Texas Review Flashcards
(163 cards)
1
Q
What stroke can lead to disinhibition like mania?
A
Right Frontal Hemisphere Stroke
2
Q
Meds to Avoid in Mania?
A
SSRIs and TCAs
3
Q
Lithium toxicity sxs
A
N/V/D, coarse tremor, ataxia, confusion, slurred speech
4
Q
Lithium Major Side Effects
A
Weight gain, acne, GI irritation, cramps
5
Q
Lithium MOA
A
Suppresses Inositol triphosphate
6
Q
Therapeutic Levels of different anticonvsulants
A
Lithium: 0.6-1.2 mg
Depakote: 6-12 mg
Carbamazepine: 60-120 mg
7
Q
What to monitor for Lithium?
A
Li level q4-8 weeks
TFTs q6mo
Cr, UA, CBC, EKG
8
Q
Contraindications for Lithium?
A
Severe renal dz, MI, diuretics or digoxin, MG, pregnancy or breastfeeding
9
Q
Valproate side effects
A
N/V/D, skin rash
10
Q
SJS/TEN with BAD
A
Lamotrigine (less likely tegretol)
11
Q
Bipolar and agranulocytosis cause
A
Tegretol. Monitor weekly CBC if ANC<1000
12
Q
Bipolar and inc. AFP in a 20 wk preggo?
A
Neural tube defect from Depakote or Tegretol. Take 4g of folate a day.
13
Q
Carbamazepine most common side effect?
A
Rash
14
Q
First thing to ask a very depressed patient?
A
Want to kill yourself?
15
Q
What kind of stroke can mimic depression?
A
Left MCA stroke
16
Q
beta-blockers, alpha-methyldopa, l-dopa, OCPs, ETOH can all trigger what
A
depression
17
Q
Porphyria, Lyme, Uremia, Hungtington’s, MS, Lupus can cause what
A
depression
18
Q
Atypical Depression Symptoms
A
- Weight gain/Increased appetite
- Hypersomnolence
- Rejection Hypersensitivity
- Leaden paralysis
19
Q
Complicated vs. Uncomplicated Bereavement?
A
No suicidal ideation other than thoughts of wanting to be with loved one. No psychosis other than hearing/seeing loved one.
20
Q
Adjustment Disorder, when must it start and how long can it last?
A
Must start within 3 months of an identifiable stressor and cannot persist longer than 6 months after the stressor ends.
21
Q
How to treat adjustment disorder?
A
Psychotherapy
22
Q
Most drug-drug interactions SSRI
A
Paroxetine
23
Q
SSRI with fewest drug-drug interactions?
A
Citalopram…I thought it was fluoxetine in Lange?
24
Q
Discontinuation syndrome sxs?
A
HA N/V/D Dizziness Fatigue Brain Zaps
25
Serotonin syndrome sxs?
```
Myoclonus (lower extremities)
Tachycardia
High BP
Hyperreflexia
n/v/d
```
MAOI + SSRI
26
SSRI causes impotence, switch to?
Bupropion
27
Contraindications to Bupropion?
Seizures, alcoholics, bulimia
28
Good for old, skinny, sad women?
Remeron for sleep and appetite
29
ECT is best for what patients
Preggos and Old people
30
Avoid what antidepressant in hypertensive patients?
Venlafaxine. Don't take with st. John's wort
31
Hypertensive crisis from MAOI
Pounding HA
Flushing
Nausea
Myoclonus
32
How to treat hypertensive crisis from MAOI?
Phentolamine 5 mg IV
| alpha1 antagonist
33
Causes of hypertensive crisis from MAOI?
Cheese, anything fermented/pickled, wine
Decongestants
Demerol (Meperidine, Pethidine)
34
Effect of TCA on EKG?
QRS widening and prolonged QT interval
35
Normal QTc in males and female?
Males: <440 ms
36
Tx for TCA overdose?
Charcoal if w/i 1-2 hrs
| IV sodium bicarb to help with metabolic acidosis and cardioprotective
37
Negative symptoms of schizophrenia?
5 A's
1. Anhedonia
2. Affective Flattening
3. Alogism
4. Avolition (Apathy)
5. Attention
38
Most common type of SCZ?
Paranoid, best prognosis
39
SCZ heritability?
MZ twin: 50%
| Sibling: 10%
40
Brief Psychotic Disorder vs. SAD vs. SCZ
BPD 6 mo.
41
How to treat SAD?
