Exam 3 -- Complete and Randomized Flashcards
Death in a patient with kuru occurs within how long after diagnosis?
9 to 24 months
Which gender has a higher prevalence of multiple sclerosis?
Female
A panic attack by itself is not considered a mental disorder. How does a panic attack specifier differ from a panic attack?
Panic attack specifier is a panic attack in the context of a mental disorder such as PTSD.
What is the average age of onset of multiple sclerosis?
20-35 years
What is the name of the anxiety disorder in which a person may use nonspoken means to communicate when encountering other people in social situations?
Selective mutism
What sort of workup can be done for a patient who has had a transient ischemic attack?
MRI (with diffusion weighted imaging), CT, MRA, CTA, ECG, CBC, metabolic panel, coagulation screening, lipid profile, ESR, CRP, Doppler and carotid Doppler
What part of the basal ganglia is damaged in Huntington’s disease?
The caudate and putamen
Some medications can induce IIH. Name some of them.
Oral contraceptives, tetracyclines, and retinoids.
The DEA has established drug schedules to classify drugs according to the acceptable medical uses and the drug’s abuse or dependency potential. The schedule runs from I to V. Which schedule has the highest potential for abuse, and which has the lowest?
Schedule I = highest potential for abuse. Schedule V = lowest potential for abuse.
A patient with ptosis due to myasthenia gravis, when looking into primary gaze from a downgaze position, might experience which phenomenon?
Cogan’s lid twich
During alcohol withdrawal, many symptoms can occur (anxiety, irritability, insomnia, tremor, tachycardia, hypertension, hyperthermia, N&V, seizures, hallucinations, etc). What type of medication can reduce the tremors, seizures, hallucinations, anxiety?
Benzodiazepines.
In terms of classifying weight severity in anorexia, what BMI is considered moderate?
16-16.99 kg/m2
How would you treat Bell’s Palsy?
Treat with 60-80mg of prednisone for 1 week (beginning within 3 days of start of symptoms). If the presentation is severe, you can add valacyclovir 1,000 mg TID.
What are the signs of Creutzfeldt-Jakob disease?
Rapidly deteriorating mental status and myoclonus.
True or false: though there is no treatment for Creutzfeldt-Jakob disease, patients usually live for 5 years after diagnosis.
False; patients live for about 6 months (and there is no treatment)
In terms of classifying the severity of bulimia, how many episodes per week is considered extreme?
Fourteen or more
Briefly outline the molecular cause of the plaques that occur in early onset Alzheimer’s (age 30-60).
Amyloid precursor protein is improperly cut, releasing beta amyloid (beta amyloid 42 in particular), which clumps up creating the senile plaques. These tend to accumulate in the hippocampus and amygdala.
Which of the schizophrenia spectrum disorders requires one or more of the characteristics of psychotic disorders? Which require two or more?
One: brief psychotic disorder; Two: schizophreniform, schizophrenia, and schizoaffective disorder.
Does Bell’s Palsy typically involve an acute or chronic onset?
Acute (within about 48 hours)
Fill in the blank:_________ dementia may be the second most common form of dementia.
Vascular.
What percent of seronegative (for autoantibodies against AChR) patients with generalized MG have autoantibodies against the receptor tyrosine kinase?
35-55%
Alteplase is a tissue plasminogen activator that is sometimes used to break down clots. It must be used within 4.5 hours of the onset of symptoms. What are two scenarios that would contraindicate the use of alteplase?
If there is evidence of hemorrhage, or if the patient is an anticoagulants (warfarin, coumadin, heparin).
Comparing intracerebral hemorrhage with subarachnoid hemorrhage, which has the more sudden onset?
Subarachnoid hemorrhage
Persistent depressive disorder, aka dysthymia, is a depressed mood for at least 2 years in adults (1 year in children), during which time symptoms must be consistent for more than 2 months. Patients must meet two or more of what criteria to be diagnosed with dysthymia?
Poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness.
In terms of pharmacologic treatment for hemorrhagic stroke, you want the patient off any anticoagulants and antiplatelets. You would also initiate anti-HTN meds, and possible anti-epileptic drugs if the patient is having seizures. What specific drug can be used for subarachnoid hemorrhage?
Nimodipine.
Name the features of Korsakoff syndrome.
Damage to thalamus and hypothalamus, inability to form new memories, memory loss, confabulation, hallucinations.
True or false: a lumbar puncture of a patient with IIH would show CSF that is normal in composition, but highly elevated in opening pressure.
True; can elevate to more than 250 mmH20
Tonic-clonic (grand mal) is a type of generalized seizure. It includes a tonic phase, a clonic phase, and a postictal recovery phase. About how long does each of these phases last?
Tonic = 10-20 seconds; clonic = 30-90 seconds, and postictal = 5-30 minutes
True or false: bulimia tends to be more chronic and resistant to treatment compared to anorexia.
False; anorexia is more chronic and resistant to treatment compared to bulimia.
What are the symptoms of IIH?
Headache is the major one; can also get transient visual obscurations, pulsatile tinnitus, and diplopia (particularly CN VI)
Which drugs are broad spectrum anti-epileptic drugs?
