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100 Cards in this Set
- Front
- Back
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CAGE questionaire for suspected EtOH abuse.
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felt a need to Cut down?
ever been Annoyed at someone for criticizing your drinking? feel Guilty about your drinking? ever have an Eye-opener drink to get you going in the morning? |
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EtOH withdrawal: these sx start 6-12 hours after last drink
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Minor withdrawal symptoms: tremulousness is most tested; others: insomnia, mildanxiety, gastrointestinal upset, headache, diaphoresis, palpitations, anorexia
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EtOH withdrawal: these sx start 12-24 hours after last drink (generally resolve within 48 hours).
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Alcoholic hallucinosis: visual, auditory, or tactile hallucinations
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EtOH withdrawal: these sx usually start 24-48 hours after last drink (can start earlier)
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Withdrawal seizures: generalized tonic-clonic seizures
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EtOH withdrawal: these sx start 48-72 hours after last drink (peak at day 5)
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Alcohol withdrawal delirium (delirium tremens): hallucinations accompanied by disorientation; other sx: tachycardia, hypertension, low-grade fever, agitation, diaphoresis
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EtOH intoxication (remember 4 sx: SAND mnemonic)
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slurred speech
ataxia nystagmus disinhibition |
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EtOH intoxication in ER: 3 labs to aid treatment.
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Blood Glucose, Thiamine, Folate
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EtOH withdrawal treatment.
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Benzo taper: can use Chlordiazepoxide (Librium), but generally use Lorazepam (Ativan) 2/2 liver disease risk
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Most feared complication in cocaine intoxication/overdose.
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sudden cardiac death due to arrhythmias and vasospasm
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Cocaine withdrawal "crash:" what is the biggest concern?
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depression and suicidality
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Amphetamine, Meth, or Ecstasy intoxication: remember 4 things.
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agitation, tachycardia, delusions, pupil dilation
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Methamphetamine intoxication pearl in Step 2 questions.
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psychosis
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PCP intoxication (3 things to remember)
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remember it's always a WEIRD presentation: combative, psychosis, STRANGE BEHAVIOR
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Most important Barbiturate and Benzo overdose sx.
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respiratory depression
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Opiate intoxication vs withdrawal: pupil size.
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INtoxicated=pIN-point
withDrawal=Dilated |
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Opiate withdrawal sx.
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cold turkey with diarrhea: sweating, dilated pupils, piloerection, rhinorrhea, N/V, cramps, diarrhea
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Other drug besides Benzos that can cause respiratory depression in overdose.
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Opiates (common post-op)
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Marijuana/Spice addiction/intoxication symptoms.
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social withdrawal, increased appetite (munchies), dry mouth, CONJUNCTIVAL INJECTION
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Caffeine withdrawal sx pearl in Step 2 questions.
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headache
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Nicotine withdrawal craving (addiction) treatment.
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Nicotine patch or gum, Zyban (Wellbutrin), Clonidine, Chantix, counseling, hypnosis
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What are "cocaine bugs"?
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intoxication hallucinations are usually tactile and feel like bugs crawling on skin
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Very important treatment in EtOH detox (besides benzos via CIWA)?
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Thiamine, Folate, and nutrition
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Schizophrenia DSMIV criteria (DOWNSHIfT mnemonic).
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Delusion
Odd Behavior W/out mood sx Negative sx Speech disorganized Hallucinations If = Impaired Function Time > 6 months |
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Schizophrenia negative sx (5 A's)
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Affect flat
Anhedonia Apathy Alogia Attention |
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Major Depressive Episode DSMIV criteria (2 weeks or more of these sx: D-SIGECAPS mnemonic).
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Sleep changes
Interest decreased (anhedonia) or Depressed Guilt Energy down Concentration down Appetite changes Psychomotor retardation Suicidality |
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Manic Episode DSMIV criteria (DIG-FAST mnemonic sx)
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Distracted
Insomnia Grandiose Flight of Ideas Activity/Agitation Speech pressured Thoughtless (impulsive) |
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Panic Attack DSMIV criteria (PANICS mnemonic)
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Palpitations
Abdominal distress No-control/No known cause Impending doom/fear of death Chest pain Sweating, shaking, SOB |
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OCD mnemonic
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Obsessions and Compulsions AND DISTRESSED ABOUT THEM (OCPD is egosyntonic, OCD is egodystonic)
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PTSD criteria from DSMIV (TRAUMA mnemonic)
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Traumatic experience in past
Re-experiencing it (flashbacks etc.) Avoiding triggers like social anxiety Unable to function More than 1 month Arousal (easily startled) |
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General Anxiety Disorder (GAD) sx from DSMIV criteria (CANTREST mnemonic)
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Concentration decreased
Agitated No control Time more than 6 months Restless Energy down Sleep changes Tense muscles |
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Borderline sx from DSMIV criteria (AM-SUICIDE mnemonic)
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Abondonment (fear of)
Mood instability Suicidal or Self-mutilating behavior Unstable relationships Impulive Control of anger lacking Identity disturbed Dissociative thinking (splitting) Emptiness (chronic feeling of) |
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Cluster A personality disorders (weird)
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paranoid
schizoid schizotypal |
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Cluster B personality disorders (wild)
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Borderline
Histrionic Narcissistic Antisocial |
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Cluster C personality disorders (wimpy)
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Obsessive/Compulsive (OCPD)
Avoidant Dependant |
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Schizoid vs. Schizotypal Personality Disorder
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Schizoid: loner
Schizotypal: magical thinking/odd |
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What disorder leads to Antisocial Personality Disorder?
