Peds/Geri/Med Flashcards
mental retardation. M:F?
IQ of 70 or below. onset before age of 18. Males are affected 2x as much as females.
does most MR have an identifiable cause? 2 most common causes.
no. Downs and fragile X (M>F)
criteria for conduct disorder
at least 3 of the following within past year:
- aggression to people or animals
- destruction of property
- deceitfulness
- serious violation of rules
criteria for ODD
at least 6 months of negativistic, hostile, and defiant behavior, which 4 of the following have been present.
- frequent loss of temper
- arguments with adults
- defying adults rules
- deliberately annoying people
- easily annoyed
- anger and resentment
- spiteful
- blaming others for mistakes or behaviors
ADHD and ODD/conduct?
2/3 of children wit ADHD also have ODD or conduct
M:F in ODD? remission?
before puberty, more common in males. after puberty, M=F. remission in 25% of children. may progress to conduct
pharm for ADHD
CNS stimulants with TCAs as adjunctive
how to diagnose autism
- problems with social interaction
- impairments in communication
3 repetitive and stereotypes patterns of behavior and activities
what kind of problems with social interactions can autistic kids have
at least two.
- impairment in nonverbal relationships- facial expression, gestures
- failure to develop peer relationships
- failure to seek sharing of interests of enjoyment with others
- lack of social/emotional reciprocity
what kind of impairments in communication can autistic kids have
at least one
- lack of or delayed speech
- repetitive use of language
- lack of varied/spontaneous play
what kind of repetitive and stereotypes patterns of behavior and activity can autistic kids have
at least one
- inflexible rituals
- preoccupation with parts of objects
how to treat autism
no cure. treat sxs.
- remedial education
- behavioral therapy
- neuroleptics- to help control aggression, hyperactivity, and mood lability
- SSRIs- to help control stereotypes and repetitive behaviors
- some children benefit from stimulants
when does autism present. what percent are mentally retarded. is there genetic assn?
usually presents before age 3.
M»>F.
70% have MR
significant assn with fragile X syndrome, tuberous sclerosis, MR, and seziures
concordance of autism in biological twins
36%
diff b/w Aspergers and autistic
Aspergers have normal language and cognitive development. but they do have problems with relationships and with restricted or stereotyped behaviors, interests, or activities
what is mutation of Rett’s? M vs. F. what is treatment
MECP2 gene on X chromosome. Seen mostly in girls, but sometimes in boys
blood test of anoerxia? Bulimia?
AN: hypochloremic, hyperkalemic akalosis.
hypercholesterolemia
leukopenia
BN: hypochloremic hypokalemic alkalsosi, increased amylase, increase BUN, hypernatreamia, metabolic acidosis, elevated bicarbonate
primary vs secondary enuresis? when is it usually established? when is enuresis usually remitted?
usually establish continence at age 4.
primary: never established continence
secondary: 5-8 incontinence after having it.
usually spontaneously remits by age 7
how to treat enuresis
behavior modification- buzzer when child pees.
TCA- imipramine.
antidiuretics- DDAVP
when is bowel control obtained normally? what to rule out in encopresis? how long do you need to have it?
normally get it at 4. need encopresis for 1x a mo for 3 mo. rule out hypothyroidism.
what other diseases is encopresis associated with
ADHD, conduct disorder
dissociative amnesia vs dementia
amnesia: can’t really name but can remember obscure details. dementia: remember stuff fro past
dissociative amneisa vs. dissociative fugue
unlike dissociative amnesia, pts w/dissociative fugue are unaware that they have forgotten anything
depersonalization disorder? how to treat?
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.
how to treat impulse control disorder
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
what is often comorbid with bulimia
kleptomania. 1/4 of BN patients
treatment for trichitolomania
SSRI, lithium, antipsychotics. hypnosis, relaxation techniques. behavioral therapy- substitites anoher habit
hypchondriasis vs factitious
hypo: anxiety is main thing- it doesnt really go away. they wouldn’t want aggressive stuff.
pathophys of ADHD
dopamine filters the noise. norepinephrine increases the volume.
when do you use clonidine
BP and ADHD and opiate withdrawal
what med to give if depressed w/heart disease
sertraline (or citalopram)
can you try ECT after MI?
after 2 months- yes. after 2 good trials, try it.
angelman syndrome sxs
chromosome 15-developmental delay, movement or balance disorder, happy demeanor, sometimes seizures, short
prader-willi syndrome sxs
chromosome 15- cog diabilities, low muscle tone, short stature, chronic feeling of hunger-> obesity, almond shaped eyes
signs of porphyra
depression. GI pain, romberg sign, decreased joint position sense
carbidopa vs levidopa
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.
pathology and pathophysio of parkinsons
loss of cells in the substantial nigra of the basal ganglia-> decrease in dopamine and loss of dopaminergic tracts
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..
caudate atrophy. this is huntingtons
Huntingtons. onset? path? diagnostic? MRI? treatment?
