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Psychiatry: high-yield facts + uworld

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1.

"A&Ox4" meaning?: Alert and oriented to time, place, person,

8.

23 yo male brought to ER with 2-day hx of fever,

and situation.
2.

headaches, and confusion. He slips into a coma and


dies several days after admission. Autopsy reveals
intense, bilateral hemorrhagic necrosis of the inferior
and medial temporal lobes. Etiology?: HSV-1 encephalitis:
TEMPORAL LOBE involvement is characteristic!
Gross brain examination reveals edema and hemorrhagic
necrosis. Eosinophilic intranuclear inclusions (Cowdry type A)
are present in glial cells and neurons. Multinucleated giant cells
may also be found.

Know the first vs. second-gen H1 receptor blockers: Firstgen H1 blockers (have antimuscarinic, antiserotonergic, and
alpha-blocking side effects):
Hydroxyzine
Promethazine
Chlorpheniramine
Diphenhydramine
Dimenhydrinate
9.

43 yo female presents with bilateral paresthesias in

Antimuscarinic = blurry vision, dry mouth, urinary retenion


Antiserotonergic = appetite stimulation
Alpha-blocking = postural dizziness
Second-gen H1 blockers:
Fexofenadine
Loratadine
Desloratadine
Cetirizine
3.

10.

11.

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6.

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7.

14.

Benzos or haloperidol can be used to treat overdose of


which 2 drug categories?: 1) Cocaine/amphetamines
2) PCP

4 drugs that can help prevent relapse in recovering


15.

Besides schizophrenia, what disorder can be treated

16.

Best treatment for atypical depression?: MAOIs, SSRIs

17.

Binge eating disorder vs. Compulsive eating disorder:

with antipsychotics?: Tourette's (haloperidol; risperidone


(preferred over TCAs)

4 indications of diazepam (long-acting benzo)?: 1)


Anxiolytic
2) Sedative-hypnotic
3) Anticonvulsant
4) Muscle relaxant

Axonal conduction:
Space constant (aka length constant)
Time constant: Space (length) constant = a measure of how far
along an axon an electrical impulse can propagate; this value is
increased by myelination
Time constant = time it takes for a change in membrane potential
to achieve 63% of the new value; myelination decreases
membrane capacitance and thus reduces the time constant
(allowing for fasting axonal confuction speed)

3 adverse effect disorders that are very similar:

alcoholics?: 1) Disulfiram (Antabuse)


2) Naltrexone
3) Topiramate
4) Acamprosate

Autism vs. Aspergers: Autism = usu below-normal


intelligence
Aspergers = usu normal intelligence "little professors"

2 most common causes of delirium: 1) Drugs (esp those with

Neuroleptic malignant syndrome


Serotonin syndrome
Malignant hyperthermia

Atypical antipsychotics:
MOA?
AE?: MOA: varied effects on serotonin, dopamine, alpha, H1
AE: clozapine and agranulocytosis; ziprasidone and prolonged
QT; quetiapine/olanzapine/clozapine and weight gain (incr risk
for diabetes)

anticholinergic side effects, remember "mad as a hatter")


2) UTIs
5.

43 yo male complains of double vision when walking


down stairs. He's healthy. Has T2DM well controlled
with glyburide. What is causing his complaints?: NOT
DIABETIC RETINOPATHY
TROCHLEAR NERVE (a common cause of vertical diplopia,
which is most noticeable when the affected eye looks toward the
nose, as when reading the newspaper or walking down stairs)

*What NT changes do you see with the following


diseases?
1) Anxiety disorders =
2) Depression =
3) Mania =
4) Alzheimer's =
5) Huntington's =
6) Schizophrenia =
7) Parkinson's = *: 1) Anxiety disorders = high NE; low GABA
and serotonin
2) Depression = low serotonin; NE; dopamine
3) Mania = high serotonin; NE; dopamine
4) Alzheimer's = low ACh
5) Huntington's = low ACh and GABA; high dopamine
6) Schizophrenia = high dopamine
7) Parkinson's = high ACh; low dopamine

4.

thumbs, middle, and index fingers. She undergoes


hemodialysis for chronic renal failure due to
uncontrolled HTN. Her condition is most likely assoc
with __:: Nerve compression within an anatomic compartment
(carpal tunnel syndrome causing median nerve compression)

Binge eating disorder is a maladaptive coping mechanism.


