Usmle Step 1 Flashcards - Neuro

Front 1

Origin of CNS neurons, ependymal cells, oligodendroglia, and astrocytes?

Back 1

Neuroectoderm

Front 2

Cells destroyed in Guillain-Barre?

Back 2

Schwann cells

Front 3

Which CNS cells are not readily discernable on Nissl stain?

Back 3

Microglia

Front 4

Which CNS cells have prominent nucleoli?

Back 4

Neurons (--> lots of Nissl substance)

Front 5

What does the epineurium contain?

Back 5

The entire nerve and blood vessels
- dense connective tissue

Front 6

Nucleus where dopamine is found?

Back 6

Ventral tegmentum and SNc
- midbrain

Front 7

Nucleus where 5-HT is found?

Back 7

Raphe nuclei
- throughout brainstem

Front 8

Nucleus where ACh is found?

Back 8

Basal nucleus of Meynert
- in basal forebrain

Front 9

Nucleus where GABA is found?

Back 9

Nucleus accumbens
- ventral striatum

Front 10

Deep cerebellar nuclei?

Back 10

Lateral to medial: Dentate, Emboliform, Globose, Fastigial
- lateral: voluntary extremity movements
- medial: balance, truncal coordination, ataxia

Front 11

Which thalamic nucleus projects to the calcarine sulcus and what info does it carry?

Back 11

LGN
- carries vision from CN II

Front 12

Why are patients with head trauma purposely hyperventilated?

Back 12

It creates a respiratory alkalosis which helps to constrict cerebral vessels and prevent vasogenic cerebral edema.

Front 13

Lateral vs ventromedial area of hypothalamus?

Back 13

Lateral: involved in hunger. Inhibited by leptin. Destruction leads to anorexia.

Ventromedial: involved in satiety. Stimulated by leptin. Destruction leads to hyperphagia.

Front 14

Anterior vs posterior area of hypothalamus?

Back 14

Anterior: involved in cooling (A/C) and parasympathetic control.

Posterior: involved in heating and sympathetic control.

Front 15

Limbic system pathway?

Back 15

Anterior thalamic nuclei --> cingulate gyrus --> cingulum --> hippocampus --> fornix --> mammillary body --> mammilo-thalamic tract --> anterior thalamic nuclei

Front 16

Lacunar stroke in subthalamic nucleus will cause what?

Back 16

Contralateral hemiballismus

Front 17

Histo findings in Parkinson's disease?

Back 17

Lewy bodies (alpha-synuclein: intracellular inclusion) and depigmentation of SNc (loss of dopaminergic neurons)

Front 18

Direct basal ganglia pathway?

Back 18

Dopamine from SNc --> D1 receptors on striatum (excitatory) --> GABA/Substance P (inhibitory)--> GPi/SNr --> inhibit thalamus --> cortex --> movement!

Front 19

Indirect basal ganglia pathway?

Back 19

Dopamine from SNc --> D2 receptors (inhibitory) on striatum --> GABA/Substance P --> inhibit GPe --> inhibit subthalamic nucleus --> stimulate GPi --> inhibit thalamus --> cortex --> movement

Front 20

What are the striatum and lentiform nucleus?

Back 20

Striatum = caudate + putamen
Lentiform nucleus = putamen + globus pallidus

Front 21

Symptoms of central pontine myelinolysis?

Back 21

Acute paralysis, dysarthria, dysphagia, diplopia, loss of consciousness

Front 22

Brodmann areas of Principal and premotor areas, Principal Sensory area, Principal visual cortex, and Primary auditory cortex?

Back 22

Principal motor area: 4
Premotor area: 6
Principal Sensory area: 1, 2, 3
Principal visual cortex: 17
Primary auditory cortex: 41, 42

Front 23

Intention tremor is seen with?

Back 23

Cerebellar dysfunction

Front 24

Kluver-Bucy syndrome comes from?

Back 24

Bilateral lesion of the amygdala.
- hyperorality, hypersexuality, and disinhibited behavior

Front 25

PPRF vs frontal eye field lesion?

Back 25

PPRF: eyes look AWAY from side of lesion
Frontal eye field lesion: eyes look TOWARD lesion

Front 26

What areas do Charcot-Bouchard microaneurysms affect?

Back 26

Small vessels in the basal ganglia, thalamus, etc. Rupture leads to intracerebral hemorrhage.

Front 27

Conduction aphasia?

Back 27

Lesion of arcuate fasciculus. Poor repetition but fluent speech and intact comprehension.

Front 28

What general symptoms does a stroke of the anterior circle of Willis cause?

