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Psychiatry 200 > Texas Review > Flashcards

Texas Review Flashcards

1
Q

What stroke can lead to disinhibition like mania?

A

Right Frontal Hemisphere Stroke

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2
Q

Meds to Avoid in Mania?

A

SSRIs and TCAs

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3
Q

Lithium toxicity sxs

A

N/V/D, coarse tremor, ataxia, confusion, slurred speech

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4
Q

Lithium Major Side Effects

A

Weight gain, acne, GI irritation, cramps

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5
Q

Lithium MOA

A

Suppresses Inositol triphosphate

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6
Q

Therapeutic Levels of different anticonvsulants

A

Lithium: 0.6-1.2 mg
Depakote: 6-12 mg
Carbamazepine: 60-120 mg

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7
Q

What to monitor for Lithium?

A

Li level q4-8 weeks
TFTs q6mo
Cr, UA, CBC, EKG

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8
Q

Contraindications for Lithium?

A

Severe renal dz, MI, diuretics or digoxin, MG, pregnancy or breastfeeding

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9
Q

Valproate side effects

A

N/V/D, skin rash

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10
Q

SJS/TEN with BAD

A

Lamotrigine (less likely tegretol)

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11
Q

Bipolar and agranulocytosis cause

A

Tegretol. Monitor weekly CBC if ANC<1000

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12
Q

Bipolar and inc. AFP in a 20 wk preggo?

A

Neural tube defect from Depakote or Tegretol. Take 4g of folate a day.

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13
Q

Carbamazepine most common side effect?

A

Rash

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14
Q

First thing to ask a very depressed patient?

A

Want to kill yourself?

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15
Q

What kind of stroke can mimic depression?

A

Left MCA stroke

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16
Q

beta-blockers, alpha-methyldopa, l-dopa, OCPs, ETOH can all trigger what

A

depression

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17
Q

Porphyria, Lyme, Uremia, Hungtington’s, MS, Lupus can cause what

A

depression

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18
Q

Atypical Depression Symptoms

A
  1. Weight gain/Increased appetite
  2. Hypersomnolence
  3. Rejection Hypersensitivity
  4. Leaden paralysis
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19
Q

Complicated vs. Uncomplicated Bereavement?

A

No suicidal ideation other than thoughts of wanting to be with loved one. No psychosis other than hearing/seeing loved one.

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20
Q

Adjustment Disorder, when must it start and how long can it last?

A

Must start within 3 months of an identifiable stressor and cannot persist longer than 6 months after the stressor ends.

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21
Q

How to treat adjustment disorder?

A

Psychotherapy

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22
Q

Most drug-drug interactions SSRI

A

Paroxetine

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23
Q

SSRI with fewest drug-drug interactions?

A

Citalopram…I thought it was fluoxetine in Lange?

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24
Q

Discontinuation syndrome sxs?

A 
HA
N/V/D
Dizziness
Fatigue
Brain Zaps
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25
Q

Serotonin syndrome sxs?

A 
Myoclonus (lower extremities)
Tachycardia
High BP
Hyperreflexia
n/v/d

MAOI + SSRI

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26
Q

SSRI causes impotence, switch to?

A

Bupropion

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27
Q

Contraindications to Bupropion?

A

Seizures, alcoholics, bulimia

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28
Q

Good for old, skinny, sad women?

A

Remeron for sleep and appetite

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29
Q

ECT is best for what patients

A

Preggos and Old people

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30
Q

Avoid what antidepressant in hypertensive patients?

A

Venlafaxine. Don’t take with st. John’s wort

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31
Q

Hypertensive crisis from MAOI

A

Pounding HA
Flushing
Nausea
Myoclonus

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32
Q

How to treat hypertensive crisis from MAOI?

A

Phentolamine 5 mg IV

alpha1 antagonist

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33
Q

Causes of hypertensive crisis from MAOI?

