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BR-Behavioral
5/19/06
| Question | Answer |
|---|---|
| Freudian stages of development | oral (0-1y), anal (1-3y), phallic-oedipal (3-6y), latency (6-11y), genital (11-20y) |
| Erikson stages of development | Trust vs mistrust (0-1); Autonomy vs shame and doubt (1-3); Initiative vs guilt (3-6); Industry vs inferiority (6-11); Identity vs role confusion (11-20); Intimacy vs isolation (20-40); Generativity vs stagnation (40-60); Ego integrity vs despair (60+) |
| Piaget stages of development | Sensorimotor (0-2); Preoperational (2-7); Concrete operations (7-11); Formal operations (11+) |
| Reflexes of infancy: palmar grasp, rooting, babinski | 0-2mo; 0-3mo; 0-12mo |
| Infancy milestones: Turn over, Sit, Walk | 5mo; 6mo; 12mo |
| Characteristics of Terrible two's | "no," balance on one foot; band-aid (2-4), parallel play (2-4) |
| Climb stairs | three year olds |
| Four year olds | throw a ball; button clothes; cooperative play (4-7) |
| Conservation of mass | 7-11 year olds |
| First menstruation, ejaculation, peer pressure | 11yo, 13yo |
| New family, children, role in society solidified, period of reassessment | 20-40yo; early adulhood |
| Height of career; mid-life crisis; menopause | 40-60; 45-55yo; middle adulthood |
| Depression (ECT); women outlive men by 6-8yrs; Kubler-Ross stages of grief and dying | 60-80yo; late adulthood |
| Kubler-Ross Stages of Grief and Dying | denial, anger, bargaining, depression, acceptance |
| Family cycle phases | marriage, child rearing, children leave home, physical decline |
| Marriage (phase 1) | mentally and physically healthier than unmarried couples; 50% end in divorse |
| Child-rearing (phase 2) | single parent households = more depression, drug abuse, suicide and criminality; kids from divorced families will likely divorce in future; death of child or suicide of spouce is most severe psychological stressor |
| Post-partum depression | experienced by 50% of women; d/t changes in hormone levels, inc responsibility, fatigue; major depression in 5-10% |
| Depression definition | 2wk course marked with 4 of 8 criteria: Anhedonia (no interest/pleasure), Sleep changes; Guilt; Low energy; Can't concentrate; Appetite changes; Psychomotor retardation; Suicidal ideation |
| Anaclitic depression | attachment of child to mother; sustained absence of mom btw 6-12mo of age leads to withdrawn and unresponsive infant |
| Infant Deprivation Effects: 4 "Ws" | weak, wordless, wanting (socially), wary; can be irreversible if >6months, infant may die |
| Minnesota Multiphasic Personality Inventory | most commonly used objective personality test |
| Rorschach test | major projective test of personality |
| Stanford-Binet scale | measures intelligence as an intelligence quotient; stable throughout life |
| Child abuse | physical, sexual, emotional; Risks = parental substance abuse, poverty, marital problems or single parent; predisposes child to PTSD, dissociative disorders, depression, anorexia, phobias, personality disorders; Dr MUST intervene |
| Physical abuse | multiple fxs, bruises, subdural hematomas, burns at variable stages of healing; pattern bruises; usu female/primary caregiver is abuser |
| Sexual abuse of children | trauma of genitalia, STD, UTI; abuser is usu a male that the child knows; peaks around 9-12yo |
| Family therapy | all family members involved, even though only 1 person may have problem; identifies dysfxnl behavior and encourages communication/problem solving; based on concept that family system = subsystems where boundaries are established w/ mutual accommodation |
| Gender identity | an individual's sense of being male or female |
| Gender role | the expression of one's gender; psychological factors involved |
| Sexual orientation | a physical preference of one or both genders (hetero, homo, bi); psychological factors involved |
| Transsexual | a person who has a sense of being the wrong-sex body and has a strong desire to correct it |
| Trasvestite | a man who dresses in woman's clothing for pleasure |
| Four stages of normal sexual response in both sexes | excitement, plateau, orgasm, resolution |
| Premajure ejaculation | early climax w/o reaching plateau phase = mc male sexual disorder |
| Sexual arousal disorder | mc sexual dyxfxn in women where lubrication cannot be maintained thru sexual act |
