EMQ Part 4 Flashcards
Patient believes stranger is their parent
?capgras, ganser, concrete thiking, de clerambault, echolalia, mitmachen, echopraxia, othello sx, intermetamorphosis, fregolli’s
Fregoli’s
Reduplicative paramnesia-> patiet believes surroundings exist in more than 1 physical environment
Pt believes spouse in unfaithful
?capgras, ganser, concrete thiking, de clerambault, echolalia, mitmachen, echopraxia, othello sx, intermetamorphosis, fregolli’s
Othello syndrome
Fusiform gyrus
?anosognosia, visual agnosia, agraphognosia, broca’s aphasia, deficits in executive functioning, ideomotor aprxia, astereognosia, wernicke’s aphasia,prosopagnosia, simultagnosia
Psoropagnosia
Dominant parietal lobe
?anosognosia, visual agnosia, agraphognosia, broca’s aphasia, deficits in executive functioning, ideomotor aprxia, astereognosia, wernicke’s aphasia,prosopagnosia, simultagnosia
Ideomotor apraxia
inability to carry out requested movement properly
Ideation- unable to carry out coordinated sequences of actions - taking match box and lighting it.
Dressing apraxia- non dominant.
Conduction apraxia- greater impairment when imitating movements than when pantomiming to command
Concetual- make content and tool selection errors. Cannot recall type of actions associated with certain tools.
Failure to recognise the whole of a complex picture, while being able to identify individual parts
?anosognosia, visual agnosia, agraphognosia, broca’s aphasia, deficits in executive functioning, ideomotor aprxia, astereognosia, wernicke’s aphasia,prosopagnosia, simultagnosia
Simultagnosis- occurs in Balint’s syndrome (occulomotor apraxia and optic ataxia) and involves lesions of posterior occipitoparietal lobe
Posterior superior temporal gyrus
?anosognosia, visual agnosia, agraphognosia, broca’s aphasia, deficits in executive functioning, ideomotor aprxia, astereognosia, wernicke’s aphasia,prosopagnosia, simultagnosia
Wernicke’s aphasia
Dorsolateral frontal lobe
?anosognosia, visual agnosia, agraphognosia, broca’s aphasia, deficits in executive functioning, ideomotor aprxia, astereognosia, wernicke’s aphasia,prosopagnosia, simultagnosia
Deficits in executive functioning
Face recognition
?amygdala, pons, medulla oblongata, cerebellar vermis, optic radiation, posterior superior temporal lobe, left inferior frontal corex, nucleus accumbens, fusiform gyrus, hippocampus
Fusiform gyrus
Addiction
?amygdala, pons, medulla oblongata, cerebellar vermis, optic radiation, posterior superior temporal lobe, left inferior frontal corex, nucleus accumbens, fusiform gyrus, hippocampus
Nucleus accumbens
Generation of speech
?amygdala, pons, medulla oblongata, cerebellar vermis, optic radiation, posterior superior temporal lobe, left inferior frontal corex, nucleus accumbens, fusiform gyrus, hippocampus
Left inferior frontal cortex
Fear
?amygdala, pons, medulla oblongata, cerebellar vermis, optic radiation, posterior superior temporal lobe, left inferior frontal corex, nucleus accumbens, fusiform gyrus, hippocampus
Amygdala
Comprehension of language
?amygdala, pons, medulla oblongata, cerebellar vermis, optic radiation, posterior superior temporal lobe, left inferior frontal corex, nucleus accumbens, fusiform gyrus, hippocampus
Posterior superior temporal lobe
Memory
?amygdala, pons, medulla oblongata, cerebellar vermis, optic radiation, posterior superior temporal lobe, left inferior frontal corex, nucleus accumbens, fusiform gyrus, hippocampus
Hippocampus
“What do you mean when you say you have panic attacks”
?interpretation, reinforcement, clarification, re-framing, reflection, empathy, summation, facilitation, open ended, confrontation
Clarification
Before we talk about panic attacks, can I go through what you have told me about your depression, correct me if I a wrong
?interpretation, reinforcement, clarification, re-framing, reflection, empathy, summation, facilitation, open ended, confrontation
Summation
I can see things have been very tough for you recently
?interpretation, reinforcement, clarification, re-framing, reflection, empathy, summation, facilitation, open ended, confrontation
Empathy
Go on..tell me more about it
?interpretation, reinforcement, clarification, re-framing, reflection, empathy, summation, facilitation, open ended, confrontation
Facilitation
Do you think there is the possibility that this impulse to do the opposite of what your mothers asks you, could be related to your angry feelings about her
?interpretation, reinforcement, clarification, re-framing, reflection, empathy, summation, facilitation, open ended, confrontation
Interpretation- making associations that may not be obvious to the patient
Repetition Transition Redirection Limit setting Confrontation Setting traps ( you said you haven't been feeling well, but you spent the whole day at the park)
72 yo M, recovering from L sided hemiplegia following ICHm develops sudden aimless and vigorous swinging movements of trunk and L arm
?catatonia, myoclonus, hemiballismus, automatism, athetosis, cataplexy, akathisia, acute dystonia, huntington’s chorea, catalepsy
Hemiballismus
Middle aged woman complains of an inner restlessness in her legs, and compulsion to move her legs. Diagnosed with Schizophrenia
?catatonia, myoclonus, hemiballismus, automatism, athetosis, cataplexy, akathisia, acute dystonia, huntington’s chorea, catalepsy
Akathisia
20 yo 4 day history not speaking, eating or moving. Past few months, become withdrawn and deteriorating grades. Stopped attending college 1 month ago
?catatonia, myoclonus, hemiballismus, automatism, athetosis, cataplexy, akathisia, acute dystonia, huntington’s chorea, catalepsy
Catatonia
Ix cause- full bloods, brain imaging, EEG (non convulsive status epilepticus, encephalopathic)
Lorazepam 1-2 mg q3H
ECT consider if minimal response to Benzo
Also treatment of choice for those with lethal/malignant catatonia, discussed by Fink
45 yo M, 1 yr dizziness, memory impairment, father had jumpy movement of arms
?catatonia, myoclonus, hemiballismus, automatism, athetosis, cataplexy, akathisia, acute dystonia, huntington’s chorea, catalepsy
Huntington’s chorea
Onset in middle life, can occur as early as 20, as late as 70-80
Phenomenon of anticipation. AD inheritance 100%.
