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143 Cards in this Set
- Front
- Back
- 3rd side (hint)
Which bacteria are encapsulated?
What test acn be used to detect encapsulated bacteria? |
Some Killers Have Nice Shiny Bodies:
Strep pneumo Neisseria Salmonella H flu (B) Klebsiella Detect w/Quelling |
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Drug of choice for anaphylactic shock
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Epi
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Drug of choice for cardiogenic shock
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Dobutamine
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Drug of choice for septic shock
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Norepi (alpha 1>>beta-1)
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Hyperacute rejection:
Mechanism Time Frame |
Pre-formed anti-donor Ab's; minutes
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A
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Acute rejection:
Mechanism Time Frame |
Cell-mediated immunity; weeks
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Chronic rejection:
Mechanism Time Frame |
Ab-mediated vascular damage; months to years
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Which antibiotics are used for narrow-spectrum anaerobic coverage?
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Metronidazole
Clindamycin |
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What portion of the brachial plexus is injured in Erb-Duchenne Palsy?
Symptoms? |
C5-C6 nerve roots
Syx: arm is in adduction, medial rotation, pronation |
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Adrenergic receptor type and effect of ligand binding on:
Vascular smooth muscle |
low dose-beta-2
high dose-alpha-1 |
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Adrenergic receptor type and effect of ligand binding on:
Renal vasculature |
D1--vasodilaiton
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Adrenergic receptor type and effect of ligand binding on:
Heart |
beta-1--inc'd HR and contractility
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Adrenergic receptor type and effect of ligand binding on:
Pulmonary bronchioles |
beta-2: bronchodilation
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Adrenergic receptor type and effect of ligand binding on:
Presynaptic neurons |
alpha-2--inhibit NE release
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Adrenergic receptor type and effect of ligand binding on:
Pupillary sphincter |
alpha1--mydriasis
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Adrenergic receptor type and effect of ligand binding on:
Kidney JG cells |
beta-1--renin release
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Adrenergic receptor type and effect of ligand binding on:
beta-cells of pancreas |
alpha-2--inhibit insuline release
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Adrenergic receptor type and effect of ligand binding on:
alpha-cells of pancreas |
alpha-2--inc'd glucagon release
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Adrenergic receptor type and effect of ligand binding on:
Liver |
beta-2--inc'd glycogenolysis and gluconeogenesis
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Elastic skin
Joint hypermobility |
Elhers-Danos Syndrome
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Enlarged, hard, left supraclavicular LN
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Virchow's node--visceral malignancy (stomach cancer)
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Strawberry tongue
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Scarlet fever
Kawasaki dz TSS |
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Resting tremor
Rigidity |
PD
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Rash on palms and soles
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Secondary Syphilis
Rocky Mtn Spotted Fever Coxsackie A virus (hand-foot-mouth dz) |
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Cytokines released by Th1 vs Th2
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Th1--IL-2, IFN-gamma
Th2--IL-4,-5,-10 |
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3 different G proteins and downstream effects?
