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Block J Detailed > Clinical > Flashcards

Clinical Flashcards

1
Q

Explain multiple sclerosis

A

autoimmune disorder resulting in degradation of myelin in CNS

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2
Q

What blocks neurotransmitters release?

A

Botulinum and tetanus toxins

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3
Q

Parkinson’s disease

A

Death of midbrain dopamine neurons causing motor and cognitive deficits

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4
Q

Involvement of forehead means :

A

Lower Motor Neuron lesion

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5
Q

Bradykinesia, rigidity, postural instability, +/- tremor

A

Parkinson’s disease

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6
Q

Major Depressive Disorder Dx

A

5 or more symptoms from DSM in 2 weeks, representing a change from previous functions, and a least of the symptoms is depressed mood or loss of interest/pleasure.

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7
Q

Key points for psychiatric disorders dx

A

5 or more symptoms
in a specific timeline
rule out other psychiatric (eg alcoholism) and physiologic (having a cancer) causes
Causes functional impairment

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8
Q

Psychiatric interview format

A

1) Introduction
2) Opening (ID, chief complaint)
3) Body (extend HPI, summarize, get collateral, screening for other disorders)
4) Closing (dx, tx options discussed)

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9
Q

What to look for in speech for psychiatric interview ?

A

Rate, rhythm and volume

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10
Q

What to look for in mood and affect for psychiatric interview?

A

Self reported subjective emotional experience

Overal pattern and type of emotional states and expression

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11
Q

What to look for in thought process for psychiatric interview?

A

Connection & speed

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12
Q

What to look for in thought content for psychiatric interview?

A 
Homocidal/suicidal ideas
Obsessions
Overvalued ideas
Idea of reference
Delusions
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13
Q

What to look for in perception for psychiatric interview?

A

Illusion
Hallucination
Dissociation

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14
Q

Visual hallucinations

A

Usually medical causes but can occur in schizophrenia

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15
Q

What to look for in cognition for psychiatric interview?

A 
Level of consciousness
Orientation to person, time and place
Attention
Memory
Overall intelligence
Use MMSE or MOCA
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16
Q

Psychiatric interviewing MSE

A 
appearance
behavior
cooperation
mood & affect
speech
thought process
thought content
perception
cognition
judgment
insight
risk assessment
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17
Q

Acute Schizophrenia treatment

A

Antipsychotic medication

Consider clozapine or other injectable medication

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18
Q

Chronic Schizophrenia tx

A

Psychotherapy (CBT)

Supported employment/social skills

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19
Q

Major depressive disorder tx

A

Antidepressant and/or psychotherapy

Possibly ECT

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20
Q

Bipolar disorder tx

A

Manic : lithium/mood stabilizer + antipsychotic
Depressed : NO ANTIDEPRESSANTS, lithium/mood stabilizer + psychotherapy +/- antipsychotics

Maintenance (mood stabilizer) + psychoeducation and relapse prevention

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21
Q

Anxiety disorder tx

A 
Psychotherapy (CBT)
Possible antidepressants (SSRIs/SNRIs)
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22
Q

Personality disorders tx

A

psychotherapy

23
Q

Substance use tx

A

Psychotherapy/counselling
Peer support
Medication depending on drug

24
Q

Enlarged 4th ventricle

A

communicating hydrocephalus (reabsorption)

25
Q

No communication of CSF with sub-arachnoid space

All ventricles except the 4th are enlarged

A

non communicating hydrocephalus (obstruction)

26
Q

Congenital hydrocephalus

A

Non communicating (aqueduct stenosis, blood)

Communicating (arachnoid villi absent, blood/pus)

27
Q

Acquired Hydrocephalus

A

Non communicating (blood, tumor, pus)

Communicating (blood/pus)

28
Q

Examination of nervous system order

A 
Mental Status
Language
Cranial nerves
Motor (bulk, tone, power, arms & legs)
Reflexes
Coordination
Sensation
Gait
29
Q

Attention in delirium

A

impaired

30
Q

Attention in dementia

A

preserved until late

31
Q

Hierarchy of basic cognitive functions

A
  1. Attention
  2. Appropriate
  3. Alert
  4. Awake
32
Q

Language testing

A 
fluency
naming
comprehension
repetition
reading
writing
33
Q

Pupillary light reflex CN involvement

A

CN II and III

34
Q

Corneal reflex CN involvement

A

CN V and VII

35
Q

Gag reflex CN involvement

A

CN IX and X

36
Q

Motor exam

A

Bulk
Tone
Power

37
Q

Spasticity

A

Velocity dependent

Feel a spastic catch

38
Q

Rigidity

A

Not velocity dependent
Constant
Feel a cog-wheel quality

39
Q

Increased reflexes

A

UMN

40
Q

Decreased reflexes

A

LMN

41
Q

Decreased Muscle bulk

A

LMN

42
Q

Increased Muscle tone

A

UMN

43
Q

Decreased muscle power

A

both UMN and LMN

44
Q

Positive Babinski

A

UMN

45
Q

Negative Babinski

A

LMN

46
Q

Fasciculations

A

LMN

47
Q

Biceps reflex nerve root

A

C5

48
Q

Triceps reflex nerve root

A

C7

49
Q

Brachioradialis reflex nerve root

A

C6

50
Q

Patellar reflex nerve root

A

L3/4

51
Q

Achilles reflex nerve root

A

S1

52
Q

Sensory testing

A
  1. Pin-Prick (pain)
  2. Temperature
  3. Joint position/vibration
  4. Sensory testing
53
Q

Gait testing

A
  • Stance/base
  • Symmetry height, step length
  • Hip, knee & ankle flexion
  • Arm swing
  • Pivot
54
Q

Romberg test

A

Eyes closed : cerebellar or proprioceptive problem

Eyes open : cerebellar

Block J Detailed (9 decks)

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