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Psychiatry USMLE Step 3 > Section 2: Anxiety Disorders > Flashcards

Section 2: Anxiety Disorders Flashcards

1
Q

Anxiety Disorders

Anxiety disorders are characterized by anxiety that interferes with daytime functioning and is not due to any other identifiable causes of symptoms

List the medical causes of anxiety

A
  • Hyperthyroidism
  • Pheochromocytoma
  • Excess cortisol
  • Heart failure
  • Arrhythmias
  • Asthma
  • COPD

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15333-15346). Kaplan Publishing. Kindle Edition.

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2
Q

Anxiety Disorders

Anxiety disorders are characterized by anxiety that interferes with daytime functioning and is not due to any other identifiable causes of symptoms

List the drugs that may cause anxiety disorder

A
  • Corticosteroids
  • Cocaine
  • Amphetamines
  • Caffeine
  • Alcohol withdrawal
  • Sedatives withdrawal

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15333-15346). Kaplan Publishing. Kindle Edition.

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3
Q

Rx for adjustment disorder

A

Counseling

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4
Q

Diagnosis

  • Tachycardia
  • Hyperventilation
  • Dizziness
  • Sweating
  • No obvious precipitating factor
  • Episodes occur regularly

Rx

A

Diagnosis: Panic disorder

Rx: Cognitive behavioral therapy and/or relaxation training and desensitization

Relaxation training and desensitization more useful for agoraphobia

Medications include

  1. SSRI
    • Fluoxetine
  2. Benzodiazepines
    • Alprazolam
    • Clonazepam
  3. Imipramine
  4. MAOIs
    • Phenelzine
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5
Q

A 19-year-old ballet dancer presents because of extreme anxiety on stage. She reports that she fell 3 months ago at a national ballet competition and since then suffers extreme anxiety, trembling, diaphoresis, and breathlessness when she has to go on stage. She denies any problems with ballet practice and has no other medical problems. Which of the following is the most likely diagnosis?

a. Acute stress disorder
b. Adjustment disorder with anxious mood
c. Panic disorder
d. Social phobia

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15380-15396). Kaplan Publishing. Kindle Edition.

A

C. Panic disorder presents with a clear precipitating event which subsequently results in anxiety in similar circumstances. Panic disorder is differentiated from social phobia, which has no clear precipitating cause

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15380-15396). Kaplan Publishing. Kindle Edition.

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6
Q

Obsessive-Compulsive Disorder (OCD)

OCD is the diagnosis when the case describes recurrent obsessions or compulsions. The case must also describe that the individual recognizes that the behavior is unreasonable and excessive (i.e., there is insight). Obsessions are anxiety provoking; thoughts are intrusive and are commonly related to contamination, doubt, guilt, aggression, and sex. Compulsions are peculiar behaviors that reduce the anxiety and are most commonly habitual hand washing, organizing, checking, counting, and praying.

Syndrome often associated with OCD

True or False: Depression and Substance abuse are common in OCD

Rx of OCD

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15380-15396). Kaplan Publishing. Kindle Edition.

A

Tourette syndrome

True

Behavioral psychotherapy and pharmacotherapy (SSRIs and clomipramine)

Obsessive symptoms in psychotic disorders may be misdiagnosed as OCD. You can differentiate psychosis from OCD by looking for a lack insight and loss of contact with reality

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15402-15408). Kaplan Publishing. Kindle Edition.

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7
Q

Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD)

These disorders involve severe anxiety symptoms that follow a life-threatening event.

  1. What is the diagnosis when symptoms last less than 1 month and occur within 1 month of stressor
  2. What is the diagnosis when symptoms last longer than 1 month
  3. List and explain the key symptom groups in ASD and PTSD

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15402-15408). Kaplan Publishing. Kindle Edition.

A
  1. ASD
  2. PTSD
  3. Key symptom groups
    • Re-experiencing of the traumatic event: Dreams, flashbacks, or intrusive recollections
    • Avoidance of stimuli associated with the trauma or numbing of general responsiveness
    • Increased arousal: Anxiety, sleep disturbances, hypervigilance, emotional lability, or impulsiveness

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15406-15422). Kaplan Publishing. Kindle Edition.

