Psychiatry Boards Studying

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VeganWithaYoYo
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309039
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Psychiatry Boards Studying
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2016-08-19 09:51:20
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Psychiatry
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Cards based on Clinical Neurology for Psychiatrists and several Psych board review books
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  1. Cause of paresis with muscle spasticity
    Upper motor neuron injury
  2. Cause of paresis with muscle flaccidity and atrophy
    Lower motor neuron injury
  3. What is stereognosis?
    Ability to identify objects by touch
  4. Site in CNS that first receives pain sensation
    Thalamus
  5. Symptoms of thalamic pain
    burning pain on the contralateral side of the body
  6. 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
  7. Most common lesion site in partial complex seizures
    Temporal lobe
  8. Signs of lesion in the Dominant Hemisphere (3)
    • 1. Aphasia
    • 2. Gerstmann Syndrome
    • 3. Alexia without agraphia
  9. Signs of lesion in the Nondominant Hemisphere (3)
    • 1. Hemi-inattention
    • 2. Anosognosia
    • 3. Constructional apraxia
  10. Symptoms of Gerstmann Syndrome (4)
    • 1. Acalculia
    • 2. Agraphia
    • 3. Finger agnosia
    • 4. Left-right confusion
  11. Which side is the lesion on in Babinski sign?
    Contralateral
  12. Site and laterality of lesion in Parkinsonism
    Contralateral substantia nigra (basal ganglia)
  13. Site and laterality of lesion in Athetosis
    Contralateral Basal Ganglia
  14. What is athetosis?
    Slow, writhing movements
  15. Site and laterality of lesion in Choreas
    Contralateral Basal Ganglia
  16. Site and laterality of lesion in Hemiballismus
    Contralateral Basal Ganglia (most often subthalamic nucleus)
  17. What is Hemiballismus?
    Intermittent flailing of the arm and leg on one side of the body
  18. Site and laterality of lesion in Postural Instabilitly
    Contralateral Basal Ganglia
  19. Site and laterality of lesion causing rigidity
    Contralateral Basal Ganglia
  20. Site of lesion causing ipselateral cranial nerve palsy and contralateral hemiparesis
    Brainstem
  21. Site of lesion causing Internuclear Ophthalmoplegia
    Brainstem
  22. What is internuclear ophthalmoplegia?
    When looking to one side, ipselateral eye only minimally adducts; contralateral eye abducts with nystagmus
  23. Site of lesion causing nystagmus
    Brainstem
  24. Site of lesion causing Bulbar Palsy
    Brainstem (Lower Motor Neurons)
  25. Bulbar Palsy
    Impaired function of cranial nerves 9, 10, 11, and 12
  26. Site and laterality of lesion causing intention tremor
    Ipselateral cerebellum
  27. Site and laterality of lesion causing Dysdiadochokinesia
    Ipselateral cerebellum
  28. Site of lesion causing scanning speech
    Cerebellum
  29. What is scanning speech?
    Speech in which words are broken into syllables, often with noticeable pauses and spoken with varying force
  30. What is Constructional Apraxia?
    • Inability to copy simple forms or arrange objects into specific patterns
    • Due to inability to integrate visual and motor functions
  31. Site and laterality of lesion in pseudobulbar palsy
    Bilateral cerebral hemispheres (corticobulbar tract)
  32. Corticobulbar Tract (origin and innervation)
    Originates in motor cortex, innervates brainstem motor nuclei
  33. Components of basal ganglia
    • 1. Globus pallidus
    • 2. Caudate
    • 3. Putamen
    • 4. Substantia nigra
    • 5. Subthalamic nucleus
  34. Components of striatum (3)
    • 1. Globus pallidus
    • 2. Caudate
    • 3. Putamen
  35. Where does the Extrapyramidal Tract originate?
    Basal Ganglia
  36. Role of Extrapyramidal Tract (3)
    • 1. Control muscle tone
    • 2. Regulate motor activity
    • 3. Generate postural reflexes
  37. What movements define Chorea?
    Intermittent, randomly-located jerking of the limbs and trunk
  38. Site of lesion in Huntington Disease
    Caudate nuclei (atrophy)
  39. Signs of Corticospinal (Pyramidal) Tract damage (3)
    • 1. Peresis
    • 2. Abnormal deep tendon reflexes
    • 3. Babinski
  40. 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
  41. Cause of Apraxic Gait
    Normal Pressure Hydrocephalus
  42. Cause of festinating gait
    Parkinson Disease
  43. What is festinating gait?
    Small shuffling steps with hypokinesia
  44. Cause of Diplegic gait
    Cerebral palsy (occasionally other congenital injuries)
  45. 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
  46. Cause of Steppage gait
    Damage to posterior columns of the spinal cord
  47. What is Steppage gait?
    Weakness in dorsiflexion causes foot drop
  48. Cause of waddling gait
    Myopathies, especially Duchenne Muscular Dystrophy
  49. Major brainstem divisions (3)
    • 1. Midbrain
    • 2. Pons
    • 3. Medulla
  50. Arteries in which obstruction affects brainstem (2)
    • 1. Basilar
    • 2. Vertebral
  51. Major structures in midbrain (2)
    • 1. Oculomotor nerve (CN3)
    • 2. Corticospinal tract
  52. Symptoms of midbrain CVA (2)
    • 1. Contralateral hemiparesis
    • 2. Ipsilateral oculomotor nerve (CN3) paralysis
  53. Ocular symptoms of pontine CVA (2)
    • 1. Contralateral hemiparesis
    • 2. Abducens Nerve (CN6) paralysis
  54. 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
  55. Cranial nerve nuclei in the lateral medulla (5)
    • 5
    • 7
    • 9
    • 10
    • 11
  56. White matter tracts in lateral medulla (3)
    • 1. Spinothalamic
    • 2. Sympathetic
    • 3. Inferior cerebellar
  57. Intoxicants causing nystagmus (4)
    • 1. Alcohol
    • 2. Dilantin (Phenytoin)
    • 3. PCP
    • 4. Barbituates
  58. Sensory changes with PCP intoxication
    Reduced sensitivity to pain and cold
  59. Site of lesion causing unilateral nystagmus
    Medial longitudinal fasciculus
  60. Artery system whose obstruction causes nystagmus
    Vertebrobasilar Artery System
  61. Disorders causing nystagmus (3)
    • 1. Multiple Sclerosis
    • 2. Wernicke-Korsakoff Syndrome
    • 3. Viral labyrinthitis
  62. What regions of the body have coordination controlled by the vermis? (3)
    • 1. Head
    • 2. Neck
    • 3. Trunk
  63. What part of the body has coordination controlled by a cerebellar hemisphere?
    Ipsilateral limbs
  64. Prognosis after unilateral cerebellar injury
    Other hemisphere is expected to compensate almost entirely (can walk, can't dance)
  65. Motor changes in cerebellar injury (2)
    • 1. Hypotonia
    • 2. Pendular reflexes (limb swings several times in each direction)
  66. Sensations transmitted in contralateral spinal tracts (2)
    • 1. Pain
    • 2. Temperature
  67. Sensations transmitted in ipsilateral spinal tracts (2)
    • 1. Positional sense
    • 2. Stereognosis
  68. Medications and intoxicants that affect the cerebellum (5)
    • 1. Phenytoin
    • 2. Lithium
    • 3. Chemotherapy
    • 4. Toluene
    • 5. Organic mercury
  69. Nutritional deprivations affecting cerebellum (2)
    • 1. Vitamin E
    • 2. Thiamine
  70. Cause of cerebellar damage in lung cancer
    Antibodies to malignancy cross-react with cerebellar tissue
  71. Most common hereditary ataxia
    Friedreich Ataxia
  72. What does the Pes Cavus deformity look like?
    Foot deformity with high arch, elevated dorsum, and retraction of first metatarsal
  73. What condition is Pes Cavus pathognomonic for?
    Friedreich Ataxia
  74. From which artery does the Posterior Inferior Cerebellar Artery arise?
    Vertebral Artery
  75. Symptoms of Horner Syndrome (3)
    • 1. Ptosis
    • 2. Miosis
    • 3. Anhydrosis
  76. Cause of Horner Syndrome
    Damage to sympathetic fibers that innervate one side of the face
  77. Symptom of lesion to Nucleus Ambiguus
    Ipsilateral soft palate paresis (uvula deviates toward the contralateral side)
  78. Does ataxia secondary to Vitamin E deficiency respond to treatment with Vitamin E?
    Yes!
  79. Major descending pathway of the spinal cord
    Lateral Corticospinal Tract
  80. Major ascending pathways of the spinal cord (4)
    • 1. Posterior columns
    • 2. Lateral Spinothalamic Tract
    • 3. Anterior Spinothalamic Tract
    • 4. Spinocerebellar Tract
  81. What columns make up the Posterior Columns of the spinal cord? (2)
    • 1. Fasciculi Cuneatus
    • 2. Fasciculi Gracilis
  82. What information do the Posterior Columns of the spinal cord carry?
    Position and vibrational sensations
  83. Where do the Posterior Columns of the spinal cord project to?
    Thalamus
  84. What information do the Lateral Spinothalamic Tracts of the spinal cord carry?
    Temperature and pain
  85. Where do the Lateral Spinothalamic Tracts of the spinal cord project to?
    Thalamus
  86. What information do the Anterior Spinothalamic Tracts of the spinal cord carry?
    Light touch
  87. Where do the Anterior Spinothalamic tracts of the spinal cord project to?
    Thalamus
  88. What information do the Spinocerebellar Tracts of the spinal cord carry?
    Position and movement sensations
  89. Where do the Spinocerebellar Tracts of the spinal cord project to?
    Cerebellum
  90. Spinal cord level at which injury will cause hypalgesia below the neck
    C4
  91. Spinal cord level at which injury will cause hypalgesia below the nipples
    T4
  92. Spinal cord level at which injury will cause hypalgesia below the umbilicus
    T10
  93. What is Brown-Séquard Syndrome?
    Hemisection of the spinal cord
  94. 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
  95. Syringomyelia
    Elongated cavity, adjacent to the central canal of the spinal cord, that affects the spinal cord
  96. Hematomyelia
    Cavity within the spine filled with blood; caused by trauma
  97. 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
  98. 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
  99. Conditions that affect the posterior columns of the spinal cord (4)
    • 1. Syphilis
    • 2. B12 deficiency
    • 3. Freidrich Ataxia
    • 4. Spinocerebellar Ataxias
  100. What causes Romberg Sign?
    Loss of position sense due to damage to posterior columns of the spinal cord
  101. Spinal columns affected by B12 deficiency (2)
    • 1. Posterior columns (demyelinated)
    • 2. Corticospinal tract (demyelinated)
  102. Cause of asymmetric, irregular demyelination of the spinal cord
    Multiple Sclerosis
  103. Presentation of HTLV-1 Myelopathy
    Spastic paresis, with spasticity disproportionately greater than paresis
  104. How does nitrous oxide affect the spinal cord?
    Inactivates B12, leading to deficiency and damage to posterior columns
  105. Mineral deficiency causing myelopathy
    Copper deficiency (often due to excess Zinc consumption)
  106. Causes of myelopathy that later cause dementia (4)
    • 1. Tabes dorsalis (syphilis)
    • 2. B12 deficiency
    • 3. AIDS
    • 4. Multiple Sclerosis
  107. Cranial Nerve 1
    Olfactory
  108. Cranial Nerve 2
    Optic
  109. Cranial Nerve 3
    Oculomotor
  110. Cranial Nerve 4
    Trochlear
  111. Cranial Nerve 5
    Trigeminal
  112. Cranial Nerve 6
    Abducens
  113. Cranial Nerve 7
    Facial
  114. Cranial Nerve 8
    Vestibulocochlear (Acoustic)
  115. Cranial Nerve 9
    Glossopharyngeal
  116. Cranial Nerve 10
    Vagus
  117. Cranial Nerve 11
    Accessory (Spinal Accessory)
  118. Cranial Nerve 12
    Hypoglossal
  119. Location of Cortical Olfactory Sensory Area
    Frontal cortex
  120. Sense that does not involve the thalamus
    Smell
  121. Cranial nerve involved in smelling irritating substances (eg ammonia)
    Trigeminal
  122. 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
  123. Common injuries causing anosmia (2)
    • 1. Inhaled metals (welders, Zinc in cold remedies)
    • 2. Head trauma (shears CN1 at the cribiform plate)
  124. Neurodegenerative diseases causing anosmia (5)
    • 1. Parkinson Disease
    • 2. Dementia with Lewy Bodies
    • 3. Wilson Disease
    • 4. Creutzfeldt-Jakob Disease
    • 5. Alzheimer Disease
  125. Sites in the brain where optic nerves project to (2)
    • 1. Cortex (visual information)
    • 2. Midbrain (light intensity information)
  126. Efferent limb of the pupillary light reflex
    Oculomotor nerve (CN3)
  127. Nerve fibers originating from the Edinger-Westphal Nuclei
    Parasympathetic fibers that join CN3
  128. Brain region where pupillary light reflex is located
    Brainstem
  129. Site at which visual fibers from the optic nerve synapse
    Lateral Geniculate Body
  130. Site at which Optic Nerve fibers controlling the pupillary light reflex synapse
    Pretectal Area
  131. Where does the Pretectal Area project to?
    Both ipselateral and contralateral Edinger-Westphal Nuclei
  132. Where do parasympathetic fibers of the Oculomotor Nerve project to?
    Ciliary ganglion (which projects to the iris sphincter muscle)
  133. What is an Adie Pupil? What causes it?
    • Dilated; responds slowly to light but accommodates more quickly
    • Caused by damage to a ciliary ganglion
  134. What is the only nerve myelinated by oligodendrocytes rather than Schwann cells?
    Optic nerve
  135. Cranial nerve whose damage causes ptosis
    Oculomotor (CN3)
  136. Cranial nerve that adducts and elevates the eye
    Oculomotor (CN3)
  137. Symptoms of oculomotor nerve impairment (3)
    • 1. Dilated pupil
    • 2. Ptosis
    • 3. Abduction of the eye
  138. What is accommodation of the eye?
    Ability to focus on near or distant objects
  139. What part of the brain does CN3 originate in?
    Dorsal Midbrain
  140. What part of the brain does CN4 originate in?
    Midbrain
  141. Eye movement controlled by the trochlear nerve
    Depression of the eye while turned inward
  142. Midbrain structures through which CN3 fibers pass before forming the peripheral nerve (2)
    • 1. Red nucleus
    • 2. Cerebral penduncle
  143. What part of the brain does CN6 originate in?
    Pons
  144. Eye movement controlled by the abducens nerve
    Abduction
  145. Most common cause of lesion to an ocular nerve
    Occlusion of a small branch of basilar artery causing small brainstem infarction
  146. Illness causing amnesia, nystagmus, and impairment of CN3 or CN6
    Wernicke Encephalopathy
  147. 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)
  148. Symptoms of infarct affecting a cerebral peduncle in the midbrain (4)
    • 1. Ipsilateral ptosis
    • 2. Ipsilateral dilated pupil
    • 3. Diplopia
    • 4. Contralateral hemiparesis
  149. Symptoms of infarct affecting a red nucleus
    • 1. Ipsilateral ptosis
    • 2. Ipsilateral dilated pupil
    • 3. Diplopia
    • 4. Ipsilateral ataxia
  150. 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)
  151. Symptoms of unilateral pontine infarct (2)
    • 1. Ipsilateral abducens nerve paresis (can't abduct one eye)
    • 2. Contralateral hemiparesis (affects corticospinal tract)
  152. 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
  153. Anatomical cause of internuclear ophtalmoplegia
    Damage to the Medial Longitudinal Fasciculus
  154. Symptoms of Internuclear Ophthalmoplegia
    • Abducting eye has nystagmus
    • Adducting eye does not cross the midline
  155. What condition is interocular ophthalmoplegia characteristic of?
    Multiple Sclerosis
  156. Most frequent lesion of oculomotor nerve
    Diabetic Infarction
  157. Symptoms of Diabetic Infarction (3)
    • 1. Sharp headache
    • 2. Ipsilateral ptosis
    • 3. Ipsilateral ocular abduction
    • (pupils equal, both reactive to light)
  158. Artery whose aneurysm may compress the Oculomotor Nerve
    Posterior Communicating Artery
  159. What is Ambylopia?
    Blindness of the deviated eye in strabismus
  160. Where is the motor nucleus of the Trigeminal Nerve (CN5)?
    Pons
  161. Path the of sensory fibers that form the Trigeminal Nerve
    • Originate in midbrain
    • Travel through medulla before forming the nerve
  162. Which cranial nerves pass though the cerebellopontine angle? (3)
    • CN5 (trigeminal)
    • CN7 (facial)
    • CN8 (vestibulocochlear)
  163. Distribution of Trigeminal Nerve branch V1
    • Forehead
    • Cornea
    • Scalp up to the vertex
  164. Distribution of Trigeminal Nerve branch V2
    Malar area
  165. Distribution of Trigeminal Nerve branch V3
    Lower jaw, except for the angle
  166. 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)
  167. Cranial nerve acting as the motor limb of the jaw jerk reflex
    Trigeminal nerve
  168. Generally, which muscles are innervated by the trigeminal nerve?
    Muscles of mastication
  169. Generally, which muscles are innervated by the facial nerve?
    Muscles of facial expression
  170. Which cerebral hemisphere innervates muscles of facial expression from the eyes up?
    Both!
  171. Which cerebral hemisphere innervates muscles of facial expression from the eyes down?
    Contralateral hemisphere
  172. What cranial nerve carries taste information from the anterior two-thirds of the tongue?
    Facial Nerve (CN7)
  173. What cranial nerve carries taste information from the anterior two-thirds of the tongue?
    Glossopharyngeal (CN9)
  174. What cranial nerve carries information to the frontal lobe and limbic system while tasting food?
    Olfactory! (not facial or glossopharyngeal)
  175. Where is a lesion unilaterally affecting both upper and lower facial muscles?
    Ipsilateral facial nerve (CN7)
  176. Where is a lesion unilaterally affecting only lower facial muscles?
    Contralateral motor cortex
  177. Nerve affected in Bell's Palsy
    Facial Nerve (CN7)
  178. What is Dysgeusia?
    Impairment of taste sensation
  179. Medications that can reduce or distort taste sensation (3)
    • 1. TCAs
    • 2. Acetazolamide
    • 3. Levodopa
  180. Symptom found along with reduced taste sensation that is indicative of damage from radiotherapy
    Hyposalivation
  181. Divisions of the Acoustic Nerve (CN8) (2)
    • 1. Cochlear Nerve (carries hearing information)
    • 2. Vestibular Nerve (carries balance information)
  182. Path of Cochlear Nerve fibers of CN8
    • Originate at middle and inner ear
    • Terminate at bilateral Superior Temporal Gyri of cerebral hemispheres
  183. Type of hearing loss associated with Presbycusis
    • Initially high frequencies, difficulty distinguishing between consonants, and impaired speech discrimination
    • Later progresses to involve all frequencies
  184. Cause of presbycusis
    Age-related degradation of the cochlea, not of the CNS or CN8
  185. Main brain region innervated by the cochlear division of the acoustic nerve
    Pons
  186. Symptoms of Meniere Disease (4)
    • 1. Vertigo
    • 2. Nystagmus
    • 3. Unilateral tinnitus
    • 4. Progressive hearing loss
  187. Brain region where Cranial Nerves 9 and 12 arise
    Medulla
  188. Symptoms of Bulbar Palsy (4)
    • 1. Dysarthria
    • 2. Dysphagia
    • 3. Hypoactive jaw reflex
    • 4. Hypoactive gag reflex
  189. Which cranial nerves are the "Bulbar Nerves"?
    9th (Glossal), 10th (Vagal), and 11th (Accessory)
  190. How does Bulbar Palsy affect communication?
    • Speech is thick and nasal or absent altogether
    • Able to comprehend
    • Able to write
  191. Effects of Bulbar Palsy on eating
    • Food can lodge in the trachea or the nasopharyngeal cavity
    • Liquids regurgitate through the nose
  192. Effect of bulbar damage on respiration
    Can injure the medullary respiratory center, requiring mechanical ventilation
  193. Common causes of bulbar palsy due to damage within the brainstem (3)
    • 1. ALS
    • 2. Polio
    • 3. Lateral medullary infarct
  194. 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
  195. What is Pseudobulbar Palsy?
    Damage to the frontal lobe (rather than brianstem in Bulbar Palsy) causes dysarthria and dysphagia
  196. 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)
  197. Effect of Pseudobulbar Palsy on Mental Status Exam
    Emotional lability with tearfulness and laughter without underlying mood change
  198. Treatments for "Pseudobulbar Affect" (3)
    • 1. Amitriptyline
    • 2. SSRIs
    • 3. Dextromethorphan with quinidine
  199. Brain region whose lesion causes superior homonymous quadrantanopsia
    Temporal lobe
  200. Conditions causing dementia and posterior column sensory loss (4)
    • 1. B12 deficiency
    • 2. Tertiary syphilis
    • 3. Spinocerebellar ataxias
    • 4. Heavy metal intoxication
  201. Foster-Kennedy Syndrome
    • Frontal lobe tumor compresses CN1 and CN2 and increased intracranial pressure
    • Ipsilateral optic atrophy and anosmia
    • Contralateral papilledema
  202. Cause of Horner's Syndrome
    Damage to the sympathetic trunk of the spinal cord, which ascends to the neck and face
  203. "Foundation" of the extrapyramidal motor system
    Basal Ganglia
  204. Frontal release signs (7)
    • 1. Snout
    • 2. Suck
    • 3. Rooting
    • 4. Jaw Jerk
    • 5. Palmomental
    • 6. Grasp
    • 7. Meyerson sign
  205. What is dysmetria?
    • Irregularity in movement or eye trajectory while performing rapid movements
    • Causes overshooting or undershooting the target
  206. At what level of the brain is the Sylvian Aqueduct?
    Midbrain
  207. In what brain region are cerebellar peduncles located?
    Medulla
  208. Gait typical of hydrocephalus
    Apraxic
  209. Gait typical of cerebellar dysfunction
    Ataxic
  210. How high in the body/spinal cord does fasciculus cuneatus originate?
    At the level of arms and upper trunk
  211. How high in the body/spinal cord does fasciculus gracilis originate?
    Lower limbs
  212. Nerve whose injury causes foot drop
    Fibular (previously called peroneal)
  213. Which side is more often affected in psychogenic hemiparesis?
    Left
  214. Is pupillary constriction mediated by sympathetic or parasympathetic innervation?
    Parasympathetic
  215. Is pupillary dilation mediated by sympathetic or parasympathetic innervation?
    Sympathetic
  216. Location of motor cell bodies in the peripheral nervous system
    Anterior Horn
  217. What is Dysesthesia?
    Painful sensations due to neuropathy
  218. What is Allodynia?
    Exaggerated painful response to a mildly noxious stimulus
  219. What is Hyperpathia?
    Delayed, then exaggerated and prolonged pain from a noxious stimulus
  220. 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
  221. Nerve affected by prolonged leg-crossing, causing foot drop
    Common Fibular
  222. Nerve whose injury causes paresis of thumb abduction
    Median Nerve
  223. Nerve whose injury causes sensory loss in the thumb, 2nd finger, 3rd finger, and lateral 4th finger
    Median Nerve
  224. Nerve whose injury causes paresis of finger and thumb abduction
    Ulnar Nerve
  225. Nerve whose injury causes sensory loss in the 5th finger and medial half of 4th finger
    Ulnar Nerve
  226. Nerve whose injury causes paresis of wrist, thumb, and finger extensors
    Radial Nerve
  227. Nerve whose injury causes sensory loss in the dorsal hand
    Radial Nerve
  228. Nerve whose injury causes loss of the brachioradialis DTR
    Radial Nerve
  229. Nerve whose injury causes paresis of knee extensors
    Femoral Nerve
  230. Nerve whose injury causes sensory loss in anterior thigh and medial calf
    Femoral Nerve
  231. Nerve whose injury causes paresis of ankle dorsiflexors and plantarflexors
    Sciatic Nerve
  232. Nerve whose injury causes loss of ankle jerk DTR
    Sciatic Nerve
  233. Nerve whose injury causes sensory loss to the buttock, lateral calf, and most of the foot
    Sciatic Nerve
  234. Nerve whose injury causes paresis of ankle dorsiflexion and eversion
    Fibular Nerve
  235. Nerve whose injury causes sensory loss of the dorsum of the foot and the lateral calf
    Fibular Nerve
  236. Consequences of chronic Carpal Tunnel Syndrome (2)
    • 1. Atrophy of thenar muscles
    • 2. Impaired fine movements of the first 3 fingers
  237. Systemic illnesses that commonly cause neuropathy (3)
    • 1. Diabetes
    • 2. Vaculitis
    • 3. Lead intoxication
  238. What is Mononeuritis Multiplex?
    • Simultaneous or stepwise development of peripheral nerve injuries, often including cranial nerves
    • Usually due to systemic illness
  239. Endogenous toxic causes of Neuropathy (3)
    • 1. Acute intermittent variegate porphyria (causes mental status change)
    • 2. Diabetes
    • 3. Uremia (causes mental status change)
  240. 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
  241. Vitamin causing Neuropathy if taken in excess
    Vitamin B6
  242. Medications causing Neuropathy (6)
    • 1. Antibiotics
    • 2. HAART medications
    • 3. Dapsone
    • 4. Isoniazid (causes mental status change)
    • 5. Nitrofurantoin
    • 6. Antineoplastic agents
  243. 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)
  244. 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)
  245. Vasculidities causing neuropathy (2)
    • 1. Lupus
    • 2. Polyarteritis (causes mental status change)
  246. Genetic illnesses causing Neuropathy (3)
    • 1. Adrenoleukodystrophy (causes mental status change)
    • 2. Metachromatic leukodystrophy (causes mental status change)
    • 3. Spinocerebellar ataxias
  247. Illnesses causing Guillain-Barré (7)
    • 1. C. Jejuni
    • 2. HIV
    • 3. Lyme
    • 4. Mononucleosis
    • 5. Hepatitis
    • 6. CMV
    • 7. West Nile Virus
  248. 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!
  249. CSF findings in Guillain-Barré
    • Elevated proteins
    • Few WBCs
  250. Duration of illness in Guillain-Barré
    Resolves completely in 3 months as PNS myelin is regenerated
  251. Treatment for Guillain-Barré (2)
    • 1. Plasmapheresis
    • 2. IVIG
    • Not steroids!
  252. Functions generally preserved in peripheral neuropathies (except diabetic neuropathy) (3)
    • 1. Bladder
    • 2. Bowel
    • 3. Sexual
  253. Illness in which CNS demyelination is not always permanent
    Multiple Sclerosis (occurs because oligodendrocytes are inflamed, not killed, during most flares)
  254. Effects of diabetic neuropathy
    • "Stocking-glove" sensory loss
    • Loss of ankle jerk and eventually knee jerk reflexes
    • Minimal motor loss
  255. Mechanism of dementia in Diabetes Mellitus
    Causes damage to vessels, potentially leading to infarcts and multi-infarct dementia
  256. Effects of lead poisoning on adults
    • Mononeuropathy or polyneuropathy (bilateral wrist or foot drop is common)
    • GI distress
    • Not cerebral effects!
  257. Dermatologic appearance of Arsenic ingestion (3)
    • 1. White bands across fingernails (Mees Lines)
    • 2. Hyperpigmentation
    • 3. Hyperkeratosis
  258. Intoxicant causing polyneuropathy, dermatologic abnormality, and mental status changes if exposed chronically
    Arsenic
  259. Intoxicant causing neuropathy, cognitive impairment, ataxia, dysarthria, and visual field changes if exposed chronically
    Mercury
  260. Skin sign of chronic mercury exposure
    Dark blue or black line along the gums
  261. Poison causing painful neuropathy and hair loss
    Thallium
  262. Vitamin whose deficiency causes night blindness
    Vitamin A
  263. Vitamin whose deficiency causes Wernicke-Korsakoff Syndrome
    B1 (Thiamine)
  264. Vitamin whose deficiency causes Beriberi
    B2 (Riboflavin)
  265. Vitamin whose deficiency causes Pellagra
    B3 (Niacin)
  266. Vitamin whose deficiency causes Seizures and Psychosis
    B6 (Pyroxidine)
  267. Vitamin whose deficiency causes neural tube defects
    B9 (Folic acid)
  268. Vitamin whose deficiency causes Combined System Disease
    B12
  269. Vitamin whose deficiency causes Ataxia/Neuropathy
    E
  270. Vitamin whose excess causes Pseudotumor Cerebri
    A
  271. Vitamin whose excess causes Neuropathy
    B6 (pyroxidine)
  272. Mineral whose deficiency causes neuropathy
    Copper
  273. Symptoms of thiamine deficiency (2)
    • 1. Absent DTRs
    • 2. Loss of position sensation
  274. Symptoms of Wernicke-Korsakoff Syndrome (4)
    • 1. Amnesia
    • 2. Dementia
    • 3. Cerebellar degeneration
    • 4. Peripheral neuropathy
  275. Symptoms of B3/Niacin Deficiency (Pellagra) (3)
    • 1. Dementia
    • 2. Dermatitis
    • 3. Diarrhea
  276. What is the mechanism of neurological damage caused by B12 deficiency?
    Demyelination of CNS and PNS neurons
  277. Neurological symptoms of Combined System Disease (3)
    • 1. Polyneuropathy
    • 2. Cognitive impairment
    • 3. Sensory loss
  278. Spinal cord columns most affected by B12 deficiency
    Posteroir columns
  279. Vitamin deficiency produced by chronic nitrous oxide exposure
    B12 deficiency (NO inactivates B12)
  280. 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
  281. PNS effects of Lyme Disease (2)
    • 1. Facial nerve paresis (unilateral or bilateral)
    • 2. Paresthesias (ranging from mild to full unilateral paralysis)
  282. CNS effects of Lyme Disease (3)
    • 1. Headache
    • 2. Delirium
    • 3. Signs of meningitis/encephalitis
  283. CSF findings in Lyme Disease (4)
    • 1. Pleocytosis
    • 2. Elevated protein
    • 3. Low glucose
    • 4. Lyme antibodies
  284. Most common infection affecting both PNS and CNS
    AIDS
  285. 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)
  286. Symptoms of an attack of Acute Intermittent Porphyria (3)
    • 1. Quadriparesis
    • 2. Abdominal pain
    • 3. Psychiatric symptoms in 25-50%
  287. Tests to diagnose an attack of Acute Intermittent Porphyria (2)
    • 1. Urine prophobilinogen
    • 2. Urine or serum 5-aminolevulinic acid
  288. Effect of Metachromatic Leukodystrophy on the nervous system
    Demyelination in both CNS and PNS, worse in CNS
  289. Pathology findings in Metachromatic Leukodystrophy (2)
    • 1. Colored granules in lysosomes of nervous system, gallbladder, pancreas, and liver
    • 2. Demyelination on nerve biopsy
  290. 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
  291. MRI findings in Metachromatic Leukodystrophy
    Demyelinated lesions
  292. Symptoms of Solvent-Induced Encephalopathy (7)
    • 1. Personality changes
    • 2. Inattention
    • 3. Depression
    • 4. Headaches
    • 5. Fatigue
    • 6. Psychosis
    • 7. Cognitive impairment
  293. Solvent predominantly damaging PNS
    n-hexane (in glue)
  294. Solvents predominantly damaging CNS (2)
    • 1. Toluene (spraypaint, markers) (causes demyelination)
    • 2. Nitrous oxide
  295. Features of Toluene-induced dementia (2)
    • 1. Gait is impaired
    • 2. Language is perserved
  296. Regions of the world where fish are more likely to be contaminated with Ciguatera Toxin (2)
    • 1. Caribbean
    • 2. Indian Ocean islands
  297. Symptoms of Ciguatera Toxin ingestion
    • Initially, nausea/vomiting
    • Later, paresthesias, pain, and loss of sensation in all limbs
  298. What is Cold Allodynia? What causes it?
    • Perception of cold objects as hot
    • Unique to Ciguatera Toxin ingestion
  299. Cause of fasciculations in ALS
    Loss of anterior horn cells
  300. Spread of weakness, atrophy, and fasciculations in ALS
    • Start in one limb, then spread asymmetrically to other limbs
    • Eventually, affect face, pharynx, and tongue
  301. Muscle functions not affected in ALS
    • 1. Bladder control
    • 2. Bowel control
    • 3. Extraocular movements
  302. Cognitive effects of ALS
    • In 90%, none!
    • In 10%, frontotemporal dementia
  303. Medication given for ALS
    Riluzole
  304. Symptoms of Spinal Muscular Atrophy
    • 1. Flaccid quadriparesis
    • 2. Muscle atrophy
    • 3. Areflexia
    • 4. Fasciculations
  305. What is Werdnig-Hoffman Disease?
    Type of Spinal Muscular Atrophy that presents in infants
  306. What is Kugelberg-Welander Disease?
    Type of Spinal Muscular Atrophy that presents in children
  307. Type of cells in the nervous system infected by polio, and where they are
    • Anterior horn cells
    • In spinal cord and lower brainstem
  308. Neurologic symptoms of polio (5)
    • 1. Asymmetric paresis
    • 2. Absent DTRs
    • 3. Fasciculations
    • If bulbar variety:
    • 4. Throat muscle paralysis
    • 5. Chest muscle paralysis
  309. What are Benign Fasciculations?
    Fasciculations without weakness, atrophy, or pathologic reflexes. Usually last days to weeks
  310. What is Spondylosis?
    Bony encroachment causes stenosis of vertebral foramina and, if high enough, of the spinal canal
  311. Symptoms of Cervical Spondylosis compressing nerve roots (5)
    • 1. Neck pain
    • 2. Arm/hand paresis
    • 3. Atrophy
    • 4. Hypoactive DTRs
    • 5. Fasciculations
  312. Symptoms of Cervical Spondylosis compressing spinal canal (4)
    • 1. Leg weakness
    • 2. Spasticity
    • 3. Hyperreflexia
    • 4. Babinski
  313. 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
  314. What is Neurogenic Claudication?
    Pain/weakness of legs only with walking
  315. How to distinguish ALS from spondylosis?
    • ALS affects facial, pharyngeal, and tongue muscles
    • Spondylosis causes neck or back pain and sensory loss
  316. Symptoms of disc herniation
    • Abrupt onset of pain radiating down a nerve's distribution
    • May have sensory loss or weakness, but may not
  317. Most common sites of lumbosacral disc herniation (2)
    • L4-5
    • L5-S1
  318. Symptoms of Cauda Equina Syndrome (4)
    • 1. Flaccid paresis of one or both legs
    • 2. Perineal pain/anesthesia
    • 3. Incontinence
    • 4. Sexual dysfunction
  319. What condition does the Watson-Schwartz Test diagnose?
    Acute Intermittent Porphyria
  320. What medication class should be given to prevent psychosis in Acute Intermittent Porphyria?
    Phenothiazines
  321. Medications that can precipitate an attack in Acute Intermittent Porphyria (2)
    • 1. Barbiturates
    • 2. Phenytoin
  322. Functions spared by Guillain-Barré (2)
    • 1. Extraocular movements
    • 2. Pupil function
  323. Nerve root responsible for ankle jerk reflex
    L5-S1
  324. Common cause of Pseudobulbar Palsy
    Multiple Sclerosis
  325. Condition causing urine to turn dark red when exposed to sunlight
    Acute Intermittent Porphyria
  326. Mechanism of Myesthenia Gravis
    Antibodies attack ACh receptors
  327. What is Pyridostigmine? What is it used to treat?
    • Cholinesterase inhibitor
    • Used to treat Myesthenia Gravis
  328. What is Neostigmine? What is it used to treat?
    • Cholinesterase inhibitor, given IV or IM
    • Used to treat Mysethenia Gravis (when severe)
  329. Treatments for Myesthenia Gravis (5)
    • 1. Cholinesterase inhibitors (-stigmine)
    • 2. Steroids
    • 3. Plasmapheresis
    • 4. IVIG
    • 5. Immunosuppressants
  330. Mechanism of Botulinum Toxin
    Blocks release of ACh at synapses
  331. Mechanism of succinylcholine
    Binds ACh receptors, inactivating them
  332. 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
  333. Muscles most typically affected in Myesthenia Gravis (3)
    • 1. Oculomotor muscles
    • 2. Facial muscles
    • 3. Bulbar muscles
  334. Patients typically affected by Myesthenia Gravis
    • Young women
    • Older men
  335. Symptoms of myesthenia gravis that has caused facial and neck muscle weakness
    • Nasal tone to voice
    • Grimace instead of smiling
    • Difficulty chewing
    • Difficulty whistling
  336. 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)
  337. Types of eye muscles affected by Myesthenia Gravis
    • Extraocular only!
    • Intraocular are not affected!
  338. Does myesthenia gravis affect bladder and bowel function?
    No!
  339. Conditions often causing exacerbations of myesthenia gravis
    • 1. Illness, (classically pneumonia)
    • 2. Psychologic stress
    • 3. Pregnancy
  340. Effects of pregnancy on myesthenia gravis
    • 40% have an exacerbation
    • 30% enjoy remission
  341. Pattern of Paresis in Muscle Disorders
    Proximal
  342. Muscle tone in muscle disorders
    Normal tone, but muscles are tender
  343. Deep tendon reflexes in muscle disorders
    Normal or hypoactive
  344. Site of damage from Black Widow Spider venom
    Neuromuscular Junction
  345. What is the Tensilon (edrophonium) test?
    • Used to test for myesthenia gravis
    • Give IV cholinesterase inhibitor (edrophonium)
    • If symptoms improve, test is positive
  346. Mechanism of Lambert-Eaton Syndrome
    Antibodies attack calcium channels, blocking release of ACh from presynaptic neurons
  347. Underlying illnesses that can cause Lambert-Eaton Syndrome (2)
    • 1. Small cell carcinoma of the lung (or other cancers)
    • 2. Rheumatologic illness
  348. Progression of Lambert-Eaton Syndrome
    Starts with weakness of limbs, then affects the trunk later
  349. Cause of weakness that improves with repeated attempts to move
    Lambert-Eaton Syndrome (repeatedly attempting to move provokes more ACh release)
  350. Neuromuscular junction condition causing both weakness and autonomic dysfunction
    Lambert-Eaton Syndrome
  351. Initial muscle group paralyses in botulism ingestion (3)
    • 1. Ocular (including dilated pupils)
    • 2. Bulbar
    • 3. Respiratory
  352. First symptoms of botulism ingestion
    Nausea, vomiting, diarrhea and fever
  353. When do paralytic symptoms occur after ingesting botulinum toxin?
    18-36 hours later
  354. Mechanism of tetanus toxin
    Blocks presynaptic release of GABA and glycine, reducing inhibition of motor neurons
  355. Mechanism of Strychnine poisoning
    Antagonizes GABA and glycine receptors, reducing inhibition of motor neurons
  356. Clinical difference between strychnine poisoning and tetanus
    Trismus occurs in tetanus, but not in strychnine poisoning
  357. Mechanism of organophosphate poisoning
    Bind and inactivate Acytylcholinesterase (AChE), causing muscle contractions and fasciculations, and eventual paralysis of the diaphragm
  358. Mechanism of nerve gas
    Bind and inactivate Acytylcholinesterase (AChE)
  359. 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
  360. 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
  361. Pattern of symptoms in myopathy
    Affect large, proximal muscles first, most severely, and often exclusively
  362. Inheritance of Duchenne Muscular Dystrophy
    • X-linked
    • 30% are de novo mutations
  363. First sites affected in Duchenne Muscular Dystrophy
    • Thighs (difficulty standing)
    • Shoulders
  364. Appearance of muscles in Duchenne Muscular Dystrophy
    Increase in size, as they are infiltrated by fat and connective tissue (pseudohypertrophy)
  365. Treatment for Duchenne Muscular Dystrophy
    Steroids (delay progression)
  366. Protein absent or damaged in Duchenne Muscular Dystrophy
    Dystrophin
  367. What is Becker Dystrophy?
    • Variant of Duchenne Muscular Dystrophy
    • Dystrophin retains some function
    • Weakness begins in 2nd decade and progresses slowly
  368. Most common myopathy in adults
    Myotonic Dystrophy
  369. Characteristics of patients when Myotonic Dystrophy first occurs
    • Age 20-25
    • No sex preference
  370. Symptoms of Myotonic Dystrophy
    • Facial and distal limb muscle weakness/atrophy
    • Involuntary prolonged muscle contraction
  371. Facial appearance in Myotonic Dystrophy
    • Sunken, elongated face (facial and temporal muscle wasting)
    • Ptosis
    • Prominent forehead
    • Frontal balding
  372. Nonneurologic symtpoms in Myotonic Dystrophy (3)
    • 1. Cataracts
    • 2. Heart conduction abnormalities
    • 3. Endocrine organ failure (infertility, diabetes)
  373. Medications given for myotonia in Myotonic Dystrophy (2)
    • 1. Phenytoin
    • 2. Quinine
  374. Cognitive effects of Myotonic Dystrophy
    • Nearly always present, and worsens with age
    • Lack of initiative
    • Progressively bland personality
  375. Disorder caused by trinucleotide repeat with sex-linked inheritance
    Fragile X Syndrome
  376. Disorder caused by trinucleotide repeat with recessive inheritance
    Friedreich Ataxia
  377. Disorders caused by trinucleotide repeat with dominant inheritance pattern (3)
    • 1. Sponocerebellar atrophy
    • 2. Huntington Disease
    • 3. Myotonic Dystrophy
  378. 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
  379. What is polymyositis?
    • Inflammatory myopathy
    • Causes weakness, myalgia, and fever
  380. What is dermatomyositis?
    Symptoms of inflammatory myopathy accompanied by a rash
  381. Where is the rash of dermatomyositis?
    Typically on face and extensor surfaces the elbows and knees
  382. Typical cause of polymyositis in children
    Viral illness
  383. Typical cause of polymyositis in adults
    Inflammatory diseases (eg polymyalgia rheumatica)
  384. What causes Eosinophilia-Myalgia Syndrome?
    Ingestion of large amounts of tryptophan
  385. Symptoms of Eosinophilia-Myalgia Syndrome (5)
    • 1. Several days of myalgia
    • 2. Fatigue
    • 3. Rash
    • 4. Neuropathy
    • 5. Cardiopulmonary issues
  386. Symptoms of AIDS Myopathy (4)
    • 1. Myalgia
    • 2. Weakness
    • 3. Fatigue
    • 4. Weight loss
  387. Presentation of steroid myopathy
    • Proximal weakness and wasting
    • Cushingoid symptoms
  388. Electrolyte that, when low, can cause myopathy
    Potassium (hypokalemic myopathy)
  389. Symptoms of hypokalemia (2)
    • 1. Confusion/agitation/stupor
    • 2. Seizures
  390. 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
  391. Preciptating factors for episodes of Hypokalemic Periodic Paralysis (3)
    • 1. Exercise
    • 2. Sleep
    • 3. Large carbohydrate meals
  392. Inheritance pattern of Hypokalemic Periodic Paralysis
    Autosomal dominant
  393. Mechanism of cyanide
    Irreversibly inactivates mitochondrial respiratory enzymes
  394. Underlying cause of a Primary Mitochondrial Myopathy
    Deficiencies in mitochondrial enzymes in muscle
  395. Symptoms of Primary Mitochondrial Myopathy (5)
    • 1. Weakness/exercise intolerance
    • 2. Short stature
    • 3. Seizures
    • 4. Deafness
    • 5. Episodic lactic acidosis
  396. Presentation of Progressive Ophthalmoplegia (5)
    • 1. Ptosis and extraocular muscle palsises
    • 2. Retinitis pigmentosa
    • 3. Short stature
    • 4. Cardiomyopathy
    • 5. Endocrine anomalies
  397. Presentation of Leber Optic Atrophy
    Hereditary optic atrophy in young men
  398. Presentation of mitochondrial encephalopathies
    • Intermittent or progressive mental status abnormalities (dementia or delirium)