Hypometabolism in caudate or putamen (PET scan)
death in 10-20 years
Clinical features- motor sx: bradykinesia, rigidity, gait disturbance, dysarthria, dysphagia, involuntary movement0 chorea, athetosis, dystonia, myoclonus and motor restlessness. Cognitive impairment.
Subcortical dementia- aphasia, apraxia, agnosia
Psychiatric sx may precede onset of movement disorder or cognitive impairment. Apathy, aggression, irritability, poor impulse control. Depressive illness common. High rate of suicide.
32 yo secretary presents with history of sudden falls, when she drops anything that she is holding at the time. Episodes occur when she is emotionally excited. her supervisor is cross with her because he has seen her sleeping on her desk on occasions
?catatonia, myoclonus, hemiballismus, automatism, athetosis, cataplexy, akathisia, acute dystonia, huntington’s chorea, catalepsy
Cataplexy
60 yo man referred with a history of worsening memory and urinary incontinence. Broad based, short stepped gait
?alcoholic dementia, CJD dementia, dementia in huntingtons, NPH, AD, multi-infarct dementia, CADASIL, depressive pseudodementia, dementia with LBD, dementia with Pick’s disease
Normal pressure hydrocephalus
GP refers an 85 yo with hx of strange things, dizziness, repeated falls, occasional LOC
?alcoholic dementia, CJD dementia, dementia in huntingtons, NPH, AD, multi-infarct dementia, CADASIL, depressive pseudodementia, dementia with LBD, dementia with Pick’s disease
Dementia with Lewy Body
Brought by his wife, 68 yo man with depression and confusion in night for past 4 months. He is fine some days, very anxious other days. On examination, he has brisk reflexes, spastic weakness of left lower limb and extensor plantar response
?alcoholic dementia, CJD dementia, dementia in huntingtons, NPH, AD, multi-infarct dementia, CADASIL, depressive pseudodementia, dementia with LBD, dementia with Pick’s disease
Multi-infarct dementia: white matter lesions, may appear as periventricular lucency (leucoaraiosis) or as deep white matter hyperintensities and central gray matter lacunae
Hachinski index to distinguish multi-infarct from AD
Abrupt onset, stepwise deterioration, fluctuating course, focal neurological signs and symptoms are important signs.
35 yo M presents with repeated strokes and recurrent migraine. He describes his uncle on the paternal side with similar symptoms
?alcoholic dementia, CJD dementia, dementia in huntington’s, NPH, AD, multi-infarct dementia, CADASIL, depressive pseudodementia, dementia with LBD, dementia with Pick’s disease
CADASIL
Cerebral Autosomal Dominant Arteriopathy with subcortical infarcts and leukoencephalopathy
Mutations on NOTCH3 gene on xsome 19
Presents with migraine and recurrent small subcortical infarcts.
TIA’s and affective disturbance
Daughter brings 58 yo M who lives with her, hx of becoming increasingly withdrawn, flattened mood over past months. Hx depression. Lately, memory has been deteriorating. Un-cooperative for MMSE.
