Test 1 Flashcards
s/s of generalized anxiety disorder
excessive worry, restlessness, irritability for at least 6 months
benzos work by increasing
GABA activity
typical pharm trx for GAD
antidepressant & benzo
risks of benzos
dependence, rebound insomnia
common side effects of antidepressants
weight gain and sexual dysfunction
complications of antidepressants in elderly
hyponatremia, hypercoagulation, osteoporosis, serotonin syndrome
buspirone is only approved for treatment of
generalized anxiety disorder
TCAs are not first line for generalized anxiety disorder because
high risk of cardiac dysrhythmias and lethal overdose
s/s of anxiety in children
diminished interest, social withdrawal
s/s of anxiety in adolescents
anger & obedience
characteristics of panic disorder
palpitations, shaking, sweating, SOB that peak in 10 minutes and then go away
characterized by excessive fears of scrutiny, embarrassment and humiliation in social or performance situations, leading to significant distress and/or impairment in functioning
social phobia
treatment for phobias
CBT, desensitization
A diagnosis of PTSD is made only after
a month has passed since traumatic event
treatment for OCD
CBT & SSRI
progressive cognitive decline mostly seen in those > 65
alzheimer’s dementia
dementia correlated with CVA
vascular dementia
dementia with fluctuating cognition associated with parkinsonism, hallucinations and delusions, gait difficulties, and falls.
Lewy body dementia
dementia with language difficulties, personality changes, and behavioral disturbances
frontotemporal dementia
these is no evidence that these prevent the onset of dementia
statins
rule these out when diagnosing alzheimer’s dementia
thyroid disease, vit B12 deficiency, depression
treatment for mild dementia
cholinesterase inhibitors
cholinesterase inhibitors
donepezil (Aricept) and rivastigmine (Exelon)
treatment for moderate to severe dementia
cholinesterase inhibitors, Namenda, or antipsychotics
Acute neurologic complication of illness and/or medication, especially common in older patients, manifested by new confusion and impaired attention.
delirium
difference between delirium and dementia
delirium is acute, dementia is chronic and progressive
characteristics of autism
ineffective social skills, inability to sustain conversation, repetitive behaviors
environmental need for autistic child
structured educational program with a routine.
early signs of autism are present by
18 months of age
red flags for autism are
don’t respond to name being called by 1 year old, no single word by 16 months
screen for autism in ALL children at
18-24 months of age
stages of grief
denial, anger, bargaining, depression, acceptance
low levels of this neurotransmitter is associated with depression
serotonin
dosage for escitalopram (Lexapro)
5-20 mg
dosage for citalopram (celexa)
10-40 mg
dosage for sertraline (zoloft)
50-200 mg
dosing for paroxetine (paxil)
20-60 mg
dosing for fluoxetine (prozac)
10-80 mg
SNRIs
venlaxafine (Effexor) and duloxetine (Cymbalta)
dosing for venlaxafine (Effexor)
75-373 mg
dosing for duloxetine (Cymbalta)
20-60 mg
dosing for buproprion (Wellbutrin)
200-450 mg
antidepressants should be continued for
6-9 months
lifelong trx of antidepressants are needed if
more than 3 depressive episodes
s/s of serotonin syndrome
confusion, hyperreflexia, fever, myoclonus
differences between depression and dementia
dementia has a slower decline in function; depression occurs more rapidly with a fluctuating course
suicide screening
o Thoughts of suicide
o Plan to commit suicide
o Means to complete the plan
o Intention to follow through with the plan
one or more manic or mixed episodes during a patient’s lifetime
bipolar I
at least one major depressive episode are met in addition to at least one hypomanic episode
bipolar II
the onset of bipolar is at ages ____ with initial episodes of _____
15-30; depression
manic episode lasts usually
one week
people with bipolar have a high risk of
substance abuse and suicide
antidepressants in a bipolar patient can
cause them to switch from a depressed to manic mood
mood stabilizers for bipolar
lithium, lamotrigine, valproate
baseline lab before starting lithium
TSH and calcium
lamotrigine for bipolar has a high risk of developing
skin rash and SJS
complications of anorexia
hypotension, bradycardia, hypothermia, amenorrhea
heart complication d/t anorexia
mitral valve prolapse
ECG findings in anorexic patients
usually normal except for bradycardia
xerosis is seen in
anorexia (dry, scaly skin)
lab results in anorexia
leukopenia, high BUN, high cholesterol, low estrogen
med for anorexia
olanzapine
first line trx for anorexia
nutritional rehab and psychotherapy
complications of anorexia
high LFT, superior mesenteric artery syndrome, acute pancreatitis
anorexia has a ____ body weight and bulimia has a ____ body weight
low; normal
in anorexia, the HR is ____, in bulimia the HR is _____.
low; high
bulimia is characterized as binge-eating and compensatory behaviors at least
once a week for 3 months
s/s of bulimia
tachycardia, hypotension, parotid gland swelling, and dental erosion
bulimia has a high risk for
diabetes
first line therapy for bulimia
fluoxetine
this is contraindicated in both anorexia and bulimia as it can cause seizures
buproprion (wellbutrin)
mandatory reporting for
elder and child abuse/neglect`
Regardless of the gender identity of the patient, physical exams should be based on
the organs present.
