 1 week, abrupt, not continuous

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12
Q

What is the difference between Bipolar I, bipolar II and rapid cycling

A

Bipolar 1 : manic episode with or without depressive episodes (often depression before mania)
Bipolar 2: depressive episodes with hypomanic episodes and NO manic episodes
Rapid cycling: four episodes (depressive, manic or mixed) in 12 months, **can be precipitated by antidepressants

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13
Q

What are the first line treatments for bipolar disorder?

A

Valproate and lithium

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14
Q

What is a common side effect with Valproate and carbamazepine?

A

blood dyscrasias

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15
Q

What are symptoms of lithium toxicity?

A

tremorpolyuria from nephrogenic DI

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16
Q

What drugs are commonly the cause of drug induced mania?

A

cocaineamphetamines

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17
Q

An ECG arrhytmia or ischemia in a young person should make you suspicious of what?

A

Drug induced mania (also tachy, HTN, dilated pupils)

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18
Q

How treat drug-induced mania?

A

Ca-channel blockers for acute autonomic sx (drug programs are better for the long-term)

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19
Q

What are the hallmark symptoms of psychosis?

A

hallucinations and delusions

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20
Q

How treat someone with psychosis who has compliance issues?

A

depot of Haldol which administers a 1mo supply of drug in a IM injection

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21
Q

What are examples of negative symptoms?

A

flat or lack of affect, avolition, alogia (poverty of speech)

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22
Q

What are positive symptoms?

A

hallucinations and delusions

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23
Q

What are the timelines for schizophrenia vs. schizophreniform vs. brief psychotic disorder?

A

Brief psychotic disorder - 1d to 1mo
Schizophreniform - 1-6mo
Schizophrenia - >6mo continuous

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24
Q

What is a delusional disorder?

A

non-bizarre delusion, i.e. things that are possible, like a cheating spouse, etc, WITHOUT hallucinations, disorganized speech or behavior

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25
Q

What kind of hallucinations do LSD and PCP cause?

A

primarily visual, taste, touch or olfactory

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26
Q

what drugs cause paranoid delusions and feeling like bugs are crawling on your skin?

A

cocaine and amphetamines

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27
Q

what drug can cause psychosis and mood disturbances early in the course of therapy?

A

corticosteroids

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28
Q

What has a higher potency, chlorpromazine or haloperidol?

A

haloperidol

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29
Q

What are the adverse effects of haldol?

A

decreased anticholinergic effects, increased movement effects

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30
Q

what are the adverse effects of chlorpromazine?

A

increased anticholinergic effects (ch in this and chlorpromazine), and decreased movement effects

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31
Q

What are the adverse effects with Clozapine

A

1% incidence of agranulocytosis–> weekly CBClowers seizure threshold

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32
Q

What are the side effects of Risperidone?

A
  • rare movement disorders (though can occur at high doses)

- new onset diabetes

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33
Q

What are the side effects of Olanzapine, quetiapine, ziprasidone and aripiprazole?

A
  • new onset diabetes

- ziprasidone and aripiprazole can cause LESS weight gain

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34
Q

How long does a panic disorder attack usually last?

A

escalate for 10 mins, remain for ~30 mins (rare to last over an hour)

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35
Q

If a young pt with symptoms of an MI presents, what dx should you consider?

A

panic disorder

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36
Q

How dx panic disorder?

A

dx of exclusion of medical condition and drug abuse

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37
Q

Treatment options for panic disorder?

A

SSRI + benzo, taper benzo after a month

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38
Q

What is acute dystonia? How long does it last?

A

sustained muscle spasm anywhere in body but often in neck (torticollis), jaw or backlasts 4hrs–> 4days

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39
Q

Tx for acute dystonia?

A

immediate IV diphenhydramine

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40
Q

What is parkinsonism? Time course?

A

cogwheel rigidity, shuffling gait, resting tremor4days–>4months

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41
Q

what is the tx for parkinsonism?

A

benztropine (anticholinergic)

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42
Q

What is tardive dyskinesia? time course?

A

involuntary, irregular movements of head, tongue, lips, limbs and trunk4mo–>4yrs

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43
Q

Tx for tardive dyskinesia?

A

immediately change meds or decrease doses b/c effects are often permanent

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44
Q

What is akathisia? time course

A

Subjective sense of discomfort that leads to restlessness (pacing, sitting down and getting up)Any Time

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45
Q

Tx for akathisia?

