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57 Cards in this Set
- Front
- Back
What disease would you expect with CT/MRI findings positive for neurofibrillary tangles and senile plaques?
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Alzheimer's
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What pathologic findings would you expect to make the diagnosis of prion disease?
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spongiform changes (confluent vacuoles), amyloid plaques. (creutzfeld-jakob)
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What CT/MRI findings would you expect to see in Huntington's disease?
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bilateral caudate atrophy or "boxcar ventricles"
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Name the gene and its chromosome for huntington's disease
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Hungtingtin on chromosome 4
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What disease would you suspect if patient had neuronal loss in substantia nigra?
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parkinson's
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What CT/MRI findings would suggest Pick's disease?
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frontotemporal loss (picks = frontotemporal dementia)
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What MRI/CT findings would you expect to see in patient w/ MS?
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periventricular white matter lesions
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Punctate hemorrhages into the mammillary bodies is suggestive of...
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Wernicke's
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What CT/MRI finding would suggest schizophrenia?
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ventricular enlargement & diffuse cortical atrophy
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Name 3 cortical dementias
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Alzheimer's Pick's, CJD
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Name 3 subcortical dementias (including basal ganglia)
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huntington's, parkinson's/lewy body, vasuclar (Binswanger's disease) and AIDS dementia
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What are the 3 M's of subcortical dementia?
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Mood (depressed), motor (ataxic) and memory (amnesia)
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What imaging would you order if suspect fracture or bleeding intracranially?
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CT
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What imaging would you order in a patient whom you suspect for papilledema
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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
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Imaging for a patient with focal neurological sx?
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MRI
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Patient presents with ataxia, nystagmus and/or n/v. What imaging would you order?
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These are posterior fossa sx. MRI, because CT cannot visualize posterior fossa
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suspected intracranial hemorrhage
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CT (faster than an MRI!)
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What labs would you order in a patient with a suspected pheochromocytoma
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urine catecholamines, metanephrine and VMA (all urine)
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What lab test/procedure would you order in a patient whom you suspect wilson's dz?
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serum ceruloplasmin (dont' forget about kayer-fleischer rings)
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What lab/procedure would you order in a patient whom you suspect cushing's?
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serum cortisol or dexamethasone supppression test
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When would carcinoid tumor become carcinoid syndrome? What test would you order to dx?
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when mets to liver/lungs. get 5-HIAA serum levels
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T/F: 5-HIAA is high in the CSF of patients who commit suicide.
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False. Its low
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What would you order in patient with AIP?
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urine porphobilinogens & urobilinogens (including d-aminolevulinic acid (ALA)).
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Patient in clinic c/o depression, weight gain, inability to concentrate, consitpation. What tests would you order?
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TSH. think depressive d/o d/t hypothyroid
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What lab test/procedure can help differentiate seizure from pseudoseizure
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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
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Besides an MRI, what test would you order to clinch MS diagnosis?
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CSF - oligoclonal bands
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What imaging would you order if you suspect a subdural hematoma?
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CT
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What imaging/procedure(s) would you order if you suspect normal pressure hydrocephalus?
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head CT, LP (opening pressure > 20)
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what tests would you order if you suspected CJD?
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EEG, CSF for protein 14-3-3
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what test would you order if you suspected temporal lobe epilepsy
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EEG
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Besides a head CT, what other test could help you dx subarachnoid hemorrhage?
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LP looking for xanthochromia (yellow CSF)
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What kind of CT would you order in a patient whom you suspect CVA?
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non-contrast CT
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What test would you order in guillain-Barre syndrome?
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LP (may see cytoalbuminologic dissociations = protein > 45 w normal WBC)
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Emergency psychiatry: differential for catatonia
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schizophrenia, MDD, bipolar, NMS or serotonin syndrome, encephalitis, non convulsive status epilepticus
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ER psych: cocktails for agitation?
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5:2:1 (5 mg halperidol:2 mg lorazepam: 1 mg cogentin) or 5:2: 50 (50 mg diphenhydramine). IM/PO Usually IM.
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ER psych: patient presents with confusion, ataxia and opthalmopelgia. What do you do first?
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thiamine before glucose. you'll probably start a banana bag later (NS + Folate, thiamine, etc.)
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Withdrawal from what drugs can be fatal?
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alcohol or benzos (and barbs)
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What lab values are classic in alcoholics?
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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)).
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Patient presents to ER w/ headache, anxiety, n/v, tremulous. what would you suspect?
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alcohol withdrawal.
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T/F: alcohol withdrawal can present with hallucinations and seizures.
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True. within 12-24 hrs and 12-48 hrs respectively.
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When does DTs occur?
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36-72hrs after last drink
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Withdrawal from benzodiazepines presents similarly to withdrawal from what drug?
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Et-OH.
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What treatment can you provide in patient who you suspect BDZ toxicity?
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flumazenil (watch out for seizures if you give it...)
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If a patient who has sx of opioid overdose doesn't respond to narcan, what would you suspect?
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multiple drug overdose including benzos! (or Et-OH)
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What 2 drugs did Heath Ledger overdose on?
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opioids and benzos. worried about respiratory depression/anoxia
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How does narcan (naloxone work)
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IV opiod mu receptor antagonist
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Patient presents with slowed cognition (bradyphrenia), blood shot eyes, increase appetite.
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MJ intoxications.
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How long will Urine tox remain + for MJ?
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up to a month with chronic use as its stored in fat
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What intoxication presents very similar to an anticholinergic intoxication?
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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)
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Mechanism of action of cocaine?
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dopamine reuptake inhibition (@ DAT1)
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mechanism of action of amphetamines?
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causes direct release of dopamine
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Pt is very aggressive and has rotary nystamus. Dx
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PCP. Ketamine only causes sedation (no aggressiveness)
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What can cause hallucinogen persisting perception d/o
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LSD! patients has flashbacks for rest of his/her life
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MC psychoactive substance
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caffeine
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MC substance abused/dependence?
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nicotine
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Substance which causes most deaths (by far!)
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nicotine
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MC used illicit psychoactive substance?
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MJ
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