Psychiatry MOC – Flashcards
394 test answers
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CSF 14-3-3
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Diagnostic indicator for Creutzfelt-Jakob
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CSF xanthochromia
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Diagnostic indicator for subarachnoid hemorrhage
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EMG 3 Hz
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Diagnostic indicator for Lambert-Eaton Myasthenic Syndrome
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EMG loss of H reflex
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Diagnostic indicator for Guillain-Barre Syndrome
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ESR
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Diagnostic indicator for Giant Cell Arteritis
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impulsive behavior
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clinical presentation of Orbitofrontal Lateral lesion
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personality changes
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Frontal lesion
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apathy
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behavioral manifestation of medial frontal lesion
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depression
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characteristic of left frontal lesion
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mania
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right frontal lesion
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cohort
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subjects followed over time
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case-control
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retrospective regarding a specific disease
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clinical trial
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randomized and determines treatment effect
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cross-sectional
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what kind of study determines point prevalence?
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crossover
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study in which groups switch
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Winnicott
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transitional object
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Winnicott
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Person who wrote about Object relations theory
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Winnicott
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good enough mother
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piaget
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Cognitive development theory: - sensorimotor - preoperational - concrete operations - formal operations
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Freud
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psychoanalysis
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Mahler
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Separation-individuation: - autism - symbiosis - differentiation - practicing - rapprochement - object constancy
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Erikson
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8 state life cycle: - trust v. mistrust - autonomy v. shame and doubt - initiative v. guilt - industry v. inferiority - identity v. role confusion - intimacy vs. self absorption - generativity v. stagnation - integrity v. despair
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skinner
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operant conditioning
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skinner
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learning with rewards
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Bandura
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social learning theory
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Hull
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drive-reduction theory
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Seligman
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learned helplessness
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Kandel
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who wrote about habituations and sensitization
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Pavlov
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Classical Conditioning
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Kraeplin
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mental disorders have different outcomes
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Kraeplin
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dementia praecox
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Bleuler
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first used the term schizophrenia
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Kohut
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wrote about narcissism and self psychology
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Wernicke's disease
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- seen in alcoholics - triad of ophthalmoplegia, confusion, gait ataxia
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Wernicke's disease brain abnormalites
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microhemorrhages in periventricular gray matter around the aqueduct and 3rd and 4th ventricles
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Parkinson's disease brain abnormalities
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depigmentation of the pars compacta of the substantia nigra in the midbrain
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Diffuse Lewy Bodies
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seen in Alzheimer's and Parkinson's diseases
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multiple sclerosis brain abnormalities
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subcortical white matter lesions perpendicular to the ventricles (Dawson's fingers) are consistent with this demyelinating disease
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Huntington's Disease inheritance
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-autosomal dominant -coded on the short arm of chromosome 4 -gene contains expanded trinucleotide repeat of CAG
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Lambert-Eaton Myasthenic syndrome features
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-paraneoplastic abnormality of presynaptic acetylcholine release -often seen in conjunction with small cell lung carcinoma -immune-mediated and directed against voltage-gated calcium channels
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Lambert-Eaton Myasthenic syndrome clinical hallmark
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generalized weakness with initial improvement in strength after minimal exercise
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Guillain-Barre clinical hallmark
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loss of deep tendon reflexes in the extremeties
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ALS brain abnormalities
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degeneration of upper and lower motor neurons (anterior horn cells)
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multiple sclerosis brain abnormalities
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callosal thinning and atrophy
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Pick's dementia brain abnormalities
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frontotemporal atrophy
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vitamin B12 deficiency brain abnormalities
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dorsal column pathology
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vitamin B12 deficiency
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clinical findings of what disorder causes loss of vibration and joint position sensation?
