STEP 2 neuro & psych

Question 1

Nonmedical interventions for schizophrenia?

Answer 1

Stable, nonstressful home environment

Family education

Question 2

NMS vs serotonin syndrome?

Answer 2

SS has:
diarrhea
hyperactive bowel sounds
dilated pupils
hyperreflexia and clonus
"autonomic instability"

Question 3

CSF study results for GBS?

Answer 3

albuminocytologic disassociation:

high protein, nl WBC count in CSF

Question 4

migraine abortive tx:

Answer 4

• prochlorperazine (compazine), chlorpromazine (thorazine), metoclopramide (reglan)
• triptan if early in course
• NSAID

Question 5

vertigo ddx

Answer 5

BPPV: otolith
- paroxysmal (usu no NV), positional (reaching overhead or turning), nystagmus (upbeat torsional)
- tx: epley maneuver
labyrinthitis vs vestibulitis: viral illness 1 wk ago.
- +NV. auditory sx = labyrinthitis. nystagmus opposite lesion.
- tx: steroids and meclizine
Meniere’s dz: chronic endolymphatic hydrops
-hearing loss, ear fullness, +NV. R/o TIA.
-tx: benzos, antimigraine
vestibular migraine: migraine sufferers
- vertigo w/o hearing loss
r/o TIA

Question 6

incidence/heritability of bipolar?

Answer 6

incidence: 1% genl pop
10% one parent
60% two parents
70% monozygotic twins

Question 7

cluster headache acute tx and ppx?

Answer 7

acute: triptan and O2
ppx: verapamil, ergotamine, lithium

Question 8

cavernous sinus thrombosis sx?

Answer 8

headache, exophthalmos, chemosis
dilated tortious retinal veins, papilledema
unilateral->bilateral

Question 9

focal neurologic signs following sharp trauma to soft palate = ?

Answer 9

ICA dissection

Question 10

side effect of fluphenazine?

Answer 10

hypothermia - inhibits hypothalamic shivering reflex

Question 11

features of thalamic hemorrhage?

Answer 11

eyes deviate AWAY from lesion
nonreactive pupils
contralateral hemiparesis/hemisensory loss

Question 12

features of pontine hemorrhage

Answer 12

coma/paralysis

pinpoint reactive pupils

Question 13

tx to prevent vasospasm after SAH?

Answer 13

nimodipine

Question 14

what are the acetylcholinesterase inhibitors? which cross the BBB?

Answer 14

edrophonium - short acting, diagnosis of MGrav only
neostigmine, pyridostigmine - tx for MG / glaucoma
physostigmine - CROSSES BBB.
donepezil - central for Alzheimer’s

Question 15

cerebellar lesions - difference btw vermis and hemisphere lesion?

Answer 15

vermis - truncal ataxia (alcohol)

hemisphere - limb ataxia

Question 16

tx for adjustment disorder?

Answer 16

psychotherapy 1st line

Question 17

tx for social anxiety disorder?

Answer 17

for performance only:
-benzo or propranolol
for more severe form:
-SSRI or SNRI

Question 18

separation anxiety disorder vs selective mutism?

Answer 18

SAD: extreme anxiety when has to go to school
selective mutism: fine at home but just doesn’t talk at school
therapy +- drugs

Question 19

structural brain abnormalities in:
autism
schizophrenia
panic disorder
OCD
PTSD

Answer 19

autism: incr total brain vol
schizophrenia: enlarged ventricles
panic disorder: decreased amygdala volume
OCD: abnormalities in orbitofrontal cortex & striatum
PTSD: decreased hippocampal volume

Question 20

CSF findings in viral meningitis?

Answer 20

lymphocytic pleocytosis, increased protein, nl glucose

Question 21

CSF findings in TB meningitis?

Answer 21

lymphocytic pleocytosis, increased protein, decreased glucose

Question 22

tx for restless leg syndrome?

Answer 22

dopaminergics: pramipexole, levodopa

Question 23

triptans are incompatible with which other migraine med?

Answer 23

dihydroergotamine (ergots) - causes severe vasoconstriction leading to possible stroke

Question 24

blurred vision + glare at night = which vision disorder?

Answer 24

cataracts

Question 25

tx for specific phobia?

Answer 25

cognitive therapy

Question 26

one episode of major depression = how long SSRI tx?

Answer 26

6 months

Question 27

lithium: contraindications? | interactions?

Answer 27

``` contraindications: -pregnancy: Ebstein's anomaly, DI -CKD: may worsen renal function, DI -heart disease: arrhythmias with CAD interactions: -diuretics -ACEI/ARB -NSAIDs -SSRIs -antiepileptics ```

Question 28

complications of anorexia nervosa?

Answer 28

-osteoporosis -euthyroid sick syndrome -long QT -elevated cholesterol & carotene -hyponatremia & other electrolyte abnormalities -HPA axis disturbances (amenorrhea, infertility) when pregnant: -postpartum depression -SGA baby

Question 29

management of IIH?

Answer 29

acetazolamide +- lasix short term: steroids and serial LPs if refractory long term: LP shunt or optic nerve sheath decompression

Question 30

lacunar stroke syndromes?

Answer 30

``` pure motor (internal capsule, equal face-arm-leg) pure sensory (thalamus?) mixed sensory-motor clumsy hand-dysarthria ataxic hemiparesis ```

Question 31

brain imaging findings in alzheimer's?

Answer 31

diffuse cortical and subcortical atrophy

Question 32

which conditions are contraindications to buproprion usage?

Answer 32

epilepsy anorexia nervosa and bulimia - electrolyte abnormalities predispose to seizures concurrent heavy alcohol or benzo use