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Level 2 Boards > Epidemiology/ Ethics/ Psychiatry > Flashcards

Epidemiology/ Ethics/ Psychiatry Flashcards

(206 cards)

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1
Q

Sensitivity

A

A/ (A+C)

TP/ (TP+FN)

Positive test of disease/ Total disease

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2
Q

Specificity

A

D/ (B+D)

TN/ (TN+FP)

Negative test of no disease/ total no disease

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3
Q

Prevalence

A

Positive test/ total population

TP+FN/ Total

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4
Q

PPV

A

A/ (A+B)

TP/(TP+FP)

True positive/ (All positives)

The higher the disease prevalence that higher the PPV

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5
Q

NPV

A

D/ (C+D)

TN/(FN+TN)

True negatives/ All negatives

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6
Q

Likelihood ratio (LR)

A

+LR= sensitivity / (1-specificity)

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7
Q

NNT

A

NNT= 1/ absolute risk reduction

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8
Q

Odds ratio

A

OR= (A/C)/ (B/D)

OR= AD/ BC

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9
Q

Relative risk

A

RR= [A/(A+B)]/ [C/(C+D)]

Risk of developing disease in those exposed divided by risk of disease in unexposed

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10
Q

Absolute risk reduction

A

ARR= [C/C+D] -[A/(A+B)]

The difference in risk attributable to the intervention compared to the control

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11
Q

Cohort

A

Exposure —> disease

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12
Q

Case control

A

Diseased and non-diseased into two group trying to find exposure

Odds ratio

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13
Q

Type I (alpha) error

A

Concluding there is a difference when there is not

False positive

Rejecting the null hypothesis when it should not be rejected

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14
Q

Type II (beta) error

A

No difference when there is

False negative

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15
Q

P value

A

estimate of the probability that differences in treatment effects in a study could have happened by chance alone

P < 0.05 statistically significant

Reject null hypothesis which states no correlation

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16
Q

Power

What increased power?

A

Probability that a study will find a statistically significant difference when one is truly there

Increase number of subjects increases power

Power= 1 - type II error (beta)

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17
Q

Live vaccines

A 
MMR
Polio (Sabin)
Yellow fever
Influenza (nasal)
Varicella
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18
Q

Inactivated vaccines

A 
Cholera
HAV
Polio (Salk) 
Rabies
Influenza (injection)
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19
Q

Toxoid vaccines

A

Diphtheria

Tetanus

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20
Q

Informed consent

A

BRAIN

Benefits
Risk
Alternatives
Indications
Nature
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21
Q

Absence of living will

A

SPOUSE CHIPS in For the patient

SPOUSE
CHIldren
Parent
Sibling
Friend
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22
Q

Distribution in 95%

Mean 230
SD 10 mg/dL

A

2 SD from mean

210 - 250

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23
Q

Stand deviation distribution

A

68% (middle)= 1 standard deviation

95%= 2 SD

99.7 (outside)= 3 SD

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24
Q

Inquire about possible risk factors and outcomes at a specific point in time (snap shot)

