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QUICKTABLESR REPETITIO O N F RE & N C O G N ITI O Table of Contents 1. Cardiology a. Coronary Artery Disease 1 b. Congestive Heart Failure 2 c. Valve Disease 3 d. Cardiomyopathy 4 e. Pericardial Disease 5 f. Hypertension 6 g. Cholesterol 7 h. ACLS 8 i. Syncope 9 2. Pulmonology a. Asthma 10 b. Lung Cancer 11 c. Pleural Effusion 12 d. DVT PE 13 e. COPD 14 f. ARDS 14 g. Diffuse Parenchymal Lung Disease 15 3. Gastroenterology a. Gallbladder Disease 16 b. Esophagitis 17 c. Esophageal Disorders 18 d. Peptic Ulcer Disease 19 e. Misc. Gastric Disorders 20 f. Acute Diarrhea 21 g. Chronic Diarrhea 21 h. Malabsorption 22 i. Diverticular Disease 22 j. Colon Cancer 23 k. GI Bleed 24 l. Jaundice 25 m. Cirrhosis Etiologies 26 n. Cirrhosis Complications 27 o. Acute Pancreatitis 28 p. Viral Hepatitis 28 q. Inflammatory Bowel Disease 29 4. Nephrology a. Acute Kidney Injury 30 b. Sodium 31 c. Calcium 31 d. Potassium 33 e. Kidney Stones 33 f. Cysts and Cancer 34 g. Acid Base 35 5. Hematology Oncology a. Macrocytic Anemia 36 b. Microcytic Anemia 37 c. Normocytic Anemia 38 d. Leukemia 39 Q u i c k T a b l e s © OnlineMedEd e. Lymphoma 40 f. Plasma Cell Dyscrasia 41 g. Thrombophilia 41 h. Bleeding, Thrombocytopenia 42 6. Infectious Disease a. Antibiotics 44 b. HIV 44 c. TB 45 d. Sepsis 45 e. Brain Inflammation 46 f. Lung Infection 47 g. UTI 47 h. Genital Ulcers 48 i. Skin Infections 49 j. Endocarditis 50 k. Antibiotics 50 l. Surgery 50 7. Endocrinology a. Anterior Pituitary 52 b. Posterior Pituitary 53 c. Thyroid Nodules 54 d. Men Syndromes 54 e. Thyroid Disorders 55 f. Adrenals 56 g. Diabetes 58 h. Diabetic Emergencies 59 8. Neurology a. Stroke 60 b. Dizziness 60 c. Seizure 61 d. Tremor 62 e. Headache 63 f. Back Pain 64 g. Dementia 65 h. Coma 66 i. Weakness 67 9. Rheumatology a. Approach To Joint Pain 68 b. Lupus 69 c. Rheumatoid Arthritis 70 d. Other Connective Tissue Dz 71 e. Monoarticular Athropathies 72 f. Seronegative Arthropathies 73 10. Dermatology a. Blistering Disease 74 b. Papulosquamous Dermatoses 75 c. Eczematous Dermatoses 76 d. Hypersensitivity Reactions 77 e. Hyperpigmentation 78 f. Hypopigmentation 79 g. Skin Infections 80 h. Alopecia 81 Q u i c k T a b l e s © OnlineMedEd Dissociative Disorders 113 k. Baby Emesis 85 f. Pharmacology I: Anti-Depressants + Mood Stabilizers 120 o. Mood II Life and Death 109 g. Orthopedics 98 u. Addiction I: Substance Abuse 122 q. Catatonia 114 l.11. Abuse 90 k. Infectious Rashes 91 m. Lower Airway 95 r. Upper Airway 94 q. Congenital Defects 86 g. FTPM and Constipation 83 d. Well Child Visit 87 h. Sleep I: Physiology 124 s. Preventable Trauma 89 j. Sickle Cell 99 w. Anxiety Disorders 104 b. Psychiatry a. Chronic Allergic Reactions 92 o. Immunodeficiencies 102 12. ALTE / BRUE and SIDS 90 l. Peds Psych 99 v. GI Bleed 96 s. Seizures 102 z. Personality Disorders 112 j. Impulse Control Disorders 105 c. Vaccinations 88 i. Addiction II: Drugs of Abuse 123 r. Peds: Behavioral 118 n. Psychotic Disorders 110 h. Mood Disorders 108 f. Pediatrics a. Gender Dysphoria 126 u. Neonatal Jaundice 84 e. Acute Allergic Reactions 92 n. ENT 93 p. OCD and Related Disorders 106 d. Ophthalmology 100 x. Newborn Management 82 b. CT Surgery 97 t. Urology 101 y. Peds: Neurodevelopmental 116 m. Sleep II: Disorders 125 t. PTSD and Related Disorders 107 e. Eating Disorders 111 i. Neonatal ICU 82 c. Somatic Symptom Disorder 127 Q u i c k T a b l e s © OnlineMedEd . Pharmacology II: Anti-Anxiety + Anti-Psychotics 121 p. Obstructive Jaundice 163 h. Post-Partum Hemorrhage 152 m. Abdominal Distention 160 e. Incontinence 130 d. Leg Ulcers 167 l. Prenatal Infections 155 q. Medical Disease 146 g. Third Trimester Bleeding 153 o. Gynecologic Cancers 128 b. Pancreas 166 k. Normal Labor 147 h. Multiple Gestations 151 l. Small Bowel 165 j. Pre-op Evaluation 158 b. Third Trimester Labs 144 e. Menopause 140 o. Adnexal Mass 131 e. Gestational Trophoblastic 129 c. Surgery: General a. Pediatrics First Day 171 Q u i c k T a b l e s © OnlineMedEd . Eclampsia 150 k.13. Vaginal Bleeding: Reproductive Years 134 i. Infertility 139 n. Antenatal Testing 153 n. Vaginal Bleeding: Anatomy 135 j. Pelvic Anatomy 132 f. Decreased Urinary Output 162 g. Esophagus 164 i. Genetic Diseases 144 d. Secondary Amenorrhea 138 m. Advanced Prenatal Evaluation 145 f. Breast Cancer 170 n. Physiology Of Pregnancy 142 b. Virilization 141 14. Contraception 157 15. Vaginal Bleeding: Premenarchy 134 h. Alloimmunization 154 p. Vaginal Bleeding: Puberty 136 k. Post-op Fever 159 c. Obstetrics a. Fistula 161 f. OB Operations 156 r. Colorectal 168 m. Normal Prenatal Care 143 c. Chest Pain 