Final Flashcards
(211 cards)
1
Q
What is mood?
A
How you feel over time
Mood reflects a person’s emotional state over a period.
2
Q
What is affect?
A
How you’re presenting
Affect refers to the observable expression of emotion.
3
Q
Define anhedonia.
A
Without pleasure
Anhedonia is a symptom often associated with depression.
4
Q
What does MDD stand for?
A
Major Depressive Disorder
MDD is characterized by persistent depression lasting for at least two weeks.
5
Q
What is the highest priority in MDD treatment?
A
Patient safety
Ensuring safety is crucial due to the risk of suicidal ideation.
6
Q
What is the first line medication for MDD?
A
SSRI (fluoxetine / sertraline)
SSRIs are commonly prescribed for their efficacy in treating depression.
7
Q
How long does it typically take for SSRIs to take effect?
A
1-3 weeks
Optimal therapeutic effects may take 2-3 months.
8
Q
What should patients avoid when taking MAOIs like phenelzine?
A
Cheese and fermented food
These foods can trigger hypertensive crises when interacting with MAOIs.
9
Q
What are the antidepressive properties of St John’s Wort?
A
It has natural antidepressant effects
St John’s Wort is often used as a herbal remedy for mild depression.
10
Q
True or False: Suicidal ideation is worse in the first few weeks of treatment.
A
True
Increased risk during the initial treatment phase is a significant concern.
11
Q
What are the symptoms of serotonin syndrome?
A
Agitation, increased vitals, LOC changes
Serotonin syndrome can occur with excessive serotonergic activity.
12
Q
What does BPD stand for?
A
Borderline Personality Disorder
BPD is characterized by mood swings and unstable relationships.
13
Q
What are the 3S symptoms associated with mania?
A
Less sleep, more sex, and spending
These behaviors are indicative of manic episodes.
14
Q
What is the purpose of lithium in treatment?
A
Mood stabilizer
Lithium is commonly used to treat bipolar disorder.
15
Q
What is the narrow therapeutic window range for lithium?
A
0.8-1.4
Levels above 1.5 can become toxic.
16
Q
What are common side effects of lithium?
A
Hand tremor, polyuria, weight gain, headache, lethargy
Monitoring is essential due to these potential side effects.
17
Q
What personality disorders are included in Cluster A?
A
Paranoid, Schizoid, Schizotypal
These disorders often involve odd or eccentric behaviors.
18
Q
What characterizes Histrionic Personality Disorder?
A
Attention seeking behavior
Individuals often exhibit exaggerated emotions and seek to be the center of attention.
19
Q
What are the key traits of Anti-Social Personality Disorder?
A
Lack of remorse, deceitful, disregard for others
Often referred to as sociopaths, individuals may engage in manipulative behaviors.
20
Q
What defines Borderline Personality Disorder?
A
Pattern of unstable relationships, impulsive in two or more behaviors
Splitting behaviors, where individuals see others as all good or all bad, are common.
21
Q
What personality disorders are classified under Cluster B?
A
Borderline, Histrionic, Anti-Social, Narcissistic
These disorders are characterized by dramatic, emotional, or erratic behavior.
22
Q
What are the characteristics of Avoidant Personality Disorder?
A
Wish they had friends, shy, feeling inadequate
Individuals often experience significant anxiety in social situations.
23
Q
What is Trauma Informed Care?
A
Realize, recognize, respond, resist
This approach focuses on understanding the impact of trauma on individuals and providing appropriate support.
24
Q
What does ‘stimming’ refer to?
A
Repetitive or unusual body movements or noise
Commonly observed in individuals with autism spectrum disorders.
25
What is a recommended treatment for communication impairments?
One-on-one interactions, may be treated with antipsychotics (aripiprazole)
## Footnote
Tailored communication strategies can enhance understanding and reduce anxiety.
26
How does ADHD present differently in girls compared to boys?
Girls more likely to be inattentive, boys more likely to be hyperactive
## Footnote
This difference can affect diagnosis and treatment strategies.