Back 28

General sensory and motor dysfunction, aphasia

Front 29

What general symptoms does a stroke of the posterior circle of Willis cause?

Back 29

CN deficits (vertigo, visual), coma, cerebellar deficits, aphasia or contralateral neglect

Front 30

Where do the lateral striate arteries come from and what do they supply?

Back 30

Divisions of MCA. Supply internal capsule, caudate, putamen, globus pallidus.

Front 31

Watershed zones in brain and significance?

Back 31

Between ACA/MCA (--> upper leg/upper arm weakness), PCA/MCA (--> defective higher order visual processing)

Front 32

Medial medullary syndrome arises from what artery and causes what?

Back 32

Anterior spinal artery damage. Contralateral hemiparesis (lower extremities), defect in contralateral proprioception, and ipsilateral paralysis of CN XII.

Front 33

Lateral medullary syndrome (Wallenberg's) arises from what artery and causes what?

Back 33

PICA damage. Contralateral loss of pain/temp, ipsilateral dysphagia, hoarse, gag reflex, vertigo, diplopia, nystagmus, vomiting, ipsilateral Horner's, ipsilateral facial pain and temperature, trigeminal nucleus, ipsilateral ataxia.
9,10,11

Front 34

Lateral inferior pontine syndrome arises from what artery and causes what?

Back 34

AICA. Ipsilateral facial paralysis, ipsilateral cochlear nucleus, vestibular (nystagmus), ipsilateral facial pain and temp, ipsilateral dystaxia (MCP, ICP)

Front 35

Pure motor vs pure sensory stroke?

Back 35

Pure motor stroke from posterior limb of internal capsule.

Pure sensory from thalamus.

Front 36

Which stroke type can cause vasospasm due to blood breakdown products that irritate vessels?

Back 36

Subarachnoid hemorrhage
- can treat with CCBs

Front 37

What type of plaque causes Amaurosis fugax?

Back 37

Hollenhorst plaque (at the bifurcation of the retinal arteries)

Front 38

Lacunar stroke pathophys?

Back 38

Hyaline arteriosclerosis (often secondary to hypertension)

Front 39

Which type of stroke forms a cystic cavity with reactive gliosis afterwards?

Back 39

Atherosclerosis.
- get necrotic area (wedge-shaped) that becomes cystic

Front 40

CSF flow?

Back 40

Choroid plexus --> lateral ventricle --> foramen of Monro --> 3rd ventricle --> cerebral aqueduct of Sylvius --> 4th ventricle --> foramen of Magendie and Luschka --> subarachnoid space --> superior sagittal sinus --> reabsorbed by arachnoid granulations/villi

Front 41

2 causes of communicating hydrocephalus?

Back 41

Decreased CSF absorption (arachnoid scarring post-meningitis) or increased CSF production (choroid plexus papilloma)

Front 42

Floppy baby at birth with tongue fasciculations?

Back 42

Werdnig-Hoffman disease (aka infantile spinal muscular atrophy)
- degeneration of anterior horns (LMN disease)
- autosomal recessive

Front 43

CSF findings with poliomyelitis?

Back 43

Lymphocytic pleocytosis with slight elevation of protein, no change in glucose

Front 44

Neuro disease caused by SOD1 (chromosome 21) mutation?

Back 44

Amyotrophic Lateral Sclerosis (Lou Gehrig's disease)
- LMN and UMN signs

Front 45

Treatment to prolong survival in ALS patients?

Back 45

Riluzole
- decreases presynaptic glutamate release

Front 46

Watershed area involving anterior spinal artery?

Back 46

Upper thoracic ASA territory
- artery of Adamkiewicz supplies ASA below T8

Front 47

What 3 conditions can cause demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts?

Back 47

Friedrich's ataxia, Vitamin B12 neuropathy, and Vitamin E deficiency

Front 48

Causes of Horner's syndrome?

Back 48

Lesion of spinal cord above T1: Pancoast tumor, Brown-Sequard syndrome, late stage syringomyelia

Front 49

Dermatome of nipple, xiphoid process, umbilicus?

Back 49

Nipple: T4, Xiphoid process: T7, Umbilicus: T10

Front 50

Findings in Friedrich's ataxia?

Back 50

Staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, HCM

Front 51

Superior colliculus function and lesion?

Back 51

Conjugate vertical gaze center. Lesion such as pinealoma causes paralysis (dorsal midbrain syndrome).

Front 52

Pineal gland functions?

Back 52

Melatonin secretion, circadian rhythms

Front 53

Biceps and triceps reflexes?

Back 53

C5 (biceps), C7 (triceps)

Front 54

Patella and achilles reflexes?

