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Endo/Msk/ Psych Review Flashcards

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1
Q

Spongiosis

A

Accumulation of edema fluid in the intercellular spaces of the epidermis

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2
Q

Islet of langerhans are a collection of what cells

A

Alpha= glucagon (peripheral)
Beta= insulin (center)
Delta= somatostatin (interspersed)

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3
Q

ADH synthesized

A

Hypothalamus (supraoptic nuclei)

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4
Q

Cortisol effects on

  • Appetite
  • Insulin resistance
  • Fibroblast activity
  • Inflammatory and Immune response
  • Bone formation
A

Increased

  • Appetite
  • Blood pressure
  • Insulin resistance
  • Gluconeogesis, lipolysis

Decreased

  • Fibroblast activity (poor wound healing)
  • Inflammatory and Immune responses
  • Bone formation
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5
Q

Things that trigger PTH secretion

A

Decreased serum Ca
Increased serum PO4
Decreased serum Mg

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6
Q

Calcitonin

A

Decrease bone reabsorption of Ca

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7
Q

Thyroid peroxidase (TPO)

A

oxidation and organification of iodide as well as coupling of MIT and DIT –> T3, T4

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8
Q

Propylthiouracil (PTU)

  • MOA
  • use
  • Adverse
A

Inhibits both thyroid peroxidase and 5’ deiodinase

Tx for hyperthyroidism

Adverse effects

  • Skin rash
  • agranulocytosis **
  • aplastic anemmia
  • hepatotoxicity
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9
Q

Methimazole

  • MOA
  • use
  • Adverse
A

inhibits thyroid peroxidase only

Tx for hyperthyroidism

Adverse effects

  • Skin rash
  • agranulocytosis **
  • aplastic anemmia
  • hepatotoxicity

Teratogenic

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10
Q

cGMP endocrine hormones

A

BNP
ANP
NO

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11
Q

IP3 endocrine hormones

A 
GnRH
Oxytocin
ADH
TRH
Histamine (H1) 
Angiotensin II
Gastrin

GOAT HAG

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12
Q

Intracellular receptor endocrine hormones

A

PET CAT on TV

Progesterone
Estrogen
Testosterone
Cortisol
Aldosterone
T3/T4
Vitamin D
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13
Q

Receptor tyrosine endocrine hormones

A 
Insulin
IGF-1
FGF
PDGF
EGF
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14
Q

Jak/Stat endocrine hormones

A

PIGGlET

Prolactin
Immunomodulators (cytokines, IL-2,IL-6, IFN)
GH
G-CSF
Erythropoietin
Thrombopoietin
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15
Q

cAMP endocrine hormones

A

FLAT ChAMP

FSH
LH
ACTH
TSH
CRH
hCG
ADH (V2)
MSH
PTH
Calcitonin
GHRH
glucagon
Histamine (H2)
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16
Q

Hyperpigmentation
Hyperkalemia
Metabolic acidosis
Hypotension

A

Primary adrenal insufficiency

Deficiency of aldosterone and cortisol

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17
Q

Tumor of adrenal medulla in child
Increased HVA and VMA in urine
N- myc
Cells are purple with dark black ring of cells around it

A

Neuroblastoma

Homer Wright rosettes

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18
Q

Thyroid histology: lymphoid aggregates with germinal centers

  • type of rxn
  • assoc with HLA
  • risk
A

Hashimoto thyroiditis

Type IV hypersensitivity

HLA DR5 HLA B5

Increased risk: B cell lymphoma of thyroid

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19
Q 
Pot belly
Pale
Puffy face child
Protruding umbilicus
Protuberant tongue
Poor brain development

Enlarged fontanelle
Dry skin
Jaundice

Tx

A

Congenital hypothyroidism (Cretinism)

6P’s

Tx: levothyroxine

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20
Q

Jaw Pain

Painful goiter

A

Subacute granulomatous thyroiditis (de Quervain)

