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Flashcards in step 3 6 Deck (57):
1

new name for hypochondriasis

illness anxiety disorder

2

anorexia mgmt

olanzapine
SSRIs + psychotherapy

3

intermittent explosive disorder vs disruptive mood dysregulation disorder

with intermittent they return to normal mood, in disruptive, patients do not

4

treatment of pathologic gambling

group psychotherapy (gambling anonymous)

5

workup for any signs of drug use

HIV
Hep B and C
PPD

6

answer to question describing a patient with alcohol abuse

UDS
Check LDH, GGTP, AST/ALT

7

wernicke-korsakoff management

Thiamine IV
B12
Folate
magnesium

8

alcohol withdrawal management

CIWA protocol for benzos PO or IV
diazepam 5-10 mg IV repeat q5-10 minutes until symptoms controlled, goal to sedate until patient is calm but alert.
If cirrhotic or alcoholic hepatitis ---> use ativan or oxazepam (serax)
when benzodiazepine doses reach 15-20 mg lorazepam IV per hour --> consider adjunctive therapy with clonidine 0.3 mg po q6h or haldol 0.5 – 1.0 mg IV q4h if delirium and psychotic features are present
qAM BMP
mag
phos
Ativan 2 mg PRN for seizure lasting longer than 5 minutes
IV access
IVF
Thiamine 100 mg daily IV
Folate 1 mg daily
MVI 1 tab/day either PO or IV starting immediately on admission and continuing for the length of their stay
Put in quiet, protective environment
IF severe liver disease → use short acting benzo, lorazepam or oxazepam

9

alcohol dependency management

Refer to inpatient rehabilitation or outpatient group therapy (AA)
If receiving psychotherapy, give Naloxone or acamprosate .

10

delirium tremens window

48-96 hours after last drink

11

cannabis withdrawal presentation

irritability, difficulty sleeping, depression, fevers, nausea, vomiting

12

paraphilia treatment

psychotherapy + aversive conditioning

13

voyeurism

watching UNSUSPECTING person having sex or naked

14

frotteurism

recurrent urge or behavior involving touching or rubbing against a nonconsenting partner

15

PMS treatment

CBT + SSRI

16

AMS in ED orders

Standard lab orders below → naloxone + thiamine + dextrose + O2/NS → UDS

17

benzo management

verify but don't give flumazenil, may precipitate a seizure

18

management of digoxin OD

digoxin-binding antibodies

19

organophosphate antidote

atropine, pralidoxime

20

ASA overdose labs

CBC
chemistry panel
ABG
PT/INR/PTT
Salicylate level

21

ASA overdose treatment

sodium bicarbonate
charcoal

22

diagnostic labs for generic overdose

UDS
CBC, chem-7, UA
ASA level
Acetaminophen level
ETOH level

23

digoxin toxicity

halos around objects and blurred vision
GI disturbance
encephalopathy

24

causes of methemoglobinemia

nitroglycerin, anesthetics, dapsone, drugs ending in caine (lidocaine, benzocaine, bupivicaine)

25

cause of NMS

Any medications within the family of neuroleptics can cause the condition, though typical antipsychotics appear to have a higher risk than atypicals

26

settings of organophosphate poisoning

crop duster/insecticides
nerve-gas

27

organophosphate poisoning treatment

atropine
pralidoxime
remove clothes and wash rest off the patient

28

first step in TCA overdose

EKG

29

black widow spider bite presentation

severe abdominal pain, rigidity, hypocalcemia, no tenderness

30

brown recluse bite

necrotic, bullae, dark lesions

31

brown recluse bite treatment

debride the wound

32

rabies treatment

immune globulin + vaccine

33

signs of respiratory injury in burns

hoarseness
wheezing
stridor

34

burn management

assess for respiratory compromise → intubate → if no respiratory compromise give fluids at 4 mL of LR or NS for each kg

35

first step in hypothermia mgmt

EKG

36

first step in acute angle closure glaucoma mgmt

pilocarpine drops

37

retinal detachment management

consult opthalmology, dilated retinal exam

38

uveitis treatment

steroids

39

uveitis presentation

photophobia

40

first step in managing mentally intact patient refusing treatment

try to discuss it with patient

41

emancipated minor

living independently, self-supporting, married, in the military

42

partial emancipation

sex
reproductive health
substance abuse

43

cases in which minors can make decisions

sex, reproductive health, HIV, prenatal care, STDs

44

requirements of informed consent

benefits, risks, alternatives, intelligible language, specific to procedure

45

consent in emergencies?

assumed unless prior wishes are known

46

when you can break patient confidentiality

someone else is at risk (transmissible disease (TB, HIV, syphilis, gonorrhea)
- psych patient trying to hurt someone

47

health care proxy meaning

both an appointed agent AND a document

48

living will utility

useless unless it specifically states interventions patient does not want

49

when to consult ethics committee

1) no capacity and no clearly stated wishes on the part of the patient
2) family is split on nature of care

50

response to patient requesting futile care

you can deny it, you are under no obligation to provide futile care

51

abortion minutiae

unrestricted in first trimester, grey area in second, illegal in third

52

gifts are fine when

small and not tied to specific treatments and tests

53

sexual contact

illegal between psychiatrists and patients, must end doctor-patient relationship for others

54

who to report impaired faculty to

department chair or dean of medical school

55

who to report impaired physicians too

state medical board of office of professional medical conduct

56

when to report physicians

only when patients are at risk of harm

57

GERD management

Start with H2/RA
If uncontrolled → PPI lowest effective dose, try to wean back to H2/RA, with goal to wean entirely off PPI
IF RF’s (men, smoker, obesity, age greater than 50)
Symptoms >5-10 years = surveillance endoscopy for barrett esophagus