Upgrade to remove ads
High Yield - Psychiatry
Terms in this set (274)
Time duration and Brain histological findings
Chronic mental disorder with periods of psychosis, disturbed behavior and thought,
and decline in functioning that lasts > 6 months.
Associated with increase dopaminergic
activity, decrease dendritic branching.
Symptoms needed for diagnosis
2 or more of the following
(first 4 in this list are "positive symptoms"):
~Disorganized speech (loose associations)
~Disorganized or catatonic behavior
"Negative symptoms"—flat affect, social withdrawal, lack of motivation, lack of speech or thought
Most common type of schizophrenia
Most treatable type of schizophrenia
Prevalence in society of schizophrenia
~Risk of MZ twin
~Risk of sibling
twin = 50%
sibling = 10%
Positive symptoms for schizophrenia
Increased dopamine in the mesolimbic tract
Negative symptoms for schizophrenia
Decreased dopamine in the mesocortical tract
Dopamine systems of the brain
which one controls the: EPS
which one regulates prolactin
Diagnosis: Delusions hallucination and flattened affect for 3 weeks
Brief psychotic disorder ( > 1 WEEK AND <1 MONTH)
Diagnosis: Delusions hallucination and flattened affect for > 1 month and < 6 month
Typical antipsychotics help what kinds of symptoms in schizophrenia
Positive symptoms, but no effect on the progression
Difference between schizoaffective disorder and depression with psychotic features?
What was present first without the other, i.e. schizoaffective thave had psychosis without any depressive symptoms
Diagnosis: MDD for 3 years and reports hearing voices telling him he is worthless and to kill himself
MDD with Psychotic Features; delusions are typically mood congruent
Treatment for MDD with Psychotic Features?
Atypical antipsychotic + SSRI or ECT (especially in pregnant patients)
Diagnosis: Persecutory delusions for past 3 years (diagnosed with schizophrenia), 6 months ago he started having sadness, guilt, insomnia, ↓ concentration, SI
Schizoaffective Disorder; delusions/hallucinations for > 2 weeks in absence of mood symptoms
Treatment for Schizoaffective Disorder?
+ SSRI if depression
+ Li if manic
A man is convinced Miley Cyrus is in love with him, but is otherwise functional
Delusional Disorder, erotomanic type.
Treatment for Delusional Disorder?
Therapeutic relationship + meds
Treatment: Acute agitation OR psychosis
--Quick onset of action
--D2 dopamine angtagonist
Haloperidol: Effects on nigrostriatal pathway and tubularinfundibulum?
Nigrostrial = causes EPS
Tubularinfundubulum = Hyperprolactinemia
Low potency antipsychotics:
Chlorpromazine and Thioridazine
--Less EPS, more anti-Ach
--Non-neurologic side effects (anticholinergic, antihistamine, and α1-blockade effects).
Side effects of Chlorpromazine?
Side effects of Thioridazine?
Side effects of haloperidol?
Symptoms of Neuroleptic malignant syndrome (NMS)?
Rigidity, myoglobinuria, autonomic instability,
Treatment for NMS?
Dantrolene, D2 agonists (e.g., bromocriptine)
Stop offending med, cooling blankets, and Dantroline Na or Bromocriptine
igidity of muscles
High potency Antipsychotics:
Trifluoperazine, Fluphenazine, Haloperidol
—neurologic side effects (EPS symptoms)
Treatment of psychotic patient with a history of medication non-adherence?
Give injection/decanoate - Fluphenazine or Haldol every 2-4 weeks
Side effect: Purple grey metallic rash over sun-exposed areas and jaundice?
Side effect: Prolonged
and pigmentary retinopathy?
Thioridazine --> can lead to torsades
Diagnosis: Medicated, psychotic patient wakes up with eyes "stuck" looking up or head "stuck" turned to the side
<12 hours of beginning medication
Treatment for Acute Dystonia?
Benztropine or diphenhydramine
Diagnosis: Medicated, psychotic patient reports feeling like they "always have to move"
30 - 90 days of beginning medication
Treatment for Akathesia?
Propranolol (1st line) or benzo
Diagnosis: Coarse resting tremor, masked facies, unsteady gait, bradykinesia
>6 months of beginning medication
Treatment of Parkinsonism side effects?
Treatment: Benztropine, diphenhydramine, amantidine or bromocriptine
Diagnosis: After 10 years on fluphenazine, tongue movements and grimacing
> Many years after starting antipsychotic
Treatment of Tardive Dyskinesia?
