UW2 Flashcards
(140 cards)
1
Q
Name 3 MAOI’s
A
Phenelzine, Tranylcypromine, and selegiline
1
Q
What may be a CC in a woman with AE from antipsychotics affecting the tuberoinfundibular pathway?
A
Secondary Amenorrhea
1
Q
What is required for delusional disorder?
A
Presence of NONBIZARRE delusions for > 1 month
1
Q
Pts with a FMHx of _____ are at increased risk of trichotillomania? Tx?
A
OCD (ego dystonic); CBT
1
Q
What is the mgmt of mucormycosis?
A
Surgical debridement and amphotericin B (look for in DKA, leukemia)
1
Q
When should pts technically get vaccinated perioperatively for splenectomy
A
14 days prior or 14 days after (HiB, pneumococcus, and meningococcus)
2
Q
What is the major AE of azathioprine?
A
Dose related diarrhea
3
Q
What is the best immediate mgmt of frostbitten extremity?
A
Rapid re-warming with warm water; NO IMMEDIATE ATTEMPT AT DEBRIDMENT
4
Q
What is the greatest risk factor for completing homicide
A
Access to GUNS
4
Q
How do you treat acute mania?
A
Antipsychotic plus a mood stabilizer because faster onset than mood stabilizer alone! Then taper off the antipsychotic
5
Q
What is required to dx adjustment disorder?
A
Development of emotional or behavioral sx WITHIN 3 MONTHS of identifiable stressor (not go longer than 6 months)
6
Q
What are some tests you should order prior to starting lithium?
A
BMP (for kidneys, i.e. serum creatinine), TFT’s for baseline thyroid fxn, and B-hCG if a woman to prevent Ebstein’s
6
Q
What are the 2 major types of acute dystonic rxn
A
Torticollis and oculogyric crisis
6
Q
What do you do in a pt with newly dx’d cirrhosis and nonbleeding varices who also has asthma?
A
Endoscopic variceal ligation because cant give nonselective BB
6
Q
What is MOA of cyclosporine and what is the MC AE?
A
Inhibits transcription of IL-2; nephrotoxicity (can also cause gum hypertrophy)
6
Q
What is the MC electrolyte in Addison’s?
A
HYPONATREMIA, but hyperkalemia is prob the one you’ll pick up on in a question
6
Q
How do you manage acute exacerbations of MS? What if no response?
A
Glucocorticoids; Plasmapheresis
6
Q
Why may a person with heat stroke bleed?
A
There can be coagulopathic bleeding likely from denaturation of the proteins
6
Q
What can you do for pts with symptomatic cholelithiasis who don?t want surgery?
A
Ursodeoxycholic acid and avoid fatty foods
6
Q
Where is the MC site of lacunar infarct? What would this cause?
A
Posterior limb of internal capsule; pure motor stroke (i.e. due to htn and small vessel lipohyalinosis)
7
Q
What do you call factitious disorder when the pt is willing to consent to invasive procedures?
A
Munchausen syndrome
8
Q
What is the best course of action when a patient is having command auditory hallucinations?
A
Hospitalize the patient involuntarily ESPECIALLY if telling the pt to hurt self or others
8
Q
What is the timeline for brief psychotic disorder, schizophreniform, and schizophrenia?
A
Brief psychotic = less than a month; schizophreniform less than 6 and schizophrenia is after 6
8
Q
Ketamine and PCP both cause what physical sx? What class of drug?
A
Nystagmus, arylcyclohexamine
8
What should be suspected in pt with COPD who has catastrophic worsening of their COPD?
Ruptured apical bleb (i.e. pneumothorax)
9
How should pts with folie a deux be interviewed?
SEPARATELY (shared psychotic disorder)
9
What is the major AE of mycophenolate mofetil?
BM suppression
9
What may you want to think about in a pt with chronic cough productive of mucopurulent sputum?
Bronchiectasis (check CT)
10
What can be seen on neuroimaging for OCD?
Orbitofrontal cortex and striatum abnormalities
12
When do you surgically remove brain mets vs. whole brain radiation
Solitary met = surgery; Many mets = whole brain radiation and need to watch for herniation
13
What is required to dx schizoaffective disorder?
2 weeks of psychotic sx in the absence of mood sx (need to rule out primary mood disorder with psychotic features)
14
What drugs are used acutely for panic attacks? What are used long term?