Compulsive eating disorder is a type of OCD.

18.

Childhood disintegrative disorder: Most common age of

31.

onset is 3-4 yo, after at least 2 yrs of normal development.


More common in boys.
Significant loss of expressive/receptive language skills, social
skills, adaptive behavioral, bowel/bladder control, play, motor
skills.
19.

2) Severe depression, headache, fatigue,


insomnia/hypersomnia, hunger
4) Belligerence, impulsiveness, nystagmus, homicidal
ideations, psychosis =
5) Headache, anxiety/depression, weight gain =
6) Euphoria, social withdrawal, impaired judgment,
hallucinations =
7) Rebound anxiety, tremors, seizures, life-threatening
=: 2) Severe depression, headache, fatigue,
insomnia/hypersomnia, hunger =
cocaine/amphetamine withdrawal
4) Belligerence, impulsiveness, nystagmus, homicidal ideations,
psychosis = PCP overdose
5) Headache, anxiety/depression, weight gain =
nicotine/caffeine withdrawal
6) Euphoria, social withdrawal, impaired judgment,
hallucinations = LSD intoxication
7) Rebound anxiety, tremors, seizures, life-threatening
= alcohol/benzo/barbiturate withdrawal

Classical presentation of homocystinuria? What enzyme


is deficient?: Thromboembolic episodes involving both large
and small vessels, esp those of the brain. Other clinical
manifestations resemble those of Marfan syndrome: lens
subluxation, elongated limbs, arachnodactyly, scholiosis.
Deficiency in cystathione synthetase

20.

Concentrations of which 3 NTs are increased by


MAOis?: NE
Dopamine
Serotonin

21.

Corneal reflex is mediated by which CN?: CN V

22.

Define dissociative amnesia: Inability to recall personal


information subsequent to severe trauma/stress

23.

32.

Define folie a deux: Development of delusional disorder in a

Delirium vs. Dementia: Delirium has altered consciousness


("waxing and waning"), and acute onset and ABNORMAL EEG.
Dementia does not, and has gradual onset and normal EEG.

25.

Difference between postpartum blues and postpartum


depression: Blues last <2 weeks
(also, postpartum depression = major depressive disorder)

26.

Displacement =: Process whereby bothersome ideas and

33.

Dissociation =
Extreme forms can result in _?: Temporary, drastic change
in personality, memory, consciousness, or motor behavior to
avoid emotional stress
Extreme forms can result in multiple personality disorder

28.

Drug of choice for treatment of generalized anxiety

34.

disorder?: Buspirone (stimulates 5-HT1A receptors)-treatment of GAD is its ONLY indication

Drug that can treat bulimia?: SSRI (note this can't be used

30.

Drugs for treatment of Tourette's syndrome?: 1)

for anorexia)
Haloperidol (neuroleptic; old)
2) Fluphenazine, Pimozide, Tetrabenazine (dopamine
antagonists; current DOC)

Dx of schizophrenia: (according to DSM): >6 mo of:


2 of the following sx:
1) Delusions
2) Hallucinations
3) Disorganized speech (loose associations)
4) Disorganized/catatonic behavior
5) Negative sx (flat affect, social withdrawal, lack of motivation,
lack of speech or thought, thought blocking)

Clean drug!
29.

Dx criteria for manic episode:: 3+ of the following over 1+


week (or hospitalization):
DIGFAST
1) Distractibility
2) Irresponsibility (hedonistic)
3) Grandiosity
4) Flight of ideas
5) Agitation; increase in goal-directed Activity
6) Sleep decreased
7) Talkative / pressured speech

feelings are transferred to a neutral person/object (Mom yells at


child because husband yelled at her).
27.

