Pathology Flashcards
1
Q
Pt. presents with mild subjective deficits, diminished capacity to process new information, detailed memory has declined, multi-tasking has become more difficult
A
Normal age related changes in cognitive function
2
Q
Pt. presents with an acute onset of mental impairment (overstated), sleep disturbances, executive functioning impaired, and reduced interest and effort
A
Depression
3
Q
What is the differences between vascular dementia and Alzheimers
A
1) VD has a Hx. of risk factors
2) VD has more visual memory impairment
3) VD has greater executive function impairment
4) VD pt. have a greater awareness of deficits
5) VD has less cognitive memory loss
4
Q
How do you differentiate between Picks disease and Alzheimers?
A
1) Picks is located within only the frontal and temporal lobes
2) Picks occurs before 65, AD after 65
3) Severe behavioral problems are observed in Picks
4) Picks has the absence of amyloid plaques
5
Q
Pt. suffering with tremors, agitation, anxiety, delirium, and psychosis due to withdrawal; may also have seizures, tachycardia, and palpitations
A
Alcohol withdrawal (Delirium Tremens)
6
Q
Pt. suffering with tremors, anxiety, perceptual disturbances, psychosis, and insomnia due to withdrawal
A
Benzodizaepine withdrawal
7
Q
Pt. suffering with nausea, vomiting, abdominal cramping, and muscle aches due to withdrawal; may also have dilated pupils, yawning, lacrimation
A
Heroin (opioid) withdrawal
8
Q
Pt. suffering with increased appetite, hypersomnia, intense psychomotor retardation, severe depression due to withdrawal
A
Cocaine-meth amphetamine withdrawal
9
Q
Pt. suffering with dysphoria, irritability, anxiety, and increased appetite due to withdrawal
A
Nicotine withdrawal
10
Q
Damage to the temporal lobe that results in hyperorality, hyperphagia, hypersexuality, and placidity
A
Kluver-Bucy syndrome
11
Q
What are Argyll Robertson pupils? What do they indicate?
A
1) Pupils that constrict to accommodation, but not light
2) Neurosyphilis or diabetes
12
Q
What chromosomes are involved with Alzheimers?
A
1) Chromsome 1 encodes Presenilin 2
2) Chromsome 14 encodes Presenilin 1
3) Chromsome 21 encodes APP
4) Chromsome 19 encodes APOE 2,3, and 4
13
Q
What is better APOE 2 or 4?
A
APOE 2- decreased risk of Alzheimers
14
Q
What neurotransmitters are low in Alzheimer?
A
1) Acetylcholine
2) Norepinephrine
3) Glutamate
15
Q
Terminology
1) Lack of speech
2) Lack of drive/motivation
3) Inability to experience pleasure
A
Negative symptoms
1) Alogia
2) Avolition
3) Anhedonia
16
Q
Where do dopamine receptors occur?
A
1) Extrapyramidal tract
2) Mesolimbic tract
3) Tubero-infundibular (controls prolactin release)
4) Brainstem
17
Q
What are the criteria for diagnosis of Schizophrenia?
A
1) 2 or more symptoms that are active for a month
2) Significant portion of time with at least one major area of dysfunction
3) Continuous signs of distrubance persisting for at least 6 months
18
Q
What must be ruled out before diagnosing a psychosis?
A
1) Medical conditions
2) Drug use
19
Q
Sensory Perceptions in the absence of external stimuli
A
Hallucinations
20
Q
False beliefs about oneself or others that persist despite the facts
A
Delusions
21
Q
Words and ideas are strung together based on sounds, puns, or loose assocaitions
A
Disorganized speech
22
Q
Hallucination commonly associated with medical illness
A
Visual hallucination
23
Q
Hallucination commonly associated with psychiatric illness
A
Auditory hallucination
24
Q
Hallucination that occurs as an aura of psychomotor epilepsy
A
Olfactory hallucination
25
What are the different subtypes of schizophrenia?
