Psychiatry Shelf Review Iv

Front 1

What disease would you expect with CT/MRI findings positive for neurofibrillary tangles and senile plaques?

Back 1

Alzheimer's

Front 2

What pathologic findings would you expect to make the diagnosis of prion disease?

Back 2

spongiform changes (confluent vacuoles), amyloid plaques. (creutzfeld-jakob)

Front 3

What CT/MRI findings would you expect to see in Huntington's disease?

Back 3

bilateral caudate atrophy or "boxcar ventricles"

Front 4

Name the gene and its chromosome for huntington's disease

Back 4

Hungtingtin on chromosome 4

Front 5

What disease would you suspect if patient had neuronal loss in substantia nigra?

Back 5

parkinson's

Front 6

What CT/MRI findings would suggest Pick's disease?

Back 6

frontotemporal loss (picks = frontotemporal dementia)

Front 7

What MRI/CT findings would you expect to see in patient w/ MS?

Back 7

periventricular white matter lesions

Front 8

Punctate hemorrhages into the mammillary bodies is suggestive of...

Back 8

Wernicke's

Front 9

What CT/MRI finding would suggest schizophrenia?

Back 9

ventricular enlargement & diffuse cortical atrophy

Front 10

Name 3 cortical dementias

Back 10

Alzheimer's Pick's, CJD

Front 11

Name 3 subcortical dementias (including basal ganglia)

Back 11

huntington's, parkinson's/lewy body, vasuclar (Binswanger's disease) and AIDS dementia

Front 12

What are the 3 M's of subcortical dementia?

Back 12

Mood (depressed), motor (ataxic) and memory (amnesia)

Front 13

What imaging would you order if suspect fracture or bleeding intracranially?

Back 13

CT

Front 14

What imaging would you order in a patient whom you suspect for papilledema

Back 14

MRI (tumors often isodense w/ healthy brain so CT won't always see them) CT can show midline shift but necessarily define borders of a tumor

Front 15

Imaging for a patient with focal neurological sx?

Back 15

MRI

Front 16

Patient presents with ataxia, nystagmus and/or n/v. What imaging would you order?

Back 16

These are posterior fossa sx. MRI, because CT cannot visualize posterior fossa

Front 17

suspected intracranial hemorrhage

Back 17

CT (faster than an MRI!)

Front 18

What labs would you order in a patient with a suspected pheochromocytoma

Back 18

urine catecholamines, metanephrine and VMA (all urine)

Front 19

What lab test/procedure would you order in a patient whom you suspect wilson's dz?

Back 19

serum ceruloplasmin (dont' forget about kayer-fleischer rings)

Front 20

What lab/procedure would you order in a patient whom you suspect cushing's?

Back 20

serum cortisol or dexamethasone supppression test

Front 21

When would carcinoid tumor become carcinoid syndrome? What test would you order to dx?

Back 21

when mets to liver/lungs. get 5-HIAA serum levels

Front 22

T/F: 5-HIAA is high in the CSF of patients who commit suicide.

Back 22

False. Its low

Front 23

What would you order in patient with AIP?

Back 23

urine porphobilinogens & urobilinogens (including d-aminolevulinic acid (ALA)).

Front 24

Patient in clinic c/o depression, weight gain, inability to concentrate, consitpation. What tests would you order?

Back 24

TSH. think depressive d/o d/t hypothyroid

Front 25

What lab test/procedure can help differentiate seizure from pseudoseizure

Back 25

arterial serum prolactin 10-20min after event --> put on ice and send to lab stat. prL is often elevated after a seizure but not in pseduoseizure

Front 26

Besides an MRI, what test would you order to clinch MS diagnosis?

Back 26

CSF - oligoclonal bands

Front 27

What imaging would you order if you suspect a subdural hematoma?

Back 27

CT

Front 28

What imaging/procedure(s) would you order if you suspect normal pressure hydrocephalus?