Stop antipsychotic and switching to and atypical or clozapine
new meds - valbenazine, deutetrabenazine. VMAT2 inhibitors
Diagnosis: Within hours of a haloperidol injections, ↑CPK, T = 103F, rigidity, autonomic instability, and delirium
Neuroleptic Malignant Syndrome
Other causes: metoclopramide, compazine and droperidol
Antipsychotic medication: Weight neutral but prolongs the QTc?
Antipsychotic medication: Weight neutral but increases akathesia?
Antipsychotic medication: Atypical agent with highest risk for EPS and ↑prolactin?
Risperidone, also in depo form
Antipsychotic medication: Most associated with weight gain, BUT most common side effect is sedation?
Antipsychotic medication: Causes orthostasis and cataracts?
--Alpha blocking properties
Antipsychotic medication: Good for treatment-refractory schizophrenia?
Most common side effects of Clozapine?
Sedation, weight gain, ↑blood sugar and lipids
Most dangerous side effects of Clozapine?
Decreased seizure threshold
What do you monitor with Clozapine?
CBC --> ANC every week for 6 months and every 2 weeks for next 6 months
Stop Clozapine if WBCs < 3000 or ANC < 1500
What the most important and first question to ask the depressed patient?
Suicidal ideation, most likely to kill the patient
Risk factors for suicidal ideation?
#1 - Prior attempt
>45 years old, white male, serious illness, detailed plan, no support, use of ETOH and drugs
Polysomnogram for a depressed person?
Early REM latency and more frequent REM
Increased hormone in depressed patient?
Dexamethsone supression test would be abnormal
Medications that might cause depression?
IFN, beta-blockers, α-methyldopa, L-dopa, OCPs, ETOH, cocaine/amphetamine withdrawal, opiates
Medical diseases that might cause depression?
HIV, Lyme, Hypothyroidism, Porphyria, Uremia, Cushings Dz, Liver disease, Huntington's, MS, Lupus,
First line drug for treatment of depression?
SSRIs = Fluoxetine, paroxetine, sertraline, citalopram
Other conditions treated with SSRIs?
OCD, bulemia, anxiety, or premature ejaculation
Side effects of SSRIs
GI distress, sexual dysfunction (anorgasmia and decreased libido)
Fewer than TCAs
Serotonin syndrome with any drug that increases 5-HT
(e.g., MAO inhibitors, SNRIs, TCAs
Symptoms of Serotonin syndrome?
Hyperthermia, confusion, myoclonus,
cardiovascular collapse, flushing, diarrhea,
Treatment of Serotonin syndrome?
Cyproheptadine (5-HT2 receptor antagonist)
SSRI with most drug-drug interactions?
SSRI that can be discontinued without a taper?
SSRI with fewest drug-drug interactions?
Suddenly stopping SSRI and experiences HA, N/V/D dizziness and fatigue
5-HT discontinuation syndrome; more common with sertraline and fluvoxam
Diagnosis: Myoclonic jerks, tachycardia, hypertension, hyperreflexia, n/v/d
5-HT syndrome, particularly if the patient is taking both SSRI + MAOI
Patient experiences loss of erection/ejaculation on SSRI?
Switch to buproprione (dopamine and norepinephrine antagonist)
Contraindications of buproprione?
Due to increased rick of seizures:
Drug: Erections lasting longer then 3 hours?
Drug: Anti-depressant for old, skinny, sad ladies?
Mirtazepine - Sedating, increases appetite
Drug: Anti-depressent NOT for hypertensives?
Drug: Anti-depressent NOT for patients taking St John's Wart?
Diagnosis: Pounding head, flushing, nausea, myoclonus after eating cheese, drinking red wine, taking decongestant or merperidine?
Hypertensive crisis with MAOI
Treatment for Hypertensive crisis with MAOI?
5mg IV phentolamine
Pediatric patient ingested unidentified pills. He now has dry mouth, tachycardia, vomiting, urinary retention, and seizures. EKG demonstrates
widened QRS and prolonged QT intervals
. What medication did the child ingest?
Most common cause of death in a kid who ingested TCAs?
Arrhythmia --> torsades, v-fib, and death
What is the treatment for tricyclic antidepressant overdose?
--Helps metabolic acidosis
Patient who is eating and sleeping more, gaining weight, and has leaden paralysis in the morning.
--Hypersensitive to rejection, affecting social functioning
Treatment for Atypical depression
Diagnosis: One month following the death of her child, a mother feels guilty, can't sleep, concentrate, eat, or enjoy her interests?
(other than thoughts of wanting to be with loved one)
(other than hearing/seeing loved one)
Treatment for Uncomplicated Bereavement?
