Neuro 2 USMLE Flashcards
In a LMN lesion of CN XII the tongue will deviate _____ (away or towards) the side of the lesion?
towards
mneu: lick your wounds
In a CN V motor lesion the jaw deviates ______ (towards or away) the side of the lesion
towards
in a CN X lesion the uvula will deviate _______ (towards or away) of the side of the lesion.
away
In a unilateral lesion of the cerebellum the pt tends to fall _______ (towards or away) the side of the lesion.
towards
In a CN XI lesion there is weakness turning head to the side _________ (ipsi or contralateral) to the lesion. There is also a shoulder droop (ipsi or contralateral) to the lesion
contralateral
ipsilateral
pt presents with paralysis of the lower half his face only. What do you suspect.
contralateral UMN lesion
either of motor cortex or connection between cortex and facial nucleus
pt presents with paralysis of one side of his entire face (upper and lower). What do you suspect?
ipsilater LMN lesion of CN VII
This disorder is due to a destruction of the facial nucleus itself or it’s brancchial efferent fibers (facial nn). It results in ipsilateral facial paralysis with an inability to close the eye of the involved side. It is often idiopathic and there is gradual recovery in most cases
Bell’s palsy
Give some diseases in which Bell’s palsy is often seen as a complicaion.
Aids, Lyme dz, Sarcoidosis, Tumors, Diabetes
mneu: ALexander BELL with STD: AIDS, Lyme, Sarcoid, Tumors, Diabetes
This herniation syndrome can compress the anterior cerebral aa
Cingulate herniation under falx cerebri
These 3 herniation syndrome can result in coma and death if brain stem is compressed.
1) downward transtentoral (central herniation
2) Uncal herniation (Uncus=medial temporal lobe)
3) Cerebellar tonsillar herniation into the foramen magnum
In the case of an uncal herniation you may see ipsilateral dilated pupil/ptosis. This is due to what?
Stretching of CN III
In the case of an uncal herniation you may see contralateral homonymous hemianopia. This is due to what?
compression of ipsilateral posterior cerebral aa
In the case of an uncal herniation you may see ipsilateral paresis. This is due to what?
compression of contralateral crus cerebri (Kernohan’s notch)
In the case of an uncal herniation you may see Duret hemorrhages (paramedian artery rupture). This is due to
caudal displacement of the brain stem
Pt can’t see at all out of his right eye (right anopia) Where is the lesion?
Right optic nn
Pts has bilateral temporal visual field defects (bitemporal hemianopia) Where is the lesion?
Optic chiasm
Pt can’t see the left visual field in either eye (Left homonymous hemianopia) Where is the lesion?
Right Optic Tract
Pt has Left upper quadratic anopsia (cant see up and to the right on both sides) Where is the lesion?
Right Temporal Lesion (Meyer’s loop)
Pt has left lower quandrantic anopia (can’t see down and to the left in either eye) Where is the lesion?
Right Parietal lesion
Dorsal optic radiation
Pt has left hemianopia with macular sparing??
???visual cortex??
this syndrome is seen in many patients with multiple sclerosis. It results in medial rectus palsy on attempted lateral gaze & nystagmus in the abducting eye. Convergence is normal.
Internuclear opthalmoplegia (MLF syndrome)
mneu: MLF=MS
explain the pathology of Internuclear opthalmoplegia (Medial longitudinal fasciculus [MLF] syndrome)[pic]
When looking left, the left nucleus of CN VI fires, which contracts the left lateral rectus and stimulates the contralateral (right) nucleus of CN III via the right MLF to contract the right medial rectus. Lesion in the MLF interrupts this process.
give the dz indicated by the following neurotransmitter changes:
↑NE,↓GABA,↓5HT
Anxiety
give the dz indicated by the following neurotransmitter changes:
↓NE & ↓5HT
depression
give the dz indicated by the following neurotransmitter changes:
↓ACh
Alzheimer’s dementia
give the dz indicated by the following neurotransmitter changes:
↓GABA,↓ACh
Huntington’s dz
give the dz indicated by the following neurotransmitter changes:
↑Dopamine
Schizophrenia
give the dz indicated by the following neurotransmitter changes:
↓ Dopamine
Parkinson’s dz
When a person becomes disoriented they generally lose concept of person(their name, who they are), place (where they are), and time. In what order does this loss usually occur?