Dx criteria for major depressive disorder:: Depressed


mood + 5 of the following, over 2+ weeks: SIGECAPS
1) Sleep disturbance
2) Interests loss
3) Guilt
4) Energy loss
5) Concentration loss
6) Appetite change
7) Psychomotor retardation or agitation
8) Suicidal ideation

person in a close relationship with someone who has delusional


disorder. (aka shared psychotic disorder)
24.

Drugs of abuse:

35.

Dysthymia vs. Hypomania vs. Cyclothymia: All are milder


versions of things, i.e.
Dysthymia = mild depression for 2+ YEARS
Hypomania = mild manic episode not severe enough to
necessitate hospitalization
Cyclothymia = mild bipolar consisting of rapidly fluctuating
dysthymia and hypomania for 2+ YEARS

36.

Evolution of EPS side effects:: 4 hr = acute dystonia (tx: give


drugs with anticholinergic side effects)
4 days = akisthesia (restlessness)
4 wk = bradykinesia (Parkinsonism)
4 mo = tardive dyskinesia: irreversible

37.

47.

(describing murder in graphic detail with no emotional


response)
48.

assume the "sick role" (unlike malingering, their goals are not
external incentives).

38.

49.

50.

Fixation =: Partially remaining at a more childish level of

40.

Heme synthesis pathway defects:

List some SNRIs and their uses.: 1) Venlafaxine


2) Duloxetine (Cymbalta)
3) Nefazodone (no sexual side effects)
4) Milnicipran

Progresses to antisocial personality disorder (>18 yo)


39.

List drugs that can be used for bipolar disorder: 1)


Lithium
2) Seizure drugs (valproic acid; carbamazepine)
3) Atypical antipsychotics

Features of conduct disorder? What can this progress


to?: Cruelty to animals; violation of the basic rights of others

List 3 atypical antidepressants:: 1) Buproprion = increases


NE and dopamine (mech. unknown); good for cotherapy with
SSRIs; lowers seizure threshold
2) Mirtazapine = alpha2-antagonist; increases release of NE and
serotonin; has antihistamine side effects (sedation; incr appetite;
dry mouth)
3) Trazodone = inhibits serotonin reuptake; mostly used for
insomnia; may cause priapism

Factitious disorder =: Consciously creates sx in order to

Ex: nurse has episodes of hypoglycemia. Blood analysis reveals


no elevation in C protein. Dx? (C protein would be elevated if the
insulin was high due to endogenous production; this is a case of
factitious disorder in which the nurse has been injecting herself
with insulin)

Isolation (of affect) =: Separation of feelings from events

development (Z Chen)
ALA synthase =
ALA dehydratase =
Uroporphyinogen I synthase (aka porphobilinogen
deaminase) =
Uroporphyrinogen decarboxylase =
Ferrochelatase =: ALA synthase = X-linked sideroblastic
anemia
ALA dehydratase = lead poisoning
Uroporphyinogen I synthase (aka porphobilinogen deaminase)
= acute intermittent porphyria (urine will darken upon exposure
to light; acute abdomen; acute psychosis)
Uroporphyrinogen decarboxylase = porphyria cutanea tarda
(most common)
Ferrochelatase = lead poisoning
41.

How long after a pt's last drink for delirium tremens to

Used for depression; venlafaxine also for GAD and panic


disorders. Duloxetine also for diabetic peripheral neuropathy
(greater effect on NE)
51.

2) Humor
3) Sublimation
4) Suppression
52.

53.

Also fetal cardiac defects (Ebstein's anomaly; malformation of


the great vessels)
54.

month
43.

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45.

55.

56.