Back 54

L4 (patella), S1 (achilles)

Front 55

Nucleus ambiguus?

Back 55

Motor innervation of pharynx, larynx, and upper esophagus (swallowing, palate elevation)
- CN IX, X, XI

Front 56

Nucleus solitarius?

Back 56

Visceral sensory information (taste, baroreceptors, gut distention)
- CN VII, IX, X

Front 57

Dorsal motor nucleus?

Back 57

Sends autonomic (parasympathetic) fibers to heart, lungs, and upper GI

Front 58

Structures that pass through foramen magnum?

Back 58

Spinal roots of CN XI, brain stem, vertebral arteries

Front 59

Structures that pass through optic canal?

Back 59

CN II, opthalmic artery, central retinal vein

Front 60

Structures that pass through superior orbital fissure?

Back 60

III, IV, V1, ophthalmic vein, sympathetic fibers

Front 61

Structure that passes through foramen spinosum?

Back 61

Middle meningeal artery

Front 62

Innervation of ear muscles?

Back 62

Stapedius (VII) and tensor tympani (V3)

Front 63

What does cavernous sinus syndrome cause?

Back 63

Ophthalmoplegia, ophthalmic and maxillary sensory loss

Front 64

Which nerves pass through the cavernous sinus?

Back 64

CN III, IV, V1, V2, VI

Front 65

Which nerve runs closest to internal carotid artery within the cavernous sinus?

Back 65

VI

Front 66

CN V motor lesion: what happens to the jaw?

Back 66

Deviates TOWARD the side of the lesion (lateral pterygoid gets bilateral cortical input)

Front 67

4 muscles of mastication and innervation?

Back 67

Masseter, temporalis, medial pterygoid all close jaw. Lateral pterygoid opens jaw.
- All are innervated by V3

Front 68

Causes of Bell's palsy?

Back 68

Sarcoid, HSV, AIDS, Lyme disease, Tumor, Diabetes, Pregnancy

Front 69

View of eye with papilledema?

Back 69

Elevated optic disk with blurred margins (especially the temporal margin)
- pts have bigger blind spot

Front 70

Describe the decreased vision with cataracts.

Back 70

Blurring, glare, induced myopia

Front 71

What happens to the ciliary muscle for near vision?

Back 71

Ciliary muscle contracts --> zonula fibers relax --> lens relaxes --> more convex

Front 72

What happens to the lens with aging?

Back 72

Sclerosis and decreased elasticity causes the lens to change shape

Front 73

Ciliary muscle receptor?

Back 73

M3 stimulation causes accommodation.

Front 74

Location of obstruction in open angle glaucoma?

Back 74

Canal of Schlemm
- associated with myopia, age, and African American race

Front 75

What is a Marcus Gunn pupil?

Back 75

Afferent pupillary defect (optic nerve damage, retinal detachment, etc). Decreased bilateral pupillary constriction when light is shone in affected eye.

Front 76

Long vs short ciliary nerve?

Back 76

Long: sympathetic from superior cervical ganglion

Short: parasympathetic from ciliary ganglion

Front 77

Describe vision changes in age-related macular degeneration.

Back 77

Loss of central vision (scotoma) due to degeneration of macula (central area of retina)

Front 78

Histo finding in Lewy body dementia?

Back 78

Alpha-synuclein defect (intraneuronal)
- like Parkinsonism (w/ dementia and hallucinations)

Front 79

Histo finding in frontotemporal dementia?

Back 79

Pick bodies: intracellular, aggregated tau protein (hence the alternative name Pick's disease)
- frontotemporal atrophy (more on L side --> aphasia)

Front 80

Genes associated with early and late onset familial Alzheimer's?

Back 80

Early: APP (21), presenilin1 (14), presenilin2 (1)
Late onset: ApoE4 (19)

Front 81

2 main histo findings in Alzheimer's?

Back 81

1. Senile plaques: amyloid A-beta, can cause amyloid angiopathy
2. Neurofibrillary tangles: intracellular, hyperphosphorylated tau (GSK-3-beta), correlate with degree of dementia

Front 82

Diagnostic findings in MS?

Back 82

CSF: increased protein (IgG), oligoclonal bands (diagnostic), increased myelin basic protein

Periventricular plaques (oligodendrocyte loss and reactive gliosis), preservation of axons.

Front 83

MS hypersensitivity type(s)?

Back 83

Type II and type IV

Front 84

Characteristics of tension headache?

Back 84

BIlateral. >30 mins of stead pain. Not aggravated by light or noise. No aura.

Front 85

Mechanism of migraine?