Inflammatory disruption of follicles and multinucleated giant cells

Self limited
- viral infection

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21
Q

Fixed hard rock like goiter in young
- disease
- histology
-

A

Riedel thyroiditis

Thyroid replaced by fibrous tissue with inflammatory infiltrates (macrophages, eosinophils)

IgG related systemic disease

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22
Q

Graves disease release of what cytokines

Associated HLA

A

TNF-alpha
IFN-gamma

HLA DR3 and HLA B8

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23
Q

Thyroid masses
Empty appearance nuclei with central clearing

  • assoc seen
  • mutations
  • Causes
A

Papillary carcinoma

Orphan Annie Eyes

psamMOma bodies

Papi and Moma adopted Orphan Annie

RET and BRAF

TObacco use
Radiation exposure

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24
Q

Follicular carcinoma

  • Histology
  • Mutation
  • Spread
  • Association
A

Uniform cuboidal cells lining follicles
Invading fibrous capsule

RAS

Hematogenous spread

PAX8-PPAR gamma 1 rearrangement

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25
Pseudohypoparathyroidism type 1A
G3 protein alpha subunit defective Increased PTH but unresponsive Decreased Ca
26
Tx Central DI
Desmopressin
27
TX Nephrogenic DI
``` HCTZ Indomethacin (decrease renal blood flow) ``` Amiloride (K sparing diuretic) - Tx for lithium toxicity caused Nephrogenic DI
28
SIADH tx
Diuretics COnivaptan Tolvaptan Demeclocycline
29
Diabetes histology
Small vessel: diffuse thickening of basement membrane Large vessel atherosclerosis
30
Diabetes - HbA1c Fasting glucose
HbA1C= > 6.5% Fasting glucose >126
31
Diabetic nephropathy pathophysiology
Increase in filtered glucose load Increase Na resorption in PT leading to decrased NA and fluid delivery to macula densa Activation of tubuloglomerular autoregulation Dilation of afferent arterioles and constriction of efferent - Increases intraglomerular capillary pressure Increased glomerular filtrate rate --> glomerular hyeprtrophy
32
Infection associated with diabetic ketoacidosis
Mucor
33
``` Dermatitis Diabetes DVT Declining weight Depression ``` Tx
Glucagonoma - Tumor of pancreatic alpha cells Over production glucagon Octreotide tx
34
Diabetes Steatorrhea Gallstones Achlorhydria Tx
Somatostatinoma Tx: Surgical resection, octreotide
35
``` High serotonin Flushing Diarrhea Wheezing Tricuspid regurg/ pulmonic stenosis ```
Carcinoid sydrome
36
MEN 1
``` Pituitary tumors (prolactin or GH) Pancreatic endocrine tumors (ZE syn, Insulinoma, VIPomas) Parathyroid adenomas ``` Mutation: Menin (tumor suppressor) Chr 11 Hypercalcemia Hypoglycemia Periperhal vision loss
37
MEN 2A
Parathyroid hyperplasia Medullary thyroid carcinoma - calcitonin Pheochromocytoma RET mutation
38
MEN 2B
Medullary thyroid carcinoma Pheochromoctyoma Mucosal neuromas RET
39
Hypercalcemia Hypoglycemia Periperhal vision loss
MEN 1
40
``` Thyroid mass Papules on lips and tongue Marfan's Increased calcitonin HTN ```
MEN 2B
41
Rapid insulin
Lispro Aspart Glulisine
42
Intermediate acting insulin
NPH
43
Long acting insulin
Detemir | Glargine
44
First line therapy in Type 2 DM MOA Adverse effects
Metformin Inhibit hepatic gluconeogenesis and the action of glucagon Increase peripheral glucose uptake Increase insulin sensitivity Weight loss Lactic acidosis **
45
Sulfonylureas: First generation - examples - MOA - adverse