?alcoholic dementia, CJD dementia, dementia in huntington’s, NPH, AD, multi-infarct dementia, CADASIL, depressive pseudodementia, dementia with LBD, dementia with Pick’s disease
Depressive pseudodementia
Raven’s progressive matrices
?pre-morbid intelligence, executive function, language, parietal lobe, non verbal intelligence, brain damage, memory, visual memory, sensory inattention, perception
Non verbal intelligence
Rey Osterrieth Test
?pre-morbid intelligence, executive function, language, parietal lobe, non verbal intelligence, brain damage, memory, visual memory, sensory inattention, perception
Visual memory
widely used neuropsychological test for evaluation of visiospatial constructional ability and visual memory
Wisconsin card sorting test
?pre-morbid intelligence, executive function, language, parietal lobe, non verbal intelligence, brain damage, memory, visual memory, sensory inattention, perception
Executive function
National adult reading test
?pre-morbid intelligence, executive function, language, parietal lobe, non verbal intelligence, brain damage, memory, visual memory, sensory inattention, perception
Pre-morbid intelligence
Halstead-Reitan Battery
?pre-morbid intelligence, executive function, language, parietal lobe, non verbal intelligence, brain damage, memory, visual memory, sensory inattention, perception
Brain damage
25 yo woman working as a marketing executive complains of extreme anxiety in public. Has to give a presentation to her company colleagues in 2 months
?therapeutic community, group psychotherapy, counselling, systematic desensitisation, mindfullness, interpersonal psychotherapy, trauma debriefing, cognitive analytic therapy, supportive psychotherapy, trauma focused CBT
Systematic desensitisation- graded exposure
55yo F recently lost her father, change her job, complains of depression
??therapeutic community, group psychotherapy, counselling, systematic desensitisation, mindfullness, interpersonal psychotherapy, trauma debriefing, cognitive analytic therapy, supportive psychotherapy, trauma focused CBT
Interpersonal psychotherapy
25 yo recently returned from duty in Iraq, complains of traumatic images and memories, along with feeling on edge
?therapeutic community, group psychotherapy, counselling, systematic desensitisation, mindfullness, interpersonal psychotherapy, trauma debriefing, cognitive analytic therapy, supportive psychotherapy, trauma focused CBT
Trauma focused CBT
34 yo severe alcohol dependence not benifitting from individual therapy
?therapeutic community, group psychotherapy, counselling, systematic desensitisation, mindfullness, interpersonal psychotherapy, trauma debriefing, cognitive analytic therapy, supportive psychotherapy, trauma focused CBT
Therapeutic community
65 yo woman been on treatment for depression, presents to A&E on July afternoon, complaining of nausea and dizziness. Hx of lethargy, weight loss, poor memory and cramps. Also takes water tablets
?torsade, clozapine induced myocarditis, hyponatremia, carbamazepine induced agranulocytosis, discontinuation, clozapine related PE, adverse reaction to lithium, NMS, lithium toxicity, serotonin syndrome
Hyponatremia- risk of SIADH
24 yo M aditted 3 days prior with severe acute psychotic episode develops hyperpyrexia, muscular rigidity, profuse sweating and disorientation
?torsade, clozapine induced myocarditis, hyponatremia, carbamazepine induced agranulocytosis, discontinuation, clozapine related PE, adverse reaction to lithium, NMS, lithium toxicity, serotonin syndrome
NMS
35 yo F on paroxetine 2 years. Presents to ED with flu-like sx, insomnia, vivid dreams, irritability and tear-fullness. Described “shock like sensations” and dizziness exacerbated by movements?torsade, clozapine induced myocarditis, hyponatremia, carbamazepine induced agranulocytosis, discontinuation, clozapine related PE, adverse reaction to lithium, NMS, lithium toxicity, serotonin syndrome
Discontinuation syndrome
40 yo with lithium resistant bipolar presents with fever, sore throat, skin rash and mouth ulcers. Bloods show low WCC. He went on another mood stabiliser recently
?torsade, clozapine induced myocarditis, hyponatremia, carbamazepine induced agranulocytosis, discontinuation, clozapine related PE, adverse reaction to lithium, NMS, lithium toxicity, serotonin syndrome
Carbamazepine induced agranulocytosis
35 yo on Cloz for 2 months, presents with fainting episodes, chest pain, tachyC, SOB, increased temp, leg swelling. ECG shows ST and T wave changes
?torsade, clozapine induced myocarditis, hyponatremia, carbamazepine induced agranulocytosis, discontinuation, clozapine related PE, adverse reaction to lithium, NMS, lithium toxicity, serotonin syndrome
Clozapine induced myocarditis
Structurally similar to GABA and used in epilepsy
?Valproate, paliperidone, vigabatrin, buspirone, aripiprazole, moclobemide, gabapentin, agomelatine, ziprasidone
Gabapentin
Antipsychotic that bypass hepatic metabolism
?Valproate, paliperidone, vigabatrin, buspirone, aripiprazole, moclobemide, gabapentin, agomelatine, ziprasidone