Lamotrigine, topiramate, valproate
ABCDD is an acronym used to estimate the risk of a stroke in the first two days after a transient ischemic attack. What do these letters stand for?
Age (over 60)
Blood pressure after TIA (over 140 systolic OR over 90 diastolic)
Clinical features (unilateral weakness, speech disturbance)
Duration
Diabetes
What are the clinical features of Lewy Body dementia?
Fluctuations or "blanking out" Recurrent, detailed visual hallucinations (67%) Parkinsonism features REM sleep behavior disorder Recurrent falls, fainting
True or false: there is evidence linking closed-angle glaucoma and Alzheimer’s Disease.
False; the evidence links primary open angle glaucoma and Alzheimer’s.
Chronic immunomodulators for MG include azathioprine, mycophenolate, cyclosporine, tacrolimus, and prednisone. What kind of dose would you use with prednisone, and why?
Low dose (no more than 1.0 mg/kg), since high dose steroids can make MG worse.
The spectrum of schizophrenia has several sub-categories, based on how long they symptoms last. How long do the symptoms have to last for the condition to be termed schizophrenia?
At least 6 months
What is the drug of choice for chorea in Huntington’s disease?
Tetrabenzaine
In what area of the brain are embolytic strokes common?
Basal ganglia.
True or false: ethosuximide and gabapentin are both acceptable drugs for absence seizures
False; only ethosuximide; gabapentin is contraindicated.
What is the survival rate of patients with bacterial meningitis?
25%
What drugs for Huntington’s disease work by blocking dopamine receptors?
Risperidone, olanzapine, haloperidol.
True or false: 1/3 of patients with schizophreniform recover within 6 months, and 2/3 develop schizophrenia or schizoaffective disorder.
True.
Some medications can be used to manage the symptoms of MS. Which medication helps with fatigue?
Amantadine. This is also a drug used for Parkinson’s.
True or false: 1/3 of patients with Bipolar I and 1/3 of patients with Bipolar II have a history of suicide attempt.
True.
Fill in the blanks: in ________% of patients with multiple sclerosis, optic neuritis is the most common symptom; in __________%, it is the first symptom.
40-50% = most common symptom; 15-20% = first symptom
What substance causes the psychoactive properties of cannabis?
delta-9-tetrahydrocannabinol (THC)
What is the drug of choice to treat focal seizures?
Lamotrigine
What is the name for an area of cerebral bruising with localized edema?
Contusion. This is the most common finding of a TBI.
What is the most common location for an intracerebral hemorrhage?
Basal ganglia.
Patients with Alzheimer’s live an average of 10 years from the time of diagnosis. What is a common cause of death?
Aspiration pneumonia.
During alcohol withdrawal, many symptoms can occur (anxiety, irritability, insomnia, tremor, tachycardia, hypertension, hyperthermia, N&V, seizures, hallucinations, etc). What type of medication can reduce the tachycardia and hypertension?
Beta blocker.
What factors can help in determining when to do CT imaging for a TBI?
Less than 15 Glasgow score Vomiting Over age 65 Amnesia for more than 30 minutes Seizures Anticoagulant use Alcohol use
Which class of drugs for Parkinson’s disease works well for patients under 65 years?
Doapmine receptor agonists (bromocriptine, pramipexole, ropinirole, apomorphine)
Holding an ice pack over the ptotic eye of a patient with MG should ___________ (improve/worsen) the ptosis.
Improve
For women under 65 and adults over 65, what is the number of standard drinks that would indicate an increase in health risks?
7/week, or 3/day
Parkinson’s disease (aka “the shaking palsy”) is more common in which gender?
Male
In order to diagnose Lewy Body dementia, two of which three features are required?
Fluctuations or “blanking out”
Recurrent, detailed visual hallucinations (67%)
Parkinsonism features
True or false: the most common symptoms of dependence in the use of cannabis are withdrawal, tolerance, continued use despite health problems, and lots of time spent obtaining or recovering from the effects of cannabis.
True.
What are some parasitic causes of aspectic meningitis?
Lyme
How would you treat bacterial meninfitis?
IV vancomyin with ceftriaxone
What type of infarcts are common with emboli in arteries with acute right angles?
Lacunar
What might neuroimaging show in a patient with Alzheimer’s?
Cortical/hippocampal atrophy, white matter lesions, enlarged ventricles.
What is the most effective medication for MS?
Natalizumab infusion
In terms of partial/focal seizures, which involves impairment of consciousness, and which does not?
Complex imapirs consciousness, simple does not.
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat borderline disorder?
Psychotherapy or sociotherapy
True or false: both CJD and vCJD commonly have a periodic sharp wave complex (PSWC) on an EEG
False; CJD does indeed have this finding, but in vCJD, it is rare and occurs later in the disease.
Weight loss is one of the main treatment options for IIH. What pharmacologic options are available?
Carbonic anhydrase inhibitor (acetazolamide), topiramate (also used for epilepsy and associated with a myopic shift and angle closure), furosemide or methazolamide (diuretics)
A lumbar puncture on a patient with MS might contain what kind of antibodies?