Chlorpropamide Tolbutamide Stimulate release of endogenous insulin in Type 2 DM Close K channel in Beta cell membrane --> cell depolarizes --> insulin release via Ca influx Adverse - Disulfiram like effects
46
Sulfonylureas: Second generation - examples - MOA - Adverse
Glimepiride Glipizide Glyburide Stimulate release of endogenous insulin in Type 2 DM Close K channel in Beta cell membrane --> cell depolarizes --> insulin release via Ca influx Adverse - hypoglycemia - weight gain
47
Closes K channels to increase insulin release
Sulfonylureas
48
Glitazones/ Thiazolidinediones - examples - use - MOA - adverse
- glitazone Pioglitazone Rosiglitazone Type 2 DM Safe to use in renal impairment Increase insulin sensitivity in peripheral tissue. Binds PPAR-gamma nuclear transcription regulator Adverse - weight gain - edema - HF - increase risk of fractures
49
Meglitinides - examples - use - MOA - adverse
-glinide Nateglinide Repaglinide Type 2 DM Stimulate postprandial insulin release by binding to K channels on beta cells membranes Hypoglcemia Increased risk of renal failure Weight gain
50
GLP-1 analogs - examples - use - MOA - adverse
``` -glutide Exenatide Liraglutide (sc injection) Albiglutide Dulaglutide ``` Type 2 DM Increase glucose dependent insulin release Decrease glucagon release Decrease gastric emptying Increase satiety Nausea Vomiting Pancreatitis ** Weight loss
51
DDP-4 Inhibitors - examples - use - MOA - adverse
- gliptin Linagliptin (weight loss) Saxagliptin Sitagliptin Type 2 DM Inhibit DPP-4 enzyme that deactivates GLP-1 , thereby increasing glucose-dependent insulin release Decrease glucagon release Decrease gastric emptying Increase satiety Mild urinary and respiratory infections
52
Amylin analogs - examples - use - MOA - adverse
Pramlintide (SC injection) Type 1 DM Type 2 DM Decrease gastric emptying Decrease glucagon Hypoglycemia (mistimed) Nausea
53
SGLT2 inhibitors - examples - use - MOA - adverse
-flozin Canagliflozin Dapagliflozin Empagliflozin Type 2 DM Block reabsorption of glucose in PCT ``` Glucosuria UTI Vaginal yeast infections Hyperkalemia Dehydration WL ```
54
alpha-glucosidase inhibitors - examples - use - MOA - adverse
Acarbose Miglitol Type 2 DM Inhibit intestinal brush border alpha-glucosidases Delayed carbohydrate hydrolysis and glucose absorption Decreased postprandial hyperglycemia GI disturbances
55
Triiodothyronine | Levothyroxine
Thyroid hormone replacement ``` Levothyroxine= T4 Triiodothyronine= T3 ``` Tachycardia Heat intolerance Termors Arrhythmias
56
Conivaptan | tolvaptan
ADH antagonists Tx SIADH, block ADH at V2
57
Demeclocycline - MOA - use - adverse effect
ADH antagonist TX: SIADH Adverse - nephrogenic DI - photosensitivity - abnormal teeth and bones
58
Fludrocortisone - MOA - use - adverse
Synthetic analog of aldosterone with little glucocorticoid effects Tx of mineralocorticoid replacement in primary adrenal insufficiency Edema HF Hyperpigmentation
59
Cinacalet - MOA - Use - Adverse
Sensitizes Ca sensing receptor (CaSR) in parathyroid gland to circulating Ca Decrease PTH Use: primary or secondary hyperparathyroidism Adverse: hypocalcemia
60
Post partum Agalactorrhea
Postpartum hemorrhage --> underperfusion of the pituitary
61
Anterior lobe of pituitary from
Ectoderm | Rathke's pouch
62
Posterior pituitary from
Hypothalamus invagination (neuroectoderm)
63
Adrenal cortex derived from Adrenal medulla derived from
