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;
221 Cards in this Set
- Front
- Back
empiric Rx for brain abcess
|
Antibiotics for primary infection
(if 2nd/2 neurosurgery: Vancomycin + Ceftazidime) Needle aspiration & drainage Corticosteroids (to decrease ICP) |
|
Rx for epidural and subdural hematoma
|
evacuation of hematoma
(burr holes) |
|
typical px for pseudotumor cerebri
|
obese
female 20-30's |
|
characteristics of grief that has become pathologic
|
IF ANY OF THE FOLLOWING ARE PRESENT:
depression for two weeks after first 2 months hopeless, helpless, worthless, & guilt suicidal ideation distressing feelings persist for > 6 months inability to move on, trust others, and reengage in life by 6 months |
|
neurotransmitter change in:
anxiety |
increased NE
decreased 5HT and GABA |
|
neurotransmitter change in:
depression |
decreased NE, DA, 5HT
|
|
neurotransmitter change in:
mania |
increased NE and 5HT
|
|
neurotransmitter change in:
alzheimer |
decreased ACh
|
|
neurotransmitter change in:
huntingtons |
decreased ACh and GABA
|
|
neurotransmitter change in:
schizo |
increased DA
|
|
neurotransmitter change in:
parkinson's |
decreased DA
increased ACh |
|
what is mood? what is affect?
|
mood=internal emotional state
affect=outward expression of that emotin |
|
what is loose association
|
jumping to new subject matter that is illogical
|
|
what is tangentiality
|
goes off on tangents (but you can see how the topic is related)
|
|
what is word salad
|
speaks words that together have no meaning
|
|
conditions a/w depression
|
hypothyroidism
hyperPTH parkinson's stroke CNS tumor pancreatic cancer |
|
what Rx can cause depression
|
sedative (alcohol, benzo, antihistamines)
stimulant withdrawal methyldopa 1st gen antipsychotics anti nausea (metoclopramide and prochlorperazine) glucocorticoids IFN-a |
|
symptoms of atypical depression
|
hypersomnia
psychomotor retardation hyperphagia/wt gain hypersensitivity to rejection |
|
Rx for atypical depression
|
MAOI's (work better than TCA's)
|
|
Rx for seasonal affective disorder
|
phototherapy (30 mins/day)
SSRI's bupropion |
|
symptoms of major depression
|
SIG E CAPS
sleep disturbance interest loss guilt energy loss concentration loss appetite changes psychomotor changes suicidal |
|
major depressive disorder must have symptoms for how long
|
> 2 weeks
|
|
Dx and where is the lesion of px with hyperphagia, hyperorality, & hypersexuality
|
dx = kluver bucy
lesion = b/l amygdala |
|
What is the MCC of seizures in young adults (18-35 y/o)
|
Trauma
EtOH withdrawal Brain tumors |
|
Rx for cluster headaches
|
100% O2 (hyperbaric)
triptans and dihydroergotamines |
|
MOA/class of fluvoxamine
|
SSRI
|
|
MOA/class of fluoxetine
|
SSRI
|
|
MOA/class of sertraline
|
SSRI
|
|
MOA/class of paroxetine
|
SSRI
|
|
MOA/class of citalopram
|
SSRI
|
|
MOA/class of escitalopram
|
SSRI
|
|
MOA/class of nortriptyline
|
TCA
|
|
MOA/class of doxepin
|
TCA
|
|
MOA/class of imipramine
|
TCA
|
|
MOA/class of amitriptyline
|
TCA
|
|
MOA/class of desipramine
|
TCA
|
|
MOA/class of clomipramine
|
TCA
|
|
MOA/class of tranylcypromine
|
MAOI
|
|
MOA/class of phenelzine
|
MAOI
|
|
MOA/class of bupropion
|
NDRI
|
|
MOA/class of milnacipran
|
SNRI
|
|
MOA/class of venlafaxine
|
SNRI
|
|
MOA/class of duloxetine
|
SNRI
|
|
MOA/class of desvenlafaxine
|
SNRI
|
|
MOA/class of mirtazapine
|
Tetracyclic
|
|
MOA/class of trazodone
|
atypical antidepressant
|
|
MOA/class of nefazodone
|
atypical antidepressant
