Neurology + Psychiatry Pathology

Front 1

Neural Tube Defects

Back 1

=Associated w/ low FOLIC ACID intake during pregnancy

**Elevated alpha-fetoprotein in amniotic fluid + maternal serum = indicates possible NTD

Front 2

Spina Bifida Occulta

Back 2

=Failure of bony spinal canal to close but NO structural herniation

**Usually seen at lower vertebral levels

Front 3

Meningocele

Back 3

=meninges herniate through spinal canal defect

Front 4

Meningomyelocele

Back 4

=meninges + SC herniate through spinal canal defect

Front 5

BRAIN LESIONS

Back 5

**I will give you the AREA of the lesion

=you say the CONSEQUENCE

Front 6

Broca's Area

Back 6

=Motor (i.e. nonfluent/expressive) aphasia with GOOD comprehension

**i.e. speech is difficult to initiate, nonfluent, labored
=they know what they want to say but have trouble getting it out

Front 7

Wernicke's Area

Back 7

=Sensory (i.e. fluent/receptive) aphasia w/ POOR comprehension

**may vary from insertion of a few incorrect words to an outpouring of jargon

Front 8

How to remember Broca vs. Wernicke's?

Back 8

BROca's is BROken speech.

Wernicke's is Wordy but makes no sense.

Front 9

Arcuate fasciculus

Back 9

**Conduction aphasia
=poor repitition w/ good comprehension
=fluent speech

**i.e. the arcuate fasciculus runs between Broca's and Wernike's
=SO, the patient can understand what is being said BUT cannot repeat it/repeats it incorrectly

Front 10

Amygdala (=bilateral)

Back 10

**Kluver-Bucy Syndrome:
=hyperorality
=hypersexuality
=disinhibited behavior

Front 11

Frontal Lobe

Back 11

**Personality changes and deficits in concentration, orientation, and judgement.

**May have reemergencce of primitive reflexes.

Front 12

Right Parietal Lobe

Back 12

**Spatial Neglect Syndrome
=agnosia of the contralateral side of the world --> i.e. leads to neglect of the left side of the visual field

**SO, patient may only eat food on the right side of the plate or only draw the right side of the clock.

Front 13

Reticular Activating System

Back 13

COMA

Front 14

Mamillary Bodies (=bilateral)

Back 14

Wernicke-Korsakoff Syndrome

Front 15

Basal Ganglia

Back 15

**May result in a tremor at rest, chorea, or athetosis (i.e. slow writhing movements of hands or feet--seen in end stages of Huntington's).

Front 16

Cerebellar Hemisphere

Back 16

Intention tremor, limb ataxia

Front 17

Cerebellar Vermis

Back 17

Truncal ataxia, dysarthria

**Ok, so think:
=Cerebellar hemispheres are locating LATERALLY and so affect LATERAL LIMBS

=Vermis is located CENTRALLY and so affects the CENTRAL body

Front 18

Subthalamic Nucleus

Back 18

Contralateral hemiballismus (i.e. large amplitude flinging movements usually of arms/legs)

Front 19

Chorea

Back 19

**Chorea = dancing (Greek)

**Sudden, jerky purposeless movements

**Characteristic of BASAL GANGLIA lesion = i.e. Huntington's Disease

Front 20

Athetosis

Back 20

**Slow, writhing movements, especially of fingers.

**Characteristic of basal ganglia lesions

**Athetos = not fixed

Front 21

Hemiballismus

Back 21

**Sudden, wild flailing of 1 arm.

**Chacteristic of CONTRALATERAL SUBTHALAMIC NUCLEUS lesion.
=loss of inhibition of thalamus through globus pallidus

Front 22

Aphasia

Back 22

1) Broca's
2) Wernicke's

Front 23

Broca's Aphasia

Back 23

=Nonfluent aphasia w/ intact comprehension

**Broca's Area = inferior frontal gyrus

Front 24

Wernicke's Aphasia

Back 24

=Fluent aphasia w/ impaired comprehension

**Wernicke's Area = Superior Temporal Gyrus

Front 25

Involving the CEREBRAL CORTEX:

Back 25

1) Alzheimer's Disease
2) Pick's Disease

Front 26

Alzhemier's Disease

Back 26

**MOST COMMON CAUSE of dementia in the elderly

**Associated with:

1) Senile Plaques
=extracellular
=B-amyloid core

2) Neurofibrillary Tangles
=intracellular
=abnormally phosphorylated tau protein

**Don't forget that AD may cause amyloid angiopathy --> INTRACRANIAL HEMORRHAGE!

Front 27

Genetics of AD

Back 27

**Familial Form (10%) associated w/ genes on chromosomes 1, 14, 19 (ApoE4 allele) and 21 (p-App gene)

COLOR IMAGE 41

Front 28

What is the SECOND most common cause of dementia in the elderly?

Back 28

MULTI-INFARCT DEMENTIA

Front 29

Pick's Disease

Back 29

**Characterized by:
1) Dementia
2) Aphasia
3) Parkinsonian symptoms

**Associated with PICK BODIES:
=intracellular, aggregated TAU protein

**Specific for FRONTAL + TEMPORAL LOBES

Front 30

Diseases involving BASAL GANGLIA + BRAINSTEM:

Back 30

1) Huntington's Disease
2) Parkinson's Disease

Front 31

Huntington's Disease:

Back 31

**Autosomal dominant inheritance.

**Characterized by:
1) Chorea
2) Dementia

**Caused by atrophy of the CAUDATE NUCLEUS
=loss of GABAergic neurons--lose ACh + GABA

Front 32

Genetics of HD:

Back 32

**Caused by a trinucleotide repeat--CAG--on chromosome 4

=CAG --> "Caudate loses ACh + GABA"

Front 33

Parkinson's Disease

Back 33

**Associated w/ Lewy bodies (=eosinophilic intracytoplasmic inclusion found in the remaining dopaminergic neurons) + depigmentation of the substantia nigra pars compacta (=and thus loss of dopaminergic neurons)

**RARE cases have been linked to exposure to MPTP--a contaminant in illicit street drugs

Front 34

Symptoms of PD:

Back 34

TRAP

=Tremor (at rest)
=Rigidity (cogwheel)
=Akinesia/bradykinesia
=Postural instability

Front 35

Diseases involving SPINOCEREBELLAR region:

Back 35

1) Olivopontocerebellar Atrophy

2) Friedreich's ataxia

Front 36

Diseases involving the MOTOR NEURON:

Back 36

1) Amyotrophic Lateral Sclerosis ("Lou Gehrig's dz.)

2) Werdnig-Hoffmann Disease

3) Polio

Front 37

ALS

Back 37

=associated w/ BOTH UMN and LMN signs
=NO SENSORY deficit

Front 38

Werdnig-Hoffman Disease

Back 38

=Autosomal Recessive inheritance --> associated w/ degeneration of anterior horns

**Presents are BIRTH as a "FLOPPY BABY" + tongue fasciculations

**Median age of death = 7 months

Front 39

Polio

Back 39

=Follows infection w/ poliovirus

**Associated w/ degeneration of the anterior horns
=LMN signs

Front 40

What is Poliomyelitis?

Back 40

**Caused by POLIOVIRUS
=transmitted via the fecal-oral route
=replicates in the oropharynx and small intestine before spreading through the bloodstream to the CNS
=in the CNS --> leads to destruction of cells in the ANTERIOR HORN of the SC (=lower motor neuron destruction)

Front 41

Symptoms:

Back 41

=Malaise
=Headache
=Fever
=Nausea + abdominal pain
=Sore throat

+ Signs of LMN lesions:
=Muscle weakness + atrophy
=Fasciculations
=Fibrillation
=Hyporeflexia

Front 42

Findings:

Back 42

**CSF w/ lymphocytic pleocytosis (=i.e. increased white cell count) w/ slight elevation of protein

**Virus can be recovered from the stool OR throat.

Front 43

Demyelinating + Dysmyelinating Diseases

Back 43

1) MS
2) PML
3) Acute Disseminated (postinfectious) Encephalomyelitis
4) Metachromatic leukodystrophy
=a lysosomal storage disease
5) Guillian-Barre Syndrome

Front 44

Multiple Sclerosis: Epidemiology

Back 44

**Most often affects WOMEN in their 20's and 30's
=more common in WHITES

**Increased prevalence with INCREASED DISTANCE from the equator

Front 45

Histology:

Back 45

**Periventricular plaques (=areas of oligodendrocyte loss + reactive gliosis) w/ an intial SPARING of axons

Front 46

Presentation:

Back 46

**Most patients have a relapsing-remitting course

**Patients can present intitially w/:
=Optic Neuritis --> painful blind eye
=MLF Syndrome --> internuclear ophthalmoplegia
=Hemiparesis
=Hemisensory symptoms--numbness or weakness
=Bowel/bladder incontinence

COLOR IMAGE 47

Front 47

What is internuclear opthalmoplegia?

