Pretest Missed Questions Flashcards
1
Q
Central achromatopsia
A
`The complete inability to perceive color
2
Q
Simultanagnosia
A
inability to integrate a visual scene to perceive as whole
3
Q
Gerstmann syndrome
A
agraphia, calculation difficulties (acalculia), right-left disorientation, and finger agnosia. Likely due to lesions of parietal lobe of the dominant hemisphere (i.e. usually left parietal)
4
Q
Apperceptive visual agnosia
A
inability to identify and draw items using visual cues
5
Q
Color anomia
A
inability to name a color despite being able to point to it
6
Q
Oculomotor apraxia
A
inability to direct gaze rapidly
7
Q
prosopagnosia
A
inability to recognize faces in the presence of preserved recognition of other objects. Likely a disconnect between the left inferior temporal cortices and the visual association area in the left parietal lobe
8
Q
Color agnosia
A
inability to recognize a color despite being able to match it
9
Q
Balint syndrome
A
optic ataxia (inability to direct optically guided movements), oculomotor apraxia, and simultanagnosia - seen with bilateral parietal/occipital lobe lesions
10
Q
Anton syndrome
A
failure to acknowledge blindness - associated with bilateral occipital lobe lesions
11
Q
Associative visual agnosia
A
inability to name or use objects despite the ability to draw them - seen with bilateral medial occipito-temporal lesions
12
Q
Target of sumatriptan
A
Serotonin 5-HT1D subtype
13
Q
Atypical antipsychotics target receptor
A
Serotonin 5-HT6 (6 is sick) and Dopamine D4 subtypes
14
Q
Receptor involved in regulating circadian rhythms
A
Serotonin 5-HT7, remember 7 hour time different to London = jet lag/circadian upset
15
Q
Antihypertensive receptor target
A
Adrenergic a-1A,B,D
16
Q
Anxiolytic receptor target
A
Serotonin 5-HT1A, “A” is for anxiety
17
Q
Bronchial muscle contraction (or relaxation ala inhalers)
A
Adrenergic B2 - beta blockers can cause broncho constriction!!
18
Q
Antiparkinsons Anticholinergic drug target
A
Cholinergic M4
19
Q
Typical antipsychotic target
A
Dopamine D2 subtype (typically came first, hence D2, atypical came later, hence D4)
20
Q
Diphenhydramine receptor target
A
H1 - old generation antihistamines came first “H1”
21
Q
Grand mal Seizure EEG pattern
A
interictal epileptiform discharges
22
Q
Hepatic encephalopathy EEG pattern
A
triphasic waves
23
Q
General toxic encephalopathy (eg electrolyte imbalance) EEG pattern
A
Diffuse slowing of background rhythms
24
Q
Stroke EEG Pattern
A
Periodic lateralizing epileptiform discharges
25
Creutzfeldt-Jakob Disease EEG
generalized periodic sharp waves
26
Opioid intoxication EEG
Decreased Alpha activity, increased theta and delta waves
27
Marijuana use EEG
Increased alpha activity in frontal lobes, overall slowed alpha activity
28
Caffeine withdrawal EEG
Increased amplitude/voltage of theta activity
29
Nicotine withdrawal EEG
Decreased alpha wave activity
30
Barbiturate withdrawal
Generalized paroxysmal activity and spike discharges
31
Where do most partial complex seizures originate?
Temporal lobes, may have olfactory hallucinations
32
What neurotransmitter is most likely involved in OCD?
Serotonin, implicated by patients responsiveness to SSRIs and TCAs.
33
What neurotransmitter is most likely involved in anxiety disorders?
Norepinephrine
34
Which neurotransmitter is most likely involved in cognitive and memory disorders?
Acetylcholine
35
Which neuropeptide affects the appetite?
Neuropeptide Y
36
What behavior results from lesions to the right prefrontal cortex?
Laughter, euphoria, tendency to joke and make puns. The resulting imbalance between right and left leads to the mood-elevating behavior produced by the left prefrontal cortex, and a lesion there would have the opposite effect
37
What is the effect of protein phosphatase-1?
Causes forgetting. Dephosphorylates cAMP response elements and decreases gene expression, PP1 effectively "cleans out" unused memories.
38
If a patient presents with recent onset anti-social PD or intermittent explosive disorder, which region of the brain may be damaged?
Orbitofrontal area. Dysfunction here results in disinhibition, irritability, lability, euphoria, lack of remorse, insight and judgement are impaired
39
Patients who display recent loss of planning, motivation, goal directness, focus, or sustained effort, and appear inattentive may have a lesion where?
Dorsolateral area. Patients may also echo questions and react only to details of environmental stimuli.
40
Chronic infections/neurosyphilis appearance on MRI
Enhanced meninges at base of brain (also seen with cryptococcosis, tuberculosis, lyme disease)
41
Dementia and gait disorder in a 40 year old female, What MRI findings?
