PSYCH COMAT REVIEW EXAM
QUESTIONS WITH ACCURATE
ANSWERS
Borderline |Personality |Disorder: |
Is |characterized |by |maladaptive |coping |strategies |usually |in |response |to |what? |
What |can |lead |to |emotional |instability |(most |commonly |seen |in |interpersonal |relationships)?
Dialectical |behavior |therapy |(DBT) |is |a |______, |_______ |approach |to |management |of |
emotional |dysregulation. |Tx |integrates |a |Zen-like |acceptance |and |validation |of |the |patient |with
|cognitive |and |behavior |change |procedures |to |address |maladaptive |patterns
childhood |trauma |(sexual) |
*leads |to |immature |defense |mechanisms |
fear |of |abandonment
comprehensive, |multi-dimensional
NOTES:
Patients |with |BPD |can |become |manipulative |and |demanding |of |DOs |in |primary |care |setting |→ |
can |provoke |feelings |of |anger |& |frustration |in |medical |providers |→ |it |is |important |that |DOs |
monitor |and |manage |negative |feeling |of |counter-transference |when |treating |patients |with |
BPD
Patient |comes |to |the |ER |and |has |a |history |/ |symptoms |of |a |panic |attack |what |do |you |do |next?
need |to |r/o |life-threatening |medical |causes |of |the |presenting |symptoms |(chest |pain, |
palpitations, |SOB, |sweating)
Electrocardiogram; |important |to |check |an |ECG |in |any |patient |w/ |panic |symptoms |appearing |to
|mimic |MI |symptoms
NOTES:
After |r/o |treat |with |short-acting |benzo |(lorazepam)
,(True |or |False) |panic |disorder |is |characterized |by |a |pervasive |fear |of |having |another |panic |
attack?
True
Panic |disorder |is |recurrent |spontaneous |panic |attack |without |a |known |trigger. |Patients |usually
|have |intense |fear |and |discomfort; |fear |of |dying. |
Panic |disorder |with |agoraphobia; |is |when |there |is |avoidance |of |places |from |which |it |would |be |
difficult |to |escape |in |the |event |of |a |panic |attack |(panic |disorder |is |freq |accompanied |by |
agoraphobia; |the |excessive |fear |of |having |a |panic |attack |in |a |public |place)
Huntington's |Disorder |is |a |rare |genetic |disorder |(autosomal |dominant) |where |patient's |will |
show |what |triad?
What |does |patient's |brain |look |like?
1. |Dementia |
2. |Choreathetoid |movements |
3. |Behavior |outbursts |(depression |/ |aggression; |the |earliest |psychiatric |features |are |irritability |
and |behavior |outbursts) |
*Earlier |in |disease |patient |will |be |clumsy |and |frequently |drop |items |→ |later |on |rigidity, |
bradykinesia |
Large |lateral |ventricles |d/t |generalized |volume |loss |in |the |caudate |nucleus |
NOTES:
- |The |stem |will |probably |give |you |a |history |about |the |patient's |family |member |having |a |similar
|disease |at |an |older |age; |the |patient |is |younger |with |the |same |presenting |symptoms |(this |is |
known |as |Anticipation) |
- |CAG |repeats |added |on |to |the |end |of |the |affected |HTT |gene |on |chromosome |4
- |Chorea |(dance; |rapid |irregular |movements) |and |athetosis |(rhythmic |writing |movements |of |
the |hands |often |linked |to |piano |playing)
Can |HIV |directly |infect |the |brain |in |significantly |immunocompromised |patients?
YES; |this |will |lead |to |HIV-assocaited |dementia |(HAD) |(confusion, |↓alterness, |apathy, |& |
impaired |concentration |which |progress |over |the |course |of |several |months)
- |Generalized |atrophy |on |MRI
- |No |systemic |signs |of |infections
, NOTES:
- |HIV |is |able |to |reach |the |CNS |via |immune |cells |→ |cerebral |damage. |Symptoms |tend |to |
progress |faster |than |those |of |other |dementia; |but |slower |than |opportunistic |infections |
- |HAD |can |be |avoided |if |pateints |are |compliant |with |HAART
Patient |comes |into |the |ER |complaining |of |she |might |be |dying; |been |having |"tingling" |
sensations |in |her |arms |and |SOB. |She |has |been |having |these |symptoms |for |about |3 |month |and
|is |frequently |worrying |about |the |possibility |of |having |another |episode |leading |her |to |have |
further |distress.
