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Psychiatry > ABPN General Psychiatry > Flashcards

ABPN General Psychiatry Flashcards

1
Q

“good enough mothering” theorist

A

Winnicott

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2
Q

“Man presents to ER in acute state of disorientation with tachycardia, ophthalmoparesis, diaphoresis, and ataxia. Dies 48 hours later”

A

Wernicke’s encephalopathy (mental confusion, ophthalmoplegia, gait ataxia)

***ophthalmoplegia = 6th CN palsy usually

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3
Q

% of schizophrenics known to smoke tobacco

A

50-90%

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4
Q

3 Hz stimulation on EMG

A

Lambert-Eaton

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5
Q

3-per-second spike and wave pattern on EEG

A

absence seizures

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6
Q

4 primary symptoms of Parkinson’s disease

A

Tremor, Rigidity, Bradykinesia, Postural instability

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7
Q

4p16.3 abnormality

A

Huntington’s Disease

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8
Q

60 yo woman with stiffness in right leg but not left. Takes her longer to complete tasks and complains she has the pace of a turtle. Sometimes forgets how to walk. Sometimes feels as if hands don’t belong to her. All symptoms over last year.

A

Corticobasal ganglionic degeneration (CBD)
- degeneration of cerebral cortex & basal ganglia
- asymmetric motor & cognitive impairments
- apraxia, alien limb phenomena, aphasia, parkinsonism

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9
Q

65 yo M with worsening hypersomnia, poor memory and concentration, social withdrawal, lack of motivation (pseudobulbar state). History of HTN. BP 170/90. Flat affect, depressed mood. Reflexes slowed. Labs are normal. MRI shows subcortical degeneration.

A

Binswanger disease = subcortical leukoencephalopathy (a form of small-vessel vascular dementia)

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10
Q

7 criteria of schizoid personality disorder

A

DSS-ACNE

  1. D- Doesn’t desire or enjoy relationships/family
  2. S- Chooses solitary activities
  3. S- Little interest in sex
  4. A- Takes pleasure in few, if any, activities
  5. C- Lacks close friends or confidants
  6. N- Appears indifferent to praise or criticism
  7. E- Shows emotional coldness, detachment, or flattened affectivity
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11
Q

A child has inhibited emotionally withdrawn behavior toward adults and minimal social or emotional responsiveness toward others due to social neglect or deprivation has:
A. Reactive attachment disorder
B. Disinhibited social engagement disorder

A

A. Reactive attachment disorder

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12
Q

a child who actively approaches and interacts with unfamiliar adults after experiencing social neglect or deprivation has:
A. Reactive attachment disorder
B. Disinhibited social engagement disorder

A

B. Disinhibited social engagement disorder

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13
Q

a man enjoys wearing female underwear

A

fetishistic disorder

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14
Q

Aaron Beck

A

founder of CBT

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15
Q

Aaron Beck’s cognitive triad is a model for what?
What is the cognitive triad?

A

Model for depression
Thoughts about:
- one’s self
- the world
- the future

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16
Q

Abulia means what?

A

an absence of willpower, reduced impulse to act or think with indifference related to consequence

Literally means = “without will”

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17
Q

acalculia, agraphia (without alexia), right and left confusion, finger agnosia (inability to name fingers)

A

Gerstmann’s syndrome = left angular gyrus / parietal lobe damage

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18
Q

action-oriented psychotherapy that teaches individuals to identify, challenge, and replace self-defeating thoughts and beliefs with healthier thoughts that promote emotional wellbeing and goal-achievement

A

Rational Emotive Behavior Therapy (REBT)
- Albert Ellis
- later influenced CBT
- ABC techniques of irrational beliefs: Activating event leads to irrational Beliefs which causes upsetting emotional Consequences

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19
Q

ADHD symptoms must be present prior to the age of:

A

12

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20
Q

agonist / partial agonist at 5HT1A receptor & agonist/antagonist at D2 receptor

A

Buspar - mainly works at 5HT1A receptor, some activity at D2 (mechanism is complex and not fully understood)

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21
Q

agoraphobia

A

fear of public spaces where escape is difficult, being outside, being in a crowd, etc

Examples:
- public transportation
- open places (parking lots, open markets, bridges)
- enclosed places (shops, theaters, cinemas)
- standing in line
- being in a crowd
- being outside the home alone

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22
Q

akinetic mutism lesion

A

Bilateral anterior cingulate

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23
Q

Alexithymia

A

Inability to describe one’s emotions

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24
Q

Alice is a 20 yo college student who often feels stressed and tends to eat compulsively to relax. She has been binging on whatever she can get her hands on about 3x/week. She feels lack of control to stop and eats until she is uncomfortably full. Then feels ashamed and disgusted. Feels fat and ugly and is depressed. Tries to induce vomiting but can’t. Compensates by running 2-3 hours in a row and feeling faint. After binging, often goes whole next day without food or water.

Diagnosis:

A

Bulimia nervosa
= binge-eating + inability to control + compensatory behaviors

(normal weight compared to anorexia)

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25
Q

Alopecia is a known side effect of which psychotropics? (2)

A

Depakote, Lithium

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26
Q

Alpha synuclein in
- striatum:
- striatum & cortex:
- striatum & cerebellum:

A
  • striatum / basal ganglia: parkinson’s disease
  • striatum / basal ganglia & cortex: DLB
  • striatum / basal ganglia & cerebellum: MSA

Alpha synuclein = Lewy bodies
striatum = basal ganglia

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27
Q

anterior horn cell degeneration, upper and lower motor neuron degeneration

A

ALS

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28
Q

anterograde and retrograde amnesia while preserving identity and knowledge, self-resolving and time-limited

A

transient global amnesia
<24 hours

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29
Q

antiepileptic that causes hirsutism, facial changes, and gingival hypertrophy

A

phenytoin

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30
Q

Antiepileptic that induces its own metabolism

A

Carbamazepine

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31
Q

Antipsychotic approved to treat schizophrenia, nausea and vomiting, acute intermittent porphyria, tetanus, and intractable hiccups

A

Chlorpromazine (Thorazine)

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32
Q

Antipsychotic that causes dark circles around eyes (oculocutaneous hyperpigmentation in sun-exposed areas)

A

Chlorpromazine (Thorazine)

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33
Q

Antipsychotic use in elderly with dementia

A

Black box warning! NEVER use! Due to increased risk of death

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34
Q

Piblokto

A

anxiety, depression, confusion, depersonalization, and derealization ending in stuporous sleep and amnesia that occurs in female Eskimos of northern Greenland

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35
Q

Are SSRIs effective for conversion disorder?

A

No - evidence has only supported CBT, TCAs, Haldol and ECT

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36
Q

Asian delusion that the penis will disappear into the abdomen and cause death

A

Koro

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37
Q

At what spine level does the spinal cord typically end in an average adult?

A

T12-L1

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38
Q

ATP7B gene
- Disease
- What protein?

A
  • Wilson’s disease
  • copper-transporting ATPase2 (transports copper from liver to other parts of body)
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39
Q

Benefits of Cariprazine

A

Vraylar!

Better side effect profile - less metabolic effects, less QTc prolongation, doesn’t affect prolactin
–> may cause nausea & akathisia

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40
Q

Benefits of Desipramine over other TCAs

A

Less histaminergic & muscarinic affinity
(less sedating & less anticholinergic effects)

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41
Q

bilateral acoustic schwannomas is classic for:

A

Neurofibromatosis 2 (NF2)

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42
Q

bitemporal hemianopsia, decreased libido, diabetes insipidus

A

Craniopharyngioma (common in kids)
- distinguishing feature from pituitary adenoma is the endocrine abnormalities
*diabetes insipidus may present as urinary frequency

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43
Q

brain pathways involved in schizophrenia/antipsychotics:
- prefrontal cortex
- mesolimbic
- tuberoinfundibular
- nigrostriatal

A
  • prefrontal cortex: negative symptoms
  • mesolimbic: positive symptoms
  • tuberoinfundibular: hyperprolactinemia
  • nigrostriatal: extrapyramidal side effects
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44
Q

Brief sensation of dryness and burning in the throat, a suffusing warmth & hunger for air. Hyperpnea, with a brief outcry, follows the first breath. In <1 minute, apnea, a few gasps, loss of consciousness and convulsions occur. Sometimes include a bitter almond-like breath and a rose-colored hue of the skin. Oxyhemoglobin in the blood.

A

Cyanide poisoning

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45
Q

callosal thinning, corpus callosum atrophy

A

MS

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46
Q

Carl Jung psychological types

A

8 psychological types - basis of the Myers-Briggs personality test
- helps to explain how people interpret respond to the world so differently

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47
Q

CATIE trial

A

Clinical Antipsychotic Trials of Intervention Effectiveness
- showed equal efficacy for atypical and typical antipsychotics

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48
Q

cerebellar brain tumor that presents with ataxia

A

Medulloblastoma

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49
Q

child presents with chronic headaches & visual changes + nausea, intracranial calcified mass with cystic spaces and cholesterol-rich fluid

A

Craniopharyngioma

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50
Q

childhood epilepsy with centrotemporal spikes

A

Rolandic epilepsy - benign, doesn’t require treatment, outgrow after puberty

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51
Q

Chronic schizophrenic taking medication every day for 20 years is an example of what kind of prevention? Primary, secondary, or tertiary?

A

Tertiary

Primary = prevent onset of disease (reduce risk factors, etc)
Secondary = identifies disease early and seeks prompt treatment
Tertiary = reducing deficits caused by illness to improve functioning

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52
Q

Chronic toluene inhalant exposure can lead to what symptoms?

A

Mimics MS! Due to DEMYELINATION
- brisk deep tendon reflexes, ankle clonus, nystagmus, ataxia
- personality & cognitive changes

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53
Q

classic triad of spongiform vacuolation, loss of neurons, and astrocyte cell proliferation

A

Creutzfeldt-Jakob disease (CJD) - prion disease

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54
Q

common migraine presentation in children (compared to adults)
- laterality?
- location?
- associated symptoms?
- duration?

A

bilateral (instead of unilateral)
frontotemporal
+photophobia common
+n/v common
shorter duration

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55
Q

compensatory behavior in binge-eating disorder

A

there is none! if there is –> bulimia or anorexia!

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56
Q

compulsive utterance of obscene words

A

coprolalia

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57
Q

Condition where patient can’t move or speak, but eyes can follow observer walking around room

A

akinetic mutism

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58
Q

conjunctival injection, increased appetite, dry mouth, tachycardia intoxication

A

cannabis

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59
Q

Criteria for bipolar I disorder:
1. At least _______ (time) of mania
2. _____ or more of the following symptoms: grandiosity, decreased sleep, talkative, racing thoughts, distractible, goal-directed activity, risky behavior
3. marked impairment in __________, requires ________________, or involves ________ features

A
  1. At least one week of mania
  2. 3 or more of the following symptoms: grandiosity, decreased sleep, talkative, racing thoughts, distractible, goal-directed activity, risky behavior
  3. marked impairment in functioning, requires hospitalization, or involves psychotic features
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60
Q

Criteria for Reactive Attachment Disorder:
- symptoms evident before age ___
- child has a developmental age of at least _______
- symptoms have been present for at least _______

A
  • symptoms evident before age 5
  • child has a developmental age of at least 9 months
  • symptoms have been present for at least 12 months
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61
Q

CSF assay for 14-3-3 and tau proteins

A

Creutzfeldt-Jakob Disease (CJD) prion disease

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62
Q

cytokines consistently elevated in MDD

A

TNF-alpha & IL6

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63
Q

decreased fluency of spontaneous speech & impaired repetition, but intact comprehension (can follow verbal commands)

Name + Lesion?

A

Broca’s aphasia, inferior frontal gyrus of the dominant hemisphere

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64
Q

Wihtigo

A

delusional fear displayed by Native American Indians of being turned into a cannibal through possession by a supernatural monster

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65
Q

Diagnostic criteria for anorexia (3)

A
  1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health
  2. Intense fear of gaining weight or becoming fat, even though underweight
  3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
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66
Q

diarrhea, restlessness, extreme agitation, myoclonus

A

serotonin syndrome

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67
Q

Diseases associated with chromosome 21 abnormalities

A

Down’s syndrome & Alzheimer’s disease

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68
Q

distinguishing feature between schizoid & schizotypal personality disorders

A

schizoid - w/o the below
schizotypal - perceptual disturbances + eccentric behavior

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69
Q

does attachment last for life?

