Quiz 3 Flashcards
(218 cards)
1
Q
What are the 5 histories to take of every patient presenting with headaches?
A
1) Family History
2) Life history
-Car sickness, abdominal pain as child
-Time course
3) Attack history
-Aura
-OLDCAAARS
4) Medical History
5) Medication History
Includes OTC, drug use, and natural products
2
Q
What are the four general stages of migraine headache episodes?
A
3
Q
What acronym is used to screen for secondary headaches?
A
4
Q
What are the four pain sensitive and five pain insensitive structures of the head?
A
5
Q
What are the three classes of primary headache disorders? What are the five classes of secondary headache disorders?
A
6
Q
What are the ICHD criteria for diagnosing migraine?
A
7
Q
What three symptoms of migraine were studied and found to be 93% predictive of migraine if 2/3 were met?
A
8
Q
How are episodic vs chronic migraines differentiated?
A
Episodic: <15 days per month
Chronic: >15 days per month
9
Q
What type of headache (only type) is more common in men than in women?
A
Cluster headaches
Named for cycling of attacks in spring or fall
10
Q
What are the diagnostic criteria for an episodic tension-type headache? What differs in chronic presentation?
A
Chronic presents on more than 15 days per month.
11
Q
What is the classic presentation of Temporal Arteritis? What labs are expected to be elevated?
A
12
Q
Is IIH or pseudotumor cerebri more common in men or women?
A
6:1 in women compared to men
13
Q
A sudden onset of the worst headache of someone’s life should always include what pathology near the top of the differential? What imaging should be done?
A
14
Q
A presentation of a new, daily, persistent headache, possibly presenting with fever and nuchal rigidity would point to what on the differential? What testing should be done?
A
Meningeal irritation: Meningitis
Lumbar puncture must be performed
15
Q
Where is the most common location for pain in trigeminal neuralgia?
A
The V2 distribution, and is often triggered by light touch
16
Q
What is the most common cause of trigeminal neuralgia in younger individuals vs older individuals?
A
17
Q
What are the genes and their respective channelopathies associated with familial hemiplegic migraines?
A
18
Q
What is the current prevailing theory regarding the etilogy of the aura that presents before about 30% of migraines?
A
That it is caused by a cortical spreading depression of brain activity.
19
Q
What effect does CGRP have on migraines? Stimulation of what ganglion increases serum CGRP? Is it a vasocontrisctor or vasodilator?
A
20
Q
What are the 4 steps in migraine management according to current guidelines?
A
21
Q
In what situations may an opiate be indicated for treatment of migraine?
A
Pregnancy
Elderly patients
Cardiac cases
22
Q
What is the MoA of Ergotamine and Dihydroergotamine? Which is more commonly used? What are notable SE or CI?
A
It can cause spontaneous miscarriage in pregnancy.
23
Q
What are 4 notable CI for triptan class drug use?
A
24
Q
What are the 4 elements of the MoA of triptan class drugs?
A
25
Which triptan drugs are short acting ? Which are long acting? Include generic and brand names for both.
26
Which triptan drug has to have its dose reduced when used with **Propranolol**? How much should the dose be reduced?
**Rizatriptan** or *MAXALT*
27
Which triptan drug cannot be used within 72 hours of a **CYP3A4 inhibitor* *(i.e. ketoconazole, clarithromycin)*?
**Eletriptan** or *Relpax*
28
What is the SE profile for triptan drugs?
29
What is the MoA of **Lasmiditan**? What advantage does it offer over *triptan class* drugs? What is the major SE?
30
Which two major drug classes can add to risk of **serotonin syndrome**?
SSRIs
Triptans
*Just one SSRI and one triptan is not enough to cause this syndrome*.
31
What is the MoA of **Gepants**? What makes them an especially promising new treatment for headaches? Name two *Gepants*.
32
What characterizes **Medication overuse headaches**? What are some drugs that can cause them? What is the two step treatment?
