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Psychiatry Shelf > Diagnoses IV > Flashcards

Diagnoses IV Flashcards

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1
Q

3 subtypes of mental retardation based on etiology

A

Mental retardation

  1. Organic (idiopathic)
  2. Prenatal (genetic)- Fragile X, Downs, TORCHES (perinatal infection), Prader-Willi
  3. Perinatal or postnatal: fetal alcohol, lead or mercury exposure
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2
Q

Criteria for mental retardation

A

MR/ID: Subaverage IQ below 70 + developmental disability

Developmental disability = deficits in 2+

  • self care, learning, mobility
  • receptive/expressive language
  • self-direction, independent living
  • economic self sufficiency
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3
Q

Which 2 diseases overlap significantly w/ Tourette’s syndrome

A

High comorbidity/overlap btwn Tourette’s, OCD, and ADHD

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4
Q

Tourettes

(a) more common in which gender?
(b) neurochemical mechansim
(c) time criteria

A

Tourette’s

(a) 3:1 M:F
(b) Dopamine dysregulation in the caudate
(c) 12+ months of both motor and vocal tics

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5
Q

What makes it difficult to treat comorbid Tourettes and ADHD

A

Tourette’s and ADHD are often comorbid, but stimulants can make the tics worse => have to find a good balance

  • pimozide or haloperidol for Tourette’s
  • low stimulant for ADHD (low enough to not exacerbate tics)
  • clonidine
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6
Q

Psychopharm to treat Tourette’s d/o

A
  • typical antipsychotic: usually pimozide or haloperidol

- clonidine = alpha2 agonist

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7
Q

Enuresis

(a) time requirement
(b) age requirement

A

Enuresis = involuntary voiding of bladder

(a) 3+ months, twice a week
(b) after age 5

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8
Q

Distinguish chronic pain vs. chronic pain syndrome

A

Both are pain w/o apparent biological cause

Chronic Pain: 3+ months, NOT maladaptive

Chronic Pain Syndrome: 6+ months, MALADAPTIVE**
-factors: depression, inactivity

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9
Q

Intermittent Explosive D/o

(a) more common in which gender
(b) neurochemical etiology
(c) symptoms
(d) differentiate from ATPD

A

Intermittent explosive d/o

(a) almost always in females
(b) low 5HT
(c) impulses of assault or property destruction out of proportion to the trigger
(d) intermittent explosive d/o- pts usually feel remorseful afterwards (while ASPD don’t have remorse)

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10
Q

Treatment for Intermittent Explosive D/o

A

Intermittent explosive d/o treatment

  • SSRI, anticonvulsant, lithium, propanolol
  • group therapy

**psychotherapy not helpful

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11
Q

What is kleptomania?

A

Kleptomania = stealing not for personal or monetary gain

-pleasure is derived from the act of stealing

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12
Q

Kleptomania

(a) more common in which gender
(b) common comorbidity
(c) therapy

A

Kleptomania

(a) F > M
(b) 1/4 of bulimics are kleptomaniacs
(c) insight-oriented psychotherapy

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13
Q

Pyromania

(a) more common in which gender
(b) common morbidity

A

Pyromania

(a) F > M
(b) common in MR

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14
Q

Criteria for pyromania

A

Criteria: 1+ intentional fire setting

  • tension before fire, relieved after
  • fascination w/ fire
  • not for monteary gain or expression of anger
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15
Q

Tx for pyromania

A
  • behavior therapy

- SSRI

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16
Q

What is trichotillomania?

