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Neuro Psych > Week 5 6 & 7 > Flashcards

Week 5 6 & 7 Flashcards

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1
Q

nociceptive pain

A

pain due to mechanical, thermal or chemical activation of receptor to noxious stimuli

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2
Q

neuropathic pain

A

pain due to damage to neuronal pathways involved in sensory processing

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3
Q

hyperalgesia

A

abnormal increase in sensitivity to painful stimuli (may occur after injury)

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4
Q

allodynia

A

perception of normal stimuli as painful

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5
Q

paresthesia

A

spontaneous sensations without generating stimuli

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6
Q

deafferentation pain

A

from interruption of afferent nerve impulses of spinothalamic tract

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7
Q

A-delta fibers

A

fast, sense pain

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8
Q

C fibers

A

slow, sense itch, temp and pain

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9
Q

gate control theory

A

interplay between fibers in dorsal horn such that activation of surrounding fibers (mechanical, shaking, pressure) can suppress pain signal (and TENS can also block)

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10
Q

pain inhibitory descending pathways (4)

A 
o	Locus coeruleus – noradrenergic 
o	Dorsal raphe – serotonergic, GABAergic 
o	Endogenous opioids
-	Endorphins, enkephalins, dynorphin 
o	Cannabinoids, adenosine
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11
Q

central wind up pain

A

intensity increases over time for a given stimulus delivered repeatedly above critical rate
has greater firing, decreased threshold, increased or abnormal VGNaC

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12
Q

3 major opioid receptor subtypes

A
  • Endorphins – MOR – Mu
  • Enkephalins – DOR – delta
  • Dynorphin – KOR – kappa
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13
Q

what does MOR do

A

Gi protein that inhibits adenyl cyclase and VGCC to increase K+ that leads to analgesia sedation, euphoria (reward, want MOR), antitussive (cough, codeine)

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14
Q

intracranial pain sensitive areas

A

venous sinuses, basal arteries, dura of fossae

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15
Q

red flags for headaches

A

change in pattern, progressive worsening, neurological dysfunction, fever, stiff neck, vomiting, confusion, LOC, character/personality change, post-trauma

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16
Q

tension headache

A

nagging, pressure, vice grip, band like

bilateral

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17
Q

migraine headache

A

unilateral, throbbing, worse with activity, aura, allodynia, triggers

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18
Q

migraine w/o aura diagnostic criteria

A

at least 5 attacks, 4-72 hours long, unilateral, pulsating, moderate to severe pain, aggravation by physical activity, associated with nausea, vomiting, photophobia or phonophobia

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19
Q

migraine w/ aura diagnostic criteria

A

At least 2 attacks fulfilling “without aura” criteria plus aura
Aura – visual disturbance like lines, lights flashing, color changes

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20
Q

retinal migraine

A

monocular visual disturbance, with scintillations, scotomata, blindness, and migraine headaches and normal optho exam

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21
Q

cluster headache

A

30-90 min
comes and goes in waves
one side, behind eye/temple, like a hot poker, eye redness and tearing, nasal discharge, drooping of eyelid, agitated, pacing, wakes at night (~1hr of sleep)

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22
Q

in elderly patients on BZDs, use ___________ to prevent ____________

A

1/2 dose to prevent falls

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23
Q

MS symptoms

A

Changes in sensation in arms, legs or face
Optic neuritis, nystagmus, diplopia
Weakness, spasms
Fatigue, cognitive impairment, depression

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24
Q

MS pathology

A

BBB breakdown allows T-cells to enter CNS and destroy myelin sheath

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25
Q

MS imaging

A

Gad enhancing lesions on T1 with plaques in white matter

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26
Q

MS labs

A

elevated IgG

oligoclonal bands

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27
Q

Neuromyelitis optica / Devic’s disease

A

demyelination and necrosis of optic nerves and spinal cord often preceded by viral illness and associate with systemic autoimmune diseases

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28
Q

Neuromyelitis optica / Devic’s disease symptoms

A

optic neuritis

myelitis

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29
Q

agoraphobia

A

distress from excessive worry in two or more situations: public transportation, open spaces, enclosed spaces, in line, in crowds or outside of the home alone

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30
Q

biomarkers for EtOH abuse (3)

A

γ-glutamyltransferase (GGT), carbohydrate-deficient transferrin (CDT) – better for recent heavy drinking/relapse

ethylglucuronide (EtG) – detects any drinking w/i 72 hours

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31
Q

Wernicke-Korsakoff syndrome

A

due to vitamin B1 deficiency
• Wernicke – encephalopathy, ataxia and ophthalmoplegia; Medical emergency – give B1 and Mg
• Korsakoff – anterograde amnesia, “stories”

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32
Q

what two drugs are not on a regular drug screen (2)

A

fentanyl, clonazepam

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33
Q

opioid drug testing

A

Natural derivatives – morphine -> test +
Semi-synthetics – hydrocodone -> test + or –
Synthetics – methadone -> test –

