Psychiatry - Pathology Part 2 Flashcards
Obsessive-compulsive disorder is associated with what movement disorder?
Tourette’s syndrome
Obsessive-compulsive personality disorder has similar symptoms as obsessive-compulsive disorder with what major difference?
Obsessive-compulsive disorder is ego dystonic whereas obsessive-compulsive personality disorder is ego syntonic
How long must symptoms be present to consider a diagnosis of posttraumatic stress disorder?
At least 1 month
What disorder is a precursor to posttraumatic stress disorder?
Acute stress disorder, which lasts no longer than 1 month
A war veteran describes recurrent nightmares and flashbacks of her close friend being brutally killed and burned on the battlefield. These flashbacks have lasted for 4 months since she returned from Iraq. What is the most likely diagnosis?
Posttraumatic stress disorder
A person who had her hand amputated as a result of a food-processing incident has recurrent flashbacks. She cannot go into a kitchen without having intense fear, and this has lasted for 3 months. What disorder does this patient have?
Posttraumatic stress disorder
How is posttraumatic stress disorder treated?
Psychotherapy and selective serotonin reuptake inhibitors
A person who had his hand amputated as a result of a food-processing incident has recurrent flashbacks. He cannot go into a kitchen without having intense fear, and this has lasted for a period of 2 weeks. What disorder does this patient have?
Acute stress disorder
The re-experiencing of traumatic events leads to what symptoms?
Feelings of horror, helplessness, fear
Define adjustment disorder.
Emotional symptoms in response to an identifiable stressor that lasts less than 6 months
What are some of the symptoms associated with generalized anxiety disorder?
Sleep problems, fatigue, difficulty concentrating
What drugs are used in the management of generalized anxiety disorder?
Benzodiazepines, selective serotonin reuptake inhibitors, and buspirone
A patient presents with a chief complaint that he is a “worrier.” He says he worries about everything all the time. What is the most likely diagnosis?
Generalized anxiety disorder
By definition, the symptoms of generalized anxiety disorder must last how long to be clinically significant?
> 6 months
A 34-year-old male presents with epigastric pain that radiates to the back. He has been admitted previously for a similar complaint as well as for opiate overdose. Physical exam shows epigastric pain that is not present with distraction. Amylase and lipase are normal. What is the likely diagnosis?
Malingering
Compare malingering and factitious disorder.
Whereas the complaints of an individual who is malingering cease after the gain is achieved, the complaints of an individual with factitious disorder continue; also, malingering is a conscious action whereas factitious disorder is a product of unconscious
A mother is found to be injecting feces into the intravenous line of her 3-year-old daughter to keep her in the hospital. What is this psychiatric syndrome called?
Munchausen’s syndrome by proxy
A patient in the emergency department is requesting to be admitted for the hundredth time this year. He has a history of multiple invasive procedures, and he seems to enjoy being in the hospital. What is this condition called?
Munchausen’s syndrome
Define the difference between malingering and factitious disorder with respect to obtaining medical care.
In malingering, patients avoid medical treatment; in factitious disorder, patients are willing to obtain any medical treatment offered
What somatoform disorder is characterized by motor and sensory symptoms that are unconsciously produced, incongruent with physical examination, and follow an acute stressor?
Conversion disorder
A patient presents with prolonged diffuse pain that has been extensively worked up with no etiology found. What is his diagnosis?
Pain disorder
A woman presents to her primary care physician of 12 years with back pain. She describes it as acute-onset, nonradiating pain. She had a similar description for leg pain a few months ago. She has a history of irritable bowel syndrome, heartburn, dyspareunia, and tingling in her feet. Diagnostic workup has been negative thus far. What is a good working diagnosis for this patient?
Somatization disorder
A patient presents at multiple visits with a preoccupation and fear that she might have a serious illness, despite being reassured of her health many times. What is this condition called?
Hypochondriasis
A supermodel presents to a plastic surgeon with a complaint that her nose does not look right. She has had 12 cosmetic surgeries on her nose in the past. What somatoform disorder does this patient have?
Body dysmorphic disorder
Somatoform disorders are more common in which sex?
Females
How do malingering patients differ from those with somatoform disorders?
Malingering is a product of conscious actions whereas somatoform disorders are products of the unconscious
Which organ systems must be involved to diagnose somatization disorder?
Gastrointestinal, sexual and neurologic symptoms must be present
Define personality trait.