Back 85

Irritation of CN V and release of substance P, CGRP, vasoactive peptides

Front 86

Partial vs generalized seizure?

Back 86

Partial: one area of the brain (most often medial temporal lobe)

Generalized: diffuse

Front 87

Simple vs complex seizure?

Back 87

Simple: consciousness is intact
Complex: impaired consciousness

Front 88

Types of generalized seizures?

Back 88

Absence (petit mal), myoclonic (repetitive jerks), tonic-clonic (grand mal), tonic (stiff), atonic ("drop")

Front 89

Leading cause of seizure in kids, adults, elderly?

Back 89

Kids: genetic, infection
Adults: tumors, trauma
Elderly: stroke, tumor

Front 90

Which disease has albuminocytologic dissociation of CSF?

Back 90

Guillain-Barre
- increased CSF protein with normal cell count
- increased protein can cause papilledema

Front 91

Pathophys of metachromatic leukodystrophy?

Back 91

Lysosomal storage disease. Arylsulfatase A deficiency. Buildup of sulfatides leads to impaired myelin sheath production.

Front 92

Cavernous hemangiomas, bilateral renal cell carcinoma, hamangioblastoma in retina, brain stem, & cerebellum, pheo. Disease?

Back 92

Von Hippel-Lindau disease
- mutated VHL tumor suppressor (chromosome 3)

Front 93

Hamartomas in CNS, skin, organs, cardiac rhabdomyoma, renal angiomyolipoma, subependymal giant cell astrocytoma, mental retardation, SZ, "ash leaf spots," sebaceous adenoma, shagreen patch. Disease?

Back 93

Tuberous sclerosis.
- aut dom

Front 94

Port wine stains (nevus flammeus) in V1 distribution, ipsilateral leptomeningeal angiomas, pheo, glaucoma, SZ, hemiparesis, MR. Disease?

Back 94

Sturge-Weber syndrome.

Front 95

Cafe-au-lait spots, Lisch nodules (iris hamartomas), neurofibromas in skin, optic gliomas, pheo. Disease?

Back 95

Neurofibromatosis type 1
- mutated NF-1 on chromosome 17
- associated with pheo, Wilm's tumor, and juvenile CML

Front 96

NMDA antagonist to help with Alzheimer's?

Back 96

Memantine.
- helps prevent excitotoxicity

Front 97

Amine depleting drugs used in Huntington's disease?

Back 97

Reserpine & Tetrabenazine

Front 98

Contraindications of sumatriptan use?

Back 98

CAD or Prinzmetal's angina
- 5-HT1A/B agonists, causes vasoconstriction and can cause coronary vasospasm

Front 99

AChE inhibitors used in Alzheimer's?

Back 99

Donepezil, galantamine, rivastigmine

Front 100

Adverse effect of long time levodopa use?

Back 100

Dyskinesia following administration and akinesia in between doses

Front 101

Nondepolarizing NMJ blockers?

Back 101

Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium

Front 102

2 phases of reversal of blockade of succinylcholine?

Back 102

Phase I (prolonged depolarization): no antidote

Phase II (repolarized but blocked): can give AChEI as antidote

Front 103

Use of benztropine for symptoms of Parkinson's?

Back 103

Muscarinic antagonist: improves tremor and rigidity

Front 104

What does amantadine do in Parkinson's disease?

Back 104

Increases dopamine release (toxicity = ataxia)

Front 105

Ergot and non-ergot derivative dopamine agonists?

Back 105

Ergot: bromocriptine
Non-ergot (preferred): pramipexole, ropinirole

Front 106

Complications of uncal herniation?

Back 106

- CN III compression --> ipsilateral dilated pupil/ptosis
- PCA compression --> contralateral homonymous hemianopia
- Compress contralateral crus cerebri (Kernohan's notch) --> ipsilateral paresis
- Caudal displacement of brainstem --> Duret hemorrhages (paramedian artery rupture)

Front 107

4 types of cerebral herniation?

Back 107

Cingulate/subfalcine, Cerebellar tonsillar (into foramen magnum), Transtentorial, Uncal

Front 108

Ddx of uniformly enhancing brain lesion?

Back 108

Lymphoma, meningioma, metastases (but usually ring enhancing)

Front 109

Ddx of heterogeneously enhancing brain lesion?

Back 109

Glioblastoma multiforme

Front 110

Ddx of ring enhancing brain lesion?

Back 110

Metastases, abscesses, toxoplasmosis, AIDS lymphoma

Front 111

What is tramadol and what is it used for?

Back 111

Weak opioid agonist, inhibits 5-HT and NE reuptake.
Used for chronic pain.
Can also decrease seizure threshold.