Cortex= mesoderm Medulla= Ectoderm
64
3beta- hydroxysteroid dehydrogenase deficiency
Inability to produce - Glucorticoids - Mineralocorticoids - Androgens - Estrogens Excessive sodium excretion in urine Ambigous genitalia
65
Aldosterone effects
Increase Na reabsorption in collecting tubules Raises blood pressure Increase K excretion
66
Tx Hyperaldosteronism
Aldosterone antagonist - Spironolactone - Eplerenone
67
HTN Hypokalemia Metabolic alkalosis
Hyperaldosteronism
68
Addison disease
Primary adrenal insufficiency Hypotension Hyponatremia Hyperkalemia Hyperpigmentation
69
Erytopoietin secreting tumors
Pheochromocytoma Renal cell carcinoma Hemangioblastoma (vascular tumor of CNS) Hepatocellular carcinoma
70
Homer Wright rosettes
Ring of black cells surrounding purple cells in center Adrenal Adrenal neuroblastoma
71
Thyroid development - begins - drived - remnants
Begins 3rd week gestation Derived from endoderm from the floor of the primitive pharynx Thyroglossal duct Foramen cecum
72
Foramen cecum
Thyroid remnant In middle of tongue
73
Thyroglossal duct
Retain connect from thyroid to tongue Moves with swallowing Midline mass
74
Hypothyroidism effect on LDL and cholesterol
Increased LDL and total cholesterol
75
Iodide (I-) --> Iodine (I2) enzyme Process called
Peroxidase Organification
76
How does pregnancy affect thyroid levels
Increases thyroid binding globulin (TBG) - Estrogen upregulates ``` Binds up circulating thyroid hormone Thyroid sense T3/T4 dropping so releases more Total T4/T3 increased Free T3/T4 normal TSH decreased ```
77
Cause of congenital hypothyroidism that can be prevented
Iodine deficiency Iodine to diet
78
Graves disease features specifically to it
Exophthalmos Pretibial myxedema connective tissue deposit in orbit, extraocular muscles, thickening of skin in front of shins due to deposition
79
Hyperthyroid tx first trimester Hyperthyroid tx 2nd and 3rd trimester
1st: PTU 2nd/3rd: Methiamzole
80
Thyroiditis - tx
Transient elevation of thyroid hormone --> hypothyroidism Tx : beta blockers
81
Mass in thyroid Increase in calcitonin - Proliferation - Assoc - Mutation - Activation
Medullary thyroid carcinoma Proliferation of parafollicular C cells MEN2A MEN 2B RET gene mutation Activation of tyrosine kinase
82
Thyroid cancer activation of tyrosine kinase
Medullary thyroid carcinoma | Follicular thyroid carcinoma
83
GLUT1 GLUT2 GLUT3 GLUT4 GLUT5
GLUT1 - RBCs - Brain GLUT2 - beta cells - Liver - Small intestine - Renal cells GLUT4 (Insulin dependent) - Adipose tissue - Skeletal
84
Type 1 DM HLA
HLA DR3- DQ2 and HLA DR4- DQ8
85
Type 1 DM antibodies
Ab against glutamic acid decarboxylase (GAD)
86
Kimmelstiel wilson nodules
Acellular nodules in glomerulus Diabetes
87
Cotton wool spots
DM
88
Acidosis on K levels
Increase extracellular K concentrations Push H into cels
89
Diabetic medication to not use in patient with abnormal kidney fxn
Metformin Sulfonyureas SGLT-2 inhibitors
90
Diabetic med that causes weight gain
Sulfonyureas | Thiazolidinediones (-glitazone)
91
Diabetic med metabolized by liver, can be used in patients with renal failure
Thiazolidinediones - glitazone Pioglitazone Posiglitazone
92
``` Hyperparathyroidism Hypocalcemia Hyperphosphatemia Increased BUN and Cr Elevated Alk phos ```
Secondary hyperparathyroidism from renal failure
93
ACL attachment
Lateral femoral condyle to anterior tibia
94
PCL attachment
Medial femoral condyle to posterior tibia
95