A personality trait is a consistent way a person processes his/her environment and his/her role in it
How does a personality disorder differ from a personality trait?
A personality trait is a consistent way a person processes his/her environment and his/her role in it. A personality disorder is a condition in which this trait becomes inflexible and maladaptive
True or False? Personality disorders are usually diagnosed during childhood.
False; personality disorders are not usually diagnosed in children; however, personality disorder patterns are generally stable by early adulthood
Cluster A personality disorders have a genetic association with which psychiatric disorder?
Schizophrenia
What cluster A personality disorder is characterized by distrust and suspiciousness?
Paranoid personality disorder
A 28-year-old woman is constantly accusing her mother of stealing her money and spying on her when she is at work. She eventually moves away from her mother and constantly changes her e-mail to maintain control over her privacy. What type of personality disorder does this patient exhibit?
Paranoid personality disorder
What is the main ego defense mechanism used by persons with paranoid personality disorder?
Projection; accusing others of things the patient is actually guilty of
Name the three cluster A personality disorders.
Paranoid, schizoid, and schizotypal
The mother of a 22-year-old woman comes to her physician reporting that her daughter is acting “weird.” She does not have friends, chooses to work the night shift, and interacts with her only during meals. Upon questioning, the daughter does not express any sadness about her isolation, nor does she find anything wrong with it. What is the likely diagnosis?
Schizoid personality disorder
Compare schizoid and avoidant personality disorders.
In schizoid personality disorder, patients are not bothered by social isolation whereas in avoidant personality disorder patients desire social contact but are unable to achieve it
A person with which personality disorder is interpersonally awkward and often has odd beliefs or magical thinking?
Schizotypal personality disorder
A 45-year-old male believes that each night the moon is full he must sleep outside to absorb its gravitational pull to rid his body of disease. What type of personality disorder does this patient exhibit?
Schizotypal personality disorder
What cluster of personality disorders is characterized by dramatic, emotional, or erratic behaviors?
Cluster B
Name the four cluster B personality disorders.
Antisocial, borderline, histrionic, and narcissistic
A 20-year-old male has multiple arrests for assault and robbery. He has a history of arson as a teenager. During the interview, he threatens the physician with physical harm. What is the likely diagnosis?
Antisocial personality disorder
What personality disorder is characterized by excessive emotionality and attention-seeking and sexually provocative behaviors?
Histrionic personality disorder
Name two conditions that have a genetic association with cluster B personality disorders.
Mood disorders and substance abuse
A woman presents to a new psychiatrist. She reports symptoms of depression related to a series of short-lived relationships and multiple sexual partners. During her interview, the psychiatrist notices a number of shallow cuts on the forearms. What is the likely diagnosis?
Borderline personality disorder
A patient storms out of the office after waiting in the waiting room for 10 minutes, exclaiming, “Doesn’t the doctor realize who I am and how busy my schedule is?” With what personality disorder is this patient’ behavior most consistent?
Narcissistic personality disorder
Describe the major defense mechanism of patients with borderline personality disorder.
Splitting; views one group as “all good” and another as “all bad”
A 25-year-old male presents to a new psychiatrist. He reports sadness that he does not fit in at work. He does not eat with his coworkers at lunch because he feels that they will not talk to him. He reports feeling this way in college. When invited to work parties, but makes up an excuse so he does not have to go. What is the likely diagnosis?
Avoidant personality disorder
A patient’s wife complains of a preoccupation with order, perfectionism, and control. What personality disorder might this patient have?
Obsessive-compulsive personality disorder
What cluster of personality disorders is characterized by increased anxiety or fear?
Cluster C
A patient presents with low self-confidence. She is submissive, clinging, and in constant need of reassurance. What type of personality disorder might this patient have?
Dependent personality disorder
Name the three cluster C personality disorders.
Avoidant, obsessive-compulsive, and dependent
What are the durations of brief psychotic disorder, schizophreniform disorder, and schizophrenia?
Brief psychotic disorder lasts <1 month, schizophreniform disorder lasts 1-6 months, and schizophrenia lasts >6 months
How does schizotypal disorder differ from schizophrenia?
The odd and disordered thinking in schizophrenia is more pronounced and disruptive.
True or False? Unlike people with anorexia, most people with bulimia may have a normal body weight.
True; anorexia is defined as a weight less than 85% of ideal body weight
What physical signs of induced vomiting may be seen in a patient with bulimia?