Benzodiazepines; SSRI
15
What enzyme is inhibited by lithium?
Inosotol-1-phosphatase in neurons
15
Which personality disorder had chronic feelings of emptiness?
Borderline personality
15
What bug is most likely to be isolated from a secondarily infected allergic contact dermatitis?
CoNS
16
In whom do you commonly see otosclerosis?
Young adults 20-30's, conductive hearing loss
17
Why can chronic NSAID use cause hyponatremia?
NSAIDs potentiate ADH and can lead to SIADH
18
Why do anorexics often need to be hospitalized?
Due to dehydration or electrolyte imbalances and to monitor for sx of refeeding syndrome
19
What is the general mgmt for schizoaffective pts?
Antipsychotic + whatever they need for mood i.e. SSRI if depressed, lithium or mood stabilizer if manic
19
Which benzo is preferred in preventing DT in a pt with cirrhosis?
Lorazepam because renally excreted (hope they don?t got dat hepatorenal syndrome doe!)
20
Why may hairy cell leukemia cause a dry tap?
It induces bone marrow fibrosis and myelophthisic process leading to the extramedullary hematopoiesis that causes the characteristic splenomegaly
22
What do you do if you suspect ischemia but EKG is normal
Stress EKG
23
What risk do valproate and carbemazipine pose to the fetus?
Neural tube defects
23
Tx of antipsychotic induced parkonsonism?
Benztropine
25
What is the mgmt of choice for generalized anxiety disorder?
SSRI and cognitive behavioral therapy (avoid benzo's b/c substance abuse)
25
What is the MC cause of constrictive pericarditis in a foreigner? US?
TB; pmhx radiation
27
What is the immediate tx of NMS?
DC the antipsychotic and give dantrolene, monitor in ICU (more nurses per pt, better monitoring)
28
What is a major AE of giving recombinant EPO in pts with CKD induced anemia?
Worsening of HTN; also if low iron stores it will precipitate a microcytic anemia
30
Which EPS is not primarily treated with benztropine?
Neuroleptic malignant syndrome, requires dantrolene!!! Also acute dystonic rxn can be txd with diphenhydramine or benztropine; Tardive not really fixable
31
What is the significance of Streptococcus gallolyticus?
i..e S. bovis can cause endocarditis in setting of CRC, do colonoscopy
32
What are the lights criteria
1) pleural fluid protein:serum protein \> 0.5 2) Pleural LDH:Serum LDH \> 0.6 or 3) Pleural LDH \> 2/3 upper limit of normal of serum LDH
33
What is the significance of Clostridium septicum?
It is a normal gut flora and in CRC it can get into blood stream and cause a spontaneous gas gangrene secondary to hematogenous spread; treat and do colonoscopy
34
How do you treat exertional heat stroke?
Rapid cooling and supportive mgmt (don?t think it?s the same for nonexertional, i.e. old ppl)
35
In acute mania if you had to choose between an antipsychotic and a mood stabilizer which would you pick?
Antipsychotic because it kicks in faster; in reality you give both for acute mania and taper off of the antipsychotic
35
What should all pts with hypothyroidism be screened for?
HLD; And all pts with HLD should be screened for hypothyroidism! (Recall Dr. John: hypothyroidism accelerates atherosclerosis, hyperthyroidism potentiates osteoporosis)
37
Why shouldn?t you give antipsychotics to ppl withdrawing from alcohol?
Lowers the seizure threshold
39
What is the best way to guide abx therapy in pts with acute bacterial prostatitis?
Obtain a midstream urine sample for bacteria and guide based on Cx
40
Which antipsychotic is least likely to cause EPS?
Clozapine but limited by risk of agranulocytosis
41
Which is synpharyngitic, IgA nephropathy or post-streptococcal GN?
IgA nephropthy (IgA in mesangium)
43
For whom is clozapine reserved for?
Pts who have failed 2 antipsychotics or who have suicidal thoughts
44
With which personality disorder is malingering heavily assoc?
Antisocial personality disorder
44
What is dissociative fugue?
They have to travel and they have to forget who they are
46
How is lithium cleared from the body?
Renally, that?s why its important to check creatinine prior to starting
48
What is the most common AE of ECT?