|
|
MOA/class of vilazadone
|
atypical antidepressant
|
|
what should not be taken with SSRI because of serotonin syndorme
|
ANY DRUG THAT INCREASES SEROTONIN:
SSRI x 2 SNRI MAOI TCA St johns wart tryptophan levodopa triptans (5-HT receptor agonists) cocaine, amphetamines, ecstacy |
|
features of serotonin syndorme
|
MENTAL STATUS CHANGES:
anxiety agitation delirium restlessness disorientation AUTONOMIC EXCITATION diaphoresis tachycardia hyperthermia HTN NEUROMUSCULAR HYPERACTIVITY tremor muscle rigidity myoclonus hyperreflexia occular clonus b/l babinski sign bilaterally |
|
compare/contrast etiology, onset, sx's, & tx of serotonin syndrome and neuroleptic malignant syndorme
|
BOTH SYNDROMES:
autonomic instability hyperthermia muscle problems SEROTONIN SYNDROME: Etiology: excess serotonin Onset: rapid Sx's: hyperkinesia & clonus Tx: BZ's NEUROLEPTIC MALIGNANT SYNDROME: Etiology: SE of antipsychotic drugs Onset: gradual Sx's: bradykinesia & lead pipe rigidity Tx: Dantrolene |
|
What is Serotonin Withdrawal Syndrome
|
aka SSRI discontinuation syndrome
Onset: within days of abrupt discontinuation of SSRI Sx's: chills, fatigue, dizziness, irritability, anxiety, nausea & muscle aches Duration: dissipates over 1-2 weeks |
|
which drugs are most known for causing serotonin w/draw syndorme
|
paroxetine & venlafaxine
(b/c very short T1/2) |
|
evaluation needed for px starting to take TCA
|
SCREEN PT HX:
heart disease palpitations sycncope/near-syncope BASELINE EKG |
|
symptoms of TCA toxicity
|
cardiotoxicity
CNS toxicity ACh'c SE's (dry mouth, constipation, urinary retention, delirium, esp in the elderly) |
|
in TCA overdose, what is used to correct QT prologation and seizures
|
QT PROLONGATION (QRS > 100 msec's):
sodium bicarb SEIZURES: benzo's, barb's, & propofol (NOTE: phenytoin is INEFFECTIVE)) |
|
antidepressant used to Rx comorbid neuropathic pain
|
duloxetine
|
|
what px is bupropion contraindicated
|
seizure disorder
eating disorder coming off benzo or alcohol |
|
antidepressant:
SE of priapism |
trazodone
|
|
antidepressant:
lowers seizure threshold and can be used for smoking cessation |
bupropion
|
|
antidepressant:
appetite stimulant that is likely to result in weight gain |
mirtazipine
|
|
antidepressant:
works well with SSRI and increases REM sleep |
trazodone
|
|
antidepressant:
can be used to Rx bedwetting |
imipramine (short-term only, e.g. vacations or sleep-overs)
|
|
Name as many SSRI's as you can
|
Fluvoxamine
Fluoxetine sertraline paroxetine citalopram escitalopram |
|
Name as many SNRI's as you can
|
milnacipran
venlafaxine duloxetine desvenlafaxine |
|
Name as many NDRI's as you can
|
bupropion
|
|
Name as many MAOI's as you can
|
phenelzine
tranylcypromine |
|
Name as many TCA's as you can
|
Mnemonic: CANDID
Clomipramine Amitriptyline Nortriptyline Imipramine Desipramine Doxepin |
|
Name as many Tetracyclic's as you can
|
Mirtazapine
|
|
Name as many Atypical Antidepressants as you can
|
Trazadone
Nefazadone Vilazadone |
|
Dx and cause a crescent-shaped lesion on CT-Brain
|
subdural hematoma
blunt head trauma --> rupture of bridging veins |
|
initial study and later study of TIA/stroke px
|
INITIAL STUDY: CT without contrast
FURTHER STUDIES: carotid doppler, echocardiogram, angiogram (i.e. CTA/MRA) |
|
how to distinguish dysthymia from MDD
|
DYSTHYMIA:
never meets MDD criteria no suicidal ideation sx's more than 1/2 the time lasting > 2 years no h/o major depressive episodes (o/w classified as recurrent depression) |
