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Psych USMLE

QuestionAnswer
criteria for generalized anxiety d/o anxiety on most days for 6mos + 3 of: restlessness, diff concentrating, irritabil, mscl tension, sleeping problems
acute tx generalized anxiety benzos (clonazepam or diazepam (Valium))
long term Rx tx generalized anxiety (3) SSRI (1st line), venlafaxine (Effexor, serotonin-NE RI), buspirone
gender predilection for OCD affects m&f equally (unlike generalized anxiety, panic d/o
tx for OCD clomipramine (TCA) or SSRI [+ cognitive behavioral therapy +/- desensitization]
onset OCD usu adolescence or early adult
key differences OCD v OCPD OCD is an Axis I d/o that is ego-dystonic (the behaviors bother them); OCPD is a personality Axis II where it doesn't bother them [ego syntonic]
key features of panic attack lasts <25min and incl 4 of: CP, palpitations, sweating, chills or hot flashes, tachypnea/SOB, choking, nausea, dizziness, trembling, depersonalization, fear of dying or going crazy
for panic d/o need an episode + xx. What specify at least 1mo worrying abt having another and changing their behavior to avoid. Must specify if w agorophobia (30-50%)
define agoraphobia fear of being alone in public places
which SSRIs are esp good for OCD paroxetine and setraline
immed relief for OCD with what benzos, ie clonazepam
what are SE of SSRIs N, GI upset, sex dysfxn, agitation, tremor
what are the 1st line uses of SSRIs generalized anxiety, OCD, PTSD
what's a key SE of buspirone? Advantages? sz w chronic use; no tolerance, dependence of withdrawal
which Rx most likely to cause SSRI wdrawal sympt? paroxetine and setraline (short acting); fluoxetine can stop cold turkey
what are 2 commonly used benzos in psych and their SE, drawbacks clonazepam and diazepam (Valium); decrsd sleep, risk of abuse/tolerance/depedence
how does bupropion work inhibits reuptake of NE and Dopa
what are names of serotonin-NE reuptake inhibitors venlafaxine (Effexor) and duloxetine (Cymbalta)
when are b blockers used in psych? Which? Which be careful for? PTSD, performance anxiety (phobia); propanolol (non specific); asthma (bronchoconstrict)
what Rx can help w social phobia low dose SSRI
for how long must sympt occur for PTSD for >1mo
what's a perfect score on MMSE? What indicates cognitive dysfxn 30; <25
2 MC forms of dementia Alzheimers (50%), multi-infarct
what's pseudodementia depression
dx of dementia amnesia [memory impairment] + 1 of: aphasia, apraxia, agnosia [4 A 's of dementia]
list some causes of dementia DEMENTIAS=Degen,Endo=thyr, parathyr, Metabol=EtOH, B12, glu, hepatic/renal, Wilson, Exogen=Lead, CO, Rx; Neoplasia; Trauma=subdural; Infxs=mening/enceph, syph, HIV, Prion, Lym; Affect=pseudodementia, Alz; Stroke/Structure vasculit, nml pressure hydroceph
name 7 infxs causes of dementia syph, HIV, prion, Lyme, mening, enceph, sepsis
w/u for dementia CBC, lytes, TFTs, VDRL/RPR, B12, folate, brain CT or MRI
key feature nml pressure hydroceph dementia, ataxia, urinary incontinence, dilated ventricles
tx dementia; what avoid cholinesterase inhib (tacrine, donepezil, galantamine); avoid benzos
Alzheimers more common in males or females females
pathol dx Alz diffuse atrophy w flattened sulci, senile plaques w amyloid, neurofib tangles from Tau proteins (also nml aging and Downs)
tx Alz NMDA antagonists (memantine), cholinesterase inhib (tacrine--but hepatic dysfxn), donepezil, galantamine)
what NT are abnl in Alz Ach and NE are decrsd
if looks like Alz, but personality/behavioral changes present early think of…; pathol Picks/Frontotemporal dementia; atrophy of frontotemproal, Pick bodies (intraneural inclusion bodies), no Tx
mechanism of Huntington (incl genetics) AD trinucleotide repeat on Chrom 4 affecting BG (loss of GABA in striatum); caudate atrophy
young person w choreiform d/o, think Wilsons
mechanism of Parkinsons loss of pigmented cells/neurons in substantia nigra giving Dopa to BG
pathology of Parkinsons Lewy bodies (hyaline intracytoplasmic inclusion bodies)
which NT are altered in Parkinsons low Dopa, high Ach
clinical characteristics of Parkinsons bradykinesia, cogwheel rigidity, resting pill rolling tremor, masklike facies, shuffling gait, dysarthria, postural instability, micrografia
tx of Parkinsons(5) 1) carbidopa-levodopa; 2) dopa agonist (bromocriptone, pergolide, pramipexole), 3) amantadine (unkn mech, transient help); 4) amitryptyline (helps as anti-chol w tremors and anti-depress; 5) MAOI (selegeline)
how does selegeline help Parkinsons, what type of Rx MAOI inhibits Dopa breakdown
what dopa agonists are used in Parkinsons pramipexole (MC), bromocriptone, pergolide
