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MTBs Step 2CK > Psyc > Flashcards

Psyc Flashcards

1
Q

Postpartum…

Blues? Depression? Psychosis?

A

Postpartum Blues
- Onset: 2-3 days - peaks D5 resolves by 2wks
- SX: mild depression, tearfulness, irritability
- TX: reassurance & monitoring
Postpartum Depression
- Onset: 4-6 wks. can last 1 yr
- SX: >2wks of moderate to severe depression, sleep or appetite disturbance, low energy, psychomotor changes, guilt, concentration difficulty, suicidal ideation
- TX: antidepressants, psychotherapy
Postpartum Psychosis
- Days to weeks
- SX: delusions, hallucinations, thought disorganization, bizarre behavior
- TX: antipsychotics, antidepressants, mood stabilizers + HOSPITALIZATION = DO NOT LEAVE MOTHER ALONE WITH INFANT

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2
Q

Pt has depression + Neuropathic pain. best drug? class?

A

SNRI = Duloxetine

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3
Q

3 SSRI’s safe in kids?

A

Fluoxetine, Sertraline & Fluvoxamine

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4
Q

Alcoholic Withdrawal Seizures

time frame? tx? sx?

A

48hrs = tonic-clonic seizures

tx: CT to R/O other cause

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5
Q

Voyeurism

A

recurrent urges to observe an unsuspecting person who is engaging in sexual activity or disrobing.

*must be more than 6months of sexual arousing w/impairment of functioning

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6
Q

pt presents with: Orthostatic headache, Tinnitus & clear bilateral nasal discharge. dx? how woudl u dx?

A 
Low Cerebrospinal Fluid(CSF) Pressure Headache: 
-	Sx:
o	Orthostatic headache
o	Tinnitus
o	Neck pain/stiffness
o	NV, dizziness, vertigo, anorexia
-	Dx: if nasal discharge = test w/Beta-2-transferrin = CSF specific marker
-	4% are idiopathic
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7
Q

Hypnogogic & Hypnopompic hallucinations

A

hallucinations that occur as patient is going to sleep or as they wake up

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8
Q

Suicide Risk Factors

A

men, older adults, social isolation, presence of psychiatric illness/drug abuse, percieved hopelessness, previous attempts

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9
Q

side fx clozapine

A

agranulocytosis = reserved for tx resistant shit

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10
Q

Defense Mechanism: Denial

A

used to avoid somthing painful “i know i do not have cancer”

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11
Q

Conversion Disorder

A

one or more neurologic sx that cannot be explained by any medical shit + psychologic factor associated with onset, PATIENT IS NOT CONCERNED ABOUT IMPAIRMENT

*bf broke up with me and now my arm doesnt work.

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12
Q

Obsessive-Compulsive Personality Disorder

A

individuals are preoccupied with orderliness, perfection, and control. They are often consumed by the details of everything and lose their sense of overall goals. they are strict and perfectionistic, overconscientious and inflexible. Associated with difficult interpersonal relationships.

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13
Q

Masochism

A

recurrent urge or behavior involving the act of humiliation or pain

*must be more than 6months of sexual arousing w/impairment of functioning

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14
Q

Cluster A personality Disorders

A

Weird = Paranoid, Schizoid, Schizotypal

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15
Q

Defense Mechanism: Displacement

A

An emotion or drive is shifted to another that resembles the original in some aspect.

“i had to get rid of the dog since my husband kicked it every time we had an argument”

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16
Q

Penetration Disorder

A

involentary constriction of outter 3rd of vagina causing pain on penitration
tx: psycotherapy & dilator therapy

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17
Q

Cataplexy

A

sudden loss of M tone; precipitated by loud nose or emotions = this is the person who laughs and collapses

*if this occurs 3x per week for 3m = narcolepsy

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18
Q

Binge Eating Disorder

sx? tx?