A

yes, according to the theorists (Bowlby) - predicts later life relationships

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70
Q

Dorsal column volume loss

A

Vit B12 deficiency

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71
Q

drive theory

A

Freud

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72
Q

Edrophonium chloride vs. Pyridostigmine in MS

A

Edrophonium chloride used to diagnose
Pyridostigmine used to treat

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73
Q

Embryonic hindbrain develops into:

A

Cerebellum, Pons, Medulla

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74
Q

Embryonic midbrain develops into:

A

Colliculi, Tegmentum, Cerebral peduncles

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75
Q

Emil Kraeplin

A

mental disorders have different outcomes

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76
Q

examples of cognition-oriented therapies

A

reality orientation (dementia) & cognitive retraining (helps with memory, attention, tasks, etc)

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77
Q

examples of stimulation-oriented therapies

A

art, music, pet therapy

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78
Q

exhibitionistic disorder

A

sexual arousal from exposing genitals to a stranger

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79
Q

FDA approved medication for bulimia

A

Fluoxetine (Prozac)

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80
Q

FDA approved medications to treat PTSD in adults

A

Sertraline, Paroxetine

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81
Q

first vs. second generation antipsychotics

A

first = dopamine antagonist
second = dopamine and serotonin antagonist

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82
Q

first-line treatment for MS acute attack

A

IV steroids followed by oral steroids

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83
Q

frontal lobe lesion that leads to apathy with limited spontaneous movement, gesture, and speech

A

medial frontal lobe

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84
Q

frontal lobe lesion that leads to depression

A

left frontal lobe / prefrontal cortex

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85
Q

frontal lobe lesion that leads to mania, euphoria, laughter

A

right frontal lobe / prefrontal cortex

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86
Q

frontal lobe lesion that leads to profanity, irritability, irresponsibility

A

orbitofrontal

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87
Q

Pick’s disease

A

frontotemporal atrophy
= Pick’s (frontotemporal) dementia
- may include hyperorality and hypersexuality

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88
Q

frotteuristic disorder

A

sexual arousal by touching or rubbing against a nonconsenting person

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89
Q

Ganser syndrome

A

When a patient gives an answer that doesn’t quite answer the question
For ex - When asked what 1+1 is, answer is 3.

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90
Q

Generalized muscle weakness with improvement in strength after minimal exercise

A

Lambert-Eaton

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91
Q

genetic factors account for ____% of risk for developing schizophrenia

A

60-80%

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92
Q

Gower’s maneuver

A

Duchenne’s muscular dystrophy - patient gets up from floor or chair using hands

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93
Q

Halstead-Reitan Battery

A

tests for brain damage

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94
Q

HAM-D rating scale

A

Hamilton Depression Rating Scale

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95
Q

Highest prevalence:
A. Depressive disorders
B. Anxiety disorders
C. Schizophrenia
D. Dementia
E. Substance abuse

A

B. Anxiety disorders

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96
Q

How do neurotransmitter levels change with age?
- Serotonin
- Dopamine
- GABA
- Glutamate

A

All decrease with age!

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97
Q

How is Methadone affected in pregnancy?

A

Clearance is increased and half-life decreased during trimester 2/3 –> may need to increase dose or decrease dose interval

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98
Q

How long can these drugs be found in urine?
- PCP:
- Cannabis:
- Cocaine:
- Heroin:

A
  • PCP: 8 days
  • Cannabis: 4 weeks
  • Cocaine: 8 hours
  • Heroin: 72 hours
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99
Q

How to diagnose Huntington’s disease

A

PCR - examines trinucleotide repeats
(>35 in adults, >50 in kids)

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100
Q

HTN, blurry vision, diaphoresis, stiff neck, headache, n/v while eating fancy cured meats, wine, beer, cheese

A

“Tyramine hypertensive crisis”
- Tyramine-containing foods can’t be broken down in presence of MAOIs so Tyramine acts as a sympathomimetic

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101
Q

Insomnia, unsteady gait, headache, nystagmus, upward gaze paralysis (can’t look up), eyelid retraction

A

Pineal gland tumor (Parinaud syndrome) = Pineoblastoma
**insomnia due to secretion of melatonin

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102
Q

infantile spasms, hypsarrhythmic EEG, psychomotor delay with age of onset between 3-8 months

A

West syndrome (infantile spasms)

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103
Q

IQ 20-40

A

Severe ID

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104
Q

IQ 40-50

A

Moderate ID

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105
Q

IQ 50-70

A

Mild ID

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106
Q

IQ 71-84

A

Borderline IQ

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107
Q

IQ < 20

A

Profound ID

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108
Q

key difference between paranoid and schizotypal personality disorder

A

magical thinking

Paranoid personality disorder - pervasive distrust & suspiciousness of others, perceive others as malevolent, doubt loyalty of others, reluctant to confide in others, bearing grudges

Schizotypal personality disorder - ideas of reference, magical thinking, unusual perceptual experiences, odd thinking, suspiciousness, odd behavior, lack of friends, social anxiety

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109
Q

known side effects of Gabapentin

A

SJS, DRESS, erythema multiforme, depression/SI, renal failure, thrombocytopenia

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110
Q

Lamictal use in pregnancy

A

safe!

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111
Q

lesion associated with abulia

A

lateral or bilateral frontal lobe injury

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112
Q

lesion to what area of hypothalamus can lead to obesity?

A

ventromedial

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113
Q

lethargy, disorientation, vomiting in someone after starting Depakote

A

hyperammonemia / hyperammonemic encephalopathy

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114
Q

Levomilnacipram (Fetzima) MOA

A

SNRI

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115
Q

LGBTQ teens revealing their sexuality to others at school leads to what with self-esteem and bullying?

A

increased self-esteem
increased bullying

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116
Q

lifetime prevalence of GAD

A

5-8%

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117
Q

likelihood of a male child inheriting Huntington’s disease from one parent who is an affected carrier

A

50%
autosomal dominant inheritance

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118
Q

low 5-HIAA & MHPG + hypoglycemia

A

firesetters

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119
Q

major excitatory neurotransmitter of the brain

A

Glutamate (acts on NMDA receptor)

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120
Q

major inhibitory neurotransmitters

A

GABA + Glycine

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121
Q

MAOI inhibitors work on what neurotransmitters?

A

Serotonin, Norepi, Dopamine

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122
Q

Mechanism of action of Zolpidem

A

GABA-A alpha-1 agonist (NOT a benzo)
- important distinction from benzos is that it preserves deep sleep stages (whereas benzos disrupt deep sleep)

**benzos non-selectively bind to all GABA subtypes

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123
Q

Mechanism of Vilazodone (Viibryd)

A

SSRI + partial serotonin (5HT1A) agonist

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124
Q

medication to help with decreasing alcohol intake when not ready to completely quit

A

Naltrexone (decreases cravings by decreasing reward pathway)

compared to Acamprosate or Disulfiram which can be uncomfortable and dangerous with alcohol use

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125
Q

microhemorrhages in the periventricular gray matter, around the aqueduct and 3/4 ventricles and superior vermis

A

Wernicke’s encephalopathy

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126
Q

Mnemonic for TCA side effects

A

Tachycardia
Cardiac effects (increased QTc, arrhythmias)
Anticholinergic effects (flushing, dilated pupils, urinary retention)
Sedation

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127
Q

MOA of Memantine

A

NMDA antagonist

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128
Q

MOA of the drug that causes people to vomit if drinking alcohol

A

aldehyde dehydrogenase irreversible inhibitor (Disulfiram)
–> causes flushing, n/v, hypotension, vertigo, chest pain if alcohol is consumed
**can include mouthwash, cough syrup, vinegar, vanilla extract

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129
Q

mood stabilizer that inhibits inositol monophosphatase

A

Lithium

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130
Q

Mood stabilizer with side effect of acne and psoriasis flares

A

Lithium

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131
Q

Most accurate confirmatory way to diagnose Creutzfeldt Jakob Disease (CJD)?

A

Pathological exam of the cortex (brain biopsy)

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132
Q

most common genetic marker for:
- Alzheimer’s
- early-onset familial Alzheimer’s

A
  • Alzheimer’s: ApoE4
  • early-onset familial Alzheimer’s: Presenilin-1
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133
Q

Most common viral cause of viral meningitis

A

Enteroviruses cause 85% of viral meningitis

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134
Q

most reliable psychological test

A

Wechsler adult intelligence scale

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135
Q

Muscle weakness that
- improves with rest
- improves with activity

A
  • improves with rest = Myasthenia gravis
  • improves with activity = Lambert-Eaton (small cell lung cancer)
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136
Q

Neonatal myasthenia gravis
- origin?
- course of illness?

A
  • origin: from mother’s autoantibodies
  • course of illness: resolves within months
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137
Q

Nefazodone (mechanism + side effect concerns)

A

serotonin antagonist & reuptake inhibitor (SARI)
known for liver monitoring & orthostatic hypotension

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138
Q

nerve entrapment from lying wrong, arm over chair or crutches that leads to weakness in wrist/fingers, inability to extend arm or turn forearm over

A

Saturday night palsy = Radial nerve entrapment

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139
Q

neural changes to the gray/white matter in brains of 3-6 year olds with MDD

A

decrease in gray matter volume and gray matter thinning
no change in white matter volume

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140
Q

neurotransmitter effects of MDMA (molly, ecstasy)
- serotonin
- norepinephrine
- dopamine
- vasopressin
- oxytocin

long-term damage comes from what?

A
  • serotonin: increases
  • norepinephrine: increases
  • dopamine: increases
  • vasopressin: increases (indirectly)
  • oxytocin: increases (indirectly)

***the latter increase or enhance love, trust, sexual arousal, social experiences

long-term damage comes from effects on serotonergic nerve terminals

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141
Q

Neurotransmitters that decrease aggression

A

GABA - inhibits aggression
Serotonin - decreases frequency of aggression
Norepi - decreases aggression

**Dopamine seems to increase aggression

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142
Q

new-onset headache, fever, fatigue, muscle aches, joint pain, night sweats, weight loss, jaw claudication (tiredness with chewing), decreased vision

A

Giant cell temporal arteritis

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143
Q

Nigrostriatal depigmentation

A

Parkinson’s

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144
Q

normal bereavement timeline

A

<2 months

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145
Q

normal reflex grade

A

2+

(0 or 1+ = sluggish or no response)
(3+ or 4+ = hyperactive or brisk response)

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146
Q

Omega 3 benefits for Alzheimer’s disease

A

MINIMAL improvement in depressive and agitation symptoms

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147
Q

Origin of craniopharyngioma

A

Rathke’s pouch

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148
Q

parkinsonism, flapping tremor, ataxia, dystonia, bulbar signs (dysphagia, dysarthria)

A

Wilson’s disease

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149
Q

pathological gambling is most associated with what?

A

Mood disorders, particularly MDD

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150
Q

Patient is asked to imagine a difficult situation they have encountered in the past and then works with the therapist to practice how to cope successfully with the problem

A

Cognitive rehearsal (a CBT technique)

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151
Q

Patients between age 54 to 66 present with loss of memory, change in intellectual function, and changes in mood. Associated with HTN and old age. Subcortical degeneration of white matter.

A

Binswanger disease = subcortical leukoencephalopathy (a form of small-vessel vascular dementia)

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152
Q

Paxil during pregnancy

A

First trimester risk of atrial & septal defects, recommended to switch but okay if benefit>risk
(Category D)

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153
Q

pergolide - drug type?

A

dopamine agonist for Parkinson’s disease (like Bromocriptine, Pramipexole, Ropinirole)

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154
Q

Person can speak fluently with normal prosody and rhythm but what they’re saying doesn’t make sense, sounds like gibberish words jumbled together. Comprehension and repetition impaired. They seem unaware of not making sense.

