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Psych and Neuro Flashcards

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1
Q

Effects and tx

Extrapyrimadial side effect tx

NMS tx

Serotonin syndrome tx

A

EPS - Benztropine, DIphenhydramien

NMS - Rigidity Daltrolene, D2 agonist

Serotonin - - clonus - Cyproheptadine

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2
Q

metoclopramide

odansetron

mech?

A

Met - D2 block

Odansetron - S block

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3
Q

HTN crisis tx? (MAO)

A

pHENTOLAMINE , NIFEDIPOINE

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4
Q

Brief Psychotic Disorder

Delusional Disorder

A

Brief - Less tahn 1 mo - stress related usu

DelusionD - 1+ mo. Functionally not impaired

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5
Q 
Schioaffective
Schizophreniform
schizophrenia
Schizoid
Schizotypal
A 
Schioaffective - 2wk+ w/ mood 
Schizophreniform - 1-6mo
schizophrenia - 6+ mo. DEC dendritic branches. Assoc /w weed in teenagers
Schizoid - voluntarily distancing 
Schizotypal - maginal thinking
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6
Q

Bipolar 1
Bipolar 2
Cyclothymic

A

Bipolar 1 - 1+ mo
Bipolar 2 hypomanic + depressive
Cyclothymic - 2 y hypomanic + dysthymia

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7
Q

MDD

Dysthymia

A

MDD - 2+ - single episode = SSRi for 6mo

Dysthymia - 2y mild depression

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8
Q

Panic disodrer
GAD
Adjustment disorder

A

Panic disodrer - 1mo + - Tx Benzo. Long term SSRI, CBT

GAD - 6+ mo no identifiable stressors - SSRI, CBT

Adjustment disorder - within 6 mo - Identifiable - Tx - Psychotherapy, CBT

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9
Q

Acute Stress Duisorder

PTSD

A

ASD - 3d - 1mo

PTSD 1mo+

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10
Q

Paranoid
Schizoid
Schizotypal

A

Paranoid - projection
Schizoid - voluntary distancing
Schizotypal - magical thinking

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11
Q

Antisocial
boderline
Histrionic
narcissistic

A

Antisocial - 18+. Conduct disrdoer by 15 req.

Boderline - Interpersonal relationship , self harm, splitting

Histrionic - Appearance, sexuality

narcissistic - Demans best. Criticism with rage

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12
Q

Avoidant
O/C
Dependent

A

Avoidant - desires relationship, hypersentiviet to rejection

O/C- does not realize odd perfectionist way

Dependent - subsmissive, low confidence

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13
Q

Social phobia

Specific phobia

A

Social phobia - SSRI, Performance issues = BB

Specific phobia - Behavior therapy

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14
Q

Conversion

somatic

Factitious

malingering

A

Conversion - neuro sign - weakness, blidness, etc Aware but indifferent.

Somatic - somatic

Factitious -Sick role only

malingering - secondary gain.

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15
Q

Brain met - tx?

A

Single met - surgery

Multiple mets - Whole brain RTx

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16
Q

Adult Brain tumors

GBM
Hemangioblastoma
meningioma
oligodendroglioma
pituitary adenoam
schwannoma
A

Adult Brain tumors

GBM - Pseudopalasing, central necrosis, hemoarrhage

Hemangioblastoma - Cerebellar. VHL. w/ retinal angioams . EPO

meningioma - whorled, psamomma. benign . estrogen rec

oligodendroglioma - Fried egg, clear cytoplasm, calcified, chicken wire. Frontal

pituitary adenoam prlactinoma, bilat temp hemi.

schwannoma - spindle, elongated w/ oval nuclei. S100+ Bilat in NF2

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17
Q

Child brain tumors

Pilocytic astrocytoma
Ependymoma
Craniopharyngioma
Medulloblastoma

A

Pilocytic astrocytoma - Cerebellar/posterior fossa. Rosenthal fibers.

