-
Cause of paresis with muscle spasticity
Upper motor neuron injury
-
Cause of paresis with muscle flaccidity and atrophy
Lower motor neuron injury
-
What is stereognosis?
Ability to identify objects by touch
-
Site in CNS that first receives pain sensation
Thalamus
-
Symptoms of thalamic pain
burning pain on the contralateral side of the body
-
What is homonymous hemianopsia, and which side is the lesion on?
- Loss of the same half-field in both eyes
- Lesion is on the contralateral side
-
Most common lesion site in partial complex seizures
Temporal lobe
-
Signs of lesion in the Dominant Hemisphere (3)
- 1. Aphasia
- 2. Gerstmann Syndrome
- 3. Alexia without agraphia
-
Signs of lesion in the Nondominant Hemisphere (3)
- 1. Hemi-inattention
- 2. Anosognosia
- 3. Constructional apraxia
-
Symptoms of Gerstmann Syndrome (4)
- 1. Acalculia
- 2. Agraphia
- 3. Finger agnosia
- 4. Left-right confusion
-
Which side is the lesion on in Babinski sign?
Contralateral
-
Site and laterality of lesion in Parkinsonism
Contralateral substantia nigra (basal ganglia)
-
Site and laterality of lesion in Athetosis
Contralateral Basal Ganglia
-
What is athetosis?
Slow, writhing movements
-
Site and laterality of lesion in Choreas
Contralateral Basal Ganglia
-
Site and laterality of lesion in Hemiballismus
Contralateral Basal Ganglia (most often subthalamic nucleus)
-
What is Hemiballismus?
Intermittent flailing of the arm and leg on one side of the body
-
Site and laterality of lesion in Postural Instabilitly
Contralateral Basal Ganglia
-
Site and laterality of lesion causing rigidity
Contralateral Basal Ganglia
-
Site of lesion causing ipselateral cranial nerve palsy and contralateral hemiparesis
Brainstem
-
Site of lesion causing Internuclear Ophthalmoplegia
Brainstem
-
What is internuclear ophthalmoplegia?
When looking to one side, ipselateral eye only minimally adducts; contralateral eye abducts with nystagmus
-
Site of lesion causing nystagmus
Brainstem
-
Site of lesion causing Bulbar Palsy
Brainstem (Lower Motor Neurons)
-
Bulbar Palsy
Impaired function of cranial nerves 9, 10, 11, and 12
-
Site and laterality of lesion causing intention tremor
Ipselateral cerebellum
-
Site and laterality of lesion causing Dysdiadochokinesia
Ipselateral cerebellum
-
Site of lesion causing scanning speech
Cerebellum
-
What is scanning speech?
Speech in which words are broken into syllables, often with noticeable pauses and spoken with varying force
-
What is Constructional Apraxia?
- Inability to copy simple forms or arrange objects into specific patterns
- Due to inability to integrate visual and motor functions
-
Site and laterality of lesion in pseudobulbar palsy
Bilateral cerebral hemispheres (corticobulbar tract)
-
Corticobulbar Tract (origin and innervation)
Originates in motor cortex, innervates brainstem motor nuclei
-
Components of basal ganglia
- 1. Globus pallidus
- 2. Caudate
- 3. Putamen
- 4. Substantia nigra
- 5. Subthalamic nucleus
-
Components of striatum (3)
- 1. Globus pallidus
- 2. Caudate
- 3. Putamen
-
Where does the Extrapyramidal Tract originate?
Basal Ganglia
-
Role of Extrapyramidal Tract (3)
- 1. Control muscle tone
- 2. Regulate motor activity
- 3. Generate postural reflexes
-
What movements define Chorea?
Intermittent, randomly-located jerking of the limbs and trunk
-
Site of lesion in Huntington Disease
Caudate nuclei (atrophy)
-
Signs of Corticospinal (Pyramidal) Tract damage (3)
- 1. Peresis
- 2. Abnormal deep tendon reflexes
- 3. Babinski
-
What is Apraxic gait?
- Stooped posture with shuffling steps
- Stop walking abruptly at times
- Due to loss of executive function; often appear not to remember how to initiate a step
-
Cause of Apraxic Gait
Normal Pressure Hydrocephalus
-
Cause of festinating gait
Parkinson Disease
-
What is festinating gait?
Small shuffling steps with hypokinesia
-
Cause of Diplegic gait
Cerebral palsy (occasionally other congenital injuries)
-
What is Diplegic gait?
- Narrow-based gait
- Legs are dragged, and toes scrape on the floor
- Hip adductors are tight, causing legs to cross midline while walking
-
Cause of Steppage gait
Damage to posterior columns of the spinal cord
-
What is Steppage gait?
Weakness in dorsiflexion causes foot drop
-
Cause of waddling gait
Myopathies, especially Duchenne Muscular Dystrophy
-
Major brainstem divisions (3)
- 1. Midbrain
- 2. Pons
- 3. Medulla
-
Arteries in which obstruction affects brainstem (2)
-
Major structures in midbrain (2)
- 1. Oculomotor nerve (CN3)
- 2. Corticospinal tract
-
Symptoms of midbrain CVA (2)
- 1. Contralateral hemiparesis
- 2. Ipsilateral oculomotor nerve (CN3) paralysis
-
Ocular symptoms of pontine CVA (2)
- 1. Contralateral hemiparesis
- 2. Abducens Nerve (CN6) paralysis
-
Symptoms of lateral medullary CVA (4)
- 1. Paralysis of ipsilateral palate (causes dysarthria)
- 2. Ipsilateral facial numbness (pain and temperature)
- 3. Contralateral anesthesia of the body (pain and temperature)
- 4. Ipsilateral ataxia
-
Cranial nerve nuclei in the lateral medulla (5)
-
White matter tracts in lateral medulla (3)
- 1. Spinothalamic
- 2. Sympathetic
- 3. Inferior cerebellar
-
Intoxicants causing nystagmus (4)
- 1. Alcohol
- 2. Dilantin (Phenytoin)
- 3. PCP
- 4. Barbituates
-
Sensory changes with PCP intoxication
Reduced sensitivity to pain and cold
-
Site of lesion causing unilateral nystagmus
Medial longitudinal fasciculus
-
Artery system whose obstruction causes nystagmus
Vertebrobasilar Artery System
-
Disorders causing nystagmus (3)
- 1. Multiple Sclerosis
- 2. Wernicke-Korsakoff Syndrome
- 3. Viral labyrinthitis
-
What regions of the body have coordination controlled by the vermis? (3)
-
What part of the body has coordination controlled by a cerebellar hemisphere?
Ipsilateral limbs
-
Prognosis after unilateral cerebellar injury
Other hemisphere is expected to compensate almost entirely (can walk, can't dance)
-
Motor changes in cerebellar injury (2)
- 1. Hypotonia
- 2. Pendular reflexes (limb swings several times in each direction)
-
Sensations transmitted in contralateral spinal tracts (2)
-
Sensations transmitted in ipsilateral spinal tracts (2)
- 1. Positional sense
- 2. Stereognosis
-
Medications and intoxicants that affect the cerebellum (5)
- 1. Phenytoin
- 2. Lithium
- 3. Chemotherapy
- 4. Toluene
- 5. Organic mercury
-
Nutritional deprivations affecting cerebellum (2)
-
Cause of cerebellar damage in lung cancer
Antibodies to malignancy cross-react with cerebellar tissue
-
Most common hereditary ataxia
Friedreich Ataxia
-
What does the Pes Cavus deformity look like?
Foot deformity with high arch, elevated dorsum, and retraction of first metatarsal
-
What condition is Pes Cavus pathognomonic for?
Friedreich Ataxia
-
From which artery does the Posterior Inferior Cerebellar Artery arise?
Vertebral Artery
-
Symptoms of Horner Syndrome (3)
- 1. Ptosis
- 2. Miosis
- 3. Anhydrosis
-
Cause of Horner Syndrome
Damage to sympathetic fibers that innervate one side of the face
-
Symptom of lesion to Nucleus Ambiguus
Ipsilateral soft palate paresis (uvula deviates toward the contralateral side)
-
Does ataxia secondary to Vitamin E deficiency respond to treatment with Vitamin E?
Yes!
-
Major descending pathway of the spinal cord
Lateral Corticospinal Tract
-
Major ascending pathways of the spinal cord (4)
- 1. Posterior columns
- 2. Lateral Spinothalamic Tract
- 3. Anterior Spinothalamic Tract
- 4. Spinocerebellar Tract
-
What columns make up the Posterior Columns of the spinal cord? (2)
- 1. Fasciculi Cuneatus
- 2. Fasciculi Gracilis
-
What information do the Posterior Columns of the spinal cord carry?
Position and vibrational sensations
-
Where do the Posterior Columns of the spinal cord project to?
Thalamus
-
What information do the Lateral Spinothalamic Tracts of the spinal cord carry?
Temperature and pain
-
Where do the Lateral Spinothalamic Tracts of the spinal cord project to?
Thalamus
-
What information do the Anterior Spinothalamic Tracts of the spinal cord carry?
Light touch
-
Where do the Anterior Spinothalamic tracts of the spinal cord project to?
Thalamus
-
What information do the Spinocerebellar Tracts of the spinal cord carry?
Position and movement sensations
-
Where do the Spinocerebellar Tracts of the spinal cord project to?
Cerebellum
-
Spinal cord level at which injury will cause hypalgesia below the neck
C4
-
Spinal cord level at which injury will cause hypalgesia below the nipples
T4
-
Spinal cord level at which injury will cause hypalgesia below the umbilicus
T10
-
What is Brown-Séquard Syndrome?
Hemisection of the spinal cord
-
Symptoms of Brown-Séquard Syndrome (7)
- Corticospinal tract:
- 1. Ipsilateral paresis
- 2. Ipsilateral hyperactive deep tendon reflexes
- 3. Ipsilateral Babinski
- Posterior Column:
- 4. Ipsilateral loss of vibration sense
- 5. Ipsilateral loss of position sense
- Spinothalamic Tract:
- 6. Contralateral loss of pain sensation
- 7. Contralateral loss of temperature sensation
-
Syringomyelia
Elongated cavity, adjacent to the central canal of the spinal cord, that affects the spinal cord
-
Hematomyelia
Cavity within the spine filled with blood; caused by trauma
-
What is damaged by Syringomyelia? (2)
- 1. Lateral spinothalamic tract fibers are pulled apart where they cross the cord
- 2. Anterior horn cells are compressed
-
Symptoms of syringomyelia
- 1. Neck pain
- 2. Loss of pain sensation in arms and hands
- 3. Loss of temperature sensation in arms and hands
- 4. Loss of muscle bulk in arms and hands
- 5. Loss of deep tendon reflexes in arms and hands
-
Conditions that affect the posterior columns of the spinal cord (4)
- 1. Syphilis
- 2. B12 deficiency
- 3. Freidrich Ataxia
- 4. Spinocerebellar Ataxias
-
What causes Romberg Sign?
Loss of position sense due to damage to posterior columns of the spinal cord
-
Spinal columns affected by B12 deficiency (2)
- 1. Posterior columns (demyelinated)
- 2. Corticospinal tract (demyelinated)
-
Cause of asymmetric, irregular demyelination of the spinal cord
Multiple Sclerosis
-
Presentation of HTLV-1 Myelopathy
Spastic paresis, with spasticity disproportionately greater than paresis
-
How does nitrous oxide affect the spinal cord?
Inactivates B12, leading to deficiency and damage to posterior columns
-
Mineral deficiency causing myelopathy
Copper deficiency (often due to excess Zinc consumption)
-
Causes of myelopathy that later cause dementia (4)
- 1. Tabes dorsalis (syphilis)
- 2. B12 deficiency
- 3. AIDS
- 4. Multiple Sclerosis
-
Cranial Nerve 1
Olfactory
-
-
Cranial Nerve 3
Oculomotor
-
Cranial Nerve 4
Trochlear
-
Cranial Nerve 5
Trigeminal
-
-
-
Cranial Nerve 8
Vestibulocochlear (Acoustic)
-
Cranial Nerve 9
Glossopharyngeal
-
-
Cranial Nerve 11
Accessory (Spinal Accessory)
-
Cranial Nerve 12
Hypoglossal
-
Location of Cortical Olfactory Sensory Area
Frontal cortex
-
Sense that does not involve the thalamus
Smell
-
Cranial nerve involved in smelling irritating substances (eg ammonia)
Trigeminal
-
Foster-Kennedy Syndrome
- Meningioma compresses an olfactory nerve and the nearby optic nerve, causing unilateral blindness and anosmia
- The tumor can affect the frontal lobe, causing personality changes, dementia, or seizures
-
Common injuries causing anosmia (2)
- 1. Inhaled metals (welders, Zinc in cold remedies)
- 2. Head trauma (shears CN1 at the cribiform plate)
-
Neurodegenerative diseases causing anosmia (5)
- 1. Parkinson Disease
- 2. Dementia with Lewy Bodies
- 3. Wilson Disease
- 4. Creutzfeldt-Jakob Disease
- 5. Alzheimer Disease
-
Sites in the brain where optic nerves project to (2)
- 1. Cortex (visual information)
- 2. Midbrain (light intensity information)
-
Efferent limb of the pupillary light reflex
Oculomotor nerve (CN3)
-
Nerve fibers originating from the Edinger-Westphal Nuclei
Parasympathetic fibers that join CN3
-
Brain region where pupillary light reflex is located
Brainstem
-
Site at which visual fibers from the optic nerve synapse
Lateral Geniculate Body
-
Site at which Optic Nerve fibers controlling the pupillary light reflex synapse
Pretectal Area
-
Where does the Pretectal Area project to?
Both ipselateral and contralateral Edinger-Westphal Nuclei
-
Where do parasympathetic fibers of the Oculomotor Nerve project to?
Ciliary ganglion (which projects to the iris sphincter muscle)
-
What is an Adie Pupil? What causes it?
- Dilated; responds slowly to light but accommodates more quickly
- Caused by damage to a ciliary ganglion
-
What is the only nerve myelinated by oligodendrocytes rather than Schwann cells?
Optic nerve
-
Cranial nerve whose damage causes ptosis
Oculomotor (CN3)
-
Cranial nerve that adducts and elevates the eye
Oculomotor (CN3)
-
Symptoms of oculomotor nerve impairment (3)
- 1. Dilated pupil
- 2. Ptosis
- 3. Abduction of the eye
-
What is accommodation of the eye?
Ability to focus on near or distant objects
-
What part of the brain does CN3 originate in?
Dorsal Midbrain
-
What part of the brain does CN4 originate in?
Midbrain
-
Eye movement controlled by the trochlear nerve
Depression of the eye while turned inward
-
Midbrain structures through which CN3 fibers pass before forming the peripheral nerve (2)
- 1. Red nucleus
- 2. Cerebral penduncle
-
What part of the brain does CN6 originate in?
Pons
-
Eye movement controlled by the abducens nerve
Abduction
-
Most common cause of lesion to an ocular nerve
Occlusion of a small branch of basilar artery causing small brainstem infarction
-
Illness causing amnesia, nystagmus, and impairment of CN3 or CN6
Wernicke Encephalopathy
-
Illness causing coma, decerebrate posturing, and a dilated pupil
Transtentorial herniation (cerebral mass lesion pushes the anterior tip of the temporal lobe through the tentorial notch)
-
Symptoms of infarct affecting a cerebral peduncle in the midbrain (4)
- 1. Ipsilateral ptosis
- 2. Ipsilateral dilated pupil
- 3. Diplopia
- 4. Contralateral hemiparesis
-
Symptoms of infarct affecting a red nucleus
- 1. Ipsilateral ptosis
- 2. Ipsilateral dilated pupil
- 3. Diplopia
- 4. Ipsilateral ataxia
-
Role of the Red Nucleus
- Receives outflow from the contralateral cerebellum
- Innervates contralateral arm and leg
- ("Double-cross" so that the cerebellum innervates its ipsilateral arm and leg)
-
Symptoms of unilateral pontine infarct (2)
- 1. Ipsilateral abducens nerve paresis (can't abduct one eye)
- 2. Contralateral hemiparesis (affects corticospinal tract)
-
What is the Medial Longitudinal Fasciculus?
- Heavily-myelinated tract between the pons and the midbrain
- Connects nuclei of CN3 (oculomotor) and CN6 (abducens) to mediate conjugate gaze
-
Anatomical cause of internuclear ophtalmoplegia
Damage to the Medial Longitudinal Fasciculus
-
Symptoms of Internuclear Ophthalmoplegia
- Abducting eye has nystagmus
- Adducting eye does not cross the midline
-
What condition is interocular ophthalmoplegia characteristic of?
Multiple Sclerosis
-
Most frequent lesion of oculomotor nerve
Diabetic Infarction
-
Symptoms of Diabetic Infarction (3)
- 1. Sharp headache
- 2. Ipsilateral ptosis
- 3. Ipsilateral ocular abduction
- (pupils equal, both reactive to light)
-
Artery whose aneurysm may compress the Oculomotor Nerve
Posterior Communicating Artery
-
What is Ambylopia?
Blindness of the deviated eye in strabismus
-
Where is the motor nucleus of the Trigeminal Nerve (CN5)?
Pons
-
Path the of sensory fibers that form the Trigeminal Nerve
- Originate in midbrain
- Travel through medulla before forming the nerve
-
Which cranial nerves pass though the cerebellopontine angle? (3)
- CN5 (trigeminal)
- CN7 (facial)
- CN8 (vestibulocochlear)
-
Distribution of Trigeminal Nerve branch V1
- Forehead
- Cornea
- Scalp up to the vertex
-
Distribution of Trigeminal Nerve branch V2
Malar area
-
Distribution of Trigeminal Nerve branch V3
Lower jaw, except for the angle
-
What is the path of innervation that carries the corneal reflex?
- Ipsilateral Trigeminal Nerve (CN5), branch V1, to pons (one cornea is touched)
- Pons to bilateral Facial Nerves (CN7) (both eyes blink)
-
Cranial nerve acting as the motor limb of the jaw jerk reflex
Trigeminal nerve
-
Generally, which muscles are innervated by the trigeminal nerve?
Muscles of mastication
-
Generally, which muscles are innervated by the facial nerve?
Muscles of facial expression
-
Which cerebral hemisphere innervates muscles of facial expression from the eyes up?
Both!
-
Which cerebral hemisphere innervates muscles of facial expression from the eyes down?
Contralateral hemisphere
-
What cranial nerve carries taste information from the anterior two-thirds of the tongue?
Facial Nerve (CN7)
-
What cranial nerve carries taste information from the anterior two-thirds of the tongue?
Glossopharyngeal (CN9)
-
What cranial nerve carries information to the frontal lobe and limbic system while tasting food?
Olfactory! (not facial or glossopharyngeal)
-
Where is a lesion unilaterally affecting both upper and lower facial muscles?
Ipsilateral facial nerve (CN7)
-
Where is a lesion unilaterally affecting only lower facial muscles?
Contralateral motor cortex
-
Nerve affected in Bell's Palsy
Facial Nerve (CN7)
-
What is Dysgeusia?
Impairment of taste sensation
-
Medications that can reduce or distort taste sensation (3)
- 1. TCAs
- 2. Acetazolamide
- 3. Levodopa
-
Symptom found along with reduced taste sensation that is indicative of damage from radiotherapy
Hyposalivation
-
Divisions of the Acoustic Nerve (CN8) (2)
- 1. Cochlear Nerve (carries hearing information)
- 2. Vestibular Nerve (carries balance information)
-
Path of Cochlear Nerve fibers of CN8
- Originate at middle and inner ear
- Terminate at bilateral Superior Temporal Gyri of cerebral hemispheres
-
Type of hearing loss associated with Presbycusis
- Initially high frequencies, difficulty distinguishing between consonants, and impaired speech discrimination
- Later progresses to involve all frequencies
-
Cause of presbycusis
Age-related degradation of the cochlea, not of the CNS or CN8
-
Main brain region innervated by the cochlear division of the acoustic nerve
Pons
-
Symptoms of Meniere Disease (4)
- 1. Vertigo
- 2. Nystagmus
- 3. Unilateral tinnitus
- 4. Progressive hearing loss
-
Brain region where Cranial Nerves 9 and 12 arise
Medulla
-
Symptoms of Bulbar Palsy (4)
- 1. Dysarthria
- 2. Dysphagia
- 3. Hypoactive jaw reflex
- 4. Hypoactive gag reflex
-
Which cranial nerves are the "Bulbar Nerves"?
9th (Glossal), 10th (Vagal), and 11th (Accessory)
-
How does Bulbar Palsy affect communication?
- Speech is thick and nasal or absent altogether
- Able to comprehend
- Able to write
-
Effects of Bulbar Palsy on eating
- Food can lodge in the trachea or the nasopharyngeal cavity
- Liquids regurgitate through the nose
-
Effect of bulbar damage on respiration
Can injure the medullary respiratory center, requiring mechanical ventilation
-
Common causes of bulbar palsy due to damage within the brainstem (3)
- 1. ALS
- 2. Polio
- 3. Lateral medullary infarct
-
Common causes of bulbar palsy due to damage of nerves after they emerge from the brainstem (3)
- 1. Guillain-Barré
- 2. Chronic meningitis
- 3. Tumors along the base of the skull or in the meninges
-
What is Pseudobulbar Palsy?
Damage to the frontal lobe (rather than brianstem in Bulbar Palsy) causes dysarthria and dysphagia
-
On neuro exam, how to distinguish Bulbar Palsy from Pseudobulbar Palsy?
- 1. Jaw jerk and gag reflexes are diminished in Bulbar Palsy, but hyperactive in Pseudobulbar Palsy
- 2. Pseudobulbar Palsy affects the corticobulbar tract (impaired facial expressions)
- 3. Pseudobulbar Palsy affects the corticospinal tract (upper motor neuron signs)
-
Effect of Pseudobulbar Palsy on Mental Status Exam
Emotional lability with tearfulness and laughter without underlying mood change
-
Treatments for "Pseudobulbar Affect" (3)
- 1. Amitriptyline
- 2. SSRIs
- 3. Dextromethorphan with quinidine
-
Brain region whose lesion causes superior homonymous quadrantanopsia
Temporal lobe
-
Conditions causing dementia and posterior column sensory loss (4)
- 1. B12 deficiency
- 2. Tertiary syphilis
- 3. Spinocerebellar ataxias
- 4. Heavy metal intoxication
-
Foster-Kennedy Syndrome
- Frontal lobe tumor compresses CN1 and CN2 and increased intracranial pressure
- Ipsilateral optic atrophy and anosmia
- Contralateral papilledema
-
Cause of Horner's Syndrome
Damage to the sympathetic trunk of the spinal cord, which ascends to the neck and face
-
"Foundation" of the extrapyramidal motor system
Basal Ganglia
-
Frontal release signs (7)
- 1. Snout
- 2. Suck
- 3. Rooting
- 4. Jaw Jerk
- 5. Palmomental
- 6. Grasp
- 7. Meyerson sign
-
What is dysmetria?
- Irregularity in movement or eye trajectory while performing rapid movements
- Causes overshooting or undershooting the target
-
At what level of the brain is the Sylvian Aqueduct?
Midbrain
-
In what brain region are cerebellar peduncles located?
Medulla
-
Gait typical of hydrocephalus
Apraxic
-
Gait typical of cerebellar dysfunction
Ataxic
-
How high in the body/spinal cord does fasciculus cuneatus originate?
At the level of arms and upper trunk
-
How high in the body/spinal cord does fasciculus gracilis originate?
Lower limbs
-
Nerve whose injury causes foot drop
Fibular (previously called peroneal)
-
Which side is more often affected in psychogenic hemiparesis?
Left
-
Is pupillary constriction mediated by sympathetic or parasympathetic innervation?
Parasympathetic
-
Is pupillary dilation mediated by sympathetic or parasympathetic innervation?
Sympathetic
-
Location of motor cell bodies in the peripheral nervous system
Anterior Horn
-
What is Dysesthesia?
Painful sensations due to neuropathy
-
What is Allodynia?
Exaggerated painful response to a mildly noxious stimulus
-
What is Hyperpathia?
Delayed, then exaggerated and prolonged pain from a noxious stimulus
-
Cause of Saturday Night Palsy
- Compression of the radial nerve at the spiral groove in the axilla
- Often occurs due to armpit compression when the arm is draped over a chair or when crutches are used
-
Nerve affected by prolonged leg-crossing, causing foot drop
Common Fibular
-
Nerve whose injury causes paresis of thumb abduction
Median Nerve
-
Nerve whose injury causes sensory loss in the thumb, 2nd finger, 3rd finger, and lateral 4th finger
Median Nerve
-
Nerve whose injury causes paresis of finger and thumb abduction
Ulnar Nerve
-
Nerve whose injury causes sensory loss in the 5th finger and medial half of 4th finger
Ulnar Nerve
-
Nerve whose injury causes paresis of wrist, thumb, and finger extensors
Radial Nerve
-
Nerve whose injury causes sensory loss in the dorsal hand
Radial Nerve
-
Nerve whose injury causes loss of the brachioradialis DTR
Radial Nerve
-
Nerve whose injury causes paresis of knee extensors
Femoral Nerve
-
Nerve whose injury causes sensory loss in anterior thigh and medial calf
Femoral Nerve
-
Nerve whose injury causes paresis of ankle dorsiflexors and plantarflexors
Sciatic Nerve
-
Nerve whose injury causes loss of ankle jerk DTR
Sciatic Nerve
-
Nerve whose injury causes sensory loss to the buttock, lateral calf, and most of the foot
Sciatic Nerve
-
Nerve whose injury causes paresis of ankle dorsiflexion and eversion
Fibular Nerve
-
Nerve whose injury causes sensory loss of the dorsum of the foot and the lateral calf
Fibular Nerve
-
Consequences of chronic Carpal Tunnel Syndrome (2)
- 1. Atrophy of thenar muscles
- 2. Impaired fine movements of the first 3 fingers
-
Systemic illnesses that commonly cause neuropathy (3)
- 1. Diabetes
- 2. Vaculitis
- 3. Lead intoxication
-
What is Mononeuritis Multiplex?
- Simultaneous or stepwise development of peripheral nerve injuries, often including cranial nerves
- Usually due to systemic illness
-
Endogenous toxic causes of Neuropathy (3)
- 1. Acute intermittent variegate porphyria (causes mental status change)
- 2. Diabetes
- 3. Uremia (causes mental status change)
-
Causes of Nutritional Deficiencies that lead to Neuropathy (5)
- 1. Celiac Disease
- 2. Combined System Disease (causes mental status change)
- 3. Alcoholism (causes mental status change)
- 4. Malabsorption
- 5. Starvation
-
Vitamin causing Neuropathy if taken in excess
Vitamin B6
-
Medications causing Neuropathy (6)
- 1. Antibiotics
- 2. HAART medications
- 3. Dapsone
- 4. Isoniazid (causes mental status change)
- 5. Nitrofurantoin
- 6. Antineoplastic agents
-
Industrial/chemical toxins causing Neuropathy (9)
- 1. Ciguatera fish poisoning (causes mental status change)
- 2. Arsenic
- 3. Lead
- 4. Mercury (causes mental status change)
- 6. Thallium
- 7. Nitrous Oxide (causes mental status change)
- 8. N-hexane
- 9. Toluene (causes mental status change)
-
Infections causing Neuropathy (6)
- 1. Mononucleosis
- 2. Hepatitis
- 3. Lyme Disease (causes mental status change)
- 4. Leprosy
- 5. Syphilis (causes mental status change)
- 6. AIDS (causes mental status change)
-
Vasculidities causing neuropathy (2)
- 1. Lupus
- 2. Polyarteritis (causes mental status change)
-
Genetic illnesses causing Neuropathy (3)
- 1. Adrenoleukodystrophy (causes mental status change)
- 2. Metachromatic leukodystrophy (causes mental status change)
- 3. Spinocerebellar ataxias
-
Illnesses causing Guillain-Barré (7)
- 1. C. Jejuni
- 2. HIV
- 3. Lyme
- 4. Mononucleosis
- 5. Hepatitis
- 6. CMV
- 7. West Nile Virus
-
Progression of deficits in Guillain-Barré
- Initially, paresthesias/numbness in fingers and toes
- Next, flaccid paresis of lower limbs
- Ascend to affect upper limbs
- May progress to respiratory insufficiency
- Rarely, progress to involve cranial nerves (first bulbar, then facial, eventually ocular paresis)
- Mental status is never affected!
-
CSF findings in Guillain-Barré
- Elevated proteins
- Few WBCs
-
Duration of illness in Guillain-Barré
Resolves completely in 3 months as PNS myelin is regenerated
-
Treatment for Guillain-Barré (2)
- 1. Plasmapheresis
- 2. IVIG
- Not steroids!
-
Functions generally preserved in peripheral neuropathies (except diabetic neuropathy) (3)
- 1. Bladder
- 2. Bowel
- 3. Sexual
-
Illness in which CNS demyelination is not always permanent
Multiple Sclerosis (occurs because oligodendrocytes are inflamed, not killed, during most flares)
-
Effects of diabetic neuropathy
- "Stocking-glove" sensory loss
- Loss of ankle jerk and eventually knee jerk reflexes
- Minimal motor loss
-
Mechanism of dementia in Diabetes Mellitus
Causes damage to vessels, potentially leading to infarcts and multi-infarct dementia
-
Effects of lead poisoning on adults
- Mononeuropathy or polyneuropathy (bilateral wrist or foot drop is common)
- GI distress
- Not cerebral effects!
-
Dermatologic appearance of Arsenic ingestion (3)
- 1. White bands across fingernails (Mees Lines)
- 2. Hyperpigmentation
- 3. Hyperkeratosis
-
Intoxicant causing polyneuropathy, dermatologic abnormality, and mental status changes if exposed chronically
Arsenic
-
Intoxicant causing neuropathy, cognitive impairment, ataxia, dysarthria, and visual field changes if exposed chronically
Mercury
-
Skin sign of chronic mercury exposure
Dark blue or black line along the gums
-
Poison causing painful neuropathy and hair loss
Thallium
-
Vitamin whose deficiency causes night blindness
Vitamin A
-
Vitamin whose deficiency causes Wernicke-Korsakoff Syndrome
B1 (Thiamine)
-
Vitamin whose deficiency causes Beriberi
B2 (Riboflavin)
-
Vitamin whose deficiency causes Pellagra
B3 (Niacin)
-
Vitamin whose deficiency causes Seizures and Psychosis
B6 (Pyroxidine)
-
Vitamin whose deficiency causes neural tube defects
B9 (Folic acid)
-
Vitamin whose deficiency causes Combined System Disease
B12
-
Vitamin whose deficiency causes Ataxia/Neuropathy
E
-
Vitamin whose excess causes Pseudotumor Cerebri
A
-
Vitamin whose excess causes Neuropathy
B6 (pyroxidine)
-
Mineral whose deficiency causes neuropathy
Copper
-
Symptoms of thiamine deficiency (2)
- 1. Absent DTRs
- 2. Loss of position sensation
-
Symptoms of Wernicke-Korsakoff Syndrome (4)
- 1. Amnesia
- 2. Dementia
- 3. Cerebellar degeneration
- 4. Peripheral neuropathy
-
Symptoms of B3/Niacin Deficiency (Pellagra) (3)
- 1. Dementia
- 2. Dermatitis
- 3. Diarrhea
-
What is the mechanism of neurological damage caused by B12 deficiency?
Demyelination of CNS and PNS neurons
-
Neurological symptoms of Combined System Disease (3)
- 1. Polyneuropathy
- 2. Cognitive impairment
- 3. Sensory loss
-
Spinal cord columns most affected by B12 deficiency
Posteroir columns
-
Vitamin deficiency produced by chronic nitrous oxide exposure
B12 deficiency (NO inactivates B12)
-
Neurologic effects of leprosy (4)
- 1. Hypopigmented skin patches are anesthetic
- 2. Anesthesia of fingers and toes
- 3. Palpable nerves
- 4. May affect large nerves, either individually or in groups
-
PNS effects of Lyme Disease (2)
- 1. Facial nerve paresis (unilateral or bilateral)
- 2. Paresthesias (ranging from mild to full unilateral paralysis)
-
CNS effects of Lyme Disease (3)
- 1. Headache
- 2. Delirium
- 3. Signs of meningitis/encephalitis
-
CSF findings in Lyme Disease (4)
- 1. Pleocytosis
- 2. Elevated protein
- 3. Low glucose
- 4. Lyme antibodies
-
Most common infection affecting both PNS and CNS
AIDS
-
Symptoms of AIDS-Associated Peripheral Nerve Disorder (3)
- 1. Distal, symmetrical dysesthesias
- 2. Numbness of soles of the feet
- 3. Mild ankle and foot weakness (loss of ankle jerk)
-
Symptoms of an attack of Acute Intermittent Porphyria (3)
- 1. Quadriparesis
- 2. Abdominal pain
- 3. Psychiatric symptoms in 25-50%
-
Tests to diagnose an attack of Acute Intermittent Porphyria (2)
- 1. Urine prophobilinogen
- 2. Urine or serum 5-aminolevulinic acid
-
Effect of Metachromatic Leukodystrophy on the nervous system
Demyelination in both CNS and PNS, worse in CNS
-
Pathology findings in Metachromatic Leukodystrophy (2)
- 1. Colored granules in lysosomes of nervous system, gallbladder, pancreas, and liver
- 2. Demyelination on nerve biopsy
-
Cognitive effects of Metachromatic Leukodystrophy (4)
- 1. Personality and behavioral changes (similar to frontal dementia)
- 2. Thought disorders
- 3. Mood disorders
- 4. Cognitive impairment that progresses to dementia
-
MRI findings in Metachromatic Leukodystrophy
Demyelinated lesions
-
Symptoms of Solvent-Induced Encephalopathy (7)
- 1. Personality changes
- 2. Inattention
- 3. Depression
- 4. Headaches
- 5. Fatigue
- 6. Psychosis
- 7. Cognitive impairment
-
Solvent predominantly damaging PNS
n-hexane (in glue)
-
Solvents predominantly damaging CNS (2)
- 1. Toluene (spraypaint, markers) (causes demyelination)
- 2. Nitrous oxide
-
Features of Toluene-induced dementia (2)
- 1. Gait is impaired
- 2. Language is perserved
-
Regions of the world where fish are more likely to be contaminated with Ciguatera Toxin (2)
- 1. Caribbean
- 2. Indian Ocean islands
-
Symptoms of Ciguatera Toxin ingestion
- Initially, nausea/vomiting
- Later, paresthesias, pain, and loss of sensation in all limbs
-
What is Cold Allodynia? What causes it?
- Perception of cold objects as hot
- Unique to Ciguatera Toxin ingestion
-
Cause of fasciculations in ALS
Loss of anterior horn cells
-
Spread of weakness, atrophy, and fasciculations in ALS
- Start in one limb, then spread asymmetrically to other limbs
- Eventually, affect face, pharynx, and tongue
-
Muscle functions not affected in ALS
- 1. Bladder control
- 2. Bowel control
- 3. Extraocular movements
-
Cognitive effects of ALS
- In 90%, none!
- In 10%, frontotemporal dementia
-
Medication given for ALS
Riluzole
-
Symptoms of Spinal Muscular Atrophy
- 1. Flaccid quadriparesis
- 2. Muscle atrophy
- 3. Areflexia
- 4. Fasciculations
-
What is Werdnig-Hoffman Disease?
Type of Spinal Muscular Atrophy that presents in infants
-
What is Kugelberg-Welander Disease?
Type of Spinal Muscular Atrophy that presents in children
-
Type of cells in the nervous system infected by polio, and where they are
- Anterior horn cells
- In spinal cord and lower brainstem
-
Neurologic symptoms of polio (5)
- 1. Asymmetric paresis
- 2. Absent DTRs
- 3. Fasciculations
- If bulbar variety:
- 4. Throat muscle paralysis
- 5. Chest muscle paralysis
-
What are Benign Fasciculations?
Fasciculations without weakness, atrophy, or pathologic reflexes. Usually last days to weeks
-
What is Spondylosis?
Bony encroachment causes stenosis of vertebral foramina and, if high enough, of the spinal canal
-
Symptoms of Cervical Spondylosis compressing nerve roots (5)
- 1. Neck pain
- 2. Arm/hand paresis
- 3. Atrophy
- 4. Hypoactive DTRs
- 5. Fasciculations
-
Symptoms of Cervical Spondylosis compressing spinal canal (4)
- 1. Leg weakness
- 2. Spasticity
- 3. Hyperreflexia
- 4. Babinski
-
Symptoms of Lumbar Spondylosis (6)
- 1. Low back pain
- 2. Sciatica
- 3. Fasciculations of legs and feet
- 4. Paresis of legs/feet
- 5. Atrophy of lower limb muscles
- 6. Knee/ankle areflexia
-
What is Neurogenic Claudication?
Pain/weakness of legs only with walking
-
How to distinguish ALS from spondylosis?
- ALS affects facial, pharyngeal, and tongue muscles
- Spondylosis causes neck or back pain and sensory loss
-
Symptoms of disc herniation
- Abrupt onset of pain radiating down a nerve's distribution
- May have sensory loss or weakness, but may not
-
Most common sites of lumbosacral disc herniation (2)
-
Symptoms of Cauda Equina Syndrome (4)
- 1. Flaccid paresis of one or both legs
- 2. Perineal pain/anesthesia
- 3. Incontinence
- 4. Sexual dysfunction
-
What condition does the Watson-Schwartz Test diagnose?
Acute Intermittent Porphyria
-
What medication class should be given to prevent psychosis in Acute Intermittent Porphyria?
Phenothiazines
-
Medications that can precipitate an attack in Acute Intermittent Porphyria (2)
- 1. Barbiturates
- 2. Phenytoin
-
Functions spared by Guillain-Barré (2)
- 1. Extraocular movements
- 2. Pupil function
-
Nerve root responsible for ankle jerk reflex
L5-S1
-
Common cause of Pseudobulbar Palsy
Multiple Sclerosis
-
Condition causing urine to turn dark red when exposed to sunlight
Acute Intermittent Porphyria
-
Mechanism of Myesthenia Gravis
Antibodies attack ACh receptors
-
What is Pyridostigmine? What is it used to treat?
- Cholinesterase inhibitor
- Used to treat Myesthenia Gravis
-
What is Neostigmine? What is it used to treat?
- Cholinesterase inhibitor, given IV or IM
- Used to treat Mysethenia Gravis (when severe)
-
Treatments for Myesthenia Gravis (5)
- 1. Cholinesterase inhibitors (-stigmine)
- 2. Steroids
- 3. Plasmapheresis
- 4. IVIG
- 5. Immunosuppressants
-
Mechanism of Botulinum Toxin
Blocks release of ACh at synapses
-
Mechanism of succinylcholine
Binds ACh receptors, inactivating them
-
What is Physostigmine? What is it used to treat?
- Cholinesterase inhibitor (the only one that crosses the blood brain barrier)
- Treats Alzheimer Disease or Anticholinergic Syndrome
-
Muscles most typically affected in Myesthenia Gravis (3)
- 1. Oculomotor muscles
- 2. Facial muscles
- 3. Bulbar muscles
-
Patients typically affected by Myesthenia Gravis
-
Symptoms of myesthenia gravis that has caused facial and neck muscle weakness
- Nasal tone to voice
- Grimace instead of smiling
- Difficulty chewing
- Difficulty whistling
-
Progression of Myesthenia Gravis (5)
- 1. Ptosis
- 2. Neck/facial muscles
- 3. Muscles of the trunk (neck, shoulder, swallowing, and respiratory; bulbar palsy)
- 4. Respiratory distress, quadriplegia, inability to speak (severe cases)
- 5. "Locked in" state (very severe cases)
-
Types of eye muscles affected by Myesthenia Gravis
- Extraocular only!
- Intraocular are not affected!
-
Does myesthenia gravis affect bladder and bowel function?
No!
-
Conditions often causing exacerbations of myesthenia gravis
- 1. Illness, (classically pneumonia)
- 2. Psychologic stress
- 3. Pregnancy
-
Effects of pregnancy on myesthenia gravis
- 40% have an exacerbation
- 30% enjoy remission
-
Pattern of Paresis in Muscle Disorders
Proximal
-
Muscle tone in muscle disorders
Normal tone, but muscles are tender
-
Deep tendon reflexes in muscle disorders
Normal or hypoactive
-
Site of damage from Black Widow Spider venom
Neuromuscular Junction
-
What is the Tensilon (edrophonium) test?
- Used to test for myesthenia gravis
- Give IV cholinesterase inhibitor (edrophonium)
- If symptoms improve, test is positive
-
Mechanism of Lambert-Eaton Syndrome
Antibodies attack calcium channels, blocking release of ACh from presynaptic neurons
-
Underlying illnesses that can cause Lambert-Eaton Syndrome (2)
- 1. Small cell carcinoma of the lung (or other cancers)
- 2. Rheumatologic illness
-
Progression of Lambert-Eaton Syndrome
Starts with weakness of limbs, then affects the trunk later
-
Cause of weakness that improves with repeated attempts to move
Lambert-Eaton Syndrome (repeatedly attempting to move provokes more ACh release)
-
Neuromuscular junction condition causing both weakness and autonomic dysfunction
Lambert-Eaton Syndrome
-
Initial muscle group paralyses in botulism ingestion (3)
- 1. Ocular (including dilated pupils)
- 2. Bulbar
- 3. Respiratory
-
First symptoms of botulism ingestion
Nausea, vomiting, diarrhea and fever
-
When do paralytic symptoms occur after ingesting botulinum toxin?
18-36 hours later
-
Mechanism of tetanus toxin
Blocks presynaptic release of GABA and glycine, reducing inhibition of motor neurons
-
Mechanism of Strychnine poisoning
Antagonizes GABA and glycine receptors, reducing inhibition of motor neurons
-
Clinical difference between strychnine poisoning and tetanus
Trismus occurs in tetanus, but not in strychnine poisoning
-
Mechanism of organophosphate poisoning
Bind and inactivate Acytylcholinesterase (AChE), causing muscle contractions and fasciculations, and eventual paralysis of the diaphragm
-
Mechanism of nerve gas
Bind and inactivate Acytylcholinesterase (AChE)
-
Symptoms of Cholinergic Chrisis (very high ACh) (7)
- 1. "Outpouring of fluids" (tearing, pulmonary secretions, diarrhea)
- 2. Miosis
- 3. Convulsions (or seizures)
- 4. Altered mental status (ranging from delirium to unconsciousness)
- 5. Respiratory depression
- 6. Bradycardia
- 7. Hypotension
-
Treatment of Cholinergic Crisis (4)
- 1. Pyridostigmine (reversible AChE inhibitor that competes with the toxin, which is an irreversible inhibitor)
- 2. Atropine
- 3. Oximes (reactivate AChE)
- 4. Benzodiazepine if concern for seizures
-
Pattern of symptoms in myopathy
Affect large, proximal muscles first, most severely, and often exclusively
-
Inheritance of Duchenne Muscular Dystrophy
- X-linked
- 30% are de novo mutations
-
First sites affected in Duchenne Muscular Dystrophy
- Thighs (difficulty standing)
- Shoulders
-
Appearance of muscles in Duchenne Muscular Dystrophy
Increase in size, as they are infiltrated by fat and connective tissue (pseudohypertrophy)
-
Treatment for Duchenne Muscular Dystrophy
Steroids (delay progression)
-
Protein absent or damaged in Duchenne Muscular Dystrophy
Dystrophin
-
What is Becker Dystrophy?
- Variant of Duchenne Muscular Dystrophy
- Dystrophin retains some function
- Weakness begins in 2nd decade and progresses slowly
-
Most common myopathy in adults
Myotonic Dystrophy
-
Characteristics of patients when Myotonic Dystrophy first occurs
- Age 20-25
- No sex preference
-
Symptoms of Myotonic Dystrophy
- Facial and distal limb muscle weakness/atrophy
- Involuntary prolonged muscle contraction
-
Facial appearance in Myotonic Dystrophy
- Sunken, elongated face (facial and temporal muscle wasting)
- Ptosis
- Prominent forehead
- Frontal balding
-
Nonneurologic symtpoms in Myotonic Dystrophy (3)
- 1. Cataracts
- 2. Heart conduction abnormalities
- 3. Endocrine organ failure (infertility, diabetes)
-
Medications given for myotonia in Myotonic Dystrophy (2)
-
Cognitive effects of Myotonic Dystrophy
- Nearly always present, and worsens with age
- Lack of initiative
- Progressively bland personality
-
Disorder caused by trinucleotide repeat with sex-linked inheritance
Fragile X Syndrome
-
Disorder caused by trinucleotide repeat with recessive inheritance
Friedreich Ataxia
-
Disorders caused by trinucleotide repeat with dominant inheritance pattern (3)
- 1. Sponocerebellar atrophy
- 2. Huntington Disease
- 3. Myotonic Dystrophy
-
Difference in inheriting trinucleotide repeats from a father vs mother
Sperm are more likely than eggs to increase the number of trinucleotide repeats that they carry
-
What is polymyositis?
- Inflammatory myopathy
- Causes weakness, myalgia, and fever
-
What is dermatomyositis?
Symptoms of inflammatory myopathy accompanied by a rash
-
Where is the rash of dermatomyositis?
Typically on face and extensor surfaces the elbows and knees
-
Typical cause of polymyositis in children
Viral illness
-
Typical cause of polymyositis in adults
Inflammatory diseases (eg polymyalgia rheumatica)
-
What causes Eosinophilia-Myalgia Syndrome?
Ingestion of large amounts of tryptophan
-
Symptoms of Eosinophilia-Myalgia Syndrome (5)
- 1. Several days of myalgia
- 2. Fatigue
- 3. Rash
- 4. Neuropathy
- 5. Cardiopulmonary issues
-
Symptoms of AIDS Myopathy (4)
- 1. Myalgia
- 2. Weakness
- 3. Fatigue
- 4. Weight loss
-
Presentation of steroid myopathy
- Proximal weakness and wasting
- Cushingoid symptoms
-
Electrolyte that, when low, can cause myopathy
Potassium (hypokalemic myopathy)
-
Symptoms of hypokalemia (2)
- 1. Confusion/agitation/stupor
- 2. Seizures
-
Presentation of Hypokalemic Periodic Paralysis
- Areflexic quadriparesis occurring for several hours to 2 days
- Remain alert, cognizant, and able to breathe normally
- Extraocular movements are preserved
-
Preciptating factors for episodes of Hypokalemic Periodic Paralysis (3)
- 1. Exercise
- 2. Sleep
- 3. Large carbohydrate meals
-
Inheritance pattern of Hypokalemic Periodic Paralysis
Autosomal dominant
-
Mechanism of cyanide
Irreversibly inactivates mitochondrial respiratory enzymes
-
Underlying cause of a Primary Mitochondrial Myopathy
Deficiencies in mitochondrial enzymes in muscle
-
Symptoms of Primary Mitochondrial Myopathy (5)
- 1. Weakness/exercise intolerance
- 2. Short stature
- 3. Seizures
- 4. Deafness
- 5. Episodic lactic acidosis
-
Presentation of Progressive Ophthalmoplegia (5)
- 1. Ptosis and extraocular muscle palsises
- 2. Retinitis pigmentosa
- 3. Short stature
- 4. Cardiomyopathy
- 5. Endocrine anomalies
-
Presentation of Leber Optic Atrophy
Hereditary optic atrophy in young men
-
Presentation of mitochondrial encephalopathies
- Intermittent or progressive mental status abnormalities (dementia or delirium)
- First occur between infancy and 12 years of age
-
Other than mental status changes, symptoms of mitochondrial encephalopathies (4)
- 1. Paresis of extraocular muscles
- 2. Psychomotor retardation
- 3. Migraines
- 4. Optic atrophy
-
What are "ragged red fibers" on muscle biopsy?