If you have to use a TCA in an elderly pt, which one, and


why?: Nortriptyline (secondary TCA; better than the tertiary
TCAs like amitriptyline) bc less anticholinergic effects

Name the famous SSRIs: 1) Sertraline (Zoloft)


2) Fluoxetine (Prozac)
3) Paroxetine (Paxil)
4) Citalopram
5) Fluvoxamine

Identification =: Modeling behavior after someone who is


more powerful (not necessarily more admired)

46.

Most common location of an intracranial


schwannoma?: Cerebllopontine angle (between the cerebellum
and lateral pons)

Hypnopompic vs. Hypnogogic hallucinations:


Hypnopompic occurs upon awakening
Hypnogogic occurs while going to sleep

Mirtazapine: MOA; indications: MOA: alpha2-selective


blocker
Indications: depression

Hx of sexual abuse is associated with what disorder?:


Dissociative identity disorder (formerly known as multiple
personality disorder)

Lithium side effects:: MNOP:


Movement (tremor)
Nephrogenic DI (blocks ADH--thus can be used to treat SIADH)
HypOthyroidism

Tx: benzos
How long do sx have to last for a diagnosis of PTSD?: >1

List the personality disorders by cluster:


A
B
C: Mnemonic: "Weird, Wild, Worried"
Cluster A = Paranoid, Schizoid, Schizotypal
Cluster B = Antisocial, Borderline, Histrionic, Narcissistic
Cluster C = Avoidant, Obsessive-compulsive, Dependent

set in? Treatment?: 2-5 days: life-threatening ANS


hyperactivity (tachycardia, tremors, anxiety, seizures) -->
psychotic sx --> confusion

42.

List the 4 mature ego defenses:: 1) Altruism

57.

Neurofibromas are derived from what cell type / what


embryonal layer?: Schwann cells, which are derived from the
neural crest.

58.

Non-schizophrenia psychotic disorders (3):: 1) Brief

69.

psychotic disorder (<1 mo)


2) Schizophreniform disorder (between 1 and 6 mo)
3) Schizoaffective disorder (psychotic sx + an episode of a mood
disorder--depressive, manic, or mixed): note a stable mood must
have been present for at least 2 weeks (or else you would consider
it a primary mood disorder with psychotic sx)
59.

production and motivation are both UNCONSCIOUS


drives
1) Somatization disorder
2) Conversion disorder
3) Hypochondriasis
4) Body dysmorphic disorder
5) Pain disorder: 1) Somatization disorder = laundry list of
complaints
2) Conversion disorder = V for Voltage (think nerves);
unexplained sensory/motor loss following acute stressor; pt is
unconcerned (la belle indifference)
3) Hypochondriasis
4) Body dysmorphic disorder
5) Pain disorder

Normal bereavement: pts are allowed to meet full


criteria for MDD for up to ____ (period of time)?: 2
months

60.

Opioid effects:
Intoxication
Overdose
Withdrawal: Post-op constipation and/or resp depression =
opioid intoxication
70.

Splitting =: Belief only in the extremes (i.e. people are either all

71.

SSRI withdrawal sx:

good or all times); cannot tolerate ambiguity.

Pinpoint pupils, n/v, seizures = opioid overdose


Anxiety, sweating, dilated pupils, piloerection, fever, rhinorrhea,
nausea, diarrhea = opioid withdrawal
61.

62.

How to avoid?: Dizziness, nausea, fatigue, muscle aches,


anxiety, irritability
Avoid by using a fluoxetine taper (long half life)

Oppositional defiant disorder?: Enduring pattern of hostile,


defiant behavior towards authorities

72.

Projection =: Unacceptable internal impulse is attributed to an


external source (ex: man who wants another woman thinks his
wife is cheating on him)

64.

A pt who needs an MRI says he can't go through with it


because of claustrophobia. What can you do to help?:
Give him 2 benzos

65.