IgG
What is the medical treatment for a myasthenic crisis?
Intubation, stop anticholinesterase meds, do plasma exchange or IV immunoglobulin, and begin immunomodulatory drugs (prednisone)
There are different types of delusional disorder. Briefly describe the eromanic subtype.
Belief that someone is in love with them.
Narcotics bind to pain receptors and reduce pain and induce euphoria. Which narcotics were asterisked in the presentation?
Morphine, heroin, codeine, and methadone.
If you performed a lumbar puncture on a patient with bacterial meningitis, what might you find?
Elevated opening pressure, elevated WBCs
In terms of classifying weight severity in anorexia, what BMI is considered severe?
15-15.99 kg/m2
When a TBI occurs, there is axonal rupture from shear forces. What types of neurotransmitters are released in response?
Excitatory (glutamate, acetylcholine). This also leads to the generation of free radicals.
Jacksonian march is associated with what type of seizure?
Simple partial.
True or false: major depressive disorder is more common among females and in the 20’s
True.
Stimulants increase alertness, attention, and energy. Which stimulants were asterisked in the presentation?
Methylphenidate, cocaine, and amphetamine derivatives.
Which part of the basal ganglia is damaged in Parkinson’s disease? What is the name for the abnormal protein clumps you might find there?
Substantia nigra; Lewy bodies.
In terms of classifying the severity of bulimia, how many episodes per week is considered moderate?
Four to seven
Jeopardy style: Parkinson’s disease features depletion of this neurotransmitter from the basal ganglia.
What is dopamine?
What is the name of the set of criteria used to determine needed clinical findings for diagnosis of MS?
McDonald criteria.
Carbidopa-levodopa is the drug of choice in treating Parkinson’s disease. What does the carbidopa portion do? What about the levodopa?
Levodopa is a dopamine precursor that is able to cross the blood-brain-barrier. Carbidopa protect l-dopa from being converted to dopamine before it crosses the BBB.
Avoidant/restrictive food intake disorder is manifested by persistent failure to meet appropriate nutritional and/or energy needs, associated with at least one of the following: significant weight loss, significant nutritional deficiency, dependence on enteral feeding or oral nutritional supplements, marked interference with psychosocial functioning. It is comorbid with anxiety disorders, OCD, autism spectrum disorders, and ADHD.
Free card.
Give a one-sentence description of a tonic seizure.
Sudden muscle stiffness with or without impaired consciousness.
Comparing subdural vs epidural hematomas, which is located between the skull and the dura?
Epidural
What is the hallmark of myasthenia gravis?
Fluctuating weakness of skeletal muscles.
What other treatment options, besides drugs and surgery, may be used to help with seizures?
Vagus nerve stimulation, and NeuroPace (brain implant that interrupts seizures automatically)
Which Cluster B personality disorder is characterized by failure to conform to social norms, deceitfulness, impulsivity, and lack of remorse?
Antiocial
Binge-eating differs from bulimia in that binge-eating involves no ____________.
Compensatory actions (to reduce weight gain)
What rating scale, from 0 to 15, is used to rank a patient’s TBI symptoms and decide whether or not they need an ER visit?
Glasgow Coma Scale
What are some non-infectious causes of aspectic meningitis?
Lupus
An MRI on a patient with MS might show what?
Plaques (demyelination and accumulation of macrophages and T cells)
What is Uhthoff’s sign?
Symptoms of MS get worse with heat.
Comparing subdural vs epidural hematomas, which involves the venous blood supply?
Subdural
True or false: at least 50% of people with antisocial disorder have depressive disorders, and at least 25% have anxiety disorder.
False; at least 50% of people with antisocial disorder have anxiety disorders, and at least 25% have depressive disorder.
Panic disorder is characterized by recurrent, unexpected panic attacks, followed by at least one month of persistent concern for another panic attack and/or significant maladaptive change in behavior.
Free card.
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Patients with which form usually progress to SPMS?
RRMS
In order to consider a diagnosis of status epilepticus, what must be true?
There must have been a seizure lasting more than 30 minutes, OR at least two seizures without full recovery between.
Which of the personality disorders are more common in men? Which are more common in women?
Men: schizoid, narcissistic, antisocial. Women: borderline, histrionic, avoidant, dependent
Which of the anxiety disorders is more common in males? In females?
Males: none. Females: separation anxiety, specific phobia, panic disorder, panic attack specifier, agoraphobia, generalized anxiety disorder
What would an EEG show in a patient with Creutzfeldt-Jakob disease?
Periodic sharp wave complexes
What are some fungal causes of aspectic meningitis?
Hisoplasm, candida
Disruptive Mood Dysregulation Disorder (DMDD) is a type of depression disorder in children. There are four criteria must be present for at least 12 months, with all four for at least three months, and in at least two settings. Name the criteria.
Severe recurrent temper outbursts; temper outbursts inconsistent with developmental age; temper outbursts 3 or more times per week; mood between outbursts is irritable/angry
Transient ischemic attacks involve no infarction (tissue death) and there is full recovery of function. How long does a TIA usually last?