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Heider
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Attribution theory
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ethosuximide
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treatment of choice for uncomplicated absence seizures
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phenytoin
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treatment for generalized tonic-clonic seizures
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modafinil mechanism of action
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acts on histamine neurons in the reticular activating system in the pons
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autosomal dominant
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Tuberous Sclerosis inheritance
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Tuberous Scherosis features
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-neurocutaneous disorder with ash leaf spots, adenoma sebaceum, and shagreen spots -retinal hamartomas -seizures, MR, Behavioral problems
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Neurofibromatosis NH1 inheritance
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mutation of the 60 exon gene on chromosome 17q
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Neurofibromatosis NH2 inheritance
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mutation of the NF2 gene on chromosome 22
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Neurofibromatosus features
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-axillary freckling -Lisch nodules (pigmented iris hamartomas) -optic nerve gliomas schwannomas
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Neurofibromatomus NH2 diagnostic hallmark
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bilateral vestibular (VIII nerve) schwannomas
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Williams Disease etiology
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Autosomal Dominant with hemizygous deletion including elastin locus chromosome 7q11-23
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Williams Disease features
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-MR -short -unusual facial features and hypermuscularity -thyroid, renal, and cardiovascular anomalies -anxiety, hyperactivity
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cholinesterase inhibitors
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treatments for Alzheimer's disease
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trail making tests
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tests executive functioning
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Wisconsin card sorting test
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evaluates abstract reasoning, flexibility, and problem-solving
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Halstead-Reitan battery
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test that helps to locate brain lesions
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triptan mechanism of action
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agonists at 5HT 1B and 5HT 1D receptors on intracranial blood vessels and coronary arteries
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lesion of splenium of corpus callosum
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clinical sign is alexia without agraphia
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amok
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A Malaysian dissociative DO (different from fugue) usually in males. Trance like state with brutal assaults and sometimes murder people or animals. The person doesn't remember the episode. A running syndrome where they get a sense of energy and run for a long time.
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koro
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Asian delusion that the penis will disappear into the abdomen and cause death
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Piblokto
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Eskimo syndrome of anxiety, depression, confusion, stuporous sleep, and amnesia
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Wihtigo
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Native American fear of being turned into a cannibal through possession of a supernatural monster
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Mal de ojo
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a concept widely found in Mediterranean cultures and elsewhere in the world. A Spanish phrase that means "evil eye." It is usually found in children and includes fitful sleep, crying without apparent cause, diarrhea, vomiting, and fever in a child or infant
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Babinski sign
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diagnostic sign that indicates corticospinal tract lesion with upward motion of big toe
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Hoffman's sign
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diagnostic sign that indicates corticospinal tract lesion with adduction of the thumb when middle finger of same side is stroked
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palmomental reflex
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frontal release sign involving chin muscle contraction as the thenar eminence of the palm contralateral to the lesion is stroked
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meyerson sign
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persistent glabellar reflex of blinking does not extinguish
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brainstem death
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only occasion to have complete loss of gag reflex
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Alzheimer's etiology
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defects in chromosome 21
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Turner syndrome etiology
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missing sex chromosome - XO
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Klinefelter's Syndrome etiology
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extra chromosome - XXY
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Locus Ceruleus
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location of noradrenergic neurons
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Raphe Nuclei in the pons
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location of seratonergic neurons
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Ventral Tegmental Area, Substantia Nigra, and Nucleus accumbens
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location of dopaminergic neurons
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Myasthenia Gravis etiology
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autoimmune neurological disorder involving production of autoantibodies against postsynaptic nicotinic acetylcholinergic receptors on muscles
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Myasthenia Gravis clinical features
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-diplopia, dysarthria, dysphagia -fatigue and muscle weakness -DTR's preserved -10% have thymoma
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endrophonium chloride (Tensilon - a cholinergic agent) test
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Myasthenia Gravis diagnosis
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pyridostigmine
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Myasthenia Gravis treatment
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EEG pattern of delirium
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generalized slow activity consisting of theta and delta waves with focal areas of hyperactivity
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EEG pattern for absence seizures
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3/second spike and wave
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EEG pattern for normal adult drowsiness
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posterior alpha rhythm
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EEG pattern for seizure focus
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right temporal spikes
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EEG with delta waves
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abnormal and indicative of a structural lesion
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Gower's maneuver
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Classic sign of Duchenne's Muscular Dystrophy
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Duchenne's MD inheritance
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Autosomal recessive lack of dystrophin
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Duchenne's MD clinical features
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-proximal muscle weakness -diminished DTR's -increased CPK -MR -large calves
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Trigeminal neuralgia
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AKA Tic Douloreux. Lightning-like pain. Electric shocks along a division of the trigeminal (usually maxillary and unilaterally) triggered by light touch (wind, bed sheets).
