Master the Boards USMLE Step 2CK - Psychiatry

Master the Boards USMLE Step 2CK - Psychiatry

To determine level of *intellectual disability/mental retardation*, patients must

exhibit deficits in both: - - Intellectual functioning (cognitive abilities)

• Social adaptive functioning (ability to do daily activities)

Gender w/ greater prevalence of intellectual disability/mental retardation - Males

Demographic w/ highest incidence of intellectual disability/mental retardation - School-age children

Degrees of intellectual disability/mental retardation - 1. Mild

• Moderate
• Severe
• Profound

IQ range associated w/ *mild* intellectual disability/mental retardation - 50-55 to 70

IQ range associated w/ *moderate* intellectual disability/mental retardation - 30- 40 to 50-55

IQ range associated w/ *severe* intellectual disability/mental retardation - 20-25 to 35-40

IQ range associated w/ *profound* intellectual disability/mental retardation - < 20

Level of functioning associated w/ *mild* intellectual disability/mental retardation - - Reaches 6th grade level of education

• Can work and live independently
• Needs help in difficult/stressful situations

Level of functioning associated w/ *moderate* intellectual disability/mental retardation - - Reaches 2nd grade level of education

• May work with supervision & support

• Needs help in mildly stressful situations

Level of functioning associated w/ *severe* intellectual disability/mental retardation - - Little/no speech

• Very limited abilities to manage self-care

Level of functioning associated w/ *profound* intellectual disability/mental retardation - Needs continuous care and supervision

What has DSM-V removed regarding the classification of intellectual disability/mental retardation? - IQ ranges (could still be used for statistical questions, so be sure to review)

Management of mothers expecting child w/ intellectual disability/mental retardation - - Genetic counseling

• Prenatal care
• Safe environment

Management of intellectual disability/mental retardation due to medical condition - Effective treatment of underlying medical condition

Management of intellectual disability/mental retardation - - Special education

• Behavioral therapy

Rationale for use of special education in management of intellectual disability/mental retardation - Improve level of functioning

Rationale for use of behavioral therapy in management of intellectual disability/mental retardation - Help reduce negative behaviors

Disorders characterized by problems in *social interactions, behavior, and language* that tend to occur in *children younger than age 3* and *impair daily functioning* - Autism spectrum disorders

Diagnosis that has replaced autism, Rett's syndrome, and Asperger's disorder - Autism spectrum disorders

Children w/ autism spectrum disorders have ongoing deficits in what area? - Social communication & interaction

Social communication & interactions deficits associated w/ autism spectrum disorders - - Lack of social connection

• Poor eye contact
• Problems w/ language, relationships, & understanding others

Other features of autism spectrum disorders - - Stereotyped/repetitive movements

• Inflexibility
• Unusual interest in sensory aspects of the environment
• Aggression
• Lack of separation anxiety
• Socially withdrawn

Goal of treatment for patients w/ autism spectrum disorders - - Improve ability to develop relationships

• Attend school
• Achieve independent living

What types of programs may patients w/ autism spectrum disorder benefit from?

• Behavioral modification programs

What do behavioral modification programs seek to do for patients w/ autism spectrum disorder? - Improve language and ability to connect w/ others

Treatment of aggression in patients w/ autism spectrum disorder - Antipsychotic medications (e.g., risperidone)

What is the most likely diagnosis? Gabriel is a a healthy 2-year-old boy whose parents have taken him to the pediatrician. His problems started at 18 months of age, when he did not speak much. He does not have much attachment to his parents and seems aggressive toward other children. - Autism spectrum disorder

Gender w/ greater prevalence of autism spectrum disorder - Males

Typical age of onset of autism spectrum disorders - By the age of 3

What should be ruled out if parents report that a child does not respond when his or her name is called? - Deafness

Disorder characterized by *inattention, short attention span, or hyperactivity* that is severe enough to *interfere w/ daily functioning* in school, home, or work

• Attention deficit hyperactivity disorder (ADHD)

Symptoms of ADHD must be present for what amount of time to make the diagnosis? - > 6 months

Typical age of onset of ADHD - < 7

Can the symptoms of ADHD persist into adulthood? - Yes

For the diagnosis of ADHD, what settings must symptoms be present in? - At least

2 areas: *home* and *school*

Symptoms of ADHD at home - - Interrupt others

• Fidget in chairs
• Run/climb excessively
• Unable to engage in leisure activities
• Talk excessively

Symptoms of ADHD at school - - Unable to pay attention

• Make careless mistakes in schoolwork
• Do not follow through w/ instructions
• Difficulty organizing tasks
• Easily distracted

1st line medications in the treatment of ADHD - - Methylphenidate

• Dextroamphetamine

Side effects of methylphenidate & dextroamphetamine - - Insomnia

• ↓ appetite
• GI disturbances