Accumulations of diseased mitochondria
-
Treatments for mitochondrial disorders (2)
- 1. Coenzyme Q10
- 2. Bone marrow transplant
-
Elements of Neuroleptic Malignant Syndrome (3)
- 1. Delirium
- 2. Extrapyramidal signs
- 3. Autonomic hyperactivity
-
Common Extrapyramidal signs in Neuroleptic Malignant Syndrome
- Rigidity
- Tremors
- Dystonic posturing
-
Prominent autonomic symptoms in Neuroleptic Malignant Syndrome
-
Consequence of muscle rigidity in Neuroleptic Malignant Syndrome
Muscles flex so strongly that rhabdomyolysis occurs, leading to kidney failure
-
Consequence of high fever in Neuroleptic Malignant Syndrome
Damage to cerebral cortex
-
Cause of Neuroleptic Malignant Syndrome at the cellular level
- Sudden drop in effects of dopamine
- Either by blocking dopamine receptors, depleting dopamine, or stopping dopamine supplementation abruptly
-
Medications used to treat Neuroleptic Malignant Syndrome (4)
- 1. Bromocriptine
- 2. Apomorphine
- 3. Amantadine
- 4. L-Dopa
-
Muscular presentation of Serotonin Syndrome
Myoclonus and tremulousness
-
Drugs of abuse that contribute to Serotonin Syndrome (3)
- 1. Ecstasy
- 2. Amphetamines
- 3. Cocaine
-
MAOIs most often associated with Serotonin Syndrome when an SSRI is added (2)
-
Migraine medication class associated with Serotonin Syndrome
Triptans
-
Medication to reduce CNS serotonin in Serotonin Syndrome
Cyproheptadine
-
Underlying cause of Malignant Hyperthermia
Excessive calcium release
-
What types of medications cause Malignant Hyperthermia?
Anesthetics (inhaled, as well as succinylcholine)
-
Medication used to treat Malignant Hyperthermia
Dantrolene
-
Medications whose overdose is often mistaken for Neuroleptic Malignant Syndrome (2)
- 1. Phencyclidine
- 2. Anticholinergics
-
Appearance of myelin damage on Nerve Conduction Studies
Reduced conduction velocity
-
Appearance of axon damage on Nerve Conduction Studies
Reduced amplitude
-
EMG changes in neuropathy
Muscles are noted to have deteriorated
-
Myocyte enzymes found in serum with muscle damage (4)
- 1. Lactic dehydrogenase
- 2. Aspartate aminotransferase
- 3. Aldolase
- 4. Creatine Kinase
-
Myopathy that causes the highest increase in CK
Neuroleptic Malignant Syndrome
-
Medical Conditions that sometimes underlie Myesthenia Gravis (2)
- 1. Hyperthyroidism
- 2. Thymoma
-
Medications associated with Neuropathy (5)
- 1. Disulfiram
- 2. Chlorpromazine
- 3. Nitrofurantoin
- 4. Isoniazid
- 5. Vitamin B6
-
Medications associated with Myopathy (3)
- 1. Chlorpromazine
- 2. Statins
- 3. Nucleoside analogues
-
Electrolyte abnormality caused by loss of colonic fluid
Hypokalemia
-
Most common cause of deterioration, confusion, and fever in advanced Parkinson Disease
Pneumonia
-
What is Global Amnesia?
Amnesia that is both anterograde and retrograde
-
Symptoms often comorbid with posttraumatic amnesia (3)
- 1. Behavior disturbance
- 2. Depressed mood
- 3. Headache
-
Symptoms often comorbid with amnesia in Wernicke-Korsakoff Syndrome (2)
- 1. Ataxia
- 2. Peripheral neuropathy
-
Symptoms of Herpes Encephalitis (4)
- 1. Amnesia
- 2. Personality changes
- 3. Complex partial seizures
- 4. Klüver-Bucy Syndrome
-
How does HSV enter the brain? What regions does it affect first?
- Enters through nasopharynx
- Attacks frontal and temporal lobes
-
Medications associated with transient amnesia (3)
- 1. GHB
- 2. Scopolamine
- 3. Zolpidem (Ambien)
-
If a discrete neurologic disorder co-occurs with amnesia, what part of the brain has dysfunction?
Cortex
-
Neuropsychologic tasks normally affected with age (4)
- 1. Recall of newly-learned lists
- 2. Shortened attention span
- 3. Slowed learning
- 4. Decreased ability to perform complex tasks
-
EEG changes with age
Slowing of alpha waves
-
Normal age-related MRI changes (5)
- 1. Decreased frontal/parietal volume
- 2. Cortical atrophy
- 3. Expansion of Sylvian Fissure
- 4. Expanded lateral and 3rd ventricles
- 5. White matter hyperintensities
-
Autoimmune/Inflammatory causes of dementia in younger patients (2)
- 1. Paraneoplastic syndromes
- 2. Vasculitis
-
Infectious causes of dementia in younger patients (3)
- 1. HIV
- 2. Creutzfeldt-Jakob disease (CJD)
- 3. Subacute sclerosing panencephalitis
-
Metabolic causes of dementia in younger patients (2)
- 1. Adrenoleukodystrophy
- 2. Wilson Disease
-
Neurodegenerative causes of dementia in younger patients (2)
- 1. Huntington Disease
- 2. Metachromatic Leukodystrophy
-
Inheritance pattern of Frontotemporal Dementia
Autosomal dominant
-
Inheritance pattern of Prion Diseases (when inheritable)
Autosomal Dominant
-
Inheritance pattern of Alzheimer Disease
Autosomal Dominant
-
Inheritance pattern of Wilson Disease
Autosomal Recessive
-
"Rapidly Progressive" Dementias (5)
- 1. HIV-associated dementia
- 2. Frontotemporal dementia
- 3. Lewy Body dementia
- 4. Paraneoplastic encephalitis
- 5. Creutzfeldt-Jakob Disease
-
Symptoms of Subcortical Dementias (5)
- 1. Apathy
- 2. Affective change
- 3. Slowed mental processing
- 4. Gait abnormalities
- 5. Extrapyramidal motor abnormalities
-
Illnesses whose dementia is subcortical (4)
- 1. Parkinson Disease
- 2. NPH
- 3. HIV-associated dementia
- 4. Vascular dementia
-
Blood tests in suspected dementia (8)
- 1. CBC
- 2. CMP
- 3. B12
- 4. HIV test
- 5. RPR
- 6. Lyme titers
- 7. TSH
- 8. Apo-E
-
Is CT or MRI better in suspected dementia?
- CT is better for screening
- MRI is better for ruling out other causes of symptoms
-
EEG in dementia
Generalized slowing; difficult to distinguish from age-related changes most of the time
-
Role of Lumbar Puncture in diagnosing dementia
- Not done routinely
- Can be used to rule out infectious causes or NPH
-
Tests for preclinical Alzheimer Disease (2)
- 1. PET scan
- 2. Lumbar puncture for amyloid and tau protein
-
What is Mild Cognitive Impairment?
- Impairment of either memory or nonmemory functions
- Can still function independently
- 10% progress to Alzheimer Disease each year
- 30% will never progress to dementia
-
Language impairments in Alzheimer Disease
- Difficulty with word finding
- Use of incorrect words
- Circumvent forgotten words
-
What is anomia?
Inability to find a word
-
What is a Paraphasic Error?
Use of an incorrect word
-
Symptoms often comorbid with Constructional Apraxia (3)
- 1. Hemi-inattention
- 2. Left homonymous hemianopsia
- 3. Aprosody
-
Paranoia in Alzheimer Disease
- Occurs in 20-40%
- Often paranoid ideations
-
Hallucinations in Alzheimer Disease
- Occur in ~10%
- Mostly visual
- Sign of poor prognosis
-
Single physical impairment in Alzheimer Disease
Anosmia
-
Areas of greater Cortical Atrophy in Alzheimer Disease (4)
- 1. Parietal-temporal junction
- 2. Limbic System (especially hippocampus)
- 3. Locus Ceruleus
- 4. Olfactory nerve
-
What are plaques made from in Alzheimer Disease?
Amyloid beta peptide
-
What are tangles made from in Alzheimer Disease?
Tau
-
Most distinctive site of neuron loss in Alzheimer Disease, and which neurotransmitter is affected
- Nucleus Basalis of Meynert
- Depletes ACh
-
Likelihood of Alzheimer Disease occurring in the child of an AD patient
20%
-
Paired variants of Apo-E that are associated with Alzheimer Disease (2)
-
Chromosomes containing genes whose damage will cause Alzheimer Disease (3)
-
Medication that slows progression in Alzheimer Disease, and its mechanism
-
Dementias characterized with ACh deficit (3)
- 1. Parkinson Disease
- 2. Alzheimer Disease
- 3. Lewy Body Dementia
-
Most common category of medications used for Alzheimer Disease
Cholinesterase inhibitors (that cross the blood-brain barrier)
-
Effects of Memantine in Alzheimer Disease
- Improved memory and learning, less agitation/aggression
- May reverse the process of apoptosis
-
To what medication class does Memantine (Namenda) belong?
NMDA receptor antagonists
-
Why should tricyclics be avoided in Alzheimer Disease?
- AD affects ACh pathways
- Antidepressants that have cholinergic effects can have exaggerated side effects
-
Antipsychotics that reduce suspiciousness in Alzheimer Disease (2)
- 1. Olanzapine
- 2. Risperdal
-
Dementia in Trisomy 21
Alzheimer-like condition occurs around age 50 in nearly all cases
-
Risk of Alzheimer Disease in mothers of children with Trisomy 21
Fivefold increased risk
-
Contents of a Lewy Body
- Core of α-synuclein and ubiquitin
- Surrounded by loose fibrils
-
Illness where Lewy Bodies are found in cortex
Lewy Body Dementia
-
Illness where Lewy Bodies are found in basal ganglia
Parkinson Disease
-
Choline Acyltransferase in Alzheimer Disease and Lewy Body Dementia
Reduced in both; greater reduction in Lewy Body Dementia
-
How many years after onset of Parkinson Disease symptoms does cognitive decline begin?
5
-
Site of Lewy Bodies in Lewy Body Dementia that correlates with visual hallucinations
Temporal lobes
-
Effects of Lewy Body Dementia on REM sleep
50% have REM Sleep Disorder, in which their limbs are not paralyzed during REM sleep
-
Antipsychotics and Lewy Body Dementia
Even at low doses, cause significant extrapyramidal signs
-
Core features of Lewy Body Dementia (3)
- 1. Parkinsonism
- 2. Visual hallucinations
- 3. Fluctuating cognition
-
Site of a lesion causing slowed thought, lack of emotions, paucity of speech, and apathy
Frontal lobe
-
What is Akinetic Mutism?
Absence of speaking and expression due to absent voluntary movements
-
Site of lesion causing superficial, odd jocularity and uncontrollable facetious laughter
Frontal lobe (these symptoms are due to inhibition!)
-
Side effects of removal of the anterior, nondominant frontal lobe
Little, if any impairment
-
Common causes of bilateral frontal lobe damage (6)
- 1. TBI
- 2. Glioblastoma multiforme
- 3. Metastatic tumor
- 4. Metachromatic leukodystrophy
- 5. MS
- 6. Anterior Cerebral artery aneurysm/infarction
-
Time course of Frontotemporal Dementia
- Onset often in mid-50s
- Fatal course lasting less than 4 years
-
Site damaged most heavily in the behavioral variant of Frontotemporal Dementia
Frontal lobes
-
Language impairment in Alzheimer Disease
Anomia
-
Language impairment in Frontotemporal Dementia (3)
- 1. Anomia
- 2. Paraphasia
- 3. Decreased fluency
-
Findings in Frontotemporal Dementia brain imaging
Frontal and temporal lobe atrophy
-
Drawing in Frontotemporal Dementia
- Can copy a picture well
- Can not draw a picture from memory
-
Pick Disease is a variant of what neurological condition?
Frontotemporal dementia
-
What chromosome contains a gene linked to Frontotemporal Dementia?
Chromosome 17
-
What illness has symptoms of dementia and conjugate eye movement disorder?
Progressive Supranuclear Palsy
-
Age of onset for Progressive Supranuclear Palsy
60-70
-
Expected course of Progressive Supranuclear Palsy
Progressive decline over approximately 7 years
-
Symptoms of Progressive Supranuclear Palsy (4)
- 1. Executive dysfunction
- 2. Reduced verbal output
- 3. Pseudobulbar palsy
- 4. Parkinsonism (without tremor)
-
Effects of Progressive Supranuclear Palsy on posture
Axial rigidity forces entire spine to be upright and unnaturally straight, leading to instability and falls
-
Effects of Progressive Supranuclear Palsy on extraocular movements
- First lose ability to voluntarily look upward, then lose ability to voluntarily look laterally
- "Doll's eyes" are preserved
-
Sites of degeneration in Progressive Supranuclear Palsy (3)
- 1. Basal ganglia
- 2. Frontal cortex
- 3. Upper brainstem
-
Primary distinction of Vascular Dementia from other dementias
Physical findings
-
Medication class that may slow progression of Vascular Dementia
Cholinesterase inhibitors
-
Cognitive domains most affected by alcoholism (4)
- 1. Short-term memory
- 2. Abstract reasoning
- 3. Visual dexterity
- 4. Psychomotor dexterity
-
What type of amnesia occurs in Wernicke-Korsakoff Syndrome?
Mainly anterograde
-
Ocular abnormalities in Wernicke-Korsakoff Syndrome (3)
- 1. Conjugate gaze paresis
- 2. Abducens nerve paresis
- 3. Nystagmus
-
Sites of hemorrhage in acute Wernicke-Korsakoff Syndrome (2)
- 1. Mamillary bodies
- 2. Periaqueductal gray
-
Cranial nerve nuclei adjacent to periaqueductal gray matter (2)
-
Treatment for acute Wernicke-Korsakoff Syndrome
Injection of Thiamine (B1)
-
Elements of Normal Pressure Hydrocephalus (3)
- 1. Dementia
- 2. Gait apraxia
- 3. Urinary incontinence
-
Site of ventricles that is particularly dilated in Normal Pressure Hydrocephalus
Temporal horns
-
Results of large volume lumbar puncture in Normal Pressure Hydrocephalus
Gait, but usually not dementia, improves
-
Brain site most affected by Normal Pressure Hydrocephalus
Internal Capsule
-
Features of Apraxic Gait
- Fail to alternate leg movements
- Do not shift weight to forward foot
- Foot may tremor and appear "magnetized" to floor when stepping because weight remains on it
-
Features of syphilitic brain infection (3)
- 1. Dementia
- 2. Hallucinations
- 3. Thought disorder
-
Physical abnormalities in syphilis (5)
- 1. Dysarthria
- 2. Tremor
- 3. Argyll Robertson pupil
- 4. Hearing loss
- 5. Vision loss
-
Cause of Subacute Sclerosing Panencephalitis
Latent or mutant measles (rubeola) virus infection of neurons
-
Mean age at which Subacute Sclerosing Panencephalitis occurs
12 years
-
Cognitive symptoms of Subacute Sclerosing Panencephalitis
Behavioral disturbances and personality changes deteriorating into dementia
-
Physical symptoms of Subacute Sclerosing Panencephalitis (4)
- 1. Weakness starting in one limb, progressing to full-body paralysis with myoclonus
- 2. Choreoathetoid movements
- 3. Seizures
- 4. Coma and death
-
Life expectancy in Subacute Sclerosing Panencephalitis
- Most live 1-2 years
- Only 5% survive 5 years, usually in a vegetative state
-
Test to confirm diagnosis of Subacute Sclerosing Panencephalitis
CSF measles antibody titer
-
Histologic appearance of Subacute Sclerosing Panencephalitis
Intranuclear eosinophilic inclusions
-
Histologic appearance of Lewy Bodies
- Intracytoplasmic
- Eosinophilic
-
Triad of Creutzfeldt-Jakob Disease (3)
- 1. Dementia
- 2. Myoclonus
- 3. Periodic EEG patterns
-
Age of onset of Creutzfeldt-Jakob Disease
50-64
-
Life expectancy in Creutzfeldt-Jakob Disease
6 months
-
Generally, neuro exam findings in Creutzfeldt-Jakob Disease (3)
- 1. Pyramidal signs
- 2. Extrapyramidal signs
- 3. Cerebellar signs
-
What is Gerstmann-Straüssler-Scheinker Disease?
Familial prion disease
-
EEG findings in Creutzfeldt-Jakob Disease
Periodic sharp-wave complexes or a burst suppression pattern
-
CSF findings in Creutzfeldt-Jakob Disease (2)
- 1. 14-3-3 protein is present
- 2. Tau is elevated
-
Definitive diagnostic test for Creutzfeldt-Jakob Disease
Brain biopsy
-
Initial symptoms of Variant Creutzfeldt-Jakob Disease
Psychiatric disturbances: dysphoria and anxiety progressing to aggression and thought disorder
-
Late symptoms of Variant Creutzfeldt-Jakob Disease
- Painful paresthesias with myoclonus
- Dementia
- Decorticate posture
-
Life expectancy in Variant Creutzfeldt-Jakob Disease
14 months
-
Site (other than brain) whose biopsy shows prions in Variant Creutzfeldt-Jakob Disease
Pharyngeal tonsil
-
Possible symptoms of CNS Lyme Disease (5)
- 1. Headache
- 2. Peripheral neuropathy
- 3. Radiculopathy
- 4. Meningitis
- 5. Encephalitis
-
CSF findings in CNS Lyme Disease (4)
- 1. ↑ Lymphocytes
- 2. ↑ Protein
- 3. ↓ Glucose
- 4. Lyme antibodies
-
Risk factors for HIV-Associated Dementia (7)
- 1. Duration of HIV illness
- 2. Low CD4 count
- 3. Viral load
- 4. Anemia
- 5. Thrombocytopenia
- 6. HepC coinfection
-
Rate of progression in HIV Associated Dementia
Rapid, over weeks to months
-
Cognitive domains impaired in HIV Associated Dementia (4)
- 1. Memory
- 2. Attention
- 3. Psychomotor speed
- 4. Construction
-
Physical effects of HIV Associated Dementia
Psychomotor retardation and clumsiness affect gait and dexterity
-
End stage symptoms of HIV Associated Dementia
Persistent vegetative state
-
Classes of medication used to treat HIV Associated Dementia (3)
- 1. HAART
- 2. Stimulants
- 3. Antidepressants
-
Brain imaging findings in HIV Associated Dementia (3)
- 1. Central atrophy with enlarged ventricles
- 2. Basal ganglia abnormalities
- 3. Nonspecific abnormalities in white matter
-
Most common CNS infection in HIV
Cerebral Toxoplasmosis
-
Cause of ring-enhancing CNS lesions in an HIV patient
Cerebral Toxoplasmosis
-
Class of medications used to treat Cerebral Toxoplasmosis
Antibiotics
-
Cause of Progressive Multifocal Leukoencephalopathy (PML)
JC Virus infecting oligodendrocytes
-
MRI findings in Progressive Multifocal Leukoencephalopathy (PML)
Multiple white matter lesions that eventually become confluent
-
Symptoms of Progressive Multifocal Leukoencephalopathy (PML) (5)
- 1. Cognitive impairment
- 2. Hemiparesis
- 3. Spasticity
- 4. Blindness
- 5. Ataxia
-
Definitive diagnosis of Progressive Multifocal Leukoencephalopathy (PML)
PCR shows JC virus DNA in CSF
-
Infections that can cause cerebral lesions in AIDS (5)
- 1. JC virus
- 2. Candida
- 3. Aspergillus
- 4. CMV
- 5. Polyoma virus
-
Most common CNS neoplasm in HIV
Primary cerebral lymphoma
-
Where do lesions occur in primary CNS lymphoma?
- Usually a single lesion
- Occur in spinal cord as well as brain
-
Prognosis of primary CNS lymphoma
Usually poorly responsive to treatment
-
Presentation of HIV infection of spinal cord
Myelitis (paraparesis, Romberg sign, etc)
-
STI causing myelitis but not cognitive impairment
HTLV-1 (Human t-cell lymphotrophic virus type 1)
-
Cause of delirium with triphasic waves on EEG
Hepatic or uremic
-
Cause of Central Pontine Myelinolysis
Too-rapid repletion of sodium
-
Symptoms of Central Pontine Myelinolysis (3)
- 1. Nystagmus
- 2. Quadriparesis
- 3. Ataxia
-
Classes of drugs of abuse whose withdrawal causes agitated delirium (3)
- 1. Benzodiazapines
- 2. Opioids
- 3. Nicotine
-
Brain region not susceptible to age-related changes
Mammilary Bodies
-
Histologic feature most associated with Alzheimer Disease
Synapse loss
-
Condition causing age-related gait impairment, weakness and loss of muscle bulk in the hands
Cervical spondylosis
-
Inheritance pattern of Wilson Disease
Autosomal recessive
-
Inheritance pattern of Familiar Creutzfeldt-Jakob Disease
Autosomal dominant
-
Inheritance pattern of Familial Alzheimer Disease
Autosomal dominant
-
Conditions in which tau is present in neurons (3)
- 1. Alzheimer Disease
- 2. Progressive Supranuclear Palsy
- 3. Frontotemporal Dementia
-
Sites of origin for the majority of cholinergic neurons in the brain (2)
- 1. Nucleus Basalis of Maynert (main site)
- 2. Basal forebrain (in the brainstem)
-
Mechanism of action of Scopolamine
- Anticholinergic
- Crosses blood brain barrier only at high dose
-
Most common risk factor for delirium
Pre-existing dementia
-
Site of damage in Anton Syndrome
Bilateral occipital lobes
-
Illness whose pathology shows argentophilic inclusions in neurons
Pick Disease
-
Illness whose pathology shows Cowdry Bodies
Subacute Sclerosing Panencephalitis (SSPE)
-
Illnesses whose pathology shows neurofibrillary tangles (2)
- 1. Alzheimer Disease
- 2. Subacute Sclerosing Panencephalitis (SSPE)
-
Illnesses whose pathology stains positive for α-synnuclein antibodies (2)
- 1. Dementia with Lewy Bodies
- 2. Parkinson Disease
-
PET findings in Parkinson Disease
Profound cholinesterase deficiency throughout the cortex
-
PET findings in Dementia with Lewy Bodies (2)
- 1. Profound cholinesterase deficiency throughout the cortex
- 2. Low uptake in basal ganglia
-
CSF findings characteristic of Alzheimer Disease (2)
-
Brain region most affected in delirium
Reticular activating system
-
What is the mechanism of Memantine? What is it used to treat?
- NMDA antagonist
- Used in Alzheimer Disease
-
Lesion causing agnosagnosia
Contralateral parietal lobe
-
Lesion causing ideomotor apraxia
Left frontal or parietal lobe
-
What is Ideomotor Apraxia?
Inability to convert an idea to action
-
What is Ideational Apraxia?
Inability to perform a sequence of steps
-
What is Abulia?
Complete or nearly complete loss of speech and other forms of expression
-
Lesion causing abulia
Frontal lobe
-
Through what structure is CSF absorbed?
Arachnoid villi/granulations
-
Illness in which the anterior horns of the lateral ventricles are convex on brain imaging
Huntington Disease
-
Site of highest concentration of plaques and tangles in Alzheimer Disease
Hippocampus
-
Common presenting symptoms of Dementia with Lewy Bodies (2)
- 1. Parkinsonism
- 2. REM sleep behavior disorder
-
Lesion causing loss of prosody when speaking
Nondominant hemisphere
-
How is brain hemisphere dominance tested if fMRI is not available?
Inject amobarbital directly into a carotid artery; if this carotid is the dominant side, the patient will be temporarily aphasic (Wada Test)
-
Which hemisphere is music processed in?
- In musically gifted people, dominant
- In most people, nondominant
-
Where do fibers from CN8 synapse after entering the brainstem?
Medial Geniculate Body
-
What is located in Heschl's Gyrus? Where is it?
- Primary auditory cortex
- Located in temporal lobe
-
What is the Arcuate Fasciculus?
Starts at Wernicke's Area, connects to Broca's Area
-
What lobe is Wernicke's Area in?
Temporal
-
What lobe is Broca's Area in?
Frontal
-
What is the Geniculocalcarine Pathway? What does it connect?
Transmits visual information from the Lateral Geniculate Bodies (thalamus) to the Visual Cortex (occipital lobes)
-
Where do fibers from the Optic Tracts synapse after entering the brainstem?
Lateral Geniculate Body
-
Sites the Perisylvian Language Arc passes near (2)
- 1. Sylvian fissure
- 2. Motor cortex's representation of face, throat, and upper extremity
-
Contents of the Perisylvian Language Arc (3)
- 1. Wernicke's Area
- 2. Arcuate Fasciculus
- 3. Broca's Area
-
Errors made in Broca's Aphasia
Telegraphic speech ("jerky" tempo)
-
Errors made in Wernicke's Aphasia (4)
- 1. Paraphasic errors
- 2. Circumlocution
- 3. Tangentiality
- 4. Clang associations
-
Deficits often co-occurring with Broca's Aphasia (2)
- 1. Right hemiparesis (more common in arm/face than leg)
- 2. Visual field cuts
- 3. Oral Apraxia
-
Deficits often co-occurring with Wernicke's Aphasia (2)
- 1. Hemisensory loss
- 2. Hemianopsia
-
Where in the brain is text converted to language?
Left parietal association region
-
3 Basic Language Functions
- 1. Repetition
- 2. Naming
- 3. Comprehension
-
Presentation of Mixed Transcortical Aphasia
- Repetition is intact (often involuntarily and sometimes compulsively)
- Comprehension is lost
-
Presentation of Transcortical Motor Aphasia
Similar to Broca's, except repetition is intact
-
Presentation of Global Aphasia
Both comprehension and repetition are lost
-
Major artery where a stroke can cause Broca's Aphasia
Middle Cerebral Artery
-
What is Oral Apraxia?
Inability to execute normal voluntary movements of the face, lips, and tongue
-
Site of lesion causing Mixed Transcortical Aphasia
Watershed region
-
Cause of damage to the Watershed Area of cortex
Hypoperfusion to the brain causes ischemia at regions perfused by distal branches of ACA, MCA, and PCA, causing cortical damage at the intersections between their distributions
-
Cause of global aphasia
Extensive damage to the dominant hemisphere
-
What requests can patients with Global Aphasia follow?
- Some gestured requests (bypass the language arc)
- No verbal requests
-
What communication remains partially intact in Global Aphasia?
- Gestures (with nondominant hand)
- Shoulder shrugs
-
Wernicke's Aphasia on exam
- Fluent aphasia
- Comprehension impaired
- Repetition impaired
-
Presentation of Transcortical Sensory Aphasia
Similar to Wernicke's Aphasia, but repetition is intact
-
Presentation of Conduction Aphasia
- Usually, the only deficit is loss of repetition!
- Can sometimes have paraphasic errors or hesitancy
-
What is a Paraphasia?
Incorrect or meaningless (possibly nonsensical) words used in speech (ie in fluent aphasia)
-
What is a Related Paraphasia?
Word substitution in fluent aphasia in which a word with a similar meaning is used (ie "spoon" for "fork)
-
What is an Unrelated Paraphasia?
Word substitution in fluent aphasia in which an entirely unrelated word is used
-
What is a Clang Association?
Connection of words based on them sounding similar, rather than by meaning
-
Neuro exam findings (unrelated to language) often seen in patients with Fluent Aphasias (3)
- 1. Hyperactive reflexes
- 2. Babinski
- 3. Field cut
-
Type of aphasia associated with Alzheimer Disease and Frontotemporal Dementia
Fluent Aphasia
-
Most common cause of Anomic Aphasia
Small stroke in the angular gyrus
-
Most common cause of Conduction Aphasia
- Embolic stroke in left parietal or temporal lobe
- Usually so small as to cause no other deficits
-
Exam finding that distinguishes schizophrenia from fluent aphasia
Schizophrenic patients can repeat polysyllabic words and complex phrases; patients with fluent aphasia can not!
-
Sites that must be damaged to cause Alexia without Agraphia (2)
- 1. Dominant occipital lobe
- 2. Posterior corpus callosum (splenium)
-
Site of lesion causing Gerstmann Syndrome
Angular Gyrus of dominant parietal lobe
-
What is apraxia?
Inability to carry out a learned action despite normal strength, sensation, and coordination
-
Condition associated with ideomotor apraxia
Nonfluent aphasia
-
Condition associated with ideational apraxia
Dementia, especially Frontotemporal Dementia
-
Damage to which hemisphere causes construction apraxia?
Nondominant
-
Damage to which hemisphere causes dressing apraxia?
Nondominant
-
Condition associated with gait apraxia
Normal pressure hydrocephalus
-
Damage to which hemisphere causes hemineglect?
Nondominant
-
What is Alien Hand Syndrome?
Form of hemi-inattention in which the nondominant hand retains semi-purposeful actions outside of the patient's control
-
Site of injury causing Alien Hand Syndrome
Nondominant parietal lobe
-
What is Aprosody?
Inability to recognize or impart emotions in speech or expressions
-
What is a Commissure in the brain?
Thick myelin-coated axonal bundle connecting two brain regions
-
What is Anterior Cerebral Artery Syndrome?
Occlusion of bilateral ACA causes bilateral frontal infarct as well as infarct of the anterior corpus callosum
-
Apraxia caused by Anterior Cerebral Artery Syndrome
- Nondominant limbs have normal spontaneous movement, but can not be moved if asked to do so
- (language cortex from dominant hemisphere can't transmit to nondominant motor cortex)
-
Symptoms of Streptomycin Toxicity (2)
-
Symptoms of Periaqueductal Hemorrhagic Necrosis (Wernicke's Encephalopathy) (4)
- 1. Delirium
- 2. Ataxia/loss of DTRs
- 3. Palsy of CN6
- 4. Bilateral nystagmus
-
Symptoms of Dilantin Toxicity (2)
-
What is Anton Syndrome?
- Denial of blindness
- Patient confabulates about objects presented to them
-
Defense Mechanisms often used in agnosagnosia
Denial and confabulation
-
Speech effects of Myasthenia Gravis
Nasal speech
-
Speech effects of Parkinsonism
Hypophonia
-
Speech effects of Spasmodic Dysphonia
Strained/stangled speech
-
Symptoms often comorbid with Limb Apraxia (2)
- 1. Aphasia
- 2. Right Homonymous Hemianopsia
-
Symptoms often comorbid with Ideomotor Apraxia (2)
- 1. Aphasia
- 2. Right Homonymous Hemianopsia
-
What is the function of the Edinger-Westphal Nuclei?
Relays information about light intensity to adjust pupil size
-
Most powerful risk factor for developing agnosagnosia following a stroke
Loss of proprioception
-
Bifrontal or bicervical dull headache lasting 30 minutes to 7 days, possibly waxing and waning
Tension Type Headache
-
Who gets Tension Type Headaches?
- Women > men
- Tends to run in families
-
Acute treatment for Tension Type Headaches
OTC medications (NSAIDs, acetaminophen, caffeine, etc)
-
Unilateral throbbing headache aggravated by physical activity
Migraine
-
Who gets Migraine Headaches?
- Women > men (3x more often)
- Increasing prevalence until age 40, but can start in childhood
-
Duration of a migraine's aura
- Evolve over 5-20 minutes
- Last less than an hour
-
Location of pain in a migraine
- Temporal, periorbital, or retroorbital
- Usually unilateral, but rarely always on the same side
-
Duration of migraine
4-72 hours
-
Presentation of frequent migraine attacks
Often evolve into chronic dull, symmetric pain that mimics Tension Type Headache but has nonheadache symptoms of migraines
-
When in the day do migraines typically occur?
Early morning, often beginning during sleep
-
When in the day do Tension Type Headaches occur?
Afternoon
-
Relationship between migraines and menstrual cycle
- Often first develop at menarche
- Attacks are often most likely to occur before or at the beginning of menses
- Most women's migraines improve during pregnancy, but some worsen
-
Type of headache associated with psychiatric comorbidities
Migraine
-
Difference in presentation of childhood migraine from adult migraine (3)
- 1. More severe
- 2. Briefer (often less than 2hrs)
- 3. Less often unilateral
-
Symptoms of Basilar-Type Migraine (5)
- (cerebellar/posterior cerebral/brainstem distribution)
- 1. Ataxia
- 2. Vertigo
- 3. Dysarthria
- 4. Diplopia
- 5. Transient memory impairment (rare, if temporal lobes are affected)
-
Symptoms of Hemiplegic Migraine (3)
- 1. Hemiparesis and anesthesia
- 2. Aphasia
- 3. Cortical symptoms
-
What is Todd's Paralysis?
Paralysis/paresis while postictal
-
Chromosome where a mutation causes Familial Hemiplegic Migraine
Chromosome 19
-
Which type of migraine places patients at highest risk of stroke?
Migraine with Aura
-
Medication classes for migraine (2)
- 1. Triptans
- 2. Ergot derivitives (ergotamine, DHE)
-
Why are Ergot Derivatives contraindicated in pregnancy?
Vasoconstriction cause fetal malformations or miscarriage
-
Why are Ergot Derivatives contraindicated in those using SSRI/SNRI?
Precipitate serotonin syndrome
-
Side effect of antiemetics
Dystonic reactions (similar to antipsychotics)
-
What is Status Migranosus?
Migraine attack lasting greater than 3 days
-
When should preventative treatment be given for migraines? (4)
- 1. 4+ headaches per month
- 2. 3-4 disabled days per month
- 3. Acute medications losing efficacy
- 4. Taking excessive medicine
-
Medication classes used for migraine prevention (3)
- 1. TCAs
- 2. β-blockers
- 3. Anti-epilleptics
-
Which antiepilleptics are used for migraine prophylaxis? (2)
-
Is Botox effective for Tension Type Headaches?
No!
-
Is Botox effective for Migraine Headaches?
Yes!
-
Conditions for diagnosis of Chronic Daily Headache
- Headaches lasting 4+ hours
- 15 days per month
- 3+ months
-
What is pain in Chronic Daily Headache like?
Dull, pressing, waxing and waning (but not pulsatile)
-
Most powerful risk factor for a headache illness evolving to Chronic Daily Headache
Medication overuse
-
Headache causing searing pain in one eye and periorbital region with conjunctival injection, tearing, and nasal congestion
Cluster Headache
-
Duration of a Cluster Headache
45-90 minutes
-
Who tends to get Cluster Headaches?
Men aged 20-40
-
What time of day to Cluster Headaches tend to happen?
- Between 9PM and 9AM
- 1/2 develop during REM sleep
-
Abortive treatments for Cluster Headaches (4)
- 1. Oxygen
- 2. Triptans
- 3. Calcium channel blockers
- 4. Ergot derivatives
- (must be given IV or IM - PO are absorbed too slowly)
-
Preventative medications for Cluster Headaches (4)
- 1. Lithium
- 2. Steroids
- 3. Verapamil
- 4. Depakote
-
Who gets temporal arteritis?
Patients older than age 55
-
Headache with dull, continuous pain in one or both temples and jaw pain on chewing
Temporal Arteritis
-
Systemic symptoms of Temporal Arteritis (3)
- 1. Malaise/low grade fever
- 2. Weight loss
- 3. Myalgia/arthralgia
-
Serious complications of Temporal Arteritis
Arterial inflammation causes arterial occlusion, leading to blindness or stroke
-
Lab tests for Temporal Arteritis (2)
-
Treatment of temporal arteritis
High-dose steroids (if suspected, give before labs are back!)
-
Clues that a headache might be due to a mass lesion
- Cognitive and personality changes are often subtle, but nearly always present
- Lateralized signs within 8 weeks
-
Distinctive features of chronic meningitis on neurological exam
Facial palsy, extraocular muscle palsy, and hearing impariment due to strangulation of CN3-8
-
Who gets Idiopathic Intracranial Hypertension?
Young, obese women with irregular menses
-
Cause of dull, generalized headache with papilledema
Idiopathic Intracranial Hypertension
-
Visual/ocular effects of Idiopathic Intracranial Hypertension (2)
- 1. Enlarged scotoma, eventually causing blindness
- 2. Abducens palsy
-
Brain imaging finding in Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)
Cerebral swelling with compressed, "slit-like" ventricles
-
LP findings in Idiopathic Intracranial Hypertension (4)
- 1. Very high CSF pressure (over 20cm H2O)
- 2. Low protein (diluted by edema)
- 3. Normal glucose
- 4. No cells
-
Treatment of Idiopathic Intracranial Hypertension that fails medical management
- Repeated LPs
- If LPs are not effective, shunt placement
-
Most common bacterial causes of meningitis (2)
- 1. Meningococus (in children)
- 2. Pneumococcus (in adults)
-
Presentation of meningitis due to Pneumococcus
- Occurs in older patients
- Insidious onset
- Subtle signs
-
Most common cause of nonepidemic viral encephalitis
HSV
-
Regions of the brain most affected in HSV Encephalitis
Underside of temporal and frontal lobes
-
Symptoms, other than those typical for encephalitis, of HSV encephalitis (4)
- 1. Complex partial seizures
- 2. Memory impairment
- 3. Aphasia
- 4. Frontal lobe behavior disorders
-
Most common sites of berry aneurysms
Arteries comprising the Circle of Willis
-
Risk of tyramines with MAOIs
Hypertensive crisis that can cause aneurysms to rupture
-
Medications that interact with MAOIs, increasing risk of Hypertensive Crisis (5)
- 1. Triptans
- 2. Demerol (meperidine)
- 3. L-Dopa
- 4. Carbamazapine
- 5. TCAs
-
Treatments for MAOI-induced hypertensive crisis (3)
- 1. Phentolamine
- 2. Chlorpromazine
- 3. Propranolol
-
Cause of dozens of 20-30 second jabs of facial pain daily
Trigeminal neuralgia
-
Most commonly-affected division of CN5 in Trigeminal Neuralgia
V2
-
Who most often gets Trigeminal Neuralgia?
Women over age 60
-
When during the day does Trigeminal Neuralgia occur?
Daytime; often abates at night, allowing full nights of sleep
-
Medical treatment for Trigeminal Neuralgia (3)
- 1. Initially, Gabapentin or Pregabalin
- 2. Antiepilleptics (especially carbamazepine and oxcarbazepine)
- 3. Pain medications (NSAIDs, TCAs, opiates, lidocaine patches, benzodiazepines)
-
Cause of headache with nausea, vomiting, and confusion with elevated serum Pyruvate and Lactate
Mitochondrial encephalopathy
-
Symptoms of Subdural Hematoma (6)
- 1. Depressed sensorium/inattention
- 2. Daily dull headaches
- 3. Anxiety/depression
- 4. Nausea/vomiting
- 5. Diplopia
- 6. Ataxia
-
Main site of serotonin-containing neurons
Dorsal Raphe nucleus
-
What nerve innervates the meninges?
CN5 (trigeminal nerve)
-
Side effects of prolonged use of Ergot derivatives (3)
- 1. Vascular spasm
- 2. Claudication
- 3. Muscle cramps
-
Cause of sinusitis with seizures
CNS infection causing meningitis or brain abscess
-
Best initial treatment for Idiopathic Intracranial Hypertension
Carbonic anhydrase inhibitors (eg acetazolamide)
-
SSRI that can increase caffeine levels
Fluoxetine
-
Normal background EEG rhythm in an awake adult with eyes closed
Alpha waves over the occipital region (Posterior Dominant Rhythm)
-
EEG rhythm seen when concentrating or becoming anxious
Beta activity over the frontal lobes
-
Frequency of Alpha Waves on EEG
8-13Hz
-
Frequency of Beta Waves on EEG
>13Hz
-
EEG rhythm seen with sedatives
Beta Waves
-
Frequency of Theta Waves on EEG
4-7Hz
-
Frequency of Delta Waves on EEG
<4Hz
-
Who normally has Theta Waves on EEG?
-
Who normally has Delta Waves on EEG?
-
What do Theta or Delta waves over the entire brain indicate in an awake adult?
Neurodegenerative illness
-
Cause of repetitive, phase-reversed spikes on EEG
Irritative cerebral focus
-
EEG pattern during seizure
Bursts of spikes, slow waves, or combinations of the two
-
EEG findings during delirium
- Theta and delta activity replaces alpha activity (background slowing)
- Focal areas of hyperactivity
-
EEG findings in metabolic ecephalopathy, especially hepatic or uremic
Triphasic waves
-
EEG findings in HSV encephalitis
Spikes and lateralizing epileptiform discharges in temporal lobes
-
How well do EEG changes correlate to metabolic encephalopathy?
Very well! Nearly always present, so if not present metabolic encephalopathy can be ruled out!
-
What is metabolic encephalopathy?
Delirium
-
EEG findings in Alzheimer Dementia
Background activity slows below 8Hz
-
EEG findings in Subacute Sclerosing Panencephalitis
Periodic sharp-wave complexes
-
EEG findings in Creutzfeldt-Jakob Disease
- Periodic sharp-wave complexes (1-2 per second)
- Background slowing
-
EEG findings in Variant Creutzfeldt-Jakob Disease
None!
-
EEG findings in Pseudodementia
None!
-
EEG findings in Locked-In Syndrome
Normal
-
EEG findings in Persistent Vegetative State
Slow, disorganized activity
-
Causes of "flat" EEG (3)
- 1. Brain Death
- 2. Hypothermia (can recover)
- 3. Drug overdose (can recover)
-
EEG findings in Benzodiazepine/Barbiturate use
Beta waves
-
EEG findings in lithium toxicity
Triphasic waves
-
Difference between simple and complex partial seizures
If complex, consciousness is altered
-
Most common and second-most-common sites of a focus in Complex Partial seizures
Temporal lobe is most common, then frontal lobe
-
What is Secondary Generalization of a partial seizure?
Spread of discharges such that they engulf the entire cerebral cortex
-
Site of a focus in generalized seizures
Subcortical structures, such as the thalamus
-
Sites of focus in seizures with olfactory symptoms (2)
- 1. Uncus (most common)
- 2. Amygdala
-
Most common cause of seizure in Central or South America
Cerebral cystericosis
-
Common cause of seizure in India
Tuberculomas
-
Age of onset of Complex Partial Seizures
Late childhood to early adulthood
-
Most common type of seizures
Complex Partial
-
Most common and second-most common lobes in which Complex Partial Seizures originate
- 1. Temporal (vast majority)
- 2. Frontal
-
Most common cause of Complex Partial seizures
Mesial temporal sclerosis
-
CNS pathology in Mesial Temporal Sclerosis (2)
- 1. Sclerosis of hippocampus
- 2. Temporal lobe atrophy
-
Typical duration of a Complex Partial Seizure
2-3 minutes
-
Lab change in postictal phase
Elevated prolactin (occurs in 40% of cases)
-
Seizure causing vocalizations and brief bilateral complex movements, with little to no postictal confusion
Frontal lobe seizures
-
Course of illness in Frontal Lobe Seizures
- Tends to develop in adulthood
- Several seizures per month, mostly during sleep
-
Seizures causing behavioral changes with undetectable EEG changes
Frontal Lobe Seizures
-
Neurologic illness with the highest Depression comorbidity
Epilepsy
-
Timing of Postictal Psychosis
- Occurs several hours after seizures (after a "lucid interval")
- Lasts hours to weeks
-
Treatment of Postictal Psychosis
Benzodiazepines or antipsychotics
-
Timing of Interictal Psychosis
- Arises at age 30-40 in patients with epilepsy since childhood
- Do not deteriorate
-
Presentation of Interictal Psychosis
- Hallucinations
- Paranoia
- Affect is normal!
-
Management of psychosis complicating epilepsy
- Antiepileptics are the mainstay
- Antipsychotic if antiepileptic is not effective
-
Antipsychotic whose overdose is most likely to cause seizure
Chlorpromazine (Thorazine)
-
Common interaction between antiepilleptics/mood stabilizers
Depakote increases Lamictal levels
-
How can carbamazapine and oxcarbazapine occasionally cause seizures?
Side effects can include hyponatremia; if very severe, this can lead to increased seizures
-
Types of medications whose levels are lowered by Phenytoin (6)
- 1. Benzodiazepines
- 2. Neuroleptics (typical and atypical)
- 3. Tricyclic antidepressants
- 4. SSRIs
- 5. Oral contraceptive
- 6. Methadone
-
Types of medications whose levels are lowered by Carbamazapine (5)
- 1. Benzodiazepines
- 2. Neuroleptics (typical and atypical)
- 3. Tricyclic antidepressants
- 4. SSRIs
- 5. Oral contraceptive
-
Medications/substances that reduce hepatic metabolism of antiepileptics (3)
- 1. Alcohol
- 2. Erythromycin
- 3. Various psychotropics
-
Antiepileptic/mood stabilizer that inhibits hepatic metabolic enzymes
Valproic Acid
-
Types of medications whose levels are increased by Valproic Acid (4)
- 1. Benzodiazepines
- 2. Tricyclic antidepressants
- 3. SSRIs
- 4. Antiepileptics (especially Lamictal)
-
Antiepileptics/mood stabilizers cleared renally, without affecting liver enzymes (3)
- 1. Lamotrigine
- 2. Topiramate
- 3. Levetiracetam
-
Antiepileptics/mood stabilizers that induce p450 (3)
- 1. Phenytoin
- 2. Carbamazepine
- 3. Phenobarbital
-
Risk of antiepileptics/mood stabilizers that induce P450, other than drug interactions
Reduce bone density, increasing risk of osteopenia
-
Effect of Valproate on bone density
Acts on osteoblasts, causing bone loss
-
Cause of skin disturbances when taking antiepileptics/mood stabilizers
Stevens-Johnson Syndrome
-
Which antiepileptic/mood stabilizer in which population is most likely to cause Stevens Johnson Syndrome?
Carbamazepine in people of Asian ancestry
-
Serious side effects of Antiepileptics/Mood Stabilizers (3)
- 1. Stevens-Johnson Syndrome
- 2. Hepatic abnormalities
- 3. Bone marrow suppression
-
Antiepileptic/mood stabilizer causing weight gain
Valproate
-
Antiepileptic/mood stabilizers causing weight loss (2)
- 1. Topiramate
- 2. Zonisamide
-
Symptoms of intoxication with antiepileptic/mood stabilizer (3)
- 1. Nystagmus
- 2. Ataxia
- 3. Dysarthria
-
Side effects specific to Topamax, but not other antiepileptics/mood stabilizers (2)
- 1. Acute glaucoma
- 2. Calcium phosphate renal stones
-
Antiepileptics/mood stabilizers that reduce efficacy of oral contraceptive pills (4)
- 1. Phenytoin
- 2. Carbamazapine
- 3. Phenobarbital
- 4. Topiramate
-
Antiepileptic/mood stabilizer that can cause PCOS
Valproate
-
Antiepileptics/mood stabilizers that are Pregnancy Category D (2)
- 1. Valproate
- 2. Carbamazapine
-
Antiepileptics/mood stabilizers that are Pregnancy Category C (4)
- 1. Lamotrigine
- 2. Levetiracetam
- 3. Oxcarbazapine
- 4. Topiramate
-
Serious birth defects associated with Valproate and Carbamazapine
Neural tube defects
-
Cardiac defect associated with antiepileptics/mood stabilizers
Ventricular Septal Defect
-
Birth defects associated with Phenytoin use (2)
- 1. Craniofacial abnormalities
- 2. Limb defects
-
Which antiepileptics/mood stabilizers are secreted at high levels in breast milk? (4)
- 1. Ethosuxamide
- 2. Lamotrigine
- 3. Topiramate
- 4. Phenobarbital
-
Which antiepileptics/mood stabilizers deplete Vitamin K dependent clotting factors? (4)
- 1. Phenobarbital
- 2. Primidone
- 3. Phenytoin
- 4. Carbamazapine
-
Definition of "refractory" epilepsy
Failing three adequate trials of antiepileptic medications
-
Most common form of partial epilepsy in childhood
Rolandic Epilepsy
-
Who gets Rolandic Epilepsy?
- Children ages 5-9
- Usually boys
-
Course of Rolandic Epilepsy
- Begins between ages 5-9
- Remits by puberty
-
Presentation of seizures in Rolandic Epilepsy
- Unilateral parethesia
- Facial movements
- Speech arrest
-
EEG in Rolandic Epilepsy
"Rolandic spikes" during sleep: high voltage spikes in the temporal region
-
Are children with Rolandic Epilepsy at risk of developing future seizures?