| Impotence | failure to reach erection and/or ejaculation; may be organic or psychogenic (stress/anxiety); can be d/t alcohol abuse or heroine; confirmation of psychogenic by oberving erections in REM sleep (tape test) |
| Vaginismus | spasm of outer 1/3 of vagina; difficulty w/intercourse or pelvic exam; results from psychological damage from rape, incest, or abuse |
| Exhibitionism | exposing genitals |
| Fetishism | inanimate objects (ex: shoes) turn person on |
| Frotteurism | secretly rubbing genitalia against a woman in public |
| Necrophilia | turned on by dead people |
| Pedophilia | turned on by kids; most common paraphilia; needs to be reported to authorities upon discovery by physician |
| Masochism | turned on by receiving physical or psychological pain and humiliation |
| Sadism | turned on by inducing physical or psychological pain and humiliation to others |
| Transvestic fetishism | turned on by wearing women's clothing (such men are still attracted to women) |
| Voyeurism | turned on by secretly watching others engage in sex, etc |
| Zoophilia | turned on by animals |
| Rape trauma syndrome | emotional lability for >1yr; grp therapy and support are important; PTSD may occur even after Tx in teens or young adults |
| PTSD | reexperiencing a traumatic event, avoidance, numbing, and arousal or hypervigilance |
| Suicide | 2nd leading cause of death in 15-24yo; 8th leading cause in US; common in elderly males; males more successful even though women make more attempts; marriage reduces risk; assess risk during mental status exam; pts with a plan are at higher risk |
| Indications for hospitalization of a suicidal pt | impulsiveness, lack of social support, a plan |
| Highest risk for suicide | divorced white males >65yo who have a plan and are taking >3meds |
| Stanford-Binet calculates IQ as? | mental age/chronological age x 100 |
| Wechsler Adult Intelligence Scale uses? | 11 subsets (6 verbal, 5 performance) |
| What is the mean IQ? | 100 with a standard deviation of 15 |
| IQ < 70 or 2 SD below the mean is a criterium for | mental retardation |
| IQ <40; <20 | severe MR; profound MR |
| What do IQ scores correlate with? | genetic factors, and school achievement |
| Are intelligence tests objective or projective? | Objective |
| Reinforcement schedules | a pattern determines how quickly a behavior is learned or extinguished |
| Continuous reinforcement | reward received after every exposure; rapidly exstinguished; think vending machine...stop using it if it does not deliver |
| Variable ratio reinforcement | reward received after random number of responses; slowly extinguished; think slot machine - continue to play even if it rarely rewards |
| Operant conditioning | learning in which a particular action is elicited b/c it produces an award; positive or negative reinforcement |
| Positive reinforcement | desired award produces action (mouse presses button to get food) |
| Negative reinforcement | removal of aversive stimulis increases behavior (mouse presses button to avoid shock); do NOT confuse with punishment |
| Classical conditioning | learning in which a natural response (ex: salivation) is elicited by a conditioned or learned stimulus (bell) that previously was presented in conjunction with an unconditioned stimulus (food); Pavlov's dog |
| Transference | patient projects feelings stemming from personal life onto physician |
| Countertransference | doctor projects feelings stemming from personal life onto patient |
| Ego defenses | automatic and unconsious reactions to physchological stress; they can be either mature or immature |
| Mature Ego Defenses: mature women wear a SASH | altruism, humor, sublimation, suppression |
| Immature Ego Defenses | acting out, dissociation, denial, displacement, fixation, identification, isolation, projection, rationalization, reaction formation, regression, repression, splitting |
| Altruism | guilty feelings alleviated by unsolicited generosity towards others; ex: mafia boss donates to charity |
| Humor | appreciating the amusing nature of an anxiety-provoking or adverse situation; ex: nervous student jokes about boards |
| Sublimation | process where one replaces an unacceptable wish w/a course of action similar to the wish w/o conflicting their value system; ex: aggressive impulses used to succeed in business venture |
