What is comfort care and do hospice patients have to be on it

To provide long-term care, especially for individuals aged 65 years and older 35,000 to 75,000 depending upon nursing home level of care A unique type of service provided to people with terminal illness and a life expectancy thought to be < 6 months. Palliation refers to the treatment of symptoms rather than a focus on curing underlying disease. Patients on hospice generally are given more palliation than curative interventions. Comfort care refers to administering no life-prolonging...

Aggression

What has happened since the 1990s to the incidence of homicide in the United States Which weapon is most commonly used in a homicide What are risk factors for being victims of homicide Which racial group is most likely to be affected by a homicide How does violence on television or video games influence aggression in children Which gender is most likely to be most aggressive Laws vary by state usually consensual age is either 16 or 18, but some states have age difference limits (eg, not over 3...

Early Stages of Life Infancy to Childhood

Describe Erik Erikson's theories of development. Describe Sigmund Freud's theories of development. Describe Jean Piaget's theories of development. Critical periods at which achievement of social goals need to be achieved, otherwise they won't be achieved. Organized by parts of the body from which pleasure is derived at each age of development. Each stage is part of the development into the sexual maturity of adulthood, characterized by ego formation and the ability to delay gratification....

Genetic Studies

What type of study uses a family tree Pedigree study to show the occurrence of traits and diseases throughout generations What type of study compares the Family risk study frequency of disease in a proband (affected individual) with its frequency in the general population What type of study compares Adoption study monozygotic and dizygotic twins to determine the effects of genetic factors from environmental factors of disease This term describes if both twins have Concordance a given trait....

Are there special concerns about children and adolescents treated for depression

For adults, suicide is most attempted after pharmacologic treatment has begun. The patient has more energy and is better able to function but low mood and hopelessness may persist. There is FDA black box warning for all antidepressants that use in children and adults younger than 25 may increase suicidal thoughts and behaviors. When starting such a medication in this population, frequent and close monitoring for suicidality is important.

How is tolerance defined

Three or more of the following Tolerance. Withdrawal. More substance taken than was intended. Failure to control use, or a desire to stop using. Much time is spent either obtaining the substance, using the substance, or recovering from its effects. Social or occupational activities are reduced because of use. Use continues despite physical or psychological impacts of use. Either a need for increased amounts of substance to achieve the same effect or diminished effect with use of the same amount...

Paraphilias

What term describes the use of unusual objects of sexual desire or unusual sexual activities Which paraphilia is most common and is characterized by a person who achieves sexual gratification from children < 14 years of age Which paraphilia is characterized by exposing genitals to strangers Which paraphilia is characterized by achieving sexual gratification from inanimate objects Which paraphilia is characterized by recurrent urges to rub against or touch a noncompliant person in a sexual...

Deja Review

Resident Physician Department of Medicine University of California, San Francisco San Francisco, California University of Washington School of Medicine Seattle, Washington Class of 2009 New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright 2010, 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or...

How do you treat depression pharmacologically

The first-line treatment option is the selective serotonin reuptake inhibitors (SSRIs) (see Table 13.1). Table 13.1 SSRIs and Their Unique Properties Standard (Sexual side effects, nausea, vomiting, headache, anxiety, insomnia) Long half-life, drug-drug interactions Standard, plus has anticholinergic effects that can cause weight gain, constipation, and sedation Short half-life, can cause withdrawal symptoms (except CR form), drug-drug interactions Are there any other antidepressants Yes, there...

How is standard deviation used

It is the outcome that is measured and affected by the experiment. The dependent variable is dependent on the independent variable. It expresses the strength of a relationship between two variables. Its value must be between -1.0 and +1.0. Note The minus sign (-) implies a negative correlation and the plus sign (+) implies a positive correlation. The absolute value of r will determine the strength of the correlation. It is the root mean square deviation from the average. The standard deviation...

Suicide

What is important to keep in mind when approaching the topic of suicide on the United States Medical Licensing Exam (USMLE) Step 1 Where does suicide rank as a cause of death in the United States What are risk factors for committing suicide Who commits suicide more frequently, men or women There is only a limited amount of information that you will be asked regarding suicide. Always think safety first when given a question regarding a psychiatric disorder. Statistics, demographics, and risk...

What is a cohort study

The researcher separates subjects into groups and merely waits for the outcome in question to happen. The researcher separates subjects into groups and applies an intervention to one or more of those groups, hoping to modify the outcome. An observational study that compares subjects who have a disease or outcome (cases) with subjects who do not have an illness or outcome (controls). Note Groups are divided based on disease presence (outcome). An observational study that compares subjects with...