Front 112

What is butorphanol?

Back 112

Partial agonist at opioid mu receptors and agonist at kappa receptors.
- Used for pain and causes less respiratory depression than full agonists

Front 113

Opioid analgesics?

Back 113

Fentanyl > morphine > codeine. Heroin, methadone, meperidine, dextromethorphan

Front 114

Opioid mechanism of action?

Back 114

Opioid receptors: open K+ channels, close Ca channels --> decrease synaptic transmission. Inhibit release of ACh, NE, 5-HT, glutamate, and substance P.

Front 115

Which glaucoma drugs will give pupillary or vision changes?

Back 115

Alpha agonist (Epi) or cholinomimetics

Front 116

Side effect of latanoprost (PGF2-alpha) use for glaucoma?

Back 116

Darkened color of iris (browning)

Front 117

Beta blockers used for glaucoma?

Back 117

Timolol, betaxolol, carteolol
- decrease aqueous humor secretion

Front 118

Function of brimonidine?

Back 118

Alpha agonist
- decreases aqueous humor synthesis in glaucoma

Front 119

Cholinomimetics for glaucoma?

Back 119

They open trabecular meshwork by contracting ciliary muscle.
- Direct: pilocarpine, carbachol
Indirect: physostigmine, echothiophate

Front 120

Rathke's pouch tumor with calcification?

Back 120

Craniopharyngioma

Front 121

Tumor with verocay bodies and Merlin mutation, associated with NF2?

Back 121

Schwannoma (acoustic)
- S100 positive

Front 122

Tumor in 4th ventricle that can cause hydrocephalus?

Back 122

Ependymoma
- perivascular pseudorosettes
- rod shaped blepharoplasts (basal ciliary bodies)

Front 123

Frontal lobe tumor with chicken wire capillary pattern?

Back 123

Oligodendroglioma
- calcifications

Front 124

GBM histo characteristics?

Back 124

Pseudopalisading pleomorphic tumor cells that border central areas of necrosis and hemorrhage, atypical mitoses, giant cells

Front 125

Solid small blue cell brain tumor?

Back 125

Medulloblastoma.
form of PNET, highly malignant but radiosensitive

Front 126

Rosenthal fibers (eosinophilic, corkscrew) seen in cystic and solid tumor. Diagnosis?

Back 126

Pilocytic astrocytoma
- low grade, well circumscribed
- often in posterior fossa/cerebellum
- GFAP positive

Front 127

Short acting benzos?

Back 127

Triazolam, Oxazepam, Midazolam

Front 128

Panic attacks - use?

Back 128

Alprazolam (Xanax)
- intermediate acting benzo

Front 129

Status epilepticus - which benzos to use?

Back 129

Diazepam, Lorazepam

Front 130

Non-benzo hypnotics?

Back 130

Zolpidem (Ambien), Zaleplon, Eszopiclone

Front 131

Induction and recovery time of anesthetics depends on?

Back 131

Solubility in blood
- decreased solubility = rapid induction and recovery time
- increased solubility: more gas required to saturate blood --> slower onset of action

Front 132

Potency of anesthetics depends on?

Back 132

Solubility in lipids
- increased lipid solubility --> increased potency (1/MAC)

Front 133

Affect of arteriovenous (AV) concentration gradient on speed of onset of anesthetic?

Back 133

Increased gradient --> increased solubility --> increased gas required to saturate tissue --> slower onset of action

Front 134

Inhaled anesthetic effects?

Back 134

Myocardial depression, respiratory depression, nausea/emesis, increased cerebral blood flow

Front 135

Toxicities of inhaled anesthetics?

Back 135

Hepatotoxicity (halothane), nephrotoxicity (methoxyflurane), proconvulsant (enflurane), malignant hyperthermia, expansion of trapped gas (nitrous oxide)

Front 136

Phenytoin mechanism?

Back 136

Use-dependent blockade of Na+ channels. Increase refractory period and inhibit glutamate release.

Front 137

Phenytoin toxicity?

Back 137

Nystagmus, ataxia, diplopia, sedation, SLE-like syndrome, CYP450 induction, gingival hyperplasia, peripheral neuropathy, hirsutism, megaloblastic anemia, teratogenic (fetal hydantoin syndrome)

Front 138

Epilepsy drug that causes weight gain? Weight loss?

Back 138

Valproic acid: weight gain
Topiramate: weight loss

Front 139

Carbamazepine toxicity?

Back 139

Diplopia, ataxia, blood dyscrasia (agranulocytosis, aplastic anemia), liver toxicity, teratogenesis, induction of CYP450, SIADH, SJS

Front 140

How does propofol work?

