Last minute things Flashcards
(95 cards)
1
Q
Self- harm (cutting) may indicate what
A
Borderline Personality disorder
2
Q
In OCD thoughts must be recurrent & time consuming (≥1hr), \_\_\_\_, OR \_\_\_\_
A
distressing
impairing
3
Q
Impressionable, considers relationships more intimate than they are, inappropriate sexual/seductive behavior, uses appearance to draw attention, dramatic displays of emotion
A
Histrionic
4
Q
Blames others for mistakes
Deliberately annoys others
Short tempered, irritable, argumentative, defiant, OR vindictive
A
Oppositional Defiant
≥6m
5
Q
ODD and Conduct disorder treated with
A
Parent Management Training
Psychotherapy & CBT, respectively
6
Q
Dissociative amnesia/fugue triggered by
A
an emotionally stressful event
7
Q
The depressive and hypomanic episodes in bipolar II disorder may resemble borderline personality disorder. However, the labile mood states in borderline personality disorder are
A
brief, typically lasting hours to days (rather than weeks to months).
and come with other Borderline symptoms
8
Q
Insecure attachment to the primary caregiver may underlie the unstable relationships and fears of abandonment commonly seen in the disorder.
A
Borderline Personality disorder
9
Q
Poor social responsiveness, limited affect, does not seek/respond to comfort, unexplained irritability/sadness/ fear, +/- toileting problems, anxiety, aggression, sleep problems
A
Reactive Attachment Disorder
10
Q
Describe delusional disorder
time frame
Treatment
A
≥1 delusion
≥1 month
no functional impairment
Antipsychotic or CBT
11
Q
Hoarding → treat with
A
CBT, if persistent use SSRI (off label)
12
Q
OCPD obsessed with
A
Details, Control, Perfectionism
NO Rituals/Compulsions
NO Feared thoughts
13
Q
Fear of Scrutiny and embarrassment
A
SAD
14
Q
GAD causes significant distress or impairment due to chronic worries ≤6m
Must have 3+ of the following symptoms (7)
A
Fatigue impaired concentration irritability Tension (muscles) On edge Restless Sleep disturbances
FiiTORS
15
Q
Panic disorder has ≥4 of the following symptoms (15)
A
SOB Trembling Upset stomach Dizziness Derealization/Depersonalization Numbness Tingly/Paresthesia Sweating Palpitations Avoidance behaviors Nausea Intense Fear of dying Chest pain/Choking
STUDDNTS PANIC
16
Q
Symptoms of PTSD (9)
A
Flashbacks Irritability Nightmares Negative mood Dissociation Avoidance (of reminders) Amnesia (of event) Hyper-vigilance
FINNDAAH
17
Q
First-line treatment of specific phobia
A
Exposure therapy & CBT
Benzos for acute settings
18
Q
Is conversion disorder intentional?
A
No
19
Q
1st line treatment for conversion disorder
A
Pt education/self-help
(2nd line) CBT
20
Q
List all the things that can cause Serotonin Syndrome
10
A
SSRI SNRI TCA MAO-I Tramadol Linezolid Dextromethorphan MDMA Ondansetron Meperidine (opioid for acute pain)
21
Q
Treatment of Genito-pelvic pain disorder
A
Desensitization therapy
Kegel pelvic floor exercises
22
Q
5HT-1A partial agonist. Inhibits serotonin reuptake
A
Vilazodone
atypical antidepressant
23
Q
5HT-1A agonist.
5HT-3 antagonist.
Inhibits serotonin reuptake
A
Vortioxetine
atypical antidepressant
24
Q
Indications for ECT (5)
A
Treatment Resistance MMD w/Psychotic features Pregnancy Refusal to eat/drink Suicidal
25
List 3 protective factors for suicide
Pregnancy
Parenthood
Religion
Social/family support
26
Depressed new mother for:
__ weeks → Blues
__ weeks → MDD
≤2 (reassurance)
| ≤ 2 (CBT + SSRI)
27
Adjustment disorder treatment
Psychotherapy
| w/ adjunctive sleep aid like Zolpidem or anxiolytic if needed.
28
Peripheral alpha 1 antagonism causes
vasodilation (orthostatic hypotension)
29
Discontinuation of SSRI may cause
```
Flu like
Insomnia
Nausea/Vomit/Diarrhea
Instability (Dizziness)
Sore muscles (myalgias)
Headache
```
30
Treatment of lithium toxicity (2)
IV hydration
| Dialysis (if severe)
31
4 contraindications for Lithium
CKD
Heart disease
Hyponatremia
Diuretic use
32
Lithium may cause
Polyuria/Polydipsia
33
List 7 psychiatric medical emergencies
```
NMS
Serotonin Syndrome
TCA overdose
Tyramine HTN crisis
Acute Dystonia
Delirium Tremens
Lithium Toxicities
```
34
Patient with Parkinson or DLB can be given what antipsychotic?