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carbemazepine
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Trigeminal neuralgia treatment
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Giant Cell Arteritis features
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-systemic vasculitis of medium-sized vessels -women more than men -over 50yo -new HA with fever, fatigue, myalgia, night sweats, weight loss, and jaw claudication -tender temporal artery -irreversible central retinal artery occlusion feared
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increased ESR
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Giant Cell Arteritis diagnostic test
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prednisone
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Giant Cell Arteritis treatment
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cluster headache
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Middle aged male complaining of incredibly painful headaches located around the eyes. Occur over days or weeks then disappear and reappear. On average last 30 minutes with 10/10 pain. History of smoking, alcohol or possibly drug abuse. Walking can somewhat alleviate the pain. Often nocturnal
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oxygen and subcutaneous sumatriptan
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cluster headache treatments
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lithium and phentolamine
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safe to use with MAOI's
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causes of acquired peripheral neuropathy
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-vincristine and INH therapies -excess B6 therapy -inhalant abuse (toluene or NO) -heavy metal poisoning -hydrocarbon exposure -B12 deficiency -niacin deficiency -mono -autoimmune diseases like lupus
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methylphenidate and antipsychotics
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drugs that increase TCA levels
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smoking
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decreases TCA levels
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dermatomyositis features
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autoimmune disease that affects the skin and muscle with a purple rash on the face and eyelids, commonly associated with occult neoplasm (50%)
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diagnosis of dermatomyositis
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Increase CPK levels, needle EMG with myopathy, muscle biopsy with perifascicular atrophy and "ghost fibers"
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water intoxication features
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tremor, ataxia, restlessness, diarrhea, vomiting, polyuria, stupor
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EEG findings with depression
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shortened latency of REM sleep, decreasd stage IV sleep, increased REM density
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homozygosity for the inheritance of the E4 allele of apolipoprotein E
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the most significant genetic risk factor for Alzheimer's Dementia is _______________
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tau
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component of neurofibrillary tangles which are a pathologic hallmark of AD
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neuropathologic abnormalities of schizophrenia
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-hippocampal neurons can be atrophic -Lamina III neurons in the hippocampus can be disorganized and scattered -enlargement of the cerebral ventricular system (lateral ventricles)
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phenytoin side effects
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hirsutism, facial dysmorphism, gingival hypertrophy, cerebellar atrophy
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Saturday night palsy
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Radial Nerve compression against the spiral groove of the humerous, weak wrist and finger extension.
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Fragile X Syndrome etiology
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A genetic condition that involves damage to the X chromosome, especially in males
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Fragile X features
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MR, long ears, narrow face, short stature, hyperextendable joints, arched palate, macro-orchidism, seizures, autistic features, ADHD, LD's
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Fetal Alcohol Syndrome features
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short palpebral fissures, smooth philtrum, thin upper lip,
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inhibits MAO-B
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Mechanism of action of selegeline
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Ziprasidone
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the only atypical that inhibits serotonin 1A and norepinephrine reuptake (the others block serotonin 2A and dopamine D2)
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Aripiprazole
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the only atypical that works as a partial dopamine agonist and antagonist
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mood elevation
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this occurs with activation of the left prefrontal cortex
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mood depression
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this occurs with activation of the right prefrontal cortex
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Wilson's Disease
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Autosomal Recessive disorder of copper metabolism. Characterized by accumulation of toxic levels of copper in vital organs including liver brain (basal ganglia)and eye. Gene is located on chromosome 13 over 30 mutations have been identified. Defect is in Copper transporting ATPase in the liver. The protein is needed to attach copper to ceruloplasmin and also to excrete copper into the bile.