Parotitis, enamel erosions, electrolyte disturbances, and dorsal hand calluses
What methods of weight control other than vomiting are used by patients with bulimia?
Laxative abuse
True or False? Individuals with anorexia nervosa realize that they are underweight.
False; body image distortion is an element of the disorder
Metatarsal stress fractures are indicative of what consequence of anorexia?
Decreased bone density
True or False? Electrolyte imbalances are specific to anorexia nervosa and not to bulimia nervosa.
False; both patient populations may present with alkalosis or other electrolyte imbalances
Anorexia nervosa is defined by body weight below what percentage of ideal body weight?
85%
What psychiatric mood disorder is commonly associated with anorexia nervosa?
Depression
Define gender identity disorder.
Persistent discomfort with one’s sex and identification as the opposite sex
A patient is considered to be dependent on a substance if he or she demonstrates how many maladaptive signs of dependence during a 1-year period?
Three or more
What are the seven maladaptive signs of substance dependence?
Tolerance; withdrawal; substance taken in larger amounts or over longer time than desired; persistent desire to or attempts to cut down on use; significant energy spent obtaining, using, or recovering from substance use; important social, occupational, or recreational activities reduced because of substance use; and continued use despite knowing the problems that the substance causes
Is recurrent use of a substance resulting in a failure to fulfill major obligations at work, school, or home a criterion for substance abuse, dependence, or both?
Both
Are recurrent substance-related legal problems a criterion for substance abuse, dependence, or both?
Abuse
Is continued substance use despite persistent problems caused by the substance a criterion for substance abuse, dependence, or both?
Both
What are the four criteria of substance abuse?
Recurrent use resulting in failure to fulfill major obligations, recurrent use in physically hazardous situations, recurrent substance-related problems, and continued use despite persistent problems caused by use; in addition, the patient must never have met the criteria for dependence
True or False? Individuals who suffer from substance abuse usually meet criteria for substance dependence as well.
False; to be diagnosed with substance abuse the patient must not meet criteria for dependence
A patient in the hospital for withdrawal is noted to be agitated, anxious, and sleepless. What type of drug might the patient have been abusing?
A sedating agent
A patient presents with disinhibition, slurred speech, ataxia, and an elevated γ-glutamyl transferase level. This patient is most likely intoxicated with what substance?
Alcohol
A man assaults a person in the waiting room. The staff cautiously approach the man, who has both vertical and horizontal nystagmus. This patient is most likely intoxicated with what substance?
Phencyclidine
A patient presents with pupillary dilation, florid hallucinations, delusions, tachycardia, and hypertension. What drug did this patient most likely use?
This patient is probably intoxicated with a stimulating agent like amphetamines or cocaine
A patient presents with a respiratory rate of eight breaths per minute, pinpoint pupils, and vomiting. This patient is most likely intoxicated with what substance?
Opioids
A patient who is being treated for anxiety is brought to the emergency room with symptoms of respiratory depression. She has a history of alcohol abuse. She is most likely intoxicated with which of the following: cocaine, phencyclidine, lysergic acid diethylamide, or barbiturates?
Barbiturates
A patient with chronic pain presents with constipation. The use of what class of drugs commonly causes constipation?
Opioids
A patient is brought to the emergency room with amnesia, ataxia, somnolence, and depression. She states that she recently took some medication for anxiety, and she denies any alcohol or barbiturate use. This patient may be intoxicated with what substance?
Benzodiazepines
What commonly abused class of drugs is also used for the treatment of attention-deficit/hyperactivity disorder?
Amphetamines
A patient who abuses drugs rushes into the clinic stating that he is being followed by a killer. He then states that he is having chest pain, and he undergoes sudden cardiac arrest shortly thereafter. This patient is most likely intoxicated with what common street drug?
Cocaine
A patient presents with visual hallucinations and vivid nightmare-like flashbacks of his childhood. His pupils are dilated. This patient is most likely intoxicated with what?
Lysergic acid diethylamide
Parents present with their teenage daughter. They note that she has recently been socially withdrawn and that she has also been eating more. The patient complains of dry mouth, but says she otherwise feels great. This patient may be intoxicated with what substance?
Marijuana
A patient presents with restlessness, insomnia, increased urination and a cardiac arrhythmia. The social history should include questions that ask about the use of what legal drug: acetaminophen, aspirin, caffeine, or ibuprofen?