Name + Lesion?

A

Wernicke’s aphasia, superior temporal gyrus in the dominant hemisphere

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155
Q

Person can’t reach for an object or point to it with their arm - Lesion of?

A

Dorsal stream - “where” stream
- relays info related to movement and spatial relationships between objects in the visual field

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156
Q

person is unable to remember certain categories of information (places, activities, people)

A

systematized dissociative amnesia

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157
Q

phonological disorder vs. fluency disorder of childhood

A

phonological disorder = pronunciation difficulty (articulation, speech impediment)
fluency disorder = stuttering

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158
Q

Pimavanserin MOA

A

selective serotonin 5HT2A inverse agonist

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159
Q

Pramipexole side effects

A
  • hallucinations
  • sleep attacks
  • congestive heart failure
  • n/v, dizziness, orthostatic hypotension
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160
Q

Pregnancy Drug Categories:

A

Category A = safe
Category B = No human studies, animal studies show no risk
Category C = No human studies, animal studies show some risk
Category D = Human studies show some risk, benefit > risk
Category X = Evidence shows risk, risk > benefit

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161
Q

preserved speech fluency and comprehension but difficulty with repetition

Lesion?

A

arcuate fasciculus (conduction aphasia) - connects Broca’s & Wernicke’s areas
• left (dominant) interior parietal or superior temporal

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162
Q

Prosopagnosia

A

face blindness (inability to recognize faces)
**fusiform gyrus in the brain

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163
Q

Prozac washout period before starting an MAOI

A

5 weeks

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164
Q

pseudocyesis

A

false pregnancy

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165
Q

Psych drugs that are known to cause SJS (3)

A

Armodafinil, Lamictal, Carbamazepine

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166
Q

RAISE study

A

Recovery After an Initial Schizophrenic Episode
comprehensive care for first-episode psychosis improves functional & clinical outcomes

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167
Q

Recreational substance that is known to cause early dementia

A

Inhalants

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168
Q

Risk of SSRIs beyond week 20 of pregnancy

A

pulmonary HTN

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169
Q

safe psychotropic to combine with MAOIs

A

Lithium

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170
Q

Schizoid vs. Schizotypal personality disorder - how to remember and set them apart

A

Schizo = split (latin)

Schizoid - split, like to be alone, don’t desire relationships
Schizotypal - more like schizophrenia with odd eccentric magical thinking & perceptual experiences

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171
Q

Sedating TCAs

A

“Just a TAD sleepy”
Trimipramine
Amitriptyline
Doxepin

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172
Q

self-psychology theory theorist

A

Kohut

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173
Q

Simple vs. complex phonic tic

A

Simple = grunt, sniffle, throat clearing
Complex = words, phrases, vulgar language

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174
Q

Someone can’t perceive or identify the size, shape or orientation of an object - Lesion where?

A

Ventral stream

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175
Q

spinal tract for conscious fine muscle control of skeletal muscle

A

Anterior + Lateral + Corticobulbar Corticospinal Tract

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176
Q

spinal tract responsible for subconscious regulation of reflex activity

A

Medial Reticulospinal Tract

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177
Q

Spinal tract responsible for subconscious upper limb muscle tone and movement

A

Lateral Rubrospinal Tract

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178
Q

spinal tract that subconsciously controls eye, head, upper limb position in response to visual and auditory stimuli

A

Medial Tectospinal Tract

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179
Q

Spinal tract that subconsciously regulates balance and muscle tone

A

Medial Vestibulospinal Tract

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180
Q

SSRI effect on cytokines

A

Decrease in IL1B

(may decrease TNF alpha & IL6 but not significant)

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181
Q

Stage of sleep for night terrors

A

NREM Stage 3/4

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182
Q

STARD trial

A

Sequenced Treatment Alternatives to Relieve Depression
patients who fail multiple antidepressants show higher rates of relapse and lower remission

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183
Q

STEP-BD trial

A

adjunctive antidepressants does not help bipolar depression or cause mania

Systematic Treatment Enhancement Program for Bipolar Disorders

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184
Q

Studies show that acupuncture has a __% success rate for treating insomnia

A

90%
(increases GABA & sleep quality)

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185
Q

Sudden awakening from sleep with piercing scream, panicky fear, and palpitations. Takes a few minutes to calm down, doesn’t seem aware of surroundings or husband. Doesn’t remember the episode.

A

Night terror

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186
Q

Amok

A

Sudden rampage involving homicide and/or suicide in Malaysian culture

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187
Q

TADS study

A

The Treatment of Adolescents with Depression Study
combination of antidepressants + therapy better than either alone

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188
Q

TCA known for less sedation effect

A

Protriptyline

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189
Q

Technique to ameliorate GI side effects of Lithium

A

switch from Lithium carbonate to Lithium citrate (syrup)

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190
Q

the emotional dependence of an infant on its mother
-vs-
the emotional attachment of a mother to her child

A

attachment
-vs-
bonding

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191
Q

theorist of attachment theory

A

John Bowlby

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192
Q

Therapist asks patient to defend the validity of his or her thoughts and beliefs. Therapist performs Socratic questioning to determine the accuracy of the patient’s maladaptive thoughts. If the patient cannot produce objective evidence supporting his or her assumptions, the invalidity is exposed.

A

Validity testing (a CBT technique)

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193
Q

Therapist focuses on developing patient’s self-esteem, ego functioning, and adaptive skills

A

Supportive psychotherapy

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194
Q

timeline for persistent depressive disorder

A

2 years

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195
Q

timeline for sexual disorders (like fetishistic disorder)

A

> 6 months

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196
Q

TORDIA study

A

Treatment of Resistant Depression in Adolescents
- adolescents with initially SSRI-resistant depression have improved outcomes with combined meds + psychotherapy

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197
Q

Trail-making test tests for:

A

executive functioning

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198
Q

Treatment for absence seizures

A

1) Ethosuximide
2) Depakote

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199
Q

treatment for rumination disorder in:
- adults:
- infants & those with intellectual disabilities:

A
  • adults: diaphragmatic breathing
  • infants & those with intellectual disabilities: behavioral habit reversal & aversive training
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200
Q

treatment of acute mania

A

Lithium, Valproate, Atypical antipsychotic

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201
Q

treatment of bipolar depression (5)

A

Quetiapine, Olanzapine/Fluoxetine, Lurasidone, Cariprazine (Vraylar), Lumateperone (Caplyta)

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202
Q

tremor entrainment test

A

if positive –> functional neurologic tremor

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203
Q

Types of dissociative amnesia:
________ – unable to remember an event or period of time (most common type)
________ – unable to remember a specific aspect of an event or some events within a period of time.
________ – complete loss of identity and life history (rare)

A

localized – unable to remember an event or period of time (most common type)
selective – unable to remember a specific aspect of an event or some events within a period of time.
generalized – complete loss of identity and life history (rare)

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204
Q

ventral tegmental area (VTA)

A

dopamine, reward pathway

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205
Q

Victims of bullying in adolescence have a *** times greater risk of developing GAD, panic disorder and agoraphobia as an adult

A

4 times higher!

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206
Q

Vomiting, fever, restless sleep caused by the evil eye occurring in Mediterranean people

A

Mal de ojo

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207
Q

voyeuristic disorder

A

sexual arousal from watching a person get naked without knowing

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208
Q

What is Adderall XR?

A

Amphetamine/Dextroamphetamine combo (2 isomers, extended release)

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209
Q

What is the most common disorder that adults with childhood-onset fluency disorder go on to develop?

A

Social anxiety disorder

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210
Q

What is the nutritional deficiency in Wernicke’s?

A

Thiamine (B1)

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211
Q

What percentage of children with ADHD will go on to be adults meeting criteria?

A

60%

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212
Q

What to know about sodium oxybate for narcolepsy

A

Improves quality of overnight sleep & thus improves daytime wakefulness
Treats catalepsy
Can cause daytime sedation –> treat with low-dose amphetamine

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213
Q

When is DBS indicated for Parkinson’s disease?

A

Late in the course when severe symptoms resistant to meds

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214
Q

Why is the Geriatric Depression Scale unique?

A

Used to evaluate depression in elderly with complex history, can distinguish depression from parkinson’s or dementia vs. mdd

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215
Q

Wisconsin card-sorting test tests for:

A

executive functioning

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216
Q

YMRS Scale

A

Young Mania Rating Scale

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217
Q

ZODIAC study

A

Ziprasidone Observational Study of Cardiovascular Outcomes
Those on Ziprasidone did not have higher cardiovascular outcomes than those on Olanzapine despite Ziprasidone’s known risk of QTc prolongation

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218
Q

what part of the brain is damaged by Thiamine deficiency (Wernicke’s)?

A

mamillary bodies

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219
Q

Correcting hyponatremia vs. hypernatremia too fast

A

Hyponatremia:
- From low to high, your pons will die (osmotic demyelination syndrome / central pontine myelinolysis) = locked in syndrome

Hypernatremia:
- From high to low, your brains will blow (cerebral edema / herniation)

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220
Q

lifetime prevalence of schizophrenia

A

1%

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221
Q

69 yo presenting with acute onset vertigo, lack of coordination, left-sided facial numbness. Loss of pinprick over left face and right body, left-sided dysmetria, rotatory nystagmus, left-sided ptosis and miosis.

A

Left Lateral Medullary (Wallenberg) Syndrome
- PICA (Vertebrobasilar)

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222
Q

Contralateral hemiparesis or hemisensory loss, ipsilateral facial sensory loss, CN palsies, diplopia, dysarthria, ataxia, vertigo, vomiting

A

Posterior circulation stroke (PICA) - vertebrobasilar
Lateral medullary = Wallenberg Syndrome

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223
Q

Contralateral face, arm weakness and sensory loss, eyes deviated toward lesion

A

MCA (left MCA = aphasia) stroke

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224
Q

Contralateral foot and leg weakness, behavioral change, confusion, impaired gait and stance (apraxia), akinetic mutism, urinary incontinence, grasp and suck reflex

A

ACA stroke

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225
Q

Arylsulfatase A deficiency

A

Metachromatic leukodystrophy

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226
Q

logorrhea

A

uncontrollable excessive talking

log = words
rrhea = flow/discharge

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227
Q

Brown Sequard Syndrome
- _____________ hemiparesis
- _____________ pain & temp loss
- _____________ propioception & vibration

A

lesion to hemisection (half) of spinal cord
- ipsilateral hemiparesis
- contralateral pain & temp loss
- ipsilateral propioception & vibration

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228
Q

term for rapid shifting from one topic to another

A

flight of ideas

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229
Q

Dramatic flinging/flailing of left arm

Name + Lesion

A

Hemiballismus - right subthalamic nucleus lesion

**hemiballismus = contralateral subthalamic nucleus

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230
Q

Postpartum hemorrhaging causing hypotension and requiring transfusion –> Mom is tired, losing weight, can’t breastfeed

A

Sheehan syndrome - postpartum pituitary infarction leading to panhypopituitarism
**can be associated with bitemporal hemianopsia (can compress the chiasm), neck stiffness & positive Kernig’s (meningeal irritation)

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231
Q

Vertebrobasilar
~vs~
Carotid artery
stroke/TIA symptoms

A

Vertebrobasilar - cerebellar symptoms (ataxia, vertigo, diplopia, dysphagia, dysarthria)

Carotid artery - blindness, sensory or motor loss, aphasia, visual field deficits

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232
Q

Myasthenia gravis is associated with what type of tumor?

A

Thymoma (20% of adults with MS have a thymoma)
**75% of adults with MS have some thymus abnormality, whether thymoma or thymus hyperplasia

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233
Q

male to female ratio for schizophrenia

A

1:1

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234
Q

What chromosome is associated with migraines?

A

Chromosome 19

235
Q

most common neurological complication of chronic alcoholism?