Back 47

=i.e. MLF Syndrome

**Occurs when you have demyelination of the medial longitudinal fasciculus --> causes binocular diplopia = double vision w/ both eyes open!

Front 48

The "CLASSIC" Triad of MS:

Back 48

MS is a SIN!

1) Scanning speech
=staccato-like speech where syllables of words are separated by pauses

2) Intention tremor

3) Nystagmus

**Patients will also have elevated protein (IgG) in their CSF.
COLOR IMAGE 47

Front 49

Treatment of MS:

Back 49

B-interferon OR immunosuppressant therapy

Front 50

Progressive Multifocal Leukoencephalopathy

Back 50

**Associated w/ the JC virus

**Seen in 2-4% of AIDS patients
=i.e. reactivation of latent viral infection

Front 51

Guillain-Barre Syndrome

Back 51

**Inflammation + demyelination of peripheral nerves + motor fibers of ventral roots (=sensory effect less severe than motor) CAUSING:

=symmetric ascecnding muscle weakness beginning in DISTAL LOWER EXTREMITIES

Front 52

Other Symptoms:

Back 52

**Facial diplegia (=paralysis of the face) is present in 50% of cases.

**AUTONOMIC FUNCTION may be severely affected:
=cardiac irregularities
=HTN or hypotension

**Almost all patients survive --> majority recover completely after weeks to months

Front 53

Findings:

Back 53

1) Elevated CSF protein w/ normal cell count
="albuminocytologic dissociation"

2) Elevated protein --> papilledema

Front 54

Treatment:

Back 54

**Respiratory support CRITICAL until recovery

**Additional treatment:
=plasmapheresis
=IV immune globulins

Front 55

What is thought to cause GBS?

Back 55

**Associated w/ infections --> lead to an immune attack of peripheral myelin

=i.e. herpesvirus OR campylobacter jejuni infection

Also linked to inoculations + stress

Front 56

Seizures:

Back 56

1) Partial Seizures
2) Generalized Seizures

Front 57

Partial Seizures

Back 57

**ONE area of the brain

1) Simple Partial Seizure
=consciousness intact

2) Complex Partial
=Impaired consciousness

**Motor = blinks, twitches, etc.
**Sensory = altered hearing, smelling, seeing
**Autonomic
**Psychic

**Partial seizures CAN SECONDARILY GENERALIZE!

Front 58

Generalized Seizures

Back 58

**DIFFUSE

1) Absence seizures
=petit mal
=blank stare

2) Myoclonic
=quick, repetitive jerks

3) Tonic-Clonic
=grand mal
=alternating stiffening + movement

4) Tonic = stiffening

5) Atonic = "drop" seizures

Front 59

CHILDREN:

Back 59

=genetic
=infection
=trauma
=congenital
=metabolic

Front 60

ADULTS:

Back 60

=tumors
=trauma
=stroke
=infection

Front 61

ELDERLY:

Back 61

=stroke
=tumor
=trauma
=metabolic
=infection

Front 62

What is Epilepsy?

Back 62

**Disorder of recurrent seizures

NOTE: febrile seizures are NOT epilepsy!

Front 63

Intracranial Hemorrhage:

Back 63

=Epidural hematoma
=Subdural hematoma
=Subarachnoid hemorrhage
=Parenchymal hematoma

Front 64

Epidural Hematoma

Back 64

**Rupture of middle meningeal artery --> often secondary to fracture of the temporal bone

**Have a LUCID interval

**CT shows a "biconvex disk" not crossing suture lines

COLOR IMAGE 44

Front 65

Subdural Hematoma

Back 65

**Rupture of bridging veins
=i.e. venous bleeding w/ delayed onset of symptoms

**Seen in:
=Elderly
=Alcoholics
=Blunt trauma
=Shaken baby

**Predisposing factors:
=Brain atrophy, shaking, whiplash

**Crescent-shaped hemorrhage that crosses suture lines.

COLOR IMAGE 43

Front 66

Subarachnoid Hemorrhage

Back 66

**Rupture of an aneurysm (=usually a berry aneurysm) OR an AVM

**Patients complain of the "WORST HEADACHE OF MY LIFE"

**Bloody or xanthochromic (=yellow tinge --> indicates hemorrhage) spinal tap

Front 67

Parenchymal Hematoma

Back 67

**Caused by:
=HTN
=Amyloid angiopathy
=DM
=Tumor

Front 68

Where do Berry Aneurysms occcur?

Back 68

**At the bifurcation of the Circle of Willis
=most common site is the bifurcation of the ANTERIOR COMMUNICATING ARTERY

**Rupture (=most common complication) leads to hemorrhagic stoke/subarachnoid hemorrhage.

Front 69

What are berry aneurysms associated with?

Back 69

1) Adult polycystic kidney disease

2) Ehlers-Danlos Syndrome

3) Marfan's Syndrome

Other Risk Factors:
=Advanced age
=HTN
=Smoking
=Race --> higher in BLACKS

COLOR IMAGE 46

Front 70

Primary Brain Tumors

Back 70

**Clinical presentation is due to MASS EFFECTS:
=seizures
=dementia
=focal lesions

**Primary brain tumors RARELY undergo metastasis

**1/2 of all adult brain tumors are METASTASES!

Front 71

Location of Primary Brain Tumors:

Back 71

**Majority of adult primary tumors are SUPRATENTORIAL

**Majority of child primary tumors are INFRATENTORIAL

Front 72

Most Common ADULT Brain Tumors (in order of MOST common --> LEAST common):

Back 72

1) Glioblastoma multiforme
=grade IV astrocytoma

2) Meningioma

3) Schwannoma

4) Oligodendroglioma

5) Pituitary adenoma

Front 73

Glioblastoma Multiforme (=grade IV astrocytoma)

Back 73

**Most common primary brain tumor

**Prognosis grave --> less than 1-year life expectancy

**Found in CEREBRAL HEMISPHERES
=can cross the corpus callosum
="BUTTERFLY GLIOMA"

**Color image 48

Front 74

Histology:

Back 74

**Stain astrocytes w/ GFAP.

**"Pseudopalisading" tumor cells
=border central areas of necrosis + hemorrhage

Front 75

Meningioma

Back 75

**2nd most common primary brain tumor

**Most often occurs in convexities of hemispheres + parasagittal region
=arises from ARACHNOID CELLS external to the brain

**Resectable

Front 76

Histology:

Back 76

**Spindle cells concentrically arranged in a WHORLED pattern

**Psammoma bodies
=laminated calcifications

Front 77

Schwannoma

Back 77

**3rd most common

**Schwann cell origin
=often localized to the 8th nerve --> "acoustic schwannoma"

**Resectable

**NOTE:
=bilateral schwannomas found in neurofibromatosis type 2

Front 78

Oligodendroglioma

Back 78

**Relatively rare

**Slow growing

**Most often in FRONTAL LOBES

COLOR IMAGE 49

Front 79

Histology:

Back 79

**Oligodendrocytes --> "FRIED EGG" apperance:
=round nuclei w/ clear cytoplasm
=often calcified

Front 80

Pituitary Adenoma

Back 80

**Prolactin-secreting is the MOST COMMON form

**Usuallly located on Rathke's pouch

**Commomn sequelae:
=Bitemporal hemianopia (due to pressure on optic chiasm)
=Hyper/hypopituitarism

Front 81

Childhood Primary Brain Tumors

Back 81

**Most common BENIGN:
=Pilocytic (low-grade) astrocytoma

**Most common MALIGNANT
=Medulloblastoma

Others:
=Ependymoma
=Hemangioblastoma
=Craniopharyngioma

Front 82

Pilocytic (=low-grade) Astrocytoma

Back 82

**Diffusely infiltrating glioma
=most often found in POSTERIOR FOSSA

**Benign --> good prognosis

Front 83

Histologic Key:

Back 83

ROSENTHAL FIBERS
=eosinophilic corkscrew fibers

Front 84

Medulloblastoma

Back 84

**Highly malignant cerebellar tumor
=a form of primitive neuroectodermal tumor (PNET)

**Can compress the 4th ventricle --> causing HYDROCEPHALUS

Front 85

Histology Keys:

Back 85

1) Rosettes or perivascular pseudorosette pattern of cells.