PMH: |
- |C-section |2 |months |ago
- |Echocardiogram |shows |cardiomyopathy
(A) |Generalized |anxiety |disorder
(B) |Panic |disorder
(C) |Anxiety |disorder |d/t |another |medical |condition |
(C) |Anxiety |disorder |d/t |another |medical |condition |
NOTES:
General |medical |conditions |that |have |similar |symptoms |to |Panic |attacks: |Cardiomyopathy |
(peripartum |cardiomyopathy), |Cardiac |arrhythmias, |Parkinson's |Disease, |COPD.
Patient |with |heroin |use |disorder |is |admitted |to |inpatient |detox |and |started |on |regimen |of |
sublingual |buprenophrine/naloxone |treatment. |After |the |first |1-2 |hours |of |treatment |she |
develops |progressively |worsening |body |aches, |cramps, |diarrhea, |pilorection, |etc. |Why |did |this |
happen?
Buprenophrine |is |a |partial |agonist |at |the |opiate |receptors |that |can |displace |heroin |already |
present |in |patient's |plasma |→ |acute |withdrawal |syndrome |
∙Naloxone |has |similar |effects |BUT |is |NOT |absorbed |orally |or |sublingually. |Naloxone |is |
included |in |the |formulation |because |it |prevents |the |patient |from |dissolving |the |drug |and |
injecting |it |IV |in |effort |to |achieve |the |rapid |onset |of |action |of |buprenophrine |(Naloxone |= |
potent |antagonist |at |the |opiate |receptor)
∙ |Buprenophrine |is |commonly |used |as |outpatient |opiate |replacement |therapy |and |DOC |for |
supervised |heroin |withdrawal.
QUESTIONS WITH ACCURATE
ANSWERS
Borderline |Personality |Disorder: |
Is |characterized |by |maladaptive |coping |strategies |usually |in |response |to |what? |
What |can |lead |to |emotional |instability |(most |commonly |seen |in |interpersonal |relationships)?
Dialectical |behavior |therapy |(DBT) |is |a |______, |_______ |approach |to |management |of |
emotional |dysregulation. |Tx |integrates |a |Zen-like |acceptance |and |validation |of |the |patient |with
|cognitive |and |behavior |change |procedures |to |address |maladaptive |patterns
childhood |trauma |(sexual) |
*leads |to |immature |defense |mechanisms |
fear |of |abandonment
comprehensive, |multi-dimensional
NOTES:
Patients |with |BPD |can |become |manipulative |and |demanding |of |DOs |in |primary |care |setting |→ |
can |provoke |feelings |of |anger |& |frustration |in |medical |providers |→ |it |is |important |that |DOs |
monitor |and |manage |negative |feeling |of |counter-transference |when |treating |patients |with |
BPD
Patient |comes |to |the |ER |and |has |a |history |/ |symptoms |of |a |panic |attack |what |do |you |do |next?
need |to |r/o |life-threatening |medical |causes |of |the |presenting |symptoms |(chest |pain, |
palpitations, |SOB, |sweating)
Electrocardiogram; |important |to |check |an |ECG |in |any |patient |w/ |panic |symptoms |appearing |to
|mimic |MI |symptoms
NOTES:
After |r/o |treat |with |short-acting |benzo |(lorazepam)
,(True |or |False) |panic |disorder |is |characterized |by |a |pervasive |fear |of |having |another |panic |
attack?
