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MS2 Unit3 Neurology > week2 lectures > Flashcards

week2 lectures Flashcards

1
Q

religions that have higher riskof suicide (2)

A

jewish + protestant

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2
Q

pt’s hx, FH, dmeographics, cultureal/regligous beliefs , and personaty traits are eg’s of

A

immutatble risks

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3
Q

4 groups of acute predictors for suicidality?

A
  • Anxiety,panic attacks, insomnia, agitation, restlessness
  • irritability, hostility, aggressiveness, impulsiveity
  • hypomania + mani
  • hopeless, helplessness
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4
Q

3 components of the risk triad

A

ideation, intention, plan

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5
Q

depression is assc with __% of suicides and schizophrenia is assc with __%

A

80%; 10%

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6
Q

1/3 of patients have sought medical attn within ___ months of death

A

6 month

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7
Q

the ss short allele for ____ conveys poor resiliences; ↑MDD; ↑risk for suicide during stress

A

serotonin

hint: LL long allele = protective

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8
Q

using others to kill oneslef; occurs as a pact by females or the elderly

A

victim-precipitated homicide; murder-suicide

hint: murder suicide turns out to be homicide/coercion/rampage kill?

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9
Q

3 screening tools

A
  • Columbia Suicide Severity Scale
  • suicide behaviors Questionnaire
  • PHQ-9
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10
Q

if you cant hospitalize a high risk suicide pt, what cna you do?

A

detain for 1-63 ∞state law

hint: extension is possible with court involvment (CPL)

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11
Q

2 drugs that ↓ suicidal ideation per FDA

A

Lithium + cloazpine

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12
Q

what does an involuntary commitment require and what are the 3 types?

A

require psychiatrist sign off

emergency hold (2 wks)
director of Community Service (72 h - 2 mo)
2 Physician Certificate (2 mo)

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13
Q

difference bwn informa land formal voluntary commitment

A

formal - pt signs in but is held for 3 days

informal - pt can sign in and out at will

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14
Q

suicide tx (4 steps)

A
  1. interview (triad)
  2. good hs with risk factos
  3. ask for protective thngs that keep them alive
  4. least restrictive approach (acute anxiety medication > slow acting antiDs> ↑support + connectivity > send to hospital)
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15
Q

explain autonomic and hormonal control of CV fx (baroR’s and vagal outflow)

A

blood loss –> ↓BP –> ↑sympathetic outflow and renin release + ↓PNS (vagal) outflow

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16
Q

M3 rcps _____ (relaxes/contracts) GI + GU sphincters and bv endothelium; explain the pathway

A

relaxes;
M3 rcp –> IC signalling –> MLCK activation (inh by SNS β2, which ↑cAMP)

hint: EDRF (endoth derived relaxing factor) = NO which relaxes sm muscle

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17
Q

what rcps what block/ activate in asthma pts?

A

bronchiolar muscle: block M3 (contracts); stim β2 (relaxes)

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18
Q

what effect does SNS have on SA node action potentials (2)

A
  • ↑rate of phase 4 depolz (cAMP channel)
  • ↑AP freq

hint: β1 –> Gs –> ↑cAMP

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19
Q

what effect does PNS have on SA node action potentials (2)

A
  • ↓rate of phase 4 depolz
  • hyperpolz max dialstolic potential (Gi K+ channel) –> ↓AP freq

hint: M2 –> Gi+K+ –> ↑ polz; M2’s are inh autoR’s

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20
Q

explain the signalling pathway for smooth muscle contraction

A

𝛂1 –> Gq + PLC –> ↑IP3/Ca+/DAG

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21
Q

explain the signalling pathway for inh of NT release

A

𝛂2 –> Gi + K and Gi + -AC –> ↓ cAMP + ↑polz

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22
Q

explain the signalling pathway for ↑F and rate of heart contraction

A

β1 –> Gs + AC –> ↑cAMP

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23
Q

explain the signalling pathway for smooth muscle relaxation

A

β2 –> Gs + AC –> ↑cAMP

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24
Q

explain the signalling pathway for lipolysis + sm muscle relaxation

A

β3 –> Gs + AC –> ↑cAMP

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25
Q

explain the dopamine signalling pathway for smooth muscle relaxation

A

D1 –> Gs + AC –> ↑cAMP

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26
Q

3 Muscarinic rcps for ↑IP3 + DAG?; which is for sm muscle contraction + which is for neuroregn?

A

M1, M3, M5

M3 = sm muscle contrctn; m1 = neuroregn

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27
Q

2 Muscarinic rcps for ↓cAMP + ↑polz?; which is for ↓Heart beat (SA node) + NT release?

A

M2 + M4

M2 = ↓HR + ↓NT release

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28
Q

ACh binds to ____ subunits on Nm pentamer rcp

A

two 𝛂1

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29
Q

Guanethidine blocks -__ which is uselful for htn; why?