What are the three classic types of opioid receptors

Testosterone suppression, gynecomastia Chronic obstructive pulmonary disease (COPD) Immunosuppression Low fetal birth weight Periaqueductal grey matter responsible for analgesia Area postrema responsible for nausea and vomiting Ventral medulla responsible for respiratory depression Edinger-Westphal nucleus responsible for the pinpoint pupil response (due to extreme miosis) Nucleus accumbens responsible for euphoria

What is the mechanism of action of amphetamines

Cocaine is a stimulant that works by preventing the reuptake of catecholamine transmitters, such as dopamine and norepinephrine, in the brain and autonomic nervous system. Amphetamines block both the reuptake of dopamine and norephinephrine at the synapse, as well as cause the release of stored catecholamines.

What is Eating Disorder Not Otherwise Specified NOS

A grab-bag of disordered eating that does not meet criteria for Anorexia or Purging behavior without true binge eating Anorexia criteria without amenorrhea Restricting type anorexia without significant weight loss (ie, no binge eating purging to meet bulimia criteria) Bulimia criteria except at a lower frequency than required for diagnosis Chewing and spitting out large amounts of food Binge eating without purging behavior

Neuropeptides

What are the two endogenous opioids 1. Endorphins What behavioral factors do endogenous opioids alter Which factor does endogenous opioids alter in research studies Which neuropeptide(s) has been implicated in aggression and pain Which neuropeptides have been implicated in Alzheimer disease Which neuropeptides have been implicated in mood disorders Seizure activity Temperature regulation Placebo effects endogenous opioids are thought to play a major role in the placebo effects seen in research...

Which opioidsopiates are partial mu receptor agonists

Both strong and partial agonists have high affinity for the receptor but unlike strong agonists, partial agonists have low efficacy to activate the receptor resulting in a weak effect. Because of this high affinity low efficacy, they can antagonize block the effects of a stronger agonist. Opiates are derived from the opium poppy, while opioids are synthetic or semisynthetic derivatives of opiates. The difference between kappa receptors and mu receptors is that activation of kappa receptors...

What is a wellknown variant of factitious disorder

This is the distinguishing characteristic between factitious and somatoform disorders. The only obvious conscious goal of factitious disorder is to assume the sick role there is no clear benefit or gain. Hematuria (from adding blood to urine or from the use of anticoagulants) and hypoglycemia (from insulin injection) Extensive knowledge of medical terminology Eager desire to undergo medical procedures and operations Traveling to different locations, hospitals, emergency rooms, etc Patients...

Are there any physical examination findings which are common in somatoform disorders

Somatization disorder Conversion disorder Hypochondriasis Body dysmorphic disorder Pain disorder A disease in which the patient intentionally feigns illness to assume the sick role, but with no other obvious motivation (aka Munchausen syndrome) Intentional feigning of illness for the purpose of gaining a conscious reward Somatoform disorders are unconscious behaviors, whereas behaviors in factitious disorders and malingering are consciously derived by the patient. No. Disease etiology must be...

Clinical Vignettes

A 17-year-old woman comes to your office worried that she might become schizophrenic. She hasn't had any symptoms, but she says that some of her family members are schizophrenic. What would be important historical information to assess her risk How closely related she is to those family members with schizophrenia. The more genetically similar to them she is, the higher her risk is. A 41-year-old Down syndrome patient has had a gradual deterioration in cognitive functioning. Lately, she has been...

Domestic Partner Abuse

What are primary findings seen in women who are victims of domestic violence What factor can greatly increase the likelihood of an abused person being killed by their abuser What is the primary gender of the perpetrator of domestic violence What are the characteristics of the abuser in a domestic violence situation What are the characteristics of the abused in a domestic violence situation If the abused person leaves the abuser. Male Threatens to kill the abused Apologetic after abuse has...

Is there a danger in taking benzodiazepines during pregnancy

Benzodiazepines target the GABAa (y-aminobutyric acid A) chloride channel receptor, resulting in an increase in the receptor's affinity for and causing the ion channels to open more frequently, thus allowing more chloride ions to pass through. Benzodiazepines can cross the placenta, and therefore should not be taken during pregnancy if possible. They are categories D and X. 1. Phase 1 The R1 and R2 residues are oxidized. 2. Phase 2 The R3 residue is hydroxylated. 3. Phase 3 The hydroxyl...