Ependymoma - 4th ventricle. Hydrocephalis. Highly malig

Craniopharyngioma - Ca, Cystic, cholesterol rich, Rathkes. Comes back after resection but BENIGN

Medulloblastoma - Homer Wright rosettes - solid blue, highly malig.. hydrocephalus. Drop mets

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18
Q

Acomm

PCA

Basilar

AICA

PICA

ASA

A

Acomm - saccular, berry anerysm -> SAH

PCA - Contra heminopia w/ macular sparing (MCA)

Basilar - locked in

AICA - CN 7, lateral pontine (facial droop)

PICA - CN 9, 10, 11, dysphagia, lateral medullary

ASA - CN 12 - contra paresis , medial medullary.

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19
Q

Stokres:
Charcot Bouchard

lacunar

basal ganglia

A

Charcot - thalamic - sensory, HTN - HTN

Lacunar - Internal capsule - motor , Negative on CT - HTN

Basal ganglia - contra sensory and motor

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20
Q

Ischemic stroke w/o A fib outside of TPA window tx

W A fib?

A

Aspring indefinitely
If it stroke recurs, add Clopidogrel

W Afib - Anticoagulate.

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21
Q

Pseudotumor dx

A

LP confirms. CSF > 250. MR to rule out central vein thrombosis. 70% have empty sella.

Tx Acetazolamide

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22
Q

MS - Gold standard dx

tx acute ?

A

Dx - MRI - not LP (oligoclonal nont sensitive/specific)

Tx acute w/ IV steroids. Not IVIG . Longerterm - Interferon, IVIG, cyclophosphamide.

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23
Q

Spinal cord compression - presentation

A

Motor and sensory. Decreased rectal tone.

Tx - IV STEROIDS, MRI, neurosurg consult.

