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Peds/Geri/Med Flashcards

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1
Q

mental retardation. M:F?

A

IQ of 70 or below. onset before age of 18. Males are affected 2x as much as females.

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2
Q

does most MR have an identifiable cause? 2 most common causes.

A

no. Downs and fragile X (M>F)

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3
Q

criteria for conduct disorder

A

at least 3 of the following within past year:

  1. aggression to people or animals
  2. destruction of property
  3. deceitfulness
  4. serious violation of rules
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4
Q

criteria for ODD

A

at least 6 months of negativistic, hostile, and defiant behavior, which 4 of the following have been present.

  1. frequent loss of temper
  2. arguments with adults
  3. defying adults rules
  4. deliberately annoying people
  5. easily annoyed
  6. anger and resentment
  7. spiteful
  8. blaming others for mistakes or behaviors
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5
Q

ADHD and ODD/conduct?

A

2/3 of children wit ADHD also have ODD or conduct

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6
Q

M:F in ODD? remission?

A

before puberty, more common in males. after puberty, M=F. remission in 25% of children. may progress to conduct

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7
Q

pharm for ADHD

A

CNS stimulants with TCAs as adjunctive

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8
Q

how to diagnose autism

A
  1. problems with social interaction
  2. impairments in communication
    3 repetitive and stereotypes patterns of behavior and activities
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9
Q

what kind of problems with social interactions can autistic kids have

A

at least two.

  1. impairment in nonverbal relationships- facial expression, gestures
  2. failure to develop peer relationships
  3. failure to seek sharing of interests of enjoyment with others
  4. lack of social/emotional reciprocity
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10
Q

what kind of impairments in communication can autistic kids have

A

at least one

  1. lack of or delayed speech
  2. repetitive use of language
  3. lack of varied/spontaneous play
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11
Q

what kind of repetitive and stereotypes patterns of behavior and activity can autistic kids have

A

at least one

  1. inflexible rituals
  2. preoccupation with parts of objects
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12
Q

how to treat autism

A

no cure. treat sxs.

  1. remedial education
  2. behavioral therapy
  3. neuroleptics- to help control aggression, hyperactivity, and mood lability
  4. SSRIs- to help control stereotypes and repetitive behaviors
  5. some children benefit from stimulants
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13
Q

when does autism present. what percent are mentally retarded. is there genetic assn?

A

usually presents before age 3.
M»>F.
70% have MR
significant assn with fragile X syndrome, tuberous sclerosis, MR, and seziures

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14
Q

concordance of autism in biological twins

A

36%

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15
Q

diff b/w Aspergers and autistic

A

Aspergers have normal language and cognitive development. but they do have problems with relationships and with restricted or stereotyped behaviors, interests, or activities

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16
Q

what is mutation of Rett’s? M vs. F. what is treatment

A

MECP2 gene on X chromosome. Seen mostly in girls, but sometimes in boys

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17
Q

blood test of anoerxia? Bulimia?

A

AN: hypochloremic, hyperkalemic akalosis.
hypercholesterolemia
leukopenia
BN: hypochloremic hypokalemic alkalsosi, increased amylase, increase BUN, hypernatreamia, metabolic acidosis, elevated bicarbonate

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18
Q

primary vs secondary enuresis? when is it usually established? when is enuresis usually remitted?

A

usually establish continence at age 4.
primary: never established continence
secondary: 5-8 incontinence after having it.
usually spontaneously remits by age 7

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19
Q

how to treat enuresis

A

behavior modification- buzzer when child pees.
TCA- imipramine.
antidiuretics- DDAVP

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20
Q

when is bowel control obtained normally? what to rule out in encopresis? how long do you need to have it?

A

normally get it at 4. need encopresis for 1x a mo for 3 mo. rule out hypothyroidism.

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21
Q

what other diseases is encopresis associated with

A

ADHD, conduct disorder

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22
Q

dissociative amnesia vs dementia

A

amnesia: can’t really name but can remember obscure details. dementia: remember stuff fro past

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23
Q

dissociative amneisa vs. dissociative fugue

A

unlike dissociative amnesia, pts w/dissociative fugue are unaware that they have forgotten anything

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24
Q

depersonalization disorder? how to treat?

A

persistent or recurrent feelings of detachment from one’s self, environment, or social situation. reality testing remans intact during episode. treat with anti anxiety agents or SSRIs.

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25
Q

how to treat impulse control disorder

A

SSRI. low levels of serotonin have been associated with impulsiveness and aggression. anticonvulsants, lithium, propranolol. individual psychotherapy is difficult and/or family therapy may be useful

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26
Q

what is often comorbid with bulimia

A

kleptomania. 1/4 of BN patients

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27
Q

treatment for trichitolomania

A

SSRI, lithium, antipsychotics. hypnosis, relaxation techniques. behavioral therapy- substitites anoher habit

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28
Q

hypchondriasis vs factitious

A

hypo: anxiety is main thing- it doesnt really go away. they wouldn’t want aggressive stuff.

