Exam 3 (week 2) Flashcards
(265 cards)
1
Q
hemiparetic gait - where is lesion
A
cortex (M1) down to reticulospinal or corticospinal tract
2
Q
hemiparetic gait - what does it look like
A
flexion of arm
projection of leg is circumducted during walking
3
Q
spastic diplegia - where is lesion
A
interhemispheric fissure of frontal cortex - bilateral leg homunculi in cortex caused by meningioma
4
Q
what is spacticity
A
velocity dependent increase in tone
can slowly extend, but if you ramp up speed, they get stuck
5
Q
what is spastic diplegia usually caused by
A
cerebral palsy
6
Q
what does spastic gait look like
A
narrow, SCISSORING, stiff, spastic gait, toe gait in children
7
Q
describe parkinsonian gait
A
narrow based shuffing stooped flexed posture slow decreased 1 arm swing multi-step turn retropulson (fall back) festination (quick steps)
8
Q
ataxic gait - what does it look like
A
wide based
unstead - falls towards affected side
can’t do tandem gait
9
Q
where is lesion/problem in ataxic gait
A
cerebellum
10
Q
what causes ataxic gait (2)
A
alcohol
cerebellar lesion
11
Q
frontal gait - what do you see
A
“magnetic gait” -feet stuck to the ground
slow, shuffling
normal arm swing
12
Q
frontal gait - cause
A
normal pressure hydrocephalus
13
Q
normal pressure hydrocephalus “Triad”
A
wacky (cognitive)
wet (urinary incontinence)
wobbly
14
Q
functional gait - what do you see
A
inconsistant, lurching gait
appears dramatic and bizarre
suggestible
no falls or injuries
15
Q
functional gait - what causes it
A
psych
16
Q
what percent of cortex is association cortex
A
80%
17
Q
3 “questions” asked by brain regarding cognitive information
A
attention (is it interesting?)
identification (if it is, what is it?)
planning (what do I do about it?)
18
Q
what lobe determines if something is interesting
A
parietal lobe
19
Q
what lobe determines what something is
A
temporal lobe
20
Q
what lobe determines what to do about something
A
frontal lobe
21
Q
how are brodmann’s areas distinguished
A
have different “packing” arrangements - cytoarchitectonic areas - turn out to have different functions
22
Q
what is in cortical layer 4
A
recipient layer for thalamic neurons
23
Q
stroke/lesion in association area of R parietal lobe causes what behavioral changes
A
contralateral neglect
INATTENTION problem
L visual field only seen by R hemisphere
R visual field seen by both R and L hemisphere
24
Q
stroke/lesion in association area of R inferior temporal lobe causes what behavioral changes
A
problems with facial recognition - fusiform face area
prosopagnosia (sometimes congenital)
25
stroke/lesion in association area in frontal lobe causes what behavioral changes
working memory
executive function
couldn't match behavior to environment around him
26
how to test prefrontal disfunction
wisconsin card sorting test - tests working memory and planning
27
3 areas of brain associated with "thinking" even during rest - "default mode"
1. inferior temporal
2. posterior cingulate
3. medial prefrontal
28
what do the brains of schizophrenic patients look like compared to control in "Default mode"
more activity, particuarly in frontal and parietal
29
what do the brains of dementia patients look like compared to control in "Default mode"
hypoactivity in posterior
hyperactivity in frontal (like in schizophrenia)
30
two main features of language
1. symbolic representation - matching of symbols to objects/actions (lexical)
2. sterotypic performance - reliable order and contex for language production (syntantic and semantic)
31
lexical aspect of language controlled by what lobe
identification
L parietal: WERNICKES
32
syntactical/semantic aspects of language controlled by what lobe
planning/production
L frontal: BROCAS
33
rolling happens when in babies
4-6 mo
34
sitting happens when
6-7mo
35
crawling happens where
9-10 mo
36
walking happens when
14-15mo
37
transfering object happens when
6mo
38
baby bats an object
2-4mo
39
hands together when
3mo
40
grabs object hwen
4mo
41
bring to mouth when
4-5 mo
42
cooing happens when
2mo
43
babbling when
6mo
44
fin pincer grasp when
9-10 mo
45
word/word approximation when
12mo
46
vertical line drawing when
2 years
47
circle drawing when
3 years
48
proto-imperative pointing -what is it and when does it occur
point with finger to object they want at 12mo
49
proto-declarative pointing - what is it and when doe sit occur