About 1 minute, but possible up to under 24 hours.
There are different types of delusional disorder. Briefly describe the grandiose subtype.
Belief that they’ve made some great discovery or have some great talent.
True or false: encephalitis has a better survival rate than meningitis.
True.
Huntington’s disease is inherited in an autosomal dominant pattern. The mutant protein responsible, huntingtin, is encoded on chromosome 4. What trinucleotide pattern is found repeating many more times in patients with Huntington’s as compared to normal patients?
CAG
Compare and contrast the age of the typical patient with Creutzfeldt-Jakob disease and variant CJD.
CJD: 65 years
vCJD: 29 years
Oral therapy for MS is the most convenient, but is less effective than infusion and injection therapies. What drug is the most commonly used oral MS drug?
Dimethyl fumarate (Tecfidera)
Carotid endarterectomy is surgical treatment that involves removal of the plaque. What two criteria must be met in order to consider this procedure for a patient?
70-99% lumen occlusion and 5+ year life expectancy
Which Cluster B personality disorder is characterized by shifts between idealization and devaluation (“splitting”)?
Borderline
True or false: Bipolar II disorder typically begins with a hypomanic episode.
False; it typically begins with a major depressive episode.
Comparing subdural vs epidural hematomas, which has a lenticular shape on a CT scan?
Epidural
In Bipolar I and II, how does a hypomanic episode differ from a manic episode?
The features are similar, but not severe enough to cause marked social or occupational impairment, for at least 4 days.
True or false: damage due to diffuse axonal injury is not as bad as it looks on imaging.
False; it is worse than appears on imaging.
Which Cluster A personality disorder is characterized by participation in solitary activities, lack of emotions, and appearing cold or detached?
Schizoid
Where would an MRI show hyperintensity in vCJD?
Pulvinar
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form is the most common?
RRMS
Fill in the blank: _____________, an anticholinesterase agent used to treat acute MG, is usually dosed at qid due to its duration of 3-4 hours.
Pyridostigmine
What would a brain biopsy show in a patient with Creutzfeldt-Jakob disease?
Spongiform degeneration (pockets left by misfolded proteins)
Which anti-epileptic medication is associated with myopic shift and angle closure? For bonus points, which other condition can this drug be used for?
Topiramate; can also be used for idiopathic intracranial hypertension.
True or false: a thymectomy is recommended in almost all patients who are positive for autoantibodies against the acetylcholine receptor, and makes the chances of a medication-free remission of MG twice as likely.
True.
Comparing subdural vs epidural hematomas, which has the worse prognosis?
Subdural
What would an MRI show in a patient with Creutzfeldt-Jakob disease?
Hyperintensity lesions at caudate, putamen, cortex
Fill in the blank: ________ is a depressive disorder screening questionnaire, scored from zero to 27, with zero being no depression, and 27 being severe.
PHQ-9
There are different types of delusional disorder. Briefly describe the jealous subtype.
Belief that their spouse or lover is unfaithful.
Which Cluster B personality disorder is characterized by a sense of self-importance, fantasies of power, needing excessive attention, lack of empathy, etc?
Narcissistic
True or false: internuclear ophthalmoplegia is one of the symptoms of MS.
True.
What are some viral causes of aspectic meningitis?
Enterovirus, herpes simplex, HIV, WNV, herpes zoster, mumps
Which type of delusional disorder is most common?
Persecutory.
A myasthenic crisis is respiratory failure due to weakness of the respiratory muscles, and can occur after thymectomy. At what point during the course of the disease does this usually occur? How many MG patients experience it?
Usually occurs in the first years after diagnosis; 10-20% of patients experience it at some point.
What protein, encoded by a gene on chromosome 17, is involved in the production of neurofibrillary tangles? What is this protein’s normal function?
Tau protein. It normally acts to stabilize microtubules, but in Alzheimer’s becomes hyperphosphorylated and can no longer perform this function.
How does schizoaffective disorder differ from schizophrenia?
It includes a major mood episode, and the schizophrenia must be uninterrupted.
What are the cardinal signs of hemorrhagic stroke?
Headache, N&V, seizures.
Patients with vascular dementia may experience multiple strokes, CV risk factors, and white matter lesions on MRI. Get their CV risk factors under control, and use the same treatment as in Alzheimer’s.
Free card.
Where would PrPsc plaques show up in a patient with kuru? What symptoms might occur in a patient with this disease?
Cerebellum; symptoms would include postural instability, myoclonus, and late onset dementia
True or false: a complex partial seizure usually lasts three minutes or less, during which time the patient either remains motionless or engages in automatisms.
True.
Which of the depressive disorders is more common in males? In females?
Males: disruptive mood dysregulation disorder. Females: major depressive disorder
In Bipolar I and II, a major depressive episode is a change in previous functioning for 2 weeks and can include features such as fatigue every day, insomnia or hypersomnia every day, depressed mood most of the day every day, significant weight loss or gain, dimished interest/pleasure in all things, and others. How many of these features does a person need to have for it to be termed “major depressive episode”? Which two features are REQUIRED for the diagnosis?