Sleep Science and Disorders

What are the normal stages of sleep REM (rapid eye movement) and NREM (nonrapid eye movement). NREM is divided into four stages 1, 2, 3, and 4. What is slow wave sleep Slow wave sleep occurs during stages 3 and 4 of NREM sleep. It is also known as delta sleep and is the deepest portion of sleep. Electroencephalogram (EEG) shows delta waves, which are the lowest frequency waves. Delta waves Deep sleep What waveforms are seen in REM sleep What waveforms are associated with Stages 1 and 2 of NREM...

Is palliative care of the terminal patient the same as euthanasia

Palliative care is not done with the intention of accelerating death. It is done with the intention of making the patient comfortable through the natural end point of a terminal illness. However, palliative care may unintentionally accelerate death as a side effect. What is an informed consent Informed consent is required if the proposed treatment or procedure involves a material risk to the patient. An informed consent includes the voluntary agreement by a patient to proceed with treatment...

Sexual Violence

What is the definition of sexual assault A person commits a sexual assault when he or she uses force or the threat of force to touch another person sexually in a way that person does not want or when that person cannot give consent because of physical or mental inability. Note Sexual assault is the legal term for rape. What are examples of force that can be Manipulation used to commit a sexual assault C0erci0n Physical force Use of weapons Use of isolation Use of substances alcohol and other...

What are the common side effects of MAOIs

Treatment of atypical depression (depression with increased sleep, appetite, and leaden paralysis) They work by inhibiting the mitochondrial enzyme monoamine oxidase which metabolizes norepinephrine, serotonin, and dopamine, resulting in a buildup of these biogenic amines and their subsequent leakage into the synapse. Anticholinergic effects Orthostatic hypotension Cardiac conduction disturbances

Clinical Practice and Difficult Situations

The USMLE sometimes gives quote questions asking you to pick something to say in a provider-patient interaction. In general, it's usually a good idea to get more information, respect the patient's autonomy, keep information confidential, and never lie. What is the importance of rapport The relationship and trust built between the doctor and patient greatly enhance the effectiveness of care. What are the most important Admit the mistake and apologize for it. things to do if a medical error Never...

Is committed

What should you do if a patient tries You should thank the patient for their to give you a gift thoughtfulness, but not accept it. Gift giving may be misinterpreted as buying better care equal care should be given to all. When is it appropriate to refer a patient Only when the problem cannot be to another physician handled by yourself. This is rarely the answer on the USMLE it is inappropriate to refer a patient to a psychiatrist just because they have a difficult situation to be dealt with

Neurotransmitters

What are the four main steps involved in neurotransmitter release 1. Presynaptic neuron stimulation. 3. Neurotransmitter moves across synaptic cleft. 4. Neurotransmitter acts on postsynaptic neuron receptors. What are the two different types of neurotransmitters What are the two main excitatory and inhibitory neurotransmitters in the CNS Which factors contribute to the magnitude of reaction neurotransmitters have on neurons 1. Excitatory increase neuron firing 2. Inhibitory decrease neuron...

Has the likelihood of reporting child sexual abuse increased or decreased when compared with the past

Immersion burns on legs, feet, or buttocks child is immersed in scalding water History inconsistent with level of child's motor development, bite marks, and any facial trauma or bruising Cupping (use of heated cups to suction out illness) Coining or Spooning (rubbed on body leaving linear marks) Low socioeconomic status Social isolation Substance abuse Close relationship to the abused (eg, spouse, offspring) person with whom the elder lives and receives financial support from Some decline of...

How is amenorrhea defined

Melanosis coli (in those that use laxatives) Absence of a menstrual period for at least three cycles Fine, downy body hair, especially seen on the trunk Blackened areas on the colon, seen with laxative abuse What is a long-term risk of anorexia Osteopenia, Mitral Valve Prolapse, Amenorrhea, Electrolyte Disturbance, and Death

Behavioral

Active recall Q& A for exam success Mnemonics and clinical vignettes cover core concepts Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the...

Sexual Development

Which sex is the default pattern for sexual development Gonad differentiation is dependent upon the presence of which chromosome Which gene present on the Y chromosome influences gonad development Which duct system present in male embryos helps form genitalia Which duct system in female embryos help form female genitalia Which organ secretes hormones that direct the differentiation of male internal and external genitalia How does exposure to different levels of hormones during prenatal life...

What are the criteriasymptoms of paranoid personality disorder

Paranoid personality disorder involves a pervasive and unwarranted suspicion and mistrust of people, hypersensitivity to others, and an inability to deal with feelings. Four or more of the following Suspicion of exploitation or deceitfulness on the part of others Preoccupation with unjustified doubts Reluctance to confide in others Reading hidden demeanings or threatening meanings into benign remarks or events Persistently bearing grudges Perception of attacks on his or her character or...

