Clinical examination Flashcards

1
Q

Lab abnormalities in depression
- dexamethasone suppression test

  • Corticotrophic releasing hormone test
  • TSH
A
  1. DST nonsuppression (DST-positive result) is seen in many disorders associated with depression e.g. depression with **serious suicidality **(78%).
  2. DST-positive patients respond more favourably to biological interventions. DST non-suppression is nonspecific
  • CRHT HP axis abnormality in major depression –> **blunted ACTH response **
  • ~ 30% of depressed patients show blunted TSH response during depression
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2
Q

Diagnostic possibilities for panic attacks

A
  • paroxysmal atrial tachycardia
  • pulmonary embolus
  • seizure disorder,
  • Meniere’s disease
  • transient ischemic attack
  • carcinoid syndrome,
  • Cushing’s disease
  • hyperthyroidism
  • hypoglycemia
  • pheochromocytoma
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3
Q

lactate infusion and panic disorder

A

Nearly 72% patients with panic disorder have a panic attack when administered IV injections of sodium lactate.
lactate provocation is used to confirm a diagnosis of panic disorder.
Hyperventilation and CO2 inhalation have been used.
Panic attacks triggered by sodium lactate are not inhibited by peripherally acting beta-blockers but are inhibited by benzodiazepines and tricyclic drugs

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4
Q

Narcoanalysis

A

interview with amobarbital
- Organic conditions tend to worsen with infusions of amobarbital
- nonorganic or psychogenic conditions tend to get better because of disinhibition, decreased
anxiety, or increased relaxation.
- useful in disorders of repression and dissociation such as amnesia and fugue.
- Benzodiazepines can be substituted for amobarbital.

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5
Q

Acute intermittent porphyria (AIP)

A

Disorders of haem metabolism, - neurological and psychiatric manifestations
no rash + abdo pain, neuropathies and constipation.

Diclofenac can precipitate an episode.
Test = increase urinary porphibilnogen during attacks. tx = reduc haem sythentis, administed haemin

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6
Q

Autoimmune encephalitis presenting as psychosis
vulnerable receptors:

A
  • Voltage Gated Potassium Channel complex (LGI1, CASPR2, contactin-2)
  • N-Methyl-D-aspartate receptor (NMDA)
  • AMPA receptor
  • GABA-B
  • Glycine receptor
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7
Q

Anti-NMDA receptor (NMDAR) encephalitis.

A

These antibodies result in destruction of ** synaptic NMDAR ** through crosslinking and internalisation. females > men
* 50% have underlying ovarian teratoma
prodromal - fever, headache, malaise

**Tests **

  1. serum NMDAR and VGKC abodies
  2. EEG and MRI brain
  3. ANA, cRP, ESR, U+E (low NA)
  4. CSF analysis
  5. feamles US/CT pelvis

Treatment
1. 3 days methylprednisolone + 5 days plasma exchange and reminssion with steroid plus rituximab

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8
Q

Anorexia
- physical abnormalities

A

endocrine
- Low LH, FSH and oestradiol
-Low T3, T4 in low normal range, normal TSH (low T3 syndrome)
- Mild increase in plasma** cortisol**
- Raised growth hormone conc
- Severe hypoglycaemia (rare)
- Low leptin (but possibly higher than would be expected for bodyweight)
cardiovascular
- prolonged Q-T

GI- dlayed gastric emptying

Haem- normocytic anaemia, leucopenia, thormbocytopenia

BMI = kg / height in m squared. underweight is under 18.5

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9
Q

alcohol use disorder - most sensitive test for heavy use

A

Carbohydrate Deficient Transferrin
(CDT), the CDT is the single most specific and sensitive test for detecting heavy alcohol use over last 10 days

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10
Q

Risk factors for prolonged QTc include

A
  • Congenital long Q-T syndrome,
  • Underlying heart disease, bradycardia, heart failure, and ischemic disease
  • Female gender, Extremes of age,
  • Presence of liver disease,
  • Electrolyte abnormalities (hypokalemia, hypocalcemia and hypomagnesemia),
  • Illicit drug use (principally stimulants),
  • Starvation or anorexia,
  • High physical exertion (agitation),
  • High dosages of the drug contributing to the lengthened Q-T interval, and
  • Rapid infusion of torsadogenic drugs
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11
Q

Renal disturbances in IV drug users:

A

Cocaine and heroin abuse = linked to nephrotic syndrome, acute glomerulonephritis, amyloidosis, interstitial nephritis, and rhabdomyolysis.
* Heroin –> nephropathy presents with = puffy face, hypertension, and weight gain.
* Infective endocarditis, HIV, HBV, and HCV infections can cause renal damage similar too
* racial differences in glomerular pathologies
* focal segmental glomerulosclerosis in Black patients
* membranoproliferative glomerulonephritis in White patients

