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STEP 2 > UW2 > Flashcards

UW2 Flashcards

1
Q

Name 3 MAOI’s

A

Phenelzine, Tranylcypromine, and selegiline

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1
Q

What may be a CC in a woman with AE from antipsychotics affecting the tuberoinfundibular pathway?

A

Secondary Amenorrhea

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1
Q

What is required for delusional disorder?

A

Presence of NONBIZARRE delusions for > 1 month

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1
Q

Pts with a FMHx of _____ are at increased risk of trichotillomania? Tx?

A

OCD (ego dystonic); CBT

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1
Q

What is the mgmt of mucormycosis?

A

Surgical debridement and amphotericin B (look for in DKA, leukemia)

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1
Q

When should pts technically get vaccinated perioperatively for splenectomy

A

14 days prior or 14 days after (HiB, pneumococcus, and meningococcus)

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2
Q

What is the major AE of azathioprine?

A

Dose related diarrhea

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3
Q

What is the best immediate mgmt of frostbitten extremity?

A

Rapid re-warming with warm water; NO IMMEDIATE ATTEMPT AT DEBRIDMENT

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4
Q

What is the greatest risk factor for completing homicide

A

Access to GUNS

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4
Q

How do you treat acute mania?

A

Antipsychotic plus a mood stabilizer because faster onset than mood stabilizer alone! Then taper off the antipsychotic

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5
Q

What is required to dx adjustment disorder?

A

Development of emotional or behavioral sx WITHIN 3 MONTHS of identifiable stressor (not go longer than 6 months)

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6
Q

What are some tests you should order prior to starting lithium?

A

BMP (for kidneys, i.e. serum creatinine), TFT’s for baseline thyroid fxn, and B-hCG if a woman to prevent Ebstein’s

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6
Q

What are the 2 major types of acute dystonic rxn

A

Torticollis and oculogyric crisis

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6
Q

What do you do in a pt with newly dx’d cirrhosis and nonbleeding varices who also has asthma?

A

Endoscopic variceal ligation because cant give nonselective BB

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6
Q

What is MOA of cyclosporine and what is the MC AE?

A

Inhibits transcription of IL-2; nephrotoxicity (can also cause gum hypertrophy)

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6
Q

What is the MC electrolyte in Addison’s?

A

HYPONATREMIA, but hyperkalemia is prob the one you’ll pick up on in a question

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6
Q

How do you manage acute exacerbations of MS? What if no response?

A

Glucocorticoids; Plasmapheresis

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6
Q

Why may a person with heat stroke bleed?

A

There can be coagulopathic bleeding likely from denaturation of the proteins

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6
Q

What can you do for pts with symptomatic cholelithiasis who don?t want surgery?

A

Ursodeoxycholic acid and avoid fatty foods

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6
Q

Where is the MC site of lacunar infarct? What would this cause?

A

Posterior limb of internal capsule; pure motor stroke (i.e. due to htn and small vessel lipohyalinosis)

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7
Q

What do you call factitious disorder when the pt is willing to consent to invasive procedures?

A

Munchausen syndrome

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8
Q

What is the best course of action when a patient is having command auditory hallucinations?

A

Hospitalize the patient involuntarily ESPECIALLY if telling the pt to hurt self or others

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8
Q

What is the timeline for brief psychotic disorder, schizophreniform, and schizophrenia?

A

Brief psychotic = less than a month; schizophreniform less than 6 and schizophrenia is after 6

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8
Q

Ketamine and PCP both cause what physical sx? What class of drug?

A

Nystagmus, arylcyclohexamine

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8
Q

What should be suspected in pt with COPD who has catastrophic worsening of their COPD?

A

Ruptured apical bleb (i.e. pneumothorax)

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9
Q

How should pts with folie a deux be interviewed?

A

SEPARATELY (shared psychotic disorder)

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9
Q

What is the major AE of mycophenolate mofetil?

A

BM suppression

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9
Q

What may you want to think about in a pt with chronic cough productive of mucopurulent sputum?

A

Bronchiectasis (check CT)

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10
Q

What can be seen on neuroimaging for OCD?

A

Orbitofrontal cortex and striatum abnormalities

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12
Q

When do you surgically remove brain mets vs. whole brain radiation

A

Solitary met = surgery; Many mets = whole brain radiation and need to watch for herniation

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13
Q

What is required to dx schizoaffective disorder?

A

2 weeks of psychotic sx in the absence of mood sx (need to rule out primary mood disorder with psychotic features)

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14
Q

What drugs are used acutely for panic attacks? What are used long term?

A

Benzodiazepines; SSRI

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15
Q

What enzyme is inhibited by lithium?

A

Inosotol-1-phosphatase in neurons

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15
Q

Which personality disorder had chronic feelings of emptiness?

