Day 4 Flashcards by Patrick Robbins

4 NMDA Receptor Antagonist Illicit Drugs

Ketamine
DXM
PCP
Nitrous Oxide

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Turner’s Syndrome (chromosome and result)

Missing sex chromosome, XO, so absent/minimal development of gonads/sex hormones
So female but no secondary sexual characteristics

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Klinefelter’s (chromosome and result)

XXY
Male, but bc of second X, don’t have strong male characteristics
Underdeveloped gonads, infertile, +breast tissue

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Myasthenia Gravis Mech

AI attack on postsynaptic nAch Rs on muscle

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MG 3 “Dys” Sx

Diplopia, dysarthria, dysphagia, and just general bulbar palsy/fatigue signs

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DTRs in MG

Preserved

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MG Tumor Association

10% associated w/ thymoma

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MG 3 Diagnostic Studies

Edrophonium (Tensilon): short acting cholinergic, so relieves
EMG/Nerve Conduction: decreased amplitude on rapid repetitive muscle stimulation
Serum Ab Titers

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MG Treatments (1 + other category)

Pyridostigmine, but can also use generalize immunosuppressive so like plasmapheresis, IVIG, steroids, azathioprine

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Delirium EEG

Generalized slow activity consisting of delta and theta waves w/ focal areas of hyperactivity

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Absence Seizures EEG

3-per-second spike and wave pattern

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Gowers’ maneuver

Sign of muscular dystrophy, using hands to get up from seated position

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Duchenne’s inheritance pattern / problem

AR, lack of dystrophin (muscle membrane protein)

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Duchenne’s 4 sx + 1 lab finding

Muscle weakness (greater proximally)
Diminished DTRs
ID in 1/3 of cases
Enlarged calf muscles due to fat infiltration
- Elevated CPK

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Fetishistic Disorder

A person (usually male) gains sexual arousal from an inanimate object

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Temporal (Giant Cell) Arteritis Other Associated Ds

Approx 25% have polymyalgia rheumatica

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Temporal Arteritis Worst Complication

Central Retinal Artery Occlusion

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Temporal Arteritis Test: First and Gold-Standard

Gold: Temporal artery biopsy

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Temporal Arteritis Tx

Prednisone

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SAH Work-Up

First CT, then, if negative, LP to look for CSF xanthochromia

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Emil Kraepelin

Pioneered mental disorders have different outcomes: differentiated course of chronic schizophrenia from manic psychosis

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Eugen Bleuler (2)

Renamed dementia praecox as schizophrenia and realized didn’t need to have deteriorating course

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Heinz Kohut

Wrote about narcissism and self-psychology

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Illness Anxiety D/o vs. Somatic Sx D/o

Illness anxiety: convinced have a disease despite negative w/u and reassurance from docs
Somatic Sx: 1+ somatic sx that are distressing or disrupt daily life, often w/ excessive thoughts/feelings/behaviors/anxiety/time

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Cluster HAs demographics

Male, 20s-30s

Cluster HA Cyclical Pattern

Often spring or fall, 3-12 weeks

Cluster HA Duration and Time of Day

Usually < 3 hours, nocturnal

Cluster HA Trigger

ETOH Consumption

Cluster HA Abortive Tx (3)

O2 Sumatriptan SubQ Ergotamine

Cluster HA Prophylactic Tx (5)

``` Prednisone Verapamil Depakote Methysergide Lithium ```

Methylphenidate CYP

1A2, so will increase clozapine, TCAs, prob olanzapine

SSRI Hyponatremia Mech

SIADH

Dermatomyositis (2 sx, lab finding, biopsy, and association)

Muscle weakness and purplish skin rash on face/eyelids/joints Elevated CPK Bx: Perifascicular atrophy and "ghost fibers" Associated w/ neoplasm in 50%

Polydipsia Intoxication Sx (7)

``` Tremor Ataxia Restlessness Diarrhea Vomiting Polyuria Eventually stupor ```

Schizophrenia Prodrome Prognostically

Longer, more insidious prodrome associated w/ worse prognosis. Acute onset = better prognosis

Sleep Stages in Depression (5)

``` Decreased REM Latency Increased REM concentration Increased length of first REM sleep Decreased Stage IV Sleep Increased awakening during 2nd half of night ```

AD Apolipoprotein Problem Allele (& Chr)

Homozygosity for E4 allele of Apo, on Chr 19

Acute Stress Disorder vs. PTSD Timeframe

1 month

Metabolic Concern in AN

Hypokalemic hypochloremic alkalosis (can lead to arrhythmias and sudden death)

Social Anxiety D/o vs. Avoidant PD

SAD: Specific social situations invoke intense anxiety + fear of embarrassment/humiliation Avoidant PD: Pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation. View self as personally unappealing and can also interfere w/ intimate relationships due to fear of shame/judgment

Phenytoin Sfx (3 + 1 long-term)

Hirsutism Facial dysmorphism Gingival hypertrophy Cerebellar atrophy long-term, w/ all associated sx

Saturday Night Palsy

Radial nerve entrapment. Weakness of triceps/wrist+finger extensors/supinator. Might take 1-2 months to resolve

Carpal Tunnel (nerve + test)

Median nerve entrapment | EMG/nerve conduction - delayed across wrist

Sodium oxybate (Xyrem)

FDA approved for cataplexy associated w/ narcolepsy. Essentially GHB (wtf?)

Chronic Fatigue Syndrome Duration Requirement

6 mo

Chronic Fatigue Syndrome 6 Associated Sx

``` Poor sleep Muscle pain HAs Impaired memory/concentration Joint pain Postexertive malaise > 24h ```

Chronic Fatigue Syndrome Improvement

Lying down

Chronic Fatigue Syndrome Associated Ds

Depression 80%

Chronic Fatigue Syndrome Treatment (2)

Graded exercise therapy and CTB

Sex Play Onset

Can start before puberty

Fragile X Appearance (5)

``` Long ears Narrow face Short stature Hyperextendable Joints Macroorchidism ```

FAS Face Characteristics (7)

``` Epicanthal folds Short palpebral fissures Flat/low nasal bridge Short/upturned nose Smooth philtrum Thin upper lip "Railroad track" ears ```

Depakote and Lamotrigine CYP Interaction

Depakote inhibitor of 3A4, so super increased levels of lamotrigine

Selegiline MAO Selectivity

Selectively MAO-B at lower doses

GI Tract MAO

MAO-A

Cocaine Long-Term NT Effect

Hypodopaminergic state (bc blocks reuptake, so decreased recycling), can last for > 1 yr after d/c

4 DA Agonists

Pergolide Bromocriptine Ropinirole Pramipexole

Buspirone Mech

5HT 1A Partial Agonist

SGA with SNRInhibition

Ziprasidone

2 Rs blocked by all SGAs

D2 | 5HT 2A

Serotonergic Cell Bodies Site

Raphe nuclei, primarily in pons

Wilson's Ds 5 Neurologic Sx

``` Parkinsonism Flapping tremor Dystonia Ataxia Bulbar Signs (dysphagia/dysarthria) ```

Wilson's Ds Chromosome Association

Chr 13