Atypical + SSRI/Li (depending on mood symptoms)
42
SAD vs. SCZ symptoms
SAD requires 2 weeks of psychotic symptoms with the absence of affective symptoms
43
Psychotic Depressino tx.
Atypical + SSRI
OR
ECT (especially if pregnant)
44
Clozapine and Prolactin?
Doesn't cause increases in prolactin?
45
Atypicals vs. Typicals effect on Prolactin
Typicals raise prolactin because they block DA so strongly, Atypicals typically don't have any substantial effect on prolactin, except for Risperdal (the most typical atypical)
46
Butyrophenone is what
Drug class: Includes Haldol
47
Chlorpromazine causes what side effects?
1. Jaundice (from anticholinergic effects?)
| 2. Purple grey metallic rash over sun-exposed areas
48
Thioridazine side effects
Pigmentary retinopathy
| Prolonged QTc
49
Antipsychotics and QTc
Low potency and atypicals have a greater effect?
50
Antipsychotics and seizure threshold
Low potency and atypicals have a greater effect?
51
Parkinsonism tx
Cogentin/Benadryl, amantadine/bromocriptine (DA agonists)
NO L-DOPA
52
Onset of different EPS
```
Acute dystonia (6 mo.)
TD (years)
```
53
Neuroleptic Malignant Syndrome sxs.
1. Hyperthermia
2. Rigidity
3. Autonomic Instability
4. Delirium
5. Increased CPK
54
NMS tx
1. D/c med
2. Dantrolene and cooling blankets
or bromocriptine (2nd line)
55
Other causes of NMS
Metoclopromide, compazine, droperidol
56
Atypical with highest risk for EPS and increased prolactin?
Risperdal
57
Atypical Weight neutral but prolongs QTc
Ziprasidone
58
Atypical Weight neutral but increases akathisia
Aripiprazole
59
Atypical Most associated with weight gain (#1 s/e is sedation)
Olanzapine
60
Atypical Causes orthostasis and cataracts
Quetiapine (alpha blocking properties)
61
Good for treating refractory SCZ
Clozapine
62
Clozapine most common s/e
Sedation, weight gain, increased blood sugar and lipids
63
Most dangerous S/e for clozapine
decreased seizure threshold and agranulocytosis
64
Clozapine monitoring
CBC: ANC qWeek for 6 mo., then q2weeks for next 6 mo.
| D/c if WBCs <1500
65
Patient comes in with something like a panic attack, what do you do first?
Cardiac screening: EKG, cardiac enzymes, echo, TSH or T4, UDS
66
Panic Disorder tx
Alprazolam or Clonazepam PRN short term
| SSRIs are preferred drug
67
Don't give benzos to these patients:
Addicts
COPD
Restrictive lung disease
68
Sedative/Hypnotic withdrawal symptoms
Hyperthermia
Convulsions
Confusion
Hypertension
69
Treating sedative/hypnotic withdrawal
Diazepam/Chlordiazepoxide + haldol if psychotic
70
Liver safe benzos
Lorazepam, Oxazepam, Temazepam
71
Specific Phobia tx
CBT with flooding or exposure/extinction
| Benzos for situational use
72
Social Phobia tx
Propranolol to stop hyperarousal and a Benzo
| CBT Assertiveness training
73
Avoidant PD tx
CBT
74
GAD tx
Buspirone (5HT1a partial agonist)
Benzos to bridge for 3 weeks
but I thought SSRIs are first line?
75
OCD comorbid with
Tourettes
76
OCD tx
SSRIs
77
OCD NT dysfunction
Serotonin (hence SSRIs and clomipramine)
78
PTSD diagnosis
1. Experienced a trauma
2. Flashbacks/Nightmares
3. Avoiding things/places/people
4. Poor mood
5. Hypervigilance/Hyperarousal/exaggerated startle
79
PTSD tx
SSRIs: Sertraline or Paroxetine
CBT
Prazosin for nightmares (alpha1 antagonist)
80
Adjustment Disorder w/ anxiety vs. PTSD
No traumatic event, but some stressor like a bad breakup....???????