Rarely; treat with antidepressants for symptoms
Diagnosis: Four months following the death of her chihuahua, a woman still feels guilty, can't sleep, concentrate, eat, or enjoy her interests?
within 3 months
of stressor and are out of proportion to inciting event
--Can't persist longer than 6 months
What is Adjustment disorder?
Emotional symptoms (i.e. anxiety, depression) causing impairment following an identifiable psychosocial stressor (e.g., divorce, illness) and lasting
< 6 months
(> 6 months in presence of chronic stressor)
Treatment for adjustment disorder?
Prevalence of Bipolar disorder in the population?
Prevalence of Bipolar disorder in MZ twin?
Diagnosis: 75 year old man with first manic phase of lifetime?
--Right frontal hemisphere stoke
What is Generalized anxiety disorder?
Pattern of uncontrollable anxiety
for at least 6 months
to a specific person, situation, or event. --Associated with sleep disturbance, fatigue, GI disturbance, and difficulty concentrating
Treatment for GAD?
SSRIs, SNRIs, buspirone, cognitive behavioral therapy
How many symptoms and for how long do you need to have in order to diagnose schizophrenia?
Bizarre delusions or hearing voices = 1 month
Otherwise = 2 or more symptoms for 6 months
Incidence of mania in the population?
Risk for diagnosis of mania in a MZ twin?
Diagnosis: Symptoms of manic depression in 75 year old patient for the
in that patient's lifetime?
--Right frontal hemisphere stroke
What medication need to be avoided in a patient with manic depression
SSRI and TCA can trigger mania
Medications to start in a manic depressive patient? For maintenance?
Haloperidol or clonazepam for
agitation/delusion (if you cant interview them)
Maintenance: Lithium or valproic acid or carbamazepine
Diagnosis: Manic patient takes Advil and develops n/v/d, coarse tremor, ataxia, confusion, and slurred speech?
Precipatated by NSAIDs
Preferred pain medications for patients on Li: aspirin or sulindac
EKG findings in Lithium toxicity?
T wave flattening
Treatment For Lithium toxicity?
Depends on serum Li levels:
<4: Fluid resuscitiation
>4: Emergent dialysis
Side effects of Lithium?
Weight gain, acne, GI irritation, and cramps
Mechanism of action of Lithium?
Suppresses inosital triphosphate (ITP)
What is the therapeutic window for Lithium?
What is the medical monitoring protocol for Lithium use?
Li serum levels every 4-8 weeks
TFTs every 6 months (can cause hypothyroidism)
Cr, UA, CBC, EKG
Contraindications to Lithium use?
Severe renal disease, because decreased serum clearence
NOT for pregnant or breastfeeding patients
What does Lithium do to fetus?
Preferred treatment for bipolar in pregnant patients?
Drug: Bipolar patient with elevated LFTs, hepatitis, n/v/d, and skin rash?
Drug: Bipolar patient with Steven Johnson's syndrome?
Lamotrogene, also can be cambazepeine
Drug: Bipolar patient with agranulocytosis?
check CBC regularly
If ANC < 2000 = watch closesly every week
If ANC <1000 = Stop
Drug: Pregnant bipolar patient with an increase AFP at 20 weeks gestation?
Valproate or carbamazepine --> Neural tube defect
Anyone of reproductive age should take 4 g of folate daily
Most common complications of carbamezapine?
Therapeutic levels of Valproate?
6 - 12
Theraputic levels of carbamezapine?
Diagnosis: 28 year old female is brought in by EMS complaining of SOB, palpitations, and chest pain. She smokes 1 PPD and her only medication is OCPs. She had one of these attacks previously while grocery shopping. She shares with you that she is so afraid of having another one she rarely leaves her house. Work up?
Panic disorder + agoraphobia
Work up: Medical work up first, EKG, drug screen, TSH/T4, cardiac enzymes
Treatment for panic disorder?
Short term: low dose Alprazolam or clonazepam PRN
Long term: SSRI
Contraindications to benzodiazepines?
Drug addicts, COPDers, or restrictive lung disease
(suppress the respiratory drive)
Patient with panic disorder on benzodiazepines discontinues medications and comes in with T=101, convulsions, confusion, and hypertension
Acute benzodiazepine withdrawal reaction
--Similar to DT
Treatment for acute benzodiazepine withdrawal reaction?
Diazepam or cholardiazepoxide
+ haloperidol, if psychotic
Patient presents with a deathly fear of flying that inhibits her from interveiwing at the program of her dreams.
What is the diagnosis and what are the two best treatments?
Treatment for specific phobia?