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29
Q

pathophys of ADHD

A

dopamine filters the noise. norepinephrine increases the volume.

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30
Q

when do you use clonidine

A

BP and ADHD and opiate withdrawal

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31
Q

what med to give if depressed w/heart disease

A

sertraline (or citalopram)

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32
Q

can you try ECT after MI?

A

after 2 months- yes. after 2 good trials, try it.

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33
Q

angelman syndrome sxs

A

chromosome 15-developmental delay, movement or balance disorder, happy demeanor, sometimes seizures, short

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34
Q

prader-willi syndrome sxs

A

chromosome 15- cog diabilities, low muscle tone, short stature, chronic feeling of hunger-> obesity, almond shaped eyes

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35
Q

signs of porphyra

A

depression. GI pain, romberg sign, decreased joint position sense

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36
Q

carbidopa vs levidopa

A

levodopa crosses the BBB, carbidopa does not. carbidopa presents conversion of levodopa in the periphery. Once levodopa crosses BBB, it is free to be converted to dopamine. levodopa can cause depression or mania.

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37
Q

pathology and pathophysio of parkinsons

A

loss of cells in the substantial nigra of the basal ganglia-> decrease in dopamine and loss of dopaminergic tracts

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38
Q

53 yr old woman with changes in personality over last 6 years. personality became irritable, sexually uninhibited, and loud. intermittent jerky movements. MRI will likely reveal..

A

caudate atrophy. this is huntingtons

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39
Q

Huntingtons. onset? path? diagnostic? MRI? treatment?

A

35-50.
trinucleotide repeat on short arm of chromosome 4. primarily affects basal ganglia.
MRI shows caudate atrophy and sometimes cortical atrophy. genetic test and MRI are diagnostic.
no effective treatment

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40
Q

Huntingtons sxs vs FTD sxs

A

both have personality changes but Huntingtons has more movement- bizarre choreiform, muscle hypertonicity, and depression and psychosis are common.. FTD has more aphasia, apraxia, agnosia.

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41
Q

cortical dementia vs. subcortical dementia

A

cortial: alzheimer, Pick’s, CJD: decline in intellectual functioning.
subcortical: huntingtons, parkinsons, NPH, multi-infarct dementia- more prominent affective and movement sxs

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42
Q

parent management therapy

A

aims to change parenting behaviors, positive reinforcement, used for disruptive behavior like ODD and Conduct Disorder

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43
Q

are related sleep changes in elderly.

A

sleep less at night and nap during the day. period of deep sleep (stage 4) becomes shorter and eventually disappears. they awaken more throughout the night. not a sleep disorder.

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44
Q

preferred treatment for narcolepsy

A

modanifil. amphetamine stimulant are second line because of their abuse potential.

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45
Q

brain changes seen in PTSD

A

decrease in size of hippocampus

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46
Q

brain changes seen in autism

A

increased total brain volume nd accelerated head growth during inancy

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47
Q

brain changes seen in OCD

A

structural abnormalities in orbitofrontal cortex and basal ganglia

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48
Q

how to qualify for insomnia

A

3x per week for at least one month. difficulty maintaining or initiating sleep. leads to difficulty in completing tasks.

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49
Q

how to qualify for primary hypersomnia

A

at least 1 month of daytime sleepiness or excessive sleep not attributable to medical conditions, medications, poor sleep hygiene, insufficient sleep or narcolepsy. usually begins in adolescence.

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50
Q

treatment for primary hypersomnia

A

stimulant are first line. sometimes SSRI may help

51
Q

EDS vs fatigue

A

EDS: falling asleep when you don’t want to (common with OSA). fatigue is being too tired to complete activities

52
Q

obstructive sleep apnea versus central sleep apnea? treatment?

A

OSA: respiratory effort is present but ventilation is obstructed by physical obstruction of airflow. tx: nCPAP (nasal continuous positive airway pressure), weight loss, uvulopalatoplasty
CSA: periodic cessation of respiratory effort. tx: bPAP with a backup rated (mechanical ventilation)

53
Q

night terror disorder vs nightmare disorder

A

nightmare disorder: fully awaken and remember episode

54
Q

pain disorder vs somatization disorder

A

somatization is before age 30. at least 2 GI, 1 repro, 1 neuro, 4 pain. pain is >6 mo pain unexplained by other stuff.

55
Q

borderline vs histrionic

A

histrionic are more funcitonal. BPD are more likely to have depression and commit suicide.