    • First occur between infancy and 12 years of age
  399. Other than mental status changes, symptoms of mitochondrial encephalopathies (4)
    • 1. Paresis of extraocular muscles
    • 2. Psychomotor retardation
    • 3. Migraines
    • 4. Optic atrophy
  400. What are "ragged red fibers" on muscle biopsy?
    Accumulations of diseased mitochondria
  401. Treatments for mitochondrial disorders (2)
    • 1. Coenzyme Q10
    • 2. Bone marrow transplant
  402. Elements of Neuroleptic Malignant Syndrome (3)
    • 1. Delirium
    • 2. Extrapyramidal signs
    • 3. Autonomic hyperactivity
  403. Common Extrapyramidal signs in Neuroleptic Malignant Syndrome
    • Rigidity
    • Tremors
    • Dystonic posturing
  404. Prominent autonomic symptoms in Neuroleptic Malignant Syndrome
    • High fever
    • Tachycardia
  405. Consequence of muscle rigidity in Neuroleptic Malignant Syndrome
    Muscles flex so strongly that rhabdomyolysis occurs, leading to kidney failure
  406. Consequence of high fever in Neuroleptic Malignant Syndrome
    Damage to cerebral cortex
  407. 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
  408. Medications used to treat Neuroleptic Malignant Syndrome (4)
    • 1. Bromocriptine
    • 2. Apomorphine
    • 3. Amantadine
    • 4. L-Dopa
  409. Muscular presentation of Serotonin Syndrome
    Myoclonus and tremulousness
  410. Drugs of abuse that contribute to Serotonin Syndrome (3)
    • 1. Ecstasy
    • 2. Amphetamines
    • 3. Cocaine
  411. MAOIs most often associated with Serotonin Syndrome when an SSRI is added (2)
    • 1. Deprenyl
    • 2. Rasagiline
  412. Migraine medication class associated with Serotonin Syndrome
    Triptans
  413. Medication to reduce CNS serotonin in Serotonin Syndrome
    Cyproheptadine
  414. Underlying cause of Malignant Hyperthermia
    Excessive calcium release
  415. What types of medications cause Malignant Hyperthermia?
    Anesthetics (inhaled, as well as succinylcholine)
  416. Medication used to treat Malignant Hyperthermia
    Dantrolene
  417. Medications whose overdose is often mistaken for Neuroleptic Malignant Syndrome (2)
    • 1. Phencyclidine
    • 2. Anticholinergics
  418. Appearance of myelin damage on Nerve Conduction Studies
    Reduced conduction velocity
  419. Appearance of axon damage on Nerve Conduction Studies
    Reduced amplitude
  420. EMG changes in neuropathy
    Muscles are noted to have deteriorated
  421. Myocyte enzymes found in serum with muscle damage (4)
    • 1. Lactic dehydrogenase
    • 2. Aspartate aminotransferase
    • 3. Aldolase
    • 4. Creatine Kinase
  422. Myopathy that causes the highest increase in CK
    Neuroleptic Malignant Syndrome
  423. Medical Conditions that sometimes underlie Myesthenia Gravis (2)
    • 1. Hyperthyroidism
    • 2. Thymoma
  424. Medications associated with Neuropathy (5)
    • 1. Disulfiram
    • 2. Chlorpromazine
    • 3. Nitrofurantoin
    • 4. Isoniazid
    • 5. Vitamin B6
  425. Medications associated with Myopathy (3)
    • 1. Chlorpromazine
    • 2. Statins
    • 3. Nucleoside analogues
  426. Electrolyte abnormality caused by loss of colonic fluid
    Hypokalemia
  427. Most common cause of deterioration, confusion, and fever in advanced Parkinson Disease
    Pneumonia
  428. What is Global Amnesia?
    Amnesia that is both anterograde and retrograde
  429. Symptoms often comorbid with posttraumatic amnesia (3)
    • 1. Behavior disturbance
    • 2. Depressed mood
    • 3. Headache
  430. Symptoms often comorbid with amnesia in Wernicke-Korsakoff Syndrome (2)
    • 1. Ataxia
    • 2. Peripheral neuropathy
  431. Symptoms of Herpes Encephalitis (4)
    • 1. Amnesia
    • 2. Personality changes
    • 3. Complex partial seizures
    • 4. Klüver-Bucy Syndrome
  432. How does HSV enter the brain? What regions does it affect first?
    • Enters through nasopharynx
    • Attacks frontal and temporal lobes
  433. Medications associated with transient amnesia (3)
    • 1. GHB
    • 2. Scopolamine
    • 3. Zolpidem (Ambien)
  434. If a discrete neurologic disorder co-occurs with amnesia, what part of the brain has dysfunction?
    Cortex
  435. 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
  436. EEG changes with age
    Slowing of alpha waves
  437. 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
  438. Autoimmune/Inflammatory causes of dementia in younger patients (2)
    • 1. Paraneoplastic syndromes
    • 2. Vasculitis
  439. Infectious causes of dementia in younger patients (3)
    • 1. HIV
    • 2. Creutzfeldt-Jakob disease (CJD)
    • 3. Subacute sclerosing panencephalitis
  440. Metabolic causes of dementia in younger patients (2)
    • 1. Adrenoleukodystrophy
    • 2. Wilson Disease
  441. Neurodegenerative causes of dementia in younger patients (2)
    • 1. Huntington Disease
    • 2. Metachromatic Leukodystrophy
  442. Inheritance pattern of Frontotemporal Dementia
    Autosomal dominant
  443. Inheritance pattern of Prion Diseases (when inheritable)
    Autosomal Dominant
  444. Inheritance pattern of Alzheimer Disease
    Autosomal Dominant
  445. Inheritance pattern of Wilson Disease
    Autosomal Recessive
  446. "Rapidly Progressive" Dementias (5)
    • 1. HIV-associated dementia
    • 2. Frontotemporal dementia
    • 3. Lewy Body dementia
    • 4. Paraneoplastic encephalitis
    • 5. Creutzfeldt-Jakob Disease
  447. Symptoms of Subcortical Dementias (5)
    • 1. Apathy
    • 2. Affective change
    • 3. Slowed mental processing
    • 4. Gait abnormalities
    • 5. Extrapyramidal motor abnormalities
  448. Illnesses whose dementia is subcortical (4)
    • 1. Parkinson Disease
    • 2. NPH
    • 3. HIV-associated dementia
    • 4. Vascular dementia
  449. 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
  450. Is CT or MRI better in suspected dementia?
    • CT is better for screening
    • MRI is better for ruling out other causes of symptoms
  451. EEG in dementia
    Generalized slowing; difficult to distinguish from age-related changes most of the time
  452. Role of Lumbar Puncture in diagnosing dementia
    • Not done routinely
    • Can be used to rule out infectious causes or NPH
  453. Tests for preclinical Alzheimer Disease (2)
    • 1. PET scan
    • 2. Lumbar puncture for amyloid and tau protein
  454. 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
  455. Language impairments in Alzheimer Disease
    • Difficulty with word finding
    • Use of incorrect words
    • Circumvent forgotten words
  456. What is anomia?
    Inability to find a word
  457. What is a Paraphasic Error?
    Use of an incorrect word
  458. Symptoms often comorbid with Constructional Apraxia (3)
    • 1. Hemi-inattention
    • 2. Left homonymous hemianopsia
    • 3. Aprosody
  459. Paranoia in Alzheimer Disease
    • Occurs in 20-40%
    • Often paranoid ideations
  460. Hallucinations in Alzheimer Disease
    • Occur in ~10%
    • Mostly visual
    • Sign of poor prognosis
  461. Single physical impairment in Alzheimer Disease
    Anosmia
  462. Areas of greater Cortical Atrophy in Alzheimer Disease (4)
    • 1. Parietal-temporal junction
    • 2. Limbic System (especially hippocampus)
    • 3. Locus Ceruleus
    • 4. Olfactory nerve
  463. What are plaques made from in Alzheimer Disease?
    Amyloid beta peptide
  464. What are tangles made from in Alzheimer Disease?
    Tau
  465. Most distinctive site of neuron loss in Alzheimer Disease, and which neurotransmitter is affected
    • Nucleus Basalis of Meynert
    • Depletes ACh
  466. Likelihood of Alzheimer Disease occurring in the child of an AD patient
    20%
  467. Paired variants of Apo-E that are associated with Alzheimer Disease (2)
    • 1. E3-E4
    • 2. E4-E4
  468. Chromosomes containing genes whose damage will cause Alzheimer Disease (3)
    • 1
    • 14
    • 21
  469. Medication that slows progression in Alzheimer Disease, and its mechanism
    • Donepazil
    • AChE inhibitor
  470. Dementias characterized with ACh deficit (3)
    • 1. Parkinson Disease
    • 2. Alzheimer Disease
    • 3. Lewy Body Dementia
  471. Most common category of medications used for Alzheimer Disease
    Cholinesterase inhibitors (that cross the blood-brain barrier)
  472. Effects of Memantine in Alzheimer Disease
    • Improved memory and learning, less agitation/aggression
    • May reverse the process of apoptosis
  473. To what medication class does Memantine (Namenda) belong?
    NMDA receptor antagonists
  474. Why should tricyclics be avoided in Alzheimer Disease?
    • AD affects ACh pathways
    • Antidepressants that have cholinergic effects can have exaggerated side effects
  475. Antipsychotics that reduce suspiciousness in Alzheimer Disease (2)
    • 1. Olanzapine
    • 2. Risperdal
  476. Dementia in Trisomy 21
    Alzheimer-like condition occurs around age 50 in nearly all cases
  477. Risk of Alzheimer Disease in mothers of children with Trisomy 21
    Fivefold increased risk
  478. Contents of a Lewy Body
    • Core of α-synuclein and ubiquitin
    • Surrounded by loose fibrils
  479. Illness where Lewy Bodies are found in cortex
    Lewy Body Dementia
  480. Illness where Lewy Bodies are found in basal ganglia
    Parkinson Disease
  481. Choline Acyltransferase in Alzheimer Disease and Lewy Body Dementia
    Reduced in both; greater reduction in Lewy Body Dementia
  482. How many years after onset of Parkinson Disease symptoms does cognitive decline begin?
    5
  483. Site of Lewy Bodies in Lewy Body Dementia that correlates with visual hallucinations
    Temporal lobes
  484. Effects of Lewy Body Dementia on REM sleep
    50% have REM Sleep Disorder, in which their limbs are not paralyzed during REM sleep
  485. Antipsychotics and Lewy Body Dementia
    Even at low doses, cause significant extrapyramidal signs
  486. Core features of Lewy Body Dementia (3)
    • 1. Parkinsonism
    • 2. Visual hallucinations
    • 3. Fluctuating cognition
  487. Site of a lesion causing slowed thought, lack of emotions, paucity of speech, and apathy
    Frontal lobe
  488. What is Akinetic Mutism?
    Absence of speaking and expression due to absent voluntary movements
  489. Site of lesion causing superficial, odd jocularity and uncontrollable facetious laughter
    Frontal lobe (these symptoms are due to inhibition!)
  490. Side effects of removal of the anterior, nondominant frontal lobe
    Little, if any impairment
  491. 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
  492. Time course of Frontotemporal Dementia
    • Onset often in mid-50s
    • Fatal course lasting less than 4 years
  493. Site damaged most heavily in the behavioral variant of Frontotemporal Dementia
    Frontal lobes
  494. Language impairment in Alzheimer Disease
    Anomia
  495. Language impairment in Frontotemporal Dementia (3)
    • 1. Anomia
    • 2. Paraphasia
    • 3. Decreased fluency
  496. Findings in Frontotemporal Dementia brain imaging
    Frontal and temporal lobe atrophy
  497. Drawing in Frontotemporal Dementia
    • Can copy a picture well
    • Can not draw a picture from memory
  498. Pick Disease is a variant of what neurological condition?
    Frontotemporal dementia
  499. What chromosome contains a gene linked to Frontotemporal Dementia?
    Chromosome 17
  500. What illness has symptoms of dementia and conjugate eye movement disorder?
    Progressive Supranuclear Palsy
  501. Age of onset for Progressive Supranuclear Palsy
    60-70
  502. Expected course of Progressive Supranuclear Palsy
    Progressive decline over approximately 7 years
  503. Symptoms of Progressive Supranuclear Palsy (4)
    • 1. Executive dysfunction
    • 2. Reduced verbal output
    • 3. Pseudobulbar palsy
    • 4. Parkinsonism (without tremor)
  504. Effects of Progressive Supranuclear Palsy on posture
    Axial rigidity forces entire spine to be upright and unnaturally straight, leading to instability and falls
  505. 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
  506. Sites of degeneration in Progressive Supranuclear Palsy (3)
    • 1. Basal ganglia
    • 2. Frontal cortex
    • 3. Upper brainstem
  507. Primary distinction of Vascular Dementia from other dementias
    Physical findings
  508. Medication class that may slow progression of Vascular Dementia
    Cholinesterase inhibitors
  509. Cognitive domains most affected by alcoholism (4)
    • 1. Short-term memory
    • 2. Abstract reasoning
    • 3. Visual dexterity
    • 4. Psychomotor dexterity
  510. What type of amnesia occurs in Wernicke-Korsakoff Syndrome?
    Mainly anterograde
  511. Ocular abnormalities in Wernicke-Korsakoff Syndrome (3)
    • 1. Conjugate gaze paresis
    • 2. Abducens nerve paresis
    • 3. Nystagmus
  512. Sites of hemorrhage in acute Wernicke-Korsakoff Syndrome (2)
    • 1. Mamillary bodies
    • 2. Periaqueductal gray
  513. Cranial nerve nuclei adjacent to periaqueductal gray matter (2)
    • 3rd
    • 6th
  514. Treatment for acute Wernicke-Korsakoff Syndrome
    Injection of Thiamine (B1)
  515. Elements of Normal Pressure Hydrocephalus (3)
    • 1. Dementia
    • 2. Gait apraxia
    • 3. Urinary incontinence
  516. Site of ventricles that is particularly dilated in Normal Pressure Hydrocephalus
    Temporal horns
  517. Results of large volume lumbar puncture in Normal Pressure Hydrocephalus
    Gait, but usually not dementia, improves
  518. Brain site most affected by Normal Pressure Hydrocephalus
    Internal Capsule
  519. 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
  520. Features of syphilitic brain infection (3)
    • 1. Dementia
    • 2. Hallucinations
    • 3. Thought disorder
  521. Physical abnormalities in syphilis (5)
    • 1. Dysarthria
    • 2. Tremor
    • 3. Argyll Robertson pupil
    • 4. Hearing loss
    • 5. Vision loss
  522. Cause of Subacute Sclerosing Panencephalitis
    Latent or mutant measles (rubeola) virus infection of neurons
  523. Mean age at which Subacute Sclerosing Panencephalitis occurs
    12 years
  524. Cognitive symptoms of Subacute Sclerosing Panencephalitis
    Behavioral disturbances and personality changes deteriorating into dementia
  525. 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
  526. Life expectancy in Subacute Sclerosing Panencephalitis
    • Most live 1-2 years
    • Only 5% survive 5 years, usually in a vegetative state
  527. Test to confirm diagnosis of Subacute Sclerosing Panencephalitis
    CSF measles antibody titer
  528. Histologic appearance of Subacute Sclerosing Panencephalitis
    Intranuclear eosinophilic inclusions
  529. Histologic appearance of Lewy Bodies
    • Intracytoplasmic
    • Eosinophilic
  530. Triad of Creutzfeldt-Jakob Disease (3)
    • 1. Dementia
    • 2. Myoclonus
    • 3. Periodic EEG patterns
  531. Age of onset of Creutzfeldt-Jakob Disease
    50-64
  532. Life expectancy in Creutzfeldt-Jakob Disease
    6 months
  533. Generally, neuro exam findings in Creutzfeldt-Jakob Disease (3)
    • 1. Pyramidal signs
    • 2. Extrapyramidal signs
    • 3. Cerebellar signs
  534. What is Gerstmann-Straüssler-Scheinker Disease?
    Familial prion disease
  535. EEG findings in Creutzfeldt-Jakob Disease
    Periodic sharp-wave complexes or a burst suppression pattern
  536. CSF findings in Creutzfeldt-Jakob Disease (2)
    • 1. 14-3-3 protein is present
    • 2. Tau is elevated
  537. Definitive diagnostic test for Creutzfeldt-Jakob Disease
    Brain biopsy
  538. Initial symptoms of Variant Creutzfeldt-Jakob Disease
    Psychiatric disturbances: dysphoria and anxiety progressing to aggression and thought disorder
  539. Late symptoms of Variant Creutzfeldt-Jakob Disease
    • Painful paresthesias with myoclonus
    • Dementia
    • Decorticate posture
  540. Life expectancy in Variant Creutzfeldt-Jakob Disease
    14 months
  541. Site (other than brain) whose biopsy shows prions in Variant Creutzfeldt-Jakob Disease
    Pharyngeal tonsil
  542. Possible symptoms of CNS Lyme Disease (5)
    • 1. Headache
    • 2. Peripheral neuropathy
    • 3. Radiculopathy
    • 4. Meningitis
    • 5. Encephalitis
  543. CSF findings in CNS Lyme Disease (4)
    • 1. ↑ Lymphocytes
    • 2. ↑ Protein
    • 3. ↓ Glucose
    • 4. Lyme antibodies
  544. 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
  545. Rate of progression in HIV Associated Dementia
    Rapid, over weeks to months
  546. Cognitive domains impaired in HIV Associated Dementia (4)
    • 1. Memory
    • 2. Attention
    • 3. Psychomotor speed
    • 4. Construction
  547. Physical effects of HIV Associated Dementia
    Psychomotor retardation and clumsiness affect gait and dexterity
  548. End stage symptoms of HIV Associated Dementia
    Persistent vegetative state
  549. Classes of medication used to treat HIV Associated Dementia (3)
    • 1. HAART
    • 2. Stimulants
    • 3. Antidepressants
  550. Brain imaging findings in HIV Associated Dementia (3)
    • 1. Central atrophy with enlarged ventricles
    • 2. Basal ganglia abnormalities
    • 3. Nonspecific abnormalities in white matter
  551. Most common CNS infection in HIV
    Cerebral Toxoplasmosis
  552. Cause of ring-enhancing CNS lesions in an HIV patient
    Cerebral Toxoplasmosis
  553. Class of medications used to treat Cerebral Toxoplasmosis
    Antibiotics
  554. Cause of Progressive Multifocal Leukoencephalopathy (PML)
    JC Virus infecting oligodendrocytes
  555. MRI findings in Progressive Multifocal Leukoencephalopathy (PML)
    Multiple white matter lesions that eventually become confluent
  556. Symptoms of Progressive Multifocal Leukoencephalopathy (PML) (5)
    • 1. Cognitive impairment
    • 2. Hemiparesis
    • 3. Spasticity
    • 4. Blindness
    • 5. Ataxia
  557. Definitive diagnosis of Progressive Multifocal Leukoencephalopathy (PML)
    PCR shows JC virus DNA in CSF
  558. Infections that can cause cerebral lesions in AIDS (5)
    • 1. JC virus
    • 2. Candida
    • 3. Aspergillus
    • 4. CMV
    • 5. Polyoma virus
  559. Most common CNS neoplasm in HIV
    Primary cerebral lymphoma
  560. Where do lesions occur in primary CNS lymphoma?
    • Usually a single lesion
    • Occur in spinal cord as well as brain
  561. Prognosis of primary CNS lymphoma
    Usually poorly responsive to treatment
  562. Presentation of HIV infection of spinal cord
    Myelitis (paraparesis, Romberg sign, etc)
  563. STI causing myelitis but not cognitive impairment
    HTLV-1 (Human t-cell lymphotrophic virus type 1)
  564. Cause of delirium with triphasic waves on EEG
    Hepatic or uremic
  565. Cause of Central Pontine Myelinolysis
    Too-rapid repletion of sodium
  566. Symptoms of Central Pontine Myelinolysis (3)
    • 1. Nystagmus
    • 2. Quadriparesis
    • 3. Ataxia
  567. Classes of drugs of abuse whose withdrawal causes agitated delirium (3)
    • 1. Benzodiazapines
    • 2. Opioids
    • 3. Nicotine
  568. Brain region not susceptible to age-related changes
    Mammilary Bodies
  569. Histologic feature most associated with Alzheimer Disease
    Synapse loss
  570. Condition causing age-related gait impairment, weakness and loss of muscle bulk in the hands
    Cervical spondylosis
  571. Inheritance pattern of Wilson Disease
    Autosomal recessive
  572. Inheritance pattern of Familiar Creutzfeldt-Jakob Disease
    Autosomal dominant
  573. Inheritance pattern of Familial Alzheimer Disease
    Autosomal dominant
  574. Conditions in which tau is present in neurons (3)
    • 1. Alzheimer Disease
    • 2. Progressive Supranuclear Palsy
    • 3. Frontotemporal Dementia
  575. 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)
  576. Mechanism of action of Scopolamine
    • Anticholinergic
    • Crosses blood brain barrier only at high dose
  577. Most common risk factor for delirium
    Pre-existing dementia
  578. Site of damage in Anton Syndrome
    Bilateral occipital lobes
  579. Illness whose pathology shows argentophilic inclusions in neurons
    Pick Disease
  580. Illness whose pathology shows Cowdry Bodies
    Subacute Sclerosing Panencephalitis (SSPE)
  581. Illnesses whose pathology shows neurofibrillary tangles (2)
    • 1. Alzheimer Disease
    • 2. Subacute Sclerosing Panencephalitis (SSPE)
  582. Illnesses whose pathology stains positive for α-synnuclein antibodies (2)
    • 1. Dementia with Lewy Bodies
    • 2. Parkinson Disease
  583. PET findings in Parkinson Disease
    Profound cholinesterase deficiency throughout the cortex
  584. PET findings in Dementia with Lewy Bodies (2)
    • 1. Profound cholinesterase deficiency throughout the cortex
    • 2. Low uptake in basal ganglia
  585. CSF findings characteristic of Alzheimer Disease (2)
    • 1. ↓ Amyloid β
    • 2. ↑ Tau
  586. Brain region most affected in delirium
    Reticular activating system
  587. What is the mechanism of Memantine? What is it used to treat?
    • NMDA antagonist
    • Used in Alzheimer Disease
  588. Lesion causing agnosagnosia
    Contralateral parietal lobe
  589. Lesion causing ideomotor apraxia
    Left frontal or parietal lobe
  590. What is Ideomotor Apraxia?
    Inability to convert an idea to action
  591. What is Ideational Apraxia?
    Inability to perform a sequence of steps
  592. What is Abulia?
    Complete or nearly complete loss of speech and other forms of expression
  593. Lesion causing abulia
    Frontal lobe
  594. Through what structure is CSF absorbed?
    Arachnoid villi/granulations
  595. Illness in which the anterior horns of the lateral ventricles are convex on brain imaging
    Huntington Disease
  596. Site of highest concentration of plaques and tangles in Alzheimer Disease
    Hippocampus
  597. Common presenting symptoms of Dementia with Lewy Bodies (2)
    • 1. Parkinsonism
    • 2. REM sleep behavior disorder
  598. Lesion causing loss of prosody when speaking
    Nondominant hemisphere
  599. 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)
  600. Which hemisphere is music processed in?
    • In musically gifted people, dominant
    • In most people, nondominant
  601. Where do fibers from CN8 synapse after entering the brainstem?
    Medial Geniculate Body
  602. What is located in Heschl's Gyrus? Where is it?
    • Primary auditory cortex
    • Located in temporal lobe
  603. What is the Arcuate Fasciculus?
    Starts at Wernicke's Area, connects to Broca's Area
  604. What lobe is Wernicke's Area in?
    Temporal
  605. What lobe is Broca's Area in?
    Frontal
  606. What is the Geniculocalcarine Pathway? What does it connect?
    Transmits visual information from the Lateral Geniculate Bodies (thalamus) to the Visual Cortex (occipital lobes)
  607. Where do fibers from the Optic Tracts synapse after entering the brainstem?
    Lateral Geniculate Body
  608. Sites the Perisylvian Language Arc passes near (2)
    • 1. Sylvian fissure
    • 2. Motor cortex's representation of face, throat, and upper extremity
  609. Contents of the Perisylvian Language Arc (3)
    • 1. Wernicke's Area
    • 2. Arcuate Fasciculus
    • 3. Broca's Area
  610. Errors made in Broca's Aphasia
    Telegraphic speech ("jerky" tempo)
  611. Errors made in Wernicke's Aphasia (4)
    • 1. Paraphasic errors
    • 2. Circumlocution
    • 3. Tangentiality
    • 4. Clang associations
  612. 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
  613. Deficits often co-occurring with Wernicke's Aphasia (2)
    • 1. Hemisensory loss
    • 2. Hemianopsia
  614. Where in the brain is text converted to language?
    Left parietal association region
  615. 3 Basic Language Functions
    • 1. Repetition
    • 2. Naming
    • 3. Comprehension
  616. Presentation of Mixed Transcortical Aphasia
    • Repetition is intact (often involuntarily and sometimes compulsively)
    • Comprehension is lost
  617. Presentation of Transcortical Motor Aphasia
    Similar to Broca's, except repetition is intact
  618. Presentation of Global Aphasia
    Both comprehension and repetition are lost
  619. Major artery where a stroke can cause Broca's Aphasia
    Middle Cerebral Artery
  620. What is Oral Apraxia?
    Inability to execute normal voluntary movements of the face, lips, and tongue
  621. Site of lesion causing Mixed Transcortical Aphasia
    Watershed region
  622. 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
  623. Cause of global aphasia
    Extensive damage to the dominant hemisphere
  624. What requests can patients with Global Aphasia follow?
    • Some gestured requests (bypass the language arc)
    • No verbal requests
  625. What communication remains partially intact in Global Aphasia?
    • Gestures (with nondominant hand)
    • Shoulder shrugs
  626. Wernicke's Aphasia on exam
    • Fluent aphasia
    • Comprehension impaired
    • Repetition impaired
  627. Presentation of Transcortical Sensory Aphasia
    Similar to Wernicke's Aphasia, but repetition is intact
  628. Presentation of Conduction Aphasia
    • Usually, the only deficit is loss of repetition!
    • Can sometimes have paraphasic errors or hesitancy
  629. What is a Paraphasia?
    Incorrect or meaningless (possibly nonsensical) words used in speech (ie in fluent aphasia)
  630. What is a Related Paraphasia?
    Word substitution in fluent aphasia in which a word with a similar meaning is used (ie "spoon" for "fork)
  631. What is an Unrelated Paraphasia?
    Word substitution in fluent aphasia in which an entirely unrelated word is used
  632. What is a Clang Association?
    Connection of words based on them sounding similar, rather than by meaning
  633. Neuro exam findings (unrelated to language) often seen in patients with Fluent Aphasias (3)
    • 1. Hyperactive reflexes
    • 2. Babinski
    • 3. Field cut
  634. Type of aphasia associated with Alzheimer Disease and Frontotemporal Dementia
    Fluent Aphasia
  635. Most common cause of Anomic Aphasia
    Small stroke in the angular gyrus
  636. Most common cause of Conduction Aphasia
    • Embolic stroke in left parietal or temporal lobe
    • Usually so small as to cause no other deficits
  637. Exam finding that distinguishes schizophrenia from fluent aphasia
    Schizophrenic patients can repeat polysyllabic words and complex phrases; patients with fluent aphasia can not!
  638. Sites that must be damaged to cause Alexia without Agraphia (2)
    • 1. Dominant occipital lobe
    • 2. Posterior corpus callosum (splenium)
  639. Site of lesion causing Gerstmann Syndrome
    Angular Gyrus of dominant parietal lobe
  640. What is apraxia?
    Inability to carry out a learned action despite normal strength, sensation, and coordination
  641. Condition associated with ideomotor apraxia
    Nonfluent aphasia
  642. Condition associated with ideational apraxia
    Dementia, especially Frontotemporal Dementia
  643. Damage to which hemisphere causes construction apraxia?
    Nondominant
  644. Damage to which hemisphere causes dressing apraxia?
    Nondominant
  645. Condition associated with gait apraxia
    Normal pressure hydrocephalus
  646. Damage to which hemisphere causes hemineglect?
    Nondominant
  647. What is Alien Hand Syndrome?
    Form of hemi-inattention in which the nondominant hand retains semi-purposeful actions outside of the patient's control
  648. Site of injury causing Alien Hand Syndrome
    Nondominant parietal lobe
  649. What is Aprosody?
    Inability to recognize or impart emotions in speech or expressions
  650. What is a Commissure in the brain?
    Thick myelin-coated axonal bundle connecting two brain regions
  651. What is Anterior Cerebral Artery Syndrome?
    Occlusion of bilateral ACA causes bilateral frontal infarct as well as infarct of the anterior corpus callosum
  652. 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)
  653. Symptoms of Streptomycin Toxicity (2)
    • 1. Deafness
    • 2. Ataxia
  654. Symptoms of Periaqueductal Hemorrhagic Necrosis (Wernicke's Encephalopathy) (4)
    • 1. Delirium
    • 2. Ataxia/loss of DTRs
    • 3. Palsy of CN6
    • 4. Bilateral nystagmus
  655. Symptoms of Dilantin Toxicity (2)
    • 1. Delirium
    • 2. Ataxia
  656. What is Anton Syndrome?
    • Denial of blindness
    • Patient confabulates about objects presented to them
  657. Defense Mechanisms often used in agnosagnosia
    Denial and confabulation
  658. Speech effects of Myasthenia Gravis
    Nasal speech
  659. Speech effects of Parkinsonism
    Hypophonia
  660. Speech effects of Spasmodic Dysphonia
    Strained/stangled speech
  661. Symptoms often comorbid with Limb Apraxia (2)
    • 1. Aphasia
    • 2. Right Homonymous Hemianopsia
  662. Symptoms often comorbid with Ideomotor Apraxia (2)
    • 1. Aphasia
    • 2. Right Homonymous Hemianopsia
  663. What is the function of the Edinger-Westphal Nuclei?
    Relays information about light intensity to adjust pupil size
  664. Most powerful risk factor for developing agnosagnosia following a stroke
    Loss of proprioception
  665. Bifrontal or bicervical dull headache lasting 30 minutes to 7 days, possibly waxing and waning
    Tension Type Headache
  666. Who gets Tension Type Headaches?
    • Women > men
    • Tends to run in families
  667. Acute treatment for Tension Type Headaches
    OTC medications (NSAIDs, acetaminophen, caffeine, etc)
  668. Unilateral throbbing headache aggravated by physical activity
    Migraine
  669. Who gets Migraine Headaches?
    • Women > men (3x more often)
    • Increasing prevalence until age 40, but can start in childhood
  670. Duration of a migraine's aura
    • Evolve over 5-20 minutes
    • Last less than an hour
  671. Location of pain in a migraine
    • Temporal, periorbital, or retroorbital
    • Usually unilateral, but rarely always on the same side
  672. Duration of migraine
    4-72 hours
  673. Presentation of frequent migraine attacks
    Often evolve into chronic dull, symmetric pain that mimics Tension Type Headache but has nonheadache symptoms of migraines
  674. When in the day do migraines typically occur?
    Early morning, often beginning during sleep
  675. When in the day do Tension Type Headaches occur?
    Afternoon
  676. 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
  677. Type of headache associated with psychiatric comorbidities
    Migraine
  678. Difference in presentation of childhood migraine from adult migraine (3)
    • 1. More severe
    • 2. Briefer (often less than 2hrs)
    • 3. Less often unilateral
  679. 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)
  680. Symptoms of Hemiplegic Migraine (3)
    • 1. Hemiparesis and anesthesia
    • 2. Aphasia
    • 3. Cortical symptoms
  681. What is Todd's Paralysis?
    Paralysis/paresis while postictal
  682. Chromosome where a mutation causes Familial Hemiplegic Migraine
    Chromosome 19
  683. Which type of migraine places patients at highest risk of stroke?
    Migraine with Aura
  684. Medication classes for migraine (2)
    • 1. Triptans
    • 2. Ergot derivitives (ergotamine, DHE)
  685. Why are Ergot Derivatives contraindicated in pregnancy?
    Vasoconstriction cause fetal malformations or miscarriage
  686. Why are Ergot Derivatives contraindicated in those using SSRI/SNRI?
    Precipitate serotonin syndrome
  687. Side effect of antiemetics
    Dystonic reactions (similar to antipsychotics)
  688. What is Status Migranosus?
    Migraine attack lasting greater than 3 days
  689. 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
  690. Medication classes used for migraine prevention (3)
    • 1. TCAs
    • 2. β-blockers
    • 3. Anti-epilleptics
  691. Which antiepilleptics are used for migraine prophylaxis? (2)
    • 1. Topamax
    • 2. Valproate
  692. Is Botox effective for Tension Type Headaches?
    No!
  693. Is Botox effective for Migraine Headaches?
    Yes!
  694. Conditions for diagnosis of Chronic Daily Headache
    • Headaches lasting 4+ hours
    • 15 days per month
    • 3+ months
  695. What is pain in Chronic Daily Headache like?
    Dull, pressing, waxing and waning (but not pulsatile)
  696. Most powerful risk factor for a headache illness evolving to Chronic Daily Headache
    Medication overuse
  697. Headache causing searing pain in one eye and periorbital region with conjunctival injection, tearing, and nasal congestion
    Cluster Headache
  698. Duration of a Cluster Headache
    45-90 minutes
  699. Who tends to get Cluster Headaches?
    Men aged 20-40
  700. What time of day to Cluster Headaches tend to happen?
    • Between 9PM and 9AM
    • 1/2 develop during REM sleep
  701. 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)
  702. Preventative medications for Cluster Headaches (4)
    • 1. Lithium
    • 2. Steroids
    • 3. Verapamil
    • 4. Depakote
  703. Who gets temporal arteritis?
    Patients older than age 55
  704. Headache with dull, continuous pain in one or both temples and jaw pain on chewing
    Temporal Arteritis
  705. Systemic symptoms of Temporal Arteritis (3)
    • 1. Malaise/low grade fever
    • 2. Weight loss
    • 3. Myalgia/arthralgia
  706. Serious complications of Temporal Arteritis
    Arterial inflammation causes arterial occlusion, leading to blindness or stroke
  707. Lab tests for Temporal Arteritis (2)
    • 1. ESR
    • 2. CRP
  708. Treatment of temporal arteritis
    High-dose steroids (if suspected, give before labs are back!)
  709. 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
  710. Distinctive features of chronic meningitis on neurological exam
    Facial palsy, extraocular muscle palsy, and hearing impariment due to strangulation of CN3-8
  711. Who gets Idiopathic Intracranial Hypertension?
    Young, obese women with irregular menses
  712. Cause of dull, generalized headache with papilledema
    Idiopathic Intracranial Hypertension
  713. Visual/ocular effects of Idiopathic Intracranial Hypertension (2)
    • 1. Enlarged scotoma, eventually causing blindness
    • 2. Abducens palsy
  714. Brain imaging finding in Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)
    Cerebral swelling with compressed, "slit-like" ventricles
  715. 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
  716. Treatment of Idiopathic Intracranial Hypertension that fails medical management
    • Repeated LPs
    • If LPs are not effective, shunt placement
  717. Most common bacterial causes of meningitis (2)
    • 1. Meningococus (in children)
    • 2. Pneumococcus (in adults)
  718. Presentation of meningitis due to Pneumococcus
    • Occurs in older patients
    • Insidious onset
    • Subtle signs
  719. Most common cause of nonepidemic viral encephalitis
    HSV
  720. Regions of the brain most affected in HSV Encephalitis
    Underside of temporal and frontal lobes
  721. 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
  722. Most common sites of berry aneurysms
    Arteries comprising the Circle of Willis
  723. Risk of tyramines with MAOIs
    Hypertensive crisis that can cause aneurysms to rupture
  724. Medications that interact with MAOIs, increasing risk of Hypertensive Crisis (5)
    • 1. Triptans
    • 2. Demerol (meperidine)
    • 3. L-Dopa
    • 4. Carbamazapine
    • 5. TCAs
  725. Treatments for MAOI-induced hypertensive crisis (3)
    • 1. Phentolamine
    • 2. Chlorpromazine
    • 3. Propranolol
  726. Cause of dozens of 20-30 second jabs of facial pain daily
    Trigeminal neuralgia
  727. Most commonly-affected division of CN5 in Trigeminal Neuralgia
    V2
  728. Who most often gets Trigeminal Neuralgia?
    Women over age 60
  729. When during the day does Trigeminal Neuralgia occur?
    Daytime; often abates at night, allowing full nights of sleep
  730. 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)
  731. Cause of headache with nausea, vomiting, and confusion with elevated serum Pyruvate and Lactate
    Mitochondrial encephalopathy
  732. Symptoms of Subdural Hematoma (6)
    • 1. Depressed sensorium/inattention
    • 2. Daily dull headaches
    • 3. Anxiety/depression
    • 4. Nausea/vomiting
    • 5. Diplopia
    • 6. Ataxia
  733. Main site of serotonin-containing neurons
    Dorsal Raphe nucleus
  734. What nerve innervates the meninges?
    CN5 (trigeminal nerve)
  735. Side effects of prolonged use of Ergot derivatives (3)
    • 1. Vascular spasm
    • 2. Claudication
    • 3. Muscle cramps
  736. Cause of sinusitis with seizures
    CNS infection causing meningitis or brain abscess
  737. Best initial treatment for Idiopathic Intracranial Hypertension
    Carbonic anhydrase inhibitors (eg acetazolamide)
  738. SSRI that can increase caffeine levels
    Fluoxetine
  739. Normal background EEG rhythm in an awake adult with eyes closed
    Alpha waves over the occipital region (Posterior Dominant Rhythm)
  740. EEG rhythm seen when concentrating or becoming anxious
    Beta activity over the frontal lobes
  741. Frequency of Alpha Waves on EEG
    8-13Hz
  742. Frequency of Beta Waves on EEG
    >13Hz
  743. EEG rhythm seen with sedatives
    Beta Waves
  744. Frequency of Theta Waves on EEG
    4-7Hz
  745. Frequency of Delta Waves on EEG
    <4Hz
  746. Who normally has Theta Waves on EEG?
    • Children
    • Sleeping adults
  747. Who normally has Delta Waves on EEG?
    • Children
    • Sleeping adults
  748. What do Theta or Delta waves over the entire brain indicate in an awake adult?
    Neurodegenerative illness
  749. Cause of repetitive, phase-reversed spikes on EEG
    Irritative cerebral focus
  750. EEG pattern during seizure
    Bursts of spikes, slow waves, or combinations of the two
  751. EEG findings during delirium
    • Theta and delta activity replaces alpha activity (background slowing)
    • Focal areas of hyperactivity
  752. EEG findings in metabolic ecephalopathy, especially hepatic or uremic
    Triphasic waves
  753. EEG findings in HSV encephalitis
    Spikes and lateralizing epileptiform discharges in temporal lobes
  754. How well do EEG changes correlate to metabolic encephalopathy?
    Very well! Nearly always present, so if not present metabolic encephalopathy can be ruled out!
  755. What is metabolic encephalopathy?
    Delirium
  756. EEG findings in Alzheimer Dementia
    Background activity slows below 8Hz
  757. EEG findings in Subacute Sclerosing Panencephalitis
    Periodic sharp-wave complexes
  758. EEG findings in Creutzfeldt-Jakob Disease
    • Periodic sharp-wave complexes (1-2 per second)
    • Background slowing
  759. EEG findings in Variant Creutzfeldt-Jakob Disease
    None!
  760. EEG findings in Pseudodementia
    None!
  761. EEG findings in Locked-In Syndrome
    Normal
  762. EEG findings in Persistent Vegetative State
    Slow, disorganized activity
  763. Causes of "flat" EEG (3)
    • 1. Brain Death
    • 2. Hypothermia (can recover)
    • 3. Drug overdose (can recover)
  764. EEG findings in Benzodiazepine/Barbiturate use
    Beta waves
  765. EEG findings in lithium toxicity
    Triphasic waves
  766. Difference between simple and complex partial seizures
    If complex, consciousness is altered
  767. Most common and second-most-common sites of a focus in Complex Partial seizures
    Temporal lobe is most common, then frontal lobe
  768. What is Secondary Generalization of a partial seizure?
    Spread of discharges such that they engulf the entire cerebral cortex
  769. Site of a focus in generalized seizures
    Subcortical structures, such as the thalamus
  770. Sites of focus in seizures with olfactory symptoms (2)
    • 1. Uncus (most common)
    • 2. Amygdala
  771. Most common cause of seizure in Central or South America
    Cerebral cystericosis
  772. Common cause of seizure in India
    Tuberculomas
  773. Age of onset of Complex Partial Seizures
    Late childhood to early adulthood
  774. Most common type of seizures
    Complex Partial
  775. Most common and second-most common lobes in which Complex Partial Seizures originate
    • 1. Temporal (vast majority)
    • 2. Frontal
  776. Most common cause of Complex Partial seizures
    Mesial temporal sclerosis
  777. CNS pathology in Mesial Temporal Sclerosis (2)
    • 1. Sclerosis of hippocampus
    • 2. Temporal lobe atrophy
  778. Typical duration of a Complex Partial Seizure
    2-3 minutes
  779. Lab change in postictal phase
    Elevated prolactin (occurs in 40% of cases)
  780. Seizure causing vocalizations and brief bilateral complex movements, with little to no postictal confusion
    Frontal lobe seizures
  781. Course of illness in Frontal Lobe Seizures
    • Tends to develop in adulthood
    • Several seizures per month, mostly during sleep
  782. Seizures causing behavioral changes with undetectable EEG changes
    Frontal Lobe Seizures
  783. Neurologic illness with the highest Depression comorbidity
    Epilepsy
  784. Timing of Postictal Psychosis
    • Occurs several hours after seizures (after a "lucid interval")
    • Lasts hours to weeks
  785. Treatment of Postictal Psychosis
    Benzodiazepines or antipsychotics
  786. Timing of Interictal Psychosis
    • Arises at age 30-40 in patients with epilepsy since childhood
    • Do not deteriorate
  787. Presentation of Interictal Psychosis
    • Hallucinations
    • Paranoia
    • Affect is normal!
  788. Management of psychosis complicating epilepsy
    • Antiepileptics are the mainstay
    • Antipsychotic if antiepileptic is not effective
  789. Antipsychotic whose overdose is most likely to cause seizure
    Chlorpromazine (Thorazine)
  790. Common interaction between antiepilleptics/mood stabilizers
    Depakote increases Lamictal levels
  791. How can carbamazapine and oxcarbazapine occasionally cause seizures?
    Side effects can include hyponatremia; if very severe, this can lead to increased seizures
  792. 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
  793. 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
  794. Medications/substances that reduce hepatic metabolism of antiepileptics (3)
    • 1. Alcohol
    • 2. Erythromycin
    • 3. Various psychotropics
  795. Antiepileptic/mood stabilizer that inhibits hepatic metabolic enzymes
    Valproic Acid
  796. Types of medications whose levels are increased by Valproic Acid (4)
    • 1. Benzodiazepines
    • 2. Tricyclic antidepressants
    • 3. SSRIs
    • 4. Antiepileptics (especially Lamictal)
  797. Antiepileptics/mood stabilizers cleared renally, without affecting liver enzymes (3)
    • 1. Lamotrigine
    • 2. Topiramate
    • 3. Levetiracetam
  798. Antiepileptics/mood stabilizers that induce p450 (3)
    • 1. Phenytoin
    • 2. Carbamazepine
    • 3. Phenobarbital
  799. Risk of antiepileptics/mood stabilizers that induce P450, other than drug interactions
    Reduce bone density, increasing risk of osteopenia
  800. Effect of Valproate on bone density
    Acts on osteoblasts, causing bone loss
  801. Cause of skin disturbances when taking antiepileptics/mood stabilizers
    Stevens-Johnson Syndrome
  802. Which antiepileptic/mood stabilizer in which population is most likely to cause Stevens Johnson Syndrome?
    Carbamazepine in people of Asian ancestry
  803. Serious side effects of Antiepileptics/Mood Stabilizers (3)
    • 1. Stevens-Johnson Syndrome
    • 2. Hepatic abnormalities
    • 3. Bone marrow suppression
  804. Antiepileptic/mood stabilizer causing weight gain
    Valproate
  805. Antiepileptic/mood stabilizers causing weight loss (2)
    • 1. Topiramate
    • 2. Zonisamide
  806. Symptoms of intoxication with antiepileptic/mood stabilizer (3)
    • 1. Nystagmus
    • 2. Ataxia
    • 3. Dysarthria
  807. Side effects specific to Topamax, but not other antiepileptics/mood stabilizers (2)
    • 1. Acute glaucoma
    • 2. Calcium phosphate renal stones
  808. Antiepileptics/mood stabilizers that reduce efficacy of oral contraceptive pills (4)
    • 1. Phenytoin
    • 2. Carbamazapine
    • 3. Phenobarbital
    • 4. Topiramate
  809. Antiepileptic/mood stabilizer that can cause PCOS
    Valproate
  810. Antiepileptics/mood stabilizers that are Pregnancy Category D (2)
    • 1. Valproate
    • 2. Carbamazapine
  811. Antiepileptics/mood stabilizers that are Pregnancy Category C (4)
    • 1. Lamotrigine
    • 2. Levetiracetam
    • 3. Oxcarbazapine
    • 4. Topiramate
  812. Serious birth defects associated with Valproate and Carbamazapine
    Neural tube defects
  813. Cardiac defect associated with antiepileptics/mood stabilizers
    Ventricular Septal Defect
  814. Birth defects associated with Phenytoin use (2)
    • 1. Craniofacial abnormalities
    • 2. Limb defects
  815. Which antiepileptics/mood stabilizers are secreted at high levels in breast milk? (4)
    • 1. Ethosuxamide
    • 2. Lamotrigine
    • 3. Topiramate
    • 4. Phenobarbital
  816. Which antiepileptics/mood stabilizers deplete Vitamin K dependent clotting factors? (4)
    • 1. Phenobarbital
    • 2. Primidone
    • 3. Phenytoin
    • 4. Carbamazapine
  817. Definition of "refractory" epilepsy
    Failing three adequate trials of antiepileptic medications
  818. Most common form of partial epilepsy in childhood
    Rolandic Epilepsy
  819. Who gets Rolandic Epilepsy?
    • Children ages 5-9
    • Usually boys
  820. Course of Rolandic Epilepsy
    • Begins between ages 5-9
    • Remits by puberty
  821. Presentation of seizures in Rolandic Epilepsy
    • Unilateral parethesia
    • Facial movements
    • Speech arrest
  822. EEG in Rolandic Epilepsy
    "Rolandic spikes" during sleep: high voltage spikes in the temporal region
  823. Are children with Rolandic Epilepsy at risk of developing future seizures?
    No!