Most likely normal pressure hydrocephalus - Dilation of ventricles on MRI
42
MRI appearance of multiple sclerosis?
Periventricular patches of increased signal intensity.
43
MRI appearance of vascular dementia?
Patches of increased signal throughout the white matter, not just in periventricular locations
44
Signs of infants exposed to cannabis in-utero
decreased visual responsiveness, tremor, increased startle reflex, disrupted sleep patterns
45
Reactive attachement disorder types and behaviors
Inhibited type: persistent failure to initiate or respond to most social interactions in an appropriate way.
Disinhibited type: Indiscriminate sociability, ie excessive familiarity with strangers
46
Reactive attachment disorder behaviors in children
Disregard of child by parents results in the child failing to develop secure and stable bonds with parents and difficulties relating to others. Children may be fearful, inhibited, withdrawn, and apathetic, or may be aggressive, disruptive, disorganized, with low frustration tolerance and poor affect modulation.
47
Associated symptoms of major depression in children
Children's symptoms may present differently than those of depressed adults. Sad affect may be replaced with aggression and irritability, prominent manifestations may be poor school functioning and refusal to attend school. Psychotic symptoms are present in 1/3 of childhood major depression.
48
Psychiatric condition associated with cushing's syndrome?
Depressive disorder - Substance/medication-induced
| A result of exogenous steroid use (i.e. chronic asthma patients)
49
First line treatment for new-onset psychosis/hallucinations in a delirious patient?
Haloperidol.
Delirium is treated by treating the underlying cause, but psychotic symptoms should be treated directly. Haloperidol may be administered IM.
50
Panic disorder diagnosis
At least FOUR of the following: Shortness of breath, tachypnea, tachycardia, tremor, dizziness, hot or cold sensations, chest discomfort, depersonalization or derealization.
51
Temporal lobe epilepsy symptoms
Hypo sexuality, emotional intensity, a perseverative approach to interactions ("viscosity"). Usually without grand map-like convulsions
52
Pick disease symptoms
Insidious onset and gradual progression, early decline in social interpersonal conduct, emotional blunting and apathy without insight, marked decline in hygiene and significant distractibility.
Pick bodies are irregularly shaped, silver staining cytoplasmic inclusion bodies that displace the nucleus to the periphery.
53
HIV dementia symptoms
impaired attention and concentration, psychomotor slowing, forgetfulness, slow reaction time, mood changes (depression). Brain atrophy.
The most frequent neurological complication of HIV, caused by the direct action of the virus on the brain.
54
Normal pressure hydrocephalus symptoms
Wet, Wobbly, Wacky - Urinary incontinence, gait abnormality, dementia. Dementia features include: impaired attention, visuospatial deficits, poor judgement, apathy, inertia, lack of concern.
55
Arsenic poisoning s/sx
bloody diarrhea (inflammation and necrosis of the intestinal mucosa, fluid loss, hypotension, nausea, vomiting, diarrhea, abdominal pain, delirium, coma, and seizures. Garlicky breath odor may be detected.
56
Korsakoff syndrome memory deficits
Both anterograde and retrograde amnesia. Patients are unable to form new memories or recall recent events. Distant memory is typically preserved.
57
S/sx of pancreatic cancer
Weight loss, depressed mood, apathy, anhedonia, decreased energy, and lethargy. Amylase may be elevated.
58
Donepezil, rivastigmine, galantamine, tacrine drug class and uses
Cholinesterase inhibitors. May treat mild to moderate symptoms of Alzheimers. Donepazil is first line due to side effects of other drugs.
59
Delirium tremens vs post-surgical delirium
DT presents with hypertension, tachycardia, and elevated temperature. "Normal" delirium does not.
60
Serum test for grand mal seizure?
Prolactin. Serum prolactin level rise for 20 minutes following grand mal seizures. There is no change in prolactin levels following non-epileptic seizures, thus this test may help narrow the differential.
61
Psychiatric side effects of corticosteroids
Mood disorders. Commonly mania or hypomania, may progress to depression with chronic steroid use. Steroid withdrawal may also precipitate mania or depression.
62
3 drug treatments for neuroleptic malignant syndrome
Dantrolene, bromocriptine, amantidine
63
Generalized anxiety disorder symptoms and treatment
Excessive worry/anxiety for more than 6 months with at least 3 of the following: restlessness/feeling on edge, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance.
SSRI, SNRI
64
Side effects of olanzapine
```
Weight gain is most common
Less common: Metabolic syndrome
Hyperglycemia
Dyslipidemia
New-onset Diabetes Mellitus
```
65
Side effects of clozapine
Agranulocytosis
Seizures
Myocarditis
Metabolic syndrome
66
Adjustment disorder definition and treatment
Emotional or behavioral symptoms that develop within 3 months following an identifiable stressor (end of relationship). Typically do not last more than 6 months.
