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Neuro 2 Midterm > Clinical Medicine > Flashcards

Clinical Medicine Flashcards

1
Q

What does EDX medicine stand for?

A

Electrodiagnostic medicine

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2
Q

What is included in an EDX medicine consultation other than a neuromuscular and MSK history and physical? (4)

A
  • differential dx
  • EDX exam of nerves via nerve conduction studies (NCSs)
  • EDX exam of mm via needle electromyography (EMG)
  • final diagnosis
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3
Q

What are some indication for EDX medicine consultation? (6)

A

suspected NM or MSK disease involving the:

  • motor neuron disease (ALS)
  • nerve root (radiculopathy)
  • plexus
  • peripheral n.
  • NMJ
  • muscle
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4
Q

Are central lesions such as a stroke an indication for an EDX medicine consultation?

A

NO no central lesions

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5
Q

What are some frequent complains of NM or MSK pathology? (7)

A
  • numbness or tingling
  • decreased sensation
  • pain
  • cramping or spasms
  • weakness
  • gait difficulty
  • fatigue
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6
Q

What can we use to…

  • clarify etiology of symptoms such as radiculopathy vs. plexopathy vs. neuropathy, type of neuropathy, and source of pain
  • localize a PNS lesion
  • predict neurological prognosis
A

EDX medicine consultation

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7
Q

What are the three components of an EMG?

A
  • nerve conduction studies (NCS)
  • Electromyography (EMG)
  • Special tests such as repetitive nerve stimulation
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8
Q

What can we use to assess the function and integrity of the peripheral nervous system?

A

EDX testing

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9
Q

What are the two basic elements of nerve conduction studies?

A

motor nerve conduction

sensory nerve conduction

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10
Q

For a NCS, peripheral nerves (motor and sensory) are stimulated with a controlled electrical stimulus. Responses such as _____ _____ _____ ______ and _____ _____ ______ ______ are then recorded.

A

compound motor action potential (CMAP)

sensory nerve action potential (SNAP)

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11
Q

When recording NCS for the median nerve, one looks at the ________ , _________, and _____ at various points along the arm and digits.

A

latency
amplitude
speed

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12
Q

TQ: What is it called in a NCS when we measure the conduction time from stimulation across a nerve through the NMJ to initial activation of the m. fibers

A

motor latency

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13
Q

TQ: What is it called in a NCS when we measure the number of activated muscle fibers

A

motor amplitude

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14
Q

TQ: What is it called in a NCS when we measure the conduction time of AP from stimulation across a nerve segment

A

sensory latency

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15
Q

TQ: What is it called in a NCS when we measure the number of activated sensory axons

A

sensory amplitude

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16
Q

TQ: What is it called in a NCS when we measure the velocity of the fastest conducting axons (motor and sensory)

A

conduction velocity

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17
Q

What test is being performed?

  • needle electrode is inserted into the muscle
  • multiple muscles are tested
  • measured at rest and different levels of sustained voluntary contraction
  • during activity, the electrical shape and pattern of the response can distinguish between nerve and muscle disease
A

EMG

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18
Q

What are the evaluated parameters in an EMG? (5)

A
  • insertional activity
  • spontaneous activity
  • motor unit configuration
  • motor unit recruitment
  • interference pattern
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19
Q

T/F: During an EMG, the muscle shows spontaneous activity at rest without a nerve or muscle abnormality.

A

FALSE

At rest, the muscle should be silent

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20
Q

What is being described and is pertinent to what test?

  • Bursts of electrical activity as the needle is inserted into muscle
  • due to disruption of muscle fiber membranes
  • prolonged with denervation, some muscle diseases
A

Insertional activity on an EMG

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21
Q

What is being described and is pertinent to what test?

  • fibrillations, positive sharp waves, fasciculations
  • hallmark of denervation, muscle membrane irritation
A

Spontaneous activity on an EMG

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22
Q

TQ: Repetitive stimulation is part of the ___________ exam

A

electrodiagnostic

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23
Q

How do we grade spontaneous activity on an EMG?

A 
0-4
0=no fibs/PSWs
1=persistent in 2 areas
2=persistent in 3+ areas
3=persistent but not obscuring baseline
4=baseline obliterated
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24
Q

What are the three components of motor unit configuration on an EMG?

A

amplitude
duration
morphology

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25
Q

What is a single motor unit?

A

a motor axon and all its muscle fibers

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26
Q

How do we test for motor unit configuration on an EMG?

A

muscle is volitionally activated at different force levels

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27
Q

What is being described and is pertinent to what test?

-pattern of motor unit activation with increasing volitional activation

A

motor unit recruitment on an EMG

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28
Q

What is being described and is pertinent to what test?

-motor unit pattern with full voluntary activation

A

interference patterns on an EMG (contracting mm.)

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29
Q

What are some general EDX diagnoses? (6)

A
  • normal
  • radiculopathy
  • plexopathy
  • neuropathy
  • myopathy
  • widespread denervation (MND)
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30
Q

What are some specific EDX options?(4)

A
  • acute vs. chronic vs. acute & chronic
  • mild vs. moderate vs. severe
  • anatomic location (root, plexus, nerve, NMJ, muscle)
  • distribution (polyradiculopathy, trunk, cord, mono vs. multiplex vs. distal symmetric)
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31
Q

What are some disorders diagnosed or evaluated by EDX testing?