A

lower medication doses

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46
Q

What is neuroleptic malignant syndrome

A

life threatening muscle rigidity with fever, increase BP and HR, rhabdomyolysis over 1-3 daysLabs: increased WBC, CK, transaminases, myoglobin and myoglobinuria

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47
Q

Tx for neuroleptic malignant syndrome?

A

Supportive, stop drug and give dantrolene (which inhibits calcium release into cells), cool patient to prevent hypoxia

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48
Q

What is agoraphobia?

A

fear of being in situations where escaping would be very difficult should a panic attack arise

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49
Q

What is the treatment for phobias?

A

Beta-blockers for prophylaxisExposure desensitization: exposure to noxious stimulis in increments while undergoing concurrent relaxation

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50
Q

What is the difference between obsessions and compulsions?

A 
obsessions = recurrent thought
compulsions = recurrent acts

obsessive thought causes anxiety and the compulsion is a way of temporarily relieving the anxiety

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51
Q

What is the difference between OCD and obsessive-compulsive personality disorder?

A

OCD - aware/recognize the absurdity
OC personality disorder
- don’t see anything wrong with compulsion

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52
Q

Treatment for OCD?

A

SSRIs or clomipramine, CBT in which patient is forced to overcome the behavior

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53
Q

What are some of the hallmark symptoms of PTSD?

A
  • reliving initial incident via conscious thoughts or dreams
  • avoiding public places and activities
  • depression, moodiness, difficulty sleeping and concentrating
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54
Q

What is the difference between Acute Stress Disorder and PTSD?

A

Acute stress disorder also requires a traumatic incident, but sx are more immediate (within 4 wks of event) and last

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55
Q

Tx for PTSD?

A

SSRIs are first line

**watch out re Benzos b/c there is a high association between substance abuse and PTSD

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56
Q

What is Generalized Anxiety Disorder?

A

worry for most days for at least 6 months

  • irritable, inability to concentrate, insomnia, fatigue, restlessness
  • need evidence of social dysfunction (ex. poor school grades, mental stagnation, etc.)
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57
Q

Tx for GAD?

A

psychotherapy because problem is chronic
CBT
Biofeedback and relaxation techniques
Pharm: Buspirone, B-blockers for peripheral sx like tachycardia, but doesn’t address the worry)

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58
Q

What is a general symptom of personality disorders?

A

pervasive pattern of maladaptive behavior causing functional impairment
consistent behavior often traced to childhood
-pts usually don’t see anything wrong with their behavior

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59
Q

What are ego defenses?

A

unconscious mental processes that individuals resort to in order to quell inner conflicts and anxiety that are inacceptable to the ego (ex. denial and projection)

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60
Q

What are Cluster A personality disorders?

A

Paranoid, schizoid and schixotypal (weird or eccentric)

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61
Q

What are Cluster B personality disorders?

A

Borderline, antisocial, histrionic and narcissistic (dramatic, wild and aggressive)

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62
Q

What are Cluster C personality disorders?

A

Avoidant, dependent, and obsessive compulsive (shy and nervous)

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63
Q

What is acting out

A

transforming unacceptable feeling into actions, ex. tantrum

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64
Q

What is displacement?

A

redirection of some emotion from a real source to a substitute person or object

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65
Q

What is introjection?

A

identifying with some idea or object so deeply that it becomes a part of that person

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66
Q

What is projection?

A

attributing unacceptable thoughts, feelings, behaviors and motives to others

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67
Q

Paranoid personality disorder characteristics?

A
  • negatively interpret actions and words of others
  • often use projection as ego defense (attribute to other people impulses and thoughts that are unacceptable to self)
  • do not hold fixed delusions or have hallucinations
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68
Q

Schizoid personality disorder

A
  • socially withdrawn, introverted
  • don’t feel need to form close emotional ties with others
  • can recognize reality(D for distant)
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69
Q

Schizotypal personality disorder

A 
Believe in concepts not considered real by rest of society/culture (magiv, vlairvoyance
)-Ego defense: fantasy
-no necessarily psychotic
-usually socially isolated
-often related to schizophrenics
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70
Q

Antisocial personality disorder

A

violate rights of others, break lawDx: have to have exhibited behavior BY age 15, BUT have to BE at least 18 for DxDDx = conduct disorder which is bad behavior dx in kids