|
Rx for bipolar disorder with mild depression
|
lithium OR lamotrigine
|
|
Rx for bipolar disorder with moderate depression
|
lithium AND lamotrigine
or lithium PLUS atypical antipsychotic or lamotrigine PLUS atypical antipsychotic |
|
Rx for bipolar disorder with severe depression
|
ECT
|
|
SE of lithium
|
CNS EFFECTS:
depression tremor cognitive dulling THYROID ABNORMALITY RENAL ABNORMALITY: nephrogenic DI renal insuffIciency GI EFFECTS: n/v diarrhea metallic taste changes wt gain |
|
Rx for DI caused by lithium
|
HCTZ with amiloride (closes Na+ channels)
|
|
how does lithium cause DI
|
Opens Na+ channels in the collecting tubules
|
|
symptoms of adjustment disorder with depressed mood
|
psychosocial stressor (not bereavement)
Onset: w/in 3 months of identifiable stressor Resolution: by 6 months after stressor subsides |
|
Rx for bipolar with renal failure
|
valproate
carbamazepine |
|
congenitaL malformation a/w lithium
|
ebstein's anomoly
|
|
difference between manic and hypomanic episode
|
HYPOMANIC:
elation/irritability > 4 days but < 1 week no significant impairment of function MANIC: elation/irritability > 1 week significant impairment of function |
|
sx's of mania
|
"DIG FAST"
Distractability Insomnia Grandiosity Flight of Ideas Activity Incr'd (goal-directed) Speech (pressured) Taking risks (sexual, drugs, spending sprees) |
|
Timeline for acute stress disorder vs PTSD
|
ACUTE STRESS D/O:
within 30 days of traumatic event PTSD: lasting > 30 days after traumatic event |
|
Timeline for Acute vs Chronic PTSD
|
Acute PTSD: sx's present < 3 months
Chronic PTSD: sx's present > 3 months |
|
Rx for PTSD
|
SSRI (1st line)
TCA MAOI Atypical Antipsychotics (in refractory cases) mood stabalizers (improve impulsiveness, arousal, & flashbacks) a-blockers (improves nightmares & sleep disturbances) |
|
Rx for OCD
|
SSRI (1st line)
clomipramine (2nd line) |
|
Rx for generalized anxiety disorder
|
SSRI's
buspirone venlafaxine (SNRI) B-blockers |
|
SE's of Benzo's
|
Depression of CNS
Dependence Disinhibition Deficits in memory Dizziness Drug inhibition or interaction (additive with other CNS depressants) Dangerous when combined with other drugs (e.g. EtOH, opiates) |
|
Antidote to Benzo toxicity; what is danger a/w administering the antidote
|
Flumazenil (Benzo antagonist)
CAREFUL: can throw pt into benzo withdrawal --> SEIZURE |
|
complication with performing LP on px with increased ICP
|
herniation of brain stem (i.e. uncal herniation) ==> death
|
|
symptoms of basilar artery stroke
|
aka pontine ischemia
**CN defects **AMS/Coma (disruption of RAS) contralateral full body weakness & decr'd sensation (corticospinal tract) vertigo, lack of coordination, difficulty speaking, & visual changes |
|
difference between bereavement and adjustment disorder
|
ADJUSTMENT D/O:
impaired ability to function tied to stressor (other than death of loved one) BEREAVEMENT no impaired function to function related to death of a loved one |
|
dx'c criteria for schizophrenia
|
AT LEAST 2 SX'S (pos or neg) during a 1 month period
SOCIAL/OCCUPATIONAL DYSFUNCTION DURATION OF SX'S > 6 MONHTS |
|
examples of positive symptoms of schizophrenia
|
DELUSIONS (irrational belief that cannot be changed with logical argument)
HALLUCINATIONS (MC = auditory) DISORGANIZED SPEECH (e.g. frequent derailment or incoherence) GROSSLY DISORGANIZED OR CATATONIC BEHAVIOR |
|
Rx's known to cause psychosis (i.e. positive sx's)
|
HALLUCINOGENS: LSD/PCP