Back 140

Potentiates GABA-A

Front 141

Ketamine mechanism?

Back 141

Block NMDA receptors. CV stimulant

Front 142

First line meds for status epilepticus?

Back 142

Benzos for acute, Phenytoin for prophylaxis

Front 143

First line meds for tonic-clonic seizures?

Back 143

Phenytoin, Carbamazepine, and Valproic acid

Front 144

Complication of cerebellar tonsillar herniation?

Back 144

Compression of the medulla with cardiorespiratory arrest

Front 145

IQ ranges for mental retardation?

Back 145

IQ < 70 = mental retardation
IQ < 40 = severe MR
IQ < 20 = profound MR

Front 146

What parts of the brain does classical conditioning use?

Back 146

Amygdala and Cerebellum

Front 147

4 mature ego defenses?

Back 147

Altruism (compensation)
Humor
Sublimation
Suppression (voluntary)

Front 148

What is anaclitic depression?

Back 148

Aka hospitalism
- depression in an infant attributable to continued separation from caregiver. Infant becomes withdrawn and unresponsive. Can result in failure to thrive and developmental disturbances.

Front 149

Neurotransmitter changes in Parkinson's disease?

Back 149

Decreased Dopamine
Increased 5-HT, ACh

Front 150

Neurotransmitter changes in anxiety?

Back 150

Increased NE
Decreased GABA, 5-HT

Front 151

3 criteria of Autistic disorder?

Back 151

1. severe language impairment
2. poor social interactions
3. repetitive behaviors

Front 152

Key differences between Asperger's and Autistic disorder?

Back 152

Asperger's: no language/verbal/cognitive impairment and usually normal intelligence

Front 153

Stereotyped hand-wringing, regression, MR, and loss of verbal skills in 3yo female?

Back 153

Rett's disorder
- X-linked, only in girls

Front 154

Who usually presents with childhood disintegrative disorder?

Back 154

3-4 yo boys (M > F)
- regression in multiple areas of functioning (language, social, bowel/bladder control, motor skills, play, etc)

Front 155

Difference between conduct disorder and oppositional defiant disorder?

Back 155

ODD: no serious violations of social norms (theft, physical aggression, destroying property)

Front 156

Time period for Tourette's?

Back 156

>1 year
- sudden, rapid, recurrent, nonrhythmic stereotyped motor movements and vocalizations (tics)

Front 157

3 treatment options for ADHD?

Back 157

Methylphenidate (Ritalin)
Amphetamines (Dexedrine)
Atomoxetine (nonstimulant SNRI)

Front 158

Causes of dementia?

Back 158

Alzheimer's, vascular thrombosis/hemorrhage, HIV, Pick's disease, substance abuse, CJD

Front 159

Common causes of loss of orientation?

Back 159

Alcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, nutritional deficiencies

Front 160

What is dissociative amnesia?

Back 160

Inability to recall important personal information
- usually after trauma or stress

Front 161

Gender difference in schizophrenia presentation?

Back 161

Presents ~10 years later in women (late 20s to early 30s)
- prevalence is the same in both genders

Front 162

5 criteria of schizophrenia?

Back 162

1. Delusions
2. Hallucinations (often auditory)
3. Disorganized speech (loose associations)
4. Disorganized or catatonic behavior
5. Negative symptoms

Front 163

Depersonalization vs derealization?

Back 163

Derealization involves distorted reality
- depersonalization: detached/estranged from body, social situation, or the environment

Front 164

Criteria for manic episode? (need 3 or more for >1 week)

Back 164

Distractibility
Irresponsibility/pleasure seeking
Grandiosity
Flight of ideas
Activity (goal directed) or agitation
Sleep (decreased need)
Talkativeness/pressured speech

Front 165

Treatment of bipolar episode?

Back 165

Mood stabilizers (lithium, valproic acid, carbamazepine), atypical antipsychotics

Front 166

Depression criteria?

Back 166

5/9 + depressed mood or anhedonia
SIGECAPS:
- sleep disturbance, loss of interest, guilt, loss of energy, loss of concentration, appetite/weight change, psychomotor agitation/retardation, suicidal ideation, depressed mood

Front 167

Difference in suicide between genders?

Back 167

Women try more often.
Men succeed more often.

Front 168

Criteria for panic disorder?

Back 168

4/10 of the following that peak in 10 minutes
Palpitations
Abdominal distress
Nausea
Intense fear of dying, light-headedness
Chills, chest pain, choking, disconnectedness
Shortness of breath, sweating, shaking

Front 169

Treatment for panic disorder?

