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Psychiatry

QuestionAnswer
What are the five major diagnostic axes? 1. clinical disorders 2. personality disorders and mental retardation 3. physical conditions and disorders 4. psychosocial and environmental problems 5. Global assessment of functioning
1. Transference 2. Countertransference 1. patient projects feelings about a person onto physician 2. physician projects feelings about a person onto the patient
1. Id 2. Ego 3. Superego 1. primal urges 2. mediator between primal urges and behavior 3. moral values
Unacceptable feeling and thoughts are covered up and expressed through actions acting out
Separating self from one's own experience to avoid emotional stress Dissociation
Defense mechanism used in: 1. obsessive compulsive disorder 2. borderline personality disorder 1. undoing 2. splitting
1. involuntary withholding of an idea or feeling from conscious awareness 2. conscious avoidance of some painful reality 3. voluntary withholding an idea from conscious awareness 1. repression 2. denial 3. suppression
A man who wants another woman thinks his wife is unfaithful. What is the defense mechanism? 1. projection 2. unacceptable internal impulse is attributed to another person
Transferring avoided ideas and feelings to some neutral person or object displacment
Unacceptable impulse channeled into something that is not in conflict with one's value system sublimation
Grief is normal up until how long? 1 year; usually less than 6 months
Autistic disorders are usually diagnosed after age 2 by what two characteristics? 1. no separation anxiety 2. no verbal/nonverbal communication
What is Rett's disorder and what symptoms are characteristic? 1. X-linked disorder seen almost exclusively in girls 2. loss of development, mental retardation and hand-wringing starting at age 1-4
Marked regression in multiple areas of functioning after at least 2 years of apparently normal development. childhood disintegrative disorder
What are the symptoms of Korsakoff's syndrome? 1. impaired recent memory 2. anterograde amnesia 3. +/- confabulation
What are the two most common causes of delirium? 1. anticholinergic drugs 2. UTI
How long must an episode last to be considered mania? at least 1 week
Hypersomnia, overeating and mood reactivity (ability to experience improved mood in response to positive events). atypical depression
How long must postpartum blues last before it is considered depression? 2 weeks
Sleep disturbance, irritability, and poor concentration after a divorce. adjustment disorder
How is obsessive-compulsive personality disorder different obsessive-compulsive disorder? in personaility disorder, behavior is consistent with one's own beliefs and attitudes (ego-syntonic)
What is the triad seen in Wernicke's encephalopathy? 1. confusion 2. ocular abnormalities 3. ataxia
What part of the brain is effected in: 1. Wernicke's 2. Korsakoff 1. cerebellar vermis 2. mamillary bodies
Delerium tremens 1. How long till it peaks? 2. what are the first symptoms to appear? 1. 2-5 days 2. tachycardia, tremors, anxiety
1. Dementia with stepwise increase in severity + focal neurological signs 2. Confirmatory test 1. multi-infarct dementia 2. CT/MRI
Dementia with resting tremor 1. Lewy Body Dementia 2. Parkinson's disease
1. What is the clinical triad of normal pressure hydrocephalus? 2. Which symptom is most likely to improve with treatment 1. Dementia + ataxia + urinary incontinence 2. dementia
1. Dementia + obesity + coarse hair + constipation 2. Confirmatory test 1. Hypothyroidism 2. TSH
1. Dementia + diminished vibratory sensation 2. Confirmatory test 1. Vitamin B12 deficiency 2. Serum B12
Delirium + elevated BP + papilledema Hypertensive encephalopathy
Delirium + tachycardia + tremor thyrotoxicosis
First line treatment for a dangerously agitated patient with delerium. quetiapine
Differential for delerium. AEIOU TIPS 1. alcohol 2. electrolytes 3. iatrogenic drugs 4. Oxygen (hypoxia) 5. Uremia 6. Trauma 7. Infection 8. Poisons 9. Seizures
What are the most common causes of dementia (3)? 1. Alzheimer's 2. Vascular 3. Major depression ("pseudodementia")
Most common focal neurologic symptoms seen in vascular dementia? 1. pseudobulbar palsy 2. dysarthria 3. dysphagia
Dementia with visual hallucination. Lewy body dementia
What are the prenatal infections and toxins that can cause mental retardation? TORCH 1. toxo 2. other (syphilis, AIDS, alcohol/illicit drugs) 3. rubella 4. CMV 5. herpes simplex
What are the three areas of learning disorders? 1. reading 2. mathematics 3. writing
What percentage of children with autism are also mentally retarded? ~70%
Stereotyped hand movements and failure to progress developmentally in a young female child. Rett's Disorder
At what age in urinary continence and bowel control usually reached? age 4
What areas of an individuals life do personality disorders effect? CAPRI 1. Cognition 2. Affect 3. Personal Relationships 4. Impulse control
What are the negative symptoms of schizophrenia? 5 A's 1. Anhedonia 2. Affect 3. Alogia (poverty of speech) 4. Avolition (apathy) 5. Attention (poor)
How does PTSD differ from acute stress disorder? 1. PTSD sypmtoms last > 1 month 2. Acute stress disorder symptoms last < 1 month
How does adjustment disorder differ from PTSD? adjustment disorder is the presence of psychological symptoms after a stressful but non-life-threatening event
What neurotransmitter is effected in: 1. Alzheimer's 2. Anxiety 3. OCD 1. ↓ acetylcholine 2. ↑ NE, ↓ GABA 3. ↓ serotonin
How does Creutzfeldt-Jakob Disease present on EEG? Periodic sharp waves/spikes
What is the difference between cause of amnesia amnestic disorders and dissociative disorders? amnesia in amnestic disorders is always secondary to an underlying medical condition or substance use while dissociative disorders is related to a stressful life event
1. What is primary gain? 2. Secondary gain? 1. expression of unacceptable feelings as physical symptoms in order to avoid facing them 2. use of symptoms to benefit the patient
What is hypochondriasis either fear of having a disease or convinced that one is present
Failure to resist aggressive impulses that result in assault or property destruction. Out of proportion to triggering events. Intermittent explosive disorder
Recurrent pulling out of one's hair, resulting in visible hair loss. Trichotillomania
What are the two subcategories of anorexia nervosa? 1. restrictive type - eats little and may vigorously exercise 2. binge eating/purging type - eat in binges followed by purging, laxatives, excessive exercise or diuretics
What are the two subcategories of bulimia? 1. Purging - involves vomiting, laxatives or diuretics 2. Nonpurging - involves excessive exercise or fasting
What is the difference between nightmare disorder and night terror disorder? 1. nightmare disorder has repeated awakenings with recall of dreams 2. in night terror disorder patients do not remember episodes
What are the 4 elements of informed consent? NARCC 1. Name/purpose of treatment 2. Alternatives 3. Risks/benefits 4. Consequences of refusing treatment 5. Capacity to make an informed decision
4 D's of malpractice Dereliction (neglect) of a Duty that led Directly to Damages