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71
Q

Borderline

A
  • volatile emotionally
  • Ego defense: splitting
  • self-destructive behavior
  • can disassociate: forget negative experiences by covering them up with overly exuberant positive behavior
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72
Q

Histrionic

A
  • require everyone’s attention

- use disassociation and repression (block feelings unconsciously)

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73
Q

Narcissistic

A

feeling entitled, because they are the best ande veryone else in inferiorhandle criticism poorly

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74
Q

Dependent personality disorder

A

can’t do much on own, can’t be alone

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75
Q

Avoidant personality disorder

A

Feel inadequate, very sensitive to negative comments

Reluctant to try new things for fear of embarassment

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76
Q

Obsessive Compulsive Personality Disorder

A

preoccupied with detail Isolation is a common ego defense

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77
Q

What is rationalization?

A

making the unreasonable seem acceptable (ex. if you get fired, saying that you wanted to quit anyway)

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78
Q

What is Reaction formation

A

setting aside unconscious feelings and expressing the exact opposite feelings (showing extra affection for someone you hate)

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79
Q

What is Sublimation?

A

taking instinctual drives (ex. sex) and funneling that energy into a socially acceptable action (studying) behavior or emotion

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80
Q

What is the difference between factitious disorder and malingering?

A

Factitious disorder = consciously faking or manipulating sx to ‘assume the sick role’ but not for material gainMalingering = consciously faking sx for material gain

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81
Q

Munchhausen is an example of what kind of disorder?

A

Factitious Disorder

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82
Q

What is somatoform Disorder?

A

ex. female pt with problems starting before age 30 w/history of frequent visits to the doctor for countless procedures and operations (often exploratory) and h/o abusive or failed relationships

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83
Q

treatment for somatoform disorder

A

continuity of care, regular appointments so pt can express sx, perform phys exam but don’t order labs, eventually suggest psych

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84
Q

What is conversion disorder?

A

neuro sx, not consciously fakedsensory defecits usually fail to correspond to a known pathwayDx: identify a stressor that preciptated the sx and exclude an adequate medical illness**some of these patients may be found to have a non-psychiatric cause of illness

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85
Q

Hypochondriasis

A

preocupation with dz, misinterprets sx as suggestive of something serious

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86
Q

Body dysmorphic disorder definition? Tx?

A

concern with body, usually 1 feature, imagines defecits that other people don’t see, exagerrate any slight imperfections if presentTx = SSRIs

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87
Q

Autism

A

pervasive developmental disorder that covers many areas of development from language, social interaction to emotional reactivity
-child is ‘living in own world
‘-sx begin by age 3

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88
Q

Aspergers

A

autism without language impairment

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89
Q

Depression in kids and teens

A

kids: can be hyperactive and aggressiveteens: can show boredom, irritability, openly antisocial behavior+ adult sx

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90
Q

Sx of Separation anxiety and Tx

A

sleep disturbance and somatic sx during times of separation (headache, upset stomach)Tx: desensitizing, imipramine sometimes used

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91
Q

Tx for ADHD?

A

methylphenidate, amphetamine (Ritalin, Concerta, Adderal)

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92
Q

Tourette’s Dx

A

require a motor tic and vocal tic for >1yr

vocal tics are usually obscene

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93
Q

Tx for Tourette’s

A

Haldol

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94
Q

Bulemia

A

binge eating and purging
more common than anorexia
can have nml appearance
Abrasion over knuckles and dental erosion

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95
Q

Cocaine/amphetamine withdrawal sx

A

hypersomnolence, dysphoria, increased appetite

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96
Q

Tx for Cocaine and amphetamines

A

Beta blockers for seizures and BP HR control

Ca channel blockers for ischemia

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97
Q

Heroin intoxication sx

A

decreased consciousness

pinpoint pupilsrespiratory depression

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98
Q

Heroin withdrawal sx

A

nausea/vomiting

pupillary dilationinsomnia

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99
Q

Tx for Heroin

A

Naloxone to reverse acute intoxication

Withdrawal tx with a methadone taper

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100
Q

Benzo and Barbiturates intox sx

A

respiratory and cardiac depression

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101
Q

Benzo and Barbiturates withdrawal

A

agitationanxietydelerium

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102
Q

Tx for Barb/Benzo intox

A

ABCscharcoal to reduce absorptionFlumazenil to reverse benzos acutely (but can cause seizures)

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103
Q

Sx and Tx for PCP intoxication

A

Intense psychosis, violence, rhabdo, hyperthermia

Tx: supportive, benzos or haldol for psychosisacidify urine with ammonium chloride and ascorbic acid

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104
Q

Sx of LSD intox

A

enhanced sensation: richer colors, music more profound, tastes heightened
tx = supportive

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105
Q

What is Dissociative disorder? What are the main symptoms?