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24
Q

Essential tremor
Cerebellar tremor
Parkinsonis tremor

A

Essential - worse w/ action
Cerebellar - worse w/ action + ataxia

Parkinsons - better w/ action

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25
Menieres - etiology and presentation?
Inner ear endolymph Ear fullness, vertigo
26
Prolonged seizure - damages...?
Cortical laminar necrosis
27
Carbamazapine - tox Tx
Agran, SIADH, hepatotox, SJS Tx - Trigeminal neuralgia. Complex partial seizures.
28
Phenytoin side effects?
Nystagmus, Gingival hyperplaia. LAD. SJS
29
Phenobarbital use?
DOC neonates. Criglig najar t2 (not as bad one)
30
Cluser headache prophylaxis? Acute tx.
Verapamil. Acute tx 100% o2, NOT sumatript
31
Alzheimer Picks parkinsons Lewy Body Multisystems Atrophy
Alzheimer - DEC ACh. Extraceullar B amyloid. Neurofib tagle (intracellular), Hyperphosph Tau. Picks - FT - disinhibition. Spherical Tau. Early alzheimer Parkinsons - DEC Dopa (sub Niag)/Basal ganglia. Lewy body (a synuclein). Lewy Body - Early dementia, hallucination. Parkinsonism late. Multisystems Atrophy - Parkinsonims w/ autonomic dysfunction.
32
Huntintons chemical changes, location, presentation.
AD - DEC GABA form caudate/basal ganglia. - Neuronal death via NMDA and glutamate toxicity.
33
Presentation - CJD Pml
CJD - Startle myoclonus - B pleated sheats - spike waves on EEG. PML - ICH - nonenhancing lesions w/o mass effects
34
``` NF1 NF2 SturgeWeber TS VHL ```
NF1 - cafe au lait, lisch nodules, optic gliomas/iris hamartomas, Pheos, Chr 17 NF2 - BIlat schannomas, meningioma, NF SturgeWeber - Port wine, ipsi leptomeningial, Hemangioma, TS - AD - Angiofibromas, Hamartomas, RHabdomyomas, Angiomyolipomas VHL - Cavernous hemangiomas, Bilat RCC, Pheos.
35
Chiari 2 Dandy walker
Chiari 2 - cerebellar hernaiation, myelomeningocele, syringomyelia Dandy Waker - absent Vermis - cystic, 4th
36
Charcot Marie TOoth - findings
AD - myelin defect - MOTOR AND SENSORY - Scoliosis, arcch/feet problem. DEC conduction of neurons.
37
Werdig Hoffman Polio
WerdigH - AR - floppy baby, anterior horn> Polio - flaccid paralysis - anterior horn
38
ALS - dm to? presentation, tx?
UMN and LMN. Full sensory. Tx baclofen, rilouzole
39
Friederichs Ataxia - signs? genetic problem?
Friedrech Ataxia - Cerebellar + Spinal findings. AR - trinucleotide. Chr 9, frataxin. Mitochondrial function. HAMMER TOES. Kyphoscoliosis.
40
Adrenoleukodystrpohy - problem and findings
CoA to fatty acid. Dmg to adrenals, testes, white matter. Adrenal crisis, coma.
41
CNS lymphoma - imaging presenation and dx?
Weakly ring enhacning - Dx EBV CSF
42
GBS - CSF findings?
Normal cell (normal WBC) and glucose. INC! protein sensory may be affected as well.
43
Menieres presentation? BPPV - Vestibulopathy
Ear fullness, tinnitus, horizontal nystagmus BPPV - Calcium crystals in semicircular canal. BRIEF. No tinitus. Vertigo WITH MOVEMENT. Vestibulopathy - nystagmus with head thrust (may be aminogylcoside induced)
44
Wernicke Korsakoff
Wernicke - Encephalopathy, oculomotor, ataxia korsakoff - Konfabulation, Irreversible amnesia, apathy
45
Brain death - what signs remain?
No eye reflexes, no breathign drive, no atropine heart reflex. DTR still intact (spinal cord still works!)
46
Alz vs NPH
NPH has gait disturbances firstg and most prominent. Alz may get ataxia and incontinence later
47
Central cord injury Anterior Spinal cord injury
Central cord injury - Upper extremity> Lower extremity due to placement in cord. Anterior spinal Cord - Lower > Upper motor, DEC pain and temp. +-bladder and bowel. DCML fine.
48
Bacterial meningitis tx?
STEROIDS (if negative for strep, d/c) ICH - Vanc, Cefapime, Ampicillin
49
CP presentation
Tone, spasticity, MR, Gain, feet abnormality. Preterm risk factors.
50
Alz tx -
Donepezil, Rivastigmine, Galantamine All anticholinesterase inhibitors
51
Uncal herniation - which CN goes first
CN3 first
52
Cluster headaches - presentation ppx Tx?
Cluster headaches - lacrimination, rhinorrhea, conjunctival injection. No n/v PPx w/ verapamil tx - 100% 02, Not sumatriptan
53
Syncope: Vasovagal vs Carotid sinus syncope
Vasovagal - clinical dx. If complciated for whatever reason, Upright table tilt. Carotid sinus syncope - not vasovagal - Hypersenstiivty of carotids. TIGHT COLLAR.
54
Astrocytomas – prognosis
based off of GRADE of anaplasia
55
CSF findings of HSV encephalitis
– WBC 25, , Glucose normal, RBC ~700+, Protein HIGH
56
BPPV – etiology and tx?