27
What are the three types of ADHD?
Inattentive, hyperactive, mixed
## Footnote
Each type has distinct characteristics that influence behavior and learning.
28
When should ADHD medications be administered?
In the morning unless otherwise stated
## Footnote
Timing can significantly impact the effectiveness of the medication.
29
What characterizes Oppositional Defiant Disorder (ODD)?
Argumentative and defiant behavior with authority figures
## Footnote
This disorder often involves frequent temper tantrums and irritability.
30
What type of behavior is associated with Conduct Disorder (CD)?
Persistent pattern of aggressive or destructive behavior
## Footnote
CD can be a precursor to Anti-Social Personality Disorder.
31
What are effective de-escalation techniques?
Only one communicator at a time, low and slow tone
## Footnote
These techniques help manage conflicts and reduce anxiety in tense situations.
32
How often should restraints be assessed?
Every 15 minutes, with a MD order within 20 minutes
## Footnote
This ensures the safety and rights of individuals in care.
33
Who is more likely to complete suicide?
Men are more likely to complete suicide, while women are more likely to attempt it.
34
What does IS PATH WARM stand for?
IS PATH WARM includes ideation, substance abuse, purposelessness, anxiety, trapped, hopelessness, withdrawal, anger, recklessness, and mood changes.
35
What is psychosis?
Psychosis is a loss of touch with reality.
36
What are positive symptoms in psychosis?
Positive symptoms are something added that wasn't there before.
37
What are negative symptoms in psychosis?
Negative symptoms are something that is gone that was there before.
38
What is a hallucination?
A hallucination involves perceiving something through the 5 senses, with auditory and visual hallucinations (AVH) being more common.
39
What is a command hallucination?
A command hallucination is a big red flag where the individual is being told what to do.
40
What is a delusion?
A delusion is a fixed and false belief.
41
What does reference mean in the context of delusions?
Reference is when an innocuous message is significant to the individual.
42
What should you do with delusions?
Don't argue with delusions.
43
What is neologism?
Neologism is the act of making up new words.
44
What is clang association?
Clang association is meaningless rhyming.
45
What is echolalia?
Echolalia is the repetition of words.
46
What is schizophrenia?
Schizophrenia is characterized by psychotic symptoms lasting for 2 or more months.
47
What is schizoaffective disorder?
Schizoaffective disorder includes both schizophrenia and a mood disorder.
48
What is a psychotic disorder not otherwise specified?
It shows symptoms but does not meet the criteria for a specific disorder.
49
What do 1st generation antipsychotics target?
1st generation antipsychotics target positive symptoms and have a higher risk of neurological problems.
50
What is acute dystonia?
Acute dystonia is a muscle spasm that can be treated with benztropine and monitored for 1-5 days.
51
What is tardive dyskinesia?
Tardive dyskinesia involuntary repetitive body movements may require lowering the dose or switching medication.
52
What do 2nd generation antipsychotics target?
2nd generation antipsychotics are atypical and target both positive and negative symptoms, but may cause metabolic side effects.
53
What should be monitored with clozapine?
Clozapine requires monitoring of white blood cell (WBC) counts.
54
What is NMS?
Neuroleptic Malignant Syndrome (NMS) is associated with antipsychotics and presents with sudden fever and blood pressure variation; medications should be stopped.
55
What are 2nd generation antipsychotics associated with?
Clozapine
## Footnote
Associated with Neuroleptic Malignant Syndrome (NMS)
56
Define empyema.
Purulent pleural fluid in the pleural space
57
What is a PleurX?
At home chest tube
58
What should you do if bubbles appear in the water of a PleurX?
It's a non-issue
59
When is it permissible to disconnect a PleurX?
Never disconnect without a physician order
60
What should you cover a broken PleurX with?
Vaseline gauze or sealed dressing
61
What is a saddle embolus?
Blockage at arterial bifurcation, type of PE
62
What is the most definitive method for diagnosing a pulmonary embolism (PE)?
