Psychiatry Flashcards Preview

► Med 11.1 - USMLE 2 > Psychiatry > Flashcards

Flashcards in Psychiatry Deck (409):
1

quid of alternative treatment(2)

yoga
acupuncture

2

what to do if a patient is intereted in alternative treatment

physician should inquire as to why

3

how to dx major depressive episode(8)

Sleep proble
Interest low
Guilt
Energu is low
Concentration
Appetite is low
Psychomotor ...
Suicidability

4

First line treatment of schizophrenia(8)

Aripiprzole
Asenapine
iloperidone
olanzapine
quetiapine
paliperidone
risperidone
ziprasidone

5

best btolerated drug in patient with psychosis

Olanzapine

6

when using injectable products in schizophrenia

non compliant patient to oral medication

7

what injectable medication can be used in schizophrenia(4)

haloperidol decanoate
fluphenazine decanoate
risperidone depot
paliperidone

8

posologie of haloperidol injectable in the rx of schizophrenia

once a month

9

posologie of fluphenazine injectable in the rx of schizophrenia

twice a month

10

posologie of risperidone injectable in the rx of schizophrenia

twice a month

11

posologie of paliperidone injectable in the rx of schizophrenia

1 a 2 fois par mois

12

best long term rx of schizophrenia

paliperidone

13

quid of bipolar(2)

lot of energy
megalomaniac

14

do you need depression to DX bipolar

no

15

rx of bipolar (3)

mood stabiliser
plus
atypical antipsychotics
atipical antipsychotics as montherapy

16

quid of mood stabiliser(3)

lithium
lamotrigine
acid valproic

17

quid of atypical antipsychotics used in bipolar(5)

risperidone
olanzapine
quetiapine
aripiprazole
ziprasidone

18

first line regimen for mild to moderate bipolar

atypical antipsychotics

19

rx of severe episodes of bipolar

mood stabiliser plus atypical anti psychotics

20

patient presenting with many symptoms has seen many doctors asking for CT even if the prior CT was normal

somatisation

21

what to do in patient with somatisation

scheduled appointment intended to reduce underlying psychological distress

22

in vignette patietn patietn with thought of being poisonned depuis 3 mois

delusionnal disorder

23

type of delusion(5)

persecutory
erotomanic
grandiose
jealous
somatic

24

erotomanic delusion

you think someone of higher status is in love with you

25

grandiose delusion

belief of great talent insights or achievements

26

Jealous delusion

unfaithful partners

27

somatic delusion

belief of bodily functions and sensation

28

how to differentiate delusion from schizophrenia(2)

you need symptoms for at least 6 months to dx schizophrenia
additional psychotic symptom in schizophrenia

29

psychotic symptom in schizophrenia(3)

hallucinations
disorganisation
negative symptom

30

clue for delusion

patient is highly functionnal

31

rx of obsessive compulsive disrder will target which substance

serotonin

32

drugs used in OCD(5)

clomipramine
fluoxetine
fluvoxamine
paroxetine
sertraline

33

class of drug for clomipramine

TCA

34

RX of choice of OCD

paroxetine

35

which neurotransmetter has altered level in OCD

serotonin

36

quid of bereavment

normal reaction to the loss of loved one

37

persistent complex bereavement syndrome

persistence of symptom at leats one year after the loss of loved one

38

dx of major depression(2)

4 symptoms in SIGECAPs
plus
mood depressed or loss of interest

39

cancer patient is at risk of what psychiatric disease

major depression

40

rx of patient with cancer and major depression

SSRI

41

can you have bereavement from cancer

yes you can

42

how a patient with bipolar will take lithium

it depends on the number of relapses

43

first episosde of bipolar rx duration

lithium for at least one year

44

second episode of bipolar

lithium for years

45

indication of lithium for many years(3)

2 episodes
severe episode
family history

46

rx of more than 3 episodes of bipolar

lithium for lifetime

47

patient taking fluoxatine for depression after 2 weeks he comes back to say there's no improvement what to do?

continue fluoxatine at the same dose

48

when a patient taking SSRI will start having improvement

in 4 -6 weeks

49

mechanism of action of risperidone

blocking dopamine D2 receptor

50

what a clinician should do in case of mistake(2)

facts should be clarified
truth told to the patient

51

patient leaves home to live on university campus weeks later develops anxiety that someone is going to break the house dx

adjustment disorder with anxiety

52

quid of adjustment diosorder with anxiety

development of emotionnal or behavioral symptom in response to an identifiable stressor within 3 months of the onset of the stressor

53

quid of acute stress disorder

anxiety developing after experiencing or whitnessing an event

54

acute stress disorder and PTSD

PTSD last more than one month

55

generalized anxiety disorder GAD

excessive worry on many aspects of life including work,family, finance etc...

56

patient starting new job worry in asking if children are safe at school, has difficulty sleeping etc...