**RADIOSENSITIVE

Front 86

Ependymoma

Back 86

**Ependymal cell tumors most commonly found in the 4th ventricle
=can cause hydrocephalus

**Poor prognosis

Front 87

Histology Keys:

Back 87

1) Characteristic perivascular pseudorosettes.

2) Rod-shaped blepharoplasts (=basal ciliary bodies) found near nucleus

Front 88

Hemangioblastoma

Back 88

**Most often CEREBELLAR

**Associated w/ von Hippel-Lindau Syndrome when found w/ RETINAL ANGIOMAS

**Can produce EPO --> leading to SECONDARY POLYCYTHEMIA

Front 89

Histology

Back 89

=Foamy cells + high vascularity

Front 90

Craniopharyngioma

Back 90

**Benign childhood tumor
=often confused w/ pituitary adenoma as it can ALSO cause bitemporal hemianopia

**MOST common childhood SUPRATENTORIAL tumor
=derived from remnants of Rathke's pouch

**Suprasellar calcifications on X-ray COMMON

Front 91

Motor Neuron Signs --> Is it an UMN lesion or an LMN lesion?

Back 91

Weakness? BOTH

Atrophy? LMN

Fasciculation? LMN

Reflexes?
=Increased --> UMN
=Decreased --> LMN

Tone?
=Increased --> UMN
=Decreased --> LMN

Babinski:
=Positive --> UMN
=Absent --> LMN

Front 92

How to remember that:

Back 92

KEY:

**In LMN, everything is LOWERED:
=less muscle mass, decreased muscle tone and reflexes, downgoing toes

**In UMN--everything is UP
=tone, DTRs, toes

Front 93

What is Syringomyelia?

Back 93

**Enlargement of the central canal of the spinal cord
=most common at C8 - T1

**Often presents in patients w/ Arnonld-Chiari Malformation

Front 94

Results:

Back 94

**Crossing fibers of spinothalamic tract are damaged:
=bilateral loss of pain and temperature sensation in upper extremities
=preseration of TOUCH sensation

Front 95

What is Tabes Dorsalis?

Back 95

**Degeneration of the dorsal columns and dorsal roots due to TERTIARY SYPHILIS

=results in impaired proprioception + locomotor ataxia

Front 96

Associated with:

Back 96

1) Charcot's Joints

2) Shooting (lightening) pain

3) Argyll Robertson Pupils
=bilateral small pupils that constrict when patient focuses on near object--i.e. "accomodation" but NOT when exposed to light--not "reactive" to light

4) Absence of DTRs

Front 97

What is Brown-Sequard Syndrome?

Back 97

**Hemisection of the spinal cord

Front 98

Findings:

Back 98

1) IPSILATERAL UMN signs (corticospinal tract) below the lesion

2) CONTRALATERAL pain + temperature loss (spinothalamic tract) below lesion

3) IPSILATERAL loss of tactile, vibration, proprioception sense (dorsal column) below lesion

4) Ipsilateral loss of all sensation AT the level of the lesion

5) LMN signs AT the level of the lesion

**IF the lesion occurs ABOVE T1 --> presents w/ Horner's Syndrome

Front 99

What is Horner's Syndrome?

Back 99

**Sympathectomy of the face:

1) Ptosis
=slight drooping of eyelid

2) Anhidrosis
=absence of sweating
=PLUS flushing (rubor) of the affected side of the face

3) Miosis
=pupil constriction

**"PAM is horny!"

Front 100

Anatomical Basis for the Symptoms you find in Horner's Syndrome:

Back 100

**There is a 3-neuron OCULOSYMPATHETIC pathway:
=projects from the HYPOTHALAMUS --> intermediolateral column of the SC --> superior cervical (sympathetic) ganglion --> then finally to the pupil, SM of the eyelids, and the sweat glands of the forehead + face

**Interruption of these pathways results in HORNERS

Front 101

What causes Horner's Syndrome?

Back 101

**Lesion of the spinal cord ABOVE T1

Examples:
=Pancoast's tumor
=Hemisection
=Late-stage syringomyelia

Front 102

Upper Extremity Nerve Injury:

Back 102

Given = NERVE

Name site of injury/deficit in motion + deficit in sensation/course

Front 103

RADIAL NERVE

=Site of injury/motion deficit

Back 103

**Shaft of humerus

=loss of triceps brachii (triceps reflex)

=loss of brachioradialis (brachioradialis reflex)

=loss of extensor carpi radialis longus (leads to WRIST DROP)

Front 104

RADIAL NERVE

=Deficit in sensation/course

Back 104

Posterior brachial cutaneous + posterior antebrachial cutaneous

**Passes through supinator

Front 105

MEDIAN NERVE

=Site of injury/motion deficit

Back 105

**Supracondyle of humerus
=NO loss of power in any of the arm muscles

**Loss of:
=Forearm pronation
=Wrist flexion
=Finger flexion
=Several thumb movements

**Eventually = thenar atrophy

Front 106

MEDIAN NERVE

=Deficit in sensation/course

Back 106

**Loss of sensation over the lateral palm + thumb + the radial 2.5 fingers

**Passes through pronator teres.

Front 107

ULNAR

=Site of injury/deficit in motion

Back 107

**MEDIAL EPICONDYLE

=impaired wrist flexion + adduction

=impaired adduction of thumb and the ulnar 2 fingers (=CLAW HAND!)

Front 108

ULNAR

=Deficit in sensation/course

Back 108

**Loss of sensation over the MEDIAL PALM + ulnar 1.5 fingers

**Passes through flexor carpi ulnaris.

Front 109

AXILLARY

=Site of injury/deficit in motion

Back 109

**Surgical neck of humerus OR anterior shoulder dislocation

=loss of deltoid action

Front 110

MUSCULOCUTANEOUS

=Site of injury/deficit in motion

Back 110

**Loss of function of coracobrachialis, biceps, and brachialis muscles (=loss of biceps reflex)

Front 111

MUSCULOCUTANEOUS

=course

Back 111

**Passes through coracobrachialis

Front 112

What Causes Erb-Duchenne Palsy?

Back 112

**Traction or tear of the upper trunk of the brachial plexus (C5 and C6 roots)

=follows blow to the shoulder OR trauma during delivery

Front 113

Findings:

Back 113

**"Waiter's Tip" apperance of the arm.

**Limb hangs by side (=paralysis of abductors), medially rotated (=paralysis of lateral rotators)

**Forearm is pronated (=loss of biceps)

Front 114

Common Peroneal (L4 - S2)

=What is the deficit in motion?

Back 114

**Loss of dorsiflexion --> FOOT DROP

**Deep peroneal nerve innervates ANTERIOR compartment; Superficial peroneal nerve innervates LATERAL compartment

**"PED = Peroneal Everts + Dorsiflexes --> IF injured, foot dropPED"**

Front 115

Tibial (L4 - S3)

=What is the deficit in motion?

Back 115

**Loss of PLANTAR FLEXION

=Tibial nerve innervates posterior compartment

**"TIP" = Tibial Inverts + Plantarflexes --> IF injured, can't stand on TIPtoes!**

Front 116

Femoral (L2 - L4)

=What is the deficit in motion?

