Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
120 Cards in this Set
- Front
- Back
Which anti-depressants can --> delirium
how to treat this? |
MAOI
IV BZ (lorazepam is a good one, b/c there is a short t 1/2) |
|
how many days should you wait to give an SSRI, in a pt that has been previously treated with MAOI?
|
14 days
|
|
what is used to treat atypical depression?
|
MOAI
|
|
which etoh detox drugs are metabolized by the liver?
|
chlordiazepoxide (librim)
diazepam |
|
which etoh detox drug is good to give to someone w impaired liver fxn?
|
oxazepam (serax)
|
|
what effect do SSRIs have on post-synaptic 5HT-2 receptors?
|
downregulates them
|
|
which NSAID does not interfere with lithium metabolism?
|
ASA
|
|
what decreases lithium excretion?
|
Metronidazole
ACE inhibitors Tetracycline Thiazide diuretics NSAIDS (not ASA) CCBs |
|
what increases lithium clearance?
|
Theophillline
Acetazolamide Caffeine Osmotic diuresis |
|
side effects of lithium?
|
nephrogenic DI
hypothyroid leukocytosis tremors acne sedation arrhythmias T wave flattening/inversion |
|
What med can exacerbate tics?
|
mehtylphenidate
|
|
what is the MOA of treating Tourrette's?
|
D2 antagonism (antipsychotics)
|
|
what drugs can be used to treat OCD?
|
Clomipramine
Fluvoxamine |
|
What decresaes impulsiveness in Borderline PD?
|
SSRI (esp fluoxetine)
haloperidol |
|
If looking for immediate relief of GAD, what class of meds should be given?
|
BZ
|
|
Effect of lithium in pregnancy?
%? |
Ebstien's
7.7% |
|
mood stabilizer that has causes fetal abnormalities if given during pregnancy?
|
clonazepam
|
|
Whath meds can be given to delirius pts?
|
low-dose atypical antipsychotics
low-dose haldol |
|
why do atypical antipsychotic meds --> orthostatic hypotension?
|
alpha 1 blockade
|
|
What drugs are used to treat PTSD and why?
which drug class is NOT effectve in PTSD? |
Clonidine: to decrease the re-experiencing of PTSD
SSRIs: to reduce the "numbness" associated w PTSD BZ not effective |
|
What is the 1st line med for panic d/o?
other drugs to treat panic d/o? |
fluvoxamine
imipramine and phenelzine can also be used, but less desirable d/t side effects |
|
which mood stabilizer --> pancreatitis?
|
valproic acid
|
|
how long should pts be treated for 1st episode of depression?
|
at least 6 mos, usually 8-12 mos to prevent relapse
|
|
how to treat drooling associated with clozapine?
|
anti-cholinergic
|
|
how to treat clozapine induced tachycardia?
|
propanolol
|
|
which of the atypical anti-psychotics are least likely to increase cholesterol or cause DM?
|
aripiprazole
ziprasadone |
|
which antidepression is used to treat depression and diabetic neuropathy?
|
duloxetine
|
|
what is the most common underlying cause for post-partum psychosis?
|
underlying bipolar I d/o
|
|
cortisol levels in MDD?
catecholamine levels? sex hormones? immune fxn? |
incresaed (50% fail dexamethasone suppression test)
decreased decreased decreased |
|
which of the psych d/o has the strongest genetic association?
|
bipolar I
|
|
manifestations of porypheria?
|
mania/psychosis + abdominal pain
|
|
organic changes seen in Kluver-Bucy syndrome
|
bilateral damage to amygdala
|
|
what effect does starvation have on:
BUN cortisol TSH response GH |
increased
increased normal increased |
|
what is the relationship between MDD and TSH?
|
1/3 of pts have no increase in TSH wiht TRH administration
|
|
what is cluster of sx seen in normal pressure hydrocephalus?
|
ataxia
confusion incontinence |
|
length of time sx need to be present in PTSD?
acute stress d/o? |
>4 wks
<4 wks |
|
long term tx for Borderline PD?
|
therapy and steady social support
|
|
hwo does insight relate to psychosis?
|
if pts have insight into their delusions/hallucinations, etc, they are not psychotic
|
|
what fraction of pts with MDD respond to placebo?