Middle Stages of Life Adolescence to Adulthood

What age range constitutes early adulthood What are the primary characteristics of this stage of life Which Erikson stage is prevalent during early adulthood Which life events often occur during this stage What percentage of Americans is married by age 30 What is the percentage of women who suffer from postpartum blues How long do the symptoms of postpartum blue last Role in society is defined. Physical development peaks. Sense of independence. Mild mood swings that may switch quite rapidly and...

What is the most common first manifestation of this disorder in women

Patients must manifest four pain, two gastrointestinal, one sexual, and one neurologic symptoms, all of which cannot be fully explained by medical etiology. Somatic complaints must begin prior to age 30. These patients often have had multiple exploratory surgeries and visit multiple doctors. Yes, however, the complaints will often be in excess of what would be normally expected. 0.2 to 2 in women and < 0.2 in men History of abusive and failed relationships What is the treatment for...

Sexual Development And Physiologic Abnormalities

Which disorder is characterized by cells that are not responsive to androgens and testicles that may appear as inguinal or labial masses What is the genotype of a person with androgen insensitivity What is the phenotype of a person with androgen insensitivity Which disorder is characterized by an adrenal gland that is unable to produce the proper amount of cortisol which leads to a significantly increased androgen secretion What is the genotype of a person with congenital adrenal hyperplasia...

What is a good statement to make when discussing the possibility of psychiatric treatment with a patient

SLE, Multiple Sclerosis, Myasthenia gravis, Hyperparathyroidism, Thyroid disturbance, Porphyria, Malignancy No. Supportive treatment with suggestions that psychotherapy may alleviate their distress is associated with a better prognosis. Remember that pain is a subjective experience. Reassurance that there is no serious underlying medical cause, but without dismissing their symptoms this may alleviate some anxiety. Many of my patients with similar symptoms have found a lot of benefit from SSRIs,...

What are the chronic effects of alcohol ingestion

What are the three types of tolerance Development of tolerance Psychological dependence Physiologic dependence (this includes tolerance and withdrawal) Huge host of medical problems, including liver disease, cancer, etc 1. Metabolic tolerance allows for more rapid metabolism and excretion 2. Behavioral tolerance involves learning to perform a task while intoxicated as if the person is not intoxicated 3. Neuroadaptation involves the evolution of alterations in the brain that help to overcome the...

What will be the neuropsychiatric consequences of a hypothalamus lesion of the ventromedial nucleus

Deficits in concentration, judgment, motivation, and orientation Right parietal lobe (contralateral neglect) result in neglecting part of the body or space Left parietal lobe verbal deficits Hallucinations Memory deficits Personality changes Bilateral damage to hippocampus leads to massive anterograde and some retrograde amnesia. Unilateral damage of hippocampus leads to memory storage and retrieval problems. Kluver-Bucy syndrome uninhibited behavior, hyperorality, hypersexuality Tremor or...

What are barriers to patient adherence

Speak to the patient, not the interpreter. Speak clearly, being sure to pause intermittently to allow the interpreter to convey information to the patient. No, not if it can be helped. Even if the family member is fluent, it is good to at least offer to get an interpreter for the patient. Family members may also have their own agenda that may unduly influence the patient. The degree to which the patient follows the advice of the treating physician Poor support structure inadequate help

What type of curve demonstrates a normal distribution

The middle number in a set of numbers when they are put in sequential order Note If there is an even amount of data in a set, the median is the average of the two middle values in the data set. The number that appears most frequently in a set of numbers. Mean (1 + 2 + 3 + 4 + 5 + 6 + 7 + 8 + 9 + 10 + 11 + 12 + 12) 13 90 13 6.923 The difference between the highest and lowest values in a data set Note The range in the data set above is 12 - 1 11. A set of numbers in which the mean, median, and...

What is the best way to solve problems requiring the calculation of sensitivity specificity PPV and NPV

The ability of a test to detect disease if it is present The ability of a test to discern one disease from another True negatives divided by all of the people without a disease or illness SPin (SPecificity rules in) and SNout (SeNsitivity rules out) The likelihood that a positive result on a test represents actual disease The likelihood that a negative result on a test actually represents the absence of disease Sensitivity and specificity are directly related to NPV and PPV (respectively), but...

What types of emotional abuse do children experience

Inappropriate knowledge about sexual events out of proportion for a given age range Excessive initiation of sexual activity with peers Genital bruising Vaginal bleeding in women Lack of caregiver attention and love Physical neglect Caregiver rejection What types of emotional abuse do elders experience How many cases of child and elder abuse are reported annually What is the physician's responsibility if they suspects child or elder abuse Neglect of needed care (eg, medical, hygiene, etc)...

