High Yield Psychiatry Review for Step 2 CK & Shelf Exam
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- Опубліковано 9 чер 2024
- Get the official study notes on Amazon: www.amazon.com/s?i=stripbooks...
Get ready for a jam packed hour of potent high yield stuffs. Great for a last minute review of the 3rd year medical school psychiatry content.
This video is targeted for 3rd year medical students preparing for their Shelf exams or Step 2 CK. It is with my intention to help you review the big topics covered in Psychiatry in less than 1 hour to help you as an overview before your psych shelf exam or as a final quick review the night before your exam! If you can easily know these concepts then you should be in good shape.
Best of luck!
Summary (1/2):
NMS vs Serotonin Syndrome:
- Serotonin Syndrome has myoclonus, both have febrile and rigidity
- Look in the history. It helps a lot.
SS Antidotes:
- Benzos or cyproheptadine
Tyramine Crisis:
- MAOIs
- Treat for hypertensive emergency
o Nitroprusside, hydralazine, labetalol, etc.
EPS symptoms of Antipsychotics:
- Dystonia, Akathisia, Parkinsonism, Tardive Dyskinesia
- Dystonia
o Happens within hours, basically non-relaxing muscle spasms, usually affects the sternocleidomastoid (torticollis)
o Treatment: Benztropine, diphenhydramine (Benadryl)
- Akathisia
o Feel like they have to keep moving, can’t sit still
o Treatment: Benzos or beta blocker or benztropine
- Parkinsonism
o Tremor, Rigidity, Bradykinesia
o Treatment: Amantadine, benztropine
- Tardive Dyskinesia
o Chronic, months or years after using antipsychotics, lip smacking.
o Treatment: Discontinue antipsychotic, switch to clozapine, valbenazine
Clozapine
- With clozapine check for decreased white blood cells
- Lowers suicide risk
- Agranulocytosis, seizures
Lithium
- Most likely to decrease suicide risk
- Lithium toxicity: hydrate, dialysis
o Dialysis: AEIOU (acidosis, electrolytes, intoxicants, overload, uremia)
o Dialyzable intoxicants: methanol, aspirin, lithium, ethylene glycol
TCA Toxicity:
- Antidote: sodium bicarbonate (the sodium is important, flushes out the TCA)
Cocaine Overdose:
- Treat with benzos (IV lorazepam)
- Don’t give beta blockers
Alcohol Withdrawal:
- Treat with benzodiazepines
- Alcoholic hallucinosis vs Delirium Tremens
o Vitals are pretty stable with AH, but hypertension and tachycardia with DT
o Hallucinosis occurs sooner
PCP Overdose:
- Treat: Benzos
- Diagnosis: violence, psychosis, nystagmus, blood test will show elevated CPK
o CPK is elevated in neuroleptic malignant syndrome as well
Benzo Overdose:
- Antidote: Flumazenil
o Only for people who are not addicted to benzos (otherwise withdrawal)
- Withdrawal: tachycardic, diaphoretic, hypertensive
o Treat with benzodiazepines again and then taper slowly
Opioid:
- Overdose: Naloxone
- Withdrawal: Supportive because not life threatening (clonidine)
o Alcohol and benzodiazepines are withdrawal status epilepticus and death
Antipsychotic Pathways:
- Mesolimbic: positive symptoms
- Mesocortical: negative symptoms
- Tuberoinfundibular: prolactin (antipsychotic blocks dopamine, increase prolactin)
o Risperidone
- Nigrostriatal: parkinsonism
Schizophrenia:
- Good prognosis: late onset, female, fast onset
- Bad prognosis: early onset, male, slow onset
First Generation Antipsychotics:
- High Potency: Haloperidol, fluphenazine
o Side effects: EPS
- Low potency: chlorpromazine, chlorprothixene, thioridazine
o Side effects: HAM Block (antihistamine, alpha 1 blockade, anti-muscarinic)
Anti-alpha predisposes to orthostatic hypertension
Anti-muscarinic and antihistamine can be sedating
Second Generation Antipsychotics:
- Side effects: metabolic syndrome (hyperlipidemia, hyperglycemia, obesity)
- Olanzapine: most likely to cause metabolic syndrome
o Check glucose, lipids
Schizoaffective Disorder:
- If baseline is schizophrenia, then schizoaffective. If baseline is depression, then MDD with psychotic features
o Periods of time without depression or mania but still schizophrenic = schizoaffective
- Treatment: second gen antipsychotics or mood stabilizers (valproate, carbamazepine)
Delusional Disorder:
- At least one month of delusions (no other schizophrenia symptoms), function normally
Prognosis:
- Mood disorders have better prognosis than psychotic.