|
1/3
|
|
what is the clinical course expected in a schizophrenic not on meds?
|
unknown
|
|
in men 30-50 yo, what % of impotence is related to pysiologic reasons?
|
10%
|
|
what is the % liklihood of a pt developing schizophrenia if:
1 parent has schizo both parents have schizo MZ twin has schizo |
12%
40% 50% |
|
other than +/- sx of schizophrenia, what behavioral can be seen
|
short-term memory deficits
unstable smooth eye pursuit can't habituate to repeated stimulus |
|
treatment for normal pressure hydrocephalus
|
shunt
|
|
delirium + hemiparesis or other focal neuro signs
dx? confirm? |
CVA or mass
brain CT/MRI |
|
delirium + elevated BP + papilledema
dx? confirm? |
HTN encephalopathy
brain CT/MRI |
|
delirium + dilated pupils and tachycardia
dx? confirm? |
drug intox
urine toxicology screen |
|
delirium + fever + nuchal rigidity + photophobia
dx? confirm? |
meningitis
lumbar puncture |
|
delirium + tachy + tremor + thyromegaly
dx? confirm? |
thyrotoxicosis
T4, TSH |
|
dementia w stepwise increase in severity + focal neuro signs
dx? confirm? |
multi-infarct dementia
CT/MRI |
|
dementia + cogwheel rigidity + resting tremor
dx? confirm? |
PArkinson's dz
CT/MRI |
|
dementia + ataxia "+ urinary incont + dilated cerebral ventricles
dx? confirm? |
NPH
CT/MRI |
|
which, delirium or dementia has EEG changes
|
delirium
|
|
dementia + obesity + coarse hair + constipation + cold intolerance
dx? confirm? |
hypothyroid
T4, TSH |
|
dementia + tremors + abnormal LFTs + kayser-Fleischer rings
|
Wilson's dz
ceruloplasmin |
|
Dementia + diminished position/vibration sense + argyll-robertson pupils
dx? confirm? |
neurosyph
CSP VDRL |
|
what NT changes are seen in Alzheimer's Dz?
|
decreased NE and ACh
|
|
treatement for Alzheimer's Dz
|
cholinesterase inhibitors (tacrine, donezepil, rivastigmine)
tx sx as necessary (BZ for anxiety, low dowse anti-psychotics for agitation/psychosis, antidepressants) |
|
what is the main difference in presentation between Pick's dz and Alzheimer's dz
|
personality changes are more prominent early in the pick's dz, but late in Alzheimer's
|
|
what pathology is seen in pick's dz
|
atrophy of fronto-temporal lobe
pick's bodies (intraneuronal bodies, not necessary for dx) |
|
pathological changes seen in HD?
|
daudate atrophy
cortical atrophy (sometimes) |
|
which chromosome is involved in HD
|
4q
|
|
what cells are affected in Parkinson's dz
|
loss of cells in substantia nigra of basal ganglia --> decreased DA and loss of dopaminergic tracts
|
|
how are MOAIs connected to PArkinsons dz tx?
|
MAO-B inhibitors inhibit breakdown of DA
ex - selegiline |
|
surgical options for Parkinson's dz
|
thalamotomy
pallidotomy |
|
what causes cortical dementia
|
alzheimer's
pick's CJD (see decline in mental fxn) |
|
what causes subcortical dementia
|
Huntington's
Parkinson's NPH multi-infarct dementia (see more prominent affective and movement sx) |
|
hallmark sx of CJD?
|
myoclonus
EPS ataxia LMNS |
|
hallmark sx of NPH
|
ataxia
incontinence dementia |
|
pathologica changes seen in NPH
|
enlarged ventricles, increased CSF pressure
|
|
eiology of NPH
|
idiopathic
or secondary to obstruction of CSF reabsorption |
|
causes of delirium
|
Impaired delivery of brain substrates
Metabolic Drug Endocrinopathy Liver dz Infrastructure Renal failure Infection Oxygen UTI Sensory deprivation |
|
changes in sleep structure in elderly
|
increased REM episodes (but duration is shorter) --> decreased total REM sleep
non-REM is increased (increased stage I and II, with decrease in stages III and IV) increased awakenings after sleep onset |
|
what changes in sleep are seen in depressed young pts
|
increased REM
decreased REM latency decreaed REM towards morning less than 25% delta sleep increased nighttime awakening |
|
what is nml % of REM in YA?