Back 116

**Loss of knee extension/knee jerk

Front 117

Obturator (L2 - L4)

=What is the deficit in motion?

Back 117

**Loss of hip adduction.

Front 118

What is Thoracic Outlet Syndrome?

Back 118

**"Klumpke's Palsy"

=an embryologic defect --> can compress subclavian artery + inferior trunk of brachial plexus (C8, T1) resulting in thoracic outlet syndrome

Front 119

Components:

Back 119

1) Atrophy of the thenar + hypothenar eminences

2) Atrophy of the interosseous muscles

3) Sensory deficits on the medial side of the forearm + hand

4) Disappearance of the radial pulse upon moving the head toward the opposite side.

Front 120

CN XII Lesion

Back 120

=tongue deviates TOWARD the side of the lesion

Front 121

CN V Lesion

Back 121

=Jaw deviates TOWARD the side of the lesion

Front 122

Unilateral lesion of the cerebellum

Back 122

Patient tends to fall TOWARD the side of the lesion

Front 123

CN X Lesion

Back 123

=uvula deviates AWAY from the side of the lesion

Front 124

CN XI Lesion

Back 124

=weakness turning head to contralateral side of lesion

=shoulder droop on side of lesion

Front 125

Facial Lesions

Back 125

=UMN Lesion

=LMN Lesion

=Bell's Palsy

Front 126

UMN Lesion

Back 126

=Lesion of motor cortex or connection between cortex and facial nucleus

**Contralateral paralysis of LOWER face only

Front 127

LMN Lesion

Back 127

Ipsilateral paralysis of upper AND lower face

Front 128

Bell's Palsy

Back 128

=Complete destruction of the facial nucleus itself OR its branchial efferent fibers (=facial nerve proper)

**Can occur idiopathically--gradual recovery in most cases
=Peripheral IPSILATERAL facial paralysis w/ inability to close eye on the involved side

Front 129

Bell's Palsy is seen as a complication in...

Back 129

ALexander Bell w/ STD:

1) AIDS
2) Lyme
3) Sarcoid
4) Tumors
5) Diabetes

Front 130

Cingulate Herniation Under Falx Cerebri

Back 130

=can compress the anterior cerebral artery

Front 131

Downward Transtentorial (Central) Herniation OR Uncal Herniation

Back 131

=coma and death rersult when these herniations compress the brainstem

**Uncus = medial temporal lobe

Front 132

What are the Clinical Signs of an UNCAL Herniation?

Back 132

1) Ipsilateral Dilated pupil/ptosis
=stretching of CNIII

2) Contralateral Homonymous Hemianopia
=compression of ipsilateral posterior cerebral artery

3) Ipsilateral Paresis
=compression of contralateral crus cerebri (Kernohan's notch)

4) Duret Hemorrhages
=paramedian artery rupture via caudal displacement of the brainstem

Front 133

What is internuclear opthalmoplegia?

Back 133

**"MLF Syndrome"

=lesion in the medial longitudinal fasciculus (MLF)
=results in medial rectus palsy on attempted lateral gaze
=convergence normal

Front 134

Explanation of the Pathology

Back 134

**When looking left, the LEFT nucleus of CNVI fires, which contracts the left LR and stimulates the CONTRALATERAL (right) nucleus of CNIII via the right MLF to contract the RIGHT medial rectus

Front 135

What is MLF Syndrome often seen i n?

Back 135

MS

Front 136

Anxiety

Back 136

=Increased NE

=Decreased GABA

=Decreased Serotonin (5-HT)

Front 137

Depression

Back 137

=Decreased NE and Serotonin

Front 138

Alzheimer's Demential

Back 138

=DECREASED ACH

Front 139

Huntington's Disease

Back 139

=Decreased GABA

=Decreased ACh

Front 140

Schizophrenia

Back 140

=Increased DA

Front 141

Parkinson's Disease

Back 141

=Decreased DA

Front 142

Orientation

Back 142

1) Is the patient aware of him/herself as a person?

2) Does the patient known his or her own name?

**Order of Loss:
=1st --> time
=2nd --> place
=3rd --> person

Front 143

Anosognosia

Back 143

=unaware that one is ill

Front 144

Autotopagnosia

Back 144

=unable to locate one's body parts

Front 145

Depersonalization

Back 145

=body seems unreal or dissociated

Front 146

Anterograde Amnesia

Back 146

**The inability to remember things that occured after a CNS insult
=no new memory

Front 147

Korsakoff's Amnesia

Back 147

**Classic anterograde amnesia that is caused by THIAMINE DEFICIENCY
=bilateral destruction of the mammillary bodies

**Seen in alcoholics + is associated w/ confabulations

Front 148

Retrograde amnesia

Back 148

**Inability to remember things that occured BEFORE a CNS insult

Front 149

Substance Dependence

Back 149

**Maladaptive pattern of substance use defined as 3+ of the following signs in a year:
=tolerance
=withdrawl
=substance taken in larger amounts or over longer time than desired
=persistent desire or attempts to cut down
=significant energy spent obtaining/using/recovering from substance

Front 150

Continued...

Back 150

=Important social, occupational, or recreational activities reduced because of substance abuse
=continued use in spite of knowing the problems it causes

Front 151

Substance Abuse

Back 151

**Defined as 1+ of the following:
=recurrent use resulting in failure to fulfill major obligations at work, school or home
=recurrent use in physically hazardous situations
=recurrent substance-related legal problems
=continued use in spite of persistent problems caused by use

Front 152

Alcohol INTOXICATION

Back 152

=Disinhibition
=Emotional lability
=Slurred speech
=Ataxia
=Coma or blackouts

Front 153

What can be used as an indicator of alcohol use?

Back 153

=Serum gamma-glutamyltransferase (GGT)

Front 154

Alcohol WITHDRAWL

Back 154

=Tremor
=Tachycardia + HTN
=Nausea
=Seizures and delirium tremors (DTs)
=Agitation and hallucinations

Front 155

Opiod INTOXICATION

Back 155

=CNS depression
=n/v
=Constipation
=PUPILLARY CONSTRICTION
=Seizures (OD is life-threatening)

Front 156

Opiod WITHDRAWL

Back 156

=anxiety, insomnia
=anorexia
=sweating + "piloerection"
=DILATED PUPILS
=fever, nausea, stomach cramps + diarrhea (flu-like symptoms)
=yawning

Front 157

Amphetamine INTOXICATION

Back 157

=psychomotor agitation --> prolonged wakefulness and attention
=impaired judgement
=PUPILLARY DILATION
=HTN, tachycardia, arrhythmias
=delusions + hallucinations

Front 158

Amphetamine WITHDRAWL

Back 158

=Post-use "crash" including depression, lethargy, hypersomnolence, headache, stomach cramps, and hunger

Front 159

Cocaine INTOXICATION

Back 159

=Euphoria
=Psychomotor agitation + impaired judement
=Tachycardia and HTN
=PUPILLARY DILATION
=Hallucinations, paranoid ideations

**Sudden cardiac death!

Front 160

Cocaine WITHDRAWL

Back 160

=Post-use "crash" including SEVERE depression and suicidality, hypersolmnolence, fatigue, SEVERE psychological craving

Front 161

PCP Intoxication

Back 161

=Belligerence, impulsiveness
=Psychomotor agitation
=Vertical and horizonal nysagmus
=Tachycardia
=Ataxia
=HOMICIDALITY

Front 162

PCP Withdrawl

Back 162

=Recurrence of intoxication symptoms due to reabsorption in GI tract --> sudden onset of severe, random, homicidal violence

Front 163

LSD

Back 163

=marked anxiety or depression
=delusions, visual hallucinations, flashbacks
=PUPILLARY DILATION

Front 164

Marijuana Intoxication

Back 164

=Euphoria
=Anxiety and paranoid delusions + hallucinations
=Perception of slowed time
=Social withdrawl
=Increased appetitie
=Dry mouth