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12
Q

SIADH and related disorders:

A

SIADH can be induced by antidepressants or antipsychotics,
* psychogenic polydipsia = excessive water consumption occurs without an underlying organic cause.
* Diabetes insipidus may result from lithium (nephrogenic) or head injury (central).
* Urine analysis = essential in diagnosing

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13
Q

-standard screening instrument for
dementia

clock drawing test

addenbrookes (ACE)

A

MMSE: The Mini-Mental State Examination (MMSE)
introduced by Folstein in 1976

clock- watson.

addenbrookes-Frontal tests such as verbal fluency are also included in the ACE, making it more sensitive
to frontal types of dementia than MMSE

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14
Q

Magnetic Resonance Spectroscopy –MRS

Functional magnetic resonance imaging

A
  • It can detect several biologically important nuclei with an odd number of protons and neutrons.
    e.g.measure concentrations of
    psychotherapeutic drugs such as lithium in the brain
  • FMRI- is a Blood Oxygen Level Dependent (BOLD) technique. Is a proxy measure of tissue activity
    No radioactive isotopes are administered in fMRI
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15
Q

Single Photon Emission Computed Tomography - SPECT

A

* uses radioactive compounds to study regional differences in cerebral blood flow within the brain
* records the pattern of photon emission from the bloodstream which varies according to the level of perfusion
* uses compounds labeled with single photon-emitting isotopes:** iodine-123,
technetium-99m, and xenon-133.**

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16
Q

Positron Emmission Tomography (PET)

Diffusion tensor imaging

A
  • PET = used to study blood flow, receptor distribution and metabolic activity of brain tissue.
  • 2 particles are emitted so more precise than SPECT. The most commonly employed ligand is [18F] fluorodeoxyglucose

DTI -combines the principles of nuclear magnetic resonance and molecular diffusion
* TI allows multiple (e.g. 16) gradients .

  • From DTI, mathematical measures such as the Fractional Anisotropy (FA) can be calculated. = an index of the integrity of white matter.
17
Q

Neuroimaging findings in depression

A
  • Periventricular and deep WM hyperintensities
  • Subcortical – thalamic and striatal hyperintensities
  • Decreased frontal + basal ganglia volumes
  • Decreased metabolism in prefrontal cortex, Anterior cingulate & amygdale
  • Higher prefrontal metabolism (esp. anterior cingulate) predict better treatment response
  • Higher 5HT2A receptor density – higher dysfunctional negative thoughts
  • Increased MAO-A activity (F>M)
  • Elevated D2 binding in untreated depression – psychomotor retardation
  • Therapeutic dose of SSRIs- 80% 5HT transporters occupied
18
Q

Neuroimaging findings in schizophrenia

A
  • ventricular enlargement
  • Loss of grey matter
  • Progressive loss of brain volume in first few years of diagnosis
  • fMRI reveals poor DLPFC activation in executive tasks
  • Decreased NAA (N-Acetyl aspartate) in PFC (neuronal loss) in MRS
  • Widespread reduction in DTI (diffusion tensor) – fractional anisotropy: frontal and corpus
    callosum – more in chronic treated patients
19
Q

Neuroimaging findings in Alzheimer’s

A
  • Ventricular enlargement
  • Loss of temporal lobe volume – especially hippocampus
  • Decreased parieto-temporal fMRI activation and SPECT blood flow
20
Q

Neuroimaging findings in OCD

A
  • Both reduced and increased volumes of caudate nuclei reported.
  • Higher caudate blood flow due to increased metabolism.
  • This reduces after effective treatment of the OCD
21
Q

Neuroimaging findings from childhood onset schizophrenia (COS)

A
  • progressice reduction in frontal and temporal lobe.
  • profound early reduction in parietal lobe in COS
  • ventricular enlargement at baseline and slower growth rates of white matter are also noted
22
Q

wilsons disease
known as?
ceruloplasmin is?

A

known as hepatocerebral degeneration
ceruloplasmin levels are typically low because of impaired copper transport
CU deposits - particularly in the lenticular nucleus, leading to neurological symptoms like tremors, dystonia, and parkinsonism. NOT dementia

23
Q

what is a healthy weight to height ratio?

A

A ratio between 0.4 and 0.49 is generally considered healthy, as it indicates a lower risk of obesity-related health conditions.

24
Q

Obsessions

Compulsions

A

obsessions → urges, images, or thoughts
Compulsions → acts (motor or mental)

25
Q

elevated Vanillylmandelic acid in urine?

A

Elevated VMA in urine = associated with pheochromocytoma

26
Q

what mH condition is PCOS associated with?

A

Bulimia nervosa