A

possess different personalities that can each take control at a given time (key is shifting identities)

106
Q

What is adjustment disorder? What are the main symptoms?

A

behavioral or emotional sx that occurs in response to stressful life events in excess of what is normal-has a catch-all quality
Sx within 3 months of stressor and has to disappear within 6 months of disappearance of stressor
(bereavement is not adjustment disorder, they are separate)

107
Q

What is the hallmark of impulse control disorders?

A

cannot resist certain actions, feel anxiety before action and gratification afterwards

108
Q

do kleptomaniacs feel guilty about stealing?

109
Q

Tx for Narcolepsy?

A

stimulants like methylphenidate or pemoline

110
Q

What are associations and complications of sleep apnea?

A

assoc: hyperthyroidismcomplications: pulmonary HTN

111
Q

Sx of pickwickian syndrome

A

somnolence, obesity and erythrocytosis

pathophys: weight of adipose on lungs and abdomen cause chronic alveolar hypoventilation

112
Q

What are night terrors? When do they occur during sleep?

A

not fully awake, sit up suddenly in bed with sweating, tachycardia, feeling frightened
-arises during NREM sleep

113
Q

When do nightmares occur?

A

REM sleepusually after an emotional eventfully awake and can recall nightmare eventsassoc with drugs

114
Q

When does sleepwalking occur?

A

during NREM sleep

115
Q

Sx of restless leg syndrome

A

irresistible urge to move limbs, commonly causes limb jerking movements during sleep that disrupts sleep stages
Tx: dopamine agonist and tx of underlying causes, like thyroid replacement

116
Q

What test is important to do 3 months after starting Olanzapine?

A

Fasting glucose and lipids

117
Q

Dx of delusional disorder?

A

non-bizarre fixed delusions for at least 1 month

doesn’t meet schizophrenia criteria

functioning in life not significantly impaired

118
Q

What drug is used to treat social anxiety disorder?

A

Paroxetine (Paxil)

119
Q

What medication can lead to seizures if it is stopped too abruptly?

A

Xanax aka Alprazolam

120
Q

Treatment for performance social anxiety?

A

Propranolol

121
Q

What blood tests should be done before lithium is started?

A
  • creatinine

- thyroid function tests

122
Q

What is the most common side effect of methylphenidate?

A

Decreased appetite

123
Q

What is the mechanism of acamprosate?

A

increases GABA, decreases glutamate–> decreased cravings

124
Q

What are the symptoms of Wernicke encephalopathy?

A 
Acute thiamine deficiency leads to:
C: reversible Confusion
O: Ophthalmoplegia (CN6 palsy)
A: Ataxia
T: Thought disturbances
Tx = IV Thiamine
125
Q

What is Korsakoff psychosis?

A

chronic thiamine deficiency

  • irreversible retrograde/anterograde amnesia
  • confabulations
126
Q

What is the treatment for delusional disorder?

A

Psychotherapy

127
Q

If a patient with MDD fails a SSRI, what is the next drug treatment?

A

a different SSRI, then switch to a different drug class

128
Q

What is trazodone primarily used for?

A

insomnia related to depression

129
Q

What defecits can lithium cause in the 2nd and 3rd trimesters?

A

Goiter

Transient neonatal neuromuscular dysfunction

130
Q

What is the treatment for alcohol withdrawal?

131
Q

What is the treatment for GAD?

A

SSRI (escitalopram) + CBT

132
Q

what is the difference between childhood disintegrative disorder and Rett syndrome?

A

Rett girls> boys, CDD boys> girls

CDD has similar loss of previously acquired skills, but CDD has no decreased head growth or hand wringing

133
Q

Treatment for rapid cyclers?

A

Carbamazepine

134
Q

Treatment for Panic Disorder?