STIMULANTS: cocaine/amphetamines WITHDRAWAL: benzos, barbs, and alcohol OTHERS: glucocorticoids & anabolic steroids |
|
examples of negative symptoms of schizophrenia
|
flat affect
social isolation apathy (lack of emotional reactivity) anhedonia avolition social isolation |
|
Rx for negative & positive sx's of schizophrenia
|
POSITIVE SX'S: typical antipyschotics
NEGATIVE SX'S: atypical antipsychotics |
|
how does delusional disorder differ from schizophrenia
|
DELUSIONAL D/O:
realistic delusions (possible, but unlikely) normal functioning SCHIZOPHRENIA: unrealistic delusions (impossible) abnormal functioning |
|
what might be seen in neuroimaging of px with schizophrenia
|
enlargemed of ventricles (lateral and 3rd)
reduction in cortical volume (mass) |
|
unique features & timeline of:
schizophrenia |
psychotic sx's >/= 6 months
|
|
unique features & timeline of:
schizoaffective |
persistent psychosis (>/= 6 months) with or without mood disorder (mood d/o comes & goes)
|
|
unique features & timeline of:
schizophreniform |
psychotic sx's > 1 month but < 6months
|
|
unique features & timeline of:
brief psychotic disorder |
psychosis < 1 month
|
|
unique features of:
schizoid |
voluntary social isolation
("schizoids avoid") |
|
unique features of:
schizotypal |
odd thoughts, behavior, & appearance
("Schizotypals dress like a pickle") |
|
What are the broad categories of antipsychotics
|
TYPICAL antipsychotics (aka traditional neuroleptics)
low-potency high-potency ATYPICAL antipsychotics |
|
Name as many LOW-potency TYPICAL antipsychotics as you can
|
chlorpromazine
thioridazine |
|
Name as many HIGH-potency TYPICAL antipsychotics as you can
|
Haloperidol
Fluphenazine Loxapine Thiothixene Trifluoperazine |
|
Name as many ATYPICAL antipsychotics as you can
|
Olanzapine
Quetiapine Risperidone Clozapine Aripiprazole |
|
What is the SE profile of antiphyschotics by category
|
TYPICAL LOW-potency neuroleptics:
anticholinergic SE's fewer mvmt SE's TYPICAL HIGH-potency neuroleptics: fewer anticholinergic SE's mvmt SE's (EPS & TD) NMS ATYPICAL neuroleptics: fewer anticholinergic SE's fewer mvmt SE's wt gain --> DM's/DKA (esp Olanzapine) |
|
What is the timing of the 2 types of "movement" disorders a/w antipsychotics
|
Extrapyramidal sx's --> acute (days to months)
Tardive Dyskinesia --> delayed (months to years) |
|
What neuroleptics are known for their EPS's
|
high-potency neuroleptics (e.g. Haloperidol)
|
|
ExtraPyramidal Sx's (EPS's) a/w antipsychotics
|
EXTRAPYRAMIDAL SX'S (EPS'S):
Dystonia Parkinsonian sx's (akinesia) Akethesia |
|
what is the Rx for acute dystonia
|
benztropine or diphenhydramine
|
|
Rx fo parkinson like SE
|
d/c or reduce dosage of offending drug
ANTICHOLINERGICS: benztropine/diphenhydramine DOPAMINE AGONIST: amantadine |
|
what time frame will you see parkinsonian like SE in px on antipsychotics
|
4 days to 4 months
|
|
features of tardive diskinesia
|
choreoathetosis
(tongue, face, neck, trunk and/or limbs) often irreversible |
|
Rx for tardive diskinesia
|
d/c or lower dosage of offending drug
switch to antipsychotic with less EPS's (mvmt SE's) |
|
features of neuroleptic malignant syndrome
|
MENTAL STATUS CHANGES:
agitated delirium with confusion (rather than psychosis) MUSCLE RIGIDITY +/- tremor HYPERTHERMIA (> 38-40C) AUTONOMIC INSTABILITY tachypnea diaphoresis tachycardia labile or high BP RHABDOMYOLYSIS (appearing over 1-3 days) |
|
Rx for neuroleptic malignant syndrome
|
STOP THE OFFENDING AGENT!