  824. Course of Absence Seizures
    • Begin between ages 4-10
    • 2/3 Remit in early adulthood, rest evolve into tonic-clonic seizure disorder
  825. Duration of an absence seizure
    2-10 seconds
  826. EEG pattern during absence seizures
    3Hz spike-and-wave complexes in all channels
  827. Postictal symptoms of absence seizures
    None
  828. Cause of absence status epilepticus
    Abrupt cessation of antiepileptic medications in a patient with history of absence seizures
  829. Interictal EEG pattern in patients with absence seizures
    Occasional, asymmetric bursts of 3Hz spike-and-wave complexes lasting 1-1.5 seconds
  830. Movements during absence seizures
    • Blinking
    • Facial and finger automatisms
    • Subtle clonic limb movements
  831. Medications for absence seizures in children (2)
    • 1. Ethosuxamide (first line)
    • 2. Valproate
  832. Prodrome of tonic-clonic seizures
    • Usually none
    • If present, malaise or depression
  833. 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
  834. EEG pattern in tonic-clonic seizures
    • Spikes, polyspikes, and occasional slow waves in all channels
    • Typically obscured by muscle artifact
  835. Interictal EEG pattern in patients with tonic-clonic seizures
    Bursts of generalized spikes in the background
  836. Lab value altered after a tonic-clonic seizure
    Prolactin is elevated
  837. Inheritance of tonic-clonic epilepsy
    Autosomal dominant
  838. During what phase of sleep do tonic-clonic seizures emerge?
    Non-REM sleep
  839. Medications typically used to suppress tonic-clonic seizures (2)
    • 1. Valproate
    • 2. Phenytoin
  840. Who most often has Psychogenic Nonepileptic Seizures?
    • Women aged 19-35
    • Relatives of people with epilepsy
    • People with a history of abuse
  841. What is Transient Global Amnesia?
    Episodic anterograde amnesia with retrograde amnesia for the past several hours/days
  842. What is Cataplexy?
    • Momentary loss of body tone (30 seconds or less)
    • Often occurs during a period of strong emotion
    • Awareness is preserved
  843. Who is most likely to have paradoxical hyperactivity with sedatives? (2)
    • 1. Children
    • 2. Adults with brain injury
  844. Medications causing EEG spikes (3)
    • 1. Lithium (if toxic)
    • 2. Tricyclic antidepressants
    • 3. Clozapine
  845. Antiepileptic most associated with psychosis, depression, or hostility
    Levitiracetam (Keppra)
  846. Significant side effects of Valproate (4)
    • 1. Obesity
    • 2. Hair thinning
    • 3. PCOS
    • 4. Hyperandrogenism
  847. Which antiepileptic causes increased facial hair?
    Phenytoin
  848. Greatest risk factors for depressed mood in epilepsy (2)
    • 1. Multiple antidepressant medications
    • 2. Complex partial seizures
  849. Effect of pregnancy on seizure disorders
    Causes antiepileptic levels to fall, causing increased seizure frequency
  850. Antiepileptic medication that does not increase risk of osteopenia
    Leviteracetam (Keppra)
  851. What is a Gelastic Seizure?
    Seizure whose sole manifestation is mirthless laughter
  852. Duration of a TIA
    • 24 hours is maximum time to be called a TIA
    • Most last 30-60 minutes
  853. Usual composition of emboli causing TIAs
    Platelet emboli
  854. Site of TIAs caused by emboli from the carotid bifurcation
    Cerebral hemispheres
  855. Frequent symptoms of TIAs with origin in carotid artery (3)
    • 1. Hemiparesis (contralateral)
    • 2. Hemisensory loss (contralateral)
    • 3. Homonymous hemianopsia (contralateral)
  856. What is Amaurosis Fugax?
    • Brief monocular blindness (1-5 minutes)
    • Caused by TIA originating in the carotid artery affecting the ophthalmic artery
  857. Retinal exam in a patient with Carotid Artery TIAs
    Plaques are present due to retinal emboli
  858. Branches of Common Carotid (2)
    • Internal carotid
    • External carotid
  859. Branches of Internal Carotid (3)
    • 1. Ophthalmic Artery
    • 2. Anterior Cerebral Artery
    • 3. Middle Cerebral Artery
  860. Vessel perfusing posterior motor cortex
    • Middle Cerebral Artery
    • Everything except the leg!
  861. Vessel perfusing sensory cortex
    Middle Cerebral Artery
  862. Vessel perfusing the Perisylvian language arc
    Middle Cerebral Artery
  863. Vessel perfusing anterior motor cortex
    • Anterior Cerebral Artery
    • Perfuses area innervating the leg
  864. Vessel perfusing the frontal lobe
    Anterior Cerebral Artery
  865. Vessel perfusing the occipital lobe
    Posterior Cerebral Artery
  866. Vessel perfusing the majority of the temporal lobe
    Posterior Cerebral Artery
  867. Artery from which Posterior Cerebral Artery arises
    Basilar
  868. Medication to prevent TIAs
    Platelet inhibitors (aspirin, clopidogrel/Plavix, Dipyiridamole-Aspirin/Aggrenox)
  869. From where does the Basilar Artery arise?
    Joining of the two vertebral arteries after they enter the skull
  870. Vessel perfusing the brainstem
    Small branches of the Basilar Artery
  871. Vessel perfusing the cerebellum
    Large branches of the Basilar Artery
  872. What does the Anterior Communicating Artery connect?
    Left and right Anterior Cerebral Arteries
  873. What does each Posterior Communicating Artery connect?
    Internal Carotid and Posterior Cerebral Artery (just as it comes off of the Basilar Artery)
  874. 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
  875. Symptoms of Basilar Artery TIAs (6)
    • 1. Circumoral tingling
    • 2. Dysarthria
    • 3. Nystagmus
    • 4. Diplopia
    • 5. Ataxia
    • 6. Vertigo
  876. 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
  877. What likely causes Transient Global Amnesia?
    TIA of the PCA, affecting the hippocampus
  878. Duration of Transient Global Amnesia
    3-24 hours total, most severe for 1-2 hours
  879. Diabetes and risk of stroke
    Risk is elevated, but only somewhat so
  880. Hypercholesterolemia and risk of stroke
    Risk is elevated, but only somewhat so
  881. Illicit drug whose use can cause cerebral hemorrhage
    Crack cocaine
  882. Presentation of Homocystinuria
    • Marfan-like body habitus
    • Ocular lens displacement
    • Strokes in childhood
  883. Evolution of stroke caused by thrombus vs. by embolus
    • Embolic strokes occur suddenly
    • Strokes caused by thrombus develop slowly or intermittently
  884. When is edema worst after a stroke?
    Day 3-5
  885. 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
  886. Symptoms of MCA Stroke (4)
    • 1. Contralateral hemiparesis
    • 2. Hemisensory loss
    • 3. Aphasia
    • 4. Hemi-inattention
  887. Symptoms of PCA Stroke (3)
    • 1. Contralateral homonymous hemianopsia
    • 2. Alexia without agraphia
    • 3. Cortical blindness, if bilateral
  888. Symptoms of stroke causing complete Basilar Artery occlusion (2)
    • 1. Coma
    • 2. Locked-in Syndrome
  889. Symptoms of stroke occluding a branch of the Basilar Artery (3)
    • 1. Cranial nerve palsy
    • 2. Contralateral hemiparesis
    • 3. Internuclear ophtalmoplegia
  890. Symptoms of Vertebral Artery Stroke
    Lateral Medullary (Wallenberg) syndrome
  891. 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
  892. Frequent sites of intracranial hemorrhage due to HTN (4)
    • 1. Basal ganglia
    • 2. Thalamus
    • 3. Pons
    • 4. Cerebellum
  893. 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)
  894. Hemorrhage caused by ruptured Berry Aneurysm
    Subarachnoid Hemorrhage
  895. Duration of Post-Stroke Depression
    • Most remit after 1 year
    • 20% remain depressed at 3 years
  896. 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
  897. Cause of persistent vegetative state
    Extensive cortical damage without brainstem damage
  898. Posturing in persistent vegetative state
    Decorticate
  899. Imaging findings in persistent vegetative state
    PET and fMRI show generalized markedly reduced cerebral blood flow and glucose metabolism
  900. Duration of vegetative state at which Persistent Vegetative State is diagnosed
    1 month
  901. Duration of TBI-induced persistent vegetative state after which there is no realistic chance of recovery
    1 year
  902. Duration of neurodegenerative disease-induced persistent vegetative state after which there is no realistic chance of recovery
    3 months
  903. What is Minimally Conscious State
    Brain injury impairs level of consciousness, but some discernible behavioral evidence of consciousness is present
  904. PET findings in Minimally Conscious State
    Some organized cerebral cortical activity is present
  905. How soon after surgery can tPA be given?
    14 days
  906. Medication causing transient myopia
    Topamax
  907. What is Hyperopia?
    "Farsightedness"
  908. Vision problem if the globe is too long or the lens is too thick
    Myopia
  909. Vision problem if the globe is too short or the lens is too thin
    Hyperopia
  910. What is the Accommodation Reflex of the eye?
    Lens thickness and pupil size adjustment to facilitate focusing of an image on the retina
  911. Psychiatric medications that can cause presbyopia (4)
    • 1. SSRIs
    • 2. SNRIs
    • 3. TCAs
    • 4. Clozaril
  912. Medication class that can cause retina hyperpigmentation if taken at high doses
    Phenothiazines
  913. Medications that can cause vision to have a yellow hue (2)
    • 1. Digoxin (if toxic)
    • 2. Viagra
  914. Medication that can cause vision to have a blue hue
    Viagra
  915. Antiepileptic medication that can cause permanent retinopathy
    Vigabatrin (Sabril)
  916. What is the Bulbar portion of the Optic Nerve?
    The Optic Disc
  917. What is the Retrobulbar portion of the Optic Nerve?
    Segment of the optic nerve behind the eye
  918. Symptoms of Optic Neuritis
    • Sudden Vision loss
    • Color desaturation
    • Pain on eye movement
  919. Most common causes of Optic Neuritis (2)
    • 1. Multiple Sclerosis
    • 2. Neuromyelitis Optica
    • (Demyelinating illnesses)
  920. Likely diagnosis if optic neuritis forms and MRI shows 2 or more brain lesions
    Multiple Sclerosis
  921. Result of repeated optic neuritis in the same eye
    Atrophy of the optic nerve, causing blindness and unreactive pupil
  922. Treatment of optic neuritis
    Steroids
  923. Cause of vision loss when methanol is consumed
    Atrophy of the optic nerves
  924. Symptoms of Temporal/Giant Cell Arteritis (4)
    • 1. Headache
    • 2. Malaise
    • 3. Aches/pains
    • 4. Optic nerve ischemia
  925. Syptoms of Leber Hereditary Optic Atrophy
    • Visual loss in one eye, then the other several months later
    • No other CNS or musculature symptoms
  926. Who most gets Leber Hereditary Optic Atrophy?
    Mostly young males
  927. Symptoms of Tay Sachs Disease (4)
    • 1. Cognitive decline
    • 2. Personality changes
    • 3. Blindness
    • 4. Death by age 5 in most cases
  928. 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
  929. Presentation of closed-angle glaucoma
    • Eye is red
    • Pupil is dilated and unreactive
    • Eye and forehead are painful
  930. Antidepressant class that can cause angle closure glaucoma
    Tricyclic antidepressants
  931. EEG change in cortical blindness
    Posterior α-rhythm is lost
  932. What is Palinopsia?
    Recurrent visual images ("echos") in an area of incomplete visual loss
  933. Site of brain injury causing Palinopsia
    Both occipital and parietal lobes
  934. What is Visual Agnosia?
    Inability to appreciate the meaning of an object despite being able to see it clearly
  935. Illnesses in which Visual Agnosia can occur (3)
    • 1. Multiple small strokes
    • 2. Alzheimer Disease
    • 3. Klüver-Bucy syndrome
  936. 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)
  937. What is Prosopagnosia?
    Inability to recognize that a face is a familiar person
  938. Site of brain injury that can cause Prosopagnosia (2)
    • 1. Bilateral frontotemporal lobes
    • 2. Right temporal lobe
  939. Site of lesion preventing a patient from matching pairs of unfamiliar faces
    Nondominant cerebral hemisphere
  940. Symptoms of Balint Syndrome (3)
    • 1. Ocular Apraxia
    • 2. Optic Ataxia
    • 3. Simultagnosia
  941. Site of brain injury causing Balint Syndrome
    Bilateral parietal-occipital region
  942. What is Ocular Apraxia?
    Inability to look away from an object once fixated on it
  943. What is Optic Ataxia?
    Inability to look/search with the eyes in a deliberate pattern
  944. 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
  945. What is a Hypnagogic Hallucination?
    Hallucination when falling asleep
  946. What is a Hypnopompic Hallucination?
    Hallucination when awakening
  947. When in the course of Lewy Body Dementia do visual hallucinations start to occur?
    Early in the course
  948. When in the course of Alzheimer Dementia do visual hallucinations start to occur?
    Late in the course
  949. Features of scotoma due to optic nerve lesion
    • Oval or kidney-shaped
    • Crosses the midline
  950. Where is visual loss if there is damage to an optic tract?
    Contralateral hemianopsia
  951. Where is visual loss if there is damage to a lateral geniculate body?
    Contralateral hemianopsia
  952. Where is the lesion causing homonymous superior quadrantanopia?
    Contralateral temporal lobe (can be associated with a seizure focus!)
  953. Cause of homonymous hemianopsia with macular sparing
    Contralateral occipital lobe lesion
  954. 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
  955. 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
  956. Which gaze centers control REM sleep?
    Nuclear centers (in pons)
  957. Which gaze centers control the "Doll's Eyes" phenomenon and react to cold caloric testing?
    Nuclear centers (in pons)
  958. 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)
  959. 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
  960. 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
  961. If the eyes deviate away from paralysis, what part of the brain is the stroke in?
    Cortex!
  962. What tracts in the brain innervate the extraocular muscle nuclei?
    Corticobulbar tracts
  963. What is located in the Pontine Paramedian Reticular Formation?
    Pontine gaze center
  964. 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)
  965. If the eyes deviate toward paralysis, what part of the brain is the stroke in?
    Pons!
  966. What nuclei are innervated by a pontine gaze center? (2)
    • 1. Ipsilateral Abducens Nucleus
    • 2. Contralateral Oculomotor Nucleus (via Medial Longitudinal Fasciculus)
  967. What is Internuclear Opthalmoplegia? Where is the lesion?
    • Inability of ipsilateral eye to adduct past midline
    • Lesion is in Medial Longitudinal Fasciculus
  968. Antiepileptic drugs that cause nystagmus at physiologic doses(2)
    • 1. Phenobarbital
    • 2. Dilantin/Phenytoin
  969. Site of illness causing nystagmus with vertigo, nausea, and vomiting
    Inner ear
  970. Effect of Huntington Disease on eye movements
    Saccades are abnormal
  971. Effect of schizophrenia on eye movements
    Abnormal smooth pursuit
  972. Which eye should be covered in monocular diplopia that persists in all directions of gaze?
    The affected eye
  973. Which eye should be covered in binocular diplopia?
    Either eye
  974. Sites of lesions causing binocular diplopia (4)
    • 1. Brainstem
    • 2. CN3, CN4, or CN6
    • 3. Neuromuscular junction
    • 4. Extraocular muscles
  975. Cranial nerves whose injury can cause diplopia on lateral gaze (2)
    • 1. Oculomotor (CN3)
    • 2. Abducens (CN6)
  976. Site of lesion causing dilated pupil, ptosis, and lateral deviation of the eye
    Oculomotor (CN3)
  977. Finding in CN3 palsy due to diabetes
    Pupil is not affected
  978. Cranial nerve affected in diplopia that worsens on both lateral and medial gaze
    Abducens (CN6)
  979. What is Amblyopia?
    Loss of vision in an eye with strabismus
  980. Which eye should be covered in strabismus?
    The unaffected eye
  981. Cause of Progressive External Ophthalmoplegia
    Mitochondrial myopathy
  982. Deviation of the eyes in Convergence Spasm
    Downward and inward
  983. Symptoms of Horner Syndrome (3)
    • 1. Ptosis
    • 2. Miosis (constricted pupil)
    • 3. Anydrosis (lack of sweating) unilaterally
  984. Where does the sympathetic nervous system originate?
    Hypothalamus
  985. 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
  986. What is Adie Pupil?
    Benign deprivation of parasympathetic innervation to a pupil causes dilation at rest and brisk, long-acting constriction with cholinergic drops
  987. 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
  988. Mechanism of visual impairment by tricyclic antidepressants
    Cause accommodation paresis
  989. Common cause of CN2 dysfunction
    Multiple Sclerosis
  990. Probable cause of loss of peripheral vision and all nighttime vision
    Retinitis Pigmentosa
  991. Origin of seizure causing musical hallucinations
    Temporal lobe
  992. Origin of seizure causing twisting, complex multicolored lights
    Temporal lobe
  993. Origin of seizure causing facial distortions
    Temporal lobe
  994. Site of lesion causing nystagmus
    Vestibular nuclei of the pons
  995. Medication class causing oculogyric crisis
    Phenothiazines (eg Thorazine, Prolixin)
  996. Site of lesion causing psychic blindness
    Bilateral temporal lobes
  997. Symptoms of Progressive External Ophthalmoplegia
    Paresis of all extraocular muscles, causing eye immobility and ptosis
  998. Cause of "snowy" vision, poor visual acuity, and slow pupillary light reaction
    Methanol poisoning
  999. Predominant pathology for Cerebral Palsy in premature infants
    Periventricular leukomalacia (damage to white matter around lateral ventricles)
  1000. Apgar scores associated with Cerebral Palsy
    Less than 4 at 10 and 15 minutes
  1001. Most common cause of pediatric motor impairment
    Cerebral Palsy
  1002. Types of Cerebral Palsy (3)
    • 1. Spastic
    • 2. Extrapyramidal
    • 3. Mixed
  1003. Age before which Cerebral Palsy can not be diagnosed
    4 months
  1004. Types of Spastic Cerebral Palsy (3)
    • 1. Diplegic
    • 2. Hemiplegic
    • 3. Quadriplegic
  1005. 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
  1006. What is the distribution of Diplegic Cerebral Palsy?
    Spastic symptoms of bilateral legs more than arms
  1007. Frequency of comorbidities in Diplegic Cerebral Palsy
    Intellectual disability and epilepsy are uncommon
  1008. What is the distribution of Hemiplegic Cerebral Palsy?
    Spastic symptoms of one side of the body, face and arm more than leg
  1009. Severe underlying cause of premature handedness in infants
    Paresis in the other hand due to Hemiplegic Cerebral Palsy
  1010. Language impairment in Hemiplegic Cerebral Palsy
    None! The unaffected hemisphere will become the dominant language hemisphere
  1011. What is the distribution of Quadriplegic Cerebral Palsy?
    • Spastic symptoms of all four limbs
    • Often accompanied by pseudobulbar palsy
  1012. Frequency of comorbidities in Quadriplegic Cerebral Palsy
    Intellectual disability and epilepsy are very common
  1013. 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")
  1014. Distinction between Dopamine-Responsive Dystonia and Extrapyramidal Cerebral Palsy
    Dopamine-Responsive Dystonia is progressive, diurnal, and improves with levodopa
  1015. Frequent comorbidity of Extrapyramidal Cerebral Palsy
    Hearing impairment (auditory pathways are often damaged in addition to basal ganglia)
  1016. Site of lesion in Extrapyramidal Cerebral Palsy
    Basal Ganglia
  1017. Age at which choreoathetosis becomes apparent in Extrapyramidal Cerebral Palsy
    Age 2-4
  1018. Incidence of Intellectual Disability an Epilepsy in Extrapyramidal Cerebral Palsy
    Very low!
  1019. Presentation of Mixed-Form Cerebral Palsy
    Both spastic paraparesis and choreoathetosis are present
  1020. Frequency of comorbidities in Mixed-Form Cerebral Palsy
    Very high (95%)
  1021. What is an Arnold-Chiari Malformation?
    The medulla and the lower portion of cerebellum protrude below the foramen magnum
  1022. What is Dandy-Walker Syndrome?
    • Posterior brain structures do not form beyond early embryonic stage
    • 4th ventricle becomes a large cystic structure
  1023. Symptoms of Arnold-Chiari Syndrome (3)
    • 1. Headaches
    • 2. Bulbar palsy
    • 3. Neck pain
  1024. Complication of Arnold-Chiari Syndrome
    Aqueductal stenosis causes obstructive hydrocephalus
  1025. What is Spina Bifida Occulta?
    • Lumbar vertebrae do not fuse, but underlying spinal cord and cauda equina are intact
    • Asymptomatic
  1026. What is Meningocele?
    • Form of spina bifida
    • Meninges and skin protrude through a lumbosacral spine defect
  1027. Symptoms of Meningocele (2)
    • 1. Leg weakness/gait impairment
    • 2. Neurogenic bladder
  1028. 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
  1029. Symptoms of Meningomyelocele (3)
    • 1. Flaccid Paraparesis
    • 2. Areflexia of lower limbs
    • 3. Incontinence
  1030. Inheritance of most neurocutaneous disorders
    Autosomal dominant
  1031. 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
  1032. Classic triad of Tuberous Sclerosis (3)
    • 1. Epilepsy (often refractory)
    • 2. Intellectual disability
    • 3. Facial angiofibroma
  1033. Neurologic syndromes with Autism-like symptoms (5)
    • 1. Angelman Syndrome
    • 2. Fragile X
    • 3. Klinefelter Syndrome
    • 4. Rett Syndrome
    • 5. Tuberous Sclerosis
  1034. CNS lesion in Tuberous Sclerosis
    "Tubers": 1-3cm nodules that irritate cortex, causing epilepsy and intellectual impairment
  1035. Sites of benign tumors in Tuberous Sclerosis (4)
    • 1. Brain
    • 2. Retina
    • 3. Kidney
    • 4. Heart
  1036. Triad of Neurofibromatosis 1 (3)
    • 1. Café-au-lait spots
    • 2. Neurofibromas
    • 3. Lisch nodules
  1037. Appearance of a Café-au-Lait spot
    • Uniformly light brown, oval, flat skin
    • May be accompanied by freckles in the axilla or groin
  1038. 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
  1039. Appearance of a Neurofibroma
    • Soft, palpable subcutaneous growth on a peripheral nerve or nerve root
    • A few millimeters to several centimeters in size
  1040. Appearance of Lisch Nodules
    Multiple pigmented aggregations on the iris of the eye
  1041. Intracerebral tumor associated with Neurofibromatosis 1
    Optic glioma
  1042. Hallmark symptom of Neurofibromatoisis 2
    Bilateral acoustic neuromas
  1043. Tumors associated with Neurofibromatosis 2 (2)
    • 1. Acoustic neuroma
    • 2. Meningioma
  1044. What is Sturge-Weber Syndrome?
    Angioma of the face (follows one or more branches of CN5) and underlying cerebral hemisphere
  1045. 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)
  1046. Cutaneous symptom of Ataxia-Telangiectasia
    Small, dilated vessels (telangiectasias) on the conjunctiva, bridge of nose, and cheeks
  1047. Cause of ataxia in Ataxia-Telangiectasia
    Degeneration of the cerebellar vermis
  1048. 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
  1049. Inheritance pattern of Ataxia-Telangiectasia
    Autosomal recessive
  1050. Condition associated with Ataxia-Telangiectasia
    Immunodeficiency (both cellular and IgA/IgE deficiency)
  1051. Enzyme that is deficient in Phenylketonuria
    Hepatic phenalalynine hydroxylase
  1052. 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
  1053. Inheritance pattern of Phenylketonuria
    Autosomal recessive
  1054. Complications of a phenylalanine-free diet (3)
    • 1. Short stature
    • 2. Anemia
    • 3. Hypoglycemia
  1055. Chromosome affected in NF1
    17
  1056. Chromosome affected in NF2
    22
  1057. Chromosome affected in Ataxia-Telangiectasia
    11
  1058. Chromosome affected in PKU
    12
  1059. Chromosome affected in Homocystinuria
    21
  1060. Causes of accumulation of homocysteine (4)
    • 1. Homocystinuria
    • 2. B12 deficiency
    • 3. Some antiepileptic medications (Carbamazapine, Phenytoin)
    • 4. Nitrous oxide
  1061. Complications of Homocystinuria (4)
    • 1. Vascular thrombotic events (strokes in young adults)
    • 2. Mental retardation
    • 3. Behavioral disturbances
    • 4. Obsessive-compulsive symptoms
  1062. Physical features of Homocystinuria (3)
    • 1. Ocular lens is displaced
    • 2. Tall, Marfan-like stature
    • 3. Sunken or bowed chest
  1063. Treatment of Homocysinuria
    Supplement Vitamin B6 and Folate
  1064. Chromosome affected in Prader-Willi Syndrome
    15
  1065. Chromosome affected in Angelman Syndrome
    15
  1066. Inheritance of Prader-Willi Syndrome
    Always either paternal inheritance or a de novo mutation
  1067. Symptoms of Prader-Willi Syndrome (3)
    • 1. Intellectual disabililty
    • 2. Behavior problems
    • 3. Hyperphagia, causing obesity
  1068. Physical anomalies in Prader-Willi Syndrome (4)
    • 1. Obesity
    • 2. Short statue
    • 3. Small hands and feet
    • 4. Small penis/testicles or labia
  1069. Inheritance of Angelman Syndrome
    Usually maternal inheritance
  1070. 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
  1071. Chromosome affected in Williams Syndrome
    7
  1072. 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"
  1073. 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")
  1074. Chromosome affected in Velocardiofacial Syndrome
    22
  1075. 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)
  1076. Neuropsychiatric symptoms of Velocardiofacial Syndrome (3)
    • 1. Low IQ
    • 2. Schizophrenia
    • 3. Major Depression
  1077. 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
  1078. Behavioral symptoms of Fragile X Syndrome (2)
    • 1. Stereotypies (especially hand wringing or flapping)
    • 2. Self-injurious behavior
  1079. Psychiatric conditions common in Fragile X Syndrome (3)
    • 1. Autism
    • 2. ADHD
    • 3. Anxiety
  1080. Cause of Fragile X Syndrome
    • Trinucleotide repeats in the X chromosome
    • Must have 200 repeats to have the disorder
  1081. At what age do symptoms of Rett Syndrome emerge?
    6-18 months
  1082. Early presentation of Rett Syndrome
    Regression over a period of several years; eventually unable to walk or produce language
  1083. Comorbidity of Rett Syndrome
    Epilepsy beginning around age 3
  1084. Presentation of an adult with Rett Syndrome
    • 1. Stereotypies, especially hand wringing/clapping/flapping and hair pulling
    • 2. Microcephaly
  1085. Chromosome affected in Rett Syndrome
    X
  1086. Gender ratio in Rett Syndrome
    Essentially entirely female; the mutation is letal to a male fetus
  1087. Chromosome affected in Lesch-Nyhan Syndrome
    X
  1088. Presentation of Lesch-Nyhan Syndrome
    • 1. Intellectual disability
    • 2. Self-mutilation
    • 3. Dystonia (prominent)
  1089. Gender ratio in Lesch-Nyhan Syndrome
    Essentially all male
  1090. Cognitive effects of Turner Syndrome
    • Most have learning disabilities
    • 10-20% have Intellectual Disability
  1091. Physical appearance in Turner Syndrome
    • Short statue
    • Webbed neck
    • Low set ears
    • Flat nose
    • Do not undergo puberty
  1092. 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
  1093. Cognitive effects fo Klinefelter Syndrome
    • 25% have intellectual disability
    • Most have below average IQ
  1094. Cognitive effects of XYY Syndrome
    • 1. Learning disabilities
    • 2. Meet milestones late
    • 3. IQ lower than siblings
  1095. Cardiac comorbidity in Williams Syndrome
    Aortic stenosis
  1096. 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
  1097. What is Porencephaly?
    Cavitations within the brain
  1098. What illness is caused by a mutation in the gene MECP2?
    Rett Syndrome
  1099. Site where pain fibers synapse in the spinal cord
    Substantia gelatinosa
  1100. Major neurotransmitter for pain at the spinal cord level
    Substance P
  1101. 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
  1102. Path of analgesic pathways in the brain
    • Originate in frontal lobe and hypothalamus
    • Project to periaqueductal gray matter
  1103. Mechanism of analgesia in the spinal cord
    Interneurons release endogenous opioids
  1104. Course of "Descending Analgesia" pathways
    • Originate in brainstem
    • Descend in the dorsolateral funiculus of the spinal cord
  1105. Neurotransmitter in brainstem analgesia pathways
    Serotonin
  1106. Most effective time to give analgesics
    Regular prophylactic dosing rather than taking medication when pain begins
  1107. What class of medication should be used for cancer pain?
    Opiates
  1108. Medications used for postherpetic neuralgia (5)
    • 1. Topical lidocaine
    • 2. Gabapentin
    • 3. Pregabalin
    • 4. Carbamazepine
    • 5. Oxcarbazepine
  1109. Nerve sometimes damaged during a mastectomy
    Intercostobrachial Nerve
  1110. Cause of arm pain after treatment of breast cancer
    Metastatic invasion of the brachial plexus
  1111. Most common sites of shingles (2)
    • 1. Thoracic dermatomes
    • 2. First branch of Trigenimal Nerve (CNV1), including the cornea
  1112. Treatment of pain due to shingles
    Opioids!
  1113. "Secondary phase" of shingles pain
    Postherpetic neuralgia lasting 3-6 months
  1114. Types of RSD/CRPS (2)
    • Type 1: No definable underlying nerve injury
    • Type 2: There is a definable underlying nerve injury
  1115. Cause of burning/stabbing pain superimposed on numbness
    CRPS/RSD
  1116. Sensory symptoms of thalamic infarction
    • Initially, contralateral hemianesthesia
    • Over time, spontaneous painful sensations on the anesthetic side of the body (lasts 6-12 months)
  1117. What does the Sylvian Aqueduct connect?
    3rd and 4th ventricles
  1118. Where do peripheral nerves carrying pain synapse with the Lateral Spinothalamic Tract?
    Substantia Gelatinosa
  1119. What is Deafferentiation Pain?
    Pain caused by loss of sensation from a body region (eg phantom limb pain)
  1120. What is Pseudoaddiction?
    Obsession with obtaining a pain medication, followed by hoarding the medication
  1121. Pain syndrome for which TENS is effective
    Diabetic neuropathy
  1122. Which nerve roots innervate uterus and cervix?
    T10-L1
  1123. 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
  1124. Frequency of relapse of MS symptoms if untreated
    Once every 1-2 years
  1125. 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)
  1126. Age of onset of Primary Progressive Multiple Sclerosis
    40s-50s (older than other forms)
  1127. CNS region most commonly affected in Primary Progressive Multiple Sclerosis
    Spinal cord
  1128. Brain region commonly affected first in Multiple Sclerosis
    Cerebellum
  1129. What is Titubation?
    Irregular head tremor in cerebellar damage
  1130. Sensory deficits most often impaired in Multiple Sclerosis
    Vibration and position sense
  1131. 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
  1132. Effects of Multiple Sclerosis on vision
    Optic neuritis causes scotoma and color desaturation, as well as pain on eye movement
  1133. Appearance of optic neuritis on Neurological Exam
    When a flashlight is swung from the normal eye to the affected eye, both pupils dilate
  1134. Ocular motility abnormalities in Multiple Sclerosis
    • Internuclear ophthalmoplegia
    • Nystagmus
  1135. Spinal Cord symptoms of Multiple Sclerosis (3)
    • 1. Incontinence (neurogenic bladder)
    • 2. Impotence
    • 3. Impaired gait (leg spasms)
  1136. Effect of Multiple Sclerosis on fertility
    • Men have low sperm count and abnormal sperm production
    • Women's fertility is not affected
  1137. What is Lhermitte's Sign?
    • Electrical sensations down the spine on neck flexion
    • Indicates a disease process affecting the cervical spine
  1138. 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
  1139. Most common psychiatric comorbidity of Multiple Sclerosis
    Major Depression
  1140. Treatment of depressed mood in Multiple Sclerosis
    • SSRIs are not effective
    • ECT is effective and is not contraindicated or restricted
  1141. Cognitive effects of Multiple Sclerosis
    • Over the course of disease, memory declines, eventually causing cortical dementia
    • Language is spared
  1142. 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
  1143. Most common course of pediatric Multiple Sclerosis
    • Nearly always relapsing-remitting at onset
    • Often evolves into secondary progressive pattern after decades
  1144. Number of CNS lesions on MRI needed to diagnose Multiple Sclerosis
    1 gadolinium-enhancing lesion OR 9 nonenhancing lesions
  1145. 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
  1146. 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
  1147. What interferon medication can cause depression?
    Alpha-interferon (used for hepatitis)
  1148. Difference in presentation of Guillain-Barré and Multiple Sclerosis
    Guillain-Barré consists of a single attack, and is symmetric
  1149. Presentation of Neuromyelitis Optica
    • Loss of vision in one or both eyes
    • Paraparesis
  1150. Pathology of Neuromyelitis Optica
    Demyelinating lesions in one or both optic nerves, as well as the spinal cord
  1151. Difference in presentation of Neuomyelitis Optica and Multiple Sclerosis
    NMO does not cause cognitive impairment or fatigue
  1152. Treatments for Neuromyelitis Optica (2)
    • 1. Plasmapheresis
    • 2. Immunosuppressants
  1153. 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
  1154. Inheritance pattern of Adrenoleukodystrophy
    Sex-linked
  1155. Presentation of Adrenoleukodystrophy
    Neurologic problems and adrenal insufficiency in boys starting between ages 5 and 15
  1156. Symptoms of advanced Adrenoleukodystrophy (3)
    • 1. Gait impairment
    • 2. Mania
    • 3. Dementia
  1157. Symptom of Metachromatic Leukodystrophy but not Adrenoluekodystrophy
    Peripheral neuropathy
  1158. Underlying cause of Adrenoluekodystrophy
    Oxidation defect in peroxisomes cause accumulation of fatty acids, leading to demyelination
  1159. What is Acute Disseminated Encephalomyelitis (ADEM)?
    Immune attack on CNS myelin 1-4 weeks after an infectious illness (often one with a skin eruption)
  1160. Region where HTLV-1 is endemic
    Caribbean
  1161. What is Marchiafava-Bignami Syndrome?
    • Contaminant of Italian red wine causes degeneration of corpus callosum
    • Causes frontal lobe damage and dementia
  1162. What is Postvaccinal Encephalomyelitis?
    • Inflammatory demyelination 1-2 weeks after smallpox vaccination
    • Rare, but if it occurs mortality rate is high!
  1163. Test for Neuromyelitis Optica
    Serum NMO antibody
  1164. Causes of bilateral horizontal nystagmus (3)
    • 1. Multiple Sclerosis
    • 2. Labyrinthitis
    • 3. Wernicke's Encephalopathy
  1165. Most common CNS symptoms of lupus (3)
    • 1. Seizures
    • 2. Strokes
    • 3. Psychosis
    • "The 3 S's"
  1166. Peripheral nerve that carries sexual impulses from the genitals to the spinal cord
    Pudendal nerve
  1167. Nerve roots that carry sympathetic information to the genitals
    T11-L2
  1168. Nerve roots that carry parasympathetic information to the genitals
    S2-S4
  1169. How to distinguish central vs. peripheral cause of saddle anesthesia?
    If central, DTRs will be hyperactive. If peripheral, hypoactive
  1170. Is constriction of the internal anal sphincter caused by sympathetic or parasympathetic innervation?
    Sympathetic! (parasympathetic causes relaxation)
  1171. Nerve roots that mediate the external anal sphincter
    S3-S4
  1172. Neurologic conditions that often cause sexual impairment (4)
    • 1. Diabetic neuropathy
    • 2. Spinal cord injury
    • 3. Multiple sclerosis
    • 4. Herniated disc
  1173. Neurological injury causing retrograde ejaculation
    Autonomic injury
  1174. What is the scrotal reflex?
    Applying a cold surface to the scrotum causes ipsilateral skin contraction and testicle retraction
  1175. What is the cremasteric reflex?
    Stroking the inner thigh causes ipsilateral scrotal skin contraction and testicle retraction
  1176. What is the anal reflex?
    Scratching the skin surrounding the anus causes the anus to tighten
  1177. Medication used for psychogenic erectile dysfunction
    Yohimbine (alpha antagonist that increases sympathetic activity)
  1178. Injectable medications for erectile dysfunction (3)
    • 1. Alprostadil
    • 2. Papaverine
    • 2. Phentolamine
  1179. Suffix of PDE inhibitors used to treat erectile dysfunction
    -afil
  1180. 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
  1181. Sexual function in lumbosacral spinal cord activity
    Can not achieve orgasm
  1182. Neurotransmitter whose inhibition (by medications) causes sexual dysfunction
    Dopamine
  1183. Most common sexual side effects of SSRIs (3)
    • 1. Delayed orgasm
    • 2. Erectile dysfunction (1/3)
    • 3. Reduced vaginal lubrication
  1184. Antidepressants with the lowest rate of sexual side effects (2)
    • 1. Wellbutrin
    • 2. Trazodone
  1185. Psychiatric medications used to treat premature ejaculation (2)
    • 1. Clomipramine
    • 2. Sertraline
  1186. Mechanism of priapism with antipsychotics
    • Alpha adrenergic blockade
    • (Rare side effect!)
  1187. Treatment of priapism
    Inject epinephrine into the penis
  1188. What is Klüver-Bucy Syndrome?
    • Damage to bilateral amygdala
    • Aggressive/sexually suggestive gestures
    • Eat, drink, and smoke excessively
    • Amnesia
  1189. 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
  1190. Type of paralysis in REM sleep
    • Flaccid paralysis
    • Areflexic
  1191. Body movements in NREM sleep
    • Repositioning every 15-20 minutes
    • Tone is intact
  1192. Ocular movements in N1 Light sleep
    Slow, rolling movements
  1193. Ocular movements in N2 Intermediate sleep
    Either slow, rolling movements or no movements
  1194. Ocular movements in N3 Deep sleep
    None
  1195. EEG in N1 Light sleep
    Slowed alpha activity
  1196. EEG in N2 Intermediate sleep
    • Low amplitude
    • Sleep spindles and/or K complexes present
  1197. EEG in N3 deep sleep
    • Delta activity
    • Sleep spindles
  1198. EEG in REM sleep
    • Similar to that of wakefulness
    • Ocular movement artifact
  1199. ANS activity in REM sleep
    • Increased
    • Pulse, blood pressure, intracranial pressure, and intracranial blood flow increase
  1200. Brain region that generates physical elements of REM sleep
    Pons
  1201. Role of the Peri-Locus Ceruleus in REM sleep
    Abolishes muscle tone
  1202. What are the monoamine neurotransmitters? (4)
    • 1. Dopamine
    • 2. Epinephrine
    • 3. Norepinephrine
    • 4. Serotonin
  1203. Effect of REM sleep on neurotransmitters (2)
    • 1. ↑ cholinergic activity
    • 2. ↓ monoamine activity
  1204. Effect of antidepressants on REM sleep
    Suppress REM activity
  1205. ANS activity in NREM sleep
    • Reduced
    • Causes hypotension, bradycardia, and cerebral blood flow
  1206. Hormones released primarily during NREM sleep (2)
    • 1. Growth hormone
    • 2. Prolactin
  1207. When does N3 (deep) sleep occur?
    Early in the sleep cycle
  1208. What is Sleep Latency?
    Time to fall asleep after going to bed
  1209. What serum level is associated with sleepiness?
    Adenosine
  1210. What is Sleep Efficiency?
    Ratio of sleep to time spent in bed
  1211. 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
  1212. What brain region controls circadian rhythm?
    Suprachiasmatic nucleus of the hypothalamus
  1213. Conditions that reduce REM latency (5)
    • 1. Depression
    • 2. Narcolepsy
    • 3. Sleep apnea
    • 4. Sleep deprivation
    • 5. Withdrawal from alcohol/hypnotics/TCAs
  1214. Where are melatonin receptors in the brain?
    Suprachiasmatic nucleus
  1215. What promotes release of melatonin?
    Darkness
  1216. What is Ramelteon?
    Melatonin agonist with longer half-life than melatonin itself
  1217. Interaction between fluvoxamine (Luvox) and Ramelteon
    Luvox inhibits metabolism of Ramelteon, causing elevated levels
  1218. Changes in sleep after sleep deprivation
    • Short sleep latency
    • Increased sleep time
    • Greater depth and duration of slow-wave sleep
  1219. 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
  1220. Psychiatric medications that suppress dreaming (2)
    • 1. SSRIs
    • 2. TCAs
  1221. Substances of abuse that suppress dreaming (5)
    • 1. Cocaine
    • 2. Amphetamines
    • 3. Opioids
    • 4. Hypnotics
    • 5. Alcohol
  1222. 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
  1223. Age of onset of narcolepsy
    • Between adolescence and 30s
    • Peaks in teenage years
  1224. Duration of sleep during a narcolepsy attack
    ~15 minutes
  1225. Symptoms comprising the Narcoleptic Tetrad (4)
    • 1. Excessive Daytime Sleepiness
    • 2. Cataplexy (not always present)
    • 3. Sleep Paralysis
    • 4. Hypnagognic/hypnopompic hallucinations
  1226. What is sleep paralysis?
    • Inability to move or speak for as long as several minutes on awakening
    • Can move eyes and breathe
  1227. Nighttime sleep in narcolepsy
    Multiple brief spontaneous awakenings occur
  1228. Presentation of narcolepsy in children
    • Develop inattention and hyperactivity
    • Behavioral, cognitive, and scholastic impairments due to fatigue
    • Often mistaken for a learning disability
  1229. Test for Narcolepsy
    Multiple Sleep Latency Test (MSLT)
  1230. What is Hypocretin?
    Excitatory neurotransmitter that maintains wakefulness and stimulates appetite
  1231. What is Modafinil (Provigil)?
    • Histaminergic (non-amphetamine) medication that promotes wakefulness
    • Does not cause excitation or nighttime insomnia
  1232. What is Armodafinil (Nuvigil)?
    • Long-acting form or Modafinil (Provigil)
    • Promotes wakefulness, but is not an amphetamine
  1233. Management of Narcolepsy
    • Regular daytime naps after meals and during late afternoon
    • Regular nighttime sleep schedule
    • Stimulant medication
  1234. Types of Sleep Apnea (2)
    • 1. Obstructive
    • 2. Central (due to inconsistent CNS ventilatory effort)
  1235. Frequent cause of obstructive sleep apnea in children
    Enlarged tonsils
  1236. Age at which Restless Legs Syndrome tends to first occur
    After 45
  1237. Mineral deficiency often present in Restless Legs Syndrome
    Iron deficiency anemia
  1238. Main class of medications to treat Restless Legs Syndrome
    Dopamine agonists (eg L-dopa, ropinirole, and pramipexole)
  1239. What is Pramipexole?
    • Dopamine agonist
    • Not an ergot derivative
  1240. What is Ropinirole?
    • Dopamine agonist
    • Not an ergot derivative
  1241. Medication classes that can provoke Restless Legs Syndrome (4)
    • 1. TCAs
    • 2. SSRIs
    • 3. SNRIs
    • 4. Antihistamines
  1242. What is Periodic Limb Movement Disorder?
    Regular episodic stereotyped movements of limbs (usually legs) during sleep
  1243. 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
  1244. Medical illnesses that can cause Periodic Limb Movement Disorder (2)
    • 1. Uremia
    • 2. Anemia
  1245. Treatment of Periodic Limb Movement Disorder
    • Usually none!
    • If necessary, benzodiazepines and dopaminergic medications
  1246. 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
  1247. Course of Kline-Levin Syndrome
    • First occurs in adolescence
    • Spontaneously resolves after about 8 years
  1248. Diagnosis and treatment of Kline-Levin Syndrome
    • No physical findings can confirm the diagnosis
    • No specific treatments exist; must treat symptoms
  1249. Action of caffeine on the p450 system
    Inhibits metabolism of medications
  1250. Effect of Luvox on caffeine
    Inhibits metabolism of caffeine, causing increased levels
  1251. What are Parasomnias?
    Mental or behavioral aberrations lasting 15 minutes or less that interrupt sleep
  1252. When in sleep does sleepwalking occur?
    NREM sleep, most often stage IV sleep in early night
  1253. When in sleep do night terrors occur?
    NREM sleep, most often stage IV sleep in early night
  1254. 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)
  1255. What are Confusional Arousals?
    • Disorentation and incoherence when partially, rather than fully, awakening from sleep.
    • Causes "talking in one's sleep"
  1256. Duration of an episode of sleepwalking
    10 minutes
  1257. Duration of a Night Terror
    1-10 minutes
  1258. Demographics of patients with Sexsomnia
    • Begins in adolescence
    • Regresses in the 5th decade
    • More common in men
  1259. 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)
  1260. When are nightmares more common?
    In REM rebound (including use of drugs or withdrawal from REM-suppressing medications)
  1261. Presentation of Nocturnal Panic Attacks
    • Occur in NREM sleep
    • Awaken able to recall the fear, but not any associated imagery
  1262. What is REM Sleep Behavior Disorder?
    Lack of paralysis during REM sleep
  1263. 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
  1264. Who most often has REM Sleep Behavior Disorder?
    Men older than 65
  1265. Neurological illnesses that can underlie REM Sleep Behavior Disorder (2)
    • 1. Parkinson disease
    • 2. Lewy Body Dementia
  1266. Classes of psychiatric medications that can cause REM Sleep Behavior Disorder (4)
    • 1. SSRIs
    • 2. SNRIs
    • 3. TCAs
    • 4. Mirtazapine
  1267. Treatment of REM Sleep Behavior Disorder
    Clonazepam taken at night
  1268. At what age is bedwetting considered a parasomnia in girls?
    After age 5
  1269. At what age is bedwetting considered a parasomnia in boys?
    After age 6
  1270. Timing of an episode of Sleep-Related Eating Disorder
    • Usually during NREM sleep, but not exclusively
    • Lasts about 5 minutes
  1271. 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
  1272. What is Night Eating Syndrome?
    Awaken fully from sleep, consume large amounts of their customary foods, then return to sleep
  1273. Effect of Major Depression on sleep efficiency
    • Reduced total sleep efficiency
    • Slow wave sleep is relatively reduced, and is fragmented
  1274. Effect of Major Depression on REM latency
    Very short; nearly always less than 60 minutes
  1275. Effect of Major Depression on frequency of REM sleep
    Increased in early nighttime; almost absent in later sleep
  1276. Effects of Major Depression on nighttime neuroendocrine cycle (2)
    • 1. Earlier cortisol release
    • 2. Earlier MHPG (norepinephrine metabolite) release
  1277. Effect of mania on REM sleep
    Nearly abolished
  1278. Classes of psychiatric medications that increase REM latency (7)
    • 1. SSRIs
    • 2. SNRIs
    • 3. TCAs
    • 4. MAOIs
    • 5. Benzodiazepines
    • 6. Amphetamines
    • 7. Lithium
  1279. Effects of chronic schizophrenia on sleep
    Polysomnography shows normal results
  1280. Effects of acute schizophrenia on sleep (2)
    • 1. Reduced slow wave sleep
    • 2. Increased sleep latency with frequent awakenings
  1281. Effects of Anxiety on sleep (2)
    • 1. Increased sleep latency
    • 2. Fragmented sleep
    • REM sleep is normal
  1282. Effects of PTSD on sleep patterns
    None! (psychologic >> physiologic sleep problems!)