159 d. Abnormal Labor 148 i. L & D Pathology 149 j. Gynecology a. Primary Amenorrhea 137 l. Gyn Infections 133 g. Endocrine 174 d. Study Design 204 f. Burns 199 g. Surgical Hypertension 173 c. Ortho Injury 190 p. Hypothesis Testing 205 h. Neck Trauma 196 d. CT Surgery 176 e. Surgery: Specialty a. Urologic Cancer 187 m. Neurosurgery Bleeds 185 k. Vaccinations 203 d. Screening 202 c. Neurosurgery Tumors 186 l. Pediatric Optho 184 j. Surgery: Trauma a. Risk 205 Q u i c k T a b l e s © OnlineMedEd . Urology Peds 188 n. Ortho Hand 192 q. Abdominal Trauma 198 f. Urologic Miscellaneous 189 o. Pediatrics Weeks To Months 172 b. Pediatrics CT 178 f. Shock 194 b. Prevention 202 b. Confidence Interval 205 i. Diagnostic Tests 203 e. Bias 204 g.15. Toxic Ingestion 201 16. Epidemiology and Stats a. Ortho Peds 193 15. Adult Ophtho 181 h. Vascular 180 g. Bites 200 h. Head Trauma 195 c. Skin Cancer 182 i. Chest Trauma 197 e. psychotherapy. Depersonalization Intense fear of psychotherapy Excessive heart losing control/ SSRI or Buspirone adjunct rate dying Benzos (only if panic attack) Numbness Chest pain Tingling Social Phobia (Social Anxiety Disorder) Sweating Path: Irrational and exaggerated fear Dx: Rule out medical disease related to social performance ˗˗ ECG + troponins Egodystonic ˗˗ Asthma 6 mo+ duration ˗˗ TSH. clowns. Toxicology Pt: Anxiety and Avoidance of stimulus Tx: Abort – Benzodiazepines Public Speaking or Public Restrooms CBT to abort without meds Dx: Clinical Control – SSRI Tx: Cognitive Behavioral Therapy F/u: Agoraphobia Beta-Blockers for Public Speaking Specific Phobia Path: Irrational and Exaggerated learned fear response to a specific trigger Egodystonic 6mo+ duration Pt: Anxiety and Avoidance of stimulus Spiders. not as good Control with SSRI during CBT 104 Q u i c k T a b l e s © OnlineMedEd .chapter 12: Psychiatry Anxiety Disorders Generalized Anxiety Disorder Panic Attack Path: Constant state of worry Path: Random and unprovoked bouts of Pt: Worry about most things on most intense anxiety without warning days of most months (≥ 6 months) Pt: Shortness of Palpitations ≥ 3 Somatic Complaints Breath Abdominal Dx: Clinical Trembling distress Unsteadiness Nausea Tx: PSYCHOTHERAPY. etc Dx: Clinical Tx: Cognitive Behavioral Therapy ˗˗ Desensitization: longer. better ˗˗ Flooding: faster. heights. OR external stimuli and not provoked 3 times at all in a year WITH harm by external stimuli ♂ >> ♀ ↓ Sxs with ↑ age Used or Kept Stashed. without external ˗˗ provocation Dx: r/o Petty Theft Tx: Ø… incarceration SSRI? Therapy? Q u i c k T a b l e s © OnlineMedEd 105 . etc) Pt CAN’T afford Pt CAN afford Pt: 2 times per week in 3 months Planned. ↑ sexual arousal. UNplanned. or ↑ pleasure ♂ >> ♀ Dx: r/o Arson Tx: Ø… incarceration F/u: Reaction Formation Arson Pyromania Monetary Gain ↓ Anxiety To Cause harm or to Sexual Arousal destroy Pleasure Kleptomania Path: Trigger = Anxiety Theft = Relief Psych Pt: Steals things ˗˗ little to NO value ˗˗ pt CAN afford ˗˗ to ↓ anxiety ˗˗ gifts / hides items ˗˗ and feels guilt / remorse ˗˗ impulsively. guilt Tx: Drugs = Therapy = Drugs + Therapy (SSRI) (Self-reflection) Pyromania Path: Setting Fire = Relief or Pleasure Pt: More than 1 occasion Fire Setting for ↓ Anxiety. with help. gifted. WITHOUT harm or provoked by WITHOUT help. Psychiatry Impulse Control Disorders Intermittent Explosive Disorder Theft Kleptomania Path: Trigger = Anxiety Desire ↓ Anxiety Violent Act = Relief Able to resist Unable to Resist Response DISPROPORTIONATE to HAS value Has NO value stressor (verbal. alone. physical. or NO remorse returned Dx: Clx NO guilt Remorse. socially Tx: CBT → SSRI Dx: Clx Trichotillomania Tx: CBT is best SSRI or Clomipramine (a TCA) Path: General Anxiety with Hair pulling Hoarding Disorder Pt: Obsessions Compulsions Path: OCD about throwing things away None Pulling out hair in items like trash Pt: Obsessions Compulsions Particular Ridding of Retaining useless Alopecia with hair in different lengths Possessions items like trash or trinkets Dx: r/o fungus (KOH prep) r/o medical cause for alopecia Unsafe or cluttered home Tx: CBT → SSRI Dx: Clx F/u: Small bowel obstruction Tx: CBT → SSRI (trichobezoar) Body Dysmorphic Disorder Path: Perceived flaws in physical appearance Pt: Obsessions Compulsions Symmetry of Appearance body Checking Hair. Safety Order. or mental acts Muscle Size Excessive Pt: Obsessions Compulsions Exercise Contamination Cleaning. unwanted and intrusive appearance Compulsions = anxiety-REDUCING Pt: Obsessions Compulsions actions. work. skin. behaviors.chapter 12: Psychiatry OCD and Related Disorders Obsessive Compulsive Disorder Muscle Dysmorphic