Bipolar:
- Mania requires hospitalization, at least 3 DIGFAST for at least one week
- Hypomania no hospitalization, can have 4 DIGFAST but no hospitalization
TCAs:
- HAM blockade and three Cs (cardiotoxicity (long QT and arrythmias), convulsions, coma)
Serotonin Syndrome:
- Typical vignette: stop SSRI for like a week and then start MAOI right away
- When you stop SSRIs it takes a few weeks to wash out serotonin before starting another one
Antidepressants:
- Take 4-6 weeks to start work
- Should take for at least 6-9 months
- Side effects but working: different SSRI in same class
- Not working at all: switch drug classes
ECT:
- Patient who will not eat or drink, high suicide risk, psychosis
- Side effect: amnesia for around 6 months which will resolve
Catatonia and Catalepsy:
- Can be antipsychotic induced
- Treatment: benzodiazepine (specifically lorazepam)
Thankyou!!
THANK YOU! Do you happen to have part 2/2? Would really appreciate it!
any luck getting part 2 of the summary @@softbee8265
hey, do u have part 2 of the summary. thanks
@thefenerbahcesk4156 summary part 2?
Recommended this to our study advisor and now she email blasts 160+ students recommending they watch your videos before Shelf exams. Great stuff.
1st line treatment of chronic persistent Restless Leg Syndrome is now Gabapentin (and the others in that class). The dopamine agonists are now 2nd line
Thank you so much for everything Dr. hy 🙏🏽🙏🏽🙏🏽
A little reminder for new treatment of restless leg syndrome based on uw:
Supplemental iron (if serum ferritin
Watching your videos the night before my shelves make all the difference! Thanks for teaching all of us :)
Let me know if you ever need a kidney
Kelli Tichy 😂
hahaha
HAHAHHA
I read this as hickey on accident 😂
😂😂
Bless your soul for these videos. Thank you thank you THANK YOU x10000000000
not me coming back again before step 2 :'-) Thank you x10000000000000000000000000000000~
omg! This is amazing review for Psych. I just did 3 blocks of UW and got 70, 80, 80!!!! Right on! Thank you :)
I wish u were my roommate during medschool
I'm surprised you don't have more followers. This is great review information. You've been super helpful for my previous shelf exams.
This is the best review I have ever seen.I even wrote some down as notes for study.Thank you!
Thank you so much Dr. HY for all your help, you are truly a blessing!
You are the HY Goljan for Clinicals. Thanks, Dr. HY!
Thank you so much for these videos. I watched them all and succeeded on my shelf exams. You are amazing!
Yoga with Helly congrats!
this is ridiculously helpful and HY!! very succinct without fluff. thank you!!
Wohoo ! Just finished my psych review with ur fabulous lecture! Gracious!
Thank you so much! My psych shelf is on Friday and this was super helpful :)
You’re amazing please please keeps up the videos ! I’ve been sharing non stop !
amy amelie ok haha I will upload the other ones too, glad I could help
I'm soooo grateful to you for all these HY videos - THANK YOU!!
Thanks for very comprehensive review :D
I think another difference b/w NMS and SS is:
Neuroleptic malignant syndrome has characteristic muscle rigidity, while in serotonin syndrome its absent
Your amazinggg!! Love that your straight to the point and cover so much! 😭 Thank you!!
Chelsy Calhoun no problem!! Wishing you All the best
@@DoctorHighYieldMD I literally heard your voice during my exam😂. I think it went well!!
