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USMLE Step 1 Flash Cards > Behavioral > Flashcards

Behavioral Flashcards

1
Q

Requirement to refer a patient for a hospice care

A

Survival prognosis of ≤ 6 months

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2
Q

Which compound is likely to be low at CSF in Narcolepsy? is associated with what symptom?

A

Hypocretin-1 (orexyn-A) - Narcolepsy with cataplexy - undetectable levels

*Hypocretin-1 (orexyn-A), Hypocretin-2 (orexyn-B) - promote wakefulness and inhibit REM sleep-related phenomena.

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3
Q

How do you identity and distinguish a conversion disorder?

A
  • Neurological symptoms incompatible with any known neurologic disease
  • Acute onset after stressful event
  • La belle indifferénce
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4
Q

How do you detect a passive aggression defense mechanism?

A
  • Passively resist perform a expected task (first agree to do it), procrastination, forgetfulness, purposeful inefficiency
  • backhanded compliments, sarcasm, denial of being angry
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5
Q

Order of next of kin of a non comunicable patient and when yo should identify?

A
  • Usual order ▶️ proximity of relationship and age ▶️ spouse, adult children, parents, adult siblings
  • Making decisions based what patient would want (NOT what next of kin want) ▶️ patient unable to make their wishes known and there is no written documentation
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6
Q

Health insurance plan recommended for a diabetic type 1 patient that want to pay low cost premium.

A

Health Maintenance Organization (HMO)

*If is willing to the limited network of providers is the best for low cost in patient with chronic medication and risk of complications.

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7
Q

What is a preventable medical error or adverse event?

A

Injury to the patient due to failure to follow evidence-based guidelines

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8
Q

Which are the mature mechanisms of defense? Describe them.

A
  • Sublimation ▶️ transform impulse into socially acceptable behavior
  • Suppression ▶️ put aside unwanted feelings, being aware of them to cope reality
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9
Q

What is an outlier, probably cause and what can affect? What measure in a study is the less affected?

A
  • Extreme and unusual value in a dataset ▶️ error in measurement or recording, natural phenomenom
  • Central tendency (median, mode, media) and dispersion measures (variance and standard deviation), and range ⏭ Mode the less affected
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10
Q

Key to identify cocaine withdrawal. Others features and treatment.

A
  • “Crash”→acute depression symptoms with suicide ideas
  • Hypersomnia, fatigue, hyperphagia, pronunced lassitude, vivid nightmares, psychomotor retardation. Minor physical signs and symptoms.
  • Tx: supportive only
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11
Q

Which factor mainly affect the negative predictive value? How does it affect NPV?

A
  • Pre-test probability
  • High pre-test probability→↓NPV
  • Low pre-test probability→↑NPV

*Prevalence is directly related with pre-test probability (high prevalente→↑pre-test probability, and viceversa)

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12
Q

Medical conditions associated with premature ejaculation. Treatment.

A
  • Prostatitis, thyroid disease

- Medications ▶️ SSRIs, topical anesthetics. Psychotherapy ▶️ address psychogenic and relation ship factors

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13
Q

How do you assess the attention and concentration?

A

Tasks requiring prolonged, continuous thinking ▶️ counting down from 100 by 3 or 7, reciting the months in reverse order, spelling “world” backward

*may be impaired in dementia, head injury, depression

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14
Q

Ranges and uses of the correlation coeficient.

A
  • Ranges from -1 to +1

- Describes strength and polarity of a linear association

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15
Q

Next step on evaluation when hace suspicious of child abuse.

A
  • Complete full history→physical exam looking for signs suggesting child abuse
  • Ask permission to the parents to interview the child alone→if they refuse to it, consider concerning for abuse (full history complete)→legally obligated to report suspected child abuse→contact child protective services (CPS)
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16
Q

What findings in physical examination do you look for when suspect child abuse?

A
  • Skin lesions
  • Signs of swelling
  • Bony tenderness and unwillingness to use an extremity
  • Retinal hemorrhages
  • Genital trauma
  • Signs of neglect→uncleanliness, malnourishment
  • Strongly concerning→multiple injuries in different stages of healing and different types, pathognomonic injuries (cigarette burns), significant behavioral disturbances (excessive compliance, pseudo-maturity)
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17
Q

What is an attrition bias? what is the consequence to have it? Most common type of studies where it can occur.

A
  • Type of selection bias→Loss of follow-up disproportionately between the exposed and unexposed groups→lost subjects differ in their risk of developing the outcome compared with the remaining subjects
  • Ex→if selective loss of high risk subjects has occured→understimate the association
  • Prospective studies
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18
Q

Best evidence for treatment of post-traumatic stress disorder

A
  • Antidepressants→SSRI, SNRI

- Trauma focused cognitive behavioral therapy

19
Q

What is the next step when you suspect elder abuse, neglect or explotation after talk with caregiver and make a full physical examination?

A

Interview patient alone: 3 questions as brief screen

  1. Dou you feel safe where you live?
  2. Who prepares your meals?
  3. Who handles your checkbook?
20
Q

How is selected the control group of a case-control study?