81
Anorexia Lab abnormalities
Vitals: Hypotension, Bradycardia, Hypothermia
CBC: Leukopenia
BMP: High HCO3, low Cl, low K, high carotene, high LFTs and amylase
TFTs: Normal
Lipids: High cholesterol
Hormones: High cortisol, low LH/FSH, low estrogen
82
Anorexia long term complications
Osteoporosis
83
Anorexia most common cause of death
Heart disease, then suicide
84
Anorexia treatment
Admit for nutrition, intensive counseling
85
Refeeding syndrome
Low Phosphate, Low Mg, low Ca, and fluid retention
| Low phosphate and Mg b/c ATP is used up to phosphorylate Glucose
86
Slow wave sleep has how much delta?
50% delta in stage 4
87
What parasomnias happen in slow wave sleep?
Sleep walking/talking/night terrors
88
Insomnia diagnosis...
>1 mo.?
89
Insomnia tx.
Sleep hygiene, then GABAa agonist
90
Dyssomnia NOS
Creepy-Crawlies on legs and must move around
91
Dyssomnia NOS causes
Fe-def anemia, chronic kidney dz, neuropathy
92
Dyssomnia NOS treatment
Ropinirole or pramipexole (DA agonists)
93
OSA vs. Breathing Related sleep diagnosis
OSA is on axis III and the other on axis I
94
Paranoid PD tx
Antipsychotics can help paranoia
95
Antisocial PD comorbid condition
2/3 have substance abuse
96
Histrionic PD comorbidities
Substance abuse, eating disorder
97
Avoidant PD tx
tx social phobia sxs w/ beta blocker or SSRI
98
Dependent PD tx
SSRI. Look for comorbid depression and anxiety
99
Biggest risk factor for delirium
Age. Underlying dementia is the 2nd biggest. Also look for acute substance withdrawal. Look for it on the 2nd or 3rd post-op day in alcoholic.
100
Delirium on EEG
Diffuse background slowing of background rhythm
101
Psychosis on EEG
Normal
102
Alzheimer's features
Aphasia, apraxia, memory loss
| on MMSE, prompting does not improve recall
103
Alzheimer's pathology
Global brain atrophy. Beta-amyloid plaques or tau tangles
104
Alzheimer's genes
APP (chr. 21), ApoE E2
105
Alzheimer's tx
Donepezil, rivastigmine, galantamine (diarrhea), memantine
106
Frontotemporal dementia (Pick's Dz) features
More sexually explicit, apathy
107
Pick's disease pathology
Lobar atrophy. Intra-neuronal silver staining inclusions
108
Pick's disease tx
Olanzapine for severe disinhibition
109
Lewy Body Dementia features
Fluctuation in consciousness, visual hallucinations and shuffling gait
110
Lewy Body Dementia pathology
Intracytoplasmic alpha-synuclein inclusions in neocortex
111
Lewy Body treatment
Give AChE inhibitors, no L-Dopa. Avoid neuroleptics
112
Cruetzfeldt-Jakob features
Myoclonus, startle response, seizures. Recently had a corneal transplant
113
Prion EEG findings
Triphasic Bursts!!!
114
NPH symptoms
Classic Triad: Incontinence, gait ataxia, rapidly developing dementia
115
NPH tx
Ventriculoperitoneal shunt improves cognitive fxn in 50-67% of patients
116
Alcohol withdrawal and autonomic hyperactivity...how long?
12-24 hrs since last drink (bimodal peak at 8 and 48 hrs)
117
How long till DTs
48-72 hrs
118
How fast is alcohol metabolized
Zero-order kinetics (25 mg/hr)
119
How to monitor if tx is sufficient
Follow hyperreflexia to dose the benzos during withdrawal
120
Best txs for alcohol withdrawal
Diazepam or Chlordiazepoxide b/c of respective 80 and 120 hr half lives
121
If he's Cirrhotic, use what benzos
Lorazepam, oxazepam, or temazepam because they are glucuronidated before elimination
122
Most specific test for ETOH consumption in the past 10 days?
Carbohydrate-deficient Transferrin
| Less specific: Elevated GGT and AST>ALT 2:1
123
Korsakoff's syndrome/psychosis
Apathy, anter/retrograde amnesia and confabulation. Can see mamillary body atrophy on MRI
124
Opiate withdrawal symptoms
```
Joint an dmuscle pain
Photophobia
Goosebumps
Diarrhea
Tachyardia
HTN
GI cramps
Dilated pupils
anxiety/depression
```
125
Non-opiate treatment for opiate addiction
Clonidine, ibuprofen (muscle cramps), loperamide for diarrhea,
126
Opiate treatment for opiate addiction
Methadone, buprenorphine, naltrexone for long-term dependence
127
PCP intoxciation signs
Horizontal nystagmus, dilated pupils, ataxia and acute psychosis
128
Stimulant withdrawal sxs
SI, hypersomnia, depression, and anergia
129
Stimulant intoxication signs
Dilated pupils, eizure, tachycardia, HTN
130
Stimulant toxicity tests and tx
EKG, then urine tox screen.