A

NE synthesis; SNS target but not PNS target

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30
Q

amphetamines + tyranie _____ (MOA)

A

release NE

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31
Q

cocainse and TCA antiD’s ___ (MOA)

A

block NE uptake

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32
Q

what enz synth’s ACh from acetyl Coa + choline?

A

choline acetultransferase (ChAT)

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33
Q

what are the 3 SNS postganglionic fibers that re NOT adrenergic?

A

sweat glands - muscarinic
renal vasc sm muscle - dopamine
Chromaggin cells - cholinergic

hint: chromaffin cells secrete epi + NE

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34
Q

Post pituitary (neurohypophysis) tumor

A

Pituicytoma

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35
Q

ciliated cuboidal epithelium with globlet cells in pituitary

A

rathke cleft cyst

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36
Q

in kids: adamantinomatous, wet keratin, β-cat⊕

in adults: papillary, BRAF V600⊕

A

Craniopharyngioma

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37
Q

midline (pineal/pituitary) tumor that occurs in young adults, ±mets or 1˚; responsive to chemo

A

Germinoma (~seminoma/dysgerminoma)

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38
Q

Cellular monomorphism and loss of reticulin netwrok in pituitary gland? What are the 8 types?

A

pituitary Adenoma;

  1. Lactotroph (PRL) - 30% most common
  2. somatotroph (GH)
  3. Mammosomatrotroph (PRL + GH)
  4. Corticotroph (ACTH)
  5. Thyrotroph (TSH)
  6. Gonadotroph (LH/FSH)
  7. null cells - 25-30%
  8. Pituitary carcinoma - <1%
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39
Q

low prolifn/infiltr potential; cured with surgical resection;(Grade I/GII/GIII/GIV)

A

grade I

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40
Q

low prolifn potential; infiltrate and recur with surgical resection;(Grade I/GII/GIII/GIV)

A

grade II

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41
Q

malignant on histo; infiltr; resection + chemo/radiation (Grade I/GII/GIII/GIV)

A

grade III

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42
Q

Malignant, necoriss, prone, infiltrative, rapid evolution (Grade I/GII/GIII/GIV)

A

Grade IV

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43
Q 
non nehancing tumor on T1 + contrast
commonly in cerebrum
nuclear atypia
ønecrosis/microvasc prolfn 
min mitotic activity.
A

astrocytoma Grade II

age: 30-40 yrs

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44
Q

AMEN for Adult astrocytoma grading stands for:

A

Atypia
Mitosis
endoth hyperplasia
Necrosis

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45
Q

Grade the following:

Diffuse astrocytoma with nuclear atypia

A

Grade II

hint: 1 criteria; 5-10 yr survival avg

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46
Q

Anaplastic astrocytoma with nuclear atypia and mitotic activity

A

Grade III

hint: more hypercellular -> Grade III tw radiation + chemo; 2-3 yr avg survival

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47
Q

Glioblastoma with nuclear atypia, mitoses, endoth hyperplasia vel necrosis

A

Grade IV

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48
Q

ring enhacing lesion is grade as _____

A

Grade IV;

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49
Q

ring enhancing; psuedopalisading around necrosis (crawling away from ischemia); endoth/microvasc prolifn (~glomeruli); ±infiltration (neuron nucelus with tumor cell around); butterfly lesion

Dx?

A

Glioblastoma

hint: usually unilateral; ±bilateral mutifocal; median survival = 5 mo dt mass effect

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50
Q

what test predicts better response to chemo?

A

MGMT promoter methylation (for Temodar);

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51
Q

what mutation status predicts survival? why?