Front 165

Barbiturate INTOXICATION

Back 165

=VERY LOW safety margin --> respiratory depression

Front 166

Barbiturate WITHDRAWL

Back 166

=Anxiety
=Seizures
=Delirium

**Life-threatening CV collapse

Front 167

Benzodiazepine INTOXICATION

Back 167

=Greater saftey margin but still causes minor respiratory depression

=amnesia
=ataxia
=somnolence

**Addictive effects w/ ALCOHOL

Front 168

Benzo WITHDRAWL

Back 168

=rebound anxiety, seizures, tremor, insomnia

Front 169

Caffeine

Back 169

Restlessness, insomnia, increased diuresis, muscle twitching, cardiac arrhythmias

Front 170

Caffeine WITHDRAWL

Back 170

=headache, lethargy, depression, weight gain

Front 171

Nicotine INTOXICATION

Back 171

=Restlessness, insomnia, anxiety, arrhythmias

Front 172

WITHDRAWL

Back 172

=Irritability
=Headache
=Anxiety
=Weight gain
=Craving

Front 173

Alcoholism

Back 173

=Physiologic tolerance + dependence w/ symptoms of withdrawl when intake is interrupted

**Continued drinking despite medial and social contraindications + life disruptions

Front 174

Treatment:

Back 174

**Disulfiram
=conditions the patient to abstain from alcohol use

**Supportive treatment of other systemic manifestations

**AA and other peer support groups

Front 175

What are Delirium Tremors?

Back 175

**Life-threatening alchol withdrawl syndrorme that peaks 2-5 days after last drink

Front 176

In order of appearance, what are the symptoms?

Back 176

1) Autonomimc system hyperactivity
=tachycardia, tremors, anxiety

2) Psychotic Symptoms
=hallucinations, delusions

3) Confusion

Front 177

Treatment?

Back 177

=benzodiazepines

Front 178

Complications of Alcoholism

Back 178

1) Alcoholic hepatitis + Cirrhosis
2) Pancreatitis
3) Dilated cardiomyopathy
4) Peripheral neuropathy
5) Cerebellar degeneration
6) Wernicke-Korsakoff Syndrome
7) Testicular atrophy and hyperestrinism
8) Mallory-Weiss Syndrome

Front 179

Alcholic Cirrhosis

Back 179

**Long-term alcohol use leads to MICRONODULAR CIRRHOSIS w/ accompanying symptoms.

Front 180

What are these symptoms?

Back 180

=Jaundice
=Hypoalbuminemia
=Coagulation factor deficiencies
=Portal HTN

Front 181

Complications:

Back 181

=Peripheral edema + ascites
=Encephalopathy
=Neurologic manifestations (i.e. asterixis)
=Esophageal varices

Front 182

What causes Wernicke-Korsakoff Syndrome?

Back 182

=Vitamin B1 (thiamine) deficiency

**Associated w/ periventricular hemorrhage/necrosis esp. in mamillary bodies

**Common in malnourished alcoholics

Front 183

Presenation:

Back 183

**Presents w/ TRIAD of:
=confusion
=opthalmoplegia
=ataxia

Front 184

May progress into:

Back 184

=memory loss
=confabulation
=personality change (i.e. Korsakoff's psychosis--irreversible)

Front 185

Treatment:

Back 185

IV Vitamin B1 (=thiamine)

Front 186

What is Mallory-Weiss Syndrome?

Back 186

**Longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting.

**Associated with PAIN in contrast to esophageal varices!

Front 187

Heroin Addiction

Back 187

**500,000 US addicts

**Heroin is a Schedule I drug = NOT prescribable

**Look for TRACK MARKS--i.e. needle sticks in veins

Front 188

Users are at risk for:

Back 188

1) Hepatitis
2) Abscesses
3) OD
4) Hemorrhoids
5) AIDS
6) RIGHT SIDED ENDOCARDITIS

Front 189

What drugs can competitively INHIBIT opiods?

Back 189

=Naloxone
=Naltrexone

Front 190

What drug can be used for heroin detoxification OR long-term maintenance?

Back 190

Methadone
=long-acting oral opiate

Front 191

What is Delirium?

Back 191

**Rapid decrease in attention span and level of arousal
=disorganized thinking
=hallucinations, illusions, + misperceptions
=disturbance in sleep-wake cycle
=cognitive dysfunction

Front 192

What is the KEY to diagnosis?

Back 192

=waxing and waning level of consiousness

**Develops RAPIDLY

Front 193

Causes?

Back 193

**Most COMMON psychiatric illness on medical and surgical floors
=often reversible
=check for drugs w/ ANTICHOLINERGIC EFFECTS

**i.e. often due to either SUBSTANCE USE or MEDICAL ILLNESS

Front 194

What is Dementia?

Back 194

**Gradual decrease in cognition
=memory deficits
=aphasia, apraxia, agnosia
=loss of abstract thought
=behavioral/personality changes
=impaired judgement

Front 195

What is the KEY to Diagnosis?

Back 195

**RULE OUT DELIRIUM
=patient is alert--no change in level of consiousness
=more gradual onset
=in ELDERLY patients, often depression presents like dementia

**Commonly irreversible.

Front 196

What classifies a Major Depressive Episode?

Back 196

**Characterized by at least 5 of the Following for 2 weeks INCLUDING either depressed mood or anhedonia:

="SIG E CAPS"

Front 197

SIG E CAPS

Back 197

1) Sleep Disturbance
2) Loss of Interest (=anhedonia)
3) Guilt/feelings of worthlessness
4) Loss of Energy
5) Loss of Concentration
6) Change in Appetite/Weight
7) Psychomotor retardation or agitation
8) Suicidal Ideations
9) Depressed Mood

Front 198

Lifetime Prevalence of a Major Depressive Episode

Back 198

**5-12% Male

**10-20% Female

Front 199

What is Major Depressive DISORDER?

Back 199

=reccurent --> requires 2 or more episodes w/ a symptom-free interval of 2 months

Front 200

What is Dysthymia?

Back 200

=milder form of depression lasting at least 2 years

Front 201

Sleep Patterns of Depressed Patients

Back 201

1) Decreased SLOW WAVE sleep

2) DECREASED REM latency

3) Early morning awakening
=important screening question!

Front 202

What are the Risk Factors for Suicide Completion?

Back 202

**"SAD PERSONS"
=Sex --> MALE
=Age --> TEEN or ELDERLY
=Depression
=Previous attempt
=Ethanol or drug use
=Loss of rational thinking
=Sickness --> medical illness OR 3+ prescription medications
=Organized plan
=No spouse (=divorced/widow/single--esp. if childless)
=Social support lacking

Front 203

Electroconvulsive Therapy

Back 203

**Treatment option for MDD refractory to other treatment
=painless and produces a seizure

Front 204

Major Adverse Effects?

Back 204

=disorientation
=anterograde/retrograde amnesia

Front 205

What is a MANIC Episode?

Back 205

=distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week

**During the mood disturbance, 3+ of the following are present

="DIG FAST"

Front 206

DIG FAST

Back 206

=Distractibility
=Irresponsibility--> seeks pleasure w/o regard for consequences
=Grandiosity--> inflated self-esteem
=Flight of Ideas--racing thoughts
=Increased in goal-directed ACTIVITY/psychomotor AGITATION
=Decreased need for sleep
=Talkativeness or pressured speech

Front 207

What is a Hypomanic Episode

Back 207

**Like a manic episode EXCEPT the mood disturbance is NOT severe enough to cause marked impairment in social/occupational functioning OR to necessitate hospitalization

=there are no psychotic features

Front 208

What is Bipolar Disorder

Back 208

**6 Separate Criteria Exist for Bipolar Disorders w/ Combinations of:
1) Manic = Bipolar I
2) Hypomanic = Bipolar II
3) Depressed Episodes

**1 Manic OR Hypomanic episode defines bipolar disorder

Front 209

What is the DOC for treating Bipolar Disorder?

Back 209

Lithium

Front 210

Cyclothymic Disorder

Back 210

=a milder form of bipolar disorder lasting at least 2 years

Front 211

Malingering Disorder

Back 211

=Patient cocnsiously fakes or claims to have a disorder in order to attain SECONDARY GAIN (i.e. avoiding work, obtaining drugs)

Front 212

What is a Factitious Disorder?