A

Cross-sectional study

Type of observational study

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25
Ascertainment (sampling) bias
Study population differs from target population due to nonrandom selection methods
26
Berkson bias
Disease studied using only hospital based patients may lead to results not applicable to target population
27
Neyman bias
Prevalence bias Exposures that happen long before disease assessment can cause study to miss diseased patients that die early or recover
28
Move from point B to A Change on sensitivity
Sensitive will increase Fewer FN
29
Confounding bias vs effect modification
Effect modification - results when an extraneous variable (modifer) changes the direction or strength of an association Modifier is associated with disease but not the risk factor Confounding bias - extraneous factor associated with both exposure and disease
30
Tourette syndrome Tx
First line: aripiprazole Tetrabenazine (dopamine depleting agents)
31
MRI of schizophrenia
Enlarged ventricles | Decreased cortical volume
32
SE Haloperidol
QTc prolongation EPS
33
QTc prolongation
Haloperidol Ziprasidone
34
Clozapine SE
Agranulocytosis
35
EPS
4 and A 4 hrs: Acute dystonia 4 days: Akinesia 4 weeks: Akathisia 4 months: Tardive dyskinesia ``` ADAPT Hours to days: Acute Dystonia (Muscle spasm, stiffness, oculogyric grisis) (prolonged involuntary gaze upward) - Benztropine - Diphenhydramine ``` ``` Days to months: Akathiasia, Parkinsonism (restlessness, bradykinesia) - Beta blockers - Benzodiazepine (lorazepam) - Benztropine --- -Benztropine - Amantadine ``` Months to years: Tardive dyskinesia (orofacial chorea) - Valbenazine - Deutetrabenazine
36
Prolonged painful tonic muscle contractions or spasm
Acute dystonia Hours Tx: Benztropine (anticholinergics)
37
Restlessness that is perceived as being distressing
Akathasia Day Tx: Betablockers (propranolol)
38
Pseudoparkinsonism EPS
Dyskinesia Benztropine (anticholinergics) or dopamine agonist (amantadine)
39
Involuntary, painless oral facial movements
Tardive dyskinesia Switch neurolepic to clozapien or risperidone
40
Dont mix with Buspirione
MAOIs
41
Tx Social anxiety disorder
Beta blockers
42
OCD Tx
SSRI Or Clomipramine (TCA)
43
TX PTSD
CBT SSRI, SNRI Prazosin (alpha blocker) for nightmares
44
Alzheimers tx
Cholinesterase inhibitors - Donepezil - Rivastigmine - Galantamine Moderate to severe - Add Memantine (NMDA antagonist)
45
SIG E CAPS
``` Sleep Interest Guilt Energy Concentration Appetite Psychomotor agitation Suicidal ideation ```
46
TCA toxicity
Tri-Cs Convulsions Coma Cardiac arrhythmias
47
Paroxetine
SSRI Avoided in pregnancy - Cardiac defects - pulmonary Htn
48
Mirtazapine
WG
49
MAOIs
MAO Take Pride In Shanghai Tranylcycpromine Phenelzine Isocarboxazid Selegilline SE: HTN crisis
50
DIG FAST
``` Distractibility Insomnia Grandiosity Flight of ideas Activites Sexual indiscretion Talkative/ pressure speech ```
51
Mania
> 1 week
52
Mania 1st line tx
Lithium
53
Lithium toxicity
Ataxia Dysarthria Delirium Acute renal failure
54
Naltrexone
first line tx for craving of alcohol Blocks u opioid receptor
55
SE TCAs
Orthostatic Hypotension
56
High QTC
470 or 480
57
Antipsychotic to give if over weight
Abilify (arippiprazole)
58
Physiology of schizophrenia
Increased DA in mesolimbic Decreased DA in mesocortical
59
Mental status changes (not psychosis) - delirium Muscle rigidity +/- tremor (lead pipe rigidity) Hyperthermia Rhabdomyolysis Autonomic instability - tachycardia, high blood pressure, tachypnea, diaphoresis Due to Tx
Neuroleptic malignant syndrome Due to antipsychotics Tx: Dantrolene Bromocriptine Elevated creatinine phosphokinase
60
Which antipsychotic is most closely associated iwth an increased risk of diabetes
Olanzapine
61
SNRI for fibromyalgia
Milnacipran
62
Chronic pain tx
Duloxetine | SNRI
63
Fibromyalgia tx
MIlnacipran (SNRI) | Amitriptyline (TCA)
64
Tx neuropathic pain
Amitriptyline
65
Antidepressant the causes appetite stimulant and weight gain
Mirtrazapine
66
Serotonin syndrome signs
