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USMLE Step 1 Flash Cards > Behavioral > Flashcards

Flashcards in Behavioral Deck (44):
1

Requirement to refer a patient for a hospice care

Survival prognosis of ≤ 6 months

2

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

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.

3

How do you identity and distinguish a conversion disorder?

- Neurological symptoms incompatible with any known neurologic disease
- Acute onset after stressful event
- La belle indifferénce

4

How do you detect a passive aggression defense mechanism?

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

5

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

- 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

6

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

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.

7

What is a preventable medical error or adverse event?

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

8

Which are the mature mechanisms of defense? Describe them.

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

9

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

- 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

10

Key to identify cocaine withdrawal. Others features and treatment.

-"Crash"→acute depression symptoms with suicide ideas
- Hypersomnia, fatigue, hyperphagia, pronunced lassitude, vivid nightmares, psychomotor retardation. Minor physical signs and symptoms.
- Tx: supportive only

11

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

- 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)

12

Medical conditions associated with premature ejaculation. Treatment.

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

13

How do you assess the attention and concentration?

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

14

Ranges and uses of the correlation coeficient.

- Ranges from -1 to +1
- Describes strength and polarity of a linear association

15

Next step on evaluation when hace suspicious of child abuse.

- 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)

16

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

- 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)

17

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

- 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

18

Best evidence for treatment of post-traumatic stress disorder

- Antidepressants→SSRI, SNRI
- Trauma focused cognitive behavioral therapy

19

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

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

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

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

21

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

- 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

How can you distinguish anorexia vs bulimia?

- Bulimia→normal or overweight
- Anorexia→low weight

23

Treatment of specific fobia

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

24

Majority of drug overdose death in US

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

25

How do you identify effect modification in a study?

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

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

26

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

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

Treatment of bulimia nervosa

- SSRI
- Cognitive behavioral therapy
- Nutritional rehabilitation

28

Pharmacotherapy for anorexia nervosa

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

29

Best test to assess the association between 2 categorical variables

Chi-square

30

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

Compare 2 group means, no categorical variables

31

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

Analysis of variance (ANOVA)

32

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

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

33

Pathophysiology of ADHD symptoms. Treatment.

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

34

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

Reality testing
- Intact in depersonalization/derealization disorder

35

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

- 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

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

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

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

37

Risk factors for neonatal abstinence syndrome

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

38

Treatment and possible cause of neonatal abstinence syndrome

- Withdrawal from transplacental opiates due to maternal drug use
- Opioid replacement therapy→morphine, metahodone

39

Symptoms of neonatal abstinence syndrome

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

40

Pharmacology treatment of behavioral and psychotic manifestations of delirium.

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

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

41

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

- 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

Indications of use of MAOI's

- Treatment-resistant depression
- Atypical depression

43

What is a atypical depression?

- 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

How do you identify tourette syndrome?

- 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