Back 212

**Patient consiously creates symptoms in order to assume a "sick role" and to get medical attention

Front 213

Munchausen's Syndrome

Back 213

**Extreme form of factitious disorder
=chronic history of multiple hosptial admissions and willingness to recieve invasive procedures

Front 214

Munchausen's by Proxy

Back 214

=seen when illness in a child is caused by the parent

**Motivation is unconcious
=often times parent feels good about playing the "concerned parent" role

**IS CHILD ABUSE and MUST be reported!

Front 215

Somatoform Disorders

Back 215

**Both illness production AND motivation are UNCONSIOUS desires

**More common in women.

**Several types:
=Conversion
=Somatiform Pain Disorder
=Hypochondriasis
=Somatization Disorder
=Body Dysmorphic Disorder
=Pseudocyesis

Front 216

Conversion

Back 216

**Motor or sensory symptoms (i.e. paralysis, or pseudoseizure) that suggest neurologic or physical disorder BUT physical exam and tests are negative
=often follows an ACUTE STRESSOR
=patient may be unconcerned about symptoms

Front 217

Somatoform Pain Disorder

Back 217

=prolonged pain that is not explained completely by illness

Front 218

Hypochondriasis

Back 218

=Preoccupation with and fear of having a serious illness in spite of medical reassurance

Front 219

Somatization Disorder

Back 219

=variety of complaints in multiple organ systems with NO identifiable underlying pathology

Front 220

Body Dysmorphic Disorder

Back 220

=Preoccupation w/ minor or imagined physical flaws--patients often seen cosmetic surgery

Front 221

Pseudocyesis

Back 221

=false belief of being pregnant associated w/ objective physical signs of pregnancy

Front 222

GAIN--Can be PRIMARY, SECONDARY, or TERTIARY.

Back 222

**Primary:
=what the symptom does for the patient's internal psychic economy

**Secondary:
-what the symptom gets the patient (sympathy, attention)

**Tertiary
=what the caretaken gets--i.e. like an MD on an interesting case

Front 223

Pain Disorder

Back 223

**Reccurent periods of intense fear and discomfort peaking in 10 minutes w/ 4 of the following--PANICS:
1) Palpitations
2) Paresthesias
3) Abdominal distress
4) Nausea
5) Intense fear of dying or losing control and lIght-headedness
7) Chest pain, Chills, Choking, disConnectedness
8) Sweating, shaking, SOB

Front 224

How is this panic described?

Back 224

=Described in context of occurence--i.e. panic disorder w/ agoraphobia

Front 225

Specific Phobia

Back 225

**Fear that is excessive or unreasonable
=cued by the presence or anticipation of a specific object or situation
=exposure provokes anxiety response

**Person recognizes that the fear is excessive (=INSIGHT)
=fear intereferes w/ normal routine

Front 226

Treatment?

Back 226

Include systematic desensitization.

Front 227

Examples:

Back 227

1) Gamophobia
=fear of marriage

2) Algophobia
=fear of pain

3) Acrophobia
=fear of heights

4) Agoraphobia
=fear of open places

Front 228

Post-Traumatic Stress Disorder

Back 228

**Person experienced or witnessed event that involved ACUTAL or THREATENED death or serious injury
=response involves fear, helplessness, or horror
=traumatic event is persientely reexperienced as nightmares or flashbacks + person avoids stimuli associated w/ the trauma

Front 229

How LONG does the disturbance last?

Back 229

>1 month

=causes severe distress and social/occupational impairment

**PTSD can follow ACUTE stress disorder which lasts 2-4 weeks

Front 230

Adjustment Disorder

Back 230

**Emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor--> i.e. divorce or moving

**lasts < 6 months

Front 231

Generalized Anxiety Disorder

Back 231

**Uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation or event

**Causes sleep disturbances, fatigue, and difficulty concentrating

Front 232

Autistic Disorder

Back 232

**Patients have severe communication problems and problems forming relationships
=characterized by repetitive behavior, unusual abilities (=savants) + usually below-normal intelligence

Front 233

Treatment?

Back 233

=Increase communication and social skills

Front 234

Asperger Disorder

Back 234

**Milder form of autism involving problems w/ social relationships + repetitive behavior

**Children are of normal intelligence and LACK social or cognitive deficiets

Front 235

Rett Disorder

Back 235

**X-linked disorder seen ONLY in girls
=affected males die in utero

**Characterized by loss of development + MR appearing at age 4
=stereotyped HAND-WRINGING

Front 236

ADHD

Back 236

**Limited attention span and hyperactivity

**Children are emotionally labile, impulsive, and prone to accidents

**Normal intelligence

Front 237

Treatment?

Back 237

Methylphenidate (=Ritalin)

Front 238

Conduct Disorder

Back 238

**Continued behavior violating social norms

**At age >18 y.o., it is diagnosed as ANTISOCIAL PERSONALITY DISORDER

Front 239

Oppositional Defiant Disorder

Back 239

**Child is noncompliant in the absence of criminality

Front 240

Tourette's Syndrome

Back 240

**Motor and vocal tics and involuntary profantiy

**Onset <18 y.o.

Front 241

Treatment?

Back 241

Haloperidol

Front 242

Separation Anxiety Disorder

Back 242

**Fear of loss of attachment figure leadingg to factitious physical complaints to avoid going back to school

**Common onset age 7-8

Front 243

Anorexia Nervosa

Back 243

**Abnormal eating habits (i.e. excessive dieting)
**Body image distortion
**Increased exercise

**Seen primarily in adolscecnt girls + commonly coexists w/ depression

Front 244

PE:

Back 244

1) Severe weight loss
2) Amenorrhea
3) Anemia
4) Electrolyte disturbances

Front 245

Bulimia Nervosa

Back 245

**Binge-eating followed by self-induced vomiting or use of laxatives

**Body weight is normal

Front 246

PE:

Back 246

1) Parotitis
2) Enamel erosion
3) Electrolyte disturbances
4) Alkalosis
5) Dorsal hand calluses from inducing vomiting

Front 247

Hallucination vs. Illusion vs. Delusion

Back 247

**Hallucinations:
=perceptions in the ABSENCE of external stimuli

**Illusions
=misinterpretations of ACUTAL external stimuli

**Delusions
=false beliefs not shared w/ other members of the culture/subculture that are FIRMLY maintained despite obvious proof to the contrary

Front 248

Delusions vs. Loose Association

Back 248

**Delusion
=disorder in the content of thought (i.e. the actual idea)

**Loose Association:
=disorder in the FORM of the thought (i.e. the way ideas are tied together)

Front 249

Visual and Auditory Hallucinations

Back 249

**Common in schizophrenia

Front 250

Olfactory Hallucinations

Back 250

**Occur as an aura of a psychomotor epilepsy

Front 251

Gustatory Hallucinations

Back 251

RARE

Front 252

Tactile Hallucinations

Back 252

i.e. FORMICATION
=sensation of ants crawling on one's skin

**Common in DTs
**Also seen in cocaine abusers (i.e. "cocaine bugs")

Front 253

HypnaGOgic Hallucinations

Back 253

Occur while GOing to sleep

Front 254

Hypnopompic Hallucinations

Back 254

Occur while WAKING from sleep

Front 255

Sleep Apnea

Back 255

**Person stops breathing for at least 10 seconds repeatedly during sleep

Front 256

Central Sleep Apnea

Back 256

NO respiratory effort

Front 257

Obstructive Sleep Apnea

Back 257

Respiratory effort AGAINST airway obstruction

Front 258

What is associated w/ sleep apnea?

Back 258

1) Obesity
2) Loud snoring
3) Systemic/pulmonary HTN
4) Arrhythmias
5) Possibly sudden death

**Individuals may become chronically tired

Front 259

Treatment:

Back 259

Weight loss, CPAP, surgery

Front 260

Narcolepsy

Back 260

**Disordered regulation of sleep-wake cycles
=may include hypnagoic or hypopompic hallucinations

**Person's episodes start off with REM cleep

**STRONG GENETIC COMPONENT

Front 261

Cataplexy

Back 261

Loss of all muscle tone following a strong emotional stimulus

**occurs in some patients w/ narcolepsy

Front 262

Treatment?