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Wilson's Disease clinical features
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parkinsonism, flapping tremor, ataxia, dystonia, and bulbar signs (dysphagia and dysarthria), signs of liver failure
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penicillamine
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treatment for Wilson's disease
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CSF oligoclonal bands and myelin basic protein
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diagnostic test for MS
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mesolimbic
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pathway from the VTA to the NA that is most involved in the sense of reward one gets from cocaine or amphetamines
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locus ceruleus of the brainstem
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area of the brain that mediates the effects of opiates and opioids
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Freud
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drive theory
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Beck
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originator of CBT which corrects cognitive distortions
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type I error
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Error of rejecting null hypothesis when in fact it is true (also called a "false positive"). You think you found a cause effect relationship but ONE IS NOT THERE
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lumbar puncture
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important cryptococcal meningitis diagnostic test
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Amphotericin B
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treatment for CNS fungal infections
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renal disease
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serious side effect seen with Amphotericin B
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8 days
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amount of time PCP can be detected in urine
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4 weeks
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amount of time cannabis can be detected in urine
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8 hours
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amount of time cocaine can be detected in urine
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72 hours
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amount of time heroin can be detected in urine
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Alzheimer's Dementia
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amyloid precursor protein is the protein that makes up the amyloid plaques found in the brain in this disease
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anorexia nervosa diagnosis
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1) Body weight is less than 85% of that expected, 2) Intense fear of gaining weight, 3) Skewed perception of self-image or denial of the seriousness of the current low body weight, 4) No period for three or more cycles
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Creutzfeldt-Jakob
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Slow but progressive infectious disease of the nervous system, caused by a virus-like particle called a prion; causes an invariably fatal deterioration of the central nervous system.
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CSF with 14-3-3 and tau proteins
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diagnostic test of choice to diagnose Creutzfeldt-Jakob disease
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Medial longitudinal fasciculus
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the lesion that produces the classic signs of internuclear ophthalmoplegia in MS is found where?
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inhalants
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this type of drug can cause persistent dementia
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Multiple Sclerosis
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A chronic, often relapsing/remitting imflammatory disease of the central nervous system marked by damage to the myelin sheath. Plaques occur in the brain and spinal cord causing tremor, weakness, incoordination, paresthesia, and disturbances in vision (optic neuritis with Marcus Gunn pupil, and internuclear ophthalmoplegia), speech, and heat sensitivity
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bilateral acoustic schwannomas
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necessary to diagnose NF2 (contrary to NF1)
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altered consciousness
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hallmark of delirium (differentiates from dementia)
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MDMA intoxication
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intense feeling of attachment and connection to others, high energy, altered time perception, peacefulness, euphoria, increased desire for sex, hieghtened sensory perceptions, dehydration. Chronic use can lead to anxiety, depression, psychosis, congitive and memory deficits, may lead to Parkinson's like disorder
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lesion in spinothalamic tract
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will result in loss of pain and temperature sensation on the opposite (contralateral) side of the body below the level of the lesion
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lesion in the dorsal columns
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conscious proprioception, two-point discrimination, and vibration sense are lost bilaterally below the T10 dermatome, all other sensations intact.
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lesion in the sensory area of the cerebral cortex
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will lead to contralateral sensory deficits
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cerebellar lesions
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- these are unilateral lesions of cerebellar hemisphere or PEDUNCLES- results in ipsilateral movement disorder (homolateral)
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upper motor neuron defect
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spastic paralysis, no significant muscle atrophy, fasciculations and fibrillations not present, hyperreflexia, Babinski reflex may be present
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lower motor neuron defect
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Flaccidity, atrophy, fibrillation/fasciculations, hypotonic DTRs, babinski absent
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ALS
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disease characterized by both UMN and LMN signs
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tertiary syphilis
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example of dorsal column irritation
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pernicious anemia
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example of dorsal column and UMN weakness
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polio
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disease with LMN involvement
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Guillain-Barre
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peripheral nerve involvement causing both sensory and LMN loss
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syringomyelia
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degenerative disease of the central cord or brainstem (unknown origin) that affects the crossing pain-temperature fibers.