RIGIDITY/HYPERPYREXIA: Dantrolene (inhibits Ca2+ release) FEVER: IVF's cooling blankets axillary ice packs Tylenol HTN: clonidine and/or nitroprusside (cutaneous vasodilation can facilitate cooling) Agitation: Benzo's (clonazepam, lorazepam) Others possible therapies: bromocriptine or amantidine DVT prevention: heparin |
|
What antipsychotic class is olanzapine & what is a common SE
|
Olanzapine = atypical antipsychotic
SE's = wt gain --> DM/DKA |
|
which antipsychotic is known to cause agranulocytosis & what must be monitored when rx'd to a pt
|
Clozapine
SE = agranulocytosis, therefore monitor CBC |
|
Drug class:
olanzapine |
atypical antipsychotic
|
|
Drug class:
quitiapine |
atypical antipsychotic
|
|
Drug class:
risperidone |
atypical antipsychotic
|
|
Drug class:
clozapine |
atypical antipsychotic
|
|
Drug class:
aripiprazole |
atypical antipsychotic
|
|
Drug class:
chlorpromazine |
LOW-potency typical antipsychotic
|
|
Drug class:
thioridazine |
LOW-potency typical antipsychotic
|
|
Drug class:
haloperidol |
HIGH-potency typical antipsychotic
|
|
Drug class:
fluphenazine |
HIGH-potency typical antipsychotic
|
|
Drug class:
loxapine |
HIGH-potency typical antipsychotic
|
|
Drug class:
thiothixene |
HIGH-potency typical antipsychotic
|
|
Drug class:
trifluoperazine |
HIGH-potency typical antipsychotic
|
|
Defense mechanism:
calmly describes a murder they witnessed |
isolation of affect
|
|
Defense mechanism:
subconsciously pushes memories out of consciousness |
repression
|
|
Defense mechanism:
woman frustrated with child yells at her husband |
displacement
|
|
personality disorder:
excessive need to be taken care of, submissive & clinging behavior, low self-confidence, fears of separation and losing support |
dependent
|
|
personality disorder:
grandiosity, entitled, lack of empathy |
narcisistic
|
|
personality disorder:
suicide attempts, unstable mood & behavior, sense of emptiness & loneliness, impulsive |
borderline
|
|
personality disorder:
distrustful, suspicious, litigious |
paranoid
|
|
personality disorder:
lifelong voluntary social withdrawal; no psychosis; socially inhibited (restricted range of affect) |
schizoid
|
|
personality disorder:
feeling inadequate, hypersensitive to rejection/criticism, socially inhibited, shy |
avoidant
|
|
personality disorder:
constant mood of unhappiness & pessimism |
depressive
|
|
personality disorder:
odd appearance, thoughts, & behavior; no psychosis; social awkwardness |
schizotypal
|
|
personality disorder:
controlling perfectionist, orderly, stubborn, indecisive |
obsessive compulsive
|
|
personality disorder:
criminality, unable to conform to social norms, disregard for others' rights |
antisocial
|
|
personality disorder:
excessively dramatic, emotional and extroverted; sexually provocative behavior; unable to maintain intimate relationships |
histrionic
|
|
defense mechanism a/w:
paranoid |
projection
|
|
defense mechanism a/w:
borderline |
splitting
|
|
defense mechanism a/w:
histrionic |
repression
|
|
defense mechanism a/w:
OC |
isolation
|
|
difference between OCD & OCPD
|
OCPD: do not recognize their behavior as problematic
OCD: recognize their behavior as problematic |
|
compare/contrast conduct d/o vs antisocial d/o
|
They are the same d/o with different age criteria:
CONDUCT D/O: < 18 y/o ANTISOCIAL D/O: > 18 y/o FEATURES OF BOTH: disregard others rights criminality cruelty to animals |
|
most serious SE of clozapine
|
agranulocytosis
|
|
what is todds paralysis
|
postictal hemiparesis, lasting 15-24 hrs
|
|
Rx for acute otitis media
|
1st line: amoxicillin x 10 days
2nd line: amoxicillin + clavulonate (i.e. augmentin) 3rd line: Cephalosporin |
|
what treatments are effective in helping recovering alcoholics