A

high dose SSRI for 8-12 months + CBTShort term Benzos for immediate relief from attacks

135
Q

Treatment for social phobia

A

SSRI (paroxetine) + CBT

136
Q

How distinguish normal stress reaction?

A

may be stressed and have decreased sleep, but does not cause any functional impairment

137
Q

What is a requirement for hospice?

A

prognosis of

138
Q

treatment for hoarding?

A

CBT and SSRI

139
Q

difference between somatization and conversion patients?

A

somatization patients are concerned about their condition, conversion pts don’t care

140
Q

Hypochondriasis time frame?

A

> 6 months

141
Q

Ddx Somatization from Hypochondriasis?

A

Hypochondriacs are worried about ONE thing, specific disease

142
Q

Treatment for body dysmorphic disorder

A

CBT + SSRI

143
Q

brain fag

A

headache, fatigue, and visual disturbances in African male student

144
Q

How dx delerium?

A

abnormal EEG

145
Q

if parents refuse therapy for their child that is non-emergent but potentially fatal what is the next step?

A

court orderif emergent, proceed with tx

146
Q

teen with behavioral changes, next step?

147
Q

Anti H2

A

sedation and weight gain

148
Q

Anti A1

A

orthostatic hypotensionsexual dysfunction

149
Q

Anti muscarinic

A

dry mouth, blurry vision, constipation, urinary retention, exacerbates Alzheimers

150
Q

anti D2

A

anti psychosis, EPS, increased prolactin

151
Q

Anti 5-HT1c

A

weight gain

152
Q

5-HT2

A

agitation, akathisia

153
Q

5-HT3

A

diarrhea, nausea + vomiting

154
Q

What are drugs that when combined with SSRIs can cause Serotonin syndrome?

A

MAOi, OTC cough meds, Linezolid

155
Q

What are drugs that when combined with MAOis can cause Serotonin syndrome

A

meperidine

MDMA/MDEA

156
Q

treatment for serotonin syndrome?

A

cyproheptadine or BDZ

157
Q

EPS Tx?

A

acute dystonia–> benztropine or diphenhydramine
akathisia–> B blockers or BDZ
Parkinsonism–> levodopa or amantadine

158
Q

What are the teratogenic defects caused by TCAs and BDZs?

A

TCAs: limb defects
BDZ: cleft palate and FAS facies

159
Q

which SSRI has the fewest withdrawal sx?

A

Fluoxetine (Prozac) bc has the longest half life

160
Q

Which SSRI has the most withdrawal sx?

A

Paroxetine (Paxil) due to shortest half life and most anticholinergic side effects

161
Q

Fluvoxamine is used to treat what?

162
Q

what is the treatment for TCA OD?

163
Q

what is the only antidepressant that can cause EPS?

A

Amoxapine (Asendin)

164
Q

Clomipramine major side effect?

A

very sedating, tx for OCD

165
Q

What are MAOis primarily used to treat?

A

atypical depression

166
Q

which type of antipsychotics are better for negative sx

A

atypicals (2nd gen) are better for negative psychotic sx

167
Q

which antipsychotic most likely causes increased prolactin and dystonic reactions

A

Risperidone (Risperdal)

168
Q

Likely cause if patient says Ziprasidone isn’t working?

A

patient wasn’t eating, food is required to activate Geodon in the body

169
Q

if someone on lithium has a blood level > 4.0, what is the next step?

A

hemodialysis

170
Q

Treatment for someone on lithium with HTN?

A

Ca channel blocker

171
Q

treatment for barbiturate overdose

172
Q

Benadryl has what kind of side effects?

A

anti-cholinergic

173
Q

What is Propranolol used to treat?

A

panic attacks, performance anxiety and akathisia

174
Q

patient has sx of schizophrenia, depression and bipolar 1 disease and is older, think…?

A

vascular dementia x frontal lobe infarct

175
Q

How does DA and 5-HT relate to libido?

A

DA increases libido5-HT decreases libido

176
Q

sildafenil is what kind of drug?

A

PDE5-inhibitor

177
Q

During what stage of sleep does sleepwalking, bedwetting and sleep terrors occur?

A

delta, stage 3-4

178
Q

What is the difference between acute and chronic insomnia?

A

acute is less than a month, chronic is more than a month

179
Q

What is Keine-Levin syndrome?

