Sheet1-表格 1 Flashcards
(197 cards)
1
Q
Are hallucinations common in narcolepsy patients?
A
Yes. Both Hypnagogic (just before sleep) and Hypnopompic (with awakening).
2
Q
Define Cataplexy.
A
Sudden collapse (falls asleep) while awake.
3
Q
Define Sleep Apnea.
A
Person stops breathing for at least 10 seconds during sleep.
4
Q
Distinguish between central and obstructive sleep apnea.
A
- In central sleep apnea, no respiratory effort.
- In Obstructive sleep apnea, respiratory effort against airway obstruction.”
5
Q
Does narcolepsy have a genetic component?
A
Yes
6
Q
Does REM sleep increase or decrease with age?
A
Decreases
7
Q
Extraocular movements during REM sleep are due to what portion of the brain?
A
- Parapontine Reticular Formation
- Conjugate Gaze Center
8
Q
How often does REM sleep occur?
A
Every 90 minutes (duration may increase during the night)
9
Q
Name 1 neurotransmitter change associated with Alzheimer’s disease.
A
Decreased Ach
10
Q
Name 1 neurotransmitter change associated with Parkinson’s disease.
A
Decreased Dopamine
11
Q
Name 1 neurotransmitter change associated with Schizophrenia
A
Increased Dopamine
12
Q
Name 2 effects of stress on the body.
A
- Induces production of FFA, 17-OH corticosteroids, lipids, cholesterol, and catecholamines
- Affects water reabsorption, muscular tonicity, gastrocolic reflex, and mucosal circulation.
13
Q
Name 2 neurotransmitter changes associated with depression.
A
Decreased NE and Serotonin (5-HT)
14
Q
Name 2 neurotransmitter changes associated with Huntington’s disease.
A
Decreased GABA and Ach
15
Q
Name 3 changes in sleep stages often found in people with depression.
A
- Reduced slow-wave sleep
- Decreased REM latency
- Early morning awakening (important screening question!)
16
Q
Name 3 possible findings in non-REM sleep.
A
“Sleepwalking, night terrors, and bedwetting”
17
Q
Name 4 physiological actions found in REM sleep.
A
- Increased/variable pulse
- rapid eye movements
- increased/variable blood pressure
- penile/clitoral tumescence
18
Q
Name 5 possible findings in REM sleep.
A
- Dreaming,
- loss of motor tone
- possible memory processing function
- erection
- increased brain O2 use
19
Q
Name 5 possible waveform patterns seen in the various sleep/wake stages.
A
- Alpha, Beta (highest frequency, lowest amplitude)
- Theta, Delta (lowest frequency, highest amplitude)
- Sleep spindles with K-complexes
20
Q
Name 7 functions of the Frontal lobe.
A
Concentration, Orientation, Language, Abstraction, Judgment, Motor regulation, Mood
21
Q
Name 1 possible chronic outcome of sleep apnea.
A
Chronic fatigue
22
Q
Name 5 findings associated with sleep apnea
A
Obesity, loud snoring, systemic/pulmonary HTN, arrhythmias, and possibly sudden death.
23
Q
What 3 things does the differential diagnosis for sexual dysfunction include?
A
- Drugs (e.g. antiHTN, neuroleptics, SSRIs, and ethanol)
- Diseases (e.g. depression and diabetes)
- Psychological (e.g. performance anxiety)
24
Q
What is a common treatment for narcolepsy?
A
Stimulants (e.g. Amphetamines)
25
What is a helpful mnemonic for the order of the corresponding waveform patterns in each stage of sleep?
At night, BATS Drink Blood.
26
What is considered the key to initiating sleep?
Serotonergic predominance of the raphe nucleus
27
What is the most notable change in function in a frontal lobe lesion?
Lack of social judgement
28
What is the principal neurotransmitter involved in REM sleep?
Ach
29
What medication shortens stage 4 sleep and Tx enuresis?
Imipramine
30
What medication shortens stage 4 sleep and Tx of night terrors and sleepwalking?
Benzodiazepines
31
What neurotransmitter can reduce REM sleep?
NE
32
What percentage of time is spent in REM sleep?
0.25
33
What percentage of time is spent in stage 1 sleep?
0.05
34
What percentage of time is spent in stage 2 sleep?
0.45
35
What percentage of time is spent in stage 3-4 sleep?
0.25
36
What phenomenon caused REM sleep to be known as 'paradoxical' or 'desynchronized' sleep?
The EEG pattern during REM sleep is the same as the EEG of a person that is awake and alert.
37
What waveform pattern is seen in a young adult who is awake (eyes open), alert, and has active mental concentration?