A

IDH mutant status; ∆IDH metabolite is carcinogenic: 2-OH-glutarate, ∆DNA methylation –> ↑neoplasia

hint: ATRX loss with IDH mut; htz gain of fx mut

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52
Q

tumor develops faster, w/o malignatn precurosrs; more common; occurs in older pts apx 64 yo (IDH wt/IDH mutant)

A

IDH wt = 1˚GB

hint: 2 yr survival

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53
Q

develops from lower grade lesions (anaplastic/diffuse astrocytoma; occurs in younger pts apx 44 yo (IDH wt/IDH mutant)

A

IDH mutant = 2˚GB

hint: 5+ yr survival

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54
Q

pt <20 yo w/ infratentorial tumor in cerebellum with mural nodule (cystic) ; on histo: bipolar piloid cells (small threadlike processes) + rosenthal fibers (corkscrews) + eosino granualar bodies (EGBs)

Common muts:
KIAA1549-BRAF fusion - 70%
BRAG V600E - 5-10%

Dx?

A

Pilocytic Atrocytoma Grade I

hint: most common glioma in kids; biphasic pattern bc slow growing

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55
Q

difficult gliomas that occur in young adults that are difficult to resect; ∆histone (∆ H3K27M

A

Brainstem glioma

hint: pontine = wrose px (Grade IV)

56
Q

40 yo pt with Perinuclear halos on parrfin (fried egg + chicken wire appearance); calification on radiology + histo; nuclear atypea

A

Oligodendroglioma requires 1p/19q co-deletion

hint:
grade II - well ddx
grade III - ↑ mitoeses + endoth prolifn ±necrosis

57
Q

MOlecular markers for oligos (3)

A
  • 1p/19q Co deletion
  • ∆IDH1 - R132H
  • ATRS + p53 help to ddx from astrocytoma
58
Q

grading better with coresponding astrocytoma
BRAF V600E mutation common (~pilocytic)
low grade ugly tumor (near surface)

clinical: ø focal neuro deficits ; nonenhancing well circ mass on imaging

A

PLeomorphic xanthoastrocytoma

59
Q

70 yo pt with brainstem w/o edema or enhancement
on histo perivasc pseudorossets
commonly around ventricles
shells out intraoperatively, but low infitlr
common drop mets

A

Ependymoma

hint: myxopapillary sub type in cauda equina (Grade I); anaplastic (↑cells/mitoses) in kids thf worse px

60
Q

subtype glioma w/ cuboidal-elongated cells, radially arrange around vasc stromal cores; located in conus medullar/cauda quin/filum terminale

A

Myxopapillary Ependymoma (Grade i)

61
Q

ganglion cells in white matter (atypical); obs with pts with long term epilepsy; seizures improve w/ resection; usually Grade I. Dx? and possible mut

A

Ganglioma (±∆BRAF 20%)

hint: if histo shows mature ganglion AND neoplastic glial cells; if mature ganglion ONLY = gangliocytoma

62
Q

all histo types of the tumor are Grade IV - firable ±rossettes
on histo: small round blues cells piled up
desmopastic/nodular&raquo_space;> anaplastic/large cell;
radiosensitive
drop mets - CSF spread

A

Medulloblastoma

63
Q

tumor seen in immunocompromised pts (EBV genome present);
on histo: perivasc cuffing, ugly mitoses, necrosis .

Dx? tx?

A

Primary CNS lymphoma (PCNSL)

hint: (±secondary occurence = systemic)

64
Q

on imaging, enhancement comes off dura and pushed in on brain; often grade I
on histo: psammoma bodies (round califications) + whorls structures (pseudo inclusions)
chrom22 deletion (NF2 gene)
grow rapidly during pregnancy

dx?

A

Meningiomas

hint: brain/bone invasion;
atypical = Grade II (clear cell + chordoid)
anaplastic = Grade III (papillary + rhabdoid)

65
Q

ring enhancing brain tumor with non inflitrative border + surrounding reactive tissue
PMH and Hx sgf for inc cancer risk

A

Mets Carcinoma

hint:
lung most common
meningeal mets = prostate

66
Q

familial tumor syndromes are assc with 4 types

A
  • Tuberous Sclerosis
  • VHL
  • NF1
  • NF2
67
Q

dx assc with mult meningiomas + schwannommas + gliomas
bilaterater 8th N Scwannoma
DX?
what gene?