CT
63
What is a VQ scan used for?
If unable to do CT angiography
64
What medications are used for clot breakage?
* Heparin
* Enoxaparin
65
What is Warfarin used for?
Long term therapy option for clot management
66
At what age does the liver reach adult function?
12 years old
67
What function tests are used for liver assessment?
* ALT
* AST
* Alk Phos
68
What are the characteristics of Hepatitis A?
* Not chronic
* Vaccine available
* Contaminated food and water
69
What are the characteristics of Hepatitis B?
* Acute and chronic
* Vaccine available
* Transmitted through body fluids
70
What is the status of a vaccine for Hepatitis C?
No vaccine available
Hepatitis C is often acute and asymptomatic, transmitted through body fluids and needles.
71
What is Hepatitis D dependent on?
Dependent on Hepatitis B
## Footnote
Hepatitis D also has no vaccine and is transmitted through body fluids.
72
How is Hepatitis E primarily transmitted?
Contaminated food and water
## Footnote
Hepatitis E is not common in the US.
73
What are the two phases of Hepatitis?
Acute phase and convalescent phase
## Footnote
The acute phase lasts 1 to 6 months and includes symptoms like decreased appetite and clay stools.
74
What characterizes the convalescent phase of Hepatitis?
Weeks to months, jaundice disappears
## Footnote
Symptoms can vary in this phase.
75
What are common causes of early-stage cirrhosis?
Chronic Hepatitis C and alcohol-related issues
## Footnote
Early-stage cirrhosis may present with few symptoms.
76
What happens to ammonia levels in liver failure?
Rise because it can't convert to Urea
## Footnote
Lactulose is often given to manage this condition.
77
What is asterixis?
Flapping tremors
## Footnote
It is often associated with liver failure.
78
What is fetor hepaticus?
Musty sweet odor to breath
## Footnote
This symptom is indicative of liver dysfunction.
79
What dietary restrictions may be necessary for liver disease?
Restrict protein as needed, high calorie and high carb diet
## Footnote
Low sodium and low fat may also be advised.
80
What is Hepatorenal Syndrome?
Cirrhosis causes renal failure
## Footnote
This syndrome is a serious complication of liver disease.
81
What does DMARD stand for?
Disease Modifying Anti-Rheumatic Drug
## Footnote
These drugs lessen the severity of rheumatoid arthritis.
82
What is the effect of Methotrexate?
Bone marrow suppression
## Footnote
It is commonly used in the treatment of rheumatoid arthritis.
83
What should be monitored during inflammation episodes in rheumatoid arthritis?
ESR and CRP values
## Footnote
These are markers of inflammation.
84
How many signs are needed for diagnosing rheumatoid arthritis?
4 or more signs for 6 weeks
## Footnote
This is a criterion for diagnosis.
85
What is Reynaud's phenomenon?
Whitening of hands and fingers
## Footnote
This is a common symptom in rheumatoid arthritis.
86
What is a common presentation of systemic lupus erythematosus (SLE)?
Butterfly rash
## Footnote
This rash is a characteristic sign of SLE.
87
What is the most common cause of dilated cardiomyopathy?
Genetics or idiopathic
## Footnote
Dilated cardiomyopathy can lead to heart failure.
88
What characterizes hypertrophic cardiomyopathy?
Left ventricular hypertrophy without dilation
## Footnote
It often involves an enlarged septum.
89
What is the least common type of cardiomyopathy?
Restrictive cardiomyopathy
## Footnote
The cause is often unknown.
90
What is a key feature of restrictive cardiomyopathy?
Stiffened ventricular wall and filling resistance
## Footnote
This leads to impaired heart function.
91
What do we monitor for HIV
CD4 and WBC
92
When do CD4 problems start? (Count)
<500
<200 is severe
93
When is AIDS diagnosed?
Less than 200 CD4 and wasting syndrome (loss of 10% of body fat)
94
ART (antiretroviral therapy) is usually how many meds?
