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step3 > 2014-03-07 USMLE Psych - USMLE Psych > Flashcards

2014-03-07 USMLE Psych - USMLE Psych Flashcards

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1
Q

Age of onset of schizophrenia

A

Men 15-25

Women 25-35

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2
Q

Prevalance of schizoprenia

A

1% in most cultures

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3
Q

List the differences between psychotic disorders

A

6 month = schizophrenia

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4
Q

Why are atypical antipsychotics preferred for maintainence therapy in psychotic disorders?

A

less EPS and better effect on negative symptoms

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5
Q

Onset of dystonia if EPS reaction?

A

hours to days

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6
Q

Treatment of acute dystonia

A
  • anithistamines (diphenhyd)

- anitcholinergics (benztropine, trihexyphenidyl)

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7
Q

Onset of akathisia if EPS reaction

A

within days

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8
Q

Treatment of akathisia

A

can try b-blockers

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9
Q

Onset of parkinsonism if EPS reaction

A

within months of treatment

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10
Q

Parkinsonism from EPS most common in

A

older women

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11
Q

Acute dystonia from EPS most common in

A

young men

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12
Q

Onset of tardive dyskinesia if EPS reaction

A

after years of treatment

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13
Q

Treatment of tardive dyskinesia

A
  • none

- likely stop antipscyhotic and switch to atypical

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14
Q

Features of neuroleptic malignant syndrome

A
  • rigidity
  • high fever (up to 107)
  • high CPK
  • sweating
  • myoglobinuria
  • mutism
  • altered mental status (agitated of obtunded)
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15
Q

Treatment of neuroleptic malignant syndrome

A
  • stop antipsychotic
  • supportive care for fever and renal
  • consider giving dantrolene
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16
Q

classic side effect of thorazine

A

retinal pigment deposits

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17
Q

classic side effect of clozapine

A

agranulocytosis

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18
Q

Classic side effects of chlorpromazine

A
  • jaundice

- photosensitivity

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19
Q

3 classic side effects of SSRIs

A
  • insomnia
  • anorexia
  • sexual dysfunction
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20
Q

Firs line treatment of depression

A

therapy and SSRIs

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21
Q

Mechanism of action of TCAs

A
  • NE reuptake block
  • serotonin reuptake block
  • a-adrenergic block
  • AchM block
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22
Q

Why do TCAs cause orthostatic hypotension?

A

a-adrenergic block

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23
Q

MAOIs may be good for

A

atypical depression (eating and sleeping more)

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24
Q

TCA overdose most concerning for

A

cardiac arrhythmias

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25
MAOIs + tyramine =
HTN crisis
26
Age of onset of bipolar disorder
16-30 years old
27
1st line agents for bipolar disorder
- lithium - valproic acid (carbamezapine 2nd line)
28
What is bipolar II?
hypomania with major depression
29
What is cyclothymia
2 years of hypomania with depressed mood without major episodes of either
30
4 classic side effects of lithium
- renal (DI) - thyroid - tremor - CNS effects
31
Classic side effect of valproic acid
liver dysfunction
32
Classic side effect of carbamazepine
bone marrow depression
33
10 major risk factors for suicide
- age above 45 - substance use - h/o violence - prior attempts - male - psych history - recent loss - loss of health - unemployment/retirement - not married/partnered
34
Greatest age risk for suicide
over 65 (15-24 also high)
35
Normal grief can last up to
1 year
36
Typical age for panic disorder
20-40
37
Treatment of panic disorder
SSRIs (fluoxetine)
38
Panic disorder is associated with
agoraphobia
39
Describe conversion discorder
- ppt event | - unexplanable neuro symptoms
40
Key features of somatization disorder
multiple complaints in multiple organ systems with negative workup
41
Treatment of somatoform disorders
- frequent clinic visits and/or therapy
42
Difference between factitious disorder and malingering
factitious disorder the patient wants to assume role of the patient. It's intentional but no monetary or other gain.
43
Key features of paranoid personality disorder
- everyone's out to get them | - law suits
44
Key features of schizoid personality disorder
- loner and not interested in having friends
45
Key features of schizotypal personality disorder
- bizarre beliefs | - bizarre way of talking but no psychosis
46
Key features of avoidant personality disorder
- inferiority complex | - has no friends but wants them
47
Key features of histrionic personality disorder
- center of attention - seductive - dramatic and attention seeking
48
Key features of narcissistic personality disorder
- no empathy - use others for own gain - sense of entitlement
49
Key features of antisocial personality disorder
* must have had conduct disorder - criminal - male - alcohol and drugs - somatization
50
Key features of borderline personality disorder
- unstable in every realm - splitting - 2 minutes of psychosis - impulsive - constant crisis
51
Key features of dependent personality disorder
- cannot be alone | - cannot do anything alone
52
Key features of obsessive-compulsive personality disorder
* different than OCD - restricted affect - rules are more important than objectives
53
What is a dissociative fugue?
patients have amnesia, travel, assume new identity
54
Dissociative identity disorder most likely assoicated with
childhood sexual abuse
55
Usually onset of OCD
adolescents or early adulthood
56
Treatment of OCD
- SSRIs (fluvoxamine - clomipramine - behavioral therapy
57
Features of narcolepsy
* decreased REM latency (enter REM as soon as fall asleep) - cataplexy - hypnopompic or phynagogic hallucinations
58
Treatment of narcolepsy
modafinil or amphetamines
59
Formications are associated with
cocaine
60
Cocaine withdrawl features
- sleepy - hungry - irritable/depressed
61
amphetamines are classically associated with ____ symptoms
psychotic
62
Likely drug intoxication if vertical and horizontal nystagmus
Phencyclidine (PCP)
63
Treatment of PCP overdose
- urine acidification
64
Is PCP toxic in overdose
yes. can cause dealth from consulsions, coma, respiratory arrest.
65
Are there withdrawl symptoms from PCP?
no
66
Are withdrawl symptoms from opiods dangerous?
no
67
Typical age for use of inhalants
11-15 years
68
Serious effects of inhalants
- respiratory depression - arrhythmia - asphyxiation - nervous system toxic - nephrotoxic
69
Is benzo withdrawl dangerous?
yes, like alcohol
70
3 classic syptoms of caffeine withdrawl
- headache - irritability - fatigue
71
6 times when ok to break confidentiality
- patient's request - child abuse - court mandate - duty to warn/protect - reportable disease - danger to other

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