Hyperreflexia and clonus Hyperthermia Autonomic instability - Cardiovascular collapse, mental status changes
67
Bulimina nervosa labs
Hypokalemic Hypochloremic Metabolic alkalosis Non-anion gap metabolic alkalosis w/ respiratory compensation Metabolic acidosis (laxative abuse) Elevated bicarbonate Incrased BUn Hypernatremia Increased amylase
68
Fixation
partially remaining at childish level of development
69
Reaction formation
Taking unacceptable thoughts and attempting to over exaggerate in opposite action
70
Projection
Taking unacceptable thoughts and believing that someone else has those thoughts
71
Displacement
Substitutes new aim/ object for something that is undesirable man yells at family for bad day at work
72
Sublimation
unacceptable impulses or feelings transformed into socially acceptable actions
73
Suppression
Voluntarily choosing to not think about something
74
Opioid withdrawal symptoms
``` Sweating Dilated pupils piloerection yawning Rhinorrhea Flu like ``` Tx: Moderate: Clonidine (autonomic signs) Severe: Methadone, suboxone
75
Reversal agent for benzo
Flumazenil - blockade of GABAergic neurotransmission Can cause seizure
76
Reversal agent for opioids
Naloxone | Naltrexone
77
Severe depression, HA, fatigue, insomnia/ hypersomnia, hunger
Cocaine and amphetamine withdrawal
78
Pinpoint pupils N/V Seizures
Opioid overdose
79
Belligerence, impulsivness, nystagmus, homicidal ideation, psychosis
PCP intoxication
80
Anxiety, piloerection, yawning, fever, rhinorhea, nausea, diarrhea
opioid withdrawal
81
Identification
Acting like the person you have positive thoughts towards (changing where you wear sthetoscope
82
Intellectualization
using logic or fact to emotionally distance onself from stressful situation
83
Patient on risperidone, increased dose now smiles less and slowed down. Mild tremor and doesnt swing arms when walking TX
Continue Risperidone and add benztropine anti-psychotic induced parkinsonism Tx anticholinergic antiparkinism benztropine or amantadine
84
Sudden sustained contraction of neck, mouth, tongue and eye muscles Tx
Acute dystonia Benztropine Diphenhydramine
85
Subjective restlessness, inability to sit still Tx
Akathisia Beta blocker (propranolol) Benzodiazepine (lorazepam) Benztropine
86
Gradual onset tremor, rigidity and bradykinesia Tx
Parkinsonism Benztropine Amantadine
87
Gradual onset after prolonged therapy (> 6 months). Dyskinesia of the mouth, face, trunk and extremities
Tardive dyskinesia Discontinue medication Switch to quetiapine or clozapine Treat with Valbenazine Deutetrabenazine Caused by dopamine receptor D2 upregulation and supersensitivity
88
``` Psychological features Depression Fatigue Hypersomnia Increased dreaming Hyperphagia Impaired concentration ```
Cocaine withdrawal
89
``` Anxiety Insomnia Tremors Tachycardia HTN ```
Alcohol withdrawal
90
Dysphoria Myalgia Yawning Abdominal cramping
Opioid withdrawl
91
``` Dieting Hallucinations Abominal pain Constipation Tingling sensation in finger tips ```
Acute intermittent porphyria Elevated urinary porphobilinogen levels ``` Painful abdomen Port wine colored urine Polyneuropathy Psylogical disturbances Precipitated by Drugs, alcohol and starvation ```
92
Alcohol withdrawal symptoms (5)
``` Anxiety Insomnia Tremors Tachycardia HTN ```
93
Opioid withdrawal symptoms (4)
Dysphoria (dissatifcation with life) Myalgia (muscle pain) Yawning Abdominal cramping
94
MDD Sleep traits
Decreased REM sleep latency (the time from sleep onset until the start of the first REM sleep period Decreased slow wave sleep Increased total REM sleep duration
95
Physiology associated with suicidal behavior
Low levels of 5-hydroxyindoleacetic acid (5-HIAA) in CSF Metabolite of serotonin
96
Hepatotoxicity medication
Valproate (mood stabilizer)
97
Bipolar plus hypercalcemia medication
Lithium
98
Antipsychotic medication effects | - Antipsychotic efficacy the pathway effected
Decreased Dopamine in mesolimbic
99
Antipsychotic medication effects | - EPS pathways
Decrease in Dopamine in nigrostriatal
100