56
Q

narcissistic vs. OCPD

A

both want assertiveness and achievement but OCPD are motivated by the work itself, narcissistic by the status

57
Q

what test to exclude reversible causes of dementia

A

15% of dementia is reversible. check VDRL (syphilis), electorlytes, TFT, CBC, b12/folate, brain CT or MRI

58
Q

dementia+ loss of position sense + megaloblasts on CBC

A

vitamin B12 deficinecy

59
Q

dementia + diminished position/vibration sense + Argyll Robertson pupils

A

neurosyphillis- check CSF VDRL or CSF FTA-ADS

60
Q

2 types of delirium

A

quiet (depressed, failure to thrive) and agitated (pulling out lines, may hallucinate)

61
Q

what should you do for delirium

A

fix reversible causes. give antipsychotic like seroquel. avoid napping. keep lights on shades open during the day. hold for sedation in orders

62
Q

ddx for delirium

A

AEIOU TIPS. alcohol, electrolytes, iatrogenic, oxygen hypoxia, uremia/encephalopathy, trauma, infecion, poison, seizures (post ictal)

63
Q

orientation and awareness in dleirium and dementia

A

delirium: lack of orientation and awareness.
dementia: they have awareness and orientation is often impaired

64
Q

EEG in delirium vs dementia

A

changes in delirium not dementia. delirium: fast waves or generalized slowing.

65
Q

how to diagnose alzheimers definitively

A

the only definitive way is pathological examination of brain at autopsy

66
Q

microscopic path of alzheimers

A

senile plaques of amyloid protein, neurofibrillary tangles from Tau protein, neuronal and synaptic loss

67
Q

gross path of alzheimers

A

diffuse atrophy with enlarged ventricles and flattened sulci

68
Q

what type of drug for alzheimers? 3 examples?

A

acetylcholinesterase ihibitors. donazepil, rivastigmine, tacrine

69
Q

can you give benzos in alzheimers

A

yes- for anxiety

70
Q

can you give antipsychotics in alzheimers

A

yes- for agitation/psychosis- like quietiapine

71
Q

can you give antidepressants in alzheimers

A

yes- for depression

72
Q

vascular dementia vs. alzheimers

A

vascular- also get focal near sxs like hyperreflexia and prosthesis. greater preservation of personality in vascular dementia.

73
Q

meds for parkinsosn

A

carbidopa/levodopa. amantidine (increases dopamine). anticholinergics (relieve tremor), bromocriptine (increase dopamine), MAO-B (e.g.: selegeline. inhibit breakdown of dopamine

74
Q

which 2 personality disorders use defense mechanism of regressin

A

dependent and histrionic

75
Q

delirium+ hemiparesis or other focal neuro signs

A

CVA or mass lesion- do CT/MRI

76
Q

delirium+ elevated BP + papilledema

A

hypertensive encephalopathy- do brain CT/MRI

77
Q

delirium+ dilated pupils + tachycardia

A

think drug intoxication- do urine tox screen

78
Q

delirium+fever+nuchal rigidity+photophobia

A

think meningitis, do LP

79
Q

delirium+tachycardia+tremor+thyromegaly

A

think thyrotoxicosis, do T4/TSH

80
Q

if a pt present with dementia but has a normal CT, what should yu do

A

order CMP and MRI

81
Q

a person gets dementia after going to woods. what do you think?

A

lyme disease

82
Q

alzheimers F:M

A

3:1

83
Q

structural changes in alzheimers

A

decrease in acetylcholine due to a loss of noradrenergic neurons in basal creels and decreased choline transferase (required for ACH)

84
Q

when do you find senile plaques and neurofibrillary tangles

A

alzheimers, Down syndrome, normal aging (downs is at increased risk of getting alzhimers- increased 21)

85
Q

alzheimer genes-

A

presenelin I/II, APP, APOe4 (if homozygous, 50-90% of developing dementia by age 85, if heterozygous, 45% chance of getting dementia by age 85)

86
Q

a stroke to frontal lobes

A

sxs of schizophrenia, bipolar I, and depression

87
Q

tx of vascular dementia

A

no truly effective tx. can use cholinesterase inhibitors. use anti-HTN to prevent onset of dementia

88
Q

core features of LBD

A

waxing and waning, parkinsonism, visual hallucinations, and sensitivity to neuroleptics. also REM disorder.