how does carbidopa work inhibits dpadecarboxylase preventing levodopa from becoming dopa before reaches brain
SE of carbidopa-levodopa dyskinesias after 5-7y, so may use dopa agonist for a while, also N/V, anorexia, HTN, hallucincations
name some Rx that can cause Parkinsonian sympt neuroleptic (haloperidol, chlorpromazine), metoclopramide (gastro Rx), reserpine (anti HTN and anti-psych)
EEG may help differentiate which dementia CJD, see periodic spikes and waves [Alz just see generalized background slowing]
what unique clinical features help differentiate CJD myoclonus, cortical blindness
if Parkinsonian like gait, dementia but also urinary incontinence think nml pressure hydroceph
key difference delirium v dementia waxing/waning, impaired attn, psych, altered sleep-wake and sun downing
what Rx can help delirium low dose quetiapine (Seroquel) or haloperidol for agitation and psychotic sympt
name components SIGECAPS Sleep, interest, guilt (worthlessness, inapprop guilt), energy, concentration, appetite, psychomotor agitation or retardation, suicidal
dx criteria for major depressive episode depressed mood or loss of interest or pleasure + 5 SIGECAPs for 2wks
name some subtypes of depression postpartum, psychotic features, atypical (wgt gain, sleep more), seasonal, dbl depression (on top of dysthmia)
describe nml bereavement shouldn't have severe impairment and should resolve within 1yr
define dysthmia milder, chronic depression w depressed mood most of the time >2yr, no mania/hypomania or psychosis. Tx resistant
what Rx can cause depression steroids, thyroid, anti-HTN, OCP, Parkinson Rx
name 4 atypical anti-depressants bupropion (Wellbutrin), venlafaxine (Effexor), mirtazapine (Remeron), trazodone
key adv/disadv bupropion decrsd sz threshold, NOT for bulimics, NO SEX SE
uses for atypical anti-depress depression, anxiety, chronic pain
CVS SE of venlafaxine diastolic HTN
SE of trazodone hi sedate, priapism
how do TCAs work prevent reuptake of NE, 5HT, block alpha adrenergic and muscarinic (causing anti-chol SE)
name 5 TCAs nortriptyline, amitriptyline, imipramine, clomipramine, desipramine
SE of TCA lethal OD from cardiac arrhythmias [toxicity 3 Cs: convulsion, coma, cardiac arrhyth], sex SE. Anti chol: dry mouth, constipation, urinary retention, sedation
uses for TCAs depression, anxiety, chronic pain, migraine, enuresis (imipramine), clomipramine (OCD)
name 2 MAOI and their uses phenelzine, tranylcypromine; depression esp atypical
SE MAOI HTN crises if taken w high tyramine (cheese, red wine, smoked meats); can't give w SSRI (serotonin syndrome), or meperidine (Demerol, an opioid). Sex SE, orthostatic hypotension, wgt gain
elderly depressed what Rx start? SSRI [TCA anti chol and sedating, MAOI have hypotension]
components neuroeleptic syn; tx FALTER=F, autonomic instability (BP), leukocytosis, tremor, elevated CPK, rigidity; also myoglobulinuria and elevated LFTs; give dantrolene or bromocriptine
what are NT levels in anxiety? Depression? Anxiety=high NE, low GABA and 5HT; depression=low NE and 5HT
features of serotonin syndrome abd pain, diarrhea, hi BP and HR, sweating, hyperthermia, myoclonus, AMS, sz
elderly w pyschotic sympt, what start low dose haloperidol (bc least anti-Chol)
which anti-psych Rx work best for negative sympt atypical/2nd gen (ie ripseridone, olanzapine (zyprexa), clozapine
which anti-psych have most extra pyramidal SE? least? haloperidol most, chlorpromazine (low potency) least
4 MC extrapyramidal SE and tx 1) acute dystonias 1st hrs/days; antichol (benztropine), anti His (benadryl); 2) akthisis, restlessness in 1st days; b blocker benzo or antichol; 3) dyskinesias/Parkinson in 1mos; 4) tardive dyskensia, decr dose, antichol, switch to clozapine)
when clozapine used in psych only for treatment resistant, severe tardive dyskinesia, PD w psych
SE clozapine agranulocytosis, must monitor CBCq wk
tx Tourettes typical anti psych, ie haloperidol, pimozidine or clonidine
SE typical anti psych EPS, hyperprolactin, antichol, sz, hypotension, sedation, QT prolong, neuroleptic syn
unique SE of thioridazine retinal pigment
name 4 atypical anti-psych clozapine, risperidone, quetiapine (Seroquel), olanzapine (Zyprexa)
SE of atypical anti-psych fewer EPS, wgt gain, DMII, somnolence/sedation, QT prolong
use of Li 1st line mood stabilizer, acute mania, bipolar
SE Li DI, thirst, polyuria, tremor, wgt gain, hypothyr, N, diarrhea, sz, teratogen, nephrotoxic longterm
Li levels incrs w what OTC NSAIDs
signs Li toxicity ataxia, dysarthria, delirium
SE carbamzepine N, skin rash and Stevens-Johnson, AV block, NTD, aplastic anemia **CBC biweekly