Five; depressed mood most of day every day, and dimished interest/pleasure in all things.
What percent of patients with MG have an abnormality of the thymus? What percent have a thymoma?
60-70% = abnormal thymus; 10-12% have a thymoma.
If resolution of a Bell’s Palsy begins within 21 days, full recovery is likely. There is a poorer prognosis if the symptoms last more than 4 months.
Free card.
What are the 4 Cs of addiction?
Loss of Control (over drug use)
Craving and Compulsive use of drug
Use of drug despite adverse Consequences
Comparing subdural vs epidural hematomas, which involves the arterial blood supply?
Epidural
What might imaging show that could be due to IIH?
Empty sella turcica, flattening of posterior sclera, enlargement of subarachnoid space around the optic nerve, turtuosity of the optic nerve, slit-like ventricles, narrowing of venous sinus.
Toxic optic neuropathy can occur if there is severe nutrient depletion (especially of B12 and folate), such as can occur with alcohol abuse. What findings are associated with toxic optic neuropathy?
Pale nerve, color vision reduction, central or cecocentral scotoma, and reduced VA.
Comparing subdural vs epidural hematomas, which has a slower onset?
Subdural
How do the symptoms of variant CJD compare with those of CJD?
They include the rapid deterioration of mental status and myoclonus, as well as psychiatric symptoms and paresthesia.
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat paranoid disorder?
Possibly pharmacotherapy
What is the name of the syndrome that can occur from vitamin B1 deficiency, often found in people with alcoholism?
Wernicke-Korsakoff Syndrome
Visual Variant Alzheimer’s Dementia (VVAD), also called posterior cortical atrophy, involves hypometabolism of glucose in the occipital-parietal area. What symptoms might a patient with this condition experience?
Simultagnosia (inability to see more than one object at a time), prosopagnosia (inability/difficulty recognizing faces), visual agnosia (inability/difficulty recognizing objects), and difficulty with depth perception.
What is the most common cause of bacterial meningitis?
Strep. Pneumoniae
What uncommon practice is associated with kuru?
Cannibalism
Which Cluster C personality disorder is characterized by a difficulty making decisions, a need for others to take charge, a difficulty expressing disagreement, and urgently seeking another relationship for care and support in case the current one ends?
Dependent
Which of the psychotic disorders has a 20% attempted suicide rate?
Schizophrenia
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat schizoid disorder?
Psychotherapy or sociotherapy
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat dependent disorder?
Psychotherapy
Cerebrovascular disease is the fifth leading cause of death in the US, second worldwide. What percentage of these events are ischemic, and what percentage are hemorrhagic?
80% are ischemic; 20% are hemorrhagic
Male patients with PPMS have the worst prognosis of MS patients.
Free card.
Which Cluster A personality disorder is characterized by suspicion without reason, and being unable to forgive?
Paranoid
IV methylprednisolone can be used for an acute attack of MS. You can use oral prednisone, but only if which symptom is absent?
Optic neuritis.
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat obsessive compulsive disorder?
Psychotherapy
Describe the age and gender of the typical MG patient.
There is a bimodal distribution: younger females (teens-20s) and older males (50-70)
Huntington’s disease is usually diagnosed in what age range? Which gender has a higher predilection?
Usually diagnosed in middle ages (30-50), and there is no gender predilection.
What disease makes up 90% of prion diseases?
Creutzfeldt-Jakob disease
Which class of drugs for Parkinson’s disease works by slowing the breakdown of existing dopamine?
Monoamine Oxidase-B inhibitors (drugs end in -giline)
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat antisocial disorder?
Sociotherapy
The spectrum of schizophrenia has several sub-categories, based on how long they symptoms last. How long do the symptoms have to last for the condition to be termed brief psychotic disorder?
More than a day, but less than a month
Idiopathic intracranial hypertension is due to an increase in CSF and is caused by what?
Trick question; there is no underlying cause (diagnosis is of exclusion)
Of the bipolar, depressive, and anxiety disorders mentioned in class, which have their onset in childhood or early adolescence?
Depressive Mood Dysregulation Disorder, selective mutism, specific phobia, and social anxiety.
Which type of TBI is the most severe?
Diffuse axonal injury
In which two situations would you use intravenous immunoglobulin for MG?
During a myasthenic crisis or prior to a thymectomy.
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form makes up 5-10% of cases?
PPMS
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form involves acute attacks followed by remission to normal or near-normal?
RRMS
An ischemic stroke that is caused by a thrombus can be atherosclerotic or an artery dissection. What are the symptoms of an artery dissection thrombus?
Headache, amaurosis fugax, Horner’s
For men under the age of 65, what is the number of standard drinks that would indicate an increase in health risks?
14/week, or 4/day
Name the features of Wernicke encephalopathy.
Permanent damage to memory areas of brain, loss of muscle coordination, confusion and loss of mental activity, alcohol withdrawal, nystagmus, ptosis.
Bell’s Palsy is thought to be related to which viral organisms?
Herpes simplex or herpes zoster.