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cranial nerve I
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Olfactory - smell
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cranial nerve II
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CN responsible for vision - called the optic nerve
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cranial nerves III, IV, VI
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Pupil constriction (III), moves eyes, accommmodates
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cranial nerve V
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chews and feels front of head
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cranial nerve VII
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moves the face, tastes, salivates, cries, closes the eye
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cranial nerve VIII
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hears and regulates balance
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cranial nerve IX
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tastes, salivates, swallows, monitors carotid body and sinus
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cranial nerve X
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tastes, swallows, lifts palate, talks, commication to and from thoraco-abdominal viscera
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cranial nerve XI
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turns head, lifts shoulders
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cranial nerve XII
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moves tongue
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facial nerve UMN lesion
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Contralateral lower face paralysis only
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facial nerve LMN lesion
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ipsilateral paralysis of upper and lower face
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Bell's palsy
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-Lower motor neuron lesion (peripheral), producing cranial nerve VII paralysis, which is almost always unilateral
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Brodmann's lesion (area 8) in DLPFC
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eyes deviate toward the side of the lesion
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MLF lesion (intranuclear ophthalmoplegia)
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commonly seen with MS; eyes will not be able to look medially
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Horner's synddrome
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ptosis myosis anhydrosis commonly the result of a lung (pancoast tumor)
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Wernicke's area lesion
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wordy nonsensical speech; sensory fluent aphasia
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T4
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nipple dermatome
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T10
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umbilicus dermatome
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L1
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groin dermatome
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Jung
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felt that development of the personality occurs through experiences that teach a person who they intrinsically are
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Sullivan
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focused on social interactions at each stage of life
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conduction aphasia lesion location
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2 locations of pathology= 1) involves that arcuate fasciculus in the dominant hemisphere, usually deep in the supramarginal gyrus. 2) The other major site is the left temporal lobe in the auditory processing association area.
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conduction aphasia lesion characteristics
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left dominant hemisphere lesion with relatively normal spontaneous speech but inability to repeat, impaired naming; may be accompanied by right hemiparesis, hemisensory loss, and limb apraxia; can follow instructions both verbal and on paper but cannot write well
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Broca's aphasia
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Damage to Brodmans 44,45 (left posterior inferior frontal gyrus); Nonfluent Aphasia, comprehension stays intact but patients speak very slowly in simple sentences with stuttering and staccato speech and inability to repeat; frequently accompanied by right hemiparesis and hemisensory loss
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Wernicke's aphasia
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Damage to Brodmann's Area 2 (superior temporal gyrus), A condition by either partial or total loss of the ability to understand what is being said or read. The individual maintains the ability to speak but speech is word salad (made up words); often accompanied by right homonymous hemianopsia; NO motor or sensory symptoms
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global aphasia
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Damage to both Broca and Wernicke areas leading to: Nonfluent aphasia with impaired comprehension; often in the area of the MCA
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transcortical aphasia
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- Retain ability to repeat phrases; rare
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tyrosine kinase receptor
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interacts with NGF and BDNF
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seven-transmembrane-domain receptor
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requires G protein to open ion channel; has NH2 terminal outside the cell and COOH terminal inside
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ligand-gated ion channel receptor
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opened or closed based on the binding of a specific ligand to the channel. Once opened, the channel allows the ion to cross the plasma membrane according to its concentration gradient. An examples is the acetylcholine receptor at the neuromuscular junction, which, when Ach binds, opens a cation channel in the muscle cell membrane.
