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Board Vitals Questions Flashcards

1
Q

What meds are FDA approved to treat bipolar depression?

A

Seroquel
Latuda
Zyprexa + Prozac

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2
Q

What are Standard Deviations?

A

68-95-99.7

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3
Q

Sleep Stages

A

Stage 1 - 5%
State 2 - 50% (sleep spindles and K-complexes on EEG)
Stage 3 - 10-20% (deep/delta)
REM - 20-25% (dreams)
Non-REM/REM alternate every 90-100 - REM periods become increasingly longer as the night progresses

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4
Q

TCAs and seizures

A
  • lower sz threshold

- levels may inc w/sz meds

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5
Q

metabolic monitoring for antipsychotics

A

fasting blood glc - baseline, 12wk, annual
BP - baseline, 12wk, annual
BMI - baseline, 4wk, 8wk, 12wk, quarterly
waist circum - baseline, annual
fasting lipid - baseline, 12wk, 5yr

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6
Q

ECT modalities

A 
bilateral
unilateral non dominant (right) - fewer cognitive SEs, less sx reduction
(no absolute contraindications)
6-10 sessions
3x/wk
1 sz/session
25 second sz

can switch from uni to bilateral after 4-6 treatments if no improvements

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7
Q

Williams syndrome

A 
ADHD
elfin facies
starburst facies
IDD
cheerful demeanor
ease with strangers
heart & blood vessel problems
strabismus
hypermuscularity
hyperacusis (sensitivity to sounds)
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8
Q

autism spectrum disorder

A

1%
communication
social interaction
restriction of activities

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9
Q

childhood onset fluency disorder

A

5%

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10
Q

vagus nerve stimulation

A

FDA approvals

  • epilepsy
  • treatment resistant depression

placed in carotid sheath

thoracic/abdominal viscera - medulla

4 failed trials

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11
Q

ADHD

A

9%

2: 1 male:female (kids)
1. 6:1 male:female (adults)

adult cut off 5 sx (of 18)
kid cut off 6 sx
6mths
prior to age 12

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12
Q

ADHD + tics

A

clonidine

guanfacine

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13
Q

stimulant max doses (kids)

A

dexmethylphenidate (Focalin) 20mg
Methylin, Ritalin, Metadate 60mg
methylphenidate-OROS (Concerta) 72mg
methylphenidate patch (Daytrana) 30mg

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14
Q

meds to avoid w/ECT

A

theophylline - prolongs szs
hypoglycemincs (insulin/orals)
beta blockers - asystole
lidocaine - reduce sz induction

lithium - prolong sz and confusion/postictal delirium
clozapine (late appearing sx)
bupropion (late appearing sx)

benzos (anticonvulsant)

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15
Q

basilar migraine

A 
transient headache
occipital pain
aura
quadriplegia (stroke like)
stupor
psychosis
blindness
coma
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16
Q

serotonin syndrome

A

clonus
tachycardia
hyperthermia

leukocytosis
rhabdomyolysis
abnormal LFTs
hypocalcemia
hyponatremia
hypomagnesemia

myoglobin - test for rhabdo

cocaine inhibits reuptake of serotonin

amphetamines
dextromethorphan
MDMA (ecstasy)
St. Johns wort
nefazodone
meperidine (Demerol)
fentanyl
antiemetics
carbamazepine
antimigraine meds
l-tryptophan
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17
Q

Korsakoff’s syndrome

A

thiamine deficiency

anterograde and retrograde amnesia
confabulation
apathy

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18
Q

herpes simplex encephalitis

A

temporal lobe
inferomedial frontal lobe

personality/behavior change
psychosis
gustatory & olfactory hallucinations
anosmia

xanthochromia
PLEDS (periodic lateralized epileptiform discharges) on EEG

IV acyclovir

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19
Q

anterior pituitary

A 
FSH
LH
ACTH
TSH
Prolactin
Endorphins
GH
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20
Q

brain cell types

A

neurons

glia

  • astrocytes
  • microglia (act like macrophages)
  • macroglia
  • -oligodendrocytes (insulate axons in CNS w/myelin sheath)
  • -astrocytes (BBB, repair/scarring)
  • -ependymal cells (line ventricles and help produce CSF)
  • -radial glia (primary progenitors - neurons, astrocytes, oligos)
  • -Schwann cells (myelinated nerves in PNS)
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21
Q

adrenoleukodystrophy

A

x-linked

accum. very long-chain fatty acids (VLCFA)
- myelin of CNS and adrenal cortex

mutations in ABCD1

vision & hearing impairment
aphasia
hyperactivity
paralysis
seizures
muscle weakness
adrenal failure
coma
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22
Q

left parietal lobe

dominate

A

Gerstmanns syndrome

right-left confusion
agraphia
acalculia
aphasia
agnosia (inability to interpret sensations)
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23
Q

right parietal lobe

non dominate

A

dressing apraxia
difficulty understanding how things relate in space

left hemineglect

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24
Q

Brocas area

A

left frontal lobe

expressive aphasia

  • understand what is being said
  • difficulty forming spoken words

impaired naming and repetition

production of speech

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25
Q

Wernickes area

A

left temporal lobe

receptive aphasia

  • unable to comprehend spoken language
  • can still speak fluently (doesn’t make sense)

language development
comprehension of speech

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26
Q

Huntingtons disease

A

caudate and putamen

chromosome 4
CAG trinucleotide repeat
anticipation

huntington

  • synaptic vesicle-associated protein
  • accum. of intracellular toxic proteins
  • degeneration of striatum

tx: tetrabenzazine
haldol - chorea

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27
Q

Creutzfeldt-Jakob disease

A

Real Time Quaking Index Conversion (RT-QuIC)

6-9mth mortality

CSF assay - tau proteins

periodic sharp wave complexes (PSWCs) on EEG

depression
anxiety
irritability
insomnia

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28
Q

temporal lobe

A

hearing
naming
visual recognition
facial recognition (fusiform gyrus)

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29
Q

parietal lobe

A

integrating sensory information

IQ

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30
Q

occipital lobe

A

primary visual cortex?

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31
Q

frontal lobe

A

executive functioning
social conduct
judgment
insight

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32
Q

tabes dorsalis

A

dorsal columns
untreated syphilis

sensory ataxia
lightening pains
urinary incontinence
paresthesias
diminished/absent reflexes
hearing impairment
(neurosyphilis)
dementia
personality change
confusion
irritability
depression
visual disturbance
Argyll Robertson pupils (accommodate but don't react to light)
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33
Q

endarterectomy

A

> 70% blockage

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34
Q

B12 deficiency

A 
megaloblastic anemia (MCV >100)
GI sx
neurologic sx
-dementia
-numbness
-depression
-muscle weakness

pallor
paresthesias
decreased reflexes
irritability
poor concentration

posterior and lateral columns

can be caused by nitrous oxide abuse

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35
Q

cryptococcal meningitis

A

AIDS
encapsulated organism
India ink test
Amphotericin B

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36
Q

hippocampus

A

medial temporal lobe

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37
Q

alcohol-induced sleep disorder

A

early sedative effect
deep sleepiness for 3-4hrs
increased wakefulness
more restless sleep for several hrs

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38
Q

absence seizures

A

3-4Hz spikes and slow wave complexes

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39
Q

coma/encephalopathy

A

diffuse or anteriorly prominent theta and delta patterns

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40
Q

MAOIs

A 
serotonin, NE, dopamine
sexual side effects
weight gain
orthostatic hypotension
edema
insomnia
  • ine (also TCAs)
  • ide (also TCAs)
  • id
  • ane
  • ole
  • one
hydrazine
Isocarboxazid
nialamide
phenelzine
hydracarbazine
tranylcypromine
bifemelane
moclobemide
pirlindole
toloxatone
rasagiline
selegiline (MAOI-B - dopamine only)
safinamide
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41
Q

parasomnias

A

earlier phases of sleep
slow phase sleep

10-30% kids - sleep walk
50% kids w/sleepwalking or night terrors develop OSA

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42
Q

myasthenia gravis

A

antibodies bloc, destroy or inactive postsynaptic neuromuscular acetylcholine receptors

thymoma

worsens w/exertion

diplopia 
dysarthria
dysphagia
fatigue
muscle weakness

edrophonium chloride - Tensilon test
(used to diagnose)

pyridostigmine
plasmapheresis
IVIG
thymectomy
steroids
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43
Q

Lambert-Eaton syndrome

A

impaired release of presynaptic acetylcholine

repetitive muscle exertion may temporarily correct sx

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44
Q

botulism

A

impaired release of presynaptic acetylcholine

botulism toxin blocks release of acetylcholine

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45
Q

REM sleep behavior disorder

A

15% Parkinsons
70% multiple system atrophy
85% Lewy body dementia

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46
Q

myotonic dystrophy

A 
muscular dystrophy
cataracts
heart conduction defects
endocrine changes
myotonia
hypersomnia
frontal hair loss
facial/temporal wasting
problems w/executive functioning

involuntary contractions w/percussion of muscle

autosomal dominant
trinucleotide repeat (CTG)
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47
Q

TCA overdose

A

<2 hrs - activated charcoal
>2hrs - IV sodium bicarbonate
(never induce emesis)

intubate
IV fluids

cardiovascular toxicity (widened QRS)

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48
Q

cortical blindness

A

Anton’s syndrome

deny blindness despite clinical evidence

bilateral occipital lobes

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49
Q

dementia

A 
Alzheimers 60%
vascular 15-30%
Lewy body 4%
frontotemporal 2%
Parkinsons 2%
all other causes 3%
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50
Q

Binswangers disease

A

dementia

2 of the following:
hypertension/vascular disease
cerebral vascular disease
subcortical dysfunction 
-neurogenic bladder
-muscular rigidity
-gait abnormalities
bilateral abnormalities of MRI/CT
syncope
pseudobulbar palsy
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51
Q

lead poisoning

A 
hypochromic microcytic anemia (MCV <80)
lead line in mucosa
irritability
seizures
coma
wrist-drop
foot-drop
peripheral neuropathies
hypertension
depression
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52
Q

limbic system

A

smell

emotion

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53
Q

hydrocephalus

A 
dementia
amnesia
decreased psychomotor movement
magnetic gait
incontinence
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54
Q

Meige’s syndrome

A

tightly blinking eyes
grimacing

botox injections

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55
Q

thalamus

A

impaired visual memory (right)
language deficits (medial)
mood and sleep-wake-cycle (arterial and medial)

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56
Q

mammillary bodies

A

posterior diencephalon

lesions:
psychosis
memory deficits
confabulation

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57
Q

amygdala

A 
behavioral issues
emotional issues
hypersexuality
hyperorality
hyperplasia
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58
Q

opioid intoxication

A 
mitosis (constricted pupils)
dec respiration
dec bowel sounds
nausea
vomiting
severe itching

naloxone

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59
Q

entacapone/tolcapone

A

catechol-O-methyltransferase (COMT) inhibitor

helps prevent degradation/metabolism of levodopa and dopamine

used in PD to reduce peripheral adverse effects of levodopa (has no actions by itself)