Unhappy triad
lateral force applied to planted leg ACL MCL Medial meniscus (lateral meniscus injury is more common)
96
Infraspinatus movement
Lateral rotates
97
Teres minor movement
Adducts and laterally rotates arm
98
Subscapular
Medially rotates Adducts arm IR
99
Supraspinatus
0-15 degress abduction
100
Wrist bones
So Long to Pinky Here Comes the Thumb Scaphoid, Lunate, Triquetrum, Pisiform Hamate, Capitate, Trapezoid, Trapezium
101
Fall on outstretch hand fracture what bone
Scaphoid
102
Midshaft fracture of humerus
Radial nerve
103
Forearm flexion and supination
Musculocutaneous
104
Cant extend ring finger and pinky
distal Ulnar nerve
105
Cant flex thumb and first two fingers
Proximal Median n
106
Cant extend thumb and first two fingers
Distal Median n.
107
Cant flex ring finger and pinky
Proximal ulnar nerve
108
Absent cremasteric reflex | Loss sensation in scrotum/ labia majora
Genitofemoral n. (L1-L2)
109
Loss of sensation dorsum of foot Foot drop - site
Common peroneal (L4-S2) Trauma or compression of lateral aspect of leg Fibular neck fracture
110
Loss of sensation sole of foot | Can stand on tip toes
Tibial n.
111
Nerve artery in location 1) Axilla 2) Surgical neck humerus 3) Midshaft humerus 4) Distal humerus/ cubital fossa 5) Popliteal fossa 6) Posterior to medial malleolus
1) Axilla - Long thoracic n. - Lateral thoracic a. 2) Surgical neck humerus - Axillary n. - Posterior circumflex a. 3) Midshaft humerus - Radial n. - Deep brachial a. 4) Distal humerus/ cubital fossa - Median n. - Brachial a. 5) Popliteal fossa - Tibial n. - Popliteal a. 6) Posterior to medial malleolus - Tibial n. - Posterior tibial a.
112
What is located at the junction of the A and I bands
T tubule
113
Estrogen effect on bones
Inhibits osteoblast apoptosis | Induces apoptosis in osteoclasts
114
Osteonecrosis (avascualr necrosis) causes
``` Corticosteroids Alcoholism Sickle cell disease Trauma The Bends Legg-Calve PErthes Gauchers disease Slipped femoral epiphysis ``` CAST Bent LEGS
115
HLA-DR4
Rheumatoid arthritis
116
Ankylosing spondylitis associated with
Aortic regurgitation Restrictive lung disease due to limited chest wall expansion
117
Sarcoidosis - elevated levels - clinical - CXR
ACE levels CD4/ CD8 Asymptomatic Enlarge lymph nodes Bilateral adenopathy and course reticular opacities Extensive hilar and mediastinal adenopathy
118
Pain in shoulders and hips No muscle weakness Elevated ESR and CRP Normal CK
Polymyalgia rheumatic assoc w/ GIant cell arteritis Tx steroids
119
Fibromyalgia - symptoms - tx
Chronic widespread Msk pain assoc w/ tender points, stiffness, paresthesias, poor sleep, cognitive disturbances Tx: exercise regularly, antidepressants (TCA, SNRI) anti convulsants (Amitriptyline, fluoxetine) FDA approved: Pregabalin, milnacipran
120
Polymyositis cell type
CD8 T cells
121
Dermatomyositis cell type
CD4 T cells
122
Myasthenia gravis vs Lambert Eaton myasthenic syndrome
MG - Ab to postsynaptic ACh receptor - Ptosis, diplopia, weakness - Worses with use - Thymoma, thymic hyperplasia - Tx pyridostigmine Lambert Eaton myasthenic syndrome - Ab to presynaptic Ca channel --> decrease ACh release - Proximal muscle weakness, dry mouth, impotence - IMPROVES with muscle use - assoc w/ small cell lung cancer
123
Puffy, taut skin no wrinkles | Fingertip pitting
Scleroderma
124
Claudins
Tight junctions
125
Connexons
Gap junctions
126
Occlusins
Tight junctions
127
Acantholysis - is what - seen in
