Test Questions Flashcards
Characteristics of adult learners
self guided, bring more and expect more, require learning to make sense, problem oriented
ADLs
From higher functioning to lower functioning: bathing, dressing, toileting, transferring, continence, feeding
Who is Michel Foucault?
Winners write the history: wrote about how language embodies power relationships and about how those in power define what is “abnormal”
MBSR
mindfullness based stress reduction
Diseases affected by stress
the answer is cancer
origin of the word “homosexual’
first encountered in Kraft-Ebbing’s book Psychopathia Sexualis in 1873
facts about the word ‘homosexual’
It is a neologism (or new word - people in the 1950s had not even heard the word before) derived from greek and latin
helpful and unhelpful aspects of the word homosexual
helpful: established a social place and rallying point; unhelpful: categorized as a ‘deviant’ type, opposite to heterosexuality, created associated connotations (has cultural context)
Temperament
Aspects of an individual’s personality that are often regarded as innate rather than learned, The idea is to understand yourself so you can recognize that people are “wired” differently and to understand others so you can “maximize interpersonal effectiveness”. (types: Extroversion vs Introversion, Sensing vs Intuition, Thinking vs Feeling, Judging vs Perceiving
When a cluster of 3+ people becomes a group
with interaction, a common relationship, and a common group task
The primary task of a group:
Is what it needs to do to survive. The group has a life of it’s own as a result of the hopes, wishes, and needs of it’s own members.
overt functions of a group
The identified primary task of the group. (i.e. order labs, perform histories, communicate, learn how to become better physicians)
covert functions of a group
the basic assumptions of a group (dependency needs, need for an ideal leader, need to identify threats, need for connection and autonomy)
Charisma of a leader
Is not in the leader but in the follower-leader relationship
Groups and autonomy
Individuals in a group need to be able to exist between autonomy and complete lack of autonomy: must has the freedom to belong/not belong
frontal lobe functions
personality, cognition (working memory), speech, executive functioning
temporal lobe functions
auditory cortex (hearing), visual recognition and naming, memory (mesial temporal lobe)
parietal lobe functions
speech, sensation, cognition, attention
occipital lobe functions
vision - primary visual cortex
prefrontal cortex functions
integration: response flexibility, social conduct, working memory, attention/concentration, stimulus appraisal, affect regulation
limbic system functions
emotion, motivation. goal directed behavior, memory, attachment
brainstem functions
basic life functions, arousal, alertness, CN nuclei, raphe nuclei, locus corelus
Two facts regarding the interconnections in the brain
Long axonal fibers link widely separated clusters of neurons in a web-like configuration. Separate, differentiated areas maintain their unique features while also linked in circuits.
The limbic system…
is connected by function
the amygdala…
is associated with emotion and connected to the hypothalamus
Information flow:
sense organ –> brainstem synapses –> thalamic synapses –> primary sensory cortex –> association cortices –> frontal cortex
epigenetic theory
environment affects the neuronal gene expression with effects behavior
Chromatin is
DNA wrapped around histones
Histone modifications
acetylation is the most common, methylation is mainly inhibitory.
enriched environments
increase the density of synaptic connections and the quantity of neurons
Experience dependent vs. experience expectant
self explanatory
circuit formation involves…
- Axon growth
- Neurogenesis and formation of new synapses
- Myelination
- Modifying existing synapse via receptor density/sensitivity
- Pruning of synapses due to disuse/toxicity
8 parts of the MSE
general appearance & behavior, sensorium (lvl of arousal), speech, mood, thought, cognition, abstract reasoning, insight & judgement
Nonverbal communication: mirroring
perception of another’s mental state and stimulation of their internal state through behavior imitation through the anterior cingulate and insula
Implicit Memory
Doesn’t require attention, reflexive, emotional memory in the limbic system and motor memory in the basal ganglia/cortex
Explicit Memory
Conscious, requires focused attention, narrative, accessible for recall, hippocampus. 1. perception (0.5 seconds, sensory memory), 2. working memory (30 seconds), 3. long term with rehearsal
Working Memory
Requires focused attention, prefrontal cortex, brief, accessible information for a specific task (long term memory requires the hippocampus)
Executive functioning
initative, planning, problem-solving, abstract thinking, mental flexibility, adaptability, set-shifting, PRE FRONTAL CORTEX, interconnection of many systems,
Attunement
reactive ability to detect another’s emotional state
amygdala in the social context
performs stimulus appraisal
Primary Neurulation
Induction, Structure, Dorsal/Ventral Patterning. Begins after the neural plate is formed and divides the ectoderm into the neural tube, the epidermis, and the neural crest cells. The neural groove sets the boundary between the right and left sides of the embryo. Begins at 29th days in response to soluble growth factors secreted by the notochord. somites flank the neural tube, crest cells migrate, pericardial bulge.