Amnesia (retrograde or anterograde)
49
Which SSRI has longest half life
Fluoxetine
50
What is maintenance therapy for bipolar after 1st bipolar episode? 2nd?
AT least 1-2 years; lifetime
51
When is colonoscopy screening for CRC indicated in UC?
8 years s/p dx and then repeat every 1-2 years
53
What sx preceding a liver abscess point you towards E. histolytica? Tx?
Bloody diarrhea; metronidazole
54
What is DOC for atypical depression?
MAOI's
56
What TCA is used for tx of OCD?
Clomipramine
56
What is the best tx for noncompliant schizophrenics?
Long-acting injectable! ONLY if they were treated but noncompliant not if they were refractory
58
What is the most critical first step for lactic acidosis in shock?
IV NS
59
A very low pleural fluid pH likely indicates?
Empyema
61
When can bicarb be used in acidosis?
Rarely only if pH
62
What are 3 psych drugs that can cause agranulocytosis?
Clozapine, carbamazepine, and mirtazepine
63
Where do you see the double duct sign?
Pancreatic CA
64
What is the preferred stimulant for narcolepsy?
Modafinil (and regularly scheduled naps)
66
How long should you wait prior to starting an SSRI after discontinuing an MAO-I
4 weeks to prevent serotonin syndrome (Tx = dantrolene, cyproheptadine)
67
Does a schizophrenic patient who is not acutely psychotic have decision making capacity for surgery?
Absolutely!
68
What is the major difference between avoidant personality and schizoid?
Avoidants desire to have friends whereas schizoids do not
68
What is the mgmt of 1st degree AV block? PR length?
Observation (no real clinical significance); PR \> 200
70
What characterizes the autism spectrum disorders?
Impairments in communication and social interaction with repetitive/stereotyped behaviors and abnormal reactivity to sensory input
72
What are 3 types of delusions?
Paranoid, grandiose, or somatic (fixed false beliefs that DO NOT respond to reason)
74
What effect do OCD and OCPD have on ego?
OCD is ego dystonic, bothers them; OCPD is ego syntonic, they have no idea
74
Why cant you give bupropion with MAOI's
Serotonin syndrome
75
What is first line tx for OCD?
SSRI or clomipramine (TCA) and CBT
76
What kind of meds often precipitate hepatic encephalopathy?
Sedative medications like benzos (contraindicated!) or hydrocodone
77
When do terminal patients need SSRI's?
If they meet criteria for MDD, i.e. not just normal grieving but hit 5 SIGECAPS
79
What is the cause of scabies
Sarcoptes scabeii
80
What does heroin withdrawal present like?
RHINORRHEA, sweating, muscle aches with severe sx OOP to physical findings
82
What is the best tx for akithisia?
Benzodiazepine
83
What do you do if a cervical LN is positive for SCC?
Triple endoscopy = EGD, laryngoscopy, and bronchoscopy
85
What should all pts with a nonprovoked first seizure get?
Non-Contrast CT of head to r/o bleeding
86
How long should you wait prior to switching SSRI's if one doesnt seem to be working?
4-6 weeks
87
What should a pt with renal dysfunction and bipolar receive?
Valproate? NO LITHIUM
89
what are the EKG findings of ventricular aneurysm?
Q waves and persistent ST elevation
91
What causes renal papillary necrosis in sickle cell?
The hypoxic renal medulla can cause sickling of RBCs' and can cause papillary necrosis; predisposes to renal medullary CA
93
What should you use to manage HTN in a pt presenting acutely with weight loss and erythema of the septum and nasal turbinates?
CCB's for cocaine overdose, BB's can lead to unopposed alpha
94
What is the best thing to do if a healthcare proxy disagrees with a living will?
Meet with BOTH the healthcare proxy and the family to have a meeting
95
Crystal-Induced nephropathy is a well known AE of what AIDS med
Indinavir (protease inhibitor)
96
What can be seen on neuroimaging for schizophrenia? Also seen in???
Increased ventricle size (lateral ventricular widening); Huntington's due to degeneration of caudate (makes up lateral wall of lateral ventricle)
98
What drug prevents urate nephropathy from TLS? What drug can prevent damage from pre-existing urate?
Allopurinol; Rasburicase
99
What physical exam technique should never be done in febrile neutropenia?
DRE
100
What is the major AE of abacavir?