Paliperidone
5HT2A and 5HT2C antagonist
?Valproate, paliperidone, vigabatrin, buspirone, aripiprazole, moclobemide, gabapentin, agomelatine, ziprasidone
Mirtazapine
Partial agonist at 5HT1A
?Valproate, paliperidone, vigabatrin, buspirone, aripiprazole, moclobemide, gabapentin, agomelatine, ziprasidone
Buspirone
Melatonin agonist and 5HTC antagonist
?Lamotrigine, agomelatine, donepezil, sildenafil, lithium, rivastigmine, citalopram, zolpedem, methadone, galantamine
Agomelatine
Acting on voltage gated Na channels, modulating glutamate
?Lamotrigine, agomelatine, donepezil, sildenafil, lithium, rivastigmine, citalopram, zolpedem, methadone, galantamine
Lamotrigine
Acts on w receptors
?Lamotrigine, agomelatine, donepezil, sildenafil, lithium, rivastigmine, citalopram, zolpedem, methadone, galantamine
Zolpidem w is the associated BZD receptor site
ACE INHIBITORS with nicotine agonist properties
?Lamotrigine, agomelatine, donepezil, sildenafil, lithium, rivastigmine, citalopram, zolpidem, methadone, galantamine
Galantamine (irreversible)
Donepezil is reversible
Phosphodiesterase inhibitor
?Lamotrigine, agomelatine, donepezil, sildenafil, lithium, rivastigmine, citalopram, zolpidem, methadone, galantamine
Sildenafil
Trisomy with greatest risk of AD in adulthood
?Turner’s, Klinefelters, prader willi, angelman’s, fragile X, downs, XYY, edward’s, retts, VCF
Down’s syndrome
Chromosome 15 deletion of maternal origin
?Turner’s, Klinefelters, prader willi, angelman’s, fragile X, downs, XYY, edward’s, retts, VCF
Angelman’s syndrome is charavterised severe developmental delay or intellectual disability, severe speech impairment, gait apraxia, tremulousness of the limbs, unique behaviour with an appropriate (Happy Puppet Syndrome)
Prader Willi is xsome 15 deletion of paternal origin
This genetic condition has high association with schizophrenia like
?Turner’s, Klinefelters, prader willi, angelman’s, fragile X, downs, XYY, edward’s, retts, VCF psychosis
VCF syndrome- Di George, 22q11 deletion CATCH22. microdeletion from xsome 22 at q11.2 band
CGG trinucleotide repeat
?Turner’s, Klinefelters, prader willi, angelman’s, fragile X, downs, XYY, edward’s, retts, VCF
Fragile X
FMR1
most common cause of ID in males, and most common single gene cause in autism
Cryotoorchidism, overeating and obesity
?Turner’s, Klinefelters, prader willi, angelman’s, fragile X, downs, XYY, edward’s, retts, VCF
Prader Willi
paranoid delusions and insects crawling under skin
?head injury, cocain intox, wernickes, opiate intox, alcohol w/d, cannabis w/d, alcohol intox, korsakoffs psychosis, opiate w/d, amph w/d
Cocaine intoxication
25 yo homeless F agitation, NV, abdominal craps, runny nose. Multiple needle marks
?head injury, cocain intox, wernickes, opiate intox, alcohol w/d, cannabis w/d, alcohol intox, korsakoffs psychosis, opiate w/d, amph w/d
Opiate w/d
50 yo alcohol dependence presents with severe headache and unequal pupils
?head injury, cocain intox, wernickes, opiate intox, alcohol w/d, cannabis w/d, alcohol intox, korsakoffs psychosis, opiate w/d, amph w/d
Head injury
Epilepsy and Ash leaf spots
?tuberous sclerosis, retts, autism, FAS, lawrence moon beidi syndrome, wilsons, Fragile X, downs, prader will, phenylketonuria
Tuberous sclerosis
AD neurocutaneous syndrome
multiple hamartomas
2/3 sporadic mutations
Triad- seizures, mental retardation and cutaneous angiofibromas
TSC1 gene on xsome 9 and TSC 2 on xsome 16 (tumor suppressor geners)
Autosomal recessive associated with psychosis and parkinsonian
?tuberous sclerosis, retts, autism, FAS, lawrence moon beidi syndrome, wilsons, Fragile X, downs, prader will, phenylketonuria
Wilsons
xsome 13
kayser fleisher, low serum ceruloplasmin, +hepatic copper
chelating agents/zinc
Mental retardation due to deficiency in phenylalanine hydroxylase enzyme
?tuberous sclerosis, retts, autism, FAS, lawrence moon beidi syndrome, wilsons, Fragile X, downs, prader will, phenylketonuria
Phenyketonuria
Autosomal recessive PAH
xsome 12
Mental retardation and high social anxiety
?tuberous sclerosis, retts, autism, FAS, lawrence moon beidi syndrome, wilsons, Fragile X, downs, prader will, phenylketonuria
Fragile X
3 yo normal development up to 6-18 months, shows progressive loss of language and motor milestones with microcephaly
?tuberous sclerosis, retts, autism, FAS, lawrence moon beidi syndrome, wilsons, Fragile X, downs, prader will, phenylketonuria
Retts
Females- severe intellectual disability
MECP2- most common mutation
CDKL5
30 yo F depression and anxiety. Headaches, joint pain, peculiar rash
?neurosarcoidosis, huntingtons, hepatic encephalopathy, MS, Partial complex seizures, tuberous sclerosis, SLE, meningitis, borrelia burgdorgeri
SLE
55 yo M, ED with confusion, difficulty remembering and paranoia. Rash on arm with bright red spots. On holidays from America
?neurosarcoidosis, huntingtons, hepatic encephalopathy, MS, Partial complex seizures, tuberous sclerosis, SLE, meningitis, borrelia burgdorgeri, herpes simplex encephalitis
Borrelia burgorferi- Lyme disease.