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60
Q

cluster headaches

A 
young males
episodic
15 mins - 3hrs
nocturnal
retroorbital
ipsilateral autonomic sx

pts prefer moving their head or pacing

high flow oxygen
triptans (abortive)
corticosteroids (bridging)
verapamil (prophylaxis)

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61
Q

ethosuximide

A

absence seizures

can cause hyperactivity

reduces low threshold T-type calcium channels

valproic acid is 2nd choice

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62
Q

schizophrenia

A 
1%
10% suicide risk
80% 5yr relapse w/o meds
40% 1yr relapse on meds
women:men 1:1
chromosome 22

active phase 1mth

late onset after 45

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63
Q

sleep changes w/MDD

A 
prolonged sleep latency
inc wake time after sleep onset
inc early morning awakenings
dec total sleep time
dec slow wave sleep
dec slow wave sleep as % of total sleep time
reduced REM latency
prolongation of 1st REM sleep period
inc REM activity
inc REM sleep %
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64
Q

sleep changes w/GAD

A

longer sleep latency
inc freq of awakenings
normal REM latency

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65
Q

mesencephalon

A

(midbrain)
dopamine production
-substantia nigra

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66
Q

diencephalon

A 
(interbrain)
hypothalamus
-control of hormone release
-temperature regulation
-sexual instincts
-control of circadian rhythms (ventrolateral preoptic nucleus VLPO)
-hydration
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67
Q

tuberomammillary nucleus

A

histamine

arousal promoting
itching

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68
Q

nucleus basalts of Meynert

A

acetylcholine

sweating

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69
Q

raphe nuclei

A

serotonin

nausea

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70
Q

locus coeruleus

A

norepinephrine

arterial vasoconstriction

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71
Q

ventral tegmental area

A

substantia nigra

-dopamine

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72
Q

pheochromocytoma

A

norepinephrine

sympathetic hyperactivity

urine vanillyl mandelic acid (VMA)
urine metanephrines

adrenal mass

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73
Q

anti-NMDA receptor encephalitis

A

young women
follows flu-like illness

ovarian teratomas
paraneoplastic syndrome

psychosis
anterograde amnesia
hallucinations
suicidal ideation
dyskinesias
autonomic instability
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74
Q

drug induced Parkinsonism

A

remove offending agent

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75
Q

alpha-synucleinopathy

A

Parkinsons
multiple system atrophy
Lewy body dementia

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76
Q

tauopathy

A

Alzheimers

Picks disease

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77
Q

cholinesterase inhibitors

A

reversible

donepezil
rivastigmine
galantamine
tacrine

start early
continue indefinitely

may reduce rate of cognitive decline

GI side effects

  • nausea
  • vomiting
  • diarrhea
  • abdominal cramping
  • improve w/time
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78
Q

medial longitudinal fasciulus

A

conjugate eye movement

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79
Q

HARP syndrome

A

Hypobetalipoproteinemia (low cholesterol)
Acanthocytosis (speculated red blood cells)
Retinitis pigmentosa (pigment deposits on retina - loss of vision)
Pallidal degeneration

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80
Q

atonic seizures

A

slow spikes and waves

or polyspikes and waves

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81
Q

hyper somnolence disorder

A

sleepiness despite 7 hrs in main sleep period

at least 3x/wk for 3mths

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82
Q

NMDA-receptor antagonist

A

moderate-severe dementia

memantine

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83
Q

delirium

A

12-40% geriatric pts
10-15% all pts
37% post op pts

22-33% 3mth mortality rate

generalized slow wave and theta/delta waves on EEG

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84
Q

sleep

A

adolescence - stage 3 and 4 peak

newborns - 50% REM

number of awakenings and amount of”light” stage 1 sleep inc in later adulthood

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85
Q

narcolepsy

A

3x/wk for 3mths

cataplexy
and/or
intrusion of REM sleep into transition between wake/sleep

hypnopompic and hypnagogic hallucinations

low levels CSF hypocretin (orexin)

sodium oxybate (Xyrem)
methylphenidate (Ritalin)
modafanil (Provigil)
structured napping times during the day

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86
Q

carbidopa/levodopa

A

levodopa - converted to dopamine in CNS and peripherally

carbidopa - reduces peripheral conversion into dopamine (reducing side effects)
-inhibits DOPA decarboxylase

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87
Q

pons

A

arousal
sleep-wake cycles
memory
language

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88
Q

brain mets

A

most common - non-small cell lung cancer

greatest risk to metastasize - melanoma and small cell lung cancer

breast (? 2nd)
renal
GI cancers

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89
Q

amaurosis fugax

A

brief loss of vision
black curtain coming down

internal carotid artery

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90
Q

paroxysmal hemicrania

A

several headaches in 1 day
short (2-30mins)

lacrimation
conjunctival inaction
neck movements trigger episodes

women

responsive to indomethacin

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91
Q

anticipation

A

more trinucleotide repeats = earlier age of onset of sx

Huntingtons (CAG)
Friedrich ataxia
myotonic dystrophy

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92
Q

Sydenham’s chorea

A

group A strep
kids
girls

OCD traits
irritability
restlessness

20-30% pts rheumatic fever

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93
Q

lower sx threshold

A

SSRIs = safe

```
bupropion
venlafaxine
TCAs?
amoxapine
clomipramine
maprotiline
~~~

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94
Q

trigeminal neuralgia

A

radiating jaw pain
electric, shock like pain
worsened by cold
worsened by trivial stimuli (touching)

carbamazepine
phenytoin
gabapentin
(no NSAIDs)

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95
Q

Erickson’s stages

A 
0-2 yrs trust vs mistrust
2-4 yrs autonomy vs shame/doubt (toilet training)
4-5 yrs initiative vs guilt (starting school)
5-12 yrs industry vs inferiority
13-19 yrs identity vs role confusion
20-39 yrs intimacy vs isolation
40-64 yrs generatively vs stagnation
65-death ego integrity vs despair
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96
Q

Piaget’s stages

A

cognitive development

birth-2 yrs sensorimotor
-object permanence

2-6 yrs pre-operational

  • egocentrism
  • rules are fixed
  • ability to use symbols and language

7-11 yrs concrete operational

  • conservation of liquids
  • logic and objectivity
  • reversibility
  • transitivity
  • classification

11yrs-adult formal operations

  • abstract
  • hypothetical
  • major principles
  • motivations
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97
Q

kleptomania

A

naltrexoine
fluoxetine
SSRIs

no meds FDA approved

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98
Q

operant conditioning

A

positive reinforcement
-add desirable stimulus to increase desired behavior

positive punishment
-add undesirable stimulus to decrease undesired behavior

negative reinforcement
-remove undesirable stimulus to increase desired behavior

negative punishment
-remove desirable stimulus to decrease undesired behavior

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99
Q

play types

A

2 yrs - parallel play
3 yrs - associative play
4 yrs - cooperative play

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100
Q

Freud’s stages

A 
birth-18 mths  oral
18 mths-3 yrs anal
3-5 yrs phallic
5-12 yrs latency
12-15 yrs genital
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101
Q

Tourettes

A 
haldol
pimozide
Abilify 
botox
clonidine

Seroquel worsens tics

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102
Q

Wernicke encephalopathy

A

acute phase of Korsakoffs syndrome
medical emergency

thiamine deficiency

confusion
ophthalmoplegia
ataxia

nystagmus
delirium
amnesia

microhemorrhages in periventricular grey matter around ventricles

give thiamine BEFORE glucose to avoid worsening of sxs

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103
Q

Mahler’s stages

A

autistic phase (first weeks)

  • total detachment
  • self-absorption

symbiotic phase (until 5mths)

  • recognizes mother
  • lacks sense of individuality

seperation-individuation

  • hatching (differentiation?)
    • shows increased interest in outside world
  • practicing (9-16mths)
    • develops ability to separate from mother
  • rapprochement (15-24mths)
    • explores outside world, but requires mother is present and able to support appropriately and emotionally in completing the task

object constancy (2-5yrs)

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104
Q

Kohlbergs developmental theories

A

3 levels of moral reasoning

preconventional
conventional
postconventional

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105
Q

ADHD scales

A

Connors Index Scale
SNAP-IV Rating Scale-Revised
Vanderbilt Diagnostic Rating Scale

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106
Q

identification

A

pts w/conversion disorder exhibit sxs similar to someone important to them

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107
Q

conversion disorder

A

subconscious
1-3% of pts w/neuro sis

neurologic sxs not solely limited to pain

young females
low SES
rural areas
not well-educated
lack of concern about sxs
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108
Q

factitious disorder

A

pt feigns sxs in order to seek the sick role

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109
Q

malingering

A

pt feigns sxs for secondary gain

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110
Q

personality disorders

A

cognition
affectivity
interpersonal functioning
impulse control

15% population

antisocial - males (1% females)
borderline - females
histrionic - females
dependent - female/neutral
avoidant - female/neutral
schizoid - male/neutral
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111
Q

schizoid

A

pervasive pattern of detachment from social relationships

restricted range of emotions

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112
Q

schizotypal

A

3% population

pervasive pattern of social and interpersonal discomfort with and reduced capacity for close relationships

cognitive or perceptual distortions and eccentricities

relatives w/schizophrenia

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113
Q

constraint

A

how easily an individual acts on an initial, emotionally based evaluation of events and people

foundation of conscientiousness

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114
Q

self-system

A

stable and realistic sense of self

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115
Q

social system

A

means of interpreting social situations and understanding the relational motives and actions of others

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116
Q

self-in-relation system

A

capacity to observe the self as it relates to others

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117
Q

narcissistic personality disorder

A

caused by inadequate soothing in Mahler’s symbiotic phase (up to 5mths) and inadequate refueling during separation-individuation (6-24mths)

psychoanalysis (Kohut, Kernberg)
group therapy

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118
Q

borderline personality disorder

A

2-3% population
12-15% clinical settings

caused by disruption of Mahler’s rapprochement (15-24mths)

acting out
splitting

SSRIs
antipsychotic
mood stabilizer

DBT
mentalization based therapy

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119
Q

sublimation

A

take negative stimulus and associated appropriate emotional response and instead convert negative response into a positive and often productive response

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120
Q

interpersonal therapy

A

12-16 weeks

relaxed/supportive

beginning - 1-3 sessions (identify target diagnosis and interpersonal context in which it presents)

middle (specific strategies)
end - 1-3 sessions

focuses on improving relationships in the present (not on what causes sxs)

negative interpersonal experiences lead to depression

induction of sick role
explaining cause of pt’s interpersonal problems (beginning phase)

complicated bereavement
-grief after loss of loved one

role dispute
-conflict in significant relationships

role transition
-difficulties adapting to change in relationships or life circumstances

interpersonal deficits
-difficulties stemming from social isolation or lack of life events (absence of one of the other 3)