33
Name examples of preventative medications for *migraine* that can be used from the following drug classes:
Anticonvulsants (2)
Anti-depressants (2*)
Beta-blockers (3)
CCBs (3)
NSAIDs (1)
5HT antagonists (1)
OTHER (4)
**CCBs**
*DHP*- Amlodipine
*Non-DHP*- Verapimil, Diltiazem
*Avoid drugs that worsen a condition (TCAs or AD in overweight individuals, etc)*
34
What 4 CGRP monocloncal antibodies have been approved by the FDA for episodic and chronic migraine treatment? Which of the 4 targets the *CGRP receptor* as opposed to the *peptide*?
35
How long should a preventative medication for migraine headache treatment be tried?
AT LEAST 6-8 weeks, possibly longer
36
What are the *preventative* and *acute* treatments for cluster headaches? Which are approved by the FDA?
**Galcanezumab** is the only FDA approved for cluster headache prevention, though **Verapamil** is the most commonly used, and *Topiramate* is used less often, sometimes as an add-on
37
What are potential side effects of *anticonvulsant therapy* such as **topiramate**?
-Brain fog
-Changes in taste
-Eye pain -> refer to ophtho
38
When should a patient with suspected cluster headaches get imaging done?
-If they are in their 30's or older
-If *neurological symptoms* present
39
What brain structure is most likely involved in a **cluster headache**?
The **ipsilateral hypothalamus**
40
Why is SC sumatriptan often preferred over PO sumatriptan when treating cluster headaches?
Cluster headaches tend to last 45 minutes to an hour, and PO sumatriptan would take to long to take effect
41
In a headache with sudden presentation and worry of a stroke, what type of imaging would be best?
CT (better visualization of fluid than a MRI; also faster)
42
Why is a *migraine aura without headache* liable to produce an EEG with lateralized slowing in the brain?
A migraine aura can cause **cortical depression**, which can lead to depressed activity on EEG
43
When should TIA/stroke be considered in patients with a *typical aura without headache*?
44
What are notable differencies in *visual** and **sensory** symptoms of an aura in *Migraine* versus in *TIA*?
45
What 4 notable MRI with contrast features are associated with **IIH**? What number out of 4 is considered *high specific* for **IIH**?
46
Are CTs or MRIs generally preferred for sudden onset headaches?
CT is generally done first
47
What are typical treatments of **Primary Thunderclap headaches**?
48
What is the classic presentation of a patient with a **cluster headache**?
49
What is the classic presentation of a patient with a **brain tumor** headache?
50
What is the classic presentation of **trigeminal neuralgia**?
51
Why is a CN VI palsy sometimes referred to as the *falsel-localizing-sign-of-6*?
CN VI weakness or palsely is often due to **elevated ICP** and not necessary a lesion to CN VI specifically
*Checking CN VII is a good idea to rule out a pontine lesion.*
52
How does a patient noting that headaches are "worse when lying down, and better when standing up" help to support a diagnosis of headache cause?
53
A patient with new onset headache who also presents with *recent weight gain*, *increased ICP* (such as papilledema, CN VI paralysis or diplopia) and *unremarkable MRI scans* would most likely have what diagnosis to explain their headaches? What is pathognomonic for this disorder?
**Idiopathic intracranial hypertension** or **IIH**
Visual dim-outs when arising from recumbency are **pathognomonic** for IIH.
*Note that the falsely localizing sign of CN VI is often seen in IIH*.
54
What diagnostic procedure could confirm suspected **IIH**?
A *spinal tap* could document the elevated ICP. This process (measuring pressure) is called **manometry**.
55
What is the normal value for CSF pressure?
12-20cm H2O
**OR**
120-200mm H2O
56
Which medications are associated with a diagnosis of **IIH**?
**High Vitamin A derivatives**
-Pre-natal vitamin or multivitamin
-Acne medications
**-cycline antibiotics**
-Doxycycline
-Minocycline
-Tetracycline
*If a medication is implied to have caused elevated ICP, the diagnosis is now IATROGENIC intracranial hypertension, as it is no longer idiopathic.*
57
What is the difference between *addiction* and *dependence*?
**Addiction**- the psychological changes and behaviors that occur with repeated substance use
**Dependence**- physiologic changes that occur with repeated substance use
58
What are the 3 stages in the *Three Stage Model of Addiction*?
59
What is the name of this molecule? What drug class does it belong to?
*Succinylcholine*, which is a **Depolarizing Neuromuscular Blocker**
60
What is the MoA of *Succinylcholine*? How quick is its onset?
