TEST 2 Flashcards by Christian Bernardo

inability to repeat certain phrases, word finding difficulty, multiple paraphasic errors; naming sometimes impaired, auditory comprehension intact

conduction aphasia (lesion to arcuate fasiculus b/w broac’s and wernicke’s)

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rapidly correcting hyponatremia leading to central pontine myelinolisis leads to

locked in syndrome (dissection of pons)

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advocacy group made up of families of mentally ill; can work locally or state wide or federal

National alliance for the mentally ill (NAMI)

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time window for TPA

within 3-4.5 hours of stroke (not later)

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ipsilateral Horner’s syndrome, ipsilateral loss of fine touch in face + contralateral loss pain/temp in body, cerebellar ataxia, vocal cord weakness; dx and localize lesion

lateral medullary syndrome (Wallenberg syndrome)

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What does NE do to aggressioN?

inhibit (like serotonin)

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metochromatic leukodystrophy (mode of inheritance, and what is deficient)

autosomal recessive, deficiency in arylsulfatase A (ASA)
causes accumulation of sulfatides -> demyelination -> gait disorder with hypotonia with lower limb areflexia

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biopsy finindgs metachroatic leukodystrophy

metachromatic inclusions within Schwann cells/macrophages; abnormal ASA enzyme assay in luekyocytes and increased sulfatide excretion

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which primitive reflex keeps going after 6 months sometimes?

parachute reflex (grasp rooting, Moro, tonic neck reflex all should be gone before 6 months)

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most commo cause of visual deficits in AIDS pt

CMV

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difficulty recognizing one’s emotions

alexithymia

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risperidone affinity to D2 receptor

just as much as haldol = also has risk for EPS

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treatment of choice for urinary retention

bethanecol

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which mood stabilizer has the most general/broad coverage for multiple seizures (general tonic clonic, absence, myclonic, etc)

VPA

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anticholinergic side effects

dry mouth, blurry vision, sweating, orthostatic hypotension, sedation, lethargy, agitation, slowed cardiac conduction

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nerve for foot flexion/dorsiflexion

L5; lesion causes foot drop

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foot extension nerve

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nerve for leg extension

L3/L4

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hip flexion nerve

L1, L2, L3

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nerve for achilles/ankle jerk motor reflex

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which antidepressant can be used to treat gastic ulcers and why?

amitriptyline; due to antihistaminic effect

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brown sequard syndrome involves what findings (spinal cord hemisection)

IPSILATERAL loss of motor+posterior column (proprioception, fine touch, vibration) to and below level of lesion
CONTRALATERAL loss of pain and temp a few dermatomes below lesion

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poor performance on cube drawing deficiency in what area

right parietal lobe, inferior temporal lobe (deficits in spatial perception and attention)

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Alzheimer’s and LBD performance on clcok drawing and delayed recall

clocko drawing - LBD worse, Alz better
delayed recall - Alz worse

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poor letter F fluency on MOCA, lesion?

frontal lobe

overall scores of initial MOCA for Alz comapred to LBD or FTD?

WORSE overall

MOCA < 26; what to brain

chronic reduction of cerebral blood flow

MOCA results in depression

global cognitive slowing; tend to be < 26 even with no dementia

MOCA deficits in brain mets?

defiits in delayed recall, language, visual/spatial executive function

pt speaks in nonsens sayin g"thar szing is phrumper zu stalking"; normal intonation but nobody can understand him;

wernicke's aphasia/fluent aphasia

pt presents with inability to write, calculate, do arithmetic, inability to dstinguish fingers on hand; where is lesion

left parietal (gerstmann syndrome)

CSF findings in HSV

lymphcytic pleocytosis (increased WBCs)

up to down (order of brainstem)

midbrain pons medulla

fmidbrain lesions cause what kind of symptoms (CN 3-5)

"eyeballs" abnormality in eye ovements and face sensation

lesions to pons cause what (CN 5-9)

"middle face" abnormalities in facial movement, chewing, saliva, hearing/balance

Damge to medulla causes what

"neck stuff" CN9-12 tongue movement, taste, swalloing, neck movement

lesions to what part of brain stem can cause ataxia?

all of them! cerebellum has projections to all parts of brainstem

pt presents with hiccups, left sided facenumbness, nystagmus, hoarseness,, deficits in pain temp on RIGHT side of body, ataxia, vertigo, nausea, vomiting; what blood vessel invovled?

lateral medullary syndrome/wallengerg occlusion of POSTERIOR INFERIOR CEREBELLAR ARTERY

treatment bell's palsy

steroids OR antivirals if caused by HSV

suspected cause of trigeminal neuralgia?

susuperior ceberallar artery compressiong CNV near connection to pons

how to differentiate alcoholic cereballar degeneration from wernicke's encephalopathy?