Latency period
meningitis, encephalitis, cranial neuritis, radiculoneuropathies.
57 yo F acute confusion on EEG has diffuse slowing, MR showing temporal lobe swelling bilaterally
?neurosarcoidosis, huntingtons, hepatic encephalopathy, MS, Partial complex seizures, tuberous sclerosis, SLE, meningitis, borrelia burgdorgeri
Herpes simplex encephalitis
acute or subacute
general and focal signs of cerebral dysfunction
PCR assay of CSF for HSV1, HSV 2
QTc >500
?sertindole, hypokalemia, hypocalcemia, haloperidol, HERG, ziprasidone, hyperkalemia, hypercalcemia, thiordiazine, hypothyroidism
Sertindole
U waves
?sertindole, hypokalemia, hypocalcemia, haloperidol, HERG, ziprasidone, hyperkalemia, hypercalcemia, thiordiazine, hypothyroidism
Hypokalemia
most common cause of prominent U waves in bradycardia
Tented T waves
?sertindole, hypokalemia, hypocalcemia, haloperidol, HERG, ziprasidone, hyperkalemia, hypercalcemia, thiordiazine, hypothyroidism
Hyperkalemia
Torsade de pointes
?sertindole, hypokalemia, hypocalcemia, haloperidol, HERG, ziprasidone, hyperkalemia, hypercalcemia, thiordiazine, hypothyroidism
HERG (KCNH2)- responsible for channels mediating the ‘rapid’ delayed rectifier K+ current which plays an important role in ventricular depolarisation
In young person with torsade, diagnosis of congenital long QT should be considered, esp if family history of sudden cardiac death or sudden infant death syndrome
Caffeine competitively inhibits this enzyme
?bioequivalence, bioavailability, CYP1A2, therapeutic index, CYP2D6, therapeutic window, zero order kinetics, glucorinidation, CYP3A4, first order kinetics
CYP1A2
fluvoxamine and grapefruit juice are potent inhibitors
involved in metabolism of clozapine and olanzapine
Phenytoin follows this type of clearance
?bioequivalence, bioavailability, CYP1A2, therapeutic index, CYP2D6, therapeutic window, zero order kinetics, glucorinidation, CYP3A4, first order kinetics
zero order
lithium, depot, alcohol
Part of phase 2 metabolism of drugs
?bioequivalence, bioavailability, CYP1A2, therapeutic index, CYP2D6, therapeutic window, zero order kinetics, glucorinidation, CYP3A4, first order kinetics
Glucorinidation
Paroxetine is a strong inhibitor
?bioequivalence, bioavailability, CYP1A2, therapeutic index, CYP2D6, therapeutic window, zero order kinetics, glucorinidation, CYP3A4, first order kinetics
CYP2D6 30% east africans ultra metabolisers fluoxetine also potent inhibitor Risperidone mainly metabolised by this enzymre Codeine metabolised
Carbamazepine in strong inducer
?bioequivalence, bioavailability, CYP1A2, therapeutic index, CYP2D6, therapeutic window, zero order kinetics, glucorinidation, CYP3A4, first order kinetics
CYP3A4
enzyme involved in quetiapine and ziprasidone + 35% metabolism of clozapine
Induced by carb, phenytoin, barbiturates and rofapicin.
erythromycin, ketoconazole, protease inhibitors inhibit
Measure of the comparability of plasma levels of different formulations of same active drug
?bioequivalence, bioavailability, CYP1A2, therapeutic index, CYP2D6, therapeutic window, zero order kinetics, glucorinidation, CYP3A4, first order kinetics
Bioequivalence
Bioavailability- amount that reaches systemic circulation
Ratio of minimum plasma concentration causing toxic effects to that causing a therapeutic effect
?bioequivalence, bioavailability, CYP1A2, therapeutic index, CYP2D6, therapeutic window, zero order kinetics, glucorinidation, CYP3A4, first order kinetics
Therapeutic index
Therapeutic window is well defined range of drugs serum concentration at which desired effect occurs. Below little effect, above is toxicity
You mentioned that your husband enjoys fishing. What about you, what sort of things do you enjoy?
Summation, compound questions, facilitation, confrontation, limit setting, interpretation, transition, setting traps, self revelation, redirection
Transition
I’m going to have to interrupt you as we need to cover a few important things today
Summation, compound questions, facilitation, confrontation, limit setting, interpretation, transition, setting traps, self revelation, redirection
Limit setting
Your liver function test have come back elevated. Is it possible you have been drinking?