It depolarizes **Nm receptors**, and due to slow removal from the NMJ it induces a *flaccid paralysis* **with fasciculations**.
**Rapid** onset
61
What are the four main examples of **Non-Depolarizing Neuromuscular Blockers**? Which are steroid derivatives vs. benzyl isoquinolones? How quick is their onset?
Rocuronium (1-2 min, *rapid*)
Vecuronium
Cistracurium
Mivacurium
All except *rocuronium* have an onset of 2-3 min
62
What characterizes Phase I block with **succinylcholine**? How long does it typically last?
It hasa duration of 5-10 minutes.
63
What characterizes Phase II block with **succinylcholine**? What can initiate phase II and why should it be avoided?
It can occur with **large doses** of succinylcholine and should be avoided to due unprredictable *duration* and *reversal*.
64
What are the durations of action of the four main **Non-Depolarizing Neuromuscular Blockers**?
Mivacurium *15-20 min*
Cistracurium *40-75 min*
Rocuronium *35-75 min*
Vecuronium *45-90 min*
65
What endogenous enzyme metabolizes **Succinylcholine**?
*Plasma pseudocholinesterase*
66
What are notable SE of **Succinylcholine**?
Malignant Hyperthermia trigger- treat with **dantrolene**
Hyperkalemia
Cardiac arrythmias
Myalgia
**Increased** ICP, IOP, IGP (intra-gastric pressure)
67
What are notable SE for the four main **Non-Depolarizing Neuromuscular Blockers**?
Mivacurium- Histamine release
Rocuronium- mild vagolytic effects
68
What is the MoA and clinical use of **Dantrolene**?
It is a *skeletal muscle relaxant* that inhibits calcium release from the SR by **antagonizing the ryanodine receptor**.
It is used to treat **Malignant Hyperthermia**.
69
What is the clinical use of **Sugammadex**?
It is a cyclodextrin reversal agent for:
**Rocuronium**
**Vecuronium**
70
What are **reversal agents** used for **Non-Depolarizing Neuromuscular Blockers**?
**Neostigmine**
**Edrophonium**
WITH:
*Glycopyrrolate*
*Atropine*
*Note that Sugammadex can be used for reversal of steroid derivative NDNMBs*
71
What characterizes the first stage of the *Three Stage Model of Addiction*?
VTA = *Ventral Tegmental Area*
It is responsible for releasing **dopamine** onto the Nucleus Accumbens.
NAc = *Nucleus Accumbens*
It is a core area associated with the reward system
72
What characterizes the second stage of the *Three Stage Model of Addiction*?
Two main impacts:
1) Baseline dopamine receptor concentration **is reduced**
2) HPA/Stress Axis is dysregulated
Hypothalamus releases *more* **CRF**
Anterior pituitary releases *more* **ACTH**
Adrenal cortex releases *more* **Cortisol**
In short, more drug is needed to reach "normal" baseline
73
What characterizes the third stage of the *Three Stage Model of Addiction*?
The *prefrontal cortex* contains the systems that provide the capacity for **executive functioning**, such as impulse control. One of these such areas is the **ventromedial prefrontal cortex**.
74
Define pain:
75
Define **transduction** as part of the nociceptive response. What are the main two types of nociceptive fibers and their respective roles?
Transduction is *conversion of energy to an electrical signal*.
76
Define **transmission** as part of the nociceptive response. In what lamina do A-delta and C fibers reside, respectively?
77
What is *central sensitization*?
78
What is *wind-up* as it pertains to nociception?
79
What is *gate theory* as it pertains to nociception? Which fibers are involved and what order neurons are affected?
80
Define **modulation** as part of the nociceptive response.
Modulation involves change of nociceptive signal.
81
What is the signifiance of the **Periaqueductal gray** or **PAG** and the **Rostral ventromedial medulla** or **RVM** in the modulation of pain?
82
Define **perception** as part of the nociceptive response. What 6 areas of the brain comprise the *pain matrix*? What two divisions of the spinothalamic tract are used to transmit nociceptive signals?
Perception involves *the interpretation of the nociceptive signals*.
83
What is generally the difference in duration between acute and chronic pain? What type of pain is consistantly nociceptive?