A

excess daytime sleepiness, aggression, hyperphagia, hypersexuality

180
Q

What is the treatment for cataplexy?

181
Q

What is delayed sleep phase disorder? tx?

A

sleep onset and awakening are delayed, nml duration/qualitytx: bright light phototherapy in AM, melatonin in evening

182
Q

What is advanced sleep phase disorder?

A

sleep onset and awakening are early, normal duration and qualitytx: bright light therapy in the evening

183
Q

tx for nightmares

A

image rehearsal therapyif severe, antidepressants

184
Q

REM sleep disorder: sx and tx

A

Sx: dream enactment (talking, yelling, etc) that often presents as injury to pt or bed partertx: clonazepam

185
Q

Restless leg syndromecausesSx

A

irresistible urge to move one’s legs while going to sleepCause: pregnancy, anemia, renal failure, metabolic disturbances

186
Q

What is the treatment for pseudodementia?

A

supportive psychotherapy + low dose antidepressantsdepression + low appetite + insomnia–> mirtazapine

187
Q

How long does normal grief last?

188
Q

what side effects of anti-depressants are more commonly seen in elderly?

A

anticholinergic

189
Q

What kind of drug is meperedine?

190
Q

Tx for opiate OD?

191
Q

Tx for opiate withdrawal

192
Q

what is the best treatment for heroin addiction?

193
Q

Teeth grinding is associated with what drug?

A

Ecstasy/MDMA

194
Q

what is dissociative amnesia?

A

1+ episode of inability to recall personal information ,not due to tTBI, medication condition, substance abuse or ordinary amneisa

195
Q

Tx for dissociative amenisa?

A

psychotherapy, most acute cases return to normal after min-dayslorazepam or amobarbital often used to help pt talk freely during interview

196
Q

What is dissociative fugue?

A

sudden, unexpected travel away from home and inability to recall one’s past

197
Q

Dissociative fugue vs. amnesia?

A

DA pts are aware of what they can’t seem to remember, DF don’t acknowledge the amnesia

198
Q

Dissociative fugue vs. transient global amnesia

A

DA pts show loss of identity, global amnesia have difficulty with more recent events but identity remains intact

199
Q

Delirium cause: focal neuro sx

A

CVA/Mass lesiondx brain CT/MRI

200
Q

Delirium cause? increased BP and papilledema

A

HTN encephalopathy dx brain CT/MRI

201
Q

Delirium cause? increased HR and dilated pupils

A

drug intox

dx: utox

202
Q

Delirium cause? increased HR, tremor and thyromegaly

A

Thyrotoxicosis

Dx TSH and t4 levels

203
Q

Delirium cause? increased ammonia?

A

Hepatic encephalopathy

tx lactulose adn neomycin

204
Q

Dementia cause: obesity, coarse hair, constipation and cold intolerance?

A

Hypothyroidism, reversibleDx: TSH and T4 levels

205
Q

Dementia cause: diminished position and vibration sense?

A

decreased B12

Dx: B12 levels

206
Q

Dementia cause: diminished position and vibration sense, pupil accommodates but doesn’t respond to light

A

Neurosyphilis

Dx: CSF FTA-ABs or VDRL levels

207
Q

Dementia cause: tremor, increased LFTs, corneal rings?

A

Wilson dz

dx: decreased serum ceruloplasmin levels

208
Q

Diagnosis? waxing and waning Parkinsonism, VH, and antipsychotic sensitivity?

A

Lew Body dementia

209
Q

treatment for adjustment disorder?

A

psychotherapy

210
Q

side effect of Lamotrigine?

A

stevens-johnson

211
Q

side effect of nefazodone?

A

hepatotoxicity

212
Q

side effect of carbamazepine?

A

anemia, thrombocytopenia, leukopenia

213
Q

symptoms of myocarditis?

A

eosinophilia, fever, tachycardia fatigue

decreased EF, increased cardiac enzymes, eKG changes

214
Q

myoclonus is associated with what adverse drug reaction?

A

serotonin syndrome

215
Q

lihtium toxicity symptoms usually begin above what level?

216
Q

what is a distinctive feature of acute stress disorder?

A

dissociation aka losing track of time

217
Q

low iron and magnesium are associated with what disorder?

A

restless leg syndrome

218
Q

night terrors vs. nightmares

A

NTs: first 1/3 of night, shout/paralysis, no memory in AM

219
Q

Enuresis nml until what age?