|
AA
disulfiram topiramate naltrexone acamprosate |
|
components of CAGE criteria
|
cut down
annoyance guilt eye-openner |
|
which vitamins are alcoholics usually deficient in
|
Vitamin A
Vitamin B1, B2, B6, B9, & B12 (i.e. thiamin, B2, B6, folate, & B12) Vitamin C |
|
most successful Rx for alcoholics
|
12-step group counseling (i.e. AA)
|
|
symptoms a/w delirium tremens
|
Tachycardia
HTN Diaphoresis Delerium/Hallucinations Seizures Agitation |
|
drug of choice for alcohol withdraw
|
LONG-ACTING BENZO'S:
diazepam lorazepam chlordiazepoxide |
|
what vaccines are recommended for alcoholics
|
pneumococcal
influenza Hep A & Hep B |
|
drug causing:
post op constipation and or respiratory depression |
opioid intoxication
|
|
drug causing:
severe depression, headache, fatigue, insomnia/hypersomnia, hunger |
amphetamine/cocaine w/draw
|
|
drug causing:
pinpoint pupils, n/v, seizures |
opioid overdose
|
|
drug causing:
belligerance, impulsiveness, nystagmus, homicidal, psychosis |
PCP intoxication
|
|
drug causing:
headache, anxiety/depression, weight gain |
caffeine/nicotine w/draw
|
|
drug causing:
anxiety/depression, delusions, hallucinations, flashbacks |
LSD intoxication
|
|
drug causing:
euphoria, social withdraw, impaired judgment, hallucinations |
marijuana
|
|
drug causing:
rebound anxiety, tremors, seizures, life-threatening |
alcohol, benzo, barb withdrawal
|
|
drug causing:
anxiety, piloerection, yawning, fever, rhinorrhea, nausea, diarrhea |
opiate withdrawal
|
|
what is the downside to adding bupropion to nicotine replacement in px trying to quit smoking
|
incr'd risk of severe HTN
|
|
cause of erythema of turbinates and nasal septum
|
cocaine abuse
|
|
Rx for px on PCP
|
restraint in a dark, quiet room
IVF to prevent rhabdomyolysis Benzo's & antipsychotics for agitation |
|
what drugs can be used in a patient with cocaine or amphetamine intoxication
|
Benzo's
a-blockers (e.g. Phentolamine) |
|
Compare/contrast LSD vs PCP intoxication
|
BOTH LSD & PCP: visual hallucinations
LSD: flashbacks PCP: agitation, aggression, & violence + vertical & horizontal nystagmus |
|
Rx for benign paroxysmal positional vertigo
|
epley maneuver (repositions otoliths)
|
|
Dx:
triad of cognitive impairment, urinary incontinence and abnormal gait |
normal pressure hydrocephalus
|
|
Dx & Tx:
Px on lithium presents with copious amounts of dilute urine |
Dx: nephrogenic DI
Tx: HCTZ + amiloride |
|
characteristics of refeeding syndrome
|
seizures
rhabdomyolysis CV collapse hypophosphatemia |
|
serum abnormalities in px with prolonged excessive vomiting/purging
|
hypochloremic metabolic alkalosis (vomiting HCl)
incr'd amylase (salivary gland inflammation) |
|
somatoform disorder:
unexplained pain |
pain disorder
|
|
somatoform disorder:
px with normal anatomy is convinced a part of their body is abnormal |
Body Dysmorphic D/o
|
|
somatoform disorder:
unexplained loss of sensory or motor function (normal PE/tests) |
conversion d/o
|
|
somatoform disorder:
unwavering belief by the patient that she has a specific disease (despite medical reassurance) |
hypochondriasis
|
|
somatoform disorder:
unexplained complaints in multiple organ systems |
somatization d/o
|
|
somatoform disorder:
false belief of being pregnant |
pseudocyesis
|
|
what eating disorder can be Rx with SSRI
|
bulemia
(as long as they don't purge after taking meds) |
|
What is Rx for pain syndrome
|
SSRI's & TCA's may help
analgesics are NOT helpful |
|
What is major difference b/w factitious/munchausen d/o & somatization/conversion d/o
|
FACTITIOUS/MUNCHAUSEN D/O:
pt performs actions to cause sx's SOMATIZATION/CONVERSION D/O: sx's from no action by the pt |
|
albuminocytologic dissociation indicates what
|
GBS
|
|
Dx