Beta waves
38
What waveform pattern is seen in a young adult who is awake but has his/her eyes closed?
Alpha waves
39
What waveform pattern is seen in a young adult who is in deeper (stage 2) sleep?
Sleep spindles and K-complexes
40
What waveform pattern is seen in a young adult who is in light (stage 1) sleep?
Theta waves
41
What waveform pattern is seen in a young adult who is in REM sleep?
Beta waves
42
What waveform pattern is seen in a young adult who is in the deepest, Non-REM (stage 3-4) sleep?
Delta waves
43
A person who is unable to remember things that occurred after a CNS insult has?
Anterograde Amnesia
44
Anterograde amnesia caused by thiamine deficiency?
Korsakoff's amnesia
45
Are DT's life threatening?
Yes
46
Are the illness production and motivation in somatoform disorders consicous drives?
No
47
Bipolar I describes?
manic
48
Bipolar II describes?
hypomanic
49
Define a Manic episode.
"Distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week"
50
Define a panic disorder.
Discrete period of intense fear and discomfort peaking in 10 minutes with 4/5 characteristics
51
Define Anosognosia.
being unaware that one is ill
52
Define Autotopagnosia.
Being unable to locate one's own body parts
53
Define Conversion disorder.
"symptoms suggest motor or sensory neurologic or physical disorder, but tests and PE are negative"
54
Define depersonalization.
body seems unreal or dissociated
55
Define Personality disorder
"when patterns become inflexible and maladaptive, causing impairment in social or occupational functioning or subjective distress"
56
Define Personality trait.
"an enduring pattern of perceiving, relating to, and thinking about the environment and oneself that is exhibited in a wide range of important social and personal contexts"
57
Delusions are?
false beliefs not shared by other memebers of culture/subculture that are firmly maintained in spite of obvious proof to the contrary
58
Describe a Paranoid Personality
distrustful and suspicious; projection is main defense mech
59
Describe a Schizoid Personality.
voluntary social withdrawl; no psychosis; limited emotional expression
60
Describe a Schizotypal Personality.
"interpersonal awkwardness, odd thought patterns and appearance"
61
Does the person who has the phobia recognize their fear as excessive?
"yes, they are exhibiting insight"
62
Does the phobic fear interfere with normal routine?
yes
63
Hallucinations are?.
perceptions in the absence of external stimuli
64
How are Cluster A personalities described?
as odd or ecentric; cannot develop meaningful social relationships; Weird
65
How are Cluster B personalities described?
"Dramatic, emotional, or erratic; Wild"
66
How are Cluster C personalities described?
"Anxious and fearful, 'Worried'"
67
How is a major depressive disorder characterized?
Recurrent-requires 2 or more depressive episodes with a symptom free interval of 2 months
68
How is a major depressive episode characterized?
"5 of the following for 2 weeks, including
(1) depressed mood or (2) anhedonia: Sleep disturbances, Loss of Interest, Guilt, Loss of Energy, Loss of Concentration, Change in Appetite, Psychomotor retardation, Suicidal ideation, Depressed mood"
69
How is maladaptive pattern of substance abuse defined?
3 or more of the above signs in 1 year
70
How is Schizophrenia described?
"periods of psychosis and disturbed behavior lasting > 6months, "
71
How long does the disturbance due to PSSD last?
> 1 month and causes distress or social/
| occupational impairment
72
How many criteria sets exist for bipolar disorder?
"6 separate criteria exist for bipolar disorders with combinations of manic, hypomanic, and depressed episodes"
73
How many hallucination types are there? Name them.
7: Visual, Auditory, Olfactory, Gustatory, Tactile, Hypnagogic, Hypnopompic"
74
How many heroin addicts are there in the US?
~500,000
75
How would you decribe a dependent personality?
"submissive and clinging, excessive need to be taken care of, low self-confidence"
76
How would you decribe an obsessive-compulsive?
"preoccupation with order, perfectionism and control"
77
How would you describe a Borderline personality?
"unstable mood and behavior; impulsive, sense of emptiness"
78
How would you describe a histrionic personality?
"excessive emotionally, somatization, attention seeking, sexually provocative"
79
How would you describe an Antisocial?
"as having a disregard for and violation of rights of others, criminality"
80
How would you describe an avoidant personality?
"sensitive to rejection, socially inhibited, timid, feelings of inadequacy"
81
How would you desribe a Narcissistic personality?
"grandiosity; sense of entitlement, many demand 'top' physician/best health care"
82
"If a patient consciously fakes or claims to have a disorder in order to attain a specific
gain, how is this behavior described?"