Back 169

Cognitive behavioral therapy
SSRI
TCA
Benzos

Front 170

Postpartum blues vs postpartum depression?

Back 170

Blues: <10 days, supportive treatment, 50-85% incidence

Depression: 2wks to 2mo, treat with antidepressants and psychotherapy, 10-15% incidence

Front 171

OCD treatment?

Back 171

SSRIs or clomipramine

Front 172

OCD vs OCPD?

Back 172

Personality disorder is ego-syntonic: behavior is consistent with beliefs and attitudes

Front 173

3 criteria of PTSD?

Back 173

1. Re-experiencing (nightmares, flashbacks)
2. Avoidance of stimuli associated with trauma
3. Persistently increased arousal

Front 174

"La belle indifference" refers to what?

Back 174

Conversion disorder (type of somatoform disorder)

Front 175

Cluster A personality disorders and association?

Back 175

Cluster A = "mad"
- Paranoid, Schizoid, Schizotypal
- associated with schizophrenia

Front 176

Cluster B personality disorders and association?

Back 176

Cluster B = "bad"
- Borderline, Antisocial, Histrionic, Narcissistic
- associated with mood disorders and substance abuse

Front 177

Cluster C personality disorders and association?

Back 177

Cluster C = "sad"
- Obsessive-compulsive, Dependent, Avoidant
- associated with anxiety disorders

Front 178

Complications of anorexia nervosa?

Back 178

Amenorrhea, decreased bone density, metatarsal stress fractures, anemia, electrolyte disturbances

Front 179

Complications of bulimia nervosa?

Back 179

Parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses (Russell's sign)

Front 180

Key distinction between substance abuse vs dependence?

Back 180

Dependence: involves both tolerance and withdrawal

Front 181

Complications of alcoholism?

Back 181

Hepatitis, pancreatitis, Cirrhosis, peripheral neuropathy, Mallory-Weiss tears, Wernicke-Korsakoff syndrome, testicular atrophy

Front 182

Order of appearance of symptoms in DT?

Back 182

Autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures) then psychotic symptoms (hallucinations, delusions), confusion

Front 183

What is suboxone and what is it used for?

Back 183

Naloxone and buprenorphine (partial agonist)
- long acting, fewer withdrawal sx than methadone
- Naloxone only active if injected

Front 184

LSD abuse signs?

Back 184

Anxiety, depression, delusions, visual hallucinations, **flashbacks**, dilated pupils

Front 185

PCP abuse signs?

Back 185

Belligerence, impulsivity, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium

Front 186

Opioid withdrawal signs?

Back 186

Sweating, dilated pupils, piloerection ("cold turkey"), fever, rhinorrhea, nausea, stomach cramps, diarrhea ("flulike-sx")

Front 187

Stomach cramps, hunger, and hypersomnolence: signs of withdrawal of what?

Back 187

Amphetamines

Front 188

Suicidality, hypersomnolence, malaise, severe craving: signs of withdrawal of what?

Back 188

Cocaine

Front 189

Typical vs atypical antipsychotics for schizophrenia symptoms?

Back 189

Typical: only work for positive symptoms

Atypical: good for positive and negative

Front 190

Atypical antipsychotics?

Back 190

Olanzapine, Clozapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone

Front 191

Atypical antipsychotic mechanism?

Back 191

Block 5-HT2, dopamine, alpha, and H1 receptors

Front 192

Typical antipsychotics?

Back 192

Haloperidol, Trifluoperazine, Fluphenazine > Thioridazine, Chlorpromazine
(haloperidol + "-azine"s)

Front 193

Typical antipsychotic mechanism?

Back 193

Block D2 receptors (increase cAMP)

Front 194

Extrapyramidal side effects of neuroleptics?

Back 194

Acute dystonia (muscle spasm, stiffness, oculogyric crisis) (within hrs)
Akinesia (days)
Akathisia (restlessness) (weeks)
Tardive dyskinesia (months) (irreversible)

Front 195

Neuroleptic malignant syndrome signs/symptoms?

Back 195

"FEVER":
Fever
Encephalopathy
Vitals unstable
Elevated enzymes
Rigidity of muscles

Front 196

Trazodone mechanism?

Back 196

Inhibit serotonin reuptake
- used for insomnia

Front 197

Mirtazapine mechanism?

Back 197

Alpha-2 antagonist (--> increase release of NE and serotonin) and 5-HT2 and 5-HT3 antagonist

Front 198

Maprotiline mechanism and side effect?

Back 198

Block NE reuptake.
- can cause sedation

Front 199

MAOi's are contraindicated with what other meds?