In transgender patients, it is important to assess and treat for
cardiovascular disorders d/t hormone intake
annual screening should be done in men who have sex with men
HIV, syphilis, chlamydia, gonorrhea
treatment for those with hypoactive sexual disorder
testosterone patch for buproprion
meds that can cause erectile dysfunction
antihypertensives, antidepressants
PDE-5 inhibitors for ED are contraindicated in those
taking nitrates
PDE5 inhibitors
sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis)
teaching for sildenafil (Viagra) and vardenafil (Levitra)
effective for short periods and have to be taken on an empty stomach
patients with dysparenuria should have
a pelvic exam and pap
characterized by excessive daytime sleepiness and inappropriate manifestations of REM sleep.
narcolepsy
undesirable physical events or experiences that occur during entry in sleep.
parasomnias
one type of REM sleep parasomnia
REM sleep behavior disorder
when patient physically act out vivid, often unpleasant dreams with vocal sounds and sudden, often violent arm and leg movements during REM sleep
REM sleep behavior disorder
REM sleep behavior disorder occurs in
men greater than 50
inhalants cause
drowsiness, dizziness, slurred speech
major hazard of nitrous oxide inhalation is
anoxia
cocaine properties
CNS stimulant
cocaine dependence can cause
seizures and arrythmias
and increase in GABA causes
sedation
intoxication is a BAC
greater than 0.10%
DTs develop within ____hour of the last drink
24-72
benzos facilitate the action of
GABA
causes of carotid sinus syncope
tight collars, shaving, head turning
causes of situational syncope
micturition, coughing, swallowing
meds that can cause syncope
ACEI, beta blockers, sulfa, quinolones
positive orthostatics if
more than 20 mmHg change in systolic, 10 mmHg change in diastolic, or more than 20 bpm in HR
how to stabilize after syncope
place supine, loosen clothing, turn patient’s head to the side
peripheral disorders that can cause dizziness
labryinthitis, benign positional vertigo, Meniere’s disease, any inner ear disorder
central disorders that can cause dizziness
TIA/CVA, multiple sclerosis, tumor
hallmarks of a peripheral lesion r/t dizziness
nausea, normal neurologic exam, position related
hallmarks of a central lesion r/t dizziness
abnormal neurologic exam
clinical test for positional vertigo
HallPike-Dix
caution with anticholinergics as it can cause
drowsiness, urinary retention, and confusion in elderly
POUND with migraine
pulsating or throbbing one day duration 4-72 hours unilateral nausea disturbance in everyday activities
alleviating factors in migraine with/without aura
quiet room with eyes closed
triggers to migraines
stress, weather, cheese, chocolate, alcohol, hormonal changes
prodrome phase of migraines
irritability, fatigue, food cravings
______ is common with migrainers
fibromyalgia
when further investigation is needed for HA
age greater than 50, decreased DTR, personality change
preventative therapy for migraines
anticonvulsant, CCB, beta blocker, antidepressant
abortive therapy for migraines
triptans, NSAIDs, corticosteroids
meds for abortive therapy for migraines should be limited to
use of 2 days or less as it can cause rebound headache.
tension headache is described as
tight band around the head
cluster headache characteristics
reaches intensity in 15 minutes, patient cannot sit still, severe pain
those with cluster headaches have a high risk of
suicide
other features that can occur with cluster headaches
ipsilateral conjunctival injection, lacrimation, rhinorrhea
preventative therapy for cluster headaches
verapamil and lithium
abortive therapy for cluster headaches
oxygen at 7L/min, triptans
vasculitis of large and medium vessels
temporal arteritis
risk factor for temporal arteritis
age greater than 50
s/s of temporal arteritis
fever, weight loss, temporal headache, jaw pain, visual changes
diagnostics for temporal arteritis
CRP and ESR
treatment for temporal arteritis
glucocorticoids, baby ASA
benign, chronic tremor of the upper extremities or head. The legs are NOT involved
essential tremor
when the tremor is accentuated as the hand approaches a given target
essential tremor
in essential tremor, the tremor disappears during
sleep or when drinking alochol
trx for essential tremor
propranolol
complication of essential tremor
alcoholism
most common cause of resting tremor
parkinson’s
resting tremor disappears when
movement is voluntary
intention tremor is caused by
multiple sclerosis and stroke
in intention tremor, the tremor increases as
it moves hand closer to target
physical exam of tremor includes
when it’s fully supported at rest, when the limb is elevated against gravity, and during goal-directed movements.