No!
-
Course of Absence Seizures
- Begin between ages 4-10
- 2/3 Remit in early adulthood, rest evolve into tonic-clonic seizure disorder
-
Duration of an absence seizure
2-10 seconds
-
EEG pattern during absence seizures
3Hz spike-and-wave complexes in all channels
-
Postictal symptoms of absence seizures
None
-
Cause of absence status epilepticus
Abrupt cessation of antiepileptic medications in a patient with history of absence seizures
-
Interictal EEG pattern in patients with absence seizures
Occasional, asymmetric bursts of 3Hz spike-and-wave complexes lasting 1-1.5 seconds
-
Movements during absence seizures
- Blinking
- Facial and finger automatisms
- Subtle clonic limb movements
-
Medications for absence seizures in children (2)
- 1. Ethosuxamide (first line)
- 2. Valproate
-
Prodrome of tonic-clonic seizures
- Usually none
- If present, malaise or depression
-
What does the patient do during the Tonic Phase of a tonic-clonic seizure?
- Lose consciousness
- Roll eyes upward
- Extend back, trunk, and limbs (forms a back-bending arch)
- Diaphragm, chest wall, and laryngeal muscles contract, causing the "epileptic cry"
- Bite tongue
- Lose continence
-
EEG pattern in tonic-clonic seizures
- Spikes, polyspikes, and occasional slow waves in all channels
- Typically obscured by muscle artifact
-
Interictal EEG pattern in patients with tonic-clonic seizures
Bursts of generalized spikes in the background
-
Lab value altered after a tonic-clonic seizure
Prolactin is elevated
-
Inheritance of tonic-clonic epilepsy
Autosomal dominant
-
During what phase of sleep do tonic-clonic seizures emerge?
Non-REM sleep
-
Medications typically used to suppress tonic-clonic seizures (2)
-
Who most often has Psychogenic Nonepileptic Seizures?
- Women aged 19-35
- Relatives of people with epilepsy
- People with a history of abuse
-
What is Transient Global Amnesia?
Episodic anterograde amnesia with retrograde amnesia for the past several hours/days
-
What is Cataplexy?
- Momentary loss of body tone (30 seconds or less)
- Often occurs during a period of strong emotion
- Awareness is preserved
-
Who is most likely to have paradoxical hyperactivity with sedatives? (2)
- 1. Children
- 2. Adults with brain injury
-
Medications causing EEG spikes (3)
- 1. Lithium (if toxic)
- 2. Tricyclic antidepressants
- 3. Clozapine
-
Antiepileptic most associated with psychosis, depression, or hostility
Levitiracetam (Keppra)
-
Significant side effects of Valproate (4)
- 1. Obesity
- 2. Hair thinning
- 3. PCOS
- 4. Hyperandrogenism
-
Which antiepileptic causes increased facial hair?
Phenytoin
-
Greatest risk factors for depressed mood in epilepsy (2)
- 1. Multiple antidepressant medications
- 2. Complex partial seizures
-
Effect of pregnancy on seizure disorders
Causes antiepileptic levels to fall, causing increased seizure frequency
-
Antiepileptic medication that does not increase risk of osteopenia
Leviteracetam (Keppra)
-
What is a Gelastic Seizure?
Seizure whose sole manifestation is mirthless laughter
-
Duration of a TIA
- 24 hours is maximum time to be called a TIA
- Most last 30-60 minutes
-
Usual composition of emboli causing TIAs
Platelet emboli
-
Site of TIAs caused by emboli from the carotid bifurcation
Cerebral hemispheres
-
Frequent symptoms of TIAs with origin in carotid artery (3)
- 1. Hemiparesis (contralateral)
- 2. Hemisensory loss (contralateral)
- 3. Homonymous hemianopsia (contralateral)
-
What is Amaurosis Fugax?
- Brief monocular blindness (1-5 minutes)
- Caused by TIA originating in the carotid artery affecting the ophthalmic artery
-
Retinal exam in a patient with Carotid Artery TIAs
Plaques are present due to retinal emboli
-
Branches of Common Carotid (2)
- Internal carotid
- External carotid
-
Branches of Internal Carotid (3)
- 1. Ophthalmic Artery
- 2. Anterior Cerebral Artery
- 3. Middle Cerebral Artery
-
Vessel perfusing posterior motor cortex
- Middle Cerebral Artery
- Everything except the leg!
-
Vessel perfusing sensory cortex
Middle Cerebral Artery
-
Vessel perfusing the Perisylvian language arc
Middle Cerebral Artery
-
Vessel perfusing anterior motor cortex
- Anterior Cerebral Artery
- Perfuses area innervating the leg
-
Vessel perfusing the frontal lobe
Anterior Cerebral Artery
-
Vessel perfusing the occipital lobe
Posterior Cerebral Artery
-
Vessel perfusing the majority of the temporal lobe
Posterior Cerebral Artery
-
Artery from which Posterior Cerebral Artery arises
Basilar
-
Medication to prevent TIAs
Platelet inhibitors (aspirin, clopidogrel/Plavix, Dipyiridamole-Aspirin/Aggrenox)
-
From where does the Basilar Artery arise?
Joining of the two vertebral arteries after they enter the skull
-
Vessel perfusing the brainstem
Small branches of the Basilar Artery
-
Vessel perfusing the cerebellum
Large branches of the Basilar Artery
-
What does the Anterior Communicating Artery connect?
Left and right Anterior Cerebral Arteries
-
What does each Posterior Communicating Artery connect?
Internal Carotid and Posterior Cerebral Artery (just as it comes off of the Basilar Artery)
-
Sites of formation for emboli that reach the Posterior Circulation of the cerebrum (2)
- 1. In the chest, at the origin of the vertebral arteries
- 2. Junction of the vertebral arteries at the base of the brain
-
Symptoms of Basilar Artery TIAs (6)
- 1. Circumoral tingling
- 2. Dysarthria
- 3. Nystagmus
- 4. Diplopia
- 5. Ataxia
- 6. Vertigo
-
What is a "Drop Attack"?
- TIA stopping all flow through the Basilar Artery causes brainstem ischemia
- Sudden loss of consciousness and tone causes the patient to collapse
-
What likely causes Transient Global Amnesia?
TIA of the PCA, affecting the hippocampus
-
Duration of Transient Global Amnesia
3-24 hours total, most severe for 1-2 hours
-
Diabetes and risk of stroke
Risk is elevated, but only somewhat so
-
Hypercholesterolemia and risk of stroke
Risk is elevated, but only somewhat so
-
Illicit drug whose use can cause cerebral hemorrhage
Crack cocaine
-
Presentation of Homocystinuria
- Marfan-like body habitus
- Ocular lens displacement
- Strokes in childhood
-
Evolution of stroke caused by thrombus vs. by embolus
- Embolic strokes occur suddenly
- Strokes caused by thrombus develop slowly or intermittently
-
When is edema worst after a stroke?
Day 3-5
-
Symptoms of ACA Stroke (5)
- 1. Contralateral lower extremity paresis
- 2. Mutism, apathy
- 3. Pseudobulbar palsy, if bilateral
- 4. Personality changes, if bilateral
- 5. Urinary incontinence, if bilateral
-
Symptoms of MCA Stroke (4)
- 1. Contralateral hemiparesis
- 2. Hemisensory loss
- 3. Aphasia
- 4. Hemi-inattention
-
Symptoms of PCA Stroke (3)
- 1. Contralateral homonymous hemianopsia
- 2. Alexia without agraphia
- 3. Cortical blindness, if bilateral
-
Symptoms of stroke causing complete Basilar Artery occlusion (2)
- 1. Coma
- 2. Locked-in Syndrome
-
Symptoms of stroke occluding a branch of the Basilar Artery (3)
- 1. Cranial nerve palsy
- 2. Contralateral hemiparesis
- 3. Internuclear ophtalmoplegia
-
Symptoms of Vertebral Artery Stroke
Lateral Medullary (Wallenberg) syndrome
-
Serious sequallae of Cerebellar Hemorrhage
- Fourth ventricle and medulla are compressed:
- Compression of fourth ventricle causes obstructive hydrocephalus
- Compression of medulla depresses respiratory drive and causes coma
-
Frequent sites of intracranial hemorrhage due to HTN (4)
- 1. Basal ganglia
- 2. Thalamus
- 3. Pons
- 4. Cerebellum
-
Cause of intracranial hemorrhage in a patient taking MAOIs
Likely due to HTN triggered by consumption of aged cheese or red wine, or taking meperidine (Demerol)
-
Hemorrhage caused by ruptured Berry Aneurysm
Subarachnoid Hemorrhage
-
Duration of Post-Stroke Depression
- Most remit after 1 year
- 20% remain depressed at 3 years
-
Symptoms of Locked-In Syndrome
- All motor function, except extraocular muscle and eyelids, is lost
- Require tracheostomy and ventilator support, as well as feeding tube
- Cognition and decision making capacity are intact
-
Cause of persistent vegetative state
Extensive cortical damage without brainstem damage
-
Posturing in persistent vegetative state
Decorticate
-
Imaging findings in persistent vegetative state
PET and fMRI show generalized markedly reduced cerebral blood flow and glucose metabolism
-
Duration of vegetative state at which Persistent Vegetative State is diagnosed
1 month
-
Duration of TBI-induced persistent vegetative state after which there is no realistic chance of recovery
1 year
-
Duration of neurodegenerative disease-induced persistent vegetative state after which there is no realistic chance of recovery
3 months
-
What is Minimally Conscious State
Brain injury impairs level of consciousness, but some discernible behavioral evidence of consciousness is present
-
PET findings in Minimally Conscious State
Some organized cerebral cortical activity is present
-
How soon after surgery can tPA be given?
14 days
-
Medication causing transient myopia
Topamax
-
What is Hyperopia?
"Farsightedness"
-
Vision problem if the globe is too long or the lens is too thick
Myopia
-
Vision problem if the globe is too short or the lens is too thin
Hyperopia
-
What is the Accommodation Reflex of the eye?
Lens thickness and pupil size adjustment to facilitate focusing of an image on the retina
-
Psychiatric medications that can cause presbyopia (4)
- 1. SSRIs
- 2. SNRIs
- 3. TCAs
- 4. Clozaril
-
Medication class that can cause retina hyperpigmentation if taken at high doses
Phenothiazines
-
Medications that can cause vision to have a yellow hue (2)
- 1. Digoxin (if toxic)
- 2. Viagra
-
Medication that can cause vision to have a blue hue
Viagra
-
Antiepileptic medication that can cause permanent retinopathy
Vigabatrin (Sabril)
-
What is the Bulbar portion of the Optic Nerve?
The Optic Disc
-
What is the Retrobulbar portion of the Optic Nerve?
Segment of the optic nerve behind the eye
-
Symptoms of Optic Neuritis
- Sudden Vision loss
- Color desaturation
- Pain on eye movement
-
Most common causes of Optic Neuritis (2)
- 1. Multiple Sclerosis
- 2. Neuromyelitis Optica
- (Demyelinating illnesses)
-
Likely diagnosis if optic neuritis forms and MRI shows 2 or more brain lesions
Multiple Sclerosis
-
Result of repeated optic neuritis in the same eye
Atrophy of the optic nerve, causing blindness and unreactive pupil
-
Treatment of optic neuritis
Steroids
-
Cause of vision loss when methanol is consumed
Atrophy of the optic nerves
-
Symptoms of Temporal/Giant Cell Arteritis (4)
- 1. Headache
- 2. Malaise
- 3. Aches/pains
- 4. Optic nerve ischemia
-
Syptoms of Leber Hereditary Optic Atrophy
- Visual loss in one eye, then the other several months later
- No other CNS or musculature symptoms
-
Who most gets Leber Hereditary Optic Atrophy?
Mostly young males
-
Symptoms of Tay Sachs Disease (4)
- 1. Cognitive decline
- 2. Personality changes
- 3. Blindness
- 4. Death by age 5 in most cases
-
Symptoms of a Sphenoid meningioma (4)
- Compresses optic nerve, frontal, and temporal lobe:
- 1. Partial seizures
- 2. Cognitive decline
- 3. Personality changes
- 4. Optic atrophy causing unilateral blindness
-
Presentation of closed-angle glaucoma
- Eye is red
- Pupil is dilated and unreactive
- Eye and forehead are painful
-
Antidepressant class that can cause angle closure glaucoma
Tricyclic antidepressants
-
EEG change in cortical blindness
Posterior α-rhythm is lost
-
What is Palinopsia?
Recurrent visual images ("echos") in an area of incomplete visual loss
-
Site of brain injury causing Palinopsia
Both occipital and parietal lobes
-
What is Visual Agnosia?
Inability to appreciate the meaning of an object despite being able to see it clearly
-
Illnesses in which Visual Agnosia can occur (3)
- 1. Multiple small strokes
- 2. Alzheimer Disease
- 3. Klüver-Bucy syndrome
-
What is Color Agnosia?
Inability to name colors, despite being able to see colors (can identify when items are the same or different colors, etc)
-
What is Prosopagnosia?
Inability to recognize that a face is a familiar person
-
Site of brain injury that can cause Prosopagnosia (2)
- 1. Bilateral frontotemporal lobes
- 2. Right temporal lobe
-
Site of lesion preventing a patient from matching pairs of unfamiliar faces
Nondominant cerebral hemisphere
-
Symptoms of Balint Syndrome (3)
- 1. Ocular Apraxia
- 2. Optic Ataxia
- 3. Simultagnosia
-
Site of brain injury causing Balint Syndrome
Bilateral parietal-occipital region
-
What is Ocular Apraxia?
Inability to look away from an object once fixated on it
-
What is Optic Ataxia?
Inability to look/search with the eyes in a deliberate pattern
-
What is Simultagnosia?
- Inability to attend to objects that are not in the center of the visual field
- Can describe elements of a scene, but not the overall picture
-
What is a Hypnagogic Hallucination?
Hallucination when falling asleep
-
What is a Hypnopompic Hallucination?
Hallucination when awakening
-
When in the course of Lewy Body Dementia do visual hallucinations start to occur?
Early in the course
-
When in the course of Alzheimer Dementia do visual hallucinations start to occur?
Late in the course
-
Features of scotoma due to optic nerve lesion
- Oval or kidney-shaped
- Crosses the midline
-
Where is visual loss if there is damage to an optic tract?
Contralateral hemianopsia
-
Where is visual loss if there is damage to a lateral geniculate body?
Contralateral hemianopsia
-
Where is the lesion causing homonymous superior quadrantanopia?
Contralateral temporal lobe (can be associated with a seizure focus!)
-
Cause of homonymous hemianopsia with macular sparing
Contralateral occipital lobe lesion
-
Course of the optic tract after Lateral Geniculate body
Move through the temporal lobe's anterior tip, then posteriorly through the temporal lobe to the occipital cortex
-
Where are gaze centers (control eye movements)?
- Supranuclear centers are in the cortex, and innervate nuclear centers
- Nuclear centers are in the pons, and innervates cranial nerve nuclei
-
Which gaze centers control REM sleep?
Nuclear centers (in pons)
-
Which gaze centers control the "Doll's Eyes" phenomenon and react to cold caloric testing?
Nuclear centers (in pons)
-
Which side's cerebral gaze center is used to look to one side?
- The contralateral side
- (think of each gaze center as "pushing" the eyes away)
-
Which direction do the eyes look during a unilateral seizure? Why?
- Away from the side with seizure activity
- Occurs because the seizure triggers the cerebral gaze center
-
Which direction do the eyes look after a unilateral stroke? Why?
- Toward the side where the stroke is
- Occurs because that side's cerebral gaze center's activity is reduced or abolished
-
If the eyes deviate away from paralysis, what part of the brain is the stroke in?
Cortex!
-
What tracts in the brain innervate the extraocular muscle nuclei?
Corticobulbar tracts
-
What is located in the Pontine Paramedian Reticular Formation?
Pontine gaze center
-
Which side's pontine gaze center is used to look to one side?
- The ipsilateral side
- (think of each gaze center as "pulling" the eyes in)
-
If the eyes deviate toward paralysis, what part of the brain is the stroke in?
Pons!
-
What nuclei are innervated by a pontine gaze center? (2)
- 1. Ipsilateral Abducens Nucleus
- 2. Contralateral Oculomotor Nucleus (via Medial Longitudinal Fasciculus)
-
What is Internuclear Opthalmoplegia? Where is the lesion?
- Inability of ipsilateral eye to adduct past midline
- Lesion is in Medial Longitudinal Fasciculus
-
Antiepileptic drugs that cause nystagmus at physiologic doses(2)
- 1. Phenobarbital
- 2. Dilantin/Phenytoin
-
Site of illness causing nystagmus with vertigo, nausea, and vomiting
Inner ear
-
Effect of Huntington Disease on eye movements
Saccades are abnormal
-
Effect of schizophrenia on eye movements
Abnormal smooth pursuit
-
Which eye should be covered in monocular diplopia that persists in all directions of gaze?
The affected eye
-
Which eye should be covered in binocular diplopia?
Either eye
-
Sites of lesions causing binocular diplopia (4)
- 1. Brainstem
- 2. CN3, CN4, or CN6
- 3. Neuromuscular junction
- 4. Extraocular muscles
-
Cranial nerves whose injury can cause diplopia on lateral gaze (2)
- 1. Oculomotor (CN3)
- 2. Abducens (CN6)
-
Site of lesion causing dilated pupil, ptosis, and lateral deviation of the eye
Oculomotor (CN3)
-
Finding in CN3 palsy due to diabetes
Pupil is not affected
-
Cranial nerve affected in diplopia that worsens on both lateral and medial gaze
Abducens (CN6)
-
What is Amblyopia?
Loss of vision in an eye with strabismus
-
Which eye should be covered in strabismus?
The unaffected eye
-
Cause of Progressive External Ophthalmoplegia
Mitochondrial myopathy
-
Deviation of the eyes in Convergence Spasm
Downward and inward
-
Symptoms of Horner Syndrome (3)
- 1. Ptosis
- 2. Miosis (constricted pupil)
- 3. Anydrosis (lack of sweating) unilaterally
-
Where does the sympathetic nervous system originate?
Hypothalamus
-
Path of the sympathetic nervous system
- Descends from hypothalamus into cervical and upper thoracic spinal cord
- Leaves from thoracic spine and makes a hairpin turn, ascending adjacent to cervical spine
- Wrap around common carotid, then internal carotid
- Enter the orbit with CNV, branch V1
-
What is Adie Pupil?
Benign deprivation of parasympathetic innervation to a pupil causes dilation at rest and brisk, long-acting constriction with cholinergic drops
-
Characteristics of Argyl-Robertson Pupils (5)
- 1. Small pupil (miosis)
- 2. Ptosis
- 3. Irregular shape
- 4. Does not react to light
- 5. Does react during accommodation
-
Mechanism of visual impairment by tricyclic antidepressants
Cause accommodation paresis
-
Common cause of CN2 dysfunction
Multiple Sclerosis
-
Probable cause of loss of peripheral vision and all nighttime vision
Retinitis Pigmentosa
-
Origin of seizure causing musical hallucinations
Temporal lobe
-
Origin of seizure causing twisting, complex multicolored lights
Temporal lobe
-
Origin of seizure causing facial distortions
Temporal lobe
-
Site of lesion causing nystagmus
Vestibular nuclei of the pons
-
Medication class causing oculogyric crisis
Phenothiazines (eg Thorazine, Prolixin)
-
Site of lesion causing psychic blindness
Bilateral temporal lobes
-
Symptoms of Progressive External Ophthalmoplegia
Paresis of all extraocular muscles, causing eye immobility and ptosis
-
Cause of "snowy" vision, poor visual acuity, and slow pupillary light reaction
Methanol poisoning
-
Predominant pathology for Cerebral Palsy in premature infants
Periventricular leukomalacia (damage to white matter around lateral ventricles)
-
Apgar scores associated with Cerebral Palsy
Less than 4 at 10 and 15 minutes
-
Most common cause of pediatric motor impairment
Cerebral Palsy
-
Types of Cerebral Palsy (3)
- 1. Spastic
- 2. Extrapyramidal
- 3. Mixed
-
Age before which Cerebral Palsy can not be diagnosed
4 months
-
Types of Spastic Cerebral Palsy (3)
- 1. Diplegic
- 2. Hemiplegic
- 3. Quadriplegic
-
Effects of Cerebral Palsy on growth
Growth arrest causes affected limbs to be short and to have short Achilles Tendons that force the patient to walk on their toes
-
What is the distribution of Diplegic Cerebral Palsy?
Spastic symptoms of bilateral legs more than arms
-
Frequency of comorbidities in Diplegic Cerebral Palsy
Intellectual disability and epilepsy are uncommon
-
What is the distribution of Hemiplegic Cerebral Palsy?
Spastic symptoms of one side of the body, face and arm more than leg
-
Severe underlying cause of premature handedness in infants
Paresis in the other hand due to Hemiplegic Cerebral Palsy
-
Language impairment in Hemiplegic Cerebral Palsy
None! The unaffected hemisphere will become the dominant language hemisphere
-
What is the distribution of Quadriplegic Cerebral Palsy?
- Spastic symptoms of all four limbs
- Often accompanied by pseudobulbar palsy
-
Frequency of comorbidities in Quadriplegic Cerebral Palsy
Intellectual disability and epilepsy are very common
-
Symptoms of Extrapyramidal Cerebral Palsy (2)
- 1. Athetosis of the face, tongue, hands, and feet
- 2. Chorea of the trunk, arms, and legs
- (Termed "choreoathetosis")
-
Distinction between Dopamine-Responsive Dystonia and Extrapyramidal Cerebral Palsy
Dopamine-Responsive Dystonia is progressive, diurnal, and improves with levodopa
-
Frequent comorbidity of Extrapyramidal Cerebral Palsy
Hearing impairment (auditory pathways are often damaged in addition to basal ganglia)
-
Site of lesion in Extrapyramidal Cerebral Palsy
Basal Ganglia
-
Age at which choreoathetosis becomes apparent in Extrapyramidal Cerebral Palsy
Age 2-4
-
Incidence of Intellectual Disability an Epilepsy in Extrapyramidal Cerebral Palsy
Very low!
-
Presentation of Mixed-Form Cerebral Palsy
Both spastic paraparesis and choreoathetosis are present
-
Frequency of comorbidities in Mixed-Form Cerebral Palsy
Very high (95%)
-
What is an Arnold-Chiari Malformation?
The medulla and the lower portion of cerebellum protrude below the foramen magnum
-
What is Dandy-Walker Syndrome?
- Posterior brain structures do not form beyond early embryonic stage
- 4th ventricle becomes a large cystic structure
-
Symptoms of Arnold-Chiari Syndrome (3)
- 1. Headaches
- 2. Bulbar palsy
- 3. Neck pain
-
Complication of Arnold-Chiari Syndrome
Aqueductal stenosis causes obstructive hydrocephalus
-
What is Spina Bifida Occulta?
- Lumbar vertebrae do not fuse, but underlying spinal cord and cauda equina are intact
- Asymptomatic
-
What is Meningocele?
- Form of spina bifida
- Meninges and skin protrude through a lumbosacral spine defect
-
Symptoms of Meningocele (2)
- 1. Leg weakness/gait impairment
- 2. Neurogenic bladder
-
What is Meningomyelocele?
- Severe form of spina bifida
- Rudimentary lower spinal cord, as well as lumbar and sacral nerve roots, protrude into the sac overlying the lumbosacral spine
-
Symptoms of Meningomyelocele (3)
- 1. Flaccid Paraparesis
- 2. Areflexia of lower limbs
- 3. Incontinence
-
Inheritance of most neurocutaneous disorders
Autosomal dominant
-
Skin lesions of Tuberous Sclerosis (4)
- 1. Facial angiofibromas: smooth, firm nodules in the malar region; appear in adolescence
- 2. Hypopigmented macules (ash-leaf spots)
- 3. Shagreen patches: leathery, scaly areas on trunk/buttocks
- 4. Periungual fibromas of the fingers
-
Classic triad of Tuberous Sclerosis (3)
- 1. Epilepsy (often refractory)
- 2. Intellectual disability
- 3. Facial angiofibroma
-
Neurologic syndromes with Autism-like symptoms (5)
- 1. Angelman Syndrome
- 2. Fragile X
- 3. Klinefelter Syndrome
- 4. Rett Syndrome
- 5. Tuberous Sclerosis
-
CNS lesion in Tuberous Sclerosis
"Tubers": 1-3cm nodules that irritate cortex, causing epilepsy and intellectual impairment
-
Sites of benign tumors in Tuberous Sclerosis (4)
- 1. Brain
- 2. Retina
- 3. Kidney
- 4. Heart
-
Triad of Neurofibromatosis 1 (3)
- 1. Café-au-lait spots
- 2. Neurofibromas
- 3. Lisch nodules
-
Appearance of a Café-au-Lait spot
- Uniformly light brown, oval, flat skin
- May be accompanied by freckles in the axilla or groin
-
How many Café-au-Lait spots are required to suggest Neurofibromatosis 1
6 or more, each larger than 5mm in children or 1.5mm in adults
-
Appearance of a Neurofibroma
- Soft, palpable subcutaneous growth on a peripheral nerve or nerve root
- A few millimeters to several centimeters in size
-
Appearance of Lisch Nodules
Multiple pigmented aggregations on the iris of the eye
-
Intracerebral tumor associated with Neurofibromatosis 1
Optic glioma
-
Hallmark symptom of Neurofibromatoisis 2
Bilateral acoustic neuromas
-
Tumors associated with Neurofibromatosis 2 (2)
- 1. Acoustic neuroma
- 2. Meningioma
-
What is Sturge-Weber Syndrome?
Angioma of the face (follows one or more branches of CN5) and underlying cerebral hemisphere
-
Symptoms of Sturge-Weber Syndrome (3)
- 1. Seizures (of any type) often refractory to medications
- 2. Learning disabilities (can have intellectual disability)
- 3. Focal neurologic symptoms related to location of cerebral angioma (sometimes)
-
Cutaneous symptom of Ataxia-Telangiectasia
Small, dilated vessels (telangiectasias) on the conjunctiva, bridge of nose, and cheeks
-
Cause of ataxia in Ataxia-Telangiectasia
Degeneration of the cerebellar vermis
-
Course of neurologic manifestations of Ataxia-Telangiectasia
- Ataxia first occurs between ages 3-5 and is progressive
- Typically wheelchair-bound by age 12
- Eventually, cognitive impairment occurs
-
Inheritance pattern of Ataxia-Telangiectasia
Autosomal recessive
-
Condition associated with Ataxia-Telangiectasia
Immunodeficiency (both cellular and IgA/IgE deficiency)
-
Enzyme that is deficient in Phenylketonuria
Hepatic phenalalynine hydroxylase
-
Symptoms of Phenylketonuria (5)
- 1. Growth restriction
- 2. Lack of pigment (hair, eyes, skin)
- 3. Eczema
- 4. Malodorous urine
- 5. Cognitive impairment with language delay
-
Inheritance pattern of Phenylketonuria
Autosomal recessive
-
Complications of a phenylalanine-free diet (3)
- 1. Short stature
- 2. Anemia
- 3. Hypoglycemia
-
Chromosome affected in NF1
17
-
Chromosome affected in NF2
22
-
Chromosome affected in Ataxia-Telangiectasia
11
-
Chromosome affected in PKU
12
-
Chromosome affected in Homocystinuria
21
-
Causes of accumulation of homocysteine (4)
- 1. Homocystinuria
- 2. B12 deficiency
- 3. Some antiepileptic medications (Carbamazapine, Phenytoin)
- 4. Nitrous oxide
-
Complications of Homocystinuria (4)
- 1. Vascular thrombotic events (strokes in young adults)
- 2. Mental retardation
- 3. Behavioral disturbances
- 4. Obsessive-compulsive symptoms
-
Physical features of Homocystinuria (3)
- 1. Ocular lens is displaced
- 2. Tall, Marfan-like stature
- 3. Sunken or bowed chest
-
Treatment of Homocysinuria
Supplement Vitamin B6 and Folate
-
Chromosome affected in Prader-Willi Syndrome
15
-
Chromosome affected in Angelman Syndrome
15
-
Inheritance of Prader-Willi Syndrome
Always either paternal inheritance or a de novo mutation
-
Symptoms of Prader-Willi Syndrome (3)
- 1. Intellectual disabililty
- 2. Behavior problems
- 3. Hyperphagia, causing obesity
-
Physical anomalies in Prader-Willi Syndrome (4)
- 1. Obesity
- 2. Short statue
- 3. Small hands and feet
- 4. Small penis/testicles or labia
-
Inheritance of Angelman Syndrome
Usually maternal inheritance
-
Symptoms of Angelman Syndrome (6)
- 1. Severe intellectual impairment with prominent language deficiency
- 2. Epilepsy
- 3. Stereotypies
- 4. Ataxic movements
- 5. Smiling face
- 6. Unprovoked laughter
-
Chromosome affected in Williams Syndrome
7
-
Appearance of a patient with Williams Syndrome (5)
- 1. Broad forehead
- 2. Prominent cheeks
- 3. Flat nasal bridge
- 4. Large, upturned nostrils
- 5. Hypoplastic, widely-spaced teeth
- "Elfin"
-
Symptoms of Williams Syndrome (3)
- 1. Slow to acquire motor milestones
- 2. Poor visuospatial sense
- 3. ADHD, phobias, or both
- 4. Mild to moderate intellectual disability
- 5. One-sided but "bubbly" conversations ("hypersocial")
-
Chromosome affected in Velocardiofacial Syndrome
22
-
Locations of physical abnormalities in Velocardiofacial Syndrome (3)
- 1. Soft palate (cleft)
- 2. Heart (VSD, abnormal aorta and pumonary artery)
- 3. Face (elongated with micrognathia, tubular nose, deformed ears)
-
Neuropsychiatric symptoms of Velocardiofacial Syndrome (3)
- 1. Low IQ
- 2. Schizophrenia
- 3. Major Depression
-
Differences between Fragile X syndrome in boys vs. girls
- Boys nearly always have physical signs, and 70% have significant intellectual disability
- Girls largely have no physical signs, and 2/3 have normal IQ
-
Behavioral symptoms of Fragile X Syndrome (2)
- 1. Stereotypies (especially hand wringing or flapping)
- 2. Self-injurious behavior
-
Psychiatric conditions common in Fragile X Syndrome (3)
- 1. Autism
- 2. ADHD
- 3. Anxiety
-
Cause of Fragile X Syndrome
- Trinucleotide repeats in the X chromosome
- Must have 200 repeats to have the disorder
-
At what age do symptoms of Rett Syndrome emerge?
6-18 months
-
Early presentation of Rett Syndrome
Regression over a period of several years; eventually unable to walk or produce language
-
Comorbidity of Rett Syndrome
Epilepsy beginning around age 3
-
Presentation of an adult with Rett Syndrome
- 1. Stereotypies, especially hand wringing/clapping/flapping and hair pulling
- 2. Microcephaly
-
Chromosome affected in Rett Syndrome
X
-
Gender ratio in Rett Syndrome
Essentially entirely female; the mutation is letal to a male fetus
-
Chromosome affected in Lesch-Nyhan Syndrome
X
-
Presentation of Lesch-Nyhan Syndrome
- 1. Intellectual disability
- 2. Self-mutilation
- 3. Dystonia (prominent)
-
Gender ratio in Lesch-Nyhan Syndrome
Essentially all male
-
Cognitive effects of Turner Syndrome
- Most have learning disabilities
- 10-20% have Intellectual Disability
-
Physical appearance in Turner Syndrome
- Short statue
- Webbed neck
- Low set ears
- Flat nose
- Do not undergo puberty
-
Physical appearance in Klinefelter Syndrome
- Tall, mostly due to long legs
- Few secondary sexual characteristics (do not go through puberty)
- Gynecomastia
- Female pattern of pubic hair
- Small testes
-
Cognitive effects fo Klinefelter Syndrome
- 25% have intellectual disability
- Most have below average IQ
-
Cognitive effects of XYY Syndrome
- 1. Learning disabilities
- 2. Meet milestones late
- 3. IQ lower than siblings
-
Cardiac comorbidity in Williams Syndrome
Aortic stenosis
-
Physical changes in Fragile X Syndrome (6)
- 1. Large ears
- 2. Macro-orchidism
- 3. Narrow ears
- 4. Short stature
- 5. Arched palate
- 6. Hyper-extendible joints
-
What is Porencephaly?
Cavitations within the brain
-
What illness is caused by a mutation in the gene MECP2?
Rett Syndrome
-
Site where pain fibers synapse in the spinal cord
Substantia gelatinosa
-
Major neurotransmitter for pain at the spinal cord level
Substance P
-
Spinal cord tracts in which pain is carried (3)
- 1. Lateral spinothalamic tract (predominant tract)
- 2. Spinohypothalamic tract
- 3. Less-defined tracts to limbic system and brainstem
-
Path of analgesic pathways in the brain
- Originate in frontal lobe and hypothalamus
- Project to periaqueductal gray matter
-
Mechanism of analgesia in the spinal cord
Interneurons release endogenous opioids
-
Course of "Descending Analgesia" pathways
- Originate in brainstem
- Descend in the dorsolateral funiculus of the spinal cord
-
Neurotransmitter in brainstem analgesia pathways
Serotonin
-
Most effective time to give analgesics
Regular prophylactic dosing rather than taking medication when pain begins
-
What class of medication should be used for cancer pain?
Opiates
-
Medications used for postherpetic neuralgia (5)
- 1. Topical lidocaine
- 2. Gabapentin
- 3. Pregabalin
- 4. Carbamazepine
- 5. Oxcarbazepine
-
Nerve sometimes damaged during a mastectomy
Intercostobrachial Nerve
-
Cause of arm pain after treatment of breast cancer
Metastatic invasion of the brachial plexus
-
Most common sites of shingles (2)
- 1. Thoracic dermatomes
- 2. First branch of Trigenimal Nerve (CNV1), including the cornea
-
Treatment of pain due to shingles
Opioids!
-
"Secondary phase" of shingles pain
Postherpetic neuralgia lasting 3-6 months
-
Types of RSD/CRPS (2)
- Type 1: No definable underlying nerve injury
- Type 2: There is a definable underlying nerve injury
-
Cause of burning/stabbing pain superimposed on numbness
CRPS/RSD
-
Sensory symptoms of thalamic infarction
- Initially, contralateral hemianesthesia
- Over time, spontaneous painful sensations on the anesthetic side of the body (lasts 6-12 months)
-
What does the Sylvian Aqueduct connect?
3rd and 4th ventricles
-
Where do peripheral nerves carrying pain synapse with the Lateral Spinothalamic Tract?
Substantia Gelatinosa
-
What is Deafferentiation Pain?
Pain caused by loss of sensation from a body region (eg phantom limb pain)
-
What is Pseudoaddiction?
Obsession with obtaining a pain medication, followed by hoarding the medication
-
Pain syndrome for which TENS is effective
Diabetic neuropathy
-
Which nerve roots innervate uterus and cervix?
T10-L1
-
Underlying mechanism of Multiple Sclerosis
- T-cell mediated inflammation leads to demyelination and sclerotic plaques in the white matter
- Axonal death leads to permanent dysfunction
-
Frequency of relapse of MS symptoms if untreated
Once every 1-2 years
-
Courses of Multiple Sclerosis (4)
- 1. Relapsing-remitting (most common)
- 2. Primary progressive
- 3. Secondary progressive (initially relapsing-remitting, then progressive)
- 4. Progressive-relapsing (steady deterioration with superimposed acute attacks)
-
Age of onset of Primary Progressive Multiple Sclerosis
40s-50s (older than other forms)
-
CNS region most commonly affected in Primary Progressive Multiple Sclerosis
Spinal cord
-
Brain region commonly affected first in Multiple Sclerosis
Cerebellum
-
What is Titubation?
Irregular head tremor in cerebellar damage
-
Sensory deficits most often impaired in Multiple Sclerosis
Vibration and position sense
-
Cranial nerves affected in Multiple Sclerosis
- Optic nerve is often affected (due to CNS myelin)
- Acoustic nerve is rarely affected (partially covered with CNS myelin)
- Others are never affected
-
Effects of Multiple Sclerosis on vision
Optic neuritis causes scotoma and color desaturation, as well as pain on eye movement
-
Appearance of optic neuritis on Neurological Exam
When a flashlight is swung from the normal eye to the affected eye, both pupils dilate
-
Ocular motility abnormalities in Multiple Sclerosis
- Internuclear ophthalmoplegia
- Nystagmus
-
Spinal Cord symptoms of Multiple Sclerosis (3)
- 1. Incontinence (neurogenic bladder)
- 2. Impotence
- 3. Impaired gait (leg spasms)
-
Effect of Multiple Sclerosis on fertility
- Men have low sperm count and abnormal sperm production
- Women's fertility is not affected
-
What is Lhermitte's Sign?
- Electrical sensations down the spine on neck flexion
- Indicates a disease process affecting the cervical spine
-
Effect of pregnancy on Multiple Sclerosis
- Risk of exacerbations is much lower than normal during pregnancy and while breastfeeding
- 2-3 months after birth, incidence of exacerbation is increased
-
Most common psychiatric comorbidity of Multiple Sclerosis
Major Depression
-
Treatment of depressed mood in Multiple Sclerosis
- SSRIs are not effective
- ECT is effective and is not contraindicated or restricted
-
Cognitive effects of Multiple Sclerosis
- Over the course of disease, memory declines, eventually causing cortical dementia
- Language is spared
-
MRI changes in advanced Multiple Sclerosis (4)
- 1. Enlarged ventricles
- 2. Atrophy of corpus callosum
- 3. Demyelination of periventricular white mater
- 4. High overall lesion load
-
Most common course of pediatric Multiple Sclerosis
- Nearly always relapsing-remitting at onset
- Often evolves into secondary progressive pattern after decades
-
Number of CNS lesions on MRI needed to diagnose Multiple Sclerosis
1 gadolinium-enhancing lesion OR 9 nonenhancing lesions
-
What is the significance of Multiple Sclerosis lesions being gadolinium-enhancing vs. nonenhancing?
Lesions that arose in the past month are enhancing; older lesions are not
-
CSF results in Multiple Sclerosis
- Normal or slightly-elevated protein
- Oligoclonal bands are frequently present, but nonspecific
- Myelin basic protein is frequently present, but nonspecific
-
What interferon medication can cause depression?
Alpha-interferon (used for hepatitis)
-
Difference in presentation of Guillain-Barré and Multiple Sclerosis
Guillain-Barré consists of a single attack, and is symmetric
-
Presentation of Neuromyelitis Optica
- Loss of vision in one or both eyes
- Paraparesis
-
Pathology of Neuromyelitis Optica
Demyelinating lesions in one or both optic nerves, as well as the spinal cord
-
Difference in presentation of Neuomyelitis Optica and Multiple Sclerosis
NMO does not cause cognitive impairment or fatigue
-
Treatments for Neuromyelitis Optica (2)
- 1. Plasmapheresis
- 2. Immunosuppressants
-
Difference in presentation between leukodystrophies and Multiple Sclerosis
- Leukodystrophy usually first appears in childhood, and is progressive and unremitting
- Leukodystrophy is entirely genetic in etiology
-
Inheritance pattern of Adrenoleukodystrophy
Sex-linked
-
Presentation of Adrenoleukodystrophy
Neurologic problems and adrenal insufficiency in boys starting between ages 5 and 15
-
Symptoms of advanced Adrenoleukodystrophy (3)
- 1. Gait impairment
- 2. Mania
- 3. Dementia
-
Symptom of Metachromatic Leukodystrophy but not Adrenoluekodystrophy
Peripheral neuropathy
-
Underlying cause of Adrenoluekodystrophy
Oxidation defect in peroxisomes cause accumulation of fatty acids, leading to demyelination
-
What is Acute Disseminated Encephalomyelitis (ADEM)?
Immune attack on CNS myelin 1-4 weeks after an infectious illness (often one with a skin eruption)
-
Region where HTLV-1 is endemic
Caribbean
-
What is Marchiafava-Bignami Syndrome?
- Contaminant of Italian red wine causes degeneration of corpus callosum
- Causes frontal lobe damage and dementia
-
What is Postvaccinal Encephalomyelitis?
- Inflammatory demyelination 1-2 weeks after smallpox vaccination
- Rare, but if it occurs mortality rate is high!
-
Test for Neuromyelitis Optica
Serum NMO antibody
-
Causes of bilateral horizontal nystagmus (3)
- 1. Multiple Sclerosis
- 2. Labyrinthitis
- 3. Wernicke's Encephalopathy
-
Most common CNS symptoms of lupus (3)
- 1. Seizures
- 2. Strokes
- 3. Psychosis
- "The 3 S's"
-
Peripheral nerve that carries sexual impulses from the genitals to the spinal cord
Pudendal nerve
-
Nerve roots that carry sympathetic information to the genitals
T11-L2
-
Nerve roots that carry parasympathetic information to the genitals
S2-S4
-
How to distinguish central vs. peripheral cause of saddle anesthesia?
If central, DTRs will be hyperactive. If peripheral, hypoactive
-
Is constriction of the internal anal sphincter caused by sympathetic or parasympathetic innervation?
Sympathetic! (parasympathetic causes relaxation)
-
Nerve roots that mediate the external anal sphincter
S3-S4
-
Neurologic conditions that often cause sexual impairment (4)
- 1. Diabetic neuropathy
- 2. Spinal cord injury
- 3. Multiple sclerosis
- 4. Herniated disc
-
Neurological injury causing retrograde ejaculation
Autonomic injury
-
What is the scrotal reflex?
Applying a cold surface to the scrotum causes ipsilateral skin contraction and testicle retraction
-
What is the cremasteric reflex?
Stroking the inner thigh causes ipsilateral scrotal skin contraction and testicle retraction
-
What is the anal reflex?
Scratching the skin surrounding the anus causes the anus to tighten
-
Medication used for psychogenic erectile dysfunction
Yohimbine (alpha antagonist that increases sympathetic activity)
-
Injectable medications for erectile dysfunction (3)
- 1. Alprostadil
- 2. Papaverine
- 2. Phentolamine
-
Suffix of PDE inhibitors used to treat erectile dysfunction
-afil
-
Sexual function in cervical or thoracic spine injured patients
- As the genital-spinal cord loop is intact, can achieve orgasm (but can not perceive it)
- Erections are often weak
- Sperm count is low (may become infertile)
- Can have autonomic hyperreflexia with an orgasm
-
Sexual function in lumbosacral spinal cord activity
Can not achieve orgasm
-
Neurotransmitter whose inhibition (by medications) causes sexual dysfunction
Dopamine
-
Most common sexual side effects of SSRIs (3)
- 1. Delayed orgasm
- 2. Erectile dysfunction (1/3)
- 3. Reduced vaginal lubrication
-
Antidepressants with the lowest rate of sexual side effects (2)
- 1. Wellbutrin
- 2. Trazodone
-
Psychiatric medications used to treat premature ejaculation (2)
- 1. Clomipramine
- 2. Sertraline
-
Mechanism of priapism with antipsychotics
- Alpha adrenergic blockade
- (Rare side effect!)
-
Treatment of priapism
Inject epinephrine into the penis
-
What is Klüver-Bucy Syndrome?
- Damage to bilateral amygdala
- Aggressive/sexually suggestive gestures
- Eat, drink, and smoke excessively
- Amnesia
-
Path of the limbic system (6)
- 1. Hippocampus and adjacent amygdala
- 2. Fornix
- 3. Mamillary bodies
- 4. Mammillothalamic tract
- 5. Thalamus (anterior nucleus)
- 6. Cingulate gyrus
-
Type of paralysis in REM sleep
- Flaccid paralysis
- Areflexic
-
Body movements in NREM sleep
- Repositioning every 15-20 minutes
- Tone is intact
-
Ocular movements in N1 Light sleep
Slow, rolling movements
-
Ocular movements in N2 Intermediate sleep
Either slow, rolling movements or no movements
-
Ocular movements in N3 Deep sleep
None
-
EEG in N1 Light sleep
Slowed alpha activity
-
EEG in N2 Intermediate sleep
- Low amplitude
- Sleep spindles and/or K complexes present
-
EEG in N3 deep sleep
- Delta activity
- Sleep spindles
-
EEG in REM sleep
- Similar to that of wakefulness
- Ocular movement artifact
-
ANS activity in REM sleep
- Increased
- Pulse, blood pressure, intracranial pressure, and intracranial blood flow increase
-
Brain region that generates physical elements of REM sleep
Pons
-
Role of the Peri-Locus Ceruleus in REM sleep
Abolishes muscle tone
-
What are the monoamine neurotransmitters? (4)
- 1. Dopamine
- 2. Epinephrine
- 3. Norepinephrine
- 4. Serotonin
-
Effect of REM sleep on neurotransmitters (2)
- 1. ↑ cholinergic activity
- 2. ↓ monoamine activity
-
Effect of antidepressants on REM sleep
Suppress REM activity
-
ANS activity in NREM sleep
- Reduced
- Causes hypotension, bradycardia, and cerebral blood flow
-
Hormones released primarily during NREM sleep (2)
- 1. Growth hormone
- 2. Prolactin
-
When does N3 (deep) sleep occur?
Early in the sleep cycle
-
What is Sleep Latency?
Time to fall asleep after going to bed
-
What serum level is associated with sleepiness?
Adenosine
-
What is Sleep Efficiency?
Ratio of sleep to time spent in bed
-
When during sleep does REM occur?
- 4-5 times per night
- First episode is 90-120 minutes after falling asleep
- Longer and more frequent in the latter half of the night
-
What brain region controls circadian rhythm?
Suprachiasmatic nucleus of the hypothalamus
-
Conditions that reduce REM latency (5)
- 1. Depression
- 2. Narcolepsy
- 3. Sleep apnea
- 4. Sleep deprivation
- 5. Withdrawal from alcohol/hypnotics/TCAs
-
Where are melatonin receptors in the brain?
Suprachiasmatic nucleus
-
What promotes release of melatonin?
Darkness
-
What is Ramelteon?
Melatonin agonist with longer half-life than melatonin itself
-
Interaction between fluvoxamine (Luvox) and Ramelteon
Luvox inhibits metabolism of Ramelteon, causing elevated levels
-
Changes in sleep after sleep deprivation
- Short sleep latency
- Increased sleep time
- Greater depth and duration of slow-wave sleep
-
Effects of loss of REM sleep on future sleep
"REM Rebound" with dreaming nearly immediately after falling asleep, more REM cycles, and longer REM cycles
-
Psychiatric medications that suppress dreaming (2)
-
Substances of abuse that suppress dreaming (5)
- 1. Cocaine
- 2. Amphetamines
- 3. Opioids
- 4. Hypnotics
- 5. Alcohol
-
Changes in REM sleep with age
REM occurs at high frequency in infancy, reducing in percentage of the night until age 5, then constant into adulthood
-
Age of onset of narcolepsy
- Between adolescence and 30s
- Peaks in teenage years
-
Duration of sleep during a narcolepsy attack
~15 minutes
-
Symptoms comprising the Narcoleptic Tetrad (4)
- 1. Excessive Daytime Sleepiness
- 2. Cataplexy (not always present)
- 3. Sleep Paralysis
- 4. Hypnagognic/hypnopompic hallucinations
-
What is sleep paralysis?
- Inability to move or speak for as long as several minutes on awakening
- Can move eyes and breathe
-
Nighttime sleep in narcolepsy
Multiple brief spontaneous awakenings occur
-
Presentation of narcolepsy in children
- Develop inattention and hyperactivity
- Behavioral, cognitive, and scholastic impairments due to fatigue
- Often mistaken for a learning disability
-
Test for Narcolepsy
Multiple Sleep Latency Test (MSLT)
-
What is Hypocretin?
Excitatory neurotransmitter that maintains wakefulness and stimulates appetite
-
What is Modafinil (Provigil)?