A

sx: recurrent episodes of binge eating 3x per weeks for more than 3 months
tx: TOPIRAMATE > SSRIs & CBT

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19
Q

timeline: schizophrenia, schizophreniform, brief psychotic disorder

A

phrenia = >6m
phreniform = 1-6m
brief psychotic disorder = <1m

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20
Q

Akathisia

sx? tx?

A

weeks to chronic use

sx: motor restlessness, do not mistake for anxiety or agitation
tx: reduce the dose; add Benzo or BB, switch to newer drugs

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21
Q

tx of cocaine/amphetamines withdrawl

A

bupropion and/or bromocriptine

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22
Q

sx of Dementia

memory? word findng? indep & functioning?

A

Dementia/Major Cognitive Disorder:

  • Memory Loss: cannot remember specific instances of forgetfulness, family is more concerened than pt, has notable decline in memory for recent important events & conversations
  • Word-finding: frequent with substitutions, some receptive aphasia
  • Independence & Functioning: becomes dependent on others for ADLs, unable to operate common appliances, loses interest in social activities, gets lost for hours in familiar territory while driving or walking
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23
Q

Defense Mechanism: Repression

A

an idea of feeling is withheld from conciousness; unconcious forgetting

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24
Q

Malingering Disoder

A

person fakes sick knowningly to get $$$$$

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25
Q

ethnic group with the highest rates of suicide?

A

Native Americans

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26
Q

which atypical antipsyc has the least risk of DM & weight gain? which has the most?

A 
most = olanzapine
least = aripiprazole
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27
Q

tx of opiate intoxication

A

naloxone

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28
Q

Defense Mechanism: Suppression

A

conscious forgetting; only consciouse defense mechanism

“i would rather talk about my operation after the party is over”

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29
Q

Acute Dystonia

sx? tx?

A

seen in 1st week

sx: Mspasms, difficulty swallowing
tx: reduce dose of drugs or Anticholinergics(benztropine, diphenhydramine, Trihexyphenidyl)

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30
Q

Autism Spectrum Disorder

sx? tx?

A

M > F; before 3 yoa, lack of peer relationships, odd preoccupation with repetitive activities

tx: family counseling, special ed

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31
Q

Serotonin Syndrome

A

hx of SSRI, agitation, hyperreflexia, hyperthermia, Mrigidity, volume contraction secondary to sweating an dinsensible fluid loss

tx: ciproheptadine, benzo

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32
Q

Schizoaffective Disorder

A

Schizo + mood disorder like depression or bipolar(can be schizo & have mania!)

**lifetime hx of delusions or hallucinations for >2wks in teh absence of major depressive or manic sx

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33
Q

Barbiturates and Benzos sx

A

inappropriate sexual or aggressive behavior, impaired memory or concentration

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34
Q

Paradoxical Agitation seen with Benzodiazepines

A

Paradoxical Agitation seen with Benzodiazepines = old ppl metabolize benzo slowly = increased risk of confusion & increased risk of falls

  • Old dude who gets irritated and cranky after taking his nightly meds which include Alprazolam.
  • Usually occurs within 1 hr of administration
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35
Q

Transvestic Fetishism

A

recurrent urge or behavior involving cross dressing or sexual gratification; usually found in heterosexual males

*must be more than 6months of sexual arousing w/impairment of functioning

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36
Q

Side effects for Valproate

A 
o	Valproate
	Side FX:
•	Tremors, weight gain, GI disturbances
•	ALOPECIA
•	TERATOGENIC
•	HEPATOTOXIC = THROMBOCYTOPENIA
•	SEVERE TOX: hyponatremia, coma, death
o	Lamotrigine
	Side FX: Stevens-johnson Syndrome
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37
Q

Gentiopelvic Pain disorder/dyspareunia

A

pain with sexual intercourse not due to medical condition

tx: psychotherapy

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38
Q

inhalants sx

A

belligerence(agressive), apathy, assaultiveness, impaired judgement, blurred vision, stupor, coma

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39
Q

Amphetamines & Cocaine sx? withdrawl?

A

euphoria, hypervigilance, autonomic hyperacitivity, weight loss, PUPIL DILATION, disturbed percetpion, stroke, MI

withdraw: anxiety, tremors, increased appetitie, depression, RISK OF SUICIDE!