Which receptors used for each G protein? |
Gq: QC
Activcates phospholipase C-->generates IP3-->inc'd intracell Ca2+ Also->generates DAG-->activates protein Kinase C Receptors: HAVe 1 M&M; H1, alpha 1, V1 (vasopressin), M1, M3 Gs protein: Stimulates adenylyl cyclase Generates cAMP from ATP cAMP activates Protein Kinase A beta1, beta2, D1, H2, V2 Gi Protein: Inhibits adenylyl cyclase Dec'd cAMP dec'd Protein kinase A MAD2's: M2, alpha-2, D2 |
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Drug category:
-ane |
inhaled anesthetics
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Drug category:
-azine |
phenothiazine neuroleptics--anti-emetics
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Drug category:
-tidine |
H2RA
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Drug category:
-tropin |
Pituitary hormone
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Drug category:
-chol |
Cholinergic agonist
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Drug category:
-bendazole |
Antiparasitic drugs
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Drug category:
-azepam |
Benzodiazepene
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Drug category:
-conazole |
Anti-fungal
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Drug category:
-tryptyline |
TCA
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Drug category:
-zosin |
alpha1-antagonist
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Drug category:
-stigmine |
AchE-inhibitor
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Drug category:
-dipine |
CCB
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Identify mature defense mechanism:
voluntarily choosing not to think about a bad piece of news |
Suppression
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Identify mature defense mechanism:
Using comedy to express feelings of discomfort |
Humor
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Identify mature defense mechanism:
Arsonist donates money to fire department |
Altruism
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Identify mature defense mechanism:
Using aggression to succeed in business ventures |
Sublimation
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Identify mature defense mechanism:
realistically planning for future inner discomfort |
Anticipation
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Identify mature defense mechanism:
consciously postponing an inner conflict until a big project if completed |
Suppression
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Identify mature defense mechanism:
redirecting impulses to a socially favorable object |
Sublimation
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Identify immature defense mechanism:
not acknowledging a piece of bad news, as though it was never said |
Denial
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Identify immature defense mechanism:
involuntary withholding of a feeling from conscious awareness |
Repression
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Identify immature defense mechanism:
Veteran describes horrific war details without emotion |
Isolation
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Identify immature defense mechanism:
Child abuser was himself abused as a child |
Identification (doing to others what was done to you)
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Identify immature defense mechanism:
Man yells at his family when he has a bad day at work |
Displacement
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Identify immature defense mechanism:
Closet homosexual hates homosexuals because of the way they make him feel |
Projection
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Identify immature defense mechanism:
Using intellectual processes to avoid affective expression |
Intellectualization
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Identify immature defense mechanism:
Belief that all people are either all good or all bad |
Splitting (borderline pts)
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Identify immature defense mechanism:
Expression aggression through passivity, masochism, and turning against self |
Passive aggressive
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Identify immature defense mechanism:
Changing ones character or personal identity to avoid emotional distress |
Projection
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Identify immature defense mechanism:
Returning to earlier level of maturation to avoid conflict at current maturation level |
Dissociation
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Identify immature defense mechanism:
Offering explanation for unacceptable belief/attitude/behavior |
Regression
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Identify immature defense mechanism:
Believing external source is responsible for unacceptable inner impulse |
Rationalization
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Identify immature defense mechanism:
Thought that is avoided is replaced by unconscious emphasis on opposite |
Reaction formation
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Identify immature defense mechanism:
Converting mental conflicts into bodily symptoms |
Somatization (conversion, etc.)
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Identify immature defense mechanism:
Temporarily inhibiting thinking but continuing to build more tension |
Blocking (schizophrenic pts)
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Identify immature defense mechanism:
Avoiding interpersonal intimacy to resolve conflict and obtain gratification |
Schizoid fantasy
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Identify immature defense mechanism:
Extreme forms can result in multiple personalities |
Dissociation
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Identify immature defense mechanism:
Chronically giving into impulse to avoid tension from unexpressed unconscious wish; tantrums |
Acting out
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65 year-old asks husband to stay in hospital overnight with her because she's afraid to be alone.
Defense mechanism? |
Regression--turning back maturational clock and going back to earlier modes of dealing with world (bedwetting, crying)
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Which defense mechanism underlies all other defense mechanisms?
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Repression--involuntary wittholding of an idea or feeling from conscious awareness (pressing bad thought into unconscious; forgetting a traumatic experience)
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60 year-old man admitted for chest pain jumps out of bed and does 50 push-ups to show nurses he has not had a heart attack.
