Step 2 Psych 2 (1-6-16)

ruhland1's version from 2016-01-04 15:23

Section 1

Question Answer
camilia sinesisjaundice (green tea)
echinaceafor colds
panax ginsengaphrodesia, stimulant like side effects
ginko bilobaprolonged bleeding
marijuanacauses cyclic vomiting syndrome, cannot be dx until pt abstain from marijuana for 2 weeks and there is a resulting reduction of symptoms
chvostekhypocalcemia, twitching when tap cheek
courvosierpalp gallbladder, think pancreatic head carcinoma
cullenperiumb blue due to panc nec or retroperit bleed, look for it in acute pancreatitis
grey turner signflank bluish, retroperit bleed or preganant
russel signcallus formation backs of hand 2ndary to self induced vomit
murphyacute cholecystitis
mcburneryacute appendicitis
homan signDVT
rebound tenderperitonitis
chandlier signPID
kerniglift pt legs they reflexively flex neck, in meningitis
waddell signmalingering (chronic lower back pain) tenderness test, simulation test, distraction tests in straight leg raise, regional distubrances, overreaction

Section 2

Question Answer
bulimiamost effective treatment is CBT, greater than drugs
anorexiagreatest impact on adolescent is family-based therapy
hypocholoremic alkalosisV or lax abuse
dehydrationBUN:creatinine > 20:1
blood lossgive isotonic saline
PCPviolence paranoia rotatory nystyg, use benzo to tx severe sx
coke w drawldysphoric mood, vivid dream, dn sleep, agitation, up apetite
LSDanx, dep, pupil dil, delusion, halluc, flashbacks
status epilepticussz lasts more than 30 min
status epilepticusIV lorazepam/diazepa/midazolam
levetriracetamanti convulsant, not a benzo!
status epilepticus benzo failsuse phenytoin. if not work use phenobarb
who does not recover from post ictal state before seizing againstatus epilepticus
status epilepneuro asess, place 2 IV cathters, pulse ox, CMP, glc, toxicology, Mg, ABG and check sz medication levels
alprazolamcontra in status epilepticus b/c dn T1/2 .: up withdrawl sz
status epileticusloarzepam -> phenytoin -> phenobarb/diazepam/midazolam
phentoinsecondline tx in status epilecticus
phenobarb3rd line tx in status epileticus

Section 3

Question Answer
to dx anx d/omust rule out the sx are not caused by a substance
anx, insomnia, psychomotor agisx of caffeine and tobacco
zolpidem zalephonhypnotic sedative used for sleep-onset insomnia
estalazolamfor sleep-maintenance insomnia
alprazolamshort t 1/2
diazpamlong t 1/2 for anx d o, acute etoh w drawl, convulsive d o, muscle spasm, procedural sedation
levetiracetamanti SZ drug
tangentialtygives response but does not answer question
maniasx for atleast 1 week (need 3 of...) distractibilty, dn sleep need, inflated self-esteem, increase in goal directed activit, hi risk activitiies and include psychotic features: euphoria, pressure speech, halluc, racting thought
classic maniaeuphoria, pressured speech, racing thoughts, psychotic features
hypomania>4 days, no psych features, no social or occupational impairment
antidepressant w o mood stabilizercan induce mania in bipolar pt being tx for dep
anorexiaa combination of genetic, bio, psych, family, enviro, and social factors
anorexia labreduced MHPG in urine and CSF, up MHPG .: depression
anorexia lab and CThyper cortisolemia, ammennorshea, dysfunc of 5ht DA and NE in paraventricular nucleus in hypothal, also involve is corticotrophin releasinf factor CRF, neuropeptide Y, GNRH, TSH, CT shows enlarrged sulci and ventricles in anorexic starved patients
how to ddx MDD from a depressed phase of bipolarlook at pt hx for past periods of elevated mood and/or mixed symptoms
MDDatleast 2 wk hx of depressed mood, sleep disturbance, anhedonia, d apetite, poor concentraion. must be ddx from depressed phase of bipolar

Section 4

Question Answer
narcolepsytertad of excessive daytime sleepy, cataplexy, hypnagogic halluc during both night and daytime sleep and sleep halluc
narcolepsydx with polysomnomram (shows short REM latency) tx is maintain regular sleep schedule, go into sports, emotional support, stimulant drugs
cataplexystong emotion causes sudden physical unconsciousness, think the goats
drugs and etohnon-factors in narcolepsy sx
splittingborderline p d o (10% suicide rate)
acting outgivens into an unacceptable impulase rather than face the anx of supressing it (me taking adderall)
projectionman feeling guilty for cheating on his wife accuses her of cheating on him
repressionunconscious prevention of thought or feeling from reaching conscious
supressionconscious prevention of unacceptable impulses or emotions in order to achieve a desired outcome
sertalinebad for preg
paroxitinebad for preg (ompahocele, heart defect)
MVP in young skinny femaledue to anorexia
delusion of parasitosisfixed belief they have bugs on skin, tx w antipsych
vivid dreams, sleep paralysisthink about narcolepsy
primary hypersomniadisturbances in anount, quality and time of sleep. dx requires atleadt 1 mo of excessice daytime sleepiness or excessive sleep and other stuff is rulled out, awake to sleep latency is short 5 min with normal REM latency
primary hypersomnia txamphet and SSRI
chronic fatigue syndomelike primary hypersomnia but also have a variety of somatic complains HA, myalgia, arthalgiam low grade F
circadia rhythm sleep d ounable to sleep at night but can sleep during the day
short REM latencyfeature of narcolepsy

Section 5

Question Answer
increase REM sleepinvolves elevating acetylchline
decrease REManticholergics antimusc (-stigmine, donepezil increase ach diphenhydramine anti musc deacrease it)
donepezilacetylcholinesterase inhibitor
SSRI and SNRIup serotonin .: supress REM
odensetron and gransetron5HT antag .: increase REM activity
initiate and maintain REMach
DA, 5HT and NEcompliment ach and control and supress REM activity
5HTprolongs total sleep, increaseds delta-sleep, decreases REM (NE and 5HT are at lowest levels during REM)
Huntington dz30-40 yo rapid, involuntary, nonreptitive or arrthymic movement involving face trunk and limbs
Huntington dzCAG expansion, striatal destruction, GABA depletion, caudate and putamen wasting
Huntinton CTcaudate atrophy
touretteonset < 18 year old, sudden rapid recurrent
tardive dyskinesialong term DA antag use, lip smakcing, sucking, facial grimacing
wilson dzauto re,dystonia, chorea, wing beating tremor, kayerfleischer
d-pencillaminecopper chelator
syndenhams choreapost strep infxn, children, choreiform(vinvoluntary,bried,random irregular mvmt of limbs and face=St.Vitus dance) emotional lability and hypotonia. associated with acute rheumatic fever
st.vitus dancesyndenham chorea in acute rheumatic fecver
wilson dztorticollis, dystonic exaggerated facial smile, writers cramp, blepharospasm
blepharospasminvoluntary tight closure of eyelids seen in wilson disease
tourettesbefore 18 yo with both motor and vocal tics
tourette braindysfunc in basal ganglia mid brain and cortex