Antipsychotic medication effects | - Hyperprolactinemia pathway
Decrease Dopamine in tuberoinfundibular
101
Increased dopamine in mesolimbic
Euphoric and psychotic symptoms
102
Patient excusing or justifying an attitude or event by developing an alternate explanation or shifting the blame Man speed who crashes into other drive. Other drives fault for not paying attention
Rationialization | `
103
Involuntary contraction of small muscles groups like repeated contraction of fingers in one hand
Tardive dyskinesia
104
Watch for what with Lamotrigine
Rash Steven Johnson syndrome Toxic epidermal necrosis
105
Channeling uncomfortable thoughts or emotions into more acceptable behavior
Sublimation | Acting out is always a negative reaction
106
Man who like risky behavior becomes stunt man
Sublimation
107
Riluzole MOA
ALS Decrease glutamate excitotoxicity
108
Drug of choice for supervised heroin withdrawal inpatient Drug of choice for supervised heroin withdrawal inpatient
Buprenorphine Buprenorphine/ naloxone Nloxone component prevents abuse of buprenorphine
109
Antipsychotic which doesnt cause hyperprolactinemia in preexisting hyperprolactinemia
Clozapine
110
Dementia Pupillary changes (anisocoria different sized pupils) Ataxia Urinary incontinence Impaired peripheral vibratory and proprioceptive sensation
Neurosyphilis
111
Risperidone causes orthostatic hypotension by
Cross reactivity as an alpha 1 adrenergic antagonist impairing binding of norepinephrine to alpha 1 receptor
112
Schizophrenia brain changes
Deterioration of Hippocampus
113
Auditory hallucination are from what part of the brain
Temporal lobe
114
Generalized anxiety disorder lab level
Elevated cortisol
115
OCD due to what part of brain
Cerebral cortex or basal ganglia
116
clonus=
serotonin syndrome
117
Lorazepam vs other benzo
Lorazepam is not metabolized by liver
118
Breathing techniques target what NT
Norepinephrine
119
Alcohol changes on sleep
Decreased REM sleep Decreased sleep latency (shorter time to fall asleep) Increased sleep fragmentation (increased nighttime awakenings)
120
Visual hallucinations in those that are blind
Charles Bonnet syndrome
121
Neutropenia in patient
Clozapine | Carbamazepine
122
Carbamazepine SE (6)
Agraulocytosis Stevens-Johnson syndrome Teratogenic in pregnancy Cytochrome P450 induction Hyponatremia Hepatotoxicity
123
Drugs that induce mania or psychosis is patients with previous history of disease (6)
Corticosteriods ``` Thyroxine Dopaminergic anti-parkinsonian drugs Amphetamines Cocaine PCP ```
124
Alcohol withdrawal what predisoses to seizures
Hypomagnesemia
125
Opioid that doesnt cause miosis
Meperidine
126
Delirium on EEG
Diffuse background slowing Delirium tremens opposite: fast EEG activity
127
What is associated with aggressive and impulsiveness lab
Low levels of serotonin in CSF
128
Kleptomania comorbid with
Bulimia nervosa
129
Durham insanity defense
Criminal act resulted from mental illness
130
OTC drugs that can cause serotonin syndrome
St. John's wort | dextromethorphan
131
M'Naghten insanity defense
Person did not understand what he/she was doing was wrong
132
Miosis pupil size Mydrasis pupil size
Miosis less than 2 mm Mydrasis larger than 4 mm
133
What inhibits lamotrigine
Valproic acid
134
Cant sleep Not hungry Depressed
Mirtazapine | - helps with sleep and increases appetite
135
Started on new medications HTN Cant move spontaneously Fever Confused
Neuroleptic malignant syndrome Dysregulation of dopamine
136
Help with alcohol cravings
Naltrexone | Acamprosate
137
Naloxone
Short acting opioid antagonist Used to tx opioid intoxication
138
Bipolar tx
Quetipine Lithium (not if renal issue) Valproate [Before haloperidol]
139
Women upset with having to take care of her father then is very kind and caring and offers to get him water multiple times
Reaction formation
140
SE SSRI
HA Insomnia Nausea
141
Psychosis with rapid speach Now how hypercalcemia What medication
Lithium
142
Risk of seizures
Clozapine
143
tx acute mania
Olanzapine Lithium Valproate (oral)
144
Pin point pupils Negative drug screen