violent px with vertical or horizontal nystagmus |
PCP
|
|
common causes of delirium
|
UTI (MCC in elderly)
DRUGS: benzo's anticholinergic (esp in elderly) antihistamines corticosteroids |
|
how does sundowning differ from delirium
|
SUNDOWNING: deterioration of behavior during the evening hours in pt's WITH DEMENTIA
DELIRIUM: occurs in pt's WITHOUT H/O DEMENTIA & can be linked to a medical or substance-related cause |
|
2 MCC of dementia
|
Dx: CT or MRI
Alzheimer's (70%) --> cortical atrophy Vascular (15%) --> multiple infarcts |
|
Dx
dementia a/w visual hallucinations and frequent falls |
lewy body dementia
|
|
Dx
dementia a/w unpleasant behavior and personality changes |
picks disease (aka frontotemporal dementia)
|
|
What is Rx in an elderly pt with delerium
|
Antipsychotic (e.g. Haloperidol)
FYI: Benzo's would exacerbate the delirium |
|
Compare/contrast delirium vs dementia
|
DELIRIUM:
ALTERNATING levels of consciousness (rapid changes thru the day) attributable to an ACUTE process REVERSIBLE DEMENTIA: CONSISTENT level of consciousness thru the day rarely attributable to an acute process IRREVERSIBLE |
|
what disease is a/w atrophy of the mamillary bodies
|
Wernicke's Encephalopathy
|
|
what is the MCC of conductive hearing loss
|
otosclerosis
|
|
what is the MCC of sensorineural hearing loss
|
presbycussis
|
|
comorbidities commonly a/w ADHD
|
oppositional defiant d/o
conduct d/o bipolar d/o learning disability depression anxiety d/o |
|
what can be used to Rx ADHD when stimulants and atomoxetine fail
|
TCA's (imipramine, desipramine, nortriptyline)
bupropion a2-agonists (e.g. clonidine) limit dietary intake of caffeine & sugar |
|
how is ADHD diagnosed
|
6 symptoms of ADHD
in 2 or more settings before the age of 7 impairs ability to function |
|
childhood psychiatric disorder:
loss of previously acquired purposeful hand skills b/w 6 - 30 months |
rett d/o (females only)
|
|
childhood psychiatric disorder:
impaired social interaction, communications, & play; repetitive behaviors |
autism
|
|
childhood psychiatric disorder:
impairment in social interactions, no language delay, & no cognitive delay |
asperger's syndrome
|
|
childhood psychiatric disorder:
stereotyped hand movements |
rett d/o (females only)
|
|
childhood psychiatric disorder:
hostility, annoyance, vindictiveness, disobedience, & resentfulness |
Oppositional Defiant D/o
|
|
childhood psychiatric disorder:
multiple motor and vocal tics |
Tourette's syndrome
|
|
childhood psychiatric disorder:
impulsive and inattentive |
ADHD
|
|
childhood psychiatric disorder:
7 y/o that avoids going to school to stay home with parents |
separation anxiety d/o
|
|
for what should a child suspected of having learning disorder be investigated
|
hearing difficulty
vision impairment |
|
How is Asperger's different from autism
|
BOTH:
impaired social skills AUTISM: repetitive behaviors cognitive deficits (usually below normal IQ) impairments in communication, language delay, repetitive phrases ASPERGER'S: +/- repetitive behaviors NO cognitive deficits NO language impairment |
|
How is childhood disintegrative d/o (CDD) different than autism
|
CDD has a period of normal development for at least 2 years before regressing (deterioration of language/social skills, loss of motor skills, & loss of bowel/bladder control)
AUTISM does NOT have a period of normal development with regression |
|
What are therapeutic options for Tourette Syndrome
|
SOCIAL ADJUSTMENT/COPING: psychotherapy
IMPAIRED LIFE FUNCTIONS: dopamine antagonists (fluphenazine, pimozide, or tetrabenazine) FOCAL MOTOR/VOCAL TICS: botox injections IMPULSE CONTROL PROBLEMS: SSRI's/Clonidine REFRACTORY CASES: deep brain stimulation (globus pallidus, thalamus, or other subcortical area) |