84
What is **nociceptive pain**? What are the two subtypes?
85
What is **somatic pain**? What is the common etiology?
86
What is **neuropathic pain**? How does it differ from *nociceptive pain*?
It is important to note that it occurs **without** activation of peripheral nociceptors by actual or potential tissue injury
87
What are four significant causes of **peripheral neuropathy**?
*Peripheral neuropathy* is a subtype of **neuropathic pain.**
88
What two notable **anticonvulsant** medications are used in the treatment of *neuropathic pain*? What is their MoA?
89
What are notable SE of *Gabapentin* and *Pregabalin*? What is unique about their doseage and frequency?
90
What in the MoA of **TCAs** makes them useable for treating neuropathic pain?
They can:
1) Block **serotonin** and **NE** reuptake in presynaptic terminals
2) Competitive antagonists on post-synpatic **alpha 1 & 2**, **muscarinic** and **histaminergic** receptors
91
Which SNRI is commonly used for neuropathic pain, and is FDA approved for diabetic PN and fibromyalgia? What are common SE?
92
How can **ketamine** be used to treat neuropathic pain?
It is used clinically as in pain management, and also as an anesthetic.
*Note it can be abused for patients to get high*
93
What is the MoA of **ziconotide**? What is unique about the delivery mechanism for this drug?
It is delivered *intra-thecally* through a pump, and is commonly a component of palliative care.
94
What are two notable local anesthetics used to treat neuropathic pain? Which is taken orally? Which is more poorly tolerated? Which is often used for post-herpetic neuralgia?
95
What are the 5 main NSAIDs to know for Step 1? Which of these is **COX-2 selective**? What are common SE of these drugs?
96
What is the MoA of **acetaminophen**? What clinical uses does it have? What is the antidote for acetaminophen overdose?
97
What are the three types of opioid receptors in the body? Which receptor binding produces the most significant analgesic effects?
The *mu* opioid receptor.
98
Of this list, which opioid side effects tend to be chronic?
99
Per the CDC guidelines regarding opioid perscription:
-How long should they be prescribed for acute pain?
-What dose should be started?
-What combination is important to avoid?
-What additional Rx should be considered?
*Note that tapering needs to be carefully controlled*
100
What are the three main areas that comprise **risk factors** for chronic pain?
*Note that this is called the Biopsychosocial model*
101
What drug is used to reverse an overdose in *Alcohol/Sedative-Hypnotic Dependence Disorder*? What is the MoA? What is the RoA and setting in which it must be used? What is its BBW?
**Flumazenil**
102
What is the main drug used in relapse prevention/maintenance for patients with *Alcohol/Sedative-Hypnotic Dependence Disorder*? What is the MoA? What is the RoA? What is the BBW? What type of therapy is it considered?
Name the other drug sometimes used for the above treatment. as well as its MoA and SE.
103
What two classes of medications are used to treat **withdrawal** in patients with *Alcohol/Sedative-Hypnotic Dependence Disorder*?
Benzodiazepines
Barbiturates
104
What are the three *benzodiazepines* that can be used for *A/SHDD* withdrawal? What is their MoA? What is their RoA? What risk is incurred by concurrent ingestion of opioids?
**Chlordiazepoxide** *(Librium)*
**Diazepam** *(Valium)*
**Lorazepam** *(Ativan)*
MoA: GABA-A receptor agonists (they increase frequency of Cl- channel opening)
RoA: PO, IM, IV
*Risk of respiratory depression when combined with opioids*
105
Which baribituate medication is used in treatment of *A/SHDD*? What is the MoA? What is the RoA?
**Phenobarbital**
MoA: GABA-A receptor agonists (they increaseduration of Cl- channel opening)
RoA: PO, IM, IV
106
What is the preferred drug to use in event of *opioid overdose*?
107
How can knowing if a patient is right or left handed help to localize a *Broca's* or *Wernicke's* aphasia?
In theory, brain dominance should be contralateral to handedness, and the dominant brain hemipshere is where the language and handedness should lie.
108
If a patient with an affected Broca's area also began to have the area anterior to it affected as well, what symptoms could be expected? What area lies anterior to Broca's?