A

alcoholic neuropathy
(Alcohol directly damages nerves)

236
Q

acute descending paralysis with ophthalmoplegia, ataxia, areflexia

A

Miller-Fisher variant of Guillain-Barre Syndrome (anti-GQ1b ganglioside)

237
Q

classic nerve conduction abnormalities of conduction block and prolonged F-wave latencies

A

pathognomonic of Guillain-Barre Syndrome (GBS)

238
Q

3 receptor types associated with glutamate

A

AMPA, kainate, and NMDA

239
Q

MOA of PCP (drug)

A

NMDA antagonist

240
Q

Author of “Ego and Mechanisms of Defense” and founder of the defense mechanisms

A

Anna Freud

241
Q

dementia pugilistica

A

Boxer’s dementia
“Punch drunk syndrome”
“chronic traumatic encephalopathy”

242
Q

What chromosome puts people at higher risk for boxer’s dementia?

A

chromosome 19 (ApoE4)

243
Q

TCA with most antihistaminergic activity

A

Doxepin

244
Q

TCA used to treat enuresis in kids

A

Imipramine

245
Q

Why does grapefruit juice interact with Methadone?

A

CYP3A4 inhibition (which increases Methadone levels)

246
Q

a non-motor symptom that often appears in Parkinson’s patients before onset of motor symptoms

A

Decreased olfactory sense

247
Q

Benefit of Pimavanserin compared to other antipsychotics for Parkinson’s

A

Doesn’t worsen motor symptoms

248
Q

most common comorbidity in delusional disorder

A

depression

249
Q

Hydroxyzine contraindications

A

Cardiac - QT prolongation, MI, CHF, bradycardia
Metabolic - electrolyte abnormalities
Pulmonary - asthma
Other - hot environmental temperature (risk of heat stroke)

250
Q

Chronic paroxysmal hemicrania vs. Cluster headaches
- More common in men vs. women:
- # of attacks per day:
- Attack duration:
- Triggered by:
- Main treatment:
- Relation to circadian rhythm:

A
  • More common in men vs. women: CPH women; Cluster men
  • # of attacks per day: CPH up to 40 per day; Cluster up to 8 per day
  • Attack duration: CPH 2-30 min; Cluster 15 min to 3 hours
  • Triggered by: CPH turning head, alcohol; Cluster alcohol
  • Main treatment: CPH indomethacin; Cluster High flow oxygen, sumatriptan
  • Relation to circadian rhythm: CPH unrelated; Cluster mostly at night
251
Q

35 yo with severe pain behind left eye. Reports intense stabbing pain that woke him at midnight, improved in 30 minutes, then returning right before he fell back asleep. Several months ago had similar episodes of pain that resolved spontaneously after 2 weeks. Exam reveals left-sided ptosis, miosis and rhinorrhea.

A

Cluster headache - can have horner syndrome, occurs in clusters then no periods of headaches

252
Q

timeline for Tourette disorder

A

at least 1 year

253
Q

timeline for GAD

A

at least 6 months

254
Q

antipsychotic that is mainly metabolized/excreted via renal/urine

A

Paliperidone (80% excreted via urine)
**compared to most other antipsychotics that are hepatically metabolized

255
Q

Timeline for erectile dysfunction disorder

A

6 months

256
Q

Timeline for rumination disorder

A

1 month

257
Q

Pioglitazone relevance to psychiatry

A

It is a an insulin sensitizing drug. Can be used as an adjunctive antidepressant in treatment-refractory cases and seems to help in non-diabetic adults with insulin resistance

258
Q

1 cause of loss of years of healthy life in both high- and low- income countries

A

Depression!

259
Q

evidence is best for what treatments for depersonalization/derealization

A

CBT + SSRI or Benzo

260
Q

2 blackbox warnings for Latuda

A
  • can increase suicidality in children and adolescents
  • can increase mortality in dementia-related psychosis
261
Q

brain tumor that causes cognitive slowing, fatigue, weight loss, headaches, new-onset seizures, speech impairment

A

oligodendroglioma

262
Q

most common location of ischemic stroke in migraine infarction

A

posterior circulation

263
Q

treatment of Hallucinogen Persisting Perception Disorder (HPPD) after use of LSD

A

Benzos (GABA agonist!)

HPPD involves persisting perceptual disturbance after d/cing use of hallucinogen, primarily involves visual hallucinations

264
Q

timeline for aura in migraine to be considered “persistent aura” without evidence of infarction?

A

at least 1 week

265
Q

Why is Desipramine sometimes used for cocaine dependence and smoking cessation?

A

Inhibits noradrenergic reuptake

266
Q

Acamprosate MOA

A

GABA + Glutamate agonist
- used for alcohol dependence

267
Q

Acamprosate contraindication

A

Severe renal impairment

268
Q

Myasthenia gravis vs. Lambert-Eaton with regards to pre- vs post-synaptic ACh receptor malfunction

A

Myasthenia gravis = post-synaptic
Lambert-Eaton = pre-synaptic

269
Q

MTA study

A

Multimodal Treatment of ADHD Study - revealed both medication alone and combination of med + therapy were superior to therapy alone for patients with ADHD

270
Q

curative surgery for epilepsy

A

temporal lobectomy

**corpus callosotomy or extra-temporal resections are palliative

271
Q

most common cause of sporadic fatal encephalitis worldwide

A

Herpes simplex virus type 1

272
Q

encephalitis affecting bilateral temporal lobe involvement

A

herpes simplex

273
Q

heritability of bipolar disorder based on twin studies

A

60-90%

274
Q

dystonia in Parkinson’s disease more common in what population?

A

Young-onset Parkinson’s (before age 40)
- think of VA guy
- can be the initial presenting symptom in this population (compared to late-onset)

275
Q

atypical antipsychotic least likely to result in weight gain

A

Abilify

276
Q

HAM-D vs. BDI

A

HAM-D: 17 questions asked by provider (ham-D for Doctor does it!)
BDI: 21 questions completed by patient
(bdI for I do it!)

277
Q

Antipsychotic MOA

A

dopamine antagonist

278
Q

Cyclothymic disorder criteria
- timeline:
- symptoms:

A
  • timeline: 2 years
  • symptoms: hypomanic & depressive symptoms that don’t meet criteria for hypomania, mania, or MDD
279
Q

Cluster A personality disorders:
- described as:
- what are they?

A
  • described as: odd, eccentric

Paranoid, Schizoid, Schizotypal

280
Q

Cluster B personality disorders:
- described as:
- what are they?

A
  • described as: dramatic, emotional

Histrionic, Borderline, Narcissistic, Antisocial

281
Q

Cluster C personality disorders:
- described as:
- what are they?

A
  • described as: anxious, fearful

Avoidant, Dependent, Obsessive-Compulsive

282
Q

most common side effect of Vortioxetine (Trintellix)

A

persistent nausea (does not resolve like typical SSRIs)

283
Q

MOA of Vortioxetine (Trintellix)

A

SRI (serotonin reuptake inhibitor, not selective)

284
Q

FDA approved meds for PMDD

A

Zoloft, Prozac, Paxil

285
Q

first drug of choice for generalized seizures

A

Depakote

286
Q

Timing for premature ejaculation

A

Less than 1 minute

287
Q

Most common side effect of DBS from the direct electrical stimulation?

A

Hypomania - can be reversed by decreasing stimulation settings

288
Q

unique benefit of Vortioxetine (Trintellix)

A

shows improvement in COGNITION independent of mood improvement. Cognitive improvements can occur even prior to mood changes.

289
Q

New neuromod technique that uses electrical signals to stimulate the trigeminal nerve CN V through a battery-powered patch placed on the patient’s forehead

A

Trigeminal Nerve Stimulation (TNS)

290
Q

Trigeminal Nerve Stimulation (TNS) is FDA approved to treat what condition

A

ADHD

291
Q

most common population for rumination disorder

A

infants between 3 months to 1 year of age

292
Q

When do myelination & synaptogenesis start, occur, peak, and end in the brain?

A

Myelination: starts in utero, peaks right before birth, continues through life

Synaptogenesis: starts in second trimester, peaks in toddlerhood (age 2), ends around age 10 (synaptic overproduction occurs before that, then synaptic pruning begins)

293
Q

Hz of Parkinson’s disease tremor

A

4-6 Hz

294
Q

acute stress disorder timeline

A

3 days to 1 month

295
Q

Circumlocutions

A

word substitutions to avoid problematic words in childhood-onset fluency disorder

296
Q

Brexpiprazole is FDA approved to treat:

A

MDD as adjunctive agent, schizophrenia

297
Q

It is the goal of the ______ to satisfy the needs of the id in a socially acceptable way

A

ego

The ego balances the id’s unconscious urges and desires with the superego’s restriction of moral standards

298
Q

30 yo resident complaining of excessive daytime sleepiness for the past 3 months. Works in the hospital during the day and moonlights at night. Increases caffeine intake for moonlighting. Has difficulty falling asleep at night bc afraid of pager going off. Daytime sleepiness so bad that she falls asleep driving to work and ran a red light.

A

Circadian rhythm sleep disorder
- persistent or recurrent sleep disturbance due to either intrinsic (altered circadian rhythm, blindness) or extrinsic (travel, daytime sleep schedule) factors with consequences, which include- insomnia, excessive daytime sleepiness, wake time dysfunction

Types:
- Delayed or advanced sleep-phase type
- Irregular sleep-wake type
- Shift work type
- Jet lag type
- Free-running type

299
Q

person-centered psychotherapy

A

Carl Rogers

300
Q

Criteria for migraine without aura:
- at least ___ attacks
- lasting for __ to __ hours
- at least __ of the following characteristics: ___lateral location, _________ quality, __________ or __________ pain intensity, aggravation/causing avoidance of routine activity
- at least __ of the following: photophobia, phonophobia, nausea, vomiting

A
  • at least 5 attacks
  • lasting for 4 to 72 hours
  • at least 2 of the following characteristics: unilateral location, pulsating quality, moderate or severe pain intensity, aggravation/causing avoidance of routine activity
  • at least 1 of the following: photophobia, phonophobia, nausea, vomiting
301
Q

Criteria for migraine with aura:
- at least __ attacks
- __ or more of the following aura symptoms: visual, sensory, speech, language, motor, brainstem, retinal
- at least __ of the following: one spreads gradually over >5 minutes, 2 or more aura in succession, each aura lasts 5-60 min, at least one aura is unilateral, at least one aura is positive, aura is accompanied by or followed within 60 min headache

A
  • at least 2 attacks
  • 1 or more of the following aura symptoms: visual, sensory, speech, language, motor, brainstem, retinal
  • at least 3 of the following: one spreads gradually over >5 minutes, 2 or more aura in succession, each aura lasts 5-60 min, at least one aura is unilateral, at least one aura is positive, aura is accompanied by or followed within 60 min headache
302
Q

MMSE scoring:

A

21-24: Mild impairment
10-20: Moderate impairment
0-9: Severe impairment

303
Q

31 yo woman 5 mos postpartum ingests chalk and clay since delivery. Has been craving and eating chalk and clay for over 4 mos and is hoping it will help her lose weight. She thinks she is overweight. She has been binging at least twice a week on food mixed with clay and chalk. Eats slowly over 3 hours until she feels uncomfortably full. Adds chalk to regular meals, as it satisfies her cravings. Sometimes she just chews on it then regurgitates it.

A

Pica

= persistent intake of nonnutritive substances for at least 1 month

she meets features of a few other eating disorders but does not meet criteria for them!

304
Q

Hypnagogic vs. Hypnopompic hallucinations

A

Hypnagogic = with sleep onset (feeling GROGGY)
Hypnopompic = with waking (POPPING awake!)

305
Q

Levomilnacipran FDA approved for?

