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Cliffnotes For NBME (Slides)

This document provides a review of key topics for the NBME psychiatry exam, including diagnostic criteria, pathophysiology, treatment indications, and medication side effects. It emphasizes accurate diagnosis, initial management, and primary care psychiatry. Exam questions may involve long vignettes set in primary care or pediatric settings. The review recommends not leaving any questions unanswered and considering starting with the last 10 questions to help manage time.

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Cassandra B
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186 views

Cliffnotes For NBME (Slides)

This document provides a review of key topics for the NBME psychiatry exam, including diagnostic criteria, pathophysiology, treatment indications, and medication side effects. It emphasizes accurate diagnosis, initial management, and primary care psychiatry. Exam questions may involve long vignettes set in primary care or pediatric settings. The review recommends not leaving any questions unanswered and considering starting with the last 10 questions to help manage time.

Uploaded by

Cassandra B
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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8/23/2010

Cliffnotes for NBME Review

 Trade names  Age and time criteria


 Names of anyone—
diseases/theories 1. Number of days, weeks, or
months req. for dx
 Numbers 2. Schizophreniform/vs
 Lab values schizophrenia
3. Encopresis/enuresis
 Drug levels 4. Conduct D/O
 “NOS” DX 5. Personality D/O’s

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8/23/2010

Child and Adolescent


•“Normal” is a good answer
•“Enuresis” at early age
•“Encopresis” at an early age
•Typical Adolescent Rebellion
•Stranger anxiety
•Sleep patterns

•Some neurology

•If “fever and confusion in an elderly


patient,” think anticholinergic
delirium, not UTI.

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8/23/2010

Norepinephrine
•Locus ceruleus, brain stem
•Pathophysiology in panic attacks

Dopamine
•Antagonism in pathophysiolgy of movement disorders
and EPS
•Substantia nigra, midbrain

Serotonin
Raphe, brainstem

Schizophrenia
Huntington’s
Tourette’s

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8/23/2010

•Typical adult psychiatry in child vignette: anxiety disorders, depressive disorders


•Mental retardation (IQ ranges, most prominent)
•ODD vs CD (know age issues)
•ADHD
•Learning disorders and communication disorders
•Selective mutism
•Separation anxiety disorder—treatment: send them to school
•PDD, Autism and co-morbidity with MR
•Rett’s—hand-wringing in a young girl
•Tourette’s disorder and co-morbidity with OCD—treat tics with antipsychotic like
risperdone
•Encopresis (>4) and enuresis (>5)

PKU
•(remember ferric chloride test even though it has low sensitivity and isn’t
used much now)
•Vignette often immigrant children
Fragile X
Down’s Syndrome
Fetal Alcohol Syndrome
•(Know the physical findings)
Lesch-Nyhan
Prader-Willi

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8/23/2010

Differentiation between the dementias


•Alzheimer’s
•Vascular dementia
•Pick’s (frontotemporal)
Creutzfeld-Jakob DZ
•Prions as cause
Cholineresterase inhibitors for treatment of dementia
•Donepezil
•Galantamine
•Rivastigmine
•Memantine
Management of delirium
•Use of low-dose antipsychotics

Signs of intoxication and withdrawal


•Opiates—how to treat intoxication
•Marijuana—rarely cause psychosis; munchies and bloodshot eyes
•Alcohol—vignette—hospitalized patient after surgery
•Cocaine
•PCP
•Inhalants
Naloxone vs. Naltrexone
•Half-life matters
•One is for reducing relapse in alcohol dependence
•One is for opiate overdose with respiratory depression
Wernicke’s and Korsakoff’s
•Both, not together
•Role of thiamine

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8/23/2010

Differentiation between:
•Major depression
•Dysthymia—time course and severity
•Adjustment disorder with depressed mood
•Bereavement
•It can last a long time in some people
•Know details
•Bipolar Disorders
•Bipolar I
•Bipolar II
•Depressive vs. mixed vs. manic

Differentiate between
•Brief psychotic disorder
•Schizophreniform disorder
•Schizophrenia
•Delusional disorder
•Relatively intact functional capacity
•Non-bizarre psychotic symtoms
•No obvious thought disorder