Back 262

**Stimulants
=i.e. amphetamines

Front 263

Schizophrenia

Back 263

**Periods of psychosis and disturbed behavior w/ a decline in functioning lasting > 6 months

Front 264

Schizophreniform Disorder

Back 264

1-6 months

Front 265

Brief Psychotic Disorder

Back 265

<1 month

=usually stress-related

Front 266

What are the 5 Subtypes of Schizophrenia?

Back 266

1) Disorganized
2) Catatonic
3) Paranoid
4) Undifferentiated
5) Residual

Front 267

Diagnosis requires 2 or more of the following:

Back 267

1) Delusions
2) Hallucinations
=often auditory
3) Disorganized thought
=i.e. loose associations
4) Disorganized or catatonic behavior

**1-4 are POSITIVE SYMPTOMS...the patient can ALSO have NEGATIVE SYMPTOMS

Front 268

What are the Negative Symptoms?

Back 268

=flat affect
=social withdrwal
=lack of motivation
=lack of speech or thought

Front 269

Etiology and Prevalence

Back 269

**GENETIC factors outweight environmental factors in the etiology

**1.5% lifetime prevalence
=males = females
=blacks = whites

BUT presents earlier in MEN

Front 270

Schizoaffective Disorder

Back 270

**A combination of schizophrenia and a mood disorder.

Front 271

Personality Trait

Back 271

**An enduring pattern of percieving, relating to, and thinking about the environment and onself--exhibited in a range of social/personal contacts

Front 272

Personality DISORDER

Back 272

**Occurs when these patterns become inflexible and maladaptive--causing impairment in social or occupational functioning

**Person is generally NOT AWARE of the problem

**NOT usually diagnosed in children.

Front 273

CLUSTER A Personality Disorders

Back 273

="odd, eccentric"

1) Paranoid
2) Schizoid
3) Schizotypal

**Patients cannot develop meaningful social relationships
**Genetic association w/ schizophrenia

Front 274

Paranoid

Back 274

=distrust and suspiciousness
=PROJECTION is main defense mechanism

Front 275

Schizoid

Back 275

=Voluntary social withdrawl
=Limited emotional expression

Front 276

Schizotypal

Back 276

**Interpersonal awkwardness

**Odd beliefs or magical thinking

**Eccentric appearance

Front 277

CLUSTER B Personality Disorders

Back 277

="dramatic, erratic"

**Genetic association w/ MOOD DISORDERS + SUBSTANCE ABUSE

1) Antisocial
2) Borderline
3) Histrionic
4) Narcissistic

Front 278

Antisocial

Back 278

**Disregard for and violation of rights of others
**Criminality

**Males > Females
=Called a "conduct disorder" if the person is <18

Front 279

Borderline

Back 279

**Unstable mood and interpersonal relationships

**Impulsiveness

**Sense of emptiness

**FEMALES > Males

Front 280

Histrionnic

Back 280

**Excessive emotionality
**Attention seeking
**Sexuallly provocative

Front 281

Narcissistic

Back 281

**Gradiosity
**Sense of entitlement

**May react to critism w/ rage

**May demand "top" physician/best healthcare

Front 282

CLUSTER C Personality Disorders

Back 282

**Anxious or fearful

**Genetic association w/ ANXIETY disorders

1) Avoidant
2) OCD
3) Dependent

Front 283

Avoidant

Back 283

**Sensitve to rejection
**Socially inhibited and timid
**Feelings of inadequacy

Front 284

Obsessive-Compulsive

Back 284

Preoccupation w/ order, perfectionism, and control

Front 285

Dependent

Back 285

**Submissive and clinging
=excessive need to be taken care of
=low self-confidence

Front 286

What is Potter's Syndrome?

Back 286

**Bilateral renal agenesis --> oligohydraminos --> limb deformities, facial deformities, pulmonary hypoplasia

**Babies w/ Potter's can't PEE in utero!

Front 287

Cause?

Back 287

**Malformation of the ureteric bud

Front 288

Horseshoe Kidney

Back 288

**Inferior poles of both kidneys fuse
=as they ascend from the pelvis during fetal development, horseshoe kidneys get TRAPPED under the inferior mesenteric artery --> and THUS remain low in the abdomen

Front 289

CASTS in the Urine:

Back 289

**Presence of casts indicates that hematuria/pyuria is of RENAL origin

Front 290

What do RBC Casts Signal?

Back 290

1) Glomerular inflammation
=nephritic syndromes

2) Ischemia

3) Malignant HTN

4) BLADDER CANCER

Front 291

What do WBC Casts Signal?

Back 291

1) Tubulointerstitial disease

2) Acute pyelonephritis

3) Glomerular disorders

4) ACUTE CYSTITIS

Front 292

What do Granular Casts Signal?

Back 292

ACUTE TUBULAR NECROSIS

Front 293

What do Hylanine Casts Signal?

Back 293

**NONSPECIFIC

Front 294

NephrItic Syndrome

Back 294

**Hematuria, HTN, oliguria, azotemia

**Think "I" for INFLAMMATION

Front 295

What can cause NephrItic Syndrome?

Back 295

1) Acute Poststreptococcal glomerulonephritis
2) Rapidly Progressive (=Cresenteric) Glomerulonephritis
3) Goodpasture's Syndrome
4) Membranoproliferative Glomerulonephritis
5) IgA Nephropathy
6) Alport's Syndrome

Front 296

Acute Poststreptococcal Glomerulonephritis

Back 296

**Most frequently seen in CHILDREN

**Presents w/ peripheral and periorbital edema

**Resolves spontaneously

Front 297

LM Findings?

Back 297

**Glomerulil enlarged and HYPERCELLULAR

**Neutrophils

**"Lumpy-Bumpy"

Front 298

EM?

Back 298

**Subepithelial humps

Front 299

Immunofluorescence? (IF)

Back 299

GRANULAR pattern

Front 300

Rapidly Progressive (Cresenteric) Glomerulonephritis

Back 300

**Rapid course to renal failure from one of many causes

Front 301

LM and IF

Back 301

CRESENCT-MOON SHAPE

Front 302

Goodpasture's Syndrome

Back 302

**Type II Hypersensitivity

**Can cause HEMOPTYSIS and hematuria

Front 303

IF

Back 303

**Linear pattern

**Anti-GBM antibodies

Front 304

Membranoproliferative Glomerulonephritis

Back 304

**Slowly progresses to renal failure

Front 305

EM

Back 305

Subendothelial humps

="tram-track" appearance

Front 306

IgA Nephropathy

Back 306

**"Berger's Disease"

**Mild disease--often postinfectious

Front 307

IG and EM

Back 307

Mesangial deposits of IgA

Front 308

Alport's Syndrome

Back 308

**Collagen IV Mutation
=can cause nerve deafness and ocular disorders

**SPLIT BASEMENT MEMBRANE

Front 309

NephrOtic Syndrome

Back 309

**Massive proteinuria, hypoalbuminemia, peripheral + periorbital edema, hyperlipidemia

**"O" = prOteinuria

Front 310

Causes:

Back 310

1) Membranous Glomerulonephritis
2) Minimal Change Disease
3) Focal Segmental Glomerular Sclerosis
4) Diabetic Nephropathy
5) SLE

Front 311

Membranous Glomerulonephritis

Back 311

**Common cause of ADULT nephrotic syndrome

Front 312

LM

Back 312

**Diffuse capillary and basement membrane thickening

Front 313

IF

Back 313

GRANULAR pattern

Front 314

EM

Back 314

"spike and dome" appearance

Front 315

Minimal Change Disease

Back 315

**"Lipoid Nephrosis"

=most common cause of childhood nephrotic syndrome

**Responds well to STEROIDS

Front 316

LM

Back 316

NORMAL glomeruli

Front 317

EM

Back 317

FOOT PROCESS EFFACEMENT

color image 93

Front 318

Focal Segmental Glomerular Sclerosis

Back 318

**Causes a more severe disease in HIV patients

Front 319

LM

Back 319

Segmental sclerosis and hyalinosis

Front 320

Diabetic Nephropathy--LM

Back 320

**Kimmelstiel-Wilson "wire loop" lesions

**Basement membrane thickening

color image 95

Front 321

SLE

Back 321

**There are actually 5 patterns of renal involvement

**In MEMBRANOUS GLOMERULONEPHRITIS
=wire-loop lesion w/ subendothelial deposits

Front 322

Kidney Stones

Back 322

**Can lead to severe complications such as:
=hydronephrosis
=pyelonephritis

**4 Major Types:
=calcium
=ammonium magnesium phosphate
=uric acid
=cystine

Front 323

Which are Radiopaque vs. Radiolucent?