Disorder Path: Obsessions = anxiety-PROVOKING Path: Perceived flaws in physical thoughts. butt Seeking Attempt to have multiple surgeries to correct what isn’t broken Dx: Clx Tx: CBT → SSRI F/u: DO NOT perform surgery as desired 106 Q u i c k T a b l e s © OnlineMedEd . nose Approval Breasts. Anabolic Steroids Symmetry Washing Roid Rage. “copper Lock Checking disorder” At least one hour per day Dx: Clx Causes impairment at school. Rhabdo (renal failure). Counting Testicular atrophy. easily startled. ˗˗ Threat Death (Self) moving away ˗˗ Combat ˗˗ Witnessed Pt: Disorder = Mood changes that don’t ˗˗ Rape (strangers) quite fit for another mood disorder ˗˗ Abuse ˗˗ Learned (family) Dx: Begin < 3 months from stressor ˗˗ Repeated Lasts < 6 months from stressors exposure to effects Tx: Generally not needed Pt: Disorder ˗˗ Intrusion Nightmares. memories Hypervigilance. loss of a job. locations. CHANGED concentration Dx: > 3 days AND < 1 month = Acute Stress > 1 month = Post-Traumatic Stress Tx: Group Therapy (best) SSRI/SNRI (adjunct) Benzos (panic attack only) CBT F/u: Mood disorder Substance abuse disorder RAD / DESD Psych Path: Stressor = Neglect or Abuse in infancy Pt: Disorder = too much attachment (DSED) too little attachment (RAD) Dx: < 5 years old r/o Autism Tx: Caregiver – teach how to parent F/u: Mood disorder Learning disabilities Q u i c k T a b l e s © OnlineMedEd 107 . amnesia Symbols. ˗˗ Neg Mood Flashbacks. Psychiatry PTSD and Related Disorders Post-Traumatic and Acute Stress Disorders Adjustment Disorder Path: Stressor Exposure Path: Stressor = Non-life-threatening event ˗˗ Actual Death ˗˗ Experienced ˗˗ Marital strife. irritability. ˗˗ Dissociation memories ˗˗ Avoidance Depression-like ˗˗ Arousal Depersonalization. NO Plan → Safety Contract Combo >> SSRI /SNRI > Psycho Therapy ECT best (refractory only) Bipolar I Path: Mania = “E” + 3 Duration ≥ 1 week Pt: Distractibility Flight of Ideas Insomnia Agitation Grandiosity Sexual Exploits Talkative Elevated Mood Racing Thoughts Dx: r/o Bipolar II r/o Cyclothymia Tx: Emergency department = Benzos Mood stabilizers = Lithium > Valproate backup = Lamotrigine. psychotic) Tx: Bipolar I F/u: If Major Depression. started SSRI. then have Mania → reveals Bipolar I 108 Q u i c k T a b l e s © OnlineMedEd . but less Dx: r/o Bipolar I (catatonia. Carbamazepine Anti-Psychotics = Quetiapine Bipolar II Path: Hypomania AND major depression Pt: Hypomania = mania.chapter 12: Psychiatry Mood Disorders Major Depressive Disorder Dysthymia = Persistent Depressive Disorder Path: ↓ mood OR Anhedonia Pt: ↓ Mood for ≥ 2 years And Symptoms Ø absent 2+ months Duration ≥ 2 weeks Dx: r/o hypothyroid AND 5 of SIG-E-CAPS Tx: SSRI / SNRI Pt: Sleep ↓ ↑ Interest ↓ ↓ Cyclothymia Guilt ↑ ↑ Pt: Mild Bipolar II Energy ↓ ↓ Concentration ↓ ↓ Appetite ↓ ↑ Psychomotor ↓ ↓ Suicidal ↑ ↑ Dx: r/o Suicidal Ideations Tx: If + SI + Plan → Hospital If + SI. global ˗˗ Dysphoria ˗˗ Guilt ˗˗ Anhedonia When mood Waxes. Psychiatry Mood II Life and Death Baby Blues Post-Partum Depression Post-Partum Psychosis Baby #1 > #1 >#1 Cares about baby Doesn’t care about baby. may hurt baby likely to kill it Timing Onset and Onset within 1 month Onset within 1 month Duration within 2 Duration ongoing Duration ongoing weeks Depression Dysthymic MDE MDE Psychosis None None + Treatment Nothing Anti-depressants Mood Stabilizers or Antipsychotics Grief PCBD Depression Onset Any ≥ 6 months Any Duration < 12 months ≥ 12 months ≥ 12 months Focus Focused on Deceased Focused on Deceased Pervasive. despondent Psych Treatment Time. can Persistent + Persistent + symptoms imagine happy Cannot imagine being Cannot imagine being happy happy Behaviors YES insight NO Insight NO Insight “Psychotic” Psychotic features Psychotic ˗˗ Hallucinations ˗˗ Delusions Talking TO deceased Talking WITH deceased Doing things as if they were there Believing they are there doing things with you Why suicide To be with deceased To end suffering. Counseling SSRI SSRI Stages of Death and Dying Denial Depression Bargaining Anger Acceptance Q u i c k T a b l e s © OnlineMedEd 109 . wanes. Fears the baby. it is a glaring sxs.Sxs Schizoaffective Any with Lifetime mood sxs treat Pt: Psychotic Break = first break occurs delusion in teenager with stressor (college) first who then begins behaving bizarrely Positive Symptoms (must have 1+) Treatment Options for Psychotic Disorders ˗˗ Bizarre Delusions + Sxs Typical Haloperidol. ˗˗ Flat Affect Ziprasidone. ˗˗ Anhedonia Olanzapine.chapter 12: Psychiatry Psychotic Disorders Delusions Variants and Duration of Treatment Fixed False Belief without basis in reality All variants have the exact