3 or more
95
What diets are used with ART?
High calorie and protein diet
96
Tuberculosis is the leading cause of death in what patients?
HIV
97
Purified protein derivative levels (TB test levels)?
>15mm - general public
>10mm - healthcare workers and drug abusers
>5 mm - HIV positive or recent contact with TB
98
What is primary TB?
Within 2 years of exposure
99
What is deactivation of TB?
2 or more years after exposure
100
What is Latent/Dormant TB?
Positive skin test but no symptoms
101
When do TB symptoms start after exposure?
2-3 weeks
102
How long are you infectious for TB?
2 weeks
103
How many drugs are in the drug regimen for TB?
4
104
What side effects from TB meds should you know?
Orange urine is normal
105
What do you have to monitor with TB?
Liver enzymes- can cut ethambutol if. Bug is susceptible
106
What are the 4 TB drugs?
Isoniazid
Rifampin
Pyrazinamide (excluded when pregnant and hep)
Ethambutol (may stop if bacteria is susceptible to all 4 drugs)
RIPE
107
What isolation is used with TB?
Airborne
108
How many negative tests for TB to be cleared?
2
109
What is Multiple sclerosis?
Progressive disease
Autoimmune disorder where myelin sheath is attacked
110
What is relapsing remitting MS?
Attacks with partial or complete recovery
111
What is primary progressive MS?
Steady progression with no remission
112
What is secondary progressive MS?
Relapse remit without remission
113
What is progressive relapsing MS?
Steady progression with onset of acute attacks
114
How much does MS reduce life expectancy?
7 years
115
Is there a cure for MS?
No
116
T/F is ALS always fatal?
TRUE
117
How many years after ALS diagnosis does a person have?
3-5 years
118
What is ALS?
Degeneration of motor neurons
119
What is a common factor during pregnancy with heart defects?
MMR
120
Acyanotic heart defects
VSD
ASD
PDA (opening between PA and aorta)
Babies will have decrease in wet diapers/ edema/ and grunting when feeding
121
What will you hear with acyanotic heart defects?
Murmur
122
How do you treat acyanotic heart defects?
Diuretics
NSAIDS can close defects
123
What are the cyanotic heart defects?
Truncus arteriosus
TGA
Tricuspid Atresia
Tetralogy of Fallot
TAPVC
124
What is Truncus arteriosus?
PA and aorta are grafted together
125
What is TGA?
PA and Aorta are swapped
126
What is Tricuspid Atresia?
Right ventricular hypertrophy and atretic valve
Tricuspid isn’t formed to solid tissue RV is not fully developed
127
What is Tetralogy of Fallot?
Pulmonary stenosis
Right ventricle hypertrophy
Overriding aorta
VSD
128
What is a tet spell with Tetralogy?
Lue when crying (knees to chest)
129
What is TAPVC?
Pulmonary veins connect to SVC
130
What kind of feeders are cyanotic heart babies?
Poor feeders
Polycythemia
Can’t gain weight
131
What is a Hgb level that needs reported immediately and why?
>22 start IV of heparin this is a blood clot risk!
132
For a heart cath in a baby how long npo?
4-6 hrs
133
What are things to look out for with heart cath babies?
Catheter side pulls may be weak (normal)
If chest tube this should be the output. (1-3hr - 5-10 mL/kg/hr)
(3 + hr - 3 mL/kg/hr)
134
What meds do you use to correct blood flow?
Digoxin and Lasix/spironolactone
135
Digoxin toxicity what are you looking out for?
N/V
Bradycardia
Vision changes
Check apical pulse for a full minute
Hold for HR less than 100
136
24 hr fluid calculations?
0-10 kg X 100
10-20 kg X 50
20+ kg X 20
Then add all together for 24 hr fluid total
137
Urinary output calculation?
1-2 mL/kg/hr
138
When do you feed babies?
At first signs of hunger and this prevents cold stress and neutral therm environment
139
What is Kawasaki disease?