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121
Q

psychodynamic therapy

A

focuses on unconscious motivations

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122
Q

aversive conditioning

A

using punishment to decrease target behavior

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123
Q

habituation

A

learning response that decreases over time as same stimulus is repeated

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124
Q

extinction

A

decrease in conditioned response due to lack of reinforcement

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125
Q

continuous reinforcement

A

reward is given every time the target response occurs

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126
Q

law of effect

A

responses that produce a satisfying effect in a particular situation are more likely to occur again in that situation

response that produce a discomforting effect are less likely to occur

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127
Q

negative practice

A

reducing a behavior by repeating the response intensely

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128
Q

modeling/observational learning

A

behavior that is learned by watching others

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129
Q

paranoid personality disorder

A

individual psychotherapy
not overly warm

10-30% psych inpatients

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130
Q

tertiary prevention

A

prevent deterioration or reduce complications of disease

ACT
metabolic monitoring
intensive case management

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131
Q

secondary prevention

A

detects diseases early when pts are asymptomatic

HIV testing
screening
prodromal schizophrenia

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132
Q

primary prevention

A

keeps disease from occurring by removing its causes

lifestyle changes
immunizations
suicide prevention programs

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133
Q

privilege

A

possessed by the individual patient, not the patient

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134
Q

hydrazine

A

MAOI

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135
Q

Isocarboxazid

A

MAOI

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136
Q

nialamide

A

MAOI

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137
Q

phenelzine

A

MAOI

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138
Q

hydracarbazine

A

MAOI

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139
Q

tranylcypromine

A

MAOI

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140
Q

aphasia vs dysarthria

A

aphasia - disturbance of language (cognitive function)

dysarthria - disturbance of speech (motor function)

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141
Q

scanning

A

slurred speech with variable cadence and volume

cerebellum

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142
Q

dysdiadochokinesia

A

impaired ability to perform rapid, alternating movements

cerebellar damage

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143
Q

T10

A

sensation below umbilicus

spastic leg weakness

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144
Q

Foster-Kennedy syndrome

A

depression

frontal lobe tumor

optic nerve compression
optic atrophy
papilledema

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145
Q

chromosome 1

A

alzheimers disease

presenillin 2

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146
Q

chromosome 3

A

von Hippel-Lindau syndrome

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147
Q

chromosome 4

A

Huntington disease

Parkinson disease alpha-synuclein gene

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148
Q

chromosome 5

A

infantile and juvenile spinal muscular atrophy

Werdnig-Hoffma and Kugelberg-Welander diseases

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149
Q

chromosome 6

A

Creutzfeldt-Jakob disease
Parkinson disease, Parkin
spinocerebellar ataxia type 1

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150
Q

chromosome 7

A

Williams syndrome

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151
Q

chromosome 9

A

dystonia (early-onset primary dystonia - DYT1)
Fredreich ataxia
tuberous sclerosis complex 2

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152
Q

chromosome 12

A

phenylketonuria

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153
Q

chromosome 13

A

Wilson disease

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154
Q

chromosome 15

A

Angelman syndrome
dyslexia
Prader-Willi syndrome
Tay-Sachs (hexosaminidase A deficiency)

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155
Q

chromosome 16

A

tuberous sclerosis complex 2

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156
Q

chromosome 17

A

Charcot-Marie-Tooth disease
frototemporal lobar degeneration
Narcolepsy-cataplexy
neurofibromatosis type I

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157
Q

chromosome 19

A

apolipoprotein E
familial hemiplegic migraine
malignant hyperthermia susceptibility
myotonic dystrophy

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158
Q

chromosome 20

A

fatal familial insomnia

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159
Q

chromosome 21

A

homocystinuria
myoclonic epilepsy
trisomy 21

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160
Q

chromosome 22

A 
metchromatic leukodystrophy
neurofibromatosis type 2
velocardiofacial
DiGeorge syndrome
schizophrenia
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161
Q

x chromosome

A 
adrenoleukodystrophy
Duchenne muscular dystrophy
Fragile X syndrome
Lesch-Nyhan syndrome
Rett syndrome
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162
Q

CGG

A

Fragile X syndrome

x linked

sex linked

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163
Q

GAA

A

Friedreich ataxia

chromosome 9

autosomal recessive

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164
Q

CAG

A

Huntingtons disease

  • chromosome 4
  • autosomal dominant

spinocerebellar atrophies

  • autosomal dominant
  • type 1 (chromosome 6)
  • type 2 (chromosome 12)
  • type 3 (chromosome 14)
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165
Q

CTG

A

myotonic dystrophy

chromosome 19

autosomal dominant

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166
Q

GCC

A

oculopharyngeal dystrophy

chromosome 14

autosomal dominant

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167
Q

atropine/scopolamine

A

blocks cerebral acetylcholine receptors

delirium
amnesia
anticholinergic effects

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168
Q

organophosphate insecticides/nerve gas

A

inhibit cholinesterase (irreversible)

  • increases acetylcholine
  • cholinergic toxicity

postsynaptic dysfunction

brief stimulation, then paresis of all muscles

increased parasympathetic activity
confusion
seizures

Diarrhea
Urination
Miosis
Bradycardia
Emesis
Lacrimation
Salivation/sweating/secretion

tx: atropine + pralidoxime

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169
Q

upper motor neuron signs

A 
weakness
hyperreflexia
tight muscles
clonus
Babinski sign
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170
Q

lower motor neuron signs

A 
weakness
areflexia
paralysis
atonia
fasciculations
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171
Q

posterior columns

A

position and vibration

fasciculus cuneatus
fasciculus gracilis

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172
Q

lateral spinothalamic tract

A

pain and temperature

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173
Q

T4

A

nipples

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174
Q

anosognosia

A

lack of self-awareness of deficit

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175
Q

neuropathy vs myelopathy

A

neuropathy - damage to nerves outside the CNS

myelopathy - damage to the spinal cord

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176
Q

Wisconsin card sorting test

A

executive functioning

color, form, number

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177
Q

Boston naming test

A

anomia (unable to recall names of everyday objects)

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178
Q

operant conditioning scheduling

A

fixed-interval
-reinforcement for response that occurs after set time

fixed-time
-reinforcement after fixed time, regardless whether behavior performed

fixed-ratio
-reinforcement every set number of responses

variable interval

  • reinforcement for responses after varying amounts of time
  • response varies w/time (checking email throughout the day to monitor for important messages)

variable ratio
-reinforcement at a varying response rate
(slot machines)

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179
Q

negative contrast

A

switched from high reward to low reward

paradoxically weakens behavior more than simply receiving low reward all along

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180
Q

reinforce devaluation

A

subject denies previously positive reinforcer is no longer valued and cannot be used to strengthen behavior any longer

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181
Q

varenicline (Chantix)

A

partial agonist at alpha4beta2

full agonist at alpha 7

binds to receptors avidly, but stimulates receptors more weakly than nicotine, reducing cravings but also limiting the pleasurable effects of smoking

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182
Q

hypericum perforatum

A

St. Johns Wart

antidepressant
anxiolytic

no (serotonin syndrome)

  • SSRIs
  • MAOIs
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183
Q

ginkgo biloba

A

improves memory

impairs anti platelet memory (causes bruising)

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184
Q

echinacea purpurea

A

improves immune system

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185
Q

lithium

A

cerebellar damage

diabetes insipidus

  • polyuria (single bedtime dose)
  • polydipsia (single bedtime dose)
  • hypernatremia
  • treat w/amiloride (K sparing diuretic)

hyperparathyroidism

  • decrease lithium clearance
  • increase lithium levels
  • -lisinopril
  • -NSAIDs
  • -HCTZ
  • -low sodium diet
  • decrease lithium level
  • -high sodium diet

level not affected by aspirin

insulin-like effect

reduces affect of ADH on kidney

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186
Q

CYP 3A4 inducers

A 
carbamazepine
oxcarbazepine
phenobarbital/barbiturates
phenytoin
oxcarbazepine
ethosuxamide
steroids
progesterone
St. John's wort
rifampin (lots of r's)
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187
Q

CYP 3A4 inhibitors

A 
(lots more)
valproic acid
nefazodone
fluoxetine
sertraline
fluvoxamine
amiodarone
cannabinoids
diltiazem
entacapone
erythromycin
grapefruit juice
omeprazole
ranitidine
ketoconazole
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188
Q

CYP 2D6 inhibitors

A

fluoxetine
sertraline
paroxetine
duloxetine

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189
Q

spinal cord

A

ends at T12-L1

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190
Q

Brown-Sequard syndrome

A

hemitransection of thoracic spine
(loss of pain sensation contralateral to paresis)

injury to lateral corticospinal tract=
ipsilateral 
-leg paresis
-hyperactive DTRs
-Babinski sign

injury to posterior columns=
ipsilateral
-impairment in vibration and position sense (proprioception)

injury to spinothalamic tract=
contralateral
-loss of temperature and pain sensation

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191
Q

cranial nerves

A 
I Olfactory
II Optic
III Oculomotor
IV Trochlear
V Trigeminal
VI Abducens
VII Facial
VIII Vestibulocochlear (Acoustic)
IX Glossopharyngeal
X Vagus
XI Spinal
XII Hypoglossal
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192
Q

spinocerebellar ataxia

A 
posterior column abnormalities (sensory loss)
Babinski sign
limb ataxia
scanning speech
pes cavus

trineucleotide repeat
chromosome 6
autosomal recessive

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193
Q

NRTs

A

(fastest to slowest)

tobacco cigarette
spray (10-15mins)
inhaler
lozenge (20-30mins)
gum (30-60mins)
patch (2-9hrs)

short acting - 3mths

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194
Q

buspirone

A

5-HT1A partial agonist at postsynaptic receptors

5-HT1A full agonist at presynaptic receptors

mild-moderate presynaptic D2, D3, D4 antagonist

partial alpha1 agonist

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195
Q

mirtazapine

A

tetracyclic antidepressant

  • alpha-2 adrenergic antagonist
  • increases release of. norepinephrine
  • histaminic antagonism
  • -sedation
  • -inc appetite
  • -weight gain
  • 5-HT3 antagonist (anti-nausea)
  • (also 5-HT2 antagonist)
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196
Q

atomoxetine

A

norepinephrine reuptake inhibitor

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197
Q

carbamazepine

A 
SIADH
hyponatremia
elevated LFTs
hepatitis
decreased WBCs
agranulocytosis 
pancytopenia
aplastic anemia
Stevens-Johnson

check LFTs

blockage of type 2 sodium channels

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198
Q

lamotrigine

A

cleft lip
cleft palate

lower dose w/valproate

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199
Q

valproate

A

neural tube defect
20-30mg/kg loading dose

increased by:

  • cimetidine
  • macrolide abx (erythromycin)
  • felbamate

decreased by:

  • carbamazepine
  • phenytoin
  • primidone
  • phenobarbital
pancreatitis
increased amylase
tremor
alopecia
ankle swelling
thrombocytopenia
hepatic failure (BLACK BOX)
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200
Q

glutamate

A

excitatory

precursor to GABA

learning
memory

receptors

  • AMPA
  • NMDA
  • kainate
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201
Q

acute intermittent porphyria

A 
confusion
hallucinations
flaccid paresis
abdominal pain
red urine

Watson-Schwartz test

contraindicated (can precipitate/worsen attack)

  • barbiturates
  • phenytoin
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202
Q

bupropion

A

dopamine-norepinephrine reuptake inhibitor

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203
Q

tardive dyskinesia

A

all typicals
5%/yr
10-20% treated for more than a year
20-40% hospitalized long term

women
children
elderly
brain damage

less

  • seroquel
  • clozaril
  • geodon
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204
Q

buprenorphine-naloxone

A

buprenorphine

  • partial agonist at mu-opiod receptor
  • antagonist at kappa-opioid receptor

naloxone
-antagonist at mu-opiod receptor

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205
Q

hypnotic half life

A

shortest to longest

zaleplon (Sonata)
ramelteon (Rozerem)
zolpidem (Ambien) / triazolam (Halcion)
eszopiclone (Lunesta)
temazepam (Restoril)
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206
Q

CYP450 inhibitor

A

valproate
fluoxetine
fluvoxamine
sertraline

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207
Q

CYP450 inducer

A

phenytoin
carbamazepine
phenobarbital
rifampin

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208
Q

clozapine

A

neutropenia
myocarditis
eosinophilic colitis

fluvoxamine - inc clozapine levels

dopamine, serotonin, alpha antagonist

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209
Q

Xyrem (sodium oxybate)

A

narcolepsy

GABA-B

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210
Q

false positives

A 
venlafaxine - PCP
amitriptyline - LSD
naproxen - barbiturates
sertraline - benzos
trazodone - amphetamine
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211
Q

panic disorder

A

1mth

sertraline
fluoxetine
paroxetine

CBT

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212
Q

oral contraceptives

A

carbamazepine - dec OCPs
oxcarbazepine - dec OCPs
topiramate >200mg

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213
Q

seizure threshold

A 
bupropion
clozapine
theophylline
clomipramine
clozapine

alcohol
cocaine
stimulants

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214
Q

SSRIs

A

inc risk of bleeding - reduction of serotonin in plts

GI SEs most common in sertraline and fluvoxamine (5HT-3)

CNS activation (anxiety, restlessness, tremor, insomnia) most common in fluoxetine

sedation most common in paroxetine

SIADH most common in fluoxetine

akathisia/EPS rare - most common in sertraline

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215
Q

GAD

A

venlafaxine
paroxetine
escitalopram
duloxetine

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216
Q

ginseng

A

can interact with

  • phenelzine
  • lithium
  • neuroleptics

can cause

  • irritability
  • insomnia
  • mania
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217
Q

pyroxidine

A

vit B6

deficiency

  • MAOIs
  • isoniazid (INH)
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218
Q

nefazodone

A

black box warning

  • liver failure
  • suicidality

hypotension
bradycardia

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219
Q

kava kava

A

sedative
anesthetic

consumed as a beverage

should not be used w/benzos, alcohol or barbiturates

liver toxicity

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220
Q

cyp 2D6 inducer

A

dexamethasone

rifampicin

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221
Q

couples therapy

A

behavioral exchange
communication training
problem solving

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222
Q

interpersonal therapy

A

communication analysis - (identify maladaptive communication patterns to help pt communicate effectively)

construct a timeline - understand relationship between depression and interpersonal experiences

treats depression

focuses on current relationships

4 core issues

  • grief
  • role transition
  • role dispute
  • interpersonal deficits
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223
Q

depressive disorder therapy

A

IPT

CBT

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224
Q

psychodynamic therapy

A

working through - identify patterns of defense mechanisms and object relations - make the subconscious conscious

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225
Q

cognitive behavioral therapy

A 
most widely used
depression
anxiety
schizophrenia
not personality disorders

identification of dysfunctional cognitions
role playing

thought mood logs
automatic thoughts

exposure and response therapy

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226
Q

dialectical behavioral therapy

A

assumes pts are doing the best they can, and they need to do even better

chain analysis
patient capabilities

group skills training
individual therapy
phone consultations
consultation team

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227
Q

Lazarus coping - model for stress management

A

self exploration
self instruction
self correction
self rehearsal

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228
Q

anorexia

A 
hypokalemia
elevated BUN
hypercholesteremia
hyperamylasemia
hypomagnesemia
hypophosphatemia

cardiac arrhythmias
osteoporosis
lanugo

female
adolescent
perfectionistic

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229
Q

prochlorperazine

A

phenothiazine
typical antipsychotic

nausea
vomiting
vertigo

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230
Q

eszopiclone

A

Lunesta

short acting

daytime sleepiness
fatigue
taste disturbance

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231
Q

Jean Baker Miller

A

relational theory

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232
Q

Sigmund Freud

A

structural theory

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233
Q

Anna Freud

A

ego psychology

defense mechanisms

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234
Q

Carl Jung

A

transpersonal psychology
analytic psychology
growth of personality

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235
Q

Melanie Klein

A

object relations theory
bad mother

tension between true and false self

paranoid-schizoid position - parts of mother as all good or all bad

depressive position - mother ambivalent, having both positive and negative aspects

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236
Q

Kohut v Kernberg

A

Kohut (self psychology)

  • self-object
  • supportive
  • transference
  • -mirroring (affirming/positive responses used to see positive responses in self)
  • -idealization (calm and soothing other provides comfort when unable to do so for self)

Kernberg

  • confronting
  • defenses
  • -splitting
  • -projectice identification
  • -primitive idealization
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237
Q

supportive therapy

A

reduce symptoms

improve self-esteem and functioning

therapist makes suggestions and gives advice

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238
Q

Kurt Schneider

A

first rank symptoms

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239
Q

Eugene Bleuler

A

coined the term schizophrenia

the 4 As
loose Associations
Affective flattening
Autism
Ambivilance
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240
Q

Emil Kraeplin

A

used the term dementia praecox (created by Morel)

classified schizophrenia as a physical disease

differentiated schizophrenia from manic-depressive illness

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241
Q

assertiveness training

A

behavioral therapy

avoidant personality disorder

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242
Q

neurosis

A

unconscious conflict between opposing wishes or between wishes and prohibitions

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243
Q

abreaction

A

process that occurs when repressed memory and associated affect is brought into consciousness

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244
Q

Josef Breuer

A

contemporary and friend of Freud

helped develop theory of hysteria

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245
Q

Salvador Minuchin

A

structural family therapy

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246
Q

medial frontal lobe lesion

A

apathy

limited spontaneous movement, gesture, speech

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247
Q

left frontal lobe lesion

A

depression

Broca’s area?

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248
Q

right frontal lobe lesion

A

mania

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249
Q

ailurophobia

A

dread of cats

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250
Q

cohort study

A

follow population over period of time

longitudinal study

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251
Q

case-control study

A

retrospective

examines persons without a particular disease

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252
Q

clinical trial

A

some patients get treatment
another group does not
assigned randomly
goal to determine effectiveness of treatment

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253
Q

cross-sectional survey

A

describe prevalence in a population at a particular point in time

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254
Q

crossover study

A

variation of double-blind

placebo and treatment groups switch at some point

255
Q

Winnicott

A

good enough mothering

transitional object

256
Q

SSRI to MAOI

A

14 day washout

28 day for fluoxetine

257
Q

resistance

A

ideas that are unacceptable to the pt are prevented from reaching awareness

258
Q

Guillain-Barre syndrom

A

acute inflammatory demyelinating polyneuropathy (AIDP)

campylobacter jejnui

ascending pain
paralysis
seonsory loss
loss of DTRs in extremities

IVIG
plasmapheresis

259
Q

polymyositis

A

inflammatory disease of the muscle

260
Q

amyotrophic lateral sclerosis (ALS)

A

upper and lower motor neurons

damage to anterior horn cells

progressive muscle weakness
fasciculations
wheelchair bound

261
Q

Bandura

A

social learning theory

learn through modeling others and social interaction

262
Q

Seligman

A

learned helplessness

organism learns that no behavioral change can influence the environment

organism becomes depressed and apathetic

263
Q

insomnia disorder

A

difficulty initiating or maintaining sleep

3x/wk for 3 maths

264
Q

GABA

A

major inhibitory neurotransmitter

chloride ion channel

265
Q

glycine

A

inhibitory

266
Q

tuberous sclerosis

A

autosomal dominant

seizures
mental retardation
behavioral problems

cutaneous lesions
facial angiofibromas
shagreen spots (irregularly shaped skin lesions on back and flank)
retinal haratomas

267
Q

Rett’s disorder

A

girls only

deceleration of head growth
loss of purposeful hand skills
stereotyped hand movements
loss of social engagement
acquired impairments in expressive and receptive language skills
seizures
268
Q

executive function tests

A

trail making test

Wisconsin card sorting test

269
Q

bromocriptine

A

prolactinomas

NMS

270
Q

thought content

A 
delusions
obsession
compulsions
phobias
suicidality
homicidality 
neologisms
depersonalization
derealization
271
Q

thought process

A 
racing thoughts
circumstantial
tangential
clang associations
perseveration
word salat
goal directed ideas
272
Q

MSE perception

A

hallucinations

273
Q

amok

A

Malaysa

sudden rampage
homicide/suicide
ends in exhaustion/amnesia

274
Q

koro

A

Asian

delusion penis will disappear into abdomen and cause death

275
Q

piblokto

A

female Eskimos

anxiety
depression
confusion
depersonalization
derealization
ending in stuporous sleep/amnesia
276
Q

wihtigo

A

Native Americans

delusional fear of being turned into a cannibal through possession by a supernatural monster (the Wihtigo)

277
Q

mal de ojo

A

Mediterranean

vomiting
fever
restless sleep

caused by the evil eye

278
Q

Hoffman sign

A

flick middle finger
+ if other fingers/thumb involuntarily flex

+ = upper motor neuron damage

279
Q

palomental reflex

A

+ when chin muscle contracts when thenar eminence contralateral to brain lesion is stroked

upper motor neuron damage

280
Q

loss of gag reflex

A

devastating stroke to brain stem

brain death

281
Q

Meyerson’s sign

A

glabeller reflex

repeated blinking when tapping on forehead

possible Parkinsons

282
Q

brain death

A

absence of brain stem reflexes

  • absent gag
  • fixed pupils
  • absent oculocephalic reflex
  • absent oculovestibular reflex
  • absent corneal reflex

eyes can be open or closed

EEG doesn’t have to be flat line (it’s all about the brain stem)