What is the relapse rate in the first year after alcohol detoxification

Minor signs occur early and subside within 2 days. They include anxiety, tremulousness, insomnia, GI upset, palpitations, diaphoresis, and headache. Tonic-clonic movements occurring from 2-48 hours after the last drink. This may progress to delirium tremens (DT). Visual, tactile, or auditory hallucinations from 12-48 hours after the last drink. Vital signs remain normal. An alcohol withdrawal syndrome with hallucinations, altered mental status, and seizures accompanied by vital sign...

Psychiatric Disorders Genetics

What is the prevalence of schizophrenia 1 in the general population In which gender is schizophrenia more Equal in males and females likely Which persons have a higher likelihood Persons with a close genetic relationship of developing schizophrenia Genetic markers on which chromosome(s) are associated with schizophrenia Does schizophrenia have a familial component Yes the closer a relative you are, the more likely you are to develop schizophrenia but concordance in twins is not 100 . What is...

Health Status And Determinants

What is the percentage of physical Approximately 70 illness that is due to individual patterns of living (eg, lack of exercise, poor dietary choices, and smoking) What are the primary determinants Education level of socioeconomic status Income Which socioeconomic group tends to delay seeking health care and present with more progressive illnesses People of low socioeconomic status due to lack of funds for health care Which gender is most likely to seek medical care Which gender has the lowest...

Other than primary psychotic disorders what other types of psychiatric illness often manifest psychotic symptoms

Brief psychotic disorder (< 1 month of symptoms) 2. Schizophreniform disorder (1 to 6 months of symptoms) 3. Schizophrenia (> 6 months of symptoms) Mood disorders Major depression or manic episodes may include psychotic symptoms, but only during a mood disturbance. Substance use Acute intoxication (especially with cocaine, lysergic acid diethylamide LSD , phencyclidine PCP , and amphetamines) or withdrawal (especially alcohol). Anytime a patient has tactile hallucinations, you should think...

Psychopathology

What is the most common psychiatric illness of the elderly What factors can lead to depression in the elderly What common disease process involving cognitive decline may mimic depression in the elderly What three methods can be used to successfully treat depression What changes in sleep patterns occur in the elderly Less cerebral blood flow Decreased brain weight Enlarged ventricles and sulci Increased amount of senile plaques and neurofibrillary tangles (also found in older brains from...

Jean Piagets Theory of Development

Which stage of development is characterized by infants and toddlers focusing on their eyes, ears, hands, and other senses Sensorimotor period from birth to age 2 years Which stage of development is characterized by children acquiring representational skills in the area of mental imagery and language Which stage of development is characterized by children being more logical, flexible, and organized than in early childhood Which stage of development is characterized by being able to think...

What are the important nonpsychiatric differential diagnoses for panic disorders

A panic disorder develops when the patient has recurrent panic attacks and has anticipatory fear about future panic attacks. Yes. Evidence does support an upregulation of adrenergic output responsible for stimulating anxiety centers in the brain which predisposes certain people to panic attacks. Agoraphobia. Patients have anticipatory fear which prevents them from venturing outside alone. Cognitive behavioral therapy including relaxation techniques SSRIs (first-line) Tricyclic antidepressant...

What is downward drift

There is no difference in the prevalence of schizophrenia between men and women however, the age of onset is affected. Men tend to develop it between 15 and 25 years of age and women between 25 and 35 years of age. Having a first degree relative with schizophrenia increases a patients' risk of schizophrenia tenfold. Being born in the cold winter months or in an area of high population density have also been associated with increased risk (though less so). This is the tendency of schizophrenics...

What are the symptomsdiagnostic criteria of dependent personality disorder

Social phobia, specific phobia, and agoraphobia Psychotherapy and assertiveness training, SSRIs, Beta-Blockers Patients are passive and may let others direct their lives and make important decisions. (Think Bill Murray's character in What about Bob ) Five or more of the following Inability to make decisions without advice Refusal to assume responsibility Has difficulty expressing disagreement Difficulty initiating projects Need for excessive nurturing and support Feelings of discomfort and...

Psychoanalytic Theory

What are the two major theories of the mind developed by Freud 1. Topographic theory of the mind includes three parts 2. Structural theory of the mind also known as the tripartite theory Which part of Freud's topographic mind contains information that one is unaware of, but can be accessed with prompting Which part of the mind contains thoughts of which a person is aware The conscious this part of the mind has no access to the unconscious. The unconscious includes what we are not aware of such...