109
What is another term for eye movement apraxia? Why do CN III, IV, and VI *technically work*, but not fully?
**Supranuclear gaze palsy**
The brainstem is intact, with full capability of moving EOM through full ROM, but *cerebral* control of the movement is impaired.
110
What is *prosopagnosia*?
*Face blindness*, or the inability to consciously recognize familiar faces, sometimes including ones own.
111
What part of the brain is lesioned to produce *prosopagnosia*?
The *fusiform gyrus*, which affects the medial occipto-temporal lobes (often bilateral).
112
What are three notable withdrawal symptoms that could be seen 4 hours after a dose of lorazepam?
Tremor
Sweating
GI distress
In short, *general autonomic instability*
113
What characerizes **Delirium Tremens**? How long after the last dose of alcohol can it take to set in? How long can it last? What is the mortality rate?
It is the most severe stage of *Alcohol withdrawal*.
114
What is the **Caine Criteria** used for? What are the four criteria? What action should be taken at what point?
It is the criteria for *diagnosis* and *treatment* of **Wernicke Encephalopathy**.
115
What are 5 symptoms of *opioid withdrawal* would be suspected in the first 24 hours since the last dose?
Chills*
Sweating*
Lacrimation
Piloerection
Midriasis
*Chills and sweating are commonly seen in alcohol and sedative withdrawal as well
116
What characterizes **Generalized Anxiety Disorder** or **GAD**?
-Excessive anxiety and worry occuring most days for **at least 6 months**
-Worry or anxiety is accompanied by **at least 3 of the following symptoms** *(only 1 in children)*:
Restlessness or feeling on edge
Fatigue
Concentration problems
Irritability
Muscle tension
Sleep disturbance
117
What characterizes **Panic Disorder**?
-Recurrent, unexpected panic attacks
- At least 1 attack is followed by **at least 1 month** of one or more of the following:
Worry about additional panic attacks or catastrophic health events
Change in behavior based on attack
118
How is a **Panic Attack** defined?
Palpitations
Sweating
Trembling or shaking
SOB
Feeling of choking
Chest pain/discomfort
MANY more
119
How long a duration must symptoms be present for *GAD*, *Agoraphobia*, *Specific Phobia*, or *Social Anxiety Disorder* to be diagnosed? How long must symptoms of *Panic Disorder* present for following a panic attack?
120
How does the time course for a normal stress response, *Acute Stress Disorder*, and *PTSD* differentiate them?
121
Are *compulsions* necessary for a diagnosis of **OCD**?
122
What are the 4 areas of symptoms required to diagnose **PTSD** or **Acute Stress Disorder**? How many symptoms are required in each section? How are these two disorders differentiated?
123
What is the function of the following areas of the cerebellum:
**Vermis**
**Hemispheres**
124
What artery supplies blood to the *anterior lobe* and *dorsal vermis* of the cerebellum?
125
What artery supplies blood to the *posterior lobe*, *inferior vermis* and *tonsils* of the cerebellum?
125
What artery supplies blood to the *anterior portion* of the **posterior lobe** as well as the *flocculus* of the cerebellum?
126
What are the three cellular layers of the cerebellum? What is significant to know about **purkinje cells**?
Purkinje cells:
-Are the *output* cell of cerebellar cortex
-Are *highly* susceptible to insults
127
Where are the cerebellar deep nuclei found?
They are found *beneath* the cerebellar cortex in the **white matter**.
128
Identify each of the 4 cerebellar deep nuclei:
129
What is the function of the **Fastigial nuclei** in the cerebellum? What is the function of the **Globose** and **Emboliform nuclei**? What is the function of the **Dentate nucleus**?
130
What is the function of the **vestibulo-cerebellum**?
131
Which cerebellar peduncle is connected to each part of the brainstem? What arteries supply each of the cerebellar peduncles?
132
What two cerebellar nuclei compose the **interposed nuclei**?
The *globose* and *emboliform* nuclei
133
FItB: The *Superior peduncle* connects the cerebellum to the **Rubrospinal system** which modulates __________ motor control. The primary neuron arises from _____________ cells, then synapses with the secondary neuron in the ______________ nucleus, which exits the **superior peduncle** and decussates in the ___________ and synpases with the tertiary neuron in the ________ nucleus. It then descends through the brainstem via the _____________ tract.