parent says, where is dog, baby points to dog
| 14mo
50
what much of a difference beyond expected connotes delay
2 standard devations
51
for walking, what month is delayed
18 months
52
for speaking, what month is delayed
15months
53
motor apraxia
can't get words out
54
at what age can you say someone has an intellectual disability
5 years
55
difference between mild and moderate delay/intellectual disability in terms of epidemiology
mild delays occur less often in developed countries
moderate-severe happen everywhere at same rate
56
seizures in children often associated with what
encephalopathy
57
how long do you correct for gestational age (in preterm birth)
until 1st year of age
58
formula for expected head circumference
length/2 + 9cm
std dev +/-2.5cm
59
low tone caused by what (2)
congenital
| metabolic
60
low tone will cause what
delayed motor milestones
61
which developmental features are most often delayed in autism
social and language
62
is autism defined by genotype or phenotype
phenotype - we don't have genetic testing, so autism is an umbrella term covering phenotypes
63
criteria for autism (5)
1. persistent deficits in social interaction and communication
2. restricted, repetitive behavior/interest (need more/less stimulation)
3. early symptoms (~18mo)
4. symptoms cause impairment in functioning (predominately social)
5. symptoms not explained by intellectual disability or global developmental delay
64
when is MCHAT done
16 and 30 mo, or 18mo
65
if MCHAT is positive, then what do you do
ADOS - intensive. done by psychologist, on individuals 12mo through adulthood.
neuropsycho eval - will give you IQ and cognitive strengths/weaknesses
66
prevelance of autism
1:59
67
gender preference of autism
4:1
| M>F
68
what percentage of patients with autism do NOT have intellectual disability (AKA only social issues)
15%
69
what percentage of patients with autism have seizures
25%
70
genetics associated with autism (3)
fragile X
Tuberous sclerosis
Dup15q syndrome (15q11.2-q13.1)
71
what early intervention has been proven to be helpful for autism
applied behavioral analysis (ABA)
72
what does karytope pick up in intellectual delay
chromosomal duplications/delesions, inversions, translocations (trisomy 21, turner)
73
what does CMA test pick up in intellectual delay
will pick up developmental delay/autism
74
what does WES test pick up in intellectual delay
mutations in central exons - still misses other things (repeats, mitochondria etc.)
75
gene panels - what do they pick up in intellectual delay
specific genes (epilepsy panel, autism panel, intellectual disability)
76
brain MRI - what will it pick up in intellectual delay
won't tell you function - can see asymmetry or tone problems
77
long narrow face, large ears, prominent jaw, flexible fingers, flat feet, large testes after puberty
fragile X
78
diagnostic tests for fragile X (2)
PCR to "size" the number of repeats and
Southern blot to assess methylation
79
genetics of fragile X
CGG triple repeat
FMR1 gene Xq27.3
80
steryotyped wringing hand movement, microcephaly, regression of developmental milestones and loss of communication skills after 7-18mo
Rett syndrome
81
epidemiology of Rett
girls - lethal in boys
sporadic, denovo
82
death in Rett - what causes it
seizures.
| prolonged QT - causes sudden death
83
genetics of Rett
X linked dominant
| MECP2gene Xq28
84
how to test for Rett genetically
tiered targeted sequencing
85
child with neonatal hypotonia and failure to thrive hyperphagia leading to obesity
hypogonadism
almond shaped eyes
Prader willi
86
```
girl with excessive laughing and smiling
absence of intelligible speech
protruding tongue
hyperactivity
seizures
```
Angelman
87
prader willi genetics
deletion of paternal 15q11-q13
inheritance of 2 copies of maternal chromosome 15 (which is disordered?)
88
angelman syndrome
deletion of maternal 15q11-q13
inheritance of 2 copies of paternal chromosome 15 (which is disordered?)
89
tic disorder presentation age
before 18yr
90
provisional tic definition
fewer than 12 months,
stop before puberty
91
persistant tic disorder definition
more than a year
one or more vocal or motor tic (NOT BOTH)
persists beyond puberty
92
tourette syndrome definition
2+ motor and AT LEAST 1 vocal tic
lasts more than a year
often associated with psych - OCD, anxiety etc.