Hypersensitivity syndrome
101
What is the best diagnostic test in a pt with amaurosis fugax? What are the cholesterol particles in the eye called?
Duplex US of neck; Hollenhorst plaques
103
What is the major cause of post-ictal acidosis?
Post-ictal hypoventilation (i.e. respiratory acidosis)
104
What do you do in a lifethreatening situation where a wife is saying her husband is Jehovah's witness and doesnt want blood but you have no documentation from the pt?
Fuck the bitch give the damn blood!
105
What do you do for nonbleeding esophageal varices?
Give a nonselective BB i.e. propanolol or nadolol for primary ppx against bleeding (if given before they ever develop, then it is pre-primary prevention)
106
What is the best drug for dysthymia
SSRI
107
What are the effects of antipsychotics on the 3 main DA pathways?
Mesolimbic (antipsychotic efficacy), Nigrostriatal (EPS), and tuberoinfundibular (hyperprolactinemia)
108
Hoarding disorder is a type of what disorder? Responds to what?
OCD (ego dystonic); responds to SSRI's and CBT
109
How could furosemide lead to ventricular tachycardia?
Causes hypokalemia and hypomagnesemia both of which predispose to arrhythmias
110
Lithium decreases rates of what in bipolar (3)?
Relapse, suicide, and hospitalizations
111
What SNRI is given in pts with fibromyalgia refractory to exercise?
Duloxetine; also TCA's are common
112
What are the 2 main reasons to start ACE-I in DM?
If pt has HTN or microalbuminuria
114
Though Hodgkin lymphoma is often curable in young ppl what is the major future issue in young ppl tx'd?
Treatment related MDS or AML; i.e. secondary malignancy and these do not respond as well to chemo and often have complex cytogenetics
115
Which arteriole is affected by angiotensin II
Efferent
116
How long does somatiform disorder have to last?
\> 6 months
117
What is the MC AE of methylphenidate?
Depressed appetite (don?t give to young kids under 6 because can fall off growth curve)
118
What drug is contraindicated in acute MI with new onset JVD and clear lungs?
NITRATES, i.e. RV infarct (check right sided leads) give fluids
120
how long should a single episode of depression be treated for
At least 6 months
121
What is the most common AE of olanzapine?
Sedation and WEIGHT GAIN, also has metabolic AE such as metabolic syndrome and frank DM II
122
What do you give in acute esophageal hemorrhage?
ABC's and IV octreotide
123
How do you manage Warfarin Skin Necrosis?
DC warfarin and give Protein C Concentrate
124
Define heat stroke
Core body temp \> 40 C with AMS
126
What is opisthotonus?
Back spasm (i..e acute dystonic rxn, tetanus)
127
What do you do if there is sexual dysfunction in SSRI's?
Switch bupropion
128
What can often normalize homocysteine levels in hyperhomocystenemia?
B6 and folate (B6 is a cofactor for Cystathione B synthase)
129
What is Russel's sign?
Scars on the hands and knuckles from self induced vomiting
130
Why would diabetic autonomic neuropathy cause incontinence
Overflow incontinence due to neurogenic bladder (high post void residual)
131
How do you tx syphilis in pts allergic to pcn? What if pregnant?
Doxycycline; desensitize to pcn then give benzathine pcn G(i..e cant give preggo doxy)
132
What are the main AE of antipsychotic action on the tuberoinfundibular pathway?
Gynecomastia/galactorrhea and decreased libido
133
What is the strongest indicator of suicide attempt?
Prior suicide attempt
134
Lid lag and tremor are commonly seen in what?
Graves dz; also thyroid bruit is pretty specific
135
What cause of restricive CMP is reversible? Dilated?
Hemochromatosis if control ferritin levels with phlebotomy; alcoholic if DC alcohol
136
What are 2 tx options for scabies
Topical 5% permethrin neck down left overnight; PO ivermectin
137
What is the MC location of ectopic foci for atrial fibrillation? Atrial flutter?
Pulmonary veins; Tricuspid annulus
138
What is the first line therapy for specific phobia?
behavioral therapy (Don?t pick benzo!!)
139
What hematologic disorder can occur with carbamazepine? What atypical antidepressant can also do it?
Agranulocytosis; Mirtazepine
140
What is alcholic hallucinosis?
Predominately auditory hallucinations that develop often 12-24 hours after no alcohol, NOT the same thing as DT's