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
Huntingtons sxs vs FTD sxs
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.
cortical dementia vs. subcortical dementia
cortial: alzheimer, Pick’s, CJD: decline in intellectual functioning.
subcortical: huntingtons, parkinsons, NPH, multi-infarct dementia- more prominent affective and movement sxs
parent management therapy
aims to change parenting behaviors, positive reinforcement, used for disruptive behavior like ODD and Conduct Disorder
are related sleep changes in elderly.
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.
preferred treatment for narcolepsy
modanifil. amphetamine stimulant are second line because of their abuse potential.
brain changes seen in PTSD
decrease in size of hippocampus
brain changes seen in autism
increased total brain volume nd accelerated head growth during inancy
brain changes seen in OCD
structural abnormalities in orbitofrontal cortex and basal ganglia
how to qualify for insomnia
3x per week for at least one month. difficulty maintaining or initiating sleep. leads to difficulty in completing tasks.
how to qualify for primary hypersomnia
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.
treatment for primary hypersomnia
stimulant are first line. sometimes SSRI may help
EDS vs fatigue
EDS: falling asleep when you don’t want to (common with OSA). fatigue is being too tired to complete activities
obstructive sleep apnea versus central sleep apnea? treatment?
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)
night terror disorder vs nightmare disorder
nightmare disorder: fully awaken and remember episode
pain disorder vs somatization disorder
somatization is before age 30. at least 2 GI, 1 repro, 1 neuro, 4 pain. pain is >6 mo pain unexplained by other stuff.
borderline vs histrionic
histrionic are more funcitonal. BPD are more likely to have depression and commit suicide.
narcissistic vs. OCPD
both want assertiveness and achievement but OCPD are motivated by the work itself, narcissistic by the status
what test to exclude reversible causes of dementia
15% of dementia is reversible. check VDRL (syphilis), electorlytes, TFT, CBC, b12/folate, brain CT or MRI
dementia+ loss of position sense + megaloblasts on CBC
vitamin B12 deficinecy
dementia + diminished position/vibration sense + Argyll Robertson pupils
neurosyphillis- check CSF VDRL or CSF FTA-ADS
2 types of delirium
quiet (depressed, failure to thrive) and agitated (pulling out lines, may hallucinate)
what should you do for delirium
fix reversible causes. give antipsychotic like seroquel. avoid napping. keep lights on shades open during the day. hold for sedation in orders
ddx for delirium
AEIOU TIPS. alcohol, electrolytes, iatrogenic, oxygen hypoxia, uremia/encephalopathy, trauma, infecion, poison, seizures (post ictal)
orientation and awareness in dleirium and dementia
delirium: lack of orientation and awareness.
dementia: they have awareness and orientation is often impaired
EEG in delirium vs dementia
changes in delirium not dementia. delirium: fast waves or generalized slowing.
how to diagnose alzheimers definitively
the only definitive way is pathological examination of brain at autopsy
microscopic path of alzheimers
senile plaques of amyloid protein, neurofibrillary tangles from Tau protein, neuronal and synaptic loss
gross path of alzheimers
diffuse atrophy with enlarged ventricles and flattened sulci
what type of drug for alzheimers? 3 examples?
acetylcholinesterase ihibitors. donazepil, rivastigmine, tacrine
can you give benzos in alzheimers
yes- for anxiety
can you give antipsychotics in alzheimers
yes- for agitation/psychosis- like quietiapine
can you give antidepressants in alzheimers
yes- for depression
vascular dementia vs. alzheimers
vascular- also get focal near sxs like hyperreflexia and prosthesis. greater preservation of personality in vascular dementia.
meds for parkinsosn
carbidopa/levodopa. amantidine (increases dopamine). anticholinergics (relieve tremor), bromocriptine (increase dopamine), MAO-B (e.g.: selegeline. inhibit breakdown of dopamine
which 2 personality disorders use defense mechanism of regressin
dependent and histrionic
delirium+ hemiparesis or other focal neuro signs
CVA or mass lesion- do CT/MRI
delirium+ elevated BP + papilledema
hypertensive encephalopathy- do brain CT/MRI
delirium+ dilated pupils + tachycardia
think drug intoxication- do urine tox screen
delirium+fever+nuchal rigidity+photophobia
think meningitis, do LP
delirium+tachycardia+tremor+thyromegaly
think thyrotoxicosis, do T4/TSH
if a pt present with dementia but has a normal CT, what should yu do
order CMP and MRI
a person gets dementia after going to woods. what do you think?