| Suppression | voluntary withholding of an idea or feeling from conscious awareness; ex: choosing not to think about USMLE until week of exam |
| Acting out | unacceptable feelings/thoughts expressed thru actions; ex: tantrums |
| Dissociation | temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress; ex: dissociative identity disorder (multiple personality) |
| Denial | avoidance of awareness of some painful reality; ex: common to newly diagnosed HIV or cancer pts |
| Displacement | process to avoid ideas/feelings by transferring it to a neutral person or object; ex: mother yells at child b/c she is angry at husband |
| Fixation | partially remaining at a more childish level of development; ex: men fixated on sports |
| Identification | modeling behavior after another person; ex: abused children become abusers |
| Isolation | separation of feelings from ideas and events; ex: describing murder in graphic detail with no emotional response |
| Projection | an unacceptable internal impulse is attributed to an external source; ex: a man who wants another woman thinks his wife is cheating |
| Rationalization | proclaiming logical reasons for actions actually performed for others reasons, usu to avoid self-blame; ex: saying the job wasn't important after being fired |
| Reaction formation | process whereby a warded-off idea/feeling is replaced by an (unconsciously derived) emphasis on the opposite; ex: pt w/libidinous thoughts enters a monastery |
| Regression | turning back the maturational clock and going back to earlier modes of dealing with the world; ex: seen in kids under stress (ex: bed wetting) or pts on dialysis (ex: crying) |
| Repression | involuntary witholding of an idea or feeling from conscious awareness; the basic mechanism underlying all others |
| Splitting | belief that people are either good or bad; ex: pt says all nurses are cold/insensitive, but that doctors are all warm/friendly |
| Schizophrenia | >6mo; +Sx = hallucination, delusion, loose associations; (-)Sx = flat affect, social withdrawal, lack of motivation; genetic link; presents earlier in men; equal prevalence |
| The 5 "As" of Schizophrenia | ambivalence, autism, affect, associations, auditory hallucinations |
| 5 types of Schozophrenia | Undifferentiated (mc); Disorganized, Catatonic, Paranoid (most difficult to Tx), Residual |
| Schizoaffective disorder | combo of mood disorder and schizophrenia |
| Freud's Id | primal urges, sex, aggression (I want it) |
| Freud's Superego | moral voices, conscience (you know you can't have it) |
| Freud's Ego | Mediator btw unconscious mind and external world (deals with the conflict) |
| Conscious mind | what you are aware of |
| Preconscious mind | what you are able to make conscious with effort (ex: your phone number) |
| Unconscious mind | what you are not aware of; the central goal of Freudian psychoanalysis is to make pt aware of what is hidden |
| Oedipus complex | repressed sexual feelings of a child for the opposite sex parent; acompanied by rivalry with same sex-parent; 1st described by Freud |
| Auditory (and visual) hallucinations are typical of | schizophrenics |
| Olfactory hallucinations present as an | aura of psychomotor epilepsy |
| Tactile hallucinations (formication) are common with | delerium tremens and cocaine abusers; sense of bugs crawling on skin |
| HypnaGnogic hallucinations occur | while Going to sleep |
| HypnoPompic hallucinations occur | while waking uP |
| Delusion is a disorder of | content of though; the actual idea; false belief not shared w/other members of same culture that are firmly maintained despite obvious proof to the contrary (ex: conspiracy theories) |
| Loose association is a disorder of | the form of thought; the way ideas are tied together |
| Hallucination | a perception in the absence of external stimuli |
| Illusion | is a misinterpretation of actual external stimuli |
| Anorexia nervosa | excessive dieting, body image distortion, inc exercise; severe wt loss, amenorrhea, anemia, electrolyte disturbances; adolescent girls; secretive, don't want help; usu die |
| Bulimia nervosa | binge eating followed by self-induced vomiting or laxatives; normal body weight; parotitis, enamel erosion, increased amylase, esophageal varices; treatable w/therapy and antidepressants |