283
Q

four horsemen of the apocalypse

A

relationship dissolution

criticism
defensiveness
contempt
stonewalling

284
Q

Karen Horney

A

actual self
real self
idealized self

social and cultural influences on psychosexual development

285
Q

Maudsley model

A

family based therapy

anorexia

286
Q

selective abstraction

A

taking a small detail out of context and using it to make an entire experience negative

287
Q

arbitrary inference

A

coming to an incorrect conclusion based on a previous experience

288
Q

dichotomous thinking

A

all or none

black or white

289
Q

overgeneralization

A

coming to a generalized conclusion based on a single experience

290
Q

magnification/minimization

A

making events more/less signification based on a negative interpretation

291
Q

sublimation

A

socially unacceptable desire is consciously transformed into a socially acceptable one

292
Q

motivational interviewing

A

Open ended questions
Affirmations
Reflective listening
Summaries

expression of empathy
rolling with the resistance
developing discrepancy
supporting self-efficacy

293
Q

OCD

A

group therapy

behavior therapy

294
Q

conduct disorder

A

multi systemic therapy

family focused
community based

295
Q

fetishistic disorder

A

obtains sexual arousal from an inanimate object

at least 6 months

296
Q

transvestism

A

sexual arousal from crossdressing (not just underwear, full outfits)

usually heterosexual men

297
Q

trigeminal neuralgia

A

brief, sharp pain
worsened by cold
unilateral

carbamazepine
oxcarbazepine

298
Q

temporal arteritis

A

women: men 3:1

elderly
headache
fever
fatigue
myalgia
night sweats
weight loss
jaw claudication

irreversible and sudden vision loss

ESR sed rate elevated

prednisone

299
Q

illness anxiety disorder

A

pt believes they have a specific serious disease despite negative
(or “a serious dx”)

6mths
1-5% population
chronic
waxing/waning

300
Q

somatic symptom disorder

A

pt has one or more somatic symptoms that are distressing and disrupt daily life

not intentionally produced

not explained by medical dx
(sx can be associated w/another medical condition)

6mths

lower level of edication
lower SES
female
older age
unemployed

tx: therapy only (group and individual)

301
Q

fluvoxamine

A

shortest half life SSRI

302
Q

dermatomyositis

A

autoimmune disease of skin and muscles

skin rash on face, eyelids, elbows, knees

carcinoma

303
Q

good prognostic indicators of schizophrenia

A

acute onset
mood disorder sx
family hx of mood disorders
positive sx

304
Q

poor prognostic indicators of schizophrenia

A 
male
no precipitating factors
withdrawn
family hx of schizophrenia
negative sx
neurological sx
hx of perinatal trauma
no remissions in early years
many relapses
hx of assaultiveness
305
Q

opioid withdrawal

A

clonidine
phentolamine (HTN)
dicyclomine (Bentyl)

306
Q

burden of proof

A

preponderance of the evidence
50% - civil cases, competency

reasonable medical certainty
50.1% - more likely than not - expert witness

clear and convincing
75% - civil commitment

beyond a reasonable doubt
greater than 90% - criminal cases

307
Q

gender

A

2yrs - gender constancy
3yrs - gender identity
5-7yrs - rigid/inflexible

308
Q

Malan

A

triangle of conflict
defense work
forming a portrait to resolve dynamic pathologic defenses

309
Q

Sifneos

A

anxiety provoking therapy

therapist acts as a teacher

310
Q

Davanloo

A

intensive short-term dynamic psychotherapy

311
Q

Mann

A

existential therapy

therapist acts as empathetic helper

312
Q

partialism

A

oralism
paraphilia

only aroused by/can only achieve orgasm through a single type of sexual contact

313
Q

klismaphilia

A

paraphilia

sexual arousal from enemas

314
Q

psychosexual factors

A

sexual identity
patter of a person’s biological sexual characteristics (usually no doubt about male vs female)

gender identity
a person’s sense of maleness or femaleness

sexual orientation
who someone is attracted to sexually (male vs female vs both)

sexual behavior
who someone actually has sex with (male vs female vs both)

315
Q

pedophiles

A

girls 8-10yrs

boys slightly older

316
Q

Hwa-Byung

A

Korea

similar to somatization do
middle aged females
psychosocial stress

317
Q

TCA levels

A

desipramine
imipramine
nortriptyline

all are cyp 2D6 substrates

318
Q

PTSD

A

CBT

more common in women

7.8% lifetime prevalance
>1mth

no way to predict who gets it
no improvement w/debriefing
decreased hippocampal volume

FDA:
sertraline
paroxetine

2nd generation antipsychotics
venlafaxine?
other SSRIs?

Benzos slow recovery rate

319
Q

body dysmorphic disorder

A

risk factors

  • childhood neglect
  • abuse

family hx

  • OCD
  • mood dos

tx:

  • SSRIs
  • MAOIs
  • TCAs

chronic
body part may change

320
Q

mental retardation

A

trisomy 21 - most common

fragile X - 2nd most common, most common heritable

321
Q

cocaine

A

blocks dopamine reuptake

dopamine and NE reuptake inhibition

increases dopamine??

hyper sexuality
shower of lights
tactile hallucinations (coke bugs)
hyperthermia (OD)
hypertension (phentolamine)

crack
coca
freeze girl
happy dust

322
Q

dopamine agonist

A

can treat Parkinson’s

pergolide
bromocriptine
pramipexole
ropinirole

buspirone - partial agonist (???)

323
Q

ziprasidone

A

inhibits serotonin and norepinephrine reuptake

5-HT agonist

324
Q

aripiprazole

A

partial dopamine D2 agonist

partial 5-HT 1A agonist

5-HT 2A antagonist (as are all atypicals)

325
Q

prefrontal cortices

A

lesion to left - depression

lesion to right - mania

326
Q

Wilsons disease

A

autosomal recessive
chromosome 13

incorporation of copper into ceruloplasmin
diminished biliary excretion of copper
excessive deposition of copper in the brain
-basal ganglia

serum ceruloplasmin

Parkinsonism
flapping tremor
ataxia
dystonia
dysphagia
dysarthria
liver failure
327
Q

nucleus accumbens

A

reward center

also VTA

328
Q

type 1 error

A

null hypothesis rejected when it should have been retained

329
Q

type 2 error

A

null hypothesis retained when it should have been rejected

330
Q

power

A

probability of finding the difference between two samples

probability of rejecting the null hypothesis when it should be rejected

331
Q

UDS

A 
cocaine - 8hrs
alcohol - 12hrs
amphetamine - 48hrs
heroin - 72hrs
PCP - 8days
cannabis - 4wks
332
Q

bruxism

A

grinding teeth

amphetamines
MDMA (ecstasy)

333
Q

cannabis

A 
reddened conjunctivae
tachycardia
dry mouth
orthostatic hypotension
anxiety
panic attacks
334
Q

MDMA (ecstasy)

A

bruxism
dilated pupils
tenting of skin

serotonin reuptake inhibitor

ecstasy
Adam
club drug
disco biscuits
love drug
335
Q

substance use disorder

A

mild 2-3
moderate 4-5
severe 6

336
Q

methyl alcohol

A

encephalopathy
ataxia
visual loss
tachypnea

hemorrhage of putamen

337
Q

alcoholic psychosis

A

alcohol withdrawal with AVH

clear sensorium

338
Q

opioid withdrawal

A 
N/V/D
yawning
perspiration
runny nose
dilated pupils
twitching muscles
339
Q

depressants

A 
alcohol
cannabis
opioids
inhalants
benzos
340
Q

stimulants

A

amphetamine

cocaine

341
Q

hallucinogen

A

LSD
MDMA
cannabis

342
Q

dissociative agent

A

PCP

ketamine

343
Q

naltrexone

A

opioid antagonist

344
Q

acamprosate

A

NMDA antagonist
structurally resembles GABA

reduces EtOH cravings

tid dosing

give after ~1wk no EtOH

345
Q

disulfiram

A

aldehyde dehydrogenase inhibitor

if drink EtOH, N/V/HTN/HA/flushing

must abstain from alcohol for several days - 1 week prior to use (minimum 12hrs)

500mg qd x1-2wks
then 250mg qd

346
Q

LSD

A

increased body temp
tachycardia
hypertension
dilated pupils

347
Q

PCP

A 
nystagmus
agitation
hypertension
tachycardia
diminished pain
slurred speech
ataxia
muscle rigidity
seizures
hyperacusis (inc sensitivity to certain frequencies)
catatonia

angel dust
belladonna
black whack

use benzos for agitation

NMDA antagonism

348
Q

methamphetamine

A 
crank
crystal
ice
speed
crystal meth
349
Q

ketamine

A 
cat valium
special K
vitamin K
kit kat
honey oil

derivative of PCP

350
Q

alcohol metabolism

A

women

  • lower adjusted body water
  • higher fat content
  • lower alcohol dehydrogenase in gastric mucosae
351
Q

methadone

A

initial dose 10-20mg

goal dose 60-100mg

352
Q

n-Hexane

A

glue inhalant

glue-sniffer neuropathy
similar to Guillain-Barre sx

bluish discoloration
decrease temperature extremities
facial numbness
vision loss

353
Q

onanism

A

masturbation

coitus interuptus

354
Q

schizophreniform good prognostic features

A

psychotic sx with 4wks of noticeable changes
confusion
good fx prior to sx
absence of flat affect

355
Q

lateral geniculate nucleus

A

thalamic nucleus

visual/retina

356
Q

ventral posteromedial nucleus

A

thalamic nucleus

face sensory

357
Q

ventral posterolateral nucleus

A

thalamic nucleus

leg and arm sensory

358
Q

ventral lateral nucleus

A

thalamic nucleus

cerebellar

359
Q

medial geniculate nucleus

A

thalamic nucleus

auditory

360
Q

Physostigmine

A

treats anticholinergic toxicity

similar to NMS/serotonin syndrome
lack of diaphoresis

361
Q

risk of schizophrenia

A 
prenatal malnutrition
radiation during 1st trimester
maternal influenza during pregnancy
family childhood stress
winter/spring births
362
Q

schizophrenia age of onset

A

men (mean 20-28)
-10-25

women (mean 26-32)

  • early 20s
  • early 30s
  • early 60s
363
Q

psychogenic polydipsia

A

high antipsychotic doses
moderate anticholinergic doses
extended hospitalization
nicotine

