Flashcards
White matter imaging
DTI
High signal T1, low signal T2, low signal T3
fat
Imaging modalities to differentiate different type of neurocognitive disorders
PET and SPECT
2 cardiac things Lithum can cause
SA block and sick sinus syndrome
Brain imaging findings of BPAD
enlarged amygdala; GP (globus pallidus) and putamen volume increase
MR spectroscopy reveals increased choline in what brain areas in depression
BG (basal ganglia) and AC (anterior cingulate)
Magnetoencephalography gets magnetic signals from what cells
pyramidal cells
Depression has volume reduction in what brain structures
Prefrontal cortex, AC (anterior cingulate) cortex, caudate, putamen
OCD has hypermetbolism in what areas
orbitofrontal cortex and anterior cingulum
PTSD brain imaging findings
smaller hippocampal volume, smaller frontal volumes
carbamazepine monitoring
CBC, LFTs, BUN/Cr
Schizophrenia brain imaging findings
ventricular enlargement, enlarged caudate, smaller thalamus, smaller temporal lobes
OCD associated with what structure
orbitofrontal cortex
what condition can have a normal EEG
catatonia
EKG findings of TCAs
prolonged PR, QRS, or QT intervals
Nortriptyline therapeutic window
50 to 150 micrograms/mL
how long for bleeding on CTH to become isodense with brain tissue?
2-6 weeks
Huntington’s disease brain imaging findings
loss of caudate (next to ventricles)
DAI best imaged by what modality
DWI MRI
L’hermitte’s sign
electric shock down neck and to extremities with neck flexion
best dural sinus imaging
MRV
hyperintense T2 finding, round/ovoid mass, heterogenous
oligodendroglioma
young pt, cystic mass
astrocytoma
thick, irregular enhancing, edema
glioblastoma
CVA imaging after CTH
CTA head/neck
How to test color perception?
Hardy-Rand-Ritter test
Digital span is a measure of what?
working memory
CJD CSF findings
14-3-3 protein
MS CSF findings
myelin basic protein
SSPE CSF findings
IgG
Pronator drift tests for what
UMN lesion
CJD EEG findings
slow 1-2 Hz periodic sharp waves with generalized slowing
Toxic metabolic EEG findings
Triphasic waves on disorganized background
TIA best test to r/o
DWI MRI
Best lab test for heavy drinking
CDT (carbohydrate deficient transferrin)
ability to inhibit behavioral responses in adolescence is due to what
maturation of the prefrontal cortex
knowledge comes from sensory experiences
empiricism
least important thing in evaluating a cultural syndrome?
culture of the clinician
Who thought that development was made up of two positions, paranoid-schizoid position and depressive position?
Melanie Klein
Who thought that symbol creation was important in understanding human nature?
Carl Jung
Who developed hierarchal model of innate behavioral reactions of animals, that motivational impulses build up in the brain and are held in check by blocks?
Nikolaas Tinbergen
Who thought that newborn animals bond with the first moving stimulus it perceives?
Konrad Lorenz
Who revised Freud’s drive theory?
Edith Jacobson
Who created orgone theory and cloudbusters?
Wilheim Reich
Who studied bees “waggle dance” regarding relaying information about more distant food sources?
Karl von Frisch
rates for anorexia and bulemia
are both increasing
secondary enuresis is most associated with what dx?
ADHD
CBT is most useful for which aspect of anorexia treatment?
relapse prevention
something uncommon to pica
leaves
enuresis requires what age as part of criteria
that child be at least 5 years old
which type of disorders in childhood predict obesity later in life?
depressive
bulimia associated with which personality disorder
borderline personality disorder
pica is normal below age what
1
rumination disorder is seen in what age range
3 months to 1 y/o
primary nocturnal enuresis treatment
DDVAP
encorpresis dsm frequency
once a month for 3 months
mortality rate of anorexia
5%
cause of death of anorexia
suicide and MODS
most common eating disorder
binge eating disorder
pica in adults occurs with what time of disorders
learning disabilities
eating disorder with lowest female to male ratio
binge eating disorder
medication most useful for binge/purge behaviors in bulemia
fluoxetine
substance that causes relaxed/tranquil then drowsiness, dizziness, nausea
GHB
substance causing RTA along with diffuse brain atrophy
toluene (inhalants)
what class of medications potentiates the effect of inhalants?
benzodiazepines
BAL level with ataxia, nystagmus, slurred speech
100-200
describe reward circuit
VTA to nucleus accumbens via dopaminergic neurons
vertical nystagmus, which substance use?