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34
Q

hallucinogen persisting perception disorder

A

re-experiencing of symptoms from hallucinogens like:

afterimages, trails, color flashes, lights and halos

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35
Q

what can you treat opioid addicted pregnant patient

A

methadone

can add buprenorphine

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36
Q

neonatal abstinence syndrome

A

high-pitched crying, yawning, sneezing, tremors, ↑ muscle tone, feeding difficulties, diarrhea, tachypnea or apnea, seizures

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37
Q

disinhibited social engagement disorder

A

o Child has experienced extremes of insufficient care (social neglect, deprivation, changes, unusual)
o After age 9 months, child develops pattern of disinhibited behavior (not just impulsivity) towards unfamiliar adults

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38
Q

acute stress disorder

A

o Exposure to trauma involving threat of death or injury or repeated exposure to details of trauma
o Leads to 9 or more of: Intrusive symptoms, negative mood, dissociative symptoms, avoidance or arousal problems (sleep, emotion, concentration)
o Lasting for 3 days to 1 month

39
Q

self induced emesis causes _________

A

metabolic alkalosis

40
Q

laxative and diuretic abuse cause ______

A

metabolic acidosis

41
Q

difference between bulimia and anorexia

A

BN patients tend to experience their eating symptoms as more ego-dystonic (distressing) & thus they more readily seek treatment, compared to AN

42
Q

Lhermitte sign

what is it and what does it suggest

A

electrical sensation runs down limbs when neck is bent forward
dorsal column lesion

43
Q

Uhthoff phenomenon

A

worsening of symptoms of demyelinating diseases when body gets overheated by weather, exercise, fever, sauna, hot tub etc

44
Q

difference between delirium and dementia

A

delirium will have an organic cause that can be seen on labs or imaging

45
Q

potential underlying causes of mental disorders

A

TIT v DID

tumor, infection, trauma, vascular, degenerative, intoxications, developmental

46
Q

delusional disorder

A

more than 1 delusion for at least one-month duration, function not markedly impaired or bizarre

47
Q

positive symptoms of schizophrenia

A

hallucinations, delusions, disorganized speech, bizarre behavior, poor affect

48
Q

negative symptoms of schizophrenia

A

alogia (poverty of speech), affective blunting (↓emotional range), apathy, anhedonia-asociality (inability to experience pleasure or enjoy activities)

49
Q

pathophysiology of schizophrenia

A

dopamine hypothesis and glutamate hypothesis

hypofunction of NMDA receptors

50
Q

schizophrenia co-morbidities risk

A

13x suicide rate, cardiovascular disease, weight gain, diabetes, metabolic syndrome, pulmonary disease, medications, lifestyle, SUDs

51
Q

schizoaffective disorder

A

period with a major depressive or manic episode with Criterion A for schizophrenia

  • Bipolar type – if the disturbance includes a manic or a mixed episode
  • Depressive type – if only includes major depressive episodes
52
Q

cataonia

A

psychomotor disturbance with stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, echolalia, echopraxia

53
Q

mesolimbic dopamine pathway - blockage causes what and comes from where

A

Block of this pathway treats positive symptoms like delusions/hallucinations

From midbrain (ventral tegmentum to nucleus accumbens)

54
Q

mesocortical dopamine - blockage causes what and comes from where

A

Block of this pathway may exacerbate the negative symptoms

From ventral tegmentum to PFC

55
Q

nigrostriatal dopamine pathway - blockage causes what and comes from where

A

Block of this pathway can lad to EPS (dyskinesia, parkinsonism, akathisia)

From substantia nigra to basal ganglia

56
Q

tuberoinfundibular dopamine pathway - blockage causes what and comes from where

A

Block of this pathway can lead to hyperprolactinemia (sexual dysfx, amenorrhea)

From hypothalamus to anterior pituitary

57
Q

acute dystonic reaction

A

abrupt, distressing, painful, sustained contraction/spasm of the muscles of the neck, eyes, mouth, tongue, trunk or extremities; within first 4 days of treatment with antipsychotics

58
Q

treatment of acute dystonic reaction

A

IM Benztropine or diphenhydramine

59
Q

tardive dyskinesia

A

From chronic dopamine blockade via nigrostriatal pathway (super-sensitivity to DA)

Lip smacking, sucking, puckering, choreoathetoid-like movements of fingers and toes and slow, writhing movements of the trunk

60
Q

neuroleptic malignant syndrome

A

Idiosyncratic reaction to dopamine antagonists that causes severe muscle rigidity, elevated temperature plus diaphoresis, confusion, coma, tachycardia, HTN, leukocytosis, elevated CK