A

Cheese, anything fermented/pickled, wine
Decongestants
Demerol (Meperidine, Pethidine)

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34
Q

Effect of TCA on EKG?

A

QRS widening and prolonged QT interval

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35
Q

Normal QTc in males and female?

A

Males: <440 ms

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36
Q

Tx for TCA overdose?

A

Charcoal if w/i 1-2 hrs

IV sodium bicarb to help with metabolic acidosis and cardioprotective

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37
Q

Negative symptoms of schizophrenia?

A

5 A’s

  1. Anhedonia
  2. Affective Flattening
  3. Alogism
  4. Avolition (Apathy)
  5. Attention
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38
Q

Most common type of SCZ?

A

Paranoid, best prognosis

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39
Q

SCZ heritability?

A

MZ twin: 50%

Sibling: 10%

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40
Q

Brief Psychotic Disorder vs. SAD vs. SCZ

A

BPD 6 mo.

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41
Q

How to treat SAD?

A

Atypical + SSRI/Li (depending on mood symptoms)

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42
Q

SAD vs. SCZ symptoms

A

SAD requires 2 weeks of psychotic symptoms with the absence of affective symptoms

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43
Q

Psychotic Depressino tx.

A

Atypical + SSRI

OR

ECT (especially if pregnant)

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44
Q

Clozapine and Prolactin?

A

Doesn’t cause increases in prolactin?

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45
Q

Atypicals vs. Typicals effect on Prolactin

A

Typicals raise prolactin because they block DA so strongly, Atypicals typically don’t have any substantial effect on prolactin, except for Risperdal (the most typical atypical)

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46
Q

Butyrophenone is what

A

Drug class: Includes Haldol

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47
Q

Chlorpromazine causes what side effects?

A
  1. Jaundice (from anticholinergic effects?)

2. Purple grey metallic rash over sun-exposed areas

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48
Q

Thioridazine side effects

A

Pigmentary retinopathy

Prolonged QTc

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49
Q

Antipsychotics and QTc

A

Low potency and atypicals have a greater effect?

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50
Q

Antipsychotics and seizure threshold

A

Low potency and atypicals have a greater effect?

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51
Q

Parkinsonism tx

A

Cogentin/Benadryl, amantadine/bromocriptine (DA agonists)

NO L-DOPA

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52
Q

Onset of different EPS

A 
Acute dystonia (6 mo.)
TD (years)
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53
Q

Neuroleptic Malignant Syndrome sxs.

A
  1. Hyperthermia
  2. Rigidity
  3. Autonomic Instability
  4. Delirium
  5. Increased CPK
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54
Q

NMS tx

A
  1. D/c med
  2. Dantrolene and cooling blankets
    or bromocriptine (2nd line)
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55
Q

Other causes of NMS

A

Metoclopromide, compazine, droperidol

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56
Q

Atypical with highest risk for EPS and increased prolactin?

A

Risperdal

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57
Q

Atypical Weight neutral but prolongs QTc

A

Ziprasidone

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58
Q

Atypical Weight neutral but increases akathisia

A

Aripiprazole

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59
Q

Atypical Most associated with weight gain (#1 s/e is sedation)

A

Olanzapine

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60
Q

Atypical Causes orthostasis and cataracts

A

Quetiapine (alpha blocking properties)

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61
Q

Good for treating refractory SCZ

A

Clozapine

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62
Q

Clozapine most common s/e

A

Sedation, weight gain, increased blood sugar and lipids

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63
Q

Most dangerous S/e for clozapine

A

decreased seizure threshold and agranulocytosis

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64
Q

Clozapine monitoring

A

CBC: ANC qWeek for 6 mo., then q2weeks for next 6 mo.

D/c if WBCs <1500

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65
Q

Patient comes in with something like a panic attack, what do you do first?