93
what 2 things to think about in terms of psych in infants
homeostasis
| attachment
94
how does reactive attachment disorder happen
when the environment goes wrong (neglect, abandonment, abuse etc.) - problem with Care
95
emotionally withdrawn 9 month infant, rarely seeks comfort, rarely responds to comfort, limited positive affect, persistently emotionally disturbed, not babbling, playing etc. has been removed from caregiver for some times
reactive attachment disorder
96
7 year old adopted kid, climbed onto stranger's lap, walked into someone else's house, tells strangers intimate details of her life, doesn't check in with caretaker, no stranger danger
disinhibited social engagement disorder
97
what is one of the most commonly reported socially aberrant behaviors in post-institutionalized children
disinhibited social engagement disorder
98
how common are sleep disorders in kids 1-5
25-43%
99
BEARS acronym regarding sleep
```
Bedtime routine
Excess daytime sleeping or dysfunction
Awake after sleep
Routines
Snoring
```
100
What are nightmares
parasomnia that happens during REM - so you remember
101
what chidlhood sleep disroder can be inherited
non-REM sleep parasomnia - night terror or sleep walking
102
what childhood sleep disorder could be linked to fear or anxiety
nightmares
103
what age is separation anxiety most often
7-8 yo
104
what is most common anxiety disorder of childhood
separation anxiety
105
learning disorder familial prevalance
4-8x higher risk in first degree relatives
106
when are learning disorders generally picked up
high school
107
IQ for mild intellectual disability
50-70
108
types of ADHD
inattentive
hyperactive-impulsive
combination
109
what ADHD type is the most common
combined
110
what percentage of ADHD is genetic
80%
111
do meds alone work better than meds plus therapy?
work the same
112
what percentage of kids respond well to treatment to ADHD- complete school as normal
50%
113
ADHD and risk for depression and substance abuse
untreated ADHD has 2-3x higher risk for dpression and substance abuse
114
angry, irritaible kid who is defiant, vindictive interaction with someone (not sibling) where they lose tempber, argues, blames other for mistakes
oppositional defiance disorder
115
really bad kid who's agressive, destructive, deceitful, harmful to animals, commits serious violation of rules, theft
conduct disorder
116
2 dimensions of disruptive behavior
overt (aggressive, bullies, stubborn)
covert (steals, sets fires, harms animals)
117
what percentage of child mental helath referrals are due to ODD or CD
1/3 - 2/3
118
genetic influences on conduct disorder
lead
peinatatl problems (smoking)
frontal lobe decreased glucose metabolism
119
myer-overton corelation
relationship between lipid bilayer/water partition coefficient and potency
120
what receptor/neurotransmitter to many anesthetics work through
GABA
121
activation of post synatpic GABA receptors does what to post synatpic action potential generation potential
makes post synaptic more leaky, less excitable less voltage change
122
receptor worked on by isoflurane
GABA
123
receptor worked on by sevoflurane
GABA
124
receptor worked on by etomidate
GABA
125
receptor worked on by propofol
GABA
126
receptor worked on by ketamine
NMDA
127
receptor worked on by nitrous oxide
kainate and NMDA
128
one dose of volatile anestetic agent is also called
minimum alveolar concnetration (MAC)
129
at what MAC does mild anesthesia occur
0.3 MAC
130
at what MAC does amnesia occur
0.5 MAC
131
what is target MAC for surgery - 99% of subjects are immobile
1.3 MAC
132
what MAC dose is potentially lethal
2.0 MAC
133
what is induction MAC
2.0 MAC - could be lethal if maintained
134
what works quicker - low solubility anestetics or high solubility anesthetics
low solubility
135
halothane adverse effects (1)
immune response causing HEPATIC NECROSIS, fever, nausea vomiting and rash
136
enflurane adverse effects (3)
CARDIOvascular DEPRESSION due to decreased contractility
SEIZURES
uterine muscle relaxant
137
isoflurane advantages
cardiac is good
138
isoflurane adverse effects (1)
progressive respiratory depression
139
sevoflurane advantages
can be used for outpatient - rapid recovery
140
desflurane advantages (2)
used for outpatient surgery
not soluble in fat
141
desflurane adverse effects/disadvantages (3)
irritating to airways
needs specially heated vaporizer
can evoke tachycardia
142
metohxyflurane blood:gas (high or low)
high
143
methoxyflurane metabolism (high or low)
high
144
methoxyflurane advantage
very potent
145
methoxyflurane adverse (2)
extensively metabolized
renal failure/tox
146
nitrous oxide use
analgesic
147
advantages of nitrous oxide