Treatment is psychotherapy.
67
Factors that indicate a poor prognosis in schizophrenia
early or insidious onset, lack of obvious precipitating causes, poor premorbid functioning, neurologic signs/symptoms, social isolation, family history of schizophrenia, presence of negative symptoms
68
Perphenazine drug class
Typical antipsychotic
69
What type of hallucination (visual, olfactory, audio, etc) are most commonly purely psychogenic and not indicative of medical disease?
Auditory hallucinations are most often purely psychogenic
70
Effect of hostile or controlling family environment on psychotic patients
Increased relapse rates
71
What complication is seen in 90% of all terminally ill patients?
Delirium, often results from condition or medications to treat it. It may be treated by resolving the underlying condition or with antipsychotics. Other conditions like depression, anxiety, and delusions occur but not at the same rate.
72
What are two short acting benzos?
lorazepam alprazolam
73
Pharmacotherapy for panic attacks?
SSRI plus short acting benzodiazepine (alprazolam/lorazepam). The benzo should be used for acute attacks only and then discontinued once the SSRI is tapered to an effective level (~4 weeks)
74
What REM patterns and movements during sleep are associated with narcolepsy?
Sleep-onset REM period, or very rapid progression to REM sleep. Nocturnal myoclonus or sleep apnea may also be seen in a patient.
75
What drug interactions must be considered in HIV patients?
CYP450 interactions. Antiretroviral drugs are metabolized by CYP450 and compete with many psychotropic drugs, increasing their levels. Bupropion, meperidine, various benzos, and SSRIs are all affected and will have higher than intended concentrations in HIV patients.
76
What is the management for clozapine-induced agranulocytosis?
Baseline CBC and weekly CBC for 6 months.
Mild WBC 3000-3500 = 2/week CBC w differentials but continue drug therapy
Moderate WBC 2000-3000 = Stop Clozapine, Daily CBC, restart clozapine after counts normalize
Severe WBC less than 2000 = Stop clozapine, place patient in protective isolation, bone marrow sample, never restart clozapine
77
Treatment for lithium overdose?
Moderate overdose, below 2.0 = supportive, IV saline, monitor urine output and frequent Li levels
Severe overdose, 2.1 and above = emergency dialysis
78
Contraindications for ramelteon?
severe hepatic impairment, severe sleep apnea, severe COPD
79
Side effects of carbamazepine?
aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia. A benign rash may develop, and carbamazepine must be discontinued because of the potential for a severe rash to follow this.
80
Flushed appearance, dry skin and palms, and tachycardia are symptoms of what?
Anticholinergic syndrome.
81
Treatment for akathesia
Beta blockers (propranolol) are most effective. Benzos and anticholinergics are helpful but less effective
82
What anesthetic agent is used in ECT?
Barbiturates (methohexital)
83
What is the half-life of lithium and how long does it take to achieve therapeutic concentrations?
Half life is 20 hours
| 4-7 days to effective concentrations
84
What is the best antipsychotic for use in a patient with parkinson's disease?
Quetiapine. Has the least EPS and is anticholinergic so it may improve parkinson's symptoms
85
Treatment for clozapine-induced seizures?
Stop clozapine and administer valproic acid. Clozapine is then restarted at 50% of its previous level and titrated up.
86
Antipsychotics that can be used in patients with orthostatic hypertension
Haloperidol, fluphenazine. High potency typical antipsychotics
87
Dizziness, nausea, vomiting, lethargy, flu-like symptoms, and sensory or sleep disturbances are symptomatic of what?
Abrupt SSRI discontinuation.
88
What are tyramine containing foods that are most likely to cause hypertensive crisis?
aged cheese, salami, pepperoni, sausage, over-ripe fruit, liquors, red wine, pickled fish, sauerkraut, and brewer's yeast (but not beer itself, which has lower quantities of tyramine and may be consumed in small quantities.
89
What drugs may be used to treat narcolepsy by delaying REM sleep?
Most antidepressants: SSRIs, TCAs, MAOIs
90
What two conditions is imipramine used for that are not mood disorders?
Bed wetting
| ADHD
91
What is the most important adverse side effect of sildenafil (or likely other impotence drugs)?
Myocardial infarction, due to increased oxygen demand and stress placed on the heart during sex.
92
What cardiac effects do TCAs have?
Slowing of cardiac conduction. May be beneficial at lower doses, but may also cause fatal heart block and prolonged QRS complex at high doses.
93
Treatment for lithium-induced tremor?
Mild tremor: dose reduction, caffeine elimination, slow release lithium preparations, beta-blockers.
Severe tremor: sign of toxicity
94
What is rabbit syndrome?
Very similar to tardive dyskinesia, but chewing movements are very rapid and the tongue and other body parts are not involved. Uncommon.
