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USMLE Step 2 - Top 5% > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Ziprasidone is an antipsychotic that has high risk of what particular side effect

A

QT prolongation

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2
Q

If family members of very very Ill patient don’t want to allow withdrawal of care, what can we do

A

Reframe discussion to become about NEOT (no escalation of treatment)

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3
Q

Three care philosophies about end of life care

A

NEOT, time limited trial, withdrawal of care

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4
Q

General diagnosis for pyromania

A

Fire setting on more than one occasion. Tensions relived when setting fire, no external gain.

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5
Q

Patient wants help quitting opioids. Recently taken them.

A

Methadone or buprenorphine. Both agonists and can decrease cravings. Not naltrexone, since it’s an antagonist an requires a period of detox prior. Not clonidine, since this is just to help reduce ANS symptoms in withdrawal (not the craving)

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6
Q

Patient ODd on methadone. Given naloxone, and gets better. Can we discharge?

A

No, need a couple of days of observation. Naloxone is short acting and methadone is long acting. Sooo when naloxone wears off, the effects of methadone will return

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7
Q

Most effective anti psychotic for Tx resistant SCZ

A

Clozapine

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8
Q

Aside from dialectical behaviour therapy, what else can be given for mood swings in BPD

A

Mood stabelisers

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9
Q

Main psych complication of MS

A

Depression

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10
Q

Can GCs cause psychosis

A

Yes

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11
Q

Treatment for binge eating disorder

A

CBT, SSRI (consider lisdexamfetamine or topiramate)

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12
Q

Treatment for bipolar is it’s severe (patient is aggressive, has multiple episodes etc.)

A

Combo therapy: Li (or other mood stabiliser) and an 2nd gen antipsychotic

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13
Q

SAD therapy

A

light therapy, with or without SSRI (if moderate or severe)

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14
Q

When to give benzos over SSRIs for panic disorder

A

If it’s acute, can give, also second line for long term. Careful in druggy people due to addiction risk

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15
Q

Can adjustment disorder be from traumatic origin

A

No,,,, don’t make my mistake

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16
Q

REM sleep disorder vs Sleep terror

A

Sleep terrors are nonREM. Sleep terror has way more confusion, occurs earlier in sleep, seen in younger patients and they don’t dream so vividly. REM sleep disorder is the opposite of this

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17
Q

Dx criteria for ADHD

A

More than 6mo, of 6or more symptoms. In 2 or more settings. Signs Begins before 12 (6*2 Rule)

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18
Q

Language delay and no compensation from other forms of communication

A

Autism

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19
Q

Cortisol l levels in depression

A

High

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20
Q

Alcohol withdrawal vs PCP intox

A

Alcohol withdrawal ,or stepwise and includes tremors and less likely nystagmus

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21
Q

List as many cannabis withdrawal side effects

A

Sleep issue, irritable, depressed, anxiety, weight loss and low appetite, abdomen pain, headache, tremor, fever, sweating

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22
Q

Adolescent SCZ key points

A

More hallucinations than delusions. They often name their delusions (friend, henry etc.). Worse Px.

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23
Q

What is the main prognostic indicator for autism

A

Language development, because it is based on social interaction

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24
Q

Why do we have to do audiometry before diagnosing autism

A

Since hearing impairment can present similarly

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25
Q

Describe the activities of daily living element to intellectual disability

A

ADL helps determine severity of intellectual disability. ADL and intellectual deficits are the two domains of intellectual disability. Mild disability patients are independent, Moderate intellectual disability patients would need a little help for ADL, severe intellectual disability patients would need significant support for ADL, profound intellectual disability patients would need full support for ADL

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26
Q

What is the most common chromosomal, preventable, inherited causes of intellectual disability

A

Downs, fetal alcohol syndrome, fragile X syndrome respectively

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27
Q

What is psychosis

A

Hallucinations +/- delusions, with no insight

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28
Q

Schizophreniform and brief psychotic disorder are less likely to have which symptoms than schizophrenia

A

Negative symptoms

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29
Q

When is resistance to antiphsycotics considered

A

When two drugs or more have been attempted without improvement of symptoms

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30
Q

Main difference between drealizatiom/depersonalisation and psychosis

A

Psychosis don’t have insight

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31
Q

Abnormalities on brain imaging in patients with OCD,

A

specifically in the orbitofrontal cortex and basal ganglia. The cortico-striato–thalamo-cortical (CSTC) circuits have been implicated in the pathophysiology of the disorder.