Chelsy Calhoun hahah nice!! 😝
Great reviews! Thanks for creating/posting
Loving your vids! Perfect review since I take CK Monday🙌🏾
Hey Doctor Helene how did it go? I’m about to take it.
Watching all these videos again day before level 2 thanks!
Always so helpful! Love your videos!
Your videos are amazing! Really Helpful! Thank you SO MUCH!
One thing I noted for Restless leg syndrome treatment Dopamine agonists (eg, pramipexole, ropinirole) not preferred. Rather treat with :
Supplemental iron (if serum ferritin
✿Updated treatment for restless leg syndrome: alpha-2- delta calcium channel ligands aka Gabapentin, Pregabalin
✿ Second line treatment for RLS: ropinerole and pramipexole
I think Benzo's are second line now right? I don't think ropinerole or pramipexole are recommended at all now
Your IM shelf was on point. I had three questions based on your video,!
These are really very helpful videos. Wondering if you could make one on EKGs , CTs , EEGs and X-rays separately. Especially on how to read EKGs on the 2Ck test
Thanks for this video. Love the way you go through topics. Keep it up. :)
just found you and having my psych shelf tomorrow, this is so helpful!
Hope it went well!
Studying for my psych shelf and I was happy to find a familiar name endorsing the quality of this review!
This is the most useful video ever, thank you very much for sharing this
Bro please keep making these videos...i am taking step2ck in 3 days it really helps
Thanks for fantastic series. It helped me a lot to pass MCCQE1 ( Canada exam) effortlessly. Massive thanks !
Yes. Our legend did finally came back. Thank you God for giving us this doctor.
Abdullahi Abdullahi. The man the myth the legend. JK. 😅
Abdullahi do not thank God for them, psychs do not believe in God thats why everything about religion to them they will say its a mental illness, delusional, incoherent thinking etc etc.
You are awesome! Thank you for the great review!
Thank you! I have my exam in two days and this video helped me a lllllllllllllllot!! Wish me luck guyz :)
Thank you so much doctor...that’s really really fantastic...God blessings brother.
Great Job Doctor
All your videos are very useful.
Super helpful, thank you!
That’s amazing!
Thank you!
Correct me if I'm wrong, but around 28:00 when you begin talking about APD vs SAD, I've found the difference to be more in how the patient sees themself being judged. Social anxiety disorder patients do not think they are inferior to others but are afraid of inappropriate judgment or making a mistake. Avoidant personality disorder patients on the other hand think they are inadequate and feel helpless. The difference concerning their wants to have a social life is a contrast between avoidant personality disorder and schizoid PD. I had a question on AMBOSS between these two and remembered this rationale for the correct answer.
Loved this !
Amazing content, great review! Thank you so much. Just wanted to add an edit in there about the new guidelines for Restless leg syndrome: 1ST line= alpha-2-delta ligands (GABAPENTIN, PREGABALIN). 2nd line= Low-dose non ergot dopamine agonists (Ropinrole or pramixpexole)
Awesome ! Please upload soon
yes I will
Sir, You're an absolute ANGEL!!! 😇 👼 Thank you SO very much!
High quality review!
you really helped me so much!!!
Hey you dropped this 👑
wow keep it up
we need more of these please.
There's more coming soon, I just gotta upload them haha
Good Job! You get a thumbs up just for having a dip set interlude at the beginning of your video. Good information Keep it up!!
haha I'm so glad someone mentioned this. Love it.
Thank you so much!
In SS vs NMS, hyperreflexia with SS is also a dead giveaway.
Yh clonus
amazing, so helpful, and engaging!! thanks so much :)
hey wenna lol
@@hargunsidhu3668 LOL hi hargun!!!
The GOAT does it again!
high yield shelf reviews...updated on my channel. Here is a link to the high yield Emergency Medicine Shelf Playlist: ua-cam.com/video/o21iBZxlo_M/v-deo.html
Amazing videos!!! Do you have any book for step 3? or which is the most helpful for step 3?
thannks so much , that was really helpful
Thankful for your life
You are a USMLE GOD !! god bless you, thank you for all the amazing ,super helpful videos! :)
how can you compare God to a human
Amazing video!
