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MS3 > Neuro/Psych > Flashcards

Neuro/Psych Flashcards

1
Q

How long does it take for a CT head to reach 95% sensitivity for a stroke? How long for an MRI?

A

CT head - 4-5 days, MRI 1-2 days

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2
Q

If a patient is on aspirin and has a stroke what are 2 options for the next step in prevention?

A

Add dipyramidole or SWITCH to clopidogrel

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3
Q

What is the time frame for thrombolytics in an ischemic stroke?

A

Less than 4.5 hours

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4
Q

What metabolism altering drug must be added to a patient’s regimen after an ischemic stroke?

A

A statin

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5
Q

What anticoagulation treatment is recommended after an ischemic stroke?

A

Heparin followed by warfarin - INR 2-3

or Rivaroxaban/dabigatran

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6
Q

What does the CHADS VAsc score measure?

A

Risk for stroke from atrial fibrilation

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7
Q

What is the recommended treatement for a patient with of symptomatic cerebrovascular disease with >70% carotid stenosis? What about <50% stenosis?

A

> 70% stenosis - endarterectomy

<50% - no endarterectomy is indicated

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8
Q

Does angioplasty or stent have value for stroke patients?

A

NO

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9
Q

What is the goal LDL post stroke?

A

<70 mg/dL

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10
Q

What is another name for pseudotumor cerebri?

A

Idiopathic Intracranial HTN

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11
Q

What physical exam findings are present for cluster headaches?

A

Red eye with tearing, rhinorrhea, possible horner syndrome

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12
Q

What physical exam findings are present for giant cell arteritis

A

Visual loss with tenderness in the temporal area

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13
Q

What physical exam findings are present for pseudotumor cerebri?

A

Papilledema with abducens palsy

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14
Q

What other eye pathology can cause headache with a red eye?

A

glaucoma

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15
Q

What is the treatment for a tension headache/

A

NSAIDs/oral analgesics

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16
Q

What are 4 abortive treatments for migraine?

A

NSAIDs/excedrin/triptans/ergotamine

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17
Q

What 2 abortive treatments are available for cluster headaches?

A

triptans/ergotamines + 100% oxygen

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18
Q

What is the initial treatement for giant cell arteritis?

A

prednisone

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19
Q

What is the initial treatment of pseudotumor cerebri?

A

weight loss + acetazolamide

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20
Q

What tests are necessary for diagnosis of IIH?

A

Head CT/MRI to rule out intracranial mass + LP to show increased pressure

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21
Q

What is prophylactic treatement for cluster headaches?

A

Verapamil

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22
Q

What are 3 intial prophylactic treatments for migraines?

A

Beta blocker (e.g. propranolol), TCA (e.g. amytriptiline), topiramate

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23
Q

What is inital treatment for trigeminal neuralgia?

A

Oxcarbazapine or carbamazapine

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24
Q

What is the order of drugs (4) for status epilepticus?

A

IV benzodiazapine –> phenytoin/fosphenytoin –> phenobarbitol –> succinylcholine/vecuronium + intubation

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25
Q

What anti-seizure has the fewest side effects?

A

Levatiracitam

26
Q

Can you take away a driver’s license for seizures?

A

No - have to strongly recommend it

27
Q

What are the components of the mental status exam (10)?

A 
Appearance
Behavior
Speech
Mood/Affect
Thought Process
Thought Content
Perceptual Disturbances
Cognition
Insight
Judgment/Impulse Control
28
Q

What are the 4 P’s of a psychiatric HPI?

A

Predisposing features
Precipitating factors
Perpetuating factors
Protective factors

29
Q

What is circumstantiality?

A

Will eventually reach the point of the converstion but a lot of trivial info is added in

30
Q

What is tangentiality?

A

Point of conversation is never reached - responses usually ballpark relevant

31
Q

What is loosening of associations?

A

no logical connection from one though to the next

32
Q

What is flight of ideas?

A

Thoughts change abruptly from one idea to another + pressured speech

33
Q

What is neologisms?

A

Made up words

34
Q

What is clang associations?

A

Words connecting through rhyming rather than content

35
Q

What is the Tarasoff rule?

A

If a patient expresses imminent threats against anyone - physician must warn them

36
Q

What are ideas of reference?

A

Thoughts that external cues (e.g. billboards/TV) are specifically addressing the patient

37
Q

What are 2 examples of delusions of control?

A

Though broadcasting and thought insertion

38
Q

What is an illusion?

A

misinterpretation of an existing stimulus

39
Q

What is the most common cause of auditory hallucinations?

A

schizophrenia

40
Q

What is the most common cause of visual hallucinations?

A

Drug intoxication/drug withdrawal or delirium

41
Q

What is the most common cause of olfactory hallucinations?

A

Aura associated with epilepsy

42
Q

What is the most common cause of tactile hallucinations?

A

Drug use or alcohol withdrawal

43
Q

What is anhedonia?

A

Inability to feel pleasure

44
Q

What is alogia?

A

Poverty of speech

45
Q

What are the 3 stages of schizophrenia?

A

Prodromal - decline in functioning before first episode
Psychotic - positive symptoms with disordered thought content
Residual - predominantly negative symptoms

46
Q

What is the time requirement for schizophrenia?

A

At least 6 months (including prodromal time)

47
Q

When is schizophrenia most likely to present for men? When for women?

A

Men - early to mid 20s

Women - late 20s

48
Q

Are men or women more likely to have negative predominant symptoms in schizphrenia?

A

Men - generally have poorer outcomes

49
Q

What is the MoA of 1st generation antipsychotics?

A

D2 antagonists

50
Q

What is the MoA of 2nd generation antipsychotics?

A

5-HT2 antagonist and D4/D2 antagonist

51
Q

What should be added to treatment if extrapyramidal symptoms occurs while on an antipsychotic?

A

Anticholinergic (e.g. benztropine, diphenhydramine)

52
Q

What should be added to treatment if anticholinergic side effects occur while on an antipsychotic?

A

Per-symptom treatment (e.g. stool softener for constipation, eye drops for dry eyes)

53
Q

What treatment change should be considered for metabolic syndrome on 2nd generation antipsychotics?

A

Switch to 1st gen antipsychotic or use aripiprazole/ziprasidone which are weight neutral

54
Q

What is the last line 2nd gen antipsychotic? Why?

A

Clozapine - due to agranulocytosis risk

55
Q

What treatment change should occur if a patient on 1st generation antipsychotic has tardive dyskinesia?

A

Discontinue/reduce drug and can use benzodiazapines/botox for symptoms

56
Q

What is the cumulative risk of developing tardive dyskinesia while on antipsychotics?

A

5% per year

57
Q

Who is at greatest risk for tardive dyskinesia on antipsychotics?

A

Older women

58
Q

What is the distiniguishing requirement for schizophreniform disorder diagnosis?

A

1-6 months of schizophrenia-like symptoms

59
Q

What is the diagnostic criteria for schizoaffective disorder?

A

Major depression/mania diagnosis + delusions and hallucinations for at least 2 weeks WHILE NOT AFFECTED BY MOOD DISORDER

60
Q

What is the diagnostic requirement for brief psychotic disorder?

A

Schizophrenia-like symptoms from 1 day to 1 month

MS3 (1 decks)

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