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8
Q

How does increased arousal present in those with ASD and PTSD

A
  • Anxiety
  • Sleep disturbances
  • Hypervigilance
  • Emotional lability
  • Impulsiveness

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15406-15422). Kaplan Publishing. Kindle Edition.

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9
Q

Rx of ASD and PTSD

A school bus is involved in a major collision. Two children are killed, and seven others are injured. What is the most important therapy to prevent PTSD

a. Diazepam
b. Fluoxetine
c. Group counseling
d. Haloperidol
e. Individual psychotherapy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15423-15436). Kaplan Publishing. Kindle Edition.

A

C. Group counseling is the most effective therapy to prevent PTSD following a traumatic event

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15423-15436). Kaplan Publishing. Kindle Edition.

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10
Q

Diagnosis

Excessive, poorly controlled anxiety that occurs daily for more than 6 months. No single event or focus is related to the anxiety

List the conditions the above diagnosis may coexist with

A

Generalized Anxiety Disorder (GAD)

It often coexists with

  • Major depression
  • Specific phobia
  • Social phobia
  • Panic disorder

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15423-15436). Kaplan Publishing. Kindle Edition.

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11
Q

Rx of GAD

A

Supportive psychotherapy, including relaxation training and biofeedback

Medications include

  • SSRIs
  • Venlafaxine
  • Buspirone
  • Benzodiazepines

Distinguish GAD from panic attack or social phobia by what is causing the anxiety. If the question describes persistent worry of a panic attack or social encounter, then GAD is not the answer. In GAD, multiple life circumstances, not just one, are causing the anxiety

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15423-15436). Kaplan Publishing. Kindle Edition.

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12
Q

Anxiolytic Medications for

Adjustment disorder with anxious mood

A

Benzodiazepines with brief psychotherapy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15437-15466). Kaplan Publishing. Kindle Edition.

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13
Q

Anxiolytic Medications for Panic disorder

What is the effect of above medications

A

SSRIs

Alprazolam

Clonazepam

Decrease frequency and intensity of panic attacks

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15437-15466). Kaplan Publishing. Kindle Edition.

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14
Q

Anxiolytic Medications for Generalized anxiety disorder

What is the effect of above medications?

A
  • Venlafaxine
  • Other SSRIS
  • buspirone

Decrease overall anxiety

OCD SSRIs and clomipramine Decrease obsessional thinking Social phobia SSRIs and buspirone Decrease fear associated with social situations Benzodiazepines Do not change dosages abruptly. Use the lowest dose in the elderly. Advise against using machinery or driving. In order from shortest to longest half-life: Alprazolam (Xanax) < lorazepam (Ativan) < diazepam (Valium) Buspirone Therapeutic effect can take up to 1 week Can be used safely with other sedative-hypnotics (no

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15437-15466). Kaplan Publishing. Kindle Edition.

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15
Q

Anxiolytic Medications for OCD

What is the effect of above medications?

A
  • SSRIs
  • Clomipramine

Decrease obsessional thinking

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15437-15466). Kaplan Publishing. Kindle Edition.

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16
Q

Anxiolytic Medications for Social Phobia

What is the effect of above medications?

A
  • SSRIs
  • Buspirone

Decrease fear associated with social situations

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15437-15466). Kaplan Publishing. Kindle Edition.

17
Q

Benzodiazepines

True or False:

  1. Do not change dosages abruptly
  2. Use the lowest dose in the elderly
  3. Advise against using machinery or driving
  4. List 3 examples in order from shortest to longest half-life
A
  1. True
  2. True
  3. True
  4. Alprazolam (Xanax) < lorazepam (Ativan) < diazepam (Valium)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15437-15466). Kaplan Publishing. Kindle Edition.

18
Q

Buspirone

  1. How long can therapeutic effect take?
  2. True or False: It has no additive effect and can be used safely with other sedative-hypnotic
  3. True or False: It has no withdrawal effect
A
  1. Up to 1 week
  2. True
  3. True

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 15437-15466). Kaplan Publishing. Kindle Edition.

19
Q

Anxiolytic medication best for those in occupations where driving or machinery is involved

A

Buspirone

Does not have sedative or cognitive impairment

Psychiatry USMLE Step 3 (7 decks)

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