1) Paranoid
2) Disorganized
3) Catatonic
4) Undifferentiated
5) Residual
26
Schizophrenia subtype characterized by a preoccupation with one or more delusions or frequent auditory hallucinations
Paranoid Schizophrenia
27
Schizophrenia subtype characterized by two automatisms
Catatonic
28
automatism consisting of motoric immobility
Catatoinic stupor
29
Automatism consisting of excessive motor activity that is purposeless
Catatonic excitement
30
Automatism consisting of negative sympotms
Extreme negativism
31
Automatism consisting of peculiarities of voluntary movements
Catatonic posturing
32
Automatism consisting of repetition of vocalizations made by another person
Echolalia
33
Schizophrenia that lasts 1-6 months
Schizophreniform disorder
34
An uninterrupted period of illness during which a major depressive, manic, or mixed episode occurs; at least 2 week duration
Schizoafffective disorder
35
Presence of hallucinations, delusions, disorganized behavior or speech for one month
Brief psychotic disorder
36
Development of delusions in a person who is in a close relationship with another person with delusional disorders; resolves with separation from individual with delusional disorder
Shared Pyschotic Disoder (Folie a deux)
37
Fixed, persistent, nonbizarre belief system lasting >1 month; functioning not impaired
Delusional disorder
38
Schizophrenia symptoms
1) Hallucinations
2) Delusions
3) Disturbed thinking
4) Bizarre behavior
Positive symptoms of schizophrenia
39
Schizophrenia symptoms
1) Lack of emotions
2) Impaired spontaneity
3) Passive/apathy
4) Social withdrawal
5) Lack of pleasure (anhedonia)
Negative symptoms of schizophrenia
40
What causes a worse prognosis of schizophrenia?
Presence of several negative symptoms
41
What causes a worse prognosis of schizophrenia?
Presence of several negative symptoms
42
What are the vulnerability genes found in schizophrnenia?
1) Neuregulin 1
2) Dysbindin
3) COMT
4) DISC
5) BDNF
43
What are the core symptoms for major depressive disorder?
Think: SIGECAPs
1) Sleep pattern changes
2) Interest changes
3) Guilt and worry
4) Energy changes
5) Concentration changes
6) Appetite changes
7) Psychomotor disturbances
8) Suicidal ideation
44
One or more major depressive episode with 5 out of 9 core symptoms that lasts a minimum of 2 weeks; absence of manic, mixed, or hypomanic episodes
Major depressive disorder
45
Risk factors for Suicide?
Think SAD PERSONS
1) Sex (male)
2) Age (teenagers and elderly)
3) Depression
4) Previous attempt
5) Ethanol
6) loss Rational
7) Sickness
8) Organized plan
9) No spouse
10) Social support is lacking
46
What are the three major neurotransmitters involved depression
1) Serotonin
2) Norepinephrine
3) Dopamine
47
What drugs can induce depression?
1) Reserpine
2) Propranolol
3) Methyldopa and clonidine
4) Ampehtamine withdrawal
5) Oral contraceptives
48
milder form of depression lasting at least 2 years
Dysthymia
49
Symptoms associated with winter season; improves in response to full-spectrum bright-light exposure
Seasonal affective disorder
50
Presence of abnormally elevated, expansive, or irritable moods for at least 1 week along with 3 out of 7 symptoms
Manic Episode
51
What are the core symptoms of a manic episode?
think: DIG FAST
1) Distractibility
2) Irresponsibility
3) Grandiosity (inflated self-esteem)
4) Flight of ideas
5) Activity directed by goals increased
6) Sleep not needed
7) Talkativeness
52
Manic like episode that is less severe; does not require hospitalization; no psychotic features
Hypomanic episode
53
Disorder lasting greater than 2 years that consists of a swing between dysthymia and hypomania; milder form of bipolar disorder
Cyclothymic disorder
54
History of one manic episode with associated symptoms (3 out of 7)
Bipolar I
55
History of one hypomanic episode
Bipolar II
56
What must you be sure of before you give a pt. an antidepressant?
1) Make sure they are not bipolar and in a depressive episode
2) Antidepressant can activate mania
57
Transplanting one's unacceptable impulses onto another person
Projection
58
Expressing unacceptable thoughts or impulses through actions; Example tantrum
Acting out
59
Redirecton of an unacceptable impulse into the opposite
reaction formation
60
Reverting to a less mature way of coping with difficulties
Regression
61
Modeling one's behavior after someone who is perceived to be more powerful
Identification
62
Unconscious belief that people are either wholly good or wholly bad
Splitting
63
Mood symptoms with concurrent symptoms of schizophrenia; Dx must have proof of psychotic symptoms in the absence of prominent mood symptoms for at least two weeks
Schizoaffective
64
Schizophrenic like symptoms that last 1-6 months
Schizophreniform disorder
65
Suicidal conditions with potential to progress rapidly to suicidal behavior
Heightened risk
66
Suicidal behavior may occur within hours
Near term risk
67
Pairing a sexually arousing paraphilic stimulus with an unpleasant odor
Aversion therapy
68
What is satiation?
