STEP 2 neuro & psych Flashcards
Nonmedical interventions for schizophrenia?
Stable, nonstressful home environment
Family education
NMS vs serotonin syndrome?
SS has: diarrhea hyperactive bowel sounds dilated pupils hyperreflexia and clonus "autonomic instability"
CSF study results for GBS?
albuminocytologic disassociation:
high protein, nl WBC count in CSF
migraine abortive tx:
- prochlorperazine (compazine), chlorpromazine (thorazine), metoclopramide (reglan)
- triptan if early in course
- NSAID
vertigo ddx
BPPV: otolith
- paroxysmal (usu no NV), positional (reaching overhead or turning), nystagmus (upbeat torsional)
- tx: epley maneuver
labyrinthitis vs vestibulitis: viral illness 1 wk ago.
- +NV. auditory sx = labyrinthitis. nystagmus opposite lesion.
- tx: steroids and meclizine
Meniere’s dz: chronic endolymphatic hydrops
-hearing loss, ear fullness, +NV. R/o TIA.
-tx: benzos, antimigraine
vestibular migraine: migraine sufferers
- vertigo w/o hearing loss
r/o TIA
incidence/heritability of bipolar?
incidence: 1% genl pop
10% one parent
60% two parents
70% monozygotic twins
cluster headache acute tx and ppx?
acute: triptan and O2
ppx: verapamil, ergotamine, lithium
cavernous sinus thrombosis sx?
headache, exophthalmos, chemosis
dilated tortious retinal veins, papilledema
unilateral->bilateral
focal neurologic signs following sharp trauma to soft palate = ?
ICA dissection
side effect of fluphenazine?
hypothermia - inhibits hypothalamic shivering reflex
features of thalamic hemorrhage?
eyes deviate AWAY from lesion
nonreactive pupils
contralateral hemiparesis/hemisensory loss
features of pontine hemorrhage
coma/paralysis
pinpoint reactive pupils
tx to prevent vasospasm after SAH?
nimodipine
what are the acetylcholinesterase inhibitors? which cross the BBB?
edrophonium - short acting, diagnosis of MGrav only
neostigmine, pyridostigmine - tx for MG / glaucoma
physostigmine - CROSSES BBB.
donepezil - central for Alzheimer’s
cerebellar lesions - difference btw vermis and hemisphere lesion?
vermis - truncal ataxia (alcohol)
hemisphere - limb ataxia
tx for adjustment disorder?
psychotherapy 1st line
tx for social anxiety disorder?
for performance only:
-benzo or propranolol
for more severe form:
-SSRI or SNRI
separation anxiety disorder vs selective mutism?
SAD: extreme anxiety when has to go to school
selective mutism: fine at home but just doesn’t talk at school
therapy +- drugs
structural brain abnormalities in: autism schizophrenia panic disorder OCD PTSD
autism: incr total brain vol
schizophrenia: enlarged ventricles
panic disorder: decreased amygdala volume
OCD: abnormalities in orbitofrontal cortex & striatum
PTSD: decreased hippocampal volume
CSF findings in viral meningitis?
lymphocytic pleocytosis, increased protein, nl glucose
CSF findings in TB meningitis?
lymphocytic pleocytosis, increased protein, decreased glucose
tx for restless leg syndrome?
dopaminergics: pramipexole, levodopa
triptans are incompatible with which other migraine med?
dihydroergotamine (ergots) - causes severe vasoconstriction leading to possible stroke
blurred vision + glare at night = which vision disorder?
cataracts
tx for specific phobia?
cognitive therapy
one episode of major depression = how long SSRI tx?
6 months
lithium: contraindications?
interactions?
contraindications: -pregnancy: Ebstein's anomaly, DI -CKD: may worsen renal function, DI -heart disease: arrhythmias with CAD interactions: -diuretics -ACEI/ARB -NSAIDs -SSRIs -antiepileptics
complications of anorexia nervosa?
-osteoporosis
-euthyroid sick syndrome
-long QT
-elevated cholesterol & carotene
-hyponatremia & other electrolyte abnormalities
-HPA axis disturbances (amenorrhea, infertility)
when pregnant:
-postpartum depression
-SGA baby
management of IIH?
acetazolamide +- lasix
short term: steroids and serial LPs if refractory
long term: LP shunt or optic nerve sheath decompression
lacunar stroke syndromes?
pure motor (internal capsule, equal face-arm-leg) pure sensory (thalamus?) mixed sensory-motor clumsy hand-dysarthria ataxic hemiparesis
brain imaging findings in alzheimer’s?
diffuse cortical and subcortical atrophy
which conditions are contraindications to buproprion usage?
epilepsy
anorexia nervosa and bulimia - electrolyte abnormalities predispose to seizures
concurrent heavy alcohol or benzo use