134
In the **Cerebellothalamocortical pathway** whhere does the primary neuron arise? Where does it synapse with the secondary neuron? Which cerebral peduncle does it exit? Where does it decussate? Where does it synapse with the tertiary neuron? Where does it terminate?
135
Where is the primary neuron in the **Corticopontocerebellar pathway**? What is the secondary neuron? Where does it decussate? Which cerebral peduncle does it enter? Where does it end in the cerebellum?
136
Are cerebellar exam signs ipsilateral or contralateral?
They are **ipsilateral**
137
Would a lesion at location A, B, and/or C produce cerebellar signs?
At C, which could be in the *cerebellum proper* or in the *peduncles*.
138
What is connected by the *olivocerebellar tract*? What process does it facilitate?
139
Is the vestibulocerebellar pathway afferent or efferent? What does it connect?
140
What is connected by the *spinocerebellar tract*?
The *proprioceptive neurons* and the *cerebellar cortex and nuclei*.
141
Recall which of the following are involved in *afferent* or *efferent* pathways:
Superior peduncle
Middle peduncle
Inferior peduncle
142
Injury to what part of the cerebellum is likely to cause truncal ataxia, gait ataxia, and abdnormal saccades?
143
Inury to what part of the cerebellum could cause ataxia, hypotonia, intention tremor, and dysdiiadochokinesia?
144
Injury to what part of the cerebellum could cause truncal ataxia and nystagmus?
145
What are the four core symptoms used for diagnosing **Brief Psychotic Disorder**? How many symptoms must be present (and which does not count by itself)? How long is the duration of the disorder?
146
What arre the five core symptoms used for diagnosing **Schizophreniform Disorder**? How many core symptoms must be present? Which of those 5 must be at least 1 present? How long is the duration of the disorder?
147
What is the difference between a diagnosis of *Schizophreniform Disorder* and **Schizophrenia**?
148
What is the diagnostic criteria for **Schizoaffective Disorder**? How does it differ from a diagnosis of *Schizophrenia* or *Schizophreniform Disorder*?
149
What are the criteria for diagnosing *Delusional Disorder*?
*Note that you do not need to memorize the types of delusions.*
150
What is the main difference between *MDD* as well as *BP I&II* and *Schizoaffective Disorder*?
151
What is the criteria for diagnosing **Substance-induced Psychotic Disorder**?
152
What is the difference between *neuroleptic* and *antipsychotic* medications?
Nothing, they are synonymous
153
Describe where each of the following dopamine pathways *begin and end* as well as their *function*.
-Mesocortical
-Mesolimbic
-Nigrostriatal
-Tuberoinfundibular
154
Name the 6 main *typical antipsychotics* or *FGAs*.
*also trifluoperazine*
155
Explain common side effects of FGAs as D2 antagonists by each of the following pathways:
-Mesocortical
-Mesolimbic
-Nigrostriatal
-Tuberoinfundibular
Mesocortical- Anhedonia, apathy
Mesolimbic- Worsened cognition, more negative symptoms
Nigrostratal- Extrapyramidal (EP) symptoms
Tuberoinfundibular- Elevated prolacin
156
What are four notable side effects of antipsychotics as a result of "dirty binding"?
157
What are the symptoms of **Neuroleptic Malignant Syndrome**? (Hint: use the acronym FEVERM) How is it treated?
Treatment:
1) Stop antipsychotics
2) Dantrolene
3) Bromocriptine
158
What are the four main **Extrapyramidal Side Effects**? What is their time course? How are they treated?
159
Address the rough timeframe for antipsychotic treatment responses in the following areas.
160
What is *Todd post-ictal paralysis*?
Temporary post-seizure paralysis that can last as long as 48 hours. It may affect speech, gaze or vision.
161
What is meant by a focal seizure *with Jacksonian march*?
It denote a seizure spread from a distal point more proximally, often ending in the ipsilateral face
162
What do spikes on a n EEG indicate?
Epileptogenic activity
163
What is the preferred first-line treatment for generalized tonic-clonic seizure?
Lorazepam (Ativan) 1mg. It can also be given SL, IV, or IM. Other benzodiazapines such as diazepam or clonazepam may be used.