- Histaminergic (non-amphetamine) medication that promotes wakefulness
- Does not cause excitation or nighttime insomnia
-
What is Armodafinil (Nuvigil)?
- Long-acting form or Modafinil (Provigil)
- Promotes wakefulness, but is not an amphetamine
-
Management of Narcolepsy
- Regular daytime naps after meals and during late afternoon
- Regular nighttime sleep schedule
- Stimulant medication
-
Types of Sleep Apnea (2)
- 1. Obstructive
- 2. Central (due to inconsistent CNS ventilatory effort)
-
Frequent cause of obstructive sleep apnea in children
Enlarged tonsils
-
Age at which Restless Legs Syndrome tends to first occur
After 45
-
Mineral deficiency often present in Restless Legs Syndrome
Iron deficiency anemia
-
Main class of medications to treat Restless Legs Syndrome
Dopamine agonists (eg L-dopa, ropinirole, and pramipexole)
-
What is Pramipexole?
- Dopamine agonist
- Not an ergot derivative
-
What is Ropinirole?
- Dopamine agonist
- Not an ergot derivative
-
Medication classes that can provoke Restless Legs Syndrome (4)
- 1. TCAs
- 2. SSRIs
- 3. SNRIs
- 4. Antihistamines
-
What is Periodic Limb Movement Disorder?
Regular episodic stereotyped movements of limbs (usually legs) during sleep
-
Characteristics of movements during Periodic Limb Movement Disorder
- 20-40 second movements for episodes of 10 minutes to several hours
- Occur during NREM sleep
- Does not arouse the patient
-
Medical illnesses that can cause Periodic Limb Movement Disorder (2)
-
Treatment of Periodic Limb Movement Disorder
- Usually none!
- If necessary, benzodiazepines and dopaminergic medications
-
What is Kleine-Levin syndrome?
- "Periodic hypersomnia" of 1-4 weeks of 18 hours of sleep per day occurring 3-4 times per year
- After awakening, eat voluminous amounts of food, are crudely sexual, and are confused
-
Course of Kline-Levin Syndrome
- First occurs in adolescence
- Spontaneously resolves after about 8 years
-
Diagnosis and treatment of Kline-Levin Syndrome
- No physical findings can confirm the diagnosis
- No specific treatments exist; must treat symptoms
-
Action of caffeine on the p450 system
Inhibits metabolism of medications
-
Effect of Luvox on caffeine
Inhibits metabolism of caffeine, causing increased levels
-
What are Parasomnias?
Mental or behavioral aberrations lasting 15 minutes or less that interrupt sleep
-
When in sleep does sleepwalking occur?
NREM sleep, most often stage IV sleep in early night
-
When in sleep do night terrors occur?
NREM sleep, most often stage IV sleep in early night
-
What triggers NREM Parasomnias?
- 1. Falling rapidly into deep sleep (overtired, hypnotic medications, etc)
- 2. Being partially awakened (need to urinate, loud noises at night, etc)
-
What are Confusional Arousals?
- Disorentation and incoherence when partially, rather than fully, awakening from sleep.
- Causes "talking in one's sleep"
-
Duration of an episode of sleepwalking
10 minutes
-
Duration of a Night Terror
1-10 minutes
-
Demographics of patients with Sexsomnia
- Begins in adolescence
- Regresses in the 5th decade
- More common in men
-
What is Rhythmic Movement Disorder?
- Stereotyped movements while in the early stages of falling asleep
- Starts in infancy, resolves by age 5 in most but can persist into teens (particularly if intellectually disabled)
-
When are nightmares more common?
In REM rebound (including use of drugs or withdrawal from REM-suppressing medications)
-
Presentation of Nocturnal Panic Attacks
- Occur in NREM sleep
- Awaken able to recall the fear, but not any associated imagery
-
What is REM Sleep Behavior Disorder?
Lack of paralysis during REM sleep
-
Distinction between NREM parasomnias and REM Sleep Behavior Disorder
- Those with REM Sleep Behavior Disorder remember the episodes (thought they are associated with dreams)
- Those with NREM Parasomnias are amnestic of their episodes
-
Who most often has REM Sleep Behavior Disorder?
Men older than 65
-
Neurological illnesses that can underlie REM Sleep Behavior Disorder (2)
- 1. Parkinson disease
- 2. Lewy Body Dementia
-
Classes of psychiatric medications that can cause REM Sleep Behavior Disorder (4)
- 1. SSRIs
- 2. SNRIs
- 3. TCAs
- 4. Mirtazapine
-
Treatment of REM Sleep Behavior Disorder
Clonazepam taken at night
-
At what age is bedwetting considered a parasomnia in girls?
After age 5
-
At what age is bedwetting considered a parasomnia in boys?
After age 6
-
Timing of an episode of Sleep-Related Eating Disorder
- Usually during NREM sleep, but not exclusively
- Lasts about 5 minutes
-
What is Sleep-Related Eating Disorder?
- While partially aroused from sleep, eat variable amounts of food
- Food may be barely edible, eg raw meats or still-frozen foods
-
What is Night Eating Syndrome?
Awaken fully from sleep, consume large amounts of their customary foods, then return to sleep
-
Effect of Major Depression on sleep efficiency
- Reduced total sleep efficiency
- Slow wave sleep is relatively reduced, and is fragmented
-
Effect of Major Depression on REM latency
Very short; nearly always less than 60 minutes
-
Effect of Major Depression on frequency of REM sleep
Increased in early nighttime; almost absent in later sleep
-
Effects of Major Depression on nighttime neuroendocrine cycle (2)
- 1. Earlier cortisol release
- 2. Earlier MHPG (norepinephrine metabolite) release
-
Effect of mania on REM sleep
Nearly abolished
-
Classes of psychiatric medications that increase REM latency (7)
- 1. SSRIs
- 2. SNRIs
- 3. TCAs
- 4. MAOIs
- 5. Benzodiazepines
- 6. Amphetamines
- 7. Lithium
-
Effects of chronic schizophrenia on sleep
Polysomnography shows normal results
-
Effects of acute schizophrenia on sleep (2)
- 1. Reduced slow wave sleep
- 2. Increased sleep latency with frequent awakenings
-
Effects of Anxiety on sleep (2)
- 1. Increased sleep latency
- 2. Fragmented sleep
- REM sleep is normal
-
Effects of PTSD on sleep patterns
None! (psychologic >> physiologic sleep problems!)
-
Effects of Alcoholism on sleep (4)
- 1. Shortened sleep latency
- 2. Increased slow-wave sleep
- 3. Decreased REM sleep in the first half of sleep, with rebound in the second half of sleep
- 4. Periods of wakefulness
-
Effects of alcohol withdrawal on sleep (2)
- 1. Increased sleep latency
- 2. REM rebound
-
Effect of dementia on sleep
- Increased light sleep
- Decreased sleep efficiency
- Many daytime naps
-
Effects of dopamine agonists and L-dopa on sleep (2)
- 1. Frightening vivid dreams
- 2. Can cause sleep attacks (episodic irresistible sleep)
-
Effects of Parkinson Disease on sleep (3)
- 1. Causes REM Sleep Behavior Disorder
- 2. Sleep reversal (sleep during day, up at night)
- 3. Fragmented sleep
-
Medication class that can help Parkinson Disease patients sleep through the night
TCAs
-
Movement disorder symptoms that disappear during sleep (3)
- 1. Tremors
- 2. Athetosis
- 3. Chorea
-
What are hypnic jerks?
Sudden contraction of antigravity muscles during wake-to-sleep transition
-
Movement disorder symptoms that remain present during sleep (4)
- 1. Dystonia
- 2. Tics
- 3. Belpharospasm
- 4. Hemifacial spasm
-
What is Fatal Familial Insomnia?
- Hereditary prion disease
- Symptoms begin at age 50
- Progressively severe insomnia, inattentiveness, and amnesia
- Eventually, endocrine and ALS-like symptoms
- Death in 6-36 months
-
In what sleep stages to seizures tend to occur in epilepsy?
N1 and N2
-
What type of seizures tend to occur during sleep in epilepsy?
- Generalized seizures
- Partial seizures are much less common
-
Effect of antiepileptic medications on sleep
- Promote normal sleep
- Can cause daytime sleepiness despite normal sleep
-
When in sleep do cardiac events tend to occur?
REM sleep
-
When in sleep to strokes tend to occur?
During the hours just before awakening
-
Behavioral treatment for insomnia patients who feel anxious while trying to fall asleep
If unable to fall asleep within 20 minutes, leave bed and read until relaxed and sleepy
-
Effects of tryptophan on SSRIs
Can precipitate serotonin syndrome
-
Effects of benzodiazepines on insomnia (2)
- 1. Increase sleep time by 10%
- 2. Decrease slow-wave and REM sleep
-
In what brain location is the Peri-Locus Ceruleus?
Pons
-
Most common treatment required for insomnia in PTSD
None! (most resolves on its own)
-
What is a SOREMP?
Sleep Onset REM Period (eg REM immediately after falling asleep)
-
Conditions that cause REM immediately after falling asleep (3)
- 1. Sleep Apnea
- 2. Narcolepsy
- 3. Sleep deprivation
-
Effect of benzodiazepines on seizures
Mild anticonvulsant effect
-
Treatments of Cataplexy (2)
- 1. TCAs
- 2. Sodium oxybate (GHB)
-
Mechanism of action of methylphenidate
Dopamine agonist
-
Mechanism of action of amphetamine
Dopamine agonist
-
Daily caffeine dose at which toxicity can occur
250mg
-
Movement disorders that occur due to basal ganglia damage (6)
- 1. Parkinson disease
- 2. Athetosis
- 3. Chorea
- 4. Hemiballismus
- 5. Wilson Disease
- 6. Generalized dystonia
-
Components of the lenticular nucleus (2)
- 1. Globus pallidus
- 2. Putamen
-
Brain region that separates the lenticular nucleus from the thalamus
Posterior Internal Capsule
-
Path of the circuit within the basal ganglia (5)
- 1. Dopaminergic neurons from substantia nigra project to Putamen
- 2. Putamen projects to Globus Pallidus
- 3. Globus pallidus projects to Ventrolateral Nucleus of the thalamus
- 4. Ventrolateral nucleus projects to motor cortex
- 5. Motor cortex projects back to Putamen
-
What nuclei constitute the basal ganglia? (5)
- 1. Caudate
- 2. Putamen
- 3. Globus Pallidus
- 4. Subthalamic Nucleus
- 5. Substantia Nigra
-
Site of origin of the Extrapyramidal Tract
Basal ganglia
-
Role of the Extrapyramidal Tract
Modulates the corticospinal tract
-
Clinically relevant tract that exists within the Extrapyramidal Tract
Nigrostriatal tract
-
What two regions are connected by the nigrostriatal tract?
Substantia Nigra and Striatum
-
What neurotransmitter does the Nigrostriatal Tract utilize?
Dopamine
-
Main neurotransmitter of the Globus Pallidus
GABA
-
Main neurotransmitter of the Subthalamic Nucleus
Glutamate
-
Which side of the body is affected by unilateral damage to the basal ganglia?
Contralateral side!
-
Effect of caffeine on movement disorders
Increases involuntary movements
-
Cause of gait alteration in Parkinson Disease
Loss of postural reflexes
-
What is retropulsion?
- Taking steps back when pulled from the shoulders
- Sign of loss of postural reflexes in movement disorders
-
Sensory change in Parkinson Disease
Anosmia
-
Autonomic symptoms of Parkinson Disease (4)
- 1. Urinary incontinence
- 2. Constipation
- 3. Dysphagia
- 4. Diaphuresis
-
When should antidepressants be used to treat Parkinson Disease patients with low mood?
After the Parkinson regimen is optimized
-
Best class of antidepressants for Parkinson Disease patients
TCAs
-
Concern with antidepressants and Selegiline in Parkinson Disease
- Selegiline prevents breakdown of serotonin at high doses
- Combined with reduced reuptake of serotonin, this can precipitate serotonin syndrome
-
Can ECT be used in Parkinson Disease patients?
- Yes!
- Helps depression, as well as bradykinesia and rigidity
-
Effect of dopaminergic treatments in Parkinson Disease on depressed mood
None; antidepressants must also be given
-
Timing of dementia in Parkinson Disease
Begins to occur approximately 5 years after onset of illness
-
Parkinson symptoms that are associated with developing dementia
Akinesia and rigidity
-
Presentation of dementia in Parkinson Disease
Inattention, slowed thinking, poor memory, and hallucinations
-
Effect of dopaminergic treatments in Parkinson Disease on dementia
None
-
Clinical distinction between Parkinson Disease with dementia and Lewy Body Dementia
In Lewy Body Dementia, dementia is the presenting symptom, whereas in Parkinson Disease it develops later
-
What class of medication is used to slow progress of dementia in Parkinson Disease?
Cholinesterase inhibitors
-
Prognosis of Parkinson Disease after psychotic symptoms occur
High rate of dementia and death within 2 years
-
Treatment of psychotic symptoms of Parkinson Disease
- Taper cholinergic medications, if possible
- Add antipsychotic medication
-
Most effective antipsychotic in Parkinson Disease patients with psychotic symptoms
Clozapine
-
What is Dopamine Dysregulation Syndrome?
- Psychiatric illness that occurs in Parkinson Disease due to dopaminergic medications
- Compulsive self-gratifying behavior (gambling, sex, buying, or binge-eating)
-
Treatment of Dopamine Dysregulation Syndrome in Parkinson Disease
- Reduce dopamine agonists
- Deep brain stimulation
-
What is Punding in Parkinson Disease?
- Mindless, repetitive, purposeless behavior that displaces normal activities
- Caused by dopaminergic medications
-
Treatment of Punding in Parkinson Disease
- Reduce dopaminergic medications
- Add an antipsychotic
-
Pathway of synthesis of Dopamine (3)
- 1. Phenylalanine converted to Tyrosine
- 2. Tyrosine converted to DOPA (by tyrosine hydroxylase) (rate determining step)
- 3. DOPA converted to Dopamine (by DOPA decarboxylase)
-
Molecular cause of Parkinson Disease
Inabilitly to convert Tyrosine to DOPA to synthesize Dopamine
-
Extrapyramidal tract damaged in Parkinson Disease
Nigrostriatal Tract
-
Neurotransmitter level (other than dopamine) reduced in CSF in Parkinson Disease
Serotonin
-
Neuropathologic finding in Parkinson Disease
Loss of pigmentation in substantia nigra, locus ceruleus, and vagus nuclei in the brainstem
-
Illness against which smoking is protective
Parkinson Disease
-
What is Dementia Pugilistica?
Intellectual deterioration and bradykinesia due to repeated head injuries (eg in boxers)
-
Movement-related side effect of Tetrabenazine
Parkinsonism
-
Movement-related side effect of Reglan (metoclopramide)
Parkinsonism
-
Movement-related side effect of Tigan (trimethobenzamide)
Parkinsonism
-
Movement-related side effect of Compazine (prochlorperazine)
Parkinsonism
-
Movement-related side effect of Phenergan (promethazine)
Parkinsonism
-
Duration of medication-induced Parkinsonism
- Typically several weeks
- In some cases, 3-12 months
-
Treatment of medication-induced Parkinsonism
- Stop the offending medication
- Amantadine can be given temporarily (stop after 3 months to see if it is necessary!)
- Do not give dopaminergic medications!
-
What is Multisystem Atrophy?
- Similar to Parkinson Disease, but due to loss of postsynaptic dopamine receptors rather than dopaminergic neurons
- Does not respond to dopaminergic medications
-
How long is L-Dopa effective in Parkinson Disease?
Approximately first 5 years of illness
-
Mechanism of action of Carbidopa
- Reduces metabolism of L-Dopa to dopamine by DOPA decarboxylase
- Does not cross blood-brain barrier, so prevents systemic side effects of L-Dopa
-
Systemic side effects of L-Dopa (3)
- 1. Nausea/vomiting (stimulates emesis center of brain)
- 2. Hypotension
- 3. Arrhythmia
-
Mechanism of action of Selegiline
- Inhibits breakdown of dopamine at usual doses (blocks MAO-B)
- At high doses, blocks MAO-A, which increases serotonin and catecholamine levels
- Breakdown products are similar to amphetamines and cause activation
-
Category of medication used in Parkinson Disease when L-Dopa is no longer effective
Dopamine agonists
-
Mechanism of action of Pramipexole
Dopamine agonist
-
Mechanism of Action of Ropinirole
Dopamine agonist
-
What is Apomorphine?
- Injectable dopamine agonist
- Used in severe Parkinson Disease or NMS
-
Effect of dopamine agonists in Parkinson Disease
Treat only rigidity and bradykinesia, not other symptoms
-
Side effects of dopamine agonists in Parkinson Disease (2)
- 1. Psychotic symptoms (hallucinations, thought disorder)
- 2. Movement disorders (chorea, akithesia, dystonia)
-
Body regions affected by athetosis (3)
- 1. Face
- 2. Neck
- 3. Distal limns
-
Most common cause of athetosis
Cerebral palsy confined to the Basal Ganglia
-
Treatment of athetosis
Dopamine antagonist
-
Illicit drugs that can cause chorea (3)
- 1. Cocaine
- 2. Amphetamine
- 3. Methylphenidate
-
Hormone that can cause chorea
Estrogen
-
Major categories of symptoms in Huntington Disease (3)
- 1. Chorea
- 2. Behavioral disturbances
- 3. Dementia
-
Age of onset of Huntington Disease
Late 30s
-
Life expectancy after Huntington Disease diagnosis
10-20 years
-
What is chorea?
Random, nonstereotyped, rapid jerking movement of the pelvis, trunk, and limbs
-
What is motor impersistence? What does it signify?
- Inability to sustain voluntary muscle contraction
- Sign of chorea
-
Depressed mood in Huntington Disease
- Occurs in half of patients
- Begins early in the illness, sometimes before other symptoms
-
Medications to treat chorea in Huntington Disease (2)
- 1. Antipsychotics (anti-dopamine)
- 2. Tetrabenazine (dopamine depleting)
-
Mechanism of action of Tetrabenazine
Depletes dopamine (predominantly), serotonin, and norepinephrine
-
Medication classes for depressed mood in Huntington Disease (2)
-
Presentation of Juvenile Huntington Disease
Rigidity, dystonia, and akethesia are the presenting symptoms
-
Does Huntington Disease cause seizures?
Juvenile form does, but adult form does not
-
What chromosome is the site of trinucleotide repeats in Huntington Disease?
Chromosome 4 (short arm)
-
How many trinucleotide repeats are required to cause Huntington Disease?
- 35-39 cause mild symptoms, but not the full disease
- 40 or more cause the disease
- 60 or more cause the Juvenile disease
-
Which parent is more likely to have passed Huntington Disease to their children?
Father
-
Site of neuronal death in Huntington Disease, and type of neurons lost
- Striatum, particularly the caudate
- GABAergic neurons are lost
-
MRI appearance of advanced Huntington Disease
Caudate is atrophied, causing lateral ventricles to balloon outward ("bat wing ventricles")
-
PET findings in Huntington Disease
Hypometabolism in the caudate
-
Causes of parkinsonism and mental decline in teenagers (3)
- 1. Wilson disease
- 2. Juvenile Huntington Disease
- 3. Drug abuse
-
Main cause of chorea in childhood
Syndenham Chorea caused by rheumatic fever
-
Who gets Syndenham Chorea?
- Children ages 5-15
- Mainly boys
-
Cause of Syndenham Chorea
Complication of rheumatic fever
-
Course of Syndenham Chorea
- Occurs during or several months after Rheumatic Fever
- Lasts ~2 months
-
Major causes of hyperactivity in children (6)
- 1. ADHD
- 2. Syndenham Chorea
- 3. Tics/Tourette's
- 4. Drug use
- 5. Medication side effects
- 6. Withdrawal-Emergent Syndrome
-
Medications that treat symptoms of Syndenham Chorea (2)
- 1. Valproate
- 2. Dopamine antagonists
-
Treatment of chorea induced by estrogen in OCPs
Resolves after cessation of OCPs
-
Symptoms of Chorea Gravidarum (3)
- 1. Chorea
- 2. Delirium
- 3. Psychosis (sometimes)
-
What artery supplies the Basal Ganglia?
Middle Cerebral Artery
-
Cause of hemiballismus in an HIV patient
Toxoplasmosis lesions in basal ganglia
-
Management of hemiballismus
- Most cases resolve spontaneously
- In persistent cases, dopamine antagonists may help
-
Major sites of copper deposits in Wilson Disease (3)
- 1. Brain
- 2. Liver
- 3. Cornea
-
Brain region damaged in Wilson Disease
Lenticular nuclei
-
Psychiatric symptoms of Wilson Disease (3)
- 1. Personality/behavior changes
- 2. Thought disorder
- 3. Cognitive impairments, culminating in dementia
-
Neurologic signs of Wilson Disease (5)
- 1. Dysarthria
- 2. Dysphagia
- 3. Gait impairment
- 4. Rigidity/dystonia
- 5. Tremor
-
Illness causing a "wing-beating tremor" of up-and-down movement of the arms at the shoulders
Wilson Disease
-
Blood test for Wilson Disease
Ceruloplasmin level (low to absent in Wilson Disease)
-
Urine test for Wilson Disease
24-hour urine copper level
-
Management of Wilson Disease (2)
- 1. Copper chelating agents
- 2. Avoid copper-containing foods
-
Who gets Early-Onset Primary Dystonia?
- Typically starts at age 9-11, but can be as late as age 26
- Predominantly Ashkenazi Jews
-
Progression of Early Onset Primary Dystonia
- Starts with one hand or foot
- Eventually affects other limbs, pelvis, trunk, and neck
- If untreated, becomes incapacitating
-
Inheritance of Early Onset Primary Dystonia
Autosomal dominant
-
Treatment of Early Onset Primary Dystonia
- 1. Dopamine antagonists
- 2. Deep brain stimulation of globus pallidus
-
Presentation of Dopamine-Responsive Dystonia
- Dystonia begins around age 8
- Dystonia is absent in the morning, worsens throughout the day
- Dystonia begins in the legs, eventually becomes generalized
- Often have superimposed parkinsonism
-
Treatment of Dopamine-Responsive Dystonia
L-Dopa
-
Inheritance of Lesh-Nyhan Syndrome
X-linked recessive
-
Age of onset of Lesh-Nyhan Syndrome
2-13 year old boy (very rarely girl)
-
Symptoms of Lesh-Nyhan Syndrome (5)
- 1. Severe self-mutilation (especially biting fingers or lips)
- 2. Mental retardation
- 3. Spasticity
- 4. Seizures
- 5. Dystonia
-
Age of onset of focal dystonias
5th decade or later
-
What is a blepharospasm?
Unprovoked bilateral spasm of eyelid muscles, causing eyes to close for 5 seconds at a time
-
Treatment of blepharospasm
Botox injections
-
What is Meige Syndrome?
Dystonia of the entire face at once
-
Cause of strained voice while speaking, but preserved shouting, singing, and whispering
Spasmotic dysphonia (spasm of the larynx)
-
Presentation of Essential Tremor
- Fine oscillation of wrist, hand, fingers, or legs
- Worse with actions or holding postures
-
Inheritance pattern of Essential Tremor
Autosomal dominant
-
Medications used for Essential Tremor (2)
- 1. Propranolol
- 2. Primidone
-
Medications that cause tremor (7)
- 1. Amiodarone
- 2. Beta agonists
- 3. Amitriptyline
- 4. Lithium
- 5. Valproate
- 6. Antipsychotics
- 7. SSRIs
-
Site of lesion causing tremor of the soft palate
Medulla
-
Change in tics as a patient ages
If tics persist, they tend to move from cehalad to caudal structures
-
Characteristics of tics for diagnosis of Tourette Syndrome (3)
- 1. Both vocal and motor
- 2. Longer than 1 year
- 3. Onset before age 18
-
Age of onset of Tourette Syndrome
- Average age is 6-7
- 90% by age 13
-
Prognosis of Tourette Syndrome
- 1/3 resolve by adulthood
- Further 1/3 improves substantially by adulthood
-
Progression of tics in Tourette Syndrome
- Initially mostly face, eyes, and head
- Later affect neck and shoulders, then arms/hands
- Later in illness, affect trunk and legs
-
Most frequent comorbidity of Tourette Syndrome
ADHD
-
Obsessions in OCD with comorbid Tourette Syndrome
Tend to be related to sex or violence
-
Compulsions in OCD with comorbid Tourette Syndrome
Tend to be simpler compulsions such as checking
-
Drugs that provide symptomatic treatment of tics in Tourette Disorder (3)
- 1. Guanfacine
- 2. Clonidine
- 3. Dopamine antagonists (typical and atypical neuroleptics)
-
Duration of stereotypies after taking cocaine
2-6 days
-
What does it mean when said that myoclonus is "stimulus-sensitive"?
Clonus can be triggered by auditory, tactile, or visual stimuli
-
Cause of delirium with myoclonus
Toxic-metabolic aberrations
-
Psychiatric medications that can trigger clonus (3)
- 1. SSRIs (in serotonin syndrome)
- 2. Lithium
- 3. Clozaril
-
Medications to suppress myoclonus (2)
- 1. Clonazepam
- 2. Valproate
-
How long after starting antipsychotic medication does tardive dyskinesia develop?
- At least 6 months
- Many cases are within 12 months, but can be years later
-
How long after changing antipsychotic dose does acute dyskinesia/dystonia develop?
- Most within 5 days
- Half within 2 days
-
Illicit drug that increases risk of dystonia with antipsychotics
Cocaine
-
What is an oculogyric crisis?
- Form of acute dystonia associated with antipsychotics
- Eyes roll forcefully upward or sideways
- Mandible and neck undergo dystonia, extending the neck and opening or forcibly closing the mouth
-
Medication classes for treatment of dystonia due to antipsychotics (2)
- 1. Anticholinergics
- 2. Antihistamines
-
Treatments for akathisia (3)
- 1. Propranolol
- 2. Clonidine
- 3. Mirtazapine
-
Gender more likely to experience Tardive Dyskinesia
Female
-
Antipsychotic regimen after Tardive Dyskinesia develops
- Taper back slowly; do not stop abruptly!
- May switch to a second-generation medication, particularly clozapine
-
Rate of remission of Tardive Dyskinesia without intervention
35%
-
Medication that can help with Tardive Dyskinesia
Tetrabenazine
-
Side effect of Tetrabenazine
Worsening depressed mood and suicidal ideations
-
Hallmark sign of Tardive Dystonia
Spasm of extensor neck muscles
-
Medications used in Tardive Dystonia (4)
- 1. Anticholinergics
- 2. Clozapine
- 3. Tetrabenazine
- 4. Botulinum toxin injections
-
What is Tardive Akathisia?
Akathisia lasting more than 6 months after an antipsychotic is begun
-
What is Withdrawal-Emergent Syndrome?
Chorea with restlessness occurring within 6 weeks of abrupt cessation of chronically-given antipsychotic medications
-
Duration of symptoms in Withdrawal-Emergent Syndrome
4-12 weeks
-
Movement symptoms of very high doses of SSRI (3)
- 1. Myoclonus
- 2. Tremor
- 3. Akathisia
-
Tremor due to TCAs
- Fine, rapid tremor resembling essential tremor
- Responds to propranolol
-
Which antidepressant can induce parkinsonism?
Amoxapine
-
Motor signs of Lithium overdose
- Coarse tremor (cerebellar dysfunction)
- Truncal ataxia (cerebellar dysfunction)
- Extrapyramidal symptoms (less common)
-
Antiepileptic medication that causes tremor at therapeutic dose
Valproate
-
Medication for treatment of mild lithium tremor
Propranolol
-
Cause of tremor that changes sides when the affected limb is restrained
Psychogenic
-
Cause of tremor whose amplitude increases when weights are placed on the affected limb
Psychogenic
-
Symptoms of catatonia (need 2 of the 5 for diagnosis)
- 1. Catalepsy (waxy flexibility)
- 2. Purposeless excessive motor activity
- 3. Stereotyped movements
- 4. Echolalia
- 5. Echopraxia
-
What is echopraxia?
Involuntary repetition of others' movements
-
-
Drug of abuse whose intoxication can cause catatonia
PCP
-
Group most susceptible to Mass Hysteria
Adolescent females
-
Movement disorders associated with cognitive impairment in young children (3)
- 1. Athetosis
- 2. Lesh-Nyhan Syndrome
- 3. Rett Syndrome
-
Movement disorders associated with cognitive impairment in adolescents (3)
- 1. Huntington Disease
- 2. Subacute Sclerosing Panencephalitis
- 3. Wilson Disease
-
Movement disorders associated with cognitive impairment in adults (3)
- 1. Creutzfeldt-Jakob Disease
- 2. Huntington Disease
- 3. Parkinson Disease
-
Effect of stimulants on tics in Tourette Disorder
When stimulants are first started, there is a transient, mild flare-up of tics that then improves
-
If OCD and Tourette Syndrome co-occur, when do OCD symptoms begin?
After both vocal and motor tics
-
If ADHD and Tourette Syndrome co-occur, when do ADHD symptoms begin?
Prior to Tourette Syndrome symptoms
-
Medication to treat tremor in hypothyroidism
Propranolol
-
Cause of nightmares while taking Levodopa
Nighttime hallucinations (side effect of the medication)
-
Cause of dyskinesia post-ECT
- Liberation of excess dopamine by the ECT
- Treat by reducing dopaminergic medications
-
Effect of antipsychotic medications on Dementia with Lewy Bodies
Exacerbation of parkinsonism
-
Metabolic cause of myoclonus
Uremia
-
Medical condition occurring late in Lesh-Nyhan Syndrome
Renal failure
-
Mechanism of botulinum toxin
Prevents release of ACh from presynaptic neurons
-
Lab finding in acute dystonic reaction to antipsychotics
Highly elevated CK
-
What type of antipsychotic is most likely to cause hyperprolactinemia?
First-generation
-
What neurotransmitter's breakdown produces 5-hydroxyindoleacetic acid?
Serotonin
-
What neurotransmitter's breakdown produces vanillylmandelic acid?
Norepinephrine
-
What neurotransmitter's breakdown produces homovanillic acid?
Dopamine
-
Major neurotransmitter of the globus pallidus
GABA
-
Major neurotransmitter of the subthalamic nucleus
Glutamate
-
Major neurotransmitter of the nucleus basalis of Maynert
ACh
-
What does the AIMS battery evaluate for?
Tardive Dyskinesia
-
Most common CNS tumor in children
Astrocytoma
-
Pathology of astrocytoma in children
- Cystic, noninvasive tumor
- If in the cerebellum, easily removed surgically
- If in brainstem, often inoperable and highly malignant
-
Pathology of astrocytoma in adults
- Predominantly in cerebrum
- Extensive infiltration
-
Treatment of astrocytoma in adults
- Surgery only if surrounding brain can be sacrificed
- Radiation is effective if low-grade
-
Most frequent type of primary brain tumor
Glioblastoma Multiforme
-
Where do glioblastomas typically occur?
Cerebrum
-
Prognosis of glioblastoma
- Poor; 15 month life expectancy
- Grow rapidly and infiltrates widely
-
Pathological appearance of frontal lobe gliomas that have advanced
Cross the corpus callosum to create a "butterfly glioma"
-
Who most often gets meningiomas?
Middle-aged women
-
What cells form glioblastomas?
Astrocytes
-
Who most commonly gets primary cerebral lymphomas?
Immunosuppressed patients
-
Treatment of primary cerebral lymphoma
- Steroids cause temporary remission
- Surgery is not effective
-
Cancers that often metastasize to brain (5)
- 1. Lung
- 2. Breast
- 3. Renal
- 4. Melanoma
- 5. GI
-
Management of cerebral metastases
- Chemotherapy often does not pass the blood-brain barrier
- Steroids and radiotherapy can be palliative
-
Prognosis if cancer has metastasized to the brain
Poor; most survive less than 9 months
-
Concerns regarding ECT if a brain tumor is present (2)
- 1. Tumors may reduce seizure threshold, leading to status epilepticus
- 2. If the tumor is very large, it can cause transtentorial herniation during ECT
-
Who is most likely to develop pseudotumor cerebri?
Overweight young adult women with menstrual irregularity
-
Symptoms of parasaggital meningioma (meningioma of the falx)
- Compresses medial motor cortex
- Spastic paresis of bilateral legs
-
Symptoms of meningioma of the sphenoid wing (3)
- 1. Temporal lobe damage
- 2. Proptosis (due to pressure on the orbit)
- 3. Paresis of eye movement (due to pressure on extraocular muscles)
-
Symptoms of olfactory groove meningioma (3)
- Compresses olfactory and optic nerves:
- 1. Anosmia
- 2. Unilateral blindness
- 3. Frontal lobe dysfunction (if very large)
-
Type of brain tumor most commonly causing rapidly-changing personality changes
Glioblastoma
-
Type of brain tumor most commonly causing rapidly-changing cognitive deficits
Glioblastoma
-
Cause of cognitive decline, paresis, and spasticity 3 months to 5 years after chemotherapy
Loss of oligodendrocytes causes demyelination
-
When does peripheral neuropathy occur with chemotherapy?
During or shortly after treatment
-
Prognosis of chemotherapy-induced peripheral neuropathy
Tends to improve over time
-
Medications that stimulate the CNS vomiting center (3)
- 1. Chemotherapeutic agents
- 2. Opiates
- 3. L-Dopa
-
When do small strokes occur after CNS radiotherapy?
6-18 months after treatment
-
Finding on MRI of patients with CNS radiotherapy-induced cognitive deficits
White matter changes
-
Physical symptoms of whole-brain radiation therapy in childhood
Hypothalamic-pituitary deficiency causes growth retardation, developmental delay, and delayed puberty
-
Cause of increased strokes after radiation therapy of chest and neck
Fibrosis of the extracranial portions of the carotid and vertebral arteries
-
Types/Sites of cancer whose paraneoplastic syndrome includes cerebellar degeneration (3)
- 1. Gynecologic cancers
- 2. Lymphoma
- 3. Small cell tumor of the lung
-
Types of anti-neuronal antibodies in paraneoplastic cerebellar degeneration (2)
-
Cause of memory impairment, irritability, behavioral disturbances, and complex partial seizures
Limbic encephalitis
-
Tumors that cause limbic encephalitis (2)
- 1. Testicular
- 2. Small cell carcinoma of the lung
-
MRI findings in limbic encephalitis
Atrophy of temporal lobes
-
EEG findings in limbic encephalitis
Spikes or slow waves originating in temporal lobes
-
Types of anti-neuronal antibodies causing limbic encephalitis (3)
- 1. Anti-Hu
- 2. Anti-VGKC
- 3. Anti-Ma2
-
Cause of progressive amnesia and behavioral disturbances, followed by psychosis, seizures, involuntary movements, and autonomic instability
Anti-NMDA Receptor Encephalitis (type of paraneoplastic syndrome)
-
MRI findings in anti-NMDA Receptor Encephalitis
None
-
CS findings in anti-NMDA Receptor Encephalitis (3)
- 1. Lymphocytic pleocytosis
- 2. Anti-NMDA antibodies
- 3. Oligoclonal bands
-
Tumor that classically causes anti-NMDA Receptor Encephalitis
Ovarian teratoma
-
Cause of low energy, erectile dysfunction, and gynecomastia in men
Pituitary prolactinoma
-
Cause of low energy, amenorrhea, and galactorrhea in women
Pituitary prolactinoma
-
What is a Chromophobe Adenoma?
Common pituitary adenoma that does not secrete prolactin
-
Medication options for prolactinoma (2)
- 1. Bromocriptine
- 2. Cabergoline
- (Dopamine agonists)
-
What is a craniopharyngioma?
- Large calcified cystic congeintal lesion of Rathke's pouch in the hypothalamus
- Causes endocrine deficiency
-
Presentation of craniopharyngioma in children (3)
- 1. Diabetes insipidus
- Delayed/incomplete...
- 2. Physical maturation
- 3. Sexual maturation
- 4. Mental maturation
-
Presentation of craniopharyngioma in adults (4)
- 1. Impaired libido
- 2. Amenorrhea
- 3. Apathy
- 4. Diabetes insipidus
-
What type of cells proliferate to cause acoustic neuroma?
Schwann cells (not neurons!)
-
Cranial nerves affected by an Acoustic Neuroma (3)
- Trigeminal (5th)
- Facial (7th)
- Acoustic (8th)
-
Hearing-related symptoms of Acoustic Neuroma (2)
- 1. Tinnitus
- 2. Loss of speech discrimination
-
3 most common cancers that metastasize to spine
- 1. Lung
- 2. Breast
- 3. Prostate
-
Pattern of pain if cancer metastasizes to the spinal dura
Local pain as well as pain in affected nerve roots
-
Common sites of tumors causing dermatomyositis (4)
- 1. Lung
- 2. Breast
- 3. Ovary
- 4. Stomach
-
Chemotherapy agent most often associated with polyneuropathy
Vincristine
-
Cause of subdural bleeding
Venous bleeding
-
Cause of epidural bleeding
Arterial bleeding
-
Cause of subarachnoid bleeding
Ruptured berry aneurysm
-
Sites of bleeding due to hypertension or cocaine use (4)
- 1. Basal ganglia
- 2. Thalamus
- 3. Pons
- 4. Cerebellum
-
What is neurocystericosis?
Intracerebral cysts originating from a GI tapeworm infection
-
Types of medication that should be given in the regimen for neurocystericosis (2)
- 1. Antibiotics
- 2. Antiepileptic drugs
-
Symptoms of basilar migraine (2)
- 1. Nausea/vomiting
- 2. Ataxia
-
Who gets glioblastomas?
Older adults
-
What type of tumor can "Tubers" in tuberous sclerosis develop into in CNS?
Glioma
-
Headache in open-angle glaucoma
None!
-
Cause of Abducens (CN6) palsy in Pseudotumor Cerebri
Increased intracranial pressure stretches the nerve, causing palsy
-
CMP abnormality commonly causing delirium in lung cancer
Hypercalcemia
-
Imaging study that shows meningioma most clearly
CT (not MRI!)
-
Who gets cerebellar astrocytomas?
Children
-
Who gets neurocystericosis?
Residents of Central America
-
Effect of tuberculoma at the neuromuscular junction
Enhances reuptake of ACh into the presynaptic neuron, causing weakness
-
-ridol
Drug is a Butyrophenone (type of typical antipsychotic)
-
-perone
Drug is a Butyrophenone (type of typical antipsychotic)
-
What is the mental nerve?
- Branch of CN5
- Provides sensation from skin overlying the chin
-
Appearance of glioblastoma on MRI
Ring-shaped mass lesion
-
Timing of depression in patients with brain tumors
Often arises after surgical excision and worsens with time
-
Age group most susceptible to cognitive impairment after CNS radiation therapy
Young children
-
Electrolyte abnormality in SIADH
Hyponatremia
-
Cause of turbid CSF with highly ↑WBCs, ↑ protein, ↓ glucose, and ↑opening pressure
Bacterial meningitis
-
Cause of turbid CSF with ↑WBCs, slightly ↑protein, and ↓glucose
Viral meningitis
-
Cause of turbid CSF with highly ↑WBCs, highly ↑protein, and slightly ↓glucose
TB or fungal meningitis
-
Cause of clear CSF with slightly to highly ↑WBCs, slightly ↑protein, and normal glucose
Neurosyphilis
-
Cause of clear CSF with barely ↑WBCs, ↑protein, and normal glucose
Guillain-Barré syndrome
-
Hematoma following the contour of the brain on CT
Subdural
-
Hematoma with elliptical shape, not following the contour of the brain on CT
Epidural
-
Cause of multiple cortical lesions with calcifications and without surrounding edema on CT
Cysticercosis
-
Appearance of acute stroke on CT
Affected brain region is darker than adjacent normal brain (due to blood being brighter on CT)
-
Brain lesions that disrupt the blood-brain barrier, allowing contrast to highlight them on CT and MRI (4)
- 1. Neoplasms
- 2. Abscesses
- 3. MS plaques
- 4. Acute infarctions
-
What brain image techniques can show white matter changes?
MRI only!
-
Head imaging technique to diagnose skull fractures
CT (they may not be visible on MRI)
-
MRI finding in Herpes Simplex Encephalitis
Hemorrhages at the base of the brain, particularly the temporal lobes
-
Imaging technique best used to diagnose prolonged postconcussion syndrome
Diffusion Tensor Imaging (DTI)
-
Endogenous enzymes that metabolize dopamine (2)
- 1. Monoamine Oxidase (MAO) (intracellular)
- 2. Catecholamine-o-Methyltransferase (COMT) (extracellular)
-
What are the 3 "long dopamine tracts" in the CNS?
- 1. Nigrostriatal tract
- 2. Mesolimbic tract
- 3. Mesocortical tract
-
Type of dopamine receptors in the striatum targeted by the Nigrostriatal Tract
D2
-
Origin and target of the Mesolimbic Tract
- Originates at the ventral tegmental area
- Target is the limbic system, especially the amygdala
-
Which dopaminergic tract is the source of positive symptoms of psychotic illnesses?
Mesolimbic Tract
-
Type of dopamine receptors in the limbic system
D4
-
Origin and target of the Mesocortical Tract
- Originates at the ventral tegmental area
- Target is mostly frontal cortex, partially cingulate and prefrontal gyri
-
Which dopaminergic tract is the source of negative symptoms of psychotic illness?
Mesocortical Tract
-
What is the Tuberoinfundibular Tract?
- Short dopamine tract from hypothalamus to the pituitary gland
- Inhibits prolactin release
-
Effects of blockade of D2, D3, and/or D4 receptors by antipsychotics (3)
- 1. Parkinsonism
- 2. Increase in prolactin
- 3. Risk of tardive dyskinesia
-
What medication is Risperdal's active metabolite?
Paliperidone (Invega)
-
Atypical antipsychotics that most often cause elevated prolactin (2)
-
Antipsychotic that has little activity in D2, D3, or D4 receptors
Clozaril
-
Which dopamine receptors are strongly antagonized by phenothiazines?
D1, D2, D3, D4, and D5
-
Which dopamine receptors are strongly antagonized by butyrophenones?
D2, D3, and D4 (effects on D1 and D5 are weaker)
-
Types of dopamine receptors with high concentration in striatum
D1, D2, D3, D4, and D5
-
Types of dopamine receptors with high concentration in the limbic system
D1 and D5
-
Types of dopamine receptors with high concentration in cortex
D1 and D2
-
Types of dopamine receptors with high concentration in Substantia Nigra
D2, D3, and D4
-
Effect of Phenylketonuria on appearance
- Inability to produce tyrosine leads to no melanin production
- Fair complexion, blond hair, and blue eyes
-
Mechanism of action of entacapone
- Reduces metabolism of L-Dopa to dopamine by COMT
- Does not cross blood-brain barrier, so prevents systemic side effects of L-Dopa
-
Antidepressant that can inhibit dopamine reuptake
Wellbutrin
-
Pathway of synthesis of Epinephrine/Norepinephrine (2)
- 1. Dopamine converted to Norepinephrine (by Dopamine β-hydroxylase)
- 2. Norepinephrine converted to Epinephrine (by Phenylethanolamine N-methyltransferase)
-
Endogenous enzymes that metabolize Norepinephrine (2)
- 1. Monoamine Oxidase (MAO) (intracellular)
- 2. Catecholamine-o-Methyltransferase (COMT) (extracellular)
-
Endogenous enzymes that metabolize Epinephrine (2)
- 1. Monoamine Oxidase (MAO) (intracellular)
- 2. Catecholamine-o-Methyltransferase (COMT) (extracellular)
-
Where is most norepinephrine produced?
Outside the CNS
-
Main CNS site of norepinephrine production
Locus ceruleus (dorsal pons)
-
Targets of noradrenergic tracts of the CNS (4)
- 1. Cortex
- 2. Limbic system
- 3. Reticular activating system
- 4. Spinal cord
-
Neurotransmitter of sympathetic nervous system's postganglionic neurons
Norepinephrine
-
Role of α2 and β2 norepinephrine receptors
- Presynaptic
- When activated, reduce norepinephrine synthesis and release
-
Effect of stimulation of the α1 noradrenergic receptor
Vasoconstriction
-
Effect of stimulation of the α2 noradrenergic receptor
Vasodilation, hypotension
-
Effect of stimulation of the β1 noradrenergic receptor
Cardiac stimulation
-
Effect of stimulation of the β2 noradrenergic receptor
Bronchodilation, increased tremor
-
What receptor is targeted by Clonidine?
Presynaptic α2 noradrenergic receptor (agonist)
-
Pathway of synthesis of Serotonin (2)
- 1. Tryptophan to 5-hydroxytryptophan (Tryptophan hydroxylase)
- 2. 5-hydroxytryptophan to 5-hydroxytryptamine/5-HT/serotonin (Amino acid decarboxylase)
-
What chemical is produced when serotonin is broken down by MAO?
5-hydroxyindoleacetic acid (5-HIAA)
-
What neurotransmitters are catecholamines? (3)
- 1. Epinephrine
- 2. Norepinephrine
- 3. Dopamine
-
What neurotransmitter is an indolamine?
Serotonin
-
What are the subgroups of monoamine neurotransmitters? (2)
- 1. Catecholamines
- 2. Indolamines
-
What is the rate limiting step in Serotonin synthesis?
Conversion of Tryptophan to 5-hydroxytryptophan by tryptophan hydroxylase
-
Which type of Monoamine Oxidase breaks down dopamine?
Predominantly MAO-B, but also MAO-A
-
Which type of Monoamine Oxidase breaks down serotonin?
MAO-A
-
What chemical is produced when serotonin is broken down by enzymes other than MAO?
Melatonin
-
Main targets of serotonergic neurons from the Dorsal Raphe (4)
- 1. Cortex
- 2. Cerebellum
- 3. Limbic system
- 4. Striatum
-
Main target of serotonergic neurons from the Caudal Raphe
Dorsal horn of the spinal cord (provide analgesia)
-
Generally, what is the role of 5-HT1 receptors?
Inhibitory
-
Generally, what is the role of 5-HT2 receptors?
Excitatory
-
Action of the 5-HT1D receptor
- Presynaptic autoreceptor
- Inhibits production and release of serotonin
-
Pattern of serotonin level in the sleep-wake cycle
- Highest while awake
- Low in slow wave sleep
- Absent in REM sleep
-
Serotonin level in Parkinson Disease
- Low
- Even lower in patients with comorbid depression
-
Serotonin level in Alzheimer Disease
Low
-
What receptors do Triptans target? (2)
- 1. 5-HT1B (agonist) (inhibits presynaptic neurotransmitter release)
- 2. 5-HT1D (agonist) (inhibits presynaptic neurotransmitter release)
-
What receptor does Zofran target?
5-HT3 (antagonist)
-
Generally, what is the role of 5-HT receptors other than 5-HT1 or 5-HT2?
Excitatory
-
Receptors targeted by 2nd Generation Antipsychotics (2)
- 1. 5-HT2A (antagonist)
- 2. D2 (antagonist)
-
Receptor targeted by LSD
5-HT2 (agonist)
-
Mechanism of action of MDMA (2)
- 1. Enhances presynaptic release of serotonin
- 2. Stimulates dopaminergic activity
-
Pathway of synthesis of Acetylcholine
Acetyl CoA and Choline to ACh (choline acetyltransferase)
-
Reuptake of ACh from synapses
Does not happen! All ACh is broken down by acetylcholinesterase
-
Main targets of cholinergic neurons in the brain (3)
- 1. Hippocampus
- 2. Amygdala
- 3. Cortical association areas
-
What type of ACh receptor predominates in the cerebral cortex?
Muscarinic
-
Are ACh receptors in the cerebral cortex inhibitory or excitatory?