Psychotic disorders are characterized by delusions, hallucinations, disorganized thinking, catatonia, and/or negative symptoms.
Free card.
Which type of seizure is most common?
Complex partial.
In terms of electrodiagnostic testing for MG, repeated nerve stimulation in a patient with MG shows reduced amplitude. This is positive in more than 75% of patients with generalized MG. Single fiber stimulation is even better at 80-95% and is better for ocular MG.
Free card.
Which of the features of Parkinson’s is the most common? Which is most commonly the presenting symptom?
Bradykinesia is the most common feature, but tremor is the most common presenting symptom.
Stooped posture and _______________ (increased/decreased) arm swing when walking are two of the ways in which Parkinsonian rigidity can manifest.
Decreased
Chronic traumatic encephalopathy is when repeated concussions cause cumulative neurologic defects, including an increase in risk for Alzheimer’s.
Free card.
MG can be exacerbated by medications. Which medications or classes of medications can do this?
Antibiotics (especially gentamycin, tobramycin, telithromycin), fluoroquinolones, hydroxychloroquine, botulinum toxin, penicillamine, beta blockers, anesthetics, and high dose steroids.
What are the ocular clinical findings associated with IIH?
Papilledema is the major one; also visual field loss.
People who live in northern latitudes have a higher risk of developing multiple sclerosis. True or false: once you have lived in a northern latitude, you carry the higher risk with you no matter where else you go.
False; your risk is thought to be associated with where you lived prior to puberty.
In terms of classifying weight severity in anorexia, what BMI is considered extreme?
Below 15 kg/m2
Some medications can be used to manage the symptoms of MS. Which medication is for anti-convulsion and is also the drug of choice for general seizures?
Valproate
Hallucinogens create distortions in a person’s perception of their surroundings. Which hallucinogens were asterisked in the presentation?
Cannabis and LSD.
Epilepsy is characterized by decreased amounts of which neurotransmitter? And increased activation of which receptors?
Decreased GABA (decreased inhibition) and increased NMDA activation (increased excitation)
Which Cluster C personality disorder is characterized by viewing self as socially inept, a fear of being shamed or ridiculed, and feelings of inadequacy?
Avoidant
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form is progressive from the onset and involves minimal relapses?
PPMS
True or false: in order to diagnose Bipolar I, a patient must experience a manic episode and a major depressive episode at least once in a lifetime.
False; they only need the manic episode in order to meet the criteria.
What are the ocular manifestations of cannabis use?
Conjunctival hyperemia, decreased IOP, decreased tear production, slightly dilated pupil.
True or false: more than 50% of patients with MG present with ocular symptoms, and 50% of these will develop generalized MG within 2 years.
True.
What three disorders make up Cluster A personality disorders?
Paranoid, schizoid, and schizotypal
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form involves minimal progression, at the beginning?
RRMS
How long must the binge eating of bulimia have been going on to meet the diagnostic criteria?
3 months (of binge eating at least once a week)
What genetic factor is associated with multiple sclerosis?
HLA-DRB1
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat shizotypal disorder?
Pharmacotherapy
Name the associated grading scale for the following conditions:
TBI
MS
IIH
TBI: Glasgow coma scale
MS: McDonald criteria
IIH: Modified Dandy criteria
What drugs are antiplatelets that can be used for reducing risk of a stroke?
Aspirin, aggrenox, clopidogrel, ticlopidine
Which Cluster B personality disorder is characterized by a need to be the center of attention, inappropriate provacative behavior, and use of physical appearance to draw attention?
Histrionic
Drugs for depression include MAOis, tricyclic antidepressants, atypical antidepressants, SSRIs, NDRIs, and SNRIs. Which class is the most commonly prescribed in the US?
SSRIs
True or false: traumatic brain injuries are the leading cause of death in the US for people up to the age of 45.
True.
Epilepsy prognosis is fairly good if controlled with medications. Children with epilepsy have a 3-4x increased risk of death. Sudden, unexplained death in epilepsy (SUDEP) occurs in 2-18% of patients with epilepsy.
Free card.
In Bipolar I and II, a manic episode is a distinct period of abnormal and persistant elevation or irritation of mood and increased energy lasting for at least one week. A manic episode can include features such as decreased need for sleep, being easily distracted, being more talkative and feeling pressure to keep talking, among others. How many of these criteria does a person need to meet before it can be termed “manic episode”?
Three to four
What are the common side effects of anti-epileptic drugs?
N&V, diarrhea, dizziness, weight gain, skin rash, blood dyscrasias, interaction with other medications, diplopia, blurred vision, nystagmus, color changes.
There are different types of delusional disorder. Briefly describe the persecutory subtype.
Belief that they are being conspired against, cheat, spied on, followed, poisoned/drugged, or obstructed in pursuit of their long time goals.
What clinical findings might a patient with bacterial meningitis have?
Fever, HA/altered mental status, and nuchal rigidity
Encephalitis has more severe brain function abnormalities than meningitis.
Free card.
How long do the symptoms last in Creutzfeldt-Jakob disease compared to variant CJD?