lyme disease
alzheimers F:M
3:1
structural changes in alzheimers
decrease in acetylcholine due to a loss of noradrenergic neurons in basal creels and decreased choline transferase (required for ACH)
when do you find senile plaques and neurofibrillary tangles
alzheimers, Down syndrome, normal aging (downs is at increased risk of getting alzhimers- increased 21)
alzheimer genes-
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)
a stroke to frontal lobes
sxs of schizophrenia, bipolar I, and depression
tx of vascular dementia
no truly effective tx. can use cholinesterase inhibitors. use anti-HTN to prevent onset of dementia
core features of LBD
waxing and waning, parkinsonism, visual hallucinations, and sensitivity to neuroleptics. also REM disorder.
in LBD, how fast after parkinsonian sxs do you need dementia
within 12 months. if >12 mo, it is parkinson disease dementia
tx for LBD
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
which is more rapid to death: Pick or ALzheimers
Pick. mean duration of illness to death is 4-6 years
tx for pick
anticholinergic and antidepressants help behavioral sxs but not cognition
HIV associated dementia
most common dementia by infectious disease. rapid decline in cognition, behavior, and motor ability. psychomotor agitation, apathy and social withdrawal, depression, language usually preserved.
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.
prob temporal lobe epilepsy
muscle changes in CJD
more than 90% of pts have myoclonus
periodic geeralized sharp waves on EEG
CJD
when does normal grief end
after 6 mo
complicated/prolonged gried
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..
bereavement associated depression
look for feelings of hopelessness, helplessness, severe guilt, worthlessness, and SI in addition to complicated grief sxs.
when do you treat for depression in grieving ts
recommended in ptsd who have 2 straight weeks of depressive sxs 6-8 wks after the loss
what is most common psych d/o in elderly
MDD
visual hallucinations early in dementia. what to do.
LBD. DONT GIVE ANTIPSYCHOTICS.
what does fragile X look like. how common?
most common inherited form of MR. FMR1 gene defect. autistic characteristics, delayed speech, motor delay, and sensory deficits. males have large testicles.
diagnosis of enuresis
involuntary void urine after age 5 at least 2x a week for 3 mo. r/o infection, diabetes, seizure
diagnosis of encoporesis
passage of feces by age 4 for 3 mo 1x a month. r/o metabolic abnormalities (hypothyroidism), lower GI probe, and dietary factors
abreaction
strong rxn pts get when retrieving traumatic memories
reality testing in depersonalization d/o
still intact during episode
how long does hypochondriasis have to persist
6 months
tx for intermittent explosive d/o
low levels of serotonin. SSRI (fluoxetine), anticonvulsants, lithium, antipsychotics, propranolol. individual psychotherapy is ineffective. group therapy/family therapy may be effective.
should refeed anorexics as quickly as posible
no- can lead to referring syndrome. fluid retention, decreased levels of phosphorous, magnesium, and calcium. arrhythmia, respiratory failure, delirium, seizures.
what is the most common approved and accepted reason to put someone on benzos
insomnia
hypnogogic vs hypnopompic hallucinations
hyponogogic- when transitioning to sleep.
hypopompic- when transitioning from sleep
cataplexy vs catalepsy
cataplexy narcoleptic. catalepsy= unprovoked muscular rigidity.
klein-Levins syndrome
rare d/o with recurrent hypersomnia with episodes of daytime sleepiness with hyperphagia, hyper sexuality, and aggression
REM sleep behavior disorder
muscle atone during REM sleep- complex motor activity associated with dream reenacment- sleep talking, yelling, limb jerking, waking
how to treat REM see behavior d/o
clonazapam for 90% of pts. also try imipramine, carbamazepine, parmipexole, levodopa
does the desire for sexual activity decease with age
no. men need more direct stimulation and more time to orgasm. intensity decreases and refractory period increases.
drugs and libido
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
dopamine, serotonin and sex
dopamine enhances libido, serotonin inhibits sexual function
most common sexual d/o of women? men?
women: sexual desire d/o, orgasmic d/o. men: secondary erectile d/o and premature ejaculation
dypareunia vs vaginismus
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
pharm for erectile d/o
PDE5 inhibitor like sildenafil (increase blood flow to penis), alprostadil (erection in absence of sexual stimulation)
pharm for premature ejaculation
SSRI and TCA