364
Q

clozapine myocarditis

A

first 1 mth

fever
flu like sx

never rechallange

365
Q

Benedict Morel

A

first coined dementia praecox

366
Q

sensory gating

A

suppress information

367
Q

cotard syndrome

A

pt feels like he/she is dead (or a zombie)

368
Q

de Clerambault syndrome

A

erotomania

369
Q

schizophrenia incidence

A

1% population
2.8-8.2% 1st degree relative
13% parent (10x)
40% monozygotic twin

370
Q

schizophrenia brain

A 
dec blood flow to frontal lobes
brain volume deficit
increased vol of lateral and 3rd ventricles and basal ganglia
smaller hippocampus
decreased activity in frontal lobes
371
Q

catatonia

A

7-17% psychosis

13-31% mood disorders

372
Q

trifluioerazine

A

Stelazine

atypical antipsychotic

373
Q

neuroleptic malignant syndrome

A

treat w/bromocriptine/dantrolene (if not responding to supportive care within 24-48hrs)

increased muscle tone
hyperthermia
elevated CPK

374
Q

Jacob Kasanin

A

schizoaffective disorder

375
Q

brief psychotic disorder

A

less than 1 month

376
Q

schizophreniform disorder

A

more than 1 month

less than 6 months

377
Q

antipsychotic w/possible pregnancy risk

378
Q

illusions

A

misinterpretations of actual stimuli

hear a dog barking, but interpret it as a person saying something

379
Q

odd EPS

A

abnormal postures
difficulty talking
drooling

380
Q

CATIE trial

A

no difference in rates of hospitalizations and EPS between meds

olanzapine highest metabolic effects

clozapine most effective

discontinuation rates all similar (longest was olanzapine, but most side effects)

no difference between 1st and 2nd generation meds

risperidone
quetiapine
ziprazidone
perphenazine

381
Q

antipsychotic sexual side effects

A

higher in women

382
Q

antipsychotic doses

A

higher in postmenopausal women
normal in men
lower in premenopausal women

383
Q

clozaril ANC

A

1,500

begin daily ANC monitoring until >1,000 (may then consider restarting)

384
Q

completed suicide ration

A

male:female 3:1

385
Q

tuberoinfundibulnar tract

A

dopamine
prolactin
amenorrhea
galactorrhea

hypothalamus to anterior pituitary

386
Q

highest prevalence

A

anxiety disorders

387
Q

pathological gambling

A

at least 5

preoccupation w/gambling
gambling increased sums of money
attempts to quit
gambling to escape dysphoric mood
lying to SOs about gambling
loss of important relationships
illegal acts to be able to gamble
relying on others to pay bills
desire to keep going back to break even
388
Q

internuclear ophthalmoplegia

A

MS

medial longitudinal fasciculus

389
Q

rumination disorder

390
Q

depersonalization

A

experience of unreality, detachment or feeling like an outside observer to your own body, actions, sensations, thoughts or feelings

391
Q

derealization

A

experience of unreality or detachment to you own surroundings

experienced as unreal, dream-like, foggy, lifeless or visually distorted

392
Q

anosognosia

A

inability to recognize neurological deficit occurring in oneself

393
Q

multiple sclerosis

A

most common inflammatory demyelinating disease

onset 15-50yrs

optic neuritis

  • eye pain increased w/movement
  • central visual loss (scotoma)
  • afferent pupillary defect (Marcus Gunn pupil) (swinging flashlight test)

internuclear ophthalmoplegia
fever worsens sxs (Uhthoff’s phenomenon)
fatigue
Lhermitte’s sign - electric shock down spine w/neck flexion

steroids
interferon

394
Q

Russells sign

A

calluses on the back of the hands due to self induced vomiting

bulimia

395
Q

neurofibromatosis type I

A 
six cafe-au-lait spots
axillary/inguinal freckling
optic glioma
2 or more neurofibromas
1st degree relative w/NF1
2 or more Lisch nodules (hamartomas of the iris)
bony lesions
396
Q

neurofibromatosis type II

A

bilateral acoustic schwannomas

397
Q

thiamine

A

vitamin B1

398
Q

alcohol use during pregnancy

A

1/3 - fetal alcohol syndrome

inc risk of ADHD
small for gestational age

399
Q

binge eating disorder

A

extroverted

SSRIs
stimulants
CBT

400
Q

clozapine monitoring

A

ANC 1,000-1,499

  • inc freq of monitoring to 3x/wk until 1,500
  • then restart at last normal dose/ANC monitoring level

ANC 500-999

  • interrupt clozapine until level resolves
  • daily ANC until 1,000
  • 3x/wk until 1,500
  • then check weekly x4wks
  • then restart at last normal dose/ANC monitoring level

ANC below 500

  • stop clozapine
  • daily ANC until 1,000
  • 3x/wk until 1,500
  • may rechallange if ANC recovers (consider risks/benefits)
  • resume as new pt
baseline ANC
ANC every wk x6mths
ANC every 2wks x6mths
ANC every mth forever
ANC every wk x4wk after stopping
401
Q

rapid correction of hyponatremia

A

central pontine myelinolysis

acute locked in syndrome

402
Q

pseudotumor cerebri

A 
black
fat
fertile
30s
OCPs
tetracycline

visual field defects
headaches
waxing/waning

lumbar puncture
opening pressure over 20

acetazolamide

403
Q

r-TPA

A

within 3hrs of stroke

exclusion criteria

  • seizure
  • hemorrhage
  • major surgery past 3mths
  • glc abnormalities
  • recent MI
  • anticoagulants
  • thrombocytopenia
404
Q

restless leg

A

ropinirole (Requip)

dopamine agonist

405
Q

violence/aggression

A

decreased levels of serotonin in CSF

dopamine - inc aggression
serotonin/NE/GABA - dec aggression

406
Q

metachromatic leukodystrophy

A 
autosomal recessive
chromosome 22
deficiency in arylsulfatase A (ASA)
lysosomal storage disease
death by age 5

gait disorder
hypotonia
lower limb areflexia
dementia
behavioral problems
407
Q

seasonal affective disorder

A

not in DSM
(with season pattern specifier in DSM)
sx must remit during other seasons

light therapy tx

  • carb cravings
  • most effective in AM
  • can precipitate hypomania
408
Q

AIDS decreased visual acuity

A

cytomegalovirus

409
Q

JC virus

A

AIDS

clumsiness
progressive weakness 
visual changes
speech changes
personality changes
410
Q

logorrhea

A

uncontrollable, excessive talking

411
Q

alexithymia

A

difficulty recognizing and describing one’s emotions

412
Q

TCA side effects

A 
constipation
anticholinergic sxs
orthostatic hypotension
sedation
tremor
prolonged QTc &amp; PR
tachycardia
413
Q

lumbar lesions

A

L1/L2/L3 - hip flexion
L3/L4 - leg extension
L5 - foot flexion
S1 - foot extension, ankle jerk

414
Q

pure motor hemiparesis

A

internal capsule lacunar stroke

415
Q

pure sensory stroke

416
Q

pure sensorimotor stroke

A

internal capsule

417
Q

histamine

A

weight gain

sedation

418
Q

anticholinergic

A 
constipation
blurred vision
dry mouth
drowsiness
urinary retention 
cognitive dysfunction
419
Q

alpha 1 adrenergic

A

orthostatic hypotension

drowsiness

420
Q

dopaminergic

A

antipsychotic effects
EPS
prolactin elevation

421
Q

hemiballismus

A

contralateral subthalamus

422
Q

biogenic amine NTs

A 
dopamine
epinephrine 
NE
acetylcholine
serotonine
histamine
423
Q

CSF

A

production
-choroid plexus

drainage into blood
-arachnoid granulations

424
Q

subacute sclerosing panencephalitis

A

measles

personality changes
myoclonic seizures
choreoathetoid movements
difficulty swallowing
death - 12mths

CSF assay (measles Ab)
EEG
brain biopsy

425
Q

Lesch-Nyhan

A

x-linked recessive

self-mutilation

426
Q

duloxetine

A

contraindicated in liver disease

withdrawal sx
fibromyalgia

427
Q

Mood Disorder Questionnaire

A

mania/hypomania screener

428
Q

Epworth Sleepiness Scale

429
Q

bipolar incidence

A

bimodal
15-24
45-54

430
Q

social rhythm therapy

A

bipolar disorder

431
Q

myxedema

A

depression
psychosis
hypothyroidism

432
Q

mad hatter syndrome

A

mania

mercury intoxication

433
Q

tetracyclic antidepressant

A

amoxapine (D2 antagonist)
maprotiline
mirtazapine

434
Q

Sturge-Weber syndrome

A 
port-wine nevus
brain angioma ipsilateral to skin nevus
contralateral hemiparesis
MR
homonymous meiagopia
glaucoma
seizures
435
Q

cyp 3A4 substrates

A 
erythromycin
clarithromycin
alprazolam
diazepam
midazolam
cyclosporine
diltiazam
nifedipine
amlodipine
verapamil
atorvastatin
simvastatin
aripiprazole
buspirone
haloperidol
tamoxifen
trazodone
propranolol
zolpidem
zaleplon
methadone
OCPs
progesterone
testosterone
fentanyl
436
Q

cigarette smoke

A

lowers levels of

amitriptyline
fluvoxamine
clozapine
olanzapine
haloperidol
imipramine
437
Q

Sheehan’s syndrome

A 
postpartum
pituitary hemorrhage
chiasmal compression
bitemporal hemianopsia
severe headache

failure to lactate

438
Q

Cushings disease

A

adrenocorticotropic hormone
pituitary gland

dexamethasone suppression test

439
Q

essential tremor

A

propranolol
primidone
benzodiazepines
botox

440
Q

glutamate receptors

A

AMPA
kainate
NMDA

441
Q

parkinsonism

A

elderly

female

442
Q

MDD recurrence

A

25% 6mths
30-50% 2yrs
50-75% 5yrs

443
Q

Tarasoff I vs Tarasoff II

A

I - duty to warn

II - duty to protect

444
Q

Durham Rule

A

not criminally responsible if act was product of mental illness or defect

445
Q

secondary amines

A

desipramine
protriptyline
nortriptyline

446
Q

3rd nerve palsy

oculomotor

A

ptosis
diplopia
inability to adduct eye

diabetes (benign)
-pupil spared

internal carotid artery aneurynm (potentially fatal)
-dilated pupil

447
Q

dementia pugilistica

A

post traumatic dementia

apo E4
chromosome 19

448
Q

OCD

A 
clomipramine
fluoxetine
fluvoxamine
paroxetine
sertraline

med+CBT

449
Q

systematic desensitization

A

involves relaxation techniques

450
Q

therapeutic graded exposure

A

carried out in real situation

451
Q

reattribution

A

CBT

pt is encouraged to consider possible alternate causes for events

452
Q

least sedating TCAs

A

desipramine
protriptyline

(myoclonic twitches)

