CNS Path Flashcards

Question

Illness Anxiety Disorder

Answer 1

History: High anxiety w/o somatic sx; pt. has a debilitating fear of getting sick PE: None Lab: None Clinical: Can admit that their condition is not as bad as they think; probably still practice unhealthy habits Management: Problems w/ transfer and costs of procedures

Answer 2

History: Pt. shows excessive concern w/ a perceived deficit in their appearance; can even be completely imagined PE: none Lab: none Clinical: Deficit is primary focus of life and will cause pts. to cover it up with dress and avoid social outings; will frequently check the deficit Management: SSRIs pretty useful

Answer 3

History: Intentional production of sx and fabrication of disorder; goal is to gain attention and pt. will undergo extensive medical procedures to do so PE: Self-inflicted; may not add up Labs: Ditto Clinical: If confronted, pt. will leave and check into another hospital; substance abuse not uncommon; intentionally gives vague answers to questions (such as MMSE) Management: Address underlying emotional problem; pts. will refuse extensive procedures

Answer 4

History: Faking sx for secondary gain (money, avoiding prison or deployment or school) ; can have true history of other psych issues PE: Discrepancies Lab: Discrepancies Clinical: Delay in completing tests; practice caution if pt. has been referred Management: Firm confrontation; identify second gain

Answer 5

Reduced level of intellectual functioning causing an individual who cannot adapt to the demands of their environment; global ability is the center of the diagnosis - Pt. has subpar intellect (IQ18 years, classified as dementia - Pt. typically cannot reciprocate social interaction, has limited interests, stereotyped and repetitive speech, insists on sameness, and may have "super hearing"

Answer 6

Deletion on chromosome 15 causes an intellectual disability and compulsive eating, bad behavior, hypogonadism, irritability

Answer 7

Individual has rapid, preserved speech and variable intellectual disability -Most common inherited intellectual disability and second-most common genetic behind Down's

Answer 8

Absences phenylalanine hydroxylase can cause a severe disability that, if not controlled by diet, will result in severe intellectual disability

Answer 9

IQ of 55-69, can hold a job, and function independently unless presented w/ unusual social problem -Language and social skills development are a little slower (6th grade-ish) and probably can't have deep social relationships like marriage

Answer 10

IQ 35-50, learns basic self-care and language, usually benefit from living in a supportive, well-structured home or community -Start seeing excessive self-stimulation, self-injury, distress due to lack of social skills, decreased self-esteem, and disruptive/conduct disorders

Answer 11

Pt. has normal development for first 5 months than shows deceleration of head size, wringing of hands, loss of social engagement, and impairment of motor functioning Tx: Try to advance normal development, promote learning and inhibit behaviors that prevent this

Answer 12

Must identify the specific area of the deficit; pt. usually will have an average IQ and present w/ frustration or distress w/ material (increased drop-out rate) - It cannot be the result of specific motor/cognitive dysfnxn, educational opportunity must be present, and deficit alone cannot account for failures in intellectual development - Manage w/ specialized instruction, modified tests, and teacher awareness

Answer 13

Have either vocal or motor tics, not both, that present every day and cause significant distress to the pt.

Answer 14

Presence of Motor AND Vocal tics; can be voluntarily suppressed until pt. is overwhelmed w/ anxiety and repeats the behavior; onset is usually at 7 years Tx: Tenex, clonidine, atypicals, Haldol *Can present as a "Triad" alongside ADHD and OCD; difficult to treat but should start w/ the symptoms that cause most distress to that pt.

Answer 15

Child stutters a shitload

Answer 16

Ben Smith without the other signs of autism

Answer 17

Articulation probs in a kid

Answer 18

Pt. may present w/ complications involving GI tract and malnourishment due to the excessive consumption of nonfood items

Answer 19

Pt. will chew, swallow, regurgitate, and eat their food again and presents w/ signs of malnourishment and failure to thrive -Often indicative of early neglect or stress in child-parent relations

Answer 20

Persistent and repetitive behavior by a child that may be aggressive and inappropriate relative to social norms/rules; pts. have inability to feel for others and do not understand guilt Specify if child onset (