Displaced otoliths or Ca crystals in semicircular. Tx is repositioning head xercises (Epley maneuver) to try to reposition displaced otoliths.
57
Migraine tx
Triptans, NSaids, Antiemetics, Ergots (Dihydroergotamine). However, do NOT give triptans and Ergots together – can cause prolonged vasospasm.
58
Migraine ppx
– Topiramate, Valproic, TCA, BB. (don’t confuse w/ cluster headache pp Verapamil)
59
More than 3/4 hours singe stroke? Tx?
Aspirin
60
After stroke, what to start everyone on?
Statin
61
Which medication can low progression of parkinsons?
MAO inhibitor (Rasagiline) Levo Amantandine pramipexole etc do not slow.
62
Restless leg syndrome tx?
Pramipexole (dopamine agonist)
63
GBS - tx? Acute Myasthenic Crisis tx?
NO STEROIDS IVIG OR Plasmapheresis - NOT AND. GBS and Myasthenai both dont take steroids. ITP has steroids.
64
ADHD - tx?
Methylpehnidate, dextroamphetamine BUT SECOND LINE - ATOMOXETINE - NE reptakei has fewer side effects, less abuse - highly lauded on Step 2 CK
65
Ataxia, dysmetria, nystagmus
cerebellar hemorrhage.
66
Contra hemiparesis and sensory loss, upgaze palsy
thalamic
67
After stroke give what ppx - Algorith with past strokes, afib etc
Aspirin. If on aspirin with stroke, give clopidogrel OR dipyridamole. If with afib, give anticoagulation.
68
Social Anxiety Disorder (Social Phobia)–
THIS IS DIFFERENT CATEGORY THAN SPECIFIC PHOBIA. Fear of scrutiny, embarrassment about performance, social situations.
69
Does not respond to Sertraline. What to do
Same class SSRI. If fail 2 trials, switch to different class
70
Ataxia, dysmetria, nystagmus Contra hemiparesis and sensory loss, up gaze palsy Contralateral hemiparesis and sensor, gaze palsy
Ataxia, dysmetria, nystagmus – cerebellar hemorrhage. Contra hemiparesis and sensory loss, up gaze palsy- thalamic Contralateral hemiparesis and sensor, gaze palsy - basal ganglia
71
Restless leg tx
Pramipexole(dopa ago) or Gabapentin (CC)
72
Parkinson gait?
Narrow based, hypokinetic. NOT Broad/wise based gait. Wide base is more cerebellar or sensory ataxia.
73
Absence seizures 2 tx
Ethosuximide, valproic.
74
Somatic disorder vs Illness anxiety Disorder
Somatic has sx 1 or more. Illness anxiety is worry with minimal/no sx.
75
Location fo Brocas and Wernickes
Brocas (frontal lobe), Wernickes (Temporal)
76
neuro/psych drugs assoc w/ pancreatitis?
Valproic associated with actue pancreatitis, as are other anti epileptics
77
Acute mania tx of choice –
Antipsychotics (Haloperidol as well as risperidone, olanzapine etc). Mood stabiliers Lithium, Valproate Carbamazepine take longer to kick in.
78
Pseudotumor concerns
BLINDNESS. Seizures, bleeds, urinarny incontienc unlikely. May shut or optic nerve seath fenestration to prevent blindness (also why you see papilledema)
79
Sexual assault associated with what risk?
PTSD, depression, suicidality. Nicotine and drugs NOT assoc risk.
80
Friedrichs Ataxia vs CP
do not mix up! Both have odd feet findings and gait/weaknes sin lower limbs. BUT friedrichs will have heart issues as well.
81
Posterior vermis syndrome
– gait, trunk dystaxia!, horizontal nystagmus, papilledema (medulloblastoma
82
Epidural hematoma algorithm
emergent craniotomy. Steroids have no role (unlike spinal compression and bacterial meningitis)
83
Fibromyalgia first line
TCA, then SSRI
84
Manic breaks and cessation of meds
If one, can stop after 1 year. If 2 -> years/lifetime. 3-> lifetime recommended.
85
Imaging findings in autism, OCD, Panic, PTSD, Sschizoprhenia:
Autism: INC total brain volume; OCD: Orbitofrontal cortex and stgriatum; Panic: Amygdala DEC; PTSD dec Hippocampal; Schizophrenia ENLARGEDMENT OF VENTRICLES.
86
Normal protein CSF levels
less than 40
87
Classic migraine picture (even in kids) without foacl neuro problems algorithm
counsel on migraines and nsaids. Triptains if these don’t work.
88
Tourette tx
– Antipsychotuic, clonidine, behavioral therapy. NOT SSRI.
89
Edpitural hematoma what to do
emergenct craniotomy for all edidurals.
90
Benzo vs Barbiturates mech?
Benzo GABA Cl INC FREQ. Barbiturates Cl INC DURATIOn.
91
Most effective therapy for prevent PTSD after traumatic event?
Group counseling
92
Antidepressant with weight loss/fewest sexual side effects
Buproprion. Assoc w/ seizures in anorexics.
93
Easiest way to differeniate anorexia from bulimia
Anorexia underwegith, bulimia normal weight. Both may have purging hx. Olanzapine great for anorexia (antipsychotic + weight gain)
94
Tx for anorexia bulemia body dysmorphic
anorexia - antispychotic (olanzapine) bulemia - SSRI body dysmorphic - SSRI/cbt

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