PCP
caffeine has antagonism at what receptor
adenosine
gambling disorder is associated with which personality disorder
paranoid personality disorder
gambling affects how many people in the US
1 million
herbal incense acts on which receptor
cannabinoid
insight oriented therapy in a gambler after how long duration?
3 months
ingestion of what gives false positive for BZD?
sertraline
opiates inhibit cAMP-dependent phosphorylation where?
locus ceruleus
pathological gambling most associated with which axis I disorder?
MDD
testosterone above what dose increases mania risk?
300 mg
stimulant-induced craving for drugs medicated by which neurotransmitter?
glutamate
lowest dose of methadone to induce cross tolerance blockade of opiates?
80-120 mg
last area to be affected for physician with a substance use disorder
job performance
what substance increases muscle mass by increasing growth hormone?
GHB
substance that has most reinforcing effect?
cocaine
is loss of a parent before 15 y/o a risk factor for gambling disorder?
yes
initial treatment for PCP intoxication?
urine acidifcation (remember RTA)
withdrawal of what substance gives vivid and unpleasant dreams?
strimulants
how do amphetamines exert their effect?
by releasing catecholamines from the neuron
“how many drinks can you hold” test
TWEAK
highest sensitivity test for assessing alcohol use disorder?
TWEAK
which personality disorder: projection, withdrawal, and controlling behavior
paranoid PD
which personality disorder: fantasy and withdrawal
schizoid PD
which personality disorder: idealism, omnipotence, rationalization
narcissistic PD
which personality disorder: repression, dissociation, externalization of emotion
histrionic PD
Kohut’s theory of personality is based on believing what?
that an individual has need for empathic interaction with self-objects
Kernberg’s theory of personality believed what?
idealization is a defense against rage, envy, contempt, and devaluation
Person who created interpersonal circumplex or interpersonal circle
Timothy Leary
Five-factor model of personality?
NEOAC
What percent of pts have a PD?
30-50%
Most prevalent PD?
antisocial
How heritable is BPD?
68% (nice)
Lifetime suicide risk in BPD?
5-10%
Personality disorder with highest reliability with regard to diagnosis?
antisocial
Personality disorder not in ICD-10
schizotypal
three personality disorders that can be associated with psychotic sx
paranoid, schizotypal, and borderline
which personality disorder has diagnostic feature of interpersonal exploitativeness?
narcissistic
which personality disorder most associated with alcohol?
antisocial
which personality disorder has a high percentage of female relatives with somatization disorder?
antisocial
somatization disorder most seen with which PD?
histrionic
how do PDE5 inhibitors work?
increase NO leads to increased cGMP which leads to smooth muscle relaxation and increased blood flow
which neurochemicals involved in ability to have orgasm?
dopamine and serotonin
how does serotonin affect sexual function?
it inhibits it by vasoconstricting cavernosal vessels (5HT1D)
what dopamine agonist has been used to treat erectile dysfunction
apomorphine
which 5HT receptor serves sexual function?
5HT1A
which factor argues against female orgasmic disorder?
IPV
what is not a risk factor for ED over age 40?
fatigue
libido, arousal, and pleasure mediated by which neurotransmitter?
dopamine
in ED, what are testosterone and LH levels?
testosterone low; LH high
which CYP metabolizes PDE-5 inhibitors?
CYP 3A4
CYP 3A4 inhibitors
ketoconazole, ritinovir, erythromycin, (fluoxetine)
what is testosterone used as a treatment for in men?
male hypoactive sexual desire disorder
which paraphilia has latest age of onset?
pedophilia
paraphilia with earliest age of onset?
transvestitism
most pedophiles are homosexual or heterosexual?
heterosexual
medication for treating paraphilia
medroxyprogesterone
percent of people with pedophilia who are homosexual?