Answer 21

Child has angry, irritable, and argumentative mood for greater than 6 months no matter who they're around; are "little lawyers" and debate every decision made by an authority figure -Also will blame others for mistakes, can be deliberately annoying, and have difficulty with transitions Tx: Therapy, teach parents, evaluate family for dysfunctions

Answer 22

Voiding of urine past the age of 5; treat w/ Bell and Pad therapy or an ultrasonic bladder alarm -If that doesn't work, use desmopressin, an ADH analog that provides temporary suppression until disorder resolves

Answer 23

Voiding of stool; always assoc. w/ severe mental health issue; treat by therapy, using bathroom after meals, and education

Answer 24

Child has excessive, debilitating anxiety when leaving home or parental figures; could be due to genetics, phobic parents, or fear-provoking past experience - Pts. are prone to nightmares, eager to please, and have sx secondary to anxiety - Treat by gradually increasing time spent away from home and possibly SSRIs

Answer 25

Child shows persistent failure to speak in social situations where it is expected; speaks fine in other situations at home -Tx with behavioral therapy, speech therapy, SSRIs; not always effective

Answer 26

ssRNA(+) virus that are enveloped (via cell membranes) and have an icosahedral capsid; protease sensitive Infection Stages: 1st= After bug bite, multiplies in RE system and rides white cells thru the blood; viremia occurs w/ assoc. B-symptoms 2nd= Virus crosses BBB producing encephalitis accompanied w/ neuronophagia, encephalomalacia, neck pain, confusion Examples are Eastern Equine Encephalitis (least prominent in US) WEE, and Venezuelan EE

Answer 27

ssRNA (+); enveloped and icosahedral capsid; protease (R) First stage= Viremia and replication in RE system w/ assoc. B-symptomms Second stage= Cross BBB and produce encephalitis Examples include WNV, YFV, Dengue

Answer 28

Flavivirus that has a second stage involving saddle back (diphasic) fever, necrosis of the liver and kidney (jaundice), and gastric hemorrhages causing RBCs to be destroyed by HCl -Has an effective live-attenuated vaccine, IMPORTED YELLOW FEVER LIKELY THE TOPIC OF THE QUESTION; QUARANTINE PATIENTS WHO HAVE THIS ****CHARACTERISTIC BLACK VOMIT

Answer 29

Produces a maculopapulaar rash, joint/muscle pain, ocular pain, saddle back fever, and then potentially progresses to hemorrhagic fever and SHOCK Called breakbone fever because it infects BM, this virus consists of 4 serotypes; if infection occurs by 1,3,4 FOLLOWED BY 2, then shock syndrome will occur -Treat hemoconcentration w/ hydration therapy

Answer 30

ssRNA(-); enveloped (from Golgi) w/ glycoprotein spikes and a helical nucleocapsid; contains many arbovirus serosgroups -RNA exists in 3 segments

Answer 31

Found mainly in Mississippi and Ohio river valleys; causes mild headache, N/V, and possible aseptic meningitis *Includes LaCrosse encephalitis seen in WV

Answer 32

Can cause Crimean-Congo hemorrhagic fever

Answer 33

Member of the bunyavirus family transmitted by sand fleas and causes headache, fever, maculopapular rash, meningitis, photophobia but results in total immunity if recovered after two years

Answer 34

Bunyavirus acquired from rodent feces and causes Hantavirus Pulmonary Syndrome; assoc. w/ Southwest states ***Treat w/ Ribavirin - Can also cause Korean Hemorrhagic Fever Virus - Assoc. w/ areas of increased rainfall

Answer 35

ssRNA(-) w/ lipid bilayer envelope; helical nucleocapsid; consists of multiple segments connected together Produces old-world and new-world viruses

Answer 36

Spread by the feces of rodents, this virus produces B-symptoms then meningitis ***Can be vertical transmission in pregnant women

Answer 37

Old world arenavirus that causes hemorrhagic fever, mouth ulcers, skin hemorrhages, and muscle aches -Seen in africa

Answer 38

New-world arenavirus in South America that causes hemorrhagic fever alongside characteristic petechiae and bleeding into the GI tract, uterus, nasal cavity, and GU tract