same pathology. usually auditory Chlorpromazine (voices) ˗˗ Disorganized speech ˗˗ Disorganized state / catatonia . and diagnosis. ˗˗ Cognitive Defects Aripiprazole Dx: Clinical Best Clozapine r/o drug abuse (cocaine) Tx: Anti-psychotics ˗˗ Typical controls positive symptoms ˗˗ Atypical controls negative symptoms ˗˗ Clozapine when all else fails 110 Q u i c k T a b l e s © OnlineMedEd .Sxs Atypical Risperidone. presentation. Negative Symptoms: Quetiapine. Do NOT confront delusion. and you will not get the time those symptoms have been anywhere by challenging them. ˗˗ Hallucinations. This leads to duration of treatment with anti-psychotics Duration Duration Schizophrenia Sxs Tx Path: Thought Disorder with unknown Acute Psychotic < 1 Month Wait (or treat) cause though there is certainly a Disorder genetic component Schizophreniform < 6 Months 3-6 weeks Receptor Pathology Schizophrenia ≥ 6 Months Lifetime ˗˗ Dopamine (too much) → + Sxs ˗˗ Serotonin (too much) → . present. Thiazide. EXCEPT truth to the patient. Mg leukopenia disorders ˗˗ CMP abnormalities. or becoming fat dieting) Patient is not fat. add SSRI / SnRI Relapse in 5 years Death from medical or suicide Bulimia Nervosa Path: Anxiety from the binge. bradycardia. teens to 20s Dorsal hand scars (from emesis) Severe Dental erosion (from emesis) ˗˗ hypotension. Diarrhea Amenorrhea. but fears fat. Cold-intolerance. teens to 20s “normal” appearance except purge signs Purge ≥ 1 x per week x 3 months Dx: Clx Tx: SSRI / SnRI = Fluoxetine (best) CBT Psych F/u: NEVER Bupropion (causes seizures) Binge-Eating Disorder Path: Anxiety from the binge .no compensation Overweight to obese Pt: F:M 10:1. Metabolic Alkalosis. Psychiatry Eating Disorders Anorexia Nervosa Methods of Eating Disorders Path: Anxiety induced by the fear of being Restriction ↓ Caloric intake (fasting. sees ↑ Caloric expenditure (exercise) herself as fat Binge Purge Eating / Binging then induced Lacks recognition of how thin she is Emesis emesis Pt: F:M 10:1. Emaciation Dx: Clx Tx: Hospitalize if severe ˗˗ IV Nutrition ˗˗ Correct E-Lytes ˗˗ Forced Feed Outpatient / ongoing ˗˗ Antipsychotics and CBT F/u: If OCD or MDD. E-lytes and albumin Binge Purge Eating / Binging then induced ˗˗ BMI < 16 Laxative diarrhea Non-Severe Metabolic Acidosis ˗˗ Lanugo. teens to 20s Cannot control eating habits Binge ≥ 1 x per week x 3 months Dx: Clx Tx: Topiramate CBT Q u i c k T a b l e s © OnlineMedEd 111 . then compensates Normal weight to overweight Pt: F:M 10:1. K. "Napoleon Dynamite" Avoid power wants relationships but Shy hot librarian struggles. Clear. Lady Gaga Brief Psychotic borders on psychosis. manipulative. "Monk" Compulsive Order. have no relationships Night-Shift Toll You won’t see them but also are happy not Booth having any relationships Schizotypal Magical Thinking. insist rights of others. make does not pursue them. "Girl Interrupted" Suicidal Gestures Promiscuous. Behavior. Dialectic control rapid changes in Behavioral mood. nonthreatening Schizoid Loners. dramatic. Ron Burgundy are followed fragile ego. demands special treatment Anti-Social Criminal. fears relationship try to sabotage their being alone own treatment Obsessive. "Gone with the Wind" Set rules. Perfection at the expense of efficacy 112 Q u i c k T a b l e s © OnlineMedEd . Episodes Bizarre Thoughts. emotional "Fatal Attraction" may be successful emptiness. The Joker they are followed lacks remorse. interpret others are malicious Gene Hackman.Rigid. responsibility. patients choose Passes on promotions Dependent Unable to assume Stay at home mom Giver clear advice. attention. clingy. insist they seeking. unable to Splitting. No regards for Tony Soprano Jail. "Enemy of the State" Clear. Must be >18 years old (conduct disorder) C Avoidant Fears rejection and criticism. in an abusive patient may Submissive. impulsive. Set rules. self-centered. Control. uses eccentric dress to draw attention. honest. Exaggerated but superfluous emotions Narcissistic Inflated sense of worth "Zoolander" Set rules. suspicious. Impulsive. Marilyn Monroe are followed use of physical appearance. insist they or talent. orderly perfectionist.chapter 12: Psychiatry Personality Disorders PD Description Examples How to handle them A Paranoid Distrustful. honest. suicidal gestures Therapy Histrionic Theatrical. and Dress nonthreatening B Borderline Unstable. hypersexual. out-of-body experience r/o malingering (depersonalization) r/o substance abuse Detached from reality. and identity for demographic) Pt: Stressor proportional to Disorder Pt: Seeing a video or dream of Dx: Amytal Interview (truth serum) self. as though in Tx: Psychotherapy