A

Neurofibromatosis type 2 (acoustic neuromas)

NF2 (Merlin/Scwannomin gene on chrom 22)

68
Q 
Cafe-au-lait skin spots 
neurofibromas
Optic gliomia (pilocytic astrocytomas)
lisch nodules (iris hamartomas)
1˚Fam hx 
Dx and what gene?
A

Neurofibromatosis type 1

NF1 (Neurofibromin chrom 17)

69
Q

cortical tubers
glioneuronal hamartomas
subependymal giant cells astrocytoma (SEGA) - Grade I

dx? types and chromosomes implicated?

A

Tuberous Scerosis

TSC1 = chrom 9
TSC2 = chrom 16
70
Q

rhabdoid cells in post fossa; ∆genes on chrom 22; øINI1 expression; common in children under 5 (live < 1 yr)

A

Atypical Teratoid/Rhabdoid tumor (Medulloblastoma)

71
Q

Dexamethasone (which mimics ___) is may not work in stress/MDD; why?

A

Cortisol; Negative feedback to shut off CRF is not working

hint: Dezmaethason Suppression Test

72
Q

how does PNS change under stress?

A

↓PNS w/↑inflamm cytokines

73
Q

how does SNS change under stress? What brain structures are affected?

A

↑SNS w/ offline prefrontal Cortex (↓self reflectin + nuanced thinking)

  • ↓ regn of amygdala/limbic sys
  • ↓ problems solving + planning
  • ↓self awareness
  • ↑mood dysregn (impulsive, reactive behav)
74
Q

which is responsible for abstract cognition/logic (lateral PFC/ medial PFC)

A

lateral PFC - abstract

75
Q

which is responsible for inegrating cognitions with emotion + visceral input [feelings + mentalization, self reflection + awareness] (lateral PFC/ medial PFC)

A

medial PFC - feels

76
Q

connected to nucleus accumbens, part of motivation circuit

A

ant cingulate

77
Q

connected to nucleus accumbens, part of reward circuit

A

ventromedial preforontal cortex

78
Q

reward/motivation: ___ input from ventral tegmental area (brainstem) –> nucleus accumbens, ventral PFC, ant cingulate

A

dopaminergic input

79
Q

___ is responsible for craving _ ___ is responsible for addiction

A

nuc accumbens + DA release –> addiction

amygdala (cnx to nuc accumbens) –> craving

80
Q

how is the hippocampus damaged by ↑ stress + nflamm? (2)

A 
neurotoxic cytokines from WBCs dmg hippo --> atrphy
neurotics cortisal (HPA) --> hippo atrophry

hint: suppression of PNS –> ↓ cholinergic anti-inflamm pathway (vagal spleen input)

81
Q

neurogenesis occurs in the ___ zone of the hippocampus and the _____; nuerogenesis is promoted by 3 NTs?

A

subventricular zone; olfactory bulb (anosmia = neurodegn)

  1. serotinin
  2. dopamine
  3. NE

hintL anosmia precedes PD

82
Q

___ promote neurogeniss; but are not nec low in depression

A

monoamines

hint: precursors = tryptophan (5HT) and tyrosine (dopamine + NE)

83
Q

how does exercise improve depression? (4)

A
  • ↑ 5HT + NE levels
  • ∞ HPA axis
  • ↑neural growth factors
  • ↑hippocampal neurogenesis
84
Q

therapy for what dx inovlvs mindfulness? what are the benefits (4)

A

bordeline personality; also anxiety + MDD

  • improved emotion regn
  • improved attn
  • improved awareness + body sensations
  • less self referential thinking?
85
Q

vulnerable CNS + psychosoal stressors –> depression

give an eg…

A

Stress diathesis model

eg: childhood abuse (epigenetics) + BDNF/SERT (∞neurogenesis)
hint: genetics is largest contributor for schizophrenia + bipolar do

86
Q

neural changes with mindfuless (4)

A
  • ↓alarm ctr acitvation (amygdala [emotion]+ insula [physical distress])
  • ↑PFC/Ant cingulate (ACC) activity
87
Q

sx w/i 3 mo of stressor ≠MDD

  • out of ppn to distress
  • out of ppn social impairment
  • sx leave w/i 6 mo of soln
A

adjusment do

88
Q
  • waves of dsyphoria (pangs)

- full range of affect (w/transient joy)

A

grief

hint: BUT if 5/9 crtieria met –> MDD!!!