  1283. 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
  1284. Effects of alcohol withdrawal on sleep (2)
    • 1. Increased sleep latency
    • 2. REM rebound
  1285. Effect of dementia on sleep
    • Increased light sleep
    • Decreased sleep efficiency
    • Many daytime naps
  1286. Effects of dopamine agonists and L-dopa on sleep (2)
    • 1. Frightening vivid dreams
    • 2. Can cause sleep attacks (episodic irresistible sleep)
  1287. 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
  1288. Medication class that can help Parkinson Disease patients sleep through the night
    TCAs
  1289. Movement disorder symptoms that disappear during sleep (3)
    • 1. Tremors
    • 2. Athetosis
    • 3. Chorea
  1290. What are hypnic jerks?
    Sudden contraction of antigravity muscles during wake-to-sleep transition
  1291. Movement disorder symptoms that remain present during sleep (4)
    • 1. Dystonia
    • 2. Tics
    • 3. Belpharospasm
    • 4. Hemifacial spasm
  1292. 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
  1293. In what sleep stages to seizures tend to occur in epilepsy?
    N1 and N2
  1294. What type of seizures tend to occur during sleep in epilepsy?
    • Generalized seizures
    • Partial seizures are much less common
  1295. Effect of antiepileptic medications on sleep
    • Promote normal sleep
    • Can cause daytime sleepiness despite normal sleep
  1296. When in sleep do cardiac events tend to occur?
    REM sleep
  1297. When in sleep to strokes tend to occur?
    During the hours just before awakening
  1298. 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
  1299. Effects of tryptophan on SSRIs
    Can precipitate serotonin syndrome
  1300. Effects of benzodiazepines on insomnia (2)
    • 1. Increase sleep time by 10%
    • 2. Decrease slow-wave and REM sleep
  1301. In what brain location is the Peri-Locus Ceruleus?
    Pons
  1302. Most common treatment required for insomnia in PTSD
    None! (most resolves on its own)
  1303. What is a SOREMP?
    Sleep Onset REM Period (eg REM immediately after falling asleep)
  1304. Conditions that cause REM immediately after falling asleep (3)
    • 1. Sleep Apnea
    • 2. Narcolepsy
    • 3. Sleep deprivation
  1305. Effect of benzodiazepines on seizures
    Mild anticonvulsant effect
  1306. Treatments of Cataplexy (2)
    • 1. TCAs
    • 2. Sodium oxybate (GHB)
  1307. Mechanism of action of methylphenidate
    Dopamine agonist
  1308. Mechanism of action of amphetamine
    Dopamine agonist
  1309. Daily caffeine dose at which toxicity can occur
    250mg
  1310. 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
  1311. Components of the lenticular nucleus (2)
    • 1. Globus pallidus
    • 2. Putamen
  1312. Brain region that separates the lenticular nucleus from the thalamus
    Posterior Internal Capsule
  1313. 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
  1314. What nuclei constitute the basal ganglia? (5)
    • 1. Caudate
    • 2. Putamen
    • 3. Globus Pallidus
    • 4. Subthalamic Nucleus
    • 5. Substantia Nigra
  1315. Site of origin of the Extrapyramidal Tract
    Basal ganglia
  1316. Role of the Extrapyramidal Tract
    Modulates the corticospinal tract
  1317. Clinically relevant tract that exists within the Extrapyramidal Tract
    Nigrostriatal tract
  1318. What two regions are connected by the nigrostriatal tract?
    Substantia Nigra and Striatum
  1319. What neurotransmitter does the Nigrostriatal Tract utilize?
    Dopamine
  1320. Main neurotransmitter of the Globus Pallidus
    GABA
  1321. Main neurotransmitter of the Subthalamic Nucleus
    Glutamate
  1322. Which side of the body is affected by unilateral damage to the basal ganglia?
    Contralateral side!
  1323. Effect of caffeine on movement disorders
    Increases involuntary movements
  1324. Cause of gait alteration in Parkinson Disease
    Loss of postural reflexes
  1325. What is retropulsion?
    • Taking steps back when pulled from the shoulders
    • Sign of loss of postural reflexes in movement disorders
  1326. Sensory change in Parkinson Disease
    Anosmia
  1327. Autonomic symptoms of Parkinson Disease (4)
    • 1. Urinary incontinence
    • 2. Constipation
    • 3. Dysphagia
    • 4. Diaphuresis
  1328. When should antidepressants be used to treat Parkinson Disease patients with low mood?
    After the Parkinson regimen is optimized
  1329. Best class of antidepressants for Parkinson Disease patients
    TCAs
  1330. 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
  1331. Can ECT be used in Parkinson Disease patients?
    • Yes!
    • Helps depression, as well as bradykinesia and rigidity
  1332. Effect of dopaminergic treatments in Parkinson Disease on depressed mood
    None; antidepressants must also be given
  1333. Timing of dementia in Parkinson Disease
    Begins to occur approximately 5 years after onset of illness
  1334. Parkinson symptoms that are associated with developing dementia
    Akinesia and rigidity
  1335. Presentation of dementia in Parkinson Disease
    Inattention, slowed thinking, poor memory, and hallucinations
  1336. Effect of dopaminergic treatments in Parkinson Disease on dementia
    None
  1337. 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
  1338. What class of medication is used to slow progress of dementia in Parkinson Disease?
    Cholinesterase inhibitors
  1339. Prognosis of Parkinson Disease after psychotic symptoms occur
    High rate of dementia and death within 2 years
  1340. Treatment of psychotic symptoms of Parkinson Disease
    • Taper cholinergic medications, if possible
    • Add antipsychotic medication
  1341. Most effective antipsychotic in Parkinson Disease patients with psychotic symptoms
    Clozapine
  1342. 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)
  1343. Treatment of Dopamine Dysregulation Syndrome in Parkinson Disease
    • Reduce dopamine agonists
    • Deep brain stimulation
  1344. What is Punding in Parkinson Disease?
    • Mindless, repetitive, purposeless behavior that displaces normal activities
    • Caused by dopaminergic medications
  1345. Treatment of Punding in Parkinson Disease
    • Reduce dopaminergic medications
    • Add an antipsychotic
  1346. 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)
  1347. Molecular cause of Parkinson Disease
    Inabilitly to convert Tyrosine to DOPA to synthesize Dopamine
  1348. Extrapyramidal tract damaged in Parkinson Disease
    Nigrostriatal Tract
  1349. Neurotransmitter level (other than dopamine) reduced in CSF in Parkinson Disease
    Serotonin
  1350. Neuropathologic finding in Parkinson Disease
    Loss of pigmentation in substantia nigra, locus ceruleus, and vagus nuclei in the brainstem
  1351. Illness against which smoking is protective
    Parkinson Disease
  1352. What is Dementia Pugilistica?
    Intellectual deterioration and bradykinesia due to repeated head injuries (eg in boxers)
  1353. Movement-related side effect of Tetrabenazine
    Parkinsonism
  1354. Movement-related side effect of Reglan (metoclopramide)
    Parkinsonism
  1355. Movement-related side effect of Tigan (trimethobenzamide)
    Parkinsonism
  1356. Movement-related side effect of Compazine (prochlorperazine)
    Parkinsonism
  1357. Movement-related side effect of Phenergan (promethazine)
    Parkinsonism
  1358. Duration of medication-induced Parkinsonism
    • Typically several weeks
    • In some cases, 3-12 months
  1359. 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!
  1360. 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
  1361. How long is L-Dopa effective in Parkinson Disease?
    Approximately first 5 years of illness
  1362. 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
  1363. Systemic side effects of L-Dopa (3)
    • 1. Nausea/vomiting (stimulates emesis center of brain)
    • 2. Hypotension
    • 3. Arrhythmia
  1364. 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
  1365. Category of medication used in Parkinson Disease when L-Dopa is no longer effective
    Dopamine agonists
  1366. Mechanism of action of Pramipexole
    Dopamine agonist
  1367. Mechanism of Action of Ropinirole
    Dopamine agonist
  1368. What is Apomorphine?
    • Injectable dopamine agonist
    • Used in severe Parkinson Disease or NMS
  1369. Effect of dopamine agonists in Parkinson Disease
    Treat only rigidity and bradykinesia, not other symptoms
  1370. Side effects of dopamine agonists in Parkinson Disease (2)
    • 1. Psychotic symptoms (hallucinations, thought disorder)
    • 2. Movement disorders (chorea, akithesia, dystonia)
  1371. Body regions affected by athetosis (3)
    • 1. Face
    • 2. Neck
    • 3. Distal limns
  1372. Most common cause of athetosis
    Cerebral palsy confined to the Basal Ganglia
  1373. Treatment of athetosis
    Dopamine antagonist
  1374. Illicit drugs that can cause chorea (3)
    • 1. Cocaine
    • 2. Amphetamine
    • 3. Methylphenidate
  1375. Hormone that can cause chorea
    Estrogen
  1376. Major categories of symptoms in Huntington Disease (3)
    • 1. Chorea
    • 2. Behavioral disturbances
    • 3. Dementia
  1377. Age of onset of Huntington Disease
    Late 30s
  1378. Life expectancy after Huntington Disease diagnosis
    10-20 years
  1379. What is chorea?
    Random, nonstereotyped, rapid jerking movement of the pelvis, trunk, and limbs
  1380. What is motor impersistence? What does it signify?
    • Inability to sustain voluntary muscle contraction
    • Sign of chorea
  1381. Depressed mood in Huntington Disease
    • Occurs in half of patients
    • Begins early in the illness, sometimes before other symptoms
  1382. Medications to treat chorea in Huntington Disease (2)
    • 1. Antipsychotics (anti-dopamine)
    • 2. Tetrabenazine (dopamine depleting)
  1383. Mechanism of action of Tetrabenazine
    Depletes dopamine (predominantly), serotonin, and norepinephrine
  1384. Medication classes for depressed mood in Huntington Disease (2)
    • 1. SSRIs
    • 2. TCAs
  1385. Presentation of Juvenile Huntington Disease
    Rigidity, dystonia, and akethesia are the presenting symptoms
  1386. Does Huntington Disease cause seizures?
    Juvenile form does, but adult form does not
  1387. What chromosome is the site of trinucleotide repeats in Huntington Disease?
    Chromosome 4 (short arm)
  1388. 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
  1389. Which parent is more likely to have passed Huntington Disease to their children?
    Father
  1390. Site of neuronal death in Huntington Disease, and type of neurons lost
    • Striatum, particularly the caudate
    • GABAergic neurons are lost
  1391. MRI appearance of advanced Huntington Disease
    Caudate is atrophied, causing lateral ventricles to balloon outward ("bat wing ventricles")
  1392. PET findings in Huntington Disease
    Hypometabolism in the caudate
  1393. Causes of parkinsonism and mental decline in teenagers (3)
    • 1. Wilson disease
    • 2. Juvenile Huntington Disease
    • 3. Drug abuse
  1394. Main cause of chorea in childhood
    Syndenham Chorea caused by rheumatic fever
  1395. Who gets Syndenham Chorea?
    • Children ages 5-15
    • Mainly boys
  1396. Cause of Syndenham Chorea
    Complication of rheumatic fever
  1397. Course of Syndenham Chorea
    • Occurs during or several months after Rheumatic Fever
    • Lasts ~2 months
  1398. 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
  1399. Medications that treat symptoms of Syndenham Chorea (2)
    • 1. Valproate
    • 2. Dopamine antagonists
  1400. Treatment of chorea induced by estrogen in OCPs
    Resolves after cessation of OCPs
  1401. Symptoms of Chorea Gravidarum (3)
    • 1. Chorea
    • 2. Delirium
    • 3. Psychosis (sometimes)
  1402. What artery supplies the Basal Ganglia?
    Middle Cerebral Artery
  1403. Cause of hemiballismus in an HIV patient
    Toxoplasmosis lesions in basal ganglia
  1404. Management of hemiballismus
    • Most cases resolve spontaneously
    • In persistent cases, dopamine antagonists may help
  1405. Major sites of copper deposits in Wilson Disease (3)
    • 1. Brain
    • 2. Liver
    • 3. Cornea
  1406. Brain region damaged in Wilson Disease
    Lenticular nuclei
  1407. Psychiatric symptoms of Wilson Disease (3)
    • 1. Personality/behavior changes
    • 2. Thought disorder
    • 3. Cognitive impairments, culminating in dementia
  1408. Neurologic signs of Wilson Disease (5)
    • 1. Dysarthria
    • 2. Dysphagia
    • 3. Gait impairment
    • 4. Rigidity/dystonia
    • 5. Tremor
  1409. Illness causing a "wing-beating tremor" of up-and-down movement of the arms at the shoulders
    Wilson Disease
  1410. Blood test for Wilson Disease
    Ceruloplasmin level (low to absent in Wilson Disease)
  1411. Urine test for Wilson Disease
    24-hour urine copper level
  1412. Management of Wilson Disease (2)
    • 1. Copper chelating agents
    • 2. Avoid copper-containing foods
  1413. Who gets Early-Onset Primary Dystonia?
    • Typically starts at age 9-11, but can be as late as age 26
    • Predominantly Ashkenazi Jews
  1414. Progression of Early Onset Primary Dystonia
    • Starts with one hand or foot
    • Eventually affects other limbs, pelvis, trunk, and neck
    • If untreated, becomes incapacitating
  1415. Inheritance of Early Onset Primary Dystonia
    Autosomal dominant
  1416. Treatment of Early Onset Primary Dystonia
    • 1. Dopamine antagonists
    • 2. Deep brain stimulation of globus pallidus
  1417. 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
  1418. Treatment of Dopamine-Responsive Dystonia
    L-Dopa
  1419. Inheritance of Lesh-Nyhan Syndrome
    X-linked recessive
  1420. Age of onset of Lesh-Nyhan Syndrome
    2-13 year old boy (very rarely girl)
  1421. Symptoms of Lesh-Nyhan Syndrome (5)
    • 1. Severe self-mutilation (especially biting fingers or lips)
    • 2. Mental retardation
    • 3. Spasticity
    • 4. Seizures
    • 5. Dystonia
  1422. Age of onset of focal dystonias
    5th decade or later
  1423. What is a blepharospasm?
    Unprovoked bilateral spasm of eyelid muscles, causing eyes to close for 5 seconds at a time
  1424. Treatment of blepharospasm
    Botox injections
  1425. What is Meige Syndrome?
    Dystonia of the entire face at once
  1426. Cause of strained voice while speaking, but preserved shouting, singing, and whispering
    Spasmotic dysphonia (spasm of the larynx)
  1427. Presentation of Essential Tremor
    • Fine oscillation of wrist, hand, fingers, or legs
    • Worse with actions or holding postures
  1428. Inheritance pattern of Essential Tremor
    Autosomal dominant
  1429. Medications used for Essential Tremor (2)
    • 1. Propranolol
    • 2. Primidone
  1430. Medications that cause tremor (7)
    • 1. Amiodarone
    • 2. Beta agonists
    • 3. Amitriptyline
    • 4. Lithium
    • 5. Valproate
    • 6. Antipsychotics
    • 7. SSRIs
  1431. Site of lesion causing tremor of the soft palate
    Medulla
  1432. Change in tics as a patient ages
    If tics persist, they tend to move from cehalad to caudal structures
  1433. Characteristics of tics for diagnosis of Tourette Syndrome (3)
    • 1. Both vocal and motor
    • 2. Longer than 1 year
    • 3. Onset before age 18
  1434. Age of onset of Tourette Syndrome
    • Average age is 6-7
    • 90% by age 13
  1435. Prognosis of Tourette Syndrome
    • 1/3 resolve by adulthood
    • Further 1/3 improves substantially by adulthood
  1436. 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
  1437. Most frequent comorbidity of Tourette Syndrome
    ADHD
  1438. Obsessions in OCD with comorbid Tourette Syndrome
    Tend to be related to sex or violence
  1439. Compulsions in OCD with comorbid Tourette Syndrome
    Tend to be simpler compulsions such as checking
  1440. Drugs that provide symptomatic treatment of tics in Tourette Disorder (3)
    • 1. Guanfacine
    • 2. Clonidine
    • 3. Dopamine antagonists (typical and atypical neuroleptics)
  1441. Duration of stereotypies after taking cocaine
    2-6 days
  1442. What does it mean when said that myoclonus is "stimulus-sensitive"?
    Clonus can be triggered by auditory, tactile, or visual stimuli
  1443. Cause of delirium with myoclonus
    Toxic-metabolic aberrations
  1444. Psychiatric medications that can trigger clonus (3)
    • 1. SSRIs (in serotonin syndrome)
    • 2. Lithium
    • 3. Clozaril
  1445. Medications to suppress myoclonus (2)
    • 1. Clonazepam
    • 2. Valproate
  1446. 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
  1447. How long after changing antipsychotic dose does acute dyskinesia/dystonia develop?
    • Most within 5 days
    • Half within 2 days
  1448. Illicit drug that increases risk of dystonia with antipsychotics
    Cocaine
  1449. 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
  1450. Medication classes for treatment of dystonia due to antipsychotics (2)
    • 1. Anticholinergics
    • 2. Antihistamines
  1451. Treatments for akathisia (3)
    • 1. Propranolol
    • 2. Clonidine
    • 3. Mirtazapine
  1452. Gender more likely to experience Tardive Dyskinesia
    Female
  1453. Antipsychotic regimen after Tardive Dyskinesia develops
    • Taper back slowly; do not stop abruptly!
    • May switch to a second-generation medication, particularly clozapine
  1454. Rate of remission of Tardive Dyskinesia without intervention
    35%
  1455. Medication that can help with Tardive Dyskinesia
    Tetrabenazine
  1456. Side effect of Tetrabenazine
    Worsening depressed mood and suicidal ideations
  1457. Hallmark sign of Tardive Dystonia
    Spasm of extensor neck muscles
  1458. Medications used in Tardive Dystonia (4)
    • 1. Anticholinergics
    • 2. Clozapine
    • 3. Tetrabenazine
    • 4. Botulinum toxin injections
  1459. What is Tardive Akathisia?
    Akathisia lasting more than 6 months after an antipsychotic is begun
  1460. What is Withdrawal-Emergent Syndrome?
    Chorea with restlessness occurring within 6 weeks of abrupt cessation of chronically-given antipsychotic medications
  1461. Duration of symptoms in Withdrawal-Emergent Syndrome
    4-12 weeks
  1462. Movement symptoms of very high doses of SSRI (3)
    • 1. Myoclonus
    • 2. Tremor
    • 3. Akathisia
  1463. Tremor due to TCAs
    • Fine, rapid tremor resembling essential tremor
    • Responds to propranolol
  1464. Which antidepressant can induce parkinsonism?
    Amoxapine
  1465. Motor signs of Lithium overdose
    • Coarse tremor (cerebellar dysfunction)
    • Truncal ataxia (cerebellar dysfunction)
    • Extrapyramidal symptoms (less common)
  1466. Antiepileptic medication that causes tremor at therapeutic dose
    Valproate
  1467. Medication for treatment of mild lithium tremor
    Propranolol
  1468. Cause of tremor that changes sides when the affected limb is restrained
    Psychogenic
  1469. Cause of tremor whose amplitude increases when weights are placed on the affected limb
    Psychogenic
  1470. 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
  1471. What is echopraxia?
    Involuntary repetition of others' movements
  1472. EEG in catatonia
    Normal!
  1473. Drug of abuse whose intoxication can cause catatonia
    PCP
  1474. Group most susceptible to Mass Hysteria
    Adolescent females
  1475. Movement disorders associated with cognitive impairment in young children (3)
    • 1. Athetosis
    • 2. Lesh-Nyhan Syndrome
    • 3. Rett Syndrome
  1476. Movement disorders associated with cognitive impairment in adolescents (3)
    • 1. Huntington Disease
    • 2. Subacute Sclerosing Panencephalitis
    • 3. Wilson Disease
  1477. Movement disorders associated with cognitive impairment in adults (3)
    • 1. Creutzfeldt-Jakob Disease
    • 2. Huntington Disease
    • 3. Parkinson Disease
  1478. 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
  1479. If OCD and Tourette Syndrome co-occur, when do OCD symptoms begin?
    After both vocal and motor tics
  1480. If ADHD and Tourette Syndrome co-occur, when do ADHD symptoms begin?
    Prior to Tourette Syndrome symptoms
  1481. Medication to treat tremor in hypothyroidism
    Propranolol
  1482. Cause of nightmares while taking Levodopa
    Nighttime hallucinations (side effect of the medication)
  1483. Cause of dyskinesia post-ECT
    • Liberation of excess dopamine by the ECT
    • Treat by reducing dopaminergic medications
  1484. Effect of antipsychotic medications on Dementia with Lewy Bodies
    Exacerbation of parkinsonism
  1485. Metabolic cause of myoclonus
    Uremia
  1486. Medical condition occurring late in Lesh-Nyhan Syndrome
    Renal failure
  1487. Mechanism of botulinum toxin
    Prevents release of ACh from presynaptic neurons
  1488. Lab finding in acute dystonic reaction to antipsychotics
    Highly elevated CK
  1489. What type of antipsychotic is most likely to cause hyperprolactinemia?
    First-generation
  1490. What neurotransmitter's breakdown produces 5-hydroxyindoleacetic acid?
    Serotonin
  1491. What neurotransmitter's breakdown produces vanillylmandelic acid?
    Norepinephrine
  1492. What neurotransmitter's breakdown produces homovanillic acid?
    Dopamine
  1493. Major neurotransmitter of the globus pallidus
    GABA
  1494. Major neurotransmitter of the subthalamic nucleus
    Glutamate
  1495. Major neurotransmitter of the nucleus basalis of Maynert
    ACh
  1496. What does the AIMS battery evaluate for?
    Tardive Dyskinesia
  1497. Most common CNS tumor in children
    Astrocytoma
  1498. Pathology of astrocytoma in children
    • Cystic, noninvasive tumor
    • If in the cerebellum, easily removed surgically
    • If in brainstem, often inoperable and highly malignant
  1499. Pathology of astrocytoma in adults
    • Predominantly in cerebrum
    • Extensive infiltration
  1500. Treatment of astrocytoma in adults
    • Surgery only if surrounding brain can be sacrificed
    • Radiation is effective if low-grade
  1501. Most frequent type of primary brain tumor
    Glioblastoma Multiforme
  1502. Where do glioblastomas typically occur?
    Cerebrum
  1503. Prognosis of glioblastoma
    • Poor; 15 month life expectancy
    • Grow rapidly and infiltrates widely
  1504. Pathological appearance of frontal lobe gliomas that have advanced
    Cross the corpus callosum to create a "butterfly glioma"
  1505. Who most often gets meningiomas?
    Middle-aged women
  1506. What cells form glioblastomas?
    Astrocytes
  1507. Who most commonly gets primary cerebral lymphomas?
    Immunosuppressed patients
  1508. Treatment of primary cerebral lymphoma
    • Steroids cause temporary remission
    • Surgery is not effective
  1509. Cancers that often metastasize to brain (5)
    • 1. Lung
    • 2. Breast
    • 3. Renal
    • 4. Melanoma
    • 5. GI
  1510. Management of cerebral metastases
    • Chemotherapy often does not pass the blood-brain barrier
    • Steroids and radiotherapy can be palliative
  1511. Prognosis if cancer has metastasized to the brain
    Poor; most survive less than 9 months
  1512. 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
  1513. Who is most likely to develop pseudotumor cerebri?
    Overweight young adult women with menstrual irregularity
  1514. Symptoms of parasaggital meningioma (meningioma of the falx)
    • Compresses medial motor cortex
    • Spastic paresis of bilateral legs
  1515. 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)
  1516. Symptoms of olfactory groove meningioma (3)
    • Compresses olfactory and optic nerves:
    • 1. Anosmia
    • 2. Unilateral blindness
    • 3. Frontal lobe dysfunction (if very large)
  1517. Type of brain tumor most commonly causing rapidly-changing personality changes
    Glioblastoma
  1518. Type of brain tumor most commonly causing rapidly-changing cognitive deficits
    Glioblastoma
  1519. Cause of cognitive decline, paresis, and spasticity 3 months to 5 years after chemotherapy
    Loss of oligodendrocytes causes demyelination
  1520. When does peripheral neuropathy occur with chemotherapy?
    During or shortly after treatment
  1521. Prognosis of chemotherapy-induced peripheral neuropathy
    Tends to improve over time
  1522. Medications that stimulate the CNS vomiting center (3)
    • 1. Chemotherapeutic agents
    • 2. Opiates
    • 3. L-Dopa
  1523. When do small strokes occur after CNS radiotherapy?
    6-18 months after treatment
  1524. Finding on MRI of patients with CNS radiotherapy-induced cognitive deficits
    White matter changes
  1525. Physical symptoms of whole-brain radiation therapy in childhood
    Hypothalamic-pituitary deficiency causes growth retardation, developmental delay, and delayed puberty
  1526. Cause of increased strokes after radiation therapy of chest and neck
    Fibrosis of the extracranial portions of the carotid and vertebral arteries
  1527. Types/Sites of cancer whose paraneoplastic syndrome includes cerebellar degeneration (3)
    • 1. Gynecologic cancers
    • 2. Lymphoma
    • 3. Small cell tumor of the lung
  1528. Types of anti-neuronal antibodies in paraneoplastic cerebellar degeneration (2)
    • 1. Anti-Hu
    • 2. Anti-Cv2
  1529. Cause of memory impairment, irritability, behavioral disturbances, and complex partial seizures
    Limbic encephalitis
  1530. Tumors that cause limbic encephalitis (2)
    • 1. Testicular
    • 2. Small cell carcinoma of the lung
  1531. MRI findings in limbic encephalitis
    Atrophy of temporal lobes
  1532. EEG findings in limbic encephalitis
    Spikes or slow waves originating in temporal lobes
  1533. Types of anti-neuronal antibodies causing limbic encephalitis (3)
    • 1. Anti-Hu
    • 2. Anti-VGKC
    • 3. Anti-Ma2
  1534. Cause of progressive amnesia and behavioral disturbances, followed by psychosis, seizures, involuntary movements, and autonomic instability
    Anti-NMDA Receptor Encephalitis (type of paraneoplastic syndrome)
  1535. MRI findings in anti-NMDA Receptor Encephalitis
    None
  1536. CS findings in anti-NMDA Receptor Encephalitis (3)
    • 1. Lymphocytic pleocytosis
    • 2. Anti-NMDA antibodies
    • 3. Oligoclonal bands
  1537. Tumor that classically causes anti-NMDA Receptor Encephalitis
    Ovarian teratoma
  1538. Cause of low energy, erectile dysfunction, and gynecomastia in men
    Pituitary prolactinoma
  1539. Cause of low energy, amenorrhea, and galactorrhea in women
    Pituitary prolactinoma
  1540. What is a Chromophobe Adenoma?
    Common pituitary adenoma that does not secrete prolactin
  1541. Medication options for prolactinoma (2)
    • 1. Bromocriptine
    • 2. Cabergoline
    • (Dopamine agonists)
  1542. What is a craniopharyngioma?
    • Large calcified cystic congeintal lesion of Rathke's pouch in the hypothalamus
    • Causes endocrine deficiency
  1543. Presentation of craniopharyngioma in children (3)
    • 1. Diabetes insipidus
    • Delayed/incomplete...
    • 2. Physical maturation
    • 3. Sexual maturation
    • 4. Mental maturation
  1544. Presentation of craniopharyngioma in adults (4)
    • 1. Impaired libido
    • 2. Amenorrhea
    • 3. Apathy
    • 4. Diabetes insipidus
  1545. What type of cells proliferate to cause acoustic neuroma?
    Schwann cells (not neurons!)
  1546. Cranial nerves affected by an Acoustic Neuroma (3)
    • Trigeminal (5th)
    • Facial (7th)
    • Acoustic (8th)
  1547. Hearing-related symptoms of Acoustic Neuroma (2)
    • 1. Tinnitus
    • 2. Loss of speech discrimination
  1548. 3 most common cancers that metastasize to spine
    • 1. Lung
    • 2. Breast
    • 3. Prostate
  1549. Pattern of pain if cancer metastasizes to the spinal dura
    Local pain as well as pain in affected nerve roots
  1550. Common sites of tumors causing dermatomyositis (4)
    • 1. Lung
    • 2. Breast
    • 3. Ovary
    • 4. Stomach
  1551. Chemotherapy agent most often associated with polyneuropathy
    Vincristine
  1552. Cause of subdural bleeding
    Venous bleeding
  1553. Cause of epidural bleeding
    Arterial bleeding
  1554. Cause of subarachnoid bleeding
    Ruptured berry aneurysm
  1555. Sites of bleeding due to hypertension or cocaine use (4)
    • 1. Basal ganglia
    • 2. Thalamus
    • 3. Pons
    • 4. Cerebellum
  1556. What is neurocystericosis?
    Intracerebral cysts originating from a GI tapeworm infection
  1557. Types of medication that should be given in the regimen for neurocystericosis (2)
    • 1. Antibiotics
    • 2. Antiepileptic drugs
  1558. Symptoms of basilar migraine (2)
    • 1. Nausea/vomiting
    • 2. Ataxia
  1559. Who gets glioblastomas?
    Older adults
  1560. What type of tumor can "Tubers" in tuberous sclerosis develop into in CNS?
    Glioma
  1561. Headache in open-angle glaucoma
    None!
  1562. Cause of Abducens (CN6) palsy in Pseudotumor Cerebri
    Increased intracranial pressure stretches the nerve, causing palsy
  1563. CMP abnormality commonly causing delirium in lung cancer
    Hypercalcemia
  1564. Imaging study that shows meningioma most clearly
    CT (not MRI!)
  1565. Who gets cerebellar astrocytomas?
    Children
  1566. Who gets neurocystericosis?
    Residents of Central America
  1567. Effect of tuberculoma at the neuromuscular junction
    Enhances reuptake of ACh into the presynaptic neuron, causing weakness
  1568. -ridol
    Drug is a Butyrophenone (type of typical antipsychotic)
  1569. -perone
    Drug is a Butyrophenone (type of typical antipsychotic)
  1570. What is the mental nerve?
    • Branch of CN5
    • Provides sensation from skin overlying the chin
  1571. Appearance of glioblastoma on MRI
    Ring-shaped mass lesion
  1572. Timing of depression in patients with brain tumors
    Often arises after surgical excision and worsens with time
  1573. Age group most susceptible to cognitive impairment after CNS radiation therapy
    Young children
  1574. Electrolyte abnormality in SIADH
    Hyponatremia
  1575. Cause of turbid CSF with highly ↑WBCs, ↑ protein, ↓ glucose, and ↑opening pressure
    Bacterial meningitis
  1576. Cause of turbid CSF with ↑WBCs, slightly ↑protein, and ↓glucose
    Viral meningitis
  1577. Cause of turbid CSF with highly ↑WBCs, highly ↑protein, and slightly ↓glucose
    TB or fungal meningitis
  1578. Cause of clear CSF with slightly to highly ↑WBCs, slightly ↑protein, and normal glucose
    Neurosyphilis
  1579. Cause of clear CSF with barely ↑WBCs, ↑protein, and normal glucose
    Guillain-Barré syndrome
  1580. Hematoma following the contour of the brain on CT
    Subdural
  1581. Hematoma with elliptical shape, not following the contour of the brain on CT
    Epidural
  1582. Cause of multiple cortical lesions with calcifications and without surrounding edema on CT
    Cysticercosis
  1583. Appearance of acute stroke on CT
    Affected brain region is darker than adjacent normal brain (due to blood being brighter on CT)
  1584. 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
  1585. What brain image techniques can show white matter changes?
    MRI only!
  1586. Head imaging technique to diagnose skull fractures
    CT (they may not be visible on MRI)
  1587. MRI finding in Herpes Simplex Encephalitis
    Hemorrhages at the base of the brain, particularly the temporal lobes
  1588. Imaging technique best used to diagnose prolonged postconcussion syndrome
    Diffusion Tensor Imaging (DTI)
  1589. Endogenous enzymes that metabolize dopamine (2)
    • 1. Monoamine Oxidase (MAO) (intracellular)
    • 2. Catecholamine-o-Methyltransferase (COMT) (extracellular)
  1590. What are the 3 "long dopamine tracts" in the CNS?
    • 1. Nigrostriatal tract
    • 2. Mesolimbic tract
    • 3. Mesocortical tract
  1591. Type of dopamine receptors in the striatum targeted by the Nigrostriatal Tract
    D2
  1592. Origin and target of the Mesolimbic Tract
    • Originates at the ventral tegmental area
    • Target is the limbic system, especially the amygdala
  1593. Which dopaminergic tract is the source of positive symptoms of psychotic illnesses?
    Mesolimbic Tract
  1594. Type of dopamine receptors in the limbic system
    D4
  1595. Origin and target of the Mesocortical Tract
    • Originates at the ventral tegmental area
    • Target is mostly frontal cortex, partially cingulate and prefrontal gyri
  1596. Which dopaminergic tract is the source of negative symptoms of psychotic illness?
    Mesocortical Tract
  1597. What is the Tuberoinfundibular Tract?
    • Short dopamine tract from hypothalamus to the pituitary gland
    • Inhibits prolactin release
  1598. Effects of blockade of D2, D3, and/or D4 receptors by antipsychotics (3)
    • 1. Parkinsonism
    • 2. Increase in prolactin
    • 3. Risk of tardive dyskinesia
  1599. What medication is Risperdal's active metabolite?
    Paliperidone (Invega)
  1600. Atypical antipsychotics that most often cause elevated prolactin (2)
    • 1. Risperdal
    • 2. Invega
  1601. Antipsychotic that has little activity in D2, D3, or D4 receptors
    Clozaril
  1602. Which dopamine receptors are strongly antagonized by phenothiazines?
    D1, D2, D3, D4, and D5
  1603. Which dopamine receptors are strongly antagonized by butyrophenones?
    D2, D3, and D4 (effects on D1 and D5 are weaker)
  1604. Types of dopamine receptors with high concentration in striatum
    D1, D2, D3, D4, and D5
  1605. Types of dopamine receptors with high concentration in the limbic system
    D1 and D5
  1606. Types of dopamine receptors with high concentration in cortex
    D1 and D2
  1607. Types of dopamine receptors with high concentration in Substantia Nigra
    D2, D3, and D4
  1608. Effect of Phenylketonuria on appearance
    • Inability to produce tyrosine leads to no melanin production
    • Fair complexion, blond hair, and blue eyes
  1609. 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
  1610. Antidepressant that can inhibit dopamine reuptake
    Wellbutrin
  1611. 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)
  1612. Endogenous enzymes that metabolize Norepinephrine (2)
    • 1. Monoamine Oxidase (MAO) (intracellular)
    • 2. Catecholamine-o-Methyltransferase (COMT) (extracellular)
  1613. Endogenous enzymes that metabolize Epinephrine (2)
    • 1. Monoamine Oxidase (MAO) (intracellular)
    • 2. Catecholamine-o-Methyltransferase (COMT) (extracellular)
  1614. Where is most norepinephrine produced?
    Outside the CNS
  1615. Main CNS site of norepinephrine production
    Locus ceruleus (dorsal pons)
  1616. Targets of noradrenergic tracts of the CNS (4)
    • 1. Cortex
    • 2. Limbic system
    • 3. Reticular activating system
    • 4. Spinal cord
  1617. Neurotransmitter of sympathetic nervous system's postganglionic neurons
    Norepinephrine
  1618. Role of α2 and β2 norepinephrine receptors
    • Presynaptic
    • When activated, reduce norepinephrine synthesis and release
  1619. Effect of stimulation of the α1 noradrenergic receptor
    Vasoconstriction
  1620. Effect of stimulation of the α2 noradrenergic receptor
    Vasodilation, hypotension
  1621. Effect of stimulation of the β1 noradrenergic receptor
    Cardiac stimulation
  1622. Effect of stimulation of the β2 noradrenergic receptor
    Bronchodilation, increased tremor
  1623. What receptor is targeted by Clonidine?
    Presynaptic α2 noradrenergic receptor (agonist)
  1624. 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)
  1625. What chemical is produced when serotonin is broken down by MAO?
    5-hydroxyindoleacetic acid (5-HIAA)
  1626. What neurotransmitters are catecholamines? (3)
    • 1. Epinephrine
    • 2. Norepinephrine
    • 3. Dopamine
  1627. What neurotransmitter is an indolamine?
    Serotonin
  1628. What are the subgroups of monoamine neurotransmitters? (2)
    • 1. Catecholamines
    • 2. Indolamines
  1629. What is the rate limiting step in Serotonin synthesis?
    Conversion of Tryptophan to 5-hydroxytryptophan by tryptophan hydroxylase
  1630. Which type of Monoamine Oxidase breaks down dopamine?
    Predominantly MAO-B, but also MAO-A
  1631. Which type of Monoamine Oxidase breaks down serotonin?
    MAO-A
  1632. What chemical is produced when serotonin is broken down by enzymes other than MAO?
    Melatonin
  1633. Main targets of serotonergic neurons from the Dorsal Raphe (4)
    • 1. Cortex
    • 2. Cerebellum
    • 3. Limbic system
    • 4. Striatum
  1634. Main target of serotonergic neurons from the Caudal Raphe
    Dorsal horn of the spinal cord (provide analgesia)
  1635. Generally, what is the role of 5-HT1 receptors?
    Inhibitory
  1636. Generally, what is the role of 5-HT2 receptors?
    Excitatory
  1637. Action of the 5-HT1D receptor
    • Presynaptic autoreceptor
    • Inhibits production and release of serotonin
  1638. Pattern of serotonin level in the sleep-wake cycle
    • Highest while awake
    • Low in slow wave sleep
    • Absent in REM sleep
  1639. Serotonin level in Parkinson Disease
    • Low
    • Even lower in patients with comorbid depression
  1640. Serotonin level in Alzheimer Disease
    Low
  1641. What receptors do Triptans target? (2)
    • 1. 5-HT1B (agonist) (inhibits presynaptic neurotransmitter release)
    • 2. 5-HT1D (agonist) (inhibits presynaptic neurotransmitter release)
  1642. What receptor does Zofran target?
    5-HT3 (antagonist)
  1643. Generally, what is the role of 5-HT receptors other than 5-HT1 or 5-HT2?
    Excitatory
  1644. Receptors targeted by 2nd Generation Antipsychotics (2)
    • 1. 5-HT2A (antagonist)
    • 2. D2 (antagonist)
  1645. Receptor targeted by LSD
    5-HT2 (agonist)
  1646. Mechanism of action of MDMA (2)
    • 1. Enhances presynaptic release of serotonin
    • 2. Stimulates dopaminergic activity
  1647. Pathway of synthesis of Acetylcholine
    Acetyl CoA and Choline to ACh (choline acetyltransferase)
  1648. Reuptake of ACh from synapses
    Does not happen! All ACh is broken down by acetylcholinesterase
  1649. Main targets of cholinergic neurons in the brain (3)
    • 1. Hippocampus
    • 2. Amygdala
    • 3. Cortical association areas
  1650. What type of ACh receptor predominates in the cerebral cortex?
    Muscarinic
  1651. Are ACh receptors in the cerebral cortex inhibitory or excitatory?
    Either, depending on the neuron
  1652. Medications that block ACh receptors in cerebral cortex (2)
    • 1. Atropine
    • 2. Scopalamine
  1653. Mechanism of action of curare
    Blocks postsynaptic ACh receptors at the neuromuscular junction
  1654. Cause of asymmetric paresis of extraocular and facial muscles, but not pupils
    Myasthenia gravis
  1655. Effect of Alzheimer Disease on the cholinergic system of the brain
    ACh concentration, choline acetyltransferase activity, and ACh receptors are all reduced
  1656. Illnesses in which cortical ACh is low (5)
    • 1. Alzheimer Disease
    • 2. Down Syndrome
    • 3. Parkinson Disease
    • 4. Progressive Supranuclear Palsy (PSP)
    • 5. Delirium
  1657. Anticholinergic side effects (4)
    • 1. Dry mouth
    • 2. Urinary hesitancy
    • 3. Constipation
    • 4. Accommodation paresis
  1658. What types of psychiatric medications cause anticholinergic side effects? (2)
    • 1. Typical antipsychotics
    • 2. Tricyclics
  1659. Symptoms of anticholinergic syndrome (7)
    • 1. Dilated pupils
    • 2. Tachycardia
    • 3. Hypertension
    • 4. Dry skin
    • 5. Hyperthermia
    • 6. Delirium
    • 7. In severe cases, coma
  1660. Which antipsychotics are most likely to cause anticholinergic side effects? (2)
    • 1. Clozapine
    • 2. Olanzapine
  1661. Pathway of synthesis of GABA
    Glutamate to GABA (glutamate decarboxylase and Vitamin B6)
  1662. Clearance of GABA from the synapse
    By reuptake or metabolism by several enzymes
  1663. 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!)
  1664. What receptor does alcohol bind to?
    GABA A
  1665. What receptor do benzodiazepines bind to?
    GABA A
  1666. What receptor do barbiturates bind to?
    GABA A
  1667. Action of the GABA A receptor
    Opens a chloride channel, hyperpolarizing the postsynaptic neuron
  1668. Action of the GABA B receptor
    GPCR that eventually has an inhibitory effect
  1669. Mechanism of action of Baclofen
    • Binds GABA B
    • Counteracts spasticity, dystonia, and neuropathic pain
  1670. Effect of Huntington Disease on GABA
    Depleted in basal ganglia, reducing inhibition
  1671. Cause of Stiff-Person Syndrome
    Anti-GAD (glutamate decarboxylase) antibodies reduce GABA synthesis, causing muscle stiffness
  1672. Treatment of Stiff-Person Syndrome (2)
    • 1. Diazepam
    • 2. Immunomodulation
  1673. Treatment of seizures caused by Isoniazid overdose
    Vitamin B6 infusion
  1674. Effect of Valproic Acid on GABA
    Increases GABA concentration in brain
  1675. Effect of Topiramate on GABA
    Enhances GABA-A receptor activity
  1676. Mechanism of action of Flumazenil
    • Blocks the action of GABA at its receptor
    • Reverses effects of benzodiazepines
    • Treats hepatic encephalopathy
  1677. Pathway of synthesis of Glycine
    Serine to Glycine (hydroxymethyl transferase)
  1678. Major sites of action of Glycine in CNS (2)
    • 1. Ventral horn of spinal cord (inhibits motor neurons)
    • 2. Brainstem
  1679. Pathway of synthesis of Glutamate
    Glutamine to Glutamate (glutaminase)
  1680. Clearance of glutamate from the synapse
    Reuptake into presynaptic neurons and to adjacent support cells
  1681. Action of Astartate as a neurotransmitter
    Excitatory
  1682. What neurotransmitters bind the NMDA receptor? What is its overall function?
    • Binds glutamate and glycine
    • Excitatory (opens calcium channel)
  1683. What drugs of abuse are NMDA antagonists? (2)
    • 1. PCP
    • 2. Ketamine
  1684. Mechanism of action of Riluzole
    NMDA antagonist
  1685. Pathway of synthesis of Nitric Oxide
    Arginine and Oxygen to Nitrous Oxide and Citrulline (nitric oxide synthase)
  1686. What is depleted with chronic Nitrous Oxide abuse?
    Vitamin B12
  1687. 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
  1688. Sympathomimetic effects of cocaine (4)
    • 1. Pupillary dilation
    • 2. Hypertension
    • 3. Vasospasm
    • 4. Arrhythmia
  1689. Half-life of cocaine
    30-90 minutes
  1690. Metabolism of cocaine
    By hepatic and plasma enzymes
  1691. How long after use can a urine toxicology detect cocaine?
    2 days
  1692. Effect of cocaine on sleep
    • Reduced overall sleep
    • Suppresses REM sleep; on discontinuation, REM rebound occurs
  1693. Presentation of cocaine overdose
    Agitated, paranoid, irrational, and hallucinatory
  1694. Medical complications of cocaine overdose (3)
    • 1. Stroke (in ~2 hours)
    • 2. Myocardial infarction
    • 3. Seizure (in ~2 hours)
  1695. What type of stroke is most common if caused by cocaine?
    Hemorrhagic (due to HTN)
  1696. Effects of cocaine on neuroleptics (2)
    • 1. Increases sensitivity to dystonic reactions
    • 2. Both reduce the seizure threshold
  1697. What class of medications should be given for hypertensive urgency/emergency due to cocaine use?
    α-blocker
  1698. Symptoms of cocaine withdrawal (2)
    • 1. Dysphoria (low energy, anhedonia, etc.)