A

Patientst who don’t have the disease, regardless of exposure status

21
Q

Physical signs that can suggest bulimia nervosa. Laboratories alteration that you may find.

A
  • Bilateral parotid gland enlargement and erosion of dental enamel→self-induced vomiting; hypotension, ↑HR, dry skin, menstrual irregularities, calluses on dorsum of hands (Russell sign)
  • Electrolyte disturbances (Hypokalemia, hypochloremia, metabolic alkalosis), ↑salivary amylase
22
Q

How can you distinguish anorexia vs bulimia?

A
  • Bulimia→normal or overweight

- Anorexia→low weight

23
Q

Treatment of specific fobia

A
  • Behavioral therapy→systematic, repeated exposure to the phobic stimulus (most effective)
  • Short-acting benzodiazepines (acutely), limited role
24
Q

Majority of drug overdose death in US

A

Opioid in isolation or co-ingestants▶️abuse and addiction of prescription and heroin

25
Q

How do you identify effect modification in a study?

A

Effect of a exposure on a outcome is modified by another variable

*Is not a bias. Is a natural phenomenon - describe, not correct.

26
Q

How can you differentiate effect modification and confounding in a study?

A

Stratified analysis▶️analyzing the cohort as different groups

  • Effect modification▶️allways significant difference between the strata (groups)▶️different measures of association
  • Confounding▶️Not significant difference between the strata
27
Q

Treatment of bulimia nervosa

A
  • SSRI
  • Cognitive behavioral therapy
  • Nutritional rehabilitation
28
Q

Pharmacotherapy for anorexia nervosa

A

Olanzapine (antipsychotic associated with weight gain), associated with psycotherapy

29
Q

Best test to assess the association between 2 categorical variables

A

Chi-square

30
Q

Utility of two-sample z test and two-sample t test.

A

Compare 2 group means, no categorical variables

31
Q

Which test do you use to compare the means of 2 or more groups?

A

Analysis of variance (ANOVA)

32
Q

What are you looking for when use matching method to compare data between 2 gropus? in which studies is most used?

A
  • Control confounding bias→match by common or potential variables confounders►age, race, gender, smoking status, etc
  • Case-control studies
33
Q

Pathophysiology of ADHD symptoms. Treatment.

A
  • ⬇️ NE and DA in prefrontal cortex

- Methylphenidate and amphetamines▶️⬆️release of NE and DA from vesicles and 🚫reuptake at synapses

34
Q

How can you differentiate the derealization and depersonalization of depersonalization/derealization disorder from psychotic disorders?

A

Reality testing

- Intact in depersonalization/derealization disorder

35
Q

What is a key feature of panic attacks, how may you identify them?

A
  • At least some of the attacks are spontaneous with no obvious trigger (ex, relaxing at home or emerging from sleep)
  • Acute onset anxiety with physical symptoms (shaking, dizziness, nausea, sweating)►recurrent and unexpected, concern about additional attacks→Panic disorder
36
Q

What can you use to treat generalized anxiety disorder without dependence, tolerance and sexual dysfunction? Mechanism of action.

A

Buspirone (2nd line Tx)→Stimulates 5-HT1A receptors

*Does not interact with alcohol (vs barbiturates, benzodiazepines)

37
Q

Risk factors for neonatal abstinence syndrome

A

Mothers with poor mental health, no prenatal care, hepatitis C infection (

38
Q

Treatment and possible cause of neonatal abstinence syndrome

A
  • Withdrawal from transplacental opiates due to maternal drug use
  • Opioid replacement therapy→morphine, metahodone
39
Q

Symptoms of neonatal abstinence syndrome

A
  • Neurologic→irritability, hypertonia, jittery movements, seizures (rare)
  • Gastrointestinal→diarrhea, vomiting, feeding intolerance
  • Autonomic→sweating, sneezing, pupillary dilation
40
Q

Pharmacology treatment of behavioral and psychotic manifestations of delirium.

A

Low-dose of antipsychotics (Haloperidol and some 2nd generation)

*Benzodiazepines can worsen confusional state→only delirium due alcohol and benzo withdrawal

41
Q

Mechanism of action of phencyclidine (PCP). Most important clinical features of intoxication.

A
  • N-methyl-D-aspartate (NMDA) receptor antagonist
  • Secondarily inhibit reuptake of norepinephrine, DA, 5HT; sigma opioid receptor
  • Agitation, hallucinations (substance-induced psychosis), violent behavior, loss coordination, horizontal and vertical nystagmus, memory loss, ataxia
42
Q

Indications of use of MAOI’s

A
  • Treatment-resistant depression

- Atypical depression

43
Q

What is a atypical depression?

A
  • Mood reactivity→ex, feeling better in response to positive events
  • Leaden paralysis→arms and legs extremely heavy
  • Recjection sensitivity→overly sensitive to slight criticism
  • ↑sleep and appetite
44
Q

How do you identify tourette syndrome?

A
  • Both vocal (at least one) and multiple motor tics
  • Tics preceded by urge and followed by relief. Can be supressed temporarily
  • Common in boys 6-15 age

USMLE Step 1 Flash Cards (9 decks)

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