CBT with flooding or exposure/extinction + benzodiazepine
Patient presents with a deathly fear of presenting a case at grand rounds because the surgeons will laugh at her.
Diagnosis and treatment?
Treatment for social phobia?
Propranolol stops hyperarousal + situational benzodiazepine
Patient keeps to herself and doesn't talk to peers because she is afraid they will laugh at her
Avoidant personality disorder
Treatment for Avoidant personality disorder?
Diagnosis: Patient is having a difficulty falling asleep because she keeps thinking about failing biochem. She can't concentrate in class because she worries her boyfriend will leave her. If her symptoms have lasted 6 months.
Generalized anxiety disorder
Treatment for GAD?
Buspirone 5-HT 1a partial agonist
Bridging treatment with benzodiazepines
Diagnosis: 18 year old patient college student with declining grades. He spends 2-3 hours in the shower scrubbing, because on days he doesn't, he worries about contracting an illness?
Obsessive compulsive disorder
Co-morbid condition with OCD?
--Vocal motor ticks
--5-7% of OCD patients have Tourette
What is the treatment for OCD?
Gold standard = Clomipramine
First line = SSRI
Diagnosis: 25 year old sexual assault survivor comes to you with a 6 week history of recurrent nightmares when she was raped at knifepoint. She now avoids situations where unknown men are present, and she had to quit her job.
--Re-living, hyperarousal, and avoidance
Treatment for PTSD?
SSRI = sertraline or paroxetine
Nightmares = alpha blockers, e.g. prazosin
Diagnosis: Patient with hyperarousal, avoidance behaviors, and re-living of an experience present for
only 3 weeks
in response to a traumatic event like rape.
Acute stress reaction
--Symptoms must stop within 1 month
Diagnosis: Patient with hyperarousal, avoidance behaviors, and re-living of an experience present for only 3 weeks in response to a bad breakup?
--Onset within 3 months and goes away by 6 months
Diagnosis: Female patient complains of pelvic pain during menses and chart reveals pain in low back, neck, arms, and feet. She complains of tingling in her arms and constipation?
Co-morbid condition with somatoform disorder?
Depression/anxiety + personality disorder
Treatment for somatoform disorder?
Frequent follow up with a physcian
What are the criteria for somatization disorder?
--NOT intentionally produced
--Onset before age 30
--4 pain symptoms
--1 GI symptoms
--1 pseudoneurological symptom
Diagnosis: Patient is brought to the ER after having a seizure in the waiting room of her neurologist office.
Her worried husband describes the episode as lasting 20 minutes, consisiting of shaking with her eyes closed
What is Conversion Disorder?
--Not intentially produced
--Not limited to pain or sexual dysfunction
--View as a cry for help
--NOT always la belle indifference
What is the best tests to confirm or deny a seizure?
High Prolactin or Normal EEG
Diagnosis: 54 year old RN has a history of 2 months of diarrhea and abdominal pain. He has been to 4 other hospitals with the same complaints. Colonoscopy reveals pigmentation in the wall of the colon?
Melanosis coloni from laxatives
What is Munchausen syndrome?
More severe then simple factitious (complaints of symptoms but don't do anything to create them)
--Patients actually induce symptoms and do it for primary gain
Diagnosis: Concerned mother presents with 15 month old baby who is having recurrent seizures. She requests an MRI, sleep deprived EEG with intercranial leads.
Munchausen syndrome by proxy
Form of child abuse --> Call CPS
Diagnosis: Patient is unemployed man involved in a car accident. He sues the drive stating he has nerve damage to his legs that keeps him from walking. Video evidence shows him dancing at a club the night before?
Associated with antisocial personality disorder
Diagnosis: Patient presents with no menstrual cycle for 3 mo. A pregnancy test is negative, but her BMI is 17. Her teeth are eroded and she has calluses on her knuckles?
Anorexia, purging type
--Amenorrhia (endocrine abnormality)
Vital signs typical of anorexia?
Hypotension, bradycardia, and hypothermia
Labs typical of anorexia?
CBC = leukopenia
Chemistry = high H3CO, low Cl, low K, high LFTs and amylase
TFT = normal
Fasting lipid profile = elevated
Hormones = elevated cortisol, low estrogen, low LH/FSH
Long term complications of anorexia?
Most common cause of death anorexia?
Heart disease, due to arrhythmias
Suicide (close second)
Complications of anorexia?
--Nutrition, i.e. TPN
Complications of TPN in anorexia?
Re-feeding syndrome =
, low mg, low ca
caused by fluid retention
EEG: What are the characteristics of alertness?