1st-time
2nd-place
last-person
what is anosognosia?
unawareness that one is ill
what is autotopagnosia
inability to locate one’s own body parts
what is depersonalization
body seems unreal or dissociated
what is ANTEROgrade amnesia?
inability to remember things that occurred afte a CNS insult
mneu: antero=after
what is RETROgrade amnesia?
inability to remember things that occurred before a CNS insult
mneu: retro=before
what is substance dependance?
maladaptive pattern of substance use defined as 3 or more of the follwing signs in 1 yr:
1)tolerance
2)withrawal
3)substance taken in larger amounts or over longer period of time than desired
4) persistant desire or attempts to cut down
5) significant energy spent obtaining, using, or recovering from substance
6 Important social, occupational, or recreational activities reduced because of substance use
7) continued use in spite of knowing the problems it causes
What is substance abuse
maladaptive pattern leading to clinically significant imparment or distress. Symptoms have not met criteria for substance dependance. 1 or more of the follwing in 1 yr:
1) recurrent use resulting in failure to fulfill major obligations at work, school, or home
2) recurrent use in physically hazardous situations
3) recurrent substance-related legal problems
4) Continued use in spite of problems caused by use
intoxication of this drug results in disinhibition, emotional lability, slurred speech, ataxia, coma, blackouts.
alcohol
gamma glutamyltransferase (GGT) is a sensitive indicator of this drugs use
alcohol
withdrawal from this drug results in tremor tachycardia, hypertension, malaise, nausea, seizures, delerium tremens (DTs), tremulousness, agitation, hallucinations
alcohol
intoxication of this substance results in CNS depression, nausea and vomiting, constipation, pupillary constriction (pinpoint pupils), seizures
*overdose is life threatening
opiods
withdrawal from this substance results in anxiety, insomnia, anorexia, sweating, dilated pupils, piloerection (goose pimples), fever, rhinorrhea, nausea, stomach cramps, diarrhea (“flulike” symptoms), yawning
opiods
intoxication of this substance results in psychomotor agitation, impared judgement, pupillary dilation, hypertension, tachycardia, euphoria, prolonged wakefulness and attention, cardiac arrhythmias, delusions, hallucinations, fever
amphetamines
withdrawal from this substance results in post use “crash”, including depression, lethargy, headache, stomach cramps, hunger, hypersomnolence
amphetamines
intoxication of with this substance results in euphoria, psychomotor agitation, impared judgement, tachycardia, pupillary dilation, hypertension, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death
cocaine
withdrawal from this substance results in a post-use “crash”, including severe depression and suicidality, hypersomnolence, fatigue, malaise, and severe psychological craving
cocaine
intoxication with this substance results in belligerence, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia, homicidality, psychosis, delirium
PCP
with this drug recurrence of intoxication symptoms can occur due to reabsorption in the GI tract, resulting in a sudden onset of severe, random, homicidal violence
PCP
intoxication with this substance can result in marked anxiety or depression, delusions, visual hallucinations, flashbacks, and pupil dilation
LSD
Intoxication with this substance can result in euphoria, anxiety, paranoid delusions, perception of slowed time, impared judgement, social withdrawal, increased appetite, dry moth, hallucinations
Marijuana
Intoxication with this drug is dangerous because of its low safety margin. higher doses result in respiratory depression
barbituates
withdrawal from this substance results in anxiety, seizures, delerium, and life-threatening cardiovascular collapse
barbiturates
These medications have a greater safety margin than barbituates. Intoxication can result in amnesia, ataxia, somnolence, minor respiratory depression.
benzodiazepines
these drugs have an additive effect with alcohol
benzodiazepines
withdrawal from these drugs results in rebound anxiety, seizures, tremor, and insomnia
benzodiazepines
excessive use of this drug results in restlessness, insomnia, increased diuresis, muscle twitching, and cardiac arrhythmias
caffeine
withdrawal from this drug results in headache, lethargy, depression, and weight gain
caffiene
use of this drug results in restlessness, insomnia, anxiety, and arrhythmias-no increased diuresis
nicotine
withdrawal from this drug results in irritability, headache, anxiety, weight gain, and extreme cravings
nicotine
use of this drug results in restlessness, insomnia, anxiety, and arrhythmias-no increased diuresis
nicotine
This dz is charachterized by physiologic tolerance and alcohol dependence with symptoms of withdrawal (tremor, tachycardia, hypertension, malaise, nausea, DTs when intake is interrupted. Pts will show continued drinking despite medical and social contradictions and life disruptions.
Alcoholism
What is a drug used in treatment of alcoholism
disulfiram
When do DTs usually appear in alcoholics?
2-5D after last drink.
In alcoholics in withdrawal what occurs 1st–autonomic system hyperactivity (tachycardia, tremors, anxiety) or psychotic symptoms (hallucinations, delusions)
1st-autonomic hyperactivity
2nd-psychotic symptoms
How do you treat DTs in alcholics going through withdrawal?
benzodiazpenes
Long-term alcohol use leads to this involving micronodular cirrhosis with accompaning symptoms of jaundice, hypoalbuminemia, coagulation factor deficiencies, and portal hypertension.
alcoholic cirrhosis
This syndrome caused by vitamin B1 (thiamine) deficiency, is common in malnourished alcoholics. They classically present with a triad of confusion, opthallmoplegia, and ataxia. This may progress to memory loss, confabulation, and personality change. It is associated with periventricular hemorrhage/necrosis, especially in mamillary bodies.