A
  • motor neuron disease (ALS)
  • Radiculopathy
  • plexopathy
  • muscle disease (inflam, metabolic, congenital)
  • NMJ dz
  • neuropathy (generalized: axonal, demyelinating or mixed: diabetic)
  • mononeuropathy multiplex
  • focal (mono): median, ulnar, peroneal, sciatic
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32
Q

What are the 3 EMG “pearls”?

A
  • EDX studies are supplemental (always do history and physical)
  • EDX results are often time-dependent
  • EDX studies are not “standardized”
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33
Q

Describe the sequence of events for the NMJ

A

AP–>depolarization–>calcium influx–>fusion of Ach vesicles with presynaptic membrane and release of Ach–>bind to post-synaptic receptors on the muscle membrane–>contraction–>Ach degraded by AchE

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34
Q

Is Lambert-Eaton myasthenic syndrome (LEMS) a presynaptic or postsynaptic disorder of the NMJ? What about myasthenia gravis?

A

Lambert-Eaten myasthenic syndrome=pre-synaptic

Myasthenia gravis=post-synaptic

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35
Q

Myasthenia gravis (MG) is caused by a defect of NM transmission due to….

A

an antibody mediated attack on AchR on muscle membrane

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36
Q

MG

  • unknown how Ab arise
  • HLA gene?
  • usually w/ autoimmune disorders (SLE, thyroid)
  • prevalence 3 in 100,000
  • more common in _______ women and ______ men.
A

younger women

older men

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37
Q

Pt presents with…dx?

  • Fluctuating weakness: “excessive fatiguability”
  • ptosis and diploplia
  • dysarthria, dysphagia,
  • limb and neck weakness
  • respond to cholinergic drugs
  • labs: AchR antibodies
  • EMG: decremental response on repetitive stimulation
    • tensilon test
A

Myasthenia gravis

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38
Q

What are some treatment options for MG?

A
  • AchE inhibitors
  • prednisone
  • plasma exchange/IVIg (especially before surgery)
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39
Q

NM blockers, excessive AchE, corticosteriods, thyroid supps, BOTOX, Mg salts, antiarrhythmics (B-blockers, lidocaine, etc), and antibiotics all may ________or ______ MG

A

exacerbate or unmask

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40
Q

______-_______ ______ ______ is due to an autoimmune attack against VGCC on the presynaptic nerve terminal

  • This leads to a presynaptic abnormality of Ach release at the NMJ leading to weakness
  • often this is associated with lung carcinoma (SCCL)
A

Lambert-Eaton Myasthenic Syndrome (LEMS)

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41
Q

Pt presents with…dx?

  • proximal weakness, loss of DTR
  • myalgias, dry mouth, impotence
  • oropharyngeal and ocular mm. MILDLY affected
  • strength improves with exercise
  • slight response to tensilon test
  • Hyporeflexia
  • EMG: low amplitude motor responses that increase after exercise, incremental response on fast repetitive stimulation
A

Lambert-Eaton Myasthenic Syndrome (LEMS)

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42
Q

What are the two main ways we treat LEMS?

A

Immunosuppresion and IVIg

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43
Q

What are some key differences in MG and LEMS?

A
  • MG normal reflexes and no dry mouth or impotence
  • MG strength is weaker post-exercise vs. LEMS which is stronger
  • MG has a decremental response to fast repetitive stimulation whereas LEMS has incremental response
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44
Q

Pt presents with…Dx?

  • dry, sore mouth and throat, blurred vision, diploplia, n/v
  • hypohydrosis, total external opthalmoplegia, facial, oropharyngeal, limb, and respiratory paralysis
A

Botulism toxin (blocks presynaptic mechanisms for release of Ach)

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45
Q

Anatomy of a peripheral n.:

_________ (individual fibers)–>perineurium (fasicles)–>epineurium (covers whole n.)

A

endoneurium

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46
Q

Myelinated vs unmyelinated:

  • myelinated: _______ conduction
  • unmyelinated: slower
A

saltatory conduction (fast and skips)

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47
Q

There are ____ types of A fibers that function in a variety of senses. They are all myelinated.

A

A

alpha, beta, gamma, delta

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48
Q

Put in order from fast to slow for the following A fibers:

  • touch and pressure
  • proprioception and somatic motor
  • pain/cold/touch
  • motor to muscle spindles
A

proprioception and somatic motor->touch and pressure->motor to muscle spindles->pain/cold/touch

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49
Q

What are some points of injury along a peripheral n.?

A 
axon (axonal degeneration)
myelin sheath (demyelination)
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50
Q

What are some general points of injury for a nerve? (4)

A
  • cell body
  • nerve root
  • peripheral n.
  • wallerian degeneration (severed nerve)
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51
Q 
TQ: 
Pt presents with...dx?
-pain in scapula/shoulder pain
-numbness in fingers
-weakness in deltoid/biceps
A

C6 nerve root lesion in neck

know the dermatomes!

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52
Q

Nerve root dysfunction that may be caused by structural (discs, tumros, etc) or non-structural conditions (DM, infections)

A

radiculopathy

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53
Q

What are the most common levels involved in radiculopathy?