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32
Q

Out of OCD and OCPD, which patient recognise their behaviour is irrational

A

OCD Patients recognize their behaviors as excessive and irrational (vs obsessive-compulsive personality disorder [OCPD]

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33
Q

Kleptomania

A

An OCD-related disorder. Where someone has the compulsion to steal, for no really reason

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34
Q

Hairs in different stages of growth and different lengths….. sign of what?

A

Trichotillomania

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35
Q

List some OCD related disorders

A

Trichotillomania, hoarding disorder, excoriation disorder, kleptomania, body dysmorphia

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36
Q

Out of dementia and pseudo dementia… who is more concerned about it?

A

Patients with dementia are usually not concerned about their cognitive decline and are often accompanied to the doctor visit by a family member or friend (vs major depressive disorder [MDD]/pseudodementia)

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37
Q

Is parental consent 100% needed if the paed has suicidal. Ideation

A

Minors with suicidal ideation should be hospitalized involuntarily with or without parental consent (although parental consent is preferred).

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38
Q

Which vessel stroke is associated with depression

A

ACA

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39
Q

Rule of two for dysthymia

A

2 or more of the symptoms, for 2 or more years. With no period of more than 2 mo free of symptoms

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40
Q

Features of atypical depression

A

Characterized by weight gain, hypersomnia, and rejection sensitivity.

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41
Q

Which SSRI should be avoided in pregnancy . Why?

A

Paroxetine. Cardiac and pulmonary ,malformations in 1st and 3 rd trim resp

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42
Q

How long should be left before Starting MAOI after SSRI. And special case if SSRI was fluoxetine

A

Discontinue SSRIs at least 2 weeks before starting an MAOI. Wait 5 weeks if the patient was on fluoxetine due to its long half-life.

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43
Q

What is double depression

A

Double depression: Diagnosed if patient meets criteria for MDD during dysthymic
periods.

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44
Q

3 key features of adjustment disorder

A

Event is not life-threatening.
Symptoms present within 3 months after onset of the stressor. Adjustment disorder
resolves within 6 months after event is over.
Adjustment disorder causes social or occupational dysfunction, as opposed to a normal
stress reaction.

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45
Q

What is premenstraul dysphoric disorder and how is it similar to dysthymia

A

Premenstrual dysphoric disorder (PMDD) presents the same as dysthymia, but the symptoms in PMDD are cyclic, whereas dysthymia is present all the time.

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46
Q

How is pin point pupils not always sensitive for opioid intox

A

Pinpoint pupils are not always a reliable sign of opioid ingestion, because co-ingestions can lead to normal or enlarged pupils. Also look for a ↓ respiratory rate, track marks, and ↓ breath sounds

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47
Q

Is prior opioid abuse a CI to use opioids for pain relief in hospital settings

A

In the appropriate clinical setting, prior substance abuse is not a contraindication to the use of opioids in pain management and requires a nonjudgmental environment and shared decision makin

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48
Q

Alcohol withdrawal

6-24 hours:
12-24 hours:
12-48 hours:
48-96 hours:

A

6-24 hours: Anxiety, tremor, tachycardia, HTN
12-24 hours: Hallucinations
12-48 hours: Seizures
48-96 hours: DTs, fever, agitation, HTN, hallucinations

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49
Q

Opioid withdrawal symptoms, is it life threatening, what’s the Mx

A

Dysphoria, insomnia, anorexia, myalgias, fever,
lacrimation, diaphoresis, dilated pupils, rhi-
norrhea, piloerection, tachycardia, nausea,
vomiting, stomach cramps, diarrhea, yawning
Opioid withdrawal is not life-threatening, “hurts
all over” and does not cause seizures; it can be
treated with buprenorphine or methadone

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50
Q

Symptoms of glue and solvent abuse

A

Tachycardia; nystagmus; tremor; ataxia; slurred speech; uncon-
sciousness followed by drowsiness and headache; perioral
rash, common among adolescents
Short duration of action
Long-term use can lead to irreversible CNS damage and poly-
neuropathy (due to vitamin B, deficiency)

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51
Q

Some key ways to distinguish between amphetamine and cocaine intoxication

A

Amphetamine is taken by mouth, and can commonly cause meth mouth (poor dentition). Cocaine is typically snorted, and can cause red matters turbinates and perforated septum. Cocaine is much shorter acting (around 30 minutes), where is amphetamine is more long-acting (several hours).