Qutiapine (which binds D2 loosely)
or
Pimvaserin
35
Antipsychotics causing orthostatic hypotension like _______ not good for elderly. Not good at all for parkinsonism.
Risperidone
| but still can be used
36
Low potency typicals do not
bind D2 very tightly
37
2nd Gen antipsychotics can cause weight gain and (2)
Dyslipidemia
Hyperglycemia
(monitor lipids & A1C)
38
Which antipsychotic causes
Metabolic syndromes/weight gain
EPS &
Prolonged Qtc
Risperidone
39
Which 2 antipsychotics cause Prolonged Qtc
Risperidone
| Ziprasidone
40
List 3 overlapping features of NMS & SS
Fever
Autonomic Instability (sweats, tachycardia, HTN)
Mental status altered
(FAM)
NMS: muscle rigidity
SS: Myoclonus/hyper-reflexia
41
Schizophrenia must have 1 of the following 3 symptoms:
&
have either of the following 3 symptoms:
Hallucinations, Delusions, Disorganized speech
Negative symptoms, Bizarre behavior, Catatonia
42
What are the 5 As of negative symptoms in Schizophrenia?
```
Alogia (brief answers/ speaking little)
Anhedonia
Affect (flat)
Avolition (apathy)
Attention (poor)
```
43
In Wilson's disease the Basal Ganglia gets deposits of copper. Neurologic findings can include (4)
& come before obvious hepatic symptoms in teenagers with acute psychosis.
dysarthria
dystonia
tremor
pooling saliva
44
Patient has overdosed on Heroin and has a RR<8 what do you do next?
Intubate then give IM Naloxone
45
With opioid intoxication what do you expect to find in ABG and finger glucose stick?
Respiratory Acidosis
| Hypoglycemia
46
What is a normal pupil size?
Normal Pupils in
LIGHT (2-4mm)
DARK (4-8mm)
Pupils <1mm = intoxication
47
What are some opioid withdrawal symptoms you can ask (8)
```
Stomach Cramps
Diarrhea
Piloerection
Insomnia
Yawning
Rhinorrhea
Lacrimation
Muscle/joint aches
```
48
What can you give for opioid withdrawal diarrhea
Loperamide
49
List 3 complications of cocaine use
Myocardial ischemia or MI
Aortic Dissection
Intracranial Hemorrhage
50
Beta 1 stimulation causes cardiac
contractility increase
51
Alpha 1 stimulation causes peripheral
vasoconstriction (HTN)
52
Beta 2 stimulation causes bronchial ____
| & peripheral _____
Dilation
| Vasodilation
53
Why are Beta Blockers contraindicated in cocaine use?
Cocaine stimulates Alpha 1 vasoconstriction & Beta 2 vasodilation and blocking B1 & B2 will lower the heart contractility and the vasodilation of B2 but leave the alpha 1 vasoconstriction unopposed causing a HTN crisis possibly.
54
Alcohol withdrawal seizures &/or Hallucinosis occurs when
within 12 hours to 2 days
55
Delirium tremens occurs when
2-4 days
| after last drink
56
Alcohol withdrawal shakes, anxiety, insomnia, and GI upset occur when
6 hours to 1 day
| after last drink
57
skin picking, teeth grinding and dental decay indicate what use disorder
Meth
58
Methadone opioid intoxication can be caused by
Cimetidine (for GERD)
Fluconazole etc. (fungal infection)
Clarithromycin (antibiotic
Fluvoxamine (SSRI)
WHAT OUT for these CYP P450 inhibitors increasing Methadone levels in the body
59
Non-selective (O-Z) Beta Blockers can cause what sexual symptom?
erectile dysfunction
60
Anticholinergic toxicity can cause (5)
```
Mydriasis (blind as a bat)
Tachycardia (fast as a fiddle)
Dry skin/mucous memb. (Dry as a bone)
Flushing (red as a beet)
Urinary retention (full as a flask)
Delirium (mad as a hatter)
Treat with Physostigmine
```
61
Marijuana causes dry mouth, red eyes and what cardio effect?