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Conduct disorder in children (remember torchering animals is pathognomonic)
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Dementia vs. Delirium acute or gradual?
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Dementia: gradual
Delirium: acute |
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Assessment of dementia: Activity of Daily Living (ADL) mnemonic ABCDEF
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Ambulates
Bathes Continent (toilets) Dresses/undresses Eats Functional transfers (OOB etc.) |
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Assessment of dementia: Independent Activities of Daily Living (IADLs) mnemonic SCUM
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Shopping
Cook and Clean Use telephone and transportation Manage Money and Medication |
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DEMENTIAS mnemonic for causes of Dementia.
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Degenerative diseases (PD, Huntington's)
Endocrine (thyroid, adrenal, etc.) Metabolic (alcohol, electrolytes, B12, hepatic, renal, etc.) Exogenous (heavy metals, CO, drugs) Neoplasm Trauma (subdural) Infection (meningitis, encephalitis, HIV, prion, etc.) Affective (psuedodementia of depression) Stroke/Structure (ischemia, NPH, etc.) |
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2 most common causes of dementia.
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Alzhiemer's (50%)
Multi-Infarct Dementia (25%) |
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Abuse vs Dependence.
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Abuse messes up your life
Dependence messes up your body |
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Most common reason to discontinue SSRI's
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sexual dysfunction
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Avoid Bupropion (Wellbutrin) in these individuals.
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Bulimics, Anorexics, Epilepsy
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Buspar is good anxiety med especially in this cohort.
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Alcoholic
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Use for performance anxiety
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Beta blocker
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Why is Xanax not the best med for anxiety?
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short half-life (withdrawal anxiety every day)
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Antidote to Benzo intoxication/overdose.
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Flumazenil
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Agorophobia vs Social Phobia
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Agorophobia: fear of being trapped in a crowd
Social Phobia: fear of being embarassed in a crowd |
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Mental Status Exam (MSE) ASEPTIC mnemonic
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Appearance
Speech Emotion (mood and affect) Perceptions (hallucinations?) Thought process and content Insight/Judgment Cognition (MMSE) |
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IWATCHDEATH mnemonic for causes of delirium
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Infection
Withdrawal Acute metabolic or subtance Abuse Trauma CNS pathology Hypoxia Deficiencies Endocrine Acute vascular/MI Toxins/drugs Heavy metals |
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Lithium side effects (4 to remember)
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Diabetes Insipidus, Teratogen (Ebstein's anomaly), Renal Failure, Cardiac Conduction defects
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Neuroleptic Malignant syndrome.
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MUSCLE RIGIDITY, HIGH FEVER, autonomic instability, AMS
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Treatment for Neuroleptic Malignant syndrome
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stop med and give dantrolene or bromocriptine (anticholinergics)
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TCA overdose.
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can be lethal 2/2 arrhythmias (don't give if h/o suicide attempts by overdose)
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Use this TCA for enuresis (bed-wetting).
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Imipramine
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What MOAI side-effect necessitates avoidance of tyramine in diet (e.g. cheese)?
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Hypertensive crisis
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After discontinuing MAOI, how long to wait before starting a new anti-depressant?
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2 weeks (wait for MAO enzyme to regenerate)
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Thing to remember about discontinuing Paroxetine (Paxil).
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brisk discontinuation symptoms (taper to d/c)
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1st major depressive episode: treat how long?
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6 months
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SSRI doesn't seem to be working after 4 weeks. How long to try before switching to a new med?
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6 weeks (2 more weeks)
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Anti-depressant with least sexual side effects?