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central pontine myelinolysis
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Focal demyelination of the pons (anterior brain stem). Due to rapid intravenous correction of hyponatremia. Occurs in severely malnourished patients (alcoholics and patients with liver disease). classically presents as acute bilateral paralysis (locked in syndeome- only move eyes)
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Wallenberg's syndrome
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Posterior Inferior Cerebellar Artery (PICA) thrombosis "Medullary Syndrome", Ipsilateral: ataxia, facial pain & temp; Contralateral: body pain & temp
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metachromatic leukodystrophy
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Leukodystrophy due to a deficiency of arylsulfatase (autosomal recessive); most common leukodystrophy
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Tay-Sachs Disease
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1 in 3600 births for Ashkanazi Jews. Missing enzyme in lysosomes for lipid breakdown. Lipid buildup causes physical and mental breakdown at 6 months. Death within 4 years, -is an autosomal recessive deficiency or absence of hetosaminidase A, which is necessary to metabolize certain lipid
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Krabbe's disease
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autosomal recessive, deficient: galactocerebrosidase, , A patient has peripheral neuropathy, developmental delay, and optic atrophy. These characteristics are typical of which lysosomal storage disease
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parachute response
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primitive reflex that is present longer than 6 months
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pseydocyesis
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false pregnancy, in which the woman displays the signs of pregnancy but is not pregnant
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cytomegalovirus
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the most common cause of retinopathy in AIDS patients
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tricyclics
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side effects of what class of drugs: orthostatic hypotension, sedation (generally wears off), cardiac dysrhythmias, dry mouth, constipation, urinary retention, excessive sweating, tachycardia, blurred vision
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L5
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motor nerve root responsible for foot flexion and big toe extension
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S1
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Achilles reflex
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amitryptyline
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-TCA with anti-histamine like action useful for treatment of antipruritis and gastric ulcer disease
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Brown-Sequard syndrome
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Damage to half of spinal cord with: - Loss of pain and temperature sensation on contralateral side -loss of motor control and proprioception and discriminatory touch on ipsilateral side of body.
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Anterior Cerebral Artery stroke
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vessel involed with: - contralateral motor loss with leg affected more than arm - eyes look to the lesion
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internal capsule, basis pontis, corona radiata
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infarct in these areas would produce pure motor hemiparesis
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thalamus
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infact in this area would produce pure sensory syptoms
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subthalamic nucleus of Luys
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What brain area is affected in hemiballismus in acute stroke?
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presynaptic dopamine depletion
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mechanism of action of reserpine
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arachnoid granulations
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Site where the CSF enters venous circulation
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Virchow-Robin spaces
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A perivascular subarachnoid space in the brain in which important immunological functions take place.
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regression analysis
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Measures the impact of a set of variables on another variable.
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sensitivity
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A measurement instrument's ability to accurately detect that which is being tested for
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kappa
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variable used to indicate a constant value
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subacute sclerosing panencephalitis
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What condition is caused by a slowly progressing, persistent infection of the brain by measles virus
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Lesch-Nyhan syndrome
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An X-linked recessive disorder characterized by HGPRT deficiency that results in hyperuricemia and self mutilation.
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Gaucher's disease
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A metabolic autosomal recessive disorder that causes liver and spleen enlargement, anemia, nose bleeds, low platelets (easy bruising, slow clotting), bone pain, and bone deterioration (Bone, Bleeding, Big organs)
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trigeminal nucleus caudalis
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The pain processing center found in the medulla that is involved in migraine is called the _______.
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carbidopa
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DOPA decarboxylase inhibitor that prevents conversion of levodopa to dopamine in the periphery
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drugs used to treat Parkinson's
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-dopamine agonists (ropinirole, pramipexole, pergolide, bromocriptine -blocking DA degradation by MAO-B (selegeline) -blocking DA degradation by COMT (tolcapone, entacapone) -anticholinergic agents reduce tremor (hexyphenidyl, benztropine)
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amoxapine
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tetracyclic antidepressant that has significant dopamine blocking activity
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maprotiline
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tetracyclic antidepressant that is a very selective inhibitor of NE reuptake; increased seizure incidence
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Sturge-Weber syndrome
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spontaneous neurocutaneous disorder with Port-wine stain, developmental delay, seizure, hemiplegia, glaucoma
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Von Hippel-Lindau syndrome
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An autosomal dominant neurocutaneous condition characterized by central nervous system and retinal hemangioblastomas, visceral cysts, phenochromocytomas, and renal cell carcinoma. They are usually found on autopsy.
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ataxia-telangiectasia
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Autosomal recessive neurodegenerative neurocutaneous disorder caused by defective ATM protein. Associated with increased risk of lymphoma, leukemia, and abnormal eye movements
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Fabry's disease
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Refers to an X-linked recessive Lysosomal storage disease d/t alpha-galactosidase A deficiency. purple papules occur around the midsection. Renal failure is a common cause of death.