Back 199

SSRIs or meperidine
- want to prevent serotonin syndrome

Front 200

MAOi's?

Back 200

Phenelzine, tranylcypromine, isocarboxazid, selegiline (MAO-B)

Front 201

SNRIs and use?

Back 201

Venlafaxine, duloxetine
- used for depression
- Venlafaxine: also for GAD
- Duloxetine: also for diabetic neuropathy

Front 202

SSRIs?

Back 202

Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Citalopram

Front 203

Treatment for serotonin syndrome?

Back 203

Cyproheptadine
- 5-HT2 antagonist

Front 204

Toxicity of TCAs and treatment?

Back 204

Convulsions, Coma, and Cardiotoxicity
- can use NaHCO3 for CV toxicity
- also anti-cholinergic (atropine-like) side effects

Front 205

TCAs?

Back 205

Imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin, amoxapine

Front 206

Least sedating TCA and one with most anticholinergic side effects?

Back 206

Least sedating ("Doesn't Sedate") = DeSipramine (but lower seizure threshold also)

Amitriptyline = Anticholinergic

Front 207

Common age of onset of ADHD, Tourette's, and separation anxiety disorder?

Back 207

ADHD: <7 yo
Tourette's: <18 yo
Separation anxiety disorder: 7-9 yo

Front 208

Stereotyped hand-wringing is seen in?

Back 208

Rett's disorder
- X linked, in girls

Front 209

Common age of onset of Rett's disorder and childhood disintegrative disorder?

Back 209

Rett's disorder: 1-4 yo
Childhood disintegrative disorder: 3-4 yo

Front 210

In what conditions do patients experience visual hallucinations?

Back 210

Delirium & Lewy body dementia

Front 211

What is varenicline?

Back 211

Drug to treat nicotine withdrawal

Front 212

What are heroin users at increased risk for?

Back 212

Hepatitis, Abscesses, Overdose, Hemorrhoids, AIDS, and right-sided Endocarditis

Front 213

What is Mirtazapine useful for treating?

Back 213

Depression with insomnia

Front 214

High vs low potency typical antipsychotics?

Back 214

High potency: Haloperidol, Trifluoperazine, Fluphenazine
- extrapyramidal sx

Low potency: Thioridazine, Chlorpromazine
- Anticholinergic, antihistamine, and alpha blocking effects

Front 215

Deposits seen with Chlorpromazine and Thioridazine use?

Back 215

Chlorpromazine: Corneal deposits

Thioridazine: reTinal deposits

Front 216

Mechanism of atypical antipsychotics?

Back 216

Block 5-HT2, dopamine, alpha, and H1 receptors

Front 217

Treatment for serotonin syndrome?

Back 217

Cyproheptadine: 5-HT2 antagonist

Front 218

Receptor that stimulates aqueous humor production?

Back 218

Beta1

On ciliary process

Front 219

Receptor for ciliary muscle accomodation?

Back 219

M3

Front 220

Receptor on dilator/radial muscle in eye?

Back 220

Alpha1

Causes mydriasis

Front 221

AChE inhibitors used in Alzheimer's?

Back 221

Donepezil
Galantamine
Rivastigmine

Front 222

Brain tumor with foamy cells and high vascularity that can produce EPO?

Back 222

Hemangioblastoma
- often cerebellar
- associated with VHL

Front 223

Brain tumor in kid with perivascular pseudorosette and rod-shaped blepharoblasts (basal ciliary bodies near nucleus)?

Back 223

Ependymoma

Front 224

Malignant small blue cell brain tumor with perivascular pseudorosettes?

Back 224

Medulloblastoma

Front 225

Two brain tumors with perivascular pseudorosettes?

Back 225

Ependymoma

Medulloblastoma

Front 226

Benign brain tumor in kids with Rosenthal fibers (eosinophilic corkscrew fibers)?

Back 226

Pilocytic (low grade) astrocytoma

Front 227

Frontal lobe calcification in adult: what tumor?

Back 227

Oligodendroglioma

Front 228

Tumor marker for Schwannoma?

Back 228

S-100

Front 229

Brain tumors that stain positive for GFAP?

Back 229

Glioblastoma multiforme (grade IV astrocytoma)

Pilocytic (low grade) astrocytoma

Front 230

Brain tumor with "pseudopalisading" pleomorphic tumor cells around a center of necrosis and hemorrhage?

Back 230

GBM

Front 231

Causes of peripheral vs central vertigo?

Back 231

Peripheral: semicircular canal debris, vestibular nerve infection, Meniere's disease

Central: vestibular nuclei, posterior fossa tumor