UWorld - Step 2 CK "Psychiatry" Flashcards
Bath salts are sympathomimetics that have a similar effect profile to phencyclidine. What is a key distinguishing feature?
Bath salts have a prolonged duration, often causing psychiatric distortions for days or even up to a week.
Also, toxicology screens can detect PCP but not bath salts.
Give the DSM-V criteria for generalized anxiety disorder.
•Excessive worry or anxiety over multiple issues for greater than 6 months
•Inability to control worrying
•Impairment of life or significant distress
•Three or more of the following symptoms:
- Restlessness/feeling on edge
- Fatigue
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
What is folie à deux?
It is a shared delusional disorder. Typically, one person develops a delusion and passes it on to a less dominant person (think parent-to-child). The best way to assess and manage this syndrome is to separate the two to break the cycle of reinforcement. Often only the dominant person needs treatment.
True or false: tardive dyskinesia can be treated with benztropine or trihexyphenidyl.
False.
Anticholinergics treat extrapyramidal symptoms (like acute dystonia, akathisia, or parkinsonism), but not tardive dyskinesia.
Tardive dyskinesia can be treated with lowering the dose of the offending medication or, if that fails, switching to clozapine.
Adverse effects of clozapine include agranulocytosis, seizures, metabolic syndrome, and _______________.
myocarditis
Bupropion is best in depressed patients with ________________.
weight gain and hypersomnolence (because it causes weight loss and is activating)
Scores less than _______ on the Mini-Mental State Examination (MMSE) are sensitive for dementia.
24
What is REM sleep behavior disorder?
A disorder in which people have complex motor or vocal actions in REM sleep (like sleepwalking or sleep talking).
Differentiate nightmare disorder and sleep terror disorder.
- Nightmare disorder –exactly like it sounds –is a disorder in which kids have vivid nightmares. They often fully wake up and remember the nightmare. It usually occurs in the second half of the night.
- Sleep terror disorder is characterized by incomplete awakening without recollection of a specific nightmare. Often kids will not recall even waking up.
Describe kleptomania.
Kleptomania is a disorder of impulse control in which people steal not for personal gain but rather for the thrill of stealing. The person will describe feeling a sense of pent-up energy or being hyper that is relieved by stealing.
True or false: trichotillomania is a disorder in which people eat their own hair.
False. Trichotillomania involves pulling one’s hair, often without consciousness of doing so. It is associated with OCD. Trichophagia is a disorder of eating hair.
A common sign of inhalation in an adolescent is _______________.
“glue sniffer’s rash” –dermatitis around the mouth and nose from chemical irritation
Interpersonal psychotherapy is great for depressed patients whose _________________.
depressive symptoms are related to interpersonal/relationship problems
Cognitive behavioral therapy works well with patients who have what two problems?
- Automatic negative interpretations of events
* Avoidance behavior
Delirium tremens typically occurs _________ days after abstinence from alcohol
2 (48 hours)
Patients with schizophrenia who have what social situations are at higher risks of relapse?
Critical, hostile, overinvolved family members
Therapy for schizophrenia involves counseling the family on minimizing stresses and conflicts.
What is normal pupil diameter?
- In bright settings: 2 - 4 mm
* In dark settings: 4 - 8 mm
Tourette’s and tic disorders are associated with two other conditions: _______________.
OCD and ADHD
Conjunctival injection and ____________ are signs of marijuana intoxication.
xerostomia (“cotton mouth”)
Avoiding social situations and _______________ are characteristic of avoidant personality disorder.
hypersensitivity to rejection
Differentiate separation anxiety disorder and stanger anxiety.
- Separation anxiety disorder is characterized by extreme distress upon being separated from a caregiver. Children with SAD will be calm around strangers so long as they are accompanied by their parents.
- Stranger anxiety is characterized by distress when children encounter new adults. They’ll be uncomfortable when meeting other adults even in the presence of their parents.
What are the diagnostic criteria for selective mutism?
Failure or refusal to talk in social situations for over one month (the classic case is a child who talks at home and with friends but is silent at school)
What is the hallmark of reaction formation?
In reaction formation, the person does the opposite of what they’re feeling.
For instance, a person who’s angry at their father for abandoning them as a child who then talks about how great it is to have to take care of the father is using reaction formation.
How should somatic symptom disorder be managed?
- Maintain contact with one provider (to avoid redundant or unnecessary workups)
- Focus on coping skills to treat mental distress
- Manage psychosocial stressors
- Psychiatric/psychological evaluation (if the patient agrees)
In what ages (according to textbooks) is an imaginary friend normal?
3-6
What is pseudocyesis?
Hysterical pregnancy: when a woman has amenorrhea, breast fullness, and morning sickness but is not pregnant
Risk factors are a history of infertility and prior pregnancy loss. Note: some women can be so convinced that they are pregnant that they will misinterpret home pregnancy tests.
In a TCA overdose, having a QRS duration greater than _____________ is worrisome for arrhythmia.
100 milliseconds
A man with bipolar disorder presents to your clinic with complaints of infertility. What class of medications might he be taking?
Antipsychotics (e.g., risperidone) that could be causing prolactinemia due to dopamine blockade in the tuberoinfundibular pathway
Irritability and a high-pitched cry in a three-day-old that is otherwise normal could indicate ________________.
neonatal abstinence syndrome (NAS),aka opiate withdrawal
What is the difference between obsessive-compulsive disorder and obsessive-compulsive personality disorder?