--Highest frequency, lowest amplitude
Characteristics of Stage 1 sleep EEG
--Consists about 5% of sleep
Characteristics of Stage 2 sleep EEG
--Sleep spindles and K complexes
--Consists about 45% of sleep
Characteristics of Stage 3 sleep EEG
--Lowest frequency, highest amplitude)* 25%
--Consists about 25% of sleep
--Deepest non-REM sleep (slow-wave sleep); when sleepwalking, night terrors, and bedwetting occur
Stage 3 is the less then 50% theta waves and stage 4 is greater then 50% theta waves
What drugs decrease Stage 3/4 sleep?
Impramine (used to decrease bedwetting)
Alcohol also decrease stage 3 and 4 sleep
Characteristics of REM sleep EEG
--Consists about 25% of sleep
--Skeletal muscle paralysis
---Loss of motor tone, increase brain O2 use
--Variable pulse and blood pressure; when
dreaming and penile/clitoral tumescence
occur; may serve a memory processing
Sleep EEG in depression
Decreased REM latency and increased REM
Sleep EEG in the elderly
Decreased REM latency and increased cycling, often less REM
Diagnosis: Trouble falling asleep or staying asleep causes impairment in functioning for over one month?
sleep hygiene 1st
, then try benzos (reduce sleep latency and increase SWS and REM)
Treatment for insomnia?
Zolpidem, zaleplon, escopiclone = GABAa agonist
Diagnosis: As patient is falling asleep, they feel creepy-crawlies on legs. Symptoms improve when they get up and move
--Restless leg syndrome and periodic leg movement syndrome
--Rule out medical causes 1st --> Fe-def anemia or chronic kidney disease/neuropathy
Treatment for Dyssomnia?
Ropinirole (side effect of pathological gambling) or Pramipexole = Dopamine agonists
Diagnosis: Daytime sleepiness and depression in a big fat guy with a big neck.
Obstructive Sleep Apnea
Diagnosis of OSA?
Need polysomnogram to diagnose and must have over 10 hypopneic/apneas per hour
Treatment for OSA?
CPAP --> reduce pulmonary HTN
Diagnosis: Irresistible attacks of refreshing (REM) sleep. Upon intense emotion, they lose muscle tone or have hallucinations as waking or falling asleep.
--Must have cataxplexy or hypnogognic or hypnopomonic hallucinations
Treatment for narcolepsy?
Modafinil and scheduled naps
Diagnosis: 30 year old man and his wife present for couples counseling. He constantly accuses her of cheating. He's in a feud with the neighbor because he feels they are attacking his character when they say they like his flowerbeds.
Paranoid Personality Disorder
Treatment for Paranoid Personality Disorder
Low dose anti-psychotics
Diagnosis: 30 year old man never been married or have any close friends, works as a night security guard and in his free time works on his model ships in his basement.
Schizoid Personality Disorder
--Distinguish from Avoidant because they don't WANT relationships
Diagnosis: 30 year old man, never been married or have any close friends because "people make him uncomfortable." He is unemployed because he spends his time reading books on how to communicate with animals so he can "be at one with nature."
Schizotypal Personality Disorder
Distinguish from Schizoid by magical thinking/interests
Distinguish from Schizophrenia by lack of delusions/hallucinations
Diagnosis: 25 year old man comes to court mandated counseling for beating his girlfriend. He was kicked out of high school for fighting and just got out jail for stealing a car.
Antisocial Personality Disorder
2/3 have substance abuse (most common co-morbid condition)
Diagnosis: Patient has a history of unstable relationships, has superficial cuts on both wrists, and is impulsive in her spending and sexual practices.
Borderline Personality Disorder
Common defense mechanism in Borderline?
Diagnosis: 26 year old MS2 is asked to seek counseling. Her classmates complain that she dresses too provocatively to class. She recently tried to seduce a professor.
Histrionic Personality Disorder
Co-morbid conditions with Histrionic?
Diagnosis: 22 year old MS1 doesn't feel like he needs to come to any classes or labs because he "already has the brilliance to be a doctor.
Narcissistic Personality Disorder
Treatment for Narcissistic?
Diagnosis: 30 year old woman has no friends and avoids happy hours with her coworkers b/c she fears ridicule and rejection. She feels "no one would want to be friends with me".
Avoidant Personality Disorder
Treatment for Avoidant?
Treat social phobia symptoms with beta-blocker or SSRI
Diagnosis: 30 year old woman has jumped from one relationship to another, because she "doesn't do well alone." She calls her friends and family >20x a day to get their input on her daily decisions.
Dependent Personality Disorder
Co-morbid conditions with Dependent?
Treatment for Dependent?