Inflammation of blood vessels
Avoid live immunizations for 11m
140
What is acute Kawasaki?
C- conjunctivitis
R-rash
A- adenopathy
S-strawberry tongue
H-hand and feet swelling
&
Burn- fever for more than 5 days even with treatment
141
What is subacute Kawasaki?
Fever goes away
142
What is Convalescent Kawasaki?
Complications remain and treat with Tylenol (10-15 mg/kg/dose)
143
What is Sickle cell disease?
Autosomal recessive disorder where hgb sticks in vessels causing ruptures and ischemia
Episodes caused by low PaO2 and dehydration (most common caused by infection)
144
What does repeated issues of sickle cell cause?
Spleen issues (bone marrow production shutdown) (usually by 4 y)
145
With SCD you use DVT prophylaxis and?
Glutamine-decreases crisis severity
Hydroxyurea- increases hgb production
Deferoxaminen B- iron overload (orange ruin is okay H&S changes)
146
What is Cystic Fibrosis?
Autosomal recessive disease median age is 6m for diagnosis
Affects the cells that produce mucus, sweat, and digestive juices which causes sticky thick fluid in lungs
147
What is the gold standard for CF?
Sweat chloride test (positive if more than 60)
148
What meds are used with CF?
Pulmozyme- breaks and thins mucus
Give pancreatic enzymes before meals
149
What diet is used for CF?
High calorie and protein diet
150
What is Cerebral Palsy?
No progressive and most common motor disability in kids
151
How do you treat CP?
Muscle relaxants (Baclofen/Diazepam)
152
What is spina bifida?
A birth defect in which a developing baby’s spinal cord fails to develop properly
153
What is spina bifida occulta?
Not visible externally (dimpling or hair)
154
What is Spina bifida cystica?
Visible with external sac
155
What is meningocele?
Sac with meninges and spinal fluid
156
What is myelomeningocele?
Meninges, spinal fluid and nerves
157
What is the main thing to know with Spina bifida cystica ?
Cover sac with sterile and moist dressing
No rectal temps
Remain prone until repaired
Monitor for hydrocephalus and infection
158
What meds are used with Spina bifida?
Acetazolamide- decrease CSF production
Furosemide- drain CSF fluid
159
What is Muscular Dystrophy?
Progressive muscle weakness and wasting
160
What is Duchenne?
This is a type of muscular dystrophy
Mainly male can be identified by Gower’s sign (walking up with hands on knees)
161
What meds do you take with Duchennes?
Corticosteroids to increase muscle strength
162
What is cancer?
Uncontrolled cell growth
163
What is neoplasm?
Abnormal tissue growth with no purpose (can harm)
164
What is Benign?
Harmless growth
165
What is Malignant?
Spreading tumor
166
What is metastasis?
Spreads to another organ
167
What is angiogenesis?
Tumor develops blood supply
168
What is the initiation stage of cancer?
Cell damage and introduction to carcinogen
169
What is Promotion stage of cancer?
Proliferation of altered cells
170
What is progression stage of cancer?
Increased growth of tumor/ metastasis/ angiogenesis
171
What does CAUTION UP stand for? (S/s of cancer)
C-change in bowel or bladder
A- a lesion that doesn’t heal
U-unusual bleeding or discharge
T-thickening lump
I-indigestion/ difficulty swallowing
O-obvious change in wart or mole
N-nagging cough
U-unexplained weight loss
P-pernicious anemia
172
What is palliative care?
symptom management and quality of life
173
What is curative care
Intent to cure
174
What is lymphatic leukemia?
Cancer in lymph system
175
What is myelogenous leukemia?
Cancer in blood
176
What is Chronic myelogenou leukemia?
Controlled with treatment in chronic phase
Blasting (Acute) needs aggressive treatment
177
What is Hodgkin lymphoma?