name 4 mood stabilizers Li, carbamazepine, valproic, lamotrigine (last 3 are also anti-convulsant)
SE of valproic acid GI (N/V), tremor, sedation, alopecia, wgt gain, NTD; rarely: pancreatitis, decrsd plts, agranulocytosis, fatal hepatotoxicity
gender predilection for bipolar equal m, f
dx of manic episode 1 wk of persistently elevated or irritated mood + 3 DIGFAST
components DIGFAST distractibility, insomnia, grandiosity, flight of ideas or racing thgts, activities/agitation, sexual indiscretion or pleasurable activities, talkative/pressured speech
differentiate bw bipolar I, II, cyclothmic 1=at least 1 manic or mixed episode, 2=at least 1 major depressive episode and 1 hypomanic; cyclothmic=chronic and less severe w episodes of hypomania and mod depression >2yrs
tx of mania anti psych and mood stabilizer
name personality disorder clusters A weird : paranoid, schizoid, schizotypal, B wild : borderlines, histrionic, narcissitic, antisocial, C worried, wimpy OCPD, avoidant, dependent
describe 3 cluster A personality d/o Paranoid-distrustful, see others as malevolent m>f; schizoid-loners don't want relationship, cold affect, m>f, schizotypal: odd bheaviors, perceptions incl cults
describe 4 cluster B personality d/o borderline: unstable mood relationships, feel empty/alone, impulsive h/o suicide, f>m; histrionic: attn seeking, dramatic, f>m; narcissitic: self imptc, uses others, lack of empathy; antisocial=deceitful, reckless, no remorse m>f
describe 3 cluster C personality d/o OCPD: perfectionism, inflexible, orderly m>f, avoidant: fear rejection so avoid social even though want relationships; dependent: f>m
gender predilection for schizo m, f equal but m tend to do worse
subtypes schizo (5) paranoid-best px, presents late; disorganized (speech, behavior), poor contact w reality, presents earlier and worse px; catatonic-rare, peculiar posturing; residual-mostly negative sympt; undifferentiated (mltpl character)
positive sympt schizo (5) halluc, delusions, disorganized speech, bizarre behavior, thgt d/o
negative sympt schizo (5) flat affect, decrsd emotional reactivity, poverty of speech, lack of purposeful action, anhedonia
dx of schizo 2 or more present for 6mos causing dysfxn
define schizophreniform if schizo <6mos
define schizoaffective d/o schizophrenia + depression or bipolar
dx of ADHD 6 or more sympt from ea inattn and hyperactivity categories in at least 2 settings for 6mo; some sympt must be present before 7yo
restrictions on antisocial dx must be >18 and have had sympt of conduct d/o as child
tx ADHD stimulants: 1)methylphenidate (Ritalin), dextramphetamine
SE ADHD meds insomnia, irritability, anorexia, tic exacerbat, decrd grwth (nmlzes when stop)
differentiate Autism and Aspergers Aspergers has no language or cognitive delay
other dzs autism assoc w tuberous sclerosis and fragile X
characteristics autism impaired social interact and commun <3yo, impaired spoken language; stereotyped speech and behavior (hand flapping); restricted interests
describe Retts neurodegen dz of females; 5mos nml grwth then head grwth stops and lose milestones
dx of conduct d/o violating basic rights of others or social norms for 1yr; can be aggressive or nonagressive. Most progress to conduct d/o
describe oppositional defiant d/o defiant, disobedient toward authority for 6mo. Can progress to conduct d/o
describe features of narcolepsy decrsd REM sleep lacency, cataplexy (sudden loss of motor tone), hallucinations as fall asleep (hynagogic) or waking up (hypnopompic), sleep paralysis
tx narcolepsy scheduled naps, stimulants (amphetamines), SSRIs for cataplexy
tx for cataplexy SSRIs
factitious v malingering factitious the gain is the medical attn, malingering there's 2ry gain
name 5 somatization d/o and key feature v factitious key: pt has no control over sympt; 1) somatization (mltpl complaints in mltpl organs); 2) conversion (motor or sensory s/p stressful event); 3) hypochondriasis-fear of having dz despite negative tests/reassurance; 4) body dysmorphic; 5) pain d/o
tx pain d/o analgesics not helpful, TCAs and venlafaxine can help
define conversion d/o motor/sensory complaint occurring close to stressful event; usu resolve spont, f>m
gender predilection for hypodchondriasis m and f equal
more like to complete suicide if male, older, depressed, prev attempt, substance/EtOH, chronic illness, no spouse/social support
how does disulfiram work for EtOH abuse inhibits acetaldehyde dehydrogenase needed for breaking down EtOH; get flushed, tachycardic, hypotension, SOB, N/V, HA
Created by: ehstephns on 2010-12-05



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