GAD

57

what's the most important factor to determine a psychiatric disorder

the level of functionning at work

58

patient with lot of stress at work because colleague quit and has more workload,sleep poorly but keep on doing well in his job dx

normal human experience

59

immature mechanism of defense in which individual expresses his aggresion toward another person with repeated passive failure to meet the other person

passive agressive behavior

60

patient after having a warm argumetn with the receptionnist called the physicyan office for a new appointment.Everytime patient calls up receptionnist says i am sorry the appointment is full what type od mechanism of defense is used by the receptionnist

passive agressive behavior

61

patient develops tonic clonic seizures , she used to take a drug for anxiety but stops taking it and suddenly develops seizure what drug she was taking

alprazolam

62

abrupt cessation of this drug cause seizure

alprazolam

63

example of catatony

patient repeats only with monosyllables and refused to make eye contact

64

symptoms of schizophrenia(5)

delusions
hallucinations
disorganised speech
catatony
negative symptom

65

patietn presenting with all symptoms of schizophrenia but depuis moins de 6 mois dx

schizophreniform disorder

66

quid of brief psychotic disorder

symptom lasting more than 1 day but less than 1 month

67

qid of chizoaffective disorder

mood disorder with active symptom of schizophrenia lasting at least 2 weeks

68

quid of delusionnal disorder(3)

delusions lasting more than 1 month
normal functionning
no psychotic symptom

69

person who is splitting people as good or bad

bordeline personnality disorder type B

70

risk of boderline personality disorder

risk of suicide
angry outburst

71

disorganized speech in schizophrenia ,quid of of circumstantiality(3)

stand around
you give detailed to a specific question but irrelevat responses
patietn deviates from the original subject but eventually return to it

72

tangential thought

patietn druft away from the subject but never return to it

73

quid of conficdentiality in medical sciences

don't discuss thing about a patient with somebody or physician directly relaled to his care

74

what to monitor in patietn taking olanzapine and clozapine(2)

fasting glucose
lipids

75

pathologic gambling

pathologic history of gambling and inability to stop

76

how to deal with angry patient

start a discussion with open ended question and let the patietn talk about the emotion and problem

77

different classes of antidepressant drugs(4)

SSRI=selective serotonin reuptake inhibitor
SNRI=serotonin norepinephrine reuptake inhibitor
TCA=tricyclic antidepressant
MAOI=mono amine oxydase inhibitor
atypical antidepressant

78

name atypical antidepressant(3)

bupropion
mirtazapine
trazodone

79

TCA(4)

amitryptiline
clomipramine
doxepin
nortryptiline

80

name SNRI(3)

duloxetin
venlafaxine
Pesvenlafaxine

81

Name MAOI (2)

phenelzine
tranylcipromine

82

when to change class of anti depressor during rx

when two trials of SSRI are inneficient

83

first line rx of GAD(2)

cognitive behavioral therapy
SSRI or SNRI

84

second line of GAD(2)

benzodiapine
buspirone

85

quid of GAD(6)

multiple wory or anxiety > ou egal a 6 months plus 3 or more of this
restlessness
fatigue
difficulty concentrating
irritability
Mx tension
sleep disturbance

86

quid of folie a deux

psychaitric disorder a delusion or set of delusion is shared simultaneously by individuals who dshared a close relationship

87

what to do in case folie a deux interview(2)

interview the two people separately
rx the one who first has the delusion

88

person always alone ,demonstrate interst in magical thing

schysotypal personality disorder

89

shizoid personality disorder

they don't have friends

90

avoidant personality disorder

they want friends but fear ridicule

91

patient major with paranoid schizphrenia compliant to meds come to the emergency with dx of ruptured ectopic pregnancy.patient is conscious ,whi can give the consent for her

the patietn as long as her jugment and decision making ability are not affected

92

who can give consent for intervention surgical in minor

patient's parent

93

minor less than 18 ans who don't require parental consent(5)

homeless
live alone
financially independent
married
military

94

minor wo dont dont need consent (6)

emergent care

95

jehovah witnesses with no advanced directives on him and requires blod transfusion but unconscious

transfusion can be done

96

quid of advance directive or card

instruction saying you want something or not during critical care

97

if the jehovah witness is conscious what can be done

he can refuse or accept the blod transfusion

98

patient found in airport or terminal bus with dissociation forgetfulness of name and adress

dissociative fugue

99

what 's the best answer to give to the parent of a kid with kleptomania

it's a mental disorder that can be treated with psychotherapy

100

rx of kleptomania

cognitive behavioral therapy

101

quid of kleptomania

impulsive control disorder

102

dx differential of kleptomania(4)

shoplifting
antisocial behavior disorder
bipolar manic episode(impaired jugment)
psychotic disorder vol because of hallucinations