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40
Q

which antipsychotic is safe in prego?

A

LURASIDONE

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41
Q

Dissociative Amnesia

A

Dissociative Amnesia = inability to recall important personal information, usually tramatic or stressfull in nature; not explained by another disorder
- Ex: dude found wondering airport after wife asks for divorce, he doesn’t know who he is or how he got there. Wife says he disappeared after she asked for divorce.

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42
Q

MC method of suicide by both men and women?

A

firearms

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43
Q

narcolepsy tx?

A

scheduled naps, Modafinil +- methylphenidate and dextraamphetamine

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44
Q

how long for alcohol withdrawal?

A

5-10days

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45
Q

Defense Mechanism: Sublimation

A

sublimation is a mature type of defense mechanism, in which socially unacceptable impulses or idealizations are unconsciously transformed into socially acceptable actions or behavior, possibly resulting in a long-term conversion of the initial impulse.

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46
Q

Eating Disorder not otherwise specified

A

anything that doesnt make the cirteria for other shit. EX: use of compensatory behavior after eating normal amounts of food

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47
Q

tx of paraphilias?

A

psychotherapy, SSRIs or antiandrogens to reduce sexual drive

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48
Q

Exhibitionism

A

recurrent urge to expose onself to strangers

*must be more than 6months of sexual arousing w/impairment of functioning

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49
Q

OCD tx

A

Obsessive-Compulsive Disorder:
- DX:
o Obesssions
 Recurrent, intrusive, anxiety provoking
 Attempts to suppress
 Not related to substance abuse or other illness
o Compulsions
 Response to obsessive thoughts with repeated behaviors or mental acts
 Excessive behaviors intended to reduce anxiety or avoid dreaded outcome
 Behaviors not connected with realizstically with preventing anxiety or fear
- TX:
o CBT or HD SSRI
o 2nd Clomipramine
o 3rd ECT

50
Q

Schizoid Personality Disorder

A

detachment and restricted emotionality = emotionally distant & fear intimacy, absorbed with their own thoughts and feelings and disinterested

*main defense is projection

51
Q

MDD sleep changes?

A
  • Increase sleep latency(time it takes to fall asleep) & decreased REM latency(time it takes to hit REM sleep)
52
Q

Mild Intellectual Disability

IQ? features?

A

IQ 50-79; 6th grade level, can live independently in a community or with minimal supervision

53
Q

Illness anxiety disorder

A

person isnt sick but is freaking the fuck about baout becomming sick ~AT LEAST 6 MONTHS

54
Q

MC method of suicide by women?

A

pills/poisons

55
Q

Sadism

A

recurrent urge or bahvior involving acts in which physical or psychological suffering of the victim is exciting

*must be more than 6months of sexual arousing w/impairment of functioning

56
Q

hallucinogens/LSD sx

A

ideas of reference(the notion that everything one perceives in the world relates to one’s own destiny), hallucinations, impaired judgments, dissociative symptoms, pupil dilation, panic, tremors, incoordination

57
Q

Pedophilia

A

recurrent urges or arousal toward prepubescent children

*must be more than 6months of sexual arousing w/impairment of functioning

58
Q

Neuroleptic Malignant Syndrome

sx? tx?

A

anytime!

sx: M rigidity, hyperthermia, volatile vital signs, altered LOC, increased WBC & CK
tx: stop drugs! Dantrolene or Diazepam, Bromocriptine

59
Q

Disruptive Mood Dysregulation Disorder

A

child with prevasively angry or irritable mood involving frequent aggressive outburts that are out of proportion to the stressor do not return to normal mood after the stressor.
sx begin before 10 yoa & lasts for 12 months

60
Q

Seasonal affective disorder

A

depression in winder months = phototherapy or sleep deprivation

61
Q

Severe Intellectual Disability & Pround ID

IQ? features?