a dream F/u: Non-severe = recovery Severe =? Reality testing INTACT Dissociative Identity Disorder Path: ≥ 2 distinct identity states Most severe and prolonged trauma Pt: Self experiences ˗˗ Memory gaps (blackouts) ˗˗ other dissociation symptoms Others Witness ˗˗ Paradoxical behaviors ˗˗ Appearance changes F/u: Fight Club. SVU Dissociative Amnesia With Fugue Psych Path: Stressors induces loss of memory WITH Travel Pt: Memory Loss of ˗˗ the event ˗˗ regular everyday occurrences / routine ˗˗ complete autobiographical self F/u: Jason Bourne. Psychiatry Dissociative Disorders Dissociative Disorders in General Depersonalization Derealization Disorder Path: Severe + Prolonged Stressor causes Path: Adolescent with minor stressor separation of otherwise intact (though stressor is relatively major thought. Sybil Dissociative Amnesia Path: Stressors induces loss of memory Pt: Memory Loss of ˗˗ the event ˗˗ regular everyday occurrences / routine ˗˗ complete autobiographical self F/u: Law and Order. memory. Archer from FX Q u i c k T a b l e s © OnlineMedEd 113 . ↑ HR.chapter 12: Psychiatry Catatonia Catatonia Path: Ø a disease state Modifier to another disease ψ – Bipolar. paraneoplastic. Depression >> schizophrenia ♥ – Autoimmune. paraneoplastic. lorazepam corrects Rigidity Catatonia Autonomic Dysfunction (↑ BP. family history 114 Q u i c k T a b l e s © OnlineMedEd . nutritional Pt: Must have 3 or more: ˗˗ Stupor ˗˗ Cata-LEPSY ˗˗ Way flexibility Retarded ˗˗ Mutism Catatonia ˗˗ Negativism ˗˗ Stereotypy ˗˗ Agitation or Grimace Excited ˗˗ Echolalia Catatonia ˗˗ Echopraxia Retarded and Excited symptoms may occur together Dx: Clx… Lorazepam Tx: Lorazepam (diagnostic and therapeutic) Dz Meds / Hx Sxs Malignant No meds. ↑ T) Neuroleptic Malignant Atypical Antipsychotics Hyperthermia Lead-Pipe Rigidity Muscle breakdown (“↑ CK”) Serotonin Syndrome SSRIs and Hypertonicity/ Hyperreflexia Malignant Hyperthermia Halothane anesthesia. nutritional Ø a disease state Modifier to another disease ψ – Bipolar. Depression >> schizophrenia ♥ – Autoimmune. Psychiatry Psych Q u i c k T a b l e s © OnlineMedEd 115 . whose parents NEVER a swear word have a tough time controlling Dx: Clx behaviorally. carbamazepine 116 Q u i c k T a b l e s © OnlineMedEd .chapter 12: Psychiatry Peds: Neurodevelopmental Intellectual Disability Disorder Autism Spectrum Path: Chromosomal: Path: Impaired Social Communication ˗˗ Down Syndrome ˗˗ Social Reciprocity ˗˗ Fragile X ˗˗ Social Relationships ˗˗ Cri-Du-Chat ˗˗ Nonverbal Communication Maternal Acquired ˗˗ Joint Attending ˗˗ EtOH in utero Restrictive / Repetitive Behavior ˗˗ Hypothyroid in utero ˗˗ Stereotypy Child Acquired ˗˗ Sameness ˗˗ Lead Poisoning ˗˗ Restricted Interests ˗˗ Head Trauma ˗˗ Change in perception Pt: ↓ Cognitive skill Pt: Young child.Syndromic physical features Repetitive useless behaviors Dx: Clx. Vocal: Grunt. Supervised ˗˗ Fidgets a lot ADLs ˗˗ Cannot wait turn < 20 Institutionalized. Tetrabenazine Ensure there are no absence seizures F/u: ADHD on stimulants who gets worse is Tic Disorder Dx: Clx Tx: Stimulants (avoid at night to ↓ insomnia) ˗˗ Methylphenidate ˗˗ Dextroamphetamine F/u: Special ed classes. and who’s like this in Tx: Dopamine Antagonists every setting. severity on adaptive functioning Insistence on consistency Severity based on IQ testing Dx: Clx. supervision 50-70 Group home. Work and ADLs Attention Deficit Hyperactivity Disorder alone Path: Impulsivity 35-49 Group home. Total Care Inattention ˗˗ Talks Fast ˗˗ Easily Distracted Tic Disorder (Tourette’s) ˗˗ Fails to complete tasks Path: Essentially OCD Timing and situation Pt: Onset < 18 years old ˗˗ ≥ 2 settings “Obsession” = impulse to perform tic ˗˗ onset 7-12 “Compulsion” = the tic itself ˗˗ duration ≥ 6 months Hidden: hair flicks. cough. conceptual (speak. ˗˗ Fluphenazine. Severity on progress (outdated) Tx: Supportive Tx: Assess social. read F/u: NO ASSOCIATION WITH write). Work and ADLs ˗˗ Blurts out answers alone ˗˗ Interrupts 20-34 Institutionalized. 