Vertical (Psych · Tox · Tropical · Ophtho) — 5-min cram sheet

Vertical (Psych · Tox · Tropical · Ophtho) — 5-min cram sheet

_Built from the vertical study index. Deck-faithful._

Buzzword → answer (the vignette reflex)

• Obsessions → anxiety → compulsions → relief, insight preserved → OCD (SSRI 1st-line; hyperactive CSTC loop)
• Ophthalmoplegia + nystagmus + ataxia + confusion → Wernicke's (thiamine/B1 deficiency; petechial haemorrhages in brain stem)
• Loss of short-term memory after untreated Wernicke's → Korsakoff's (irreversible)
• Disorientation + visual hallucinations + alcohol-withdrawal signs → Delirium tremens (also benzo & cocaine withdrawal)
• Oculogyric crisis + torticollis in young neuroleptic-naïve male → Acute dystonia (high-potency e.g. haloperidol; IM procyclidine)
• Fever + rigidity + altered mental status + autonomic dysfunction + ↑↑CK → NMS (bromocriptine + dantrolene)
• Inner restlessness + compulsion to move, foot stamping/pacing → Akathisia (propranolol)
• Early-morning wakening + diurnal mood variation (worse AM) → biological (melancholic) depression
• QRS >100 ms after overdose → TCA toxicity (antidote sodium bicarbonate)
• Pin-point pupils + respiratory depression + sedation/coma → Opioid overdose (naloxone)
• DUMBELS / cholinergic crisis, pin-point pupils, salivation → Organophosphate (atropine + oximes)
• Cherry-red skin + throbbing headache → Carbon monoxide (hyperbaric O₂)
• Bitter almond smell + red asphyxia (no cyanosis) → Cyanide (cyanide kit)
• Tinnitus + hyperventilation + mixed acid-base → Aspirin/salicylate (sodium bicarbonate)
• Bradycardia + AV block + hyperkalaemia → Digoxin toxicity (Digibind / digoxin immune Fab)
• Multiple radio-opaque foreign bodies in GIT → Body packing (whole bowel irrigation)
• Anaesthetic hypopigmented macule, 1–2 lesions + thickened palpable nerves → Tuberculoid leprosy (lepromin positive)
• Leonine facies + madarosis + numerous lesions, normal sensation → Lepromatous leprosy (lepromin negative)
• Subcutaneous nodules + pruritus + blindness; skin snips → Onchocerciasis / river blindness (ivermectin)
• Calabar swellings + worm crossing subconjunctiva → Loiasis (DEC; diurnal periodicity)
• Cherry-red spot at fovea + sudden painless vision loss + RAPD → CRAO ("stroke of the eye")
• "Blood and thunder" fundus (extensive haemorrhages) → CRVO
• Cotton wool spots + venous beading + IRMA → severe NPDR; neovascularisation on disc → proliferative DR (PRP)
• Macular drusen (early) / CNVM + metamorphopsia on Amsler grid → dry / wet AMD (anti-VEGF for wet)

Poisoning / toxidrome → antidote (as the index gives it)

Empiric coma cocktail (undifferentiated poisoning) = Dextrose · Naloxone · Thiamine (± Oxygen).