Malingering
83
Illusions are?
"misinterpretation of actual external stimuli, ex. Mistaking coat rack for man"
84
In what kind of disorder does a person consciously create symptoms in order to assume a sick role and get medical attention?
Factitious Disorder
85
Is Heroin prescribable?
NO
86
Is the motivation concious in Munchausen's by proxy?
NO
87
Name the 5 subtypes of schizophrenia.
"Disorganized, Catatonic, Paranoid, Undifferentiated, Residual"
88
Name the types of Cluster B personalities.
Antisocial, Borederline, Histrionic, Narcissistic
89
To be a manic episode what characteristic behaviors must be present?
3 or more of the following:
Distractibility, Insomnia, Grandiosity, Flight of Ideas, Inc in Activity/pyschomotor agitation, Pressured Speech, Thoughtlessness
90
What are the signs of Barbiturate withdrawal?
Anxiety, seizures, delirium, life-threatening CV collapse
91
What are the signs of nicotine withdrawl?
"Irritablility, headache, anxiety, weight gain, craving, tachycardia"
92
What are the 4 A's of schizophrenia?
- Ambivalence (uncertainty),
- Autism (self-preoccupation and lack of communication),
- Affect (blunted),
- Associations (loose)
93
What are the characteristics of Dementia?
development of mulitple cognitive deficits: memory, apahasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgement
94
Whare are the signs of Benzodiazepine intox?
Amnesia, ataxia, somnolence, minor resp depression
95
What are are the signs of caffeine intox?
restlessness, insomina, increased diuresis, muscle twitching, cardiac arrhythmias
96
Whare are the signs of Marijuana intox?
Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired jugdment, social withdrawl, increased appetite, dry mouth and hallucinations
97
Whare are the signs of PCP intoxication?
Belligerence, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia, homicidality, psychosis and delirium
98
What are 2 opioid comptetitive inhibitors?
Naloxane and Naltrexone
99
What are some common causes of delirium?
substance use/abuse or medical illness
100
What are some related diagnoses of Heroin addicts?
substance use/abuse or medical illness
101
What are the 5 characteristics of panic?
Palipitations, Abdominal distress, Nausea, Increased perspiration, Chest pains, chills and choking
102
What are the 6 somatoform disorders?
conversion, somatoform pain disorder, hypochondriasis, somatization disorder, body dysmorphic disorder, pseudocyesis
103
What are the characteristics of Delirium?
Decreased attention span and level of arousal, disorganized thinking, hallucinations, illusions, misperceptions, disturbance of sleep-wake cycle, cognitive dysfxn
104
What are the etiologic factors for schizophrenia?
genetics and environment, genetics outweigh env
105
What are the maladaptive signs of substance use?
Tolerance, Withdrawl, Substance taken in larger amounts than intended, Persistent desire or attempst to cut down, lots of energy spent trying to obtain substance, withdrawl from responsibility, used continued in spite of knowing the problems that it cause
106
What are the negative symptoms of schizophrenia?
flat affect, social withdrawl, thought blocking, lack of emotion
107
What are the Positive symptoms of Schizophrenia?
Hallucinations, delusions, strange behavior and loose associations
108
What are the signs of alcohol use?
Disinhibition, emotional lability, slurred speech, ataxia, coma, blackouts
109
What are the signs of alcohole withdrawl?
Tremor, Tachycardia, HTN, malaise, nausea, seizures, delirium tremens, tremulousness, agitation, hallucinations
110
What are the signs of Amphetamine intoxication?
Psychomotor agitation, impaired judgement, pupillary dilation, HTN, tachycardia, euphoria, prolonged wakefulness and attention, cardiac arrhythmias, delusions, hallucinations, fever
111
What are the signs of Amphetamine withdrawl?
Post-use crash, including anxiety, lethargy, headache, stomach cramps, hunger, severe depression, dysphoric mood, fatigue, insomnia/hypersomnia
112
What are the signs of Barbiutate intox?
respiratory depression
113
What are the signs of benzo withdrawl?
Rebound anxiety, seizures, tremor, insomnia
114
What are the signs of ca!eine withdrawl?
Headache, lethargy, depression, weight gain
115
What are the signs of cocaine intoxication?
Euphoria, psychomotor agitation, impaired judgment, tachycardia, pupillary dilation, HTN, hallucinations (including tactile:bugs on skin), paranoid ideations, angina, and sudden cardiac death
116
What are the signs of cocaine withdrawl?
Hypersomnolence, fatigue, depression, malaise, severe craving, suicidality
117
What are the signs of LSD intoxication?