103

kid with ALL but parent refuse chimio next step

obtain a court order for chemo

104

why you should obtain a court order for chemo in patient with ALL but parent refusing rx

50% des cas ALL is treated with chemo

105

straight A student 16 yo become suddenly to develop odd bahavior missed class failing in math ,what the best next thing to do

obtain urine toxicolog screening

106

any changes in adolecent behavior what to check(5)

check drug use
partner violence
date rape
pregnancy
sexual or physical abuse

107

patient on antipsychotics develops milky discharge in nipple cause?

risperidone

108

clue for prolactinoma

prolactinemia > 200 ng /ml

109

clue ofr dependent personnality disorder(3)

partner physically abusive but wife can leave him
avoid arguments whenever possible to be pleasant to others
fear of being alone

110

clue for bulimia nervosa(3)

patient eats a lot and sometime vomit(throw up)
tends to fast or exercicie to compensate
BMI is normal or slighlty above

111

clue for anorexia nervosa(2)

patient with low BMI
amenorrheic

112

BMI in bulimia nervosa(2)

normal
or
slightly elevated

113

clue for persistent depressive disorder

dysthimia ,chronic low grade depression that last 2 years or more

114

how to differentiate major depressive disorder and persistent depressive disorder

you don't have all 5 crtieria in SIGECAP in persistent depressive disorder

115

symptom in persistent depressive disorder(2)

sadness
low energy for years

116

pain during sexual intercourse or when attempting penetration

genito pelvic pain penetration disorder

117

quid of alcohol hallucinosis

alcohol withdrawal syndrome occurring 12-24 h after the last drink and resolves within 24-48 h

118

patient with history of 6-8 beers /day develops auditory hallucination after an accident

alcohol hallucinosis

119

quid of delirium tremens

fever
HTA
tachycardia
occuring 48-96 hr after stopping alcohol

120

quid of withdrawal seizures

alcohol withdrawal causing seizures

121

quid of mild withdrawal alcohol(2)

palpitation
or
tremulation

122

complication of mild withdrawal or alcohol withdrawal seizures

Delirium tremens

123

differentiate alcohol hallucinosis and DT

vitals are normal in alcohol hallucinosis

124

quid of pyromania

intentionnal and repeated fire setting with no obvious motive

125

immature mechanism of defense in which individuals displace negative feelings associated with an unacceptable object or situation ob a safer object or situation

displacement
dan pouri gen fos sou bannann mu

126

side effct most commonly seen with olanzapine

weight gain

127

cause of acute dystonic reaction(2)

haloperidol
metochlopramine

128

rx of acute dystonic reaction

benztropine
or
antihistaminics(diphenidramine)

129

quid of bereavment

sadness after a bad event

130

patietn with cancer can develop what disease

major depression

131

rx of bereavment

SSRI

132

drug used in NMS

dantrolene

133

after a dx of cancer patient goes on internet to search for data on his disease waht mechanism of defense used by the patient(2)

intellectualisation
an immature mechanism of defense

134

difference between boulimia nervosa and binge eating disorder

in binge eating disorger no compensatory behavior

135

rx of binge eating disorder(2)

SSRI
and
CBT

136

first line rx in boulimia nervosa and anorexia nervosa

CBT
nutritionnal rehab

137

when use pharmacologic rx in boulimia nervosa and anorexia nervosa

when first line regimen fails

138

clue for inducing vomiting(surreptitious vomiting)(4)

parotid gland hypertrophy
dental caries
halithosis
scars and calluses over hand

139

quid of hoarding disorder

difficulty discarding possessions regardless of their actual values

140

first line rx of hoarding disorder(2)

CBT
SSRI

141

patient with history of dependence of opiod develops false symptom of back pain to get morphine dx

malingering

142

what's the deadline for a physician to give a copy of medical record on patient's request

30 jours

143

what to do if relatives or patient want to get a copy of dossier

patient must request a copy of medical record

144

pregnant woman with clear indication of CS refuses it what to do

respect the patient decision and proceed with vaginal delivery

145

why respect the patient decision and proceed with vaginal delivery in case of refusal of CS

pregnant women have the right to refuse rx even if it places her unborn child at risk

146

mother refuses to vaccinate children next step

document in the medical chart that the risks and benefits of vaccination have been explained

147

quid of advance directives

document completed while patietn have decision making capacity to ensure that decisions are made according to his wishes in the event that they lose decision making capacity