Where you reward the good and then place them in a bad environment and they cannot please themselves any longer
69
Enduring patterns of behavior and inner experiences that deviates markedly from the cultures expectation
Abnormal personality disorder
70
Pervasive distrust and suspiciousness of others
Paranoid personality disorder
71
What is the cause of Paranoid personality?
1) Early shame inducing experiences/mistrust
| 2) Experiences of mistreatment
72
What are the defense mechanisms of a paranoid personality disorder?
1) Splitting
| 2) Projection
73
Pervasive detachment from relationships
Schizoid personality disorder
74
What are the different clusters of personality disorders?
Think: Weird, Wild, and Wimpy
1) Odd and Eccentric Personality disorders
2) Dramatic, Emotional, and Erratic Disorders
3) Anxious and Fearful
75
Pervasive pattern of excessive need to be taken care of by others
Dependent personality disorder
76
Pervasive pattern or preoccupation with details at the expense of efficiency
Obsessive compulsive
77
Pervasive pattern of feelings of inadequacy, hypersensitivity to any form of critisicsm
Avoidant
78
Pervasive pattern of exploiting others, disregard for the rights of others and society
Antisocial
79
Pervasive pattern of extreme emotionality and attention seeking
Histrionic
80
Pervasive pattern of grandiosity, superiority, lack of emphathy for others
Narcissistic
81
What are the group A: Odd and Eccentric Personality disorders?
1) Paranoid
2) Schizoid
3) Schizotypal
82
What are the group B: Dramatic, Emotional, and Erratic disorders?
1) Borderline
2) Narcissistic
3) Histrionic
4) Antisocial
83
What are the group C: Anxious and Fearful disorders?
1) Avoidant
2) Dependent
3) Obsessive compulsive
84
What is the criteria for the Confusion Assessment Method (CAM)?
Requires criteria 1, 2, and 3/4
1) Acute change in mental status and fluctuating course
2) Inattention
3) Disorganized thinking
4) Altered level of consciousness
85
What is the criteria for mental retardation diagnosis?
1) IQ <70
2) Diagnosis before 18
3) Deficits in more than one area of daily living skills
86
What are the criteria that must be met for the diagnosis of autism?
1) Communication problems
2) Social impairments
3) Behaviors that are restricted or repetitive
87
Inability to achieve in reading, writing or math at a level consistent with one's IQ
Learning disorder
88
What are good prongosis factors for autism?
1) High IQ
| 2) Better language or social skils
89
Severe disabling level of anxiety where the child is fearful to be away from parent. What is the disorder? What is necessary for diagnosis?
1) Separation Anxiety disorder
| 2) At least 3 of 8 symptoms must be present for at least four weeks
90
Presence of both motor and vocal tics that has occured over a year
Tourette's disorder
91
Children have defiant quallities but not as bad as conduct disordered behavior; commonly called "spoiled"
Oppositional defiant disorder
92
Pattern of behavior that violates the rights of others; increased risk of having an Antisocial Personality disorder
Conduct disorder
93
Treatment for delirium without underlying causes
Antipsychotics (HALDOL!)
94
Recurrent, spontaneous, primary attacks with 4 out of 13 panic symptoms followed by 1 month of either persistent concern of another attack, worries about implications of attack, or behavioral changes due to attack.
Panic Disorder
95
Diagnosis of panic disorder?
Episodic panic (4 out of 13 symptoms) with 1 month of:
1) fear of another attack
2) Implications of attack
3) Behavioral changes due to attack
96
Fear and anxiety due to situations where escape might be difficult; public transportation, crowds, and elevators elicit fear
Agoraphobia
97
Exposure to a traumatic event that involved threat to life and was filled with a response of intense fear, helplessness, and horror that lasts for a minimum of two days and no longer than four weeks. What does this become if greater than two weeks?
1) Acute Stress Disorder
| 2) Post Traumatic Stress Disorder
98
Repetitive behavior that a person feels driven to perform
Compulsion
99
What are the mature defenses?