Great video Doctor 👍 Thanks for this.
From where I can get the pdf form of high yield notes of Psychiatry, neurology and psychology
This is great. Is everything still up to date four years later?
just amazing!
You are the best!
thank you so much!! please don't forget to repeat answers from the audience because it can be hard to hear them
PMDD is different from PMS which is different from Primary Dysmenorrhea. They are 3 distinct entities. Only primary dysmenorrhea happens during menstruation. PMS can have mood sx, but they are not as severe or as depressive as experienced during PMDD.
Thank you so much
thank you papa
I work across the street from you! Hope to see you around town/in the hospital ;)
So good . Thnx
Thank You man
For IBS, TCAs are used rather than SSRIs
Fabulous!
This was awesome
I'm dying every time you say benzo and a picture of a sls pops up
😂
Speechless 👏
Treatment for opioid withdrawal is methadone/buprenorphine in addition to supportive.
thank you so muchhhh
thanks homie
Do you have a review for Social Sciences please? quality ethics?
I don't quite understand what the other people are saying. It would be great if you could put some subtitles. Great stuff. Thank you!
Sorry another question. For pms is the treatment OCP not NSAID? I didn’t hear the answer at the end. I heard the nsaid answer/question, just not the one right before.
Thanks!!
a popular question is how to diagnose, and the answer will be keep a menstrual diary, if symptoms are difficult to control the tx is SSRI or OCP
thx Dr.High yield
Opioid withdrawal treatment you said Clonidine but i’ve seen Methadone as a more common option. Also UTD gives buprenorphine as the best first line.
Pardeep Singh depends on the severity. The problem with making a 1 hour high yield video is I can't include everything and go into super details otherwise it will take much longer. my source was first aid psychiatry and for severe SX eg severe vomiting and diarrhea or unstable vitals then you can use buprenorphine or methadone. More commonly though it is just supportive care and on top of that clonidine can be used. Hope that helps
hey! great review, I really enjoy it! Actually, I found that first line treatment for fibromyalgia is excercise and good sleep 51:28, if does not work consider pharmacotherapy!
Thank youuuu
Sodium Oxybate is first line for narcolepsy, helps with their sleep quality I believe
Classic answer for the boards for narcolepsy will be modafinil.
is there a way to distinguish between atypical depression and grief? since atypical has mood reactivity.
The way I remembered it was that grief usually has ups and downs. The patient is functioning. Grief comes in waves. Depression is constant and associated with feelings of worthlessness.
Thank you for this awesome review!! -- quick update: OCPs + lifestyle changes are now considered first line for PMDD; SSRIs are added either around menstruation or daily for severe PMDD
Do you have PPTs or word Document type notes for these videos?! they are amazing!!
Finalizing them, been behind but hopefully soon!
@@DoctorHighYieldMD I can only imagine with all of this right now! Applying this year is gonna be wild..
First-line for restless leg syndrome is not dopamine agonists
there is nystagmus in alcohol intox?
This one is great. Wish it it was redone to include more personality disorders from clusters ABC. It's also hard to hear the people in the back when they answer. otherwise I love your videos!
Is it orlistat second line tx ?
Oh noooo you use a Mercedes-Benz symbol for benzodiazepines but Sketchy uses a Mercedes-Benz symbol for benztropine!!! My brain!!!!!!! That aside, thanks for another kickass review :) :) :)
EDIT: just realized that your DIGFAST @ 17:07 is similar but not quite the same as what I learned in school/through Amboss: Distractibility, Impulsivity, Grandiosity, Flight (flight of ideas), Activity (psychomotor hyperactivity), Sleep (sleep deficit), Talk (pressured speech)
The videos contents do you have it written as pdf or word document, so you can upload it as well along with the videos?
Yes working on it
@@DoctorHighYieldMD thank you
Some corrections. Short term psychotic disorders by definition have better prognoses than many chronic MI, mood or otherwise, because they resolve in
7:23 what is CPK? He mentioned it is positive for PCP intoxication.
Serum Creatinine Kinase/ also called as serum Creatinine Phospho Kinase (CPK)
Modafinil is not an orexin agonist.