Back 323

RADIOPAQUE:
=Calcium
=Ammonium magnesium phosphate (struvite)

Radiolucent:
=Uric acid
=Cystine

Front 324

Calcium

Back 324

**MOST COMMON kidney stones (75-85%)

**Can be composed of calcium oxalate, calcium phosphate or both

COLOR IMAGE 97

Front 325

What could cause these calcium stones?

Back 325

**Conditions that cause HYPERCALCEMIA:
=cancer
=increased PTH
=increased vitamin D
=milk-alkali syndrome

**TEND TO RECUR!

Front 326

Ammonium Magnesium Phosphate

Back 326

**STRUVITE STONES**

**2nd most common kidney stone
=caused by INFECTION w/ UREASE-POSITIVE BUGS

**Can form STAGHORN CALCULI that can be a nidus for UTIs

Front 327

What are urease-positive bugs?

Back 327

=Proteus
=Staph
=Klebsiella

Front 328

Uric Acid

Back 328

**Strong association w/ HYPERURICEMIA (i.e. GOUT)

**Often seen as a result of diseases w/ increased cell turnover such as:
=leukemia
=myeloproliferative disorders

Front 329

Cystine

Back 329

**Most often secondary to cystinuria

Front 330

Renal Cell Carcinoma--Epidemiology:

Back 330

**Most common renal malignancy

**Most common in MEN ages 50-70

**Increased incidence w/ SMOKING and OBESITY

Front 331

Genetic Origin?

Back 331

**Associated w/ von Hippel-Lindau AND gene deletion in chromosome 3

Front 332

Where does it originate and where does it go?

Back 332

**Originates in renal tubule cells --> polygonal clear cells

**Invades IVC and spreads hematogenously

Front 333

Presentation

Back 333

=hematuria
=palpable mass
=secondary polycythemia
=flank pain
=fever
=weight loss

Front 334

Is it associated w/ paraneoplastic syndromes?

Back 334

**YES**

=ectopic EPO
=ACTH
=PTHrP

COLOR IMAGE 98

Front 335

Wilm's Tumor

Back 335

**Most common renal malignancy of early childhood (age 2-4)

**Caused by a deletion of tumor suppression gene WT1 on chromosome 11

Front 336

Can be part of the WAGR Complex:

Back 336

1) Wilm's Tumor
2) Aniridia
3) Genitourinary malformation
4) Mental-motor retardation

Front 337

Presenation

Back 337

**Presents w/ a huge, palpable flank mass, hemihypertrophy

Front 338

Transitional Cell Carcinoma

Back 338

**Most common tumor of the URINARY TRACT SYSTEM--> can occur in:
=renal calyces
=renal pelvis
=ureters
=bladder

Front 339

What symptom is especially suggestive of bladder cancer?

Back 339

Painless hematuria

Front 340

Associated with:

Back 340

**Associated w/ problems in your "Pee SAC:"

1) Phenacetin
2) Smoking
3) Aniline dyes
4) Cyclophosphamide

COLOR IMAGE 90

Front 341

Pyelonephritis

Back 341

Can be ACUTE or CHRONIC

Front 342

Acute Pyelonephritis

Back 342

**Affects cortex with relative SPARING of the glomeruli/vessels

**White cells casts in urine are pathognomonic

**Presents w/ fever, CVA tenderness

COLOR IMAGE 89A

Front 343

Chronic Pyelonephritis

Back 343

**Coarse, asymmetric corticomedullary scarring

**Tubules can contain eosinophilic casts = "thyroidization of the kidney"

COLOR IMAGE 89B

Front 344

What is diffuse cortical necrosis?

Back 344

**Acute generalized infarction of cortices of both kidneys

**Likely due to a combination of vasospasm AND DIC

Front 345

What is it associated with?

Back 345

1) Obstetric catastrophes
=i.e. abruptio placentae

2) Septic Shock

Front 346

Acute Tubular Necrosis

Back 346

**MOST common cause of acute renal failure
=reversible BUT fatal if left untreated
=death most often occurs during the initial oliguric phase

**Recovery in 2-3 weeks

Front 347

What is it associated with?

Back 347

1) Renal ischemia
=i.e. shock

2) Crush injury
=myoglobulinuria

3) Toxins

Front 348

What is Renal Papillary Necrosis associated with?

Back 348

1) Diabetes Mellitus
2) Acute pyelonephritis
3) Chronic phenacetin use

Front 349

Acute Renal Failure

Back 349

**Abrupt decline in renal function with INCREASED creatinine and INCREASED BUN over a period of several days

1) Prerenal azotemia
2) Intrinsic renal
3) Postrenal

Front 350

Prerenal Azotemia

Back 350

**Decreased RBF (i.e. hypotension) --> DECREASED GFR

=Na and water retained by the kidney

Front 351

Intrinsic Renal

Back 351

**Generally due to acute tubular necrosis OR ischemia/toxins

**Patchy necrosis leads to debris obstructing the tubule and fluid backflow across necrotic tubule --> DECREASED GFR

**Urine has epithelial/granular casts

Front 352

Postrenal

Back 352

**Outflow obstruction
=stones
=BPH
=neoplasia

**Develops only with bilateral obstruction

Front 353

Consequences of Renal Failure

Back 353

**Failure to make urine and excrete nitrogenous wastes

**2 Forms of Renal Failure:
1) Acute Renal Failure
=often due to hypoxia
2) Chronic Renal Failure
=due to HTN and diabetes

Front 354

Uremia

Back 354

**The actual clinical syndrome marked by INCREASED BUN and CREATININE and associated symptoms.

Front 355

SO, consequences of renal failure:

Back 355

1) Anemia
=failure of erythropoietin production
2) Renal osteodystrophy
=failure of active vitamin D production
3) Hyperkalemia
=can lead to cardiac arrythmias
4) Metabolic acidosis
=due to decreased acid secretion and decreased generation of HCO3-

Front 356

Continued...

Back 356

5) Uremic encephalopathy
6) Sodium and H20 excess --> CHF and pulmonary edema
7) Chronic pyelonephritis
8) HTN

Front 357

Low Serum Sodium

Back 357

=disorientation
=stupor
=coma

Front 358

High Serum Sodium

Back 358

**Neurologic
=irritability
=delirium
=coma

Front 359

Low serum Chlorine

Back 359

Secondary to metabolic alkalosis

Front 360

High serum chlorine

Back 360

Secondary to non-anion gap acidosis

Front 361

Low serum Potassium

Back 361

**U waves on ECG

**Flattened T-waves

**Arrhythmias

**Paralysis

Front 362

HIGH serum potassium

Back 362

**Peaked T-waves

**Arrhythmias

Front 363

Low serum Calcium

Back 363

**Tetany

**Neuromuscular irritability

Front 364

High serum calcium

Back 364

**Delirium

**Renal stones

**Abdominal pain

Front 365

Low serum magnesium

Back 365

**Neuromuscular irritability

**Arrhythmias

Front 366

High serum magnesium

Back 366

**Delirium

**Decreased DTR's

**Cardiopulmonary arrest

Front 367

Low serum phosphate

Back 367

**Low-mineral ion product = causes bone loss

Front 368

High serum phosphate

Back 368

**High-mineral product = causes metastatic calcification

**Renal stones