A

Cervical:

  • C5-6=C6 nerve root compression
  • C6-7=C7 nerve root compression

Lumbar:

  • L4-L5=L5 nerve root compression
  • L5-S1=S1 nerve root compression
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54
Q

Pt presents with…Dx?

  • pain in scapula/shoulder region
  • sensory loss in lateral arm
  • weakness upon shoulder abduction
  • Biceps DTR loss
A

C5 nerve root radiculopathy

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55
Q

Pt presents with…Dx?

  • pain in scapula/shoulder/proximal arm (biceps)
  • sensory loss in the 1st and 2nd digit, lateral arm
  • weakness upon shoulder abduction and elbow flexion
  • Biceps DTR loss
A

C6 nerve root radiculopathy

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56
Q

Pt presents with…dx?

  • pain in the scapula/shoulder/arm/elbow/forearm
  • sensory loss in the 3rd digit
  • weakness upon elbow ext, wrist ext
  • Triceps DTR loss
A

C7 nerve root radiculopathy

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57
Q

Pt presents with….dx?

  • pain in the scapula/shoulder/arm/medial forearm
  • sensory loss of the 4th and 5th digit
  • weakness upon finger abduction and finger flexion
  • cant flex fingers (intrinsic mm. of hand)
A

C8 nerve root radiculopathy

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58
Q

Pt presents with…dx?

  • pain in the antlat thigh, knee, medial calf
  • sensory loss of the medial calf
  • weakness upon hip flexion, knee extension
  • Patella DTR loss
A

L4 nerve root radiculopathy

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59
Q

Pt presents with…dx?

  • pain in the dorsolateral thigh and lateral calf
  • sensory loss in the lat calf and dorsum of foot
  • weakness upon foot dorsiflexion, inversion, eversion
  • NO DTR LOSS
A

L5 nerve root radiculopathy

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60
Q

Pt presents with…dx?

  • pain in the post thigh and post calf
  • sensory loss in the postlat calf and lat foot
  • weakness in hamstrings and foot plantarflexion
  • Achilles DTR loss
A

Lumbosacral radiculopathy

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61
Q

What are the 3 categories we classify peripheral neuropathy as?

A

mononeuropathy
polyneuropathy
mononeuropathy multiplex

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62
Q

Pt presents with..dx?

  • single nerve root affected
  • specific pattern of sensory loss
  • weakness only in specific mm.
A

mononeuropathy

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63
Q

Pt presents with…dx?

  • diffuse, symmetrical disease-motor sensory or both
  • stocking/glove sensory loss
  • distal weakness, possible atrophy (legs first)
  • hypo or arreflexia
  • usually progressive
  • acquired or inherited
A

polyneuropathy

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64
Q

A positive sensory symptom for peripheral neuropathy resulting in pins and needles sensation is a paresthesia secondary to ______ ______ fiber disease

A

large myelinated

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65
Q

A positive sensory symptom for peripheral neuropathy resulting in a burning sensation is pain secondary to _____ _________ fiber disease

A

small unmyelinated

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66
Q

What is a negative sensory symptom for peripheral neuropathy?

A

loss of sensation (vibration, pain, temp, etc.)

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67
Q

What are some motor symptoms for peripheral neuropathy?

A
  • distal weakness
  • cramps
  • muscle fasciculations
  • atrophy
  • decreased deep tendon reflexes
  • reduced tone
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68
Q

Large myelinated sensory fibers: impairment of…

A
  • light touch (cotton swab)
  • 2 pt
  • vibration (128 Hz tuning fork)
  • joint position sense
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69
Q

Small unmyelinated sensory fibers: impairment of…

A
  • temperature perception

- pain perception (pin prick)

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70
Q

TQ: Nerve roots dont split fingers, so if 2 fingers are affected + pain in the neck then it is…

A

C6 radiculopathy

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71
Q

TQ: If all 3 fingers are affected then it is a peripheral nerve disease such as…

A

median n. peripheral neuropathy

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72
Q

TQ: If the entire 4th and 5th fingers are affected then the diagnosis could be…

A

C8 radiculopathy

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73
Q

TQ: What nerve is affected?

  • wrist compression
  • anterior interosseus compression
A

median n. entrapment neuropathy

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74
Q

TQ:What nerve is affected?

  • elbow compression with recent elbow leaning
  • froment sign
A

Ulnar n. entrapment neuropathy

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75
Q

TQ: What nerve is affected?

  • spiral groove compression
  • wrist drop (saturday night palsy)
A

Radial n. entrapment neuropathy

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76
Q

TQ: What nerve is affected?

  • fibular neck compression
  • foot drop, weak evertors
  • sensory loss in dorsum of food
  • crossing the legs, or elderly
A

peroneal n. entrapment neuropathy

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77
Q

TQ: What nerve is affected?

  • inguinal ligament compressoin
  • tight clothing/weight gain
  • sensory loss in the lateral thigh
A

lateral femoral cutaenous n. entrapment neuropathy

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78
Q

TQ: Pt presents with CC of the outside of their calf being numb…how can we tell if it is a peroneal n. neuropathy or a radiculopathy?

A

the peroneal nerve allows for dorsiflexion, eversion

L5 nerve root allows for dosiflexion, everion AND INVERSION..

if inversion weak then L5 radiculopathy
if inversion strong then peroneal n.

