Clinical

Question 1

Explain multiple sclerosis

Answer 1

autoimmune disorder resulting in degradation of myelin in CNS

Question 2

What blocks neurotransmitters release?

Answer 2

Botulinum and tetanus toxins

Question 3

Parkinson’s disease

Answer 3

Death of midbrain dopamine neurons causing motor and cognitive deficits

Question 4

Involvement of forehead means :

Answer 4

Lower Motor Neuron lesion

Question 5

Bradykinesia, rigidity, postural instability, +/- tremor

Answer 5

Parkinson’s disease

Question 6

Major Depressive Disorder Dx

Answer 6

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.

Question 7

Key points for psychiatric disorders dx

Answer 7

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

Question 8

Psychiatric interview format

Answer 8

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

Question 9

What to look for in speech for psychiatric interview ?

Answer 9

Rate, rhythm and volume

Question 10

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

Answer 10

Self reported subjective emotional experience

Overal pattern and type of emotional states and expression

Question 11

What to look for in thought process for psychiatric interview?

Answer 11

Connection & speed

Question 12

What to look for in thought content for psychiatric interview?

Answer 12

Homocidal/suicidal ideas
Obsessions
Overvalued ideas
Idea of reference
Delusions

Question 13

What to look for in perception for psychiatric interview?

Answer 13

Illusion
Hallucination
Dissociation

Question 14

Visual hallucinations

Answer 14

Usually medical causes but can occur in schizophrenia

Question 15

What to look for in cognition for psychiatric interview?

Answer 15

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

Question 16

Psychiatric interviewing MSE

Answer 16

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

Question 17

Acute Schizophrenia treatment

Answer 17

Antipsychotic medication

Consider clozapine or other injectable medication

Question 18

Chronic Schizophrenia tx

Answer 18

Psychotherapy (CBT)

Supported employment/social skills

Question 19

Major depressive disorder tx

Answer 19

Antidepressant and/or psychotherapy

Possibly ECT

Question 20

Bipolar disorder tx

Answer 20

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

Maintenance (mood stabilizer) + psychoeducation and relapse prevention

Question 21

Anxiety disorder tx

Answer 21

Psychotherapy (CBT)
Possible antidepressants (SSRIs/SNRIs)

Question 22

Personality disorders tx

Answer 22

psychotherapy

Question 23

Substance use tx

Answer 23

Psychotherapy/counselling
Peer support
Medication depending on drug

Question 24

Enlarged 4th ventricle

Answer 24

communicating hydrocephalus (reabsorption)

Question 25

No communication of CSF with sub-arachnoid space

All ventricles except the 4th are enlarged

Answer 25

non communicating hydrocephalus (obstruction)

Question 26

Congenital hydrocephalus

Answer 26

Non communicating (aqueduct stenosis, blood)

Communicating (arachnoid villi absent, blood/pus)

Question 27

Acquired Hydrocephalus

Answer 27

Non communicating (blood, tumor, pus)

Communicating (blood/pus)

Question 28

Examination of nervous system order

Answer 28

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

Question 29

Attention in delirium

Answer 29

impaired

Question 30

Attention in dementia

Answer 30

preserved until late

Question 31

Hierarchy of basic cognitive functions

Answer 31

1. Attention
2. Appropriate
3. Alert
4. Awake

Question 32

Language testing

Answer 32

fluency
naming
comprehension
repetition
reading
writing

Question 33

Pupillary light reflex CN involvement

Answer 33

CN II and III

Question 34

Corneal reflex CN involvement

Answer 34

CN V and VII

Question 35

Gag reflex CN involvement

Answer 35

CN IX and X

Question 36

Motor exam

Answer 36

Bulk
Tone
Power

Question 37

Spasticity

Answer 37

Velocity dependent

Feel a spastic catch

Question 38

Rigidity

Answer 38

Not velocity dependent
Constant
Feel a cog-wheel quality

Question 39

Increased reflexes

Answer 39

UMN

Question 40

Decreased reflexes

Answer 40

LMN

Question 41

Decreased Muscle bulk

Answer 41

LMN

Question 42

Increased Muscle tone

Answer 42

UMN

Question 43

Decreased muscle power

Answer 43

both UMN and LMN

Question 44

Positive Babinski

Answer 44

UMN

Question 45

Negative Babinski

Answer 45

LMN

Question 46

Fasciculations

Answer 46

LMN

Question 47

Biceps reflex nerve root

Answer 47

C5

Question 48

Triceps reflex nerve root

Answer 48

C7

Question 49

Brachioradialis reflex nerve root

Answer 49

C6

Question 50

Patellar reflex nerve root

Answer 50

L3/4

Question 51

Achilles reflex nerve root

Answer 51

S1

Question 52

Sensory testing

Answer 52

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

Question 53

Gait testing

Answer 53

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

Question 54

Romberg test

Answer 54

Eyes closed : cerebellar or proprioceptive problem

Eyes open : cerebellar