A

MDD

306
Q

Cannabinoid 1 vs 2 receptors

A

CB1 = psychiatric effects
CB2 = immune system, inflammatory response, pain

307
Q

Piaget stage where conservation is achieved

A

Concrete operations = CONservation

308
Q

Genetic inheritance of Tourette’s

A

Autosomal dominant

309
Q

Concordance of Tourette’s disorder in monozygotic twins

A

85%

310
Q

Heschl’s gyrus

A

Primary auditory cortex - bilateral superior temporal lobe

311
Q

periodic high-amplitude sharp triphasic wave complexes on EEG

A

Creutzfeldt-Jakob disease

312
Q

Periodic lateralizing epileptiform discharges (PLED) on EEG

A

Herpes encephalitis

313
Q

CSF:
- opening pressure: elevated
- WBC: elevated lymphocytes
- protein: elevated
- glucose: low

A

Fungal/TB Meningitis

314
Q

CSF:
- opening pressure: elevated
- WBC: elevated neutrophils
- protein: elevated
- glucose: low

A

Bacterial Meningitis

315
Q

CSF:
- opening pressure: normal or elevated
- WBC: elevated lymphocytes
- protein: normal to elevated
- glucose: normal low

A

Viral (Aseptic) Meningitis

316
Q

Mahler’s stage in which baby spends more time asleep than awake

A

Normal autism (birth to 2 mos)

317
Q

Mahler’s stage when baby is developing the ability to distinguish the inner from the outer world. The child perceives itself as being part of a single entity with its mother.

A

Symbiosis (2-5 mos)

318
Q

Mahler’s stage when child is drawn further into the outside world and begins to distinguish itself from its mother.

A

Differentiation (5-10 mos)

319
Q

Mahler’s stage when baby has the ability to move independently and explore the outside world (crawling, walking, exploring)

A

Practicing (10-18 mos)

320
Q

Mahler’s stage in which the child’s independence vacillates with its need for its mother. The child moves away from the mother, then quickly returns for reassurance. Now they’re more tentative and want to make sure mom is still there.

A

Rapprochement (18-24 mos)

321
Q

Mahler’s stage in which the child understands the permanence of other people, even when they are not present, allowing separation.

A

Object constancy (2-5 yrs)

322
Q

statistical test that checks differences between means of 2 versus 3 or more groups

A

2 = t-test
> 3 = ANOVA

323
Q

statistical test that checks difference between 2 or more categorical outcomes

A

chi-square

324
Q

Head bleed resulting from tear of middle meningeal artery

A

Epidural hematoma

Epidural = middle meningeal ARTERY
Subdural = bridging VEINS

325
Q

Head bleed resulting from tear of meningeal bridging veins

A

Subdural hematoma

Epidural = middle meningeal ARTERY
Subdural = bridging VEINS

326
Q

toxicity of acetylcholinesterase inhibitors (physostigmine) (organophosphates) (pesticides)

A

DUMBBELS
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Emesis
Lacrimation
Salivation

**cholinergic toxicity

327
Q

Pt presents with vomiting, shortness of breath, bradycardia, hypoxia, pinpoint pupils, lacrimation, widespread rhonchi, muscle fasciculations, increased bowel sounds and diarrhea.

diagnosis + management

A

Insecticide poisoning (organophosphates, anticholinesterase inhibitor, increases cholinergics)
–> immediate atropine (anticholinergic/antimuscarinic)
**remove clothes bc can be absorbed via skin

328
Q

most common sleep disruption in depression

A

early morning awakening

329
Q

hypsarrhythmia

A

EEG pattern for infantile spasms

West syndrome = infantile spasms, hypsarrhythmia, and psychomotor developmental arrest

330
Q

microcephaly, a characteristic “mousy” odor, infantile spasms, and light hair and skin pigmentation

A

PKU (Phenylketonuria)

331
Q

Brain structure suspected to be involved in Tourette’s with dopaminergic activity

A

Caudate nucleus - causes the movements related to Tourette’s, Parkinson’s, tics

332
Q

rate-limiting enzyme in the dopamine synthetic pathway

A

Tyrosine hydroxylase

333
Q

Drugs that work on GABA-A vs GABA-B

A

GABA-A: Benzos, Barbiturates, Alcohol

GABA-B: Sodium oxybate, Lioresal (antispasticity agent)

334
Q

Entacapone & Tolcapone MOA

A

COMT inhibitors

335
Q

Benzos metabolized by conjugation

A

LOT =
Lorazepam
Oxazepam
Temazepam

long-acting benzos that bypass oxidation so safer in hepatic disease, also have no active metabolites

336
Q

method of obtaining a prediction for the value of one variable in relation to another variable is called

A

regression analysis

337
Q

triphasic waves on EEG

A

hepatic encephalopathy

338
Q

compulsive eating, hypersexuality, hyperorality, visual agnosia, docility (calm, subserviant)

A

Kluver-Bucy Syndrome = bilateral lesions of the temporal lobe disconnecting amygdaloid bodies

339
Q

While working on the ward of a state hospital, a psychiatrist comes across a patient with schizophrenia. The patient sits in one spot for extended periods of time, without changing position. This phenomenon is best described as:

A

catalepsy

= immobile position that is constantly maintained.

340
Q

How is sleep affected in elderly?
- # REM episodes:
- Length of REM:
- % of N1:
- % of N2:
- % of N3:

A
  • # REM episodes: increased
  • Length of REM: decreased
  • % of N1: increased
  • % of N2: increased
  • % of N3: decreased
341
Q

alogia

A

lack of speech that results from a mental deficiency or dementia (lack of thought content)

342
Q

To meet criteria for rapid cycling specifier in bipolar disorder, the patient must present with at least _____ mood episodes over the past ___ months

A

4 mood episodes over 12 months

343
Q

age to be considered late-onset in schizophrenia

A

45

344
Q

of neurons in the developed human brain

A

86-100 billion

345
Q

Premonitory phase of migraines symptoms (6)

A

Hypo/peractivity
Fatigue
Depression
Food cravings
Yawning
Neck stiffness

Occurs hours to days before migraine

346
Q

Mirtazapine MOA

A

alpha-2 antagonist (+histamine H1 blockade –> sedation; +5HT3 antagonism –> antinausea)

347
Q

FDA-approved meds for pediatric bipolar disorder (6)

A

Lithium
Four atypicals:
- Abilify
- Risperdal
- Quetiapine
- Olanzapine
- Asenapine

348
Q

Timeline for seizures in alcohol withdrawal

A

first 48 hours

349
Q

Prazosin MOA

A

alpha-1 antagonist

350
Q

Ketamine MOA

A

glutamate NMDA antagonist

351
Q

hypnagogic hallucinations are a known side effect of what antipsychotic

A

Asenapine

352
Q

bipolar disorder rapid cycling definition

A

at least 4 mood episodes in the last 12 mos

353
Q

most appropriate effective treatment for hypoactive sexual desire disorder

A

Stimulants

354
Q

narcolepsy criteria:
- symptoms at least ___ times per week over the past ___ months
- recurrent episodes of uncontrollable sleepiness, lapsing into sleep, or napping during the same day

At least one of the following:
- Episodes of cataplexy occurring at least ___ times a month
- ____ Hypocretin
- REM sleep latency of ___ minutes and a mean sleep latency of ___ minutes

A
  • symptoms at least 3 times per week over the past 3 months
  • recurrent episodes of uncontrollable sleepiness, lapsing into sleep, or napping during the same day

At least one of the following:
- Episodes of cataplexy occurring at least several times a month
- Low Hypocretin
- REM sleep latency of 15 minutes and a mean sleep latency of 8 minutes

355
Q

oligoclonal bands in CSF

A

Multiple Sclerosis

356
Q

Saffron use in Alzheimer’s

A

similar cognitive improvements and efficacy compared to Donepezil with fewer side effects (less nausea)

357
Q

body integrity identity disorder

A

feeling that a limb or other body part is foreign and doesn’t belong to them, needs to be removed

358
Q

most common psychiatric illness/comorbidity in Lupus

A

depression

359
Q

best OCD meds target what receptor profile

A

serotonin

360
Q

What does SCOFF stand for?

A

Sick (vomit)
Control
One
Fat
Food

361
Q

SCOFF sensitivity and specificity

A

High sensitivity (identifies all eating disorder patients, low false negatives)
Low specificity (low false positives, may falsely diagnose some but at least all of the real ones are captured)

362
Q

least common type of seizure in Lennox-Gastaut

A

myoclonic

363
Q

falls & vertical gaze palsy, writing smaller (micrographia) –> progresses to symmetric rigidity & dementia

A

progressive supranuclear palsy (PSP)

**rapidly progressive and fatal

364
Q

management of autonomic dysreflexia (high BP) in spinal cord injury patients

A
  1. Look for urinary retention of bowel distention (triggered by insults below the level of injury)
  2. Treat with IV short-acting antihypertensive agent - sodium nitroprusside or labetalol
365
Q

nondominant hemisphere in most people

A

right hemisphere

366
Q

Stroke-
With eyes closed, touch left arm and can feel it. Then touch both arms and can only feel right.

Name for syndrome?
Lesion to what?
What side of brain?

A

Hemineglect syndrome
= lesion to parietal or frontal lobe of nondominant hemisphere (right)

Dominant Left = pays attention to right only
Non-Dominant Right = pays attention to both right & left (preferentially to left)

Thus: if non-dominant right is damaged –> the left brain will outweigh –> thus the right side of body will be preferenced

367
Q

Most common comorbidity in hoarding disorder

A

Depression (NOT OCD!)

368
Q

FDA approved drug for Lennox-Gastaut Syndrome

A

Felbamate

369
Q

BARS scale

A

Barnes akathisia rating scales

370
Q

Vagus nerve stimulator known to reduce what seizure type

A

Complex partial

371
Q

Gabapentin anacarbil

A

= Gabapentin XR

take with FOOD!!!!

372
Q

major active metabolite of Risperidone

A

Paliperidone

373
Q

Painless transient loss of vision in one eye described as “curtain falling over eye” that only lasts a few seconds

Name + Etiology + Next step in diagnosis:

A

Amaurosis fugax - retinal ischemia secondary to small embolism in ophthalmic artery originating from carotid artery

technically a TIA*

**question hint may be carotid bruit on exam

–> Carotid duplex ultrasound

374
Q

Location of synthesis of neurotransmitters:
- Serotonin:
- ACh:
- GABA:
- NE:
- Dopamine:

A
  • Serotonin: raphe nucleus
  • ACh: basal nucleus of Meynert
  • GABA: nucleus accumbens
  • NE: locus ceruleus, adrenal medulla
  • Dopamine: substantia nigra
375
Q

Man with recent flu vaccine presents with acute onset paraparesis and urinary incontinence. Symptoms began a week ago with progressive low back pain that led to bilateral leg weakness.

A

Transverse myelitis
**question stem may make you think of Guillain-Barre but think of this when there’s sensory level loss and bowel/bladder dysfunction after a URI or vaccine

  • course = back pain –> leg weakness –> urinary incontinence
376
Q

Reliability vs. Accuracy in diagnosis

A

Reliability = Precision = consistence = can apply across he board (doctors at diff locations would agree on the diagnosis)

Accuracy = Validity = how accurate = how true values are (the disorder has features that are characteristic enough to separate it from other disorders)

377
Q

Term for when a diagnosis allows doctor to predict clinical course and treatment response (a test is able to predict a future outcome)

  • Face validity
  • Content validity
  • Construct validity
  • Convergent validity
  • Predictive validity
A

Predictive validity

378
Q

Term for when a diagnosis is based on underlying pathophys and the use of biologic markers to confirm the disease

  • Face validity
  • Content validity
  • Construct validity
  • Convergent validity
  • Predictive validity
A

Construct validity

379
Q

the extent to which a test assesses all the aspects of the condition it purports to assess

ex: a rating scale that doesn’t measure neurovegitative signs would have low ***** validity for assessing depression

  • Face validity
  • Content validity
  • Construct validity
  • Convergent validity
  • Predictive validity
A

Content validity

380
Q

The extent to which a test correlates with other tests for the same condition

Ex: New depression rating scale correlates highly with HAM-D scores, therefore has high *** validity

  • Face validity
  • Content validity
  • Construct validity
  • Convergent validity
  • Predictive validity
A

Convergent validity

381
Q

Child with horner syndrome in setting of cervical paravertebral mass

A

Neuroblastoma

382
Q

Horner’s syndrome etiology

A

Lesion of thalamus or medulla, or common carotid

383
Q

Prosopagnosia

A

inability to recognize familiar faces

384
Q

Astereognosis

A

inability to recognize and identify items by weight, texture, and form alone when items are held in hand (a form of tactile agnosia)

a=without
stereo=solid, 3D, texture
gnosis=recognition/knowledge

385
Q

Aprosodia

A

deficit in emotional aspect of expressive or receptive speech

386
Q

Bells palsy vs stroke

A

Bells palsy = full face
Stroke = spares upper third of face (brow, eyelid, forehead)

387
Q

35 yo presents with complaints of muscle weakness and sensory loss in upper extremities. MVC 7 yrs ago, sustained whiplash C spine injury. Moderate wasting of small hand muscles and impaired pain/temp in bilat UE. Light touch vibration position sense intact.