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79
Q

T/F: In 25% of pts with peripheral neuropathy it is idiopathic

A

TRUE

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80
Q

Peripheral neuropathy etiology:

  • hereditary
  • metabolic (DM)
  • endocrine (thyroid)
  • infectious (mono, hep, lyme, HIV, leprosy, syphilis, herpes)
  • immune mediated
  • deficiency (B vitamans, E, Cu)
  • toxins (alcohol, metals)
  • idiopathic (__%)
  • drug induced (phenytoin, isoniazid, alkaloids, etc)
  • vasculitic (RA, SLE)
  • Paraneoplastic (cancer)
A

25

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81
Q

What are the two types of chacot-marie-tooth neuropathies (hereditary motor sensory neuropathies)?

A

CMT I: most common & demyelinating

CMT II: axonal

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82
Q

Pt presents with..dx?

  • autosomal dominant
  • onset in adulthood
  • distal symmetric atrophy (legs>arms)
  • areflexia
  • mild sensory loss
  • EMG: normal motor nerve conduction loss (axonal loss)
A

CMT II

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83
Q

What are the 2 main acquired demyelinating polyneuropathies?

A

AIDP and Guillain-Barre Syndrome

84
Q

Guillain-Barre syndrome is acute _________ motor paralysis often caused by illness, surgery, immunization, HIV, or Hodgkin’s dz
-effects 1-2 in 100,000/yr

A

ascending

85
Q

Pt presents with…Dx?

  • low back/leg pain at onset
  • ascending usually symmetric weakness
  • hypo or absent DTRs
  • no/minimal sensory symptoms or signs
  • **respiratory failure possible, autonomic involvement
  • CSF: high protein, normal glucose
  • NCVs: slowed CV
A

Guillain-Barre syndrome

86
Q

What is the prognosis for Guillain-Barre syndrome?

A
  • 90% recover in wks to months
  • 25% require ventilator
  • :( if NCV/EMG low amplitude motor responses b/c then implies axonal involvement
87
Q

What variant of Guillain-Barre syndrome involves opthalmoplegia, ataxia, arreflexia, facial weakness, dysarthria, dysphagia, and GQ1b and GT1a antibodies

A

Miller-Fisher syndrome

88
Q

This polyneuropathy is similar to GBS but is persistent (i.e.> 2mo)

  • progressive or relapsing course
  • may have monoclonal Ab
  • Tx: IVIg, steroids, plasma exchange, immunosuppresive agents
A

Chronic inflammatory demyelinating polyneuropathy (CIDP)

89
Q

What is the most common identifiable cause of neuropathy in the US?

A

Diabetes Mellitus (feel it in the feet)

90
Q

T/F: EMG/NCV usually leads to specific diagnosis

A

FALSE! EMG/NCV rarely leads to specific diagnosis except for axonal vs. demyelinating aka GBS, CMT1

91
Q

Which nerve is biopsied for neuropathy?

A

sural n.

92
Q

GAF score showing that pt is a candidate for inpatient care

A

GAF score 1–30

93
Q

GAF score showing that pt is a candidate for outpatient care

A

GAF score 31–69

94
Q

GAF score showing that medical necessity is not indicated bc pt is functioning too well to be candidate for therapy

A

70+

95
Q

TQ:

  • Pt has a reduced level of consciousness and difficulty focusing, shifting or sustaining attention
  • Cognitive change that a dementia cannot better explain
  • Symptoms develop rapidly (hours to days) and tend to vary during the day (i.e., acute onset ***)
  • General medical condition has directly caused condition
A

Delirium due to a general medical condition

96
Q

TQ:

  • Pt has a reduced level of consciousness and difficulty focusing, shifting or sustaining attention
  • Cognitive change that a dementia cannot better explain
  • Symptoms develop rapidly (hours to days) and tend to vary during the day (i.e., acute onset ***)
  • Symptoms developed during substance intoxication or they are caused by the use of a medication
A

Substance Intoxication Delirium

97
Q

Substances assoc w delirium: (8)

A
  • Alcohol
  • Opiates
  • Antipsychotic drugs
  • Antihistamines ***(diphenhydramine or benadryl)
  • PCP
  • Benzodiazepines
  • Steroids
  • Anti-Parkinson’s drugs
98
Q

TQ:

What substance for sleep should never be given to older people bc it notoriously causes delirium?

A

Antihistamines

  • Diphenhydramine (“BAD BAD BAD”)
  • Benadryl
99
Q

In someone coming in with mental status changes, and if they’re a COPD pt or oncology pt, what would you look for in the meds list?