89
Q
  • øanhedonia
  • appropriate guilt (burden to family)
  • øpersistent low mood
  • suicidal ideation in ppn to qlty of life*
A

vegetative state dt medical illness

hint: veg sx = ∆sleep, Energy, conc

90
Q
  • ±wt gain + hypersomnia
  • leaden paralysis, carb cravings, rejection HS
  • ∞childhood trauma, bipolar do; bulimia
A

atypical dperession

hint: some enjoyment experienced

91
Q
  • 100% anhedonia
  • diurnal (worse in AM)
  • use Rx/ECT
A

Melancholic depression

92
Q
  • delusions, hallucinations, though do

- Rx: antiD + antiPsy ±ECT

A

Psychotic

93
Q
  • ∞time of year (fall/winter ↓ light)
A

seasonal

94
Q
  • PHINE w/ mutism helps dx ____; what does it stand for?
A

catatonia

peculiar movement/posture
hyperactivity 
immobility 
negativism + mutism* 
echolalia/echopraxia
95
Q
  • ddx w/ SIGECAPS, 2 wk duration, thought do, hallucinations etc
  • w/i 2-3 days of delivery
  • mild and self limtited w/i 2 wks
A

postpartum onset blues

96
Q
  • more common w/bipolar do

- infanticide risk = peripartum dp + psychosis

A

puerperal psychosis

97
Q

Primary psychiatic conidtions (3)

A
  • Mood disorders
  • PTSD
  • General aniety do GAD)
98
Q

mood disorders (4)

A
  • persistnet Depressive do
  • premenetural dysphoric do
  • bipolar do
  • mood dysregn
99
Q

CRIMES helps dx _____ w/ 6 month of chronic worry in mult areas of life ; what does it stand for?

A 
General Anxiety disorder; 
Conc ↓
Restlessness 
Irritabilitu
Muscle tension
Energy ↓
Sleep ↓
100
Q

ddx for 2˚depression from organic causes (4)

A
  • susbtance induced mood do (alcoholism*)
  • dementia (apathy, mood swings)
  • delirium (CANT dx mood do)
  • depression 2˚ medical conidtions
101
Q

3 signs for organic causes?

A
  • new onset ∆cogn out of ppn w/ psych sx ≠disorientation***
  • letahry/somnolence/arousal difficulty
  • new psychosis onset after age 35 (esp after age 45)
102
Q

Structural causes for depression 2˚to medical illness (2)

A
  • infalmm after stroke
  • dmg to monoaminergic pathways (∆5HT, NE, DA transmission)

hint: CNS lesion; L frontal lobe***

103
Q

organic dz’s unliekly to cause depression (ølow mood, guilt, SI or anhedonia) - 3

A
  • inftn (pneumonia/flu
  • diabetes (endocrine)
  • renal/pulmonary dz
104
Q

3 personality DOs that have HIGHEST risk for MDD

A
  • avoidant, borderline, dependent

hint: dt 1) adverse childhood; 2) low SES 3) less social support

105
Q
  • identical to MDD
  • ± worsen pre-existing MDD
  • ±tx resistance without abstinence***
A

substance induced depression

hint: ask about prior MDD episodes while sober

106
Q

Rx regiment: what should you di if there’s ø risk of recurrence; dperession responsed to Rx and was NOT severe

A

DC meds after 6 mo

107
Q

Rx regiment: what should you do if pt is at risk for recurrenceafter chronic/severe depression?

A

Rx for 1-3 years (maint)

108
Q

Rx regiment: what should you do if pt has chronic/severe MDD epidosdies; OR comoborbid psychiatric/medical DOs

A

Rx indefinitely

109
Q

Rx- reistance depression can occur with what eaily missed, medical conditions (3)

A
  • sleep apnea
  • hypothyroidism
  • autoimmune conidtions (MS [direct CNS], Crohns, RA)
110
Q

metabolic, Non strucutral organic causes for depressions (3)

A

B12 defc
sleep apnea
substance idnuced depression (that looks like MDD)

111
Q

inflamm/autoimmune nonstrcutral causes for organic dperession? (2)

A

lupus, MS

112
Q

infectious nonstrcutral causes for organic dperession? (1)

A

HIV

hint: damages striatum (reward)