A

Central cord syndrome due to Syrinomyelia
- CSF drainage from central canal of spinal cord is disrupted –> fluid filled cavity compresses surrounding neural tissue
- most caused by Arnold-Chiari malformation
- classic is cape or shawl pattern sensory deficit of upper arms and trunk
- sensory deficits (pain and temp) + LMN signs (flaccidity, muscular atrophy, fasciculations)

388
Q

Opsoclonus-myoclonus in an infant vs. an adult

A

Paraneoplastic movement disorder seen most often in infants 6-18 mos, 50% or more associated with neuroblastoma

“dancing eyes and dancing feet syndrome” (multifocal myoclonus and rapid dancing movements of the eyes)

In adults = lung cancer

389
Q

Bells palsy vs. Ramsay-Hunt

A

Both facial droop involving forehead, ear pain, hearing abnormalities, but Ramsay-Hunt includes a rash in the ear

Ramsay-Hunt = VZV reactivation in sensory ganglion affecting facial (7) and acoustic (8) cranial nerves

390
Q

Anton’s syndrome

A

Visual anosognosia = blindness without insight, patients often confabulate and refuse to believe they are blind.

Results from stroke or brain damage to occipital lobe

391
Q

Riluzole MOA + indication

A

Glutamate antagonist
ALS

392
Q

AIDS patient with CD4 of 50 presenting with gait instability, spasticity, leg weakness, sphincter dysfunction, loss of proprioception

A

Vacuolar myelopathy
- most common cause of spinal cord pathology in AIDS patients
- occurs in late-stage AIDS with low CD4 count

393
Q

HIV, low CD4 count, visual symptoms, gait ataxia, asymmetric patchy non-enhancing white matter lesions

A

Progressive Multifocal Leukoencephalopathy (PML) - JC virus

394
Q

HIV patient presenting with fevers, headaches, vomiting, papilledema, encapsulated yeasts on LP

A

Cryptococcal meningitis
- cryptococcus replicates in CNS –> clogs arachnoid villi –> CSF outflow obstruction –> increased ICP –> headaches, n/v, confusion, lateral gaze palsy, etc

395
Q

HIV patient with floaters and blurry vision

A

CMV Retinitis

396
Q

HIV patient with cognitive and personality changes

A

HSV encephalitis (affects temporal lobes)

397
Q

HIV patient with gradual onset of incoordination, lack of attention and motivation, memory loss. MRI with white matter changes.

A

HIV dementia
- early symptoms of attention and concentration problems
- slowed thought (bradyphrenia)
- social withdrawal, apathy, depression, fatigue
–> can lead to gait incoordination, rigidity, slowed gait

***white matter changes! (diffuse increase in intensity of white matter)

398
Q

Cervical myelopathy + Bilateral optic neuropathy

A

Neuromyelitis optica = Devic’s disease (variant of MS)

399
Q

Kuru

A

prion disease affecting cannibalistic Fore people - manifests as progressive cerebellar ataxia

400
Q

Triad of headache, ipsilateral Horner’s syndrome and contralateral hemiparesis

A

Carotid artery occlusion
– horner’s itself can cause headache

401
Q

Vet presents with 4-week history of headache, vague fever, paresthesias in fingers and toes. Temp is 103.5 F. Complains of difficulty swallowing with pharyngeal spasms for the past 3 days.

A

Rabies!!!
- hydrophobia - fear of drinking due to pharyngeal spasms

402
Q

Double vision, ptosis, difficulty swallowing, nausea, dry mouth. Had potato salad yesterday from home-canned potatoes

A

Botulism = Diplopia, Dysarthria, Dysphagia, Dyspnea, Urinary retention

403
Q

Pure motor hemiparesis on same side of face and body

A

Lacunar infarct - contralateral face, arm, leg affected with motor symptoms (no sensory deficits usually)
= posterior limb of internal capsule!

404
Q

Balint’s syndrome

A

Rare stroke from simultaneous lesions to bilateral parietal-occipital lobes

Leads to Ocular apraxia (inability to scan extrapersonal space), Optic ataxia (jerks that can impede vision), Simultanagnosia (inability to perceive a scene with multiple parts to it)

405
Q

Ocular apraxia (inability to scan extrapersonal space), Optic ataxia (jerks that can impede vision), Simultanagnosia (inability to perceive a scene with multiple parts to it)

A

Balint’s syndrome

406
Q

Is depression or schizophrenia a higher risk factor for completing suicide?

A

Depression

407
Q

blepharospasm and oromandibular dystonia

A

Meige’s syndrome

blepharospasm = eyelid blinking
involuntary contraction of eyelids and lower facial muscles

408
Q

Scanning speech

A

Ataxic speech - cerebellar lesion
(irregular, choppy speech)

409
Q

Aphemia

A

near muteness with normal reading, writing, and comprehension
(a=without; phenia=phasia=voice=speech)

410
Q

least anticholinergic TCA

A

Desipramine

411
Q

Hoover’s sign

A

patient suspected of a hysterical or psychogenic hemiparesis does not give effort in the contralateral (unaffected) lower extremity when asked to lift the paretic (affected) lower extremity off the table

The examiner places a hand under the patient’s heel on the unaffected side to feel if the patient is pushing down toward the bed in an attempt to give a full effort at raising the affected leg. In a real hemiparesis, the patient would be expected to make every effort to brace himself with the unaffected leg while trying to raise the paretic leg.

412
Q

Hoffman’s sign

A

equivalent of Babinski’s in the upper extremity

413
Q

Tiagabine

A

selective GABA reuptake inhibitor for partial complex seizures

414
Q

GABA type that benzos target

A

GABA-A

415
Q

Head bruit

A

Hallmark of AVM

416
Q

Mixed opioid agonist/antagonist

A

Buprenorphine

417
Q

Hallervorden-Spatz syndrome

A

autosomal recessive neurodegenerative disease of childhood that presents with dementia and parkinsonism, caused by lesions to basal ganglia

418
Q

dementia, dermatitis, diarrhea

A

triad for Pellagra (Vitamin B3 / Niacin deficiency)

419
Q

Pimozide

A

dopamine antagonist approved for tics / tourette’s

(in europe, antipsychotic approved for schizophrenia)

420
Q

treatment for atypical depression

A

NOT STANDARD TREATMENT!

–> MAOIs!

**Atypical depression shows excellent response to MAOIs compared to other meds

421
Q

BPRS

A

Brief psychiatric rating scale - used for schizophrenia and psychosis

422
Q

Antipsychotic that can cause retrograde ejaculation and impotence

A

Thioridazine

423
Q

Donepezil MOA

A

Acetylcholinesterate inhibition

424
Q

What neurotransmitters does ecstasy affect?

A

Dopamine and Serotonin

425
Q

Kleine-Levin syndrome

A

rare disorder with hypersomnia interrupted by irritability, hyperorality, hypersexuality

other symptoms can include confusion, disorientation, incoherent speech, apathy, hallucinations, delusions, memory impairment

avg onset age 10-20, resolves by age 40

426
Q

Relative contraindications to Amantadine

A

Renal disease, Seizure disorder

427
Q

Defense mechanism associated with specific phobia

A

Repression
**spider bite as a kid leads to fear of spiders, despite repressing and not remembering the spider bite

428
Q

Meds that can be useful for binge-eating (5)

A

1) SSRIs (Fluoxetine is the best!)
2) Topamax, Atomoxetine, Sibutramine, Duloxetine

429
Q

Brodmann areas associated with language production and speech

A

Brodmann areas 44 & 45

430
Q

Brodmann area 17

A

primary visual cortex

431
Q

Brodmann area 4

A

primary motor cortex

432
Q

Brodmann areas associated with the primary auditory cortex

A

Brodmann areas 41 & 42

433
Q

Most common psychiatric comorbidity in narcissistic personality disorder

A

Anxiety disorders

434
Q

Only MAOI that is specific to MAO-B

A

Selegiline

435
Q

Recurrent brief attacks of vertigo that occur without warning and resolve spontaneously in otherwise healthy children

Diagnosis + age of onset

A

Benign paroxysmal vertigo of childhood (BPVC)

Age of onset is 3-4 years old

436
Q

Spinal cord level that leads to autonomic dysreflexia

A

T6 or above

437
Q

AUD remission timeline

A

Early remission = 3-12 months
Sustained remission = >12 months

**none of criteria met, SOBER and symptom FREE!

438
Q

Tonic seizures:
- duration:
- occur during wakefulness or sleep?
- symmetry:
- extremity movement:

A
  • duration: 5-20 seconds
  • occur during wakefulness or sleep? sleep
  • symmetry: symmetrical
  • extremity movement: flexion OR extension
439
Q

Criteria for intermittent explosive disorder:
- Verbal aggression (temper tantrums, arguments, fights) or physical aggression toward property, animals or other individuals occurring ___ x per week for at least ___ months.
OR
- __ episodes of aggression or outbursts that result in damage of property or others in a __-month period

A
  • Verbal aggression (temper tantrums, arguments, fights) or physical aggression toward property, animals or other individuals occurring 2x per week for at least 3 months.
    OR
  • 3 episodes of aggression or outbursts that result in damage of property or others in a 12-month period
440
Q

Hydroxyzine MOA

A

Central & peripheral histamine H1 receptor antagonist

441
Q

Minamata disease

A

Methylmercury intoxication or mercury-induced encephalitis

442
Q

Atrophy of visual calcarine cortex and cerebellum

A

Mercury intoxication/encephalitis
- causes cerebellar ataxia, dysarthria, intention tremor, gaze nystagmus, dysmetria, dysdiadochokinesia

443
Q

distinguishing factors between NMS and Serotonin Syndrome

A

Both present with: AMS, autonomic instability, diaphoresis, mutism, can have elevated CPK

Distinct to SS are: myoclonus, hyperreflexia, GI symptoms (diarrhea)

NMS presents with rigidity and slowed reflexes

Also - SS is abrupt onset, NMS is gradual

444
Q

caudate head atrophy

A

Huntington’s disease

445
Q

most common source of brain mets

A

Lung

446
Q

subdural vs epidural hematoma shape

A

epidural can’t draw an S (lemon)
subdural could draw an S (banana)

447
Q

ring-enhancing lesion on MRI (4 causes)

A

tuberculosis, lymphoma (HIV), toxoplasmosis (HIV), Nocardia

448
Q

alexia without agraphia stroke / territory

A

left PCA (posterior cerebral artery) - affects posterior occipital lobe / corpus collosum

449
Q

PTSD brain imaging finding

A

decreased hippocampal volume (unclear if that’s what predisposes individuals to developing PTSD vs if PTSD causes it)

450
Q

Sphingomyelinase deficiency

A

Niemann-Pick disease

may initially present in adulthood with psychosis, and when psychosis is associated with a vertical supranuclear gaze palsy, various dyskinesias, and seizures, NPC should be suspected

451
Q

most common cause of mental retardation

A

Fragile X > Down syndrome

452
Q

chromosome 7q11 deletion

A

Williams’ syndrome

453
Q

Elfin facies, short stature, mild MR, hypoplastic teeth, friendly personality, gifted musically

A

Williams’ syndrome (7q11 deletion)

454
Q

mature defense mechanisms (5)

A

Altruism, Humor, Sublimation, Suppression, Anticipation

455
Q

Do prodromal symptoms count toward the 6 months to meet criteria for schizophrenia?

