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CMN 568 > Unit 5 - SG > Flashcards

Unit 5 - SG Flashcards

1
Q

non-contrast CT:
sufficient to exclude?
does not exclude?

A

Sufficient: intracranial hemorrhage + intracranial masses

does not exclude: SAH (need LP)

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2
Q

OTTAWA SAH clinical decision rule

A

predicts SAH:

  • > 40y/o
  • neck pain/stiffness
  • witnessed LOC
  • onset during exertion
  • thunderclap HA
  • limited neck flexion
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3
Q

Migraine: s/s

A

pulsatile
4-72 hours

unilateral, aggravated by routine physical activity
N/V, photophobia, photophobia
Aura or no aura

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4
Q

Migraines: symptomatic (acute) therapy

A

rest quiet/dark room
ASA, tylenol, NSAIDS - limit analgesics to <15 days/month, combo analgesics <10 days/month

Ergotamines
Triptans
chlorpromazine 
Firocet (risk of dependence - last resort)
opioids (avoid d/t rebound)

neuromodulation

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5
Q

Migraines: preventative therapy

A

lifestyle changes

acupuncture
Botox

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6
Q

Cluster headache: s/s

A 
precranial tenderness
poor concentration
constant daily HA
viselike or tight (not pulsatile)
no focal neuro symptoms

generalized most intense at neck/back of head

stress/fatigue/noise/glare worsens

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7
Q

Cluster headaches; treatment

A

1st line = sumatriptan, or O2

prophylactic: lithium, verapamil, to primate

transitional = prednisone, ergotamine

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8
Q

rebound headaches:

cause medications

A 
>10 days/month:
ergotamines
triptans
butalbital
opioids

> 15 days/month:
tylenol
acetylsalicylic acoid
NSAIDS

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9
Q

trigeminal neuralgia: s/s

A

brief episodes of stabbing facial pain exacerbated by touch

- near one side of mouth shoots towards ear, eye,nostril on that side

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10
Q

trigeminal neuralgia: treatment

A

1st line: oxycarbazepine/carbamazepine
- if ineffective try phenytoin

w/ MS - gabapentin (suspect MS if <40y/o)

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11
Q

Nimodipine

A

reduces ischemic deficits from arterial vasospasm (SAH)

given 21 days prophylactically for all SAH patients

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12
Q

SAH: s/s

A

sudden severe HA “thunderclap”
signs of meningeal irritation (ducal rigidity)
obtundation, confused/irritable
N/V

focal deficits usually absent

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13
Q

Pseudotumor Cerebri: s/s

A

“Idiopathic intracranial HTN”

HA worse on straining
visual obscuration or diplopia
papilledema
abducens palsy
pulse synchronous tinnitus

CSF normal (confirms presence of intracranial HTN)

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14
Q

Pseudotunor Cerebri: tx

A

Acetazolamide

toprimate (antieleptic, carboanhydrase inhibitor)

lasix

repeated LPs
VP shunt

DC use of: tetracycline, OCP, vitamin A, restart steroid if recently abruptly stopped

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15
Q

Adjustment Disorder

A

must specify “w/ symptom”
w/in 3 months of identifiable stressor
not at severity of major depressive episode or chronicity of GAD

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16
Q

Adjustment Disorder: meds

A

lorazepam for limited time

short term SSRI

17
Q

PTSD: tx

A

psychotherapy ASAP

SSRI (sertraline and paroxetine)
BB (propranolol)
clonidine (noradrengic)
alpha adregnic blocker (prazosin)
antieleptic (carbamazepine)
benzo (clonazepam)
trazodone (non habit forming hypnotic)
18
Q

GAD: meds

A

1st line:
SNRIs (venlafaxine, duloxetine)
SSRIs (escitalopram, paroxetine)

TCAs/MAOIs
aminoketones(bupropion)
anticonvulsants (gabapentin)
BB (propanolol)

benzos (immediate effect):
lorazepam, diazepam, triazolam

19
Q

lag time for SSRIs/SNRIs

A

2-4 weeks for long term management

20
Q

Panic Disorder: meds

A

1st line:
SNRIs (venlafaxine)
SSRIs (fluoxetine, paroxetine, sertraline)

benzos
propanolol

21
Q

Phobic Disorder: meds

A

SNRIs (venlafaxine)
SSRIs (fluvoxamine, paroxetine, sertraline)

propanolol

22
Q

OCD: tx

A

SSRIs and clomipramine

systematic desensitization

CBT

thought stopping (ID thought and derail it)

23
Q

chronic pain disorders: meds

A

SNRIs (venlafaxine & milnacipran - fibromyalgia, duloxetine - chronic pain conditions)

TCAs (nortriptyline)

anticonvulsants (gabapentin, pregabalin)

24
Q

paraphilias: meds

A

medroxyprogesterone

fluoxetine (SSRIs)

LHRH-agonists (severe)

25
Q

Paraphilias

A

“deviations” “variations”
associates w/ sexual objects or orientations different from those usually associated w/ adult sexual stimulation

  • exhibitionism
  • voyeurism
  • pedophilia
  • incest
  • sexual sadism
  • sexual masochism
26
Q

Erectile Dysfunction: meds

A

phosphodiesterase type 5 inhibitors: sildenafil, tadalafil, vardenafil (1 hours prior to sex, NO NITRATES!)

27
Q

Ejaculation Dysfunction: meds

A

SSRI for premature ejaculation

28
Q

Hyposexual Desire Disorder: meds

A

5HT1A-agonist / 5HT2 antagonist (fibanserin)

no ETOH b/d hypotension

29
Q

Bipolar I vs II

A

I: manic episodes

II: hypomanic episodes w/o frank mania

CMN 568 (10 decks)

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