Apical construction
cells move away from axis and change to pyramidal in shape
Neurulation anterior and posterior plate.
Inhibitory signals – anterior neuroectoderm. FGF and inhibitory signals — posterior neural plate.
Primary Neurulation: Structure
Prosencephalon - telencephalon and diencephalon; mesencephalon - midbrain; rhombencephalon - pons and cerebellum; spinal cord
Neurulation, dorsal/ventral
dorsal - alar plate, ventral - basal plate
Errors of Neuropore closure
Anterior - anencephaly, posterior - spinal bifidia
Pre eclampsia
abrupt hypertension, leakage of protein into the urine, and edema of the hands, feet, and face - most common, third trimester
ectopic pregnancy
fertilized egg settles in ANY location other than the inner uterus, most occur in fallopian tube, major risk factor is rupture and internal bleeding
stillborn
can occur from infections, placental abruptions, trauma, and often occurs in full term pregnancies
spontaneous abortion
occurs in 15-20% of all recognized pregnancies, any pregnancy where the fetus is born before the 20th week of pregnancy
placental abruption
where the placental lining separates from the uterus, significant contributor to maternal mortality, most common cause of late pregnancy bleeding
placenta previa
when the placenta lays low in the uterus and maybe even covers the cervix
Piaget
Theory of cognitive development: Sensorimotor (birth to two years, object permanence - 7 months and causality), Pre-operational (2 to 7, symbols and intuitive thought, egocentric thinking, no evidence of conservation, mental activity is not reversible), Concrete (7 to 11, concept of conservation acquired, mental actions are reversible, egocentric thought diminishes), Formal Operational (adolescence and adulthood, abstract thinking, return to egocentric thought, many people do not think formally in adulthood)
Vygotsky
Theory of cognitive development, zone of proximal development (between anxiety and boredom - gap btw capacity and current knowledge), scaffolding, language and thought, teaching strategies, EXTERNAL WORLD MODELS THE MIND, mediation (language, tools, symbolic)
Scaffolding
Vygotsky - cognitive development in the zone of proximal development that stresses teh role of a social partner to the student that is more skilled. that student can then go and be the skilled partner for the next person (holding hand when walking on a balance beam)
Erikson
- Infancy (Birth – 18 months)
Significant relationships= Primary caregiver
Ego development outcomes = Trust vs. Mistrust (seen in suicides) - Early Childhood (18 months – 3 years)
Significant relationships= Parents
Ego development outcomes = Autonomy (Learn to say No) vs. Shame - Play Age (3 – 5 years)
Psychosocial crisis = Oedipal struggle/role identifications
Significant relationships= Family
Ego development outcomes = Initiative vs. Guilt - School Age (6-12 years)
Psychosocial crisis = Latency -> numerous skills develop
Significant relationships= School/neighborhood peers
Ego development outcomes = Industry vs. Inferiority - Adolescence (12-18 years)
Significant relationships= Peers
Ego development outcomes = Identity vs. Role Confusion - Young Adulthood (18- 35 years)
Significant relationships= Significant others and friends
Ego development outcomes = Intimacy/Solidarity vs. Isolation - Middle Adulthood (35 – 65 years)
Significant relationships = Coworkers, community, family
Ego development outcomes = Generativity vs. Self-absorption/Stagnation - Late Adulthood (65 –death)
Significant relationships= All of mankind (?)