Back 28

head CT, LP (opening pressure > 20)

Front 29

what tests would you order if you suspected CJD?

Back 29

EEG, CSF for protein 14-3-3

Front 30

what test would you order if you suspected temporal lobe epilepsy

Back 30

EEG

Front 31

Besides a head CT, what other test could help you dx subarachnoid hemorrhage?

Back 31

LP looking for xanthochromia (yellow CSF)

Front 32

What kind of CT would you order in a patient whom you suspect CVA?

Back 32

non-contrast CT

Front 33

What test would you order in guillain-Barre syndrome?

Back 33

LP (may see cytoalbuminologic dissociations = protein > 45 w normal WBC)

Front 34

Emergency psychiatry: differential for catatonia

Back 34

schizophrenia, MDD, bipolar, NMS or serotonin syndrome, encephalitis, non convulsive status epilepticus

Front 35

ER psych: cocktails for agitation?

Back 35

5:2:1 (5 mg halperidol:2 mg lorazepam: 1 mg cogentin) or 5:2: 50 (50 mg diphenhydramine). IM/PO Usually IM.

Front 36

ER psych: patient presents with confusion, ataxia and opthalmopelgia. What do you do first?

Back 36

thiamine before glucose. you'll probably start a banana bag later (NS + Folate, thiamine, etc.)

Front 37

Withdrawal from what drugs can be fatal?

Back 37

alcohol or benzos (and barbs)

Front 38

What lab values are classic in alcoholics?

Back 38

Look for AST/ALT > 2:1 with significant intoxication. MCV will be elevated (d/t poor nutrition, and decreased folate and possibly B12, which can cause neuro sx (folate can't)).

Front 39

Patient presents to ER w/ headache, anxiety, n/v, tremulous. what would you suspect?

Back 39

alcohol withdrawal.

Front 40

T/F: alcohol withdrawal can present with hallucinations and seizures.

Back 40

True. within 12-24 hrs and 12-48 hrs respectively.

Front 41

When does DTs occur?

Back 41

36-72hrs after last drink

Front 42

Withdrawal from benzodiazepines presents similarly to withdrawal from what drug?

Back 42

Et-OH.

Front 43

What treatment can you provide in patient who you suspect BDZ toxicity?

Back 43

flumazenil (watch out for seizures if you give it...)

Front 44

If a patient who has sx of opioid overdose doesn't respond to narcan, what would you suspect?

Back 44

multiple drug overdose including benzos! (or Et-OH)

Front 45

What 2 drugs did Heath Ledger overdose on?

Back 45

opioids and benzos. worried about respiratory depression/anoxia

Front 46

How does narcan (naloxone work)

Back 46

IV opiod mu receptor antagonist

Front 47

Patient presents with slowed cognition (bradyphrenia), blood shot eyes, increase appetite.

Back 47

MJ intoxications.

Front 48

How long will Urine tox remain + for MJ?

Back 48

up to a month with chronic use as its stored in fat

Front 49

What intoxication presents very similar to an anticholinergic intoxication?

Back 49

cocaine/amphetiamines. May also present with diaphoresis and seizures and psychotic sx. Keep high on ddx in young patient with MI or CVA (but ask about thrombophilias, sickle cell and fam hx)

Front 50

Mechanism of action of cocaine?

Back 50

dopamine reuptake inhibition (@ DAT1)

Front 51

mechanism of action of amphetamines?

Back 51

causes direct release of dopamine

Front 52

Pt is very aggressive and has rotary nystamus. Dx

Back 52

PCP. Ketamine only causes sedation (no aggressiveness)

Front 53

What can cause hallucinogen persisting perception d/o

Back 53

LSD! patients has flashbacks for rest of his/her life

Front 54

MC psychoactive substance

Back 54

caffeine

Front 55

MC substance abused/dependence?

Back 55

nicotine

Front 56

Substance which causes most deaths (by far!)

Back 56

nicotine

Front 57

MC used illicit psychoactive substance?

Back 57

MJ