A

Cardiac screening: EKG, cardiac enzymes, echo, TSH or T4, UDS

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66
Q

Panic Disorder tx

A

Alprazolam or Clonazepam PRN short term

SSRIs are preferred drug

67
Q

Don’t give benzos to these patients:

A

Addicts
COPD
Restrictive lung disease

68
Q

Sedative/Hypnotic withdrawal symptoms

A

Hyperthermia
Convulsions
Confusion
Hypertension

69
Q

Treating sedative/hypnotic withdrawal

A

Diazepam/Chlordiazepoxide + haldol if psychotic

70
Q

Liver safe benzos

A

Lorazepam, Oxazepam, Temazepam

71
Q

Specific Phobia tx

A

CBT with flooding or exposure/extinction

Benzos for situational use

72
Q

Social Phobia tx

A

Propranolol to stop hyperarousal and a Benzo

CBT Assertiveness training

73
Q

Avoidant PD tx

74
Q

GAD tx

A

Buspirone (5HT1a partial agonist)
Benzos to bridge for 3 weeks

but I thought SSRIs are first line?

75
Q

OCD comorbid with

76
Q

OCD tx

77
Q

OCD NT dysfunction

A

Serotonin (hence SSRIs and clomipramine)

78
Q

PTSD diagnosis

A
  1. Experienced a trauma
  2. Flashbacks/Nightmares
  3. Avoiding things/places/people
  4. Poor mood
  5. Hypervigilance/Hyperarousal/exaggerated startle
79
Q

PTSD tx

A

SSRIs: Sertraline or Paroxetine
CBT
Prazosin for nightmares (alpha1 antagonist)

80
Q

Adjustment Disorder w/ anxiety vs. PTSD

A

No traumatic event, but some stressor like a bad breakup….???????

81
Q

Anorexia Lab abnormalities

A

Vitals: Hypotension, Bradycardia, Hypothermia
CBC: Leukopenia
BMP: High HCO3, low Cl, low K, high carotene, high LFTs and amylase
TFTs: Normal
Lipids: High cholesterol
Hormones: High cortisol, low LH/FSH, low estrogen

82
Q

Anorexia long term complications

A

Osteoporosis

83
Q

Anorexia most common cause of death

A

Heart disease, then suicide

84
Q

Anorexia treatment

A

Admit for nutrition, intensive counseling

85
Q

Refeeding syndrome

A

Low Phosphate, Low Mg, low Ca, and fluid retention

Low phosphate and Mg b/c ATP is used up to phosphorylate Glucose

86
Q

Slow wave sleep has how much delta?

A

50% delta in stage 4

87
Q

What parasomnias happen in slow wave sleep?

A

Sleep walking/talking/night terrors

88
Q

Insomnia diagnosis…

89
Q

Insomnia tx.

A

Sleep hygiene, then GABAa agonist

90
Q

Dyssomnia NOS

A

Creepy-Crawlies on legs and must move around

91
Q

Dyssomnia NOS causes

A

Fe-def anemia, chronic kidney dz, neuropathy

92
Q

Dyssomnia NOS treatment

A

Ropinirole or pramipexole (DA agonists)

93
Q

OSA vs. Breathing Related sleep diagnosis

A

OSA is on axis III and the other on axis I

94
Q

Paranoid PD tx

A

Antipsychotics can help paranoia

95
Q

Antisocial PD comorbid condition

A

2/3 have substance abuse

96
Q

Histrionic PD comorbidities

A

Substance abuse, eating disorder

97
Q

Avoidant PD tx

A

tx social phobia sxs w/ beta blocker or SSRI

98
Q

Dependent PD tx

A

SSRI. Look for comorbid depression and anxiety

99
Q

Biggest risk factor for delirium

A

Age. Underlying dementia is the 2nd biggest. Also look for acute substance withdrawal. Look for it on the 2nd or 3rd post-op day in alcoholic.