1) Altruism
2) Humor
3) Sublimation
4) Suppression
100
Unselfishly assisting others to avoid negative feelings
Altruism
101
Rerouting an unacceptable drive in a socially acceptable way
Sublimation
102
Temporary, drastic change in personality, memory, consciousness or motor behavior to avoid emotional stress
Dissociation
103
Disorder by which an individual consciously or unconsciously uses the body or bodily symptoms for psychological purposes
Somatization disorder
104
What is required for diagnosis of somatization disorder?
1) Four pain symptoms
2) Two GI symptoms
3) One sexual symptom
4) One pseduoneurological symptom
105
Monosymptom with symbolic relationship between conflict and physical symptoms: unconscious
Conversion disorder
106
Preoccupation with fear of having a serious disease
Hypochondriasis
107
Pattern of cognition invoking the emotional memory of the trauma; lasting >6 months
Post Traumatic Stress Disorder
108
Uncontrollable worry with no specific trigger for at least 6 months
Generalized Anxiety Disorder
109
What is the first line treatment for anxiety disorders?
SSRIs
- Sertraline
- Paroxetine
- Citalopram
- Escitalopram
- Fluoxetine
- Fluvoxamine
110
What are clinical features of a pt. with Anorexia nervosa?
1) Fatigue
2) Headache
3) Abdominal bloating
4) Constipation
5) Hair loss
6) Cold intolerance
7) Fractures with minimal trauma
8) Anxiety, depression, or stress
9) Excessive exercise
111
What physical exam findings might indicate Anorexia nervosa?
1) Brittle hair and nails
2) Hair loss
3) Bradycardia
4) Low body temperature
5) Low BP
6) Acrocyanosis
7) Dry skin
112
What physical exam findings might indicate Bulimia nervosa?
1) Parotid or salivary gland enlargement
2) Russel sign - callusses and abrasions on the skin of hand
3) Dental enamel errosions
113
What is the equation for BMI?
BMI = (Weight (lbs))/((Height in inces)^2 (703))
114
What drives the circadian rhythm?
1) Suprachiasmatic nucleus of the hypothalamus
| 2) Inhibits melatonin synthesis in the pineal gland
115
What are the stages of NREM sleep?
1) Stage N1 (Pre-sleep)
2) Stage N2
3) Stage N3 (Slow wave sleep)
116
What is the most restorative stage of sleep?
N3 (slow wave sleep)
117
What stage of sleep is at increased risk for parasomnias?
N3 (slow wave sleep)
118
Transient reduction, but not complete cessation of breathing for 10 seconds or longer
Hypopnea
119
Presence of Sleep spindles/K complexes indicates what stage of sleep?
Stage N2
120
What is the strongest stimulus of the circadian rhythm?
1) Light
| 2) Controls suprachiasmatic nucleus
121
What hormone is dependent upon delta sleep (stage N3)
Growth hormone
123
what is the clasisc tetrad for narcolepsy
1) Excessive daytime sleepiness
2) Catplexy (pathognmonic)
3) Hypnagogic hallucinations
4) Sleep paralysis
124
Maladaptive pattern of substance use defined as 3 or more of the following over a year:
1) Tolerance
2) Withdrawal
3) Predominance of thoughts on drugs or inability to quit
4) Substance taken in larger amounts over longer time than desired
5) Important social, occupational, or recreational activity reduction
6) Use in spite of knowing it to be a problem
Substance dependance
125
Maladaptive substance use patern consisting of 1 of the following over a year:
1) Recurrent use resulting in failure to fulfill major obligations
2) Recurrent use in physically hazardous situations
3) Recurrent substance related legal problems
4) Continued use in spite of persistent problems
Substance abuse
126
X linked disorder seen exclusively in Girls; occurs around 1-4 yrs old; Loss of development, loss of verbal abilities, mental retardation, and stereotyped handwriting
Rett syndrome
127
Marked regression in multiple areas of mental functioning after 2 years of normal development; common in boys
Childhood disintegrative disorder
128
Marked regression in multiple areas of mental functioning after 2 years of normal development; common in boys
Childhood disintegrative disorder
129
Complete cessation of breathing lasting 10 or more seconds while asleep
Apnea
130
Cessation of breathing with no respiratory effort during occurence
Central apnea
131
What is the purpose of the Epworth sleepiness score?
To determine objectively pt. sleepiness
132
What is the Mallampati classification?
Classification of airway obstruction
133
What Mallapmpati classification indicates complete block of viewing anything in the mouth
Class IV
134
When does melatonin peak?
2-4 am