Separation of epidermal cells Pemphigus vulgaris
128
Acanthosis
Epidermal hyperplasia
129
Erysipelas - is what - causes it - clinical presentation
Infection involving upper dermis and superficial lymphatics S pyogenes Presents with well defined dercation between infected and normal skin
130
Flaccid blisters - type - MOA - Type hypersensitivity - Immunoflorence pattern - Sign
Pemphigus vulgaris IgG against desmoglein Component of desmosomes Type II hypersensitivity rxn IF: Ab in reticular (netlike) pattern) Nikolsky sign +
131
Round smooth blisters - type - MOA - Immunoflorence - Sign
Bullous pemphigoid IgG against hemidesmosomes IF: linear pattern at epidermal-dermal junction Nikolsky sign negative
132
S-100 skin cancer
melanoma
133
Melanoma mutation
BRAF
134
Aspirin overdose effects
Gastric ulcer Tinnitus Interstitial nephritis
135
Selectively inhibits COX2 - use - adverse
Celecoxib RA and osteoarthritis Adverse - risk of thrombosis - sulfa allergy
136
Alendronate - type - MOA - use - adverse
Bisphophonates - binds hydroxyapatite in bone Inhibits osteoclast activity Use: Osteoporosis Hypercalcemia Paget Adverse - Esophagitis - Osteonecrosis of jaw
137
Teriparatide - Type - MOA - Use - Risk
Recombinant PTH analog give SQ daily Increase osteoblast activity Use - Osteoporossi Risk - osteosarcoma
138
Allopurinol vs Febuxostat
Allopurinol - competitive inhibitor of xanthine oxidase Febuxostat - inhibits xanthine oxidase
139
Etanercept
Fusion protein (receptor for TNF-alpha + IgG1 Fc) Intercepts TNF RA, Psoriasis, ankylosing sponylitis
140
TNF-alpha inhibitors
Infliximab Adalimumab Certolizumab Golimumab IBD, RA, Ankylosing spondylitis, psoriasis
141
11;22 bone tumor
Ewing sarcoma
142
McCune Albright
One side Cafe-au lait spot Unilateral fibrous dysplasia of bone - bone replaced by collagen and fibroblats Precocious puberty
143
Osteopetrosis deficiency of
Carbonic anhydrase II
144
Ankle sprain injury to
Anterior talofibular lig (Always tears first) Calcaneofibular lig Posterior talofibular lig
145
What is injuried in posterior hip dislocation
Medial and lateral circumflex femoral arteries Femoral vein Sciatic nerve Head of femur
146
Ab not RA
Rheumatoid factor | Anti-citrullinated protein Ab
147
How do NSAIDS cause renal disease
Block prostaglandin synthesis Constrict renal vessels Decrease renal blood flow
148
Tx of choice acute gout
NSAIDS Colchicine Steroids
149
Tx chronic gout
Probenecid - increases renal excretion of uric acid - Inhibits reabsorption of uric acid in PCT Allopurinol Febuxostat
150
Tx for seronegative sponyloarthropathies
TNF-alpha inhibitor - prevents activation of immune system - Etanercept - Inflixumab, Adalimumab, Golimumab, Certolizumab Check PPD skin test before giving
151
Reactive arthritis typically follows infect with
Chlamydia GI infections (Shigella, Salmonella, Yersinia, Campylobacter, clostridium)
152
Skin disorders of SLE
Malar rash Discoid rash Photosensitivity Painless oral ulcers**
153
Tx SLE
Steroids NSAIDS Hydroxychloroquine Cyclophosphamide
154
Component of hemidesmosomes
Integrins
155
Psoriasis increase and decrease in what skin layers
Increase stratum spinosum Decrease stratum granulosum
156
Psoriasis tx
Topical tx - steroids - Vit D analog - retinoids Methotrexate Cyclosporine Systemic retinoids Biological agents - Adalimumab - Etanercept - Infliximab
157
Palasading nuclei of mark on skin
Basal cell carcinoma
158
Melasma