analgesic
rapid induction
little tox
148
disadvantages/adverse effects of nitrous oxide (2)
can't use in patient with any enclosed air space (air embolus, loop of bowel) because it will expand
can cause hypoxia
149
what is malignant hyperthermia and what is it caused by
inherited inability of sarcoplasmic reticulum to sequester Ca2+, volatile anesthetics and succinylcholine cause increased body temp and massive muscle contraction
150
advantages of sodium thiopental
no vomitting or excitement after anesthetic
water sol
151
disadvantages of sodium thiopental (4)
no analgesia
slow recovery
no antagonist
resp and CV depression
152
what kind of drug is sodium thiopental
barbiturate
153
propofol advantages
forgetful rest
little accumulation
rapid metabolism
154
propofol disadvantages
no analgesia
CV depression
injection pain
not water sol
155
ketamine advantages
no resp depression
analgesic
156
ketamine disadvantages
hallucinations(less likely in children)
increased muscle tone and involuntary movements (less likely in children)
157
etomidate advantages
there is an antagonist
158
etomidate disadvantages
accumulates
no analgesia
injection pain
159
what percentage of american shave alcohol or drug abuse/addiction
20%
160
cost of drug and alcohol abuse to US society
~200 billion/year
161
what genes are thought to be polymorphic for substance use disorder (4)
D4 dopamine receptor
mu opioid
delta opioid
dopa transporter
162
diference between physioloigical dependence and substace use disorder
substance usde disorder includes behavioral syndrome - drug seeking behavior
163
what 3 neuronal populations are targetted in the reward pathway
1. GABA interneurons
2. dopa neurons in VTA
3. medium spiny GABA neurons in NAc
164
what pathway do ALL drugs of abuse activate
mesolimbic dopa reward pathway (1 or more of the neuronal populations between VTA and NAc)
165
alcohol reward pathway mech of action (3)
enhance GABA binding at GABAa
inhibit glutamate activation of excitatory NMDA
facilitate release of endogenous opioids in VTA
166
TX for mild alcohol withdrawal (2)
sympathetic driven
clonidine or propranolol to suppress symp activity
167
TX for severe alcohol withdrawal (1)
seizures
diazepam (long acting benzo)
168
TX for preventing alcohol relapse (5)
(aversion therapy)
1. disulfram (nausea vomitting)
(anti-craving)
2. naltrexone
3. acamprosate
4. topiromate
5. SSRI
169
barbiturates reward pathway mech of action (2)
increase GABA binding to GABAa
at high doses can directly open GABAa
170
bartiburate detox tx (1)
to suppress seizures
| reversal of dependence
stabilize patient on long acting phenobarbital, taper (4-8wk)
171
benzos reward pathway mech of action
increase GABA binding to GABAa
172
benzo withdrawal following moderate usage symptoms
anxiety, light sensitivity, paresthesia, cramps, dizziness, sleep disturbances
173
benzo withdrawal following high dose usage symptoms
delirum
| seizures
174
benzo detox treatment
tapering doses of phenobarbital OR diazepam (long acting benzo)
175
opioid reward pathway mech of action
activation of mu-opioid receptor on GABA interneurons in VTA
176
opioid withdrawal tx (3)
1. methodone
2. LAAM (longer acting than methodone - 2-3/week instead of daily)
3. buprenorphine (more favorable - partial agonist, less resp failure, antagonist to heroin, better compliance) as sublocade, suboxone
177
nicotine reward pathway mech of action
stimulates nicotinic Ach receptors on dopa neurons in VTA
178
tx for nicotine use disorder (3)
1. nicotine replacement (gum/patch) - slower pharmacokinetics than smoking
2. buproprion - antidepressant, antagonist of nicotinic Ach receptors, inhibits dopa and NE reuptake (reduces craving and withdrawal)
3. varenicline - partial agonist on nicotinic Ach - superior (40% quit rate)
179
amphetamine mech of action in reward pathway
enhance release of dopa and NE
| also weakly blocks MAO and acts as direct agonist
180
cocaine mech of action in reward pathway
blocks reuptake of dopa (and less so for NE and 5-HT)
181
overdose of cocaine symptoms/cause
seizures (because of blocking GABAa, increasing CNS excitability)
182
cocaine/amphetamines tolernace symptoms
reverse tolerance - sensitization (with chronic use can get increase susceptiility to cardiac arrhytmias and stroke)
183
tx to reduce relapse for cocaine/amphetamine use disorder
topiramate
184
5-HT related psychedelics (2)
LSD
| psilocybin
185
dopa and amphetamine related psychedelics (1)
MDMA
186
dissociative drugs (2)
PCP, Ketamine
187
mech of action for LSD (1)
agonists at 5-HT, dopa, and adrenergic reeptors
188
mech of action for MDMA (3)
induce 5-HT and dopa release
5-HT reuptake inhibition