Diagnosis: 25 year old MS4 spends more time color coding her notes and textbook highlighting than actually studying. She makes lists and study schedules 3 times per day. People don't like to work with her because she is so "anal"
Obsessive Compulsive Personality Disorder
Different from OCD because actions are ego-syntonic
Diagnosis: 78 year old lady is brought in from her nursing home for altered mental status. She sleeps more during the day and becomes agitated at night-reporting seeing green men in the corner. She also complains of pain upon urination. First step in the work up of this patient?
Medical work-up is the first step in suspected delrium
UA and culture
Glucose, chemistry, blood culture, B12, RPR
Medications: Benadryl, opiates, benzos
What is the biggest risk factor for delrium?
2) Underlying dementia
What is a common cause of delrium?
Acute substance withdrawal
What are the EEG changes of the Delrium?
Diffuse slowing of the background rhythm
= Slow waves
What are the EEG changes of psychosis?
Treatment for Delrium?
--Reduce excessive stimuli, calendar and clock to orient the patient
--STOP unecessary medications
--Haloperidol for agitation
Diagnosis: 78 year old female presents with memory loss, in addition to aphasia, apraxia, and gets lost while driving?
What is the most common type of dementia?
What is the pathology of Alzheimer's Dementia on MRI?
--Diffuse brain atrophy, beta-amyloid plaques or tau tangles
tangles correlate with the degree of dementia
--Decreased ACH (Basal nucleous of Meyhert)
What are the genes associated to Alzheimer's Dementia?
Early onset: APP (Chr 21), presenilin-1 (Chr 14), presenilin-2 (Chr 1)
Late onset: ApoE4 (Chr 19),
ApoE2 (Chr 19) is protective
Treatment for Alzheimer's Dementia?
Rivastigmine, Donepezil, Galantamine
--> Ach-esterase inhibitors =
--> NMDA antagonist - decrease excitability
None of these improve memory, only decrease rate of decline
Diagnosis: 78 year old female presents with memory loss, becomes more sexually explicit, apathy?
Frontotemporal Dementia/Pick's Disease
Pathology of Frontotemporal Dementia/Pick's Disease?
Lobar atrophy, with sparing of the parietal lobe
intra-neuronal silver staining inculsions
What is the treatment for Frontotemporal Dementia/Pick's Disease?
Olanzepine (for severe disinhibition, stops behavioral problems)
Diagnosis: 78 year old female presents with memory loss, fluctuation in consciousness,
and shuffling gait
Pathology of Lewy-body Dementia?
Intra-cytoplasmic, alpha-synuclein inclusions in neocortex
Treatment for Lewy-body Dementia?
Avoid neuroleptic -
no haliperdol or benzos
Diagnosis: 78 year old female presents with memory loss, sudden, step-wise decrease in memory/cognitions.
Work-up: MRI and MRA
Diagnosis: 78 year old female presents with memory loss, loss of vibration sense, and labile affect. Pupils accommodate but don't react. What is the test?
Tests: +RPR, VDRL
Spinal tap to look for spirochetes, if seen IV pencillin
Treatment for Tertiary Syphilis?
If Pen-allergic, must desensitize
Diagnosis: 78 year old female presents with memory loss, myoclonus, startle response, and seizures. Recently had a corneal transplant. What is the pathology ?
Pathology: Spongiform encephalopathy
What are the EEG findings in Creutzfeldt Jakob?
Diagnosis: 78 year old female presents with memory loss Incontinence, gait disturbance with frequent falls, and rapidly developing. Work up?
Normal Pressure Hydrocephalus.
CT/MRI shows hydrocephalus
Spinal tap shows normal opening pressure
Treatment for Normal Pressure Hydrocephalus?
Improves cognitive function in 50-67% of patients
50 year old known alcoholic presents to the ER with tonic clonic seizures. BP 180/110, HR 118, T 100.1.
How long since the last drink?
Bimodal peak at 8 and 48 hours
Diagnosis: 50 year old known alcoholic presents to the ER with tonic clonic seizures. BP 180/110, HR 118, T 100.1. How long until he develops confusion, fluctuations in consciousness, and the feeling of ants crawling on him?
48-72 hours since last drink
A 50 y/o known alcoholic presents to the ER with tonic clonic seizures. BP 180/110, HR 118, T 100.1.
His blood alcohol level is 225mg/mL. How long till its out of his system?
~9hrs, Alcohol is metabolized by zero order kinetics (same amt/unit time = 25mg/hr)
50 year old known alcoholic presents to the ER with tonic clonic seizures. BP 180/110, HR 118, T 100.1. If his medications included propranolol, lactulose, and allopurinol, what would be the best sign to monitor for his withdrawals?