“folie a deux”

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8/23/2010

SSRI --Treatment of choice


Panic disorder
•Recurrent, unexplained panic attacks
•Role of lactate
Social anxiety disorder
•“stage fright” version treated with propranolol
•Generalized version treated with SSRI
•GAD
•PTSD vs Acute Stress Disorder

Somatization Disorder
•MULTIPLE COMPLAINTS
•Pain
•GI
•Sexual symptoms
•Etc.
Hypochondriasis—fear of having a specific disease
Conversion—
•presenting with a neurological motor or sensory defect
•Not matching normal anatomical presentations
•Not believed to be consciously produced as it would be in Malingering
Pain Disorder—may sound like hypochondriasis but pain is the major
feature
Body dysmorphic disorder—rare questions

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8/23/2010

Sexual Dysfunction
•A lot of focus

Anorexia
•Amenorrhea
•Extremely underweight
•Lanugo
•May present with MEDICAL urgency/emergency
Bulimia
•Binging and either purging or laxative abuse (exercise abuse)
•Metabolic changes and physical signs associated with purging

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8/23/2010

KNOW THEM ALL--Frequent questions


Schizoid vs schizotypal
Paranoid Personality Disorder vs Delusional Disorder vs Schizophrenia
Borderline Personality Disorder
Antisocial Personality Disorder (age requirements)
OCPD

FACTITIOUS DISORDERS
•Vs. Malingering
•No obvious “secondary gain”
•Consciously produced
DISSOCIATIVE DISORDERS
•Dissociative fugue vs Dissociative Identity Disorder
SLEEP DISORDERS
•Narcolepsy
•Sleep studies and findings
•Treatment
•Nightmare Disorder vs Sleep Terrors
•Differences between the phases of sleep
•consciousness/arousal upon awakening
•REM Behavior Disorder
•Classed as a Parasomnia
•Physically “acting out” nightmare
OTHERS
•Physical abuse of a child
•Confidentiality of records despite your friend asking for them
•Indications for emergent hospitalization
•Severe anorexia with metabolic complications
•Post-partum depression with any hint of suicidal/homicidal thoughts
•“Imminent” dangerousness

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Indications and side effects


Safety in pregnancy—a lot of emphasis on the exam
Generic names of ALL psychotropic medications especially the SSRI’s
Antipsychotics—old and new
TCA’s
Anti-cholinergic side effect—usually an elderly patient receiving an antipsychotic or
TCA
Extrapyramidal side effects of antipsychotic medications
•How to treat
•Stressed on exam at times
Chlormipramine
•OCD
•Trichotillomania
Psychiatric uses of propranolol
•“Stage fright”
•Akathisia
•Drug tremors

Atypical antipsychotic medications (second generation)


•Metabolic syndrome
•Relative efficacy for negative symptoms
Uses of depot antipsychotics
•Haloperidol deconoate
•Fluphenazine deconoate
•Risperidone microspheres
Lithium
•Side effects and toxicity
•Hypothyroidism
Medical treatments for various overdose scenarios
•Acetaminophen
•Opiates
•Benzodiazepines
•Methanol
•Combinations

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8/23/2010

Family therapy
•For families of patients with schizophrenia especially when they are high
expressed emotion families
Cognitive-behavioral therapy
•Depression
•Anxiety disorders (including Exposure-Response Prevention for OCD)
Parental training
•For out-of-control kids
Social skills training
•Pervasive developmental disorders/autism
Psychodynamic psychotherapy or insight-oriented psychotherapy
•These are often listed as possible answers
•They are never the right answer on the exam
•There are certain studies that demonstrate benefit for certain conditions

•This review is only a general guide


•General focus is on primary care psychiatry
•Major emphasis is on accurate diagnosis and basic initial
management/treatment
•Some of the vignettes are long
•Keep track of your time
•Settings are usually primary care office, pediatrics clinic, or
emergency room
•NEVER LEAVE A QUESTION UNANSWERED
•Consider doing the last 10 questions first
•Read the last sentence of vignette first

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