Exposed to DA agonist within 72 hours, but can be up to 30 days

61
Q

treatment for neuroleptic malignant syndrome

A

muscle relaxant dantrolene, dopamine agonist bromocriptine, or ECT

62
Q

paroxysmal depolarization shift

A

Intense depolarization of epileptic neurons because the opening of the voltage gated potassium channels is not enough to bring the membrane down to baseline

63
Q

most typical EEG wave

A

alpha

8-13 Hz

64
Q

Benign Rolandic Epilepsy (Benign Epilepsy with Central Temporal Spikes)

A

Twitching, numbness, or tingling of the child’s face or tongue (a partial seizure), which often interferes with speech and may cause drooling

65
Q

genetics related to Janz Syn (myoclonic epilepsy of childhood)

A

6p EF, GABRA1

66
Q

genetics related to astrocytoma (4)

A

IDH1, EGFR, ATRX, and TERT

67
Q

genetics related to oligodendroglioma (2)

A

1p and 19p co-deletions

68
Q

genetics related to medulloblastoma (1)

A

MYCN amp

69
Q

genetics related to Temozolomide treatment response

A

MGMT

70
Q

type of edema seen with brain tumors

A

vasogenic

71
Q

children with brain tumors often present with ____________

A

early morning headache and vomiting

72
Q

children often have brain tumors located in _________

A

midline

leading to loss of coordination and spasticity due

73
Q

features of glioblastoma (4)

A

worst adult tumor
angiogenesis/ neovascularization
prominent palisading necrosis
ring enhancing lesion on imaging

74
Q

features of pilocytic astrocytoma (4)

A

benign
biphasic cystic pattern
elongated cells and Rosenthal fibers

75
Q

features of oligodendroglioma (3)

A

round nuclei with halos, fried egg appearance
chicken wire vascularization
calcifications

76
Q

features of ependymoma (2)

A

rosettes

4th ventricle

77
Q

features of medulloblastoma (4)

A

grade 4 tumor of children
small blue cells
homer wright rosettes
radio-sensitive

78
Q

medulloblastoma genetics

A
  • Wnt pathway has best prognosis

* Myc pathway has worse prognosis

79
Q

delirium treatment options

A

haloperidol
atypical antipsychotics
BZDs

80
Q

neurofibromatosis I

A

o NF1 on Chr 17q AD

Peripheral neuromas, optic glioma
Café-au-lait spots, subQ nodules
Developmental delay, visual issues, painful neuromas, scoliosis

81
Q

neurofibromatosis II

A

o NF2 on Chr 22 AD

Bilateral acoustic neuromas, earing and balance issues

82
Q

Tuberous Sclerosis

A

o TS C-1 (hamartin) and TS C-2 (tuberin) AD to inhibit mTOR kinase

Developmental delay, seizures, adenoma sebaceous
Ash leaf spots, Pial hemagiomatosis, calcification, seizures
Giant Cell Astrocytoma

83
Q

sturge weber syndrome

A

o GNAQ Chr 9:21  sporadic

Development delay, ADHD, headache, seizures, Pial hemagiomatosis, calcification, Port wine stain, buphthalmos

84
Q

von hippel lindau

A

o VHL tumor suppressor gene 3p25-26 AD

Polycythemia, cystic lesions, tumors, telangiectasias, hemangioblastomas

85
Q

Ataxia Telengectasia

A

o ATM AR

IgA and IgG deficiency that can lead to sinus and lung infections
Telangiectasias, cerebellar dysfunction, gait abnormalities

86
Q

Osler Weber Rendu (Hereditary hemorrhagic telangiectasia)

A

o ALK-1, ENG, and SMAD4 genes AD

Ocular and nail related telangiectasias
Brain arteriovenous malformations, seizures/headaches/ataxia, visual

87
Q

Klippel Trenauny syndrome

A

o PIK2CA gene

Overgrowth of bone and tissues, pain, bleeding, port-wine stains
Spinal cord arteriovenous malformations, paralysis (Coup de Poignard)

88
Q

acute meningitis bugs

A
  • Viral – enterovirus
  • Bacteria – many (Neisseria, group B strep in newborns)
  • Naegleria fowleri
89
Q

subacute meningitis bugs

A
  • Mycobacteria – Mycobacterium tuberculosis
  • Spirochetes – Treponema pallidum, Borrelia burgdorferi
  • Fungi – Cryptococcus neoformans, Candida spp. Coccidio, Aspergillus
90
Q

CSF changes in meningitis

A

low glucose, increased protein

91
Q

acute encephalitis bugs

A
  • Viral – arthropod borne (West Nile), HSV, HIV, CMV, polio, rabies
  • Other – listeria, rickettsia, mycoplasma, toxoplasma
92
Q

chhonic encephalitis bugs

A

Tuberculous tuberculoma, neurosyphilis

93
Q

malignant hyperthermia

A

rapid onset of tachycardia, muscle rigidity, HTN, hyperthermia, hyperkalemia, hypercapnia and metabolic acidosis

Neuro Psych (4 decks)

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