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52
Q

Patient with PCP intox… suddenly symptoms recur after recovering for a few hours

A

Recurrence of intoxication symptoms caused by
reabsorption in the Gl tract; sudden onset of
severe, random violence

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53
Q

LSD vs PCP vs ecstasy symptoms

A

LSD more hallucinationogenic, but does not alter vital signs much. PCP is more dissociative (with some hallucinations too), and causes major vital sign change. Ecstasy causes heightened senses and increased emotional liability (euphoria), and elevated muscle tone (bruxism) and elevated heat excertion.

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54
Q

CAGE questions for alcohol use disorder

A
  1. Have you ever felt the need to Cut down on your drinking?
  2. Have you ever felt Annoyed by criticism of your drinking?
  3. Have you ever felt Guilty about drinking?
  4. Have you ever had to take a morning Eye opener?
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55
Q

Delerium tremens….. vs alcohol hallucinosis

A

48-96 hours since last drink
Autonomic instability (hyperadrenergic state;
1 blood pressure [BP], T heart rate (HR])
Disorientation, agitation
Hallucinations

12-24 hours since last drink
Visual, auditory, and tactile hallucinations

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56
Q

Benzos/ barbiturates withdrawal is similar to alcohol…. Which is the main difference

A

Alcohol withdrawal usually causes autonomic instability

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57
Q

Avoid pure Bb’s in which intoxication?

A

Cocaine. Unopposed Alpha can cause worsened HTN

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58
Q

Issue with buspirone and MOAI

A

Like SSRIs, buspirone should not be used in conjunction with monoamine oxidase inhibitor

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59
Q

Increased sensitivity to lactate infusion is seen in which disorder

A

Panic disorder

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60
Q

Which area of the brain is associated with OCD

A

The cortico-striato–thalamo-cortical (CSTC) circuits have been implicated in the pathophysiology of the disor

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61
Q

OCD vs OCPD…. Who recognises their disorder as problematic

A

OCPD…. Not sure if this is true

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62
Q

Suicidal minors. Do they need parental consent to hospitalise

A

Minors with suicidal ideation should be hospitalized involuntarily with or without parental consent (although parental consent is preferred).

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63
Q

Older people usually complain of which aspects of MDD

A

Somatic symptoms more

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64
Q

Anorexia versus bulimic patience, who are distressed and who are not distressed about the illness

A

Bulimic patients are usually distressed (make sense because they compensate). Anorexic patients usually not distressed

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65
Q

Normal sexual changes with aging in men

A

Increased stimulation needed to reach orgasm, decrease intensity of orgasm, longer refractory period before next orgasm

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66
Q

Normal sexual changes with aging in women

A

Vaginal dryness, some coitus discomfort,

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67
Q

Patients with gender dysphoria are At increased risk of which psychiatric diseases

A

Depression, anxiety, substance abuse, personality disorders

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68
Q

What are some sleep Hygiene measures

A

Sleep schedule, limit caffeine, avoid napping, warm baths in evening, his bedroom for sleeping six only, exercise early in the day, relaxation techniques, avoid large meals near bed

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69
Q

What is Hoover sign in relation to conversion disorder

A

If it involves leg paralysis in conversion disorder. Asked the patient lying down to lift up the unaffected leg, if the affected leg extends, this could rule out true leg paralysis

70
Q

Patient having seizure. Eyes are closed and resistant to opening. Thoughts?