| Autistic disorder | severe communication problems, unable to form relationships; repetitive behavior, unusual abilities (savants), below normal intelligence; Tx = increase communication skills |
| Asperger syndrome | milder form of autism involving problems with social relationships and repetitive behavior; kid have normal intelligence and lac social or cognitive deficits |
| Rett disorder | X-linked; seen ONLY IN GIRLS b/c affected males die in utero; loss of development and MR appearing at 4yrs of age |
| ADHD | limited attention span and hyperactivity; kids are emotionally labile, impulsive, prone to accidents; normal intelligence; Tx = methylphenidate |
| Methylphenidate is the treatment for: | ADHD |
| Conduct disorder | continued behavior violating social norms; oppositional defiant disorder seen when child is noncompliant in the absence of criminality |
| Tourette's syndrome | motor/vocal ticks and involuntary profanity; onset <18yo; Tx = haloperidol |
| How can you treat Tourette's sydrome? | Haloperidol (neuroleptic drug) |
| Separation anxiety disorder | fear of loss of attachment figure leads to factitious physical complaints to avoid going to school; usu in kids aged 7-8 |
| What are the cluster A personality disorders? | Paranoid, Schizoid, Schizotypal; they are weird, odd, eccentric; cannot develop meaningful social relationships; No Psychosis; genetic a/w schizophrenia; |
| Paranoid personality disorder | distrust and suspiciousness; projection is main defence mechanism |
| Schizoid personality disorder | voluntary social withdrawal; limited emotional expression |
| Schizotypal personality disorder | interpersonal awkwardness, odd thought patterns and appearance |
| What are the Cluster B personality disorders | Antisocial, Borderline, Histrionic, Narcissistic; Wild, dramatic, emotional, erratic; genetic a/w mood disorders |
| Antisocial personality disorder | disregard for and violation of rights of others; criminality; males > females; conduct disorder if <18yo |
| Borderline personality disorder | *Unstable* mood and behavior, impulsiveness, sense of emptiness; females > males; often suicidal |
| Histrionic personality disorder | excessive emotionality, somatization, Attention Seeking, Sexually Provocative |
| Narcissistic personality disorder | Grandiosity, sense of Entitlement; may demand to see "top" physician |
| What are the cluster C personality disorders? | Avoidant, Obsessive-Compulsive, Dependent; Worried, anxious, fearful; genetic a/w Anxiety Disorders |
| Avoidant personality disorder | sensitive to rejection, socially inhibited, timid, feelings of inadequacy |
| Obsessive-compulsive personality disorder | preoccupation with order, perfection, and control |
| Dependent personality disorder | submissive, clinging; excessive need to be taken care of, low self-confidence |
| Personality Trait | an enduring pattern of perceiving, relating to, thinking about the environment and oneself that is exhibited in a wide range of important social and personal contexts |
| Personality Disorder | when personality trait patterns become inflexible and maladaptive, causing IMPAIRMENT in social or occupational functioning or subjective distress; person is usu NOT AWARE of the problem |
| Primary Gain | what the symptom does for the patient's internal psychic economy |
| Secondary Gain | what the symptom gets the patient (sympathy, attention) |
| Tertiary Gain | what the caretaker gets |
| Panic disorder | discrete periods of intense fear/discomfort peaking in 10min w/4 of the following: Panic, Abdominal distress, Nausea, Inc perspiration, Chest pain/Chills/Choking; must be diagnosed in context of occurence |
| Specific Phobia | fear that is excessive or unreasonable, cued by presence/anticipation of specific object of entity; exposure = anxiety response; person knows fear is excessive & interferes with normal routine; Tx = Systemic Desensitization |
| How do you treat phobias? | Systemic Desensitization |
| Gamophobia | fear of marriage |
| Algophobia | fear of pain |
| Acrophobia | fear of heights |
| Agoraphobia | fear of open places, ex: the market |
| PTSD | ** >1month duration** causes distress or impairment; person experienced or witnessed an event that involved or threatened serious injury/death; intense fear, helplessness, or horror; Traumatic event is persistently reexperienced; person avoids stimuli; |