Ego development outcomes =Integrity vs. Despair
How old is a first grader
6-7 yrs. old
Kohlberg
Pre-conventional (Egocentric, Unquestioned Obedience), Conventional (Approval, Interpersonal Conformity), Post-conventional (the system - social contract, Principled Conscience)
Memory
Classical conditioning involves an associative enhancement of the presynaptic facilitation that is dependent on activity, LTP in the hippocampus is an example of associative and non-associative learning in the mammalian brain, habituation is synaptic transmission depression, sensitization is synaptic transmission enhancement
Cognition, metacognition, metamemory
manipulating information in your memory, manipulating complex strategies for solving problems, knowledge about you’re own memory
Theory of Mind
Achieved by middle childhood - awareness of one’s mental processes and the mental processes of others
long term memory
requires the synthesis of new proteins and the growth of new synaptic connections
long term habituation
decrease in presynaptic terminals
Developmental tasks of adolescence
independence from parental ties, establishing romantic relationships, consolidation of a firm sense of identity, cognitive development
Role of the peer group
peer relationships are particularly important, being excluded is serious issue, important to have skills that the peers admire, sensitivity to rejection, bullying can increase cortisol levels
Erikson stage found in puberty
Identity vs. Role Confusion, mastering this stage creates a firm sense of personal identity.
Kernberg in adolescence
identity diffusion: the inability to approach relationships with a firm sense of self and consistency. requires the ability to experience guilt and concern, the capacity for establishing lasting, non-exploitive relationships, and a consistently expanding and depending sense of values.
Characteristics of youth learners: preschool child, grade school, teenagers, adolescents
preschool child: lack of concept of reversibility which prevents the understanding of healing/illness, grade school: understands reversibility and the need to cooperate, but need concrete terms, teenagers: have more complex, abstract thought, adolescents: encourage “checking in”, allow for questions, gauge reactions, and titrate to validate understanding
Characteristics of adult learners
self-guided, bring more and expect more, require learning to make sense, problem oriented
Early Closure
not listening to what a patient is saying, making a decision before weighing all the facts, allows you to see many patients but predisposes you to misdiagnosis
Three elements of effective learning
spatial learning (over time with repetition), retrieval (testing), teaching (you are required to learn the information)
aspects of clinical care that influence patient learning and your ability to teach
Acute = may limit your time spent with the patient, primary focus is on stabilizing patient
-Chronic=becoming increasingly prevalent and proper education and collaboration often lead to better outcomes
Demographics of Chronic Illness
1 cause of death and disability in the US, 45% of adults, 7/10 deaths in the US, 75% of the nations health care spending, 2/3 of the increase in spending, 30% due to increase in obesity, could be prevented with healthy eating, stop smoking, and getting in shape. a severe disability is when you need someone else to do everyday activities
ADLs (in order of highest functioning to lowest functioning)
Bathing, Dressing, Toileting, Transferring, Continence, Feeding
Ways a healthcare provider can help patients cope with chronic illness
adapting to the diagnosis and experiencing normal grief, reviewing useful approaches to past challenges, developing a sense of control, support system, accepting changes in appearance, encourage step by step improvement, approach the patient at the appropriate stage, shared decisions, motivational interviewing,
Bowlby’s attachment
one of several innate behavioral systems. Common elements of attachment behavior for primates (visually track caregiver, cling to caregiver, maintain close proximity to caregiver).
- Attachment may be most crucial system to ensure survival of infant - Drive to form bonds with others is part of normal mental health - Early attachment experiences establish internal working models that guide future attempts at relationships - Upon separation from caregiver, child reacts with protest, then with despair, and finally detachment
Ainsworth - strange situation
Secure =flexibility of attention, explores room with parent present, often cries on separation, rejoins mother on reunion and is soothed, coherent story line
- Resistant/Ambivalent Insecure = Maximizes attachment seeking due to unpredictability in parent, separation anxiety causes focus to be inflexible and always toward parent, too distressed to play when mother leaves and too angry to be soothed upon reunion. Lack narrative flow seen in secure.