1-4 years old ↓ Adaptive Functioning No social smile or eye contact +/. parent education If absence seizures. Pt: The “bad kid” who is male. and practical (self mgmt) VACCINES Special education. blinking. disrupts rubbing class and moves all over the place. yell fails to wait his turn. fix the medical problem (glasses. Non-native Speaker Poor Education to Date ˗˗ Low socioeconomic class. Blind. Psychiatry Peds: Neurodevelopmental Learning Disabilities Path: Performing substantially below expected for age and grade Pt: Medical Conditions ˗˗ Deaf. hearing aids). fix the teacher to student ratio Psych Q u i c k T a b l e s © OnlineMedEd 117 . home schooled Dx: Audiology test Vision testing Language assessment Tx: Remediate. chapter 12: Psychiatry Peds: Behavioral Conduct Disorder Enuresis – Was Once Dry Path: Antisocial personality disorder but… Path: Regression. it’s NORMAL Dx: Clx Tx: POSITIVE reinforcement Alarm Blankets Water Restriction before bed DDAVP as last resort F/u: TCAs may also be used Negative Reinforcement (never) 118 Q u i c k T a b l e s © OnlineMedEd . Cheats. abuse Rules Violation ˗˗ Truancy ˗˗ Run-away at least twice Encopresis and Enuresis ˗˗ Staying out at night before 13 Path: Encopresis (stool) or Enuresis (urine) Dx: Clx repeatedly on clothes or bed. Tx: Juvenile Detention ˗˗ Intentional (acting out) ˗˗ Incontinent(cognitive impairment) F/u: Fights Authority HARMS peers ˗˗ Medication side effect ˗˗ Anatomic (fistula) ˗˗ Regression (abuse. or new Teen acting out house Pt: NO Bullying ˗˗ Does NOT hurt animals / people Dx: See above ˗˗ Does NOT use torture / cruelty Tx: See above ˗˗ Forced Sex Destruction ˗˗ Lies. Abuse. Steal ˗˗ Breaks into property Rules Violation ˗˗ Truancy ˗˗ Run-away at least twice ˗˗ Staying out at night before 13 Dx: Clx Tx: Improved Parenting F/u: Fights Authority COOPERATES with peers Enuresis – Never Been Dry Path: Normal toilet training takes up to 7 years old Pt: If < 7 and still wets bed. stressor) Oppositional Defiant Disorder Pt: Dependent on patients. new step parent. < 18 years old Anatomic Pt: Bullying Pt: Was once dry. Steal Anatomic (resection) ˗˗ Breaks into property Regression (identify stressor). Infection. Look for new Path: Incongruent parenting sibling. if STI then abuse ˗˗ Lies. now is not ˗˗ Hurts animals / people ˗˗ Uses torture / cruelty Dx: U/A ˗˗ Forced Sex U/S Destruction Clx ˗˗ Fire starting Tx: Infection (abx). Cheats. Psychiatry Psych Q u i c k T a b l e s © OnlineMedEd 119 . Acute Mania. Depression Nephrotoxic > 1. better versions of Duloxetine SSRIs. GAD β-Blockers Performance Anxiety Bradycardia. lack of washout or Tranylcypromine eating of tyramine (red wine/cheese) Selegiline Distinguish from other hypertensive-hyperthermia disorders in psych by the ABSENCE of lead-pipe rigidity and fever Mood Stabilizers Drug Indication Side Effect Lithium First-Line. Cardiac) Doxepin so get an ECG Has Anti-Ach properties (dry mouth. SJS Absence Seizures AV Block Anti-Anxiety Benzos Abort panic attack Dependence Treats EtOH withdrawal Withdrawal Seizure SSRIs First-Line long term medication for See Anti-Depressants. acute attack PTSD. sedation. Constipation) MAO-Is Phenelzine HTN Crisis when mixed together. Uretention. Ø useful in treatment of chronic anxiety: OCD. More expensive Atypical Bupropion Smoking cessation No weight gain Bulimia NEVER (↑seizures) SM Mirtazapine Appetite Stimulant Trazadone Sleep Aid.chapter 12: Psychiatry Pharmacology I: Anti-Depressants + Mood Stabilizers Anti-Depressants SSRIs (Es)citalopram ↓ Libido sometimes Fluoxetine Delayed Ejaculation sometimes Paroxetine Serotonin Syndrome Sertraline GI. Insomnia SnRIs (Des)Venlafaxine Cleaner. Coma.5 Augmentation Causes Nephro DI Narrow TI Valproate First Line in Bipolar if Li cannot be used Teratogen (Spina Bifida) Thrombocytopenia Also treats Seizures Agranulocytosis Pancreatitis Quetiapine Second Line bipolar Weight gain All phases of treatment QTc prolongation Lamotrigine Second Line bipolar Blurred Vision Newer anticonvulsant SJS Carbamazepine Third line bipolar Teratogen (Cleft palate) Trigeminal Neuralgia Rash. caution priapism TCAs “-tryptilines” Used for enuresis (anti-ach) Imipramine 1st line use is neuropathic pain Desipramine Can be Lethal because of CCC: (Convulsions. Drug of Choice for Bipolar Teratogen Bipolar. Asthma 120 Q u i c k T a b l e s © OnlineMedEd . Anti-Ach Aripiprazole Currently “first line” for psychosis (small risk) Ziprasidone DM and Weight Gain Clozapine Unique to itself The best antipsychotic Agranulocytosis The most selective for D2C Requiring CBC q week and 5HT1 ( and ) Drug of last resort Extrapyramidal Side Effects Akathisia A Feeling of Restlessness ↓Dose…. torticollis. then try another Q u i c k T a b l e s © OnlineMedEd 121 . Beta blockers Anti-Ach (Benztropine) Acute Dystonia Involuntary muscle contractions. most dangerous Hospitalized and off their meds Atypical.sxs EPS. Olanzapine More selective so lower risk of EPS Sedation. ↑ Dose q Day until maxed. gynecomastia Atypicals = Second generation Antipsychotics (SGA) Risperidone Both D2C and 5-HT1 so QTc prolongation Quetiapine work on + and . dopamine-R = suppressible Sxs initially worsen oral-facial movements Choosing the Right Drug Psych Compliant Young Adult. Psychiatry Pharmacology II: Anti-Anxiety + Anti-Psychotics Antipsychotics Typicals = First Generation Antipsychotics (FGA) Haloperidol Mesolimbic D2C-R-i Potency of drug proportional Fluphenazine treats + symptoms to EPS Thioridazine Chlorpromazine Nigrostriatal Antagonism leads to EPS side Potency inversely effects proportional to Anti-Ach Tuberoinfundibular antagonism causes ↑ prolactin. Any atypical po ↓ SE profile without complications Combative ER patient Haloperidol Depot Sedating Noncompliant Psychotic Olanzapine depot q 1wk Risperidone depot Haloperidol depot Dysphagia or IM not available Olanzapine ODT Oral dissolving tablet Risperidone ODT Everything else has failed Clozapine Best. hand Anti-Ach (Benztropine) ringing. and oculogyric crisis Dyskinesia Parkinsonism Anti-Ach (Benztropine) Dyskinesia = Bradykinesia Tardive Dyskinesia Irreversible hypersensitization of Stop Drug. Gynecomastia. Giving up what you used to like to do Risk Taking 8. gambling.chapter 12: Psychiatry Addiction I: Substance Abuse Substance Abuse Disorder Path: Using a drug or alcohol in any other way than it is intended Substance = Drug. taking steps Action Actual changing behavior Maintenance Sustained changed behavior 122 Q u i c k T a b l e s © OnlineMedEd . Failure of responsibilities at work. home. sex. Withdrawal: physical symptoms when stopped Dx: Severity Mild 2-3 Moderate 4-5 Severe 6+ Screen Cut down CAGE Anger about criticism Guilt about using or what you do when using Eye-opener Tx: Pharm Antabuse (di-sulfuram for EtOH) Naloxone (Opiate. Investing time in obtaining of recovering from use 4. EtOH) Methadone (Opiates) Usually pharm doesn’t work Group Therapy Alcoholics Anonymous F/u: 50-90% will relapse Relapse is not failure Back on the horse F Feedback R Responsibility – sobriety and mistakes A Advice – help them M Menu of options E Empathy S Self-Efficacy Five Stages Of Substance Abuse Pre-contemplative Unaware. Use in hazardous condition (legal issues. denial Contemplative Admits there’s a problem. driving) 9. school Social 6. Use despite previous consequences Health Effects 10. Choosing substance over people relationships Outcomes 7. Tolerance: needing more to feel the same effect 11. Alcohol. Consuming more than was intended Controlling 2. Difficulty cutting down or stopping Use 3. acceptance Preparation Committed. Craving Adverse 5. sex Pt: Difficulty 1. perspiration. tachycardia. Flashbacks Supportive Flashbacks. bugs” for agitation psychosis HTN treated with α then β blockade Angina / HTN crisis MDMA Overheat (fever. Ataxia. Supportive Care HTN. amnesia Opiates Euphoria. Depression. pupil Yawning. Tremor. lateral. Tachycardia and HTN. dissociative symptoms THC Tiredness. blunted senses LSD Hallucinations. Pt has to Chantix (Varenicline) Overdose a lot → Vfib Amphetamines Tachycardia. (withdrawal) Blackouts. lacrimation. Heightened senses. the munchies. and potential track marks Cocaine Psychomotor agitation. Naloxone constriction. suicidality. enhance excretion impossible strength. Crash Supportive tachycardia) and water intoxication. “cocaine Benzos / antipsychotics dilated pupils. nothing required) Psych conjunctivitis. or Acidify Urine to rotary nystagmus. irritability. sweating depression. N/V and hurts Methadone (long-term) respiratory everywhere. Crash None hypertension. Pupillary Dilation. pressured speech. Psychiatry Addiction II: Drugs of Abuse Drug Intoxication Withdrawal Drug / Antidote EtOH Slurred speech. Impaired eventual seizures Judgment Benzos Delirium in elderly. flight of ideas Q u i c k T a b l e s © OnlineMedEd 123 . Seizures. Depression and coma Psychosis (with ↑ dose). Flumazenil Respiratory HTN. Redistribute into fat Ø Benzos safer Nicotine None . and Disulfiram (Long-Term) Loss. slowed Ø Supportive (often reflexes. Severe random Violence Haloperidol to subdue vertical. overdose brings paranoia Barbs Low safety margins. Tremor.just jittery and Cravings Bupropion stimulated. Memory hallucinations. Psychosis PCP Aggressive psychosis. Tachycardia. Benzo Taper Disinhibition. Atony.chapter 12: Psychiatry Sleep I: Physiology Stage EEG Sleep Walking / Eating/ Driving / Sex Awake State of arousal Path: N3 Sleep Stage NI Theta Waves. kids aren’t Dx: Clx Tx: Reassurance Nightmare Path: Dreams gone bad. no need to treat Sleep Talking Path: N3 Sleep Stage Pt: Mumbling in sleep Will not reveal secrets Dx: Clx Tx: Reassurance 124 Q u i c k T a b l e s © OnlineMedEd . Sleep Spindles Dx: Clx N III Delta waves Tx: Reassurance REM Awake EEG. remembers the dream Dx: Clx Tx: Treat underlying psych condition (PTSD) If not part of syndrome. REM Pt: Any age group wakens from sleep. Absence of Alpha Pt: Do