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Clerckship_USMLE > chapter_2 _Q&A > Flashcards

chapter_2 _Q&A Flashcards

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1
Q

What are the key components of a psychiatric interview?

A
  1. Establish rapport
  2. Gather history
  3. Perform mental status exam (MSE)
  4. Assess risk factors
  5. Consider differential diagnosis
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2
Q

What are the major components of a psychiatric history?

A
  1. Identifying data
  2. Chief complaint
  3. History of present illness (HPI)
  4. Past psychiatric history
  5. Substance history
  6. Medical history
  7. Family history
  8. Social/developmental history
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3
Q

What are the essential components of the Mental Status Examination (MSE)?

A
  1. Appearance/Behavior
  2. Speech
  3. Mood/Affect
  4. Thought process
  5. Thought content
  6. Perceptual disturbances
  7. Cognition
  8. Insight
  9. Judgment
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4
Q

How is mood assessed in the MSE?

A

Ask the patient how they feel and record their subjective response.

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5
Q

What is the difference between mood and affect?

A

Mood: Patient’s subjective emotional state
Affect: Examiner’s observation of emotional expression

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6
Q

What are the types of affect?

A
  1. Full (normal)
  2. Constricted
  3. Blunted
  4. Flat
  5. Labile
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7
Q

Define circumstantial thought process.

A

Patient provides unnecessary details but eventually answers the question.

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8
Q

What is tangential thought process?

A

Patient never reaches the point or answers the question.

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9
Q

What is thought blocking?

A

Sudden cessation of thought, often seen in schizophrenia.

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10
Q

What is a delusion?

A

A fixed, false belief that persists despite contrary evidence.

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11
Q

What are examples of delusions?

A
  1. Persecutory (paranoia)
  2. Grandiose
  3. Religious
  4. Somatic
  5. Thought broadcasting
  6. Thought insertion + withdrawal
  7. Eratomanic
  8. infidelity (jealousy)
  9. Reference
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12
Q

What is the most common type of hallucination in schizophrenia?

A

Auditory hallucinations

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13
Q

What are the different types of hallucinations?

A
  1. Auditory
  2. Visual
  3. Olfactory
  4. Tactile
  5. Gustatory
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14
Q

What are two common bedside cognitive tests?

A
  1. Mini-Mental State Examination (MMSE)
  2. Montreal Cognitive Assessment (MoCA)
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15
Q

What does the MMSE assess?

A
  1. Orientation
  2. Attention
  3. Memory
  4. Language
  5. Visuospatial skills
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16
Q

What are key components of the MoCA?

A
  1. Orientation
  2. Memory
  3. Attention
  4. Language
  5. Abstraction
  6. Executive function
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17
Q

What are key suicide risk factors?

A

SAD PERSONS

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18
Q

How do you assess homicidal risk?

A
  1. Ask about intent
  2. Ask about access to weapons
  3. Ask about past violent behavior
  4. Identify specific targets
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19
Q

What are the most commonly used intelligence tests?

A
  1. Wechsler Adult Intelligence Scale (WAIS)
  2. Wechsler Intelligence Scale for Children (WISC)
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20
Q

What is an IQ of 70 or below classified as?

A

Intellectual disability

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21
Q

What are examples of objective personality tests?

A
  1. Minnesota Multiphasic Personality Inventory (MMPI)
  2. Millon Clinical Multiaxial Inventory (MCMI)
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22
Q

What are projective personality tests?

A
  1. Rorschach Inkblot Test
  2. Thematic Apperception Test (TAT)
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23
Q

What is the Tarasoff Rule?

A

A psychiatrist has a duty to warn and protect individuals who are at risk from a patient.

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24
Q

What are key considerations when interviewing a violent patient?