Wernicke-Korsakoff syndrome
What is the tx of Wernicke-Korsakoff syndrome
IV vitamine B1 (thiamine)
this complication of alcoholism consists of longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting. In contrast to esophageal varices it is associated with pain.
Mallory-Weiss syndrome
Heroine is a schedule __ drug
schedule I (not perscribable)
addicts of this drug are at increase risk of hepatitis, abscesses, overdose, hemorrhoids, AIDS, and right sided endocarditis.
heroine
These drugs can competatively inhibit opiods
Naloxone (narcan) and naltrexone
This long acting oral opiate is used for heroine detoxification or long term maitenance
methadone
this psychiatric illnesss involves rapid decrease in attention span and level of arousal. Pts show disorganized thinking, have hallucinations, illusions, misperceptions, disturbance in sleep wake cycle, and cognitive disfunction.
The key to diagnosis is its rapid onset and the waxing and waning of level of conciousness.
delerium
mneu: deliRIUM=changes in sensoRIUM
this is the most common psychiatric illness on medical and surgical floors.
delerium
delerium is often iatrogenic and reversable. Look at pts meds for ones with this effect.
anticholenergic
This psychiatric illness ivolves a gradual decrease in cognition–memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavior/ personality changes, and impared judgement.
Be sure to differentiate this from delerium. The key to diognosis is the more gradual onset and the fact that pt is alert with no change in his/her level of conciousness.
Dementia
mneu: DeMEMtia is characterized by MEMory loss. Commonly irreversable.
In elderly pts this disease can often present like dementia.
depression
DSM Criteria of Major depressive episode
characterized by at least 5 of the following for 2 weeks, including either depressed mood or anhedionia:
1) Sleep disturbance
2) ↓ Interest
3) Guilt or feelings of worthlessness
4) ↓ Energy
5) ↓Concentration
6) ↕Appetite
7) Psychomotor retardation/agitation
8) Suicidal ideations
mneu: SIG E CAPS
Lifetime prevalence of a major depressive episode is _____ for males and _____ for females
5-12% - males
10-25% - females
This variation on Major depressive disorders invoves 2 or more major depressive episodes with a symptom free interval of 2 months
RRECURRENT Major Depressive Disorder
This disorder is a milder form of depression that lasts at least 2 years
dysthymia
Pts with depression typically have the follwing 3 changes in their sleep stages.
1) ↓ slow wave sleep
2) ↓REM latency
3) Early-morning awakening (important screening question
Risk factors for suicide completion
Sex (male) Age (teenager or elderly) Depression Previous attempt Etoh (or drug use) Rational thinking (loss of) Sickness (≥3 perscriptions) Organized plan No spouce (esp if childless) Social support lacking
mneu: SAD PERSONS
ECT is a treatment option when?
MDD refractory to other treatment
Major adverse effects of ECT
anterograde and retrograde amnesia, and confusion
T or F: ECT is painful.
F
This psychiatric disorder is characterized by a period of abnormally and persistantly elevated, expansive, or irritable mood lasting at least one week.
Manic episode
Describe the DSM criteria for a manic episode.
During a manic episode, 3 or more of the follwing are present:
1) Distractibility
2) Irresponsibility
3) Grandiosity
4) Flight of ideas
5) ↑Activity
6) ↓Sleep
7) Talkativeness
mneu: DIG FAST
this psychiatric disturbance is like a manic episode except mood disturbance is not severe enough to cause marked imparement in social and/or occupational functioning or to necessitate hospitalization. There are no psychotic features
Hypomanic episode
In this disorder pt consciosly fakes or claims to have a disorder in order to attain a specific gain (e.g., avoiding work, obtaining drugs)
malingering
Drug of choice for bipolar disorder
lithium
what is cyclothymic disorder?
a milder form of bipolar disorder lasting at least 2 years
In this disorder the pt conciously creates symptoms in order to assume the “sick role” and to get medical attention.
factitious disorder
This form of factitious disorder is manifested by a chronic history of multiple hospital admissions and willingness to receive invasive procedures.
Munchausen’s syndrome
This factitious disorder is seen when an illness in the child is caused by the parent. The motivation is unconscious. It is a form of child abuse and must be reported.
Muchausen’s syndrome by proxy
In this psychiatric disorder both illness production and motivation are unconcious drives. These are more common in women and manifest themselves in a variety of ways.