Summation, compound questions, facilitation, confrontation, limit setting, interpretation, transition, setting traps, self revelation, redirection
Confrontation
You said things were not going well for you, but youve just state that you have got a good job
?Summation, compound questions, facilitation, confrontation, limit setting, interpretation, transition, setting traps, self revelation, redirection
Setting traps
How has your appetite and sleep been lately? Do you have enough energy when you wake up?
Summation, compound questions, facilitation, confrontation, limit setting, interpretation, transition, setting traps, self revelation, redirection
Compound questions
Warfarin
?naloxone, physostigine, vit K, BAL chelation, pyridoxine, hyperbaric oxygen, naltrexone, sodium bicarb, atropine, glucagon
Vitamin K
Amitryptiline
?naloxone, physostigine, vit K, BAL chelation, pyridoxine, hyperbaric oxygen, naltrexone, sodium bicarb, atropine, glucagon
Sodium bicarb
Benztropine
?naloxone, physostigine, vit K, BAL chelation, pyridoxine, hyperbaric oxygen, naltrexone, sodium bicarb, atropine, glucagon
Physostigmine
Carbon monoxide poisoning
?naloxone, physostigine, vit K, BAL chelation, pyridoxine, hyperbaric oxygen, naltrexone, sodium bicarb, atropine, glucagon
Hyperbaric oxygen
Beta blockers
?naloxone, physostigine, vit K, BAL chelation, pyridoxine, hyperbaric oxygen, naltrexone, sodium bicarb, atropine, glucagon
Glucagon
Seen in cerebellar lesions where patient in unable to perform rapid alternating movements
?brudzinski’s sign, weber’s test, dysdiadochokinesis, gower sign, babinski’s sign, dysmetria, chovostek’s sign, myerson sign, kernig’s sign, asterixis
Dysdiadochokinesis
Sign in meningitis, knees and hips flex on flexing neck
?brudzinski’s sign, weber’s test, dysdiadochokinesis, gower sign, babinski’s sign, dysmetria, chovostek’s sign, myerson sign, kernig’s sign, asterixis
Brudzinski’s
sign in metabolic encephalopathies
?brudzinski’s sign, weber’s test, dysdiadochokinesis, gower sign, babinski’s sign, dysmetria, chovostek’s sign, myerson sign, kernig’s sign, asterixis
Asterixis
Seen in severe myopathies, when patient attempts to stand up from floor by climbing up the legs to push themselves up
?brudzinski’s sign, weber’s test, dysdiadochokinesis, gower sign, babinski’s sign, dysmetria, chovostek’s sign, myerson sign, kernig’s sign, asterixis
Gower sign
Patient continues to blink with repeated glabellar taps
?brudzinski’s sign, weber’s test, dysdiadochokinesis, gower sign, babinski’s sign, dysmetria, chovostek’s sign, myerson sign, kernig’s sign, asterixis
Myerson’s sign
In hypocalcemia tapping side of cheek causes facial tetanic contractions
?holmes adie pupil, stepping gait, shuffling gait, marcus gunn, argyll robertson, waddling gait, chovosteks sign, hemiparetic gait, anisocoria
Chovosteks
Trousseaus sign- BP cuff, flexion of wrist, MCPJ, hyperext fingers, flexion of thumb
Neuroexcitability
Paradoxical pupillary reflex
?holmes adie pupil, stepping gait, shuffling gait, marcus gunn, argyll robertson, waddling gait, chovosteks sign, hemiparetic gait, anisocoria
Marcus gunn-> flashing/swinging light test
Gait seen in peripheral neuropathy where patient takes high steps walking on level surface
?holmes adie pupil, stepping gait, shuffling gait, marcus gunn, argyll robertson, waddling gait, chovosteks sign, hemiparetic gait, anisocoria
Stepping gait
Accomodation reflex, slow/absent light reflex. Once pupil has constricted, remains small for abnormally long time. Also has absent deep tendon jerks.