Tx seizure with lorazepam
Tx HTN and tachycardia with CCB, do not use beta-blockers
131
Most common inherited cause of MR
Fragile X (dominant inheritance, CGG repeats with anticipation)
132
Down syndrome physical signs
Decreased tone, oblique palpebral fissures, simian crease, big tongue, white spots on his iris
133
Down syndrome medical complications
1. Heart: VSD, endocardial cushion defect
2. GI: Hirschsprung's, intestinal atresia, imperforate anus, annular pancreas
3. Endocrine: Hypothyroidism
4. MSK: Atlanto-axial instability
5. Neuro: Increased risk of Alzheimer's (APP is on Chr. 21)
6. Cancer: 10x increased risk of ALL
134
Neurofibromatosis
Cafe au lait spots, seizures large head. Aut. dominant
135
Hurler syndrome
Coarse facies, short stature, cloudy cornea. Aut. rec.
136
Smith Magenis
Broad, square face, short stature, self-injurious behavior. Deletion on Chr. 17
137
Prader-Willi
Hypotonia, hypogonadism, hyperhagia, skin picking, aggression. Deletion on paternal Chr15
138
Angelman
Seizures, strabismus, sociable with episodic laughter. Deletion on maternal Chr15
139
Williams
Elfin appearance, friendly, increased empathy and verbal reasoning ability. Deletion on Chr7
140
Fetal alcohol syndrome
ADHD like sxs, microcephaly, smooth philtrum. Most common cause of mental retardation
141
Congenital CMV infection
Seizures, chorioretinitis, hearing impairments, periventricular calcifications, petechiae at birth, hepatitis
142
Congenital Rubella Syndrome
Seizures, hearing impairments, cloudy cornea/retinitis, heart defects, low birth weight
143
Cerebral Palsy from birth asphyxia
Abnormal muscle tone, unsteady gait, seizures, mental retardation or learning disability
144
Cornelia de Lange
IUGR, hypertonia, distinctive facies, limb malformation, self-injurious behavior, hyperactive
145
CHARGE
Coloboma, heart defects, choanal atresia, growth retardation, GU anomalies, ear deformity, and deafness. Chr. 8
146
DiGeorge
Autism spectrum sxs, heart disease, palate defects, hypoplastic thymus, hypoCa. Chr 22 deletion
147
Maple Syrup Urine Disease
Vomiting, seizures, lethargy, coma. Acidosis with stress, illness. Causes neurological damage
148
Rett Syndrome
Exclusively in girls, normal development for 6-8 mo. then regression, ahndwrining, loss of speech, and use of hands. Xlinked dominant deletion of MECP2
149
Childhood Disintegrative Disorder
Normal development until age 2 then major loss of verbal, social skills with autistic like behavior
150
Autism
Lack of mother-child eye contact, language delay/repetitive language, preoccupation with parts of toys before age 3
151
Asperger
Problems with social skills (usually recognized in preschool) with preserved verbal ability
152
Heritability of ADHD
77%
153
Risk factors for ADHD
Low birth weight, tobacco/etoh exposure
154
ADHD comorbid condition
ODD/CD in 30-50%
155
Weird ADHD meds
Clonidine, guanfacine (alpha2 agonists)
156
Conduct disorder diagnosis
Need sxs for 6 mo.
Comorbid substance abuse
May become antisocial PD
157
Oppositional Defiant diagnosis
Need sxs for 12 mo.
| Stops just short of breaking the law or physically harming others
158
Tourettes diagnosis
Tics at least once a day for 1 year w/o a tic free peiod longer than 3 mo.
159
Tourettes comorbid
OCD
160
Tourettes tx
First line: Clonidine, then Pimozide/Haldol
161
Fecal retention tx
behavioral modification that only rewards
162
Urinary incontinence diagnosis
UA and urine culture. Imipramine works but relapse is common. Use alarm and pad for 6 wks first. ddAVP has the same problem as imipramine with relapse but side effects of headaches, nausea, and hyponatremia
163
Desmopressin and blood pressure
Does not increase blood pressure like vasopressin