50%
most common paraphilia among women
sexual masochism disorder
autoerotic asphyxiation most common in what group?
adolescent boys
according to psychoanalytic models, paraphilias arise from what
a failure to complete the process of genital adjustment
what is the difference between women and men with regard to Alzheimer’s and neurofibrillary tangles?
in women, each neurofibrillary tangle unit equals 3-fold increase in women but 20-fold increase in men
most specific factor in shaping gender identity?
androgen
genital self-stimulation begins at what age
15 to 19 months
sexual orientation recognized at what age?
school age
what percent seek gender reassignment surgery?
10%
gender dysphoria associated with what disorder?
anxiety disorders
at what age does one have a gender identity
2-3 years old
75% of boys begin cross dressing before what age
4 years old
ependymoma most likely to cause head size increase in what demographic?
babies
chorioid plexus carcinoma in what demographic?
children with HA
opsoclonus-myoclonus paraneoplastic; characterized by what?
antibodies against postsynapatic neurons
paraneoplastic limbic encephalitis; two characteristics
voltage gated K channels; hyponatremia
hallmark of paraneoplastic cerebellar degeneration
loss of Purkinje cells
brain tumor type that develops from embryonic fetal tissue?
medulloblastoma
types of cancer with paraneoplastic association
small cell cancer, breast/gyn cancer, Hodgkin’s lymphoma
largest association btwn paraneoplastic disorder and what?
thymoma
GBM associated with amplification of what gene
EGFR gene
paraneoplastic stiff-person syndrome associated with which gene
anti-amphiphysin
hemangioblastoma; what condition?
von Hippel Lindau syndrome
CrAg screening at what CD4 cutoff
100
variant CJD, what is seen on light microscopy?
florid plaques
sporadic CJD, what is seen on light microscopy?
spongiform degeneration and astrocytic gliosis
mosquitoes transmit epidemic encephalitis via what vector?
arbovirus
ataxia, tremors, choreoathetosis, Papua New Guinea
Kuru
most common signs and symptoms of poliomyelitis
none
brain abscess from sinus or dental infection due to what organism
anaerobic strep
flu like symptoms, then encephallitis sx, temporal lobe involvement
HSV-1 encephalitis
complication of rheumatic fever
Sydenham’s chorea
2 things about fatal familial insomnia
thalamus atrophy; PRNP gene
GSS syndrome related to CJD but different how?
amyloid plaques of abnormally folded protein
lobe with AH
temporal lobe
lobe with VH
occipital lobe
best imaging modality to look at the dural sinuses
MRV
pathological laughing and crying: name 3 step pathway
frontal cortex, pons, cerebellum
akinetic mutism can result from b/l infarctions of what
anterior cingulate gyrus
where is Broca’s area located?
dominant frontal lobe
fear/anxiety center, startle
amygdala central nucleus
which area of the PFC is most involved with anxiety?
medial or orbitofrontal cortex
CSF produced by what
choroid plexus
what are cortical columns used for
functional units for information processing
exposure to light helps entrain the circadian rhythm by activating nonvisual photoreceptors that project where?
suprachiasmatic nucleus (which is located in the anterior hypothalamus)
gustatory special sensory seizures (auras) localize to what brain structure
insula
purpose of pineal gland
production of melatonin
risk taking behavior mediated by what structure?
orbitofrontal cortex
neuroplasticity is based on what changing?
dendritic spikes
CNS neurons derive from
ectoderm to form the neural tube
PNS neurons derive from
the neural crest
appetite and thirst regulation
hypothalamus
storing and retrieving long term memories happens in which brain region
temporal lobe
basal ganglia derived from what embroyonically
telencephalon
DLPFC functions for what
working memory
hippocampus located in what region
temporal lobe
foramen of Monro
communication between lateral ventricles with third ventricle
medulla oblongata derives from what embryonically
myelencephalon
mesolimbic pathway connects ventral tegmental area to what
ventral striatum (which includes the nucleus accumbens)
what does the middle frontal gyrus contain
frontal eye field
where does the spinal cord end?