A

Could be conversion disorder

71
Q

Risk factors for suicide

A

Previous attempt (main risk factor), male, above 45, psychiatric comorbidities, history of hospitalisation for psychiatrist issue, history of violent behaviour, substance abuse, recent stressor, poor social support, family history

72
Q

Adults between 45 and 64 versus adults between 18 and 25. Who is more likely to die from the suicides, who has a higher risk of thoughts an attempt suicide

A

In that order

73
Q

Protective factors for suicide

A

Social support, good family network, religious, pregnant, parenthood

74
Q

Antidepressants and suicide risk, what’s the link

A

Impatience less than 24, all antidepressant medications have a blackbox warning for increased suicide risk

75
Q

Age above or below 17 and the Dx of ADHD

A

Less than 17: diagnosis required 6 or more symptoms

Above 17: 5 or symptoms

But the symptoms must start above 12 years of age

76
Q

Best initial Tx for ADHD. Consider if 6 or older/or younger

A

Behavioural only if your younger

Older, you should do both Pharma and behavioural

77
Q

Rather than amphetamines…. Which non addictive medication can I give instead for ADHD

A

Atomexitine…. No addiction potential ato

78
Q

Is decreasing sugar intake ever a proper option for ADHD.

A

No

79
Q

Two domains of autism and then ADHD

A

Disorder in social interaction, and communition. Then restricted and repetitive patterns.

Inattention and hyperactivity for ADHD

80
Q

Which psych disorder does DMDD most likely to become in adulthood

A

Depression

81
Q

DMDD cannot be diagnosed before what age

A

6

82
Q

Is IDD (intellectual development disorder) the same as specific learning disorders

A

No, recall we need both domains of IDD. Not just isolated learning disorder (reading, math etc.)

83
Q

We know tetrabenazine e is good for Tourette’s. What other medications are good

A

Antipsychotics or alpha 2 agonists

84
Q

Persistent motor tics for over one year. Is this Tourette’s

A

Only if vocal tics also.

85
Q

Some facts on separation anxiety disorder

A

Fear of separation from attachment figure or home. Remember it’s normal around 1yo-1.5yo. But if extends or is really bad, then look for SAD. Need at least three of the main signs

86
Q

Separation anxiety disorder Tx

A

CBT, family therapy

87
Q

Patient refusing to speak in certain circumstances…. What is this a sign of?

A

Selective mutism. Not always autism

88
Q

Can ODD progress to conduct disorder

A

Yes

89
Q

Main time frame difference between ODD and DMDD

A

ODD for 6mo. DMDD for 1year

90
Q

Two domains of intellectual developmental disorder

A

Intellectual deficit and adaptive function deficits (activities of daily living help)

91
Q

Main diagnostic criteria for Tourette’s

A

Multiple motor tics and one or more phonic tics. More than 1 year. Recurrent. Dx before 18

92
Q

Best initial Tx for Tourette’s

A

Habit reversal and behavioural therapy. Then try meds like tetrabenazine

93
Q

Caviat with SCZ Dx

A

Two or more of the 4 symptoms we know. But at least one is halluc, delu, disorganised speech

94
Q

Main schizoaffective element to Dx

A

SCZ Dx, but has also got concmittent mood disorder most of the time. Need psychosis for >2 weeks and no mood

95
Q

Do we needs day to day dysfunction for diagnosis of delusional disorder

A

No

96
Q

Patient is timid and introverted before getting SCZ symptoms. Does this affect Px

A

Yes, worsens it

97
Q

Worse atypical for causing hyperprolactinemia

A

Risperidone (Perry got the Rizz with those boobs)

98
Q

Worse atypical for causing QT prolongations

A

Ziprasidone (QT Zebra)

99
Q

Best atypical for causing least hyperprolactinemia

A

Aripiprazole (Avi not so good with the boobs) since it’s weirdly a partial agonist

100
Q

Thioridazine and chlorpromazine . Mention these fellas

A

They are the less powerful typical antipsychotics. More antiCh than EPS. So they can sedate, orthostasis is etc. And recall these guys do the eye side effects

101
Q

Dx this:

24 year old women, 2mo ago became isolated, heard voices, slept poorly, felt sad. Now her mood is better but she still hears voices

A

Schizoaffective. I’m these Qs, keep a look out for a SCZ p with a weird amount of mood issues…. Then see if fits the two weeks no mood criteria

102
Q

Catatonia

A

Posturing, mutism, immobile. Give either benzos or ECT

103
Q

Patient with tardive Dyskinesia. Dose of antipsych decreased… and it gets worse. Normal? What to do?