Either, depending on the neuron
-
Medications that block ACh receptors in cerebral cortex (2)
- 1. Atropine
- 2. Scopalamine
-
Mechanism of action of curare
Blocks postsynaptic ACh receptors at the neuromuscular junction
-
Cause of asymmetric paresis of extraocular and facial muscles, but not pupils
Myasthenia gravis
-
Effect of Alzheimer Disease on the cholinergic system of the brain
ACh concentration, choline acetyltransferase activity, and ACh receptors are all reduced
-
Illnesses in which cortical ACh is low (5)
- 1. Alzheimer Disease
- 2. Down Syndrome
- 3. Parkinson Disease
- 4. Progressive Supranuclear Palsy (PSP)
- 5. Delirium
-
Anticholinergic side effects (4)
- 1. Dry mouth
- 2. Urinary hesitancy
- 3. Constipation
- 4. Accommodation paresis
-
What types of psychiatric medications cause anticholinergic side effects? (2)
- 1. Typical antipsychotics
- 2. Tricyclics
-
Symptoms of anticholinergic syndrome (7)
- 1. Dilated pupils
- 2. Tachycardia
- 3. Hypertension
- 4. Dry skin
- 5. Hyperthermia
- 6. Delirium
- 7. In severe cases, coma
-
Which antipsychotics are most likely to cause anticholinergic side effects? (2)
- 1. Clozapine
- 2. Olanzapine
-
Pathway of synthesis of GABA
Glutamate to GABA (glutamate decarboxylase and Vitamin B6)
-
Clearance of GABA from the synapse
By reuptake or metabolism by several enzymes
-
Sites of highest GABA concentration in CNS (4)
- 1. Striatum
- 2. Hypothalamus
- 3. Spinal cord
- 4. Temporal lobe
- (of note, GABA is found throughout the CNS!)
-
What receptor does alcohol bind to?
GABA A
-
What receptor do benzodiazepines bind to?
GABA A
-
What receptor do barbiturates bind to?
GABA A
-
Action of the GABA A receptor
Opens a chloride channel, hyperpolarizing the postsynaptic neuron
-
Action of the GABA B receptor
GPCR that eventually has an inhibitory effect
-
Mechanism of action of Baclofen
- Binds GABA B
- Counteracts spasticity, dystonia, and neuropathic pain
-
Effect of Huntington Disease on GABA
Depleted in basal ganglia, reducing inhibition
-
Cause of Stiff-Person Syndrome
Anti-GAD (glutamate decarboxylase) antibodies reduce GABA synthesis, causing muscle stiffness
-
Treatment of Stiff-Person Syndrome (2)
- 1. Diazepam
- 2. Immunomodulation
-
Treatment of seizures caused by Isoniazid overdose
Vitamin B6 infusion
-
Effect of Valproic Acid on GABA
Increases GABA concentration in brain
-
Effect of Topiramate on GABA
Enhances GABA-A receptor activity
-
Mechanism of action of Flumazenil
- Blocks the action of GABA at its receptor
- Reverses effects of benzodiazepines
- Treats hepatic encephalopathy
-
Pathway of synthesis of Glycine
Serine to Glycine (hydroxymethyl transferase)
-
Major sites of action of Glycine in CNS (2)
- 1. Ventral horn of spinal cord (inhibits motor neurons)
- 2. Brainstem
-
Pathway of synthesis of Glutamate
Glutamine to Glutamate (glutaminase)
-
Clearance of glutamate from the synapse
Reuptake into presynaptic neurons and to adjacent support cells
-
Action of Astartate as a neurotransmitter
Excitatory
-
What neurotransmitters bind the NMDA receptor? What is its overall function?
- Binds glutamate and glycine
- Excitatory (opens calcium channel)
-
What drugs of abuse are NMDA antagonists? (2)
-
Mechanism of action of Riluzole
NMDA antagonist
-
Pathway of synthesis of Nitric Oxide
Arginine and Oxygen to Nitrous Oxide and Citrulline (nitric oxide synthase)
-
What is depleted with chronic Nitrous Oxide abuse?
Vitamin B12
-
Mechanism of action of cocaine (4)
- 1. Causes release of dopamine from presynaptic storage vesicles
- 2. Blocks dopamine reuptake
- 3. Blocks serotonin reuptake
- 4. Blocks norepinephrine reuptake
-
Sympathomimetic effects of cocaine (4)
- 1. Pupillary dilation
- 2. Hypertension
- 3. Vasospasm
- 4. Arrhythmia
-
Half-life of cocaine
30-90 minutes
-
Metabolism of cocaine
By hepatic and plasma enzymes
-
How long after use can a urine toxicology detect cocaine?
2 days
-
Effect of cocaine on sleep
- Reduced overall sleep
- Suppresses REM sleep; on discontinuation, REM rebound occurs
-
Presentation of cocaine overdose
Agitated, paranoid, irrational, and hallucinatory
-
Medical complications of cocaine overdose (3)
- 1. Stroke (in ~2 hours)
- 2. Myocardial infarction
- 3. Seizure (in ~2 hours)
-
What type of stroke is most common if caused by cocaine?
Hemorrhagic (due to HTN)
-
Effects of cocaine on neuroleptics (2)
- 1. Increases sensitivity to dystonic reactions
- 2. Both reduce the seizure threshold
-
What class of medications should be given for hypertensive urgency/emergency due to cocaine use?
α-blocker
-
Symptoms of cocaine withdrawal (2)
- 1. Dysphoria (low energy, anhedonia, etc.)
- 2. Vivid, disturbing dreams
-
Mechanism of action of amphetamines (3)
- 1. Provokes dopamine release
- 2. Blocks dopamine reuptake
- 3. Increases noradrenergic activity
-
Effects of amphetamines on sleep (2)
- 1. Reduced total sleep
- 2. Suppress REM sleep
-
Half-life of amphetamines
- 8 hours (amphetamine)
- 12 hours (methamphetamine)
-
Presentation of amphetamine overdose
- Thought disorder
- Hallucinations
- Dyskinesias/stereotypies
-
Treatment of cocaine overdose
- Mostly behavioral (seclusion, etc.)
- Neuroleptics if necessary
-
Treatment of amphetamine overdose
Neuroleptics
-
Mechanism of action of MDMA
Causes release of presynaptic serotonin stores
-
Somatic symptoms of MDMA use (4)
- 1. Dry mouth
- 2. Sweating
- 3. Bruxism
- 4. Hyperthermia
-
Classic triad of opiate overdose
- 1. Coma
- 2. Miosis
- 3. Respiratory depression
-
Use of naltrexone in opiate abuse
Can be taken orally for extended times to block the opiate receptor
-
Timing of methadone withdrawal
- Starts 1-2 days after the last dose
- Peaks at 6 days
-
Mechanism of clonidine
α2 agonist
-
Role of clonidine in opiate withdrawal
Can alleviate autonomic hyperactivity
-
Medications that reduce methadone levels (2)
- 1. Phenytoin (Dilantin)
- 2. Carbamazepine (Tegretol)
-
Symptoms of PCP at low doses (3)
- 1. Euphoria
- 2. Dysarthria/ataxia
- 3. Nystagmus
-
Symptoms of PCP at high doses (3)
- 1. Disorganized/bizarre thinking
- 2. Visual hallucinations
- 3. Both positive and negative symptoms of schizophrenia
-
Symptoms of PCP overdose (4)
- 1. Muscle rigidity (can cause rhabdomyalysis)
- 2. Bursts of horizontal and vertical nystagmus
- 3. Stereotypies
- 4. Seizures
-
Treatment of PCP intoxication
- Seclusion and sedation
- Neuroleptics may increase muscle rigidity, and should be used only in extreme situations!
-
Mechanism of GHB
GABA agonist; reduces activity of dopaminergic neurons
-
Effects of marijuana on sleep
Reduces REM sleep
-
Duration of marijuana
- 1-3 hours with light use
- 1-2 days with heavy use
-
Mechanism of nicotine
Binds nicotinic cholinergic receptors, activating dopaminergic neurons in the mesolimbic system and frontal coertex
-
Mechanism of action of Varenicline (Chantix)
Partial agonist of nicotinic cholinergic receptors
-
Mechanism of Wellbutrin in smoking cessation (2)
- 1. Nicotinic receptor antagonist
- 2. Inhibits dopamine reuptake
-
Mechanism of action of "Bath Salts"
Inhibit dopamine and norepinephrine reuptake
-
Cause of Parkinsonism in heroin users
Heroin contaminated with MPTP, which destroys nigrostriatal neurons
-
Which antipsychotics have the most potent anti-muscarinic effects (and therefore the least EPS) (2)
- 1. Clozapine
- 2. Olanzapine
-
What chemical's concentration is low in CSF in violent suicides?
5-HIAA
-
Mechanism of action of Tranylcypromine
MAO-A antagonist
-
Medication used to treat Neuroleptic Malignant Syndrome
Dantrolene
-
Most common type of GABA receptor
GABA A
-
Treatment of mild serotonin syndrome
Supportive only
-
Treatment of cocaine-induced psychosis and violent behavior
Dopamine-blocking neuroleptic
-
Mechanism of action of tizanidine
- α2 agonist
- Alleviates spasticity
-
Duration of unconsciousness that qualifies as severe TBI
12 hours
-
Method of neuronal death after trauma
Necrosis
-
Predominant type of inflammatory cell that infiltrates brain tissue after trauma
Monocytes
-
Imaging modality that shows diffuse axonal shearing after TBI
- Diffusion tensor imaging
- CT and MRI do not show this damage!
-
Innermost layer of the meninges
Pia mater
-
Which space is CSF found in?
Subarachnoid
-
At what height in the spinal column is the conus medularis?
T12 to L1
-
Artery whose laceration causes an epidural hematoma in a temporal bone fracture
Middle meningeal artery
-
Type of intracranial hematoma that causes transtentorial herniation if not treated surgically
Epidural
-
Cause of unconsciousness, followed by a lucid interval, then decerebrate posture following head injury
Epidural hematoma
-
Course of bleeding in a subdural hematoma
- Bridging veins are damaged and begin to bleed slowly
- Bleeding is usually stopped by brain tissue
- If bleeding continues, transtentorial herniation or cerebellar herniation through the foramen magnum can occur
-
Presentation of acute subdural hematoma
Headache, confusion, and deteriorating level of consciousness over 1-2 days
-
Duration of bleeding in a chronic subdural hematoma
Several weeks
-
Presentation of chronic subdural hematoma
- Insidious headache, change in personality, and cognitive impairment
- Subtle physical deficits may be present
-
Duration for most comatose patients to die, improve, or enter a vegetative state
4 weeks
-
Typical time to reach maximum physical recovery after TBI
6 months
-
Brain region whose traumatic injury disrupts the sleep wake cycle
Hypothalamus
-
Frequency of Post-Traumatic Epilepsy after a head trauma
- After major head trauma, ~50%
- After minor head trauma, rare
-
When do Immediate Posttraumatic seizures occur?
Within 24 hours of TBI
-
When do Early Posttraumatic seizures occur?
Within 7 days of TBI
-
Typical time to reach maximum cognitive recovery after TBI
18 months
-
Typical time to reach maximum motor and language recovery after TBI
6 months
-
Classes of medications that can help memory after TBI (2)
- 1. Anticholinesterases
- 2. Dopaminergics (especially methylphenidate)
-
Types of medications to treat aggression in TBI (3)
- 1. β blockers
- 2. Antidepressants
- 3. Antiepileptics
-
Class of antidepressants most commonly used in Depression following TBI
SSRIs
-
Medication regimen for psychosis following TBI
Antipsychotic with co-administered antidepressant or mood stabilizer
-
Age before which the nondominant hemisphere can assume control of language after TBI
5
-
How long can amnesia persist for head trauma to be classified as Minor?
No longer than 24 hours
-
Physical symptoms of concussion (5)
- 1. Nausea/vomiting
- 2. Impaired tandem gait
- 3. Diplopia (damage to CN4)
- 4. Dizziness (damage to labyrinthine system)
- 5. Headache
-
Duration of physical symptoms after concussion
~1 week
-
What is Second Impact Syndrome?
Potentially fatal cerebral edema caused by a second head injury within days of a concussion
-
Core Symptoms of Postconcussion Syndrome (3)
- 1. Dull, generalized headache
- 2. Memory impairment
- 3. Insomnia with sleepiness not relieved by sleep
- (must last more than 2-3 months)
-
Duration of postconcussive symptoms in uncomplicated cases
~3 months
-
Duration of pain following Whiplash injuries
- Most cases last 3-6 months
- 20% last 2 years or longer
-
What type of amnesia is most common in TBI?
Anterograde
-
Most common type of seizure in Posttraumatic Epilepsy
Partial with secondary generalization
-
Most reliable indicator of TBI sequelae
Duration of retrograde amnesia
-
Correlation between location of traumatic brain lesion and level of impairment
Poor, with exception of left temporal lesions causing language deficits
-
Cutaneous side effects of Lithium (4)
- 1. Acne
- 2. Follicular eruptions
- 3. Macropapular eruptions
- 4. Allopecia
-
Major side effects of Lithium (7)
- 1. GI compliants
- 2. Tremor
- 3. Diabetes Insipidus
- 4. Hypothyroidism
- 5. Weight gain
- 6. Arrhythmia
- 7. Edema
-
Side effects of Lamotrigine (5)
- 1. Stevens-Johnson Syndrome
- 2. Anemia
- 3. Thrombocytopenia
- 4. Liver failure
- 5. Pancreatitis
-
Method by which benzodiazepine overdose causes death
Respiratory suppression
-
Major side effects of Risperdal (6)
- 1. EPS
- 2. NMS
- 3. Metabolic syndrome
- 4. GI upset
- 5. Hypersalivation
- 6. Lactation
-
Major side effects of Oxcarbazepam (3)
- 1. Leulopenia
- 2. Thrombocytopenia
- 3. Stevens Johnson Syndrome
-
According to attachment theory, what does a mother provide? (2)
-
What theory did John Bowlby develop?
Attachment Theory
-
In attachment theory, what is Bonding?
Mother's feelings for the infant
-
Symptoms of lesion of the Medial Frontal Cortex (2)
- 1. Apathy
- 2. Limited spontaneous movements, gestures, or speech
-
Psychiatric symptom of lesion of the left frontal lobe
Depression
-
Psychiatric symptom of lesion of the right frontal lobe
Mania
-
What is Ailurophobia?
Far of cats
-
What is another term for Cohort Study?
Longitudinal Study
-
Are Case-Control studies prospective or retrospective?
Always retrospective
-
What concepts is Winnicott known for? (2)
- 1. "Good Enough Mothering"
- 2. Transitional objects
-
What are Piaget's stages of cognitive development? (4)
- 1. Sensorimotor
- 2. Preoperational thought
- 3. Concrete operations
- 4. Formal operations
-
What are Freud's stages of development? (4)
- 1. Oral
- 2. Anal
- 3. Phallic
- 4. Latency
-
What are Mahler's Stages of Separation? (6)
- 1. Normal autism
- 2. Symbiosis
- 3. Differentiation
- 4. Practicing
- 5. Rapprochment
- 6. Object Constancy
-
What are Erikson's Stages? (8)
- 1. Trust vs. Mistrust
- 2. Autonomy vs. Shame and Doubt
- 3. Initiative vs. Guilt
- 4. Industry vs. Inferiority
- 5. Identity vs. Role Diffusion
- 6. Intimacy vs. Self Absorption
- 7. Generativity vs. Stagnation
- 8. Integrity vs. Despair and Isolation
-
Autopsy finding in Wernicke's Encephalopathy
Microhemorrhages in the Periventricular Gray matter, especially near the aqueduct and 3rd/4th ventricles
-
Autopsy finding in Pick's Dementia
Frontal and temporal lobe atrophy
-
Cause of "Dawson's Fingers" on autopsy or MRI
Demyelinating diseases, especially Multiple Sclerosis
-
What are "Dawson's Fingers"?
- Subcortical white matter lesions of the brain
- Located perpendicular to the ventricles
-
Which type of Monoamine Oxidase breaks down norepinephrine?
MAO-A
-
How long a "washout" is required when switching from an SSRI to an MAOI?
- 14 days for most SSRIs (and most other medications)
- 28 days for fluoxetine
-
Major side effects of MAOIs (5)
- 1. Orthostatic hypotension
- 2. Weight gain
- 3. Edema
- 4. Sexual dysfunction
- 5. Insomnia
-
Which MAOIs do not require a tyramine-free diet at low doses? (2)
- 1. Moclobemide (not used in US)
- 2. Selegiline
-
Atypical antipsychotics that can be given in a rapid-release injectable (2)
- 1. Olanzapine (Zyprexa)
- 2. Ziprasidone (Geodon)
-
What is Resistance?
Ideas that are unacceptable to the patient are prevented from reaching awareness
-
What is Confrontation?
Addressing an issue that a patient does not wish to accept
-
What ages constitute Middle Adulthood?
40-65
-
What is the task of the end of Early Adulthood?
Review the past and decide what the future will hold
-
Life tasks faced in Middle Adulthood (4)
- 1. Take stock of accomplishment
- 2. Reassess commitment to family and work
- 3. Use power ethically
- 4. Deal with parents' illness
-
Tasks whose completion signifies the beginning of adulthood (3)
- 1. Selecting a mate
- 2. Choosing an occupation
- 3. Achieving independence and self-sufficiency
-
What is Primary Prevention?
Preventing the onset of a disease
-
What is Secondary Prevention?
Identifying a disease in early stages to provide prompt treatment
-
What is Tertiary Prevention?
Reducing deficits caused by an illness to maximize functioning
-
Classic EMG change in Lambert-Eaton Syndrome
Dramatic decrease in amplitude of motor action potentials with repeated stimulation
-
What illness is Acute Inflammatory Demyelinating Polyneuropathy (AIDP) a severe form of?
Guillain-Barré Syndrome
-
Nerve Conduction Study findings in Guillain-Barré Syndrome (3)
- 1. Loss of H Reflex
- 2. Decreased nerve conduction velocities
- 3. Prolonged F-wave latency
-
Neurological illness causing atrophy/thinning of the Corpus Callosum
Multiple Sclerosis
-
Is it ethical for psychiatrists to participate in executions?
No!
-
Is it ethical to accept commission for patient referrals?
No!
-
What is required of a psychiatrist when retiring? (2)
- 1. Give patients sufficient notice
- 2. Make an effort to find follow-up care for patients
-
What concept was developed by Skinner?
Operant Conditioning
-
What form of conditioning involves positive and negative reinforcement?
Operant Conditioning
-
What concept was developed by Bandura?
Social Learning Theory
-
What is the concept underlying Social Learning Theory?
People learn by social interaction and modeling others
-
What is the concept underlying Attribution Theory?
People attribute their own behavior to situational causes, but the behavior of others to personality traits
-
What concept was developed by Hull?
Drive Reduction theory of learning
-
What concept was developed by Seligman?
Learned Helplessness
-
What is Learned Helplessness?
Learning that no behavioral change can affect the environment
-
What concepts were developed by Kandel?
Habituation and Sensitization Theories
-
What is the concept underlying Habituation Theory?
An organism can learn to stop responding to a repeated stimulus
-
What is the concept underlying Sensitization Theory?
An organism can be taught to respond more easily to a stimulus
-
What types of seizures can Valproic Acid treat? (3)
- 1. Partial complex
- 2. Primary generalized
- 3. Absence
-
When is Diazepam used in seizures?
Emergencies, eg status epilepticus
-
Are attacks of sleep in narcolepsy refreshing?
Yes!
-
How often must sleep attacks occur for diagnosis of narcolepsy?
3 months
-
Sleep changes associated with depressed mood (2)
- 1. Early morning waking
- 2. Difficulty staying asleep
-
Neurotransmitter associated with onset of aggression
Dopamine
-
Neurotransmitters associated with decreased aggression (3)
- 1. Serotonin
- 2. GABA
- 3. Norepinephrine
-
What medication induces its own metabolism?
Carbamazepine
-
Best way to prevent a behavior from extinction
Intermittent and variable positive reinforcement
-
How is extinction of a behavior effected?
Conditioned stimulus is repeated without the unconditioned stimulus until the response disappears
-
In conditioning, what is Generalization?
Transfer of a conditioned response from one stimulus to another
-
In conditioning, what is Discrimination?
Recognizing and responding to differences between similar stimuli
-
What is Respondent Conditioning?
Another term for Classical Conditioning
-
Classic neurologic features of Tuberous Sclerosis (3)
- 1. Seizures
- 2. Mental retardation
- 3. Behavioral problems
-
Tumors associated with Neurofibromatosis 1 (3)
- 1. Optic glioma
- 2. Schwannoma
- 3. Neurofibroma
-
What chromosome contains the NF1 gene (responsible for Neurofibromatosis 1)?
Chromosome 17
-
What chromosome contains the NF2 gene (responsible for Neurofibromatosis 2)?
Chromosome 22
-
What protein is affected in Williams Syndrome?
Elastin
-
Mechanism of action of Tacrine
Cholinesterase inhibitor
-
Mechanism of action of Galantamine
Cholinesterase inhibitor
-
Mechanism of action of Rivastigmine
Cholinesterase inhibitor
-
What does the Trail-Making Test evaluate?
Executive function
-
What does the Wisconsin Card Sorting Test evaluate?
Executive function
-
What is theThematic Apperception Test?
- Make up stories based on pictures
- Accepted traits are attributed to characters most physically like the patient
- Unconscious/unaccepted traits are attributed to characters most physically unlike the patient
-
What does the Halstead-Reitan Battery evaluate? (2)
- 1. Presence or absence of neurological damage
- 2. Location of lesions in brain
-
Requirements to have capacity to make a will (3)
- 1. Ability to understand nature and extent of one's property
- 2. Know that one is making a will
- 3. Know to whom the property will be bequeathed
-
Average age of puberty for boys
13
-
Average age of puberty for girls
11
-
FSH and LH levels in adolescence
Increase throughout teenage years, above normal adult levels around ages 17-18
-
Contraindications for triptans (2)
- 1. Coronary artery disease
- 2. HTN
- (Triptans have a risk of vasospasm causing MI)
-
Medications that increase TCA levels by altering p450 (9)
- 1. Antipsychotics (!)
- 2. Methylphenidate (!)
- 3. Acetazolamide
- 4. Aspirin
- 5. Cimetidine
- 6. Thiazides
- 7. Fluoxetine
- 8. Sodium bicarbonate
-
Medications and other substances that decrease TCA levels by altering p450 (5)
- 1. Cigarette smoking
- 2. Ascorbic acid
- 3. Lithium
- 4. Barbiturates
- 5. Primidone
-
Most common method of suicide by adolescents
Self-inflicted gunshot wound
-
What age group has recently had an increase in suicide?
Adolescents
-
Highest risk period for suicide in men
After age 45
-
Highest risk period for suicide in women
After age 55
-
What race are most likely to commit suicide?
Caucasian
-
What social status are most likely to commit suicide?
High social status (direct relation between social status and suicide rate!)
-
What therapy did Marsha Linehan develop?
DBT
-
Effect of first generation antipsychotics and risperidone on pituitary microadenomas
Block dopamine and increase prolactin levels, causing volume of the adenoma to increase
-
Treatment of enlarging pituitary microadenoma in the setting of antipsychotic use (2)
- 1. Stop the antipsychotic
- 2. (possibly) give bromocriptine
-
What is "Amok"?
- Malaysian cultural syndrome
- Sudden rampage of suicide and homicide ending in exhaustion and amnesia
-
What is "Koro"?
- Asian cultural syndrome
- Delusion that the penis will disappear into the abdomen, causing death
-
What is "Piblokto"?
- Inuit cultural syndrome occurring in women
- Anxiety, depression, confusion, depersonalization, and deprealization
- Ends in stuporous sleep and amnesia
-
What is "Wihtigo"?
- Native American cultural syndrome
- Delusional fear of being turned into a cannibal by being possessed by a supernatural monster
-
What is "Mal de Ojo"?
- Mediterranean cultural syndrome
- Belief that vomiting, fever, and restless sleep are caused by "the evil eye"
-
What is Hoffman's Sign?
- Thumb adducts when the index or middle finger is flicked downward
- Upper motor neuron sign
-
What is Meyerson's Sign?
Blinking when the forehead is tapped that does not extinguish after several taps
-
How does excitotoxicity cause cell death?
Causes excessive intracellular calcium and nitric oxide
-
Major sites of glutamate in the brain (6)
- 1. Cerebellum (granular cells)
- 2. Striatum
- 3. Hippocampus
- 4. Cortex (pyramidal cells)
- 5. Thalamocortical projections
- 6. Corticostriatal projections
-
What brainstem reflexes may be present for diagnosis of brain death?
None!
-
Must eyes be open or closed for diagnosis of brain death?
Either!
-
What EEG activity may be present for diagnosis of brain death?
Positive activity may be present
-
How is diazepam cleared?
Hepatic
-
Neurotransmitters associated with anxiety (3)
- 1. Norepenephrine
- 2. Serotonin
- 3. GABA
-
Concern with Myesthenia Gravis in pregnancy
Anti-nicotinic adrenergic receptor antibodies cross placenta, causing symptoms in the baby at birth
-
What class of medication is Azathioprine?
Immunosuppressant
-
Tests to diagnose Myasthenia Gravis (3)
- 1. EMG
- 2. Edrophonium test
- 3. Nerve conduction study (decrementing on repeated muscle stimulation)
-
What is Gower's Sign?
- Patient gets up from the floor using hands, walking the hands up the legs
- Sign of a myopathy, especially Muscular Dystrophy
-
Where is muscle weakness usually greatest in Duchenne Muscular Dystrophy?
Proximally
-
Reflex preserved in Duchenne Muscular Dystrophy
Achilles reflex
-
Lab finding in Duchenne Muscular Dystrophy
CPK
-
Antidepressants that are sedating (3)
- 1. TCAs
- 2. Trazodone
- 3. Mirtazapine
-
Most sedating TCAs (3)
- 1. Amitriptyline
- 2. Trimipramine
- 3. Doxepin
-
Least sedating TCAs (2)
- 1. Desipramine
- 2. Protriptyline
-
What is fetishism?
- Sexual arousal from an inanimate object
- Must occur for at least 6 months for diagnosis
-
What is Jaw Claudication?
- Tiredness on chewing
- Classic sign of Temporal Arteritis
-
Who pioneered the concept that mental disorders have different outcomes?
Kraepelin
-
Who first differentiated between schizophrenia and bipolar disorder?
Kraepelin
-
Who coined the term Schizophrenia?
Bleuler
-
What theory did Winnicott help develop?
Object Relations
-
What concepts did Winnicott develop? (2)
- 1. "Good enough mothering"
- 2. Transitional object
-
What theory did Kohut help develop?
Self Psychology (specifically with narcissism)
-
What is the more common name of Briquet's Syndrome?
Hypochondriasis
-
When in the year do Cluster Headaches tend to occur?
Spring and Fall
-
What is a Chronic Cluster Headache?
A period of attacks lasts at least a year with remission periods lasting less than 2 weeks at a time
-
When in the day do Cluster Headaches occur?
Night time
-
Effect of EtOH on Cluster Headaches
Triggers headaches
-
Cause of a headache in which the patient moves their head or paces rather than sitting still
Cluster Headache
-
Effect of Bupropion on weight
Causes weight loss
-
Effect of Bupropion on blood pressure
Elevates BP, but does *not* cause hypertensive crises and is *not* contraindicated in patients with HTN
-
Effect of Venlafaxine on blood pressure
- Can cause hypertension
- In some cases, can cause a hypertensive crisis
-
What anesthesia can not be given with an MAOI?
Spinal anesthetics with epinephrine
-
What drug of abuse causes peripheral neuropathy?
Inhalants
-
Medications that increase TCA levels (8)
- 1. Methylphenidate
- 2. Antipsychotics
- 3. Acetazolamide
- 4. Aspirin
- 5. Cimetidone
- 6. Thiazides
- 7. Fluoxetine
- 8. Sodium bicarbonate
-
Effect of smoking on TCA levels
Lowers levels
-
Medications that lower TCA levels (4)
- 1. Ascorbic acid
- 2. Lithium
- 3. Barbiturates
- 4. Primidone
-
SSRI with longest half-life
Fluoxetine (1-2 weeks)
-
SSRI with shortest half-life
Fluvoxamine (15 hours)
-
Half-life of most SSRIs
About 1 day
-
Findings on muscle biopsy in Dermatomyositis (2)
- 1. Perifascicular atrophy
- 2. "Ghost" fibers
-
EMG findings in Dermatomyositis (2)
- 1. Myopathy
- 2. Muscle irritabililty
-
Symptoms of Water Intoxication (7)
- 1. Tremor
- 2. Ataxia
- 3. Restlessness
- 4. Diarrhea
- 5. Vomiting
- 6. Polyuria
- 7. Stupor (eventually)
-
Type of schizophrenia with the latest onset
Paranoid Schizophrenia
-
Form of schizophrenia with the least cognitive decline and least emotional blunting
Paranoid Schizophrenia
-
Type of schizophrenia with earliest onset
Disorganized Schizophrenia
-
Rate of catatonia in Disorganized Schizophrenia
Low
-
Presentation of Disorganized Schizophrenia
- Primitive, disinhibited, disorganized behavior
- Prominent thought disorder, poor contact with reality
-
What is Residual Schizophrenia?
- Schizophrenic disturbance without a complete set of active symptoms
- Not enough symptoms to qualify as another type of Schizophrenia
-
Prognosis of schizophrenia with late onset
Good
-
Prognosis of schizophrenia with clear precipitating factors
Good
-
Prognosis of schizophrenia with acute onset
Good
-
Prognosis of schizophrenia with mood symptoms
Good
-
Prognosis of schizophrenia with family history of mood disorders
Good
-
Prognosis of schizophrenia with positive symptoms
Good
-
Prognosis of schizophrenia with early onset
Poor
-
Prognosis of schizophrenia with insidious onset
Poor
-
Prognosis of schizophrenia with withdrawn/autistic behavior
Poor
-
Prognosis of schizophrenia with neurological symptoms
Poor
-
Prognosis of schizophrenia with negative symptoms
Poor
-
EEG appearance of Hepatic Encephalopathy
Bilateral triphasic slow waves
-
What illness does a mutation in Presenilin 1 or 2 increase risk for?
Alzheimer Disease
-
Cause of increased risk of Alzheimer Disease in Down Syndrome
Overexpression of the Amyloid Precursor Protein gene
-
Duration of disturbance for diagnosis of PTSD
1 month or longer
-
Symptoms that signify that grief is not normal grief (5)
- 1. Suicidality
- 2. Hallucinations
- 3. Excessive guilt
- 4. Psychomotor retardation
- 5. Thoughts of worthlessness
-
Most consistent neuropathology finding in schizophrenia
Enlarged ventricles, especially lateral ventricles
-
Brain regions where pathologic findings are present in schizophrenia (3)
- 1. Thalamus
- 2. Dorsolateral prefrontal cortex
- 3. Hippocampus
-
Blood tests to order in Anorexia (9)
- 1. Electrolytes
- 2. Rental function tests
- 3. Thyroid function tests
- 4. Glucose
- 5. Amylase
- 6. CBC
- 7. Cholesterol
- 8. Dexamethasone suppression test
- 9. Carotene
-
Why should EKGs be ordered in Anorexia?
Hypokalemic, hypochloremic alkalosis can cause arrhythmia
-
Is impaired daily functioning required for diagnosis of Delusional Disorder?
No!
-
Are mood symptoms present in Delusional Disorder?
No!
-
Can bizarre delusions be present for diagnosis of Delusional Disorder?
No!
-
Effect of age on incidence of female orgasm
Incidence increases with age
-
Do patients with Avoidant Personality Disorder desire relationships?
Yes! They avoid relationships due to fear of rejection, not out of lack of interest
-
Facial changes caused by Dilantin/Phenytoin (3)
- 1. Hirsuitism
- 2. Facial dysmorphism
- 3. Gingival hypertrophy
-
Serious side effects of Carbamazapine (4)
- 1. Rash (can lead to Stevens Johnson Syndrome)
- 2. Antidiuretic Hormone effect (can cause hyponatremia)
- 3. Leukopenia
- 4. Toxic hepatitis
-
Significant side effects of Valproic Acid (5)
- 1. Leukopenia
- 2. Liver failure
- 3. PCOS
- 4. Weight gain
- 5. Hair loss
-
Side effect of levitiracetam
Agitation/hyperactivity (rare)
-
Duration of "Saturday Night Palsy"
Resolves in 1-2 months
-
Sites where the Ulnar Nerve can be entrapped (2)
- 1. Elbow (cubital tunnel)
- 2. Wrist
-
What muscles become weak if the Ulnar Nerve is compressed?
Hand flexors
-
What is Phalen's Maneuver?
- Flexion of the hand at the wrist for 1 minute
- Causes paresthesia in carpal tunnel syndrome
-
What is Musculocutaneous Nerve Injury?
- Biceps and brachialis weakness due to compression of nerves at the shoulder
- Caused by trauma or carrying heavy objects over the shoulder
-
Symptom of nerve injury due to forward traction of the shoulder
- Denervation of infraspinatus and supraspinatus muscles
- Aching pain of the posterior shoulder
-
Duration of sleep disturbance to diagnose Primary Insomnia or Primary Hypersomnia
1 month or more
-
Symptoms of Primary Hypersomnia
Excessive sleepiness causing prolonged nighttime sleeping or daily sleep episodes during the day
-
What medication is used for Catapexy?
Xyrem (sodium oxybate)
-
What symptoms can be present for Conversion Disorder?
Neurological symptoms that are not limited to either pain or sexual function
-
What class of psychiatric medications is contraindicated if Levodopa/Carbidopa is being given?
MAOIs
-
What does a child learn during Piaget's Concrete Operations Stage?
To deal with information outside himself and to see things from others' perspectives
-
What is Conservation (according to Piaget)?
- Idea that although objects are not identical, they have characteristics that allow them to be recognized as the same
- eg leaves can be different shapes/colors but still be leaves
- Developed in the Concrete Operations Stage
-
What is Reversibility (according to Piaget)?
- Idea that things that change form/shape can change back again
- Developed in the Concrete Operations Stage
-
Age at which infants begin to explore their genitalia
15 months
-
When do sexual curiosity and sex play begin?
Typically before puberty
-
Conditions typically comorbid in Fragile X Syndrome (2)
- 1. ADHD
- 2. Learning disorders
-
Second-most common cause of Intellectual Disabililty
Fragile X Syndrome
-
Age at which a child with normal attachment can tolerate its mother's absence without distress
25 months
-
Age at which a normally-attached child would use a transitional object in place of the mother
18 months
-
Period of life during which appearance would affect self-esteem the most
Adolescence
-
Life period in which friend relationships become more important than family relationships
Adolescence
-
Enzyme that metabolizes Tyramine in the GI tract
MAO-A
-
Illicit drug associated with decreased cerebral blood flow
Cocaine
-
Mechanism of action of Pergolide
Dopamine agonist
-
Mechanism of action of Bromocriptine
Dopamine agonist
-
Neurotransmitter affected more by Typical than by Atypical Antipsychotics
Dopamine (antagonized by Typicals)
-
Atypical Antipsychotic with dopamine antagonist characteristics
Quetiapine (Seroquel)
-
Mechanism of Buspar/Buspirone
5-HT 1A partial agonist
-
Personality effects of damage to the Orbitofrontal region (5)
- 1. Disinhibition
- 2. Irritability
- 3. Euphoria
- 4. Poor judgement
- 5. Distractibility
-
Personality effects of damage to the Dorsolateral Frontal region
Executive deficits
-
Personality effects of damage to the Medial Frontal region
Apathy syndrome
-
Which atypical antipsychotic inhibits reuptake of serotonin and norepinephrine?
Geodon (Ziprasidone)
-
What receptors does Ziprasidone (Geodon) antagonize? (5)
- 1. 5-HT-1D
- 2. 5-HT-2A
- 3. 5-HT-2C
- 4. D2
- 5. D3
-
Which atypical anipsychotic is a partial agonist of the D2 receptor?
Abilify (aripiprazole)
-
Which atypical antipsychotics are partial agonists of the 5HT-1A receptor? (3)
- 1. Abilify (aripiprazole)
- 2. Geodon (ziprasidone)
- 3. Clozeril (clozapine)
-
Which atypical antipsychotic is an antagonist of the 5HT-2A receptor?
Abilify (Aripiprazole)
-
Effect of antipsychotics on negative symptoms
- Worsen negative symptoms due to antagonism of dopamine receptors in the frontal cortex
- More extreme in typicals than atypicals
-
Effect of activation of the left prefrontal cortex
Mood is lifted
-
Effect of activation of the right prefrontal cortex
Mood is depressed
-
Neurotransmitter released from the Ventral Tegmental Area
Dopamine
-
Neurotransmitter released from Substantia Nigra
Dopamine
-
Neurotransmitter released from Nucleus Accumbens
Dopamine
-
What chromosome is affected in Wilson's Disease?
Chromosome 13
-
Site of most copper deposition in the brain in Wilson's Disease
Basal Ganglia
-
Screening test for Sarcoidosis
Serum Angiotensin Converting Enzyme (ACE) level
-
Brain region that mediates the effects of opiates
Locus ceruleus
-
Therapeutic focus of Motivational Enhancement Therapy
Ambivalence (eg toward remaining clean from substance use)
-
Psychological test with the highest reliability
WAIS
-
According to Freud, what drives motivate behavior? (2)
-
According to Freud, what does the "Source" of a drive refer to?
Region in the body where the drive originates
-
According to Freud, what does the "Impetus" of a drive refer to?
Intensity of the drive
-
According to Freud, what does the "Aim" of a drive refer to?
Action that discharges tension from the drive
-
According to Freud, what does the "Object" of a drive refer to?
Target of actions that discharge the drive's tension
-
Most common cause of intracerebral hemorrhage
Hypertension
-
Most common sites of hemorrhage in the cerebrum (2)
- 1. Putamen (most common)
- 2. Thalamus
-
What form of treatment did Beck develop?
CBT
-
What is a Type 1 Error?
- Null hypothesis is rejected when it should have been retained
- eg incorrectly believing that a true difference occurs when the difference was due to chance
-
CD4 count at which cryptococal meningitis occurs in an HIV patient
200 or fewer
-
Cause of clear CSF with leukocytosis (mostly lymphocytes), ↑ protein, and ↑ opening pressure
Cryptococcal meningitis
-
CSF testing for Cryptococcal Meningitis (2)
- 1. India ink stain
- 2. Cryptococcal antigen assay
-
Drug of choice for CNS fungal infections
Amphotercin B
-
Major side effect of Amphotercin B
Renal toxicity (occurs in 80%)
-
What is Point Prevalence?
Number of people with a disorder at a specific point in time
-
Percent of normal body weight below which anorexia is diagnosed
85%
-
How long after use is PCP detectable in urine?
8 days
-
How long after use is marijuana detectable in urine?
4 weeks
-
How long after use is cocaine detectable in urine?
8 hours
-
How long after use is heroin detectable in urine?
72 hours
-
Hematopoetic changes from Carbamazapine (4)
- 1. ↓WBCs
- 2. Agranulocytosis
- 3. Pancytopenia
- 4. Aplastic anemia
-
Effects of schizophrenia on eye movements (2)
- 1. Disordered smooth pursuit
- 2. Disinhibition of saccadic eye movements
-
Can Borderline Personality Disorder cause psychotic episodes?
Yes! They are brief and occur when emotionally unstable
-
What type of mental illness is most common?
Anxiety disorders
-
Mental illnesses often comorbid with Pathological gambling (3)
- 1. Mood disorders
- 2. Panic disorder (with or without agoraphobia)
- 3. OCD
-
Type of schizophrenia with the most cognitive decline
Disorganized Schizophrenia
-
How is Pathological Gambling categorized in the DSM?
Type of Impulse Control Disorder
-
What is Derealization?
Subjective feeling that the environment is strange/unreal
-
What is Depersonalization?
Person's sense that they themselves are unreal or unfamiliar
-
Drug of abuse that can cause persistent dementia
Inhalants
-
Effect of temperature on Multiple Sclerosis
Increased core temperature can bring on or worsen symptoms
-
What is Russel's Sign?
Cuts/scrapes on the backs of the hands due to self-induced vomiting
-
Characteristic symptom of Ampehtamine-Induced Psychosis
Paranoia
-
Timing of Acute Stress Disorder
- Begins within 4 weeks of a traumatic event
- Lasts 2 days to 4 weeks
-
In ethical terms, what does Justice mean?
Fair distribution of services
-
Onset of Tourette's Disorder
- Usually around age 7
- Can be as early as age 2
-
Progression of motor tics in Tourette's Disorder
Start in the face/head and progress down the body
-
What group of psychiatric patients are most likely to become violent?
Substance abusers
-
Characteristics of patients who can tolerate Psychodynamic Psychotherapy (5)
- 1. Able to be psychologically minded
- 2. At least one meaningful relationship
- 3. Can tolerate affect and interpretations
- 4. Defenses are flexible
- 5. No tendency toward splitting, projection, or denial
-
Management of a Borderline patient with past suicide attempts who is performing any type of self-harm
Recommend inpatient admission
-
Management of a Borderline patient who is becoming psychotic
Recommend inpatient admission
-
Effect of SSRIs on heart attacks
- Protective!
- Platelet serotonin receptors reduce aggregation
-
Most common neurocutaneous disease
Neurofibromatosis Type 1 (NF1)
-
Physical effects of amphetamines (9)
- 1. Fever
- 2. Headache
- 3. Cyanosis
- 4. Vomiting (can lead to dehydration)
- 5. Shortness of breath
- 6. Ataxia/tremor
- 7. Myocardial infarction
- 8. HTN (can be severe)
- 9. Ischemic colitis
-
Presentation of Ketamine intoxication
- Beligerent, impulsive, impaired judgement
- Psychomotor agitation
-
Physical effects of Ketamine (5)
- 1. Nystagmus
- 2. HTN
- 3. Ataxia
- 4. Dysarthria
- 5. Muscle rigidity
-
Duration of psychosis after taking Ketamine
Usually only during intoxication, but can persist for up to 2 weeks after intoxication (!)
-
Presentation of intoxication with inhalants (4)
- 1. Beligerent/assaultive
- 2. Apathetic
- 3. Impaired judgement
- 4. Euphoria
-
Physical effects of Inlalants (6)
- 1. Nystagmus
- 2. Impaired coordination/unsteady gait
- 3. Lethargy
- 4. Tremor
- 5. Psychomotor retardation
- 6. Muscle weakness
-
How did Jung believe that a personality develops?
Experiences teach a person who they intrinsically are
-
According to Jung what does libido include?
- Sexual energy
- Spiritual urges
- Drive to understand the meaning of life
-
What did Henry Stack Sullivan study?
Social interactions and how they shape development of a personality
-
What ages go through Trust vs. Mistrust?
Birth to 1 year
-
What ages go through Autonomy vs. Shame and Doubt?
1-3
-
What ages go through Initiative vs. Guilt?
3-5
-
What ages go through Industry vs. Inferiority?
6-11
-
What ages go through Ego Identity vs. Role Confusion?
11 to end of adolescence
-
What ages go through Intimacy vs. Isolation?
20-40
-
What ages go through Generativity vs. Stagnation?
40-65
-
What ages go through Ego Identity vs. Despair?
65+
-
What is the effect of developing trust as an infant?
Develop self-confidence
-
Which of Erikson's stages includes learning to walk and feed oneself?
Autonomy vs. Shame and Doubt
-
What would cause Shame instead of Autonomy, according to Erikson?
Excessive punishment
-
What would cause Self-Doubt instead of Autonomy, according to Erikson?
Being made to feel ashamed of actions
-
What would cause a sense of Inferiority instead of Industry, according to Erikson?
Being inferior to peers with tools/skills and thus having lower status
-
What is the task of Intimacy vs. Isolation?
Forming life-long attachments and self-abandonment
-
What would cause Isolation instead of Intimacy, according to Erikson?
Viewing others as dangerous
-
What would cause Stagnation instead of Generativity, according to Erikson?
Isolation, excessive self-concern, and absence of intimacy
-
Which terminal of a G-protein is intracellular, and which is extracellular?
- NH2 terminal is extracellular
- COOH terminal is intracellular
-
Substrates of a Tyrosine Kinase receptor (2)
- 1. Nerve growth factor (NGF)
- 2. Brain derived neurotrophic factor (BDNF)
-
Classic complication of rapid sodium replacement in hyponatremia
- Central pontine myelinosis
- Can cause transection of the pons, leading to locked-in syndrome
-
Causes of "Locked In" Syndrome (5)
- 1. Ventral pontine infarct (due to basilar artery stroke)
- 2. Central pontine myelinolysis (eg due to rapid sodium replacement in hyponatremia)
- 3. AIDB
- 4. Myasthenia Gravis
- 5. Neuromuscular blocking agents
-
What are the Narcissistic Defenses? (3)
- 1. Denial
- 2. Distortion
- 3. Projection
-
What are the Mature Defenses? (6)
- 1. Altruism
- 2. Anticipation
- 3. Asceticism
- 4. Humor
- 5. Sublimation
- 6. Suppression
-
Cause of waxing and waning headache with intermittent visual changes
Pseudotumor cerebri (intermittent intracranial hypertension)
-
What population makes up the National Alliance for the Mentally Ill (NAMI)?
Family members of the mentally ill
-
How many headaches must occur for diagnosis of Migraine Without Aura?
5 (each lasting 4-72 hours)
-
Diagnostic characteristics of Migraine Without Aura (6)
- Two of:
- 1. Unilateral
- 2. Pulsating
- 3. Moderate to severe intensity
- 4. Occurring with routine physical activity
- And one of:
- 5. Phonophobia and photophobia
- 6. Nausea/vomiting
-
Aura features that would establish diagnosis of Migraine with Typical Aura (4)
- 1. Homonymous visual changes
- 2. Unilateral numbness
- 3. Unilateral weakness
- 4. Aphasia
-
Lifetime prevalence of schizophrenia
1%
-
How long after a stroke can tPA be given?
3 hours
-
Scale given to determine presence of neurologic deficit when evaluating for tPA administration
NIH Stroke Scake
-
Can tPA be given if a stroke co-occurs with a seizure?
No!
-
Can tPA be given to a patient with prior intracranial hemorrhage?
No!
-
Blood pressure at which tPA can not be given
Over 185/110
-
How long after a head injury can tPA be given?
3 months
-
How long after a prior stroke can tPA be given?
3 months
-
How long after GI or urinary bleeding can tPA be given?
3 weeks
-
Blood glucose range at which tPA can be given
50-400
-
INR above which tPA can not be given
1.7
-
How long after heparin use can tPA be given?
48 hours
-
Platelet count below which tPA can not be given
100,000
-
How long after an arterial puncture (at non-compressible site) can tPA be given?
7 days
-
What is the only medication FDA approved to treat Restless Legs Syndrome?
Ropinorole (Requip) (dopamine agonist)
-
Classes of medication that can treat Restless Legs Syndrome (4)
- 1. Dopamine agonists
- 2. Benzodiazepines
- 3. Opiates
- 4. Gabapentin
-
Prevalence rate of Restless Legs Syndrome
5%
-
What age group gets Restless Legs Syndrome?
Middle-aged or older-aged
-
Pattern of inheritance of Restless Legs Syndrome
Autosomal Dominant
-
CSF finding associated with higher levels of aggression
Low serotonin level
-
Effect of dopamine on aggression
Increased aggression
-
Effect of norepinephrine on aggression
Decreased aggression
-
Effect of serotonin on aggression
Decreased aggression
-
Effect of GABA on aggression
Decreased aggression
-
Enzyme that is deficient in Metachromatic Leukodystrophy
Arylsolfatase A (ASA)
-
Chromosome affected in Metachromatic Leukodystrophy
22
-
Early manifestation of Metachromatic Leukodystrophy in children
Lower limb hypotonia (causes areflexia, poor gait)
-
Early manifestation of Metachromatic Leukodystrophy in adults
Dementia with behavior problems
-
Most common diagnostic tests for Metachromiatic Leukodystrophy (3)
- 1. MRI
- 2. Urine sulfatide levels (increased)
- 3. Leukocyte ASA enzyme assay
-
Treatment of Metachromatic Leukodystrophy
Bone marrow transplant
-
Physical exam finding in Tay Sachs Disease
Hypersensitive to loud noise, hyperactive startle response
-
What enzyme is deficient in Tay Sachs Disease?