Cancer of lymph system
Presence of reed Sternberg cells (more common younger)
More men than women
More predictable
Unknown risk factors
Night sweats, fever, fatigue, weight loss, painless lymphadenopathy
Diagnosis by lymph node biopsy and presence of reed sternburg cells or (Epstein Barr)
Good prognosis cure is goal
Ratdiation for 95% of cases chemo for stage 3-4
178
What is non-Hodgkin?
Cancer of lymph system
Older population
Immunocompromised
Painless lymphadenopathy, weight loss, widespread disease at time of diagnosis
Diagnosed with lymph node biopsy and bone marrow biopsy
Fair diagnosis
Surgery for symptoms chemoradiation depends on sight and stage
179
What is Multiple Myeloma?
Neoplastic cells infiltrate bone marrow
No cure but manageable
Presence of hence jones protein (24 hr urine collection)
Elevated serum creatinine
180
What are the lung cancer types?
Non small cell (most common)
Small cell (aggressive)
181
What is colorectal cancer and when do you screen for it?
Start as GI polyps
Colonoscopy at 45 then every 10 yrs
Low residue die
182
What is biggest risk factor for breast cancer and what to look for and screening?
Age
Pale orange skin
Mammography at 40
183
T/F prostate cancer has no cure
False it does have a cure
184
Do you use chemo when pregnant?
NO
185
External beam radiation need to know
Pt is not radioactive
Most common form
186
Internal beam need to know
Brachytherapy
Pt is radioactive
187
Stem cell transplant need to know
Pt has long hospital stay and huge risk for infection
188
What do you monitor for chemoradiation pts?
WBC-5k-11k. (Five filgrastim to encourage bone marrow production)
Platelets-150k-450k. (Transfuse at 20K)
Hgb-<10
RBC-<1m
Albumin-3.5-5.5
Pre-albumin-15-50
TSP- 6.4-8.2
ABS lymph- <1000 indicates malnutrition
189
When do we use enteral feedings?
When pt can’t ingest but can digest
190
When do we use parenteral feedings?
To bypass the stomach
191
What is refeeding syndrome?
Fatal shift in fluids (Hypophosphatemia is hallmark)
192
What is neuroblastoma?
Originate in the renal medulla
193
What is Nephroblastoma (Wilma tumor)?
Hypotension is common indicator
Metastasis is rare
DO NOT PALPATE
194
What is Osteosarcoma?
Occurs in the cells that form bones
195
What is Ewings sarcoma?
Occurs in the shafts of long bones
196
What is Rhabdomyosarcoma?
Most commonly found in head and neck
197
What is acute pain?
Less than 3m (known cause and episodic)
198
What is chronic pain?
More than 3m (Pain doesn’t go away)
199
What is somatic pain?
Sharp and burning
200
What is visceral pain?
Deep ache
201
What is neuropathic pain?
Burning and tingling
202
What is breakthrough pain?
Flare up with med management
203
What is a breakthrough incident?
Predictable and caused by triggers
204
What is breakthrough end of dose?
At end of dose (change dose or schedule)
205
What is breakthrough spontaneous pain?
Unpredictable and unassociated
206
What meds do you use for opioid intolerance?
Methadone
Prolonged QT interval
207
Why do we rotate fentanyl path location?
To prevent the skin breakdown and where it is absorbed since it is potent (date time initial patch)
208
What is the PCA basal rate
Given without pt demand (set at lower end of range)
209
What is Superior vena cava syndrome?
When the SVC is compressed/ blood can’t drain from head
210
What is spinal cord compression?
Complaints of spontaneous back pain is a s/s
It is compression of spinal cord (DUH)
211
What is Tumor lysis syndrome?
Rapid influx of electrolytes (Occurs in 24 to 48h)
Potassium and phosphate increase
Uric acid concentration in the blood (give allopurinol)
Dehydration worsens hyperkalemia (>12)
Moans, stones, thrones, groans, and bones. Aggressive hydration (3L daily)
Zoledronic acid to stop osteoclast absorption
Avoid Vit. D, thiazide, diuretics, and lithium
