USMLE (Fach) / Psychiatry (Lektion)
In dieser Lektion befinden sich 106 Karteikarten
USMLE First Aid
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- Panic disorder Recurrent unexpected panic attacks not associated with a known trigger. Periods of intense fear and discomfort peak in 10 minutes with at least 4 of the following:- Palpitations- Paresthesias- Depersonalization ...
- Specific phobia Severe, persistent (≥6 months) fear or anxiety due to presence or anticipation of a specific object or situation. Person often recognizes fear is excessive.- Can be treated with systematic desensitization. ...
- Generalized anxiety disorder Anxiety lasting >6 months unrelated to a specific person, situation, or event. Associated with:- Restlessness, irritability- Sleep disturbance, fatigue- Muscle tension- Difficulty concentrating Treatment: ...
- Obsessive-compulsive disorder Recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress; relieved in part by the performance of repetitive actions (compulsions). - Ego-dystonic: behavior inconsistent ...
- Post-traumatic stress disorder Experiencing a potentially life-threatening situation (eg, serious injury, rape, witnessing death) → persistent hyperarousal, avoidance of associated stimuli, intrusive re-experiencing of the event ...
- Cluster A personality disorders "Weird." Odd or eccentric; inability to develop meaningful social relationships.No psychosis; genetic association with schizophrenia. Paranoid – pervasive distrust and suspiciousness of others and a ...
- Cluster B personality disorders "Wild." Dramatic, emotional, or erratic; genetic association with mood disorders and substance abuse. Antisocial – Disregard for and violation of rights of others with lack of remorse, criminality, ...
- Cluster C personality disorders "Worried." Anxious or fearful; genetic association with anxiety disorders. Avoidant – Hypersensitivity to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others ...
- Enuresis Urinary incontinence ≥2 times/week for ≥3 months in person >5 years old. - First-line treatment: behavioral modification (eg, scheduled voids) and positive reinforcement.- Refractory cases: bedwetting ...
- Serotonin syndrome Any drug that ↑ 5-HT. Psychiatric drugs: MAO inhibitors, SSRIs, SNRIs, TCAs, vilazodone, vortioxetineNonpsychiatric drugs: tramadol, ondansetron, triptans, linezolid, MDMA, dextromethorphan, meperidine ...
- Carcinoid syndrome Carcinoid tumor of GI tract, lung Manifestation:- Diarrhea- Flushing- Wheezing- Right heart disease (if tumor is in the gut) Treatment: Ocreotide
- Hypertensive crisis Eating tyramine-rich foods (eg, aged cheeses, cured meats, wine) while taking MAO inhibitor. Manifestation:- Hypertensive crisis (tyramine displaces other neurotransmitters [eg, NE] in the synaptic ...
- Neuroleptic malignant syndrome Cause: Antipsychotics + genetic predisposition Manifestation:- Myoglobinuria- Fever- Encephalopathy- Unstable vitals- ↑ enzymes (eg, ↑ CK)- Rigidity of muscles ("lead pipe") Treatment: Dantrolene, ...
- Malignant hyperthermia Inhaled anesthetics, succinylcholine + genetic predisposition Manifestation: Fever, severe muscle contractions Treatment: Dantrolene
- Delirium tremens Alcohol withdrawal; occurs 2-4 days after last drink. Classically seen in hospital setting when inpatient cannot drink. Manifestation:- Altered mental status (eg, hallucinations)- Autonomic hyperactivity- ...
- Acute dystonia Typical antipsychotics, anticonvulsants (eg, carbamazepine), metoclopramide Manifestation:- Sudden onset of muscle spasm, stiffness, oculogyric crisis - Occurs within hours to days after medication use- ...
- Lithium toxicity - Change in lithium dosage or health status (narrow therapeutic window)- Concurrent use of thiazides, ACE inhibitors, NSAIDs, or other nephrotoxic agents Manifestation:- Nausea, vomiting- Slurred speech- ...
- Tricyclic antidepressant toxicity TCA overdose Manifestation: - Cardiotoxicity (arrhythmia due to Na+ channel inhibition)- Convulsions- Coma- Respiratory depression- Hyperpyrexia- Prolonged QT interval Treatment: Supportive treatment, ...
- Alcohol Intoxication: Emotional lability, slurred speech, ataxia, coma, blackouts. - Serum γ-glutamyltransferase (GGT) – sensitive indicator of alcohol use. - AST:ALT is >2:1 Withdrawal:- 3-36 hours: tremors, ...
- Phencyclidine (PCP) Intoxication: Violence, impulsivity, psychomotor agitation, nystagmus, tachycardia, hypertension, analgesia, psychosis, delirium, seizures.- Trauma is most common complication. Withdrawal: none
- Lysergic acid diethylamide Intoxication: Perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks. Withdrawal: none
- MDMA (ecstasy) Intoxication: Hallucinogenic stimulant: euphoria, disinhibition, hyperactivity, distorted sensory and time perception, teeth clenching Withdrawal: Depression, fatigue, change in appetite, difficulty ...
- Marijuana (cannabinoid) Intoxication: Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawal, ↑ appetite, dry mouth, conjunctival injection, hallucinations.- Pharmaceutical ...