113
Q

endocrine nonstrcutral causes for organic dperession? (3)

A
  • hypothryroidsim
  • hyperadrenalism (cushings –> madness)
  • hypoadrenalism (Addisons –> apathy)
114
Q

degenerative nonstrcutral causes for organic dperession? (3)

A

AD, vasc dementia. PD/Lewy body

hint: ↓DA + 5HT

115
Q

neoplastic nonstrcutral causes for organic dperession? (1)

A

Gi Cancer

hint: pancrese + gastric ***

116
Q

where in the brain is dopamine made? (3)

A
  • Ventral tegmental area
  • substantia nigra (movement)
  • hypothalamus (↓prolactin release)
117
Q

where in the brain is serotonin and NE made?

A
  • Raphe nucleus - 5HT

- Locus Coereleus - NE

118
Q

SSRis cause p450 inhibitioon; what 3 drugs cause the lease effect

A
  • citlaopram
  • escitalopram
  • sertraline
119
Q

name the targeted rcp: transient ↑anxieity –> desensitization and mood improvent (thf start at low dose)

eg of drug?

A

5HT1A rcp

eg: fluvoxidine

120
Q

name the targeted rcp: assc with GI efx (N/V/D)

eg of drug?

A

5HT3 rcps (prsynap autoR)

eg: ondansetron

121
Q

sexual dysfx is cuased by? (2 pathways)

A
  1. 5HT2a agonism (trazabone for priapism = 2a antag)

2. 5HT –> ↓DA –> ↓orgasm (useful for premature ejac)

122
Q

low dose (1-200 mg) for sleep (non addicting)
anti adrenergic –> ortho BP
anti H1 –> drowsiness
5HT2a antag –> priapism*

A

trazadone

hint: dont use for depression (too sedating)

123
Q

rel new usefule antiD that’s also a serotinine modulator (partial 5HT1a antag)

(vorteoxetine/vilazodone/trazadone)?

A

Vilazodone

124
Q

5HT7 antag for cogn improvment + serotonin modulatur

(vorteoxetine/vilazodone/trazadone)?

A

Vrotioxetine

125
Q

Serotonin modulators (SSRI+) - 3?

A

Trazadone
Vilazadone
Vortioxetine

126
Q

SSRI only fx (6); NO antagonism/agonism

A 
Fluoxetine
Sertraline
Ccitalopram
Escitalopram
Paroxetine
Fluvoxamine
127
Q

use MAOi as a 3rd line agent in Tx-refractory depression bc?

A

severe SEs

128
Q

atypical antiD’s (3)

A

bupropion
mirtazepinez
SNRIs

129
Q

other neurostimulation tehcniques for refracotry depression (4, besides ECT)

A

Vagus Nerve Stim (VNS)
Transcranial Magnetics Stim (TMS)
Deep Brain Stim (DBS)
Transcranial Direct Current Stim (TDCS)

130
Q

Psychotherapies most studied (2)?

A

CBT and IPT (interpesonal tx)

131
Q 
Name the Drug Class
Venlafaxine
Desvenlafaxine
Duloxteine
Levomilnacaprine
\+ TCAs

important SE?

A

SNRI (5HT + NE only);
SE = htn + discontinuation syndrome (must taper)

hint: neuropathy

132
Q

Name the Drug Class

Tricyclics

important SE?

A

SNRI+ (5HT + NE); SE = salty HAM

133
Q

Name the Drug Class

Bupropion

important SE?

A

NDRI (NE + DA);
SE = seizure risk*, anxiety , htn, tachyC

hint:
dont cause sex SEs or serotonin syndrome
contra in eating DO (bc ∆electrolyte), seizure DO

134
Q

Name the Drug Class

Mirtazapine

important SE?

A

unique (inc NE + some 5HT release); SE = wt gain + sedation (watch out for diabetics!!!

135
Q

2 drug classes + 1 drug that cause discontinuation syndrome?

A

MAOi, paroxetine (SSRI), SNRIs

136
Q 
blocks 𝛂2 autoR --> ↑NE
blockks 5HT heteroR --> ↑5HT 
blocks H1 --> wt gain, sedation anxiolytic
metabolic SEs
tx depression w. anxiety vel insomnia
A

Mirtazipine

MS2 Unit3 Neurology (10 decks)

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