A

Fairly normal. Try valbenazine or deutetrabenazine

104
Q

When to give dantrolene vs benztropine

A

Give dantrolene for NLMS. Benztropine is usually used for acute dystonia, or akathisia, or dyskinesia after anti psych

105
Q

Dissociation disorders main Tx

A

PsychTx. And relevant meds for comorbs

106
Q

Buspirone use for GAD?

A

Less sexual side effects than SSRI… (like bupronorphrine also has…. But we use this where?)

107
Q

Buspirone same risk for SeroT syndrome (ie.wait 2 weeks after discontinue, to start MAOI)

A

Yes. Same risk

108
Q

Panic disorder extra details on Dx

A

Recurrent attacks and at least 1mo:

Persistent worry, maladaptive behaviour.

109
Q

Name the somatic symptoms of GAD to look out for

A

Wound up, (Absent minded) Low conc, Worn out, Restless, muscle Tension, Sleep issue, (usually need around 3)

Worry WARTS

110
Q

Other than SSRI, what is the main alternative Med for OCD

A

Clomipramine TCA (Chloe was OCD)

111
Q

Trichotillomania hair follicle finding

A

Hair in different phases of growth

112
Q

Excessive cosmetic procedures may be a sign of which psych disorder

A

Body dysmorphic disorder (a type of OCD). And we should discourage them from getting these procedures (obviously don’t dismiss their complaints though).

113
Q

Tx of all OCDs

A

CBT and SSRI

114
Q

Top PTSD causes in women and men

A

Women: child abuse and sexual assault

Men: sexual assault and war

115
Q

CBT and SSRI are great for PTSD. But what’s also good non pharma

A

Eye movement desense and reprocessing.

116
Q

15-25 year olds. Main causes of death

A

Unintentional injury, then suicide

117
Q

PEP for HIV we give in RAPE victim

A

Tenofovir emtricitabine and integrase inhibitor

118
Q

In order to Dx illness a society disorder what needs to be present (other than the obvious)

A

Maladaptive behaviour. Repeat self checks, uses the healthcare system l a lot, avoids hospital, etc.

119
Q

Random key fact 🔑

A

Pseudo epilepsy can occur together with seizure disorder

120
Q

Primary insomnia Dx (times)

A

Three or more times a week, for at least one month

121
Q

For primary insomnia, After good sleep hygiene (our first line), what is our second lines

A

Psychotherapy or CBT for insomnia. Pharma (anti H or the Z drugs) for <2 weeks at a time

122
Q

Best Tx for primary Hypersomnia

A

CNS stimulant

123
Q

Narcolepsy rule of three

A

Symptoms occur for at least threee times a week, for at least 3 months

124
Q

Tx overview for narcolepsy

A

Scheduled naps, and amphetamine or modafinil. SSRI for cataplexy

125
Q

What is the confusion assessment method

A

CAM score, to check for delirium. Acute onset/fluctuating course, in attention, disorganised thinking, altered mental status, need first and second and then either third or fourth

126
Q

Why is there a blackbox warning for load of psychotics in older adults for delirium

A

Increase mortality

127
Q

Adjustment disorder has to be within how many months of stressor

A

3

128
Q

In a patient breathing who has illusions or hallucinations of the deceased. What’s the main wait to see whether this is normal or psychosis

A

Patient will be aware that there are hallucinations, and will have insight 

129
Q

Contrast the time of onset between postpartum blues and depression

A

Blues usually within two weeks of delivery, where is postpartum depression is usually months after delivery

130
Q

What’s the rule of sex when talking about SSRIs

A

Allow up to 6 weeks to take affect. Once a cheat permission need to keep going with the medication for six months. Allow two weeks washout before starting MAOI

131
Q

Bupropion
Buspirone

A

The former is a depression medication. With less sexual side effects, but decrease seizure threshold

The latter is an anxiety medication, which also has less sexual side effects

132
Q

Why should paroxetine be avoided in pregnancy

A

First trimester causes cardiac defects, Saif third trimester causes pulmonary hypertension

133
Q

Main medication for atypical depression

A

MAOI

134
Q

Other than patients with a seizure disorder, buproprion is contraindicated in what else