453
Q

ECT risk factors

A

no absolute contraindications

brain tumors
aneurysms
recent MI
increased ICP
uncontrolled HTN
454
Q

carbamazepine no combos

A

OCPs
MAOIs
clozapine (bone marrow suppression)

455
Q

enuresis

A

bell pad
imipramine
desmopressin

456
Q

transient global amnesia

A
  • reversible anterograde and retrograde amnesia
  • inability to learn new info
  • retain personal info/identity

ask same question repeatedly

men
50s or older

acute
several hours

457
Q

lyme disease

A

borrelia burgdorferi
ixodes dammini
ixodes pacificus

mimics neuro conditions

  • meningitis
  • Bell’s palsy
  • Guillain-Barre

rash

458
Q

epidural hematoma

A

middle meningeal artery

temporal or parietal areas

LOC then lucid

younger

459
Q

subdural hematoma

A

meningeal bridging veins

crescent shape

older
alcoholics

460
Q

bacterial meningitis CSF

A

marked lymphocytosis
increased protein
decreased glucose

461
Q

aseptic/viral meningitis CSF

A

mild-mod lymphocytosis
normal-mild inc protein
normal glucose

462
Q

arsenic poisoning

A

mees lines
-white lines in finger nails

N/V/D
hypotension
tachycardia

tx: chelation

463
Q

ANOVA

A

compares two groups and determines if the differences are due to experimental influence or chance

multiple binary predictor variables
one continuous outcome variable

464
Q

regression analysis

A

uses data to predict the value of one variable in relation to another

two continuous or binary variables
one continuous outcome variable

465
Q

bereavement vs depression

A

depression

suicidality
worthlessness
anger/ambivalence toward deceased
social contacts don't help
person isolates
others find depressed person irritating/annoying

bereavement

pt evokes sympathy from others

466
Q

methadone

467
Q

PKU

A

autosomal recessive
chromosome 12
phenylalanine hydroxyls deficiency

mousy odor
microcephaly
infantile spasms
light hair/skin
MR
468
Q

nigrostriatrial tract

A

parkinsonian sxs
EPS sxs

substantia nigra to basal ganglia

469
Q

mesocortical tract

A

negative sxs

ventral tegmental area to frontal cortex

470
Q

mesolimbic tract

A

positive sxs

ventral tegmental area to nucleus accumbent

471
Q

correlation coefficient

A

measurement of direction and strength of relationship between 2 variables

472
Q

dopamine synthesis

A

tyrosine hydroxylase
-rate limiting step

dopamine - NE - epinephrine

473
Q

Ganser syndrome

A

malingering
prison

giving approximate answers
believes sxs are real

474
Q

Todd’s paralysis

A

brief postictal paralysis
48hrs
contralateral to sz focus

475
Q

hepatic encephalopathy

A

triphasic waves - EEG

asterixis

476
Q

clonidine

A

alpha 2 agonist

decreases NE released

477
Q

Kluver-Bucy syndrome

A

amygdaloid bodies

hyper sexuality
hyperoralitu
placidity

478
Q

impulse control disorder

A

comorbid

  • fire setting
  • substance use
  • eating disorders

tx:

  • mood stabilizers
  • SSRIs
  • TCAs
479
Q

catalepsy

A

immobile position constantly maintained (catatonia)

480
Q

stereotypy

A

repetitive fixed pattern of movement or speech

481
Q

relative risk

A

ration of incidence in those with risk factors to the incidence in those without risk factors

482
Q

attributable risk

A

absolute incidence in pts exposed to condition that can be attributed to exposure

483
Q

geriatric sleep

A 
lower % stage 3 sleep
decreased delta waves
more stage 1/2 sleep
less total REM sleep
more REM episodes
shorter REM episodes
increased awakenings
484
Q

lithium + clozapine

A

increases NMS

485
Q

alogia

A

poverty of speech and thought content

486
Q

Bowlby

A

separation from mother

protest
despair
detachment/denial of affection

487
Q

Freud stage issues

A

oral - dependency
anal - obsessive compulsive
phallic - poor resolution of Oedipal complex

488
Q

specific phobia

A 
animal
natural enviornment
blood injection injury
situational
other
489
Q

most common brain tumor over 60

A

glioblastoma multiforme

490
Q

AIDS

A

most common CNS cancer

  • lymphoma
  • -Epstein Barr

most frequent CNS opportunistic infection
-toxoplasmosis

most common spinal cord pathology
-vacuolar myelopathy

491
Q

purging

A

hypokalemia
hyperchloremia
pancreatic inflammation
esophageal erosion

492
Q

kuru

A

prion disease

endemic to cannibalistic Fore people

493
Q

Bells palsy

A

herpes simplex virus
facial nerve palsy

steroids
acyclovir

494
Q

spinal cord mets

A

breast
lung
prostate

495
Q

vitamin b12

496
Q

YMRS

A

Young Mania Rating Scale

497
Q

multiple sclerosis types

A

relapsing-remitting
-sxs clear, then return

primary-progressive
-sxs do not clear, new ones appear

secondary-progressive
-initial relapsing-remitting course, then new sxs

498
Q

botulism

A 
dysphagia
dysarthria
ptosis
diplopia
urinary retention

infants/honey
weak cry
lethargy
floppiness
poor suck
constipation
499
Q

Hoovers sign

A

pt does not give effort in unaffected leg when asked to push down with affected leg (feigning)

500
Q

SIADH

A

carbamazepine
SSRI

decreased urine output

501
Q

NE reuptake inhibitor

A

TCAS
venlafaxine
bupropion
nefazodone

502
Q

pellagra

A

niacin deficiency
vitamin b3

dementia
dermatitis
diarrhea

503
Q

pimozide

A

tics - Tourettes

dopamine antagonist

504
Q

brief psychiatric rating scale

A

psychosis

schizophrenia

505
Q

thioridazine

A 
Mellaril
retrograde ejaculation
low EPS
anticholinergic
orthostatic hypotension
506
Q

sarcoidosis

A

granulomatous disease
multiple organs

peripheral neuropathy
facial nerve palsy

507
Q

OCPD

A 
isolation of affect
undoing
reaction formation
intellectualization
rationalization
508
Q

antihypertensives inc depression

A

propranolol

alpha-methyldopa

509
Q

Lewy body dementia psychosis

A

no antipsychotics

cholinesterase inhibitor
lower dose of antiparkinson med

510
Q

GAD

A

at least 3 somatic sxs

  • restlessness
  • fatigue
  • difficulty concentrating
  • irritability
  • muscle tension
  • sleep disturbance

excessive worry
multiple events
6mths

511
Q

exposure and response therapy

A

OCD

specific phobia

512
Q

motivational enhancement therapy

A

substance use

513
Q

serotonin syndrome vs NMS

A

NMS

  • muscle rigidity
  • high CPK

serotonin syndrome

  • clonus
  • GI sx
  • hyperreflexia
514
Q

Lewy body dementia

A

visual hallucinations
fluctuating cognition
Parkinsonism

REM sleep behavior do
neuroleptic sensitivity
low uptake in basal ganglia

515
Q

fiduciary duty

A

obligation to work in pts best interest

516
Q

beneficence

A

help pts and relieve suffering

517
Q

chronic alcoholism

A

cerebellar atrophy
truncal ataxia (vermis)
gait unsteadiness
wide-based gait

518
Q

T test

A

one binary predictor variable

one continuous outcome variable

519
Q

chi squared test

A

one binary predictor variable

one binary outcome variable

520
Q

binary variable

A

two possible values

yes/no
positive/negative
female/male

521
Q

continuous variable

A

falls somewhere on a range

height
weight
age

522
Q

correlation

A

one continuous predictor variable

one continuous outcome variable

523
Q

homocystinuria

A 
pectus excavatum
ocular lens dislocation
Marfan's habitus
mental retardation
scoliosis

error of amino acid metabolism

524
Q

most common single-gene cause of autism

525
Q

neurotic defenses

A

displacement

repression

526
Q

immature defenses

A

hypochondriasis

introjection

527
Q

sensory deficits

A

thalamic lesions/strokes

posterior cerebral arteries

528
Q

HIV related dementia

A 
difficulty w/attention and concentration 
bradyphrenia (slowed thought)
social withdrawal
apathy
depression
fatigue

gait incoordination
rigidity
slowness of gait
fine and skilled hand and finger movements affected

529
Q

Parkinsons dementia

A
  • depigmentation and neuronal loss of substantial nigra
  • presence of Lewy bodies
  • dopaminergic under activity in the striatum
  • 60-85% of stratal dopamine neurons must be lost before sxs
  • asymmetrical early in disease
  • bilateral later in course
  • levodopa-carbidopa mainstay tx
  • dopamine agonists
  • MAOIs
  • anticholinergics
530
Q

low folate

A 
fatigue
agitation
depression
delirium
dementia
psychosis
paranoia
531
Q

PTSD risk factors

A

heavy alcohol use
women
childhood trauma
perception of an external locus of control (natural cause) (not human cause)

borderline personality do
paranoid
dependent
antisocial

very old
very young

532
Q

erythromycin

A

increase carbamazepine levels

533
Q

postherpetic neuralgia

A

deep, burning pain
worsened by light touch

follows herpes zoster (shingles)

gabapentin

534
Q

hemicrainia continua

A

women
continuous headache
indomethacin

535
Q

prion diseases

A

Creutzfeld-Jakob disease
kuru (New Guinea)
Gerstmann-Straeussler-Scheinker syndrome
fatal familial insomnia

536
Q

episodic memory

A

declarative memory

recall of personal facts

what you ate for dinner
what you did on vacation

537
Q

semantic memory

A

declarative memory

recall of general facts

who was 1st president
difference between bus/train

538
Q

procedural memory

A

how to drive

how to type

539
Q

declarative memory

A

retention and recall of facts

semantic
episodic

540
Q

anxiety disorders

A

women higher than men

OCD equal

541
Q

tardive dystonia

A

slow sustained twisting movement of the limbs, trunk, neck

tardive dyskinesia - choreoathetoid movement, involuntary, irregular

542
Q

face validity

A

dx based on general consensus among clinicians and researchers

543
Q

descriptive validity

A

dx based on characteristic features that distinguish it from other disorders

544
Q

predictive validity

A

dx will allow clinicians to accurately predict tx response and clinical course

545
Q

construct validity

A

dx based on understanding of underlying pathophysiology

546
Q

black box suicide warning

A

SSRIs
SNRIs
atomoxetine

547
Q

PANSS

A

positive and negative sx scale

psychosis

548
Q

CAPS

549
Q

postpartum depression

A

onset within 4wks

550
Q

palilalia

A

repetition of one’s own speech

551
Q

biofeedback

552
Q

Guillain-Barre vs transverse myelitis

A

GB
-lower motor neuron signs

TM

  • upper motor neuron signs
  • loss of bowel/bladder control
553
Q

bipolar maintenance

A

lamotrigene

554
Q

bipolar mania

A

valproic acid

carbamazepine

555
Q

pregnancy categories

A

A- studies show no human risk
B- animal studies show no risk
C- animal studies show risk
D- human fetal risk seen (may use in life-threatening situations)
E- proved fetal risk (no indication even in life-threatening situations)