A

Trichotillomania = recurrent pulling out of hair resulting in visible hair loss
-can be eyebrows, public hair

  • tension before, relieved by action
  • causes marked distress or impairment
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17
Q

Trichotillomania

(a) more common in which gender
(b) common comorbidity
(c) common trigger
(d) treatment

A

Trichotillomania

(a) F > M
(b) comorbid w/ OCD/OCPD
(c) often after stressful event
(d) tx: SSRI, antipsychotic, hypnosis, behavioral therapy

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18
Q

Define delirium

A

Basically a change in mental status w/ evidence of underlying cause

  • impaired consciousness
  • change in cognition or perception
  • acute onset, fluctuates
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19
Q

WHIMP acronym for delirium

A

Etiologies of delirium

W- Wernicke's encephalopathy (B12 deficiency)
H- hypoxemia
I- intracranial bleeding
M- meningitis
P- poisons
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20
Q

Delirium vs. dementia

Main difference

(a) onset
(b) duration
(c) alertness and attention
(d) sleep
(e) consistently of course

A

Delirium vs. dementia

Change in mental status vs. memory problems

Delirium

(a) acute onset
(b) transient, hours to days
(c) alertness and attention are impaired
(d) awake at night (same as dementia)
(e) fluctuates**

Dementia

(a) insidious, gradual onset
(b) much longer lasting: months to years
(c) alertness and attention are normal
(d) awake at night
(e) symptoms stable throughout the day

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21
Q

Treatment for delirium

(a) Use
(b) Don’t use

A

Delirium treatment

(a) Quetiapine or haloperidol
(b) Avoid benzos- can have paradoxically worsening effect in elderly

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22
Q

Hallmarks symptoms of delirium

A

Waxing and waning symptoms (may have lucid intervals)

  • visual hallucinations
  • short attention span
  • impairment in recent memory
  • disorientation: usually to time and place
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23
Q

Most common finding in delirium

A

Impairment in recent memory

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24
Q

What can cause delirium?