agonist at 5-HT, dopa and adrenergic receptors
189
abuse disorder liklihood for psychedelics
low
190
mech of action of dissociatives
inhibit glutamatergic NMDA in reward pathway
191
peripheral effects of dissociatives
sympathomimetic - increased HR, BP, sweating
192
classical conditioning
scared of thunder, which is associated with lighning. over time, lightning alone will cause fear response
193
operant conditioning
reinforcement - press lever to get reward (positive), press lever to stop adverse stimulus (negative)
punishment - add adverse stimulus to decrease behavior (positive), remove pleasant stimulus to decrease behavior (negative)
194
what type of "schedule" is the most reinforcing?
intermittent variable ratio
195
what is the percentage range for heritability of alcohol and drug dependence
40-60%
196
CAGE tool
C - had to Cut back
A - others Annoyed
G - Guilty
E - need Eye opener
197
how many DSM symptoms for mild, moderate and severe use disorder
```
mild = 2-3
moderate = 4-5
severe = >6
```
198
alcohol withdrawal symptoms within 6-12hr
insomnia, anxiety, tremors, sweating, GI upset, palpitations
199
alcohol withdrawal symptoms within 12-24hr
visual, auditor or tactile hallucinations
200
alcohol withdrawal symptoms within 24-48hr
generalized tonic clonic seizures
201
alcohol withdrawal symptoms within 48-72hr
delirium tremens - visual hallucinations, disorientation, tachycardia, HTN, fever, agitation, sweating
202
triad with wernicke's
1. confusion
2. ataxia
3. abnormal eye movements
203
triad with korsakoff's
1. amnesia
2. confabulation
3. hallucinations
204
what is bruxism
grinding teeth - meth mouth
205
PCP intoxication symptoms (Acronym)
RED DANES
Rage
Erythema
Dilated pupils
```
Delusions
Amnesia
Nystagmus
Excitation
Skin dryness
```
206
tx for PCP
acidification of urine...?
207
when does glial washing occur
slow wave sleep
208
what is poor glial washing associated iwth
amyloid plaques in alzheimers
209
how often does REM happen
90 - 120 min intervals - doesn't start til 1.5 hours
210
after exposure, how much time is best for learning
up to 2 days of sleep, and then plateaus
211
how much sleep does an adult need
7-9 hours
212
how much sleep does a teenager need
9.25h
213
how much sleep does an 5-12 year old need
10-11hr
214
processes of circadian rhythim
Process S (homeostatic sleep drive)
Process C (clock dependent alertness)
215
what is the retino-hypothalamic pathway
there are photopic receptors (retinal gangioln cells) that process light, at dusk, secretes melatonin due to input from suprachiasmatic nucleus
216
delayed sleep phase usually between what times
3am - 11am
217
who gets delayed sleep phase
teenagers and some people geneticaly
218
how does sleep changewith age
decreased slow wave, increased fragmentation
219
what percentage of individual has chronic insomnia
15%
220
what kind of insomnia responds to CBT
sleep onset
221
symptoms for narcolepsy
1. excessive sleepiness
2. sleep paralysis
3. hypnogogic hallucination
4. cataplexy
5. fragmentation of sleep
222
does orexin make you awake or sleepy
sustains wakefulness
223
degrees of hypothermia
mild: 90-95
moderate: 82-90
severe: <82
224
degrees of frostbite
1st: superficial, limited to skin and superficial tissue, swelling and redness
2nd: superficial, with blisters over first 24hr that will slough off
3rd: deeper, involves bloody blisters that blacken and slough off about 2 weeks after injury
4th: muscles and bones, causes necrosis and loss of tissue
225
difference between heat exhaustion and heat stroke
heat exhaustion: weakness and loss of water
heat stroke: results in hyperthermia (>104)
226
how to determine age of lice
distance from scalp -> 1cm = 1month
227
treatment for lice
permethrin 1% cream 2x (once a week later)
228
why is scabies more contagious than lice
scabies can live on surface for 24 hours. also you can't see them
229
symptoms of scabies
very very itchy
230
treatment for scabies
promethrin 5% cover whole body for a whole day and then wash off
also have to wash and dry clothing in heat
231
how much more likely are patients with mental illness to suffer violence
10x
232
what percentage of homeless individuals suffer from severe mental illness versus the general population
25% vs 6%
233
what substances are abused most often in homeless population, and what percent
tobacco - 70-80%
| alcohol - 38%
234
what is leading cause of death in homeless population between 40s and 60s
cardiovascular disease
235
parts of "quadruple aim" model
1. patient experience of care
2. per capita cost
3. population health/outcomes
4. clinician experience
236
what level of government regulates most health policy
state
237
is healthcare in the constitution?