Defense mechanism? |
Denial
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Infant deprivation effects:
What is it? Symptoms? |
Long-term deprivation of affection:
-Dec'd muscle tone -Poor language skills -Poor socialization skills -Lack of basic trust -Anclitic depression -Weight loss -Physical illness Severe deprivation-->infant death |
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Signs of physical abuse on child
Abuser epidemiology |
Healed fractures on x-ray
Cigarette burns Subdural hematomas Multiple bruises Retinal hemorrhage/detachment (shaken baby) Usually female and primary caregiver |
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Signs of sexual abuse on child
Abuser epidemiology |
Genital/anal trauma
STDs UTIs Abuser usually known to victim, usually male |
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Signs of regression in children
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Children regress to ounger patterns of bhvr under conditions of stress (physical illness, punishment, birth of a new sibling, fatigue)
Signs of regression: bedwetting in previously toilet-trained child when hospitalized |
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Methylphenidate:
MOA Use |
Amphetamine; increases pre-synaptic NE vesicle release
Use in ADHD |
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Dextroamphetamine:
MOA Use |
Ampethamine; increases pre-synaptic NE vesicle release
Use in ADHD |
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Atomoxetine:
MOA Use |
NE reuptake inhibitor
ADHD |
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When are stimulants such as amphetamines indicated?
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ADHD
Narcolepsy Obstructive sleep apnea Major depressive disorder |
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Conduct disorder:
What is it? |
Repetitive and pervasive behavior violating rights of others
After 18 years of age diagnosed as antisocial (anti-society, really) personality disorder Ex: animal abuse |
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Oppositional defiant disorder:
What is it? |
Enduring pattern of hostile, defiant behavior toward authority, but don't disobey rights of others
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Autism:
Characteristic features |
"Living in his own world"
Syx evident prior to age 3 Lack of responsiveness to others, poor eye contact, absence of social smile Impaired communication, language delay, repetitive phrases Repetitive, ritualistic habits (spinning around, hand flapping) Fascination with specific, mundane objects (vacuum cleaners, sprinklers) Below normal intelligence (usually) |
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Asperger's Syndrome:
Characteristic features |
Milder form of autism
Char'd by all-absorbing interests, repetitive behavior, problems w/social relationships Children are of normal intelligence No verbal, cognitive deficitsThis is x-linked dominant; males die in utero. Disease of women! Syx apparents at ages 1-4, followed by regression, loss od dev't, MR, loss of verbal abilities Mid-line hand wringing |
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Rett's Disorders:
Characteristic features |
This is x-linked dominant; males die in utero. Disease of women!
Syx apparents at ages 1-4, followed by regression, loss od dev't, MR, loss of verbal abilities Mid-line hand wringing |
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Childhood disintegrative disorder:
What is it? |
Marked regression in multiple area of functioning after at least 2 years of apparently normal development
Ex: loss of expressive or receptive language skills, social skills, bowel/bladder control |
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When a young monkey is separated from its mother, it becomes withdrawn, socially isolated, and grooms poorly.
What is the human equivalent of this problem? |
Anaclitic Depression
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Identify childhood psychiatric disorder:
Impulsive and inattentive |
ADHD
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Identify childhood psychiatric disorder:
Females only, loss of previously acquired purposeful hand skills between 6-30 months |
Rett Disorder
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Identify childhood psychiatric disorder:
Impairments in social interactions, communications, play, repetitive behaviors |
Autism
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Identify childhood psychiatric disorder:
Impairment in social interaction (but not avoidance), no language delay |
Asperger's
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Identify childhood psychiatric disorder:
Stereotyped hand movements |
Rett's disorder
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Identify childhood psychiatric disorder:
Ignoring basic rights of others |
Conduct disorder
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Identify childhood psychiatric disorder:
Hostility, annoyance, vindictiveness, disobedience, resentfulness |
Oppositional defiant disorder
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Identify childhood psychiatric disorder:
Multiple motor and vocal tics |
Tourette's syndrome
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Identify defense mechanism:
7 year-old avoids going to school to say at home with parent |
Separation anxiety disorder
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Trichotillomania:
What is it? Presentation |
Compulsive nervous hair pulling, common in young girls
Presentation reveals unusual patterns of broken hairs of varying length (wine brush feel) Tx: Education! |
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Anorexia vs Bulimia
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Anorexia nervosa:
Excessive dieting ±purging; intense feat of gaining weight, body image distortion; <85% ideal body weight Bulimia: binge eating ±purging: followed by self-induced vomiting, laxatives, diuretics, emetics Body weight within normal range! |
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Electrolyte changes seen in bulimia (emetic variant)
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Hypokalemia
Hypochloremia Metabolic alkalosis |
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Enlarged parotid glands
Mother found laxatives in patient's closet |
Bulimia
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How does binge eating disorder differ from bulemia?
