Rosh Material #1 Flashcards
wernicke encephalopathy triad
encephalopathy
oculomotor dysfxn
gait ataxia
oculomotor dysfxn associated w. wernicke encephalopathy
horizontal nystagmus - mc
lateral rectus palsy
conjugate gaze palsies
tx for wernicke’s
- thiamine
- glucose
must give thamine before glucose
consequence of wernicke’s that involes irreversible memory loss
korsakoff
in order for dx of mania, episodes must last a minimum of
1 week
in order for dx of hypomania, sx must last a minimum of
4 days
2 risks associated w. quetiapine
parkinsonism
qt prolongation
3 risks associated w. valproate
weight gain
tremor
liver failure
3 risks associated w. lithium
diabetes insipidus
hypothyroidism
tremor
risk associated w. lamotrigine
skin rash
SJS
tx for acute mania
mood stabilizers:
lithium
valproate
+/- antipsychotics (haldol)
tx for acute dpn in bipolar
lithium
lamotrigine
quetiapine
+/- antidepressant add on
maintenance therapy for bipolar
1st line: whichever drug relieved acute symptoms
2. lithium, lamotrigine, valproate, quetiapine
2 mc s.e of SGA’s
sedation
weight gain
how to remember SGA’s (atypical)
pines: olanzapine, quetiapine, asenapine, clozapine
dones: lurasidone, resperidone, paliperidone, iloperidone
pips: aripiprazole, brexpiprazole
rip: cariprazine
2 indications for bupropion as 1st line tx for dpn
to avoid sexual dysfxn
concomitant tobacco use
indication for trazadone as first line tx for dpn
dpn w. insomnia
major s.e of clozapine
neutropenia
when does mdd w. peripartum onset occur
during pregnancy or w.in 4 weeks of delivery
recommended age to screen for autism spectrum disorder
18-24 mo
dx is typically made prior to 3 yo
5 a’s of tobacco cessation
- ask
- advise
- assess
- assist
- arrange
stages of change for tobacco smoking/cessation
- precontemplation
- contemplation
- preparation
- action
- maintenance
which stage of change is associated w. smokers who are ready to quit
contemplation
mc comorbid mental health illness associated w. delusional d.o
dpn
specifiers for delusional d.o (6)
erotomanic
grandiose
jealous
persecutory
somatic
bizarre content
belief that a stranger removed one’s internal organs and replaced them with other organs without leaving a scar
delusional d.o w. bizarre content
order of tx for gad
- SSRI or SNRI
- different SSRI or SNRI
2 add on options if pt w. gad had partial response to SSRI or SNRI
buspirone
pregabalin
6 established adverse effects of SSRIs
sexual dysfxn
drowsy
insomnia
wt gain
HA
dizzy
5 common s.e of SNRIs
nausea
dizziness
insomnia
sedation
constipation
3 common s.e of buspirone
insomnia
agitation
nausea
2 common s.e of pregabalin
sedation
dizziness
what is pagophagia
craving for ice
what deficiency does pagophagia make you think of
iron
3 sx of severe ida
koilonychia
atrophic glossitis
angular cheilosis
7 risk factors for dpn
1st degree fam hx
low socioeconomic status
divorced/separated/widowed
lack of interpersonal relationships
recent difficult life events
early childhood trauma
postpartum
what US ancestry is associated w. dpn
american indian
what ancestry has lowest prevalence of dpn
asian
6 common fetishes
underpants
bras
shoes
feet
toes
hair
medications for dpn should be continued for how long after symptoms resolve
6-12 months
first line tx for bipolar major dpn (2)
quetiapine
lurasidone
tx for benzo withdrawal for pt who uses benzos chronically
IV long acting benzo (ex diazepam) taper
PE finding of refeeding syndrome
peripheral edema
seizure
lab findings of refeeding syndrome
hypophosphatemia
hypokalemia
hypomagnesemia
primary cause of clinical findings of refeeding syndrome
hypophosphatemia
indication for hospitalization for refeeding syndrome
edema
seizures
serum phos < 2 mg/dL
refeeding syndrome is associated with low _ (2) and elevated _ (2)
low: glucose, insulin
high: glucagon, gluconeogenesis
broadband assessment tool for ADHD
child behavior checklist/teacher report form
also assesses anxiety, dpn, aggression, withdrawal, somatic complaints
narrow band assessment tools for ADHD (2)
conners 3rd edition
vanderbilt
what assessment tools for ADHD are most sensitive/specific
narrowband:
conners
vanderbilt
increased serotnergic activity from therapeutic medication drug interactions or self poisoning
serotonin syndrome
sx of serotonin syndrome
-AMS
-autonomic instability: tachy, diarrhea, shivering, diaphoresis, mydriasis
-neuromuscular abnormalities: clonus, hyperreflexia, tremor, seizure
tx for serotonin syndrome
benzos
hydration/cooling
cyproheptadine
what drug is associated w. malignant hyperthermia
muscle relaxants
2 risk factors for serotonin syndrome
2 or more serotoning agonists
dosage changes
t/f: there is a strong link btw suicidal ideation and OCD
t!