Answer 39

Delivery of brief, controlled seizures via electrodes under anesthesia about 2-3/week; used to treat Major Depressive Disorder, Bipolar disorder and thought disorders **DOESNT WORK ON ANXIETY OR PERSONALITY DISORDERS Effects: Increases DA and 5-HT release, decreases metabolic activity in frontal and cingulate cortex, reduces activity in the left dorsolateral PFC, and increases BDNF CIs: Intracranial hemorrhage, strokes, lesions, MI, angina

Answer 40

Succinylcholine; only works for 5 mins -Should test for pseudocholinesterase deficiency or proper liver fnxn because this could cause prolonged apnea

Answer 41

Rapid action anesthetic used in ECT; second line is etomidate Used ketamine if maximum stimulus reached w/o adequate response

Answer 42

Postictal disorientation, interictal confusion, memory impairment (retrograde can last really long), dysrhythmia, headache, N/V, moodc changes Limit these by using concentrated, brief pulses, dosing the intensity of the stimulus, and using right-unilateral electrode placement

Answer 43

Non-invasive technique that uses metal coils producing rapidly alternating magnetic fields to generate currents in specific brain regions; often targets the dorsolateral PFC - Have to do way more often the ECT and sessions last 40 mins - Typically less effective than ECT and cannot do if pt. has any metal medical devices implanted

Answer 44

Combines the effects of ECT and rTMS w/o the skull impedence and widespread brain stimulation (ECT) or the limited effectiveness of rTMS; done under general anesthesia but has same CIs as rTMS -Becoming an encouraging alternative to ECT

Answer 45

Continuous stimulation of implanted electrodes on the brain being used to treat hyperresistant depression

Answer 46

Theory: Object is to make the unconscious, conscious and restore balance b/w the id and super-ego; must work through the internal defense mechanisms the pt. has developed and achieve transference Management: Therapy is "free-flow" and therapist serves as blank slate; failure to meet appt. is seen as resistance

Answer 47

Pt. acts towards the therapist as if they are another important figure in their life bringing to light the unconscious

Answer 48

The therapist develops an emotional response to the pt. that is merely a reflection of their own, personal experience

Answer 49

Theory: Person can become healthy thru self-realization and on their own given enough time; not defined by any standard or ideal Plan: Therapists are warm and inviting to pts., use open ended statements and empathy, and work to end external idealization w/ happiness coming from the inside -Clients decide how often they will come and they are typically seen as the experts on themselves

Answer 50

Theory: Most scientific of the psychotherapies in that if a result cannot be seen or measured, it doesn't matter; popular therapy *especially in lower functioning pts. Plan: Reinforce the desired behaviors usually thru external stimuli; problem focused so therapy may wind up being brief -Tend to avoid using pharmaceuticals and work on the nurturing belief

Answer 51

Theory: Works to change the internal thought processing of an individual; patterns of dysfunctional thinking are what cause psychiatric issues Plan: Highly structured sessions that address specific problems in the pt.; teaches pts. to dispute the negative thoughts that run thru their head - Often involves Homework; use of Socratic dialogue (structured) - Qualifies as evidence based practice; very effective and pts. will use it to apply to many aspects of their life

Answer 52

Risk factors of CVD are the same as in this type of Alzheimer's; typical sx of Alzheimer's however they occur in a stepwise fashion -Will see lacunar infarcts on CT scan

Answer 53

Sx of Parkinson's and dementia; ***ASSOC w/ HALLUCINATIONS and FALLS

Answer 54

MUST HAVE ACUTE ONSET AND INATTENTION -Must also have EITHER disorganized thinking or an altered level of consciousness Risk factors include being a male, over 65, having dementia, vision/hearing loss, polypharmacy, alcohol abuse Tx: Haloperidol; atypicals -Second line would be benzos (usually use if withdrawal etiology)

Answer 55

Drugs Electrolyte imbalances Loss of drugs (withdrawal, B12 deficiency, Infection (UTIs, sepsis) Reduced Sensory Input Intracranial tissue (hemorrhage, stroke) Urine retention Major systems (COPD, hypoxia, renal failure)