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reflex sympathetic dystrophy
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Abnormal response of sympathetic nervous system following injury; Most often in hand or foot; Hypersensitivity, redness, burning/aching pain, swelling, atrophy
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2C19 and 3A4
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p450 enzymes induced by carbemazepine
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1A2
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p450 enzyme induced by smoking
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risperdal
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antipsychotic NOT affected by cigarette smoking
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Sheehan's Syndrome
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Infarct of the Anterior Pituitary after pregnancy/labor because of lack of blood supply to a enlarged tissue. Classic presenting symptom is poor lactation after pregnancy. Can also cause loss of pubic hair, fatigue, and anorexia.
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Normal Pressure Hydrocephalus
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what disorder classically presents with the triad of cognitive impairment (thought problems), urinary incontinence, and abnormal gait? GUT
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Diffuse Lewy Body disease
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second most common type of dementia with classic triad of Parkinsonism + early dementia + visual hallucinations. Extreme sensitivity to dopamine antagonists
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Sydenham's chorea
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a form of involuntary twitching associated with rheumatic fever, usually occurring in childhood.
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carotid artery TIA
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Ipsilateral vision loss (amaurosis fugax) and contralateral hand/arm weakness or sensory loss and face and leg symptoms.
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vertebrobasilar stroke
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vertigo, ataxia, ipsilateral sensory loss to face, contralateral hemiparesis/sensory loss to body
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desipramine
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TCA that would worsen essential tremors
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urban, babies born in winter and early spring
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increased prevalence for schizophrenia
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Fredrich's ataxia
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This autosomal recessive disorder on chromosome 9 with Tri-nucleotide repeat (GAA) is associated with ataxia, proprioceptive loss, absence of DTR's, and significant CNA involvement (dysarthria, Babinski, eye mmt anomalies) diagnosis in adolescence and death in 40's due to hypertrophic cardiomyopathy
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Myotonic Dystrophy
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Autosomal dominant on chromosome 19 with repeat expansion. Onset around 20-30 years of age. Pregressive weakness and myotonia, cataracts, cognitive impairment, frontal baldness, triangular drooping facies. Severity correlates with length of the trinucleotide repeat region
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19
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chromosome involved in migraines
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T. solium
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infecting agent in cysticercosis; found in pork tapeworms
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E. granulosus
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What causes the cyctic echinococcosis?
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T. spiralis
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Nematode parasite, occurring in rats, pigs, bears and humans, and is responsible for the disease trichinosis. Cyst infective. Affects muscle tissue.
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T. Gondii
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toxoplasmosis is caused by this organism; detected by ring-enhancing lesions on MRI/CT
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alcoholic neuropathy
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the presentation for this is distal paresthesias and numbness progressing proximally, pain often present and increased intensity with progression, motor effects develop after sensory symptoms
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Marchiafava-Bignami
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Rare demyelination seen frequently in alcoholics. Involves central fibers (medial zone) of corpus callosum. Most common findings are frontal lobe damage and dementia
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Alcoholic nutritional cerebellar degeneration
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truncal ataxia seen when there is atrophy of the cerebellar vermis
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Miller-Fisher syndrome
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Variant of Guillain-Barre with acute onset of triad of ophthalmoplegia, cerebellar ataxia and areflexia
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Lorenz
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worked on phenomenon of imprinting
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cortical dementia
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two types of this dementia are Alzheimer's disease and cerebrovascular dementia; characterized by amnesia, aphasia, apraxia, and agnosia
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subcortical dementia
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Huntingtons and Parkinson's; shows changes in personality and attention span as well as a slowed thinking
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AMPA, Kainate, NMDA
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receptors associated with glutamate
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nicotinic and muscarinic
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receptors associated with acetylcholine
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alpha 1, alpha 2, and beta
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receptors associated with NE
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mu and delta
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receptors associated with opioids
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serotonin 1A agonist
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mechanism of action of Buspar
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Dusky vs. US
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foundation for competency to stand trial
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Tarasoff vs Regents of the University of California
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duty to warn (and protect)
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desipramine, nortryptyline and protryptyline
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list the secondary amine TCA's
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imipramine, amitriptyline, clomipramine, trimipramine
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list the tertiary amine TCA's
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2D6