REM latency? REM pattern? percentage delta? nighttime awakenings |
25%
90 min increased REM towards AM 35% 1-3 |
|
what EEG pattern is seen in stage 1 of sleep?
|
theta
|
|
what EEG pattern is seen in stage 2 of sleep?
|
sleep spindle
K complex |
|
what EEG pattern is seen in stage 3 of sleep?
|
delta waves
|
|
what EEG pattern is seen in stage 4 of sleep?
|
delta waves
|
|
what EEG pattern is seen in REM?
|
sawtooth
beta alpha theta |
|
what stage of slep do sleep terrors, sleep walking, and bedwetting occur?
|
stages 3 and 4
|
|
what stage of sleep do nightares occur?
|
REM
|
|
what stage of sleep do night terrors occur?
|
stages 3/4
|
|
when in sleep does bruxim occur
|
stage 2
|
|
what is Kleine-Levin syndrome
|
recurrent periods of ecessive leepiness daily for 1+ months
sleepiness not relieved by daytime naps often accompanied by hyperphagia |
|
what is localized amnesia?
|
memory loss ocuring during a particular time period, especially after a traumatic event
|
|
what is selective amnesia/
|
can't remember certain aspects of an event
|
|
what is cotard syndrome
|
delusion that nothing exists
feeling that body is disintegrated or that they are dead |
|
what is fregoli syndrome?
|
person takes the form of many other ppl/creatures
|
|
what is pyshiologically occuring in a person w OCD
|
increased metabolism in caudate nucleus, frontal lobe, and cigulum
|
|
what is circumlocution?
|
word substitution
|
|
what structures shrink in schizophrenia
|
hippocampus
parahyoppocampal gyrus amygdala |
|
what is verbigeration
|
repetitive meaningless talking
|
|
what is glossolalia
|
ability to speak new language suddenly
|
|
si/sx of WErnicke's encephalopathy
|
CN VI palsy (bilat)
horizontal nystagmus ataxia global confusion |
|
what is oculogyric crisis?
|
acute dystonia reaction with spasm of extraocular muscles
|
|
what is trismus?
|
spasm of jaw muscles
|
|
can hallucinations + delusions = delusional d/o
|
NO
|
|
sx of tertiary syphilis
|
sensory ataxia
+ romberg decreased vibration/proprioception in lwer extremities decresed DTR pupil abnormalities |
|
mens rea
|
criminal intent
|
|
actus rea
|
criminal act
|
|
schizophrenia, residual type
|
absence of + sx
|
|
testamentary capacity
|
competence required to write a will
1. ability to understand the writing/signning of awill 2. knowlege of potential heirs 3. understanding extent of one's assets 4. Lack of undue influence 5. Absence of delusions compromising rational thought |
|
what --> not guilty by reason of insanity
|
can't appreciate wrongfulness of act
can't conform to conduct laws |
|
habeus corpus
|
due process
|
|
parens patriae
|
state cares for people that can't care for themselves
|
|
informed consent requires:
|
1. mental competency
2. voluntary choice 3. risk-benefit analysis 4. alternative tx options |
|
what makes someone an emancipated minor
|
married
have kids in military self-supporting |
|
when is parental consent not required for a minor:
|
OB care
STD tx substance abuse |
|
what type of therapy is useful in bulemia
|
CBT
|
|
rumination d/o
|
repeated regurgitation and rechewing of food >1 month following nml fxnign
seen when there are multiple caregivers |
|
how to confirm rumination d/o
|
esophageal pH
|
|
what is the #1 cause of halluciation in children
|
substance induced
|
|
common side effects from fluoxetine
|
H/A and nausea
|
|
describe progression with Rette d/o
|
nml prenatal and perinatal development, till about 5 months
then, decreased head growth, stereotyped hand movt and decreased social interaction MR |
|
what is the first line tx for Tourette's
|
Clonidine (also good for ADHD, so good when there is comorbidity)
|
|
medical tx for enuresis
|
imipramine
|
|
what happens to brain of anorexic pt
|
ventricles enlarge
|
|
#1 side effect from clonidine
|
sedation
|
|
what illness is associated with psychiatric issues
|
strep --> OCD and Tourette's
|