148

what to do if patient's healthcare proxy disagrees with a living will and demands care that contradicts the patietn written wishes

discuss the matter with the proxy and other family member

149

what if the family members fails to resolve the problem

the hospital ethics commmitee shold be consulted

150

why you shoul not give bupropion to patient with eating disorder

risk for seizures

151

why can you have seizures with bupropion in patient with eating disorder

electrolytes disturbance

152

why bupropion is contrindicated in epilepsy

it's decreases the tresholf of seizure

153

why patient snorting cocaine tends to lose weight

because they have decreased appetite

154

when using haloperidol in patient with manic episodes

extreme agitation

155

some clue for manic episode(7)

inflated self esteem or grandiosity
decreaased need for sleep
increase talktiveness or pressured speech
flight of ideas
distractibility or irritability
increase goal directed activity or psychomotor agiatation
increasse involvement in pleasurable activities (sex,gambling,purchasing)

156

patient with presenting with mx pain diarrhea abdominal cramps sweating and HTA abd dilated pupils what drugs can cause that

heroin withdrawal

157

action of heroin

everything is high

158

# 1 cause of NMS

haloperidol

159

clue for major depression with psychotic symptom(2)

when the patient is depressed psychotic event occurs
when the patietn is euthymic no psychotic symptom

160

quid of schizoaffective disorder

at least > ou egal a 2 weeks of delusions or hallucinations in absence of mood depression and than mood depression occurs with psychotic symptom

161

bipolar with psychotic features(2)

when the patient is manic ,psychotic features occur
when the patient is ok no psychotic features

162

quid of autism(3)

children perform stereotyped behavior
no emotionnla bonds with others
participation in restricted activities

163

age of onset of autism

before 3 yo

164

patient thinking he has special power

grandiose delusion

165

dx of bipolar

elevated or irritable mood with 3 or more of this
DIGFAST

166

quid of DIGFAST in bipolar disorder

D=distractibility
I=impulsivity
G=grandiosity
F=flight of ideas
A=activity
S=sleep need decreased
T=talktiveness or pressured speech

167

quid of hypomanic episode(3)

less severe than bipolar
symptoms > ou egal a 4 consecutives days
no psychotic features

168

can you have psychotic features in bipolar

yes

169

quid of bipolar type 1

manic episode
plus
depressive episode

170

do you require depressive episode in bipolar type 1

no

171

quid of bipolar type 2(2)

hypomanic episodes
you must have 1 day or more of depressive episodes

172

differenciate type 1 bipolar from type 2(2)

in type 1 no depressive episode is needed
in type 2 you need at one episode at major depression

173

quid of cyclothymic disorder

2 years of fluctuating mild hypomanic and depressive symptom

174

what to suspect in children with sudden behaviral changes

physical or sexual abuse

175

risk factor of sexual abuse or physical abus(2)

parent with unstable economic backgrounds
parent with history of drugs or alcohol abuse

176

quid of response during rx in psychiatry

50% reduction in the baseline level of severity

177

quid of remission during rx in psychiatry

absence of Symptom or minimal symptom

178

quid of sustained remission during rx in psychiatry

stabilisation of patient's symptom

179

quid of recovery during rx in psychiatry

episode is over

180

quid of reccurence during rx in psychiatry

after recovery symptom reappears

181

quid of relapse during rx in psychiatry

during sustained remission symptoms reappears

182

patient with schizophrenia says he is hearing voice telling her to do bad thing.he has a history of suicide attempt 10 years ago ,the patietn refuses to be hospitalised next step

hospitalise the patient involuntarily

183

telling her to do bad thing.he has a history of suicide attempt 10 years ago ,the patietn refuses to be hospitalised ,why you should hospitalise this patient involuntarily

he is a danger for himself and other

184

what medication ingestion contrindicated consumption of meat and aged cheese and why(2)

phenelzine
risk of icrease of blood presure

185

quid of phenelzine

monoamine oxydase inhibitor

186

patiet 16 yo with attempted suicide next step

hospitalisation

187

anxiety restricted to social or performance situations

social anxiety

188

young girl with no close friend during interview the patient says nobody wants to be friend of someone ugly and stupid like me dx

avoidant pesonality disorder

189

quid of body dismorphic disorder

it's an obsessive compulsive disorder

190

what to in case of body dismorphic disorder(4)

continue to meet regularly to discuss concerns of the patient
psychoterapy
SSRI
referral to a psychiatrist

191

Quid of body dismorphic disorder

preoccupation with at least one perceived physical detect

192

quid of most likely cause of tardive dyskinesia

risperidone

193

common manif of tardive dyskinesia(9)

face grimacing
chewing
biting
tongue protrusion
torticolis
shoulder shruugging
respiratory grunting noises
rocking and swaying
rotary hip movements

194

limb abnormality in tardive dyskinesia(4)

limb twisting and spreading
piano playing finger
foot tapping
dystonic extension of the toe

