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Step 1 > Behavioral Health UWorld > Flashcards

Behavioral Health UWorld Flashcards

1
Q

Side effects of first generation antipsychotics

A

Low potency: chlorpromazine and thioridazine
Antihistamine: sedation
Anticholinergic
Alpha-blocking: orthostasis

High potency: haloperidol and fluphenazine
EPS

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2
Q

Causes of new onset lithium toxicity

A

Thiazide diuretics: reduced Na+ reabsorption at the DCT results in increased Na+ and Li+ reabsorption at the PCT
NSAIDs (not ASA)
Reduced GFR: CHF, cirrhosis increase Na and Li uptake at proximal tubule
ACE-I

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3
Q

Drugs that can cause Parkinsonian like symptoms

A

Anti-psychotics (1st generation > 2nd generation)
Anti-emetics: prochlorperazine
Motility agents: metoclopramide

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4
Q

Treatment for drug-induced Parkinsonism

A

Anticholinergics (benztropine or trihexyphenidyl)

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5
Q

A mom feels depressed after her daughter leaves for college; however, she does not exhibit any social or occupational impairment as a result. What is your diagnosis?

A

Normal sadness. DSM-V diagnoses require significant occupational or social impairment for diagnosis.

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6
Q

Most common cause of death in patients intoxicated with PCP?

A

Trauma from violent behavior.

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7
Q

Strongest single risk factor for suicide

A

Prior attempts

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8
Q

Conditioning involved in an officer writing a speeding ticket

A

Positive punishment (punishment decreases behavior)

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9
Q

Conditioning involved in parents taking keys away from their teenager for disobedience.

A

Negative punishment (reward removal decreases behavior)

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10
Q

Conditioning involved in paying kids for good grades

A

Positive reinforcement (giving reward increases behavior)

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11
Q

Conditioning involved in deciding to use sunscreen after getting a bad sunburn last time at the beach

A

Negative reinforcement (removal of punishment increases behavior)

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12
Q

Conditioning involved in white coat hypertension

A

Classical: past doctor visits (unconditioned stimulus) that made patients feel anxious (unconditioned response) are associated with blood pressure cuffs (neutral stimulus). Repeated associated of the unconditioned stimulus with the neutral stimulus results in anxiety in the face of the neutral stimulus by itself (conditioned stimulus and conditioned response)

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13
Q

Expressing unacceptable feelings through actions

A

Acting out - immature

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14
Q

Behaving as if an aspect of reality does not exist

A

Denial - immature

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15
Q

Transferring feelings to an unrelated object

A

Displacement - immature

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16
Q

Using intellect to avoid uncomfortable feelings

A

Intellectualization - immature

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17
Q

Avoiding conflict by expressing hostility covertly

A

Passive-aggression - immature

18
Q

Attributing one’s feelings to others

A

Projection - immature

19
Q

Justifying behavior to avoid difficult truths

A

Rationalization - immature

20
Q

Responding in a manner opposite to one’s actual feelings

A

Reaction formation - immature

21
Q

Reverting to earlier developmental stages

A

Regression - immature

22
Q

Seeing others as all bad or all good

A

Splitting - immature

23
Q

Channeling impulses into socially acceptable behaviors

A

Sublimation - mature

24
Q

Consciously putting unwanted feelings aside to cope with reality

A

Suppression - mature

25
Q

What property of barbiturates make them more dangerous to use than benzodiazepines?

A

Benzodiazepines allosterically bind the GABAa receptor and increase the frequency at which the receptor opens, hyper polarizing the cell by Cl- influx.

Barbiturates act similarly, but increase the duration the channel is open, and at high concentrations can open the channels in the absence of GABA.

26
Q

What happens when GABAb receptors are activated? GABAc?

A

GABAb = binds G-protein in brain -> K+ efflux, reduced Ca influx and inhibition of adenylate cyclase.

GABAc = Cl- channel in retina

27
Q

Timeline of alcohol withdrawal symptoms

A

8 - 12 hours: autonomic hyperactivity, insomnia, tremors and anxiety

12 - 48 hours: withdrawal seizures

48 - 96 hours: delirium tremens (fever, disorientation and severe agitation)

28
Q

Benzos to use in patients with alcohol withdrawal and liver disease

A

“LOT”: lorazepam, oxazepam and temazepam do not have active metabolites that need liver metabolism

29
Q

When can patient confidentiality be breeched?

A

Stab/gunshot wounds, reportable communicable diseases, abuse and harm to self or others.

30
Q

Disulfiram mechanism of action

A

Inhibits aldehyde dehydrogenase, resulting in accumulation of aldehyde and sickness if the patient drinks

31
Q

Acamprosate mechanism of action

A

Modulates glutamate transmission at NMDA receptors

32
Q

Behavioral treatment of insomnia

A

Sleep hygiene: environment, sleep schedule, exercise, avoid tobacco, caffeine and alcohol

Stimulus: use bed only for sleep and sex, leave bed if not sleeping, fixed wake up time

Relaxation

Sleep restriction

33
Q

Why are HMO’s cheap insurance plans

A

There is a limited range of services patients can get within their network and they cannot get services outside of their network (as opposed to PPOs)

34
Q

1st line SSRI for bulimia nervosa

A

Fluoxetine

35
Q

Medication of choice for a patient with bipolar disorder and myoclonic seizures? Toxicity to watch for?

A

Valproate is first line for myoclonic seizures and works as a mood stabilizer for bipolar disorder. Look out for hepatotoxicity.

36
Q

Next step in determining what, how and why an undesirable medical outcome has occurred?

A

Root-cause analysis

37
Q

Circumstances when a minor does not need parental consent for medical care

A

Pre-natal care
STD treatment/screening
Substance abuse
Urgent care

38
Q

Female athlete triad

A

Anorexia, amenorrhea and osteoporosis

39
Q

Common drug-drug interactions implicated in serotonin syndrome

A 
Antidepressants (TCAs, SSRIs, MAO-Is, SNRIs)
Tramadol
Ondansetron (5-HT3 antagonist)
Linezolid
Triptans
40
Q

Where do you report physician intoxication in a non-emergent setting?

A

Physician health program and then the state licensing board if that doesn’t work

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