A

Steroids

100
Q
  • Longer than 6 months
  • Delusions
  • Hallucinations
  • Incoherent, disorganized speech
  • Severely disorganized or catatonic behavior
  • “Waxy flexibility”
A

Schizophrenia

101
Q

TQ:

  • Possible genetic factors *
  • 1% prevalence **
  • The later the onset, the better the prognosis *
  • High rate of suicide *
  • Equally prevalent in M/F, seen earlier in men**
  • Possible viral infection influence
A

Schizophrenia

102
Q

Tx of choice for psychotic depression:

A

Electroconvulsive therapy (ECT)

103
Q

TQ:

  • A distinct period of elevated, expansive, or irritable mood lasting at least 1 week
  • Grandiosity
  • Decreased need for sleep *
  • More talkative than usual
  • Flight of ideas/thoughts are racing
  • Distractibility
A

Manic episode within bipolar disorder

104
Q

TQ:

  • Preoccupation with imagined defect in the body, usually the face
  • Frequent visits to dermatologist/plastic surgeon
  • Depression and OCD are common
A

Body dysmorphic disorder

type of somatoform disorder

105
Q

TQ:

  • Paresthesias / anesthesias
  • Weakness
  • Paralysis
  • Pseudoseizures
  • Involuntary movements (e.g., tremors, tics)
  • Sensory disturbances (blindness, mutism)
A

Conversion disorder

106
Q
  • Voluntary control of symptoms
  • Self-injected feces or saliva
  • Bizarre or unusual symptoms
A

Factitious disorder

107
Q

Production or intentional symptoms in another individual (usually a child) for the purpose of having the other person assume the sick role

A

Munchausen by proxy

a type of factitious disorder, NOS

108
Q
  • Inability to recall important personal info

- Usually info regarding traumatic experience

A

Dissociative amnesia

109
Q
  • Sudden, unexpected travel away from home

- Inability to recall one’s past / personal identity

A

Dissociative fugue

110
Q
  • Formerly known as “multiple personality disorder”

- Often survivors of sexual abuse

A

Dissociative identity disorder

111
Q

Ambien causes ___________, including nightmare, sleep terror, and/or sleepwalking.

A

parasomnias

112
Q

Frontal lobe injury typical of what disorder?

A

Impulse control disorder

113
Q

What impulse control disorder involves pulling hair out?

A

Trichotillomania

114
Q

One event within a 3 month period constitutes an __________ disorder.

A

Adjustment

115
Q
  • Inflexible**, maladaptive, and rigidly pervasive pattern of behavior
  • Cause subjective distress and/or impaired functioning
  • Person is usually unaware of problem
  • Presents by early adulthood
A

Personality disorder

Axis II

116
Q

Personality diagnosis cannot be made until the person is at least __ years of age.

A

18

117
Q

Diagnoses of personality disorders are notoriously unreliable in the _______ population.

A

elderly

118
Q

TQ:

  • Disorder characterized by irrational suspicions and mistrust of others
  • Cluster A (“weird” disorder)
A

Paranoid personality disorder

Axis II

119
Q

TQ:

  • Lack of interest in social relationships, seeing no point in sharing time with others (e.g., don’t care if they have friends or not)
  • Appear indifferent to the praise or criticism of others and often seem cold or aloof
  • E.g., the unibomber
  • Cluster A (“weird” disorder)
A

Schizoid personality disorder

Axis II

120
Q

TQ:

  • Characterized by odd behavior or thinking
  • Ideas of reference (i.e., believing that public messages are directed personally at them)
  • Odd beliefs or magical thinking
  • Vague, circumstantial, or stereotyped speech
  • Excessive social anxiety that does not diminish with familiarity
  • Idiosyncratic perceptual experiences or bodily illusion
  • Cluster A (“weird” disorder)
A

Schizotypal personality disorder

Axis II

121
Q
  • Repeated violations of the law**
  • Pervasive lying and deception
  • Physical aggressiveness
  • Reckless disregard for safety of self or others
  • Consistent irresponsibility in work and family environments
  • Lack of remorse
  • 3x more in men
  • At risk for substance abuse**
  • Cluster B (dramatic, emotional, or erratic disorder)
A

Antisocial personality disorder
(“sociopath”)
(Axis II)

122
Q

TQ:

  • Frantic efforts to avoid expected abandonment
  • Unstable and intense personal relationships and self-image
  • Impulsivity* in 2+ area that are self-damaging (e.g., sex, substance abuse, reckless driving)
  • Suicidal behaviors - cutting***
  • Feelings of emptiness, anger
  • Immature personality traits (“teddy bear sign,” “tweety bird sign”)
  • Will often “split” staff members/providers against each other**
  • Often victims of sexual or emotional abuse
  • High rate of comorbid major depression
  • 3x more in women
  • Cluster B (dramatic, emotional, or erratic disorder)
A

Borderline personality disorder

Axis II

123
Q
  • Excessive emotionality and attention-seeking behavior
  • Dramatic, sexually provocative/seductive
  • “La belle indifference” - don’t care if they make a scene
A

Histrionic personality disorder

Axis II

124
Q
  • Exaggeration of their own talents or accomplishments
  • Sense of entitlement
  • Lack of empathy
  • Envy of others
  • Arrogant, haughty attitude
  • 50-75% male
A

Narcissistic personality disorder

Axis II

125
Q
  • Actually desire relationships with others (differs from schizoid in this way)
  • Paralyzed by their fear and sensitivity to negative evaluation
  • Feelings of inadequacy
  • Avoidance of social interaction
  • Cluster C (anxious or fearful disorders)
A

Avoidant personality disorder

Axis II

126
Q
  • Pervasive psychological dependence on other people
  • Difficulty making decisions w/o guidance and reassurance
  • Discomfort or helplessness when alone
  • Urgent seeking for another relationship when one has ended
  • Cluster C (anxious or fearful disorders)
A

Dependent personality disorder

Axis II

127
Q

TQ:

  • Characterized by rigid conformity to rules, moral codes and excessive orderliness
  • Preoccupied with perfectionism and control
  • Lack flexibility and openness
  • Often stingy/stubborn
  • 2x more in men
  • Cluster C (anxious or fearful disorders)
A

Obsessive-compulsive personality disorder

Axis II

128
Q
  • Presence of two or more distinct identities or personality states
  • MC in women
  • Assoc w/ hx of sexual abuse
A

Dissociative identity disorder

Axis II

129
Q

Tx that examines the way pts perceive events.