    • 2. Vivid, disturbing dreams
  1699. Mechanism of action of amphetamines (3)
    • 1. Provokes dopamine release
    • 2. Blocks dopamine reuptake
    • 3. Increases noradrenergic activity
  1700. Effects of amphetamines on sleep (2)
    • 1. Reduced total sleep
    • 2. Suppress REM sleep
  1701. Half-life of amphetamines
    • 8 hours (amphetamine)
    • 12 hours (methamphetamine)
  1702. Presentation of amphetamine overdose
    • Thought disorder
    • Hallucinations
    • Dyskinesias/stereotypies
  1703. Treatment of cocaine overdose
    • Mostly behavioral (seclusion, etc.)
    • Neuroleptics if necessary
  1704. Treatment of amphetamine overdose
    Neuroleptics
  1705. Mechanism of action of MDMA
    Causes release of presynaptic serotonin stores
  1706. Somatic symptoms of MDMA use (4)
    • 1. Dry mouth
    • 2. Sweating
    • 3. Bruxism
    • 4. Hyperthermia
  1707. Classic triad of opiate overdose
    • 1. Coma
    • 2. Miosis
    • 3. Respiratory depression
  1708. Use of naltrexone in opiate abuse
    Can be taken orally for extended times to block the opiate receptor
  1709. Timing of methadone withdrawal
    • Starts 1-2 days after the last dose
    • Peaks at 6 days
  1710. Mechanism of clonidine
    α2 agonist
  1711. Role of clonidine in opiate withdrawal
    Can alleviate autonomic hyperactivity
  1712. Medications that reduce methadone levels (2)
    • 1. Phenytoin (Dilantin)
    • 2. Carbamazepine (Tegretol)
  1713. Symptoms of PCP at low doses (3)
    • 1. Euphoria
    • 2. Dysarthria/ataxia
    • 3. Nystagmus
  1714. Symptoms of PCP at high doses (3)
    • 1. Disorganized/bizarre thinking
    • 2. Visual hallucinations
    • 3. Both positive and negative symptoms of schizophrenia
  1715. Symptoms of PCP overdose (4)
    • 1. Muscle rigidity (can cause rhabdomyalysis)
    • 2. Bursts of horizontal and vertical nystagmus
    • 3. Stereotypies
    • 4. Seizures
  1716. Treatment of PCP intoxication
    • Seclusion and sedation
    • Neuroleptics may increase muscle rigidity, and should be used only in extreme situations!
  1717. Mechanism of GHB
    GABA agonist; reduces activity of dopaminergic neurons
  1718. Effects of marijuana on sleep
    Reduces REM sleep
  1719. Duration of marijuana
    • 1-3 hours with light use
    • 1-2 days with heavy use
  1720. Mechanism of nicotine
    Binds nicotinic cholinergic receptors, activating dopaminergic neurons in the mesolimbic system and frontal coertex
  1721. Mechanism of action of Varenicline (Chantix)
    Partial agonist of nicotinic cholinergic receptors
  1722. Mechanism of Wellbutrin in smoking cessation (2)
    • 1. Nicotinic receptor antagonist
    • 2. Inhibits dopamine reuptake
  1723. Mechanism of action of "Bath Salts"
    Inhibit dopamine and norepinephrine reuptake
  1724. Cause of Parkinsonism in heroin users
    Heroin contaminated with MPTP, which destroys nigrostriatal neurons
  1725. Which antipsychotics have the most potent anti-muscarinic effects (and therefore the least EPS) (2)
    • 1. Clozapine
    • 2. Olanzapine
  1726. What chemical's concentration is low in CSF in violent suicides?
    5-HIAA
  1727. Mechanism of action of Tranylcypromine
    MAO-A antagonist
  1728. Medication used to treat Neuroleptic Malignant Syndrome
    Dantrolene
  1729. Most common type of GABA receptor
    GABA A
  1730. Treatment of mild serotonin syndrome
    Supportive only
  1731. Treatment of cocaine-induced psychosis and violent behavior
    Dopamine-blocking neuroleptic
  1732. Mechanism of action of tizanidine
    • α2 agonist
    • Alleviates spasticity
  1733. Duration of unconsciousness that qualifies as severe TBI
    12 hours
  1734. Method of neuronal death after trauma
    Necrosis
  1735. Predominant type of inflammatory cell that infiltrates brain tissue after trauma
    Monocytes
  1736. Imaging modality that shows diffuse axonal shearing after TBI
    • Diffusion tensor imaging
    • CT and MRI do not show this damage!
  1737. Innermost layer of the meninges
    Pia mater
  1738. Which space is CSF found in?
    Subarachnoid
  1739. At what height in the spinal column is the conus medularis?
    T12 to L1
  1740. Artery whose laceration causes an epidural hematoma in a temporal bone fracture
    Middle meningeal artery
  1741. Type of intracranial hematoma that causes transtentorial herniation if not treated surgically
    Epidural
  1742. Cause of unconsciousness, followed by a lucid interval, then decerebrate posture following head injury
    Epidural hematoma
  1743. 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
  1744. Presentation of acute subdural hematoma
    Headache, confusion, and deteriorating level of consciousness over 1-2 days
  1745. Duration of bleeding in a chronic subdural hematoma
    Several weeks
  1746. Presentation of chronic subdural hematoma
    • Insidious headache, change in personality, and cognitive impairment
    • Subtle physical deficits may be present
  1747. Duration for most comatose patients to die, improve, or enter a vegetative state
    4 weeks
  1748. Typical time to reach maximum physical recovery after TBI
    6 months
  1749. Brain region whose traumatic injury disrupts the sleep wake cycle
    Hypothalamus
  1750. Frequency of Post-Traumatic Epilepsy after a head trauma
    • After major head trauma, ~50%
    • After minor head trauma, rare
  1751. When do Immediate Posttraumatic seizures occur?
    Within 24 hours of TBI
  1752. When do Early Posttraumatic seizures occur?
    Within 7 days of TBI
  1753. Typical time to reach maximum cognitive recovery after TBI
    18 months
  1754. Typical time to reach maximum motor and language recovery after TBI
    6 months
  1755. Classes of medications that can help memory after TBI (2)
    • 1. Anticholinesterases
    • 2. Dopaminergics (especially methylphenidate)
  1756. Types of medications to treat aggression in TBI (3)
    • 1. β blockers
    • 2. Antidepressants
    • 3. Antiepileptics
  1757. Class of antidepressants most commonly used in Depression following TBI
    SSRIs
  1758. Medication regimen for psychosis following TBI
    Antipsychotic with co-administered antidepressant or mood stabilizer
  1759. Age before which the nondominant hemisphere can assume control of language after TBI
    5
  1760. How long can amnesia persist for head trauma to be classified as Minor?
    No longer than 24 hours
  1761. 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
  1762. Duration of physical symptoms after concussion
    ~1 week
  1763. What is Second Impact Syndrome?
    Potentially fatal cerebral edema caused by a second head injury within days of a concussion
  1764. 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)
  1765. Duration of postconcussive symptoms in uncomplicated cases
    ~3 months
  1766. Duration of pain following Whiplash injuries
    • Most cases last 3-6 months
    • 20% last 2 years or longer
  1767. What type of amnesia is most common in TBI?
    Anterograde
  1768. Most common type of seizure in Posttraumatic Epilepsy
    Partial with secondary generalization
  1769. Most reliable indicator of TBI sequelae
    Duration of retrograde amnesia
  1770. Correlation between location of traumatic brain lesion and level of impairment
    Poor, with exception of left temporal lesions causing language deficits
  1771. Cutaneous side effects of Lithium (4)
    • 1. Acne
    • 2. Follicular eruptions
    • 3. Macropapular eruptions
    • 4. Allopecia
  1772. Major side effects of Lithium (7)
    • 1. GI compliants
    • 2. Tremor
    • 3. Diabetes Insipidus
    • 4. Hypothyroidism
    • 5. Weight gain
    • 6. Arrhythmia
    • 7. Edema
  1773. Side effects of Lamotrigine (5)
    • 1. Stevens-Johnson Syndrome
    • 2. Anemia
    • 3. Thrombocytopenia
    • 4. Liver failure
    • 5. Pancreatitis
  1774. Method by which benzodiazepine overdose causes death
    Respiratory suppression
  1775. Major side effects of Risperdal (6)
    • 1. EPS
    • 2. NMS
    • 3. Metabolic syndrome
    • 4. GI upset
    • 5. Hypersalivation
    • 6. Lactation
  1776. Major side effects of Oxcarbazepam (3)
    • 1. Leulopenia
    • 2. Thrombocytopenia
    • 3. Stevens Johnson Syndrome
  1777. According to attachment theory, what does a mother provide? (2)
    • 1. Resources
    • 2. Security
  1778. What theory did John Bowlby develop?
    Attachment Theory
  1779. In attachment theory, what is Bonding?
    Mother's feelings for the infant
  1780. Symptoms of lesion of the Medial Frontal Cortex (2)
    • 1. Apathy
    • 2. Limited spontaneous movements, gestures, or speech
  1781. Psychiatric symptom of lesion of the left frontal lobe
    Depression
  1782. Psychiatric symptom of lesion of the right frontal lobe
    Mania
  1783. What is Ailurophobia?
    Far of cats
  1784. What is another term for Cohort Study?
    Longitudinal Study
  1785. Are Case-Control studies prospective or retrospective?
    Always retrospective
  1786. What concepts is Winnicott known for? (2)
    • 1. "Good Enough Mothering"
    • 2. Transitional objects
  1787. What are Piaget's stages of cognitive development? (4)
    • 1. Sensorimotor
    • 2. Preoperational thought
    • 3. Concrete operations
    • 4. Formal operations
  1788. What are Freud's stages of development? (4)
    • 1. Oral
    • 2. Anal
    • 3. Phallic
    • 4. Latency
  1789. What are Mahler's Stages of Separation? (6)
    • 1. Normal autism
    • 2. Symbiosis
    • 3. Differentiation
    • 4. Practicing
    • 5. Rapprochment
    • 6. Object Constancy
  1790. 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
  1791. Autopsy finding in Wernicke's Encephalopathy
    Microhemorrhages in the Periventricular Gray matter, especially near the aqueduct and 3rd/4th ventricles
  1792. Autopsy finding in Pick's Dementia
    Frontal and temporal lobe atrophy
  1793. Cause of "Dawson's Fingers" on autopsy or MRI
    Demyelinating diseases, especially Multiple Sclerosis
  1794. What are "Dawson's Fingers"?
    • Subcortical white matter lesions of the brain
    • Located perpendicular to the ventricles
  1795. Which type of Monoamine Oxidase breaks down norepinephrine?
    MAO-A
  1796. 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
  1797. Major side effects of MAOIs (5)
    • 1. Orthostatic hypotension
    • 2. Weight gain
    • 3. Edema
    • 4. Sexual dysfunction
    • 5. Insomnia
  1798. Which MAOIs do not require a tyramine-free diet at low doses? (2)
    • 1. Moclobemide (not used in US)
    • 2. Selegiline
  1799. Atypical antipsychotics that can be given in a rapid-release injectable (2)
    • 1. Olanzapine (Zyprexa)
    • 2. Ziprasidone (Geodon)
  1800. What is Resistance?
    Ideas that are unacceptable to the patient are prevented from reaching awareness
  1801. What is Confrontation?
    Addressing an issue that a patient does not wish to accept
  1802. What ages constitute Middle Adulthood?
    40-65
  1803. What is the task of the end of Early Adulthood?
    Review the past and decide what the future will hold
  1804. 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
  1805. Tasks whose completion signifies the beginning of adulthood (3)
    • 1. Selecting a mate
    • 2. Choosing an occupation
    • 3. Achieving independence and self-sufficiency
  1806. What is Primary Prevention?
    Preventing the onset of a disease
  1807. What is Secondary Prevention?
    Identifying a disease in early stages to provide prompt treatment
  1808. What is Tertiary Prevention?
    Reducing deficits caused by an illness to maximize functioning
  1809. Classic EMG change in Lambert-Eaton Syndrome
    Dramatic decrease in amplitude of motor action potentials with repeated stimulation
  1810. What illness is Acute Inflammatory Demyelinating Polyneuropathy (AIDP) a severe form of?
    Guillain-Barré Syndrome
  1811. Nerve Conduction Study findings in Guillain-Barré Syndrome (3)
    • 1. Loss of H Reflex
    • 2. Decreased nerve conduction velocities
    • 3. Prolonged F-wave latency
  1812. Neurological illness causing atrophy/thinning of the Corpus Callosum
    Multiple Sclerosis
  1813. Is it ethical for psychiatrists to participate in executions?
    No!
  1814. Is it ethical to accept commission for patient referrals?
    No!
  1815. 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
  1816. What concept was developed by Skinner?
    Operant Conditioning
  1817. What form of conditioning involves positive and negative reinforcement?
    Operant Conditioning
  1818. What concept was developed by Bandura?
    Social Learning Theory
  1819. What is the concept underlying Social Learning Theory?
    People learn by social interaction and modeling others
  1820. What is the concept underlying Attribution Theory?
    People attribute their own behavior to situational causes, but the behavior of others to personality traits
  1821. What concept was developed by Hull?
    Drive Reduction theory of learning
  1822. What concept was developed by Seligman?
    Learned Helplessness
  1823. What is Learned Helplessness?
    Learning that no behavioral change can affect the environment
  1824. What concepts were developed by Kandel?
    Habituation and Sensitization Theories
  1825. What is the concept underlying Habituation Theory?
    An organism can learn to stop responding to a repeated stimulus
  1826. What is the concept underlying Sensitization Theory?
    An organism can be taught to respond more easily to a stimulus
  1827. What types of seizures can Valproic Acid treat? (3)
    • 1. Partial complex
    • 2. Primary generalized
    • 3. Absence
  1828. When is Diazepam used in seizures?
    Emergencies, eg status epilepticus
  1829. Are attacks of sleep in narcolepsy refreshing?
    Yes!
  1830. How often must sleep attacks occur for diagnosis of narcolepsy?
    3 months
  1831. Sleep changes associated with depressed mood (2)
    • 1. Early morning waking
    • 2. Difficulty staying asleep
  1832. Neurotransmitter associated with onset of aggression
    Dopamine
  1833. Neurotransmitters associated with decreased aggression (3)
    • 1. Serotonin
    • 2. GABA
    • 3. Norepinephrine
  1834. What medication induces its own metabolism?
    Carbamazepine
  1835. Best way to prevent a behavior from extinction
    Intermittent and variable positive reinforcement
  1836. How is extinction of a behavior effected?
    Conditioned stimulus is repeated without the unconditioned stimulus until the response disappears
  1837. In conditioning, what is Generalization?
    Transfer of a conditioned response from one stimulus to another
  1838. In conditioning, what is Discrimination?
    Recognizing and responding to differences between similar stimuli
  1839. What is Respondent Conditioning?
    Another term for Classical Conditioning
  1840. Classic neurologic features of Tuberous Sclerosis (3)
    • 1. Seizures
    • 2. Mental retardation
    • 3. Behavioral problems
  1841. Tumors associated with Neurofibromatosis 1 (3)
    • 1. Optic glioma
    • 2. Schwannoma
    • 3. Neurofibroma
  1842. What chromosome contains the NF1 gene (responsible for Neurofibromatosis 1)?
    Chromosome 17
  1843. What chromosome contains the NF2 gene (responsible for Neurofibromatosis 2)?
    Chromosome 22
  1844. What protein is affected in Williams Syndrome?
    Elastin
  1845. Mechanism of action of Tacrine
    Cholinesterase inhibitor
  1846. Mechanism of action of Galantamine
    Cholinesterase inhibitor
  1847. Mechanism of action of Rivastigmine
    Cholinesterase inhibitor
  1848. What does the Trail-Making Test evaluate?
    Executive function
  1849. What does the Wisconsin Card Sorting Test evaluate?
    Executive function
  1850. 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
  1851. What does the Halstead-Reitan Battery evaluate? (2)
    • 1. Presence or absence of neurological damage
    • 2. Location of lesions in brain
  1852. 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
  1853. Average age of puberty for boys
    13
  1854. Average age of puberty for girls
    11
  1855. FSH and LH levels in adolescence
    Increase throughout teenage years, above normal adult levels around ages 17-18
  1856. Contraindications for triptans (2)
    • 1. Coronary artery disease
    • 2. HTN
    • (Triptans have a risk of vasospasm causing MI)
  1857. 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
  1858. Medications and other substances that decrease TCA levels by altering p450 (5)
    • 1. Cigarette smoking
    • 2. Ascorbic acid
    • 3. Lithium
    • 4. Barbiturates
    • 5. Primidone
  1859. Most common method of suicide by adolescents
    Self-inflicted gunshot wound
  1860. What age group has recently had an increase in suicide?
    Adolescents
  1861. Highest risk period for suicide in men
    After age 45
  1862. Highest risk period for suicide in women
    After age 55
  1863. What race are most likely to commit suicide?
    Caucasian
  1864. What social status are most likely to commit suicide?
    High social status (direct relation between social status and suicide rate!)
  1865. What therapy did Marsha Linehan develop?
    DBT
  1866. Effect of first generation antipsychotics and risperidone on pituitary microadenomas
    Block dopamine and increase prolactin levels, causing volume of the adenoma to increase
  1867. Treatment of enlarging pituitary microadenoma in the setting of antipsychotic use (2)
    • 1. Stop the antipsychotic
    • 2. (possibly) give bromocriptine
  1868. What is "Amok"?
    • Malaysian cultural syndrome
    • Sudden rampage of suicide and homicide ending in exhaustion and amnesia
  1869. What is "Koro"?
    • Asian cultural syndrome
    • Delusion that the penis will disappear into the abdomen, causing death
  1870. What is "Piblokto"?
    • Inuit cultural syndrome occurring in women
    • Anxiety, depression, confusion, depersonalization, and deprealization
    • Ends in stuporous sleep and amnesia
  1871. What is "Wihtigo"?
    • Native American cultural syndrome
    • Delusional fear of being turned into a cannibal by being possessed by a supernatural monster
  1872. What is "Mal de Ojo"?
    • Mediterranean cultural syndrome
    • Belief that vomiting, fever, and restless sleep are caused by "the evil eye"
  1873. What is Hoffman's Sign?
    • Thumb adducts when the index or middle finger is flicked downward
    • Upper motor neuron sign
  1874. What is Meyerson's Sign?
    Blinking when the forehead is tapped that does not extinguish after several taps
  1875. How does excitotoxicity cause cell death?
    Causes excessive intracellular calcium and nitric oxide
  1876. 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
  1877. What brainstem reflexes may be present for diagnosis of brain death?
    None!
  1878. Must eyes be open or closed for diagnosis of brain death?
    Either!
  1879. What EEG activity may be present for diagnosis of brain death?
    Positive activity may be present
  1880. How is diazepam cleared?
    Hepatic
  1881. Neurotransmitters associated with anxiety (3)
    • 1. Norepenephrine
    • 2. Serotonin
    • 3. GABA
  1882. Concern with Myesthenia Gravis in pregnancy
    Anti-nicotinic adrenergic receptor antibodies cross placenta, causing symptoms in the baby at birth
  1883. What class of medication is Azathioprine?
    Immunosuppressant
  1884. Tests to diagnose Myasthenia Gravis (3)
    • 1. EMG
    • 2. Edrophonium test
    • 3. Nerve conduction study (decrementing on repeated muscle stimulation)
  1885. 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
  1886. Where is muscle weakness usually greatest in Duchenne Muscular Dystrophy?
    Proximally
  1887. Reflex preserved in Duchenne Muscular Dystrophy
    Achilles reflex
  1888. Lab finding in Duchenne Muscular Dystrophy
    CPK
  1889. Antidepressants that are sedating (3)
    • 1. TCAs
    • 2. Trazodone
    • 3. Mirtazapine
  1890. Most sedating TCAs (3)
    • 1. Amitriptyline
    • 2. Trimipramine
    • 3. Doxepin
  1891. Least sedating TCAs (2)
    • 1. Desipramine
    • 2. Protriptyline
  1892. What is fetishism?
    • Sexual arousal from an inanimate object
    • Must occur for at least 6 months for diagnosis
  1893. What is Jaw Claudication?
    • Tiredness on chewing
    • Classic sign of Temporal Arteritis
  1894. Who pioneered the concept that mental disorders have different outcomes?
    Kraepelin
  1895. Who first differentiated between schizophrenia and bipolar disorder?
    Kraepelin
  1896. Who coined the term Schizophrenia?
    Bleuler
  1897. What theory did Winnicott help develop?
    Object Relations
  1898. What concepts did Winnicott develop? (2)
    • 1. "Good enough mothering"
    • 2. Transitional object
  1899. What theory did Kohut help develop?
    Self Psychology (specifically with narcissism)
  1900. What is the more common name of Briquet's Syndrome?
    Hypochondriasis
  1901. When in the year do Cluster Headaches tend to occur?
    Spring and Fall
  1902. 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
  1903. When in the day do Cluster Headaches occur?
    Night time
  1904. Effect of EtOH on Cluster Headaches
    Triggers headaches
  1905. Cause of a headache in which the patient moves their head or paces rather than sitting still
    Cluster Headache
  1906. Effect of Bupropion on weight
    Causes weight loss
  1907. Effect of Bupropion on blood pressure
    Elevates BP, but does *not* cause hypertensive crises and is *not* contraindicated in patients with HTN
  1908. Effect of Venlafaxine on blood pressure
    • Can cause hypertension
    • In some cases, can cause a hypertensive crisis
  1909. What anesthesia can not be given with an MAOI?
    Spinal anesthetics with epinephrine
  1910. What drug of abuse causes peripheral neuropathy?
    Inhalants
  1911. Medications that increase TCA levels (8)
    • 1. Methylphenidate
    • 2. Antipsychotics
    • 3. Acetazolamide
    • 4. Aspirin
    • 5. Cimetidone
    • 6. Thiazides
    • 7. Fluoxetine
    • 8. Sodium bicarbonate
  1912. Effect of smoking on TCA levels
    Lowers levels
  1913. Medications that lower TCA levels (4)
    • 1. Ascorbic acid
    • 2. Lithium
    • 3. Barbiturates
    • 4. Primidone
  1914. SSRI with longest half-life
    Fluoxetine (1-2 weeks)
  1915. SSRI with shortest half-life
    Fluvoxamine (15 hours)
  1916. Half-life of most SSRIs
    About 1 day
  1917. Findings on muscle biopsy in Dermatomyositis (2)
    • 1. Perifascicular atrophy
    • 2. "Ghost" fibers
  1918. EMG findings in Dermatomyositis (2)
    • 1. Myopathy
    • 2. Muscle irritabililty
  1919. Symptoms of Water Intoxication (7)
    • 1. Tremor
    • 2. Ataxia
    • 3. Restlessness
    • 4. Diarrhea
    • 5. Vomiting
    • 6. Polyuria
    • 7. Stupor (eventually)
  1920. Type of schizophrenia with the latest onset
    Paranoid Schizophrenia
  1921. Form of schizophrenia with the least cognitive decline and least emotional blunting
    Paranoid Schizophrenia
  1922. Type of schizophrenia with earliest onset
    Disorganized Schizophrenia
  1923. Rate of catatonia in Disorganized Schizophrenia
    Low
  1924. Presentation of Disorganized Schizophrenia
    • Primitive, disinhibited, disorganized behavior
    • Prominent thought disorder, poor contact with reality
  1925. What is Residual Schizophrenia?
    • Schizophrenic disturbance without a complete set of active symptoms
    • Not enough symptoms to qualify as another type of Schizophrenia
  1926. Prognosis of schizophrenia with late onset
    Good
  1927. Prognosis of schizophrenia with clear precipitating factors
    Good
  1928. Prognosis of schizophrenia with acute onset
    Good
  1929. Prognosis of schizophrenia with mood symptoms
    Good
  1930. Prognosis of schizophrenia with family history of mood disorders
    Good
  1931. Prognosis of schizophrenia with positive symptoms
    Good
  1932. Prognosis of schizophrenia with early onset
    Poor
  1933. Prognosis of schizophrenia with insidious onset
    Poor
  1934. Prognosis of schizophrenia with withdrawn/autistic behavior
    Poor
  1935. Prognosis of schizophrenia with neurological symptoms
    Poor
  1936. Prognosis of schizophrenia with negative symptoms
    Poor
  1937. EEG appearance of Hepatic Encephalopathy
    Bilateral triphasic slow waves
  1938. What illness does a mutation in Presenilin 1 or 2 increase risk for?
    Alzheimer Disease
  1939. Cause of increased risk of Alzheimer Disease in Down Syndrome
    Overexpression of the Amyloid Precursor Protein gene
  1940. Duration of disturbance for diagnosis of PTSD
    1 month or longer
  1941. Symptoms that signify that grief is not normal grief (5)
    • 1. Suicidality
    • 2. Hallucinations
    • 3. Excessive guilt
    • 4. Psychomotor retardation
    • 5. Thoughts of worthlessness
  1942. Most consistent neuropathology finding in schizophrenia
    Enlarged ventricles, especially lateral ventricles
  1943. Brain regions where pathologic findings are present in schizophrenia (3)
    • 1. Thalamus
    • 2. Dorsolateral prefrontal cortex
    • 3. Hippocampus
  1944. 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
  1945. Why should EKGs be ordered in Anorexia?
    Hypokalemic, hypochloremic alkalosis can cause arrhythmia
  1946. Is impaired daily functioning required for diagnosis of Delusional Disorder?
    No!
  1947. Are mood symptoms present in Delusional Disorder?
    No!
  1948. Can bizarre delusions be present for diagnosis of Delusional Disorder?
    No!
  1949. Effect of age on incidence of female orgasm
    Incidence increases with age
  1950. Do patients with Avoidant Personality Disorder desire relationships?
    Yes! They avoid relationships due to fear of rejection, not out of lack of interest
  1951. Facial changes caused by Dilantin/Phenytoin (3)
    • 1. Hirsuitism
    • 2. Facial dysmorphism
    • 3. Gingival hypertrophy
  1952. 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
  1953. Significant side effects of Valproic Acid (5)
    • 1. Leukopenia
    • 2. Liver failure
    • 3. PCOS
    • 4. Weight gain
    • 5. Hair loss
  1954. Side effect of levitiracetam
    Agitation/hyperactivity (rare)
  1955. Duration of "Saturday Night Palsy"
    Resolves in 1-2 months
  1956. Sites where the Ulnar Nerve can be entrapped (2)
    • 1. Elbow (cubital tunnel)
    • 2. Wrist
  1957. What muscles become weak if the Ulnar Nerve is compressed?
    Hand flexors
  1958. What is Phalen's Maneuver?
    • Flexion of the hand at the wrist for 1 minute
    • Causes paresthesia in carpal tunnel syndrome
  1959. 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
  1960. Symptom of nerve injury due to forward traction of the shoulder
    • Denervation of infraspinatus and supraspinatus muscles
    • Aching pain of the posterior shoulder
  1961. Duration of sleep disturbance to diagnose Primary Insomnia or Primary Hypersomnia
    1 month or more
  1962. Symptoms of Primary Hypersomnia
    Excessive sleepiness causing prolonged nighttime sleeping or daily sleep episodes during the day
  1963. What medication is used for Catapexy?
    Xyrem (sodium oxybate)
  1964. What symptoms can be present for Conversion Disorder?
    Neurological symptoms that are not limited to either pain or sexual function
  1965. What class of psychiatric medications is contraindicated if Levodopa/Carbidopa is being given?
    MAOIs
  1966. What does a child learn during Piaget's Concrete Operations Stage?
    To deal with information outside himself and to see things from others' perspectives
  1967. 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
  1968. What is Reversibility (according to Piaget)?
    • Idea that things that change form/shape can change back again
    • Developed in the Concrete Operations Stage
  1969. Age at which infants begin to explore their genitalia
    15 months
  1970. When do sexual curiosity and sex play begin?
    Typically before puberty
  1971. Conditions typically comorbid in Fragile X Syndrome (2)
    • 1. ADHD
    • 2. Learning disorders
  1972. Second-most common cause of Intellectual Disabililty
    Fragile X Syndrome
  1973. Age at which a child with normal attachment can tolerate its mother's absence without distress
    25 months
  1974. Age at which a normally-attached child would use a transitional object in place of the mother
    18 months
  1975. Period of life during which appearance would affect self-esteem the most
    Adolescence
  1976. Life period in which friend relationships become more important than family relationships
    Adolescence
  1977. Enzyme that metabolizes Tyramine in the GI tract
    MAO-A
  1978. Illicit drug associated with decreased cerebral blood flow
    Cocaine
  1979. Mechanism of action of Pergolide
    Dopamine agonist
  1980. Mechanism of action of Bromocriptine
    Dopamine agonist
  1981. Neurotransmitter affected more by Typical than by Atypical Antipsychotics
    Dopamine (antagonized by Typicals)
  1982. Atypical Antipsychotic with dopamine antagonist characteristics
    Quetiapine (Seroquel)
  1983. Mechanism of Buspar/Buspirone
    5-HT 1A partial agonist
  1984. Personality effects of damage to the Orbitofrontal region (5)
    • 1. Disinhibition
    • 2. Irritability
    • 3. Euphoria
    • 4. Poor judgement
    • 5. Distractibility
  1985. Personality effects of damage to the Dorsolateral Frontal region
    Executive deficits
  1986. Personality effects of damage to the Medial Frontal region
    Apathy syndrome
  1987. Which atypical antipsychotic inhibits reuptake of serotonin and norepinephrine?
    Geodon (Ziprasidone)
  1988. What receptors does Ziprasidone (Geodon) antagonize? (5)
    • 1. 5-HT-1D
    • 2. 5-HT-2A
    • 3. 5-HT-2C
    • 4. D2
    • 5. D3
  1989. Which atypical anipsychotic is a partial agonist of the D2 receptor?
    Abilify (aripiprazole)
  1990. Which atypical antipsychotics are partial agonists of the 5HT-1A receptor? (3)
    • 1. Abilify (aripiprazole)
    • 2. Geodon (ziprasidone)
    • 3. Clozeril (clozapine)
  1991. Which atypical antipsychotic is an antagonist of the 5HT-2A receptor?
    Abilify (Aripiprazole)
  1992. 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
  1993. Effect of activation of the left prefrontal cortex
    Mood is lifted
  1994. Effect of activation of the right prefrontal cortex
    Mood is depressed
  1995. Neurotransmitter released from the Ventral Tegmental Area
    Dopamine
  1996. Neurotransmitter released from Substantia Nigra
    Dopamine
  1997. Neurotransmitter released from Nucleus Accumbens
    Dopamine
  1998. What chromosome is affected in Wilson's Disease?
    Chromosome 13
  1999. Site of most copper deposition in the brain in Wilson's Disease
    Basal Ganglia
  2000. Screening test for Sarcoidosis
    Serum Angiotensin Converting Enzyme (ACE) level
  2001. Brain region that mediates the effects of opiates
    Locus ceruleus
  2002. Therapeutic focus of Motivational Enhancement Therapy
    Ambivalence (eg toward remaining clean from substance use)
  2003. Psychological test with the highest reliability
    WAIS
  2004. According to Freud, what drives motivate behavior? (2)
    • 1. Libido
    • 2. Aggression
  2005. According to Freud, what does the "Source" of a drive refer to?
    Region in the body where the drive originates
  2006. According to Freud, what does the "Impetus" of a drive refer to?
    Intensity of the drive
  2007. According to Freud, what does the "Aim" of a drive refer to?
    Action that discharges tension from the drive
  2008. According to Freud, what does the "Object" of a drive refer to?
    Target of actions that discharge the drive's tension
  2009. Most common cause of intracerebral hemorrhage
    Hypertension
  2010. Most common sites of hemorrhage in the cerebrum (2)
    • 1. Putamen (most common)
    • 2. Thalamus
  2011. What form of treatment did Beck develop?
    CBT
  2012. 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
  2013. CD4 count at which cryptococal meningitis occurs in an HIV patient
    200 or fewer
  2014. Cause of clear CSF with leukocytosis (mostly lymphocytes), ↑ protein, and ↑ opening pressure
    Cryptococcal meningitis
  2015. CSF testing for Cryptococcal Meningitis (2)
    • 1. India ink stain
    • 2. Cryptococcal antigen assay
  2016. Drug of choice for CNS fungal infections
    Amphotercin B
  2017. Major side effect of Amphotercin B
    Renal toxicity (occurs in 80%)
  2018. What is Point Prevalence?
    Number of people with a disorder at a specific point in time
  2019. Percent of normal body weight below which anorexia is diagnosed
    85%
  2020. How long after use is PCP detectable in urine?
    8 days
  2021. How long after use is marijuana detectable in urine?
    4 weeks
  2022. How long after use is cocaine detectable in urine?
    8 hours
  2023. How long after use is heroin detectable in urine?
    72 hours
  2024. Hematopoetic changes from Carbamazapine (4)
    • 1. ↓WBCs
    • 2. Agranulocytosis
    • 3. Pancytopenia
    • 4. Aplastic anemia
  2025. Effects of schizophrenia on eye movements (2)
    • 1. Disordered smooth pursuit
    • 2. Disinhibition of saccadic eye movements
  2026. Can Borderline Personality Disorder cause psychotic episodes?
    Yes! They are brief and occur when emotionally unstable
  2027. What type of mental illness is most common?
    Anxiety disorders
  2028. Mental illnesses often comorbid with Pathological gambling (3)
    • 1. Mood disorders
    • 2. Panic disorder (with or without agoraphobia)
    • 3. OCD
  2029. Type of schizophrenia with the most cognitive decline
    Disorganized Schizophrenia
  2030. How is Pathological Gambling categorized in the DSM?
    Type of Impulse Control Disorder
  2031. What is Derealization?
    Subjective feeling that the environment is strange/unreal
  2032. What is Depersonalization?
    Person's sense that they themselves are unreal or unfamiliar
  2033. Drug of abuse that can cause persistent dementia
    Inhalants
  2034. Effect of temperature on Multiple Sclerosis
    Increased core temperature can bring on or worsen symptoms
  2035. What is Russel's Sign?
    Cuts/scrapes on the backs of the hands due to self-induced vomiting
  2036. Characteristic symptom of Ampehtamine-Induced Psychosis
    Paranoia
  2037. Timing of Acute Stress Disorder
    • Begins within 4 weeks of a traumatic event
    • Lasts 2 days to 4 weeks
  2038. In ethical terms, what does Justice mean?
    Fair distribution of services
  2039. Onset of Tourette's Disorder
    • Usually around age 7
    • Can be as early as age 2
  2040. Progression of motor tics in Tourette's Disorder
    Start in the face/head and progress down the body
  2041. What group of psychiatric patients are most likely to become violent?
    Substance abusers
  2042. 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
  2043. Management of a Borderline patient with past suicide attempts who is performing any type of self-harm
    Recommend inpatient admission
  2044. Management of a Borderline patient who is becoming psychotic
    Recommend inpatient admission
  2045. Effect of SSRIs on heart attacks
    • Protective!
    • Platelet serotonin receptors reduce aggregation
  2046. Most common neurocutaneous disease
    Neurofibromatosis Type 1 (NF1)
  2047. 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
  2048. Presentation of Ketamine intoxication
    • Beligerent, impulsive, impaired judgement
    • Psychomotor agitation
  2049. Physical effects of Ketamine (5)
    • 1. Nystagmus
    • 2. HTN
    • 3. Ataxia
    • 4. Dysarthria
    • 5. Muscle rigidity
  2050. Duration of psychosis after taking Ketamine
    Usually only during intoxication, but can persist for up to 2 weeks after intoxication (!)
  2051. Presentation of intoxication with inhalants (4)
    • 1. Beligerent/assaultive
    • 2. Apathetic
    • 3. Impaired judgement
    • 4. Euphoria
  2052. Physical effects of Inlalants (6)
    • 1. Nystagmus
    • 2. Impaired coordination/unsteady gait
    • 3. Lethargy
    • 4. Tremor
    • 5. Psychomotor retardation
    • 6. Muscle weakness
  2053. How did Jung believe that a personality develops?
    Experiences teach a person who they intrinsically are
  2054. According to Jung what does libido include?
    • Sexual energy
    • Spiritual urges
    • Drive to understand the meaning of life
  2055. What did Henry Stack Sullivan study?
    Social interactions and how they shape development of a personality
  2056. What ages go through Trust vs. Mistrust?
    Birth to 1 year
  2057. What ages go through Autonomy vs. Shame and Doubt?
    1-3
  2058. What ages go through Initiative vs. Guilt?
    3-5
  2059. What ages go through Industry vs. Inferiority?
    6-11
  2060. What ages go through Ego Identity vs. Role Confusion?
    11 to end of adolescence
  2061. What ages go through Intimacy vs. Isolation?
    20-40
  2062. What ages go through Generativity vs. Stagnation?
    40-65
  2063. What ages go through Ego Identity vs. Despair?
    65+
  2064. What is the effect of developing trust as an infant?
    Develop self-confidence
  2065. Which of Erikson's stages includes learning to walk and feed oneself?
    Autonomy vs. Shame and Doubt
  2066. What would cause Shame instead of Autonomy, according to Erikson?
    Excessive punishment
  2067. What would cause Self-Doubt instead of Autonomy, according to Erikson?
    Being made to feel ashamed of actions
  2068. 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
  2069. What is the task of Intimacy vs. Isolation?
    Forming life-long attachments and self-abandonment
  2070. What would cause Isolation instead of Intimacy, according to Erikson?
    Viewing others as dangerous
  2071. What would cause Stagnation instead of Generativity, according to Erikson?
    Isolation, excessive self-concern, and absence of intimacy
  2072. Which terminal of a G-protein is intracellular, and which is extracellular?
    • NH2 terminal is extracellular
    • COOH terminal is intracellular
  2073. Substrates of a Tyrosine Kinase receptor (2)
    • 1. Nerve growth factor (NGF)
    • 2. Brain derived neurotrophic factor (BDNF)
  2074. Classic complication of rapid sodium replacement in hyponatremia
    • Central pontine myelinosis
    • Can cause transection of the pons, leading to locked-in syndrome
  2075. 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
  2076. What are the Narcissistic Defenses? (3)
    • 1. Denial
    • 2. Distortion
    • 3. Projection
  2077. What are the Mature Defenses? (6)
    • 1. Altruism
    • 2. Anticipation
    • 3. Asceticism
    • 4. Humor
    • 5. Sublimation
    • 6. Suppression
  2078. Cause of waxing and waning headache with intermittent visual changes
    Pseudotumor cerebri (intermittent intracranial hypertension)
  2079. What population makes up the National Alliance for the Mentally Ill (NAMI)?
    Family members of the mentally ill
  2080. How many headaches must occur for diagnosis of Migraine Without Aura?
    5 (each lasting 4-72 hours)
  2081. 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
  2082. Aura features that would establish diagnosis of Migraine with Typical Aura (4)
    • 1. Homonymous visual changes
    • 2. Unilateral numbness
    • 3. Unilateral weakness
    • 4. Aphasia
  2083. Lifetime prevalence of schizophrenia
    1%
  2084. How long after a stroke can tPA be given?
    3 hours
  2085. Scale given to determine presence of neurologic deficit when evaluating for tPA administration
    NIH Stroke Scake
  2086. Can tPA be given if a stroke co-occurs with a seizure?
    No!
  2087. Can tPA be given to a patient with prior intracranial hemorrhage?
    No!
  2088. Blood pressure at which tPA can not be given
    Over 185/110
  2089. How long after a head injury can tPA be given?
    3 months
  2090. How long after a prior stroke can tPA be given?
    3 months
  2091. How long after GI or urinary bleeding can tPA be given?
    3 weeks
  2092. Blood glucose range at which tPA can be given
    50-400
  2093. INR above which tPA can not be given
    1.7
  2094. How long after heparin use can tPA be given?
    48 hours
  2095. Platelet count below which tPA can not be given
    100,000
  2096. How long after an arterial puncture (at non-compressible site) can tPA be given?
    7 days
  2097. What is the only medication FDA approved to treat Restless Legs Syndrome?
    Ropinorole (Requip) (dopamine agonist)
  2098. Classes of medication that can treat Restless Legs Syndrome (4)
    • 1. Dopamine agonists
    • 2. Benzodiazepines
    • 3. Opiates
    • 4. Gabapentin
  2099. Prevalence rate of Restless Legs Syndrome
    5%
  2100. What age group gets Restless Legs Syndrome?
    Middle-aged or older-aged
  2101. Pattern of inheritance of Restless Legs Syndrome
    Autosomal Dominant
  2102. CSF finding associated with higher levels of aggression
    Low serotonin level
  2103. Effect of dopamine on aggression
    Increased aggression
  2104. Effect of norepinephrine on aggression
    Decreased aggression
  2105. Effect of serotonin on aggression
    Decreased aggression
  2106. Effect of GABA on aggression
    Decreased aggression
  2107. Enzyme that is deficient in Metachromatic Leukodystrophy
    Arylsolfatase A (ASA)
  2108. Chromosome affected in Metachromatic Leukodystrophy
    22
  2109. Early manifestation of Metachromatic Leukodystrophy in children
    Lower limb hypotonia (causes areflexia, poor gait)
  2110. Early manifestation of Metachromatic Leukodystrophy in adults
    Dementia with behavior problems
  2111. Most common diagnostic tests for Metachromiatic Leukodystrophy (3)
    • 1. MRI
    • 2. Urine sulfatide levels (increased)
    • 3. Leukocyte ASA enzyme assay
  2112. Treatment of Metachromatic Leukodystrophy
    Bone marrow transplant
  2113. Physical exam finding in Tay Sachs Disease
    Hypersensitive to loud noise, hyperactive startle response
  2114. What enzyme is deficient in Tay Sachs Disease?
    Hexosaminidase A
  2115. What chromosome carries the affected gene in Tay Sachs Disease?
    15
  2116. Enzyme deficiency causing Krabbe's Disease (Globoid Cell Leukodystrophy)
    Galactocerebrosidase β-galactosidase
  2117. Inheritance pattern of Krabbe's Disease (Globoid Cell Leukodystrophy)
    Autosomal recessive
  2118. What chromosome carries the affected gene in Krabbe's Disease?
    14
  2119. Pathology findings in Krabbe's Disease (Globoid Cell Leukodystrophy) (2)
    • 1. Multinucleated macrophages in white matter
    • 2. Demyelination in both CNS and PNS
  2120. 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
  2121. Treatment of Krabbe's Disease (Globoid Cell Leukodystrophy)
    Stem cell transplantation
  2122. 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
  2123. Age at which the Parachute Response disappears
    After 6 months
  2124. Age at which the Moro Reflex disappears
    6 months
  2125. Age at which the Tonic Neck Reflex disappears
    3 months
  2126. Age at which the Grasp Reflex disappears
    6 months
  2127. Age at which the Rooting Reflex disappears
    6 months
  2128. What is Pseudocyesis?
    False belief that one is pregnant
  2129. Illnesses that fall under Somatoform Disorder NOS (2)
    • 1. Pseudocyesis
    • 2. Symptoms that do not meet time criteria for other diagnoses
  2130. Criteria for Somatization Disorder (4)
    • 1. 4 Pain symptoms
    • 2. 2 GI symptoms
    • 3. 1 Sexual symptom
    • 4. 1 Pseudoneurological symptom
  2131. Most common infectious agent causing retinopathy in AIDS
    CMV
  2132. Prevalence of narcolepsy
    3-6 per 10,000
  2133. What biochemical system is affected in narcolepsy?
    Hypocretin (orexin) peptide system
  2134. What is Alexithymia?
    Difficulty in recognizing and describing one's emotions
  2135. What is Stilted Speech?
    Formal, stiff speech pattern
  2136. 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)
  2137. How should the airway be managed in status epilepticus?
    Can use external protection and give oxygen by nasal cannula
  2138. Why is Geodon effective in depression?
    Inhibits serotonin and norepinephrine reuptake
  2139. Atypical antipsychotic with the highest risk of EPS
    Risperdal
  2140. Why does Seroquel have low risk of EPS?
    Low affinity for the D2 receptor
  2141. Receptors for which Seroquel has high affinity (5)
    • 1. 5-HT-2
    • 2. 5-HT-6
    • 3. H1
    • 4. α1
    • 5. α2
  2142. Major side effects of Clozaril (2)
    • 1. Agranulocytosis
    • 2. Seizures
  2143. Treatment of urinary retention due to anticholinergic side effects of antipsychotics
    Urecholine (Bethanechol)
  2144. What antiepileptic has the broadest spectrum of seizure coverage?
    Valproic acid
  2145. Mechanism of action of Valproic Acid (Depakote)
    • 1. Enhances GABA
    • 2. Blockade of voltage-gated sodium channels
  2146. Effect of phenytoin on absence seizures
    None
  2147. Mechanism of action of Phenytoin (Dilantin)
    Blockade of voltage-gated sodium channels
  2148. Effect of oxcarbazepine on absence seizures
    Worsens seizures
  2149. Effect of carbamazepine on absence seizures
    Worsens seizures
  2150. Indication for ethosuximide
    Uncomplicated absence seizures
  2151. Mechanism of action of Ethosuximide
    Lowers voltage-gated calcium conduction in the thalamus
  2152. 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
  2153. Which motor root mediates dorsiflexion?
    L5
  2154. Which motor root mediates extension of the big toe?
    L5
  2155. Which motor root mediates foot extension?
    S1
  2156. Which motor roots mediate leg extension?
    L3 and L4
  2157. Which motor roots mediate hip flexion? (3)
    • L1
    • L2
    • L3
  2158. Tricyclics whose strong antihistamine properties can treat gastric ulcer (3)
    • 1. Amitriptyline
    • 2. Doxepin
    • 3. Trimipramine
  2159. What occurs during Piaget's Sensorimotor Stage? (3)
    • 1. Learn by responding to environmental stimuli
    • 2. Develop object permanence
    • 3. Begin to understand symbols
  2160. 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)
  2161. 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
  2162. What occurs during Piaget's Formal Operations Stage?
    Think abstractly and reason deductively
  2163. Motor deficit caused by Anterior Cerebral Artery stroke
    • Contralateral
    • Affects leg more than arm
    • Affects the face
  2164. Where is Norepinephrine made?
    Locus Ceruleus
  2165. Where is Serotonin made?
    Dorsal Raphe nuclei
  2166. Where is Dopamine made?
    Substantia Nigra
  2167. Where is Acetylcholine made?
    Nucleus Bsalis of Meynert
  2168. Sites where a lacunar stroke would cause pure motor hemiparesis (3)
    • 1. Internal capsule
    • 2. Basis pontis
    • 3. Corona radiata
  2169. Site where a lacunar stroke would cause pure sensory symptoms
    Ventroposterolateral nucleus of the thalamus
  2170. 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
  2171. Sites where a lacunar stroke would cause ataxic hemiparesis (2)
    • 1. Basis pontis
    • 2. Posterior limb of internal capsule
  2172. Site where a lacunar stroke would cause Dysarthria-Clumsy Hand Syndrome
    Basis pontis
  2173. Effects of M1 receptor stimulation (4)
    • 1. Constipation
    • 2. Blurred vision
    • 3. Dry mouth
    • 4. Drowsiness
  2174. Effects of Alpha 1 receptor stimulation (2)
    • 1. Dizziness
    • 2. Reduced blood pressure
  2175. What are the Biogenic Amine neurotransmitters? (6)
    • 1. Dopamine
    • 2. Epinephrine
    • 3. Norepinephrine
    • 4. Acethycholine
    • 5. Histamine
    • 6. Serotonin
  2176. What precursor are all catecholamine neurotransmitters synthesized from?
    Tyrosine
  2177. Mechanism of action of Reserpine
    • Blocks reuptake of biogenic amine neurotransmitters
    • Causes depletion of dopamine, serotonin, and norepinephrine
  2178. Effects of Reserpine on the body
    • Treats dystonia
    • Worsens depression and Parkinsonism
  2179. Medications that reduce CSF production (lowering intracranial pressure) (2)
    • 1. Mannitol
    • 2. Acetazolamide
  2180. In statistics, what is a Central Tendency?
    • Central value around which other values are distributed
    • Examples are mean, median, and mode
  2181. 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
  2182. First and second-most common sites of intracranial hemoorrage
    • 1. Putamen
    • 2. Lobar hemorrhage
  2183. Glasgow Coma Score at which intubation is indicated
    8 or less
  2184. Medication to reverse heparin
    Protamine sulfate
  2185. Tests of choice for SSPE (3)
    • 1. Lumbar puncture (assay for Rubeola)
    • 2. Brain biopsy
    • 3. EEG
  2186. Duration of symptoms for diagnosis of ADHD
    6 months
  2187. Inheritance pattern of Metachromatic Leukodystrophy
    Recessive
  2188. Enzyme deficiency in Gaucher's Disease
    β-glucosidase
  2189. Chromosome affected in Gaucher's Disease
    1
  2190. 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)
  2191. Duration of positive symptoms for diagnosis of schizophrenia
    1 month
  2192. Duration of negative symptoms for diagnosis of schizophrenia
    6 months, but must also have had positive symptoms for one of those months
  2193. 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
  2194. Duration of brief psychotic disorder
    Less than 1 month
  2195. Aura of a basilar migraine (6)
    • 1. Vertigo
    • 2. Dysarthria
    • 3. Tinnitus
    • 4. Speech defects
    • 5. Hallucinations
    • 6. May lose consciousness
  2196. Who gets Paroxysmal Hemicrania?
    • Women more than men
    • Begins early in life
  2197. Symptoms of Paroxysmal Hemicrania (2)
    • 1. Five or more unilateral periorbital/temporal headaches lasting 20 minutes each per day
    • 2. Ipsilateral autonomic features
  2198. CNS site thought to be the genesis of migraines
    Trigeminal Nucleus Caudalis (TNC)
  2199. Mechanism of action of Tolcapone
    • COMT inhibitor
    • Prevents peripheral degradation of levadopa
  2200. Medication class for treatment of tremor in Parkinson's Disease
    Anticholinergics
  2201. Cause of cell death in Spinal Muscular Atrophy
    Apoptosis
  2202. Cause of cell death in Parkinson's Disease
    Apoptosis
  2203. Cause of cell death in ALS
    Apoptosis
  2204. Cause of cell death in Alzheimer Disease
    Apoptosis
  2205. What class of medication is Amoxapine?
    Tetracyclic Antidepressant
  2206. What class of medication is Maprotiline?
    Tetracyclic antidepressant
  2207. 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
  2208. Unique property of Maprotiline among antidepressants
    Very selective inhibitor of norepinephrine reuptake
  2209. Side effects of Maprotiline
    • 1. Reduces seizure threshold
    • 2. Mildly sedative
    • 3. Mildly anticholinergic
  2210. Half life of Maprotiline
    Long! (43 hours)
  2211. Inheritance pattern of Sturge-Weber Syndrome
    Sporadic; not inherited!