A
  1. Never interview alone
  2. Be aware of exits
  3. Ask about homicidal thoughts
  4. Consider hospital security presence
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25
What is the best approach when interviewing a delusional patient?
Do not confront the delusion directly; instead, acknowledge the patient’s experience without reinforcing the false belief.
26
What is the first step in assessing a psychiatric patient?
Establish rapport and ensure patient safety.
27
What is the most important predictor of future violence?
A prior history of violence.
28
What are the key features of delirium?
1. Acute onset 2. Waxing and waning course 3. Inattention 4. Altered level of consciousness
29
How do you differentiate between delirium and dementia?
Delirium is acute and fluctuating, while dementia is chronic and progressive.
30
What is the difference between illusion and hallucination?
Illusion: Misinterpretation of real external stimuli. Hallucination: Perception without external stimuli.
31
What are the DSM-5 criteria for schizophrenia?
At least 2 of the following for 1 month: 1. Delusions, 2. Hallucinations, 3. Disorganized speech, 4. Disorganized behavior, 5. Negative symptoms. Duration must be 6+ months.
32
What are the core symptoms of major depressive disorder (SIG E CAPS)?
1. Sleep changes 2. Interest loss 3. Guilt 4. Energy loss 5. Concentration issues 6. Appetite changes 7. Psychomotor changes 8. Suicidal ideation
33
What is the best initial treatment for acute mania?
Atypical antipsychotics (e.g., olanzapine, risperidone) or mood stabilizers (e.g., lithium, valproate).
34
What is the first-line treatment for generalized anxiety disorder?
SSRIs or SNRIs, plus cognitive-behavioral therapy (CBT).
35
What is the mechanism of action of benzodiazepines?
Enhance GABA-A receptor activity, increasing chloride channel opening frequency.
36
What are the types of thought process abnormalities?
1. Tangentiality 2. Circumstantiality 3. Loosening of associations 4. Flight of ideas 5. Thought blocking 6. Word salad 7. Clang associations 8. Neologisms 9. incoherent
37
What are command hallucinations and why are they important?
Hallucinations instructing the patient to perform actions; they increase the risk of suicide or homicide.
38
How do you assess insight in a psychiatric patient?
Ask the patient if they understand their illness and need for treatment; responses range from full to poor insight.
39
What is the most sensitive test for detecting cognitive impairment?
Montreal Cognitive Assessment (MoCA), as it better detects mild cognitive impairment than MMSE.
40
How is judgment assessed in the MSE?
Ask how a patient would respond to hypothetical situations (e.g., 'What would you do if you found a wallet on the ground?').
41
What is the importance of asking about alcohol or drug use in psychiatric evaluations?
Substance use can mimic or exacerbate psychiatric disorders and is crucial in differentiating primary vs. secondary psychiatric conditions.
42
How do you approach a patient with suspected malingering?
Assess for inconsistency in symptoms, lack of distress, external incentives (e.g., avoiding jail, obtaining medication).
43
What is a major difference between delirium and psychotic disorders?
Delirium is associated with fluctuating consciousness and inattention, while primary psychotic disorders have a clear sensorium.
44
Which conditions must be ruled out before diagnosing primary psychiatric illness?
1. Neurological disorders (e.g., stroke, tumor, epilepsy) 2. Endocrine abnormalities (e.g., thyroid disorders) 3. Substance intoxication/withdrawal 4. Infectious diseases (e.g., syphilis, HIV, meningitis)
45
What is a major risk factor for developing delirium in hospitalized patients?
Older age, baseline cognitive impairment, polypharmacy, infection, ICU admission, sensory deprivation (e.g., hearing/vision impairment).
46
What is the average IQ score in the general population?
100, with a standard deviation of 15.
47
What is the cutoff for intellectual disability?
IQ < 70, along with deficits in adaptive functioning.
48
What is the IQ range for borderline intellectual functioning?
IQ 70–79.
49
What are the IQ classifications for intellectual disability?
1. Mild: 50–69 2. Moderate: 35–49 3. Severe: 20–34 4. Profound: <20.
50
Which test is the most commonly used for measuring intelligence in adults?
Wechsler Adult Intelligence Scale (WAIS).
51
Which intelligence test is used for children?
Wechsler Intelligence Scale for Children (WISC).
52
What are the four index scores assessed in the WAIS?
1. Verbal comprehension 2. Perceptual reasoning 3. Working memory 4. Processing speed.
53
What is the difference between crystallized and fluid intelligence?
Crystallized intelligence: Knowledge accumulated over time. Fluid intelligence: Ability to solve new problems without prior knowledge.
54
Which factors can influence IQ scores?
1. Genetics 2. Environment (education, socioeconomic status) 3. Nutrition 4. Health conditions (e.g., lead exposure, prenatal factors).
55
What is the Flynn effect?
The phenomenon of rising IQ scores over generations due to improved education, nutrition, and living conditions.
56
What are the main types of perceptual disturbances?
1. Hallucinations 2. Illusions 3. Derealization 4. Depersonalization
57
What is the difference between a hallucination and an illusion?
Hallucination: Perception without an external stimulus. Illusion: Misinterpretation of a real external stimulus.
58
What is the most common type of hallucination in schizophrenia?
Auditory hallucinations.
59
Which type of hallucination is most commonly associated with delirium?
Visual hallucinations.
60
What are hypnagogic and hypnopompic hallucinations?
Hypnagogic: Occur while falling asleep. Hypnopompic: Occur while waking up.
61
What is depersonalization?
A feeling of detachment from oneself, as if watching oneself from the outside.
62
What is derealization?
A feeling that the external world is unreal or distorted.
63
Which psychiatric disorders commonly present with perceptual disturbances?
1. Schizophrenia (hallucinations) 2. Delirium (visual hallucinations) 3. PTSD (flashbacks) 4. Depersonalization/Derealization disorder

Clerckship_USMLE (8 decks)

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