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Neuro Psych > Week 5 6 & 7 > Flashcards

Week 5 6 & 7 Flashcards

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1
Q

nociceptive pain

A

pain due to mechanical, thermal or chemical activation of receptor to noxious stimuli

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2
Q

neuropathic pain

A

pain due to damage to neuronal pathways involved in sensory processing

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3
Q

hyperalgesia

A

abnormal increase in sensitivity to painful stimuli (may occur after injury)

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4
Q

allodynia

A

perception of normal stimuli as painful

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5
Q

paresthesia

A

spontaneous sensations without generating stimuli

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6
Q

deafferentation pain

A

from interruption of afferent nerve impulses of spinothalamic tract

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7
Q

A-delta fibers

A

fast, sense pain

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8
Q

C fibers

A

slow, sense itch, temp and pain

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9
Q

gate control theory

A

interplay between fibers in dorsal horn such that activation of surrounding fibers (mechanical, shaking, pressure) can suppress pain signal (and TENS can also block)

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10
Q

pain inhibitory descending pathways (4)

A 
o	Locus coeruleus – noradrenergic 
o	Dorsal raphe – serotonergic, GABAergic 
o	Endogenous opioids
-	Endorphins, enkephalins, dynorphin 
o	Cannabinoids, adenosine
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11
Q

central wind up pain

A

intensity increases over time for a given stimulus delivered repeatedly above critical rate
has greater firing, decreased threshold, increased or abnormal VGNaC

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12
Q

3 major opioid receptor subtypes

A
  • Endorphins – MOR – Mu
  • Enkephalins – DOR – delta
  • Dynorphin – KOR – kappa
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13
Q

what does MOR do

A

Gi protein that inhibits adenyl cyclase and VGCC to increase K+ that leads to analgesia sedation, euphoria (reward, want MOR), antitussive (cough, codeine)

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14
Q

intracranial pain sensitive areas

A

venous sinuses, basal arteries, dura of fossae

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15
Q

red flags for headaches

A

change in pattern, progressive worsening, neurological dysfunction, fever, stiff neck, vomiting, confusion, LOC, character/personality change, post-trauma

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16
Q

tension headache

A

nagging, pressure, vice grip, band like

bilateral

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17
Q

migraine headache

A

unilateral, throbbing, worse with activity, aura, allodynia, triggers

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18
Q

migraine w/o aura diagnostic criteria

A

at least 5 attacks, 4-72 hours long, unilateral, pulsating, moderate to severe pain, aggravation by physical activity, associated with nausea, vomiting, photophobia or phonophobia

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19
Q

migraine w/ aura diagnostic criteria

A

At least 2 attacks fulfilling “without aura” criteria plus aura
Aura – visual disturbance like lines, lights flashing, color changes

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20
Q

retinal migraine

A

monocular visual disturbance, with scintillations, scotomata, blindness, and migraine headaches and normal optho exam

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21
Q

cluster headache

A

30-90 min
comes and goes in waves
one side, behind eye/temple, like a hot poker, eye redness and tearing, nasal discharge, drooping of eyelid, agitated, pacing, wakes at night (~1hr of sleep)

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22
Q

in elderly patients on BZDs, use ___________ to prevent ____________

A

1/2 dose to prevent falls

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23
Q

MS symptoms

A

Changes in sensation in arms, legs or face
Optic neuritis, nystagmus, diplopia
Weakness, spasms
Fatigue, cognitive impairment, depression