Tachycardia
62
List the Neuroleptic Malignant Syndrome mnemonic
| M-FEVER
```
Myoglobinuria (RBCs on UA)
Fever
Elevated Enzymes (CK & leukocytosis)
Vital Unstable
Encephalopathy (Delirium)
Rigidity lead pipe
```
63
Meperidine (opioid) + MOI can cause
Serotonin Syndrome
64
```
Meperidine (opioid)
Triptans (migraines)
Ondansetron (anti-emetic)
Dextromethorphan (cough syrup)
MDMA (Ecstasy/ Molly)
Tramadol (analgesic)
MAOI
TCAs/SNRIs/SSRIs
```
can be combined to cause
Serotonin Syndrome
65
Slow wave sleep is what phase
N3
66
N3 slow wave sleep is characterized by what waves, frequency, and amplitude?
Delta (low frequency, high amplitude)
67
Sleep apnea may cause an increase in what hormone?
EPO (erythropoiesis; high RBC count)
68
What 2 lab findings are seen in Bulimia
```
Hypokalemia
Metabolic Alkalosis (High bicarb)
```
69
How to tell apart
NPH vs
Alzheimer's MSA
MUD DUM
Motor > Urinary> Dementia = NPH
Dementia > Urinary > Motor = MSA
70
Tetrabenazine (for Tourette's) is a
dopamine depleter
71
List the OARS technique for motivational interviewing
Open ended questions
Affirmation of Positives
Reflect on how it might feel in the Positive
Summarize
72
Fragile X Syndrome is often associated with what learning/psych problems?
Intellectual disability
ADHD
Autism
Anxiety
73
Self- injurious behavior is associated with what 2 congenital illnesses?
Fragile X
| Lesch Nyan
74
Long face
Protruding ears
Hypermobility of joints
intellectual/developmental delay
Fragile X
75
In Alzheimer's what neurotransmittor is affected
↓ ACH
76
In parkinson what neurotransmittor(s) are affected
↑ ACH
↓ Dopamine
↓ Serotonin
77
In Anxiety what neurotransmittor(s) are affected
↓ Serotonin
↓ GABA
↑ NE
78
In Huntington what neurotransmittor(s) are affected
↓ ACH
↓ GABA
↑ Dopamine
79
What is a U-wave on ECG?
A little hill after T wave (the last wave in 1 ECG cycle)
80
Lithium causes what 2 possible changes on ECG
| due to HYPOKALEMIA?
```
U waves (after T wave)
Flat/upside down T waves
```
81
List 5 MOAI
```
Tranyl-cypro-mine
Rasagiline
Isocarboxazid
Phenelzine
Selegiline
(TRIPS)
```
82
List 6 TCAs
```
Amoxapin
Desipramine
Amyltriptyline
Nortriptyline
Doxepin
Imipramine
(A DANDI)
*Timipramine
```
83
List 5 SNRIs
```
Desvenlafaxine
Levomilnacipran
Duloxetine
Milnacipran
Venlafaxine
(Don't Lose DMV)
```
84
List 3 Antiemetics
Metoclopramide 5HT3 & D2 antagonist
Ondansetron (Zofran) 5HT3 antagonist
Prochlorperazine (Compazine) D2 antagonist
(MOP vomit)
85
Absent DTRs
+ Romberg
Ataxia
Shooting pain
tertiary syphilis
86
Enuresis/Encopresis can be associated with what 3 psychiatric conditions?
Autism
ADHD
Conduct Disorder
87
Triptans (anti-migraine meds) can cause
Serotonin Syndrome
88
Phenobarbital is a ____ acting barbituate
Long
*so is Barbitone/Mephobarbitone
89
PENTObarbital is a ____ acting barbituate
Medium
90
Thiopental is a ____ acting barbituate
Short
91
Huntington chorea/ tardive dyskinesia can be treated with
Tetrabenazine (for Tourettes too)
| VMAT-I for ↓ Dopamine release
92
Alzheimers progression can be hindered with what drugs
Ach-Esterase Inhibitors
(Donepezil, Rivastigmine, Galantamine)
NMDA receptor antagonist (Ca2+ excitotox)
(Memantine)
*Of note: Amantadine is a weak, non-competitive NMDA receptor antagonist for DI-Parkinsonism
93
Trihexyphenidyl is used for
DI-Parkinsonism
*same MOA as Benzotropine (antimuscarinic curbs excess cholinergic activity in parkinson)
94
For treatment of Parkinson disease first line is ____ or ____
carbidopa-levodopa
or (or as adjunctive)
Dopamine receptor agonist (Pramipexole/Ropinirole/Bromocriptine 3rd choice)
*If it doesn't respond to one it won't respond to the other option.
95
Other second line treatments for Parkinson disease
are (
*(aside from carbidopa-levodopa & Dopamine receptor agonist )
```
COMT inhibitors (Encapone/Talcopone) + Carbi/Levo
NMDA antagonist (Amantadine - for Akinesia)
MAO-B Inhibitors (Rasagiline, Selegiline) + Carbi/Levo
```