Beta-blockers mask signs of autonomic hyperactivity
Dose benzos based on hyperreflexia
Best initial treatment for alcohol withdrawal?
Diazepam or chloridiazepoxide, due to long 1/2 lives; 80 & 120 hours, respectively
Best initial treatment for alcohol withdrawal if the alcoholic is child class C?
Lorazepam, oxazepam, or tempazepam in settings of cirrhosis
Most specific test for ETOH consumption in the past 10 days?
and AST >2xAST
Diagnosis: Patient with a history of alcohol use comes in with confusion, ataxia, opthalmopelegia?
Cause: thiamine deficiency
Treatment for Wernicke Encephalopathy?
Give thiamine first, then glucose containing fluids
Is Wernicke Encephalopathy reversible?
Wernicke Encephalopathy can progress to what and how can you tell?
Due to irreversible damage to mamillary bodies
Mamillary body atrophy on MRI
Characteristics of Korsakoff's syndrome?
Apathy, anter/retrograde amnesia, and confabulation
Diagnosis: Patient is brought into the ER in a non-responsive state. His BP is 100/60, HR is 50,
RR is 6
. He has multiple track marks on his arms. Best first step?
Best initial step: Intubate (under 8 = intubate)
Next: IV or IM naloxone (full mu-opiate antagonist)
Diagnosis: Patient is brought into the ER in a non-responsive state. His BP is 100/60, HR is 50, RR is 6. He has multiple track marks on his arms. You realize his pupils are dilated.
Hypoxia due to respiratory depression can cause pupil dilation
What symptoms do you expect as he starts to withdraw from heroin?
Joint and muscle pain, photophobia, goosebumps, diarrhea, tachycardia, HTN, GI cramps, dilated pupils, anxiety/depression
Treatment for heroin withdrawal?
--Clonidine for autonomic symptoms
--Ibuprofen for muscle cramps
--Loperimide for diarrhea
--Methadone, buprenorphrine or Naltrexone can be used for long-term dependence
Diagnosis: Patient presents with horizontal nystagmus, dilated pupils, ataxia, and acute psychosis.
Hallucinogen (PCP) intoxication
Treatment for Hallucinogen (PCP) intoxication?
Haloperidol for acute psychosis
Diagnosis: Patient presents s/p MVC with injected conjunctiva, sedation, and is asking for Doritos.
Diagnosis: Patient presents with suicidal ideation, hypersomnia, depression, and anergia
Diagnosis: Patient presents with dilated pupils, seizure, tachycardia and HTN. Best first test?
Next: Urine tox screen
How do you treat seizures induced by cocaine/amphetamine intoxication?
How do you treat HTN and tachycardia in a patient with cocaine/amphetamine intoxication?
Calcium channel blocker
Beta-blockers are CONTRAINDICATED
Piaget's Stages: When is death considered permanent?
6 - 11 years
IQ of 40-55...
IQ of 55-70...
IQ of 25-40...
IQ of <25...
What is the average and standard deviation for IQ?
Average = 100
STD deviation = 15
Diagnosis: 11 year old boy is evaluated for developmental delay, poor school and social performance. Formal IQ testing reveal his IQ to be 50. He has a macrocephaly, long face and macro-orchidism. What is the genetic inheritance?
What are the co-morbid genetic conditions
X-linked dominate inheritance, CGG repeats with anticipation
What are the co-morbid genetic conditions with Fragile X?
Seizures, MVP, dilation of the aorta, tremors, ataxia, ADHD-like behavior.
Diagnosis: A newborn baby has decreased tone, oblique palpebral fissures, a simian crease, big tongue, white spots on his iris.
White spots: Brushfield spots
What can you tell the mother of Down Syndrome newborn about his expected IQ?
Likely mild-moderate MR
Expected speech, gross, and fine motor skill delays
Common medical complications Down Syndrome?
--Heart: VSD, endocardial cushion defects
--GI: Hirschsprung's, intestinal atresia, imperforate anus, annular pancreas
--MSK: Atlanto-axial instability - careful for intubation
--Neuro: Increased risk of Alzheimer's by 30-35x - APP is on Chr21
--Neoplasm: 10x increased risk of ALL
Diagnosis: Café-au-lait spots, seizures, large head. Genetic inheritance?
Diagnosis: Coarse facies, short stature, cloudy cornea. Genetic inheritance?
Diagnosis: Hypotonia, hypogonadism, hyperphagia, skin picking, agression. Allelic anomaly?
Deletion on paternal Chr15.