Somatoform disorders
Type of somatoform disorder in which pt presents with motor or sensory symptoms (e.g., paralysis, pseudoseizure) that suggest neurologic of physical disorder, but tests and physical exam are negative. Onset of symptoms often follow an acute stressor. Pt may seem strangely unconcerned about symptoms
Conversion disorder
Type of somatoform disorder in which pt presents with prolonged pain that is not explained completely by an illness.
Somatoform pain disorder
Type of somatoform disorder in which pt presents with preoccupation with and fear of having a serious illness in spite of medical reassurance
hypochondriasis
Type of somatoform disorder in which pt presents with a variety of complaints in multiple organ sytems with no identifiable underlying physical findings
Somatization disorder
Type of somatoform disorder in which pt presents with preoccupation with minor or imagined physical flaws. Pts often seek cosmetic surgery
Body dysmorhic disorder
Type of somatoform disorder in which pt presents with false belief of being pregnant associated with objective physical signs of pregnancy
pseudocyesis
What type of gain: primary, secondary, tertiary?
What the symmptom does for the patients internal psychic economy
primary gain
What type of gain: primary, secondary, tertiary?
What the symptom gets the patient (sympathy, attention)
secondary gain
What type of gain: primary, secondary, tertiary?
What the caretaker gets (like an doctor on an interesting case)
tertiary
Describe DSM characterization of panic disorder
recurrent periods of intense fear and discomfort peaking in 10 minutes with 4 of the following: Palpitations Paresthesias Abdominal distress Nausa, Intense fear of dying or losing control lIght headedness Chest pain Chills Choking disConnectedness Sweating Shaking Shortness of breath
mneu: PPANIICCCCSSS
note: panic disorder is descrribed in context of occurrence (e.g., panic d/o w/ agoraphobia)
This psychiatric disorder involves a specific fear that is excessive or unreasonable. It is cued by presence or anticipation of a specific object or situation. Exposue to this object or situation provokes an anxiety response. Person recognizes the fear is excessive (insight). This fear interfears with normal routine.
specific phobia
what form of psychotherapy works well for specific phobias
systematic desensitation
gamophobia
fear of marrage
algophobia
fear of pain
acrophobia
fear of heights
agoraphobia
fear of open spaces
In this disorder person experiences or witnesses an event that involved actual or threatened death or serious injury. response involves intense fear, helplessness, or horror. The traumatic event is persistently reexperienced as nightmares or flashbacks. The person persistantly avoids stimuli associated with the trauma and experiences persistant symptoms of increased arousal. Disturbance lasts > 1mo and cuases distress or socia/occupation imparent. This disorder often follwos acute stress disorder which lasts up to 2-4 weeks.
Post-traumatic stress disorder
In this disorder emotional symptoms (anxiety, depression) causing impairment follw an identifiable psychosocial stressor (e.g., divorse, moving). This lasts less than 6 months
Adjustment disorder
This psychiatric disorder is characterized by uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation, or event. Sleep disturbance, fatigue, and difficulty concentrating are common.
generalized anxiety disorder
children with this disorder have severe communication problems and difficulty forming relationships. This disorder is characterized by repetitive behavior, unusual abilities (savants), and usually below-normal intelligence.
Autistic disorder
This disorder is a milder form of autism involving problems with social relationships and repetitive behavior. These children are of normal intellegence and lack social or cognitive deficits.
Asperger disorder
This is an X-linked disorder seen only in girls (affected males die in utero). It is characterized by a loss of development and mental reatardation appearing at approximately age 4. There is steriotyped hand-wringing.
Rett disorder
this disorder is characterized by limited attention span and hyperactivity. Children are emotionally labile, impulsive, and prone to accidents. These children typically have normal intellegence.
Attention Deficit Hyperactivity Disorder (ADHD)
What is the treatment of ADHD
methylphenidate
This psychiatric disorder of childhood is characterized by behavior that continually violates social norms. At >18 y/o this disorder is recategorized as antisocial personality disorder.
Conduct disorder
This psychiatric disorder of childhood is characterized by noncompliance in the absence of criminality.
Oppositional defiant disorder.
This psychiatric disorder of childhood is characterized by motor/vocal tics and involuntary profanity. Onset is <18 y/o.
Tourette’s syndrome
What is the treatment for Tourette’s syndrome
haloperidol
This psychiatric disorder of childhood is characterized by fear of loss of attachment figure leading to factitious physical complaints to avoid going to school. The common onset is age 7-8.
Seperation anxiety disorder.
This eating disorder is commonly seen in adolescent girls and coexists with depression. It is characterized by excessive dieting, body image distortion, and increased exercise. Pts often experience severe weight loss, amenorrhea, anemia and eventually electrolyte disturbance.
Anerexia nervosa