Criteria / scores / classifications at a glance

• OCD (ICD-11 / DSM-5): obsessions and/or compulsions; threshold >1 hour/day OR significant distress/impairment.
• Acute Stress Disorder (DSM-5): 5 symptom categories (intrusion + negative mood + dissociation + avoidance + arousal); duration 3 days–1 month after trauma.
• PTSD: duration >1 month; 4 core clusters — intrusion + persistent avoidance + negative alterations in cognition/mood + alterations in arousal/reactivity.
• ICD alcohol dependence: ≥3 of 6 features over past year (compulsion, difficulty controlling, withdrawal, tolerance, neglect of interests, persisting despite harm).
• Depression (ICD-10): ≥2 weeks, ≥2 of 3 core symptoms + additional (mild ≈4, moderate 5–6, severe ≥7 total).
• GAD: excessive worry most days ≥6 months. Panic disorder: recurrent unexpected attacks (peak ~10 min) + ≥1 month anticipatory worry.
• Mental capacity: 4 components (understand · retain · weigh & decide · communicate) + 5 principles (presumption of capacity, task/time-specific, support decisions, unwise ≠ incapacity, best-interests/least-restrictive).
• SADQ: <16 mild / 16–30 moderate / >30 severe dependence.
• AUDIT: 3 domains (hazardous · dependence · harmful use); AUDIT-C positive if ≥5.
• COWS: 7 parameters — resting pulse, sweating, restlessness, pupil size, bone/joint aches, runny nose/tearing, GI upset.
• Leprosy Ridley-Jopling: TT (stable, highest CMI, lowest load) → BT → BB → BL → LL (stable, lowest CMI, highest load).
• Leprosy WHO: Paucibacillary = 1–5 lesions (TT, BT); Multibacillary = >5 lesions (BB, BL, LL).
• Filariasis habitat: Lymphatic = W. bancrofti, B. malayi, B. timori · Cutaneous = Loa loa, O. volvulus, M. streptocerca · Body-cavity = M. perstans, M. ozzardi.
• Lymphoedema grading: I reversible on elevation · II not reversible, no skin changes · III non-pitting + skin thickening · IV nodular/warty excrescences (elephantiasis).
• Diabetic retinopathy staging: NPDR (background) → severe NPDR → proliferative DR → advanced diabetic eye disease.
• HTN retinopathy grading 0–4: grade 4 = grade 3 + disc swelling = malignant HTN emergency.
• Acid-base: Met acidosis ↓pH/↓HCO₃ (2° ↓pCO₂) · Met alkalosis ↑pH/↑HCO₃ (2° ↑pCO₂) · Resp acidosis ↓pH/↑pCO₂ (2° ↑HCO₃) · Resp alkalosis ↑pH/↓pCO₂ (2° ↓HCO₃).
• Anion gap: (Na⁺) − (Cl⁻ + HCO₃⁻); normal 8–12 mEq/L (no K), 12–16 (with K), 7 ± 4 mmol/L (alt deck value). Elevated AG = MUDPILES.
• BAC: UK drive limit 0.08 (80 mg/100 mL blood; 35 µg/100 mL breath); >0.50 → poisoning/death.
• Toxidromes (BP·P·RR·T·pupils): Anticholinergic ↑↑↑↑ pupils↑ (dry, flushed, retention, delirium) · Cholinergic ± (salivation/lacrimation/urination/bronchorrhoea/fasciculation) · Sedative-hypnotic all↓ · Opioid all↓ pupils↓ · Sympathomimetic ↑↑↑↑ pupils↑ (tremor/seizures) · EtOH withdrawal ↑↑↑↑ (tremor/seizures/hallucinations) · Opioid withdrawal (vomiting, rhinorrhoea, piloerection, diarrhoea, yawning).
• DUMBELS (muscarinic/OP): Diarrhoea, Urination, Miosis, Bradycardia/bronchospasm/bronchorrhoea, Emesis, Lacrimation, Salivation, Sweating.
• MATCH (nicotinic/OP): Muscle fasciculations, Adrenal medullary hyperactivity, Tachycardia/arrhythmias, Cramping skeletal muscle, Hypertension.
• CHIPES (radiopaque on AXR): Chloral hydrate, Heavy metal, Iron, Phenothiazine, Enteric-coated, Sustained-release.
• Disturbed behaviour hierarchy (5 stages): verbal de-escalation → time out → rapid tranquilisation → physical restraint → seclusion.
• Rapid tranquillisation: lorazepam 1–2 mg (max 4 mg/24h) ± haloperidol 5–10 mg (PO 30 mg/24h, IM 18 mg/24h); non-psychotic → lorazepam alone, psychotic → + antipsychotic; ensure flumazenil available; ECG for all who receive haloperidol.
• ABC model: Antecedents → Behaviour → Consequences; intervention = Prevention → Management → Harm reduction.
• MHA vs MCA: MHA = (possible) mental disorder, assessment/treatment of mental illness only; MCA = lack of capacity in dissenting patient, treatment in best interests.
• Observation levels: Constant (within hand reach) · L1 every 15 min · L2 every 30 min · L3 every hour.
• Egyptian Mental Health Act 2009: Art 11 voluntary hold max 72h (danger to self/others / unable to self-care; extension ≤1 week) · Art 12 minors/incapacitated (notify ≤2 business days) · Art 13 involuntary admission (psychiatrist + severe illness + refusing; notify ≤24h) · Art 14 non-psychiatrist admission max 48h (notify prosecutor ≤24h) · Art 16 stays >1 week (2 assessments; paperwork to Regional Council ≤7 days) · Art 17/18/21 transfers/escapes (urgent notify ≤24h) · Art 28 ongoing refusal (review ≤4 weeks; new assessment if forced Rx >3 months) · Art 29 emergency forced treatment max 72h · ECT (Art 28 & 30) = GA + muscle relaxer + written consent (max 2 emergency sessions) · Seclusion & restraints = last resort, 3 forms (physical, mechanical, chemical).

Discriminators that decide questions

1. Acute Stress Disorder vs PTSD — duration 3 days–1 month (ASD) vs >1 month (PTSD); symptoms beyond 1 month → PTSD.
2. Tuberculoid vs Lepromatous leprosy — TT: lepromin positive, highest CMI, lowest load, anaesthetic lesion, non-infectious, early nerve affection. LL: lepromin negative, lowest CMI, highest load, normal sensation in lesions, infectious, late nerve, leonine facies.
3. CRAO vs CRVO — CRAO: cherry-red spot at fovea, pale retina, attenuated vessels, embolus (ophthalmic emergency, first 15 min→1h). CRVO: "blood and thunder" extensive haemorrhages, engorged tortuous vessels, macular oedema.
4. Viper vs Cobra envenomation — Viper: hemotoxic + vasculotoxic (severe local pain, oedema, ecchymosis, gangrene, coagulopathy, myoglobinuria). Cobra: neurotoxic (minimal local pain/oedema, fasciculation → skeletal-muscle paralysis; consciousness + sensation spared).
5. Anticholinergic vs cholinergic toxidrome — Anticholinergic: dilated pupils, dry/flushed skin, urinary retention, delirium, hyperthermia, ↓bowel sounds. Cholinergic: salivation, lacrimation, urination, bronchorrhoea, fasciculation, paralysis.
6. Atropine vs oximes in organophosphate — atropine = muscarinic antagonist only (does NOT block nicotinic); oximes = reactivate AChE → correct all 3 (muscarinic + nicotinic + CNS), critical window first 24–48h before "aging".