A

Yes, to meet criteria, must have a 6-month period of active-phase symptoms (delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms), prodromal symptoms, or residual symptoms

456
Q

Triptan MOA

A

Serotonin 5HT1B/1D agonist

457
Q

Frovatriptan unique quality

A

not contraindicated in combo with MAOIs or SSRIs (like other triptans)

458
Q

Triptans work by _______ cranial vessels, ______________ neuropeptide release, and reducing pain transmission in the __________ pathways

A

Triptans work by constricting cranial vessels, decreasing/inhibiting neuropeptide release, and reducing pain transmission in the trigeminal pathways

459
Q

Priapism is a known side effects of what psych meds (5):

A

Trazodone, Antipsychotics, Prazosin, Stimulants, Strattera

460
Q

Latuda MOA

A

Dopamine D2 and Serotonin 5HT2 antagonist

less histamine activity so less weight gain compared to other antipsychotics

461
Q

Conduct disorder precursor and later manifestation

A

Precursor = often ODD
Later manifestation = Antisocial personality (after age 18)

462
Q

Which antipsychotics can lower WBC (through bone marrow suppression)?

A

SGAs / Atypical antipsychotics
(Risperdal, Abilify, Zyprexa, Quetiapine, Clozapine)
- dones and -pines

463
Q

elements of “evidence-based treatment practice” (3)

A

1) scientific/research evidence
2) Clinical expertise / expert opinion
3) Choices, values and goals of the patient

464
Q

Reactive attachment disorder vs. Disinhibited social engagement disorder

A

RAD = fearful, untrusting, doesn’t seek comfort in others, minimal social/emotional response to others, irritable
DSED = friendly with strangers (disinhibited), lack of fear or caution, over-familiar, seek attention in strangers

465
Q

antisocial personality disorder criteria:
- must occur prior to age ___
- must be at least age ___

A
  • must occur prior to age 15 (evidence of conduct disorder prior to that age)
  • must be at least age 18
466
Q

Criteria for encopresis:
- Age must be ___ yo
- repeated passage of feces into inappropriate places, e.g., clothing or floor
- intentional or involuntary?

At least ___ such event must occur every month for at least ___ months

A
  • Age must be at least 4 yo
  • repeated passage of feces into inappropriate places, e.g., clothing or floor
  • intentional or involuntary? EITHER!

At least 1 such event must occur every month for at least 3 months

467
Q

Partial vs. Full remission in binge-eating disorder

A

Partial = binging less than 1x/week for a sustained period
Full = Not meeting criteria at all for a sustained period

468
Q

core conditions of Carl Rogers’ client-centered therapy (3):

A

empathy, congruence/acceptance, unconditional positive regard

469
Q

timeline to meet criteria for pica

A

at least 1 month

470
Q

timeline for alcohol withdrawal:

A

8-12 hours: Tremulous, insomnia, anxiety, autonomic instability (diaphoresis, palpitations)

12-48 hours: Seizures (highest in 24-48 hours!!!), hallucinations

48-96 hours: Delirium tremens (fever, disorientation, SEVERE agitation, confusion, hallucinations) **emergency, treat with benzos!

471
Q

unilateral complete loss of sensation

A

Contralateral thalamic stroke
**thalamus is the major relay for all sensory information

472
Q

the “talk and die” syndrome, where there is a brief loss of consciousness followed by a period of lucidity then sudden deterioration

A

epidural hematoma

**vs subdural which is progressive, gradual increasing headache and confusion, often goes unrecognized in alcoholics with frequent falls

473
Q

Older person with headache and sudden onset blindness in one eye. Recent complaints of fever, pelvic and shoulder girdle pain, weight loss, elevated ESR.

A

Temporal (giant cell) arteritis
+ Polymyalgia rheumatica

  • usually elderly female
  • can cause jaw claudication
  • blindness due to ophthalmic artery occlusion
  • due to focal granulomatous inflammation
  • treated with steroids before temporal artery biopsy!
474
Q

Sudden onset headache (“worst headache of my life”) with vomiting, collapse, photophobia, preserved consciousness. Some neck stiffness on exam.

A

subarachnoid hemorrhage
**often caused by aneurysm or AVM rupture

475
Q

childhood brain tumor causing cerebellar symptoms

A

pilocytic astrocytoma (eosinophilic, corkscrew fibers) vs. medulloblastoma (rosettes, small blue cells)

PA is most common brain tumor in childhood, benign, good prognosis
MB is most common malignant brain tumor in kids, poor prognosis

476
Q

neuroimaging findings in schizophrenia

A
  • enlarged lateral & 3rd ventricles
  • decreased metabolic activity / thinning of frontal lobes
477
Q

Cause of hyperkalemic periodic paralysis

A

sodium channel mutation

478
Q

most common risk factors for lacunar strokes (3)

A

HTN, diabetes, current tobacco smoking

479
Q

Dandy-Walker malformation

A

fourth ventricle balloons out and cerebellum doesn’t develop

480
Q

startle myoclonus

A

creutzfeldt-jakob disease

481
Q

Kohut self-object terms:
- Mirroring
- Idealizing
- Twinship

A
  • Mirroring – This is where the parent (usually the mother) would reflect back at the child a sense that he or she is worthy, loved and special. Praise, pride! Experience where the caregiver recognizes the child’s capabilities and talents and affirms the child’s feelings of strength.
  • Idealiizing – Kohut believed that children need to idealize their caregiver and see them as powerful and knowledgeable. The child needs to feel as though they can turn to their caregiver to meet their needs and to help them make sense of their world. Their caregiver needed to be able to calm and reassure them. Children need someone whom they can admire and idealize and from whom to gain beliefs, values, aspirations, and strength. As the child feels connected to a powerful selfobject other, she develops a sense of self through the unconscious experience that says, “You’re powerful; you make me feel better. I’m connected to you; therefore, I’m powerful, too”

Twinship – Kohut believed that children need to feel they fit in with others. They have a need to be similar to their parents – not too different that they felt “wrong”. Children mimic behaviours or characteristics from their caregiver and gradually as the child matures, would be able to feel more comfortable with any differences. Example is shaving next to dad in the mirror.

482
Q

Behavioral theory behind gambling

A

Operant conditioning

483
Q

Location of TMS

A

Left dorsolateral prefrontal cortex

484
Q

Indication for TMS

A

Failed benefit from one antidepressant at adequate dose/duration

485
Q

contraindications to T3 for depression augmentation (3)

A

cardiac disease, angina, HTN

486
Q

Only anxiety disorder with equal rates in men and women
VS
Mood disorder with equal rates in men and women

A

OCD
Bipolar disorder

487
Q

term for
- when a diagnosis is based on a general consensus among experienced clinicians and researchers:
- when a diagnosis is based on an understanding of the underlying pathophysiology:
- when a diagnosis is based on characteristic features that distinguish it from other disorders:

A
  • when a diagnosis is based on a general consensus among experienced clinicians and researchers: face validity
  • when a diagnosis is based on an understanding of the underlying pathophysiology: construct validity
  • when a diagnosis is based on characteristic features that distinguish it from other disorders: descriptive validity
488
Q

conditioning type that exposure is based on

A

classical conditioning

extinction = no longer get conditioned response with unconditioned stimulus

extinction burst = sudden increase in response’s frequency

489
Q

Psychotropics for intractable hiccups (3)

A

Thorazine, Perphenazie, Metoclopramide

490
Q

Beck Anxiety Inventory primarily screens for what?

A

Panic disorder

491
Q

Feeding centers of brain + functions + lesions + hormones

A

Lateral Hypothalamus = increases appetite via Ghrelin (makes you hunGGHREEE). Lesion of LH –> Less Hunger!

VentroMedial Hypothalamus = satiety via Leptin (makes you fuLLLLL). Lesion of VMH –> Very Much Hunger!

492
Q

Sleep stages:
- “slow-wave sleep”
- K complexes
- high frequency beta
- slower alpha
- Delta
- Theta waves
- Sleep spindles

A

Stage 1: Theta waves

Stage 2: Sleep spindles, K complexes

Stage 3/4: “slow-wave sleep,” Delta

REM: Rapid eye movement

Awake: high frequency Beta, slower Alpha

493
Q

Kohlberg

A

theory of moral development

494
Q

Operant Conditioning principles:
- Reinforcement:
- Punishment:
- Positive:
- Negative:

A
  • Reinforcement: response increases in frequency
  • Punishment: response decreases in frequency
  • Positive: introduce stimulus
  • Negative: remove stimulus
495
Q

Defense Mechanism:
“I can’t remember a time before the divorce”

  • Repression
  • Suppression
  • Reaction Formation
  • Projection
  • Rationalization
  • Displacement
  • Sublimation
  • Isolation of Affect
  • Undoing
A

Repression = unconsciously remove idea/feeling from consciousness

496
Q

Defense Mechanism:
“I don’t know what to think about it right now”
An olympic athlete focuses on training activities to put aside anxiety about upcoming competition

  • Repression
  • Suppression
  • Reaction Formation
  • Projection
  • Rationalization
  • Displacement
  • Sublimation
  • Isolation of Affect
  • Undoing
A

Suppression = conscious repression

497
Q

Defense Mechanism:
Using baby talk to give bad news
Going home when stressed so parents will do laundry and cook for you

  • Repression
  • Suppression
  • Reaction Formation
  • Projection
  • Rationalization
  • Displacement
  • Sublimation
  • Isolation of Affect
  • Undoing
A

Regression = returning to earlier stage of development

498
Q

Defense mechanism:
Fighting with someone you have a crush on

  • Repression
  • Suppression
  • Reaction Formation
  • Projection
  • Rationalization
  • Displacement
  • Sublimation
  • Isolation of Affect
  • Undoing
A

Reaction Formation = unacceptable impulse transformed into the opposite

499
Q

Defense Mechanism:
Man who cheated convinced of his wife cheating

  • Repression
  • Suppression
  • Reaction Formation
  • Projection
  • Rationalization
  • Displacement
  • Sublimation
  • Isolation of Affect
  • Undoing
A

Projection = place wishes, thoughts, etc onto others

500
Q

Defense Mechanism:
“I know cheating is wrong but my teacher didn’t teach us this”

  • Repression
  • Suppression
  • Reaction Formation
  • Projection
  • Rationalization
  • Displacement
  • Sublimation
  • Isolation of Affect
  • Undoing
A

Rationalization = Justifying attitudes, beliefs, or behaviors

501
Q

Defense Mechanism:
Taking anger out on dog or wife when mad at boss

  • Repression
  • Suppression
  • Reaction Formation
  • Projection
  • Rationalization
  • Displacement
  • Sublimation
  • Isolation of Affect
  • Undoing
A

Displacement = changing target of emotion

502
Q

Defense Mechanism:
Boss attracted to employee becomes her mentor
Putting anger into winning a tennis match
Instead of self-harming by cutting one’s wrist, using an ice cube instead to feel pain.

  • Repression
  • Suppression
  • Reaction Formation
  • Projection
  • Rationalization
  • Displacement
  • Sublimation
  • Isolation of Affect
  • Undoing
A

Sublimation = channeling unacceptable impulse in a socially acceptable direction

503
Q

Defense Mechanism:
Despite being devastated by his divorce, John said with a straight face that he had no feelings about having just been left by his wife.

  • Repression
  • Suppression
  • Reaction Formation
  • Projection
  • Rationalization
  • Displacement
  • Sublimation
  • Isolation of Affect
  • Undoing
A

Isolation of Affect = Separating feelings from ideas and events. The ego represses the affect (emotion) but the thought remains conscious. The person seems devoid of feeling to others.

504
Q

Defense Mechanism:
Jane stole merchandise at work and then gave a dollar to a homeless person on the street on her way home.

  • Repression
  • Suppression
  • Reaction Formation
  • Projection
  • Rationalization
  • Displacement
  • Sublimation
  • Isolation of Affect
  • Undoing
A

Undoing = The ego’s chance at a “do-over.” The ego gets to reverse something it feels is unacceptable or uncomfortable.