| Acute stress disorder | 2-4 weeks of reexperiencing a traumatic event; often precedes PTSD |
| Adjustment Disorder | ** <6months** an anxiety disorder w/emotional symptoms (anxiety/depression) causing impairment following in identifiable psychosocial stressor (ex: divorce, moving) |
| Generalized Anxiety disorder | ** >6months** uncontrollable anxiety unrelated to a specific person, situation or event; GI symptoms, fatigue, difficulty concentrating |
| What are the somatiform disorders? | Conversion, Pain disorder, Hypochondriasis, Somatization disorder, Body Dysmorphic disorder, Pseudocyesis...the illness production and motivation are unconscious; more common in women |
| Conversion disorder | symptoms suggest motor or sensory neurologic or physical disorder, BUT tests and physical exam are normal |
| Somatiform Pain disorder | prolonged pain that is not explained by illness |
| Hypochondriasis | misinterpretation of normal physical findings, leading to preoccupation with and fear of having a serious illness despite medical reassurance |
| Somatization disorder | variety of complaints in multiple organ systems |
| Body dysmorphic disorder | pt convinced that part of own anatomy is malformed |
| Pseudocyesis | false belief of being pregnant a/w objective physical signs of pregnancy |
| Munchausen's syndrome | chronic h/o multiple hospital admissions and willingness to receive invasive procedures |
| Munchausen's by proxy | illness in a child is caused by the parent; motivation is UNCONSCIOUS |
| Malingering | pt CONSCIOUSLY fakes or claims to have a disorder to attain a specific gain (ex: financial) |
| Bipolar disorder | 6 separate criteria with combinations of manic (bipolar I), hypomanic (bipolar II) and depressed episodes; 1 manic or hypomanic episode defines the disorder; Tx = Lithium |
| Cyclothymic disorder | a milder form of bipolar disorder lasting at least 2 years |
| Hypomanic episode | like mania, except mood disturbance is not severe enough to impair social and/or occupational functioning or to necessitate hospitalization; NO PSYCHOSIS |
| Manic episode: DIG FAST | **LASTS >1 week** distractability, insomnia, grandiosity, "flight of ideas," active/agitated; speech is pressured; thoughtlessness; a distinct period of abnormally and persistently elevated/expansive/irritable mood |
| Electroconvulsive Therapy is a treatment option for? | Major Depressive disorder that is refractory to other treatments; |
| What is electroconvulsive therapy? | painless, produces a seizure; complications can result from anesthesia; adverse effects = disorientation and retrograde amnesia |
| Major Depressive Episode: SIG E CAPS | ** >2 Weeks** & characterized by 5 of the following: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor retardation, Suicidal, and depressed mood |
| Recurrent major depressive disorder | requires 2 or more episodes with symptom free intervals of 2 months; more prevalent in women |
| Risks for suicide completion | White, male, alone, prior attempts, plan, medical illness, substance abuse, >3 prescription drugs; women try more often but rarely succeed |
| Delirium | medical emergency; Waxing/Waning consiousness that develops RAPIDLY; check for drugs with ANTICHOLINERGIC effects; cognitive dysfxn, altered sensorium, hallucinations, misperceptions |
| Dementia | GRADUAL onset; Pt is ALERT w/o change in level of consciousness; Multiple cognitive deficits (Memory loss, Aphasia, Apraxia, Agnosia, Behavior/personality changes, Imparied judgement); similar to depression in elderly |
| Heroin Addiction | an opioid addiction; look for track marks; hepatitis, abscess, overdose, hemorrhoids, AIDS, RIGHT-SIDED ENDOCARDITIS |
| How do you treat a Heroin Overdose? | Naloxone (narcan) and Naltrexone; they competitively inhibit opioids |
| What can you prescribe for detoxication or long-term maintenance of heroin addiction? | Methadone, a long-acting oral opiate |
| Delirium Tremens | life-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink; Appears in this order: Autonomic hyperactivity (tachy, tremors, anxiety), Psychosis (hallucinations, delusions), Confusion; Tx with BZDs |
| How can you treat alcohol withdrawal and delirium tremens? | Benzodiazepines |