A

Borderline personality

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15
Q

What bug is most likely to be isolated from a secondarily infected allergic contact dermatitis?

A

CoNS

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16
Q

In whom do you commonly see otosclerosis?

A

Young adults 20-30’s, conductive hearing loss

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17
Q

Why can chronic NSAID use cause hyponatremia?

A

NSAIDs potentiate ADH and can lead to SIADH

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18
Q

Why do anorexics often need to be hospitalized?

A

Due to dehydration or electrolyte imbalances and to monitor for sx of refeeding syndrome

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19
Q

What is the general mgmt for schizoaffective pts?

A

Antipsychotic + whatever they need for mood i.e. SSRI if depressed, lithium or mood stabilizer if manic

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19
Q

Which benzo is preferred in preventing DT in a pt with cirrhosis?

A

Lorazepam because renally excreted (hope they don?t got dat hepatorenal syndrome doe!)

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20
Q

Why may hairy cell leukemia cause a dry tap?

A

It induces bone marrow fibrosis and myelophthisic process leading to the extramedullary hematopoiesis that causes the characteristic splenomegaly

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22
Q

What do you do if you suspect ischemia but EKG is normal

A

Stress EKG

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23
Q

What risk do valproate and carbemazipine pose to the fetus?

A

Neural tube defects

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23
Q

Tx of antipsychotic induced parkonsonism?

A

Benztropine

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25
Q

What is the mgmt of choice for generalized anxiety disorder?

A

SSRI and cognitive behavioral therapy (avoid benzo’s b/c substance abuse)

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25
Q

What is the MC cause of constrictive pericarditis in a foreigner? US?

A

TB; pmhx radiation

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27
Q

What is the immediate tx of NMS?

A

DC the antipsychotic and give dantrolene, monitor in ICU (more nurses per pt, better monitoring)

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28
Q

What is a major AE of giving recombinant EPO in pts with CKD induced anemia?

A

Worsening of HTN; also if low iron stores it will precipitate a microcytic anemia

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30
Q

Which EPS is not primarily treated with benztropine?

A

Neuroleptic malignant syndrome, requires dantrolene!!! Also acute dystonic rxn can be txd with diphenhydramine or benztropine; Tardive not really fixable

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31
Q

What is the significance of Streptococcus gallolyticus?

A

i..e S. bovis can cause endocarditis in setting of CRC, do colonoscopy

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32
Q

What are the lights criteria

A

1) pleural fluid protein:serum protein > 0.5 2) Pleural LDH:Serum LDH > 0.6 or 3) Pleural LDH > 2/3 upper limit of normal of serum LDH

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33
Q

What is the significance of Clostridium septicum?

A

It is a normal gut flora and in CRC it can get into blood stream and cause a spontaneous gas gangrene secondary to hematogenous spread; treat and do colonoscopy

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34
Q

How do you treat exertional heat stroke?

A

Rapid cooling and supportive mgmt (don?t think it?s the same for nonexertional, i.e. old ppl)

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35
Q

In acute mania if you had to choose between an antipsychotic and a mood stabilizer which would you pick?

A

Antipsychotic because it kicks in faster; in reality you give both for acute mania and taper off of the antipsychotic

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35
Q

What should all pts with hypothyroidism be screened for?

A

HLD; And all pts with HLD should be screened for hypothyroidism! (Recall Dr. John: hypothyroidism accelerates atherosclerosis, hyperthyroidism potentiates osteoporosis)

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37
Q

Why shouldn?t you give antipsychotics to ppl withdrawing from alcohol?

A

Lowers the seizure threshold

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39
Q

What is the best way to guide abx therapy in pts with acute bacterial prostatitis?

A

Obtain a midstream urine sample for bacteria and guide based on Cx

40
Q

Which antipsychotic is least likely to cause EPS?

A

Clozapine but limited by risk of agranulocytosis

41
Q

Which is synpharyngitic, IgA nephropathy or post-streptococcal GN?

A

IgA nephropthy (IgA in mesangium)

43
Q

For whom is clozapine reserved for?

A

Pts who have failed 2 antipsychotics or who have suicidal thoughts

44
Q

With which personality disorder is malingering heavily assoc?

A

Antisocial personality disorder

44
Q

What is dissociative fugue?

A

They have to travel and they have to forget who they are

46
Q

How is lithium cleared from the body?

A

Renally, that?s why its important to check creatinine prior to starting

48
Q

What is the most common AE of ECT?

A

Amnesia (retrograde or anterograde)

49
Q

Which SSRI has longest half life

A

Fluoxetine

50
Q

What is maintenance therapy for bipolar after 1st bipolar episode? 2nd?