what assessment tool is used for OCD
yale-brown obsessive-compulsive scale
common historical finding in pt w. borderline pd
childhood trauma
7 environmental factors associated w. oppositional defiant disorder
insecure attachment
unresponsive parents
maternal aggression
abuse
community violence
parental psychopathology
peer rejection
what differentiates mild vs mod vs severe oppositional defiant d.o
number of settings where symptoms take place (1 vs 2 vs 3)
3 comorbidities mc associated w. PTSD
anxiety
dpn
SUD
mc rf for schizophrenia
positive fam hx
which 2 personality d.o’s are associated w. lack of empathy for others
narcissistic
antisocial
1st line pharm for social anxiety d.o (aka social phobia)
SSRI or SNRI
for dx of social anxiety d.o (social phobia) in children, anxiety must occur in _ settings rather than exclusively w. adults
peer
5 symptoms of irritable/expansive mood in cyclothymia
increased goal-directed behavior
decreased need for sleep
inflated self-esteem
talkative
distractibility
6 symptoms of depressed mood in cyclothymic d.o
lack of interest
increased/decreased sleep
increased/decreased appetite
poor self esteem
guilt
sadness
6 symptoms of depressed mood in cyclothymic d.o
lack of interest
increased/decreased sleep
increased/decreased appetite
poor self esteem
guilt
sadness
t/f: for dx of cyclothymic d.o, pt must have both hypomanic and depressive symptoms
t!
for dx of cyclothymic d.o in children, symptoms must be present for _
a full year
2 years for adults
what type of anemia is assocaited w. AUD
macrocytic (MCV > 96 fL)
3 causes of macrocytic anemia
etoh
folate deficiency
B12 deficiency
which ion channel is associated with benzo MOA
Cl
which 3 SGAs cause the least amt of weight gain
ziprasidone
aripiprazole
lurasidone
5 types of specific phobias
animal
natural environment
blood-injection-injury
situational
other: choking/vomiting/loud sounds/clowns
3 examples of situational phobias
airplanes
elevators
enclosed spaces
t/f: most youths have multiple specific phobias
t!
5 sx of cannabinoid hyperemesis syndrome
n/v
abdominal pain
bloating
diaphoresis
wt loss
what relieves sx of cannabinoid hyperemesis syndrome and can aid in the diagnosis
relief of symptoms w. hot showers
4 complications of cannabinoid hyperemesis syndrome
mallory-weiss tear
AKI
hypovolemia
rhabdo
tx for cannabinoid hyperemesis syndrome
rehydration
bowel rest
haldol
capsaicin
what differentiates cyclic vomiting syndrome from cannabinoid hyperemesis syndrome
presence of a psychological stressor as trigger
common s.e of first gen antipsychotics
extrapyramidal
TD
management of RLS (4)
iron replacement
behavior mod
pramipexole/ripinirole
gabapentin
exacerbations of RLS (3)
antihistamines
dopamine antagonists
antidepressants
5 common symptoms of conversion d.o
weakness/paralysis
visual
speech
globus sensation
abnormal movement
nonepileptic sz
4 known triggers for conversion d.o
traumatic injury
neurologic illness
interpersonal conflict
life stress
major way in which conversion d.o is differentiated from factitious d.o and malingering
conversion d.o symptoms are unconsciously produced
cannabis can be detected for up to _ days in non chronic users
30
rf for ASD
male
advanced parental age
fam hx
genetics
brain abnormalities
most sedating SSRI
paroxetine
SSRI most associated w. GI sx
fluvoxamine
what 2 medications are appropraite for etoh dependence
disulfram
naltrexone
delirium tremens may start after _ hr of etoh withdrawal
48 hr
sympathomimetic toxidrome is associated w. what 2 substances
cocaine
amphetamines
drug to avoid for bp control in sympathomimetic toxidrome
bb
due to unopposed alpha receptor stimulation
what drug is used for bp control in sympathomimetic toxidrome
lorazepam
what do you think when you see: mydriasis, diaphoresis, hyperthermia, htn, tachy, increased bowel sounds
sympathomimetic toxidrome
how does sympathomimetic toxidrome differ from anticholinergic toxidrome (2)
anticholinergic toxidrome has:
dry skin
decreased bowel sounds
what psychiatric med is contraindicated in eating disorders
bupropion
lowers sz threshold