A

Almost any medical condition can cause delirium

Most common causes

  • infection
  • meds
  • intoxication or withdrawal
  • electrolyte imbalance
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25
Delirium + hemiparesis
Delirium + focal neurological symptom (like hemiparesis)- think CVA (cerebral vascular accident- TIA/stroke) or mass lesion => get brain CT/MRI
26
Delirium + elevated BP + papilledema
Delirium + elevated BP + papilledema (optic disc swelling) = hypertensive encephalopathy => get brain CT/MRI
27
Delirium + dilated pupils + tachycardia
Delirium + dilated pupils + tachycardia = drug intoxication (ex: cocaine) => get UTOX
28
Delirium + fever + nuchal rigidity + photophobia
Delirium + fever + nuchal rigidity + photophobia = meningitis => get lumbar puncture
29
Delirium + tachycardia + tremor + thyromegaly
Delirium + tachycardia + tremor + thyromegaly = thyrotoxicosis => get T4 or TSH level
30
Delirium + cogwheel rigidity + resting tremor
Lewy body dementia vs. Parkinsons disease
31
Dementia + obesity + constipation + cold intolerance
Hypothyroidism
32
Dementia + diminished position and vibration sensation + megaloblasts on CBC
Vitamin B12 deficiency
33
Dementia + tremor + abnormal LFTs + Kayer-Fleischer rings
Wilson disease
34
Dementia + diminished position and virbation sensation + Argyll Robertson Pupils
Argyll Robertson Pupils = accommodation response present, response to light absent = Neurosyphilis
35
Screening test for dementia
Mini mental status exam (MSSE) - assesses orientation, attention/concentration, language, recall - sensitive for dementia, particularly moderate to severe forms - perfect score (30), dysfunction under 25
36
List the 3 most common types of dementia
Dementia Most common type = Alzheimers: 60-70% Second = Vascular dementia: 15-20% Third = Lewy Body Dementia: 10-15% Fourth = frontotemporal (Pick's disease) 5%
37
Neurochemical mechanism of Alzheimer's
Decrease in acetylcholine due to loss of noradrenergic neurons in the basal ceruleus and decreased choline acetyltransferase (required for ACh synthesis) -due to amyloid cascade hypothesis: excess of A-beta peptides
38
ApoE4
Gene that increases susceptibility to Alzheimer's
39
What kind of cognitive decline is associated w/ Down's syndrome
Down's syndrome pts have increased risk of Alzheimer's -neurofibrillary tangles and senile plaques are found in both
40
Pharma treatment for Alzheimer's (a) 2 drugs for mild to moderate disease (b) 1 drug for moderate to severe disease
Alzheimer's drugs (a) Mild to moderate disease: use cholinesterase inhibitors - Donepezil (Aricept) - Rivastigmine (Exelon) (b) Moderate to severe disease: NMDA antagonist - Memantine (Namenda)
41
Risk factors for vascular dementia
- hypertension - CAD - Afib
42
CT findings of vascular dementia
Multiple small lacunar infarcts (small vessel disease) -multiple cortex lesions => step-wise process as these accumulate
43
Pathological process of lewy body dementia
LBD = 3rd most common dementia -lewy bodies (pathologic alpha-synuclein aggregates) in the brain, primarily in the basal ganglia
44
3 key features of lewy body dementia
1. waxing and waning course 2. visual hallucinations 3. Parkinsonism
45
Treatment for lewy body dementia
- cholinesterase inhibitors (Donepazil, Rivastigmine) help improve VH - L-dopa and dopamine agonists may improve cognition, psychomotor slowing
46
Key features of frontotemporal dementia
- faster progression to death (4-6 years, vs. 10 years for Alzheimer's) - profound personality changes w/ preservation of language and memory
47
Most common dementia caused by infectious disease
HIV-associated dementia
48
Percent of Parkinson's pts that develop dementia
30-40% | -resemble Alzheimer's type, but the dementia is not the initial symptom
49
Most common clinical feature of CJD
Creutzfeld-Jakob Disease | -90% of pts have myoclonus (sudden muscle spasms)
50
Name 2 types of potentially reversible dementia
- normal pressure hydrocephaglus | - hypothyroidism induced dementia
51
Clinical triad of NPH
Normal pressure hydrocephalus: 3 W's Wobbly: gait disturbance = apraxia (often appears first) Wet = urinary incontinence Wacky = Dementia (mild, insidious onset)
52
Differentiate presenting symptoms of Alzheimer's and Vascular dementia
Vascular dementia- same symptoms of Alzheimer's + focal neurological findings -also Vascular dementia proceeds in step-wise fashion
53
Cardinal signs of Parkinson-type dementia
-bradykinesia, tremor, rigidity, postural rigidity
54
Treatment of normal pressure hydrocephalus
Shunting of cerebral aqueduct | -provide CSF drainage
55
What is transient global amnesia
Inability to learn new info + inability to recall recent info -personal ID not lost -almost always recover