Marked anxiety and depression, delusions, visual hallucinations and flashbacks
118
What are the signs of narcotic abstinence syndrome?
dilated pupils, lacrimation, rhinorrhea, sweating, yawning, irritability, and muscle aches
119
What are the signs of opioid intoxication?
CNS depression, nausea and vomiting, constipation, pupillary constriction, seizures
120
What are the signs of opioid withdrawl?
Anxiety, insomnia, anorexia, sweating/piloerection(cold turkey), fever, rhinorrhea, nausea, stomach cramps, diarrhea, flu-like symptoms, yawning
121
What are the signs of PCP withdrawl?
Recurrence of intoxication symptoms due to reabsorption in GI tract, sudden onset of severe, random, homicidal violence
122
What are the symptoms of DT's (in order of appearance)?
ANS Hyperactivity (tachycardia, tremors, and anxiety), Psychotic symptoms (hallucinations, delusions), confusion
123
What are the symptoms of nicotine intoxication?
Restlessness, insomnia, anxiety, arrhythmias
124
What are the types of Cluster A personalities?
Paranoid, Schizoid, Schizotypal
125
What are the types of Cluster C personalities?
Avoidant, Obsessive-Compulsive, Dependent
126
What are treatment options of phobias?
systematic desensitization
127
What can be confused with dementia in elderly?
depression
128
What complication result from ECT?
complications associated with anesthesia and retrograde amnesia
129
What does exposure to object of phobia evoke?
an anxiety response
130
What drug is used for long term maintenance of heroin detox?
Methadone
131
What else is classically associated with Korsakoff's?
"Confabulations, ie. Making it up as you go along"
132
What is a hallmark sign of heroin addiction?
track marks
133
What is a Hypomanic Episode?
it is like a manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization; no psychotic features
134
What is a pain somatoform disorder?
pain that is not explained completely by illness
135
What is a phobia?
"fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or entity"
136
What is a schizoaffective disorder?
a combo of schizophrenia and a mood disorder
137
What is a somatization disorder?
Varitey of complaints in multiple organ systems
138
What is Cyclothymic disorder?
milder form of bipolar lasting at least 2 years
139
What is dementia characterized by?
commonly irreversible memory loss
140
What is destroyed in Korsakoff's Amnesia?
Mamillary bodies(bilaterally)
141
What is drug of choice for bipolar?
Lithium
142
What is Dysthymia?
milder form of depression lasting at least 2 years
143
What is Electroconvulsive Therapy(ECT)?
a tx option for major depressive disorder refractory to other tx. It is painless and produces a seizure with transient memory loss and disorientation.
144
What is Hypochondriasis?
"misinterpretation of normal physical findins, leading to preoccupation with and fear of having a serious medical illness in spite of medical reassurance"
145
What is it called when a parent causes their child to become ill in order to receive attention?
Munchausen's by proxy
146
What is post-traumatic stress disorder?
when a person experienced or witnessed an event that involoved actual or threatened death or serious injury. The traumatic event is reexperienced; person persistently avoids stimuli associated with the trauma and experiences persistent symptoms of increas
147
What is primary gain?
what the symptom does for the patient's nternal psychic economy
148
What is retrograde amnesia a complication of?
ECT-electroconvulsive therapy(shock)
149
What is secondary gain?
What the symptoms gets the patient(sympathy or attention)
150
What is tertiary gain?
what the caretaker gets
151
What is the criterion for dx of substance abuse?
"One or more of the following in 1 year: Recurrent use resulting in failure to complete responsiblities, recurrent use in physically hazardous situations, recurrent legal problems, continued use in spite of persistent problems of use"
152
What is the definition of substance abuse?
"maladaptive pattern of use leading to clinically significant impairment or distress, symptoms have not met criteria for dependence"
153
What is the difference between delusions and loose associations?
delusion is a disorder in the content of thought (the actual idea) where a loose association is a disorder in the form of thought (the way the idea is tied together)
154
what is the fear of heights?
acrophobia
155
what is the fear of marriage?
gamophobia
156
what is the fear of open places?
agoraphobia
157
what is the fear of pain?
algophobia
158
What is the Fifth A?
Auditory hallucinations
159
What is the inability to remember things that happened before CNS insult?
Retrograde Amnesia
160
What is the key to delirium diagnosis?
Waxing and waning level of conciousness that develops rapidly
161
What is the key to dementia diagnosis?
"rule out delirium-patient is alert, no change in level of conciousness. More often gradual onset. "
162
What is the lifetime prevalence for Major Depressive Disorder in Males and Females:
"13% for males, and 21% for females"
163
What is the lifetime prevalence for schizophrenia?