  • Assumes that perceptions are shaped by early life
  • Identify perceptual distortions and their historical sources
  • Frequency = several times/week to once a month
  • Makes use of transference
A

Psychodynamic psychotherapy

130
Q
  • Tx that deals with how people think about the world and their perception of it
  • Typically limited to episodes of 6-20 weeks, once weekly
A

Cognitive Behavior Therapy (CBT)

131
Q
  • Tx that allows interpersonal psychopathology to display itself among peer pts
  • Usually once weekly over a course that may range from several months to years
A

Group psychotherapy

132
Q

TQ:

  • Tx of choice for Borderline personality disorder***
  • Both individual and group formats
  • Manual-based therapy is on the development of coping skills to improve affective stability and impulse control and on reducing self-harmful behavior
A

Dialectical Behavior Therapy (DBT)

133
Q

T/F: Medications are curative for any personality disorder.

A

FALSE

Medications are NOT curative for any personality disorder.

134
Q

What classes of medications are safe and reasonably effective? (2)

A
  • Selective serotonin reuptake inhibitors (SSRIs)

- Newer antidepressants

135
Q

Which cluster of personality disorders has the worst prognosis?

A

Cluster B

  • Susceptible to problems of substance abuse
  • Impulse control, suicidal behavior
136
Q

Culture with highest rate of alcoholism:

A

Native Americans

137
Q

TQ:

Important to supplement alcohol dependent and alcohol withdrawal patients with:

A

Thiamine

138
Q

Clinical presentation:

  • Daily or frequent drinking to function
  • Violence assoc w/ drinking, and defensive when confronted
  • Neglect of food intake, physical appearance and hygiene
  • Nausea/vomiting, shaking in the morning, confusion
A

Alcoholism

139
Q

TQ:

What is the detox order set for alcohol withdrawal? (5)

A
  • Benzodiazepines**
  • Antipsychotics
  • Fluids
  • Vitamins (Thiamine***)
  • Restraints
140
Q

What is the term to describe alcohol withdrawal (30% mortality rate is not treated)?

A

“Delirium Tremens”

141
Q
  • Drug used to maintain abstinence in alcoholics following withdrawal
  • Inhibits GABA in CNS and antagonizes the receptor in a similar way as alcohol
  • Does NOT treat withdrawal, prevent intox, interact with, or lessen harmful effects of alcohol
  • Generally well tolerated
A

Acamprosate

142
Q
  • Drug used to control EtOH intake

- Produces unpleasant adverse effects if the patient drinks during the course of treatment

A

Disulfram

143
Q

TQ:

What are some signs for intoxication of stimulants (amphetamines and cocaine)? (9)

A
  • Incr energy and alertness
  • Anxiety / irritability
  • Insomnia, exhaustion
  • Hyperthermia
  • Loss of appetite and weight
  • Hallucinations
  • Dilated pupils*** (mydriasis)
  • Incr BP and pulse
  • Seizures
144
Q

Treatment for stimulant abuse:

  • For HTN and hyperthermia:
  • For psychotic symptoms:
A
  • For HTN and hyperthermia: Phentolamine

- For psychotic symptoms: Haloperidol

145
Q

TQ:

Things to remember for PCP intoxication: (5)

A
  • Violence***
  • Hyperactivity
  • Nystagmus
  • Muscular rigidity
  • Seizures
146
Q

TQ:

  • Euphoria
  • Constricted (pinpoint) pupils (miosis)
  • Constipation

Think:

A

Opioids

147
Q

Drug for treatment for abuse of opioids:

A

Naloxone

148
Q

Drugs / drug combos to treat withdrawal for opioids: (3)

A
  • Buprenorphine or methadone
  • Buprenorphine and naloxone ***
  • Clonidine
149
Q

TQ:
Gold standard study used to make diagnosis of MS:
What would you see?
Will acute lesions enhance?

A

MRI

  • Ovoid lesions of high signal on T2 weighted imaging in the periventricular*** white matter and in spinal cord
  • Yes, acute lesions enhance
150
Q

What MS imaging study will give you an idea of what’s happening in the optic pathway?

A

VEP
(Visual Evoked Potential test)
-optic neuritis

151
Q

TQ:

In MS, what would you see in lumbar puncture for CSF analysis?

A

Presence of oligoclonal bands and/or increased IgG

152
Q

TQ:

How is MS diagnosed?

A

By multiple lesions over space and time.