| Alcohol intoxication | disinhibition, emotional labile, slurred speech, ataxia, coma, blackouts |
| Opioid intoxication | CNS depression, N/V, Constipation, PINPOINT PUPILS, seizures from overdose are life-threatening |
| Amphetamine intoxication | psychomotor agitation, impaired judgement, PUPIL DILATION, HTN, tachycardia, Euphoria, prolonged Wakefullness & Attention, Arrhythmias, Delusions, Hallucinations, Fever |
| Cocaine intoxication | Euphoria, psychomotor agitation, impaired judgement, tachycardia, PUPIL DILATION, HTN, Hallucinations (TACTILE), Paranoid Ideations, Angina, SUDDEN CARDIAC DEATH |
| PCP Intoxication | BELLIGERENT, Impulsive, Fever, psychomotor agitation, NYSTAGMUS (vertical and horizontal), Tachycardia, Ataxia, HOMICITALITY, Psychosis, Delirium |
| LSD intoxication | marked anxiety or depression, Delusions, Visual Hallucinations, Flashbacks, PUPIL DILATION |
| Marijuana intoxication | euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawal, increased appetite, dry mouth, hallucinations |
| Barbituate intoxication | low safety margin, RESPIRATORY DEPRESSION |
| Benzodiazepam intoxication | Amnesia, ataxia, somnolence, minor Respiratory depression, ADDICTIVE with Alcohol, greater safety margin |
| Caffeine intoxication | restlessness, insomnia, increased diuresis, muscle twitching, cardiac arrhythmias |
| Nicotine intoxication | restlessness, insomnia, anxiety, arrhythmias |
| Which drugs do not have withdrawal symtoms? | Marijuana and LSD |
| Nicotine withdrawal | irritability, headache, anxiety, wt gain, craving |
| Caffeine withdrawal | HA, lethargy, depression, wt gain |
| BZD withdrawal | rebound anxiety, seizures, tremor, insomnia |
| Barbituate withdrawal | anxiety, seizures, delirium, life-threatening cardiovascular collapse!! |
| PCP withdrawal | recurrence of intoxication symptoms d/t reabsorption in GI; sudden SEVERE VIOLENCE (random, homocidal) |
| Cocaine withdrawal | Post-use "crash" including severe depression and suicidiality, hypersomnolence, fatigue, malaise, severe psychosocial craving to talk |
| Amphetamine withdrawal | post-use "crash" with depression, lethargy, HA, stomach cramps, hunger, hypersomnolence |
| Opioid withdrawal | anxiety, insomnia, anorexia, sweating, DILATED pupils, piloerection, fever, rhinorrhea, nausea, stomach cramps, diarrhea, yawning |
| Alcohol withdrawal | tremor, tachycardia, HTN, malaise, nausea, seizures, delirium tremens, tramulousness, agitation, hallucinations |
| Substance abuse | <1year of impairment/distress; recurrent use causing failure to fulfill obligations, put self in hazardous situations, get into drug-legal issues, continue to use despite problems |
| Substance dependence | 3 or more in 1year: tolerance, withdrawal, taking more than intended, attempts to cut down, energy spent on optaining substance, loss of social/work activities, continued use despite problems |
| Anterograde amnesia | after...inability to remember things that occurred after a CNS insult (no new memory) |
| Korsakoff's amnesia | classic anterograde amnesia d/t thiamine deficiency (bilateral destruction of mammillary bodies) seen in alcoholics; a/w confabulations |
| Retrograde amnesia | before...inability to recall events that occurred before a CNS insult; a complication of ECT |
| Orientation | is pt aware of him/herself as a person? does the pt know his/her own name? |
| Anosognosia | unaware that one is ill |
| Autotopagnosia | unable to locate one's own body parts |
| Depersonalization | body seems unreal or dissociated |
| Orientation: Order of losses | 1st - time, 2nd - place, 3rd - person |
| Body mass index calculation | [wt in kg] / [height in meters]^2; measure of weight adjusted for height |
| Underweight BMI | <18.5 |
| Normal BMI | 18.5 - 24.9 |
| Overweight and Obese BMI | 25.0 - 29.9; >30.0 |
| Drugs that can cause Sexual dysfunction | antihypertensives, neuroleptics, SSRIs, ethanol |
| Diseases that can cause sexual dysfunction | depression, DIABETES |
| Psychological causes of sexual dysfunction | performance anxiety |
| What does stress do to your body? | induces production of FFAs, 17-OH corticosteroids, lipids, cholesterol, catecholamines; Affects water absorption, muscular tone, gastrocolic reflex and mucosal circulation |