CJD: 6 months; vCJD: 14 months
Comparing subdural vs epidural hematomas, which is located between the dura and the arachnoid?
Subdural
Give a one-sentence description of a myoclonic seizure.
Sudden, brief muscle contractions lasting 1-2 seconds, without impaired consciousness.
What are some systemic conditions that are associated with IIH?
Sleep apnea, polycystic ovary syndrome, coagulation disorders, anemia, lupus
Comparing subdural vs epidural hematomas, which has a more acute onset?
Epidural
What four disorders make up Cluster B personality disorders?
Borderline, narcissistic, histrionic, and antisocial
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat avoidant disorder?
Psycotherapy
In terms of classifying weight severity in anorexia, what BMI is considered mild?
More than 17 kg/m2
Give a one-sentence description of a clonic seizure.
Muscle spasms with or without impaired consciousness.
What is the name for the postictal paresis that can sometimes occur in a patient after a tonic-clonic seizure?
Todd’s paralysis; it typically lasts less than 48 hours
What drug is used in the diagnosis of MG? What class of drug is this, and what is its antidote?
Edrophonium; class is acetylcholinesterase inhibitor; atropine is the antidote.
In terms of classifying the severity of bulimia, how many episodes per week is considered mild?
One to three
What are some of the long term effects of bulimia?
Tooth decay, osteoporosis, electrolyte imbalance, swollen salivary glands, hypotension, low body temperature.
What percent of patients with generalized MG have autoantibodies against the acetylcholine receptor?
80-90%
Which medication for Parkinson’s is an antiviral that can also be used to manage the fatigue of multiple sclerosis?
Amantadine
What is the drug of choice to treat general seizures? What pregnancy category does this drug fall into?
Valproate; Category D. Note: valproate can also be used for anti-convulsion in MS.
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). In which form is the gender predilection equal?
PPMS
Bipolar I is the classic manic-depressive disorder. How does Bipolar II differ?
It requires at least one major depressive episode and at least one hypomanic episode.
Tranquilizers cause euphoria and sluggishness. Which tranquilizers were asterisked in the presentation?
Benzodiazepines.
What are the three most commonly abused drugs in the US?
Alcohol, tobacco, and marijuana.
Avoidant/restrictive food intake disorder contrasts with anorexia nervosa and bulimia nervosa in that _____________ is not a factor in avoidant/restrictive food intake disorder.
Self-image
True or false: smoking increases the risk of Parkinson’s disease.
False; it may actually decrease the risk.
There are different types of delusional disorder. Briefly describe the somatic subtype.
Belief that something is wrong with their body in some way (parasites in body, bugs on skin)
Some medications can be used to manage the symptoms of MS. Which medication helps improve walking speed?
Dalfamiridine
Non-ocular symptoms of MS include muscle fatigue/weakness/spasms, numbness, tingling, pain, cognitive decline, bladder, bowel, and sexual dysfunction.
Free card.
Psychotherapy is a general term for the process of treating a condition by talking about it with a mental health provider. There are three specific subdivisions mentioned in class–cognitive behavioral therapy, psychodynamic psychotherapy, and psychoeducation.
Free card.
The proposed mechanism of IIH involves decreased outflow of CSF via?
Venous stenosis and/or venous sinus thrombosis
The following are isoforms of the gene APOE on chromosome 19. Which of these isoforms is detrimental, and found in late onset Alzheimer’s? What does it cause?
APOE-ε2
APOE-ε3
APOE-ε4
APOE-ε4. It increases beta-amyloid clumping, affects microtubule function, affects choline acetyltransferase activity in the hippocampus, and is associated with vascular disease.
True or false: in Lewy Body dementia, memory is affected sooner than in Alzheimer’s.
False; it is affected later.
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat narcissistic disorder?
Psychotherapy
Comparing subdural vs epidural hematomas, which has a lunar shape on a CT scan?
Subdural
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form usually occurs 10-20 years after the initial onset?
SPMS
Fill in the blank: _____________ is the repeated involuntary regurgitation of food over a period of at least 1 month that is not attributed to a GI or other medical issue.
Rumination disorder
Injection therapy for MS is safer than infusion therapy, but less effective. Name a few injectable MS medications.
Interferon beta (Avonex, Rebif, Betaseron, Plegrity), Glatiramer
What percentage of dementia are classified as Alzheimer’s?
60-80%
What two classes of drugs are available to treat Alzheimer’s disease?
Acetylcholinesterase inhibitors (Donepezil in particular) and NMDA receptor antagonists (Memantidine)
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat histrionic disorder?
Psychotherapy
What are the features of Parkinson’s disease?
Bradykinesia, (resting) tremor, rigidity, and postural instability.
The spectrum of schizophrenia has several sub-categories, based on how long they symptoms last. How long do the symptoms have to last for the condition to be termed schizophreniform disorder?
More than a month, but less than 6 months.
What is the name for the “shivering disease” or “laughing sickness”?
Kuru
There are different types of delusional disorder. Briefly describe the mixed subtype.
Involves a mix of the other categories, with none predominating.
Which drugs are anti-epileptic drugs for focal seizures?