A

AT least 1-2 years; lifetime

51
Q

When is colonoscopy screening for CRC indicated in UC?

A

8 years s/p dx and then repeat every 1-2 years

53
Q

What sx preceding a liver abscess point you towards E. histolytica? Tx?

A

Bloody diarrhea; metronidazole

54
Q

What is DOC for atypical depression?

A

MAOI’s

56
Q

What TCA is used for tx of OCD?

A

Clomipramine

56
Q

What is the best tx for noncompliant schizophrenics?

A

Long-acting injectable! ONLY if they were treated but noncompliant not if they were refractory

58
Q

What is the most critical first step for lactic acidosis in shock?

A

IV NS

59
Q

A very low pleural fluid pH likely indicates?

A

Empyema

61
Q

When can bicarb be used in acidosis?

A

Rarely only if pH

62
Q

What are 3 psych drugs that can cause agranulocytosis?

A

Clozapine, carbamazepine, and mirtazepine

63
Q

Where do you see the double duct sign?

A

Pancreatic CA

64
Q

What is the preferred stimulant for narcolepsy?

A

Modafinil (and regularly scheduled naps)

66
Q

How long should you wait prior to starting an SSRI after discontinuing an MAO-I

A

4 weeks to prevent serotonin syndrome (Tx = dantrolene, cyproheptadine)

67
Q

Does a schizophrenic patient who is not acutely psychotic have decision making capacity for surgery?

A

Absolutely!

68
Q

What is the major difference between avoidant personality and schizoid?

A

Avoidants desire to have friends whereas schizoids do not

68
Q

What is the mgmt of 1st degree AV block? PR length?

A

Observation (no real clinical significance); PR > 200

70
Q

What characterizes the autism spectrum disorders?

A

Impairments in communication and social interaction with repetitive/stereotyped behaviors and abnormal reactivity to sensory input

72
Q

What are 3 types of delusions?

A

Paranoid, grandiose, or somatic (fixed false beliefs that DO NOT respond to reason)

74
Q

What effect do OCD and OCPD have on ego?

A

OCD is ego dystonic, bothers them; OCPD is ego syntonic, they have no idea

74
Q

Why cant you give bupropion with MAOI’s

A

Serotonin syndrome

75
Q

What is first line tx for OCD?

A

SSRI or clomipramine (TCA) and CBT

76
Q

What kind of meds often precipitate hepatic encephalopathy?

A

Sedative medications like benzos (contraindicated!) or hydrocodone

77
Q

When do terminal patients need SSRI’s?

A

If they meet criteria for MDD, i.e. not just normal grieving but hit 5 SIGECAPS

79
Q

What is the cause of scabies

A

Sarcoptes scabeii

80
Q

What does heroin withdrawal present like?

A

RHINORRHEA, sweating, muscle aches with severe sx OOP to physical findings

82
Q

What is the best tx for akithisia?

A

Benzodiazepine

83
Q

What do you do if a cervical LN is positive for SCC?

A

Triple endoscopy = EGD, laryngoscopy, and bronchoscopy

85
Q

What should all pts with a nonprovoked first seizure get?

A

Non-Contrast CT of head to r/o bleeding

86
Q

How long should you wait prior to switching SSRI’s if one doesnt seem to be working?

A

4-6 weeks

87
Q

What should a pt with renal dysfunction and bipolar receive?

A

Valproate? NO LITHIUM

89
Q

what are the EKG findings of ventricular aneurysm?

A

Q waves and persistent ST elevation

91
Q

What causes renal papillary necrosis in sickle cell?

A

The hypoxic renal medulla can cause sickling of RBCs’ and can cause papillary necrosis; predisposes to renal medullary CA

93
Q

What should you use to manage HTN in a pt presenting acutely with weight loss and erythema of the septum and nasal turbinates?

A

CCB’s for cocaine overdose, BB’s can lead to unopposed alpha

94
Q

What is the best thing to do if a healthcare proxy disagrees with a living will?

A

Meet with BOTH the healthcare proxy and the family to have a meeting

95
Q

Crystal-Induced nephropathy is a well known AE of what AIDS med

A

Indinavir (protease inhibitor)

96
Q

What can be seen on neuroimaging for schizophrenia? Also seen in???

A

Increased ventricle size (lateral ventricular widening); Huntington’s due to degeneration of caudate (makes up lateral wall of lateral ventricle)

98
Q

What drug prevents urate nephropathy from TLS? What drug can prevent damage from pre-existing urate?

A

Allopurinol; Rasburicase

99
Q

What physical exam technique should never be done in febrile neutropenia?

A

DRE

100
Q

What is the major AE of abacavir?

A

Hypersensitivity syndrome

101
Q

What is the best diagnostic test in a pt with amaurosis fugax? What are the cholesterol particles in the eye called?