220
Q

Encopresis nml until what age?

221
Q

refeeding syndrome is associated with what metabolic abnormality?

A

decreased phosphorus

222
Q

Dx: confusion/delirium, lethargy, constipation, abdominal pain, polyuria

A

hypercalcemia

223
Q

what psych drugs can cause hyponatremia?

A

SSRIs and carbamazepine

224
Q

lesions in what part of the brain can cause hypomania or mania?

A

R frontal lobe lesions

225
Q

olfactory hallucinations are associated with what illness?

A

temporal lobe epilepsy

226
Q

What psych sx? interferon

A

depression

227
Q

What psych sx? Beta-blockers

A

depression

228
Q

What psych sx? Corticosteroids

A

hypomania, depression, psychosis and mania *not associated with ‘roid rage which is from anabolic steroids

229
Q

What psych sx? Dopaminergic antiparkinson meds

230
Q

What psych sx? Dopaminergic antiemetics like prochlorperazinea and metoclopramide

231
Q

What psych sx? Anticholinergic meds like diphenhydramine, benztropine

A

precipitate or worsen delirium

232
Q

What psych sx? Meperidine

A

precipitate or worsen delirium

233
Q

What psych condition is prazosin used for?

A

at bedtime for PTSD related nightares

234
Q

What is buproprion used for?

A
  • depressed pts who need to quit smoking

- depressed pts thought to have bipolar disorder-sexual s/e from SSRIs

235
Q

what med for patients with neurovegetative sx of depression (decreased sleep and appetitie)?

A

Mirtazapine

236
Q

Contraindications: Buproprion

A

pts with seizure disorders and eating disorders

237
Q

Contraindications: Valproic acid

A

pregnant women (neural tube defects)

238
Q

Contraindications: Carbamazepine

A

pregnant women (neural tube defects)

239
Q

Delusional disorder: time frame? functional impairment?

A

> 1 month, withOUT functional impairment

240
Q

treatment for cocaine withdrawal

A

Buproprion

241
Q

characteristics of insomnia?

A

decreased sleep duration or quality

242
Q

what drug decreases alcohol cravings?

A

naltrexone

243
Q

When do you NOT want to give Haldol?

A

alcohol withdrawal, can decrease seizure threshold

244
Q

tx for acute mania in a pt with bipolar disorder

A

haldol or clonazepam

245
Q

tx for bipolar dz in preggos

A

Clonazepam

246
Q

bipolar and agranulocytosis: what drug? when d/c?

A

Carbamazepine, d/c if ANC

247
Q

HA, N/V, dizziness and fatigue when stop what drug suddenly?

A

5HT discontinuation syndrome, most common with sertraline and fluvoxamine

248
Q

contraindications to buproprion

A

bulemia, alcoholics, epileptics

249
Q

Tx fo HTN crisis

A

5mg IV phentolamine

250
Q

tx for TCA OD in a kid?

A

Charcoal if within 1-2 hours

IV Na-Bicarb helps met acidosis and cardioprotective

251
Q

purple grey metallic rash over sun-exposed areas and jaundice, what drug?

A

chlorpromazine

252
Q

prolonged qTc and pigment retinopathy, what drug?

A

thioridazine

253
Q

When d/c clonzapine?

A

Clozapine, d/c if ANC

254
Q

how long have anxiety to diagnose GAD?

A

> 6 months

255
Q

first step in mgmt of restless leg syndrome

A

rule out iron deficiency anemia or CKD

tx ropinirole or pramipexole

256
Q

EEG shows diffuse background slowing, dx?

257
Q

most specific test for EtOH consumption in past 10 days

A

carb-deficient transferrin

less specific is elevated GGT and AST 2x ALT

258
Q

tx for PCP intox

A

haldol for acute psychosis

259
Q

pt with SI, hypersomnia, depression adn anergia: dx?

A

cocaine/amph withdrawal

260
Q

pt presents with dilated pupils, seizure, tachycardia and HTN, dx? best first test?

A

cocaine/amphetamine intox

EKG then utox, tx seizure with lorazepam

tx HTN with CCB, BB are contraindicated!

261
Q

tourettes tx

A

clonidine, haldol or pimozide

262
Q

suppression vs. repression?

A

suppression is conscious

repression is unconscious

STEP 2 (8 decks)

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