556
Q

most common anxiety disorder

A

specific phobia

also most common mental disorder among women

2nd most common in men (after substance use)

557
Q

culture

A

correlates with ethnicity

set of meanings, norms, beliefs, values, behavior patterns shared by a group of people

taught, passed on

way of life/customs

558
Q

race

A

people grouped based on outer appearance

biologic and genetic underpinnings

559
Q

ethnicity

A

subjective sense of belonging to a group of people with a common national or regional origin

shared believes, value and practices, including religion

common heritage, ancestry, history

560
Q

lithium metabolism

A

reabsorbed in proximal tubules w/Na

decrease Na (low Na diet, HCTZ)
increase reabsorption
561
Q

ipecac

A

heart probs
tachycardia
inc LFTs
skeletal muscle atrophy

562
Q

left brain

A

logical, analytical

563
Q

right brain

A

creative, emotional, intuitive

564
Q

Eri Erikson

A

epigenetic principle

each stage must be properly resolved for development to proceed normally

565
Q

differences in myositis

A

inclusion body myositis

  • men
  • worse on one side
  • most common

polymyositis

  • women
  • symmetrical
  • follows flu like illness

dermatomyositis
-women
-skin involvement
symmetrical

566
Q

nicotine withdrawal

A

bradycardia
insomnia

4 sxs w/in 24 hours - DSM

567
Q

t-Pa

A

within 3 hours of sx onset

  • neuro deficit
  • no hemorrhage on CT

exclusion:

  • improving neuro deficit
  • seizure
  • prior intracranial hemorrhage
  • blood glc high or low
  • GI or GU bleed in past 3wks
  • recent MI
  • anticoagulants
  • thrombocytopenia
  • major surgery past 3mths
  • stroke/head injury past 3mths
  • arterial puncture past 7days
  • BP over 185/110
568
Q

nystagmus

A

PCP
inhalants
alcohol
sedative hypnotics

569
Q

brain death

A
  • coma (may retain spinal reflexes)
  • no spontaneous respirations
  • absence of brain stem reflexes (pupillary, oculocephalic, corneal, gag)
  • EEG silence (isoelectric not mandatory)
  • absence of cerebral blood flow
  • absence of reversible causes
  • positive apnea test (necessity)
570
Q

glucuronidation

A 
phase II
(phase I = oxidation/cyp)

lorazepam
oxazepam
temazepam

571
Q

suicide

A

50% - affective dos (MDD, bipolar)
25% - substance abuse
5% - personality dos

4-10% borderlines complete
5% antisocials complete
5-10% schizophrenics complete

affective dos 30x risk

572
Q

clozapine contraindications

A

agranulocytosis

carbamazepine
phenytoin
propylthiouracil
sulfonamides
captopril
573
Q

phentolamine

A

pheochromocytomoa
cocaine hypertension
MAOI hypertensive crisis

574
Q

child abuse risk factors

A 
poverty
psychosocial stress
less parental education
underemployment
poor housing
single parenting
welfare reliance
many children
physical handicap
MR
prematurity
parental mental illness
parents substance abuse
social isolation
domestic violence
575
Q

dialectical

A

substitutes both/and for either/or

sees truth as an evolving product of the opposition of different views

seeking synthesis between seemingly contradictory ideas and emotions

576
Q

pedophilia

A

perpetration at least 16
at least 5yrs difference
prepubescent child (13 or younger)

do not include late adolescent w/12yo or 13yo

577
Q

encopresis

A

at least 4yo
at least monthly x3mths

more common in boys

correlates with:
sexual abuse
maternal hostility
punitive/harsh parenting

578
Q

benzos

A

pregnancy category D

579
Q

kappa

A

quantifies degree of agreement between two raters in a study

tells whether test produces reliable/reproducible results

580
Q

capacity

A
  • communicate a choice
  • understand info presented
  • understand how info related to own circumstances
  • reason in logical manner (even if most people wouldn’t agree w/decision)
581
Q

Benton visual retention test

582
Q

anticipation

A

planning for future inner discomfort

mature defense

583
Q

schizoid fantansy

A

indulging in autistic-like retreat to resolve conflict

interpersonal intimacy avoided by driving others away w/eccentricity

immature defense

584
Q

ECT indications

A

depression
psychosis
mania
OCD?

585
Q

interpretation

A

making something unconscious conscious

links feeling, thought, behavior, symptom to its unconscious meaning

586
Q

clarification

A

reformulating what pt has said to create coherent view of what has been communicated

587
Q

flunitrazepam

588
Q

cyclothymia

A

hypomania

depressive sxs that do not meet criteria for MDD

at least 2yrs

589
Q

agoraphobia

A

fear of being in places or situations that may be difficult to escape from

590
Q

avoidance

A

learn to avoid certain painful stimuli by avoiding certain behaviors

dont go to crowded mall lobby bc it causes panic attacks

variation of negative reinforcement

591
Q

borderline therapy

A

DBT
mentalization therapy
transference-focused psychotherapy (Kernberg)

592
Q

PTSD criteria

A

1 intrusion sx (nightmares)
1 avoidance sx (restricted affect?)
2 increased arousal sxs
2 negative cognition/mood sxs

593
Q

classical conditioning

A

neutral stimulus (conditioned) (chainsaw)

paired with a stimulus that evokes a response (unconditioned) (fire)

in time, neutral stimulus elicits same response as as unconditioned stimulus

594
Q

operant conditioning

A

voluntary behavior is modified as pt actively tries different behaviors to see which will deliver desired reward

595
Q

Premack’s principle

A

behavior engaged in at high frequency (things we like to do) can be used to reinforce behavior that occurs at a low frequency (things we don’t like to do)

596
Q

prior to ECT

A 
CBC
CT (suspicion of sx or tumor)
EKG
CXR?
dental exam in elderly
spine X-ray (if spinal disease)
597
Q

ECT anesthesia

A

most common:
methohexital (Brevital)

don’t use due to inc sz threshold:
propofol

598
Q

mania in medical conditions

A

glioma
cushings disease
MS

599
Q

drugs causing mania

A 
isoniazid
cimetidine
metoclopramide
steroids
bronchodilators
antidepressants
anticonvulsants
stimulants
barbiturates
drugs of abuse
600
Q

facilitation

A

using verbal and nonverbal cues to encourage pt to keep talking

601
Q

clarification

A

tries to get more details about what the pt has already said

602
Q

poor prognosis for paraphilias

A
  • early age of onset
  • lack of guilt/shame
  • high frequency of acts
  • substance use
  • no coitus w/paraphilic act
  • low IQ
  • personality dos
  • lack of attachment/relationships
  • axis I do
  • multiple paraphilias
603
Q

paraphilia interventions

A
  • CBT
  • insight-oriented psychotherapy
  • anti androgens
  • twelve step programs
  • sex therapy
604
Q

transsexual

A

wish to have body of another sex

605
Q

genderqueer

A

in between genders; both genders; neither gender

606
Q

Ford v Wainwright

A

competence to be executed

607
Q

glossolalia

A

unintelligible jargon that has meaning to the speaker but not the listener

608
Q

verbigeration

A

meaningless and stereotyped repetition of words or phrases

609
Q

laconic speech

A

reduction in quality of spontaneous speech

610
Q

pseudologia phantastica

A

pt believes reality of fantasies and acts on them

611
Q

anorexia specifiers

A

BMI

17 mild
16 moderate
15 severe
<15 extreme

612
Q

pavor nocturnus

A

nighttime panic attacks

613
Q

jactatio capitis nocturna

A

head banging during sleep

614
Q

“atypical” antipsychotics

A

5-HT 2A antagonism

help w/negative sxs

615
Q

new onset psychosis medical ddx

A 
SLE
temporal lobe epilepsy
neurosyphilis
Wilsons disease
AIDS
B12 deficiency
heavy metal poisoning
delirium
dementia
Huntingtons
pellagra
tumor
stroke/bleed
herpes encephalitis 
autism
616
Q

violence risk

A 
past violent behaviors
battered, underprivileged child
low education
poor family supports
unstable housing
unemployed
poor coping skills
lack of resources
617
Q

Alzheimer’s survival

618
Q

atypical depression

A

hypersomnia
increased appetite
weight gain
(= reversed vegetative sxs)

tx: MAOIs

619
Q

chronic fatigue syndrome

A

CBT

graded exercise therapy

620
Q

prior to stimulants

A 
pulse
BP
height
weight
physical exam

EKG only if concern for cardiac issues

621
Q

stimulant abuse

A

Vyvanse - prodrug, not active is snorted, crushed, injected

Concerta, Metadate ER - extended release

622
Q

delirium risk factors

A 
age over 70
male
alcohol abse
smoking
recent surgery
brain damage/disease
diabetes
cancer
blindness
malnutrition
intoxication/withdrawal
623
Q

delirium causing meds

A 
narcotic painkillers
steroids
anesthetics
antineoplastic agents
anticholinergics
antibiotics
antifungals
antiviral agents
624
Q

delirium pathophys

A

reticular formation (attention and arousal)

dorsal tegmental pahtway

mesencephalic retircular formation - tectum and thalamus

625
Q

delirium neurotransmitters

A

NE (inc)
serotonin
acetylcholine (dec)
glutamate

626
Q

EEG

A

delirium - background slowing

triphasic waves - hepatic encephalopathy

PLEDs - herpes simplex virus encephalitis

temporal lobe spikes - temporal lobe epilepsy

hypsarrhythmia - infantile spasms

627
Q

IV haldol

A

torsades de pointes

628
Q

delirium aftermath

A

depression

PTSD

629
Q

conversion do vs somatic sx do

A

conversion do

  • neuro sxs (motor or sensory)
  • la belle indifference
  • acute/pts recover

somatic sx do

  • somatic/physical sxs and maladaptive thoughts
  • histrionic about sxs
  • chronic/relapsing-remitting
  • both involuntarily produced
  • both could involve pain
630
Q

naltrexone

A

5 days after short acting narcotic

10 days after long acting narcotic

631
Q

suboxone

A

buprenorphine/naloxone

8/4, 2/0.5

typical maintenance doses: 4-16mg qd

632
Q

cannabis withdrawal

A 
insomnia
irritability
restlessness
depression
nervousness
anxiety
muscle twitches
sweating
633
Q

MDD

A

5 sxs

1 must be depressed mood or loss of interest

Board Vital Questions (1 decks)

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