195

next step in rx tardive dyskinesia

stop risperidone
begin clozapine

196

side effect of clozapine

agranulocytoiss

197

in cae of suicidability what patient should be hospitalised(2)

patient with ideation
intent and plan

198

suicidability with no plan next step(3)

rx underlying depression
family support
reduce access to potential means

199

rx of performance only social anxiety(2)SAD

Bblocker
or
benzodiapines

200

rx used in Generalised social AD and SAD

CBT

201

how to give propranolol in anxiety provoking situation

30-60 mn before the act

202

quid of generalised social anxiety disorder

anxiety in meeting new people
initiating or maintaining conversation

203

rx of generalised social anxiety disorder (2)

CBT
SSRI

204

2 types of social anxiety

performance only
generalised

205

indication of buspirone

generalised anxiety social disorder

206

what about CBT in social anxiety compared to drug

equally efficace

207

tetrad of alzheimer(5)

memory impairment
apraxia
aphasia or language dysfunction
agnosia
you can have 2 of them

208

quid of agnosia

difficulty recognizing object

209

quid of apraxia

difficulty carrying out activities

210

what should be done before making the dx of alzheimer

rule out any medical causes of cognitive decline

211

the best way to break bad news(2)

use a symptom to ask the question
what do you think is going on with your back pain for example

212

steps to prepare meeting with family to break bad news

SPIKES

213

quid of SPIKES(6)

S=set up situation
P=perception of the family is assessed
I=obtain family Invitation,how much info they need to know
K=give knowledge and information
E=use empathic statements
S=staregy and summary

214

clue for panic attack(4)

suddeny you have a patient with
palpitation
chest pain and
diaphoresis

215

first thing to do in patient with palpitation chest pain and diaphoresis(2)

EKG
drug screening

216

acute rx of panic attack

benzodiazepine

217

long term rx of panic attack

SSRI

218

gender involved in panic attack

woman

219

you receive le fils d'une femme avec dx of de cancer .Le fils vous demande to withhold the dx to his mother what to do

is there a specific reason you don't want your mother to know the DX

220

quid of trichotillomania

it's an OCD

221

rx of trichotillomania

CBT

222

reaction of pain ,distress after the loss of a close relationship pendant

greaf of bereavement

223

normal laps of time to speak of greaf bereavment

about 6 months

224

complication of greaf bereavment

major depression

225

rx of greaf bereavment(2)

SSRI
plus
psychoterapy

226

first line rx of OCD(2)

SSRI
or
clomipramine

227

patient with bruises on body come to clinic when physicians saks on bruises patient start crying dx and next step(2)

tell me more about the bruises on your body
physical abuse

228

rx of withdrawal alcohol seizures

long acting benzodiapines

229

quid of long acting benzodiapines(3)

diazepam
lorazepam
chlordiazepoxide

230

action of long acting benzodiazepines in rx withdrawal seizures

stimulate gamma aminobutyric acid receptor causing sedation

231

quid of alcoholic in USMLE

6-10 beers /day

232

indication of disulfuram (antabuse)

to maintem long term abstinenece in alcoholic patients

233

rx of alzheimer dementia

initiate cholinesterase inhibitor

234

example of cholinesterase inhibitor(3)

donepezil
galantamine
rivastigmine

235

children with motor tick =grimacing,blinking shouldeer shrugging
vocal tick barking grunting coughing and throat clearance dx

tourette syndrome

236

complication of tourette(2)

hyperactivity disorder
OCD

237

patient with insomnia and use of caffeine alcohol and nicotine especially at the period preceding sleep,engaging to activities too close to bed time ,use of the bed for other activities cause of imsomnia

poor sleep hygiene

238

risk for survivor of sexual assault(3)

PTSD
depression
suicidability

239

quid of narcolepsy(2)

daytime drowsiness
plus
cataplexy

240

quid of cataplexy

sudden loss of mx tone triggered by strong emotions

241

rx of narcolepsy

modafinil
or
amphetamine stimulants

242

preferred drug in narcoplepsy

modafinil also called provigil

243

measure in narcolepsy(3)

avoid alcohol
maintain proper sleep schedules
avoid drugs causing drowsiness

244

what to do if an employer asks to hospital information on hospitalised patient what you need to do that

verbal or written autorization from patient

245

what to do if an employer asks to hospital information on hospitalised patient with patient's autorization(2)

disclose only minimal necessary information
i can confirm the patietn is hospitalised and i anticipate he will be able to return to work

246

indication of methylphenidate

hyperactivity disorder

247

side effect # 1 of methylphenidate

decreased appetite

248

contrindication of methylphenidate

children less than 6 years

249

common side effect of methylphenidate(3)

abdominal pain
insomnia
nervousness

250

quid of dysthimia

depressed mood for at least 2 years

251

differenciation between dysthimia and major depression

in dysthimia you have the same symptom than major depression but less severe and longer duration

252

patient rx with sertraline for major depression accuses improvement next step?