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Binge eating disorder:
No purging Expression of deeper psychological problems Many have negative feelings toward food |
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How does compulsive eating disorder differ from bulimia?
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NO purging
Type of OCD Much time is spent thinking and fantasizing about food |
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What is gender identity disorder?
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Persistent cross-gender identification
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Transvestism vs Transsexualism
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Transvestism: paraphilia; wearing clothes (VEST) of opposite sex (cross dressing)--done for purpose of sexual arousal (not trying to identify with gender)
Transsexualism: desire to live as opposite SEX, oftehn through surgery or homones |
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NT disorders with depression
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Dec'd NE
Dec'd 5HT Decd' DA |
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NT disorders with anxiety
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Inc'd NE
Dec'd GABA Dec'd 5HT |
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NT changes with Alzheimer's dementia
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Dec'd ACh
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NT changes with HD
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Dec'd GABA
Dec'd Ach |
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NT changes with schizophrenia
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Inc'd DA
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NT changes with PD
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Dec'd DA
Inc'd 5HT Inc'd ACh |
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What is delirium?
2 most common causes |
Waxing and waning level of consciousness with acute onset
Rapid dec in attention span and level of arousal, hallucinations, illusions, disturbances 2 most common causes: UTIs Drugs--anti-cholinergics (mad as a hatter). often reversible. |
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What is dementia?
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Gradual dec in cognition with no change in level of consciousness; memory loss
Usually irreversible |
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What is pseudodementia?
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Depression presenting like dementia in elderly patients.
Ex: if patient consistently loses keys, and complains to MD about possible dementia, the patient DOES NOT have dementia. pts with dementia would not be aware of losing keys over and over. more likely to be depression. |
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72 year-old patient not able to recall 3 objects on mini-mental.
When asked what he'd do if he smelled smoke in a movie theater, he replies he would yell "fire." When asked what a table and chair have in common, he replied they both have 4 legs and are made of wood. Family reports for last year, someone has had to stay with him at all times for his own safety. He stays awake all day and sleeps well at night. |
Dementia
Yelling fire is socially inappropriate--would expect to look around to identify source of smoke. 4 legs and made of wood = concrete thinking--would expect an abstract answer, like "furniture" |
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72 year-old patient brought to clinic by family because of strange behaviors over past week.
She has been agitated, takes many naps during the day, occasionally urinates on herself, and has poor appetite. She is unable to complete a mini-mental because of poor ability to focus her attention. |
Delirium
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Temporal lobe atrophy-->AD
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Neurofibrillary tangles-->AD
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Most common cause of dementia in the elderly
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AD
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Memantine:
MOA Use |
NMDA receptor antagnoist-->prevents excitotoxicity
AD |
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Donepezil:
MOA Use |
ACHe inhibitor
AD |
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Galantamine:
MOA Use |
ACHe inhibitor
AD |
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Rivastigmine:
MOA Use |
ACHe inhibitor
AD |
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Pick's Disease:
Characteristic features |
Dementia, aphasia, parkinsonian aspects; personality changes
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Tau protein
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Pick's Disease
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Lewy Body dementia:
Characteristic features |
Parkinsonian with dementia and hallucinations
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When are Lewy bodies seen?
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AD
Lewy Body dementia PD |
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Cretutzfeldt-Jakob disease:
Characteristic features |
Rapidly progressive (weeks to months) dementia with myoclonus.