Hexosaminidase A
-
What chromosome carries the affected gene in Tay Sachs Disease?
15
-
Enzyme deficiency causing Krabbe's Disease (Globoid Cell Leukodystrophy)
Galactocerebrosidase β-galactosidase
-
Inheritance pattern of Krabbe's Disease (Globoid Cell Leukodystrophy)
Autosomal recessive
-
What chromosome carries the affected gene in Krabbe's Disease?
14
-
Pathology findings in Krabbe's Disease (Globoid Cell Leukodystrophy) (2)
- 1. Multinucleated macrophages in white matter
- 2. Demyelination in both CNS and PNS
-
Presentation of Krabbe's Disease (5)
- 1. Rapid deterioration of motor and intellectual development in infancy
- 2. Hypertonicity
- 3. Optic nerve atrophy
- 4. Opisthotonic posture (same as tetanus)
- 5. Seizures
-
Treatment of Krabbe's Disease (Globoid Cell Leukodystrophy)
Stem cell transplantation
-
Criteria for Seasonal Affective Disorder (2)
- 1. 2 mood episodes in the same season of the past 2 years
- 2. Seasonal episodes substantially outnumber other mood episodes
-
Age at which the Parachute Response disappears
After 6 months
-
Age at which the Moro Reflex disappears
6 months
-
Age at which the Tonic Neck Reflex disappears
3 months
-
Age at which the Grasp Reflex disappears
6 months
-
Age at which the Rooting Reflex disappears
6 months
-
What is Pseudocyesis?
False belief that one is pregnant
-
Illnesses that fall under Somatoform Disorder NOS (2)
- 1. Pseudocyesis
- 2. Symptoms that do not meet time criteria for other diagnoses
-
Criteria for Somatization Disorder (4)
- 1. 4 Pain symptoms
- 2. 2 GI symptoms
- 3. 1 Sexual symptom
- 4. 1 Pseudoneurological symptom
-
Most common infectious agent causing retinopathy in AIDS
CMV
-
Prevalence of narcolepsy
3-6 per 10,000
-
What biochemical system is affected in narcolepsy?
Hypocretin (orexin) peptide system
-
What is Alexithymia?
Difficulty in recognizing and describing one's emotions
-
What is Stilted Speech?
Formal, stiff speech pattern
-
Medical treatments for Status Epilepticus (6)
- 1. Diazepam (rectal or IV)
- 2. Lorazepam (IV)
- 3. Phenytoin (IV)
- 4. Phosphenytoin (IV)
- 5. Valproic acid (IV)
- 6. Phenobarbital (IV)
-
How should the airway be managed in status epilepticus?
Can use external protection and give oxygen by nasal cannula
-
Why is Geodon effective in depression?
Inhibits serotonin and norepinephrine reuptake
-
Atypical antipsychotic with the highest risk of EPS
Risperdal
-
Why does Seroquel have low risk of EPS?
Low affinity for the D2 receptor
-
Receptors for which Seroquel has high affinity (5)
- 1. 5-HT-2
- 2. 5-HT-6
- 3. H1
- 4. α1
- 5. α2
-
Major side effects of Clozaril (2)
- 1. Agranulocytosis
- 2. Seizures
-
Treatment of urinary retention due to anticholinergic side effects of antipsychotics
Urecholine (Bethanechol)
-
What antiepileptic has the broadest spectrum of seizure coverage?
Valproic acid
-
Mechanism of action of Valproic Acid (Depakote)
- 1. Enhances GABA
- 2. Blockade of voltage-gated sodium channels
-
Effect of phenytoin on absence seizures
None
-
Mechanism of action of Phenytoin (Dilantin)
Blockade of voltage-gated sodium channels
-
Effect of oxcarbazepine on absence seizures
Worsens seizures
-
Effect of carbamazepine on absence seizures
Worsens seizures
-
Indication for ethosuximide
Uncomplicated absence seizures
-
Mechanism of action of Ethosuximide
Lowers voltage-gated calcium conduction in the thalamus
-
Side effects of Tricyclic Antidepressants (10)
- Anticholinergic side effects!
- 1. Constipation
- 2. Dry mouth
- 3. Blurred vision
- 4. Sweating
- 5. Orthostatic hypotension
- 6. Sedation/lethargy
- 7. Agitation
- 8. Tremor
- 9. Prolonged QTC
- 10. Tachycardia
-
Which motor root mediates dorsiflexion?
L5
-
Which motor root mediates extension of the big toe?
L5
-
Which motor root mediates foot extension?
S1
-
Which motor roots mediate leg extension?
L3 and L4
-
Which motor roots mediate hip flexion? (3)
-
Tricyclics whose strong antihistamine properties can treat gastric ulcer (3)
- 1. Amitriptyline
- 2. Doxepin
- 3. Trimipramine
-
What occurs during Piaget's Sensorimotor Stage? (3)
- 1. Learn by responding to environmental stimuli
- 2. Develop object permanence
- 3. Begin to understand symbols
-
What occurs during Piaget's Preoperational Stage? (4)
- 1. Believe that bad deeds will always cause punishment
- 2. Egocentrism
- 3. Thoughts/feelings given to inanimate objects
- 4. Phenomenalistic causality (events that co-occur cause one another)
-
What occurs during Piaget's Concrete Operations Stage? (3)
- 1. Can take others' point of view into account
- 2. Grouping by characteristics
- 3. Understand conservation and reversibility
-
What occurs during Piaget's Formal Operations Stage?
Think abstractly and reason deductively
-
Motor deficit caused by Anterior Cerebral Artery stroke
- Contralateral
- Affects leg more than arm
- Affects the face
-
Where is Norepinephrine made?
Locus Ceruleus
-
Where is Serotonin made?
Dorsal Raphe nuclei
-
Where is Dopamine made?
Substantia Nigra
-
Where is Acetylcholine made?
Nucleus Bsalis of Meynert
-
Sites where a lacunar stroke would cause pure motor hemiparesis (3)
- 1. Internal capsule
- 2. Basis pontis
- 3. Corona radiata
-
Site where a lacunar stroke would cause pure sensory symptoms
Ventroposterolateral nucleus of the thalamus
-
Sites where a lacunar stroke would cause both sensory and motor symptoms (2)
- 1. Internal capsule and thalamus
- 2. Posterior limb of the internal capsule
-
Sites where a lacunar stroke would cause ataxic hemiparesis (2)
- 1. Basis pontis
- 2. Posterior limb of internal capsule
-
Site where a lacunar stroke would cause Dysarthria-Clumsy Hand Syndrome
Basis pontis
-
Effects of M1 receptor stimulation (4)
- 1. Constipation
- 2. Blurred vision
- 3. Dry mouth
- 4. Drowsiness
-
Effects of Alpha 1 receptor stimulation (2)
- 1. Dizziness
- 2. Reduced blood pressure
-
What are the Biogenic Amine neurotransmitters? (6)
- 1. Dopamine
- 2. Epinephrine
- 3. Norepinephrine
- 4. Acethycholine
- 5. Histamine
- 6. Serotonin
-
What precursor are all catecholamine neurotransmitters synthesized from?
Tyrosine
-
Mechanism of action of Reserpine
- Blocks reuptake of biogenic amine neurotransmitters
- Causes depletion of dopamine, serotonin, and norepinephrine
-
Effects of Reserpine on the body
- Treats dystonia
- Worsens depression and Parkinsonism
-
Medications that reduce CSF production (lowering intracranial pressure) (2)
- 1. Mannitol
- 2. Acetazolamide
-
In statistics, what is a Central Tendency?
- Central value around which other values are distributed
- Examples are mean, median, and mode
-
In statistics, what is Kappa?
- Number used for binary data that indicates whether a test produces reliable or reproducible results
- Used to measure inter-rater reliability
-
First and second-most common sites of intracranial hemoorrage
- 1. Putamen
- 2. Lobar hemorrhage
-
Glasgow Coma Score at which intubation is indicated
8 or less
-
Medication to reverse heparin
Protamine sulfate
-
Tests of choice for SSPE (3)
- 1. Lumbar puncture (assay for Rubeola)
- 2. Brain biopsy
- 3. EEG
-
Duration of symptoms for diagnosis of ADHD
6 months
-
Inheritance pattern of Metachromatic Leukodystrophy
Recessive
-
Enzyme deficiency in Gaucher's Disease
β-glucosidase
-
Chromosome affected in Gaucher's Disease
1
-
Symptoms of Type 1 Gaucher's Disease (5)
- 1. Hematologic anomalies
- 2. Hypersplenism
- 3. Bone lesions
- 4. Skin pigmentation
- 5. Pingueculae (yellow lesions of the cornea)
-
Duration of positive symptoms for diagnosis of schizophrenia
1 month
-
Duration of negative symptoms for diagnosis of schizophrenia
6 months, but must also have had positive symptoms for one of those months
-
Conditions treated with Botulinum Toxin (7)
- 1. Cervical dystonia
- 2. Blepharospasm
- 3. Hemifacial spasm
- 4. Strabismus
- 5. Axillary hyperhidrosis
- 6. Spasticity of Multiple Sclerosis
- 7. Migraine
-
Duration of brief psychotic disorder
Less than 1 month
-
Aura of a basilar migraine (6)
- 1. Vertigo
- 2. Dysarthria
- 3. Tinnitus
- 4. Speech defects
- 5. Hallucinations
- 6. May lose consciousness
-
Who gets Paroxysmal Hemicrania?
- Women more than men
- Begins early in life
-
Symptoms of Paroxysmal Hemicrania (2)
- 1. Five or more unilateral periorbital/temporal headaches lasting 20 minutes each per day
- 2. Ipsilateral autonomic features
-
CNS site thought to be the genesis of migraines
Trigeminal Nucleus Caudalis (TNC)
-
Mechanism of action of Tolcapone
- COMT inhibitor
- Prevents peripheral degradation of levadopa
-
Medication class for treatment of tremor in Parkinson's Disease
Anticholinergics
-
Cause of cell death in Spinal Muscular Atrophy
Apoptosis
-
Cause of cell death in Parkinson's Disease
Apoptosis
-
Cause of cell death in ALS
Apoptosis
-
Cause of cell death in Alzheimer Disease
Apoptosis
-
What class of medication is Amoxapine?
Tetracyclic Antidepressant
-
What class of medication is Maprotiline?
Tetracyclic antidepressant
-
Side effect profile of Amoxapine compared to other antidepressants
Due to dopamine antagonism, can cause the same side effects as antipsychotics in addition to those of antidepressants
-
Unique property of Maprotiline among antidepressants
Very selective inhibitor of norepinephrine reuptake
-
Side effects of Maprotiline
- 1. Reduces seizure threshold
- 2. Mildly sedative
- 3. Mildly anticholinergic
-
Half life of Maprotiline
Long! (43 hours)
-
Inheritance pattern of Sturge-Weber Syndrome
Sporadic; not inherited!
-
Inheritance pattern of Von Hippel Lindau Syndrome
Autosoman dominant
-
Chromosome containing a gene linked to Von Hippel Lindau Syndrome
3
-
Sites of tumors in Von Hippel Lindau Syndrome (3)
- 1. Retina (hemangioblastoma)
- 2. CNS (hemangioblastoma)
- 3. Viscera (cysts or tumors)
-
Ophthalmologic syndrome associated with Sturge-Weber Syndrome
Glaucoma (can lead to blindness)
-
Most common CNS site of tumor in Von Hippel Lindau Syndrome
Cerebellum
-
Most common site of visceral cysts in Von Hippel Lindau Syndrome
Renal
-
Rare tumor that is common in Von Hippel Lindau Syndrome
Pheochromocytoma (10-20%)
-
Enzyme that is deficient in Fabry's Disease
α-galactosidase A
-
Heritability of Fabry's Disease
X-Linked
-
Dermatologic manifestation of Fabry's Disease
Asymptomatic red/purple papules around the umbilicus, hips, thighs, and scrotum
-
Severe symptoms of Fabry's Disease (5)
- 1. Corneal deposits
- 2. Pain in distal extremities
- 3. Cerebral thrombosis/hemorrhage
- 4. Vascular narrowing
- 5. Renal failure (frequent cause of death)
-
What is Reflex Sympathetic Dystrophy?
Regional pain and sensory changes following a trauma
-
Progression of Reflex Sympathetic Dystrophy (3)
- 1. Pain out of proportion to injury
- 2. Tissue edema with cool, cyanotic, hyperhidrotic skin and constant pain worsened by touch
- 3. Paroxysmal pain with irreversible tissue damage; thin, shiny skin and contractured fascia
-
Treatment of Reflex Sympathetic Dystrophy (4)
- 1. Physical therapy
- 2. Steroids
- 3. Phenoxybenzamine (sympathetic antagonist)
- 4. Anesthesia by regional block
-
Which enzymes of the p450 system are induced by Carbamazapine? (2)
-
Anti-infectious medications metabolized by 3A4 (3)
- 1. Macrolide Antibiotics (-mycin)
- 2. Cyclosporine
- 3. HAART (Indinavir, Ritonavir, Saquamavir)
-
Psychiatric medications metabolized by 3A4 (5)
- 1. Aripiprazole
- 2. Buspar
- 3. Haldol
- 4. Trazodone
- 5. Zolpidem
-
Antihypertensive medications metabolized by 3A4 (2)
- 1. Calcium channel blockers (Diltiazem, Nifedipine, Amlodipine, Verapamil)
- 2. Propranolol
-
Pain medications metabolized by 3A4 (2):
-
What type of hormones are metabolized by 3A4?
Sex hormones (Estradiol, Progesterone, Testosterone, Tamoxifen)
-
What type of cholesterol medications are metabolized by 3A4?
Statins
-
Psychiatric medications metabolized by 2C19 (4)
- 1. Amitriptyline
- 2. Citalopram
- 3. Clomipramine
- 4. Imipramine
-
Somatic medications metabolized by 2C19 (3)
- 1. Warfarin
- 2. Propranolol
- 3. Primidone
-
What p450 enzyme breaks down Lamotrigine?
1A4
-
Effect of Carbamazapine on Lamotrigine levels
Induces 1A4, lowering lamotrigine levels
-
What p450 enzyme breaks down Clozapine?
1A2
-
What is the Standard of Substituted Judgement?
Standard that a surrogate decision maker will make decisions based on what the patient would have wanted
-
What is the Best Interest Principle?
- Standard that a surrogate decision maker will decide what is in the patient's best interests
- Was previously, but is not currently, the standard!
-
What course of action will the state take if no surrogate decision maker is found for a patient?
Course that preserves human life
-
What p450 enzyme is induced by Tobacco smoking?
1A2
-
Psychiatric medications metabolized by 1A2 (6)
- 1. Amitriptyline
- 2. Fluvoxamine
- 3. Clozapine
- 4. Haldol
- 6. Imipramine
-
What p450 enzyme breaks down Risperdal?
2D6
-
What p450 enzyme is induced by Dexamethasone?
2D6
-
What p450 enzyme is induced by Rifampin?
2D6
-
What psychiatric medications inhibit 2D6? (7)
- 1. Wellbutrin
- 2. SSRIs
- 3. Clomipramine
- 4. Doxepin
- 5. TCAs
- 6. Duloxetine
- 7. Phenothiazine neuroleptics
-
When does Sheehan's Syndrome cause hypotension?
When a pre-existing ACTH deficiency exists
-
Diagnosis of Sheehan Syndrome
MRI or CT
-
Treatment of Sheehan Syndrome
- Typically supportive
- In some cases, corticosteroid replacement or surgical decompression
-
Test to diagnose Cushing's Syndrome
Dexamethasone Suppression Test
-
Test if Subarachnoid Hemorrhage is suspected but CT is negative
Lumbar puncture
-
Most common sites of aneurysm in anterior cerebral circulation (3)
- 1. Anterior communicating artery
- 2. Posterior communicating artery
- 3. Trifurcation of the MCA
-
Most common sites of aneurysm in posterior cerebral circulation (2)
- 1. Posterior inferior cerebellar artery
- 2. Basilar artery (bifurcation)
-
Cognitive effects of Normal Pressure Hydrocephalus
Apathy, abulia
-
Which antipsychotics can treat visual hallucinations in Lewy Body Dementia? (3)
- 1. Seroquel
- 2. Clozapine
- 3. Ziprasidone
-
Sites of MRI abnormalities in Werkicke Encephalopathy (3)
- 1. Periaqueductal grey
- 2. Mamillary bodies
- 3. Medial thalami
-
Behavioral manifestations of Syndenham Chorea (3)
- 1. Irritability
- 2. Obsessive-compulsive traits
- 3. Restlessness
-
MRI finding in Syndenham Chorea
Enlarged basal ganglia
-
Duration of symptoms for diagnosis of Cyclothymic Disorder
2 months
-
Rate of Cyclothymic disorder, by gender
Equal
-
Rate of Bipolar Disorde,r by gender
Equal
-
Does BPAD more often present with mania or depression in women?
Depression
-
Symptoms of Vertebrobasilar stroke or TIA (6)
- 1. Sensory loss (bilateral or ipsilateral face with contralateral body)
- 2. Homonymous visual field deficit (contralateral or bilateral)
- 3. Vertigo
- 4. Diplopia
- 5. Dysphagia
- 6. Dysarthria/ataxia
-
Effect of TCAs on Essential Tremor
Can worsen
-
Surgical treatments for Essential Tremor (2)
- 1. Thalotomy
- 2. DBS of the thalamus
-
Duration of symptoms for diagnosis of MDD
2 weeks
-
Rate of schizophrenia, by gender
Equal
-
What chromosome is affected in Friedreich Ataxia?
9
-
Course of Friedreich Ataxia
- Onset in adolescence with ataxia, loss of DTRs, and loss of proprioception in lower extremtiies
- Develop dysarthria and upper motor neuron signs
- Death in the 4th decade
-
Cause of death in Friedreich Ataxia
Hypertrophic cardiomyopathy
-
Cardiac complication of Myotonic Dystrophy
Fibrotic/infiltrative cardiomyopathy
-
What chromosome is affected in Myotonic Dystrophy?
19 (trinucleotide repeat)
-
Finding on muscle biopsy in Myotonic Dystrophy
Perifascicular muscle fiber atrophy
-
Cause of a "dive bomber" sound after muscle relaxation on EMG
Myotonic dystrophy
-
What neurotransmitter is associated with producing REM sleep?
Acetylcholine
-
Diagnosis of neurcystericosis (2)
- 1. Parasites seen on MRI
- 2. ELISA of serum or CSF
-
What illess is caused by Taenia Solium
Cystericosis
-
What illness is caused by Echinococcus Granulosus?
Tapeworm causing CNS echinococcosis
-
How are people infected by Taenia Solium?
Consuming infected pork
-
How are people infected by Echinococcus Granulosus?
Contact with dogs that are infected
-
MRI/Pathology findings of CNS Echinococcosis
Solitary spherical cyst in the CNS without edema
-
Treatment of CNS Echinococcosis (2)
- 1. Abendazole
- 2. Surgical resection of a cyst (if abendazole fails)
-
Regimen for CNS Toxoplasmosis (3)
- 1. Pyrimethamine
- 2. Sulfadiazine
- 3. Folinic Acid
-
Labs elevated in alchoholics (5)
- 1. Gamma-Glutamyl Transferase (GGT)
- 2. MCV
- 3. Uric acid
- 4. Triglycerides
- 5. AST/ALT
-
What is Miller-Fisher Syndrome? (3+)
- Variant of GBS causing:
- 1. Ataxia
- 2. Areflexia
- 3. Ophtalmoplegia
-
What do IgG to Ganglioside GQ1b indicate?
Miller-Fisher Syndrome
-
EMG findings in Miller-Fisher Syndrome (2)
- 1. Reduced/absent SNAP amplitudes
- 2. F-wave latencies are intact
-
What is Konrad Lorenz known for?
Imprinting (got ducklings to imprint on him)
-
What is Imprinting?
Young animals attaching to parents during early development
-
Most common organism causing Guillain Barré
C. Jejuni
-
Caused of cell death due to excess Ca2+
Production of NO causes excitotoxicity
-
Major function of IP3
Cause release of CA2+ from the cell's ER
-
Is depression more common in cortical dementia or subcortical dementia?
Subcortical Dementia
-
When do motor abnormalities occur in cortical dementia?
Almost never
-
Dermatome that includes the back of the head
C2
-
Dermatome that includes the thumb
C6
-
Dermatome that includes the little finger
C8
-
Dermatome that includes the middle finger
C7
-
Dermatome that includes the groin
L1
-
Dermatome that includes the lateral thigh
L2
-
Dermatome that includes the medial thigh
L3
-
Dermatome that includes the medial leg
L4
-
Dermatome that includes the lateral leg
L5
-
Dermatome that includes the big toe
L5
-
Dermatome that includes the sole of the foot
S1
-
Dermatome that includes the little toe
S1
-
Receptors associated with Glutamate (3)
-
How long does Buspirone take to produce therapeutic effects?
2-3 weeks
-
Inhibitors of 3A4 (6)
- 1. Nefazodone
- 2. Fluoxetine
- 3. Calcium Channel Blockers
- 4. Erythromycin
- 5. Antifungals
- 6. Grapefruit juice
-
What psychiatric medication's levels are increased by Buspar
Haldol
-
Receptors affected by PCP (3)
- 1. NMDA (antagonist)
- 2. Calcium cannel (blocker)
- 3. Dopmamine receptors
-
Treatment of behavioral abnormalities caused by PCP (2)
- 1. Benzodiazapines
- 2. Dopamine antagonists
-
What are the immature defenses? (9)
- 1. Hypochondriasis
- 2. Introjection
- 3. Regression
- 4. Passive Aggression
- 5. Acting Out
- 6. Blocking
- 7. Somatization
- 8. Projection
- 9. Schizoid Fantasy
-
What is Introjection (ego defense)?
Internalizing the qualities of an outside object (eg identifying with an aggressor)
-
What class of medication is Phenelzine
MAOI
-
Effect of MAOIs on movement symptoms of Parkinson's Disease
None
-
Effect of Amoxapine on the D2 receptor
- Strong antagonistic properties
- Is a derivative of the neuroleptic loxapine
-
What is the major contribution of Fromm?
Defined 5 character types common in western culture
-
Finding of Dusky vs. United States
A defendant must understand proceedings against them and be able to consult a lawyer with understanding
-
Percentage of patients whose depression recurs within 6 months
25%
-
Percentage of patients whose depression recurs within 2 years
30-50%
-
Percentage of patients whose depression recurs within 5 years
50-75%
-
Duration of symptoms for diagnosis of dysthymia
2 years
-
What is the Durham Rule?
A defendant is not criminally responsible if the criminal act was due to a mental illness
-
Finding of O'Connor vs. Donaldson
Harmless mentally ill patients can not be confined involuntarily without treatment
-
Findings of Clites vs. State
Doctors who gave neuroleptics but did not conduct physical exams or labs, and did not intervene when TD symptoms began were liable for the TD
-
Which TCAs are Tertiary Amines? (4)
- 1. Imipramine
- 2. Amitriptyline
- 3. Clomipramine
- 4. Trimipramine
-
Which TCAs are Secondary Amines? (3)
- 1. Desipramine
- 2. Nortriptyline
- 3. Protriptyline
-
Result of metabolism of Tertiary Amine TCAs
Converted to Secondary Amine TCAs
-
Effect of thalotomy on Parkinson Disease
- Very effective for tremor and rigidity on the contralateral side
- Does not affect bradykinesia
-
Site of DBS to treat tremor and rigidity in Parkinson Disease
- Thalamus
- Does not affect bradykinesia
-
Effect of pallidotomy in Parkinson Disease
Improves dopa-induced dyskinesia and akinesia
-
Site of DBS to treat dopa-induced dyskinesia and akinesia in Parkinson Disease
Globus Pallidus
-
Which antidepressant's metabolite antagonizes D2, causing Parkinsonism?
Amoxapine
-
Effects of large right MCA stroke (6)
- 1. Hemineglect
- 2. Visual extinction
- 3. Tactile extinction
- 4. Loss of speech prosody
- 5. Agnosognosia
- 6. Confusion
-
What p450 enzyme breaks down Tricyclic Antidepressants
2D6
-
What neuroleptics are Phenothiazines? (4)
- 1. Chlorpromazine (Thorazine)
- 2. Fluphenazine (Prolixin)
- 3. Perphenazine
- 4. Promethazine (Phenergan)
- (other obscure neuroleptics ending in "-azine"
-
Somatic medications that are competitive substrates for 2D6 (3)
- 1. Carbamazepine
- 2. Propafenone
- 3. Flecainide
-
What p450 enzyme is inhibited by cimetidine?
2D6
-
What p450 enzyme is inhibited by quinidine?
2D6
-
Differential diagnosis of isolated 3rd nerve palsy
- Diabetes vs internal carotid artery aneurysm
- If an aneurysm is present, the pupil is typically dilated
-
Treatment of tics in Tourette's Syndrome
Neuroleptics, especially Haldol, Pimozide, or atypicals
-
Non-neuroleptic treatment of tics in Tourette's Syndrome
Clonidine
-
Effect of antidepressants on tics in Tourette's Syndrome
None
-
Symptoms of lesion of the Optic Radiations of the MCA
Contralateral homonymous hemianopsia or inferior quadrantanopsia
-
Effect of Calcium influx into a neuron on neurotransmitters
Promotes both synthesis and release
-
Which type of Monoamine Oxidase breaks down norepinephrine?
MAO-A
-
Syndrome caused by deficit in Hypoxanthine-Guanine Phosphoribosyltransferase
Lesch-Nyhan Syndrome
-
Symptoms of Ornithine Transcarbamylase Deficiency (3)
- 1. Hyperammonemia
- 2. Encephalopathy
- 3. Respiratory Alkalosis
-
Treatment of Ornithine Transcarbamylase Deficiency
Low protein diet with arginine supplementation
-
Inheritance of Ornithine Transcarbamylase Deficiency
X-linked
-
Inheritance of Carbamylphosphate Synthase Deficiency
Recessive
-
Symptoms of Carbamylphosphate Synthase Deficiency (3)
- 1. Hyperammonemia
- 2. Encephalopathy
- 3. Respiratory Alkalosis
-
Types of Carbamylphosphate Synthase Deficiency (2)
- 1. Type 1: Early onset, fatal form
- 2. Type 2: Delayed-onset form
-
Symptom of Arginase Deficiency
Hyperammonemia
-
Chromosome affected in Arginase Deficiency
Chromosome 6
-
Symptoms of Adenylosuccinase Deficiency (4)
- 1. Autism
- 2. Growth retardation
- 3. Psychomotor delay
- 4. Seizures
-
Symptom profile of dementia following head trauma
- Slowed processing
- Deficits in executive functioning
-
Who is at increased risk of dementia if a head trauma occurs?
ApoE carriers
-
Tricyclic antidepressant with the strongest antihistamine activity
Doxepin
-
Standard of care for OCD treatment
Either an SSRI or Clomipramine
-
Tricyclic antidepressant with the strongest serotonergic effects
Clomipramine (hence it is useful for OCD)
-
What correlates most closely with time to clinical improvement on TCAs?
Downregulation of serotonin and adrenergic receptors
-
Medications to treat enuresis (2)
- 1. Tricyclic antidepressants
- 2. Desmopression (DDAVP)
-
EKG changes caused by TCAs (4)
- 1. Flattented T-waves
- 2. Tachycardia
- 3. QT prolongation
- 4. ST depression
-
Major side effects of TCAs (3)
- 1. Cardiac conduction abnormalities
- 2. Orthostatic hypotension
- 3. Anticholinergic effects
-
What is Therapeutic Graded Exposure?
Similar to systematic desensitization, but relaxation techniques are not used during the exposures
-
What is Participant Modeling?
Learning a new behavior by observation first, then eventually by doing it
-
What condition is Participant Modeling particularly helpful for?
Agoraphobia
-
What is Abreaction?
- Emotional release after recalling a painful event
- Part in psychodynamic psychotherapy
-
What actions constitute Primary Gain?
Seeking medical help, either because it is needed or because of enjoying the sick role
-
Intracranial factors that increase risk of ECT (4)
- 1. Tumor
- 2. Aneurysm
- 3. Vascular malformation
- 4. Increased intracranial pressure
-
Management of a patient with a brain tumor, aneurysm, or increased ICP during ECT (2)
- 1. Careful blood pressure control
- 2. Dexamethasone before ECT
-
Side effect of combining Carbamazapine with Clozapine
Increased risk of bone marrow suppression
-
-
Effects of low CSF serotonin level
Increased rate of aggression or suicide
-
EKG change at high lithium levels
Nonspecific t-wave changes
-
How does lithium cause polyuria?
ADH antagonism
-
Risk of TCAs when given with anesthesia
- Risk of hypertension
- TCAs should be stopped before surgery!
-
TCAs that can cause myoclonic twitches and tremors (2)
- 1. Desipramine
- 2. Protriptyline
-
Cardiac uses of TCAs (2)
- 1. Terminate V-fib
- 2. Increase blood supply to ischemic heart tissue
-
Cardiotoxic effects of TCA overdose (4)
- 1. Decreased contractility
- 2. Tachycardia
- 3. Hypotension
- 4. Increased myocardial irritability
-
How do patients appear during attacks of Transient Global Amnesia?
Awake and alert, retaining personal information and identity
-
What demographics are affected by Transient Global Amnesia?
- Men more than women
- Usually aged 50s or older
-
What triggers attacks of Transient Global Amnesia?
- Physical/sexual exertion
- Extremes of temperature
-
Relationship between Transient Global Amnesia and risk for future strokes
No increased risk
-
How often does Transient Global Amnesia recur?
Rarely (no need for workup)
-
Effect of GABA on seizure activity
Reduces seizure rates
-
Effect of GABA on mania
Decreases mania
-
Mechanism of action of Tigabine
Blocks GABA transporters (GABA reuptake inhibitor)
-
Illness caused by Borrelia Burgdorferi
Lyme Disease
-
Illness-mimicking presentations of early Lyme Disease (6)
- 1. Meningitis
- 2. Bell's Palsy
- 3. Painful radiculoneuritis
- 4. Optic neuritis
- 5. Mononeuritis multiplex
- 6. Guillain-Barré
-
First line treatments for Lyme Disease (2)
- 1. IV Ceftriaxone
- 2. IV PCN
-
Treatments for Lyme Disease in penicillin or cephalosporin allergic patients (2)
- 1. Tetracycline
- 2. Chloramphenicol
- (give together)
-
Illness caused by Rickettsia Rickettsii
Rocky Mountain Spotted Fever
-
When do symptoms of Rocky Mountain Spotted Fever begin?
2-14 days after tick bite
-
Common presentation of Rocky Mountain Spotted Fever (4)
- 1. Fever
- 2. Headache
- 3. Muscle aches
- 4. GI distress
-
Rash of Rocky Mountain Spotted Fever
- Starts on wrists and hands
- Spreads to the feet and forearms
-
Systemic symptoms of Rocky Mountain Spotted Fever (3)
- 1. Meningoencephalitis
- 2. Renal Failure
- 3. Pulmonary edema
-
Funduscopic exam in Rocky Mountain Spotted Fever
Shows rentinal vasculitis
-
Diagnosis of Rocky Mountain Spotted Fever
Skin biopsy with immunologic staining
-
Treatment of Rocky Mountain Spotted Fever (3)
- Initially, either:
- 1. Tetracycline
- 2. Chloramphenicol
- Then:
- 3. Doxycycline
-
What illness is caused by Yersinia Pestis?
Bubonic plague
-
Neurologic condition caused by Bubonic Plague
Meningitis
-
Treatment of Bubonic Plague (2)
- 1. Streptomycin (if uncomplicated infection)
- 2. Chloramphenicol (if meningitis)
-
What illness is caused by Leptospira Interrogans?
Leptospirosis
-
How is Leptospirosis transmitted?
Through urine of infected rodents or farm animals
-
Neurological syndrome caused by Leptospirosis
Meningitis
-
Systemic syndromes caused by Leptospirosis (4)
- 1. Meningitis
- 2. Renal failure
- 3. Hemorrhage
- 4. Jaundice
-
Treatment of Leptospirosis (2)
- 1. Pencillin (if severe)
- 2. Doxycycline (if mild)
-
What illness is caused by Treponema Pallidum
Syphilis
-
Treatment of Body Dysmorphic Disorder
- Therapy
- Serotonergic medications
-
Level of development at which Tourette's Syndrome has the worst symptoms
Adolescence
-
Heredity of Tourette's Syndrome
Autosomal dominant
-
Medications that treat both ADHD symptoms and tics (2)
- 1. Guanfacine
- 2. Clonidine
-
Effect of stimulants on tics
May worsen tics, but may also alleviate them
-
ADHD medication for patients with tics that worsen with stimulants
Atomoxetine (Strattera)
-
Criteria to diagnose Schizoaffective Disorder
- Periods of mania or depression with psychotic symptoms
- 2-week period of psychotic symptoms in the absence of mood symptoms
-
Haldol in breastfeeding
- Passes into breast milk
- Patients on Haldol should not breastfeed
-
Haldol in pregnancy
- Teratogenic in animals, but no good research in humans
- Give only if benefit outweighs risk
-
Risk of lithium in pregnancy
Ebstein's Anomaly (1 in 1000)
-
Risk of Valproic Acid in pregnancy
Neural tube defects in 1-2% if given in first trimester
-
Antiemetic that antagonizes D2, and can cause EPS and Tardive Dyskinesia
Metoclopramide (Reglan)
-
Classes of medication for Narcolepsy (2)
- 1. Stimulants
- 2. Antidepressants
-
Where is the Calcarine Cortex? What does it do?
- In occipital lobes
- Interprets/processes visual input
-
Site of highest concentration of Glycine receptors
Spinal cord
-
What is hyperkplexia?
- Mutation of the glycine receptor
- Main symptom is exaggerated startle response
-
Age group most likely to have Subdural Hematomas
Over 60
-
EEG findings in Herpes Simplex Encephalitis
Periodic lateralizing epileptiform discharges
-
Criteria for diagnosis of Polysubstance Dependence
- Repeated use of 3 groups of substances for 12 months
- Dependence criteria must be met for each group of substances, but not for any particular substance
-
CSF finding in Herpetic Meningitis
Many RBCs
-
At what age does Mahler's Normal Autism stage occur?
Birth to 2 months
-
At what age does Mahler's Symbiosis stage occur?
2-5 months
-
At what age does Mahler's Differentiation stage occur?
5-10 months
-
At what age does Mahler's Practicing stage occur?
10-18 months
-
At what age does Mahler's Rapprochement stage occur?
18-24 months
-
At what age does Mahler's Object Constancy stage occur?
2-5 years
-
Characteristics of Mahler's Normal Autism stage
Baby spends more time asleep than awake
-
Characteristics of Mahler's Symbiosis stage
- Child begins to distinguish inner from outer world
- Child believes it is part of a single entity with the mother
-
Characteristics of Mahler's Differentiation stage
Child begins to understand that it is separate from the mother
-
Characteristics of Mahler's Practicing stage
Child begins to move independently and explore the outside world
-
Characteristics of Mahler's Rapprochement stage
Child's independence vacillates with need for the mother
-
How long after arsenic exposure does peripheral neuropathy occur?
2-3 weeks
-
How long after arsenic exposure to Mees' lines appear on the fingernails?
3-6 weeks
-
Systemic effects of arsenic poisoning (2)
- 1. Nausea/vomiting/diarrhea
- 2. Vasomotor collapse (hypotension, tachycardia)
-
Toxins that can cause Mees' Lines on the fingernails (2)
-
Effects of lead poisoning on children
- Encephalopathy with confusion, drowsiness, intracranial hypertension, and seizures
- GI distress
-
Lab finding (other than lead level) in lead poisoning
Hypochromic, microcytic anemia
-
Cause of a blue line at the gingival margin
Lead exposure
-
What is Dimercaprol?
Chelating agent used to treat lead exposure
-
Toxin causing personality changes, drowsiness, insomnia, irritability, confusion, stupor, and intention tremor with acute exposure
Mercury
-
Cause of death in organophosphate poisoning
Respiratory or cardiac failure
-
What is an ANOVA?
Method of comparing two groups and determining whether the differences between them are due to chance
-
Duration of exposure to manganese required to cause neurotoxicity
Months to years
-
Neurologic effects of manganese exposure (3)
- 1. Parkinsonism/motor effects
- 2. Behavioral changes/cognitive disturbances ("Manganese Madness")
- 3. Headache
-
Characteristic gait due to manganese exposure
- "Cock walk"
- Walking on the toes with spine erect and elbows flexed
-
Electrolyte affected by Thallium poisoning
- Potassium is depleted
- Causes tachycardia, t-wave changes, and u-waves
-
Treatment of Thallium poisoning (3)
- 1. Dialysis
- 2. Forced diuresis
- 3. IV potassium
-
Brain region whose injury causes truncal ataxia
Cerebellar vermis
-
Region of the cerebellum whose injury causes dysdiadochokinesis
Ipsilateral Hemisphere
-
Symptoms of lesion of the cerebellopontine angle
- 1. Ipsilateral facial palsy (CN7)
- 2. Weakness of masseter muscles (CN5)
- 3. Ipsilateral facial numbness (CN5)
- 4. Ipsilateral hearing loss (CN8)
-
What is the Thalamic Syndrome of Dejerine-Roussy?
Central thalamic pain in extremities and/or face due to thalamic lesion
-
What is Parinaud's Syndrome?
- Oculomotor symptoms due to midbrain lesion
- Ischemia of areas perfused by PCA penetrating branches
-
What is Weber's Syndrome?
- Caused by PCA stroke
- Contralateral hemiplegia of face, arm, and leg
- Ipsilateral oculomotor paresis with fixed dilated pupil (CN3)
-
Contraindications to Lumbar Puncture (4)
- 1. Infection at the level of puncture
- 2. Thrombocytopenia
- 3. Cerebral mass lesion
- 4. Head trauma
-
Symptoms of Trisomy 18 (7)
- 1. Severe intellectual disability
- 2. Microcephaly
- 3. Round face
- 4. Widely spaced eyes
- 5. Micrognathia
- 6. Hypotonia
- 7. Low-set ears
-
What is Dissociation?
Unconscious segregation of mental/behavioral processes from the rest of psychological activity
-
Suicidality in normal bereavement
Rare
-
Effect of social contact on normal bereavement
Improves mood
-
Effect of none bereavement on self-worth
None
-
Does Polio affect upper or lower motor neurons?
Lower
-
What are Brandt-Daroff exercises used to treat?
Benign paroxysmal positional vertigo
-
Direction of nystagmus if Dix-Hallpike Maneuver is positive
- Toward the affected ear when looking toward the affected side
- Rotating toward the affected ear when looking up
-
Sleep-wake cycle in persistent vegetative state
Preserved
-
Spontaneous movements in persistent vegetative state
Spontaneous movements are preserved, but the patient can not obey commands
-
Ocular movements in persistent vegetative state
Eye opening and eye tracking can be present
-
Swallowing in persistent vegetative state
Can be preserved
-
Response to noxious stimuli in persistent vegetative state
None
-
How long after onset of persistent vegetative state does irreversible brain damage occur, if there was brain trauma?
12 months
-
How long after onset of persistent vegetative state does irreversible brain damage occur, if there was anoxic brain injury?
3 months
-
Symptoms of Ataque de Nervious (7)
- 1. Headache
- 2. Insomnia
- 3. Anorexia
- 4. Fear
- 5. Anger
- 6. Despair
- 7. Diarrhea
-
What is Ataque de Nervios?
Anxiety syndrome associated with Latin American cultures
-
Most typical effect of depression on sleep
Early morning awakening
-
Treatment of choice of benzodiazepine overdose
Flumazenil
-
Most serious side effect if flumazenil is given to treat benzodiazepine overdose
Seizures
-
Clinical triad of West's Syndrome (3)
- 1. Infantile spasms
- 2. Hypsarrhythmia
- 3. Psychomotor developmental arrest
-
What is the pattern of Hypsarrhythmia on EEG?
Posterior diffuse slow and sharp waves and spikes
-
Cognitive symptoms of AIDS (6)
- 1. Dementia
- 2. Personality changes
- 3. Depressed mood
- 4. Low libido
- 5. Impaired memory
- 6. Poor concentration
-
Where does Papez's Circuit originate?
Hippocampus
-
What does Papez's Circuit connect the hippocampus to? (3)
- 1. Thalamus
- 2. Hypothalamus
- 3. Cortex
-
Brain regions included in Papez's Circuit (6)
- 1. Hippocampus
- 2. Hypothalamus
- 3. Thalamus (especially anterior nucleus)
- 4. Mammilary bodies
- 5. Fornix
- 6. Cingulate
-
Cause of Benign Familial Neonatal Convulsions
Mutation in voltage gated potassium channels
-
Course of Benign Familial Neonatal Convulsions
- Tonic clonic seizures begin around the 3rd day of life
- Remit spontaneously in weeks to months
-
Molecule whose mutation causes Hypokalemic Periodic Paralysis
Calcium channel
-
Molecule whose mutation causes Familial Hemiplegic Migraine
Calcium channel
-
What receptors, in what tract, cause Parkinsonism when blocked by neuroleptics?
D2 receptors in the Nigrostriatal Tract
-
What receptors, in what brain region, cause bradykinesia when blocked by neuroleptics?
D2 receptors in the Caudate
-
What protrudes through the foramen magnum in a Chiari I mutation?
Cerebellar tonsils
-
What protrudes through the foramen magnum in a Chiari II mutation?
Cerebellar tonsils, with caudal displacement of the 4th ventricle and medulla
-
Site of neural tube defect that accompanies Chiari II mutations
Lumbar spine
-
What is Lissencephaly?
Agyria
-
What is the pathologic hallmark of Schizencephaly?
Clefts in the cerebral hemispheres
-
Clinical Manifestations of Dandy-Walker Syndrome (2)
- 1. Intellectual disability
- 2. Spastic paralysis
-
Percent stenosis of the internal carotid at which endarterectomy is indicated if asymptomatic
80%
-
Percent stenosis of the internal carotid at which endarterectomy is indicated if symptomatic
70%
-
Underlying infection causing Guillain-Barré with a worse prognosis than other infections
C. Jejuni (more often associated with axonal AIDP)
-
Effect of lithium on WBC count
Increased
-
Electrolyte imbalance that can cause toxic lithium levels
Hyponatremia
-
What is Meralgia Paresthetica?
- Compression of the lateral femoral cutaneous nerve as it passes beneath the inguinal ligament
- Causes pain and numbness of the lateral thigh
-
Treatment of pain in Meralgia Paresthetica (2)
- 1. TCAs
- 2. Anticonvulsants
-
Cause of Fibrillation Potentials on EMG
Denervation of a muscle
-
What are Sharp Waves on EMG?
Spontaneous activity from groups of denervated muscle fibers
-
What would an EMG showing fibrillation potentials and sharp waves indicated?
Radiculopathy (neuropathy)
-
Cause of small, short potentials on EMG
Reduction in size of muscle fibers due to myopathy
-
Cerebral cause of tics
Overstimulation of D2 receptors in the caudate
-
Timing of Cerebral Venous Thrombosis after childbirth
1 day to 4 weeks postpartum
-
Clinical presentation of postpartum Central Venous Thrombosis (3)
- 1. Headache
- 2. Seizures
- 3. Personality changes
-
Most common congenital viral infection
Cytomegalovirus
-
Most common myopathy after age 50
Inclusion Body Myositis
-
Gender distribution of Inclusion Body Myositis
Men > Women
-
Presentation of Inclusion Body Myositis
- Weakness of distal arm and leg muscles
- Painless
- Chronic and progressive
-
Diagnostic test for Inclusion Body Myositis
Muscle biopsy
-
Findings in muscle biopsy in Inclusion Body Myositis (2)
- 1. Macrophage invasion of muscle
- 2. Inclusion bodies in nuclei ("rimmed vacuoles")
-
Inheritance pattern of Facioscapulohumeral Dystrophy
Autosomal Dominant
-
Chromosome affected in Facioscapulohumeral Dystrophy
Chromosome 4
-
Regions whose muscles are weak in Facioscapulohumeral Dystrophy (5)
- 1. Orofacial
- 2. Shoulders
- 3. Upper arm (biceps and triceps)
- 4. Hip flexors
- 5. Quadriceps
-
Inheritance pattern of Oculopharyngeal Muscular Dystrophy
Autosomal dominant
-
Chromosome affected in Oculopharyngeal Muscular Dystrophy
Chromosome 14
-
Presentation of Oculopharyngeal Muscular Dystrophy
- Starts in 5th or 6th decade
- Eye muscle weakness, then difficulty swallowing
- May die by starvation without nutritional support!
-
Inheritance pattern of Becker Muscular Dystrophy
X-linked
-
Criteria for diagnosis of sleep apnea
5 apneic episodes lasting 10 seconds in one hour or 30 episodes lasting 10 seconds per night
-
Toxic blood lithium level
2 or higher
-
Lethal blood lithium level
4 or higher
-
What receptor does Sodium Oxybate (GHB) bind to?
GABA B (agonist)
-
What receptor does Lioresal bind to? What is its effect?
- GABA B (agonist)
- Potent muscle relaxant
-
What is Ganser's Syndrome?
Dissociative disorder in which the patient intentionally gives approximate answers or talks past the point
-
What is Capgras's Syndrome?
Delusional belief that a familiar person is actually an imposter
-
What concept did Martin Seligman develop?
Learned Helplessness
-
Specificity of Phenelzine for types of Monoamine Oxidase
Nonspecific; affects MAO A and MAO B
-
Effect of ibuprofen on lithium levels
Can increase levels drastically
-
Effect of diuretics on lithium levels
Many increase levels
-
Effect of NSAIDs on lithium levels
Many increase levels, though aspirin does not!
-
Effect of ACE inhibitors on lithium levels
Increase levels
-
Effect of Naproxen on lithium levels
Increases levels
-
Effect of Anticonvulsants on lithium levels
Can increase levels
-
Timing of Tabes Dorsalis after initial syphilis infection
15-20 years
-
Clinical triad of Tabes Dorasalis (spinal syphilis) (3)
- 1. Sensory ataxia
- 2. Lightning pains
- 3. Urinary incontinence
-
Illness causing Charcot's (neuropathic) Joints
Tabes Dorsalis (spinal syphilis)
-
What is the Marcus Gunn Pupil?
Affected pupil enlarges when a flashlight is moved away to the other eye, rather than constricting
-
Illnesses causing Marcus Gunn pupil (2)
- 1. Multiple Sclerosis
- 2. Optic Neuritis
-
Symptoms of Serotonin Withdrawal Syndrome (and SSRI Withdrawal) (5)
- 1. Nausea
- 2. Insomnia
- 3. Muscle aches
- 4. Anxiety
- 5. Dizziness
-
Duration of Todd's Paralysis after seizure
Resolves completely after 48 hours
-
3-Hydroxy Benzodiazepines (benzodiazepines without active metabolites) (3)
- 1. Oxazepam
- 2. Lorazepam
- 3. Temazepam
-
2-Keto Benzodiazepines (benzodiazepines with multiple active metabolites) (3)
- 1. Chlordiazepoxide
- 2. Diazepam
- 3. Prazepam
-
What is Tropical Spastic Paresis?
Term for myelopathy due to HTLV-1 infection
-
Who gets Tropical Spastic Paresis?
-
Diagnosis of Tropical Spastic Paresis (HTLV-1 myelopathy)
PCR of CSF
-
Progression of HTLV-1 Myelopathy (Tropical Spastic Paresis)
- Starts with upper motor neuron symptoms and sensory loss
- In 10 years, 60-70% can not walk
-
In what illnesses is lithium effective for aggression? (3)
- 1. Conduct disorder / antisocial personality
- 2. Schizophrenia
- 3. Intellectual disability
-
Cause of X-Linked Spinobulbar Muscular Atrophy
Trinucleotide repeat
-
What is Chvostek's Sign? What does it indicate?