  2212. Inheritance pattern of Von Hippel Lindau Syndrome
    Autosoman dominant
  2213. Chromosome containing a gene linked to Von Hippel Lindau Syndrome
    3
  2214. Sites of tumors in Von Hippel Lindau Syndrome (3)
    • 1. Retina (hemangioblastoma)
    • 2. CNS (hemangioblastoma)
    • 3. Viscera (cysts or tumors)
  2215. Ophthalmologic syndrome associated with Sturge-Weber Syndrome
    Glaucoma (can lead to blindness)
  2216. Most common CNS site of tumor in Von Hippel Lindau Syndrome
    Cerebellum
  2217. Most common site of visceral cysts in Von Hippel Lindau Syndrome
    Renal
  2218. Rare tumor that is common in Von Hippel Lindau Syndrome
    Pheochromocytoma (10-20%)
  2219. Enzyme that is deficient in Fabry's Disease
    α-galactosidase A
  2220. Heritability of Fabry's Disease
    X-Linked
  2221. Dermatologic manifestation of Fabry's Disease
    Asymptomatic red/purple papules around the umbilicus, hips, thighs, and scrotum
  2222. 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)
  2223. What is Reflex Sympathetic Dystrophy?
    Regional pain and sensory changes following a trauma
  2224. 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
  2225. Treatment of Reflex Sympathetic Dystrophy (4)
    • 1. Physical therapy
    • 2. Steroids
    • 3. Phenoxybenzamine (sympathetic antagonist)
    • 4. Anesthesia by regional block
  2226. Which enzymes of the p450 system are induced by Carbamazapine? (2)
    • 1. 2C19
    • 2. 3A4
  2227. Anti-infectious medications metabolized by 3A4 (3)
    • 1. Macrolide Antibiotics (-mycin)
    • 2. Cyclosporine
    • 3. HAART (Indinavir, Ritonavir, Saquamavir)
  2228. Psychiatric medications metabolized by 3A4 (5)
    • 1. Aripiprazole
    • 2. Buspar
    • 3. Haldol
    • 4. Trazodone
    • 5. Zolpidem
  2229. Antihypertensive medications metabolized by 3A4 (2)
    • 1. Calcium channel blockers (Diltiazem, Nifedipine, Amlodipine, Verapamil)
    • 2. Propranolol
  2230. Pain medications metabolized by 3A4 (2):
    • 1. Methadone
    • 2. Fentanyl
  2231. What type of hormones are metabolized by 3A4?
    Sex hormones (Estradiol, Progesterone, Testosterone, Tamoxifen)
  2232. What type of cholesterol medications are metabolized by 3A4?
    Statins
  2233. Psychiatric medications metabolized by 2C19 (4)
    • 1. Amitriptyline
    • 2. Citalopram
    • 3. Clomipramine
    • 4. Imipramine
  2234. Somatic medications metabolized by 2C19 (3)
    • 1. Warfarin
    • 2. Propranolol
    • 3. Primidone
  2235. What p450 enzyme breaks down Lamotrigine?
    1A4
  2236. Effect of Carbamazapine on Lamotrigine levels
    Induces 1A4, lowering lamotrigine levels
  2237. What p450 enzyme breaks down Clozapine?
    1A2
  2238. What is the Standard of Substituted Judgement?
    Standard that a surrogate decision maker will make decisions based on what the patient would have wanted
  2239. 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!
  2240. What course of action will the state take if no surrogate decision maker is found for a patient?
    Course that preserves human life
  2241. What p450 enzyme is induced by Tobacco smoking?
    1A2
  2242. Psychiatric medications metabolized by 1A2 (6)
    • 1. Amitriptyline
    • 2. Fluvoxamine
    • 3. Clozapine
    • 4. Haldol
    • 6. Imipramine
  2243. What p450 enzyme breaks down Risperdal?
    2D6
  2244. What p450 enzyme is induced by Dexamethasone?
    2D6
  2245. What p450 enzyme is induced by Rifampin?
    2D6
  2246. What psychiatric medications inhibit 2D6? (7)
    • 1. Wellbutrin
    • 2. SSRIs
    • 3. Clomipramine
    • 4. Doxepin
    • 5. TCAs
    • 6. Duloxetine
    • 7. Phenothiazine neuroleptics
  2247. When does Sheehan's Syndrome cause hypotension?
    When a pre-existing ACTH deficiency exists
  2248. Diagnosis of Sheehan Syndrome
    MRI or CT
  2249. Treatment of Sheehan Syndrome
    • Typically supportive
    • In some cases, corticosteroid replacement or surgical decompression
  2250. Test to diagnose Cushing's Syndrome
    Dexamethasone Suppression Test
  2251. Test if Subarachnoid Hemorrhage is suspected but CT is negative
    Lumbar puncture
  2252. Most common sites of aneurysm in anterior cerebral circulation (3)
    • 1. Anterior communicating artery
    • 2. Posterior communicating artery
    • 3. Trifurcation of the MCA
  2253. Most common sites of aneurysm in posterior cerebral circulation (2)
    • 1. Posterior inferior cerebellar artery
    • 2. Basilar artery (bifurcation)
  2254. Cognitive effects of Normal Pressure Hydrocephalus
    Apathy, abulia
  2255. Which antipsychotics can treat visual hallucinations in Lewy Body Dementia? (3)
    • 1. Seroquel
    • 2. Clozapine
    • 3. Ziprasidone
  2256. Sites of MRI abnormalities in Werkicke Encephalopathy (3)
    • 1. Periaqueductal grey
    • 2. Mamillary bodies
    • 3. Medial thalami
  2257. Behavioral manifestations of Syndenham Chorea (3)
    • 1. Irritability
    • 2. Obsessive-compulsive traits
    • 3. Restlessness
  2258. MRI finding in Syndenham Chorea
    Enlarged basal ganglia
  2259. Duration of symptoms for diagnosis of Cyclothymic Disorder
    2 months
  2260. Rate of Cyclothymic disorder, by gender
    Equal
  2261. Rate of Bipolar Disorde,r by gender
    Equal
  2262. Does BPAD more often present with mania or depression in women?
    Depression
  2263. 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
  2264. Effect of TCAs on Essential Tremor
    Can worsen
  2265. Surgical treatments for Essential Tremor (2)
    • 1. Thalotomy
    • 2. DBS of the thalamus
  2266. Duration of symptoms for diagnosis of MDD
    2 weeks
  2267. Rate of schizophrenia, by gender
    Equal
  2268. What chromosome is affected in Friedreich Ataxia?
    9
  2269. 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
  2270. Cause of death in Friedreich Ataxia
    Hypertrophic cardiomyopathy
  2271. Cardiac complication of Myotonic Dystrophy
    Fibrotic/infiltrative cardiomyopathy
  2272. What chromosome is affected in Myotonic Dystrophy?
    19 (trinucleotide repeat)
  2273. Finding on muscle biopsy in Myotonic Dystrophy
    Perifascicular muscle fiber atrophy
  2274. Cause of a "dive bomber" sound after muscle relaxation on EMG
    Myotonic dystrophy
  2275. What neurotransmitter is associated with producing REM sleep?
    Acetylcholine
  2276. Diagnosis of neurcystericosis (2)
    • 1. Parasites seen on MRI
    • 2. ELISA of serum or CSF
  2277. What illess is caused by Taenia Solium
    Cystericosis
  2278. What illness is caused by Echinococcus Granulosus?
    Tapeworm causing CNS echinococcosis
  2279. How are people infected by Taenia Solium?
    Consuming infected pork
  2280. How are people infected by Echinococcus Granulosus?
    Contact with dogs that are infected
  2281. MRI/Pathology findings of CNS Echinococcosis
    Solitary spherical cyst in the CNS without edema
  2282. Treatment of CNS Echinococcosis (2)
    • 1. Abendazole
    • 2. Surgical resection of a cyst (if abendazole fails)
  2283. Regimen for CNS Toxoplasmosis (3)
    • 1. Pyrimethamine
    • 2. Sulfadiazine
    • 3. Folinic Acid
  2284. Labs elevated in alchoholics (5)
    • 1. Gamma-Glutamyl Transferase (GGT)
    • 2. MCV
    • 3. Uric acid
    • 4. Triglycerides
    • 5. AST/ALT
  2285. What is Miller-Fisher Syndrome? (3+)
    • Variant of GBS causing:
    • 1. Ataxia
    • 2. Areflexia
    • 3. Ophtalmoplegia
  2286. What do IgG to Ganglioside GQ1b indicate?
    Miller-Fisher Syndrome
  2287. EMG findings in Miller-Fisher Syndrome (2)
    • 1. Reduced/absent SNAP amplitudes
    • 2. F-wave latencies are intact
  2288. What is Konrad Lorenz known for?
    Imprinting (got ducklings to imprint on him)
  2289. What is Imprinting?
    Young animals attaching to parents during early development
  2290. Most common organism causing Guillain Barré
    C. Jejuni
  2291. Caused of cell death due to excess Ca2+
    Production of NO causes excitotoxicity
  2292. Major function of IP3
    Cause release of CA2+ from the cell's ER
  2293. Is depression more common in cortical dementia or subcortical dementia?
    Subcortical Dementia
  2294. When do motor abnormalities occur in cortical dementia?
    Almost never
  2295. Dermatome that includes the back of the head
    C2
  2296. Dermatome that includes the thumb
    C6
  2297. Dermatome that includes the little finger
    C8
  2298. Dermatome that includes the middle finger
    C7
  2299. Dermatome that includes the groin
    L1
  2300. Dermatome that includes the lateral thigh
    L2
  2301. Dermatome that includes the medial thigh
    L3
  2302. Dermatome that includes the medial leg
    L4
  2303. Dermatome that includes the lateral leg
    L5
  2304. Dermatome that includes the big toe
    L5
  2305. Dermatome that includes the sole of the foot
    S1
  2306. Dermatome that includes the little toe
    S1
  2307. Receptors associated with Glutamate (3)
    • 1. AMPA
    • 2. NMDA
    • 3. Kainate
  2308. How long does Buspirone take to produce therapeutic effects?
    2-3 weeks
  2309. Inhibitors of 3A4 (6)
    • 1. Nefazodone
    • 2. Fluoxetine
    • 3. Calcium Channel Blockers
    • 4. Erythromycin
    • 5. Antifungals
    • 6. Grapefruit juice
  2310. What psychiatric medication's levels are increased by Buspar
    Haldol
  2311. Receptors affected by PCP (3)
    • 1. NMDA (antagonist)
    • 2. Calcium cannel (blocker)
    • 3. Dopmamine receptors
  2312. Treatment of behavioral abnormalities caused by PCP (2)
    • 1. Benzodiazapines
    • 2. Dopamine antagonists
  2313. 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
  2314. What is Introjection (ego defense)?
    Internalizing the qualities of an outside object (eg identifying with an aggressor)
  2315. What class of medication is Phenelzine
    MAOI
  2316. Effect of MAOIs on movement symptoms of Parkinson's Disease
    None
  2317. Effect of Amoxapine on the D2 receptor
    • Strong antagonistic properties
    • Is a derivative of the neuroleptic loxapine
  2318. What is the major contribution of Fromm?
    Defined 5 character types common in western culture
  2319. Finding of Dusky vs. United States
    A defendant must understand proceedings against them and be able to consult a lawyer with understanding
  2320. Percentage of patients whose depression recurs within 6 months
    25%
  2321. Percentage of patients whose depression recurs within 2 years
    30-50%
  2322. Percentage of patients whose depression recurs within 5 years
    50-75%
  2323. Duration of symptoms for diagnosis of dysthymia
    2 years
  2324. What is the Durham Rule?
    A defendant is not criminally responsible if the criminal act was due to a mental illness
  2325. Finding of O'Connor vs. Donaldson
    Harmless mentally ill patients can not be confined involuntarily without treatment
  2326. 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
  2327. Which TCAs are Tertiary Amines? (4)
    • 1. Imipramine
    • 2. Amitriptyline
    • 3. Clomipramine
    • 4. Trimipramine
  2328. Which TCAs are Secondary Amines? (3)
    • 1. Desipramine
    • 2. Nortriptyline
    • 3. Protriptyline
  2329. Result of metabolism of Tertiary Amine TCAs
    Converted to Secondary Amine TCAs
  2330. Effect of thalotomy on Parkinson Disease
    • Very effective for tremor and rigidity on the contralateral side
    • Does not affect bradykinesia
  2331. Site of DBS to treat tremor and rigidity in Parkinson Disease
    • Thalamus
    • Does not affect bradykinesia
  2332. Effect of pallidotomy in Parkinson Disease
    Improves dopa-induced dyskinesia and akinesia
  2333. Site of DBS to treat dopa-induced dyskinesia and akinesia in Parkinson Disease
    Globus Pallidus
  2334. Which antidepressant's metabolite antagonizes D2, causing Parkinsonism?
    Amoxapine
  2335. Effects of large right MCA stroke (6)
    • 1. Hemineglect
    • 2. Visual extinction
    • 3. Tactile extinction
    • 4. Loss of speech prosody
    • 5. Agnosognosia
    • 6. Confusion
  2336. What p450 enzyme breaks down Tricyclic Antidepressants
    2D6
  2337. What neuroleptics are Phenothiazines? (4)
    • 1. Chlorpromazine (Thorazine)
    • 2. Fluphenazine (Prolixin)
    • 3. Perphenazine
    • 4. Promethazine (Phenergan)
    • (other obscure neuroleptics ending in "-azine"
  2338. Somatic medications that are competitive substrates for 2D6 (3)
    • 1. Carbamazepine
    • 2. Propafenone
    • 3. Flecainide
  2339. What p450 enzyme is inhibited by cimetidine?
    2D6
  2340. What p450 enzyme is inhibited by quinidine?
    2D6
  2341. Differential diagnosis of isolated 3rd nerve palsy
    • Diabetes vs internal carotid artery aneurysm
    • If an aneurysm is present, the pupil is typically dilated
  2342. Treatment of tics in Tourette's Syndrome
    Neuroleptics, especially Haldol, Pimozide, or atypicals
  2343. Non-neuroleptic treatment of tics in Tourette's Syndrome
    Clonidine
  2344. Effect of antidepressants on tics in Tourette's Syndrome
    None
  2345. Symptoms of lesion of the Optic Radiations of the MCA
    Contralateral homonymous hemianopsia or inferior quadrantanopsia
  2346. Effect of Calcium influx into a neuron on neurotransmitters
    Promotes both synthesis and release
  2347. Which type of Monoamine Oxidase breaks down norepinephrine?
    MAO-A
  2348. Syndrome caused by deficit in Hypoxanthine-Guanine Phosphoribosyltransferase
    Lesch-Nyhan Syndrome
  2349. Symptoms of Ornithine Transcarbamylase Deficiency (3)
    • 1. Hyperammonemia
    • 2. Encephalopathy
    • 3. Respiratory Alkalosis
  2350. Treatment of Ornithine Transcarbamylase Deficiency
    Low protein diet with arginine supplementation
  2351. Inheritance of Ornithine Transcarbamylase Deficiency
    X-linked
  2352. Inheritance of Carbamylphosphate Synthase Deficiency
    Recessive
  2353. Symptoms of Carbamylphosphate Synthase Deficiency (3)
    • 1. Hyperammonemia
    • 2. Encephalopathy
    • 3. Respiratory Alkalosis
  2354. Types of Carbamylphosphate Synthase Deficiency (2)
    • 1. Type 1: Early onset, fatal form
    • 2. Type 2: Delayed-onset form
  2355. Symptom of Arginase Deficiency
    Hyperammonemia
  2356. Chromosome affected in Arginase Deficiency
    Chromosome 6
  2357. Symptoms of Adenylosuccinase Deficiency (4)
    • 1. Autism
    • 2. Growth retardation
    • 3. Psychomotor delay
    • 4. Seizures
  2358. Symptom profile of dementia following head trauma
    • Slowed processing
    • Deficits in executive functioning
  2359. Who is at increased risk of dementia if a head trauma occurs?
    ApoE carriers
  2360. Tricyclic antidepressant with the strongest antihistamine activity
    Doxepin
  2361. Standard of care for OCD treatment
    Either an SSRI or Clomipramine
  2362. Tricyclic antidepressant with the strongest serotonergic effects
    Clomipramine (hence it is useful for OCD)
  2363. What correlates most closely with time to clinical improvement on TCAs?
    Downregulation of serotonin and adrenergic receptors
  2364. Medications to treat enuresis (2)
    • 1. Tricyclic antidepressants
    • 2. Desmopression (DDAVP)
  2365. EKG changes caused by TCAs (4)
    • 1. Flattented T-waves
    • 2. Tachycardia
    • 3. QT prolongation
    • 4. ST depression
  2366. Major side effects of TCAs (3)
    • 1. Cardiac conduction abnormalities
    • 2. Orthostatic hypotension
    • 3. Anticholinergic effects
  2367. What is Therapeutic Graded Exposure?
    Similar to systematic desensitization, but relaxation techniques are not used during the exposures
  2368. What is Participant Modeling?
    Learning a new behavior by observation first, then eventually by doing it
  2369. What condition is Participant Modeling particularly helpful for?
    Agoraphobia
  2370. What is Abreaction?
    • Emotional release after recalling a painful event
    • Part in psychodynamic psychotherapy
  2371. What actions constitute Primary Gain?
    Seeking medical help, either because it is needed or because of enjoying the sick role
  2372. Intracranial factors that increase risk of ECT (4)
    • 1. Tumor
    • 2. Aneurysm
    • 3. Vascular malformation
    • 4. Increased intracranial pressure
  2373. Management of a patient with a brain tumor, aneurysm, or increased ICP during ECT (2)
    • 1. Careful blood pressure control
    • 2. Dexamethasone before ECT
  2374. Side effect of combining Carbamazapine with Clozapine
    Increased risk of bone marrow suppression
  2375. Calculation of IQ
  2376. Effects of low CSF serotonin level
    Increased rate of aggression or suicide
  2377. EKG change at high lithium levels
    Nonspecific t-wave changes
  2378. How does lithium cause polyuria?
    ADH antagonism
  2379. Risk of TCAs when given with anesthesia
    • Risk of hypertension
    • TCAs should be stopped before surgery!
  2380. TCAs that can cause myoclonic twitches and tremors (2)
    • 1. Desipramine
    • 2. Protriptyline
  2381. Cardiac uses of TCAs (2)
    • 1. Terminate V-fib
    • 2. Increase blood supply to ischemic heart tissue
  2382. Cardiotoxic effects of TCA overdose (4)
    • 1. Decreased contractility
    • 2. Tachycardia
    • 3. Hypotension
    • 4. Increased myocardial irritability
  2383. How do patients appear during attacks of Transient Global Amnesia?
    Awake and alert, retaining personal information and identity
  2384. What demographics are affected by Transient Global Amnesia?
    • Men more than women
    • Usually aged 50s or older
  2385. What triggers attacks of Transient Global Amnesia?
    • Physical/sexual exertion
    • Extremes of temperature
  2386. Relationship between Transient Global Amnesia and risk for future strokes
    No increased risk
  2387. How often does Transient Global Amnesia recur?
    Rarely (no need for workup)
  2388. Effect of GABA on seizure activity
    Reduces seizure rates
  2389. Effect of GABA on mania
    Decreases mania
  2390. Mechanism of action of Tigabine
    Blocks GABA transporters (GABA reuptake inhibitor)
  2391. Illness caused by Borrelia Burgdorferi
    Lyme Disease
  2392. 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
  2393. First line treatments for Lyme Disease (2)
    • 1. IV Ceftriaxone
    • 2. IV PCN
  2394. Treatments for Lyme Disease in penicillin or cephalosporin allergic patients (2)
    • 1. Tetracycline
    • 2. Chloramphenicol
    • (give together)
  2395. Illness caused by Rickettsia Rickettsii
    Rocky Mountain Spotted Fever
  2396. When do symptoms of Rocky Mountain Spotted Fever begin?
    2-14 days after tick bite
  2397. Common presentation of Rocky Mountain Spotted Fever (4)
    • 1. Fever
    • 2. Headache
    • 3. Muscle aches
    • 4. GI distress
  2398. Rash of Rocky Mountain Spotted Fever
    • Starts on wrists and hands
    • Spreads to the feet and forearms
  2399. Systemic symptoms of Rocky Mountain Spotted Fever (3)
    • 1. Meningoencephalitis
    • 2. Renal Failure
    • 3. Pulmonary edema
  2400. Funduscopic exam in Rocky Mountain Spotted Fever
    Shows rentinal vasculitis
  2401. Diagnosis of Rocky Mountain Spotted Fever
    Skin biopsy with immunologic staining
  2402. Treatment of Rocky Mountain Spotted Fever (3)
    • Initially, either:
    • 1. Tetracycline
    • 2. Chloramphenicol
    • Then:
    • 3. Doxycycline
  2403. What illness is caused by Yersinia Pestis?
    Bubonic plague
  2404. Neurologic condition caused by Bubonic Plague
    Meningitis
  2405. Treatment of Bubonic Plague (2)
    • 1. Streptomycin (if uncomplicated infection)
    • 2. Chloramphenicol (if meningitis)
  2406. What illness is caused by Leptospira Interrogans?
    Leptospirosis
  2407. How is Leptospirosis transmitted?
    Through urine of infected rodents or farm animals
  2408. Neurological syndrome caused by Leptospirosis
    Meningitis
  2409. Systemic syndromes caused by Leptospirosis (4)
    • 1. Meningitis
    • 2. Renal failure
    • 3. Hemorrhage
    • 4. Jaundice
  2410. Treatment of Leptospirosis (2)
    • 1. Pencillin (if severe)
    • 2. Doxycycline (if mild)
  2411. What illness is caused by Treponema Pallidum
    Syphilis
  2412. Treatment of Body Dysmorphic Disorder
    • Therapy
    • Serotonergic medications
  2413. Level of development at which Tourette's Syndrome has the worst symptoms
    Adolescence
  2414. Heredity of Tourette's Syndrome
    Autosomal dominant
  2415. Medications that treat both ADHD symptoms and tics (2)
    • 1. Guanfacine
    • 2. Clonidine
  2416. Effect of stimulants on tics
    May worsen tics, but may also alleviate them
  2417. ADHD medication for patients with tics that worsen with stimulants
    Atomoxetine (Strattera)
  2418. 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
  2419. Haldol in breastfeeding
    • Passes into breast milk
    • Patients on Haldol should not breastfeed
  2420. Haldol in pregnancy
    • Teratogenic in animals, but no good research in humans
    • Give only if benefit outweighs risk
  2421. Risk of lithium in pregnancy
    Ebstein's Anomaly (1 in 1000)
  2422. Risk of Valproic Acid in pregnancy
    Neural tube defects in 1-2% if given in first trimester
  2423. Antiemetic that antagonizes D2, and can cause EPS and Tardive Dyskinesia
    Metoclopramide (Reglan)
  2424. Classes of medication for Narcolepsy (2)
    • 1. Stimulants
    • 2. Antidepressants
  2425. Where is the Calcarine Cortex? What does it do?
    • In occipital lobes
    • Interprets/processes visual input
  2426. Site of highest concentration of Glycine receptors
    Spinal cord
  2427. What is hyperkplexia?
    • Mutation of the glycine receptor
    • Main symptom is exaggerated startle response
  2428. Age group most likely to have Subdural Hematomas
    Over 60
  2429. EEG findings in Herpes Simplex Encephalitis
    Periodic lateralizing epileptiform discharges
  2430. 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
  2431. CSF finding in Herpetic Meningitis
    Many RBCs
  2432. At what age does Mahler's Normal Autism stage occur?
    Birth to 2 months
  2433. At what age does Mahler's Symbiosis stage occur?
    2-5 months
  2434. At what age does Mahler's Differentiation stage occur?
    5-10 months
  2435. At what age does Mahler's Practicing stage occur?
    10-18 months
  2436. At what age does Mahler's Rapprochement stage occur?
    18-24 months
  2437. At what age does Mahler's Object Constancy stage occur?
    2-5 years
  2438. Characteristics of Mahler's Normal Autism stage
    Baby spends more time asleep than awake
  2439. 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
  2440. Characteristics of Mahler's Differentiation stage
    Child begins to understand that it is separate from the mother
  2441. Characteristics of Mahler's Practicing stage
    Child begins to move independently and explore the outside world
  2442. Characteristics of Mahler's Rapprochement stage
    Child's independence vacillates with need for the mother
  2443. How long after arsenic exposure does peripheral neuropathy occur?
    2-3 weeks
  2444. How long after arsenic exposure to Mees' lines appear on the fingernails?
    3-6 weeks
  2445. Systemic effects of arsenic poisoning (2)
    • 1. Nausea/vomiting/diarrhea
    • 2. Vasomotor collapse (hypotension, tachycardia)
  2446. Toxins that can cause Mees' Lines on the fingernails (2)
    • 1. Arsenic
    • 2. Thallium
  2447. Effects of lead poisoning on children
    • Encephalopathy with confusion, drowsiness, intracranial hypertension, and seizures
    • GI distress
  2448. Lab finding (other than lead level) in lead poisoning
    Hypochromic, microcytic anemia
  2449. Cause of a blue line at the gingival margin
    Lead exposure
  2450. What is Dimercaprol?
    Chelating agent used to treat lead exposure
  2451. Toxin causing personality changes, drowsiness, insomnia, irritability, confusion, stupor, and intention tremor with acute exposure
    Mercury
  2452. Cause of death in organophosphate poisoning
    Respiratory or cardiac failure
  2453. What is an ANOVA?
    Method of comparing two groups and determining whether the differences between them are due to chance
  2454. Duration of exposure to manganese required to cause neurotoxicity
    Months to years
  2455. Neurologic effects of manganese exposure (3)
    • 1. Parkinsonism/motor effects
    • 2. Behavioral changes/cognitive disturbances ("Manganese Madness")
    • 3. Headache
  2456. Characteristic gait due to manganese exposure
    • "Cock walk"
    • Walking on the toes with spine erect and elbows flexed
  2457. Electrolyte affected by Thallium poisoning
    • Potassium is depleted
    • Causes tachycardia, t-wave changes, and u-waves
  2458. Treatment of Thallium poisoning (3)
    • 1. Dialysis
    • 2. Forced diuresis
    • 3. IV potassium
  2459. Brain region whose injury causes truncal ataxia
    Cerebellar vermis
  2460. Region of the cerebellum whose injury causes dysdiadochokinesis
    Ipsilateral Hemisphere
  2461. 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)
  2462. What is the Thalamic Syndrome of Dejerine-Roussy?
    Central thalamic pain in extremities and/or face due to thalamic lesion
  2463. What is Parinaud's Syndrome?
    • Oculomotor symptoms due to midbrain lesion
    • Ischemia of areas perfused by PCA penetrating branches
  2464. What is Weber's Syndrome?
    • Caused by PCA stroke
    • Contralateral hemiplegia of face, arm, and leg
    • Ipsilateral oculomotor paresis with fixed dilated pupil (CN3)
  2465. Contraindications to Lumbar Puncture (4)
    • 1. Infection at the level of puncture
    • 2. Thrombocytopenia
    • 3. Cerebral mass lesion
    • 4. Head trauma
  2466. 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
  2467. What is Dissociation?
    Unconscious segregation of mental/behavioral processes from the rest of psychological activity
  2468. Suicidality in normal bereavement
    Rare
  2469. Effect of social contact on normal bereavement
    Improves mood
  2470. Effect of none bereavement on self-worth
    None
  2471. Does Polio affect upper or lower motor neurons?
    Lower
  2472. What are Brandt-Daroff exercises used to treat?
    Benign paroxysmal positional vertigo
  2473. 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
  2474. Sleep-wake cycle in persistent vegetative state
    Preserved
  2475. Spontaneous movements in persistent vegetative state
    Spontaneous movements are preserved, but the patient can not obey commands
  2476. Ocular movements in persistent vegetative state
    Eye opening and eye tracking can be present
  2477. Swallowing in persistent vegetative state
    Can be preserved
  2478. Response to noxious stimuli in persistent vegetative state
    None
  2479. How long after onset of persistent vegetative state does irreversible brain damage occur, if there was brain trauma?
    12 months
  2480. How long after onset of persistent vegetative state does irreversible brain damage occur, if there was anoxic brain injury?
    3 months
  2481. Symptoms of Ataque de Nervious (7)
    • 1. Headache
    • 2. Insomnia
    • 3. Anorexia
    • 4. Fear
    • 5. Anger
    • 6. Despair
    • 7. Diarrhea
  2482. What is Ataque de Nervios?
    Anxiety syndrome associated with Latin American cultures
  2483. Most typical effect of depression on sleep
    Early morning awakening
  2484. Treatment of choice of benzodiazepine overdose
    Flumazenil
  2485. Most serious side effect if flumazenil is given to treat benzodiazepine overdose
    Seizures
  2486. Clinical triad of West's Syndrome (3)
    • 1. Infantile spasms
    • 2. Hypsarrhythmia
    • 3. Psychomotor developmental arrest
  2487. What is the pattern of Hypsarrhythmia on EEG?
    Posterior diffuse slow and sharp waves and spikes
  2488. Cognitive symptoms of AIDS (6)
    • 1. Dementia
    • 2. Personality changes
    • 3. Depressed mood
    • 4. Low libido
    • 5. Impaired memory
    • 6. Poor concentration
  2489. Where does Papez's Circuit originate?
    Hippocampus
  2490. What does Papez's Circuit connect the hippocampus to? (3)
    • 1. Thalamus
    • 2. Hypothalamus
    • 3. Cortex
  2491. Brain regions included in Papez's Circuit (6)
    • 1. Hippocampus
    • 2. Hypothalamus
    • 3. Thalamus (especially anterior nucleus)
    • 4. Mammilary bodies
    • 5. Fornix
    • 6. Cingulate
  2492. Cause of Benign Familial Neonatal Convulsions
    Mutation in voltage gated potassium channels
  2493. Course of Benign Familial Neonatal Convulsions
    • Tonic clonic seizures begin around the 3rd day of life
    • Remit spontaneously in weeks to months
  2494. Molecule whose mutation causes Hypokalemic Periodic Paralysis
    Calcium channel
  2495. Molecule whose mutation causes Familial Hemiplegic Migraine
    Calcium channel
  2496. What receptors, in what tract, cause Parkinsonism when blocked by neuroleptics?
    D2 receptors in the Nigrostriatal Tract
  2497. What receptors, in what brain region, cause bradykinesia when blocked by neuroleptics?
    D2 receptors in the Caudate
  2498. What protrudes through the foramen magnum in a Chiari I mutation?
    Cerebellar tonsils
  2499. What protrudes through the foramen magnum in a Chiari II mutation?
    Cerebellar tonsils, with caudal displacement of the 4th ventricle and medulla
  2500. Site of neural tube defect that accompanies Chiari II mutations
    Lumbar spine
  2501. What is Lissencephaly?
    Agyria
  2502. What is the pathologic hallmark of Schizencephaly?
    Clefts in the cerebral hemispheres
  2503. Clinical Manifestations of Dandy-Walker Syndrome (2)
    • 1. Intellectual disability
    • 2. Spastic paralysis
  2504. Percent stenosis of the internal carotid at which endarterectomy is indicated if asymptomatic
    80%
  2505. Percent stenosis of the internal carotid at which endarterectomy is indicated if symptomatic
    70%
  2506. Underlying infection causing Guillain-Barré with a worse prognosis than other infections
    C. Jejuni (more often associated with axonal AIDP)
  2507. Effect of lithium on WBC count
    Increased
  2508. Electrolyte imbalance that can cause toxic lithium levels
    Hyponatremia
  2509. 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
  2510. Treatment of pain in Meralgia Paresthetica (2)
    • 1. TCAs
    • 2. Anticonvulsants
  2511. Cause of Fibrillation Potentials on EMG
    Denervation of a muscle
  2512. What are Sharp Waves on EMG?
    Spontaneous activity from groups of denervated muscle fibers
  2513. What would an EMG showing fibrillation potentials and sharp waves indicated?
    Radiculopathy (neuropathy)
  2514. Cause of small, short potentials on EMG
    Reduction in size of muscle fibers due to myopathy
  2515. Cerebral cause of tics
    Overstimulation of D2 receptors in the caudate
  2516. Timing of Cerebral Venous Thrombosis after childbirth
    1 day to 4 weeks postpartum
  2517. Clinical presentation of postpartum Central Venous Thrombosis (3)
    • 1. Headache
    • 2. Seizures
    • 3. Personality changes
  2518. Most common congenital viral infection
    Cytomegalovirus
  2519. Most common myopathy after age 50
    Inclusion Body Myositis
  2520. Gender distribution of Inclusion Body Myositis
    Men > Women
  2521. Presentation of Inclusion Body Myositis
    • Weakness of distal arm and leg muscles
    • Painless
    • Chronic and progressive
  2522. Diagnostic test for Inclusion Body Myositis
    Muscle biopsy
  2523. Findings in muscle biopsy in Inclusion Body Myositis (2)
    • 1. Macrophage invasion of muscle
    • 2. Inclusion bodies in nuclei ("rimmed vacuoles")
  2524. Inheritance pattern of Facioscapulohumeral Dystrophy
    Autosomal Dominant
  2525. Chromosome affected in Facioscapulohumeral Dystrophy
    Chromosome 4
  2526. Regions whose muscles are weak in Facioscapulohumeral Dystrophy (5)
    • 1. Orofacial
    • 2. Shoulders
    • 3. Upper arm (biceps and triceps)
    • 4. Hip flexors
    • 5. Quadriceps
  2527. Inheritance pattern of Oculopharyngeal Muscular Dystrophy
    Autosomal dominant
  2528. Chromosome affected in Oculopharyngeal Muscular Dystrophy
    Chromosome 14
  2529. Presentation of Oculopharyngeal Muscular Dystrophy
    • Starts in 5th or 6th decade
    • Eye muscle weakness, then difficulty swallowing
    • May die by starvation without nutritional support!
  2530. Inheritance pattern of Becker Muscular Dystrophy
    X-linked
  2531. Criteria for diagnosis of sleep apnea
    5 apneic episodes lasting 10 seconds in one hour or 30 episodes lasting 10 seconds per night
  2532. Toxic blood lithium level
    2 or higher
  2533. Lethal blood lithium level
    4 or higher
  2534. What receptor does Sodium Oxybate (GHB) bind to?
    GABA B (agonist)
  2535. What receptor does Lioresal bind to? What is its effect?
    • GABA B (agonist)
    • Potent muscle relaxant
  2536. What is Ganser's Syndrome?
    Dissociative disorder in which the patient intentionally gives approximate answers or talks past the point
  2537. What is Capgras's Syndrome?
    Delusional belief that a familiar person is actually an imposter
  2538. What concept did Martin Seligman develop?
    Learned Helplessness
  2539. Specificity of Phenelzine for types of Monoamine Oxidase
    Nonspecific; affects MAO A and MAO B
  2540. Effect of ibuprofen on lithium levels
    Can increase levels drastically
  2541. Effect of diuretics on lithium levels
    Many increase levels
  2542. Effect of NSAIDs on lithium levels
    Many increase levels, though aspirin does not!
  2543. Effect of ACE inhibitors on lithium levels
    Increase levels
  2544. Effect of Naproxen on lithium levels
    Increases levels
  2545. Effect of Anticonvulsants on lithium levels
    Can increase levels
  2546. Timing of Tabes Dorsalis after initial syphilis infection
    15-20 years
  2547. Clinical triad of Tabes Dorasalis (spinal syphilis) (3)
    • 1. Sensory ataxia
    • 2. Lightning pains
    • 3. Urinary incontinence
  2548. Illness causing Charcot's (neuropathic) Joints
    Tabes Dorsalis (spinal syphilis)
  2549. What is the Marcus Gunn Pupil?
    Affected pupil enlarges when a flashlight is moved away to the other eye, rather than constricting
  2550. Illnesses causing Marcus Gunn pupil (2)
    • 1. Multiple Sclerosis
    • 2. Optic Neuritis
  2551. Symptoms of Serotonin Withdrawal Syndrome (and SSRI Withdrawal) (5)
    • 1. Nausea
    • 2. Insomnia
    • 3. Muscle aches
    • 4. Anxiety
    • 5. Dizziness
  2552. Duration of Todd's Paralysis after seizure
    Resolves completely after 48 hours
  2553. 3-Hydroxy Benzodiazepines (benzodiazepines without active metabolites) (3)
    • 1. Oxazepam
    • 2. Lorazepam
    • 3. Temazepam
  2554. 2-Keto Benzodiazepines (benzodiazepines with multiple active metabolites) (3)
    • 1. Chlordiazepoxide
    • 2. Diazepam
    • 3. Prazepam
  2555. What is Tropical Spastic Paresis?
    Term for myelopathy due to HTLV-1 infection
  2556. Who gets Tropical Spastic Paresis?
    • Men > women
    • Over age 30
  2557. Diagnosis of Tropical Spastic Paresis (HTLV-1 myelopathy)
    PCR of CSF
  2558. 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
  2559. In what illnesses is lithium effective for aggression? (3)
    • 1. Conduct disorder / antisocial personality
    • 2. Schizophrenia
    • 3. Intellectual disability
  2560. Cause of X-Linked Spinobulbar Muscular Atrophy
    Trinucleotide repeat
  2561. What is Chvostek's Sign? What does it indicate?
    • Corner of the mouth contracts involuntarily when the cheek is tapped
    • Sign of chronic hypocalcemia
  2562. Mechanism of Atomoxetine (Strattera)
    Inhibits reuptake of Norepinephrine
  2563. First line agents for spasticity (6)
    • 1. Lioresal
    • 2. Gabapentin
    • 3. Diazepam
    • 4. Clonidine
    • 5. Tizanidine
    • 6. Dantroline
  2564. Second-line agents for spasticity (5)
    • 1. Marinol
    • 2. Chlorpromazine
    • 3. Cyproheptadine (antihistamine)
    • 4. Phenytoin
    • 5. Phenobarbitol
  2565. Effect of Depakote on weight
    Weight gain
  2566. Effect of Depakote on hair
    Causes thinning
  2567. Psychiatric medication causing ankle swelling
    Depakote
  2568. Does depakote cause tremor?
    Yes!
  2569. Is Depakote sedating?
    Sometimes yes
  2570. Psychiatric medication that can cause pancreatitis
    Depakote
  2571. Organ to which Depakote can be toxic
    Liver
  2572. Severe side effect of Depakote on CBC
    Pancytopenia
  2573. Why can neuroleptics cause orthostatic hypotension?
    α1 antagonism
  2574. What mechanism do Atypical Neuroleptics have that Typicals do not?
    Serotonin antagonism
  2575. How long after use is alcohol detectable in urine?
    12 hours
  2576. Causes of Klüver-Bucy Syndrome (3)
    • 1. Pick's Disease (most common)
    • 2. Stroke
    • 3. Alzheimer Dementia
  2577. Neurological signs in Klüver-Bucy Syndrome (2)
    • 1. Psychic blindness
    • 2. Prosopagnosia (inability to recognize faces)
  2578. Absolute contraindications to ECT
    None
  2579. 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
  2580. Chromosomal change in Klinefelter Syndrome
    XXY Triploidy
  2581. Organs that may have abnormalities in Turner Syndrome (2)
    • 1. Heart
    • 2. Kidneys
  2582. Presentation of Intermittent Explosive Disorder
    • Physical aggression due to failure to resist aggressive impulses
    • Aggression out of proportion to a stressor
  2583. Course of an aggressive episode in Intermittent Explosive Disorder
    • Arise due to a stressor or without a trigger
    • Remit spontaneously, with no residual aggression
  2584. Predisposing factors for Intermittent Explosive Disorder (3)
    • 1. Underprivileged/tempestuous childhood
    • 2. Childhood abuse
    • 3. Early frustration/deprivation
  2585. Treatments that reduce both aggression and number of episodes in Intermittent Explosive Disorder (2)
    • 1. Mood stabililzers
    • 2. Gabapentin
  2586. Treatments that reduce aggression in Intermittent Explosive Disorder, but do not prevent episodes (2)
    • 1. SSRIs
    • 2. TCAs
  2587. Mechanism of Bupropion (Wellbutrin)
    Inhibits reuptake of both dopamine and norepinephrine
  2588. Antidepressant least likely to precipitate mania in bipolar disorder
    Wellbutrin
  2589. Presentation of monkeys who were partially, but not completely, isolated (3)
    • 1. Vacant stare
    • 2. Self-mutliation
    • 3. Stereotyped behavior
  2590. Presentation of totally isolated monkeys
    • Fearful
    • Unable to copulate
    • Unable to raise young
  2591. Presentation of monkeys raised only by a mother
    • Didn't explore
    • Afraid of other monkeys
    • Didn't copulate
  2592. Presentation of monkeys raised only by peers
    • Clung to other monkeys
    • Timid
    • Little playfulness
  2593. Presentation of monkeys separated from their mothers
    Initial protest phase followed by despair
  2594. Surgical treatment for OCD
    Cingulotomy
  2595. Complication of Cingulotomy if used to treat OCD
    Seizures (can be managed by anticonvulsants)
  2596. Factors contributing to Dissociative Identity Disorder (3)
    • 1. Childhood trauma
    • 2. Absent social supports, especially in childhood
    • 3. Poor coping mechanisms
  2597. Forms of talk therapy used in Dissociative Identity Disorder (2)
    • 1. Insight-oriented (mainstay!)