Oxycodone
145
Acute onset psychosis in child Arthralgia Thrombocytopenia Hematuria Proteinuria
SLE Check ANA
146
Tx resistant schizophrenia
Clozapine
147
Antipsychotic Has DM
Ziprasidone [Avoid olanzapine]
148
``` HA Tachycardia Palpitations Sweating HTN- drug resistant ``` Hyperglycemia
Pheochromocytoma
149
Night terrors last
1-2 years Resolve spontaneously
150
Seen in MDD
Increased serum cortisol concentration Decreased REM sleep latency Decreased slow wave sleep
151
Quetiapine MOA
Serotonin 2A | Dopamine D2 receptor blockade
152
Antipsychotics work on
D2 receptors
153
Norepinephrine and dopamine reuptake inhibition
Bupropion
154
Serotonin and noreepinephrine reuptake inhibition
Venlafaxine SNRI Tricyclic antidepressants
155
Distruptive mood dysregulation disorder
Irritable or angry mood together with temper tantrums that are out of proportion Not made prior to six or after age 18
156
Parkinson disease with psychotic symptoms Tx
Dopamine agonists (pramipexole) are at greater risk of psychosis Quetiapine Clozapine
157
False positive phencyclidine (4)
Dextromethorphan Diphenhydramine Ketamine Tramadol Venlafaxine
158
False positive Amphetamine (4)
Atenolol Propranolol Bupropion Nasal decongestants
159
Tremor Hyperreflexia Myoclonus
Serotonin syndrome Citalopram + MAOI (less than 2 week wash out period)
160
Generalized rigidity Confusion Fever
Neuroleptic malignant syndrome Due to Risperidone Tx Dantrolene Bromocriptine
161
NMS vs Serotonin syndrome
NMS - High fevers - Rigidity SS - Tremor - Hyperreflexia - Myoclonus
162
Amnesia of a particular event Traveling or wandering Doesnt know who they are Doesnt recognize his name Father recently passed away
Dissociative amnesia
163
Loss of time and place No loss of personal identy
Transient global amnesia
164
MDD and Worsening diabetic neuropathy
SNRI | Duloxetine
165
MDD with psychotic features Tx
Sertraline | Risperidone
166
Fatigue Constipation Myalgias What drug
Lithium Hypothyroidism
167
Antidepressant or Antipsychotic Causes WL and HTN
Venlafaxine SNRI Dose-dependent HTN
168
Galactorrhea Impotence Menstrual dysfunction Decreased libido Medication
Dopamine antagonists Chlorpromazine Promethazine Risperidone Quetipine Clozepine
169
Mother who is angry at her husband yells at her child
Displacement
170
Girl who is upset with her best friend acts overly kind
Reaction formation
171
Hospitalized 10 year old begins to wet his bed
Regression
172
Young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways Diagnosis Tx
Acute dystonia (Oculogyric crisis) Tx: Benztropine Diphenhydramine
173
Medications to avoid in patients with history of alcohol withdrawal seizures
Neuroleptics Lower the seizure threshold ``` Aripiprazole Clozapine Lurasidone Olanzapine Quetiapine Risperidone ```
174
Previously healthy 6 month old girl has decrease in head growth Truncal discoordination Decreased social interaction
Rett disorder Regression and loss of milestones is common Hand wringing
175
Severe hypoglycemia Blood analysis reveals no elevation in C peptide
Factitious disorder
176
Schizophrenic patient that takes haloperidol for 1 year and develops uncontrollable tongue movements. Diagnosis? Tx?
Tardive dyskinesia Decrease or discontinue haloperidol Switch to risperidone or clozapine
177
Delayed sleep wake disorder
Excessive morning sleepiness Sleep until 11 AM naturally
178
Advanced sleep wake disorder
Inability to stay awake in evening (usually after 7 pm)
179
More people have been diagnosed with leukemia in town A than B. Which of the following designs would be best suited to determine whether a towns location is related to apparent difference in leukemia? ``` A. Case control B. Case series C. Clinical trial D. Cohort E. Ecological ```
D. Cohort Study in which groups are chosen based upon presence or absence of one or more risk factors All subjects develop disease of interest Incidence
180
Case control study
Subjects with the disease of interest (cases) are compared to otherwise similar group of disease-free subjects Information is collect about exposure to risk factors Retrospective Odds ratio