"1.5%-(males/females, blacks/whites) presents earlier in men"
164
What is the most common psych illness on medical and surgical floors?
Delirium, often reversible
165
What is the order of loss or orientation?
Time, place, and Person
166
What is the response to the traumatic event?
"intense fear, helplessness or horror"
167
What is the trigger for DT's?
alcohols withdrawl
168
What patient population will you see Korsakoff's?
Alcoholics
169
What questions do you have to answer when assessing an patient's orientation?
Is the patient aware of him/herself as a person? Does the patient know his/her name?
170
What syndrome is manifested by a chronic history of multiple hospital admissions and willingness to receive invasive procedures?
Munchausen's
171
What is body dysmorpic disorder?
patient is convinced that part of one's own anatomy is malformed
172
Whate is pseudocyesis?
false belief of being pregnant associated with objective signs of pregnancy
173
When are the halluinations common?
- Visual (acute organic brain syndrome ),
- Auditory (Schizophrenia),
- Olfactory (aura of psychomotor epilepsy),
- Gustatory (rare),
- Tactile (DT's and Cocaine abusers),
- Hypnagogic (while going to sleep),
- Hypnopmpic(while waking from sleep)"
174
When do DT's peak?
2-5 days after last drink
175
When must a painc disorder be dx?
in the context of the occurrence
176
Who are more likely to be antisocial, male or female?
male
177
Who are more likely to be borderline, male or female?
female
178
Who do you need to see to witness caffeine withdrawl approx every six weeks?
Blake Williams
179
Define Autonomy.
Obligation to respect pts as individuals and to honor their preferences in medical care
180
"Legally, what does informed consent require?"
- discussion of pertinent information
- obtaining the patient's agreement to the plan of care
- freedom from coercion
181
Pt autonomy vs. beneficence: when does autonomy win out?
If pt makes an informed decision, ultimately, the pt. has the right to decide.
182
What 3 proofs are required for a sucessful malpractice civil suit for neglegence?
- Dr. breach of duty to patient
- pt. suffers harm
- breach of duty causes harm
Note
- beyond reasonable doubt not needed, just more likely than not
183
What are the 4 exceptions to confidentiality?
- potential harm to others is serious
- likelihood of harm is great
- no alternative means exist to warn or to protect those at risk
- Drs. Can take steps to prevent harm
184
What are the 4 exceptions to informed consent?
- pt. lacks decision-making capacity (not legally competent)
- implied consent in an emergency
- therapeutic privilege
- withholding information when disclosure would severly harm the pt or undermine informed decision-making capacity
- waver
185
What are the 5 signs of a pt's decision-making capacity?
- pt. makes and communicates a choice
- pt. is informed
- decision remains stable over time
- decision consistent w/ pt's values and goals
- decision not a result of delusions or hallucinations
186
What are the types of written advance directives?
- LIVING WILLS-
- pt. directs Dr. to withhold/withdraw life-sustaining tx if the pt develops terminal disease or enters a persisitent vegative state
- DURABLE POWER OF ATTORNEY
- pt designates a surrohate to make medical decisions in an event
187
What is beneficence?
Dr. have special ethical responsibility to act in the pt's best interest. Pt. autonomy may conflict with beneficience
188
What is confidentiality?
Confidentiality respects pt. privacy and autonomy. Disclosure to family and friends should be guided by what pt. would want. Pt can waive right to confidentiality (i.e. to insurance co.)
189
What is nonmaleficence?
Do no harm. But, if benefits of intervention outweigh risks, pt may make an informed decision to proceed.
190
What must patients understand in informed
| consent?
- risks
- benefits
- alternatives, which includes no intervention
191
When is an oral directive valid?
Incapacitated patient's prior oral statements commonly used as guide, but problems arise from variance in interpretation. if pt was INFORMED, directive is SPECIFIC, pt. MAKES A CHOICE and decision is REPEATED over time, the oral directive is more valid.
192
At what ages does sexual abuse in children peak?
9 to 12 years of age
193
At what time (minutes after birth) do you run an APGAR score?
after 1 min. and 5 min., score 0-2 in 5 categories (10 is perfect score)
194
Define low birth weight
less than 2500g
195
Irreversible changes of long term deprivation of affection occurs after how long?
6 months
196
Physical abuse in children leads to how many deaths in the U.S.?
~3000 deaths/yr.
197
What are evidence of physical abuse in children?
- healed fractures on x-ray
- cigarette burns
- subdural hematomas
- multiple bruises
- retinal hemorrhage or detachment