A

Severe: IQ 20-35
Profound: <20

Cant live on their own, need full time help

62
Q

Defense Mechanism: Splitting

A

“the morning staff is perfect, the evening staff is terrible”

63
Q

2 benzo that can be used with alcohol withdrawl

A

lorazepam & oxazepam = safe on liver

chlordiazepoxide = toxic to liver but can still be used

64
Q

Depersonalization/Derealization Disorder

A

Depersonalization/Derealization Disorder = persistant or recurrent experiences of 1 or both: depersonalization(feelings of detachment from, or being outside of observer of, one’s self) and/or derealization(experiencing surroundings as unreal)

65
Q

Defense Mechanism: isolation

A

separation of an idea form the affect that accompanies it

“as she arrived at the station to identify the body, she appeared to show no emotion”

66
Q

Cluster C Personality Disorders

A

Worried = Avoidant, Dependent, Obsessive-Compulsive

67
Q

Narcolepsy

A
  • DSM5:
    o Recurrent Lapses into sleep or naps(3x per weeks for 3 months)
    o At least 1 of the following:
     Cataplexy: Brief loss of muscle tone precipitated by strong emotion(laughter, excitment)
     Low CSF levels of hypocreti9n-1
     Shortened REM sleep latency
  • Associated: Hypnagogic of Hypnopompic hallucinations(hallucinations before and after nap), Sleep paralysis
68
Q

Defense Mechanism: Blocking

A

temporary block in thinking “i have known him for years but can never seeem to remember his name”

69
Q

Anorexia Nervosa vs buliemia

side effects?

A

KEY IS LOW BMI <18!!! *both have great concern over weight
fx: hypotension, bradycardia, lanugo hair, edema, EKG changes as a result of K deficiency

*buliemia will have binge eating + compensatory behavior but normal BMI

70
Q

PCP sx

A

panic reactions, assaultiveness, agitation, NYSTAGMUS, HTN, seizures, coma, hyperacusis

71
Q

Defense Mechanism: Regression

A

return to an earlier stage of dvelopment, most immature

*9yo kid starts wetting his bed in response to parents divorce

72
Q

Dependent Personality Disorder

A

Submissive and clinging behavior related to a need to be taken care of. individuals are consumed with the need to be taken care of. they are clingy and worry about abandonment. they feel inadequate and helpless and avoid disagreements with others. they usually focus dependency on a family member or spouse

73
Q

Ramelteon use? C/I?

A

mimics melatonin = good for pt who need help falling asleep

C/I: hepatic impairment, severe sleep apnea, severe COPD

74
Q

Schizotypal Personality Disorder

A

discormfort with social relationshps, thought distortion, eccentricity = like schizoid but have magical thinking, vlairvoyance, ideas of reference or paranoid ideation = sx arnt severe enough for schizophrenia

75
Q

Adjustment Disorder

tx?

A

normal anxiety, depression, irritablity within 3 months of stressful event

tx: psychotherapy

76
Q

MCC of death in Anorexia Nervosa?

A

arrhythmia

77
Q

Alcohol intoxication sx

A

talkative, sullen(bad tempered/moody), gregarious, moody

78
Q

Normal grief vs MDD

A 
NORMAL GRIEF/BEREAVEMENT	
<1Y = sadness, tearfulness, decreased sleep, appetitie, interest in the world
-	Sx wax and wane
-	Shame and guilt are mild
-	Usually resolves in 2m
-	Tx: supportive
MAJOR DEPRESSIVE DISORDER
>1Y = sadness, tearfulness, decreased sleep, appetite, interest in the world
- sx are pervasive and unremitting
-  shame and guild are SEVERE
- threaten suicide often
-tx: antidepressants
79
Q

Minor Alcohol withdrawal

time frame? tx? sx?

A

6hrs, Insomnia, tremulousness, mild anxiety, HA, diaphoresis, palpitations
tx: B1, Folate, Multivitamin and Glucose

80
Q

Fetishism

A

use of nonliving objects usually associated with the human body

*must be more than 6months of sexual arousing w/impairment of functioning

81
Q

Cyclothymia

tx?