A pt with ST elevation inferior MI is treated with the


appropriate therapy, including a medication for her
bradycardia. After initial treatment, her BP is 120/70
and pulse is 76/min. However, she now complains of
severe right-sided eye pain. Why?: Inferior MIs are due to
blockage of the RCA, which supplies the SA and AV nodes. Thus
sx include bradycardia. To treat this bradycardia, atropine is
given (blocks vagal input at SA and AV nodes in order to increase
HR). However, its antimuscarinic effects can precipitate an
attack of acute closed-angle glaucoma in individuals of high risk
(esp Asians) bc atropine causes mydriasis, resulting in
narrowing of the anterior chamber angle and fiminished outflow
of aqueous humor.

66.

67.

Regression =: Turning back the maturational clock and going


back to earlier modes of dealing with the world

68.

73.

Sleep patterns of depressed pts:: Decr slow-wave sleep (i.e.


stages 3-4)
Decr REM latency; Incr total REM
Early morning awakening

Suffixes for TCAs:: -triptamine


-pramine

74.

Sx of serotonin syndrome?
Mainstays of treatment?: Muscle rigidity
Hyperthermia
CV collapse
Tx: cooling and benzos (then cyproheptadine--5HT2 receptor
antagonist--if needed)

75.

Sx of TCA overdose?
Treatment for cardiotoxicity?: Tri C's:
1) Cardiotoxicity (treat with NaHCO3)
2) Convulsions
3) Coma
+ Respiratory depression and Hyperpyrexia

Reaction formation =: Emphasizing the opposite (ex: person


with libidinous thoughts enters a monastery)

SSRIs can be used in the treatment of.... (basically


everything; list 7): 1) Depression
2) Panic disorder
3) Social phobia
4) OCD
5) PTSD
6) Generalized anxiety disorder
7) Bulimia

Presentation of bulimia?: Parotitis, enamel erosion,


hypochloremic hypokalemic metabolic alkalosis, dorsal hand
calluses from induced vomiting (Russell's sign)

63.

Somatoform disorders: remember that illness

76.

Temporarily inhibiting thinking but continuing to build


more tension = ?
Avoiding interpersonal intimacy to resolve conflict and
obtain gratification = ?: Temporarily inhibiting thinking but
continuing to build more tension = blocking (seen in
schizophrenics)
Avoiding interpersonal intimacy to resolve conflict and obtain
gratification = schizoid fantasy

77.

Ticking timebomb of global cerebral ischemia::

87.

What is important to remember when treating an


alcoholic with IV fluids?: ALWAYS GIVE THIAMINE
BEFORE GLUCOSE
Why? Think about it. 2 of the enzymes that thiamine acts as a
cofactor for directly feed into glucose utilization for energy
production (pyruvate dehydrogenase and alpha-ketoglutarate).
The third enzyme, transketolase, functions in the HMP shunt to
convert pentoses to G3P (a glycolytic intermediate).
Thus pts with thiamine deficiency have severe under-utilization
of glucose due to these non-functioning enzymes. If you give
more glucose, this would worsen the Wernicke-Korsakoff
symptoms. ALWAYS GIVE THIAMINE FIRST!

5-10 seconds: syncope


>1 minute: cessation of neuronal activity
4-5 min: permanent tissue damage
78.

Tx for ADHD? What is the MOA?: CNS stimulants:


methylphenidate, amphetamines
MOA: increase catecholamine (esp NE and dopamine) vesicle
release at synaptic cleft

88.

pregnant?: Pseudocyesis
89.

Typical antipsychotics: AE: 1) EPS (high potency)


2) Anticholinergic (dry mouth, constipation; delirium in elderly)
3) Histamine (sedation)
4) Endocrine (dopamine block --> hyperprolactinemia)

80.

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92.

93.

94.

95.