100
Q

Delirium on EEG

A

Diffuse background slowing of background rhythm

101
Q

Psychosis on EEG

102
Q

Alzheimer’s features

A

Aphasia, apraxia, memory loss

on MMSE, prompting does not improve recall

103
Q

Alzheimer’s pathology

A

Global brain atrophy. Beta-amyloid plaques or tau tangles

104
Q

Alzheimer’s genes

A

APP (chr. 21), ApoE E2

105
Q

Alzheimer’s tx

A

Donepezil, rivastigmine, galantamine (diarrhea), memantine

106
Q

Frontotemporal dementia (Pick’s Dz) features

A

More sexually explicit, apathy

107
Q

Pick’s disease pathology

A

Lobar atrophy. Intra-neuronal silver staining inclusions

108
Q

Pick’s disease tx

A

Olanzapine for severe disinhibition

109
Q

Lewy Body Dementia features

A

Fluctuation in consciousness, visual hallucinations and shuffling gait

110
Q

Lewy Body Dementia pathology

A

Intracytoplasmic alpha-synuclein inclusions in neocortex

111
Q

Lewy Body treatment

A

Give AChE inhibitors, no L-Dopa. Avoid neuroleptics

112
Q

Cruetzfeldt-Jakob features

A

Myoclonus, startle response, seizures. Recently had a corneal transplant

113
Q

Prion EEG findings

A

Triphasic Bursts!!!

114
Q

NPH symptoms

A

Classic Triad: Incontinence, gait ataxia, rapidly developing dementia

115
Q

NPH tx

A

Ventriculoperitoneal shunt improves cognitive fxn in 50-67% of patients

116
Q

Alcohol withdrawal and autonomic hyperactivity…how long?

A

12-24 hrs since last drink (bimodal peak at 8 and 48 hrs)

117
Q

How long till DTs

118
Q

How fast is alcohol metabolized

A

Zero-order kinetics (25 mg/hr)

119
Q

How to monitor if tx is sufficient

A

Follow hyperreflexia to dose the benzos during withdrawal

120
Q

Best txs for alcohol withdrawal

A

Diazepam or Chlordiazepoxide b/c of respective 80 and 120 hr half lives

121
Q

If he’s Cirrhotic, use what benzos

A

Lorazepam, oxazepam, or temazepam because they are glucuronidated before elimination

122
Q

Most specific test for ETOH consumption in the past 10 days?

A

Carbohydrate-deficient Transferrin

Less specific: Elevated GGT and AST>ALT 2:1

123
Q

Korsakoff’s syndrome/psychosis

A

Apathy, anter/retrograde amnesia and confabulation. Can see mamillary body atrophy on MRI

124
Q

Opiate withdrawal symptoms

A 
Joint an dmuscle pain
Photophobia
Goosebumps
Diarrhea
Tachyardia
HTN
GI cramps
Dilated pupils
anxiety/depression
125
Q

Non-opiate treatment for opiate addiction

A

Clonidine, ibuprofen (muscle cramps), loperamide for diarrhea,

126
Q

Opiate treatment for opiate addiction

A

Methadone, buprenorphine, naltrexone for long-term dependence

127
Q

PCP intoxciation signs

A

Horizontal nystagmus, dilated pupils, ataxia and acute psychosis

128
Q

Stimulant withdrawal sxs

A

SI, hypersomnia, depression, and anergia

129
Q

Stimulant intoxication signs

A

Dilated pupils, eizure, tachycardia, HTN

130
Q

Stimulant toxicity tests and tx

A

EKG, then urine tox screen.
Tx seizure with lorazepam
Tx HTN and tachycardia with CCB, do not use beta-blockers

131
Q

Most common inherited cause of MR

A

Fragile X (dominant inheritance, CGG repeats with anticipation)

132
Q

Down syndrome physical signs

A

Decreased tone, oblique palpebral fissures, simian crease, big tongue, white spots on his iris

133
Q

Down syndrome medical complications

A
  1. Heart: VSD, endocardial cushion defect
  2. GI: Hirschsprung’s, intestinal atresia, imperforate anus, annular pancreas
  3. Endocrine: Hypothyroidism
  4. MSK: Atlanto-axial instability
  5. Neuro: Increased risk of Alzheimer’s (APP is on Chr. 21)
  6. Cancer: 10x increased risk of ALL
134
Q

Neurofibromatosis

A

Cafe au lait spots, seizures large head. Aut. dominant

135
Q

Hurler syndrome

A

Coarse facies, short stature, cloudy cornea. Aut. rec.