OCD presents as repeated behaviors that cause the person much anxiety if not done. OCPD presents with a need to have a controlled, perfected environment that does not lead to distress. (Often people with OCPD are comfortable when they can control something.)
REM sleep disorder is more likely to occur in the ______________ part of the night.
later (when REM sleep is more common)
Beta-blockers and benzodiazepines are used to treat what extrapyramidal symptom?
Akathisia
What is the most basic definition of cyclothymic disorder?
- Up and down moods that fail to meet criteria for mania or depression
- Greater than 2 years’ duration
Delayed-phase sleep syndrome is characterized by ________________.
only being able to sleep at a much later time than usual and desire to sleep in (basically being a night owl)
Patients with delirium will not have a normal ______________ exam.
neurologic/cognitive
What asthma medication can cause psychosis?
Steroids
What timeline does “brief psychotic disorder” encompass?
Greater than 1 day to less than 1 month
What two treatments should be offered to a patient with catatonia?
- Benzodiazepines
* Electroconvulsive therapy
Describe the diagnostic criteria and treatment for adjustment disorder?
- Depressive/anxious symptoms in response to a life stressor within the past 6 months
- Treat with psychotherapy
Recurrent, intrusive, anxiety-provoking thoughts with subsequent actions meant to quell those thoughts are characteristic of __________________.
obsessive-compulsive disorder
The obsessions seen in OCD typically fall into these four categories: ________________.
- Fear of harm
- Taboo things (like violence or sex)
- Symmetry
- Contamination
What signs and symptoms are typical of autism spectrum disorders?
- Impaired social skills (such as failure to make eye contact, paucity of language, or appearing to not listen)
- Rigid adherence to known patterns
- Stereotypic, repetitive movements
A child who sets fires but does not display violence toward others or violations of personal respect likely has _________________.
pyromania, an impulse control disorder
If a patient still has depression after taking a first-line agent (like an SSRI) for greater than six weeks, then the next option would be to ______________.
give another first-line agent with a different mechanism of action (like bupropion or venlafaxine)
What timeline requirements are necessary for a diagnosis of adjustment disorder?
- Symptoms must develop within 3 months of an identifiable stressor
- Symptoms must last no longer than 6 months after the stressor ceases
Antagonism of __________ receptors by second-generation antipsychotics is thought to cause sedation.
histamine
You’re treating a woman for major depression. She responds to fluoxetine in about five weeks. How long should she continue taking fluoxetine?
At least 4-9 months
Recall that CT scans of those with schizophrenia sometimes show _________________.
enlargement of the lateral ventricles
Some USMLE questions try to trip you up by giving you a situation in which parents of a child disagree on the significance of the child’s symptoms. What should you look for in these questions?
Pick the answer that acknowledges both parents and suggests a further workup.
Hoarding disorder –which is characterized by hoarding obejects and anxiety only when thinking about getting rid of them – is best treated by _____________.
cognitive-behavioral therapy
If a question mentions that a depressed patient has lost weight and is refusing to eat or drink, then they’re trying to tell you that _________________.
the patient needs urgent treatment, often suggesting electroconvulsive therapy
All classes of antidepressants take weeks to become effective. If a patient has lost a significant amount of weight and is refusing to eat, then they may injure themselves by not eating in the weeks that it would take for antidepressants to work.
One of the key properties of being empathetic is that you should not assume that ________________.
you know how the other person feels
Most cases of neuroleptic malignant syndrome can be clinically diagnosed. If you were to draw labs, what two abnormal values would you likely notice?
- Elevated creatine kinase
* Leukocytosis
What symptom suggests social anxiety as opposed to avoidant personality disorder?
Marked anxiety in social situations without a pattern of avoidance
_______________ is now the firstline treatment for bipolar I disorder.
- Lithium and quetiapine
* Valproate and quetiapine (for those with renal complications)
In addition to (1) excessive worry or anxiety about multiple issues for greater than 6 months and (2) inability to control this worry, patients need to have at least three of the following for a diagnosis of GAD:
__________________.
- Restlessness
- Fatigue
- Concentration difficulties
- Irritability
- Sleep disturbances
- Muscle tension
- Distress
On USMLE exams, doctors need to give patients bad news ______________.
in person; phone conversations for difficult diagnoses are inappropriate
In addition to decreased total sleep time and earlier awakenings than desired, _________________ are also normal changes with age (two things).
nocturnal awakenings and daytime naps
________________ can be signs of intellectualization (the defense mechanism).
Focusing on details of a traumatic event or diagnosis and continuing to work even if you don’t need to
What are the signs and symptoms of dependent personality disorder?
- Clinginess
- Submissiveness
- Fear of losing support or approval
Sexual assault victims are at increased lifetime risk of ____________________.
suicide
Exposure and response training is another first-line treatment for ____________.
OCD
True or false: tyramine syndrome presents with hyperthermia.
False. Serotonin syndrome presents with hyperthermia. Tyramine syndrome causes hypertension and headache.
______________ can be given to treat severe cases of anorexia.
Olanzapine
True or false: prolonged seizure, aspiration pneumonia, and amnesia are adverse effects of ECT.
False. The seizures induced by ECT are brief and having patients not eat or drink before the procedure nearly eliminates the possibility of aspiration. Amnesia can occur (both retrograde and anterograde).
What sleep disturbance pattern is characteristic of alcohol-related insomnia?
Waking up in the middle of the night (when blood alcohol levels drop and CNS arousal occurs)