89
Q

in LBD, how fast after parkinsonian sxs do you need dementia

A

within 12 months. if >12 mo, it is parkinson disease dementia

90
Q

tx for LBD

A

cholinesterase inhibitors help improve hallucinations. psychostimualnts, levodopa/carbidopa, ad dopamine agonists may improve cognition, apathy, and psychomotor slowing, atypical neuroleptics for agitations anddleusions, klonopin for REM sleep behavior d/o

91
Q

which is more rapid to death: Pick or ALzheimers

A

Pick. mean duration of illness to death is 4-6 years

92
Q

tx for pick

A

anticholinergic and antidepressants help behavioral sxs but not cognition

93
Q

HIV associated dementia

A

most common dementia by infectious disease. rapid decline in cognition, behavior, and motor ability. psychomotor agitation, apathy and social withdrawal, depression, language usually preserved.

94
Q

a 46 y/o man presents with recurrent attacks of smelling strange smells and a sensation that objects appear very small, followed by a temporary loss of consciousness. his wife says he tends to smack his lips during these episodes.

A

prob temporal lobe epilepsy

95
Q

muscle changes in CJD

A

more than 90% of pts have myoclonus

96
Q

periodic geeralized sharp waves on EEG

A

CJD

97
Q

when does normal grief end

A

after 6 mo

98
Q

complicated/prolonged gried

A

lasts for at least 6 mo. includes 4 of following including difficulty moving on with life, numbness/detachment, feeling that life is empty w/o deceased..

99
Q

bereavement associated depression

A

look for feelings of hopelessness, helplessness, severe guilt, worthlessness, and SI in addition to complicated grief sxs.

100
Q

when do you treat for depression in grieving ts

A

recommended in ptsd who have 2 straight weeks of depressive sxs 6-8 wks after the loss

101
Q

what is most common psych d/o in elderly

A

MDD

102
Q

visual hallucinations early in dementia. what to do.

A

LBD. DONT GIVE ANTIPSYCHOTICS.

103
Q

what does fragile X look like. how common?

A

most common inherited form of MR. FMR1 gene defect. autistic characteristics, delayed speech, motor delay, and sensory deficits. males have large testicles.

104
Q

diagnosis of enuresis

A

involuntary void urine after age 5 at least 2x a week for 3 mo. r/o infection, diabetes, seizure

105
Q

diagnosis of encoporesis

A

passage of feces by age 4 for 3 mo 1x a month. r/o metabolic abnormalities (hypothyroidism), lower GI probe, and dietary factors

106
Q

abreaction

A

strong rxn pts get when retrieving traumatic memories

107
Q

reality testing in depersonalization d/o

A

still intact during episode

108
Q

how long does hypochondriasis have to persist

A

6 months

109
Q

tx for intermittent explosive d/o

A

low levels of serotonin. SSRI (fluoxetine), anticonvulsants, lithium, antipsychotics, propranolol. individual psychotherapy is ineffective. group therapy/family therapy may be effective.

110
Q

should refeed anorexics as quickly as posible

A

no- can lead to referring syndrome. fluid retention, decreased levels of phosphorous, magnesium, and calcium. arrhythmia, respiratory failure, delirium, seizures.

111
Q

what is the most common approved and accepted reason to put someone on benzos

A

insomnia

112
Q

hypnogogic vs hypnopompic hallucinations

A

hyponogogic- when transitioning to sleep.

hypopompic- when transitioning from sleep

113
Q

cataplexy vs catalepsy

A

cataplexy narcoleptic. catalepsy= unprovoked muscular rigidity.

114
Q

klein-Levins syndrome

A

rare d/o with recurrent hypersomnia with episodes of daytime sleepiness with hyperphagia, hyper sexuality, and aggression

115
Q

REM sleep behavior disorder

A

muscle atone during REM sleep- complex motor activity associated with dream reenacment- sleep talking, yelling, limb jerking, waking

116
Q

how to treat REM see behavior d/o

A

clonazapam for 90% of pts. also try imipramine, carbamazepine, parmipexole, levodopa

117
Q

does the desire for sexual activity decease with age

A

no. men need more direct stimulation and more time to orgasm. intensity decreases and refractory period increases.

118
Q

drugs and libido

A

alcohol and MJ enhance it by decreasing inhibition but then long term use decreases desire. narcotics inhibit it. cocaine and amphetamines increase it by stimulating dopamine receptors

119
Q

dopamine, serotonin and sex

A

dopamine enhances libido, serotonin inhibits sexual function

120
Q

most common sexual d/o of women? men?

A

women: sexual desire d/o, orgasmic d/o. men: secondary erectile d/o and premature ejaculation

121
Q

dypareunia vs vaginismus

A

dyspareinuria- gential pain before during and after sexual intercourse. often associated with vaginismus (involuntary muscle contraction of the outer 1/3 of vagina during insertion of object

122
Q

pharm for erectile d/o

A

PDE5 inhibitor like sildenafil (increase blood flow to penis), alprostadil (erection in absence of sexual stimulation)

123
Q

pharm for premature ejaculation

A

SSRI and TCA

Psych (7 decks)

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