no, except in the preamble that says "to promote the general welfare"
238
how does federal gov get away with regulating helathcare?
1. tax and spend (can create incentives for states to act - highway funds etc.)
2. interstate commerce (health insurance, child labor, civil rights, environmental protection)
3. necessary and proper elastic clause
239
Medicare and medicaid and levels of government involvement
medicare - federal is direct purchaser
medicaid - state program, federal sets minimum services for baseline
240
Romer's law
when you build more beds, more people will fill them - also applies to technology (CT, MRI etc)
241
definition of treatment resistant depression
people who do not respond to at least 2 antidepressants
242
pros and cons of uni vs bilateral seizure induction thearpy
uni = less effective but fewer memory loss side effects
bi = more effective, more cognitive effects
243
how much of the applied charge actually gets into the brain
20% - skull impedes a lot
244
ECT effects (3)
1. increases GABA transmission and receptor antagonism
2. down regulates beta adrenergic receptors
3. increaes endogenous opioids
245
ECT absolutely contraindications
increased intracranial pressure
246
can you use ECT in pregnancy
yes
247
side effects of ECT
temporary retrograde amnesia and confusion
248
transcranial magnetic stimulation (TMS) uses (2)
neuropathic pain
treatment resistant major depressive dirosder and bipolar disorder
249
TMS adverse effects
some fainting or discomfort - not a lot
250
bright light therapy uses
seasonal depression
251
vagus nerve stimulation mechanism
changes blood flow in brain and boosts neurotransmitters
252
deep brain stimulation uses (3)
MDD
OCD
Parkinsons
253
what unit is measured for ECT
mili coulombs
254
sexual response cycle
desire
excitement/arousal
orgasm
relaxation
255
diagnostic criteria for female sexual interest/arousal disorder
absent/reduced sexual interest with 3 domains, of at least 6 months duration causing distress, w/o any other psych disorder, meds
256
diagnostic criteria for male hypoactive sexual desire disorder
deficient/absent sexual desire for 6 months duration causing significant distress w/o any other psych disorder, meds
257
timing for premature ejaculation
under 1min
258
what percentage of male population suffers from premature ejaculation
30%
| 40% of men treated for sexual disroder
259
demographics for premature ejaculation
college educated men
260
treatment for premature ejaculation
1- squeeze technique
2- stop start
3- psychotherapy sensate focus
4- SSRIs or topical anesthetics
261
4 types of difficulties you can see with genito-pelvic pain/penetration disorder
one of the following:
1. difficulty with vaginal penetration
2. difficulty with geneital pain during intercourse
3. fear/anxiety about pain during intercourse
4. tightening of pelvic floor muscles during penetration
262
diagnostic criteria for parahpilias
intense, recurrent fantasies towards non consenting individuals or that humiliate oneself or others
EITHER 6 months of fantasies that cause distress or impairment
or having acted on the fantasies, with or without distress or impairment
263
voyeurism
peeping tom
264
exhibitionism
exposing to unsuspecting individual
265
frotteurism
rubbing against people in crowds