164
What are three common traeatments for epilepsy?
Levatiracetam (Keppra)
Phenytoin (Dilantin)
Valproic acid (Depakote)
165
What is the difference between *hypnogogic* and *hynopompic* hallucinations?
Hyponogogic- Hallucinations occur as one is *falling asleep*
Hypnopumpic- Hallucinations as one is *awakening*
166
What is the preferred test for diagnosing *Narcolepsy*?
The *Multiple Sleep Latency Test* or **MSLT**.
It is performed by ovserving how rapidly a patient enters REM sleep after multiple interruptions.
167
What are the top three treatments for *Narcolepsy*?
**Modafinil**
**Armodafinil**
Sleep hygiene (such as planned naps, sleep diary, etc)
168
What 5 notable MoAs of *General Anesthetics*? What are examples of medications used in each MoA?
GABA-A receptor potentiation- **Propofol**
Glycine receptor agonism & *Nicotinic* acetylcholine receptors- **Inhalational anesthetics**
NMDA receptor antagonism- Ketamine and NO
K+ channels- ?
169
What is **context-sensitive half-time**?
The time for plasma concentration of a drug to decrease by *50%* after the infusion is stopped.
170
What are the four stages of anesthesia?
171
What is the concept of **Minimum Alveolar Concentration** or **MAC**?
The equilibrated alveolar concentration of an inhalational anesthetic at which 50% of patients do not move in response to surgical incision.
172
Whta testing should be done in a patient with an impending diagnosis of a seizure disorder?
*Electrolytes, blood glucose, LFTs and toxicology*
If signs of infection are present -> *Lumbar puncture*
**Neuroimaging** is strongly recommended, MRI for better resolution and/or CT to rule out bleeding
173
What is a **seizure**?
An *uncontrolled burst of electrical activity* between neurons tha causes temporary abnormalities in:
- **muscle tone** or **movements**
-**behaviors**
-**sensations**
-states of **awareness**
174
What are some expected symptoms that can help to localize a seizure to each cortical lobe of the brain?
175
What is the difference between a *simple* and *complex* partial seizure?
Simple partial seizure- Focal onset with retained awareness
Complex partial seizure- Focal onset with impaired awareness
176
Which of the three *cerebellar peduncles* contain most of the cerebellar afferent tracts? Which contain most of the cerebellar efferent tracts?
**Superior peduncle**- Mostly efferent
**Inferior and Middle peduncle**- Mostly afferent
177
What are *mossy fibers* in context of the cerebellum?
**Mossy fibers** are cerebellar *afferent* axons that terminate on granule cells. Most excitatory cerebellar afferents are mossy fibers.
178
Symptoms of **truncal ataxia**, **titubation** (a rocking or tremor of head) and **dysmetric saccades** would indicate a lesion to what specific area of the cerebellum?
The *vermis*
179
What types of sensory endings *besides muscle spindles* convey information to cerebellum via the spinocerebellar tract?
*Golgi tendon organs* and *Mechanoreceptors*
180
The pontine nuclei receive information from the (ipsilateral/contralateral) cerebral cortex destined for the (ipsilateral/contralateral) cerebellar hemisphere.
The pontine nuclei receive information from the **ipsilateral** cerebral cortex destined for the **contralateral** cerebellar hemisphere.
181
What is the blood supply of the *Basal Ganglia*?
The **MCA**, specifically branches called the *lenticulostriate vessels*.
182
Where do **efferent** axons project to from the following:
*Globus pallidus*
*Putamen*
Globus pallidus
**Thalamus** *(Pallidothalamic tract)*
**Subthalamus**
Putamen
**Globus pallidus** (but no afferents)
183
In Parkinson's cases frefractory to L-dopa, what thalamic nucleus is the stereotaxic target?
**Ventral dorsal**, *ventral lateral/anterior*
184
RIght hemiballismus would occur due to a lesion in what part/side of the brain?
The *left subthalamic nucleus*
185
What part of the internal capsule separates the *caudate* from the *putamen* in the striatum?
The *anterior limb* of the internal capsule
186
What signifiant change in the Basal Ganglia is characteristic of **Huntington's disease**?
THe loss of medium sized cells in the *caudate8 and *putamen*.