- Corner of the mouth contracts involuntarily when the cheek is tapped
- Sign of chronic hypocalcemia
-
Mechanism of Atomoxetine (Strattera)
Inhibits reuptake of Norepinephrine
-
First line agents for spasticity (6)
- 1. Lioresal
- 2. Gabapentin
- 3. Diazepam
- 4. Clonidine
- 5. Tizanidine
- 6. Dantroline
-
Second-line agents for spasticity (5)
- 1. Marinol
- 2. Chlorpromazine
- 3. Cyproheptadine (antihistamine)
- 4. Phenytoin
- 5. Phenobarbitol
-
Effect of Depakote on weight
Weight gain
-
Effect of Depakote on hair
Causes thinning
-
Psychiatric medication causing ankle swelling
Depakote
-
Does depakote cause tremor?
Yes!
-
Is Depakote sedating?
Sometimes yes
-
Psychiatric medication that can cause pancreatitis
Depakote
-
Organ to which Depakote can be toxic
Liver
-
Severe side effect of Depakote on CBC
Pancytopenia
-
Why can neuroleptics cause orthostatic hypotension?
α1 antagonism
-
What mechanism do Atypical Neuroleptics have that Typicals do not?
Serotonin antagonism
-
How long after use is alcohol detectable in urine?
12 hours
-
Causes of Klüver-Bucy Syndrome (3)
- 1. Pick's Disease (most common)
- 2. Stroke
- 3. Alzheimer Dementia
-
Neurological signs in Klüver-Bucy Syndrome (2)
- 1. Psychic blindness
- 2. Prosopagnosia (inability to recognize faces)
-
Absolute contraindications to ECT
None
-
Illnesses placing patients at high risk in ECT (4)
- 1. Elevated intracranial pressure (including mass lesion)
- 2. At risk for intracranial bleed
- 3. Recent MI
- 4. Uncontrolled HTN
-
Chromosomal change in Klinefelter Syndrome
XXY Triploidy
-
Organs that may have abnormalities in Turner Syndrome (2)
-
Presentation of Intermittent Explosive Disorder
- Physical aggression due to failure to resist aggressive impulses
- Aggression out of proportion to a stressor
-
Course of an aggressive episode in Intermittent Explosive Disorder
- Arise due to a stressor or without a trigger
- Remit spontaneously, with no residual aggression
-
Predisposing factors for Intermittent Explosive Disorder (3)
- 1. Underprivileged/tempestuous childhood
- 2. Childhood abuse
- 3. Early frustration/deprivation
-
Treatments that reduce both aggression and number of episodes in Intermittent Explosive Disorder (2)
- 1. Mood stabililzers
- 2. Gabapentin
-
Treatments that reduce aggression in Intermittent Explosive Disorder, but do not prevent episodes (2)
-
Mechanism of Bupropion (Wellbutrin)
Inhibits reuptake of both dopamine and norepinephrine
-
Antidepressant least likely to precipitate mania in bipolar disorder
Wellbutrin
-
Presentation of monkeys who were partially, but not completely, isolated (3)
- 1. Vacant stare
- 2. Self-mutliation
- 3. Stereotyped behavior
-
Presentation of totally isolated monkeys
- Fearful
- Unable to copulate
- Unable to raise young
-
Presentation of monkeys raised only by a mother
- Didn't explore
- Afraid of other monkeys
- Didn't copulate
-
Presentation of monkeys raised only by peers
- Clung to other monkeys
- Timid
- Little playfulness
-
Presentation of monkeys separated from their mothers
Initial protest phase followed by despair
-
Surgical treatment for OCD
Cingulotomy
-
Complication of Cingulotomy if used to treat OCD
Seizures (can be managed by anticonvulsants)
-
Factors contributing to Dissociative Identity Disorder (3)
- 1. Childhood trauma
- 2. Absent social supports, especially in childhood
- 3. Poor coping mechanisms
-
Forms of talk therapy used in Dissociative Identity Disorder (2)
- 1. Insight-oriented (mainstay!)
- 2. Hypnotherapy
-
Types of medication used in Dissociative Identity Disorder (2)
- 1. Antidepressant
- 2. Anxiolytic
-
Lithium level at which dialysis is needed
4
-
Signs of lithium toxicity for which dialysis is indicated (3)
- 1. Nephrotoxicity
- 2. Convulsions
- 3. Coma
-
Most useful long term treatment parameter for a violent schizophrenic with history of noncompliance
Outpatient commitment program
-
Features of an Outpatient Commitment Program
- Judge mandates cooperativeness
- Physician can order that the patient be picked up involuntarily for evaluation
-
What is Conservatorship?
Court appoints a conservator to make decisions on a patient's behalf, including involuntary hospitalization
-
Opiate medication that can never be given with an MAOI
- Meperidine (demerol)
- Can cause death!
-
What is the only common anesthetic that can be given with MAOIs?
Lidocaine
-
Medications to treat what common somatic illness can not be combined with MAOIs?
Asthma
-
What over the counter medication can not be given with MAOIs?
Dextromethorphan
-
Street drugs that can not be combined with MAOIs (2)
- 1. Amphetamines
- 2. Cocaine
-
Effect of combining epinephrine and MAOIs
Hypertensive crisis
-
How often should CBC be monitored on Clozapine?
- Baseline before treatment
- Weekly for 6 months
- Every 2 weeks until 1 year
- Either every 2 weeks or monthly after 1 year
-
How often should CBC be monitored after stopping Clozapine?
Weekly for 4 weeks
-
Effect of age >65 on REM sleep
- More REM episodes, but they are shorter in duration
- Less total REM sleep
-
Psychiatric medications that increase Clozapine levels (3)
- 1. SSRIs
- 2. TCAs
- 3. Depakote
-
Somatic medications that increase Clozapine levels (2)
- 1. Erythromycin
- 2. Cimetidine (for GERD)
-
Medications that can cause agranulocytosis, and thus should not be given with Clozapine (5)
- 1. Carbamazepine
- 2. Prophylthiouracil
- 3. Sulfonamides
- 4. Captopril
- 5. Phenytoin
-
Effect of Clozapine on CNS depressants
Exacerbates CNS depression
-
Risks of combining Clozapine with Lithium (4)
- 1. Neuroleptic Malignant Syndrome
- 2. Movement disorders
- 3. Seizures
- 4. Confusion
-
Most widely-used recreational drug among high school students
Marijuana (used regularly more than alcohol is used regularly!)
-
What is Alogia?
Lack of speech due to dementia or mental deficiency
-
Criteria for Rapid Cycling specifier in BPAD
3 mood episodes over the past 12 months
-
Gender breakdown of Rapid Cycling in BPAD
Women > Men
-
What is a Primary Reinforcer of a behavior?
Reward independent of previous learning (eg need to eat)
-
What is a Secondary Reinforcer of a behavior?
Reward based on previous learning (eg giving a child a present when they do well)
-
Gender breakdown of late-onset schizophrenia
Women > Men
-
Age of onset at which Schizophrenia is considered Late-Onset
45
-
Bowlby and Robertson's stages of separation response in children (3)
- 1. Protest
- 2. Despair and pain
- 3. Detachment and denial of affection upon return
-
Presentation of a child during Bowlby and Robertson's Protest Stage after separation
Crying, calling out, searching for mother
-
Presentation of a child during Bowlby and Robertson's Despair and Pain Stage after separation
Loses faith that the mother will return
-
Effect of Wellbutrin on ADHD
Reduces symptoms
-
Medications approved for treatment of OCD in children (2)
- 1. Zoloft (sertraline)
- 2. Fluvoxamine
-
Medication approved for MDD in children aged 8 and older
Prozac
-
Dosing interval for Risperdal Consta
2 weeks
-
Storage of Risperdal Consta
- Powdered drug must be refrigerated
- Once reconstituted, must use within 6 hours
-
Injection site for Risperdal Consta
Gluteus
-
How long after initiation of Risperdal Consta should oral Risperdal be continued?
3-4 weeks
-
What is Naltrexone?
Opioid antagonist with half life of 72 hours
-
At what Kübler-Ross stage of grief do patients self-blame and ask "Why me?"
Anger
-
If a patient's symptoms in the Kübler-Ross grief stage of Depression meet criteria for MDD, should antidepressants be used?
Yes!
-
Duration of typical grief/mourning
6-12 months after a loss
-
Duration of the acute symptoms of grief
1-2 months after a loss
-
Group whose suicide rate has quadrupled since 1950
Adolescents
-
Duration of action of Ambien
1 to 4.5 hours (half life 2.5 hours)
-
Sleeping agent whose half-life is the longest
Eszopiclone (Lunesta)
-
How often should Liver Function Tests be done when giving Depakote?
At baseline and every 6-12 months thereafter
-
Ages at which a child is in Freud's Oral Phase
Birth to 1 year
-
Results of not completing Freud's Oral Phase successfully
Dependent in adulthood
-
Adult benefits of successful resolution of Freud's Oral Phase
Able to give and receive without excessive dependency or envy
-
Ages at which a child is in Freud's Anal Phase
1-3 years
-
What is Freud's Anal Phase marked by?
Increase in aggressive and labidinal drives
-
Benefits of successful resolution of Freud's Anal Phase
Sense of independence from the parent
-
Result of failing to complete Freud's Anal Phase
Obsessive-Compulsive Neuroses
-
Ages at which a child is in Freud's Phallic Phase
3-5 years
-
What is Freud's Phallic Phase marked by?
Focus on sexual interests and excitement in the genital area
-
Goal of Freud's Phallic Phase
- Focus erotic interests
- Lay groundwork for gender identity
-
Result of failing to complete Freud's Phallic Phase
Neuroses associated with poor resolution of the Oedipal complex
-
Adult benefits of completing Freud's Phallic Phase (4)
- 1. Sense of sexual identity
- 2. Initiative without guilt
- 3. Curiosity without embarassment
- 4. Mastery over internal and external things
-
Ages at which a child is in Freud's Latency Phase
5 years until puberty
-
Ages at which a child is in Freud's Genital Phase
Puberty until adulthood
-
What is Freud's Genital Phase marked by?
- Intensified labidinal drives
- Regression in personality organization, allowing resolution of prior conflicts and solidification of the adult personality
-
Goal of Freud's Genital Phase
- Ultimate separation from the parents
- Development of non-family object relations
-
Feature that distinguishes MCA ischemia from Carotid Artery ischemia
Anamorosis Fugax is present if the Carotid Artery is affected, but not if only the MCA is affected
-
Cause of ipsilateral facial paresis with contralateral limb paresis
ischemia of the brainstem above the decussation of the pyramids in the medulla
-
Result of ischemia of the lenticulostriate territory
Lacunar infarcts of internal capsule, causing pure motor hemiparesis
-
Cause of spinal cord pathology soon after an influenza vaccine or infection
Transverse myelitis
-
Classic presentation of Transverse Myelitis
Bilateral leg weakness with a clear sensory level below the level of the lesion
-
Sensory deficits in Transverse Myelitis
- Pain and temperature are affected below a clear sensory level
- Proprioception and vibration are spared
-
Treatment of Transverse Myelitis
High dose IV steroids
-
Presentation of Vacuolar Myelopathy
- Similar to B12 deficiency
- Almost exclusive to AIDS paitients
-
What is the distinction between Acute Disseminated Encephalomyelitis (ADEM) and Transverse Myelitis?
- ADEM affects the entire CNS
- Transverse Myelitis is localized to a site on the spinal cord
-
What is Descriptive Validity of a diagnosis?
A definition of a disorder is characteristic enough to separate it from other disorders
-
What is Predictive Validity of a diagnosis?
Diagnosis of a disorder allows prediction of clinical course
-
What is Construct Validity of a diagnosis?
Diagnosis is based on underlying pathology, so biologic markers can confirm the illness
-
Site of ischemia causing Horner-like Syndrome without anhydrosis
Internal carotid
-
What is astereognosis?
Inability to recognize an item held in the hand by touch
-
Treatment of PCP agitation
Haldol every 2-4 hours until calm
-
Duration of evolution of Bell's Palsy
24-48 hours
-
Site of pain often accompanying Bell's Palsy
Behind the ipsilateral ear
-
Most frequent viral pathogen causing Bell's Palsy
Herpes Simplex Virus (HSV)
-
Prognostic sign in Bell's Palsy
Complete paralysis carries worse prognosis than incomplete paralysis
-
Side effect of huffing belladonna alkaloids, but not benzenes
Urinary Retention
-
Organs damaged by huffing benzenes/glue (4)
- 1. Brain
- 2. Liver
- 3. Kidneys
- 4. Heart
-
What is Opsoclonus-Myoclonus?
- Paraneoplastic movement disorder
- "Dancing eyes-dancing feet" syndrome
- Multifocal myoclonus with rapid eye movements
-
Whose cancer most often causes Opsoclonus-Myoclonus?
Infants
-
Cancer most often causing Opsoclonus-Myoclonus
Infantile neuroblastoma
-
Site of cancer most often causing Opsoclonus-Myoclonus in adults
Lung
-
Other than cancer, what illnesses can cause Opsoclonus-Myoclonus? (4)
- 1. Viral encephalitis
- 2. Multiple Sclerosis
- 3. Thalamic hemorrhage
- 4. Hyperosmolar coma
-
Treatments for Opsoclonus-Myoclonus (2)
- 1. Steroids
- 2. Adrenocorticotropic Hormone (ACTH)
-
Most definitive symptom of Social Phobia
Fear of scrutiny
-
What is Ramsay Hunt Syndrome?
Neuritis of CN7 and CN8 (facial and acoustic) caused by VZV infection
-
What class of psychiatric illness often co-occurs with Body Dysmorphic Disorder?
Mood Disorders
-
Peak incidence of Anaplastic Astrocytoma
Bimodal in 1st and 3rd decades
-
Peak incidence of Acoustic Neuromas
4th and 5th decades
-
Brain sites with abnormalities in OCD (3)
- 1. Caudate
- 2. Thalamus
- 3. Orbitofrontal cortex
-
Sites of increased metabolism in the brain in OCD (3)
- 1. Basal ganglia
- 2. Frontal lobes
- 3. Cingulate
-
Lab change caused by Riluzole
Elevated liver enzymes
-
Period of development that is the peak of neuronal proliferation
2nd trimester of gestation
-
Period of development that is the peak of neuronal migration
First 6 months of gestation
-
Period of development that is the peak of synapse formation
2 years
-
Treatment of HIV-Associated Dementia
HAART
-
Presentation of CNS Toxoplasmosis in an AIDS patient
- Headache
- Focal neurological deficit
-
Specific neurologic deficits that can occur in CNS Toxoplasmosis (3)
- 1. Aphasia
- 2. Seizures
- 3. Hemiparesis
-
Late stage of CNS Toxoplasmosis in HIV
Confusion and lethargy leading to coma
-
Medications used for CNS Toxoplasmosis (3)
- 1. Pyrimethamine
- -and-
- 2. Sulfadiazine
- -or (if sulfa-allergic)-
- 3. Clindamycin
-
CMP abnormalities caused by self-induced vomiting (5)
- 1. ↓ Potassium
- 2. ↑ Chlorine
- 3. ↓ Magnesium
- 4. Alkalosis
- 5. ↑ Amylase
-
Most common cause of spinal cord pathology in AIDS
Vacuolar Myelopathy
-
Most common periperal nerve syndrome in AIDS
Distal Sensory Polyneuropathy
-
Presentation of Distal Sensory Polyneuropathy in an AIDS patient (2)
- 1. Decreased pain, temperature, and vibration sensation in bilateral feet
- 2. Diminished ankle jerk bilaterally
-
Treatment of Distal Sensory Polyneuropathy in AIDS
- HAART
- Symptomatic pain treatment
-
Chromosome that can carry prions
20
-
Presentation of Kuru
- Progressive ataxia
- Death in 12 months
-
Symptoms that occur in any combination in Gerstmann-Straüssler-Scheinker Disease (3)
- 1. Ataxia
- 2. Parkinsonism
- 3. Dementia
-
What is Devic's Disease?
Term for Neuromyelitis Optica
-
Symptoms of Carotid Occlusion (3)
- 1. Headache
- 2. Ipsilateral Horner's Syndrome
- 3. Contralateral hemiparesis
-
Prognosis of Pontine Hemorrhage
- Can cause death rapidly if the bleed is large
- Neurologic emergency!
-
Presentation of a large bleed in the Basal Tegmentum of the Pons (6)
- 1. Coma
- 2. Decerebrate posturing
- 3. Abnormal respiratory rhythm
- 4. Quadriplegia
- 5. Hypoerthermia
- 6. Ocular bobbing
-
What is Bell's Phenomenon?
When a patient with Bell's Palsy tries to close the affected eye with effort, the globe turns up and out
-
What is Bannwarth's Syndrome?
Facial diplegia due to aseptic meningitis caused by Lyme Disease
-
Autoimmune disease that can cause facial nerve palsy
Sarcoidosis
-
Incubation period of Rabies Virus
1-2 months
-
Symptoms of prodromal period of rabies (3)
- 1. Paresthesia
- 2. Headache
- 3. Fever
-
Characteristic symptom of progressive phase of Rabies
Pharyngeal and nuchal spasms triggered by swallowing, tastes, smells, or sounds
-
Symptoms of late-stage Rabies (3)
- 1. Encephalitis
- 2. High fever
- 3. Can lead to coma and death
-
Most common presentation of West Nile Virus infection
Asymptomatic or flu-like symptoms (meningitis or encephalitis is rare!)
-
Diagnostic tests for West Nile Virus (2)
- 1. Serum IgM and IgG
- 2. CSF IgM
-
What is Risus Sardonicus?
Sustained involuntary grimace due to facial spasm, such as in tetanus
-
Treatment of Tetanus
Tetanus Immune Globulin to neutralize tetanus toxin
-
Treatment of Botulism
Supportive, particularly airway protection
-
Neurologic manifestations of Epstein-Barr Virus (4)
- 1. Meningitis
- 2. Transverse myelitis
- 3. Sensory polyneuropathy
- 4. Guillain-Barré
-
Treatment of Pick Disease (2)
- 1. Treat low mood with antidepressants
- 2. Treat impulsivity with atypical antipsychotics
-
Illnesses in which Hirano Bodies are seen in neurons (2)
- 1. Creutzfeldt-Jakob Disease
- 2. Alzheimer's Dementia
-
Criterion for diagnosis of Fibromyalgia
Tenderness at 11 of 18 trigger points
-
Psychiatric comorbidity of pancreatic cancer
Depression
-
Treatment of spinal cord compression due to metastatic tumor (2)
- 1. Decompressive laminectomy
- 2. Radiotherapy (works as well as surgery!)
Chemotherapy is not effective!
-
Other than neurologic deficits, effects of B12 deficiency (2)
- 1. Macrocytic anemia
- 2. Atrophic glossitis
-
Amino Acid Neurotransmitters (3)
- 1. Aspartate
- 2. Glutamate
- 3. GABA
-
What are "Petis Pas"?
- Literally "small steps"
- Describes the Parkinsonian gait
-
Criterion for Reading Disorder
Reading achievement substantially below what is expected given IQ and education
-
What is "Top of the Basilar Syndrome"?
Occlusion of the rostral Basilar Artery, often by an embolus
-
Symptoms of "Top of the Basilar Syndrome" (4)
- 1. Delirium
- 2. Peduncular hallucinosis
- 3. Obtundation
- 4. Memory deficits
-
Sites of lesion causing Motor Apraxia (3)
- 1. Internal capsule
- 2. Pons
- 3. Nondominant hemisphere
-
Neurological/psychiatric effects of chronic huffing of benzenes (3)
- 1. Hallucinosis
- 2. Psychosis
- 3. Seizures
-
End organ damage due to chronic huffing of benzenes (3)
- 1. Renal failure
- 2. Liver failure
- 3. Bone marrow suppression
-
Treatment of Delusional Disorder
Antipsychotic medications along with psychotherapy
-
Effect of stimulants on the seizure threshold
Lower the threshold
-
Most common neurologic adverse effect of stimulants
Headache
-
Stimulant most likely to induce seizures
Cocaine
-
Severe neurologic side effects of stimulant abuse (3)
- 1. Myoclonus
- 2. Encephalopathy
- 3. Seizures
-
Drug of abuse most likely to cause stroke
Cocaine
-
Psychiatric illness most likely to lead to suicide
Major Depressive Disorder
-
What is the M'Naughtten rule?
States that a patient is Guilty By Reason of Insanity if a mental illness caused them to be unaware of the nature and consequences of their actions
-
What was the holding of Ford vs. Wainwright?
A patient must be found competent in order to be executed
-
What is aphemia?
- Motor speech disorder
- Near muteness with no other language deficits
-
Sites where lesion would cause Aphemia (2)
- 1. Primary motor cortex
- 2. Broca's Area
-
What ions can pass through the channel of an NMDA receptor? (3)
- 1. Ca2+ (primary ion)
- 2. Na+
- 3. K+
-
What is Stupor?
Unresponsiveness with arousal only if stimulated vigorously and repeatedly
-
Somatoform disorder with the best prognosis
Conversion disorder
-
Prognosis of Hypochondriasis
Fair to good
-
Prognosis of Conversion Disorder
90-100% remit within less than a month
-
Prognosis of Body Dysmorphic Disorder
Poor
-
Prognosis of Pain Disorder
Variable, but generally guarded
-
Brain region responsible for recalling emotional contexts of specific events
Amygdala
-
Brain regions required for short term memory (3)
- 1. Hippocampus
- 2. Nucleus Basalis of Maynert
- 3. Medial Temporal Lobe
-
Which TCA is the least cholinergic?
Desipramine
-
Age at which a child coos
2 months
-
Age at which a child has a social smile
2 months
-
Age at which a child holds its head up 45 degrees
2 months
-
Age at which a child laughs/squeals
4 months
-
Age at which a child sustains social contact
4 months
-
Age at which a child grasps objects
4 months
-
Age at which a child begins to bear weight on its legs
4 months
-
Age at which a child imitates speech sounds
6 months
-
Age at which a child produces single syllables
6 months
-
Age at which a child begins to prefer mother to other people
6 months
-
Age at which a child first notices mirrors
6 months
-
Age at which a child transfers objects hand to hand
6 months
-
Age at which a child develops a raking grasp
6 months
-
Age at which a child sits up with support
6 months
-
Age at which a child plays peek-a-boo
8 months
-
Age at which a child waves "bye bye"
8 months
-
Age at which a child sits without support
8 months
-
Age at which a child crawls
8 months
-
Age at which a child uses "mama" and "dada" specifically
12 months
-
Age at which a child plays simple games with a ball
12 months
-
Age at which a child adjusts the body to being dressed
12 months
-
Age at which a child stands alone
12 months
-
Age at which a child uses a two-finger pincer grasp
12 months
-
Age at which a child has a 1-2 word vocabulary
14 months
-
Age at which a child indicates desires by pointing
14 months
-
Age at which a child hugs parents
14 months
-
Age at which a child walks alone
14 months
-
Age at which a child stoops and recovers
14 months
-
Age at which a child has a 6 word vocabulary
18 months
-
Age at which a child can feed itself
18 months
-
Age at which a child walks up stairs while its hand is held
18 months
-
Age at which a child imitates scribbling
18 months
-
Age at which a child combines words
24 months
-
Age at which a child has a 250 word vocabulary
24 months
-
Age at which a child helps to undress self
24 months
-
Age at which a child listens to picture stories
24 months
-
Age at which a child runs
24 months
-
Age at which a child makes circular scribbles
24 months
-
Age at which a child copies a horizontal line
24 months
-
Age at which a child knows full name
30 months
-
Age at which a child refers to self as "I"
30 months
-
Age at which a child pretends in play
30 months
-
Age at which a child helps put things away
30 months
-
Age at which a child climbs stairs with alternating feet
30 months
-
Age at which a child copies a vertical line
30 months
-
Age at which a child counts 3 objects
36 months
-
Age at which a child knows age and sex
36 months
-
Age at which a child helps in dressing
36 months
-
Age at which a child rides a tricycle
36 months
-
Age at which a child stands briefly on one foot
36 months
-
Age at which a child copies a circle
36 months
-
Age at which a child tells a story
48 months
-
Age at which a child counts four objects
48 months
-
Age at which a child plays with other children
48 months
-
Age at which a child uses a toilet alone
48 months
-
Age at which a child hops on one foot
48 months
-
Age at which a child uses scissors
48 months
-
Age at which a child copies a square
48 months
-
Age at which a child copies a cross
48 months
-
Age at which a child names four colors
60 months
-
Age at which a child counts ten objects
60 months
-
Age at which a child asks about word meanings
60 months
-
Age at which a child engages in domestic roleplaying
60 months
-
Age at which a child skips
60 months
-
Age at which a child copies a triangle
60 months
-
What is Hoover's Sign?
- Not giving effort on the unaffected extremity when asked tot push down on a bed with a paretic lower extremity
- Sign of psychogenic hemiparesis
-
What tract is damaged if Hoffman's Sign is present?
Contralateral Corticospinal Tract
-
What is Lasègue's Sign?
Straight leg raising while lying flat produces sciatic pain or paresthesia
-
What is Gegenhalten?
"Clasp knife" rigidity in extremities due to stroke, MS, or catatonia
-
Can TCAs be given in pregnancy?
No!
-
What is Parens Patriae?
Legal concept allowing the state to act as a surrogate parent for those unable to take care of themselves
-
What is Actus Reus?
Voluntary Conduct
-
What is Mens Rea?
"Evil intent"
-
What is Tigabine used to treat?
Partial Complex seizures
-
Conditions that Vagus Nerve Stimulators are FDA-approved to treat (2)
- 1. Major Depression
- 2. Partial Complex Epilepsy
-
Efficacy of Carbamazepine in Alcohol withdrawal
May be as effective as benzodiazepines
-
Metabolism of Carbamazepine
Metabolized by liver, excreted by kidneys
-
Effects of Carbamazapine on blood cells
- Transient decrease in WBCs
- Rarely, aplastic anemia and agranulocytosis
-
Site of hemorrhage due to ruptured AV Malformation
Intracerebral
-
What does a "button nose" in the ventricular system on a brain MRI represent?
Colloid cyst of the 3rd ventricle
-
Symptoms of a colloid cyst of the 3rd ventricle (2)
- 1. Intermittent headaches
- 2. Brief intermittent drop attacks
-
Presentation of Hallevorden-Spatz Syndrome
Childhood onset dementia and parkinsonism
-
Inheritance pattern of Hallevorden-Spatz Syndrome
Recessive
-
Classic neuropathologic hallmark of Hallevorden-Spatz Syndrome
Discoloration of the globus pallidus and substantia nigra due to iron accumulation
-
Enzyme deficient in Hallevorden-Spatz Syndrome
Cysteine dioxygenase
-
Vitamin deficiency due to Isoniazid
B6
-
Medications that can cause B6 deficiency (3)
- 1. Isoniazid
- 2. Hydralazine
- 3. Penicillamine
-
Neurologic syndrome caused by Hypervitaminosis A
Pseudotumor cerebri
-
Cause of Vitamin A deficiency
Malabsorption syndromes
-
What type of virus is West Nile Virus?
Arbovirus
-
What type of virus is Lymphocytic Choriomeningitis Virus?
Arenavirus
-
What type of virus is Lassa Fever Virus?
Arenavirus
-
What is the vector for Arenaviruses?
Rodents
-
What type of virus is Ebola?
Filovirus
-
What type of virus is Marburg Virus?
Filovirus
-
What type of virus is JC Virus?
Papovavirus
-
Effect of lithium on weight
Causes weight gain
-
Dermatologic effects of lithium (2)
-
Cognitive effects of Lithium Toxicity (3)
- 1. Slowed thinking
- 2. Impaired memory
- 3. Impaired consciousness
-
Neurotransmitter associated with the Basal Forebrain
Acetylcholine
-
Neurotransmitter associated with maintaining attention
Acetylcholine
-
Neurotransmitter associated with short term memory
Aceetylcholine
-
Neurotransmitter associated with executive functioning
Acetylcholine
-
Neurotransmitter associated with novelty seeking
Acetylcholine
-
Effect of Nefazodone on Norepinephrine
Blocks reuptake
-
Mechanism of Mirtazapine
- Presynaptic α2 blocker
- Blocks feedback inhibition of release of norepinephrine
-
Best benzodiazepines for patients with liver dysfunction (3)
- 1. Temazepam
- 2. Oxazepam
- 3. Lorazepam
-
Site of colonization of Aspergillus
- Paranasal sinuses
- Can cause hypersensitivity pneumonitis
-
Consequences of local invasion by Aspergillus (3)
- 1. Enters posterior circulation, causing basilar strokes
- 2. Enters brain directly
- 3. Enters thoracic vertebrae, causing cord compression
-
Neurologic manifestations of Histoplasma infection (4)
- 1. Cerebritis
- 2. Basilar meningitis
- 3. CNS granuloma
- 4. Cerebral abscess
-
CNS effects of Candida Albicans in immunocompromised patients (4)
- 1. Intracranial abscess
- 2. Vasculitis
- 3. Small vessel thrombosis
- 4. Forms mycotic intracranial aneurysms that can rupture
-
CNS effects of Pseudallecheria Boydi in immunocompromised patients (2)
- 1. Meningitis
- 2. Multiple brain abscesses
-
Adverse effects of Fluoxetine that are not present in other SSRIs (3)
- 1. Headache
- 2. Anxiety
- 3. Respiratory complaints
-
What is Identity Diffusion?
Failure to develop a cohesive self or self-awareness
-
Treatment of Separation Anxiety Disorder in children (3)
- 1. Return to school (graded if necessary)
- 2. Therapy for the child and the family
- 3. Medications
-
Focus of parental education for a child suffering Separation Anxiety Disorder
Giving constant support but maintaining clear boundaries regarding avoidant behaviors
-
Effect of Naltrexone in alcohol abuse
Reduces craving and alcohol consumption
-
Gender breakdown of Major Depression
Women > Men
-
Effect of cortisol levels on depression
Hypersecretion of cortisol is associated with depression
-
What is State-Dependent Learning?
Facilitated recall of information if in the same environment or internal state as when the information was learned
-
Dermatologic manifestatiton of B3 (Niacin) deficiency
Keratotic rash over much of the body
-
Neurologic manifestations of B3 (niacin) deficiency
Depression, apathy, irritability, and memory impairment
-
Neurological triad of Vitamin E Deficiency (3)
- 1. Neuropathy
- 2. Retinopathy
- 3. Areflexia
-
Neurologic effects of Folate deficiency (2)
- 1. Neuropathy
- 2. Upper motor neuron signs
-
Effects of Cannabis on vital signs (2)
- 1. Tachycardia
- 2. At high dose, orthostatic hypotension
-
Medication to treat akathesia
Propranolol
-
Lab value most likely to be abnormal in alcohol abuse
GGT (elevated)
-
What is Pimozide? What does it treat?
- Dopamine antagonist
- Treats tics in Tourette's Disorder
-
Site of the Amyloid Precursor Protein Gene
Chromosome 21
-
What is the Paranoid Schizoid Position?
View from the infant's perspective, in which the world is separated into good and bad elements
-
What is the Depressive Position?
Able to view the mother as having both positive and negative elements
-
Whose work included the Paranoid-Schizoid Position and the Depressive Position?
Melanie Klein
-
Effect of Erythromycin on Carbamazapine levels
Increases carbamazapine levels
-
Treatment of choice for Atypical Depression
MAOIs
-
SNRI that requires blood pressure monitoring
Venlafaxine (Effexor); can cause HTN
-
What did Nikolas Tinbergen study in animals?
- Effect of stimuli on behaviors of animals
- Found innate release mechanisms used when stress was very high (such as doing an unrelated activity)
-
What did Nikolas Tinbergen study in humans?
- Studied autistic children
- Determined that stimuli that are comforting for normal children may be scary to autistic children
-
What illnesses is the Brief Psychiatric Rating Scale (BPRS) used to evaluate for?
Psychoses, especially schizophrenia
-
Medication used to treat Sleep Terror Disorder
Diazepam at low doses
-
What class of medication is Thioridazine?
Typical antipsychotic
-
Side effects of Thioridazine (5)
- 1. Sedation
- 2. Anticholinergic effects
- 3. Orthostatic hypotension
- 4. Impotence
- 5. Retrograde ejaculation
-
Most common manifestation of neurosarcoidosis
Cranial neuropathies
-
Diagnosis of Neurosarcoidosis
- Clinical!
- Can confirm with muscle biopsy or CSF angiotensin converting enzyme (ACE) level
-
Antidepressant noted to have no sexual side effects
Mirtazapine
-
GAF score corresponding to "some difficulty in social, occupational, or school functioning but generally functioning well, has meaningful personal relationships"
70
-
GAF score corresponding to persistent failure to maintain personal hygeine
10
-
GAF score corresponding to major impairment in several areas
40
-
GAF score corresponding to superior functioning in all areas
100
-
GAF score corresponding to having no friends and being unable to keep a job
30
-
Effects of H1 blockade (2)
- 1. Weight gain
- 2. Sedation
-
Effect of ACh blockade (5)
- 1. Dry mouth
- 2. Constipation
- 3. Blurred vision
- 4. Urinary retention
- 5. Cognitive dysfunction
-
Effect of α1 blockade (2)
- 1. Orthostatic hypotension
- 2. Drowsiness
-
Most sensitive test for Myasthenia Gravis
EMG showing increased "jitter"
-
Is elevated CPK more likely in NMS or Serotonin Syndrome?
NMS, due to muscular rigidity
-
Is myoclonus more likely in NMS or Serotonin Syndrome?
Serotonin Syndrome
-
Is hyperreflexia more likely in NMS or Serotonin Syndrome?
Serotonin Syndrome
-
Are GI Symptoms more likely in NMS or Serotonin Syndrome?
Serotonin Syndrome
-
Is muscle rigidity more likely in NMS or Serotonin Syndrome?
NMS
-
Effect of L-Dopa in Dementia with Lewy Bodies
Treats Parkinsonism, but can cause agitated delirium or hallucinations
-
Foods that induce 1A2 (2)
- 1. Charbroiled meats
- 2. Cruciferous vegetables
-
Most common primary tumor site that metastasizes to brain
Lung
-
What is Fidiciary Duty?
Obligation to work in a patient's best interests
-
What is Beneficence?
Obligation to help patients and relieve suffering
-
Duration of Schizophreniform Disorder
1 to 6 months
-
Does a stressor precede Brief Psychotic Episodes?
Often yes, but not always
-
Is Parkinson's Disease a Synnucleinopathy?
Yes!
-
Duration of symptoms to qualify as a Manic Episode
1 week
-
How many additional symptoms are required to diagnose mania if the core symptom is euphoria?
3
-
How many additional symptoms are required to diagnose mania if the core symptom is irritability?
4
-
Features that can be present in mania, but not hypomania (3)
- 1. Impaired social/occupational functioning
- 2. Need for hospitalization
- 3. Psychosis
-
Duration of symptoms to qualify as a Hypomanic Episode
4 days
-
Treatment of Wilson Disease
D-penicillamine to chelate copper
-
Characteristics of Primary Torsion Dystonia
- Action-induced dystonia of a limb, often spreading to trunk or other limbs
- Larynx and pharynx are not affected
- Cognition is not affected
-
What percentage of the population has a diagnosable personality disorder?
10-15%
-
Course of TB Meningitis
Subacute; starts with milder symptoms, eventually progresses to fulminant meningitis
-
CT/MRI appearance of intracranial tuberculoma
Ring-enhancing lesion
-
Brain imaging changes in schizophrenia
Generalized atrophy with enlarged ventricles
-
Symptom of MCA stem occlusion in the dominant hemisphere
Global aphasia
-
Symptom of MCA stem occlusion in the nondominant hemisphere
Hemineglect
-
Aphasia caused by upper division MCA infarct
Broca's aphasia
-
Feature of hemiparesis caused by MCA stroke
Face and arm weakness are worse than leg weakness, because the leg region of the motor strip has collateral blood from the ACA
-
Aphasia caused by inferior division MCA infarct
Wernicke's
-
What is a Continuous Variable?
Variable that falls on a range (eg weight, height)
-
What is an Independent Variable (predictor variable)?
Variable manipulated by the experimenter
-
What is a Dependent Variable (outcome variable)?
Variable not manipulated by the experimenter
-
What types of variables are compared by a Chi-Squared Test?
A binary predictor variable and a binary outcome variable
-
What types of variables are compared by a T-Test?
A binary predictor variable and a continuous outcome variable
-
What types of variables are compared by an ANOVA?
Multiple binary predictor variables and one continuous outcome variable
-
What types of variables are compared by correlation?
A continuous predictor variable and a continuous outcome variable
-
What types of variables are compared by a Regression Analysis?
Multiple continuous or binary predictor variables and one continuous outcome variable
-
Age at which a child can build a tower of 6 blocks
18 months
-
Age at which a child engages in parallel play
18 months
-
CNS regions of sphyngomyelin accumulation in Niemann-Pick Disease, and symptom from each (3)
- 1. Cerebellum (causes ataxia)
- 2. Basal ganglia (causes dystonia)
- 3. Upper brainstem (causes gaze palsy)
-
Organ inflammation caused by Depakote (2)
- 1. Pancreatitis
- 2. Hepatitis
-
Most common inherited cause of Intellectual Disability
Fragile X
-
Effect of Down Syndrome on genitalia
- Genitals are small
- Infertility is common
-
Demeanor of a patient with Williams Syndrome
Unusually at ease with strangers and pleasant
-
Area not affected by cognitive delay in Williams Syndrome
Language skills are strong!
-
How many RUL ECT treatments should be done without benefit before changing to Bilateral?
4-6
-
Effect of Lithium during ECT
Prolongs seizure activity
-
Effect of Clozapine during ECT
Can cause late-appearing seizures
-
Malignancy in 10-15% with Ataxia-Telangiectasia by adulthood
Lymphoma
-
Is Displacement a mature, neurotic, or immature defense?
Neurotic
-
Is Repression a mature, neurotic, or immature defense?
Neurotic
-
Brain region whose lesion is the most common cause of cerebral sensory deficit
Thalamus
-
Brain region whose compression causes the cognitive symptoms of NPH
Anterior brain, including frontal lobes
-
Age at which a child can play "Pat-a-Cake"
10 months
-
Sites of nonspecific white matter anomalies HIV-Associated Dementia on MRI (3)
- 1. Hemispheres
- 2. Thalamus
- 3. Basal ganglia
-
What p450 enzyme is inhibited by methadone?
2D6
-
What p450 enzyme breaks down Wellbutrin?
2B6
-
What percentage of nigrostriatal dopaminergic neurons must be lost before Parkinson's Disease symptoms occur?
60-85%
-
Cerebellar region most atrophied in alcoholism
Vermis
-
Factors increasing the effect of alcohol on women compared to men (2)
- 1. Less alcohol dehydrogenase in the gut
- 2. Lower body water content
-
Psychological effects of folate defieiency (6)
- 1. Fatigue
- 2. Dementia
- 3. Delirium
- 4. Psychosis
- 5. Paranoia
- 6. Agitation
-
Effect of Phenobarbital on Carbamazapine levels
Decreases carbamazapine levels
-
Effect of Theophylline on Carbamazapine levels
Decreases carbamazapine levels
-
Effect of Carbamazapine on Doxycycline levels
Decreases doxycycline levels
-
Effect of Carbamazapine on Cyclosporine levels
Decreases cyclosporine levels
-
Presentation of extracranial Vertebral Artery dissection
- High cervical pain
- May radiate to the occipital region
-
Risk of extracranial Vertebral Artery dissection
Posterior circulation TIAs and strokes
-
Most common cause of extracranial Vertebral Artery dissection
- Trauma
- May be severe or mild (including simple hyperextension while shaving)
-
Management of extracranial Vertebral Artery dissection
Anticoagulation to prevent posterior circulation TCAs and strokes
-
Poor prognostic indicator in Bell's Palsy
Fibrilation of facial muscles 10-14 days after onset of weakness
-
Site of lesion causing coma after Carbon Monoxide posioning
Globus Pallidus
-
Regions primarily affected in Stiff-Person Syndrome
Lower trunk and legs (though the upper body can be affected to a lesser degree)
-
Precipitating factors of muscle spasms in Stiff-Person Syndrome (2)
- 1. Emotional upset
- 2. Auditory or tactile stimuli
-
Effect of sleep or anesthesia on Stiff-Person Syndrome
Relieves rigidity
-
Symptomatic treatment for Stiff-Person Syndrome
GABAergic medications
-
Receptor mediating the anti-nausea effect of Mirtazapine
5-HT3 (antagonist)
-
Receptor mediating the anti-nausea effect of Ondansentron
5-HT3 (antagonist)
-
Location of medulloblastomas
4th ventricle (cause obstruction)
-
Brain regions though which the Reticular Activating System passes (2)
-
PET/fMRI finding in Schizophrenia
Decreased activity in frontal lobes
-
Symptoms of C5 nerve root lesion
- Pain and paresthesia over the shoulder
- Weakness of deltoid, biceps, and brachioradialis
-
Symptoms of C6 nerve root lesion
- Paresthesia of the thumb and lateral distal forearm
- Weakness of biceps, triceps, and brachioradialis
-
Symptoms of C7 nerve root lesion
- Paresthesia of the index, middle, and ring fingers
- Weakness in triceps and pronators
-
What is Pick's Disease?
Type of frontotemporal dementia
-
Molecule whose mutation causes Potassium-Sensitive Periodic Paralysis
Sodium Channel
-
Chromosome affected in Potassium-Sensitive Periodic Paralysis
17
-
Inheritance pattern of Potassium-Sensitive Periodic Paralysis
Autosomal Dominant
-
Symptom of Potassium-Sensitive Periodic Paralysis
Weakness caused by potassium exposure
-
Treatment of Hemicrania Continua (Paroxysmal Hemicrania)
Prophylactic indomethacin
-
What is the Chiari III Mutation?
Cervical spina bifida through which the cerebellum protrudes
-
Cognitive area not affected by Prader-Willi Syndrome
Visuospatial skills
-
Cognitive area most prominently affected by Prader-Willi Syndrome
Executive Functioning
-
Major morbidity of Pseudotumor Cerebri
Optic nerve damage causing field cuts
-
What is Kohut's Mirroring?
- Obtaining praise from others to satisfy the Grandiose Self
- Normal in children, but can become part of transference in narcissists
-
What is Kohut's Idealizing Transference?
- Associating the therapist with primitive fantasies of omnipotent parental perfection
- Occurs due to chronic disappointment over failings of early idealized figures
-
Brain regions that mediate Episodic Memory (5)
- 1. Medial temporal lobe
- 2. Anterior thalamus
- 3. Mamillary body
- 4. Fornix
- 5. Prefrontal cortex
-
Brain region that mediates Semantic Memory
Inferolateral temporal lobe
-
Brain regions that mediate Procedural Memory (3)
- 1. Basal ganglia
- 2. Cerebellum
- 3. Supplementary Motor Area
-
What is the basis of Operant Conditioning?
Learning occurs by experiencing positive and negative consequences of action
-
What concept was developed by Burns?
Cognitive Distortions
-
Why should TCAs be avoided in dementia?
Anticholinergic effects can worsen agitation and overall dementia
-
Standardized treatment location for TMS
Left prefrontal cortex
-
Indication for TMS in MDD
Failed one antidepressant at adequate dose for adequate time
-
"Fast-Off" theory regarding atypical antipsychotics
- Atypicals have low affinity for the D2 receptor, and are rapidly released
- This leads to improved cognition, less EPS, and less elevation in prolactin
-
Populations most affected by Conversion Disorder (5)
- 1. Rural
- 2. Lower education
- 3. Lower IQ
- 4. Lower socioeconomic status
- 5. Combat veterans
-
Drugs of abuse that affect serotonin (2)
-
Site of damage due to MDMA use
Serotonergic nerve terminals in CNS
-
What is the L-Scale of the MMPI?
- Lie Scale
- Focuses on rarely-practiced socially desirable behaviors
- Tests whether patient is being honest
-
What is the F-Scale of the MMPI?
- Infrequency Scale
- Used to identify malingering, illiteracy, confusion, psychosis, and panic
-
What is the K-Scale of the MMPI?
- Suppressor Scale
- Used to decrease false positives and false negatives
-
Contraindications of Thyroid Hormone (3)
- 1. Thyrotoxicosis
- 2. Uncorrected adrenal insufficiency
- 3. Acute MI
-
Effect of Thyroid Hormone on Warfarin
Potentiate effects of Warfarin
-
Effect of Thyroid Hormone on Insulin
Increase insulin requirements in diabetes
-
Effect of Thyroid Hormone on Digitalis
Increase digitalis requirements in cardiac disease
-
How long after alcohol cessation is GGT elevated?
8 weeks
-
Psychiatric symptoms of Adrenal Insufficiency (Addison's Disease) (5)
- 1. Depression
- 2. Apathy
- 3. Irritability
- 4. Psychosis
- 5. Delirium
-
Effect of Valproic Acid on Carbamazepine levels
Doubles Carbamazapine levels
-
Effect of Carbamazapine on Lamotrigine levels
Halves lamotrigine levels
-
Age at which myelination of peripheral nerves is complete
2 years
-
Which gender is more likely to be affected by Tardive Dyskinesia?
Women
-
Age ranges more susceptible to Tardive Dyskinesia
-
Disorders that increase risk of Tardive Dyskinesia (2)
- 1. Brain damage
- 2. Mood disorders
-
Age range whose Tardive Dyskinesia is least-likely to remit
Elderly patients
-
Absorption rate of clonazepam
Rapid
-
Absorption rate of alprazolam
Medium
-
Absorption rate of diazepam
Rapid
-
Absorption rate of lorazepam
Medium
-
Half-life of Clonazepam
34 hours
-
Half-life of Alprazolam
12 hours
-
Half-life of Diazepam
100 hours
-
Half-life of Lorazepam
15 hours
-
Mnemonic for benzodiazepines in renal impairment
- "Tolerated by Our Liver"
- Temazepam
- Oxazepam
- Lorazepam
-
Topics assessed by the SCID (8)
- 1. General overview
- 2. Mood Disorders
- 3. Psychotic Disorders
- 4. Substance Use
- 5. Anxiety Disorders
- 6. Somatiform Disorders
- 7. Eating Disorders
- 8. Adjustment Disorders
-
Electrolyte abnormality that can be caused by Carbamazapine
Hyponatremia
-
Metabolism of Olanzapine
Hepatic
-
Metabolism of Quetiapine
Hepatic
-
Metabolism of Ziprasidone
Hepatic
-
Metabolism of Risperidone
Hepatic
-
Metabolism of Paliperidone
Renal
-
Metabolism of Desvenlafaxine
Renal
-
Side effects specific to Desvenlafaxine (3)
- 1. Orthostasis
- 2. Hyponatremia
- 3. Hypertension
-
GAF above which symptoms are generally minor
60
-
GAF below which a patient is severely impaired and persistently dangerous to self or others
20
-
How long does it take for Atomoxetine (Strattera) to reach full effect?
10 weeks
-
Side effects of Atomoxetine (Strattera) (3)
- 1. Dizziness
- 2. Reduced appetite
- 3. Dyspepsia
-
Metabolism of Atomoxetine (Strattera)
Hepatic
-
Can Atomoxetine (Strattera) be combined with stimulants?
Yes! Both well-tolerated and effective
-
Which field of Psychology states that a child needs others to help with self-object functions?
Self Psychology
-
Substances whose dependence can be treated with depot Naltrexone (2)
-
What does the HAM-D evaluate?
Depression
-
What does the PANSS evalute?
Severity of psychosis
-
What antidepressant is FDA-approved for pain in Fibromyalgia?
Duloxetine
-
What alcohol is safe with MAOIs?