56
Kofsakoff's syndrome
``` Alcohol induced amnesia Comorbid Wernicke's encephalopathy = confusion, ataxia, opthalmoplegia (paralysis of muscles around the eye) -confabulation -apathy -passivity ```
57
Prognosis for Kosakoff's syndrome
Thiamine => 25% recover totally | -25% never recover
58
What is amnestic disorder
Inability to learn new info OR inability to recall old info due to a medical condition (axis III) -poor insight => confabulate
59
Define hazardous drinking for M and F
Hazardous drinking Men: 5+ drinks/day Women: 4+ drinks/day
60
How long can the following be detected in the urine (a) EtOH (b) Cocaine (c) PCP (d) Sedative hypnotics (e) Amphetamines (f) Opioids
UTOX (a) EtOH- not in urine! use breathalyzer or BAC (b) Cocaine- positive for 3 days (c) PCP positive for about 1 week (d) Benzos positive for about 1 week (e) Amphetamines for about 3 days (same as cocaine) (f) Opioids for 12-36 hrs
61
Treating alcohol withdrawal (a) good vs. bad liver fxn (b) supportive (c) long term plan
Treating alcohol withdrawal (a) Benzossss - Lorazepam (or Oxazepam/Temazepam) if poor liver fxn - longer acting if good liver fxn (b) supportive = banana bag (c) AA
62
Name the 3 components of a banana bag and their functions
Banana bag = IV fluids + thiamine + folic acid + MgSO4 (a) thiamine- B1 to prevent Wernicke-Korsakoff syndrome (b) folic acid to replenish (quickly depleted w/ alcohol intake (c) MgSO4 to prevent seizures
63
Which 2 drugs of abuse don't have a withdrawal syndrome?
No withdrawal syndrome = PCP and hallucinogens PCP: no withdrawal but flashbacks common
64
Alcohol withdrawal (a) 6-24 hr (b) within 72 hrs
Alcohol withdrawal (a) 6-24 hrs: insomnia, anxiety, irritability, tachycardia, hyperreflexia, delirium, HTN, seizures, hallucinosis - hallucinosis = hallucinations while alert and oriented (b) w/in 72 hrs: DT - delirium tremens, 20% mortality - visual/tactile hallucinations
65
Pupillary reaction to (a) cocaine/amphetamine intoxication (b) PCP (c) benzos (d) opioid intoxication (e) hallucinogen intoxication (f) opioid withdrawal
Pupillary rxn (a) Cocaine/amphetamine intoxication = dilated pupils (tons of sympathetic tone) (b) PCP => rotary nystagmus (c) Benzos => nystagmus (d) Opioid intoxication: constricted pupils (miosis) (e) hallucinogens => dilated pupils (f) opioid withdrawal => dilated pupils (mydriasis)
66
Serotonin syndrome vs. NMS (a) reflexes (b) use of bromocriptine (c) rigidity (d) degree of dysautonomia (e) CPK level (f) reason for fever
SS vs. NMS SS - hyperreflexia - bromocriptine could make it worse - rigidity less severe, more cogwheel not lead pipe - less severe dysautonomia - mildly elevated CPK (like 400s) - fever produced peripherally NMS - hyporeflexia - bromocriptine (DA agonist) helpful - severe rigidity - severe dysautonomia - extremely elevated CPK (like 60-80,000) - fever produced by DA blockade at hypothalamus (centrally)
67
Explain the following in SS/NMS (a) CPK levels (b) renal risk
SS/NMS (a) CPK levels are elevated b/c of muscle rigidity (b) Renal risk b/c of the tons of protein breakdown products the kidney has to deal with
68
What are the effects of hallucinogens? (a) duration of effect
Hallucinogens: psilocybin (shrooms) and LSD (lysogenic acid diethylamide) have stimulant-like effects - dilated pupils - perceptual distortions (a) last 8-12 hrs
69
How to treat opioid (a) overdose (b) withdrawal (b) dependence
Opioid | a) overdose => Naloxone (opioid receptor blocker (b) withdrawal: - clonidine (alpha agonist) - buprenorphone
70
How to treat PCP intoxication (a) Way to increase rate of clearance (b) Treating symptoms (c) For psychosis- why may not treat this?
PCP intoxication (a) increase clearance by acidifying urine (give ammonium, NH4+) (b) Treating symptoms - tx muscle rigidity => benzos, DA agonist (c) If psychosis- potentially give haloperidol - however this worsens the hyperpyrexia
71
Lab values in PCP intoxication: two things that are elevated
PCP intoxication: - elevated CPK - elevated AST
72
Mechanism of PCP
PCP = NMDA antagonist
73
Symptoms of PCP intoxication
- aggression - increased pain tolerance - rotary nystagmus - ataxia - muscle rigidity
74
Mechanisms by which benzo withdrawal can be fatal
Seizures
75
How to treat overdose of (a) cocaine/amphetamines (b) barbiturates (c) benzos
Treating overdose (a) cocaine/amphetamine tx w/ benzos (b) barbiturate OD- alkalinize urine (c) Benzos- Flumazenil
76
Describe opioid withdrawal
Wet: - lacrimation (tears) - rhinorrhea (runny nose) - N/V/D - piloerection (goose bumps) - generalized myalgias - mydriasis (dilated pupils) - yawning *not life threatening, but treat (w/ clonidine/buprenorphone) b/c uncomfortable for pt

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