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24
Q

MS pathology

A

BBB breakdown allows T-cells to enter CNS and destroy myelin sheath

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25
MS imaging
Gad enhancing lesions on T1 with plaques in white matter
26
MS labs
elevated IgG | oligoclonal bands
27
Neuromyelitis optica / Devic's disease
demyelination and necrosis of optic nerves and spinal cord often preceded by viral illness and associate with systemic autoimmune diseases
28
Neuromyelitis optica / Devic's disease symptoms
optic neuritis | myelitis
29
agoraphobia
distress from excessive worry in two or more situations: public transportation, open spaces, enclosed spaces, in line, in crowds or outside of the home alone
30
biomarkers for EtOH abuse (3)
γ-glutamyltransferase (GGT), carbohydrate-deficient transferrin (CDT) – better for recent heavy drinking/relapse ethylglucuronide (EtG) – detects any drinking w/i 72 hours
31
Wernicke-Korsakoff syndrome
due to vitamin B1 deficiency • Wernicke – encephalopathy, ataxia and ophthalmoplegia; Medical emergency – give B1 and Mg • Korsakoff – anterograde amnesia, “stories”
32
what two drugs are not on a regular drug screen (2)
fentanyl, clonazepam
33
opioid drug testing
Natural derivatives – morphine -> test + Semi-synthetics – hydrocodone -> test + or – Synthetics – methadone -> test –
34
hallucinogen persisting perception disorder
re-experiencing of symptoms from hallucinogens like: | afterimages, trails, color flashes, lights and halos
35
what can you treat opioid addicted pregnant patient
methadone | can add buprenorphine
36
neonatal abstinence syndrome
high-pitched crying, yawning, sneezing, tremors, ↑ muscle tone, feeding difficulties, diarrhea, tachypnea or apnea, seizures
37
disinhibited social engagement disorder
o Child has experienced extremes of insufficient care (social neglect, deprivation, changes, unusual) o After age 9 months, child develops pattern of disinhibited behavior (not just impulsivity) towards unfamiliar adults
38
acute stress disorder
o Exposure to trauma involving threat of death or injury or repeated exposure to details of trauma o Leads to 9 or more of: Intrusive symptoms, negative mood, dissociative symptoms, avoidance or arousal problems (sleep, emotion, concentration) o Lasting for 3 days to 1 month
39
self induced emesis causes _________
metabolic alkalosis
40
laxative and diuretic abuse cause ______
metabolic acidosis
41
difference between bulimia and anorexia
BN patients tend to experience their eating symptoms as more ego-dystonic (distressing) & thus they more readily seek treatment, compared to AN
42
Lhermitte sign | what is it and what does it suggest
electrical sensation runs down limbs when neck is bent forward dorsal column lesion
43
Uhthoff phenomenon
worsening of symptoms of demyelinating diseases when body gets overheated by weather, exercise, fever, sauna, hot tub etc
44
difference between delirium and dementia
delirium will have an organic cause that can be seen on labs or imaging
45
potential underlying causes of mental disorders
TIT v DID | tumor, infection, trauma, vascular, degenerative, intoxications, developmental
46
delusional disorder
more than 1 delusion for at least one-month duration, function not markedly impaired or bizarre
47
positive symptoms of schizophrenia
hallucinations, delusions, disorganized speech, bizarre behavior, poor affect
48
negative symptoms of schizophrenia
alogia (poverty of speech), affective blunting (↓emotional range), apathy, anhedonia-asociality (inability to experience pleasure or enjoy activities)
49
pathophysiology of schizophrenia
dopamine hypothesis and glutamate hypothesis | hypofunction of NMDA receptors
50
schizophrenia co-morbidities risk
13x suicide rate, cardiovascular disease, weight gain, diabetes, metabolic syndrome, pulmonary disease, medications, lifestyle, SUDs
51
schizoaffective disorder
period with a major depressive or manic episode with Criterion A for schizophrenia - Bipolar type – if the disturbance includes a manic or a mixed episode - Depressive type – if only includes major depressive episodes
52
cataonia
psychomotor disturbance with stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, echolalia, echopraxia
53
mesolimbic dopamine pathway - blockage causes what and comes from where
Block of this pathway treats positive symptoms like delusions/hallucinations From midbrain (ventral tegmentum to nucleus accumbens)
54
mesocortical dopamine - blockage causes what and comes from where
Block of this pathway may exacerbate the negative symptoms From ventral tegmentum to PFC
55
nigrostriatal dopamine pathway - blockage causes what and comes from where
Block of this pathway can lad to EPS (dyskinesia, parkinsonism, akathisia) From substantia nigra to basal ganglia
56
tuberoinfundibular dopamine pathway - blockage causes what and comes from where