continue medication for 6 months

253

rx of simple episode of depression duration

6 mois rx

254

in multiple episode of major depression duration of rx

continue maintenance rx for a long time

255

patient with manic episode has been on rx for 6 months for a prior manic episode develops manic episode next step(2)

initiate antipsychotic
recommend hospitalisation

256

any patient on lithium and develops manic episode next step(4)

hospitalisation
antipsychotic plus moodstabilizer
urine toxicology
mood stabilizer drug levels

257

patient 60 ans with colon cancer refuses rx next step

ask the patient why he doesn't want rx and intervention of any kind

258

what to do if a patient refuses rx

it's important to fully discuss the specific reasons for the decision before honoring it

259

patient has seen many doctors for symptoms but all tests are negative ,she comes to you and asks for CT abdominal scan what to answer ?

i would like to see you at a follow up visit to evaluate your symptom again before deciding the ct scan

260

why patient with somatisation should be seen at follow up visit for further evaluation

because they have to be seen in regular scheduled visits that focus on psychological distress associated with their symptoms

261

patient comes to the hospital for severe haeadache despite of extensive follow up he is sure he has cerebral hemmorrage dx

hypochondriasis

262

next step after dx hypochondriasis

initiate discussion about current emotionnal stressors

263

why you shoud initiate discussion about current emotionnal stressors in case of hypochondriasis

because the symptom will develop in stressfull period

264

rx of hypochondriasis

brief psychotherapy

265

clue for amphetamine intox(8)

agitation
excitability
delirium
paranoia
tachycardia
hta
mydriasis
diaphoresis

266

complication of amphetamine intox(4)

cardiac arythmia
seizures
hyper thermia
intracerebral hemorrage

267

what differentiate amphetamine intox from anticholinergic poisonning intox(5)

same symptom sauf
dry skin and mucous membranes
ileus
retention d'urine
tremor and myoclonic jerk favors anticholinergic

268

patient with low mood but no impairement of daily functionning dx

normal stress response

269

conversion disorder quid

neurologic symptom after a stressor event

270

most common presentation of conversion(4)

weakness
paralysis
seizures
but normal neurologic exam

271

first line rx in conversion

education

272

second line rx in conversion

CBT

273

2 ways of presentation of conversion

hysterical
indifferent

274

sleep pattern in older people

they tend to frequently awaken from sleep and spend less time sleeping overall

275

persistent complex bereavment syndrome

symptom last more than 12 months followiing the loss

276

In USMLE anytime you see death what to rule out

breavement syndrome

277

exposure to lithium during first trimester of pregnancy

cardiac malformation

278

what are the 2 cardiac abnormalities seen in litium during pregnancy(2)

septal defect
ebstein anomaly

279

quid of ebstein anomaly

malformed and inferiorly atached tricuspid valve causing a part of the right ventricle to become part of the right atrium

280

Ebstein

atrialisation of the right ventricle

281

complication of lithium on baby during 3 e trimestre de la grossesse(2)

goiter
transient neuromxar dysfunction

282

rx of tourette(3)

first generation antipsychotics
pimozide
haloperidol
fluphenazine

283

second line rx of tourette(2)

atypical antipsychotics
risperidone

284

quid of tourette syndrome

multiple motor and vocal ticks for 1 yaer

285

should you have vocal ticks and motor ticks together for tourette

no you can them separately

286

first rx for tourette

risperidone

287

quid of narcistic personality disorder

exaggerated senseof self importance feelings and entitlement egocentrism and lack of empathy to others

288

indication of electroconvulsive rx(5)

severe depression
depression in pregnancy
refractory mania
NMS
catatnic schizophrenia

289

adverse effect of electroconvulsive rx(6)

prolonged seizures
delirium
skin burns
amnesia
headache
nausea

290

most common side effect of electroconvulsive rx

amnesia

291

quid of factitious disorder

patient induces symptom to play the sick role

292

example of factitious disorder

patient taking insulin

293

munchausen syndrome

patient playing the sick role in order to get surgery

294

complication in baby with mother suffering from anorexia nervosa

small of gestationnal age baby

295

anomaly in anorexia nervosa in patient(6)

osteoporosis
increase cholesterol and carotene levels
cardiac arythmia
euthyroid sick syndrome
hyponatremia
hypothalamic pituitary axis dysfunction


296

cardiac arythmia seen in anorexia nervosa

prolonged QT syndrome

297

anorexia nervosa and hypothalamic pituitary axis dysfunction(3)

amenorrhea
anovulation
estrogen deficiency

298

why hyponatremia in anorexia nervosa

excess of water drinking

299

why you can have many electrolytes disturbances in anorexia nervosa

because of purging behavior

300

complication of pregnancy in anorexia nervosa(6)

miscarriage
intrauterine growth retardation
hyperemesis
premature birth
cesarean section
post partum depression

