Exam 4: Psych/SUD/Repro

Question 1

Stress-Diathesis Theory

Answer 1

Trauma because of a variety of reasons underlies a wide range of psychiatric disorders

Question 2

Schizophrenia

Answer 2

Patho: affects thoughts feelings, perceptions and overall behavior while interfering with filtering of stimuli from the environment

Epi: onset between 16-30, increased in men but it does equalize later in life

Clinical manifestations: incomprehensible speech, hallucinations, delusions, grossly disorganized or catatonic behavior

Question 3

Major Depressive Disorder

Answer 3

Patho: loss of interesting in previously enjoyed activities

Etiology: early life stressor, trauma, vitamin D issues

Epi: women are twice as likely, numbers are increasing in all age groups

Question 4

Bipolar disorder

Answer 4

Patho: a mood disorder with depressive components plus mania

Etiology: the book outlines 4 types of bipolar disorder. occur from genetic, neuroendocrine, autonomic and immune dysregulation.

Question 5

Substance Use Disorder (SUD)

Answer 5

epidemiology: men more likely than women, but closing gap

etiology:
D2 dopamine receptor (DRD2) gene located at 11q23 is associated with addictive behaviors
Mu-opioid receptor, Delta-opioid receptor, brain-derived neurotrophic factor, Pre-existing psychological disease like anxiety, PTSD, depression, Exposure to substance use, Childhood abuse or trauma

Question 6

Mesolimbic dopamine pathway

Answer 6

Goes to the Nucleus accumbens and is associated with the reward system
Normal reinforcement of adaptive behaviors get a natural high/release of dopamine
Drugs lead to abnormal message being sent through the network
Hypofunctioning reward system
Makes it harder to get a high

Question 7

Drug tolerance

Answer 7

occurs when a subject’s reaction to a specific drug and concentration of the drug is progressively reduced, requiring an increase in concentration to achieve the desired physiological and psychological effects.

Question 8

Withdrawal symptoms

Answer 8

, specific noxious physiological effects, occur if the individual does not maintain regular use of the drug.

Question 9

Alcohol (ETOH)

Answer 9

mainly a CNS depressant
↓GABA receptors
↑NMDA receptors

Clinical manifestations
In low doses, alcohol disinhibits the individual, which may lead to out-of-character activities.
At higher doses, individuals show irrational thinking, lack of judgment, and absence of motor coordination.

Question 10

AWS

Answer 10

alcohol withdrawal symptoms

Sympathetic stimulation initially

Hallucinations

Withdrawal seizures - gen. tonic/clonic, short

Delirium tremens - change in LOC

Question 11

Opioids

Answer 11

heroine, oxycodone, morphine, codeine

Opioid clinical manifestations:
Respiratory depression, analgesia, euphoria, and miosis
Slurred speech or sedated

Opioid use and specific risk factors chronic use
Risk for infection related to inadequate sterile technique and contaminated drugs

Question 12

Opioid withdrawal

Answer 12

Dysphoria and restlessness
Rhinorrhea and lacrimation, mydriasis, diaphoresis
Myalgias and arthralgias
Nausea, vomiting, abdominal cramping, and diarrhea

Question 13

Abnormal uterine bleeding

Answer 13

“PALM-COEIN”
polyp, adenomyosis, leiomyoma, malignancy & hyperplasia, coagulopathy, ovulatory dusfunction, endometrial, iatrogenic, not otherwise classified

Question 14

Polycystic ovary syndrome

Question 15

vaginitis,

Answer 15

Inflammation or infection of vagina
Most common cause is bacterial vaginosis in childbearing years
Atrophic most common for post menopausal: lack of regenerative growth of vaginal epithelium
Clinical manifestations Burning, itching, redness, swelling vaginal tissues

Question 16

cervicitis

Answer 16

Acute or chronic inflammation of the cervix
Reddened and edematous
Direct infection
C trachomatis: mucopurulent cervicitis
Secondary
Vaginal or uterine infection
Asymptomatic or mucopurulent drainage
Untreated can extend to pelvic cellulitis, cervical stenosis, infection into uterus or fallopian tubes

Question 17

Disorders of Pelvic Support

Answer 17

• cele = prolapse

Question 18

Pelvic inflammatory disease (PID)

Answer 18

An acute inflammatory process caused by infection of upper reproductive tract (uterus, fallopian tubes, ovaries)

Pathophysiology
Infection (STI or UTI)→enters uterus and surrounding structures→ inflammatory response → necrosis→ repeated infections

Asymptomatic
Lower abdominal pain
Fever
Symptoms occur during or end of menstruation
Increased pain with exercise
Cervical motion tenderness

Question 19

Polycystic ovarian syndrome

Answer 19

Epidemiology
Affects 6-15% of women
50% are obese
Hyperinsulinemia and insulin resistant play a part
Leading cause of infertility in US, affecting young women