- Anorexia nervosa Intense fear of weight gain and distortion or overvaluation of body image leading to restriction of caloric intake and severe weight loss (BMI <18.5 kg/m2). Restricting and binge/purge subtypes. - Associated ...
- Verbal interventions Reflection: Facilitating interview technique in which the physician repeats what the patient has said, either word for word (also known as mirroring) or by paraphrasing. The technique assures the patient ...
- Classical conditioning Learning in which a natural response (salivation) is elicited by a conditioned, or learned, stimulus (bell) that previously was presented in conjunction with an unconditioned stimulus (food). Usually ...
- Operant conditioning Learning in which a particular action is elicited because it produces a punishment or reward.Usually deals with voluntary reponses. Reinforcement: Target behavior (response) is followed by desired reward ...
- Transference and countertransference Transference: Patient projects feelings about formative or other important persons on to physician (eg, psychiatrist is seen as a parent). Counterference: Doctor projects feelings about formative or other ...
- Passive aggression Demonstrating hostile feelings in a nonconfrontational manner; showing indirect opposition. Example: Disgruntled employee is repeatedly late to work, but won't admit it is a way to get back at the manager. ...
- Infant deprivation effects Long-term deprivation of affection results in:- Failure to thrive- Poor language/socialization skills- Lack of basic trust- Reactive attachment disorder (infant withdrawn/unresponsive to comfort)- Disinhibited ...
- Child neglect Failure to provide a child with adequate food, shelter, supervision, education, and/or affection. - Most common form of child maltreatment. Evidence: - Poor hygiene- Malnutrition- Withdrawal- Impaired ...
- Orientation Patient's ability to know who he or she is, where he or she is, and the date and time. Common causes of loss of orientation: alcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, infection, ...
- Amnesias Retrograde amnesia: Inability to remember things that occured before a CNS insult. Anteriograde amnesia: Inability to remember things that occured after a CNS insult (↓ acquisition of new memory). Korsakoff ...
- Hallucinations Presentation of psychosis. Perceptions in the absence of external stimuli (eg, seeing a light that is not actually present). Contrast with illusions, misperceptions of real external stimuli. Types include:- ...
- Mood disorder Characterized by an abnormal range of moods or internal emotional states and loss of control over them. Severity of mood causes distress and impairment in social and occupational functioning. Includes ...
- Risk factors for suicide completion - Sex (male)- Age (young adult or elderly)- Depression- Previous attempt (highest risk factor)- Ethanol or drug use- Rational thinking loss (psychosis)- Sickness (medical illness)- Organized plan- No ...
- Anxiety disorder Inappropriate experience of fear/worry and its physical manifestations (anxiety) incongruent with the magnitude of the perceived stressor. Symptoms interfere with daily functioning and are not attributable ...
- Illness anxiety disorder Also known as hypochondriasis. Excessive preoccupation with acquiring or having a serious illness, often despite medical evaluation and reassurance. Minimal somatic symptoms.
- Bulimia nervosa Binge eating with recurrent inappropriate compensatory behaviors (eg, self-induced vomiting, using laxatives or diuretics, fasting, excessive exercise) occuring weekly for at least 3 months and overvaluation ...
- Binge eating disorder Regular episodes of excessive, uncontrollable eating without inappropriate compensatory behaviors. ↑ risk of diabetes. Treatment: psychotherapy such as CBT is first line; SSRIs, lisdexamfetamine.
- Gender dysphoria Persistent cross-gender identification that leads to persistent distress with sex assigned at birth. Transsexualism – desire to live as the opposite sex, often through surgery or hormone treatment. ...
- Sexual dysfunction Includes sexual desire disorders (hypoactive sexual desire or sexual aversion), sexual arousal disorders (erectile dysfunction), orgasmic disorders (anorgasmia, premature ejaculation), sexual pain disorders ...
- Sleep terror disorder Inconsolable periods of terror with screaming in the middle of the night; occurs during slow-wave/deep (stage N3) sleep.- Most common in children. Occurs during non-REM sleep (no memory of the arousal ...
- Substance use disorder Maladaptive pattern of substance use defined as 2 or more of the following signs in 1 year related specifically to substance use:- Tolerance – need more to achieve same effect- Withdrawal – manifesting ...
- Stages of change in overcoming substance addiction 1. Precontemplation – not yet acknowledging that there is a problem 2. Contemplation – acknowledging that there is a problem, but not yet ready or willing to make a change 3. Preparation/determination ...
- Opioids Intoxicity: Euphoria, respiratory and CNS depression, ↓ gag reflex, pupillary constriction (pinpoint pupils), seizures (overdose). - Most common cause of drug overdose death.- Treatment: naloxone. ...
- Barbiturates Intoxication: Low safety margin, marked respiratory depression.- Treatment: symptom management (eg, assist respiration, ↑ BP). Withdrawal: Delirium, life-threatening cardiovascular collapse.
- Benzodiazephines Intoxication: Greater safety margin. Ataxia, minor respiratory depression.- Treatment: flumazenil (benzodiazepine receptor antagonist, but rarely used as it can precipitate seizures). Withdrawal: Sleep ...
- Amphetamines Intoxication: Euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia, fever. - Skin excoriations with methamphetamine use.- Severe: ...
- Cocaine Intoxication: Impaired judgement, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death.- Chronic use may lead to perforated nasal septum due to vasoconstriction ...