?holmes adie pupil, stepping gait, shuffling gait, marcus gunn, argyll robertson, waddling gait, chovosteks sign, hemiparetic gait, anisocoria
Holmes Adie pupil
considered variation of normal, lay result from lesion in efferent parasympathetic pathway
GAD 1 variation implicated in condition
?SZC, TS, HD, antisocial, angelman, FX, FTD, BPAD, AD, NF
Schizophrenia
22q11- deltion here causes VCFS/Di George
Deletion affects COMT and GRK 3 genes, DISC 1 and DISC 2
Dysbindin, Neureglin
Locus 13q 34 codes for D amino acid oxidases activator and is responsible for susceptibility in this condition
?SZC, TS, HD, antisocial, angelman, FX, FTD, BPAD, AD, NF
Schizophrenia
Depression: Short allele of 5HTTLPR
influences stress reactivity rather than directly causing depression. Short associated with poor efficacy of SSRI
Long has better SSRI efficacy
BPAD- DAOA (G72) and BDNF, SLC6A4, Dopamine transporter, circadian rhythm
Autism-> main geners are engrailed 2 involved in coding protein needed for development of cerebellum SLC6A4
Associated with CGG repeats
?SZC, TS, HD, antisocial, angelman, FX, FTD, BPAD, AD, NF
Fragile x
High MAO-A activity protect against development
?SZC, TS, HD, antisocial, angelman, FX, FTD, BPAD, AD, NF
Antisocial behaviour. Gene on xsome C. 2 variants, high and low activity. High activity protects against AS outcomes esp in maltreated boys and to some extent girls
Xsome 17 linkage associated with condition
?SZC, TS, HD, antisocial, angelman, FX, FTD, BPAD, AD, NF
FTD linked with FTD parkinsonism variant
Single genetic defect producing variety of defects
?endophenotype, alleic heterogeneity, pleiotropy, polymorphism, locus heterogeneity, mitochondrial inheritance, epistasis, serotonin transporter, autosomal dominant
Pleiotropy
From maternal genes only
?endophenotype, alleic heterogeneity, pleiotropy, polymorphism, locus heterogeneity, mitochondrial inheritance, epistasis, serotonin transporter, autosomal dominant
Mitochondrial inheritance
Exchange of genetic material between two chromosomes
?endophenotype, alleic heterogeneity, pleiotropy, polymorphism, locus heterogeneity, mitochondrial inheritance, epistasis, serotonin transporter, autosomal dominant
Epistasis
Any marker that is heritable and present in a high proportion in families having the disease
?endophenotype, alleic heterogeneity, pleiotropy, polymorphism, locus heterogeneity, mitochondrial inheritance, epistasis, serotonin transporter, autosomal dominant
Endophenotype
Phenotypic variation that can be attributable to genetic factors
?endophenotype, alleic heterogeneity, pleiotropy, polymorphism, locus heterogeneity, mitochondrial inheritance, epistasis, serotonin transporter, autosomal dominant
Heritability
how much variation in a trait that is due to variation in genetic factors
Pt has spoken at lengths but has not given adequate information to answer the question
?perseveration, flight of ideas, echolalia, stilted speech, poverty of speech, loss of goal, entgleisen, pressure of speech, tangentiality, poverty of content of speech
Poverty of content of speech
Patient talks rapidly and difficult to interrupt
?perseveration, flight of ideas, echolalia, stilted speech, poverty of speech, loss of goal, entgleisen, pressure of speech, tangentiality, poverty of content of speech
Pressure of speech
Pattern of speech in which ideas slip off the track onto another one that is clearly but obliquely related or onto one that is unrelated
Entgleisen- derailment, loosening of associations, tangential, knights move, entgleisen.
Schneider-> verschmelzung= fusion, faseln= muddling, entgleiten- snapping off, entgleisen= derailment
Persistent repetition of words, ideas or subjects
?perseveration, flight of ideas, echolalia, stilted speech, poverty of speech, loss of goal, entgleisen, pressure of speech, tangentiality, poverty of content of speech
Perseveration
22 yo F with persistent bizarre concern about her forehead being too large. On evaluation, the belief is at delusional intensity
?dysthymia, somatoform, depersonalisation/derealisation, fibromyalgia, BDD, atypical depression, Persistent delusional disorder, neurasthenia, cyclothymia, CFS
Body dysmorphic disorder
25 yo G long standing depression and hypersomnia, hyperphagia and fatigue
?dysthymia, somatoform, depersonalisation/derealisation, fibromyalgia, BDD, atypical depression, Persistent delusional disorder, neurasthenia, cyclothymia, CFS
Atypical depression
35 yo F depressive symptoms post viral. Memory complaints, poor sleep and fatigue. Fatigue Worsened by exertion
?dysthymia, somatoform, depersonalisation/derealisation, fibromyalgia, BDD, atypical depression, Persistent delusional disorder, neurasthenia, cyclothymia, CFS
Chronic fatigue syndrome
severe fatigue >6 months +postexertional malaise, unrefreshing sleep, impaired memory/concentration, muscle pain, polyarthraligia, sore throat, tender lymph nodes, new headaches.
Should evaluate for concurrent depression, pain and sleep disturbance.
CBT, graded exercise therapy. Shown to mod improve fatigue levels, work and social adjustment, anxiety and postexertional fatigue
Protein produced in condition characeterised by ash leaf macules and nodules on brain
?APOE3, 22q 11, APOE 2, pre senilin 1/2, hamartin, 17q 21, huntington’s disease, FX, huntingtin, APOE4
Hamartin-> tuberous sclerosis. TSC1 and TSC2. Tuberin (TSC2) localised in golgi apparatus, may function in vesicular transport. Hamartin (TSC1) unknown
Lipoprotein associated with AD increases risk late onset in dose dependent
?APOE3, 22q 11, APOE 2, pre senilin 1/2, hamartin, 17q 21, huntington’s disease, FX, huntingtin, APOE4
APOE4
FAD-> gene mutation in 21, 14, 1.