Diagnosis: Seizures, strabismus, sociable with episodic laughter. Allelic anomaly?
Deletion on maternal Chr15.
Diagnosis: Elfin-appearance, friendly, increased empathy and verbal reasoning ability. Allelic anomaly?
Deletion on Chr7
Diagnosis: ADHD-like symptoms, microcephaly, smooth philtrum. Most common cause of mental retardation.
Fetal Alcohol Syndrome
Diagnosis: Seizures, chorioretinitis, hearing impairments,
, petechiae at birth, hepatitis.
Congenital CMV infection
Diagnosis: Seizures, hearing impairments,
, heart defects, low birth weight.
Congenital Rubella Syndrome
Diagnosis: Abnormal muscle tone, unsteady gait, seizures, mental retardation or learning disability.
risk factor - prematurity
Diagnosis: Coloboma, heart defects, choanalatresia, growth retardation, GU anomalies, ear deformity and deafness.
Diagnosis: palate defects, hypopasticthymus, hypocalcemia. Allelic anomaly?
Diagnosis: Vomiting, seizures, lethargy, coma, acidosis with stress, illness. Causes neurological damage.
Maple Syrup Urine Disease
Diagnosis: Exclusively in girls, normal development for 6-8 months then regression, handwringing, loss of speech and use of hands. Allelic anomaly?
X-linked dominant deletion of MECP2.
Diagnosis: Lack of mother-child eye contact, language delay/repetitive language, preoccupation with "parts of toys" before age 3.
Diagnosis: 7 year old boy is brought in by his parents. They report he must be told several times to complete his chores, they cannot get him to focus on completing his homework (he is easily distracted), and that he often loses his shoes, pencils, books. Next best step?
Normal age appropriate behavior
Diagnosis of ADHD needs misbehavior in 2+ settings
Next best step: How does he do at school?
Risk factors for ADHD?
--Family history = 77% heritability
--Tobacco and ETOH exposure
Co-morbid conditions with ADHD?
ODD/CD in 30-50%
Treatment and side effects for ADHD?
Methylphenidate: DA antagonist
Amphetamine: DA and NE antagonist
Atomoxetine: NE antagonist, non stimulant
Side Effects: Nausea, decreased appetite, increase HR and BP, stunted growth
Diagnosis: 14 year old boy is sent for court mandated counseling. He stole his neighbor's lawn mower and then set fire to his tool shed. He has a 5 year history of truancy from school and assaulted a 13 year old school mate.
Symptoms must be present for at least 6 months
Co-morbidity with Conduct Disorder?
Diagnosis: 14 year old boy is brought in by his grandmother. For the past year, he has been getting in trouble at school for being argumentative and disrespectful to his teachers. He defies the rules she sets for the house and often deliberately annoys her.
Oppositional Defiant Disorder
Symptoms must be present for at least 12 months
Stops short of law-breaking or physically harming others
Diagnosis: 9 year old boy is sent to counseling at the recommendation of his teacher. She states that at least once a day he makes loud grunting noises and hand movements that are disruptive to the class.
Tics must occur at
x1/day for 1 year
tic-free period longer than 3 months
Co-morbid conditions with Tourette?
Compulsions of OCD
Treatment for Tourette?
First line: Clonidine, relatively benign side effects
Most Effective: Haloperidol or pimozide (DA antagonists)
Diagnosis: 7 year old complains of frequent abdominal pain resulting in many missed school days. He never gets the pain on the weekends or in the summer.
Separation Anxiety Disorder
Diagnosis: 6 year old adopted child is brought in because she has not formed a relationship with her adoptive parents. She is inhibited and hyper vigilant.
Reactive Attachment Disorder
Diagnosis: 18 month old baby has recently been regurgitating and re-chewing her food. She had previously been eating normally. Test?
Check lead levels
Diagnosis: 6 year old stools in her clothes once every 2 weeks. Next best test?
Next best test: Check for fecal retention
Treatment for fecal retention?
Behavioral modification that only rewards
Diagnosis: 6 year old that urinates in her clothes once a day. Next best test?
Test: Rule out UTI
Treatment for bed-wetting?
Treatment: Alarm and pad (behavioural therapy)
DDAVP or TCAs if therapy doesn't work, but relapse is common
THIS SET IS OFTEN IN FOLDERS WITH...
DSM-5 diagnostic criteria and mnemonics
Psychiatry DSM-5 Criteria
YOU MIGHT ALSO LIKE...
Psych PA Questions
Psy Prev 250+
OTHER SETS BY THIS CREATOR
EM M4 SAEM
Psychiatry pillar 3
Radiology Pillar 2