A

recurrent hypodepression + hypomania for at least 2 years

  • patient describes low energy, fatigue times & other times of feeling up and optomistic
    tx: phototherapy
82
Q

Frotteurism

A

rubbing, usually ones penis or erect penis, against a nonconsenting person for sexual gratification

*must be more than 6months of sexual arousing w/impairment of functioning

83
Q

Factitious disorder

A

person fakes sick so they can be patient; does this knowningly

84
Q

Paranoid Personality Disorder

A

distruct and suspiciousness in motives and actions of otheres, often secretive and isolated, emotionally cold and odd, often take legal action against other ppl

  • main defense = projection
  • dont confused with paranoid schizophrenia
85
Q

tx of rapid cycling bipolar disorder when Li is ineffective or C/I?

A

DIVALPROEX

86
Q

Bradykinesia(Parkinsonism)

sx? tx?

A

weeks

sx: bradykinesia, tremors, rigidity, sx of parkinsons
tx: reduce dose of drugs or Anticholinergics(benztropine, diphenhydramine, Trihexyphenidyl)

87
Q

Alcoholic Hallucinosis

time frame? sx?

A

12-24 hrs, visual hallucinations +/- tactile and auditory

*if hallucinations are present with AMS then its not due to alcohol

88
Q

Major Depressive Disorder

A

depressed mood of anhedonia lasting 5/9 lasting 2+ weeks:
SIGECAPS: Sleep changes, Interest loss, Guilt/worthlessness, Energy loss, Concentration difficulties, Appetitie loss/gain, Psychomotor changes, Suicide

89
Q

PCP sx

A

panic reactions, assaultiveness, agitation, NYSTAGMUS, HTN, seizures, coma, hyperacusis

90
Q

Delirium Tremens

time frame? sx?

A

48-96hrs = hallucinations, disorientation, tachycardia, hypertension, low-grade fever, agitation and iaphoresis

**look for person who hasnt had booz in 2days!

91
Q

Sleep paralysis

A

patient is awake but unable to move; this typically occurs upon awakening

92
Q

Dysthymia

A

Persistent depressive disorder = hypodepression lasting most days for at least 2 years

93
Q

Moderate Intellectual Disability

IQ? features?

A

IQ 35-50; 2nd grade level, can live in residential community settings, may be able to do some acitivties of daily living

94
Q

side fx of Li

A

o Lithium
 <2.5 = mild tox = flush with saline
 >2.5 = dialysis
 Side FX:
• Adversely affect the kidneys & thyroid
o Tubulointerstital nephropathy
o NEPHROGENIC DI
• Tremors, weight gain, GI disturbances
• TERATOGENIC
• LEUKOCYTOSIS
• SEVERE TOX: confusion, ataxia, lethargy, abdominal reflexes
 C/I: CKD, Heart disease, Hyponatremia or diuretic use
 Baseline studies: BUN, Cr, Ca, U/A, Thyroid function tests, ECG in pt with coronary risks

95
Q

Tardive Dyskinesia

sx? tx?

A

months to years

sx: choreoathetosis and other involuntary movements after chronic use; often irreversable
tx: stop older drugs and switch to newer drugs = sx will worsen ofter drugs stopped initially

96
Q

tx of barb/benzo intoxication

A

Flumazenil

97
Q

Which 2nd gen antipsyc has least risk of tardive dyskinesia

A

clozapine

98
Q

Bipolar Disorder

sx of mania?

A

depression + hypomania = 2
mania = 1
^for at least 1 week.

Mania: DIG FAST
Distractibility, irresponsibility, gradiosity, flight of ideas, activity increased, sleep is decreased, talkativeness

99
Q

Defense Mechanism: Dissociation

A

splitting off of the brain from conscious awareness

“i heardly remember getting to the hsopital after my husband was hit by a car”

100
Q

which antipsyc can cause QT prolongation

A

thioridazine & ziprasidone

101
Q

Sexual Identity, Gender Identitiy, Gender Role, Sexual Orientation

A

Sexual Identity = based on secondary sexual characteristics
Gender Identitiy = who they identify with = usually figured out by age 3
Gender Role = based on external patterns of behavior
Sexual Orientation = persons choice of love object

102
Q

Defense Mechanism: Introjection

A

“resident physician dresses like the attending whom he admires”

103
Q

Cannabis sx?