| What happens to the sleep patterns in depressed people? | decreased slow-wave sleep, decreased REM latency; early morning awakening (VERY IMPORTANT screening question) |
| Narcolepsy | person falls asleep suddenly; may have hypnaGogic or hypnoPompic hallucinations; all sleep episodes start off with REM sleep; Tx = amphetamine stimulants |
| Cataplexy | sudden narcoleptic collapse while awake in some patients; strong genetic component; Tx = stimulants (amphetamines) |
| Central Sleep apnea | no respiratory effort; person stops breathing for >10seconds |
| Obstructive Sleep apnea | respiratory effor against airway obstruction after 10sec |
| Sleep apnea in general and treatment | a/w obesity, loud snoring, systemic/pulmonary HTN, arrhythmias, possible sudden death; chonically tired; Tx = wt loss, CPAP, surgery |
| What helps initiate sleep? | Serotonergic predominance of Raphe Nucleus |
| What induces REM sleep? | Norepinephrine |
| What controls the movement of extraocular eye muscles during REM sleep? | the activity of PPRF (paramedian pontine Reticular Formation/conjugate gaze center) |
| What phase of sleep has the same EEG pattern as being awake and alert? | REM |
| What can be used to shorten stage 4 sleep and reduce night terrors and sleepwalking? | Benzodiazepines |
| What drug can be used to treat enuresis by decreasing stage 4 sleep? | Imipramine (antidepressant) |
| Awake (eyes open), alert, active mental concentration Waveform | Beta; highest frequency, lowest amplitude |
| Awake (eyes closed) Wafeform | Alpha |
| Stage 1 sleep | light, 5%, Theta waves |
| Stage 2 sleep | deeper, 45%, Sleep Spindles and K complexes |
| Stage 3-4 sleep | Deepest; 25%, non-REM; Sleepwalking, Night Terrors, Bed-wetting; Delta SLOW waves (low freq, high amp) |
| REM sleep | Dreaming, 25%, loss of motor tone, memory processing function, erections, increased brain O2 use; Beta Waves |
| How often does REM sleep occur? | every 90minutes; duration increases throughout the night |
| What is the primary neurotransmitter in REM sleep? | ACh; causes variable pulse and BP; decreases with age |
| Frontal lobe functions | concentration, orientation, language, abstraction, judgement, motor regulation, mood |
| What does a lesion to the frontal lobe present with? | lack of social judgement, ludeness, perverted behavior |
| NT changes with Anxiety | inc NE, decreased GABA and serotonin (5HT) |
| NT changes with Depression | decreased NE and serotonin |
| NT changes with Alzheimers disease | decreased ACh |
| NT changes with Schizophrenia | increased dopamine |
| NT changes with Parkinson's disease | decreased dopamine |
| APGAR | appearance, pulse, grimace, activity, respiration; each score is 0, 1 or 2 for a total of 10 |
| Low birth weight is defined as: | <2500g; inc incidence of physical and emotional problems; d/t prematurity or intrauterine growth restriction |
| complications of low birth weight | infections, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, persistent fetal circulation |
| Regression in children is a/w | stress; ex: physical illness, punishment, birth of new sibling, tiredness (a previously toilet-trained child may begin bed-wetting when hospitalized) |
| Who is MedicarE for? | the elderly |
| Who is MedicaiD for? | the destitute and mentally ill; federal and state money for very poor people |
| Medicare Part A | hospital bills |
| Mediare Part B | doctor bills |
| Medicare Part D | prescription plan |
| Where did Mediare and Medicaid originate? | amendments to the federal Social Security Act |
| If a pt is noncompliant... | work to improve the physician pt relationship |
| If pt has difficulty taking meds... | provide written instructions or try to simplify regimen |
| Family asks for info on pt's prognosis... | avoid discussion without permission from pt |
| 17yo is pregnant and asks for abortion... | inform pt that most states require parental concent, but it is not required in an emergency, for Tx of STDs or for medical care during pregnancy |
| Terminally ill pt requests for Dr to help end his life... | refuse involvement in any form of euthanasia; Dr may prescribe medically appropriate analgesics tht coincidentally shorten the pt's life |
| Pt finds you attractive... | ask direct, closed-ended questions and use a chaperone; this is not appropriate |