Diagnosis: need at least 2 out of 3
Few or anovulatory menstrual cycles
Elevated levels of androgens (hyperandrogenism)
Polycystic ovaries via ultrasound

Complications
Cardiovascular disease, Diabetes, Sleep apnea, Fatty liver, Association between breast, & endometrial CA
*maybe ovarian CA it is controversial
Infertility

Question 20

Endometriosis

Answer 20

Functional endometrial tissue is found in ectopic sites outside of the uterus
In reproductive years ovarian hormones stimulate endometrial to proliferate and breakdown→ bleed into surrounding structures → no exit for blood surrounding tissue irritated and develops fibrous tissues

clinical manifestations: Dysmenorrhea, Dyspareunia,
Infertility, Pain* 80% will present with pain, Strongest premenstrual, subsiding after cessation of menstruation, Pain with defection (bowel movement) or urination, Asymptomatic

Question 21

Cervical cancer

Answer 21

Etiology: Human papillomavirus (HPV) is central to the development of cervical neoplasia and can be detected in 99.7% of cervical CAs

3rd most common cancer for people with uteruses

Patho: Oncogenic HPV infection of epithelium -> Persistence of the HPV infection -> Progression from persistent viral infection to pre-cancer -> Development of carcinoma and invasion through the basement membrane

Question 22

Menopause

Answer 22

HRT

Question 23

Varicoele

Answer 23

dilation of testicular veins, feeling of fullness,

scrotal abnormalities among infertile men

Question 24

hydrocele

Answer 24

scrotal swelling due to excess fluid

Question 25

Phimosis

Answer 25

Foreskin cannot be retracted over glands of the penis
Caused by chronic inflammation and infection from poor hygiene
Remove infection then circumcise
Predisposing factor for penile cancer

Question 26

Paraphimosis

Answer 26

Foreskin has been retracted and cannot be moved forward over glans
Retracted can constrict penis and cause edema of glans
Reduce foreskin or surgery depending on severity

Question 27

Priapism

Answer 27

Prolonged penile erection >4 hours
Painful not associated with sexual arousal
Considered urologic emergency
Aspirate blood from the corpus through glands

Question 28

Peyronie disease

Answer 28

Fibrotic condition curvature of penis during erection
Middle aged men
Painful erection
Painful intercourse (for both partners)

Question 29

Erectile dysfunction

Answer 29

Etiology: two types
psychogenic due to performance anxiety or psychological disorders
Organic: hormonal, vascular, drug, disorders, age
Epi: affects 30 million males age 40-70

Question 30

Testicular cancer

Answer 30

young men, 15-35

Clinical Manifestations
Painless testicular enlargement
Ache in the abdomen or dragging or heaviness in the scrotum
Frank pain
Increase in growth of tumor
Metastatic
Swelling lower extremities, back pain, neck mass, dizziness, gynecomastia

Question 31

Gonorrhea

Answer 31

N. Gonorrhoea

can become chronic and reinfections are common and the bacteria can adapt quickly and develop resistance to antibiotics which could ultimately lead to an untreatable infection.

men - Asymptomatic, Urethra pain, Creamy yellow bloody discharge, Rectal infections in homosexual men

women - Asymptomatic, Genital or urinary discharge
Dysuria, pelvic pain/tender, Symptoms may occur or increase during menses

Question 32

Syphilis

Answer 32

Treponema pallidum

Primary manifestations
Chancre at site of exposure (penis, anus, mouth, vagina, cervix), Within 3 weeks exposure, Discrete raised borders, Chancre heals 3-6 weeks

Secondary
weeks- a few months, Rash palms, mucous membranes, stomach, lymph nodes, Fever/sore throat
Enters a latent phrase after secondary phase

Tertiary
Decades after infection, Cardiovascular lesions, Aorta aneurysm, aortic valve insufficiency, Development of central nervous system lesions, Blindness, dementia, mimic SCI, ataxia, sensory loss

Question 33

Chlamydia

Answer 33

Etiology: most common bacterial STI intercourse, oral/anal sex, during birth

Clinical manifestations: asymptomatic, may or may not get discharge

Prognosis: leading cause infertility men and women, PID, ectopic pregnancy, pass disease to newborn

Question 34

Herpes

Answer 34

Etiology: virus that spread through sexual activity

Epi: women have a great mucosal surface area exposed so therefore have a greater risk of acquiring the infection

Patho: virus spread through peripheral nerves and can become dormant or reactivated. It is unknown what reactivates the virus.

Clinical manifestations: local tenderness, burning and erythema, with eruptions of vesicles that develop into painful sores, crusting of lesions after several days. Can be asymptomatic

Prognosis: no cure antiviral medications treat infection to reduce symptoms and outbreak. It can be transmitted to baby during birth in which case we worry about the baby getting encephalitis or meningitis.