181
Case series
Study involving only patients already diagnosed with condition of interest Can be helpful in determining the natural history of uncommon conditions
182
Ecological studies
Unit of observation is population Disease rates and exposures are measured in 2 or more populations Associated between disease rates and exposure is determined
183
Study to determine incidence
Cohort
184
ARR
Risk of placebo- risk with treatment % NNT= 1/ ARR%
185
PPV
True positives/ Total positive
186
Synthetic cathinones
Bath salts Negative drug screen
187
Breast mass Negative fnA What are the chances that she really does not have breast cancer? ``` A. Sensitivity B. Specificity C. PPV D. NPV E. Validity ```
D. NPV Probability of being free of disease if test results are negative NPV with vary with the pretest probability of a disease A patient with high probability of having a disease will have a low NPV [Specificity: probability that when the disease is absent, the test is negative] Vs probably a person with a negative test actually doesnt have disease
188
Severe nausea and vomiting after receiving chemotherapy Hx Bipolar and alcohol abuse Lithium and lamotrigine Lithium level 0.6 (normal 0.6-1.2) Tx IV saline and antiemetic Several hours later= sudden neck pain, neck muscle stiffness and difficulty speaking ``` What medication caused this? A. Aprepitant B. Hydroxyzine C. Lamotrigine D. Lithium E. Metoclopramide F. Ondansetron ```
E. Metoclopramide Acute dystonia= EPS Dopamine antagonists like antiemetics (metoclopramide and prochlorperazine)
189
Randomization helps prevent
Confounding Even distributes confounding variables
190
Effect modification
Results when an external variable positively or negatively impacts the effect of a risk factor on the disease of interest Risk of venous thrombosis is increased by estrogen but is augmented by smoking
191
Post hoc analysis
Performing unplanned statistical tests on patterns that were identified after the fact in data from a completed study
192
Loss to follow up results in what bias
Selection bias known as attrition bias
193
Reporting bias
Occurs when a subject is reluctant to report an exposure due to stigma about the exposure (sexual behavior, drug use)
194
Surveillance bias
Exposed group undergoes increased monitoring relative to the general population
195
When treatment regimen selected for a patient depends on severity of patients condition
Selection bias Susceptibility bias (confounding by indication)
196
HIV < 200 Ventricular enlargement Diffuse white matter changes
HIV associated neurocognitive disorder Diffuse brain atrophy Ventricular enlargement Diffuse white matter changes
197
Progressive multifocal leukoencephalopathy
Reactivation of JC virus Altered mental status Motor deficits - Focal arm/leg weakness or hemiparesis - Ataxia - Vision abnormalities MRI: well delineated asymmetric white matter lesions (not diffuse like HIV)
198
Study showed that women with high baseline saturated fat consumption have 4x risk of colorectal cancer in 7 year period compared to low fat consumption RR= 4.0, 95% CI= 1.5-6.5 According to study results, what percentage of colorectal carcinoma in women with high fat consumption could be attributed to diet?
Attributable risk (ARP) ARP= (risk in exposed - risk in unexposed) / risk in exposed ARP= (RR-1)/ RR ARP= (4.0-1)/ 4.0= 75%
199
Shifting curve to right by increase cutoff value effect on TP Sensitivity Specificity
TP would decrease So sensitivity would decrease Fewer individuals without the disease would test positive so increase TN —> increase specificity
200
Delirium patient that is violent what to give
Haloperidol
201
Relative risk in what study
Cohort
202
Odds ratio used in what study
Case control
203
Disease prevalence used in what study
Cross sectional study
204
Case control measure
Odds ratio
205
Cross sectional study measures
Disease Prevalence
206
Cohort measures
Relative risk

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