True
Panic |disorder |is |recurrent |spontaneous |panic |attack |without |a |known |trigger. |Patients |usually
|have |intense |fear |and |discomfort; |fear |of |dying. |
Panic |disorder |with |agoraphobia; |is |when |there |is |avoidance |of |places |from |which |it |would |be |
difficult |to |escape |in |the |event |of |a |panic |attack |(panic |disorder |is |freq |accompanied |by |
agoraphobia; |the |excessive |fear |of |having |a |panic |attack |in |a |public |place)
Huntington's |Disorder |is |a |rare |genetic |disorder |(autosomal |dominant) |where |patient's |will |
show |what |triad?
What |does |patient's |brain |look |like?
1. |Dementia |
2. |Choreathetoid |movements |
3. |Behavior |outbursts |(depression |/ |aggression; |the |earliest |psychiatric |features |are |irritability |
and |behavior |outbursts) |
*Earlier |in |disease |patient |will |be |clumsy |and |frequently |drop |items |→ |later |on |rigidity, |
bradykinesia |
Large |lateral |ventricles |d/t |generalized |volume |loss |in |the |caudate |nucleus |
NOTES:
- |The |stem |will |probably |give |you |a |history |about |the |patient's |family |member |having |a |similar
|disease |at |an |older |age; |the |patient |is |younger |with |the |same |presenting |symptoms |(this |is |
known |as |Anticipation) |
- |CAG |repeats |added |on |to |the |end |of |the |affected |HTT |gene |on |chromosome |4
- |Chorea |(dance; |rapid |irregular |movements) |and |athetosis |(rhythmic |writing |movements |of |
the |hands |often |linked |to |piano |playing)
Can |HIV |directly |infect |the |brain |in |significantly |immunocompromised |patients?
YES; |this |will |lead |to |HIV-assocaited |dementia |(HAD) |(confusion, |↓alterness, |apathy, |& |
impaired |concentration |which |progress |over |the |course |of |several |months)
- |Generalized |atrophy |on |MRI
- |No |systemic |signs |of |infections
, NOTES:
- |HIV |is |able |to |reach |the |CNS |via |immune |cells |→ |cerebral |damage. |Symptoms |tend |to |
progress |faster |than |those |of |other |dementia; |but |slower |than |opportunistic |infections |
- |HAD |can |be |avoided |if |pateints |are |compliant |with |HAART
Patient |comes |into |the |ER |complaining |of |she |might |be |dying; |been |having |"tingling" |
sensations |in |her |arms |and |SOB. |She |has |been |having |these |symptoms |for |about |3 |month |and
|is |frequently |worrying |about |the |possibility |of |having |another |episode |leading |her |to |have |
further |distress.
PMH: |
- |C-section |2 |months |ago
- |Echocardiogram |shows |cardiomyopathy
(A) |Generalized |anxiety |disorder
(B) |Panic |disorder
(C) |Anxiety |disorder |d/t |another |medical |condition |
(C) |Anxiety |disorder |d/t |another |medical |condition |
NOTES:
General |medical |conditions |that |have |similar |symptoms |to |Panic |attacks: |Cardiomyopathy |
(peripartum |cardiomyopathy), |Cardiac |arrhythmias, |Parkinson's |Disease, |COPD.
Patient |with |heroin |use |disorder |is |admitted |to |inpatient |detox |and |started |on |regimen |of |
sublingual |buprenophrine/naloxone |treatment. |After |the |first |1-2 |hours |of |treatment |she |
develops |progressively |worsening |body |aches, |cramps, |diarrhea, |pilorection, |etc. |Why |did |this |
happen?
Buprenophrine |is |a |partial |agonist |at |the |opiate |receptors |that |can |displace |heroin |already |
present |in |patient's |plasma |→ |acute |withdrawal |syndrome |
∙Naloxone |has |similar |effects |BUT |is |NOT |absorbed |orally |or |sublingually. |Naloxone |is |
included |in |the |formulation |because |it |prevents |the |patient |from |dissolving |the |drug |and |
injecting |it |IV |in |effort |to |achieve |the |rapid |onset |of |action |of |buprenophrine |(Naloxone |= |
potent |antagonist |at |the |opiate |receptor)
∙ |Buprenophrine |is |commonly |used |as |outpatient |opiate |replacement |therapy |and |DOC |for |
supervised |heroin |withdrawal.