505
Q

Erikson Stage:
Age 0-18 mos
“Can I trust the world?”
Learning to trust, paying attention to environment

A

Trust vs. Mistrust

506
Q

Erikson Stage:
Age 18 mos-3 years
“Can I do things myself or must I rely on others?”
Independence, learning to do things on own, encouragement builds you up and punishment breaks you down

A

Autonomy vs. Shame and Doubt

507
Q

Erikson Stage:
Age 3-6 years
“Is it okay for me to do, move, act?”
Exploring and taking initiative to do things on your own, asserting one’s self to gain a sense of purpose

A

Initiative vs. Guilt

508
Q

Erikson Stage:
Age 6-12 years
“How can I be good?”
Developing self-confidence through learning things, trying to meet social and academic demands to feel competent

A

Industry vs. Inferiority

509
Q

Erikson Stage:
Age 12-18 years
“Who am I?”
Trying to discover who you are, trusted with more responsibility, treated like an adult at times and a kid at other times, developing a sense of self and identity

A

Identity vs. Role Confusion

510
Q

Erikson Stage:
Age 19-40 years
“Can I love and be loved? What do others think of me?”
Relying on others and intimate relationships for support

A

Intimacy vs. Isolation

511
Q

Erikson Stage:
Age 40-65 years
“What can I contribute to the world?”
Provide value to society through productivity and mentorship to others, feeling accomplishment or usefulness to others

A

Generativity vs. Stagnation

512
Q

Erikson Stage:
Age 65+
“Was my life a good one?”
Reflection on life, providing wisdom and fulfillment vs bitterness and regret

A

Integrity vs. Despair

513
Q

Mahler:
Continuation of intrauterine life, there is no difference between self and external world. No sight, sleeping all the time, always on mother.

Stage + Age?

A

Normal Autism
(birth to 2 mos)

514
Q

Mahler:
Vaguely acknowledges the mother’s existence, not as a unique entity but as the main source of need-satisfaction. “Mutual cueing” & social smile.

Stage + Age?

A

Symbiosis
(2-5 mos)

515
Q

Mahler:
Infant starts to “hatch” and begins to see self as separate from mother. Can be held by others, separation anxiety, crawling away & back.

Stage + Age?

A

Differentiation
(5-10 mos)

516
Q

Mahler:
Increased exploration of the outer world, intent to separate as a distinct self. Walking away.
Stage + Age?

A

Practicing
(10-18 mos)

517
Q

Mahler:
A balance b/w a desire to assert autonomy and independence as a separate object with a fear of abandonment with complete separation. Begin to see that good and bad can overlap. Toddlers saying no, no, no. “terrible twos” and temper tantrums.

Stage + Age?

A

Rapprochment
(18-24 mos)

518
Q

Mahler:
Marks the development of an internalized mental model of the mother, which unconsciously accompanies and supports the child even when they are physically separated. Playing and knowing Mom will return.

Stage + Age?

A

Object Constancy
(2-3 yrs)

519
Q

Piaget:
Acquires knowledge through sensory experiences and manipulating objects - through reflexes, sense, motor responses. Achieve objective permanence (things continue to exist when not seen).

Stage + Age?

A

Sensorimotor
(0-2 yrs)

520
Q

Piaget:
Emergence of language, using words and pictures to represent objects with symbolic thought. Egocentric, struggles to see perspective of others. Concrete. Learn through pretend play.

Stage + Age?

A

Preoperational
(2-7 yrs)

521
Q

Piaget:
Begin thinking more logically about concrete events (logical thought), achieve concept of conservation (amount of liquid in short wide cup equals tall skinny cup), less egocentric, realize their thoughts are their own

Stage + Age?

A

Concrete Operational
(7-11 yrs)

522
Q

Piaget:
Abstract thought, hypothetical reasoning. Begin to think about moral, philosophical, ethical, social, political issues. Use deductive logic and scientific reasoning.

Stage + Age?

A

Formal Operational
(12 yrs+)

523
Q

Ages for Freudian stages:
Oral
Anal
Phallic
Latency
Genital

A

Oral = 0-1 yrs
Anal = 1-3 yrs
Phallic = 3-5 yrs
Latency = 5 yrs until puberty
Genital = puberty to adulthood

524
Q

Distinguish between simple partial and complex partial seizures

A

Both are “Focal” or “Partial” seizures

Simple = focal aware
Complex = focal unaware

525
Q

Types of Generalized Seizures (compared to focus/partial):
(8)

A

~ Absence
~ Atonic (“drop attack”) - involuntary loss of muscle control
~ Tonic - spontaneous rigidity of muscles
~ Clonic - repetitive contractions (convulsions)
~ Generalized tonic-clonic - tonic following by clonic most common type!
~ Myoclonic - Brief non-rhythmic muscle spasms/jerks
~ Infantile spasms
~ Febrile

526
Q

Developmental Milestone Age:
- cooing, social smile, holding head up 45 degrees, recognizes parent

A

2 months

527
Q

Developmental Milestone Age:
- cooing, laughing, grasping, weight bearing on legs, rolling

A

4 months

528
Q

Developmental Milestone Age:
- Imitating sounds, single syllables, transferring objects from hand to hand, sits up with support

A

6 months

529
Q

Developmental Milestone Age:
- Babbling, playing peek-a-boo, waves bye-bye, sits up without support, army crawling or crawling

A

8 months

530
Q

Developmental Milestone Age:
- Dada/Mama, Playing simple ball games, standing alone, walks holding on, thumb-finger pincer grasp

A

12 months

531
Q

Developmental Milestone Age:
- 1-2 word vocabulary, indicating desires by pointing, walking, stoops and recovers

A

14/15 months

532
Q

Developmental Milestone Age:
- 16 word vocabulary, able to feed self, walking well without any support

A

18 months

533
Q

Developmental Milestone Age:
- Combining words, helping undress, running well, walks up stairs, kicks a ball

A

24 months

534
Q

Developmental Milestone Age:
- knows full name, pretend play, taking clothes off, jumps off ground with both feet

A

30 months

535
Q

Developmental Milestone Age:
- Riding a tricycle, standing on one foot, drawing a circle

A

36 months (3 years)

536
Q

Developmental Milestone Age:
- Hopping on one foot, using scissors

A

48 months (4 years)

537
Q

Developmental Milestone Age:
- Skipping, copying a triangle, counts to 10

A

60 months (5 years)

538
Q

When do white matter tracks mature? Vs. white matter volume peaks?

A

Mature: age 30
Volume peaks: age 50

539
Q

Most common defense mechanisms used in histrionic personality disorder

A

Repression, Dissociation

540
Q

4 yo boy who has been jealous of siblings, increasingly competitive, ambitious about taking on the world. Has been searching for his purpose and role within the family. Erikson stage?

A

Initiative vs. Guilt

541
Q

sleepwalking is most common in what age group

A

middle-age children (peaks at age 10)

542
Q

Features that make retinal migraine unique:

A
  • Unilateral vision disturbance
  • Gradual onset
  • +/- headache

Can involve scintillations, scotomata or blindness

543
Q

psychiatric disorder with highest risk of violence

A

substance use disorders!!!!!!&raquo_space;»» schizophrenia

544
Q

what is the risk of tyramine-foods with MAOIs?

A

hypertensive crisis (HTN, neck stiffness, diaphoresis, n/v)

545
Q

Seeing setbacks as a reflection of your core self. Rather than thinking, “I
made a mistake,” you think, “I’m a loser.” This distortion also occurs when
assessing others.

A

Essentializing (cognitive distortion term)

546
Q

4 skill modules of DBT:

A

Acceptance = Mindfulness + Distress tolerance

Change = Emotion regulation + Interpersonal effectiveness

547
Q

Indications for schema therapy

A

Borderline & Narcissistic personality disorder

548
Q

Information from the environment is fit into existing schemas
“Toddler calls a horse a big dog”

Assimilation or Accommodation?

A

Assimilation

Accommodation would be being able to differentiate a horse from a dog based on learning distinguishing features

549
Q

Prozac CYP enzyme

A

CYP2D6 inhibitor

550
Q

Stage of sleep for sleepwalking

A

Stage 3

551
Q

Psychotropics that are excreted unchanged in the urine (2)

A

Paliperidone, Gabapentin

552
Q

Grapefruit juice CYP

A

CYP3A4 inhibitor

553
Q

What should all patients be started on within 48 hours of stroke to reduce risk of stroke recurrence, disability & death?

A

Aspirin!

554
Q

Most common anxiety disorder

A

Specific phobia! (we don’t think of it because regular people out in the world don’t see psychiatrists for it!)

555
Q

Drug that reduces accumulation of plaques and disability in patients with MS?

A

Interferon B-1a

556
Q

Who coined the term “epigenetic principle”?

A

Erikson

= human development occurs in sequential, clearly defined stages, and that each stage must be properly resolved for development to proceed normally.

557
Q

Sudden onset symmetrical muscle weakness + elevated CK =
+ rash =

vs. Asymmetrical muscle weakness =

A

Sudden onset symmetrical muscle weakness + elevated CK = polymyositis
+ rash = dermatomyositis

vs. Gradual onset asymmetrical muscle weakness = Inclusion body myositis

558
Q

Sadism vs Masochiasm

A

Sadism - hurting other is SAD

Masochism - like to hurt Myself

559
Q

positive sharp waves and fibrillation potentials on EMG

A

ALS

560
Q

adult brain tumor where seizure is a common presenting symptom

A

Glioblastoma multiforme

561
Q

Treatment of abnormal involuntary movements in Huntington’s

A

Haldol - treats chorea

562
Q

Involuntary gait acceleration

A

Festination (Parkinson’s)

563
Q

Meningitis triad

A

Headache, fever, neck stiffness

564
Q

% of sleep in REM

A

25%

565
Q

Criteria for OCD

A

obsessions OR compulsions OR both

566
Q

age of onset required for conduct disorder

A

prior to age 13

567
Q

Latin terms to be found guilty of a crime (2)

A

Mens rea (evil intent) + Actus reus (voluntary conduct)

568
Q

statistical measure used to quantify the degree of agreement between two raters in a study (how much two people agree)

A

Kappa

569
Q

Tricuspid valve abnormality in fetus

A

Ebstein’s anomaly - Lithium

570
Q

timeline required to meet criteria for panic disorder

A

1 month

571
Q

Psychotropics excreted as changed drugs in feces

A

Abilify, Geodon

572
Q

CYP1A2 inducers vs. inhibitors

+ what drugs it mainly affects

A

inducers = tobacco
inhibitors = fluvoxamine

Clozapine, Olanzapine

573
Q

CYP2C9 inducer

+ what drug it mainly affects

A

St. John’s Wort

Valproic acid

574
Q

CYP3A4 inducers vs. inhibitors

+ what drugs it mainly affects

A

inducers = carbamazepine, st. john’s wort
inhibitors = grapefruit juice, -onazoles

lots of SSRIs & antipsychotics & other psychotropics

575
Q

Why to not combine Clozapine and Carbamazepine

A

risk of agranulocytosis

576
Q

55 yo with multiple falls and dizziness. Dry mouth, dry skin, erectile dysfunction. Recent onset resting tremors. Diagnosed with diabetes 6 mos ago, controlled with diet. + orthostatic hypotension. Rigidity and bradykinesia on exam.

A

MSA (Multiple System Atrophy) / Shy-Drager Syndrome
= parkinsonism + cerebellar + corticospinal + autonomic dysfunction (postural hypotension, sweating, bowel/bladder incontinence, salivation/lacrimation, ED)

577
Q

Malan’s Triangle of Conflict

A

Defenses, Anxiety, Feelings

Short-term Brief Psychodynamic Therapy model

578
Q

Timeline for Agoraphobia

A

6 mos (like most other anxiety disorders)

579
Q

Timeline for Separation Anxiety Disorder in a child

A

at least 1 month

580
Q

Khyâl Attacks

A

“Wind attacks” = panic attacks in Cambodians

581
Q

Parder-Willi chromosome

A

absence of paternal chromosome 15

582
Q

Receptor that makes Clozapine unique

A

D4

583
Q

Object permanence —> separation anxiety age

A

8 months (sensorimotor)

Psychiatry (4 decks)

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