Block of this pathway can lead to hyperprolactinemia (sexual dysfx, amenorrhea) From hypothalamus to anterior pituitary
57
acute dystonic reaction
abrupt, distressing, painful, sustained contraction/spasm of the muscles of the neck, eyes, mouth, tongue, trunk or extremities; within first 4 days of treatment with antipsychotics
58
treatment of acute dystonic reaction
IM Benztropine or diphenhydramine
59
tardive dyskinesia
From chronic dopamine blockade via nigrostriatal pathway (super-sensitivity to DA) Lip smacking, sucking, puckering, choreoathetoid-like movements of fingers and toes and slow, writhing movements of the trunk
60
neuroleptic malignant syndrome
Idiosyncratic reaction to dopamine antagonists that causes severe muscle rigidity, elevated temperature plus diaphoresis, confusion, coma, tachycardia, HTN, leukocytosis, elevated CK Exposed to DA agonist within 72 hours, but can be up to 30 days
61
treatment for neuroleptic malignant syndrome
muscle relaxant dantrolene, dopamine agonist bromocriptine, or ECT
62
paroxysmal depolarization shift
Intense depolarization of epileptic neurons because the opening of the voltage gated potassium channels is not enough to bring the membrane down to baseline
63
most typical EEG wave
alpha | 8-13 Hz
64
Benign Rolandic Epilepsy (Benign Epilepsy with Central Temporal Spikes)
Twitching, numbness, or tingling of the child's face or tongue (a partial seizure), which often interferes with speech and may cause drooling
65
genetics related to Janz Syn (myoclonic epilepsy of childhood)
6p EF, GABRA1
66
genetics related to astrocytoma (4)
IDH1, EGFR, ATRX, and TERT
67
genetics related to oligodendroglioma (2)
1p and 19p co-deletions
68
genetics related to medulloblastoma (1)
MYCN amp
69
genetics related to Temozolomide treatment response
MGMT
70
type of edema seen with brain tumors
vasogenic
71
children with brain tumors often present with ____________
early morning headache and vomiting
72
children often have brain tumors located in _________
midline | leading to loss of coordination and spasticity due
73
features of glioblastoma (4)
worst adult tumor angiogenesis/ neovascularization prominent palisading necrosis ring enhancing lesion on imaging
74
features of pilocytic astrocytoma (4)
benign biphasic cystic pattern elongated cells and Rosenthal fibers
75
features of oligodendroglioma (3)
round nuclei with halos, fried egg appearance chicken wire vascularization calcifications
76
features of ependymoma (2)
rosettes | 4th ventricle
77
features of medulloblastoma (4)
grade 4 tumor of children small blue cells homer wright rosettes radio-sensitive
78
medulloblastoma genetics
* Wnt pathway has best prognosis | * Myc pathway has worse prognosis
79
delirium treatment options
haloperidol atypical antipsychotics BZDs
80
neurofibromatosis I
o NF1 on Chr 17q AD Peripheral neuromas, optic glioma Café-au-lait spots, subQ nodules Developmental delay, visual issues, painful neuromas, scoliosis
81
neurofibromatosis II
o NF2 on Chr 22 AD Bilateral acoustic neuromas, earing and balance issues
82
Tuberous Sclerosis
o TS C-1 (hamartin) and TS C-2 (tuberin) AD to inhibit mTOR kinase Developmental delay, seizures, adenoma sebaceous Ash leaf spots, Pial hemagiomatosis, calcification, seizures Giant Cell Astrocytoma
83
sturge weber syndrome
o GNAQ Chr 9:21  sporadic Development delay, ADHD, headache, seizures, Pial hemagiomatosis, calcification, Port wine stain, buphthalmos
84
von hippel lindau
o VHL tumor suppressor gene 3p25-26 AD | Polycythemia, cystic lesions, tumors, telangiectasias, hemangioblastomas
85
Ataxia Telengectasia
o ATM AR IgA and IgG deficiency that can lead to sinus and lung infections Telangiectasias, cerebellar dysfunction, gait abnormalities
86
Osler Weber Rendu (Hereditary hemorrhagic telangiectasia)
o ALK-1, ENG, and SMAD4 genes AD Ocular and nail related telangiectasias Brain arteriovenous malformations, seizures/headaches/ataxia, visual
87
Klippel Trenauny syndrome
o PIK2CA gene Overgrowth of bone and tissues, pain, bleeding, port-wine stains Spinal cord arteriovenous malformations, paralysis (Coup de Poignard)
88
acute meningitis bugs
* Viral – enterovirus * Bacteria – many (Neisseria, group B strep in newborns) * Naegleria fowleri
89
subacute meningitis bugs
* Mycobacteria – Mycobacterium tuberculosis * Spirochetes – Treponema pallidum, Borrelia burgdorferi * Fungi – Cryptococcus neoformans, Candida spp. Coccidio, Aspergillus
90
CSF changes in meningitis
low glucose, increased protein
91
acute encephalitis bugs
* Viral – arthropod borne (West Nile), HSV, HIV, CMV, polio, rabies * Other – listeria, rickettsia, mycoplasma, toxoplasma
92
chhonic encephalitis bugs
Tuberculous tuberculoma, neurosyphilis
93
malignant hyperthermia
rapid onset of tachycardia, muscle rigidity, HTN, hyperthermia, hyperkalemia, hypercapnia and metabolic acidosis

Neuro Psych (4 decks)

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