actions without remembering N II K-Komplexes. sit up. Saccadic F/u: Worse with BZD1 (zolpidem) Eyes. Erections Vocabulary of sleep Sleep Going to bed to falling asleep Latency ↑ in insomnia ↓ in sleep deprivation REM Falling asleep (N1) to REM Latency ↓ in Narcolepsy ↓ in sleep deprivation REM More REM faster after Rebound Deprivation state Night Terror Path: N3 Sleep Stage Pt: Child 4-10 who will: ˗˗ maintain tone. opens eyes ˗˗ be asleep (inconsolable) ˗˗ not remember anything Parents distressed. Psychiatry Sleep II: Disorders Obstructive Sleep Apnea Insomnia Path: Excess tissue of oropharynx and chest Path: Poor sleep hygiene wall (obesity) obstructs airway For this setting. difficult to Dx: r/o MDD… SIGECAPS exam oropharynx r/o Bipolar… DIGFASTER Daytime Somnolence (“sleeps” but r/o substance… caffeine. cocaine never reaches REM. so not restful sleep) Tx: Life style = Sleep Hygiene Cor Pulmonale ˗˗ Avoid stimulants w/I 5 hrs of sleep Dx: Polysomnography (Sleep Study) ˗˗ Avoid exercise near sleep ˗˗ 15 apneas / hour ˗˗ Avoid naps during the day ˗˗ 5 apneas / hr + snoring ˗˗ Bed for sex and sleep only Tx: CPAP = PEEP ˗˗ Lights Out = Sleep Time Weight loss Pharm F/u: ↓ Alveolar Oxygen → Pulm Htn ˗˗ Diphenhydramine → Trazadone Pulm htn = isolated heart failure. short neck. snores. stroke. Has Cheyne-stokes 3 times per week x 3 months Dx: CSF Hypocretin – 1 (Also polysomnography) Tx: Scheduled Naps Stimulants (Amphetamines) Psych Q u i c k T a b l e s © OnlineMedEd 125 . Acidotic ˗˗ Wakeup Refreshed Caused by opiates. → Quetiapine → Zolpidem Narcolepsy Jet Lag Path: Uncertain Etiology Insomnia and Travel Pt: “Sleep Attack” … wakes Power through and Melatonin REFRESHED ˗˗ Cataplexy. assume no psych Multiple awakenings prevent illness progression to REM Pt: Trouble falling asleep Ventilation spared (CO2 normal) Trouble staying asleep Oxygenation impaired (↓ O2) < 6 hrs / night total sleep Pt: Obese. Paralysis Central Sleep Apnea ˗˗ ↓ REM Latency Patient “forgets” to breather ˗˗ HypoGOgic / Hypnopompic ˗˗ Response to emotion or bang ↓ Ventilation = ↑ CO2 = Altered. or to be TREATED as dif gender ˗˗ Wanting to rid sex char ˗˗ Belief that they are another gender KIDS ˗˗ Add REJECT roles of assignment ˗˗ Add ACCEPT roles of opposite Dx: Clx Tx: Therapy >> surgery reassignment and hormones Defining Paraphilias Common Pedophilia Sexual focus on children Often Male adult → female child Exhibitionism Exposing genitals to strangers Voyeurism Observing private activities of unaware victims Frotteurism Touching.chapter 12: Psychiatry Gender Dysphoria Gender Terms Assignment Your Genitals at birth “What you are physically” Gender Your gender in your mind Identity “What you are mentally” Transgender Someone who’s identity is more often incongruent than their assignment Transsexual Not only identifying. but has socially or physically changed to another assignment Transvestic Cross-Dressing but Disorder NOT transgendered Gender Dysphoria Path: Assignment DOES-NOT-EQUAL Identity AND Distress over incongruence Pt: 6-month duration AND any 1 of: ˗˗ Assignment DOES-NOT-EQUAL Identity ˗˗ desire to BE. rubbing or a nonconsenting person Uncommon Fetishism Inanimate objects Masochism Being humiliated or forced to suffer Sadism Inflicting humiliation or pain on others Transvestic Sexually aroused by cross disorder dressing 126 Q u i c k T a b l e s © OnlineMedEd . Psychiatry Somatic Symptom Disorder Somatic Symptom Disorder (new Somatization) Path: Somatic anxiety disorder with or without explanation Pt: ≥ 6 months AND One or more somatic symptoms OR ˗˗ High level of Health related anxiety ˗˗ Disproportionate concern to seriousness ˗˗ Excessive time and energy devoted to them Tx: Psychotherapy Conversion Disorder Path: Life Stressor NOT intentional NOT fabricated Pt: Sensory or Motor Related to the Stressor La belle Indifference Will not harm self Tx: Psychotherapy Confront Stressor Illness Anxiety Disorder (hypochondriasis) Pt: Preoccupation with GETTING SICK Usually has no illness or complaint Dx: r/o organic disease Tx: One provider. get freedom (out of jail) Tx: Confrontation Q u i c k T a b l e s © OnlineMedEd 127 . UC). set limits – do not over test Psychotherapy Factitious / Munchausen’s Pt: Conscious. get drugs (ED. intentional fabrication to play the sick role Psych Grid-Iron Abdomen Flight at Confrontation Abuse of a dependent (By Proxy) Tx: Confrontation of Factitious Jail of Factitious by proxy Malingering Pt: Conscious. intentional fabrication to obtain secondary gain Get money (disability). 01 PRIME : Notes 02 ACQUIRE: Video & Audio 03 CHALLENGE: Questions 04 ENFORCE: Flashcards & Quicktables .