PSYCHIATRY - UWORLD STEP 2
1. Side effect of Electroconvulsive therapy: Anteograde and retrograde
amne- sia (short lived)
2. Alcoholic hallucinosis: **12-24 hours after hospitalization, lasts 48
hours: visual/auditory/tactile hallucinations, but STABLE vitals and
SENSORIUM
Vs. Delirium tremens (DT): not alert or orientated + confusion, fever,
tachy, HTN, diaphoresis, agitation --> 48-96 hours after alcohol
withdrawal
3. Medication side effect: acute onset of hallucinations in child (talking to
bunny or dog at 4 years): Common after taking cold meds like
Antihistamine and alpha-adrenergics, or cough suppressant
dextromethorphan (NMDA antagonist)
--> confusion and hallucinations, esp if exceed dose for kids
Vs. Normal imaginary friends for kids at age 4: unlikely with acute
onset, esp after starting OTC cold medications
4. Normal stress response (to acute stress at work): Lower severity +
NO significant functional impairment
5. Clozapine (atypical antipsychotic): Monitor for NEUTROPENIA (not
Pancy- topenia!!) --> agranulocytosis
6. Ways to reduce opioid misuse: 1) Query the prescription drug-
,monitoring database at each visit (for undisclosed co-prescriptions)
2) RANDOM drug screens (not scheduled)
3) regular follow-ups ever 3 months of les if high risk (not every 6
months)
*risk factors for opioid misuse: <45, psychiatric disorder,
personal/family history of substance disorder + legal history
7. Normal aging: Occasionally forgetful, word-finding difficulty that
doesn't impact activities of daily living
8. Panic disorder: Unexpected recurrent attacks, fear of future attacks,
avoidance behaviour
*must rule out triggered panic attacks, and medial:substance
abuse induced causes
9. bulimia nervosa: Recurrent binge eating and restrictive/purging
compensatory behaviours
Bs. Anorexia: same but BMI is <18.5!!
,10.MDD symptoms (newly treated breast cancer): >2 weeks of at least
5/9 symptoms: SIGECAPS --> Sleep disturbance, loss of interest,
guilt, low energy, impaired concentration, change in appetite,
psychomotor retardation
Vs. Referring to a breast cancer support group would NOT be enough
(symptoms too severe) - and two weeks is enough for MDD diagnosis
and antidepressant therapy
11.Conduct disorder: Violating right of others and under 18 (not
antisocial per- sonality disorder yet)
Vs. ADHD and oppositional defiant - comorbid conditions but still
different
12.Best FIRST Antipsychotic medication therapy:: Second generation
like Quetiapine!
Vs. Clozapine is reserved for patients who have failed atleast two
antipsychotic trials (bc of agranulositosis)
Vs. Injectable Rispwrisone or Halaperidol --> only after oral forms have
NOT worked, or if there's repeated medication non-adherence
13.Factitious disorder: Intentionally produce sign and symptoms for
assuming a sick role - patients are demanding and upset when
confronted, leave against medical advice and seek help elsewhere
Vs. Malingering: involves external incentive!!
, Vs. Somatic symptom disorder: excessive preoccupation and
overestimation of seriousness of >1 somatic complaints - high usage of
medical care. But in this case the symptoms are real (eg. Vomiting in
front of Heath care personal, unlike factitious and malingering: making
it up!)
14.Teen with recent breakup - signs of depression: First question to ask:
any risk of suicide??
*don't promise confidentiality, as it can't be maintained in high-risk
groups
15.electroconvulsive therapy (ECT): Treats MDD with LOW risk of
complica- tions even for the elderly/geriatric population- esp if it's
severe, and they are refusing to eat, or drink or take meds --> this is
a rapid intervention
16.Antipsychotic induced NMS: Neuroepileptic malignant syndrome -->
altered mental status, fever, muscle rigidity, autonomic instability
1. Side effect of Electroconvulsive therapy: Anteograde and retrograde
amne- sia (short lived)
2. Alcoholic hallucinosis: **12-24 hours after hospitalization, lasts 48
hours: visual/auditory/tactile hallucinations, but STABLE vitals and
SENSORIUM
Vs. Delirium tremens (DT): not alert or orientated + confusion, fever,
tachy, HTN, diaphoresis, agitation --> 48-96 hours after alcohol
withdrawal
3. Medication side effect: acute onset of hallucinations in child (talking to
bunny or dog at 4 years): Common after taking cold meds like
Antihistamine and alpha-adrenergics, or cough suppressant
dextromethorphan (NMDA antagonist)
--> confusion and hallucinations, esp if exceed dose for kids
Vs. Normal imaginary friends for kids at age 4: unlikely with acute
onset, esp after starting OTC cold medications
4. Normal stress response (to acute stress at work): Lower severity +
NO significant functional impairment
5. Clozapine (atypical antipsychotic): Monitor for NEUTROPENIA (not
Pancy- topenia!!) --> agranulocytosis
6. Ways to reduce opioid misuse: 1) Query the prescription drug-
,monitoring database at each visit (for undisclosed co-prescriptions)
2) RANDOM drug screens (not scheduled)
3) regular follow-ups ever 3 months of les if high risk (not every 6
months)
*risk factors for opioid misuse: <45, psychiatric disorder,
personal/family history of substance disorder + legal history
7. Normal aging: Occasionally forgetful, word-finding difficulty that
doesn't impact activities of daily living
8. Panic disorder: Unexpected recurrent attacks, fear of future attacks,
avoidance behaviour
*must rule out triggered panic attacks, and medial:substance
abuse induced causes
9. bulimia nervosa: Recurrent binge eating and restrictive/purging
compensatory behaviours
Bs. Anorexia: same but BMI is <18.5!!
,10.MDD symptoms (newly treated breast cancer): >2 weeks of at least
5/9 symptoms: SIGECAPS --> Sleep disturbance, loss of interest,
guilt, low energy, impaired concentration, change in appetite,
psychomotor retardation
Vs. Referring to a breast cancer support group would NOT be enough
(symptoms too severe) - and two weeks is enough for MDD diagnosis
and antidepressant therapy
11.Conduct disorder: Violating right of others and under 18 (not
antisocial per- sonality disorder yet)
Vs. ADHD and oppositional defiant - comorbid conditions but still
different
12.Best FIRST Antipsychotic medication therapy:: Second generation
like Quetiapine!
Vs. Clozapine is reserved for patients who have failed atleast two
antipsychotic trials (bc of agranulositosis)
Vs. Injectable Rispwrisone or Halaperidol --> only after oral forms have
NOT worked, or if there's repeated medication non-adherence
13.Factitious disorder: Intentionally produce sign and symptoms for
assuming a sick role - patients are demanding and upset when
confronted, leave against medical advice and seek help elsewhere
Vs. Malingering: involves external incentive!!
, Vs. Somatic symptom disorder: excessive preoccupation and
overestimation of seriousness of >1 somatic complaints - high usage of
medical care. But in this case the symptoms are real (eg. Vomiting in
front of Heath care personal, unlike factitious and malingering: making
it up!)
14.Teen with recent breakup - signs of depression: First question to ask:
any risk of suicide??
*don't promise confidentiality, as it can't be maintained in high-risk
groups
15.electroconvulsive therapy (ECT): Treats MDD with LOW risk of
complica- tions even for the elderly/geriatric population- esp if it's
severe, and they are refusing to eat, or drink or take meds --> this is
a rapid intervention
16.Antipsychotic induced NMS: Neuroepileptic malignant syndrome -->
altered mental status, fever, muscle rigidity, autonomic instability