    • 2. Hypnotherapy
  2598. Types of medication used in Dissociative Identity Disorder (2)
    • 1. Antidepressant
    • 2. Anxiolytic
  2599. Lithium level at which dialysis is needed
    4
  2600. Signs of lithium toxicity for which dialysis is indicated (3)
    • 1. Nephrotoxicity
    • 2. Convulsions
    • 3. Coma
  2601. Most useful long term treatment parameter for a violent schizophrenic with history of noncompliance
    Outpatient commitment program
  2602. Features of an Outpatient Commitment Program
    • Judge mandates cooperativeness
    • Physician can order that the patient be picked up involuntarily for evaluation
  2603. What is Conservatorship?
    Court appoints a conservator to make decisions on a patient's behalf, including involuntary hospitalization
  2604. Opiate medication that can never be given with an MAOI
    • Meperidine (demerol)
    • Can cause death!
  2605. What is the only common anesthetic that can be given with MAOIs?
    Lidocaine
  2606. Medications to treat what common somatic illness can not be combined with MAOIs?
    Asthma
  2607. What over the counter medication can not be given with MAOIs?
    Dextromethorphan
  2608. Street drugs that can not be combined with MAOIs (2)
    • 1. Amphetamines
    • 2. Cocaine
  2609. Effect of combining epinephrine and MAOIs
    Hypertensive crisis
  2610. 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
  2611. How often should CBC be monitored after stopping Clozapine?
    Weekly for 4 weeks
  2612. Effect of age >65 on REM sleep
    • More REM episodes, but they are shorter in duration
    • Less total REM sleep
  2613. Psychiatric medications that increase Clozapine levels (3)
    • 1. SSRIs
    • 2. TCAs
    • 3. Depakote
  2614. Somatic medications that increase Clozapine levels (2)
    • 1. Erythromycin
    • 2. Cimetidine (for GERD)
  2615. Medications that can cause agranulocytosis, and thus should not be given with Clozapine (5)
    • 1. Carbamazepine
    • 2. Prophylthiouracil
    • 3. Sulfonamides
    • 4. Captopril
    • 5. Phenytoin
  2616. Effect of Clozapine on CNS depressants
    Exacerbates CNS depression
  2617. Risks of combining Clozapine with Lithium (4)
    • 1. Neuroleptic Malignant Syndrome
    • 2. Movement disorders
    • 3. Seizures
    • 4. Confusion
  2618. Most widely-used recreational drug among high school students
    Marijuana (used regularly more than alcohol is used regularly!)
  2619. What is Alogia?
    Lack of speech due to dementia or mental deficiency
  2620. Criteria for Rapid Cycling specifier in BPAD
    3 mood episodes over the past 12 months
  2621. Gender breakdown of Rapid Cycling in BPAD
    Women > Men
  2622. What is a Primary Reinforcer of a behavior?
    Reward independent of previous learning (eg need to eat)
  2623. What is a Secondary Reinforcer of a behavior?
    Reward based on previous learning (eg giving a child a present when they do well)
  2624. Gender breakdown of late-onset schizophrenia
    Women > Men
  2625. Age of onset at which Schizophrenia is considered Late-Onset
    45
  2626. 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
  2627. Presentation of a child during Bowlby and Robertson's Protest Stage after separation
    Crying, calling out, searching for mother
  2628. Presentation of a child during Bowlby and Robertson's Despair and Pain Stage after separation
    Loses faith that the mother will return
  2629. Effect of Wellbutrin on ADHD
    Reduces symptoms
  2630. Medications approved for treatment of OCD in children (2)
    • 1. Zoloft (sertraline)
    • 2. Fluvoxamine
  2631. Medication approved for MDD in children aged 8 and older
    Prozac
  2632. Dosing interval for Risperdal Consta
    2 weeks
  2633. Storage of Risperdal Consta
    • Powdered drug must be refrigerated
    • Once reconstituted, must use within 6 hours
  2634. Injection site for Risperdal Consta
    Gluteus
  2635. How long after initiation of Risperdal Consta should oral Risperdal be continued?
    3-4 weeks
  2636. What is Naltrexone?
    Opioid antagonist with half life of 72 hours
  2637. At what Kübler-Ross stage of grief do patients self-blame and ask "Why me?"
    Anger
  2638. If a patient's symptoms in the Kübler-Ross grief stage of Depression meet criteria for MDD, should antidepressants be used?
    Yes!
  2639. Duration of typical grief/mourning
    6-12 months after a loss
  2640. Duration of the acute symptoms of grief
    1-2 months after a loss
  2641. Group whose suicide rate has quadrupled since 1950
    Adolescents
  2642. Duration of action of Ambien
    1 to 4.5 hours (half life 2.5 hours)
  2643. Sleeping agent whose half-life is the longest
    Eszopiclone (Lunesta)
  2644. How often should Liver Function Tests be done when giving Depakote?
    At baseline and every 6-12 months thereafter
  2645. Ages at which a child is in Freud's Oral Phase
    Birth to 1 year
  2646. Results of not completing Freud's Oral Phase successfully
    Dependent in adulthood
  2647. Adult benefits of successful resolution of Freud's Oral Phase
    Able to give and receive without excessive dependency or envy
  2648. Ages at which a child is in Freud's Anal Phase
    1-3 years
  2649. What is Freud's Anal Phase marked by?
    Increase in aggressive and labidinal drives
  2650. Benefits of successful resolution of Freud's Anal Phase
    Sense of independence from the parent
  2651. Result of failing to complete Freud's Anal Phase
    Obsessive-Compulsive Neuroses
  2652. Ages at which a child is in Freud's Phallic Phase
    3-5 years
  2653. What is Freud's Phallic Phase marked by?
    Focus on sexual interests and excitement in the genital area
  2654. Goal of Freud's Phallic Phase
    • Focus erotic interests
    • Lay groundwork for gender identity
  2655. Result of failing to complete Freud's Phallic Phase
    Neuroses associated with poor resolution of the Oedipal complex
  2656. 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
  2657. Ages at which a child is in Freud's Latency Phase
    5 years until puberty
  2658. Ages at which a child is in Freud's Genital Phase
    Puberty until adulthood
  2659. 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
  2660. Goal of Freud's Genital Phase
    • Ultimate separation from the parents
    • Development of non-family object relations
  2661. 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
  2662. Cause of ipsilateral facial paresis with contralateral limb paresis
    ischemia of the brainstem above the decussation of the pyramids in the medulla
  2663. Result of ischemia of the lenticulostriate territory
    Lacunar infarcts of internal capsule, causing pure motor hemiparesis
  2664. Cause of spinal cord pathology soon after an influenza vaccine or infection
    Transverse myelitis
  2665. Classic presentation of Transverse Myelitis
    Bilateral leg weakness with a clear sensory level below the level of the lesion
  2666. Sensory deficits in Transverse Myelitis
    • Pain and temperature are affected below a clear sensory level
    • Proprioception and vibration are spared
  2667. Treatment of Transverse Myelitis
    High dose IV steroids
  2668. Presentation of Vacuolar Myelopathy
    • Similar to B12 deficiency
    • Almost exclusive to AIDS paitients
  2669. 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
  2670. What is Descriptive Validity of a diagnosis?
    A definition of a disorder is characteristic enough to separate it from other disorders
  2671. What is Predictive Validity of a diagnosis?
    Diagnosis of a disorder allows prediction of clinical course
  2672. What is Construct Validity of a diagnosis?
    Diagnosis is based on underlying pathology, so biologic markers can confirm the illness
  2673. Site of ischemia causing Horner-like Syndrome without anhydrosis
    Internal carotid
  2674. What is astereognosis?
    Inability to recognize an item held in the hand by touch
  2675. Treatment of PCP agitation
    Haldol every 2-4 hours until calm
  2676. Duration of evolution of Bell's Palsy
    24-48 hours
  2677. Site of pain often accompanying Bell's Palsy
    Behind the ipsilateral ear
  2678. Most frequent viral pathogen causing Bell's Palsy
    Herpes Simplex Virus (HSV)
  2679. Prognostic sign in Bell's Palsy
    Complete paralysis carries worse prognosis than incomplete paralysis
  2680. Side effect of huffing belladonna alkaloids, but not benzenes
    Urinary Retention
  2681. Organs damaged by huffing benzenes/glue (4)
    • 1. Brain
    • 2. Liver
    • 3. Kidneys
    • 4. Heart
  2682. What is Opsoclonus-Myoclonus?
    • Paraneoplastic movement disorder
    • "Dancing eyes-dancing feet" syndrome
    • Multifocal myoclonus with rapid eye movements
  2683. Whose cancer most often causes Opsoclonus-Myoclonus?
    Infants
  2684. Cancer most often causing Opsoclonus-Myoclonus
    Infantile neuroblastoma
  2685. Site of cancer most often causing Opsoclonus-Myoclonus in adults
    Lung
  2686. Other than cancer, what illnesses can cause Opsoclonus-Myoclonus? (4)
    • 1. Viral encephalitis
    • 2. Multiple Sclerosis
    • 3. Thalamic hemorrhage
    • 4. Hyperosmolar coma
  2687. Treatments for Opsoclonus-Myoclonus (2)
    • 1. Steroids
    • 2. Adrenocorticotropic Hormone (ACTH)
  2688. Most definitive symptom of Social Phobia
    Fear of scrutiny
  2689. What is Ramsay Hunt Syndrome?
    Neuritis of CN7 and CN8 (facial and acoustic) caused by VZV infection
  2690. What class of psychiatric illness often co-occurs with Body Dysmorphic Disorder?
    Mood Disorders
  2691. Peak incidence of Anaplastic Astrocytoma
    Bimodal in 1st and 3rd decades
  2692. Peak incidence of Acoustic Neuromas
    4th and 5th decades
  2693. Brain sites with abnormalities in OCD (3)
    • 1. Caudate
    • 2. Thalamus
    • 3. Orbitofrontal cortex
  2694. Sites of increased metabolism in the brain in OCD (3)
    • 1. Basal ganglia
    • 2. Frontal lobes
    • 3. Cingulate
  2695. Lab change caused by Riluzole
    Elevated liver enzymes
  2696. Period of development that is the peak of neuronal proliferation
    2nd trimester of gestation
  2697. Period of development that is the peak of neuronal migration
    First 6 months of gestation
  2698. Period of development that is the peak of synapse formation
    2 years
  2699. Treatment of HIV-Associated Dementia
    HAART
  2700. Presentation of CNS Toxoplasmosis in an AIDS patient
    • Headache
    • Focal neurological deficit
  2701. Specific neurologic deficits that can occur in CNS Toxoplasmosis (3)
    • 1. Aphasia
    • 2. Seizures
    • 3. Hemiparesis
  2702. Late stage of CNS Toxoplasmosis in HIV
    Confusion and lethargy leading to coma
  2703. Medications used for CNS Toxoplasmosis (3)
    • 1. Pyrimethamine
    • -and-
    • 2. Sulfadiazine
    • -or (if sulfa-allergic)-
    • 3. Clindamycin
  2704. CMP abnormalities caused by self-induced vomiting (5)
    • 1. ↓ Potassium
    • 2. ↑ Chlorine
    • 3. ↓ Magnesium
    • 4. Alkalosis
    • 5. ↑ Amylase
  2705. Most common cause of spinal cord pathology in AIDS
    Vacuolar Myelopathy
  2706. Most common periperal nerve syndrome in AIDS
    Distal Sensory Polyneuropathy
  2707. 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
  2708. Treatment of Distal Sensory Polyneuropathy in AIDS
    • HAART
    • Symptomatic pain treatment
  2709. Chromosome that can carry prions
    20
  2710. Presentation of Kuru
    • Progressive ataxia
    • Death in 12 months
  2711. Symptoms that occur in any combination in Gerstmann-Straüssler-Scheinker Disease (3)
    • 1. Ataxia
    • 2. Parkinsonism
    • 3. Dementia
  2712. What is Devic's Disease?
    Term for Neuromyelitis Optica
  2713. Symptoms of Carotid Occlusion (3)
    • 1. Headache
    • 2. Ipsilateral Horner's Syndrome
    • 3. Contralateral hemiparesis
  2714. Prognosis of Pontine Hemorrhage
    • Can cause death rapidly if the bleed is large
    • Neurologic emergency!
  2715. 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
  2716. 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
  2717. What is Bannwarth's Syndrome?
    Facial diplegia due to aseptic meningitis caused by Lyme Disease
  2718. Autoimmune disease that can cause facial nerve palsy
    Sarcoidosis
  2719. Incubation period of Rabies Virus
    1-2 months
  2720. Symptoms of prodromal period of rabies (3)
    • 1. Paresthesia
    • 2. Headache
    • 3. Fever
  2721. Characteristic symptom of progressive phase of Rabies
    Pharyngeal and nuchal spasms triggered by swallowing, tastes, smells, or sounds
  2722. Symptoms of late-stage Rabies (3)
    • 1. Encephalitis
    • 2. High fever
    • 3. Can lead to coma and death
  2723. Most common presentation of West Nile Virus infection
    Asymptomatic or flu-like symptoms (meningitis or encephalitis is rare!)
  2724. Diagnostic tests for West Nile Virus (2)
    • 1. Serum IgM and IgG
    • 2. CSF IgM
  2725. What is Risus Sardonicus?
    Sustained involuntary grimace due to facial spasm, such as in tetanus
  2726. Treatment of Tetanus
    Tetanus Immune Globulin to neutralize tetanus toxin
  2727. Treatment of Botulism
    Supportive, particularly airway protection
  2728. Neurologic manifestations of Epstein-Barr Virus (4)
    • 1. Meningitis
    • 2. Transverse myelitis
    • 3. Sensory polyneuropathy
    • 4. Guillain-Barré
  2729. Treatment of Pick Disease (2)
    • 1. Treat low mood with antidepressants
    • 2. Treat impulsivity with atypical antipsychotics
  2730. Illnesses in which Hirano Bodies are seen in neurons (2)
    • 1. Creutzfeldt-Jakob Disease
    • 2. Alzheimer's Dementia
  2731. Criterion for diagnosis of Fibromyalgia
    Tenderness at 11 of 18 trigger points
  2732. Psychiatric comorbidity of pancreatic cancer
    Depression
  2733. Treatment of spinal cord compression due to metastatic tumor (2)
    • 1. Decompressive laminectomy
    • 2. Radiotherapy (works as well as surgery!)

    Chemotherapy is not effective!
  2734. Other than neurologic deficits, effects of B12 deficiency (2)
    • 1. Macrocytic anemia
    • 2. Atrophic glossitis
  2735. Amino Acid Neurotransmitters (3)
    • 1. Aspartate
    • 2. Glutamate
    • 3. GABA
  2736. What are "Petis Pas"?
    • Literally "small steps"
    • Describes the Parkinsonian gait
  2737. Criterion for Reading Disorder
    Reading achievement substantially below what is expected given IQ and education
  2738. What is "Top of the Basilar Syndrome"?
    Occlusion of the rostral Basilar Artery, often by an embolus
  2739. Symptoms of "Top of the Basilar Syndrome" (4)
    • 1. Delirium
    • 2. Peduncular hallucinosis
    • 3. Obtundation
    • 4. Memory deficits
  2740. Sites of lesion causing Motor Apraxia (3)
    • 1. Internal capsule
    • 2. Pons
    • 3. Nondominant hemisphere
  2741. Neurological/psychiatric effects of chronic huffing of benzenes (3)
    • 1. Hallucinosis
    • 2. Psychosis
    • 3. Seizures
  2742. End organ damage due to chronic huffing of benzenes (3)
    • 1. Renal failure
    • 2. Liver failure
    • 3. Bone marrow suppression
  2743. Treatment of Delusional Disorder
    Antipsychotic medications along with psychotherapy
  2744. Effect of stimulants on the seizure threshold
    Lower the threshold
  2745. Most common neurologic adverse effect of stimulants
    Headache
  2746. Stimulant most likely to induce seizures
    Cocaine
  2747. Severe neurologic side effects of stimulant abuse (3)
    • 1. Myoclonus
    • 2. Encephalopathy
    • 3. Seizures
  2748. Drug of abuse most likely to cause stroke
    Cocaine
  2749. Psychiatric illness most likely to lead to suicide
    Major Depressive Disorder
  2750. 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
  2751. What was the holding of Ford vs. Wainwright?
    A patient must be found competent in order to be executed
  2752. What is aphemia?
    • Motor speech disorder
    • Near muteness with no other language deficits
  2753. Sites where lesion would cause Aphemia (2)
    • 1. Primary motor cortex
    • 2. Broca's Area
  2754. What ions can pass through the channel of an NMDA receptor? (3)
    • 1. Ca2+ (primary ion)
    • 2. Na+
    • 3. K+
  2755. What is Stupor?
    Unresponsiveness with arousal only if stimulated vigorously and repeatedly
  2756. Somatoform disorder with the best prognosis
    Conversion disorder
  2757. Prognosis of Hypochondriasis
    Fair to good
  2758. Prognosis of Conversion Disorder
    90-100% remit within less than a month
  2759. Prognosis of Body Dysmorphic Disorder
    Poor
  2760. Prognosis of Pain Disorder
    Variable, but generally guarded
  2761. Brain region responsible for recalling emotional contexts of specific events
    Amygdala
  2762. Brain regions required for short term memory (3)
    • 1. Hippocampus
    • 2. Nucleus Basalis of Maynert
    • 3. Medial Temporal Lobe
  2763. Which TCA is the least cholinergic?
    Desipramine
  2764. Age at which a child coos
    2 months
  2765. Age at which a child has a social smile
    2 months
  2766. Age at which a child holds its head up 45 degrees
    2 months
  2767. Age at which a child laughs/squeals
    4 months
  2768. Age at which a child sustains social contact
    4 months
  2769. Age at which a child grasps objects
    4 months
  2770. Age at which a child begins to bear weight on its legs
    4 months
  2771. Age at which a child imitates speech sounds
    6 months
  2772. Age at which a child produces single syllables
    6 months
  2773. Age at which a child begins to prefer mother to other people
    6 months
  2774. Age at which a child first notices mirrors
    6 months
  2775. Age at which a child transfers objects hand to hand
    6 months
  2776. Age at which a child develops a raking grasp
    6 months
  2777. Age at which a child sits up with support
    6 months
  2778. Age at which a child plays peek-a-boo
    8 months
  2779. Age at which a child waves "bye bye"
    8 months
  2780. Age at which a child sits without support
    8 months
  2781. Age at which a child crawls
    8 months
  2782. Age at which a child uses "mama" and "dada" specifically
    12 months
  2783. Age at which a child plays simple games with a ball
    12 months
  2784. Age at which a child adjusts the body to being dressed
    12 months
  2785. Age at which a child stands alone
    12 months
  2786. Age at which a child uses a two-finger pincer grasp
    12 months
  2787. Age at which a child has a 1-2 word vocabulary
    14 months
  2788. Age at which a child indicates desires by pointing
    14 months
  2789. Age at which a child hugs parents
    14 months
  2790. Age at which a child walks alone
    14 months
  2791. Age at which a child stoops and recovers
    14 months
  2792. Age at which a child has a 6 word vocabulary
    18 months
  2793. Age at which a child can feed itself
    18 months
  2794. Age at which a child walks up stairs while its hand is held
    18 months
  2795. Age at which a child imitates scribbling
    18 months
  2796. Age at which a child combines words
    24 months
  2797. Age at which a child has a 250 word vocabulary
    24 months
  2798. Age at which a child helps to undress self
    24 months
  2799. Age at which a child listens to picture stories
    24 months
  2800. Age at which a child runs
    24 months
  2801. Age at which a child makes circular scribbles
    24 months
  2802. Age at which a child copies a horizontal line
    24 months
  2803. Age at which a child knows full name
    30 months
  2804. Age at which a child refers to self as "I"
    30 months
  2805. Age at which a child pretends in play
    30 months
  2806. Age at which a child helps put things away
    30 months
  2807. Age at which a child climbs stairs with alternating feet
    30 months
  2808. Age at which a child copies a vertical line
    30 months
  2809. Age at which a child counts 3 objects
    36 months
  2810. Age at which a child knows age and sex
    36 months
  2811. Age at which a child helps in dressing
    36 months
  2812. Age at which a child rides a tricycle
    36 months
  2813. Age at which a child stands briefly on one foot
    36 months
  2814. Age at which a child copies a circle
    36 months
  2815. Age at which a child tells a story
    48 months
  2816. Age at which a child counts four objects
    48 months
  2817. Age at which a child plays with other children
    48 months
  2818. Age at which a child uses a toilet alone
    48 months
  2819. Age at which a child hops on one foot
    48 months
  2820. Age at which a child uses scissors
    48 months
  2821. Age at which a child copies a square
    48 months
  2822. Age at which a child copies a cross
    48 months
  2823. Age at which a child names four colors
    60 months
  2824. Age at which a child counts ten objects
    60 months
  2825. Age at which a child asks about word meanings
    60 months
  2826. Age at which a child engages in domestic roleplaying
    60 months
  2827. Age at which a child skips
    60 months
  2828. Age at which a child copies a triangle
    60 months
  2829. 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
  2830. What tract is damaged if Hoffman's Sign is present?
    Contralateral Corticospinal Tract
  2831. What is Lasègue's Sign?
    Straight leg raising while lying flat produces sciatic pain or paresthesia
  2832. What is Gegenhalten?
    "Clasp knife" rigidity in extremities due to stroke, MS, or catatonia
  2833. Can TCAs be given in pregnancy?
    No!
  2834. What is Parens Patriae?
    Legal concept allowing the state to act as a surrogate parent for those unable to take care of themselves
  2835. What is Actus Reus?
    Voluntary Conduct
  2836. What is Mens Rea?
    "Evil intent"
  2837. What is Tigabine used to treat?
    Partial Complex seizures
  2838. Conditions that Vagus Nerve Stimulators are FDA-approved to treat (2)
    • 1. Major Depression
    • 2. Partial Complex Epilepsy
  2839. Efficacy of Carbamazepine in Alcohol withdrawal
    May be as effective as benzodiazepines
  2840. Metabolism of Carbamazepine
    Metabolized by liver, excreted by kidneys
  2841. Effects of Carbamazapine on blood cells
    • Transient decrease in WBCs
    • Rarely, aplastic anemia and agranulocytosis
  2842. Site of hemorrhage due to ruptured AV Malformation
    Intracerebral
  2843. What does a "button nose" in the ventricular system on a brain MRI represent?
    Colloid cyst of the 3rd ventricle
  2844. Symptoms of a colloid cyst of the 3rd ventricle (2)
    • 1. Intermittent headaches
    • 2. Brief intermittent drop attacks
  2845. Presentation of Hallevorden-Spatz Syndrome
    Childhood onset dementia and parkinsonism
  2846. Inheritance pattern of Hallevorden-Spatz Syndrome
    Recessive
  2847. Classic neuropathologic hallmark of Hallevorden-Spatz Syndrome
    Discoloration of the globus pallidus and substantia nigra due to iron accumulation
  2848. Enzyme deficient in Hallevorden-Spatz Syndrome
    Cysteine dioxygenase
  2849. Vitamin deficiency due to Isoniazid
    B6
  2850. Medications that can cause B6 deficiency (3)
    • 1. Isoniazid
    • 2. Hydralazine
    • 3. Penicillamine
  2851. Neurologic syndrome caused by Hypervitaminosis A
    Pseudotumor cerebri
  2852. Cause of Vitamin A deficiency
    Malabsorption syndromes
  2853. What type of virus is West Nile Virus?
    Arbovirus
  2854. What type of virus is Lymphocytic Choriomeningitis Virus?
    Arenavirus
  2855. What type of virus is Lassa Fever Virus?
    Arenavirus
  2856. What is the vector for Arenaviruses?
    Rodents
  2857. What type of virus is Ebola?
    Filovirus
  2858. What type of virus is Marburg Virus?
    Filovirus
  2859. What type of virus is JC Virus?
    Papovavirus
  2860. Effect of lithium on weight
    Causes weight gain
  2861. Dermatologic effects of lithium (2)
    • 1. Psoriasis
    • 2. Acne
  2862. Cognitive effects of Lithium Toxicity (3)
    • 1. Slowed thinking
    • 2. Impaired memory
    • 3. Impaired consciousness
  2863. Neurotransmitter associated with the Basal Forebrain
    Acetylcholine
  2864. Neurotransmitter associated with maintaining attention
    Acetylcholine
  2865. Neurotransmitter associated with short term memory
    Aceetylcholine
  2866. Neurotransmitter associated with executive functioning
    Acetylcholine
  2867. Neurotransmitter associated with novelty seeking
    Acetylcholine
  2868. Effect of Nefazodone on Norepinephrine
    Blocks reuptake
  2869. Mechanism of Mirtazapine
    • Presynaptic α2 blocker
    • Blocks feedback inhibition of release of norepinephrine
  2870. Best benzodiazepines for patients with liver dysfunction (3)
    • 1. Temazepam
    • 2. Oxazepam
    • 3. Lorazepam
  2871. Site of colonization of Aspergillus
    • Paranasal sinuses
    • Can cause hypersensitivity pneumonitis
  2872. 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
  2873. Neurologic manifestations of Histoplasma infection (4)
    • 1. Cerebritis
    • 2. Basilar meningitis
    • 3. CNS granuloma
    • 4. Cerebral abscess
  2874. 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
  2875. CNS effects of Pseudallecheria Boydi in immunocompromised patients (2)
    • 1. Meningitis
    • 2. Multiple brain abscesses
  2876. Adverse effects of Fluoxetine that are not present in other SSRIs (3)
    • 1. Headache
    • 2. Anxiety
    • 3. Respiratory complaints
  2877. What is Identity Diffusion?
    Failure to develop a cohesive self or self-awareness
  2878. 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
  2879. Focus of parental education for a child suffering Separation Anxiety Disorder
    Giving constant support but maintaining clear boundaries regarding avoidant behaviors
  2880. Effect of Naltrexone in alcohol abuse
    Reduces craving and alcohol consumption
  2881. Gender breakdown of Major Depression
    Women > Men
  2882. Effect of cortisol levels on depression
    Hypersecretion of cortisol is associated with depression
  2883. What is State-Dependent Learning?
    Facilitated recall of information if in the same environment or internal state as when the information was learned
  2884. Dermatologic manifestatiton of B3 (Niacin) deficiency
    Keratotic rash over much of the body
  2885. Neurologic manifestations of B3 (niacin) deficiency
    Depression, apathy, irritability, and memory impairment
  2886. Neurological triad of Vitamin E Deficiency (3)
    • 1. Neuropathy
    • 2. Retinopathy
    • 3. Areflexia
  2887. Neurologic effects of Folate deficiency (2)
    • 1. Neuropathy
    • 2. Upper motor neuron signs
  2888. Effects of Cannabis on vital signs (2)
    • 1. Tachycardia
    • 2. At high dose, orthostatic hypotension
  2889. Medication to treat akathesia
    Propranolol
  2890. Lab value most likely to be abnormal in alcohol abuse
    GGT (elevated)
  2891. What is Pimozide? What does it treat?
    • Dopamine antagonist
    • Treats tics in Tourette's Disorder
  2892. Site of the Amyloid Precursor Protein Gene
    Chromosome 21
  2893. What is the Paranoid Schizoid Position?
    View from the infant's perspective, in which the world is separated into good and bad elements
  2894. What is the Depressive Position?
    Able to view the mother as having both positive and negative elements
  2895. Whose work included the Paranoid-Schizoid Position and the Depressive Position?
    Melanie Klein
  2896. Effect of Erythromycin on Carbamazapine levels
    Increases carbamazapine levels
  2897. Treatment of choice for Atypical Depression
    MAOIs
  2898. SNRI that requires blood pressure monitoring
    Venlafaxine (Effexor); can cause HTN
  2899. 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)
  2900. 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
  2901. What illnesses is the Brief Psychiatric Rating Scale (BPRS) used to evaluate for?
    Psychoses, especially schizophrenia
  2902. Medication used to treat Sleep Terror Disorder
    Diazepam at low doses
  2903. What class of medication is Thioridazine?
    Typical antipsychotic
  2904. Side effects of Thioridazine (5)
    • 1. Sedation
    • 2. Anticholinergic effects
    • 3. Orthostatic hypotension
    • 4. Impotence
    • 5. Retrograde ejaculation
  2905. Most common manifestation of neurosarcoidosis
    Cranial neuropathies
  2906. Diagnosis of Neurosarcoidosis
    • Clinical!
    • Can confirm with muscle biopsy or CSF angiotensin converting enzyme (ACE) level
  2907. Antidepressant noted to have no sexual side effects
    Mirtazapine
  2908. GAF score corresponding to "some difficulty in social, occupational, or school functioning but generally functioning well, has meaningful personal relationships"
    70
  2909. GAF score corresponding to persistent failure to maintain personal hygeine
    10
  2910. GAF score corresponding to major impairment in several areas
    40
  2911. GAF score corresponding to superior functioning in all areas
    100
  2912. GAF score corresponding to having no friends and being unable to keep a job
    30
  2913. Effects of H1 blockade (2)
    • 1. Weight gain
    • 2. Sedation
  2914. Effect of ACh blockade (5)
    • 1. Dry mouth
    • 2. Constipation
    • 3. Blurred vision
    • 4. Urinary retention
    • 5. Cognitive dysfunction
  2915. Effect of α1 blockade (2)
    • 1. Orthostatic hypotension
    • 2. Drowsiness
  2916. Most sensitive test for Myasthenia Gravis
    EMG showing increased "jitter"
  2917. Is elevated CPK more likely in NMS or Serotonin Syndrome?
    NMS, due to muscular rigidity
  2918. Is myoclonus more likely in NMS or Serotonin Syndrome?
    Serotonin Syndrome
  2919. Is hyperreflexia more likely in NMS or Serotonin Syndrome?
    Serotonin Syndrome
  2920. Are GI Symptoms more likely in NMS or Serotonin Syndrome?
    Serotonin Syndrome
  2921. Is muscle rigidity more likely in NMS or Serotonin Syndrome?
    NMS
  2922. Effect of L-Dopa in Dementia with Lewy Bodies
    Treats Parkinsonism, but can cause agitated delirium or hallucinations
  2923. Foods that induce 1A2 (2)
    • 1. Charbroiled meats
    • 2. Cruciferous vegetables
  2924. Most common primary tumor site that metastasizes to brain
    Lung
  2925. What is Fidiciary Duty?
    Obligation to work in a patient's best interests
  2926. What is Beneficence?
    Obligation to help patients and relieve suffering
  2927. Duration of Schizophreniform Disorder
    1 to 6 months
  2928. Does a stressor precede Brief Psychotic Episodes?
    Often yes, but not always
  2929. Is Parkinson's Disease a Synnucleinopathy?
    Yes!
  2930. Duration of symptoms to qualify as a Manic Episode
    1 week
  2931. How many additional symptoms are required to diagnose mania if the core symptom is euphoria?
    3
  2932. How many additional symptoms are required to diagnose mania if the core symptom is irritability?
    4
  2933. Features that can be present in mania, but not hypomania (3)
    • 1. Impaired social/occupational functioning
    • 2. Need for hospitalization
    • 3. Psychosis
  2934. Duration of symptoms to qualify as a Hypomanic Episode
    4 days
  2935. Treatment of Wilson Disease
    D-penicillamine to chelate copper
  2936. 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
  2937. What percentage of the population has a diagnosable personality disorder?
    10-15%
  2938. Course of TB Meningitis
    Subacute; starts with milder symptoms, eventually progresses to fulminant meningitis
  2939. CT/MRI appearance of intracranial tuberculoma
    Ring-enhancing lesion
  2940. Brain imaging changes in schizophrenia
    Generalized atrophy with enlarged ventricles
  2941. Symptom of MCA stem occlusion in the dominant hemisphere
    Global aphasia
  2942. Symptom of MCA stem occlusion in the nondominant hemisphere
    Hemineglect
  2943. Aphasia caused by upper division MCA infarct
    Broca's aphasia
  2944. 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
  2945. Aphasia caused by inferior division MCA infarct
    Wernicke's
  2946. What is a Continuous Variable?
    Variable that falls on a range (eg weight, height)
  2947. What is an Independent Variable (predictor variable)?
    Variable manipulated by the experimenter
  2948. What is a Dependent Variable (outcome variable)?
    Variable not manipulated by the experimenter
  2949. What types of variables are compared by a Chi-Squared Test?
    A binary predictor variable and a binary outcome variable
  2950. What types of variables are compared by a T-Test?
    A binary predictor variable and a continuous outcome variable
  2951. What types of variables are compared by an ANOVA?
    Multiple binary predictor variables and one continuous outcome variable
  2952. What types of variables are compared by correlation?
    A continuous predictor variable and a continuous outcome variable
  2953. What types of variables are compared by a Regression Analysis?
    Multiple continuous or binary predictor variables and one continuous outcome variable
  2954. Age at which a child can build a tower of 6 blocks
    18 months
  2955. Age at which a child engages in parallel play
    18 months
  2956. 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)
  2957. Organ inflammation caused by Depakote (2)
    • 1. Pancreatitis
    • 2. Hepatitis
  2958. Most common inherited cause of Intellectual Disability
    Fragile X
  2959. Effect of Down Syndrome on genitalia
    • Genitals are small
    • Infertility is common
  2960. Demeanor of a patient with Williams Syndrome
    Unusually at ease with strangers and pleasant
  2961. Area not affected by cognitive delay in Williams Syndrome
    Language skills are strong!
  2962. How many RUL ECT treatments should be done without benefit before changing to Bilateral?
    4-6
  2963. Effect of Lithium during ECT
    Prolongs seizure activity
  2964. Effect of Clozapine during ECT
    Can cause late-appearing seizures
  2965. Malignancy in 10-15% with Ataxia-Telangiectasia by adulthood
    Lymphoma
  2966. Is Displacement a mature, neurotic, or immature defense?
    Neurotic
  2967. Is Repression a mature, neurotic, or immature defense?
    Neurotic
  2968. Brain region whose lesion is the most common cause of cerebral sensory deficit
    Thalamus
  2969. Brain region whose compression causes the cognitive symptoms of NPH
    Anterior brain, including frontal lobes
  2970. Age at which a child can play "Pat-a-Cake"
    10 months
  2971. Sites of nonspecific white matter anomalies HIV-Associated Dementia on MRI (3)
    • 1. Hemispheres
    • 2. Thalamus
    • 3. Basal ganglia
  2972. What p450 enzyme is inhibited by methadone?
    2D6
  2973. What p450 enzyme breaks down Wellbutrin?
    2B6
  2974. What percentage of nigrostriatal dopaminergic neurons must be lost before Parkinson's Disease symptoms occur?
    60-85%
  2975. Cerebellar region most atrophied in alcoholism
    Vermis
  2976. Factors increasing the effect of alcohol on women compared to men (2)
    • 1. Less alcohol dehydrogenase in the gut
    • 2. Lower body water content
  2977. Psychological effects of folate defieiency (6)
    • 1. Fatigue
    • 2. Dementia
    • 3. Delirium
    • 4. Psychosis
    • 5. Paranoia
    • 6. Agitation
  2978. Effect of Phenobarbital on Carbamazapine levels
    Decreases carbamazapine levels
  2979. Effect of Theophylline on Carbamazapine levels
    Decreases carbamazapine levels
  2980. Effect of Carbamazapine on Doxycycline levels
    Decreases doxycycline levels
  2981. Effect of Carbamazapine on Cyclosporine levels
    Decreases cyclosporine levels
  2982. Presentation of extracranial Vertebral Artery dissection
    • High cervical pain
    • May radiate to the occipital region
  2983. Risk of extracranial Vertebral Artery dissection
    Posterior circulation TIAs and strokes
  2984. Most common cause of extracranial Vertebral Artery dissection
    • Trauma
    • May be severe or mild (including simple hyperextension while shaving)
  2985. Management of extracranial Vertebral Artery dissection
    Anticoagulation to prevent posterior circulation TCAs and strokes
  2986. Poor prognostic indicator in Bell's Palsy
    Fibrilation of facial muscles 10-14 days after onset of weakness
  2987. Site of lesion causing coma after Carbon Monoxide posioning
    Globus Pallidus
  2988. Regions primarily affected in Stiff-Person Syndrome
    Lower trunk and legs (though the upper body can be affected to a lesser degree)
  2989. Precipitating factors of muscle spasms in Stiff-Person Syndrome (2)
    • 1. Emotional upset
    • 2. Auditory or tactile stimuli
  2990. Effect of sleep or anesthesia on Stiff-Person Syndrome
    Relieves rigidity
  2991. Symptomatic treatment for Stiff-Person Syndrome
    GABAergic medications
  2992. Receptor mediating the anti-nausea effect of Mirtazapine
    5-HT3 (antagonist)
  2993. Receptor mediating the anti-nausea effect of Ondansentron
    5-HT3 (antagonist)
  2994. Location of medulloblastomas
    4th ventricle (cause obstruction)
  2995. Brain regions though which the Reticular Activating System passes (2)
    • 1. Brainstem
    • 2. Thalamus
  2996. PET/fMRI finding in Schizophrenia
    Decreased activity in frontal lobes
  2997. Symptoms of C5 nerve root lesion
    • Pain and paresthesia over the shoulder
    • Weakness of deltoid, biceps, and brachioradialis
  2998. Symptoms of C6 nerve root lesion
    • Paresthesia of the thumb and lateral distal forearm
    • Weakness of biceps, triceps, and brachioradialis
  2999. Symptoms of C7 nerve root lesion
    • Paresthesia of the index, middle, and ring fingers
    • Weakness in triceps and pronators
  3000. What is Pick's Disease?
    Type of frontotemporal dementia
  3001. Molecule whose mutation causes Potassium-Sensitive Periodic Paralysis
    Sodium Channel
  3002. Chromosome affected in Potassium-Sensitive Periodic Paralysis
    17
  3003. Inheritance pattern of Potassium-Sensitive Periodic Paralysis
    Autosomal Dominant
  3004. Symptom of Potassium-Sensitive Periodic Paralysis
    Weakness caused by potassium exposure
  3005. Treatment of Hemicrania Continua (Paroxysmal Hemicrania)
    Prophylactic indomethacin
  3006. What is the Chiari III Mutation?
    Cervical spina bifida through which the cerebellum protrudes
  3007. Cognitive area not affected by Prader-Willi Syndrome
    Visuospatial skills
  3008. Cognitive area most prominently affected by Prader-Willi Syndrome
    Executive Functioning
  3009. Major morbidity of Pseudotumor Cerebri
    Optic nerve damage causing field cuts
  3010. 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
  3011. 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
  3012. Brain regions that mediate Episodic Memory (5)
    • 1. Medial temporal lobe
    • 2. Anterior thalamus
    • 3. Mamillary body
    • 4. Fornix
    • 5. Prefrontal cortex
  3013. Brain region that mediates Semantic Memory
    Inferolateral temporal lobe
  3014. Brain regions that mediate Procedural Memory (3)
    • 1. Basal ganglia
    • 2. Cerebellum
    • 3. Supplementary Motor Area
  3015. What is the basis of Operant Conditioning?
    Learning occurs by experiencing positive and negative consequences of action
  3016. What concept was developed by Burns?
    Cognitive Distortions
  3017. Why should TCAs be avoided in dementia?
    Anticholinergic effects can worsen agitation and overall dementia
  3018. Standardized treatment location for TMS
    Left prefrontal cortex
  3019. Indication for TMS in MDD
    Failed one antidepressant at adequate dose for adequate time
  3020. "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
  3021. Populations most affected by Conversion Disorder (5)
    • 1. Rural
    • 2. Lower education
    • 3. Lower IQ
    • 4. Lower socioeconomic status
    • 5. Combat veterans
  3022. Drugs of abuse that affect serotonin (2)
    • 1. LSD
    • 2. MDMA
  3023. Site of damage due to MDMA use
    Serotonergic nerve terminals in CNS
  3024. What is the L-Scale of the MMPI?
    • Lie Scale
    • Focuses on rarely-practiced socially desirable behaviors
    • Tests whether patient is being honest
  3025. What is the F-Scale of the MMPI?
    • Infrequency Scale
    • Used to identify malingering, illiteracy, confusion, psychosis, and panic
  3026. What is the K-Scale of the MMPI?
    • Suppressor Scale
    • Used to decrease false positives and false negatives
  3027. Contraindications of Thyroid Hormone (3)
    • 1. Thyrotoxicosis
    • 2. Uncorrected adrenal insufficiency
    • 3. Acute MI
  3028. Effect of Thyroid Hormone on Warfarin
    Potentiate effects of Warfarin
  3029. Effect of Thyroid Hormone on Insulin
    Increase insulin requirements in diabetes
  3030. Effect of Thyroid Hormone on Digitalis
    Increase digitalis requirements in cardiac disease
  3031. How long after alcohol cessation is GGT elevated?
    8 weeks
  3032. Psychiatric symptoms of Adrenal Insufficiency (Addison's Disease) (5)
    • 1. Depression
    • 2. Apathy
    • 3. Irritability
    • 4. Psychosis
    • 5. Delirium
  3033. Effect of Valproic Acid on Carbamazepine levels
    Doubles Carbamazapine levels
  3034. Effect of Carbamazapine on Lamotrigine levels
    Halves lamotrigine levels
  3035. Age at which myelination of peripheral nerves is complete
    2 years
  3036. Which gender is more likely to be affected by Tardive Dyskinesia?
    Women
  3037. Age ranges more susceptible to Tardive Dyskinesia
    • Children
    • Over age 50
  3038. Disorders that increase risk of Tardive Dyskinesia (2)
    • 1. Brain damage
    • 2. Mood disorders
  3039. Age range whose Tardive Dyskinesia is least-likely to remit
    Elderly patients
  3040. Absorption rate of clonazepam
    Rapid
  3041. Absorption rate of alprazolam
    Medium
  3042. Absorption rate of diazepam
    Rapid
  3043. Absorption rate of lorazepam
    Medium
  3044. Half-life of Clonazepam
    34 hours
  3045. Half-life of Alprazolam
    12 hours
  3046. Half-life of Diazepam
    100 hours
  3047. Half-life of Lorazepam
    15 hours
  3048. Mnemonic for benzodiazepines in renal impairment
    • "Tolerated by Our Liver"
    • Temazepam
    • Oxazepam
    • Lorazepam
  3049. 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
  3050. Electrolyte abnormality that can be caused by Carbamazapine
    Hyponatremia
  3051. Metabolism of Olanzapine
    Hepatic
  3052. Metabolism of Quetiapine
    Hepatic
  3053. Metabolism of Ziprasidone
    Hepatic
  3054. Metabolism of Risperidone
    Hepatic
  3055. Metabolism of Paliperidone
    Renal
  3056. Metabolism of Desvenlafaxine
    Renal
  3057. Side effects specific to Desvenlafaxine (3)
    • 1. Orthostasis
    • 2. Hyponatremia
    • 3. Hypertension
  3058. GAF above which symptoms are generally minor
    60
  3059. GAF below which a patient is severely impaired and persistently dangerous to self or others
    20
  3060. How long does it take for Atomoxetine (Strattera) to reach full effect?
    10 weeks
  3061. Side effects of Atomoxetine (Strattera) (3)
    • 1. Dizziness
    • 2. Reduced appetite
    • 3. Dyspepsia
  3062. Metabolism of Atomoxetine (Strattera)
    Hepatic
  3063. Can Atomoxetine (Strattera) be combined with stimulants?
    Yes! Both well-tolerated and effective
  3064. Which field of Psychology states that a child needs others to help with self-object functions?
    Self Psychology
  3065. Substances whose dependence can be treated with depot Naltrexone (2)
    • 1. Alcohol
    • 2. Opioids
  3066. What does the HAM-D evaluate?
    Depression
  3067. What does the PANSS evalute?
    Severity of psychosis
  3068. What antidepressant is FDA-approved for pain in Fibromyalgia?
    Duloxetine
  3069. What alcohol is safe with MAOIs?
    Clear alcohols (eg vodka) in small amounts
  3070. REM Latency during Cataplexy
    Decreased; within a few minutes, many patients are in REM sleep
  3071. IQ Range classified as Mild Intellectual Disability
    50-70
  3072. IQ Range classified as Moderate Intellectual Disability
    35-50
  3073. IQ Range classified as Severe Intellectual Disability
    20-35
  3074. IQ Range classified as Profound Intellectual Disability
    Less than 20
  3075. Risk of Clozapine dosing over 600mg daily
    Much higher risk of seizure than lower doses of Clozapine
  3076. Risk of Lithium with Clozapine
    Increased risk of NMS
  3077. Is Agranulocytosis from Clozapine dose-related?
    No!