- Avoidant Insecure = Minimizes attachment seeking due to unresponsive/under involved parenting (parental rejection of attachment). No anxiety when mother leaves and little interest upon her return. Focus is inflexible and always away from parent and towards toys/exploring.
- Disorganized Insecure = disoriented behavior like freezing or falling to floor. Can be evidence of trauma or abuse.
- Patterns are specific to specific caregiver
- Predicts behavior in nursery school
- Attachment strategies may be self perpetuating and usually those who change categories do so after adverse life events
adult attachment
-Secure/autonomous = generally value attachment. May be positive/negative in content. Able to reflect on experience coherently.
-Dismissive = Much of the quality of description is lost with little memory of attachment experiences. Disavows impact of negative experiences
-Preoccupied =Lots of affect but description is entangled/confusing. Can feel a lot but cannot reflect on it.
-Strongly predicts attachment mode of infant
AAI - structured interview, illustrates the internal working model, and predicts the attachment style of the infant before birth
Attachment styles as seen in clinical practice
- Preoccupied/ Insecure-ambivalent = compulsive careseekers. Constant distress signal to maintain attachment. Can be appreciative but exhausting. Must establish clear limits and preemptive delivery of empathy
- Dismissive/Insecure-avoidant = not initially problematic due to being distant and underdemanding. Self-reliance and rejection of dependence can lead them to reject medical advice. Must allow patient to set the distance, maintain polite formality, and find places where they can control their own care
- Disorganized insecure = create confusing mixed messages. May demand care and then reject help. Must be patient and have a team that will support each other.
Feelings of the patient
Anxious/frightened (seriousness of illness, death, cost, etc.)
- Embarassed/ashamed (vulnerable, helpess, exposed, dehumanized, ugly) - Sad (unfulfilled dreams, loss of ability, etc.) - Angry (illness is unfair, previous mistreatment, etc.)
Transference
displacing old feelings, expectations, longings onto present day figures (reactions that don’t make sense of that are more extreme than expected)
Counter-transference
Physician feelings evoked by transference: frustration, anger, must be contained
Compromise formations
provide option between total rejection of painful thoughts and total immediate expression of those feelings in action. Generated by the Ego.
Psychotic Defenses
Psychotic denial = Complete refusal to acknowledge illness even exists
Psychotic Projection = Being persecuted from without (aliens, etc.)
Immature Defenses
Projection = Paranoia. Doctor has malevolent intentions
Splitting = Separating good and bad feelings and attaching them to different people
Acting Out= Displaces feelings through action (punching wall, driving erratically)
Fantasy = Daydreaming
Neurotic (intermediate) Defenses
Somatization/Hypochondriasis = Experience vague symptoms in body or preoccupation with illness. Allows patient to be further comforted (secondary gain). Can result in secondary neurological deficit (conversion symptom).
Displacement = move feelings from one object to another (can cause phobias)
Isolation of affect (Intellectualization) = Disconnects from disturbing feelings making them unconscious. Will have accurate perception but lack emotional response.
Repression = Making oneself unaware of the disturbing thought/feeling. May have trouble sleeping or be nervous.
Reaction formation = Turns vice into a virtue. Unaware of their over-praise.
Mature Defenses
Suppression = Partly conscious and is temporary Sublimation = Turning unacceptable impulse into socially productive outlet Humor = turn tragic experiences into comedy. Different from making fun of someone. Altruism = Subordination of one’s own interest in service of others
Topographical Model of the Mind - Freud
- Transference = feelings a person had towards someone in their past are displaced onto someone in present
- Counter-transference = feelings that are evoked in response to another’s transference
- Id = drive to satisfy pleasure and emotional satisfactions
- Ego = mental functions resolved in making reasoned decisions. Concerned with what is possible and prudent
- Superego = mental functions that tell us what is permissible, morally wrong, and taboo
Optimal Ego Functioning
- Modulating intensity of feelings
- Postponing gratification and tolerating the tension • Understanding context and perspective
- Channeling feelings productively
- Is creative in solutions
- Matures over a life time
Defense Mechanisms in general
Necessary for healthy and normal living • Not every experience in life can or should be fully tolerated right this moment • Some self deception may be necessary • Mostly defenses are unconscious