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Bupropion (Wellbutrin)
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Serotonin Syndrome
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Siezures, clonus, diarrhea, cramps, fever, autonomic instability, AMS
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What syndrome: Siezures, diarrhea, cramps, fever, autonomic instability, AMS
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serotonin syndrome (2/2 SSRIs etc)
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What syndrome: MUSCLE RIGIDITY, HIGH FEVER, autonomic instability, AMS
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neuroleptic malignant syndrome (2/2 antipsychotics)
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Duloxetine (Cymbalta), besides psych indications, is also used for . . .
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chronic/neuropathic pain
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Valproic Acid and Carbemazepine in pregnant woman. What teratogenic defect?
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neural tube defects
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Treatment for antipsychotics induced dystonia (2)
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dephenhydramine (Benadryl) and Benztropine (anticholinergics)
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Treatment for parkinsonism induced by antipsychotics.
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Benztropine (anticholinergic)
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Antipsychotic meds good for non-compliant patients (3).
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Haloperidol decanoate qMonth
Fluphenazine decanoate q2wks Risperidone CONSTA q2ks |
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Clozapine (Clozaril) is the most efficacious antipsychotic, but is seldom used because. . .
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risk of agranulocytosis (monitor weekly CBC if using)
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Risperidone effect on the endocrine axis.
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elevates prolactin
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Olanzapine (Zyprexa) is this side effect most of all the antipsychotics.
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weight gain
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Quetiapine (Seroquel) has the least of which side-effects amoung antipsychotics?
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least ExtraPyramidal Sympoms (EPS)
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Treatment for akathisia induced by antipsychotics.
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Propranolol
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Management of Tardive Diskinesia induced by antipsychotics
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discontinue med
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Which 2 antipsychotics don't have weight gain as a side-effect?
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Ziprasidone (Geodon) and Aripiprazole (Abilify)
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1st line class for mood and anxiety disorders.
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SSRIs (guess SSRI if you are guessing in a psych question)
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Which antipsychotic in a pregnant woman?
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Haldol
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Benzo teratogenicity 1st trimester vs 3rd trimester.
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1st trim: cleft palate
3rd trim: floppy baby |
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ANOREXIA mnemonic
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*Amenorrhea
No other cause of weight loss Obviously thin, but feels fat *Refusal to maintain nl body wt (BMI under 19) Epigastric discomfor X-symptoms (peculiar symptoms) *Intense fear of gaining wt Always thinking about food |
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Anorexia vs Bulimia: egosyntonic or egodystonic?
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Anorexia: egosyntonic
Bulimia: egodystonic |
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BULIMIA mnemonic
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*Binge eating
Under strict diet *Lacks control over eating Induces *vomiting *Minimum of 2 episodes/wk for 3 mo Increased concern of body size Abuse of diuretics/*laxatives |
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Bupropion (Wellbutrin) is a good anti-depression med in this cohort.
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Smokers
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The most concerning side-effect of Lamotragine (Lamictal).
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Stevens Johnson Syndrome (rash)
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Teacher complains kid has poor concentration. 1st question to mom before diagnosing ADHD.
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symptoms at home too? (dx requires 2 settings)
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Memorize these 4 signs of autism (age 2 mo, 12 mo, 16 mo, and 24 mo).
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no eye contact by 2 mo
no babbling by 12 mo no single words by 16 mo no 2-word phrases by 24 mo |
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Treatment for Tourette's.
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Dopamine receptor antagonists (Haloperidol, pimozide) or Clonidine
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Lanugo. Diagnosis?
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Anorexia (lanugo is fine hair all over)
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Scar on dorsal hand surface (DIP). Diagnosis?
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Bulimia
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Osteoporosis/Stress Fractures in female college athlete. Diagnosis?
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Anorexia
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Good sleep hygiene advice (SLEEP mnemonic).
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Schedule sleep time
Limit caffeine Exercise early in the day Eating prohibited just before bedtime Prevent daytime naPs |
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Morning headaches. Suspected diagnosis?
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OSA
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Narcolepsy meds.
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Modafinil, Methylphenidate
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Likes the sick role. Diagnosis?
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Factitious
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Malingering vs. Factitious: how to differentiate.
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Malingering patients have a secondary gain MORE than the sick-role empathy.
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Somatization Disorder vs. Conversion disorder: extent of symptoms.
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Somatization: multiple organ systems
Conversion: "neuro" sx |
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SADPERSONS mnemonic for suicide risk.
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Sex (male)
Age (elderly) Depression Previous attempt EtOH or Drug abuse Rational thought (can plan) Sickness (e.g. chronic pain) Organized plan No spouse Social support lacking |
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Most common complication of a Somatoform disorder.
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Iatrogenic complications from repeated invasive work-up.
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How long before bereavement can be called depression?
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1 year
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