136
Q

Smith Magenis

A

Broad, square face, short stature, self-injurious behavior. Deletion on Chr. 17

137
Q

Prader-Willi

A

Hypotonia, hypogonadism, hyperhagia, skin picking, aggression. Deletion on paternal Chr15

138
Q

Angelman

A

Seizures, strabismus, sociable with episodic laughter. Deletion on maternal Chr15

139
Q

Williams

A

Elfin appearance, friendly, increased empathy and verbal reasoning ability. Deletion on Chr7

140
Q

Fetal alcohol syndrome

A

ADHD like sxs, microcephaly, smooth philtrum. Most common cause of mental retardation

141
Q

Congenital CMV infection

A

Seizures, chorioretinitis, hearing impairments, periventricular calcifications, petechiae at birth, hepatitis

142
Q

Congenital Rubella Syndrome

A

Seizures, hearing impairments, cloudy cornea/retinitis, heart defects, low birth weight

143
Q

Cerebral Palsy from birth asphyxia

A

Abnormal muscle tone, unsteady gait, seizures, mental retardation or learning disability

144
Q

Cornelia de Lange

A

IUGR, hypertonia, distinctive facies, limb malformation, self-injurious behavior, hyperactive

145
Q

CHARGE

A

Coloboma, heart defects, choanal atresia, growth retardation, GU anomalies, ear deformity, and deafness. Chr. 8

146
Q

DiGeorge

A

Autism spectrum sxs, heart disease, palate defects, hypoplastic thymus, hypoCa. Chr 22 deletion

147
Q

Maple Syrup Urine Disease

A

Vomiting, seizures, lethargy, coma. Acidosis with stress, illness. Causes neurological damage

148
Q

Rett Syndrome

A

Exclusively in girls, normal development for 6-8 mo. then regression, ahndwrining, loss of speech, and use of hands. Xlinked dominant deletion of MECP2

149
Q

Childhood Disintegrative Disorder

A

Normal development until age 2 then major loss of verbal, social skills with autistic like behavior

150
Q

Autism

A

Lack of mother-child eye contact, language delay/repetitive language, preoccupation with parts of toys before age 3

151
Q

Asperger

A

Problems with social skills (usually recognized in preschool) with preserved verbal ability

152
Q

Heritability of ADHD

153
Q

Risk factors for ADHD

A

Low birth weight, tobacco/etoh exposure

154
Q

ADHD comorbid condition

A

ODD/CD in 30-50%

155
Q

Weird ADHD meds

A

Clonidine, guanfacine (alpha2 agonists)

156
Q

Conduct disorder diagnosis

A

Need sxs for 6 mo.
Comorbid substance abuse
May become antisocial PD

157
Q

Oppositional Defiant diagnosis

A

Need sxs for 12 mo.

Stops just short of breaking the law or physically harming others

158
Q

Tourettes diagnosis

A

Tics at least once a day for 1 year w/o a tic free peiod longer than 3 mo.

159
Q

Tourettes comorbid

160
Q

Tourettes tx

A

First line: Clonidine, then Pimozide/Haldol

161
Q

Fecal retention tx

A

behavioral modification that only rewards

162
Q

Urinary incontinence diagnosis

A

UA and urine culture. Imipramine works but relapse is common. Use alarm and pad for 6 wks first. ddAVP has the same problem as imipramine with relapse but side effects of headaches, nausea, and hyponatremia

163
Q

Desmopressin and blood pressure

A

Does not increase blood pressure like vasopressin

Psychiatry 200 (5 decks)

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