ACD doens't cause eye movement issues or eye pain

treatment for Huntington's

symptomatic treatment can also uses haldol or high potency antipsychotics

activity of subthalamic nucleus and globus pallidus in parkinson's

INCREASED (leads to DA inhibition and movement disorders like bradykinesia)

what mood stabilizer can be helpful in pseudotumor cerebri?

topamax (inhibits carbonic anhydrase leading to decerased cSF production and lowers ICP)

CSF MS

oligoclonal bands, elevated protein, nucleated cells

what can trigger MS flares?

infections (common cold, URI), heat, pregnancy, emotional stress

how to differentiate ALS from cervical spondylosis and transverse myelitis

ALS doesn't present with SENSORY issues; only motor

stocking glove sensory deifict

GBS

most helpful test for ALS

EMG (w/ fibrilations)

parkinson symptoms (gait issues, bradykinesia, rigidity) with difficulties with vertical gaze?

progressive supranuclear palsy

pupils in botulism

DILATED (causes blurred vision)

autoantibodies taret what in lambert eaton

PRESYNAPTIC CALCIUM (prevents release of Ach)

pupils in MG

NORMAL, reactive

antibodies target in MG

POST SYNAPTIC Ach receptors (so Ach production is normal just blocked)

site of Ach production

nucleus basalis of Meynert

introns or exons geneticall y active?

EXONS; introns are spliced out

DNA methylation does what to transcription

represses (DNA Methylation Masks)

Histone methylation vs histone acetylation

methylation - REPRESSES DNA transcription most of the time; "Methylation Mostly Mutes" acetylation - relaexes chromatin coils and ACTIVATES transcription; "Acetylation ACTivates"

single gene affecting multiple phenotypes

pleiotropy (PKU)

Same genotype yielding varying phenotypes/clinical features/disease severity

variable expressivity (NF-1, MS)

imprinting on chromosome 15

angelman - Paternal imprinting (lmom's chromosome deleted/silent) Prader Willi - maternal imprinting; (father's chromosome 15 deleted)

chromsomal translocation occuring on pairs of acrocentric chromosomes leading to long and short arms

robertsonian translocations (downs, Patau, miscarriage, stillbirth)

transitional object; "good enough mother"

Winnicott

"ego splitting", infant/mother relationship; "depressive/paranoid/schizoid positions

Melanie Klein

"mirroring", narcissim

Kohut (Self psychology)

who developed modern, short-term therapy by shortening sessions/decreasing frequency

Franz Alexander

who developed/utilized interpersonal therapy

developed by Klerman, uutilized by Harry Stack Sullivan

who developed therapy that reduces overt behaviors/symptoms of mental illness, uses conditioning and modeling

John Watson (developed behavioral therapy)

counterconditioning to decrease maladaptive anxiety; decreases response to anxiety provoking stimuli

systematic desensitization; good for phobias

what is like systematic desensitization but nore extreme and with no hierarchy

flooding (intead of slowly exposing someone to increasing heights, just tell them to go to tallest building and sit there until fear subsides)

who designed biofeedback

Miller

unearthing repressed emotoins and reliving them to increase insight

abreaction

expression of an emotion in one member elicits expression of emotion in another

contagion

idea that an individual is not alone with their problems

universalization

what type of therapy involves neutraility, circular interaction between family/therapists, circular questions

Milan system; type of family therapy

mechanism carbidopa-levodopa

carbidopa - inhibits DOPA decarboxylase and prevents metabolism of levodopa to dopa before it can cross BBB

defense mechanism most often seen in psychosis and paranoid personality disorder

projection

seizures, hemiparesis, facial cutaneous angioma (PORT WINE NEVUS), ID; toddler

Sturge Weber

retinal+CNS hemangioblastomas, visercal cyssts, tumors; most often in cerebellum and kidneys

Von Hippel Landau

early onset ataxia with small dilated bruising

ataxia telangectasia

sweating/cool/blue skin after constant pain after injury/trauma

COOL SKIN AFTER PAIN? reflex sympathetic dystrophy

carbamazepine inducer at what?

2C19 3A4

clozapine substrate of what

1A2

if pt loses capacity and no surrogate decision maker can be found...what does the state do?

takes steps to make a decision that PRESERVES AND PROTECTS HUMAN LIFE

tobacco smoking lowers levels of which meds?

CLOZAPINE OLANZAPINE HALDOL AMITRIPTYLINE IMIPRAMINE