Caffeine
What are the symptoms of alcohol withdrawal?
Tremor, hypertension, delirium tremens, and hallucinations
What are the symptoms of opioid withdrawal?
Sweating, dilation of pupils, diarrhea, yawning, rhinorrhea, and anxiety
What are the symptoms of an amphetamine “crash”?
Depression, hypersomnolence, stomach cramps, hunger, and headache
What are the symptoms of a cocaine “crash”?
Severe psychologic craving, suicidality, and severe depression
What is the major symptom of phencyclidine withdrawal?
The sudden onset of severe, random, homicidal violence
What are the major symptoms associated with barbiturate withdrawal?
Life-threatening cardiovascular collapse, anxiety, seizures, and delirium (ie, symptoms similar to those associated with alcohol withdrawal)
What are the major symptoms associated with benzodiazepine withdrawal?
Rebound anxiety, seizures, tremor, and insomnia
What are the symptoms associated with caffeine withdrawal?
Headache, lethargy, depression, and weight gain
What are the symptoms associated with nicotine withdrawal?
Irritability, headache, weight gain, anxiety, and craving
What medications are used to treat delirium tremens?
Benzodiazepines
True or False? Opioid withdrawal is treated with naloxone.
False; opioid overdose can be treated with either naloxone or naltrexone, withdrawal is treated symptomatically
What drug can be detected in urine up to 1 month after last use?
Marijuana
Because heroin is injected intravenously, heroin users may get endocarditis on which side of the heart?
The right side; it is rare to see right-sided endocarditis in nonintravenous drug users
Intravenous drugs users are at increased risk of what conditions?
Viral hepatitis, AIDS, right-sided endocarditis, skin abscesses
Suboxone is a combination of what two drugs?
It is a combination of naltrexone and buprenorphine (partial agonist); it is a longer acting drug with fewer withdrawal symptoms than methadone
Why do heroin abusers have hemorrhoids?
Because of chronic opioid-induced constipation
Suboxone has a lower abuse potential secondary to what adverse effect?
When injected, suboxone causes withdrawal symptoms due to the addition of naltrexone
What two drugs competitively inhibit opioid receptors?
Naloxone and naltrexone
What long-acting oral opioid is used for heroin detoxification or maintenance?
Methadone
What drug inhibits acetaldehyde dehydrogenase and is useful for alcoholism treatment?
Disulfiram
What is the triad of signs of Wernicke-Korsakoff syndrome?
Confusion, ophthalmoplegia, and ataxia
What are the clinical manifestations of chronic alcoholism?
Alcoholic cirrhosis, pancreatitis, hepatitis, peripheral neuropathy, testicular atrophy
A deficiency of what substance may result in Wernicke-Korsakoff syndrome?
Thiamine (vitamin B1); commonly seen in alcoholics who derive most of their caloric intake from alcohol
What neurologic pathology is associated with Wernicke-Korsakoff syndrome?
Bilateral necrosis of the mamillary bodies
What is the treatment for Wernicke-Korsakoff syndrome?
Intravenous thiamine (vitamin B1); it should be given before any dextrose-containing fluids
A deficiency of what vitamin may result in confusion, ophthalmoplegia, and ataxia in alcoholics?
Thiamine (vitamin B1)
A patient presents to the emergency room with confusion and vomiting. He violently vomits gastric contents a few times. This is followed by hematemesis. What is the likely explanation?
Mallory-Weiss syndrome, caused by prolonged vomiting/retching that leads to lacerations of the esophagus
If Wernicke’s encephalopathy is not quickly treated, it may progress to the development of what disease?
Korsakoff’s psychosis, which consists of irreversible memory loss, confabulation, and personality change
A patient presents with painful hematemesis after a night of binge drinking; what can cause this specific finding?
Mallory-Weiss syndrome
How do presentations of esophageal varices differ from Mallory-Weiss tears?
Varices are painless whereas Mallory-Weiss tears are painful
Irreversible memory loss, confabulation, and personality change describe which condition associated with alcohol abuse?
Korsakoff’s psychosis
Delirium tremens are a potentially deadly alcohol withdrawal syndrome that peaks how many days after an alcoholic’s last drink?
2 to 5 days
List the symptoms of alcohol withdrawal.
Tachycardia, tremors, and high blood pressure followed by psychotic symptoms
Delirium tremens are treated with what class of drugs?
Benzodiazepines