A

Waiting disorder

135
Q

What’s phenelzine

A

MAOI

136
Q

What’s tranylcypromine

A

MAOI

137
Q

Those with two or more episodes of MDD should have what

A

Maintenance antidepressant therapy

138
Q

We know that SSRIs need a two week wash out before MAOI. However watch the exception with fluoxetine

A

Fluoxetine requires five weeks (F equals F)

139
Q

Best treatment for dysthymia

A

Psychotherapy. If resistant then can add some medication

140
Q

Main difference between adjustment disorder a normal stress reaction

A

Adjustment disorder will have social and occupational dysfunction. Normal stress reaction wont

141
Q

What is premenstrual dysphoric disorder

A

Essentially dysthymia but symptoms of cycle with the menstrual cycle

142
Q

Ropinirole may cause what symptoms

A

Mania like

143
Q

Symptom duration diagnosis for:

Dysthymia or cyclothymia

A

2 years

144
Q

Symptom duration diagnosis for:

Narcolepsy

A

3 mo

145
Q

Symptom duration diagnosis for:

Panic disorder (length of underlying symptoms)

A

One month

146
Q

Symptom duration diagnosis for:

PTSD

A

One month

147
Q

Symptom duration diagnosis for:

GAD

A

6mo

148
Q

Symptom duration diagnosis for:

Delusional disorder

A

1mo

149
Q

Symptom duration diagnosis for:

DMDD

A

1yr

150
Q

Symptom duration diagnosis for:

Tic disorder

A

1 year

151
Q

Symptom duration diagnosis for:

ODD

A

6mo

152
Q

Symptom duration diagnosis for:

ADHD

A

6mo

153
Q

Symptom duration diagnosis for:

Adjustment disorder

A

Less than 6mo

154
Q

Lithium side-effect profile, other than the ones you know

A

Tremor, weight gain, GI side-effects, ataxia,. Contraindicated in low renal function, sodium depression, significant CVD

155
Q

After lithium, which is the second line mood stabiliser

A

Lamotrigone

156
Q

Main contraindication for valproic acid

A

Liver disease.

157
Q

General idea for when you treat mild compared to severe mania

A

Mild can just give an atypical antipsychotic. More severe you give the mood stabiliser plus or minus in antipsychotic

158
Q

Mania in pregnancy treatment

A

Typical antipsychotic. Or ECT

159
Q

If a patient has all the signs of opioid overdose, but the people is a normal. What can you be thinking of

A

That this may just be a poo ingestion with something that causes mydriasis. So if they have low respiratory Drive, track marks, et cetera go with it

160
Q

Deletion tremendous after how long of withdrawal

A

48hr

161
Q

How to treat your opioid intoxication. What is given as a short acting antagonist, which is given as a long acting antagonist prevent relapse

A

Naloxone and naltrexone respectively

162
Q

Withdrawal from opioids obviously not life-threatening, but can be treated with what. Consider if mild or severe

A

Anti emetics or anti diahrrea if mild. Buprenorphine or methadone if severe cravings. Clonidine if severe ANS

163
Q

Long-term use of inhalants can cause which deficiency

A

B12 according to you first aid.

164
Q

Cocaine cause the sensation of water under the skin

A

Bugs

165
Q

Best initial treatment for alcohol abstinence

A

Naltrexone best, can start while patient still drinking. And long-term rehabilitation. Can also consider disulfiram

166
Q

We all know that alcohol hallucinosis is up to 48 hours after. Where is delirium tremens is after 48 hours. What is the main difference in the symptom

A

The former has usually visual hallucinations, but no delirium. May have some autonomic instability two. The latter has hallucinations, autonomic instability, delirium, potentially seizures

167
Q

President should we avoid in anorexia and bulimia

A

Bupropion, just because seizure risky so high

168
Q

Anorexics versus bulemics , which are more distressed about their symptoms

A

Anorexics

169
Q

Can we give naltrexone if somebody is using heroin currently

A

No. We need a full opioid free period, and naltrexone could cause withdrawal. So give methadone instead

170
Q

Other than tetrabenazine, what’s the other options for Tourette’s

A

Antipsychotics

171
Q

When is biofeedback needed

A

Usually in chronic pain disorders

USMLE Step 2 - Top 5% (34 decks)

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