Answer 56

Typically depends on symptoms; Cholinesterase inhibitors(good for Parkinsonism sx) REM Sleep disorder? =>> Clonazepam or Melatonin Hallucinations? =>> Quetiapine IF YOU MUST

Answer 57

- Can be subtle, clonic, tonic, or myoclonic - Due likely to genetics or infection - Cause should always be investigated

Answer 58

"Infantile Spasms" Seizures appear as brief spasms of the head, neck, or limbs and commonly seen w/ a clasp-knife reflex of the arms; head usually drops briefly too and all of this is repetitive -Can be due to cerebral dysformation, tuberous sclerosis, phenylketonuria ***EEEG shows hypsarrhthymia Tx: Refractory to most forms of treatment; ACTH successful

Answer 59

Presents b/w ages 4-10 and can occur up to 100 times per day - Often confused w/ ADHD due to poor school performance * EEG shows characteristic 3Hz Spike and Wave Tx: Ethosuximate

Answer 60

Presents as a triad of MR, recurring seizures (often atonic), and characteristic EEG -Very hard to treat

Answer 61

Generalized seizures that occur w/ fever in children 6months-6yrs; seizures are due to the rapid increase in temp -Risk of epilepsy development increases 10% w/ multiple seizures

Answer 62

Simple partial seizures w/ preserved consciousness and the presence of automatisms (including drooling, twitching); at nighttime usually appears global clonic-tonic -Usually disappears by adulthood; carbamazepine is DOC

Answer 63

Myoclonic jerks, usually in the morning, that is assoc. w/ family history of epilepsy *IS NOT OUTGROWN -VA is DOC; Carbamazepine makes it worse

Answer 64

Bizarre presentation of sx including singing, dancing; easy to miss status epilepticus -Temporal lobe epilepsy is much more common tho and presents w/ strong auras

Answer 65

Frequently a stress response and not consciously controlled, but does not have corresponding irregular EEG activity

Answer 66

Common presenting condition of MS that will show afferent pupillary defect, mild pain w/ extraocular movements, and progressive vision loss -Not enough to diagnose on its own though and would not start pt. on preventative tx w/ just this sx

Answer 67

Methyl-prednisone injection

Answer 68

IFN-B therapy; can cause fever sx as an ADR ***INEFFECTIVE if pts. smoke because they probably have antibodies -Glatiramir could also be used but causes some pulmonary tightness and is not as effective

Answer 69

Limits enzyme in pyrimidine synthesis pathway by blocking activation of T and B cells

Answer 70

Monoclonal ab that targets a4-integrin and inhibits white cells from crossing the BBB ADR: PML; must test pts. for JC virus

Answer 71

Common presenting sx of MS that shows as hemi-sided weakness, sensory loss, and urinary incontinence due to the presence of a lesion in the SC -Usually does not occur over more than one level

Answer 72

Variant of MS that does not respond to therapies; diagnosis is made in retrospect

Answer 73

Relapsing inflammatory disease that occurs due to antibodies to the aquaporin 4 chloride channel; can be discovered in a serum IgG test -Presents w/ Sudden vision loss/ocular weakness and urinary incontinence; focal lesion in SC often spans >1 vertebral level **Treated w/ Rituximab which binds to CD20 and induces apoptosis of white cells

Answer 74

A migraine w/ an extensive aura that can often mimic a stroke; diagnose thru exclusion of other more serious conditions

Answer 75

Incapable of inactivating 5-HT; expressed in platelets so they can store their serotonin

Answer 76

Endothelial layer deep to the stromal layer of the cornea that pumps out water to keep the stroma dehydrated =>>Failure to do so causes a milky white appearance of the cornea leading to possible blindness

Answer 77

With replication in the epithelial layer of the cornea -Can spread to the stroma causing corneal ulcers which heal poorly

Answer 78

Severe manifestation of HSV reactivation that occurs when PMNs infiltrate the corneal stroma in response to antigens and further recruit cytokines and macros that exacerbate ulcerations =>>Can lead to destruction of the endothelial membrane and cause excess hydration

CNS Path Flashcards

(102 cards)