301

quid of antisocial personnality disorder

patient 18 ou plus engages in illegal activities and disregard rights of others

302

what to monitor in all patietns taking clozapine

WBC

303

why monitor WBC in patient taking clozapine

to rule out agranulocytosis

304

other side effect of clozapine

lower seizure treshold

305

rs of alcohol withdrawal syndrome

diazepam

306

patietn asking to see doctor after time of closing office for sore in the mouth what to do(2)

politely and firmly refuses to see the patient and schedules her for tomorrow
although i undestood your concern we should address the issue tomorrow because it's not an emergency

307

quid of somatisation

symptom more than 6 months with disruption of daily life

308

quid of illness anxiety disorder

prolonged fear and concern about getting or having a disease but with minimal or no actual physical symptom

309

children verbal and talkative at home but refuses to speak in specific settings generally at school dx

selective mutism

310

patient presenting with sudden palpitations sweating trembling or shaking shortness of breath and hot and cold sensations dx

panic disorder

311

disease associated with panic disorder(4)

major depression
agoraphobia
bipolar
substance abuse

312

risk in patient with panic attack

suicide

313

abnormal imaging associated with schizophrenia

enlargement of cerebral ventricles

314

abnormal imaging associated with autism

increase total brain volume

315

abnormal imaging associated with OCD

abnormalities in orbitofrontal cortex and striatum

316

abnormal imaging associated with PTSD

decrease volume of amygdala

317

which ventricle is enlarged in schizophrenia

lateral ventricle

318

hiv positive woman is terrified by her lab result she has trouble telling that to her husband what to say

encourage the patient to tell her husband but tell her you to inform the local health department

319

what will do the local health department in hiv case

departement health will call the husband to him he is at risk of hiv without telling him about the person who placed him at risk

320

patietn with caught his girlfriend cheating on him he develops worthless,sleep problem all began 2 months after the rupture dx(2)

adjustement disorder
it's not depression

321

rx of adjustment disorder(2)

psychodynamic psychotherapy
brief cognitive psychotherapy

322

quid of adjustment disorder

emotionnal or behavioral symptom that develops within 3 months of exposure to an identifiable stressor

323

quid of rationalisation

an immatire defense mechanism characterised by excusing an unacceptable behavior in a false but logical way to avoid the true reasons for the behavior

324

a woman noticed a mass in a breast but resolved not to see a doctor.when asked why she made this decision she replies:i didn't want to have a bunch of appointment when i should be helping my children with homeworkwhat mechanism is used to explain why she didn't come to see doctors

rationalisation

325

clue for EPS type parkinsonian(4)

walk much slower
not swinging arms
facial expressions flat ,unchanged
micrographia

326

rx for EPS

benztropine

327

indication of CBT(3)

overgeneralisation of negative events
catastrophising
maximizing negative events

328

when CBT can be used(5)

anxiety
mood problem
personality problem
somatic symptom
eating disorder

329

how many sessions of CBT is recommnaded

12

330

indication to place a patient in a hospice care

patient with prognosis less than 6 months

331

what are the focus in hospice care(5)

symptom control
quality of life
psychosocial
spiritual
bereavment care

332

rx of meningococcemia(3)

isolation
IV antibiotics
supportive care

333

can a patient refuse the rx of meningococcemiaand why(2)

no
because he could be pose a threat to the health and welfare of others

334

patient comes in hospital for symptom she has last week and asked to see the same doctor in private without the nurse,she comes with no appointment what to do

ask the receptionnist instruct the patient to shedule an appointment during normal office hours

335

rx of specific phobia first line

CBT

336

second line rx of specific phobia

benzodiazepines

337

what they do during CBT

exposure technique

338

quid of phobia

fear of specific object or situation

339

strongest indication for a future suicide in patient with psychiatric disorder

previous suicide attempt

340

indication for suicide(8)

preexisting psychiatric disorder
hopelessness impulsivity
never married
elderly white men
unemployed or unskilled
physical illness
family history or genetics
family discord

341

protective fgactors against suicide(4)

social support/family connectedness
pregnancy
parenthood
religion and participation in religious activities

342

the greatest risk to attempt suicide in future

past history of suicide attempt

343

what must be present for the dx of major depression(2)

low mood or anhedonia
plus
SIGECAPS

344

duration of symptom to dx major depression

two weeks or more

345

what the most important element to dx grief(2)

loss
emptyness

346

dx depression

5 on 9 depressive symptoms which at least 2 weeks
at least one is depressed mood or looss of interest/pleasure