21-> APP
14-> PSEN2, 1-> PSEN1
Early onset in 5% AD
Commonest inherited learning disability usually in males, presenting with hand flapping, waving, gaze avidance and social anxiety
?APOE3, 22q 11, APOE 2, pre senilin 1/2, hamartin, 17q 21, huntington’s disease, FX, huntingtin, APOE4
Fragile X
Site of COMT gene linked to DA in frontal cortex
A VAL-VAL polymorphism reduces availability of pre-frontal DA
?APOE3, 22q 11, APOE 2, pre senilin 1/2, hamartin, 17q 21, huntington’s disease, FX, huntingtin, APOE4
22q 11DS
common microdeletion, markedly ++risk of schizophrenia
Cognitive impairment and low IQ, deficits in executive function common in childhood
25 yo F with diagnosis of BPAD presents with fever, blurred vision, muscle fasiculation and vomiting last week.
Recent infectious diarrhea
?lihtium toxicity, schizophreniform psychosis, sydenhams chorea, SCZ, GDL tourettes, porphyria, PANDAS, FTD, NMS, migraine
?lihtium toxicity, schizophreniform psychosis, sydenhams chorea, SCZ, GDL tourettes, porphyria, PANDAS, FTD, NMS, migraine
33 yo w/ visual and auditory hallucinations. Believes bowels are blocked and pain in abdomen due to external forces. Recently started on OCP. No hx psychosis
?lihtium toxicity, schizophreniform psychosis, sydenhams chorea, SCZ, GDL tourettes, porphyria, PANDAS, FTD, NMS, migraine
Acute intermittent porphyria
most common of four porphyrias. Mimics variety of abdo pain (presents as this is 90-05%)
some develop psychosis
rare AD metabolic, porphobillinogen deaminase gene
neurotoxic levels of delta-aminolevulinic acid and porphobillinogen, acute life threatening clinical syndrome
acute psychotic symptoms + GIT sx
8 yo M sudden onset OCD sx after throat infection
?lihtium toxicity, schizophreniform psychosis, sydenhams chorea, SCZ, GDL tourettes, porphyria, PANDAS, FTD, NMS, migraine
PANDAS
40 yo presents with depression, personality change and tremor.
Father developed depressioin at 50 and committed suicide. grandmother had memory problems age 54, died at 60 of aspiration pneumonia
?lihtium toxicity, schizophreniform psychosis, sydenhams chorea, SCZ, GDL tourettes, porphyria, PANDAS, FTD, NMS, migraine
FTD
Behavioural variant
Primary progressive aphasia-> non-fluent/agrammatic variant, or semantic variant and logopenic ariant.
Also overlap with parkinsonian syndromes, progressive supranuclear palsy and corticobasal syndrome.
Banks provide bonuses to their employees based on performance. Performance bonus may occur at an appraisal
?stimulus generalisation, working memory, fixed reinforcement, implicit memory, good enough mothering, repetition compulsion, continuous reinforcement, extinction, partial reinforcement, variable reinforcement
Variable reinforcement
remember friends phone number, able to recall when asked
?stimulus generalisation, working memory, fixed reinforcement, implicit memory, good enough mothering, repetition compulsion, continuous reinforcement, extinction, partial reinforcement, variable reinforcement
explicit memory
dog given a treat every time he does the trick as trained by the trainer
?stimulus generalisation, working memory, fixed reinforcement, implicit memory, good enough mothering, repetition compulsion, continuous reinforcement, extinction, partial reinforcement, variable reinforcement
continuous reinforcement
paid a commission, bonus every 4th sale
?stimulus generalisation, working memory, fixed reinforcement, implicit memory, good enough mothering, repetition compulsion, continuous reinforcement, extinction, partial reinforcement, variable reinforcement
fixed reinforcement
man with phobia against pythons. after several years has phobia against all snakes
?stimulus generalisation, working memory, fixed reinforcement, implicit memory, good enough mothering, repetition compulsion, continuous reinforcement, extinction, partial reinforcement, variable reinforcement
stimulus generalisation
memory involved in driving your car
?stimulus generalisation, working memory, fixed reinforcement, implicit memory, good enough mothering, repetition compulsion, continuous reinforcement, extinction, partial reinforcement, variable reinforcement
implicit memory
woman in abusive relationships. recolects parents relations “I never thought i would end up in a relationship like my mother”
?stimulus generalisation, working memory, fixed reinforcement, implicit memory, good enough mothering, repetition compulsion, continuous reinforcement, extinction, partial reinforcement, variable reinforcement
repetition compulsion-> propensity to repeat formative early life experiences
holding environment where too much or too little parenting is associated with emotional difficulties in the child
?stimulus generalisation, working memory, fixed reinforcement, implicit memory, good enough mothering, repetition compulsion, continuous reinforcement, extinction, partial reinforcement, variable reinforcement
good enough mothering