Wilson’s disease is
autosomal recessive
Wilson’s disease is an impairment of
copper
Wilson’s disease tremor
asymmetrical tremor
partial seizures involve
only a portion of the brain
when the patient has deja vu, hallucination, or activity of an arm or leg that doesn’t cause a loss of consciousness
simple partial seizure
when the patient stares into space and either remains motionless or engages in repetitive behaviors (lip smacking, chewing, etc).
complex partial seizure
generalized seizures involve
both hemispheres of the brain
nonconvulsive generalized seizure
absence (petit mal)
atonic (drop attacks)
convulsive generalized seizure
myoclonic
tonic-clonic
caution with antiepileptic drugs as they have interactions with
warfarin, antibiotics, and oral contraceptives
education with antiepileptics
- don’t switch between brand name and generic
- can increase suicide thougts
Most common neuro disorders in children with a systemic viral or bacterial infection.
febrile seizure
risk factor for febrile seizure
age, viral infection, recent immunization
simple febrile seizure
last less than 15 min once in a 24-hour period
complex febrile seizure
last more than 15 min more than once in 24 hours
Lumbar puncture in children with febrile seizures
unnecessary if the child returns to baseline
Do not treat patients with febrile seizures with
antiepilectic drugs
to obtain a driver’s license, there is no evidence of clinical seizures in a
3 month period prior to medical review
is the doctor held liable for their recommendation on the patient for obtaining driver’s license?
no
seizure free restriction of ____ months is needed to drive in Texas
6 months
Chronic progressive inflammatory and neurodegenerative disease affecting the CNS.
multiple sclerosis
s/s of multiple sclerosis
paresthesia, limb weakness, increased DTR, unsteady gait, nystagmus
diagnostic of multiple sclerosis
MRI
trx for multiple sclerosis
disease modifying therapy: interferons
prognosis for multiple sclerosis
capable of living a regular life for 15-20 years
clinical features of parkinson’s
resting tremor, bradykinesia, rigidity, postural instability
parkinson’s is caused by
low dopamine
the goal of trx for parkinson’s is to
maximize functional ability. you cannot slow the progression of the disease
complications of parkinson’s
psychosis, dementia, depression
TIAs are
acute ischemic deficits that last less than 24 hours
most common causes of meningitis in adults and children
N. meningitides and Strep pneumoniae
presentation of meningitis
fever, headache, stiff neck
is present if the patient resists passive knee extension when the hip is fully flexed.
kernig sign
present if a patient actively flexes the hips when the neck is passively flexed.
Brudzinski sign
LP in meningitis shows
very high WBC and protein, high glucose, and positive gram stain
encephalitis is caused by
herpes virus, west nile, adenovirus, enterovirus, mumps/measles
difference b/t meningitis and encephalitis
normal mental status in meningitis; encephalitis has altered mental status
LP in encephalitis
high WBC and protein, normal glucose, neg gram stain
this has been effective in lowering in the meningitis rate
Hib vaccine
when meningitis vaccine is given
11-12 and college freshman
acute inflammation of the facial nerve
bell’s palsy
goal of bell’s palsy trx
protection of the eye
higher risk of bell’s palsy in
pregnancy
bell’s palsy affects CN
VII
trigeminal neuralgia affects CN
V
trigeminal neuralgia characterisitscs
burning, sharp pain to one side of the face
trigeminal neuralgia can be exacerbated by
chewing, talking, facial movement, weather
trigeminal neuralgia trx
anticonvulsant
Characterized by rapid, progressive, and symmetric loss of motor function
GBS
causes of GBS
occurs 1-4 weeks after a URI and GI infection.
characteristics of GBS
numbness/tingling in lower limbs that works up.
complication of GBS
decline in respiratory status
initial diagnostics for GBS
peak flow meter and pulse ox.
hydrocele in an infant resolves at
1 year of age
characteristics of muscle dystrophy
muscle weakness, normal intellect
age when toddler should walk independently
12-14 months
risk factors for hydrocephaly
prematurity, meningitis, intrauterine infection
what child should do at 6-8 months
wave bye, sit up without support
newborn jaundice that occurs less than 12 hours old indicates
ABO incompatibility
how long should child remain in “time out”
1 min for each year of life
should a 2 year old with asthma receive the Flu-mist vaccine?
no
a child should not delay immunizations when
they are being treated with atbx
anterior fontanel closes at
9-14 months
the posterior fontanel closes at
4 months
age to use “time out” as a discipline method
18 month-2 years
a childhood immunization that is likely to cause a fever
pneumococcal
at what age should a child be to ride a tricycle?
3 years old
children should not receive tetracycline before
9 years of age
when should children be able to tie their shoes?
6-7 years
when should children be able to voice that they are hungry, cold, tired, etc
4 years old
a newborn loses up to ___% of birth weight in the first week of life
10
Fluoroquinolones should be not be given before
18 years of age
sulfa drugs should not be prescribed before
2 months of age
Wernicke encephalopathy is caused by
thiamine deficiency
rotten teeth is associated with
methamphetamines
alcohol withdrawal is associated with
clonidine