347

reaction formation

transformation of an unwanted thought or feeling into it's opposite

348

woman is angry because of increasing number of immigrants asking for job,he volunteers to help immigrant families by offering vocationnal guidance to find job DX

reaction formation

349

patient with creat 1,9 and bipolar what medication can be given in long term rx (as mood stabiliser )of the patient

acid valproic

350

bipolar and renal failure

no lithium

351

in major depression evaluation what should be screened

suicidal ideation

352

if suicidal ideation is present during major depression evaluation what should be done

hospitalisation

353

helpful measure in schizophrenia

keep family stresses and conflicts to a minimum

354

what about school during schizophrenia

gradual return with a reduced schedule would be more appropriate

355

patient seen in clinics but refuses to speak,her husband is with her but replies to all the question during interview next step

ask the husband to step out the room and then try to speak to the patient

356

what types of question patient can have difficulty to answer in front of family members(3)

question regarding
drug use
sexual history
domestic violence

357

clue for marijuana intox(3)

increased appetite
impaired perception
conjunctival injection

358

clue for PCP intox

nystagmus

359

type of drug PCP is

hallucinogen

360

clue for LSD intox

visual halucinations

361

complication of cocaine(2)

chest pain
seizures

362

clue heroin intox(3)

deressed mental status
miosis
respiratory depression

363

what type of drug is heroin

opioid

364

type of drug is marijuana

psychoactive drugs

365

gynecomastia in use of cannabis meaning?

chronic use

366

what test shold be done before initiating lithium rx(2)

creatinine
thyroid function

367

complication of lithium(3)

nephrogenic insipidus diabetes
hypothyroidism
ebstein anomaly in fetus

368

neurologic action of lithium

inhibit inositol 1 phosphatase in neuron

369

why headache is important in psychiatry

could be indicative of depression in elderly

370

can you physical symptom in depression

sometimes patient with depression comes to see you with physical symptom

371

drugs causing halluciantions and combative behavior

Phenylcyclidine

372

drugs causing hallucinations and intensified perceptions

PCP and LSD

373

what are the 3 A for negative symptoms(3)

asociability
alogia
affective flattening

374

SIGECAPS

S=sleep
I=interst
G=guilt
E=energy
C=concentration
A=appetite
P=psychomotor
S=suicidability

375

teens you can rx without parents consent(4)

contraception
prenatal care
substance abuse
STD

376

drugs used in depression and smoking cessation

bupropion

377

druds used to rx all forms of anxiety and fright disorder

SSRI

378

if father ,or sibling or dizygotic tween or first degree relative twin has schizophrenia what's the probability to progeniture to have it

5 a 10 %

379

twin monozygotic has schizophrenia what the probility of having it in other twin

70%

380

a child with both parents schizophrenic what the probability for the child to have it

60%

381

schizophrenia probability in the general population

1%

382

the 3 manif of extra pyramidal syndrome

acute dystonic reaction
akathisia
parkinsonism

383

symptom in acute dystonic reaction

neck rigidity

384

symptom in acute akathisia

restlessness

385

rx of akathisia

propranolol

386

rx of parkinsonism(2)

amantadine
or
anticholinergic

387

hallmark of NMS(3)

hyperthermia
rigidity
autonomic instability

388

complication of NMS

rhabdomyolysis

389

rx of NMS(3)

dantrolene
or
amantadine
or/and dopamine agonist

390

rx of anorexia nervosa

olanzapine

391

rx of bulimia

SSRI

392

quid of russel's sign(2)

cicatrices and calluses over the hand
seen in anorexia nervosa

393

triad of anorexia nervosa(3)

low BMI

394

first thing to do if child abuse is suspected

complete physical examination

395

second thing to do if child abuse is suspected

skeletal survey

396

third thing to do if child abuse is suspected

coagulation profile

397

4e thing to do if child abuse is suspected

child protective services

398

5e et 6 e thing to do if child abuse is suspected(2)

hospitalisation if necessary
consultation with a psychiatrist

399

patient with depression develops HTA crisis while eating cheese what drug is he on

phenelzine

400

substance containing tyramine and hta crisis during depression if patient is taking phenelzine(2)

meat
cheese

401

indication of cl0zapine in hospiatalised patietn with schizophrenia(2)

treatment resistant schizophrenia
schizophrenia associated with suicidability

402

adverses effect of clozapine(4)

agranulocytosis
seizures
myocarditis
metabolic syndrome

403

patient with delusion or hallucinations ask you if you believe him the best answer to give him

i know your experienc ehas been difficult for yo.Let's see what we can do to help u

404

approach the patient with delusions(2)

acknowledge the patient distress
without endorsing specific delusions or halucinations

405

first line regimen in psychosis

second generation anitpsyhotics

406

patient foud by police wandering in the street .whe askin what she fels she answers"jingle jangle " doctor dx

psychosis

407

patient hospitalised three months later for psychosis come to see you with erectile dysfunction and gynecomastia what cause that and physiopatho

hyperprolactinemia caused by antopsychotics
reason=decreased or blackade of dopamine activity in the tuberoinfundibular pathway

408

kid 5 yo talking to herself.She says she has a friend called Mindy dx

imaginary friends

409

what to do in case of imaginary friends(2)

nothing
imaginary friend is outgrown by the early elementary school years