Blocks NMDA receptor activation

Which defense mechanism underlies all other defense


mechanisms?: Repression (involuntary withholding of a
thought or idea from conscious awareness)

infant due to long-term deprivation of affection


What is another name for PCP: PHENCYCLIDINE

Which antidepressant...:
1) Lowers seizure threshold
2) Works well with SSRIs and increases REM sleep
3) Stimulates appetite (weight gain)
4) Can be used for bedwetting in kids
5) AE: priapism: 1) Lowers seizure threshold = bupropion
2) Works well with SSRIs and increases REM sleep = trazodone
3) Stimulates appetite (weight gain) = mirtazepine
4) Can be used for bedwetting in kids = imipramine
5) AE: priapism = trazodone

Note co-dosing of MAOis and beta-agonists can also trigger this


reaction.

86.

Which 3 enzymes is thiamine a cofactor for?: 1) Pyruvate


dehydrogenase (glycolysis into TCA)
2) Alpha-ketoglutarate dehydrogenase (TCA cycle)
2) Transketolase (HMP pathway: converts pentose --> G3P)

What happens if you ingest tyramine while on MAOis?:

What is anaclitic depression?: Withdrawn, unresponsive

What kind of amnesia is caued by thiamine deficiency?:


Korsakoff's amnesia is anterograde (no new memories); assoc
with mammillary body destruction. Seen in alcoholics. Also
accompanied by confabulation.

Hypertensive cheese crisis = risk for hemorrhagic stroke; cardiac


arrhythmias

85.

What is unique about the atypical antipsychotics?: Have


been shown to improve both positive and negative sx of
schizophrenia
Clozapine, Olanzapine, quetiapine, risperidone

What are the components of the CAGE questionnaire?:


Used to assess alcoholism:
Cut back
Annoyed
Guilt
Eye opener

84.

91.

What are the 3 key elements of a DNR?: 1) No intubation or


mechanical ventilation
2) No defibrillation or IV drugs to acutely treat a terminal rhythm
3) No chest compressions

What is the triad seen in Wernicke's encephalopathy


(thiamine deficiency)?: 1) Confusion
2) Ophthalmoplegia
3) Ataxia

Typical vs. Atypical neuroleptics (antipsychotics)::


Typical = block dopamine D2 receptors (incr cAMP)
Atypical = block dopamine and 5-HT

82.

90.

Typical antipsychotics: high vs. low potency: High


potency = Trifluoperazine, Fluphenazine, Haloperidol (high rate
of EPS)
Low potency = Chlorpromazine, Thioridazine (high rate of
anticholinergic side effects)

What is the "on-off" phenomenon of Parkinson's dz?:


After a period of time of L-dopa therapy, there may be periods of
time when L-dopa efficacy is lost; this may last several hours and
occur sporadically throughout the day, resulting in hypokinesia
and rigidity. This is unpredictable and dose-independent. (Drug
holidays are not helpful in preventing this phenomenon).

Atomoxetine = NE reuptake inhibitor


79.

What is it called when you falsely believe you're

96.

Which immature ego defense?


Closet homosexual hates all homosexuals because of the
way they "make him feel": Projection

97.

Which NT is involved in the development of morphine tolerance?: Glutamate: binds/activates NMDA receptors --> incr
phosphorylation of opioid receptors and incr NO levels leading to morphine tolerance
NMDA receptor antagonists like ketamine can block the actions of glutamate and potentially block morphine tolerance from developing.
(Dextromethorphan is another drug that may be able to do this)

98.

Which personality disorder is assoc. with splitting?: Borderline

99.

Which property of methadone makes it a good substitute for heroin in detoxification of addicts?: Long half-life.
Other properties of methadone: extended, mild withdrawal syndrome (due to concentration in tissues and gradual release); good oral
bioavailability; potent mu receptor agonist with strong analgesic effects; can cause resp depression (just like most other opioids)

100.

You prescribe diazepam to a patient in order to decrease muscle spasticity. You should caution him to avoid which
drug?: Chlorpheniramine (and other first-generation H1 blockers: they have CNS penetration and block both central and peripheral H1
receptors, resulting in sedation)
This would potentiate the sedating effects of benzos, and be dangerous.