Dark discoloration common in pregnant women, those taking OCP and hormone replacement Melanocytes stimulated by estrogen and progesterone Spontaneously resolves
159
Impetigo tx
``` Topical mupirocin (mild) Oral dicloxacillin , cephalexin (serious) ```
160
Cellulitis Tx
Non-MRSA: oral dicloxacillin, cephalexin MRSA: oral TMP-SMX, clindamycin
161
Necrotizing fasciitis tx
Surgical debridement | IV carbapenem + clindamycin
162
Scaled skin syndrome tx
Nafcillin, oxacillin, vancomycin
163
Dermatitis herpetiformis
Chronic blistering disease IgA in tips of dermal papillae Assoc w/ celiac disease
164
Fever Bulla formation Necrosis Sloughing of skin
Steven johnson syndrome Hypersensitivity rxn Antiseizure drugs Sulfa drugs Penicillins Allopurinol
165
Expressing extremely positive thoughts of self and others while ignoring negative thoughts
Idealization
166
Replacing warded off ideas or feelings by an (unconsciously derived) emphasis on its opposite
Reaction formation Patient with libidinous thoughts enters a monastery
167
Repetitive and pervasive behavior violating the basic rights of others or social norms. Agression to people and animals. Destruction of property, left. Under age 18.
Conduct disorder
168
Disruptive mood dysregulation disorder
Severe and recurrent tempor outbursts out of proportion to situation Child constantly angry and irritable
169
Testing for what 1) Providing name, locationg, and current date 2) Following multistep commands 3) Reciting months of years backwards 4) Recalled 3 unrelated words after 5 minutes 5) Providing details of significant life events 6) Writing a complete sentence with noun-verb agreement 7) Drawing intersecting pentagons 8) Drawing a clock oriented to the time requested
1) Orientation 2) Comprehension 3) Concentration 4) Short term memory 5) Long term memory 6) Language 7) Visual-spatial 8) Executive function
170
Brief psychotic disorder
<1 month
171
Schizophreniform
1-6 months
172
Schizoaffective disorder
> 2 weeks of hallucinations or delusions without major mood episode
173
Schizophrenia tx
First line: Antipsychotic | - Risperidone
174
Hypomanic Manic
4 consecutive days At least 1 week
175
Bipolar I
1 manic +/- a hypomanic or depressive episdoe
176
Bipolar II
Hypomanic and depressive episode
177
Bipolar tx
Mood stabilizers - Lithium - Valproic acid - Carbamazepine - Lamotrigine
178
Major depressive Timeline Tx
>= 2 weeks Tx: CBT and SSRI
179
Postpartum blues duration
2-3 days after delivery --> 10 days
180
Post partum depression TX
>= 2 weeks CBT and SSRI
181
Tx Aniexty
CBT SSRIS SNRIS
182
Tx Panic disorder
CBT, SSRI, Venlafaxine are first line
183
Specfiic phobia
Severe persistent >= 6 months fear or anxiety due to specific object
184
Generalized anxiety disorder Tx
> 6 months Worry about multiple issues Tx CBT, SSRI, SNRI first line
185
Adjustment disorder TX
Emotional symptoms that occur within 3 months of stressor, lasting < 6 months CBT SNRI
186
Obsessive compulsive disorder tx
CBT SNRI Clomipramine
187
Body dysmorphic disorder tx
CBT
188
Acute stress disorder
3 days --> 1 month
189
Post traumatic stress Tx
Trauma > 1 month CBT, SSRI, venlafaxine first line Prazosin can reduce nightmares
190
``` Self mutilation Suicidal Splitting personality Unstable mood Impulsive ```
Borderline
191
Excessive emotionality and excitability Attention seeking Sexually provocative Overly concerned with appearance
Histrionic
192
