Neuro/Psych 4

Question 1

Simple seizures

Answer 1

Focal (1 hemisphere)

• No LOC/postictal state
• Motor, sensory, autonomic, or psychic sx

Tx: narrow spectrum

Question 2

Complex seizures

Answer 2

Focal (1 hemisphere)

• LOC and postictal state
• May have automatisms (e.g. lip smacking)

Tx: narrow spectrum

Question 3

Tonic-clonic

Answer 3

Generalized (both hemis)

• LOC and Postictal state
• Diffuse muscle contraction (tonic) — then rhythmic jerking (clonic)

Tx: Broad spectrum

Question 4

Myoclonic seizures

Answer 4

Generalized

• No LOC or postictal state
• Brief jerking movements

Tx: broad spectrum

Question 5

Absence seizures

Answer 5

Generalized

• Brief LOC (blank stare)
• May have automatisms (e.g. lip smacking)
• Usually no postictal state

Tx: ethosuximide

Question 6

What are narrow spectrum tx for seizures?

Answer 6

Carbamazepine

Gabapentin

Phenobarbital

Phenytoin

Question 7

What are broad spectrum tx for seizures?

Answer 7

Lamotrigine

Levetiracetam

Topiramate

Valproic acid

Question 8

Tx for bulimia nervosa

Answer 8

• SSRIs
• Nutritional rehab
• CBT

Question 9

Why is buproprion contraindicated in someone with bulimia?

Answer 9

Elevated risk of seizures

Question 10

MOA of carbamazepine

Answer 10

Blocks VG-Na channels in cortical neurons

Stabilizes these channels in an inactivated state => fewer Na channels

Question 11

Adverse effects of carbamazepine?

Answer 11

• Bone marrow suppression => anemia, agranulocytosis, thrombocytopenia
• Hepatoxic
• SIADH

Get LFTs and CBC periodically

Question 12

Which tx are used in AD?

Answer 12

• Cholinesterase inhibitors (Donepezil)
• Antioxidants (Vit E)
• NMDA receptor antagonists (Memantine)

Question 13

Clinical features of OCD?

Answer 13

Obsessions:
- Recurrent, intrusive, anxiety-provoking thoughts, urges, images

Compulsions

• Response to obsessions w/repeated behaviors
• Behaviors not connected realistically w/ preventing feared event

Time-consuming (>1h/day)

Question 14

Subdural hematoma on a CT scan

Answer 14

Crescent-shaped

Rupture of cortical bridging veins

Question 15

Subdural hematoma clinical signs

Answer 15

• ^ed ICP (BP)

Young pts:

• Gradual onset of HA and confusion
• think MVA, bad fall

Elderly:

• Minor trauma
• Variety of neuro sx (gait, seizures, somnolence, confusion, memory loss)

Question 16

CT scan of Dandy-Walker malformation

Answer 16

Hypoplasia/absence of cerebellar vermis

Cystic dilation of 4th ventricle

Posterior fossa enlargement

Question 17

Clinical presentation of Dandy-Walker malformation

Answer 17

Present in infancy

• Developmental delay
• Progressive skull enlargement
• Cerebellar dysfunction
• Non-communicating hydrocephalus

Question 18

Primary CNS lymphomas

Answer 18

• Associated w/ immunocompromised pts
• Arise from B cells
• Universally associated w/ RBV
• High grade => poor prognosis

Question 19

Which drug group is associated with the majority of overdose-related deaths?

Answer 19

Opioid pain relievers

Question 20

How do the meningicoccal vxs work?

Answer 20

• Produce Abs that prevent inhibit pilus-mediated attachment of the meningococcus to mucosal epithelium of nasopharynx
• Prevents colonization and invasion

Question 21

Uncal herniation

Answer 21

• (Ipsilateral) Fixed, dilated pupil
• Ips oculomotor muscle paralysis
• Contra/ips hemiparesis
• Contra homonymous hemianopsia

Question 22

What is a congenital malformation?

Answer 22

primary abnormality in the developmental process

Question 23

Congenital disruption

Answer 23

secondary destruction of a previously well-formed tissue or organ

Question 24

Congenital deformation

Answer 24

secondary to extrinsic compression

Question 25

Congenital agenesis

Answer 25

complete absence of an organ

Question 26

Holoprosencephaly

Answer 26

- Failure of forebrain cleavage into cerebral hemis | - Congenital malformation

Question 27

Amniotic band syndrome

Answer 27

Can compress or amputate fetal limbs Congenital disruption

Question 28

Potter syndrome

Answer 28

- Congenital hip dislocation - Clubbed feet - Flat facies Congenital deformation and sequence

Question 29

Clozapine indications

Answer 29

Tx-resistant schizophrenia Schizophrenia associated w/ suicidality

Question 30

Adverse effects of clozapine

Answer 30

- Agranulocytosis - Seizures - Myocarditis - Metabolic syndrome Must regularly monitor PMNs

Question 31

Lambert-Eaton syndrome

Answer 31

- Wkness improves during the day & w/exercise - Wkness of proximal muscles - Associated w/ pre-existing malignancy - Abs against pre-synaptic Ca channels - Tensilon test: no clinical improvement - Nerve stimulation: incremental response

Question 32

Which type of cancer is usually associated w/Lambert-Eaton syndrome?

Answer 32

Small cell lung cancer

Question 33

Diabetic mononeuropathy

Answer 33

- Involves CNIII (down & out, normal light and accomodation) - Causes by central ischemia => somatic nerve fibers - Don't affect peripheral parasympathetic fibers

Question 34

Measuring blood levels of what correlates closely with morbidity and mortality in N. meningitidis

Answer 34

Meningococcal lipooligosaccharide (LOS) => toxic effects observed in meningitis and meningococcemia

Question 35

Clinical signs of tertiary syphilis

Answer 35

Tabes dorsalis: - Affects dorsal columns and dorsal roots - Loss of position and vibration sense - Severe lancinating pains - Absent peripheral reflexes Argyll Robertson pupils: - Small, irregularly shaped pupils - Don't constrict in response to light - Constrict w/ accomodation - Midbrain tectum

Question 36

Tetrahydrobiopterin (BH4)

Answer 36

- Cofactor used by hydroxylase enzymes - synthesizes tyrosine, dopamine, serotonin Deficiency: - PKU