  • “Remissions and exacerbations”
153
Q

Only medication approved for chronic progressive MS:

A

Betaseron (interferon beta-1B)

Also used: Copaxone

154
Q

Dz-modifying (maintenance) meds for MS: (3)

A
  • Avonex, Rebif
  • Betaseron
  • Copaxone
155
Q

Other meds to be considered for pts with progressive dz (chronic progressive MS): (4)

A
  • Azothiaprine
  • Methotrexate
  • Novantrone
  • Cyclophosphamide
156
Q

Medication used to treat an acute exacerbation in MS:

A

High dose corticosteroids

Solumedrol

157
Q

It’s nearly impossible to differentiate a first time MS attack from a post-infectious or post-immunication encephalomyelopathy (Acute Disseminated Encephalomyelitis - ADEM). How can you make a diagnosis in the future?

A

ADEM should never recur. If a pt develops future symptoms or new lesions on MRI, MS is more likely diagnosis.

(Time is the answer!)

158
Q

What drug is most commonly used to treat spasticity assoc w/ MS?

A

Baclofen

159
Q

What drugs are most commonly used to treat intention tremor assoc w/ MS? (3)

A
  • Propranolol
  • Primidone
  • Clonazepam
160
Q

What drugs are most commonly used to treat urinary urgency (spastic bladder) assoc w/ MS? (2)

A
  • Oxybutinin

- Detrol LA

161
Q

What drug is most commonly used to treat urinary retention/hesitancy assoc w/ MS? (1)

A

Bethanechol

162
Q

What drugs are most commonly used to treat painful dysesthesias assoc w/ MS? (5)

A
  • CBZ
  • OXCBZ
  • Gabapentin
  • Phenytoin
  • Baclofen
163
Q

MC bradykinetic disorder (aka Akinetic Rigid syndrome)

A

Parkinsonism

  • Idiopathic Parkinson’s dz**
  • Postencephalitic
  • Toxin-induced
  • MPTP (meperidine analog)
164
Q

TQ:

Cardinal features of Idiopathic Parkinson’s dz: (3)

A
  • Tremor: resting, starts unilateral, “pill-rolling,” mouth or chin tremor
  • *Rigidity: increased resistance to passive movement, “cogwheel” quality
  • *Akinesia / Bradykinesia: slowness, often difficulty initiating movement
  • Shuffling
  • Masked facies, “reptilian stare”
  • Myerson sign - sustained blinking, pt can’t stop after tapping on forehead
165
Q

Other Akinetic Rigid syndromes: (3)

A
  • Progressive Supranuclear Palsy (PSP)
  • Shy-Drager Syndrome (Multiple Systems Atrophy - MSA)
  • Cortical Basal Ganglionic Degeneration (CBGD)
166
Q
  • Bradykinesia and rigidity

- Loss of voluntary control of eye movements (esp vertical gaze**)

A

Progressive Supranuclear Palsy (PSP)

167
Q
  • Bradykinesia and rigidity
  • Pronounced autonomic dysfunction (dysautonomia)**
  • NO tremor
A

Shy-Drager Syndrome (Multiple Systems Atrophy - MSA)

168
Q
  • Bradykinesia and rigidity
  • May also see cortical sensory loss, apraxia, myoclonus or aphasia **
  • “Alien limb”
A

Cortical Basal Ganglionic Degeneration (CBGD)

169
Q
  • Gradual onset and progression of chorea and dementia
  • Caused by inherited trinucleotide repeat gene defect on Chr. 4
  • Autosomal dominant, lifespan 15yr after onset of symptoms
  • Caution for suicide
A

Huntington’s dz

170
Q
  • Occurs mainly in children and adolescents as a complication of a previous infection with Group A hemolytic strep
  • May be form of arteritis
  • Unilateral choreiform movements
  • Tx: bedrest and antibiotics
A

Sydenham’s Chorea

171
Q
  • Characterized by dystonic movements and postures without other signs
  • Onset may be in childhood or later life, but remains throughout life
  • May see torticollis, blepharospasm, oromandibular spasm, arm/leg dystonia
A

Idiopathic Torsion Dystonia

172
Q
  • Dystonia confined to focal area
  • Blepharospasm
  • Oromandibular dystonia
  • Spasmodic torticollis
  • Writer’s cramp
A

Focal Torsion Dystonia

173
Q

Tx of choice for Focal Torsion Dystonia:

A

BOTOX

174
Q

TQ:

  • Autosomal recessive disorder of copper metabolism that produces neurologic and hepatic dysfunction
  • Chr. 13
  • Decreased binding of copper to ceruloplasmin&raquo_space; free copper deposits into tissues
  • Presents in childhood or young adult life
  • Both bradykinetic and hyperkinetic features present
  • Dx: incr copper excretion in 24hr urine collection, labs: decr serum ceruloplasmin, Kayser-Fleischer Ring** on eye exam
  • Tx: Penicillamine (chelating agent)
A

Wilson’s dz

175
Q
  • Chronic multiple motor and vocal tics
  • Onset before age 21
  • Most cases sporadic
  • MC in males
  • Tics vary in presentation
  • Tx: Clonidine, haldol, phenothiazines
A

Gilles De La Tourette’s syndrome

176
Q
  • Postural or kinetic tremor of both hands and may involve the head or voice
  • Can begin in early adulthood, but often not until later in life
  • Progresses slowly over years to decades
  • EtOH often decreases the tremor temporarily
  • Tx: Beta-blockers (propranolol), primidine, benzodiazepines
A

Essential Tremor

aka Benign Familial Tremor

177
Q

What are the 2 basic components of an electrophysiologic exam?