  3078. Effect of smoking on Clozapine levels
    Decreases clozapine levels
  3079. Largest factor in likelihood of developing PTSD after a trauma
    Degree of trauma and its subjective meaning to the individual
  3080. Effect of childhood trauma on future PTSD
    Increased risk of developing PTSD from a future trauma
  3081. Gender breakdown of PTSD
    Women > Men
  3082. Effect of alcohol on developing PTSD
    Recent abuse of alcohol increases likelihood of PTSD if a trauma occurs
  3083. Most important predictor of suicide in a schizophrenic patient
    Presence of a depressive episode
  3084. 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
  3085. Timing of Postpartum Depression
    Within 4 weeks of delivery
  3086. Psychiatric symptoms that can occur in Acute Intermittent Porphyria (4)
    • 1. Delirium
    • 2. Psychosis
    • 3. Depression
    • 4. Anxiety
  3087. Prevalence of Alzheimer Disease after age 85
    20-40%
  3088. 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
  3089. Mental Illnesses most likely in chronically homeless (2)
    • 1. Schizophrenia
    • 2. Substance abuse
  3090. Metnal Illnesses most likely in episodically homeless (3)
    • 1. Personality disorders
    • 2. Mood disorders
    • 3. Substance abuse
  3091. Treatments of acute arsenic poisoning (2)
    • 1. Penicillamine
    • 2. Dimercaptol derivative (DMSA or DMPS)
  3092. Treatments of lead ecephalopathy (2)
    • 1. Sertoids to treat cerebral edema
    • 2. Chelating agents (dimercaprol or DMPS)
  3093. Does a patient have a right to psychotherapy notes under HIPAA?
    No!
  3094. Does a patient have a right to dictate the method of communication of health information under HIPAA?
    Yes!
  3095. Histaminergic effect of Mirtazapine
    • Potent H1 antagonist
    • Causes sedation, increased appetite, and weight gain
  3096. MRI results in Transverse Myelitis
    Spinal cord enhancement
  3097. How often does Transverse Myelitis develop into Multiple Sclerosis?
    7% of patients develop MS
  3098. Mood stabilizer that is FDA approved for bipolar maintenance
    Lamotrigine
  3099. Mood stabilizer that is FDA approved for both mania and depression
    Lamotrigine
  3100. What psychiatric symptoms is Carbamazapine FDA approved for?
    Mania
  3101. What psychiatric symptoms is Valproic Acid FDA approved for?
    Mania
  3102. Typical duration of sleepwalking
    Less than 10 minutes
  3103. Site of brain injury causing Simultagnosia
    Left occipital region
  3104. What is Anomic Aphasia?
    Difficulty naming or word-finding
  3105. Deficits often co-occurring with Conduction Aphasia
    Right-sided sensory loss, typically with intact motor function
  3106. Eye and head position after ACA stroke
    Deviate toward the lesion
  3107. Branches of ACA whose obstruction causes sphincter incontinence
    Hemispheric branches
  3108. Branches of the ACA whose obstruction causes apraxia, agraphia, and tactile anomia of the hand
    Pericallosal branches
  3109. Branches of the ACA whose obstruction causes anxiety, agitation, and memory impairment
    Basal branches
  3110. Symptoms of infarction of the Medial Lenticulostriate Artery
    Internal capsule infarction causes pure motor impairment of face and arm
  3111. Symptoms of Anterior Choroidal Artery Syndrome (3)
    • 1. Hemiparesis (affects internal capsule)
    • 2. Hemisensory loss (affects thalamus)
    • 3. Hemianopia (affects Lateral Geniculate Nucleus)
  3112. Visual field deficit occurring in Anterior Choroidal Artery Syndrome
    • Homonymous
    • Affects superior and inferior fields, but spares the horizontal meridian
  3113. Metabolism of Gabapentin
    • Not metabolized by the liver
    • Excreted unchanged in urine
  3114. What information remains lost after an episode of Transient Global Amnesia resolves?
    • A brief period before the episode
    • Memories from the episode itself
  3115. Gender breakdown of Psychogenic Nonepileptic Seizures
    Women > Men
  3116. Blood test that suggests Psychogenic Nonepileptic Seizures
    Prolactin is sometimes elevated after a true seizure, but never after a pseudoseizure
  3117. First-line treatment for akathesia
    Beta Blockers
  3118. Treatments for akathesia (2)
    • 1. Beta Blockers
    • 2. Benzodiazepines
  3119. Drug of choice for Trigeminal Neuralgia
    Carbamazepine
  3120. Efficacy of opiates in Trigeminal Neuralgia
    Some sources say not effective
  3121. Efficacy of baclofen in Trigeminal Neuralgia
    Very effective
  3122. How long after ischemic stroke can aspirin be started to be beneficial?
    48 hours
  3123. Presentation of Thoracic Outlet Syndrome
    • Pain on the medial arm or diffusely in the arm
    • Tingling along the medial forearm and hand
  3124. 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
  3125. Most common Anxiety Disorder
    Specific Phobia
  3126. Most common mental illness among women
    Specific Phobia
  3127. Most common mental illness among men
    Substance abuse
  3128. Inheritance pattern for Neurofibromatosis 1
    Autosomal dominant
  3129. Inheritance Pattern for Neurofibromatosis 2
    Autosomal dominant
  3130. Bony lesion characteristic of Neurofibromatosis 1
    Thinned cortex of long bones
  3131. What factor correlates most with peoples' culture?
    Ethnicity
  3132. Inheritance pattern of Acute Intermittent Porphyria
    Autosomal dominant
  3133. Duration of an attack of Acute Intermittent Porphyria
    Days to weeks
  3134. Treatments for an attack of Acute Intermittent Porphyria (3)
    • 1. IV Hemin
    • 2. IV Glucose
    • 3. Pain control
  3135. Effect of thazide diuretics on lithium levels
    Increase lithium reabsorbtion in the kidney
  3136. Medication that reduces overall disability and plaque formation in Multiple Sclerosis
    Interferon
  3137. Cardiac effects of Ipecac abuse (4)
    • 1. Cardiomyopathy
    • 2. Cardiomegaly
    • 3. QTc prolongation
    • 4. Tricuspid/mitral valve insufficiency
  3138. Lab values affected by Ipecac abuse (3)
    • 1. Increased CK-MB (due to cardiomyopathy)
    • 2. Low WBCs
    • 3. Elevated LFTs
  3139. What is Binswanger's Disease? Who gets it?
    • Subcortical vascular dementia
    • Occurs in patients in their 50s with hypertension
  3140. Presentation of Binswanger's Disease (3)
    • 1. Progressive dementia
    • 2. Motor and sensory deficits
    • 3. Seizures
  3141. Age at which a child can respond to simple directions
    23 months
  3142. Age at which a child can understand pronouns
    23 months
  3143. Age at which a child begins to understand complex sentences
    23 months
  3144. Who gets Essential Tremor?
    • Men > Women
    • Caucasian > Non-Caucasian
  3145. Effect of alcohol on Essential Tremor
    Small ingestion of ethanol can cause marked improvement in tremor
  3146. 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
  3147. What can acutely precipitate Wernicke's Encephalopathy?
    Loading with carbohydrates, including IV glucose infusion
  3148. Sites of MRI abnormalities in Wernicke's Encephalopathy (3)
    • 1. Periaqueductal regions
    • 2. Medial thalamus
    • 3. Mammillary bodies
  3149. Where in the brain does the Judgment of Line Orientation test show disease?
    Right hemisphere
  3150. What is Dystonic Tremor?
    Irregular oscillatory movements of a head or limb when moved away from the "null point" of the dystonic pulling
  3151. Chromosome associated with Adult-Onset Primary Dystonia
    Chromosome 18
  3152. 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
  3153. EEG in Juvenile Myoclonic Epilepsy
    • Bilateral 3-5Hz spikes and polyspike-and-wave patterns
    • Maximal in the frontocentral regions
  3154. Treatment of Juvenile Myoclonic Epilepsy
    Valproic Acid
  3155. 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
  3156. EEG in Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS)
    • Sharp waves in the midtemporal and central regions
    • Increased frequency when asleep
  3157. 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
  3158. Cranial nerve most commonly affected bilaterally in isolation
    Abducens nerve (CN6)
  3159. 2 most common causes of bilateral Abducens palsy
    • 1. Trauma
    • 2. Increased intracranial pressure
  3160. Most common diabetic cranial mononeuropathy
    Oculomotor (CN3) palsy
  3161. Hallmark of Diabetic CN3 Palsy
    Pupillary sparing
  3162. 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"
  3163. Periods of onset that are modifiers for Substance-Induced Anxiety Disorder (2)
    • 1. "with onset during intoxication"
    • 2. "with onset during withdrawal"
  3164. Treatment for Herpes Simplex Encephalitis
    Acyclovir
  3165. Imaging of choice for suspected Herpes Simplex Encephalitis
    MRI
  3166. Site of EEG abnormalities in Herpes Simplex Encephalitis
    Temporal Lobes
  3167. Distribution of weakness in Dermatomyositis
    • Symmetrical
    • Proximal more than distal muscles of arms and legs
  3168. Distribution of weakness in Polymyositis
    • Symmetrical
    • Proximal more than distal muscles of arms and legs
  3169. Most common mitochondrial disorder
    Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS)
  3170. Unique radiological feature of Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS)
    Stroke involves cortex only, sparing white matter
  3171. 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
  3172. Cause of Myoclonic Epilepsy with Ragged Red Fiber Myopathy (MERRF)
    Mitochondrial abnormality
  3173. Triad of Kearns-Sayre Syndrome (KSS) (3)
    • 1. Progressive external ophthalmoplegia
    • 2. Onset before age 20
    • 3. Other systemic symptoms co-occurring
  3174. Prognosis of Anterior Ischemic Optic Neuropathy
    • Rate of spontaneous remission is high
    • May recur in the other eye
  3175. Drugs of abuse that can cause nystagmus (4)
    • 1. Alcohol
    • 2. Inhalants
    • 3. Sedative hypnotics
    • 4. PCP
  3176. What response to noxious stimuli may be present for diagnosis of brain death?
    None!
  3177. Is apnea test required for diagnosis of brain death?
    Yes! Must use ABG to confirm elevated CO2 pressure after apnea test
  3178. What p450 enzyme breaks down Codeine?
    2D6
  3179. What p450 enzyme breaks down Beta Blockers?
    2D6
  3180. What p450 enzyme breaks down Clozapine?
    2D6
  3181. What p450 enzyme breaks down Thioridazine?
    • 2D6
    • If a 2D6 inhibitor is being given, Thioridazine is contraindicated!
  3182. Onset of muscle weakness in classic, spinal ALS
    Most often in upper extremities
  3183. Onset of muscle weakness in bulbar-onset ALS
    Begins in bulbar-innervated muscles (muscles of mouth and throat)
  3184. Presentation of a seizure caused by a CNS tumor
    Focal (reflecting tumor location), with secondary generalization
  3185. Medication that reduces chorea, but does not improve gait, in Huntington's Disease
    Haloperidol
  3186. What is Festination?
    Series of rapid, small, accelerating steps to keep from falling forward
  3187. What is Astasia?
    Inability to stand upright unassisted
  3188. What is Abasia?
    Lack of motor coordination in walking
  3189. What is Astasia-Abasia?
    • Inability to stand or walk in a normal manner
    • Often a sign of conversion disorder
  3190. Most common pathogens in Bacterial Meningitis (3)
    • 1. N. Meningiditis
    • 2. S. Pneumoniae
    • 3. H. Influenzae
  3191. Most common pathogens causing meningitis in neonates (3)
    • 1. Group B Strep
    • 2. E. Coli
    • 3. Listeria
  3192. CSF findings in Guillain Barre Syndrome
    Increased protein without pleocytosis
  3193. Is weakness in Guillain Barre ascending or descending?
    Ascending
  3194. Clinical presentation of cerebellar hemorrhage
    • Sudden onset of vertigo, headache, vomiting, and inability to stand or walk
    • No hemiparesis or hemiplegia
  3195. When is neurosurgical intervention needed in cerebellar hemorrhage
    When first signs/symptoms of hydrocephalus develop
  3196. Posture in Stiff-Person Syndrome
    Extreme lumbar lordosis
  3197. EMG in Stiff-Person Syndrome
    Continuous firing of motor units
  3198. 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
  3199. Treatment for Tolosa-Hunt Syndrome
    Corticosteroids and other immunosuppressive agents
  3200. Which Benzodiazepines are metabolized by Glucuronidation? (3)
    • 1. Temazepam
    • 2. Oxazepam
    • 3. Lorazepam
  3201. Receptor for serotonin that is responsible for GI side effects of SSRIs
    5HT-3
  3202. SSRIs with the most intense GI symptoms (2)
    • 1. Sertraline
    • 2. Fluvoxamine
  3203. Cognitive side effects of Lithium
    • Slowed reaction time, lack of spontaneity
    • Dysphoria
    • Memory issues
    • (Similar to depression!)
  3204. What p450 enzyme is induced by Carbamazapine, causing its own degredation?
    3A4
  3205. Blood monitoring with Carbamazapine
    • CBC every 3 months for a year
    • If no bone marrow suppression, reduce interval of CBC
  3206. At what ages does grammar develop?
    3yrs to 4.5yrs
  3207. Which patients should not take lithium and clozapine together?
    Patients with prior history of Neuroleptic Malignant Syndrome
  3208. Effect of giving clomipramine and clozapine together
    Increases clozapine levels
  3209. Effect of giving paroxetine and clozapine together
    May trigger clozapine-associated neutropenia
  3210. What percent of sleep time is REM sleep in a newborn?
    50% or more
  3211. What percent of sleep time is REM sleep in an infant?
    Less than 40%
  3212. What percent of sleep time is REM sleep in young adulthood?
    25%
  3213. What stage of sleep do adults spend the most sleep time in?
    Stage II
  3214. 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)
  3215. Effect of β-blockers with cocaine
    • Cause unopposed α-adrenergic vasoconstriction
    • Paradoxical increase in BP
  3216. What class of medication is used in a hypertensive crisis caused by MAOIs?
    α-blocker
  3217. Effect of co-administering SSRI and Lithium
    • Elevated serotonin
    • Can cause serotonin syndrome
  3218. Treatment of serotonin syndrome
    • Discontinue the offending agents
    • Supportive care (can be ICU-level!)
  3219. Factor most correlated with childhood physical abuse
    Poverty and psychosocial stress, especially financial stress
  3220. 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
  3221. 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
  3222. 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)
  3223. 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
  3224. How does Interpersonal Therapy (IPT) deal with Complicated Bereavement?
    Promote appropriate mourning
  3225. How does Interpersonal Therapy (IPT) deal with Role Dispute?
    Resolve interpersonal struggles between the patient and their significant other
  3226. 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
  3227. How does Interpersonal Therapy (IPT) deal with Personal Deficits?
    Decrease social isolation
  3228. 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
  3229. Criteria for Pedophilia in DSM IV
    • Age 16 or older
    • Attraction to children at least 5 years younger
  3230. Second choice of Methylphenidate fails in a child with ADHD
    Dextroamphetamine or amphetamine/dextroamphetamine salt
  3231. Underlying cause of most fugue states
    Traumatic circumstances leading to altered state of consciousness with wish to flee
  3232. Primary method of treatment of fugue states
    Psychodynamic psychotherapy
  3233. Lab findings related to norepinephrine in pathological gamblers (3)
    • 1. ↓ norepinephrine metabolites in serum
    • 2. ↑ norepinephrine metabolites in CSF
    • 3. ↑ urinary norepinephrine
  3234. What does decreased platelet MAO activity suggest?
    Serotonergic dysfunction
  3235. 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
  3236. Physical symptom of Rett Syndrome in early childhood
    Deceleration of head growth
  3237. Age of decline in Childhood Disintegrative Disorder
    2 years
  3238. Whose theories included Archetypes?
    Jung
  3239. Whose theories included the Collective Unconscious?
    Jung
  3240. Whose theories included Complexes?
    Jung
  3241. Whose theories included introverts and extroverts?
    Jung
  3242. Whose theories included the Anima and Animus?
    Jung
  3243. Whose theories included the Persona?
    Jung
  3244. Whose theories included Individuation?
    Jung
  3245. What concept did Kurt Goldstein advance?
    Self-Actualization
  3246. What theories did Edith Jacobson propose?
    Infant's experience of pleasure or lack of pleasure and its effect on the parent-child relationship
  3247. What is Phase II metabolism of benzodiazepines?
    Glucoronidation
  3248. What is Phase I metabolism of benzodiazepines?
    • Oxidation via p450
    • Generates active metabolites that must be Phase II metabolized
  3249. Pregnancy category of benzodiazepines
    D
  3250. Most common reason for psychiatric malpractice lawsuits
    Suicide attempt or completion
  3251. What does Respondeat Superior mean?
    • Legal term
    • Person occupying a high position in a hierarchy is responsible for those in lower positions
  3252. Best therapy for Panic Disorder
    • CBT, if monotherapy
    • CBT with an SSRI is more effective than CBT alone
  3253. What psychiatric condition is Propranolol indicated for?
    Performance anxiety
  3254. What is Ebstein's Anomaly?
    Abnormal formation of the tricuspid valve
  3255. What is Schizoid Fantasy (defense mechanism)?
    • Immature defense
    • Retreating into fantasy or eccentricity to avoid intimacy
  3256. What is Anticipation (defense mechanism)?
    • Mature defense
    • Planning for future inner discomfort
  3257. Effects of lithium on the parathyroid gland (2)
    • 1. Hyperplasia
    • 2. Increased risk of adenoma
    • Either can lead to hyperparathyroidism!
  3258. Black box warning for Valproic Acid
    Hepatic failure
  3259. What psychiatric medication can cause Eosinophilic Colitis?
    Clozapine
  3260. How did Levinson view development?
    Separated into 4 stages, each lasting about 25 years
  3261. What psychological factors did Valliant study?
    • Happy childhood led to positive traits in middle life
    • Adaptive styles mature over time
  3262. What is Normality-as-Process?
    Notion that changes in personality over time are an essential part of development
  3263. What labs should routinely be followed in patients on lithium? (4)
    • 1. CBC
    • 2. Electrolytes
    • 3. BUN/Creatinine
    • 4. Thyroid function tests
  3264. 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
  3265. How long after a loved one's death can MDD be diagnosed?
    2 months
  3266. Symptoms of Hyperthermic Syndrome of MDMA (5)
    • 1. Disseminated Intravascular Coagulation
    • 2. Rhabdomyolysis
    • 3. Liver failure
    • 4. Kidney Failure
    • 5. Death
  3267. Relationship of MDMA dose to risk of Hyperthermic Syndrome
    • None!
    • Can occur at any dose
  3268. What is the common name for Flunitrazepam?
    Rohypnol
  3269. Effect of combining CBT and pharmacology for Social Anxiety Disorder
    No clear benefit over CBT alone or pharmacology alone
  3270. What type of therapy for substance abuse includes Skills Training?
    CBT
  3271. Effects of Lamictal on weight
    Weight neutral
  3272. Lowest effective methadone dose
    50mg daily
  3273. Average methadone dose
    80mg daily
  3274. What medications should be given for a patient with OCD and tics? (2)
    • 1. SSRI for OCD symptoms
    • 2. Dopamine blocker for tics
  3275. Criteria for diagnosis of Bipolar II
    One hypomanic episode and one depressive episode
  3276. How often should a patient with Hypochondriasis see a primary MD?
    Regularly scheduled appointments are necessary!
  3277. Management of a patient on Clozapine who develops a white count between 2000 and 3000
    • Stop clozapine
    • May restart clozapine if white count improves
  3278. Management of a patient on Clozapine who develops a white count between 3000 and 3500
    • Continue clozapine
    • Monitor WBCs twice weekly until over 3500
  3279. Management of a patient on Clozapine who develops a white count below 2000
    • Stop clozapine
    • Can not be re-challenged in the future!
  3280. Normal QTc
    Less than 450
  3281. QTc at which medications that prolong the QT interval must be considered carefully
    500
  3282. Cognitive side effects of Interferon
    • Mimic depression
    • Low mood, suicidality, insomnia, fatigue, cognitive insufficiency
  3283. Requirements for PTSD diagnosis (3)
    • 1. One symptom of reexperiencing
    • 2. Two symptoms of increased arousal
    • 3. Three symptoms of avoidance
  3284. PTSD symptoms considered Avoidance Symptoms (3)
    • 1. Restricted affect
    • 2. Sense of foreshortened future
    • 3. Avoiding people associated with the trauma
  3285. First-line medications for PTSD
    SSRIs and SNRIs
  3286. Type of psychotherapy with the most evidence of effectiveness in PTSD
    CBT
  3287. Effect of benzodiazepines in PTSD
    Slow recovery rates
  3288. Prognosis of PTSD if onset of symptoms is rapid
    Good
  3289. Prognosis of PTSD if duration of symptoms is less than 6 months
    Good
  3290. Age groups with the highest likelihood of developing PTSD after a trauma
    Very old or very young
  3291. Age group that fares best in PTSD
    Those in the middle of life
  3292. Brain area affected in PTSD
    • Locus Coeruleus
    • Increased norepinephrine turnover
  3293. What is Premack's Principle?
    Behavior engaged in at a high frequency can be used to reinforce behavior that occurs at a low frequency
  3294. Workup for all patients who will receive ECT (3)
    • 1. Blood/urine chemistries
    • 2. EKG
    • 3. CXR
  3295. Management of small intracranial mass lesions in ECT
    Premedicate with dexamethasone (Decadron)
  3296. How long after myocardial infarction is risk of ECT diminished?
    • Partially diminished at 2 weeks
    • Substantially diminished at 3 months
  3297. Characteristics required for a seizure to be effective in ECT (2)
    • 1. Bilateral and generalized
    • 2. Lasts at least 25 seconds
  3298. Mortality rate in ECT
    0.01%
  3299. Why should benzodiazepines not be given during ECT?
    Increase the seizure threshold
  3300. Why should lithium not be given during ECT?
    • Prolonged seizures
    • Cause postictal delirium
  3301. Why is Propofol not a useful anesthetic in ECT?
    Raises the seizure threshold
  3302. 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
  3303. Criteria for Cyclothymic Disorder
    Hypomania with sub-threshold depression symptoms for 2 years
  3304. Can glioma cause mania?
    Yes!
  3305. Effect of benzodiazepines on mania
    Lessen symptoms
  3306. Classes of psychiatric medications that can cause mania (4)
    • 1. Antidepressants
    • 2. Anticonvulants
    • 3. Stimulants
    • 4. Barbiturates
  3307. Somatic medications that can cause mania (5)
    • 1. Isoniazid
    • 2. Cimetidine
    • 3. Metoclopramide
    • 4. Steroids
    • 5. Bronchodilators
  3308. Brain sites where cocaine affects dopamine (3)
    • 1. ↑ in mesolimbic pathway
    • 2. ↑ in mesocortical pathway
    • 3. ↓ in corpus striatum
  3309. Hallucinations associated with heavy cocaine use (2)
    • 1. Shower of lights in central vision
    • 2. Black dots on skin and in the environment
  3310. Why is Diazepam given in cocaine overdose?
    Prevents seizures
  3311. Percent of patients with BPAD who have a co-occurring substance abuse disorder
    60%
  3312. What Defense Mechanism was first described by Kernberg?
    Projective Identification
  3313. What is Projective Identification?
    Projecting intolerable aspects of self onto another person, who is then induced to play the projected role
  3314. What is the Content of an interview?
    What is explicitly said between doctor and patient
  3315. What is the Process of an interview?
    Things that may be observed nonverbally, such as body language, behaviors, or avoidance of difficult topics
  3316. What is Partialism?
    Paraphilia in which sexual activity is concentrated on one part of the body to the exclusion of all others
  3317. How long must sadistic fantasies be present for diagnosis of Sexual Sadism?
    6 months
  3318. How long must masochistic fantasies be present for diagnosis of Sexual Masochism?
    6 months
  3319. Diagnostic criterion for Fetishism
    6 months of sexual fantasies involving nonliving objects
  3320. Prognosis of paraphilias with early age of onset
    Poor
  3321. Prognosis of paraphilias if coitus occurs with the paraphilia
    Good
  3322. Prognosis of paraphilias if only one paraphilia is present
    Good
  3323. Psychotherapies used in paraphilias (3)
    • 1. Dynamic therapy
    • 2. CBT
    • 3. Sex therapy (adjunctive to dynamic therapy)
  3324. Typical attraction pattern in TransWomen
    2/3 are attracted to men only
  3325. When should a Forensic Psychiatrist assess competency to stand trial?
    Should be done for every person evaluated!
  3326. 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!
  3327. 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
  3328. 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
  3329. Components required for an act to be criminal (2)
    • 1. Actus Reus
    • 2. Mens Rea
    • Intent to harm is not sufficient without these!
  3330. 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
  3331. GAF score corresponding to some danger of hurting self or others or occasional failure to maintain hygeine
    20
  3332. GAF score corresponding to persistent danger of harming self or others
    10
  3333. What is Pseudologia Phantastica?
    Lying about one's past while appearing to believe the fantasy and acting as though it were true
  3334. What is Algophobia?
    Fear of pain
  3335. What do Positive Symptoms of schizophrenia predict regarding course of illness?
    • Frequency of hospitalization
    • Not long-term functional outcome
  3336. What symptoms of Schizophrenia correlate most strongly with long-term functional outcome?
    Cognitive symptoms
  3337. Age range in which Schizophrenics are most likely to commit suicide
    First few years of illness
  3338. What is Echopraxia?
    Imitation of posture or behavior of an examiner
  3339. Cardiac effects of anorexia (2)
    • 1. Bradycardia
    • 2. Arrhythmia
  3340. CBC changes that can occur in anorexia
    Pancytopenia
  3341. CMP changes that can occur in anorexia (2)
    • 1. ↑ LFTs
    • 2. ↑ BUN
  3342. Neurological effects of anorexia (3)
    • 1. Peripheral neuropathy
    • 2. Seizures
    • 3. Metabolic encephalopathy
  3343. Weight at which anorexics should be hospitalized
    < 75% of expected weight
  3344. Should anorexics be hospitalized if growth arrests?
    Yes!
  3345. Classes of medications used for anorexia (2)
    • 1. Antidepressants
    • 2. Antipsychotics
  3346. Risks of self-induced vomiting during pregnancy (2)
    • 1. ↑ risk of spontaneous abortion
    • 2. ↑ risk of low birth weight
  3347. Effects of abuse of ipecac syrup (3)
    • 1. Muscle atrophy (skeletal and cardiac)
    • 2. QTc prolongation
    • 3. Tachycardia
  3348. Use of benzodiazepines in Social Anxiety Disorder
    Very helpful if used judiciously in social situations
  3349. Concern with Bupropion in anxiety disorders
    Activation may worsen anxiety
  3350. What does a patient with social phobia fear?
    Embarassment
  3351. What does a patient with avoidant personality disorder fear?
    Rejection
  3352. What is the Non-Generalized Subtype of Social Phobia?
    Performance Anxiety
  3353. Common medical illness in which Beta Blockers are contraindicated
    Asthma
  3354. Duration of social anxiety symptoms in a patient under age 18 for diagnosis of Social Anxiety Disorder
    6 months
  3355. CNS complication of sleep apnea
    Increased risk of stroke
  3356. What are Dyssomnias?
    Disorders of duration, quality, or timing of sleep
  3357. What are Parasomnias?
    Disorders in which undesired behaviors occur during sleep or sleep transitions
  3358. Medication used in narcolepsy
    Modafinil
  3359. Illness whose risk is increased in REM Behavior Disorder
    Parkinson Disease
  3360. What is Pavor Nocturnus?
    Sleep Terror Disorder
  3361. What is Jactatio Capitis Nocturna?
    Movement disorder including head banging in sleep
  3362. Treatment of Jactatio Capitis Nocturna
    • Symptoms can not be treated
    • Create an environment in which head banging will not cause injury
  3363. Effect of Obstructive Sleep Apnea on respiratory effort
    During episodes, airflow stops and respiratory effort increases
  3364. Effect of Central Sleep Apnea on respiratory effort
    During episodes, airflow stops and respiratory effort decreases
  3365. Criteria for diagnosis of sleep apnea
    30 episodes per night lasting 10 seconds each
  3366. Gender breakdown of REM Sleep Behavior Disorder
    Mostly seen in men
  3367. Psychiatric medications that worsen REM Sleep Behavior Disorder (3)
    • 1. Fluoxetine
    • 2. TCAs
    • 3. Stimulants
  3368. Medications that reduce symptoms of REM Sleep Behavior Disorder (2)
    • 1. Clonazepam
    • 2. Carbamazepine
  3369. Most common side effects of Ziprasidone (Geodon) (2)
    • 1. Sedation
    • 2. Cardiac effects
  3370. Risk of weight gain with Ziprasidone (Geodon)
    Low
  3371. Risk of extrapyramidal side effects with Ziprasidone (Geodon)
    Low
  3372. 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
  3373. 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
  3374. Diagnoses that can involve 1 month of psychosis without meeting Criterion A for Schizophrenia (2)
    • 1. Delusional Disorder
    • 2. Psychosis NOS
  3375. Hallucinations in Delusional Disorder
    • Auditory and visual hallucinations are not present
    • Tactile, olfactory, or gustatory may be present if related to the delusion
  3376. Effect of Delusional Disorder on memory
    None!
  3377. Primary preventative measures for Brief Psychotic Disorder
    None!
  3378. What is an Illusion?
    Sensory misperception of actual stimuli
  3379. How often can IM Haldol 5mg be given until sedation occurs?
    Every 20-30 minutes
  3380. Gender breakdown of episodes of domestic violence
    About equal (!)
  3381. What is Zyprexa Relprevv?
    Long-acting injectable olanzapine
  3382. Gender breakdown of Dissociative Identity Disorder
    Mostly women (5-10 to 1 ratio)
  3383. Group therapy in Dissociative Identity Disorder
    • Useful
    • Best-conducted with only DID patients
  3384. Effect of benzodiazepines in Dissociative Identity Disorder
    Helpful at low doses
  3385. Medication classes used in Dissociative Identity Disorder (3)
    • 1. SSRIs
    • 2. Antipsychotics
    • 3. Mood stabilizers (except lithium!)
  3386. Percent of patients with dementia whose illness is reversible if treated very early
    15%
  3387. When should Donepezil be given for dementia?
    Immediately, even before a workup is done to confirm the diagnosis!
  3388. Survival expectancy of Alzheimer Dementia
    ~8 years after onset of illness
  3389. Treatment regimen for Alzheimer Dementia (2)
    • 1. Cholinesterase inhibitor
    • and/or
    • 2. NMDA antagonist
  3390. Treatment of vascular dementia (2)
    • 1. Antiplatelet aggregants
    • 2. Medications targeted at HTN, DM, or HLP if present
  3391. Effect of history of alcohol abuse on development of Delirium
    Increases risk
  3392. Effect of history of smoking on development of Delirium
    Increases risk
  3393. Effect of history of HTN on development of Delirium
    Not a risk factor
  3394. Gender breakdown of Delirium
    More common in men
  3395. Neuroanatomical area implicated in Delirium
    Reticular Formation
  3396. Brain pathway implicated in Delirium
    Dorsal Tegmental Pathway
  3397. What does the Dorsal Tegmental Pathway connect?
    From Reticular Formation to Tectum and Thalamus
  3398. Neurotransmitters affected in Delirium (3)
    • 1. Acethycholine (decreased activity)
    • 2. Serotonin
    • 3. Glutamate
  3399. Cause of delirium in Alcohol Withdrawal
    Hyperactive noradrenergic neurons in Locus Ceruleus
  3400. Why should a patient receiving IV Haldol be placed in a monitored bed?
    Risk of Torsades
  3401. Typical duration of Delirium
    1 week
  3402. First-line medications for Body Dysmorphic Disorder
    Serotonergic (SSRI, SNRI, TCA, MAOI)
  3403. Psychodynamic explanation for Body Dysmorphic Disorder
    Displacement of sexual/emotional conflict onto unrelated body parts
  3404. Age of onset of Body Dysmorphic Disorder
    15-30
  3405. Gender breakdown of Body Dysmorphic Disorder
    Affects women slightly more often than men
  3406. Are patients with Body Dysmorphic Disorder more often married or single?
    Single
  3407. Psychiatric illness often comorbid with Body Dysmorphic Disorder
    Mood disorders, especially depressive disorders
  3408. What fraction of patients with Body Dysmorphic Disorder improve with medications?
    About 50%
  3409. 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
  3410. Age of onset of Somatization Disorder
    Before age 30
  3411. How do Somatization Disorder patients describe their symptoms?
    Histrionic, emotional, exaggerated fashion
  3412. How do Conversion Disorder patients describe their symptoms?
    • "La belle indifference"
    • Inappropriately cavalier attitude toward apparently serious symptoms
  3413. Disorder whose symptoms appear to overlap heavily with Somatization Disorder
    Attention Deficit Disorders
  3414. Biological factors of Somatization Disorder (2)
    • 1. Abnormal cytokine regulation
    • 2. Decreased metabolism in frontal lobes and nondominant hemisphere
  3415. 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
  3416. Gender breakdown of Somatization Disorder
    Women >> Men (factor of 5-20 times higher)
  3417. Lifetime prevalence of Somatization Disorder
    1-2%
  3418. Social factors increasing risk of Somatization Disorder (2)
    • 1. Low income
    • 2. Poor education
  3419. Course of Somatization Disorder
    • Chronic relapsing disorder
    • Rarely remits completely
  3420. Most useful strategy for Somatization Disorder
    Individual and group psychotherapy
  3421. 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
  3422. Minimum duration off of alcohol to start disulfiram
    12 hours
  3423. What is Campral?
    • NMDA and glutamate antagonist
    • Reduces cravings for alcohol
  3424. How soon after stopping alcohol can Campral be started?
    1 week
  3425. Dosing strategy for Disulfiram
    • 500mg daily for 1-2 weeks
    • 250mg thereafter for maintenance
  3426. Effect of Phenytoin on Methadone level
    Decreased
  3427. Effect of Hypericum on Methadone level
    Decreased
  3428. Effect of Dextromethorphan on Methadone level
    Decreased
  3429. Effect of Abacavir on Methadone level
    Decreased
  3430. Effect of Carbamazapine on Methadone level
    Decreased
  3431. Effect of Cocaine on Methadone level
    Decreased
  3432. Effect of Dexamethasone on Methadone level
    Decreased
  3433. Effect of Nevirapine on Methadone level
    Decreased
  3434. Effect of Rifampin on Methadone level
    Decreased
  3435. Effect of Spironolactone on Methadone level
    Decreased
  3436. Effect of Tobacco on Methadone level
    Decreased
  3437. Effect of Ciprofloxacin on Methadone level
    Increased
  3438. Effect of Erythromycin on Methadone level
    Increased
  3439. Effect of Disulfiram on Methadone level
    Increased
  3440. Effect of Verapamil on Methadone level
    Increased
  3441. Effect of Dihydroergotamine on Methadone level
    Increased
  3442. Effect of Grapefruit on Methadone level
    Increased
  3443. Effect of Moclobemide on Methadone level
    Increased
  3444. Effect of Ecinacea on Methadone level
    Increased
  3445. Symptoms of Cannabis withdrawal (7)
    • 1. Insomnia
    • 2. Restlessness/irritability
    • 3. Depressed mood
    • 4. Anxiety
    • 5. Tremors/twitches
    • 6. Sweating
    • 7. Myalgia
  3446. Duration of Cannabis withdrawal
    2 weeks
  3447. Antidepressant that, in particular, causes Serotonin Syndrome and Neuroleptic Malignant Syndrome if given with an MAOI
    Velafaxine
  3448. Condition commonly comorbid with prepubertal BPAD
    ADHD
  3449. Comorbid illness correlated with a much earlier onset of BPAD
    Childhood ADHD
  3450. Regarding culture change, what is Assimilation?
    Making contact with the new culture without retaining original cultural values
  3451. Regarding culture change, what is Integration?
    Making contact with the new culture while retaining original cultural values
  3452. Regarding culture change, what is Separation?
    Retaining original cultural values and not making contact with the new culture
  3453. Regarding culture change, what is Marginalization?
    Not making contact with the new culture while also shedding original cultural values
  3454. Birth defects associated with Carbamazepine other than neural tube defects (3)
    • 1. Craniofacial defects
    • 2. Developmental delays
    • 3. Fingernail hypoplasia
  3455. Requirements for giving Informed Consent (3)
    • 1. Decision-making capacity
    • 2. Relevant information has been disclosed to the one giving consent
    • 3. Voluntariness
  3456. Psychotherapy modalities best-studied for MDD (2)
    • 1. CBT
    • 2. Interpersonal therapy
  3457. Antidepressant for which nausea is not a prominent side effect
    • Mirtazapine (Remeron)
    • Can be used to treat nausea!
  3458. Gender breakdown of experiencing a traumatic event
    Males > Females
  3459. Gender breakdown of developing PTSD
    Females > Males
  3460. Body weight at which hospitalization is recommended in anorexia
    25% below expected weight
  3461. Atypical antipsychotic that causes elevated prolactin at rates similar to typical antipsychotics
    Risperidone
  3462. Psychiatric illness with highest relative risk for first-degree relatives
    BPAD
  3463. Relative risk of schizophrenia for first-degree relatives
    18
  3464. Relative risk of BPAD for first-degree relatives
    25
  3465. Relative risk of Panic Disorder for first-degree relatives
    10
  3466. Relative risk of anorexia for first-degree relatives
    5
  3467. Relative risk of Alcoholism for first-degree relatives
    7
  3468. Serious side effect of oxcarbazapine
    Hyponatremia
  3469. Lab values changed by Valproic Acid (2)
    • 1. ↑ LFTs
    • 2. ↑ Ammonia
  3470. Lab values changed by Topiramate (2)
    • 1. ↑ Chloride
    • 2. ↓ Bicarb
    • (Hyperchloremic, non-ion-gap metabolic acidosis)
  3471. What is Social Rhythm Therapy?
    • Combination of Circadian Regulation and Interpersonal Psychotherapy
    • Used to treat BPAD
  3472. Medications that cause Rapid Cycling in BPAD
    Antidepressants
  3473. Psychiatric symptom of anterior left hemisphere stroke
    Poststroke depression
  3474. Psychiatric illnesses that run in families of people with OCD (3)
    • 1. MDD
    • 2. Anxiety disorders
    • 3. Tourette's Syndrome
  3475. Ethnic group at the lowest risk of suicide
    Asian Americans
  3476. Effect of Wellbutrin on ADHD
    Improves symptoms!
  3477. First-line treatment for a depressed adolescent with ADHD who smokes
    Wellbutrin (treats smoking, depression, and ADHD!)
  3478. Effect of early onset on Conduct Disorder
    Predicts more severe and prolonged illness
  3479. Effect of comorbid ADHD on Conduct Disorder
    Predicts more severe and prolonged illness
  3480. What p450 enzyme breaks down Desipramine?
    2D6
  3481. Effect of Fluoxetine on Desipramine levels
    Fluoxetine inhibits 2D6, raising Desipramine levels
  3482. Initial presentation of Lewy Body Dementia
    Psychosis and hallucinations
  3483. What feature of cognition declines with normal aging?
    Speed of cognition (learning, processing, and performance speed)
  3484. Age at which symptoms must present for diagnosis of Reactive Attachment Disorder
    Before age 5
  3485. First-line approach for OCD in children/adolescents
    CBT
  3486. SSRIs approved in OCD (4)
    • 1. Fluoxetine (Prozac)
    • 2. Fluvoxamine (Luvox)
    • 3. Sertraline (Zoloft)
    • 4. Paroxetine (Paxil)
  3487. Illness characterized by Echolalia and Echopraxia
    Catatonia
  3488. Side effects of high doses of GHB (3)
    • 1. Vomiting
    • 2. Muscle spasms
    • 3. Loss of consciousness
  3489. Effect of combining GHB with alcohol
    Slows breathing to a dangerously low rate
  3490. Other than altered mental status, effects of Flunitrazepam (Rohypnol) (2)
    • 1. GI distubrance
    • 2. Urinary retention
  3491. Medications/drugs that can cause catatonia (2)
    • 1. Neuroleptics
    • 2. PCP
  3492. Neurological conditions that can cause catatonia (2)
    • 1. Parkinsonism
    • 2. Encephalitis
  3493. Brain region that interprets emotional tone of speech/prosody
    Nondominant hemisphere region corresponding to Wernicke's Area
  3494. Brain region that interprets expressive language production/"music" of speech
    Nondominant hemisphere region corresponding to Broca's Area
  3495. Goal of Cognitive Therapy for Social Phobia
    Alter biased perceptions and dysfunctional beliefs
  3496. How should internists manage Hypochondriasis?
    Regularly scheduled appointments with limited reassurance
  3497. Medication management strategy for Borderline Personality Disorder
    Target the symptoms that are currently causing disruption
  3498. Site of reabsorption of Lithium
    Proximal tubules
  3499. Electrolyte imbalance that causes increased reabsorption of Lithium
    Sodium deficiency
  3500. Female-to-male ratio in Borderline Personality Disorder
    3:1 female
  3501. Relative risk of Borderline Personality Disorder for first-degree relatives
    5
  3502. Psychiatric symptom scales on which girls score higher than boys (2)
    • 1. Anxious/depressed scale
    • 2. Somatic complaints scale
  3503. Psychiatric symptom scales on which boys score higher than girls (3)
    • 1. Attention problems
    • 2. Delinquent behavior
    • 3. Aggressive behavior
  3504. 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
  3505. Personality disorder most commonly found in relatives of patients with Schizophrenia
    Schizotypal Personality Disorder
  3506. Gender ratio of Panic Disorder
    2-3:1 more common in women
  3507. Mean age at presentation of Panic Disorder
    25
  3508. Respiratory substances that can induce panic symptoms (3)
    • 1. CO2
    • 2. Sodium lactate
    • 3. Bicarbonate
  3509. Most effective medications in Panic Disorder (2)
    • 1. SSRIs
    • 2. Clomipramine
  3510. Mechanism of Codeine
    Metabolized to morphine by 2D6
  3511. Time to medication response in OCD
    10-12 weeks
  3512. First-line medications for BPAD (2)
    • 1. Lithium
    • 2. Lamotrigine
  3513. Treatment of choice for psychiatric side effects of Interferon
    SSRIs
  3514. Most prevalent psychiatric symptom in dialysis patients
    Depressed mood
  3515. Intervention that most improves medication adherence
    Focus on attitudinal and behavioral aspects of taking medications (eg cognitive-motivational interventions)
  3516. Duration of Brief Dynamic Therapy
    Average of 6 sessions, but can last 1 to 40
  3517. Goal of Brief Dynamic Therapy
    • Addresses a specific, limited focus
    • Does not aim for character change like most dynamic therapy
  3518. Effect of Xanthine Bronchodilators (-phylline) on lithium levels
    Decrease levels
  3519. Effect of NSAIDs on lithium levels
    Increase levels
  3520. Effect of ACE inhibitors on lithium levels
    Increase levels
  3521. Symptoms that differentiate Lewy Body dementia from Alzheimer Dementia (2)
    • 1. Visual hallucinations
    • 2. Parkinsonism
  3522. How are "flashbacks" best understood?
    As dissociative states
  3523. 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
  3524. When should guilt prompt concern of MDD in bereavement?
    When guilt is generalized, not based on "missed opportunities" with the deceased
  3525. 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
  3526. When should hallucinations prompt concern of MDD in bereavement?
    If the content of the hallucinations is not the deceased
  3527. When should psychomotor retardation prompt concern of MDD in bereavement?
    Always!
  3528. What aspect of cognition is the Ventral Striatum associated with?
    Motivation
  3529. MRI findings in Creutzfeldt-Jakob Disease, other than general atrophy
    Basal ganglia changes
  3530. 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
  3531. Personality disorder most often associated with Anorexia
    Obsessive-Compulsive Personality Disorder
  3532. 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
  3533. Somatic medication that can cause akathesia
    Metoclopramide (Reglan)
  3534. Effect of taking oral contraceptives with Lamotrigine
    Rapid drop in lamotrigine levels
  3535. Brain circuit with abnormalities in OCD
    Cortico-Striato-Thalamic Circuit
  3536. How often do Anorexic patients have comorbid depression?
    2/3 of the time!
  3537. How often do Anorexic patients have comorbid Social Phobia?
    1/3 of the time!
  3538. How often do Anorexic patients have comorbid OCD?
    1/4 of the time!
  3539. What form of therapy does Short-Term Anxiety-Regulating psychotherapy derive from?
    Psychodynamic psychotherapy
  3540. Brain regions that must be active to derive pleasure from drug use (3)
    • 1. Tegmentum
    • 2. Nucleus accumbens
    • 3. Prefrontal cortex
  3541. What neurotransmitters are involved in addiction to drugs? (2)
    • 1. Dopamine
    • 2. Glutamate
  3542. Brain regions involved in Schizophrenia (4)
    • 1. Anterior cingulate
    • 2. Thalamus
    • 3. Cerebellum
    • 4. Temporal lobe
  3543. Effect of Ritonavir on benzodiazepines
    Induces metabolism of Temazepam, Oxazepam, and Lorazepam
  3544. Effect of protease inhibitors on benzodiazepines
    Inhibits 3A4, increasing levels of some benzos (eg midazolam)
  3545. Result of family therapy in Schizophrenia
    • Reduced relapse rates
    • Reduced family burden
  3546. What is "empathy"
    Understanding a patient's feelings without becoming involved in them
  3547. How often must a person binge to meet criteria for Bulemia?
    Average of twice weekly
  3548. Risk of osteopenia in bulemia
    Not elevated (as opposed to anorexia)
  3549. Main symptoms of Hyperparathyroidism
    Weakness and anorexia
  3550. Main symptoms of Hypoparathyroidism
    Neuromuscular signs
  3551. Where is the Presinilin 1 gene?
    Chromosome 14

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