DUE TO PRIONS |
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Perception in absence of external stimuli
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Hallucination
Ex: seeing light that is not actually present |
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Misinterpretation of actual external stimuli
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Illusion
Ex: seeing light and thinking it's the sun |
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False beliefs not shared with other members of culture that are firmly maintained despite obvious proof to the contrary
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Delusion
Ex: thinking CIA is spying on you |
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Disorder in form of thought
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Loose associations (way ideas are tied together)
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Schizophrenia:
Characteristic features |
Delusions (auditory), illusions
Disorganized speech Flat affect (social withdrawal) Alogia--lack of speech, poverty of speech Poor grooming At least 6 months of symptoms! Inc'd risk of suicide! |
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Whit is a brief psychotic disorder?
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Syx of schizo (delusions, hallucinaitons, disorganized speech, flat affect) for <1 month; usually stress related
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What is schizophreniform disorder?
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Syx of schizo (delusions, hallucinaitons, disorganized speech, flat affect) for 1-6 monhts
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What is schizoeffective disorder?
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At least 2 weeks of stable mood w/psychotic syx plus major depressive, manic, or mixed (both) episode--bipolar or depressive
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Treatment of schizophrenia
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Antipsychotics--azines, heloperidol
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Antipsychotics:
High potency vs Low potency -Why is this important? -Drugs for each category |
High potency neuroleptics have more extrapyramidal side effects and less anticholinergic side effects (delusional, dry as a bone, etc.)
High potency: haloperidol, fluphenazine, thiothixene Low potency: more likely to have anticholinergic side effects, less likely to have extrapyramidal side effects Low potency: thioridazine, chlorpromazine |
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Neuroletpics:
Suffix MOA AEs |
-azines
Block D2 receptors to inc cAMP AEs: Extrapyramidal system side effects--muscle spasm, neck twisting, dystonia, tardive dyskinesia Dec'd DA-->dec'd PL inhibition-->galactorrhea Block muscarinic (dry mouth, constipation), block alpha (hypotn), block histamine (sedation) receptors |
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What is neuroleptic malignant syndrome?
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excess muscle contraction-->rigidity, break down muscle tissue-->myoglobinemia-->myoglobinuria (can cause renal failure)
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Positive vs Negative Symptoms of schizophrenia:
General Treatment |
Positive: excess/distortion of normal symptoms (delusions, hallucinations, thought disorders)
Tx w/antipsychotics (neuroleptics): haloperidol, -azines Negative: diminishment/absence of normal function (flat affect, poor grooming) Treat with atypical antipsychotics: olanzapine (can also be used for OCD< ANX, depression), clozapine, risperidone |
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How do atypical antipsychotics differ from the typical antipsychotics?
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Atypicals have fewer extrapyramidal and anticholinergic side effects; however, have greater weight gain (block histamine)
Clozapine must be watched clozely (agranulocytosis) Atypicals can be used to tx both positive and negative syx of schizophrenia |
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Define schizotypal disorder.
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interpersonal awkwardness--odd thoughts/appearance
strange people |
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Define schizoaffective disorder.
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schizophrenia syx + plus a mood disorder
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Define schizoid disorder.
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Voluntary social withdrawal, go live in woods
No pyshchosis |
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Define schizophreniform disorder.
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Schizo syx for less than 6 mos, more than a month
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What are the clinical features of neuroleptic malignant syndrome?
How is it treated? |
muscle rigidity
autonomic instability myoglobinuria hyperpyrexia mental status change (early) Tx w/DA agonist like bromocriptine |
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Patient with mild dementia is hospitalized for MI.
Nurse asks if she can give sleep medicine or diphenhydramine. What do you give? |
Do not give diphenyhydramine bc has anti-cholinergic side effects! Will make pt delirious.
Can give anti-depressant (trazodone) or can give haloperidol (fewer anti-chol syx) |
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Multiple personality disorder is currently known as _______.
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Dissociative identity disorder
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