187
Which tract is used by the Basal Ganglia to exert effects on motor behavior?
The corticospinal tract
188
What part of the internal capsule do *pallidothalamic axons* cross from the globus pallidus to the thalamus?
The *posterior limb* of the internal capsule
189
What drug is commonly referred to as "tranq"?
**Xylazine**
Note, it is an animal tranquilizer that is cheap and easy for the Mexican drug cartels to use. It is commonly cut with fentanyl to provide a longer high. It is very dangerous and found around the country, notably in Utah
190
What type of brain waves are observable during waking hours? What about when one is drowsy or very relaxed? List waves seen and/or notable waveforms seen in the following:
NREM 1
NREM 2
NREM 3
REM
*Also, note that GAMMA waves are seen during problem solving, and concentration during wake hours*.
191
What are **five** notable indications for **polysomnography**?
192
What is a **Multiple Sleep Latency Test**?
A test to assess disorders of *excessive sleepiness*
It involves a series of 5 scheduled naps and measures how quickly one falls asleep
193
What acronym describes the main symptoms associated with **Narcolepsy**?
194
What are three treatments for **Narcolepsy** that address *cataplexy*? What are three treatments that address *excessive daytime sleepiness*?
*Cataplexy*
-Fluoxetine
-Sertraline
-Venlafaxine
*EDS*
-Modafinil
-Armodafinil
-Dextroamphetamine
195
What criteria are used to diagnose **insomnia disorder**?
196
What are the **five ** classes of drugs used to treat insomnia?
1) **Z drugs** such as:
- *Zaleplon* (Sonata)
- *Zolpidem* (Ambien)
- *Eszopiclone* (Lunesta)
2) **Melatonin/ M receptor agonists**
3) **Benzodiazepines**
4) **Sedating Antidepressants**
5) **Antihistamines**
197
What is **Restless leg syndrome**? What time of day is it often worse? What is it associated with?
198
Though **Restless leg syndrome** can be treated by counterstimulation (baths, rubbing legs) and avoiding exacerbative drugs. what are some medical treatments?
**Gabapentin**
**Dopamine agonists** like Pramipexole or Rpoinirole (2 hours before sleep)
**Sedative hypnotics** like *Zaleplon*, *Zolpidem* and *Clonazepam*
199
Address the differences between **REM** (REM sleep behavior, Nightmare disorder) and **NREM** (Sleepwalking, Sleep terrors) disorders of sleep in the following areas:
Time of night
Sleep stage
Eye position during episode
Sensorium if awakened
Recall after episode
Polysomnography findings
200
What is the criteria for diagnosing **GAD**?
201
What is the diagnostic criteria for **agoraphobia**?
202
How long must symptoms be present for most anxiety disorders?
6 months
203
How long must panic attacks be present for the situation to be considered "panic disorder*?
1 month
204
Which of these symptoms could be better explained by another condition than OCD? What are examples for each?
Obsession with particular aspect of appearance
Hair pulling
Eating patterns
Difficulty parting with objects
Substance obsessions/compulsions
205
How is trauma defined as used in diagnosis of psychiatric disorders? Would exposure through the media be considered trauma?
No, PTSD criteria would involve witnessing first hand or being directly related or extremely close to a person experiencing the trauma firsthand
206
How is PTSD diagnosed?
207
How is *Acute Stress Disorder* different from PTSD?
208
What are the signs of **Neuroleptic Malignant Syndrome**? What causes it? What is the treatment?
It can be caused by antipsychotic medications, oftentimes in overdose
209
What differentiates left brain and right brain EEG leads?
210
Alpha, beta, theta, delta are all examples of measures of **what** in EEG?
EEG **frequency**
211
A seizure characterized by the following would be called what?
**Absence** seizure
212
A seizure characterized by the following would be called what?
**Clonic** seizure
213
A seizure characterized by the following would be called what?
**Automatism** (seen in generalized or focal seizures)
214
A seizure characterized by the following would be called what?
**Tonic-clonic** seizure *(Grand mal)*, which is a type of generalized seizure
215
A seizure characterized by the following would be called what?
**Myoclonic** seizure
216
A seizure characterized by the following would be called what?
**Tonic** seizure
217