L1
uncinate fasciculus connects what to what
anterior temporal lobe to ventral prefrontal region (like OFC)
CN 8 exits at what level
level of the pons
visual information through optic tract to where (x2)
lateral geniculate body to primary visual cortex
Wernicke’s speech area located where
superior temporal gyrusd
parasympathetic innervation to ciliary muscles and iris sphincter muscles from where?
Edinger-Westphal nucleus
brain structure that provides pain, touch, temperature
thalamus
brain cells that provide nutrients to nerve cells and control chemical composition
astrocytes
saltatory conduction via nodes of Ranvier via what kind of channels
Na channels
upbeating nystagmus, lesion where?
medulla
L cerebellar lesion affects which side and what?
L side, skilled movements
default mode network of the brain does what
involved in reprocessing previously experienced stimuli
what is the roof of the 4th ventricle?
cerebellum
diencephalon is composed of what two structures?
thalamus and hypothalamus
what forms the lenticular nucleus?
globus pallidus and putamen
what forms the striatum?
caudate and putamen
third ventricle walls are made up of what
thalamus and hypothalamus
SIADH, hyponatremia due to which MAOI?
tranylcypromine
MAOI with least likelihood for HTN crisis?
selegeline
phenelzine is a strong MAOI, what are contraindications to it?
liver disease, CHF, pheochromocytoma
which SNRI/SSRI highest risk in pregnancy?
Paxil
which SSRI with most norepi reuptake inhibition?
Paxil
majority of neurotransmitters mediate their effects via
G protein coupled receptors
receptors with intrinsic enzyme activity
tyrosine kinase and phosphatase
LSD acts on which 5HT receptor to cause psychomimetic sx?
5HT2
dopamine to norepinephrine via what enzyme?
dopamine hydroxylase
rate limiting enzyme for norepinephrine synthesis
tyrosine hydroxylase
norepinephrine to epinephrine via what enzyme?
phenylethanolamine NMT
rate limiting enzyme for serotonin synthesis
tryptophan hydroxylase
serotonin to 5-hydroxyindoleacetic acid via what enzyme
MAO
measurement of dopamine degradation
homovanillic acid
end-stage metabolite of norepinephrine
VMA vanillylmandelic acid
tyrosine to dopamine via what enzyme
tyrosine hydroxylase
products of choline acetyltransferase
aceteylcholine and coenzymeA
rate limiting step of acetylcholine synthesis
active transport of choline uptake into the presynaptic nerve
MAO located where
OAM outer area of mitochondria
calmodulin, protein kinase C bind what?
calcium
brussel sprouts are a ** and will affect the metabolism of **
1A2, clomipramine
venlafaxine is metabolized by ** and these are ** inducers
2D6; dexamethasone and rifampin
methadone metabolized by what, and what is an inhibitor of this?
3A4; clarithromycin
how do carbamazepine and St. John’s wort act, and can affect what medication?
2C9 inducer; glyburide
rifampin inhibits or induces?
induces a lot
NSAIDs and what, via what? need to monitor
fluconazole; 2D9
fluoxetine is what kind of inducer/inhibitor
potent 2D6 inhibitor
sertraline induces 3A4 and inhibits everything but what
1A2
SSRI with most norepinephrine reuptake inhibition?
Paxil
worst SSRI in pregnancy
Paxil
most common side effect of Wellbutrin
dry mouth
mirtazapine what type of AD
noradrenergic and specific serotonergic
medications FDA approved for PTSD
sertraline, paroxetine
antidepressant not associated with weight gain
duloxetine
ciprofloxacin inhibits or induces duloxetine metabolism
inhibits metabolism A12
shortest half life BZD
triazolam
high potency BZDs
triazolam, alprazolam, clonazepam
BZDs act on what channel
GABA-A chloride
what teratogenic effect of BZD
oral cleft
Buspar mechanism
full agonist pre, partial agonist postsynaptic 5HT1A
Buspar affected by what med?
ritinovir, 3A4