A

Duplex US of neck; Hollenhorst plaques

103
Q

What is the major cause of post-ictal acidosis?

A

Post-ictal hypoventilation (i.e. respiratory acidosis)

104
Q

What do you do in a lifethreatening situation where a wife is saying her husband is Jehovah’s witness and doesnt want blood but you have no documentation from the pt?

A

Fuck the bitch give the damn blood!

105
Q

What do you do for nonbleeding esophageal varices?

A

Give a nonselective BB i.e. propanolol or nadolol for primary ppx against bleeding (if given before they ever develop, then it is pre-primary prevention)

106
Q

What is the best drug for dysthymia

A

SSRI

107
Q

What are the effects of antipsychotics on the 3 main DA pathways?

A

Mesolimbic (antipsychotic efficacy), Nigrostriatal (EPS), and tuberoinfundibular (hyperprolactinemia)

108
Q

Hoarding disorder is a type of what disorder? Responds to what?

A

OCD (ego dystonic); responds to SSRI’s and CBT

109
Q

How could furosemide lead to ventricular tachycardia?

A

Causes hypokalemia and hypomagnesemia both of which predispose to arrhythmias

110
Q

Lithium decreases rates of what in bipolar (3)?

A

Relapse, suicide, and hospitalizations

111
Q

What SNRI is given in pts with fibromyalgia refractory to exercise?

A

Duloxetine; also TCA’s are common

112
Q

What are the 2 main reasons to start ACE-I in DM?

A

If pt has HTN or microalbuminuria

114
Q

Though Hodgkin lymphoma is often curable in young ppl what is the major future issue in young ppl tx’d?

A

Treatment related MDS or AML; i.e. secondary malignancy and these do not respond as well to chemo and often have complex cytogenetics

115
Q

Which arteriole is affected by angiotensin II

A

Efferent

116
Q

How long does somatiform disorder have to last?

A

> 6 months

117
Q

What is the MC AE of methylphenidate?

A

Depressed appetite (don?t give to young kids under 6 because can fall off growth curve)

118
Q

What drug is contraindicated in acute MI with new onset JVD and clear lungs?

A

NITRATES, i.e. RV infarct (check right sided leads) give fluids

120
Q

how long should a single episode of depression be treated for

A

At least 6 months

121
Q

What is the most common AE of olanzapine?

A

Sedation and WEIGHT GAIN, also has metabolic AE such as metabolic syndrome and frank DM II

122
Q

What do you give in acute esophageal hemorrhage?

A

ABC’s and IV octreotide

123
Q

How do you manage Warfarin Skin Necrosis?

A

DC warfarin and give Protein C Concentrate

124
Q

Define heat stroke

A

Core body temp > 40 C with AMS

126
Q

What is opisthotonus?

A

Back spasm (i..e acute dystonic rxn, tetanus)

127
Q

What do you do if there is sexual dysfunction in SSRI’s?

A

Switch bupropion

128
Q

What can often normalize homocysteine levels in hyperhomocystenemia?

A

B6 and folate (B6 is a cofactor for Cystathione B synthase)

129
Q

What is Russel’s sign?

A

Scars on the hands and knuckles from self induced vomiting

130
Q

Why would diabetic autonomic neuropathy cause incontinence

A

Overflow incontinence due to neurogenic bladder (high post void residual)

131
Q

How do you tx syphilis in pts allergic to pcn? What if pregnant?

A

Doxycycline; desensitize to pcn then give benzathine pcn G(i..e cant give preggo doxy)

132
Q

What are the main AE of antipsychotic action on the tuberoinfundibular pathway?

A

Gynecomastia/galactorrhea and decreased libido

133
Q

What is the strongest indicator of suicide attempt?

A

Prior suicide attempt

134
Q

Lid lag and tremor are commonly seen in what?

A

Graves dz; also thyroid bruit is pretty specific

135
Q

What cause of restricive CMP is reversible? Dilated?

A

Hemochromatosis if control ferritin levels with phlebotomy; alcoholic if DC alcohol

136
Q

What are 2 tx options for scabies

A

Topical 5% permethrin neck down left overnight; PO ivermectin

137
Q

What is the MC location of ectopic foci for atrial fibrillation? Atrial flutter?

A

Pulmonary veins; Tricuspid annulus

138
Q

What is the first line therapy for specific phobia?

A

behavioral therapy (Don?t pick benzo!!)

139
Q

What hematologic disorder can occur with carbamazepine? What atypical antidepressant can also do it?

A

Agranulocytosis; Mirtazepine

140
Q

What is alcholic hallucinosis?

A

Predominately auditory hallucinations that develop often 12-24 hours after no alcohol, NOT the same thing as DT’s

STEP 2 (13 decks)

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