Loss of sensory or motor function (paralysis blindness, mutism) often following an acute stressor.
Conversion disorder
193
Excessive preoccuption with acquiring or having a serious illness, despite medical evaluation and reassurance
Illness anxiety disorder (hypochondriasis)
194
Narcolepsy caused by
Decreased hypocretin (orexin) production in lateral hypothalamus
195
Delirium tremens - due to - clinical features Tx
Lifethreatening alcohol withdrawal 2-4 days after last drink Tachycardia, tremors, anxiety, seizures Respiratory alkalosis Tx: Benzodiazepines (chlordiazepoxide, lorazepam, diazepam)
196
Tourette syndrome | TX
Alpha 2 agonist- clonidine Antipsychotics (anti-dopamine) - Fluphenazine pimozide Tetrabenazine
197
Typical antipsycotics - examples - MOA - High potency
``` Haloperidol pimozide trifluperAZINE fluphenazine Thioridazine (low potency) Chlorpromazine (low potency) ``` Block D2 dopamine recpetor --> Increase cAMP High potency: Try to Fly High (Trifluoperazine, Fluphenaizne, Haloperidol)
198
Atypical antipsychotics - examples - MOA - Adverse effects
``` Aripiprazole AsenAPINE clozapine Olanzapine iloPERIDONE risperidone ``` D2 antagonists aripiprazole: D2 partial agonist Varied effects on 5HT-2, dopamine and alpha and H receptors Clozapine: agranulocytosis Risperidone: hyperprolactinemia Olanzapine : obesity
199
LIthium side effects
``` Tremor Hypothyroidism polyuria Teratogenesis Ebstein anomaly ```
200
Buspirone - MOA - Use
Stimulates 5-HT1A receptors | Generalized anxiety disorder No sedation, addiction or tolerance
201
SSRI - Examples - MOA - Use - Adverse
``` Fluoxetine Fluvoxamine Parxetine Sertraline Escitalopram Citalopram ``` Inhbit 5HT reuptake Depression, anxiety, panic, OCD, bulimia, PTSD... Adverse - GI distress - SIADH, - Sexual dysfunction
202
SNRI - examples - MOA - Use - Adverse
``` Venlafaxine Desvenlafaxine Duloxetine Levomilnicipran milnacipran (fibromyalgia only) ``` Inhibit 5-HT and NE reuptake Duloxetine: fibromyalgia Increase BP
203
Tricyclic antidepressants - examples - MOA - Adverse
-ipramine, triptyline Inhibit NE and 5-HT uptake TriC's - Convulsion - Coma - Cardiotoxicity - Can prolong QT Tx for overdose: Sodium bicarbonate
204
Monoamine oxidase inhibitors - examples - MOA - Use - Adverse
Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline Increase level of amine NT (NE, 5-HT, dopamine) ``` Atypical depression, anxiety Parkinson disease (selegiline) ``` CNS Stimulation Hypertensive crisis with ingestion of tyramine - brown bananas, wine, aged cheese, soy sauce, aged beef
205
Buproprion - type - MOA - Use - adverse
Atypical antidepressant Inhibits reuptake NE adn dopamine Smoking cessation May help alleviate sexual dysfuntion Seizures in anorexic/ buliemic patients
206
Mirtazapine - type - MOA - Adverse
Alpha 2 antagonist - increase release NE and 5-HT 5HT2 5HT3 receptor antagonst H1 antagonist Adverse - Sedation - Increased appetite WG
207
Trazodone - MOA - Use - Adverse
Blocks 5-HT2, alpha 1 adrenergic, H1 receptor Weakly inhibits 5HT reuptake Tx for insomnia Adverse - Sedation - Priapism - Postural hypotension
208
Nicotinic ACh recpetor partial agonist Used for smoking cessation Toxicity
Varenicline Sleep disturbance may depress mood
209
Methylphenidate and dexmethylphenidate MOA
block reuptake of dopamine and NE
210
Tx any drug withdrawal (Cocaine, LSD)
Benzo

AM- STEP1 (20 decks)

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