First Aid for the USMLE Step 2CK Rapid Review – Psychiatry – Flashcards
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First-line pharmacotherapy for depression
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SSRIs
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Antidepressants associated with hypertensive crisis
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MAOIs
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Galactorrhea, impotence, menstrual dysfunction, and ↓ libido
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Dopamine antagonists
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A 17-year-old girl has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found
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Conversion disorder
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Name the defense mechanism: - A mother who is angry at her husband yells at her child. - A girl who is upset with her best friend acts overly kind. - A man calmly describes a grisly murder. - A hospitalized 10-year-old begins to wet his bed.
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- Displacement - Reaction formation - Isolation - Regression
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Life-threatening muscle rigidity, high fever, autonomic instability, confusion, and elevated creatine phosphokinase
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Neuroleptic malignant syndrome
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Amenorrhea, low body weight (< 85%), bradycardia, and abnormal body image in a young woman
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Anorexia
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A 35-year-old man has recurrent episodes of palpitations, diaphoresis, and fear of impending doom
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Panic disorder
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The most serious side effect of clozapine
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Agranulocytosis
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A 21-year-old man has 3 months of social withdrawal, worsening grades, flattened affect, and concrete thinking
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Schizophreniform disorder (a diagnosis of schizophrenia requires ≥ 6 months of symptoms)
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Key side effects of atypical antipsychotics
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Weight gain, type 2 DM, QT-segment prolongation
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A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
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Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
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Medication to avoid in patients with a history of alcohol withdrawal seizures
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Neuroleptics, which can lower the seizure threshold
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A 13-year-old boy has a history of theft, vandalism, and violence toward family pets
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Conduct disorder. Associated with antisocial personality disorder in adults
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A 5-month-old girl has ↓ head growth, truncal discoordination, and ↓ social interaction
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Rett disorder. Loss of milestones is commonly described
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A patient hasn't slept for days, lost $20,000 gambling, is agitated, and has pressured speech. Diagnosis? Treatment?
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Acute mania. Start a mood stabilizer (eg, lithium)
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After a minor "fender bender," a man wears a neck brace and requests permanent disability
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Malingering
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A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C-peptide
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Factitious disorder
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A patient spends most of his time acquiring cocaine despite losing his job and being threatened with legal charges
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Substance use disorder
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Medication to avoid in patients with PTSD
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Benzodiazepines (have high addiction potential). Patients commonly have a history of substance abuse
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A violent patient has vertical and horizontal nystagmus
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Phencyclidine hydrochloride (PCP) intoxication
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A woman who was abused as a child frequently feels outside of or detached from her body
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Depersonalization disorder
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A schizophrenic patient takes haloperidol for 1 year and develops uncontrollable tongue movements. Diagnosis? Treatment?
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Tardive dyskinesia. ↓ or discontinue haloperidol and consider another antipsychotic (eg, risperidone, clozapine)
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A man with major depressive disorder is counseled to avoid tyramine-rich foods with his new medication. What class of medications is he taking?
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MAOIs