A

impaired motor coordination, impaired time perception, social withdrawal, increased appetitie, dry mouth, tachycardia, conjunctival redness

104
Q

Defense Mechanism: Undoing

A

“i need to wash my hands whenever i have these thoughts”

Undoing is a defense mechanism in which a person tries to ‘undo’ an unhealthy, destructive or otherwise threatening thought or action by engaging in contrary behavior. For example, after thinking about being violent with someone, one would then be overly nice or accommodating to them.

105
Q

Cluster B Personality Disorders

A

Wild = Histrionic, Boarderline, Antisocial, Narcissistic

106
Q

Intermittent explosive disorder

tx?

A

aggression out of proportion to the stressor. >6yoa occuring 2x wk for more than 3m or involve destructive episodes 3x within 12m period. *pt return to normal mood after stressor
tx: SSRI & mood stablizers

107
Q

Sleep attack

A

episodes of irresistable sleepiness and feeling refrshed upon awaking = pt will not collapse

108
Q

Delusional Disorder

sx? ddx? tx?

A 
Delusional Disorder
-	SX:
o	>1 delusion for >1m
o	No other psychotic sx present
o	Ability to function apart from delusion; behavior not bizarre or odd
-	DDX:
o	Schizophrenia: other psychotic sx not present(no hallucinations, disorganization negatie sx)
o	Personality disorders
-	TX:
o	Antipsychotics, CBT
109
Q

Defense Mechanism: Somatization

A

psychic derivatives are converted into bodily symptoms. = thinkin of an exam makes you feel sick

110
Q

Conduct vs Oppositional defiant disorder

A

Conduct: bullying, fighting, cruelty to people or animals, rape, vandalism

Oppositional Defiant: typical teen anger, not present with friends

111
Q

Which mood stabalizer can cause alopecia

A

valproate

112
Q

all 2nd gen/atypical antipsycs have a risk of

A

DM & weight gain

113
Q

Suicide Protective Factors

A

connection to family, pregnancy, responsibility for children, religious affiliation

114
Q

Barbiturates and Benzos sx

A

inappropriate sexual or aggressive behavior, impaired memory or concentration

115
Q

Opiates sx

A

apathy, dysphoria, CONSTRICTED PUPILS,drowsiness, slurred speech, impaired memory, coma, death

116
Q

Defense Mechanism: Projection

A

attributing your own wishes, thoughts, or feelings onto someone else

ex: ‘im sure my wife is cheating on me”

117
Q

Dissociative Identity Disorder

A

Dissociative Identity Disorder = marked discontinuity in identity & loss of personal agency with fragmentation into >2 personality states.
- Aka split personality disorder

118
Q

Obsessive-Compulsive Personality Disorder

A

individuals are preoccupied with orderliness, perfection, and control. They are often consumed by the details of everything and lose their sense of overall goals. they are strict and perfectionistic, overconscientious and inflexible. Associated with difficult interpersonal relationships.

119
Q

Premature Ejaculation

A

ejaculation just before or just after penitration

tx: stop & go, Squeeze technique, SSRIs

120
Q

Gender Dysphoria(Formerly Gender Identity Disorder)

A

persistent discomfort and sense of inappropriateness regarding patients assigned sex

tx: psychotherapy & reassignment surgery

121
Q

Defense Mechanism: Reaction Formation

A

an unacceptable impulse is transfored in to its opposite, results in the formatino of character traits

“listen to him tell his family he was not afraid, when i saw him crying”

122
Q

Histrionic Personality Disorder

A

colorful, exaggerated behavior and excitable, shallow expression of emotions, use physical appearance to draw attention to self, sexually seductive, discomfort in situations where not the center of attention

MTBs Step 2CK (20 decks)

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