| Pt refuses a necessary procedure and wants an unnecessary one... | attempt to understand, address underlying conditions, avoid unnecessary procedures |
| Pt is angry about amt of time spent in waiting room... | apologize, stay away from trying to explain the delay |
| Pt is upset by the way he was treated by another doctor... | suggest the pt speak to that dr directly, if dr is on your staff, suggest that you'll speak with him |
| A child wants to know more about his illness... | ask what the parents have told the child about his illness; parents may decide what information can be relayed to the child about the illness |
| Pt continues to smoke, believing cigarettes are good for him... | ask pt how he feels about his smoking; offer advice on cessation if pt is willing to make the effort |
| Autonomy | obligation to respect pt as an individual and to honor their preferences in medical care |
| Informed consent legally requires what 3 things? | discussion of pertinent info (risks, benefits, alternatives including no intervention), Pt's agreement to the plan of care, Freedom of Coercion |
| Exceptions to informed consent (4) | Pt lacks decision making capacity; It is implied in an emergency; Therapeutic privilege (withholding information when disclosure whould harm pt or undermine their decision-making capacity); Waiver (pt waives right to informed consent) |
| Decision-making Capacity (5) | Pt makes and communicates a choice; Pt is informed; Decision is consistent w/pt's values and goals; Decision is not a result of delusions or hallucinations |
| Can a patient's family require that a doctor withold information from the patient? | NO |
| Oral advanced directive | an incapacitated person's prior oral statement is used as a guide for treatment; problematic d/t variance in interpretation; |
| When is an oral advanced directive most valid? | when a pt is informed, the directive is specific, the patient makes a choice and the decision is repeated over time |
| What is a Living Will? | the pt directs the dr to withhold or withdraw life-sustaining treatment if the pt develops a terminal disease or enters a persistent vegetative state |
| What is a Durable Power of Attorney? | the pt designates a SURROGATE to make madical decisions in the event that the pt loses decision-making capacity; pt may specify decisions in clinical situations; Surrogate retains power unless revoked by patient |
| Which is more flexible, a Living Will or a Durable Power of Attorney? | a durable power of attorney |
| What is "nonmaleficence?" | doing no harm; but if the benefits of an intervention outweighs the risks, a patient may make an informed decision to proceed |
| What does Beneficence mean? | that doctors have an ethical responsibility to act in the pt's best interest ("physician is a fiduciary"). Pt autonomay may conflict with this, and if a pt makes an informed decision the pt ultimately has the right to decide |
| What does Confidentiality involve? | respecting the pt's privacy and autonomy; disclosing info to family and friends should be guided by what the pt would want; the pt has the right to waive confidentiality (ex: insurance companies) |
| What are some Exceptions to Confidentiality? | Potential harm to others; Likelihood of harm to self is great; No alternative means exist to warn or to protect those at risk; Physician can take steps to prevent harm |
| Infectious disease reporting | Drs have duty to warn public health officials and identifiable people at risk; exception to confidentiality |
| Tarasoff decision | law requires drs to directly inform and protect potential victims from harm; may involve a breach of confidentiality |
| Other legal breaches of confidentiality include... | child and/or elder abuse, impaired automobile drivers; suicidal or homocidal patients |
| When can a doctor admit a patient against their will? | when the pt is at risk of harming themself or someone else |
| A civil suit under negligence requires (3): | Breach of duty to patient (Dereliction); Pt suffers harm (Damage); Breach of duty causes harm (Direct) |
| What is the most common factor leading to litigation between pt and dr? | poor communication |
| Unlike a criminal suit, in which the burden of proof is "beyond a reasonable doubt," the burden of proof in a malpractice suit is... | "more likely than not" |
Created by:
bscaryp