A
  • Nerve conduction studies

- Electromyography (EMG)

178
Q

Common symptoms requiring EMG: (4)

A
  • Paresthesias (tingling)
  • Muscle spasm
  • Paresis (weakness)
  • Pain in the limb
179
Q

Definitive diagnosis is NOT reached with only an EMG, so what is it useful for?

A

Really an extension of physical exam

180
Q

When you test for nerve conduction and EMG, are you testing for CNS or PNS?

A

Peripheral nervous system

-Starts with anterior horn cell, runs distally

181
Q

What are some examples of mononeuropathy? (3)

A
  • Carpal tunnel syndrome
  • Cubital tunnel syndrome
  • Radial nerve palsy (Saturday night palsy)
182
Q

What does a radiculopathy involve?

A

Nerve root!

-E.g., C5, C6, S1, etc

183
Q

What are some examples of polyneuropathy?

A

Sensory AND motor affecting multiple nerves

  • Starts distal, lower extremities (toes)
  • LMN involvement - hyporeflexia
184
Q
  • Weakness in proximal* lower limbs
  • Symmetric
  • Areflexia (LMN)
  • NO sensory loss
  • Progress days-weeks
  • Good prognosis - back to normal, near normal
A

Guillain-Barre syndrome

Acute Inflammatory Demyelinating Polyneuropathy -AIDP

185
Q

MC level and cervical nerve root to be involved in cervical radiculopathy?

A

C6-7&raquo_space; Nerve root C7

186
Q

Irregular, brief, “dancelike” movements; may be incorporated into purposeful movements

A

Chorea

187
Q

Writhing, sinuous movements (often occur in combination with chorea)

A

Athetosis

188
Q

Sustained muscle contractions that produce twisting and repetitive movements and abnormal postures

A

Dystonia

189
Q

Large amplitude, flinging movement, usually from proximal part of an extremity

A

Ballism

190
Q

Brief, rapid, repetitive, seemingly purposeless stereotyped action that may involve single or multiple muscle groups

A

Tic

191
Q

TQ:

A general medical condition is coded on what Axis?

A

Axis III

192
Q

TQ:

Major depressive disorder goes hand in hand with what?

A

Myocardial infarction (MI)

193
Q

TQ:

Describe Stress Theory.

A

Stimulation of the sympathetic nervous system&raquo_space; Tachycardia, HTN, increased CO&raquo_space; Stress

194
Q

TQ:
-Medical symptoms: fever, photosensitivity, butterfly rash*, joint pains, headache

-Psychiatric symptoms: depression, mood disturbances, psychosis*, delusions, hallucinations

A

Systemic Lupus Erythematosus (SLE)

Musculoskeletal system

195
Q
  • Medical symptoms: sensory distortions, violence, belligerence
  • Psychiatric symptoms: confusion, psychosis, dissociative states, catatonic-like state, bizarre behavior
A

Seizure disorder

Musculoskeletal system

196
Q

30% of asthmatics meet criteria for _____ disorder or ___________.

A

30% of asthmatics meet criteria for PANIC disorder or AGORAPHOBIA.

197
Q

TQ:
-Medical symptoms: heat intolerance, excessive sweating, diarrhea, weight loss, tachycardia, palpitations, vomiting, fine tremor, ADHD-like, impaired recent memory, bulging eyes*

-Psychiatric symptoms: nervousness, excitability, irritability, pressured speech, insomnia, psychosis*, visual hallucinations

A

Hyperthyroidism

Endocrine system

198
Q

TQ:
-Medical symptoms: increased urination/thirst, high glucose levels

-Psychiatric symptoms: frustration, loneliness, dejection, depression**

A

Diabetes mellitus

Endocrine system

(Diabetes and depression go together like cardiac stuff and depression)

199
Q

TQ:
-Medical symptoms: excessive thirst, polydipsia, stupor, coma, seizures

  • Psychiatric symptoms: confusion***, lethargy, personality changes
  • elderly people
A

Hyponatremia

Metabolic system

200
Q

TQ:
-Medical symptoms: neuropathy, cardiomyopathy, Wernicke-Korsakoff syndrome, malaise, common in alcoholics

-Psychiatric symptoms: poor concentration, confusion, confabulation

A

Thiamine deficiency

Metabolic system

201
Q

TQ:
-Medical symptoms: pallor, dizziness, peripheral neuropathy, dorsal column signs, ataxia

-Psychiatric symptoms: irritability, inattentiveness, psychosis, dementia***

A

Cobalamin (Vit. B12) deficiency

202
Q

Abdominal pain + psychosis

A

Acute Intermittent Porphyria

203
Q

Which Axis?

Primary psych diagnosis:
Personality disorder:
Medical condition:

A

Primary psych dx: Axis I
Personality disorder: Axis II
Medical condition: Axis III

204
Q

Basic features of the DSM:

-Primarily designed to describe the manifestations of mental illness, does NOT deal with _________.

A

DSM does NOT deal with CAUSATION.

205
Q

TQ:

Limitations of the DSM: (5)

A
  • Does NOT deal with causation
  • Many of the illnesses have overlapping symptoms
  • Questionable validity of some diagnoses
  • Some symptoms seen in pts do not fit within specific diagnoses
  • Classifications and codes for each illness are essential for billing and insurance purposes

Neuro 2 Midterm (5 decks)

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