Clear alcohols (eg vodka) in small amounts
-
REM Latency during Cataplexy
Decreased; within a few minutes, many patients are in REM sleep
-
IQ Range classified as Mild Intellectual Disability
50-70
-
IQ Range classified as Moderate Intellectual Disability
35-50
-
IQ Range classified as Severe Intellectual Disability
20-35
-
IQ Range classified as Profound Intellectual Disability
Less than 20
-
Risk of Clozapine dosing over 600mg daily
Much higher risk of seizure than lower doses of Clozapine
-
Risk of Lithium with Clozapine
Increased risk of NMS
-
Is Agranulocytosis from Clozapine dose-related?
No!
-
Effect of smoking on Clozapine levels
Decreases clozapine levels
-
Largest factor in likelihood of developing PTSD after a trauma
Degree of trauma and its subjective meaning to the individual
-
Effect of childhood trauma on future PTSD
Increased risk of developing PTSD from a future trauma
-
Gender breakdown of PTSD
Women > Men
-
Effect of alcohol on developing PTSD
Recent abuse of alcohol increases likelihood of PTSD if a trauma occurs
-
Most important predictor of suicide in a schizophrenic patient
Presence of a depressive episode
-
Symptoms of Sheehan's Syndrome (6)
- 1. Failure to lactate
- 2. Amenorrhea
- 3. Loss of secondary sex characteristics
- 4. Weight loss
- 5. Constant fatigue
- 6. Diminished libido
-
Timing of Postpartum Depression
Within 4 weeks of delivery
-
Psychiatric symptoms that can occur in Acute Intermittent Porphyria (4)
- 1. Delirium
- 2. Psychosis
- 3. Depression
- 4. Anxiety
-
Prevalence of Alzheimer Disease after age 85
20-40%
-
Definition of "Disability" in the Americans with Disabilities Act
Physical or mental impairment that substantially limits one or more major life activities of that individual
-
Mental Illnesses most likely in chronically homeless (2)
- 1. Schizophrenia
- 2. Substance abuse
-
Metnal Illnesses most likely in episodically homeless (3)
- 1. Personality disorders
- 2. Mood disorders
- 3. Substance abuse
-
Treatments of acute arsenic poisoning (2)
- 1. Penicillamine
- 2. Dimercaptol derivative (DMSA or DMPS)
-
Treatments of lead ecephalopathy (2)
- 1. Sertoids to treat cerebral edema
- 2. Chelating agents (dimercaprol or DMPS)
-
Does a patient have a right to psychotherapy notes under HIPAA?
No!
-
Does a patient have a right to dictate the method of communication of health information under HIPAA?
Yes!
-
Histaminergic effect of Mirtazapine
- Potent H1 antagonist
- Causes sedation, increased appetite, and weight gain
-
MRI results in Transverse Myelitis
Spinal cord enhancement
-
How often does Transverse Myelitis develop into Multiple Sclerosis?
7% of patients develop MS
-
Mood stabilizer that is FDA approved for bipolar maintenance
Lamotrigine
-
Mood stabilizer that is FDA approved for both mania and depression
Lamotrigine
-
What psychiatric symptoms is Carbamazapine FDA approved for?
Mania
-
What psychiatric symptoms is Valproic Acid FDA approved for?
Mania
-
Typical duration of sleepwalking
Less than 10 minutes
-
Site of brain injury causing Simultagnosia
Left occipital region
-
What is Anomic Aphasia?
Difficulty naming or word-finding
-
Deficits often co-occurring with Conduction Aphasia
Right-sided sensory loss, typically with intact motor function
-
Eye and head position after ACA stroke
Deviate toward the lesion
-
Branches of ACA whose obstruction causes sphincter incontinence
Hemispheric branches
-
Branches of the ACA whose obstruction causes apraxia, agraphia, and tactile anomia of the hand
Pericallosal branches
-
Branches of the ACA whose obstruction causes anxiety, agitation, and memory impairment
Basal branches
-
Symptoms of infarction of the Medial Lenticulostriate Artery
Internal capsule infarction causes pure motor impairment of face and arm
-
Symptoms of Anterior Choroidal Artery Syndrome (3)
- 1. Hemiparesis (affects internal capsule)
- 2. Hemisensory loss (affects thalamus)
- 3. Hemianopia (affects Lateral Geniculate Nucleus)
-
Visual field deficit occurring in Anterior Choroidal Artery Syndrome
- Homonymous
- Affects superior and inferior fields, but spares the horizontal meridian
-
Metabolism of Gabapentin
- Not metabolized by the liver
- Excreted unchanged in urine
-
What information remains lost after an episode of Transient Global Amnesia resolves?
- A brief period before the episode
- Memories from the episode itself
-
Gender breakdown of Psychogenic Nonepileptic Seizures
Women > Men
-
Blood test that suggests Psychogenic Nonepileptic Seizures
Prolactin is sometimes elevated after a true seizure, but never after a pseudoseizure
-
First-line treatment for akathesia
Beta Blockers
-
Treatments for akathesia (2)
- 1. Beta Blockers
- 2. Benzodiazepines
-
Drug of choice for Trigeminal Neuralgia
Carbamazepine
-
Efficacy of opiates in Trigeminal Neuralgia
Some sources say not effective
-
Efficacy of baclofen in Trigeminal Neuralgia
Very effective
-
How long after ischemic stroke can aspirin be started to be beneficial?
48 hours
-
Presentation of Thoracic Outlet Syndrome
- Pain on the medial arm or diffusely in the arm
- Tingling along the medial forearm and hand
-
Presentation of Idiopathic Brachial Plexopathy
- Abrupt pain in any part of the upper limb/shoulder area
- Pain lasts hours to weeks
- When pain subsides, 2-3 weeks of weakness in the same distribution
-
Most common Anxiety Disorder
Specific Phobia
-
Most common mental illness among women
Specific Phobia
-
Most common mental illness among men
Substance abuse
-
Inheritance pattern for Neurofibromatosis 1
Autosomal dominant
-
Inheritance Pattern for Neurofibromatosis 2
Autosomal dominant
-
Bony lesion characteristic of Neurofibromatosis 1
Thinned cortex of long bones
-
What factor correlates most with peoples' culture?
Ethnicity
-
Inheritance pattern of Acute Intermittent Porphyria
Autosomal dominant
-
Duration of an attack of Acute Intermittent Porphyria
Days to weeks
-
Treatments for an attack of Acute Intermittent Porphyria (3)
- 1. IV Hemin
- 2. IV Glucose
- 3. Pain control
-
Effect of thazide diuretics on lithium levels
Increase lithium reabsorbtion in the kidney
-
Medication that reduces overall disability and plaque formation in Multiple Sclerosis
Interferon
-
Cardiac effects of Ipecac abuse (4)
- 1. Cardiomyopathy
- 2. Cardiomegaly
- 3. QTc prolongation
- 4. Tricuspid/mitral valve insufficiency
-
Lab values affected by Ipecac abuse (3)
- 1. Increased CK-MB (due to cardiomyopathy)
- 2. Low WBCs
- 3. Elevated LFTs
-
What is Binswanger's Disease? Who gets it?
- Subcortical vascular dementia
- Occurs in patients in their 50s with hypertension
-
Presentation of Binswanger's Disease (3)
- 1. Progressive dementia
- 2. Motor and sensory deficits
- 3. Seizures
-
Age at which a child can respond to simple directions
23 months
-
Age at which a child can understand pronouns
23 months
-
Age at which a child begins to understand complex sentences
23 months
-
Who gets Essential Tremor?
- Men > Women
- Caucasian > Non-Caucasian
-
Effect of alcohol on Essential Tremor
Small ingestion of ethanol can cause marked improvement in tremor
-
What is the Communication Stage of development? When does it occur?
- Age 55 months onward
- Can use language to tell stories, share ideas, and discuss alternatives
-
What can acutely precipitate Wernicke's Encephalopathy?
Loading with carbohydrates, including IV glucose infusion
-
Sites of MRI abnormalities in Wernicke's Encephalopathy (3)
- 1. Periaqueductal regions
- 2. Medial thalamus
- 3. Mammillary bodies
-
Where in the brain does the Judgment of Line Orientation test show disease?
Right hemisphere
-
What is Dystonic Tremor?
Irregular oscillatory movements of a head or limb when moved away from the "null point" of the dystonic pulling
-
Chromosome associated with Adult-Onset Primary Dystonia
Chromosome 18
-
Presentation of Juvenile Myoclonic Epilepsy
- Sudden myoclonic jerks of the arms and shoulders just after waking (Characteristic Feature!)
- Most develop generalized tonic-clonic seizures
- Some develop absence seizures
-
EEG in Juvenile Myoclonic Epilepsy
- Bilateral 3-5Hz spikes and polyspike-and-wave patterns
- Maximal in the frontocentral regions
-
Treatment of Juvenile Myoclonic Epilepsy
Valproic Acid
-
Presentation of Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS)
- Seizures begin in childhood, stop in adolescence
- Conscious during seizures
- Tonic activity of the face, with pooled saliva and somatosensory disturbance of the mouth
-
EEG in Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS)
- Sharp waves in the midtemporal and central regions
- Increased frequency when asleep
-
What is the Epigenetic Principle? Who developed it?
- States that human development occurs in sequential, clearly-defined stages that must each be resolved to start the next stage
- Developed by Erickson
-
Cranial nerve most commonly affected bilaterally in isolation
Abducens nerve (CN6)
-
2 most common causes of bilateral Abducens palsy
- 1. Trauma
- 2. Increased intracranial pressure
-
Most common diabetic cranial mononeuropathy
Oculomotor (CN3) palsy
-
Hallmark of Diabetic CN3 Palsy
Pupillary sparing
-
Types of anxiety symptoms that are modifiers for Substance-Induced Anxiety Disorder (4)
- 1. "with Generalized Anxiety"
- 2. "with Panic Attacks"
- 3. "with Obsessive-Compulsive Symptoms"
- 4. "with Phobic Symptoms"
-
Periods of onset that are modifiers for Substance-Induced Anxiety Disorder (2)
- 1. "with onset during intoxication"
- 2. "with onset during withdrawal"
-
Treatment for Herpes Simplex Encephalitis
Acyclovir
-
Imaging of choice for suspected Herpes Simplex Encephalitis
MRI
-
Site of EEG abnormalities in Herpes Simplex Encephalitis
Temporal Lobes
-
Distribution of weakness in Dermatomyositis
- Symmetrical
- Proximal more than distal muscles of arms and legs
-
Distribution of weakness in Polymyositis
- Symmetrical
- Proximal more than distal muscles of arms and legs
-
Most common mitochondrial disorder
Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS)
-
Unique radiological feature of Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS)
Stroke involves cortex only, sparing white matter
-
Presentation of Myoclonic Epilepsy with Ragged Red Fiber Myopathy (MERRF)
- Myoclonic epilepsy in childhood
- Progresses to other seizure patterns soon after presentation
- Ataxia and intellectual disability later in childhood
-
Cause of Myoclonic Epilepsy with Ragged Red Fiber Myopathy (MERRF)
Mitochondrial abnormality
-
Triad of Kearns-Sayre Syndrome (KSS) (3)
- 1. Progressive external ophthalmoplegia
- 2. Onset before age 20
- 3. Other systemic symptoms co-occurring
-
Prognosis of Anterior Ischemic Optic Neuropathy
- Rate of spontaneous remission is high
- May recur in the other eye
-
Drugs of abuse that can cause nystagmus (4)
- 1. Alcohol
- 2. Inhalants
- 3. Sedative hypnotics
- 4. PCP
-
What response to noxious stimuli may be present for diagnosis of brain death?
None!
-
Is apnea test required for diagnosis of brain death?
Yes! Must use ABG to confirm elevated CO2 pressure after apnea test
-
What p450 enzyme breaks down Codeine?
2D6
-
What p450 enzyme breaks down Beta Blockers?
2D6
-
What p450 enzyme breaks down Clozapine?
2D6
-
What p450 enzyme breaks down Thioridazine?
- 2D6
- If a 2D6 inhibitor is being given, Thioridazine is contraindicated!
-
Onset of muscle weakness in classic, spinal ALS
Most often in upper extremities
-
Onset of muscle weakness in bulbar-onset ALS
Begins in bulbar-innervated muscles (muscles of mouth and throat)
-
Presentation of a seizure caused by a CNS tumor
Focal (reflecting tumor location), with secondary generalization
-
Medication that reduces chorea, but does not improve gait, in Huntington's Disease
Haloperidol
-
What is Festination?
Series of rapid, small, accelerating steps to keep from falling forward
-
What is Astasia?
Inability to stand upright unassisted
-
What is Abasia?
Lack of motor coordination in walking
-
What is Astasia-Abasia?
- Inability to stand or walk in a normal manner
- Often a sign of conversion disorder
-
Most common pathogens in Bacterial Meningitis (3)
- 1. N. Meningiditis
- 2. S. Pneumoniae
- 3. H. Influenzae
-
Most common pathogens causing meningitis in neonates (3)
- 1. Group B Strep
- 2. E. Coli
- 3. Listeria
-
CSF findings in Guillain Barre Syndrome
Increased protein without pleocytosis
-
Is weakness in Guillain Barre ascending or descending?
Ascending
-
Clinical presentation of cerebellar hemorrhage
- Sudden onset of vertigo, headache, vomiting, and inability to stand or walk
- No hemiparesis or hemiplegia
-
When is neurosurgical intervention needed in cerebellar hemorrhage
When first signs/symptoms of hydrocephalus develop
-
Posture in Stiff-Person Syndrome
Extreme lumbar lordosis
-
EMG in Stiff-Person Syndrome
Continuous firing of motor units
-
What is Tolosa-Hunt Syndrome?
- Idiopathic, self-limited, painful inflammation of the cavernous sinus
- Causes cranial nerve palsies, eye pain, and a sensation of exopthalmos
-
Treatment for Tolosa-Hunt Syndrome
Corticosteroids and other immunosuppressive agents
-
Which Benzodiazepines are metabolized by Glucuronidation? (3)
- 1. Temazepam
- 2. Oxazepam
- 3. Lorazepam
-
Receptor for serotonin that is responsible for GI side effects of SSRIs
5HT-3
-
SSRIs with the most intense GI symptoms (2)
- 1. Sertraline
- 2. Fluvoxamine
-
Cognitive side effects of Lithium
- Slowed reaction time, lack of spontaneity
- Dysphoria
- Memory issues
- (Similar to depression!)
-
What p450 enzyme is induced by Carbamazapine, causing its own degredation?
3A4
-
Blood monitoring with Carbamazapine
- CBC every 3 months for a year
- If no bone marrow suppression, reduce interval of CBC
-
At what ages does grammar develop?
3yrs to 4.5yrs
-
Which patients should not take lithium and clozapine together?
Patients with prior history of Neuroleptic Malignant Syndrome
-
Effect of giving clomipramine and clozapine together
Increases clozapine levels
-
Effect of giving paroxetine and clozapine together
May trigger clozapine-associated neutropenia
-
What percent of sleep time is REM sleep in a newborn?
50% or more
-
What percent of sleep time is REM sleep in an infant?
Less than 40%
-
What percent of sleep time is REM sleep in young adulthood?
25%
-
What stage of sleep do adults spend the most sleep time in?
Stage II
-
What class of medication is Phentolamine? What is its most important use?
- α1 blocker
- Used in hypertensive emergencies, especially those in which a β-blocker is contraindicated (such as cocaine-induced hypertension)
-
Effect of β-blockers with cocaine
- Cause unopposed α-adrenergic vasoconstriction
- Paradoxical increase in BP
-
What class of medication is used in a hypertensive crisis caused by MAOIs?
α-blocker
-
Effect of co-administering SSRI and Lithium
- Elevated serotonin
- Can cause serotonin syndrome
-
Treatment of serotonin syndrome
- Discontinue the offending agents
- Supportive care (can be ICU-level!)
-
Factor most correlated with childhood physical abuse
Poverty and psychosocial stress, especially financial stress
-
Goals of the Initial Phase of Interpersonal Therapy (IPT)
- Identify the diagnosis and the interpersonal context in which it presents
- Link the diagnosis to the interpersonal focus
- Take an Interpersonal Inventory
-
What is cataloged in the Interpersonal Inventory taken in the Initial Phase of Interpersonal Therapy?
- Review of patterns in relationships
- Capacity for intimacy
- Current relationships
-
Potential problem areas in Interpersonal Therapy (IPT) (4)
- 1. Complicated bereavement
- 2. Role dispute (struggle with significant other)
- 3. Role transition (significant life change)
- 4. Personal deficits (no current life event)
-
Goals of the Middle Phase of Interpersonal Therapy (IPT)
- Deal specifically with the problem area that is the focus of therapy
- Goal: Address ability to assert his/her own needs and wishes
-
How does Interpersonal Therapy (IPT) deal with Complicated Bereavement?
Promote appropriate mourning
-
How does Interpersonal Therapy (IPT) deal with Role Dispute?
Resolve interpersonal struggles between the patient and their significant other
-
How does Interpersonal Therapy (IPT) deal with Role Transition?
Help the patient to mourn the loss of an old role and accept the new one
-
How does Interpersonal Therapy (IPT) deal with Personal Deficits?
Decrease social isolation
-
Goals of the End Phase of Interpersonal Therapy (IPT)
- Remind the patient that termination is nearing
- Review accomplishments made in treatment to help the patient feel more capable and independent
-
Criteria for Pedophilia in DSM IV
- Age 16 or older
- Attraction to children at least 5 years younger
-
Second choice of Methylphenidate fails in a child with ADHD
Dextroamphetamine or amphetamine/dextroamphetamine salt
-
Underlying cause of most fugue states
Traumatic circumstances leading to altered state of consciousness with wish to flee
-
Primary method of treatment of fugue states
Psychodynamic psychotherapy
-
Lab findings related to norepinephrine in pathological gamblers (3)
- 1. ↓ norepinephrine metabolites in serum
- 2. ↑ norepinephrine metabolites in CSF
- 3. ↑ urinary norepinephrine
-
What does decreased platelet MAO activity suggest?
Serotonergic dysfunction
-
Criteria for conduct disorder (4)
- 3 in past 12 months, 1 in past 6 months:
- 1. Aggression to people/animals
- 2. Destruction of property
- 3. Deceitfulness/theft
- 4. Serious violations of rules
-
Physical symptom of Rett Syndrome in early childhood
Deceleration of head growth
-
Age of decline in Childhood Disintegrative Disorder
2 years
-
Whose theories included Archetypes?
Jung
-
Whose theories included the Collective Unconscious?
Jung
-
Whose theories included Complexes?
Jung
-
Whose theories included introverts and extroverts?
Jung
-
Whose theories included the Anima and Animus?
Jung
-
Whose theories included the Persona?
Jung
-
Whose theories included Individuation?
Jung
-
What concept did Kurt Goldstein advance?
Self-Actualization
-
What theories did Edith Jacobson propose?
Infant's experience of pleasure or lack of pleasure and its effect on the parent-child relationship
-
What is Phase II metabolism of benzodiazepines?
Glucoronidation
-
What is Phase I metabolism of benzodiazepines?
- Oxidation via p450
- Generates active metabolites that must be Phase II metabolized
-
Pregnancy category of benzodiazepines
D
-
Most common reason for psychiatric malpractice lawsuits
Suicide attempt or completion
-
What does Respondeat Superior mean?
- Legal term
- Person occupying a high position in a hierarchy is responsible for those in lower positions
-
Best therapy for Panic Disorder
- CBT, if monotherapy
- CBT with an SSRI is more effective than CBT alone
-
What psychiatric condition is Propranolol indicated for?
Performance anxiety
-
What is Ebstein's Anomaly?
Abnormal formation of the tricuspid valve
-
What is Schizoid Fantasy (defense mechanism)?
- Immature defense
- Retreating into fantasy or eccentricity to avoid intimacy
-
What is Anticipation (defense mechanism)?
- Mature defense
- Planning for future inner discomfort
-
Effects of lithium on the parathyroid gland (2)
- 1. Hyperplasia
- 2. Increased risk of adenoma
- Either can lead to hyperparathyroidism!
-
Black box warning for Valproic Acid
Hepatic failure
-
What psychiatric medication can cause Eosinophilic Colitis?
Clozapine
-
How did Levinson view development?
Separated into 4 stages, each lasting about 25 years
-
What psychological factors did Valliant study?
- Happy childhood led to positive traits in middle life
- Adaptive styles mature over time
-
What is Normality-as-Process?
Notion that changes in personality over time are an essential part of development
-
What labs should routinely be followed in patients on lithium? (4)
- 1. CBC
- 2. Electrolytes
- 3. BUN/Creatinine
- 4. Thyroid function tests
-
DSM criteria for Panic Disorder
- Recurrent panic attacks
- -or-
- One attack followed by 1 month of persistent concern about having more attacks or about the implications of the attack
-
How long after a loved one's death can MDD be diagnosed?
2 months
-
Symptoms of Hyperthermic Syndrome of MDMA (5)
- 1. Disseminated Intravascular Coagulation
- 2. Rhabdomyolysis
- 3. Liver failure
- 4. Kidney Failure
- 5. Death
-
Relationship of MDMA dose to risk of Hyperthermic Syndrome
- None!
- Can occur at any dose
-
What is the common name for Flunitrazepam?
Rohypnol
-
Effect of combining CBT and pharmacology for Social Anxiety Disorder
No clear benefit over CBT alone or pharmacology alone
-
What type of therapy for substance abuse includes Skills Training?
CBT
-
Effects of Lamictal on weight
Weight neutral
-
Lowest effective methadone dose
50mg daily
-
Average methadone dose
80mg daily
-
What medications should be given for a patient with OCD and tics? (2)
- 1. SSRI for OCD symptoms
- 2. Dopamine blocker for tics
-
Criteria for diagnosis of Bipolar II
One hypomanic episode and one depressive episode
-
How often should a patient with Hypochondriasis see a primary MD?
Regularly scheduled appointments are necessary!
-
Management of a patient on Clozapine who develops a white count between 2000 and 3000
- Stop clozapine
- May restart clozapine if white count improves
-
Management of a patient on Clozapine who develops a white count between 3000 and 3500
- Continue clozapine
- Monitor WBCs twice weekly until over 3500
-
Management of a patient on Clozapine who develops a white count below 2000
- Stop clozapine
- Can not be re-challenged in the future!
-
-
QTc at which medications that prolong the QT interval must be considered carefully
500
-
Cognitive side effects of Interferon
- Mimic depression
- Low mood, suicidality, insomnia, fatigue, cognitive insufficiency
-
Requirements for PTSD diagnosis (3)
- 1. One symptom of reexperiencing
- 2. Two symptoms of increased arousal
- 3. Three symptoms of avoidance
-
PTSD symptoms considered Avoidance Symptoms (3)
- 1. Restricted affect
- 2. Sense of foreshortened future
- 3. Avoiding people associated with the trauma
-
First-line medications for PTSD
SSRIs and SNRIs
-
Type of psychotherapy with the most evidence of effectiveness in PTSD
CBT
-
Effect of benzodiazepines in PTSD
Slow recovery rates
-
Prognosis of PTSD if onset of symptoms is rapid
Good
-
Prognosis of PTSD if duration of symptoms is less than 6 months
Good
-
Age groups with the highest likelihood of developing PTSD after a trauma
Very old or very young
-
Age group that fares best in PTSD
Those in the middle of life
-
Brain area affected in PTSD
- Locus Coeruleus
- Increased norepinephrine turnover
-
What is Premack's Principle?
Behavior engaged in at a high frequency can be used to reinforce behavior that occurs at a low frequency
-
Workup for all patients who will receive ECT (3)
- 1. Blood/urine chemistries
- 2. EKG
- 3. CXR
-
Management of small intracranial mass lesions in ECT
Premedicate with dexamethasone (Decadron)
-
How long after myocardial infarction is risk of ECT diminished?
- Partially diminished at 2 weeks
- Substantially diminished at 3 months
-
Characteristics required for a seizure to be effective in ECT (2)
- 1. Bilateral and generalized
- 2. Lasts at least 25 seconds
-
Mortality rate in ECT
0.01%
-
Why should benzodiazepines not be given during ECT?
Increase the seizure threshold
-
Why should lithium not be given during ECT?
- Prolonged seizures
- Cause postictal delirium
-
Why is Propofol not a useful anesthetic in ECT?
Raises the seizure threshold
-
Indications for starting ECT with bilateral electrode placement (5)
- 1. Severe depressive symptoms / acute suicide risk
- 2. Mania
- 3. Catatonia
- 4. Treatment-resistant schizophrenia
- 5. Marked agitation
-
Criteria for Cyclothymic Disorder
Hypomania with sub-threshold depression symptoms for 2 years
-
Can glioma cause mania?
Yes!
-
Effect of benzodiazepines on mania
Lessen symptoms
-
Classes of psychiatric medications that can cause mania (4)
- 1. Antidepressants
- 2. Anticonvulants
- 3. Stimulants
- 4. Barbiturates
-
Somatic medications that can cause mania (5)
- 1. Isoniazid
- 2. Cimetidine
- 3. Metoclopramide
- 4. Steroids
- 5. Bronchodilators
-
Brain sites where cocaine affects dopamine (3)
- 1. ↑ in mesolimbic pathway
- 2. ↑ in mesocortical pathway
- 3. ↓ in corpus striatum
-
Hallucinations associated with heavy cocaine use (2)
- 1. Shower of lights in central vision
- 2. Black dots on skin and in the environment
-
Why is Diazepam given in cocaine overdose?
Prevents seizures
-
Percent of patients with BPAD who have a co-occurring substance abuse disorder
60%
-
What Defense Mechanism was first described by Kernberg?
Projective Identification
-
What is Projective Identification?
Projecting intolerable aspects of self onto another person, who is then induced to play the projected role
-
What is the Content of an interview?
What is explicitly said between doctor and patient
-
What is the Process of an interview?
Things that may be observed nonverbally, such as body language, behaviors, or avoidance of difficult topics
-
What is Partialism?
Paraphilia in which sexual activity is concentrated on one part of the body to the exclusion of all others
-
How long must sadistic fantasies be present for diagnosis of Sexual Sadism?
6 months
-
How long must masochistic fantasies be present for diagnosis of Sexual Masochism?
6 months
-
Diagnostic criterion for Fetishism
6 months of sexual fantasies involving nonliving objects
-
Prognosis of paraphilias with early age of onset
Poor
-
Prognosis of paraphilias if coitus occurs with the paraphilia
Good
-
Prognosis of paraphilias if only one paraphilia is present
Good
-
Psychotherapies used in paraphilias (3)
- 1. Dynamic therapy
- 2. CBT
- 3. Sex therapy (adjunctive to dynamic therapy)
-
Typical attraction pattern in TransWomen
2/3 are attracted to men only
-
When should a Forensic Psychiatrist assess competency to stand trial?
Should be done for every person evaluated!
-
Does Competency to Stand Trial evaluation assess mental status at the time the alleged acts were committed, or at the time of evaluation?
At the time of evaluation only!
-
Does assessment for "not guilty by reason of insanity" assess mental status at the time the alleged acts were committed, or at the time of the evaluation?
At the time the alleged acts were committed
-
When should a forensic evaluation include neuropsychological testing?
- Always!
- Neuropsychologist must give a verbal report prior to a written report, and an attorney can request that the written report not be produced if the verbal report is not helpful
-
Components required for an act to be criminal (2)
- 1. Actus Reus
- 2. Mens Rea
- Intent to harm is not sufficient without these!
-
If a doctor is found Not Guilty by Reason of Insanity, who makes the decision about medical license revocation?
State licensing department, not the court
-
GAF score corresponding to some danger of hurting self or others or occasional failure to maintain hygeine
20
-
GAF score corresponding to persistent danger of harming self or others
10
-
What is Pseudologia Phantastica?
Lying about one's past while appearing to believe the fantasy and acting as though it were true
-
What is Algophobia?
Fear of pain
-
What do Positive Symptoms of schizophrenia predict regarding course of illness?
- Frequency of hospitalization
- Not long-term functional outcome
-
What symptoms of Schizophrenia correlate most strongly with long-term functional outcome?
Cognitive symptoms
-
Age range in which Schizophrenics are most likely to commit suicide
First few years of illness
-
What is Echopraxia?
Imitation of posture or behavior of an examiner
-
Cardiac effects of anorexia (2)
- 1. Bradycardia
- 2. Arrhythmia
-
CBC changes that can occur in anorexia
Pancytopenia
-
CMP changes that can occur in anorexia (2)
-
Neurological effects of anorexia (3)
- 1. Peripheral neuropathy
- 2. Seizures
- 3. Metabolic encephalopathy
-
Weight at which anorexics should be hospitalized
< 75% of expected weight
-
Should anorexics be hospitalized if growth arrests?
Yes!
-
Classes of medications used for anorexia (2)
- 1. Antidepressants
- 2. Antipsychotics
-
Risks of self-induced vomiting during pregnancy (2)
- 1. ↑ risk of spontaneous abortion
- 2. ↑ risk of low birth weight
-
Effects of abuse of ipecac syrup (3)
- 1. Muscle atrophy (skeletal and cardiac)
- 2. QTc prolongation
- 3. Tachycardia
-
Use of benzodiazepines in Social Anxiety Disorder
Very helpful if used judiciously in social situations
-
Concern with Bupropion in anxiety disorders
Activation may worsen anxiety
-
What does a patient with social phobia fear?
Embarassment
-
What does a patient with avoidant personality disorder fear?
Rejection
-
What is the Non-Generalized Subtype of Social Phobia?
Performance Anxiety
-
Common medical illness in which Beta Blockers are contraindicated
Asthma
-
Duration of social anxiety symptoms in a patient under age 18 for diagnosis of Social Anxiety Disorder
6 months
-
CNS complication of sleep apnea
Increased risk of stroke
-
What are Dyssomnias?
Disorders of duration, quality, or timing of sleep
-
What are Parasomnias?
Disorders in which undesired behaviors occur during sleep or sleep transitions
-
Medication used in narcolepsy
Modafinil
-
Illness whose risk is increased in REM Behavior Disorder
Parkinson Disease
-
What is Pavor Nocturnus?
Sleep Terror Disorder
-
What is Jactatio Capitis Nocturna?
Movement disorder including head banging in sleep
-
Treatment of Jactatio Capitis Nocturna
- Symptoms can not be treated
- Create an environment in which head banging will not cause injury
-
Effect of Obstructive Sleep Apnea on respiratory effort
During episodes, airflow stops and respiratory effort increases
-
Effect of Central Sleep Apnea on respiratory effort
During episodes, airflow stops and respiratory effort decreases
-
Criteria for diagnosis of sleep apnea
30 episodes per night lasting 10 seconds each
-
Gender breakdown of REM Sleep Behavior Disorder
Mostly seen in men
-
Psychiatric medications that worsen REM Sleep Behavior Disorder (3)
- 1. Fluoxetine
- 2. TCAs
- 3. Stimulants
-
Medications that reduce symptoms of REM Sleep Behavior Disorder (2)
- 1. Clonazepam
- 2. Carbamazepine
-
Most common side effects of Ziprasidone (Geodon) (2)
- 1. Sedation
- 2. Cardiac effects
-
Risk of weight gain with Ziprasidone (Geodon)
Low
-
Risk of extrapyramidal side effects with Ziprasidone (Geodon)
Low
-
Symptoms of Criterion A in the diagnosis of Schizophrenia (5)
- 2 of the following for 1 month:
- 1. Delusions
- 2. Hallucinations
- 3. Disorganized speech
- 4. Disorganized behavior
- 5. Negative symptoms
-
Symptoms that meet Criterion A for diagnosis of Schizophrenia when appearing alone (3)
- 1. Bizarre delusion
- 2. Running commentary of voices
- 3. Voices conversing with each other
-
Diagnoses that can involve 1 month of psychosis without meeting Criterion A for Schizophrenia (2)
- 1. Delusional Disorder
- 2. Psychosis NOS
-
Hallucinations in Delusional Disorder
- Auditory and visual hallucinations are not present
- Tactile, olfactory, or gustatory may be present if related to the delusion
-
Effect of Delusional Disorder on memory
None!
-
Primary preventative measures for Brief Psychotic Disorder
None!
-
What is an Illusion?
Sensory misperception of actual stimuli
-
How often can IM Haldol 5mg be given until sedation occurs?
Every 20-30 minutes
-
Gender breakdown of episodes of domestic violence
About equal (!)
-
What is Zyprexa Relprevv?
Long-acting injectable olanzapine
-
Gender breakdown of Dissociative Identity Disorder
Mostly women (5-10 to 1 ratio)
-
Group therapy in Dissociative Identity Disorder
- Useful
- Best-conducted with only DID patients
-
Effect of benzodiazepines in Dissociative Identity Disorder
Helpful at low doses
-
Medication classes used in Dissociative Identity Disorder (3)
- 1. SSRIs
- 2. Antipsychotics
- 3. Mood stabilizers (except lithium!)
-
Percent of patients with dementia whose illness is reversible if treated very early
15%
-
When should Donepezil be given for dementia?
Immediately, even before a workup is done to confirm the diagnosis!
-
Survival expectancy of Alzheimer Dementia
~8 years after onset of illness
-
Treatment regimen for Alzheimer Dementia (2)
- 1. Cholinesterase inhibitor
- and/or
- 2. NMDA antagonist
-
Treatment of vascular dementia (2)
- 1. Antiplatelet aggregants
- 2. Medications targeted at HTN, DM, or HLP if present
-
Effect of history of alcohol abuse on development of Delirium
Increases risk
-
Effect of history of smoking on development of Delirium
Increases risk
-
Effect of history of HTN on development of Delirium
Not a risk factor
-
Gender breakdown of Delirium
More common in men
-
Neuroanatomical area implicated in Delirium
Reticular Formation
-
Brain pathway implicated in Delirium
Dorsal Tegmental Pathway
-
What does the Dorsal Tegmental Pathway connect?
From Reticular Formation to Tectum and Thalamus
-
Neurotransmitters affected in Delirium (3)
- 1. Acethycholine (decreased activity)
- 2. Serotonin
- 3. Glutamate
-
Cause of delirium in Alcohol Withdrawal
Hyperactive noradrenergic neurons in Locus Ceruleus
-
Why should a patient receiving IV Haldol be placed in a monitored bed?
Risk of Torsades
-
Typical duration of Delirium
1 week
-
First-line medications for Body Dysmorphic Disorder
Serotonergic (SSRI, SNRI, TCA, MAOI)
-
Psychodynamic explanation for Body Dysmorphic Disorder
Displacement of sexual/emotional conflict onto unrelated body parts
-
Age of onset of Body Dysmorphic Disorder
15-30
-
Gender breakdown of Body Dysmorphic Disorder
Affects women slightly more often than men
-
Are patients with Body Dysmorphic Disorder more often married or single?
Single
-
Psychiatric illness often comorbid with Body Dysmorphic Disorder
Mood disorders, especially depressive disorders
-
What fraction of patients with Body Dysmorphic Disorder improve with medications?
About 50%
-
Course of Body Dysmorphic Disorder
- Onset can be gradual or abrupt
- Course is undulating, with few symptom-free intervals
- Body part that is focused on may stay the same or may change
-
Age of onset of Somatization Disorder
Before age 30
-
How do Somatization Disorder patients describe their symptoms?
Histrionic, emotional, exaggerated fashion
-
How do Conversion Disorder patients describe their symptoms?
- "La belle indifference"
- Inappropriately cavalier attitude toward apparently serious symptoms
-
Disorder whose symptoms appear to overlap heavily with Somatization Disorder
Attention Deficit Disorders
-
Biological factors of Somatization Disorder (2)
- 1. Abnormal cytokine regulation
- 2. Decreased metabolism in frontal lobes and nondominant hemisphere
-
Presentation of Somatization Disorder among families
- Tends to run among women in families
- Male relatives have an increased risk of antisocial personality disorder and substance disorders
-
Gender breakdown of Somatization Disorder
Women >> Men (factor of 5-20 times higher)
-
Lifetime prevalence of Somatization Disorder
1-2%
-
Social factors increasing risk of Somatization Disorder (2)
- 1. Low income
- 2. Poor education
-
Course of Somatization Disorder
- Chronic relapsing disorder
- Rarely remits completely
-
Most useful strategy for Somatization Disorder
Individual and group psychotherapy
-
How soon after the last dose of a narcotic can Naltrexone be started?
- 5 days after a short-acting narcotic
- 10 days after a long-acting narcotic
-
Minimum duration off of alcohol to start disulfiram
12 hours
-
What is Campral?
- NMDA and glutamate antagonist
- Reduces cravings for alcohol
-
How soon after stopping alcohol can Campral be started?
1 week
-
Dosing strategy for Disulfiram
- 500mg daily for 1-2 weeks
- 250mg thereafter for maintenance
-
Effect of Phenytoin on Methadone level
Decreased
-
Effect of Hypericum on Methadone level
Decreased
-
Effect of Dextromethorphan on Methadone level
Decreased
-
Effect of Abacavir on Methadone level
Decreased
-
Effect of Carbamazapine on Methadone level
Decreased
-
Effect of Cocaine on Methadone level
Decreased
-
Effect of Dexamethasone on Methadone level
Decreased
-
Effect of Nevirapine on Methadone level
Decreased
-
Effect of Rifampin on Methadone level
Decreased
-
Effect of Spironolactone on Methadone level
Decreased
-
Effect of Tobacco on Methadone level
Decreased
-
Effect of Ciprofloxacin on Methadone level
Increased
-
Effect of Erythromycin on Methadone level
Increased
-
Effect of Disulfiram on Methadone level
Increased
-
Effect of Verapamil on Methadone level
Increased
-
Effect of Dihydroergotamine on Methadone level
Increased
-
Effect of Grapefruit on Methadone level
Increased
-
Effect of Moclobemide on Methadone level
Increased
-
Effect of Ecinacea on Methadone level
Increased
-
Symptoms of Cannabis withdrawal (7)
- 1. Insomnia
- 2. Restlessness/irritability
- 3. Depressed mood
- 4. Anxiety
- 5. Tremors/twitches
- 6. Sweating
- 7. Myalgia
-
Duration of Cannabis withdrawal
2 weeks
-
Antidepressant that, in particular, causes Serotonin Syndrome and Neuroleptic Malignant Syndrome if given with an MAOI
Velafaxine
-
Condition commonly comorbid with prepubertal BPAD
ADHD
-
Comorbid illness correlated with a much earlier onset of BPAD
Childhood ADHD
-
Regarding culture change, what is Assimilation?
Making contact with the new culture without retaining original cultural values
-
Regarding culture change, what is Integration?
Making contact with the new culture while retaining original cultural values
-
Regarding culture change, what is Separation?
Retaining original cultural values and not making contact with the new culture
-
Regarding culture change, what is Marginalization?
Not making contact with the new culture while also shedding original cultural values
-
Birth defects associated with Carbamazepine other than neural tube defects (3)
- 1. Craniofacial defects
- 2. Developmental delays
- 3. Fingernail hypoplasia
-
Requirements for giving Informed Consent (3)
- 1. Decision-making capacity
- 2. Relevant information has been disclosed to the one giving consent
- 3. Voluntariness
-
Psychotherapy modalities best-studied for MDD (2)
- 1. CBT
- 2. Interpersonal therapy
-
Antidepressant for which nausea is not a prominent side effect
- Mirtazapine (Remeron)
- Can be used to treat nausea!
-
Gender breakdown of experiencing a traumatic event
Males > Females
-
Gender breakdown of developing PTSD
Females > Males
-
Body weight at which hospitalization is recommended in anorexia
25% below expected weight
-
Atypical antipsychotic that causes elevated prolactin at rates similar to typical antipsychotics
Risperidone
-
Psychiatric illness with highest relative risk for first-degree relatives
BPAD
-
Relative risk of schizophrenia for first-degree relatives
18
-
Relative risk of BPAD for first-degree relatives
25
-
Relative risk of Panic Disorder for first-degree relatives
10
-
Relative risk of anorexia for first-degree relatives
5
-
Relative risk of Alcoholism for first-degree relatives
7
-
Serious side effect of oxcarbazapine
Hyponatremia
-
Lab values changed by Valproic Acid (2)
-
Lab values changed by Topiramate (2)
- 1. ↑ Chloride
- 2. ↓ Bicarb
- (Hyperchloremic, non-ion-gap metabolic acidosis)
-
What is Social Rhythm Therapy?
- Combination of Circadian Regulation and Interpersonal Psychotherapy
- Used to treat BPAD
-
Medications that cause Rapid Cycling in BPAD
Antidepressants
-
Psychiatric symptom of anterior left hemisphere stroke
Poststroke depression
-
Psychiatric illnesses that run in families of people with OCD (3)
- 1. MDD
- 2. Anxiety disorders
- 3. Tourette's Syndrome
-
Ethnic group at the lowest risk of suicide
Asian Americans
-
Effect of Wellbutrin on ADHD
Improves symptoms!
-
First-line treatment for a depressed adolescent with ADHD who smokes
Wellbutrin (treats smoking, depression, and ADHD!)
-
Effect of early onset on Conduct Disorder
Predicts more severe and prolonged illness
-
Effect of comorbid ADHD on Conduct Disorder
Predicts more severe and prolonged illness
-
What p450 enzyme breaks down Desipramine?
2D6
-
Effect of Fluoxetine on Desipramine levels
Fluoxetine inhibits 2D6, raising Desipramine levels
-
Initial presentation of Lewy Body Dementia
Psychosis and hallucinations
-
What feature of cognition declines with normal aging?
Speed of cognition (learning, processing, and performance speed)
-
Age at which symptoms must present for diagnosis of Reactive Attachment Disorder
Before age 5
-
First-line approach for OCD in children/adolescents
CBT
-
SSRIs approved in OCD (4)
- 1. Fluoxetine (Prozac)
- 2. Fluvoxamine (Luvox)
- 3. Sertraline (Zoloft)
- 4. Paroxetine (Paxil)
-
Illness characterized by Echolalia and Echopraxia
Catatonia
-
Side effects of high doses of GHB (3)
- 1. Vomiting
- 2. Muscle spasms
- 3. Loss of consciousness
-
Effect of combining GHB with alcohol
Slows breathing to a dangerously low rate
-
Other than altered mental status, effects of Flunitrazepam (Rohypnol) (2)
- 1. GI distubrance
- 2. Urinary retention
-
Medications/drugs that can cause catatonia (2)
-
Neurological conditions that can cause catatonia (2)
- 1. Parkinsonism
- 2. Encephalitis
-
Brain region that interprets emotional tone of speech/prosody
Nondominant hemisphere region corresponding to Wernicke's Area
-
Brain region that interprets expressive language production/"music" of speech
Nondominant hemisphere region corresponding to Broca's Area
-
Goal of Cognitive Therapy for Social Phobia
Alter biased perceptions and dysfunctional beliefs
-
How should internists manage Hypochondriasis?
Regularly scheduled appointments with limited reassurance
-
Medication management strategy for Borderline Personality Disorder
Target the symptoms that are currently causing disruption
-
Site of reabsorption of Lithium
Proximal tubules
-
Electrolyte imbalance that causes increased reabsorption of Lithium
Sodium deficiency
-
Female-to-male ratio in Borderline Personality Disorder
3:1 female
-
Relative risk of Borderline Personality Disorder for first-degree relatives
5
-
Psychiatric symptom scales on which girls score higher than boys (2)
- 1. Anxious/depressed scale
- 2. Somatic complaints scale
-
Psychiatric symptom scales on which boys score higher than girls (3)
- 1. Attention problems
- 2. Delinquent behavior
- 3. Aggressive behavior
-
Cognitive issues in OCD (5)
- 1. Decreased capacity for selective attention
- 2. Negative beliefs about responsibility
- 3. Memory biased for disturbing themes
- 4. Low confidence in memory
- 5. Deficits in spatial recognition
-
Personality disorder most commonly found in relatives of patients with Schizophrenia
Schizotypal Personality Disorder
-
Gender ratio of Panic Disorder
2-3:1 more common in women
-
Mean age at presentation of Panic Disorder
25
-
Respiratory substances that can induce panic symptoms (3)
- 1. CO2
- 2. Sodium lactate
- 3. Bicarbonate
-
Most effective medications in Panic Disorder (2)
-
Mechanism of Codeine
Metabolized to morphine by 2D6
-
Time to medication response in OCD
10-12 weeks
-
First-line medications for BPAD (2)
-
Treatment of choice for psychiatric side effects of Interferon
SSRIs
-
Most prevalent psychiatric symptom in dialysis patients
Depressed mood
-
Intervention that most improves medication adherence
Focus on attitudinal and behavioral aspects of taking medications (eg cognitive-motivational interventions)
-
Duration of Brief Dynamic Therapy
Average of 6 sessions, but can last 1 to 40
-
Goal of Brief Dynamic Therapy
- Addresses a specific, limited focus
- Does not aim for character change like most dynamic therapy
-
Effect of Xanthine Bronchodilators (-phylline) on lithium levels
Decrease levels
-
Effect of NSAIDs on lithium levels
Increase levels
-
Effect of ACE inhibitors on lithium levels
Increase levels
-
Symptoms that differentiate Lewy Body dementia from Alzheimer Dementia (2)
- 1. Visual hallucinations
- 2. Parkinsonism
-
How are "flashbacks" best understood?
As dissociative states
-
What is the psychotherapeutic technique of Response Prevention?
- Exposure of an OCD patient to "contamination" followed by prevention of engaging in compulsive acts
- Effective in decreasing frequency of rituals
-
When should guilt prompt concern of MDD in bereavement?
When guilt is generalized, not based on "missed opportunities" with the deceased
-
When should thoughts of death prompt concern of MDD in bereavement?
When the preoccupation with death is general, not based on wishes to join the deceased
-
When should hallucinations prompt concern of MDD in bereavement?
If the content of the hallucinations is not the deceased
-
When should psychomotor retardation prompt concern of MDD in bereavement?
Always!
-
What aspect of cognition is the Ventral Striatum associated with?
Motivation
-
MRI findings in Creutzfeldt-Jakob Disease, other than general atrophy
Basal ganglia changes
-
Most sensitive test for heavy alcohol use over the past week
- Carbohydrate-Deficient Transferrin (CDT)
- There is no reference range, so test must be against the patient's own baseline
-
Personality disorder most often associated with Anorexia
Obsessive-Compulsive Personality Disorder
-
Components of Personality Disorders according to Psychodynamic theory (4)
- 1. Biologically-based temperment
- 2. Internalized object relations
- 3. Enduring sense of self
- 4. Specific constellation of defense mechanisms
-
Somatic medication that can cause akathesia
Metoclopramide (Reglan)
-
Effect of taking oral contraceptives with Lamotrigine
Rapid drop in lamotrigine levels
-
Brain circuit with abnormalities in OCD
Cortico-Striato-Thalamic Circuit
-
How often do Anorexic patients have comorbid depression?
2/3 of the time!
-
How often do Anorexic patients have comorbid Social Phobia?
1/3 of the time!
-
How often do Anorexic patients have comorbid OCD?
1/4 of the time!
-
What form of therapy does Short-Term Anxiety-Regulating psychotherapy derive from?
Psychodynamic psychotherapy
-
Brain regions that must be active to derive pleasure from drug use (3)
- 1. Tegmentum
- 2. Nucleus accumbens
- 3. Prefrontal cortex
-
What neurotransmitters are involved in addiction to drugs? (2)
-
Brain regions involved in Schizophrenia (4)
- 1. Anterior cingulate
- 2. Thalamus
- 3. Cerebellum
- 4. Temporal lobe
-
Effect of Ritonavir on benzodiazepines
Induces metabolism of Temazepam, Oxazepam, and Lorazepam
-
Effect of protease inhibitors on benzodiazepines
Inhibits 3A4, increasing levels of some benzos (eg midazolam)
-
Result of family therapy in Schizophrenia
- Reduced relapse rates
- Reduced family burden
-
What is "empathy"
Understanding a patient's feelings without becoming involved in them
-
How often must a person binge to meet criteria for Bulemia?
Average of twice weekly
-
Risk of osteopenia in bulemia
Not elevated (as opposed to anorexia)
-
Main symptoms of Hyperparathyroidism
Weakness and anorexia
-
Main symptoms of Hypoparathyroidism
Neuromuscular signs
-
Where is the Presinilin 1 gene?
Chromosome 14
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