Carbamazepine, phenytoin, phenobarbital, gabapentin.
The average age of death for patients with Huntington’s disease is 51-57; most survive 10-25 years after onset.
Free card.
What system is activated by all addictive drugs?
Mesolimbic dopamine system.
Early onset Alzheimer's is inherited in an autosomal dominant fashion. Defects may occur in the following chromosomes and genes: Chromosome 1 (PSEN2) Chromosome 21 (APP) Chromosome 14 (PSEN1) Which inheritance of these defective genes is most commonly the cause of early onset Alzheimer's?
PSEN1, on chromosome 14
What three disorders make up Cluster C personality disorders?
Avoidant, dependent, and obsessive compulsive
For focal seizures, surgical removal of the area causing the seizure is a treatment option, leaving 65-75% of patients seizure free. What is the most common site of the surgery?
Temporal lobe.
True or false: absence seizures (petite mal) are convulsive seizures.
False; they are non-convulsive.
Which gender has a higher predilection for Alzheimer’s?
Females
What are the main features of Huntington’s disease?
Chorea (dance-like unpatterened movement, dystonia), psychiatric problems, and dementia.
Separation anxiety disorder is defined as a developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached. How long does this anxiety need to last for diagnosis in children? In adults?
4 weeks for children, 6 months for adults
What is the name for the set of criteria used to determine if a case qualifies as IIH?
Modified Dandy criteria
Which of the personality disorders has a 10% suicide rate?
Borderline
True or false: the normal volume of CSF is between 60-150ml, and the body produces about 250ml a day.
False; there is indeed 60-150ml of CSF, but the body produces 500ml per day
True or false: the symptoms of MS are separated in time and space and are usually followed by partial or complete remission.
True.
Bell’s Palsy is the most common cranial nerve palsy and is most common in what kind of patient?
Pregnant women.
True or false: MS is thought to decrease lifespan by 15 years.
False; it is thought to decrease lifespan by 7 years.
Which Cluster A personality disorder is characterized by unusual perceptual experiences and odd beliefs or magical thinking?
Schizotypal
What are the major risk factors for idiopathic intracranial hypertension?
Female of childbearing age, obesity
What percent of untreated patients with MS develop significant disability in 20-25 years?
30%
The diagnosis of dementia requires an acquired decline in one or more of several areas (learning/memory, language, executive function, etc.). What additional signs might be found in a patient with Alzheimer’s Disease?
Loss of insight, sleep disturbances, seizures, olfactory changes.
Pica is the eating of non-nutritive, non-food substances over a period of at least 1 month. At what age does it most commonly onset, and what comorbidities accompany it?
Onset during childhood; comorbid with autism spectrum disorder or intellectual disability.
What is the cause of most cases of encephalitis?
Viral (usually herpes simplex)
Which class of drugs for Parkinson’s disease are good for patients with tremor?
Anticholinergic drugs.
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form involves gradual worsening and may or may not include relapses?
SPMS
There are different types of delusional disorder. Briefly describe the unspecified subtype.
Delusion doesn’t match any of the other categories.
Lhermitte’s sign, which is one of the symptoms of multiple sclerosis, involves a a radiating pain down the spine due to movement of what body part?
Neck
What surgical options might be considered for a patient with IIH?
Optic nerve sheath fenestration, CSF shunting.
In terms of classifying the severity of bulimia, how many episodes per week is considered severe?
Eight to thirteen
True or false: an embolytic stroke has symptoms that are more acute than thrombolytic.
True.
What clinical feature is found in 97% of patients with a subarachnoid hemorrhage?
A sudden, severe headache.
What 7-minute test is the most widely used cognitive test for dementia? What does the shorter version of this test involve?
The Mini-Mental State Examination (MMSE), which involves testing the patient’s presence of mind and ability to follow instructions. The shorter version of the test involves having the patient repeat three words, draw a picture of a clock, and then repeat those same three words back to you from memory.
The spectrum of schizophrenia has several sub-categories, based on how long they symptoms last. Delusional disorder involves having at least one delusion for how long?
Greater than one month.
Variant CJD involves amyloid plaques with PrPsc.
Free card.
When can a bipolar disorder be defined as cyclothymic?
When it doesn’t meet the criteria for a manic, hypomanic, or major depression.
What would show in the CSF of a patient with Creutzfeldt-Jakob disease?
14-3-3 protein
What supplements can be given for the malnutrition of alcoholism?
IV thiamine, folate, and multivitamin (banana bag)
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form has a later age of onset and has a worse prognosis?
PPMS
MS attacks in a patient are typically reduced during what life event?
Pregnancy.
Of the four features of Parkinson’s disease, which occurs later in the disease and is not a diagnostic criteria?
Postural instability.
Which Cluster C personality disorder is characterized by preoccupation with details, perfectionism, devotion to the point of exclusion of lesure, and reluctance to delegate tasks or work with others?
Obsessive compulsive
What are some of the long term effects of anorexia?
Leukopenia, low bone mineral density, dehydration, dry/yellowish skin, severe constipation, brittle hair/nails, brain damage, internal body temperature drop, infertility.