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enzyme that metabolizes TCA's
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third nerve palsy
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One dilated eye, non reactive, ptosis, eye turned down and out. often seen in diabetics
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middle cerebral artery lesion
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What vessel lesion would involve the following areas: Motor Cortex (upper limb and face), Sensory Cortex (upper limb and face), Wernicke's area and Broca's areas
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dementia pugilistica
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a severe form of chronic traumatic brain injury (dementia) often experienced by boxers; increased risk is seen among ApoE4 carriers (chromosome 19)
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decreased number of beta-adrenergic and 5-HT receptors
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most likely mechanism of action of TCA's
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abreaction
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psychoanalytic term for reliving an experience in order to purge its emotional distress
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pinpoint pupils
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obvious sign of heroin intoxication
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heroin withdrawal symptoms
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. runny nose, yawning, fever, muscle & joint pain, diarrhea (Remember flu-like symptoms)
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desipramine and protriptyline
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least sedating TCA's
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imipramine, amoxapine, nortripytyline, and maprotiline (NAMI)
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moderately sedating TCA's
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amitriptyline, trimipramine, and doxepin (TAD)
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very sedating TCA's
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lithium intoxication
answer
diahrrea, vomiting, drowsiness, weakness, thirst, hand tremors, ataxia
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vascular dementia
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2nd most common cause of dementia. Sometimes able to get better. Different from Alzheimer's in that is more abrupt with a stepwise decline
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clomipramine
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most serotonin-selective of the TCA's
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Piaget's sensorimotor stage
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Spans the first two years of life. Infants and toddler's "think" with their eyes, ears, hands, and other sensorimotor equipment. They cannot yet carry out many activities with their heads. They understand symbols and develop object permanence.
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Piaget's preoperational stage
answer
2-7yrs old; make believe play, animistic thinking, dual representation, sensory motor activity leads to internal images of experience, those then become words. There's a sense of punishment for bad deeds (immanent justice) and also for phenomenalistic causality. Egocentric thought.
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Piaget's concrete operations stage
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Ages 7 to 11. Children's ability to classify things into different sets and consider their interrelationships and the points of views of others. Children can put things in order and group them. Increased spatial reasoning (directions, maps). Conservation, reversibility, and classification.
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Piaget's formal operations stage
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Age: 11 years-adulthood, person can think abstractly, deal with hypothetical situations and think about possibilties
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T. pallidum
answer
What is the common pathogen for syphilis?
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B. burgdorferi
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the etiological agent for lyme disease which presents early as meningitis then with chronicum migrans (macular rash), and is diagnosed with ELISA and then confirmed with Western blot.
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metoclopramide (Reglan)
answer
anti-emetic that is a potent antagonist of D2 receptors
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temporal lobe
answer
primary auditory cortex is located in this brain region
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epidural hematoma
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caused by laceration of the medial meningeal artery; usually in temporal or parietal lobes
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subdural hematoma
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caused by blunt trauma and tearing of the bridging veins; is the most common kind of intracranial hematoma
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periodic high amplitude sharp wave complexes
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typical EEG finding with Creutzfeldt-Jakob disease
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Mahler's stages
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Normal autism, symbiosis, differentiation, practicing, rapprochment, object constancy.
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Mees' lines
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Transverse white striae on the fingernails can occur with either acute or chronic arsenic exposure
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correlation coefficient
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A statistical index of the relationship between two things (from -1 to +1)
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control group
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Group exposed to all variables except independent, and is used for comparison.
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Analysis of variance
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Test for the differences among the means of two or more independent samples
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null hypothesis
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Hypothesis that predicts NO relationship between variables. The aim of research is to reject this hypothesis
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organophosphate poisoning
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often seen in gardeners exposed to pesticides; Inhibits the action of Acetylcholinesterase (AChE) in nerve cells leading to cholinergic toxicity
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lead poisoning
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oral manifestations include ulcerative stomatitis and a bluish line along the marginal gingiva, metallic taste; behavioral manifestations include: anorexia, hyperirritability, altered sleep patterns, & decreased play
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truncal ataxia
answer
Cerebellar vermis lesion causes what symptom
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cerebellopontine angle lesion
answer
location into which acoustic neuromas may grow and compromise CNs 7/8, causing ipsilateral symptom
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glycine
answer
neurotransmitter synthesized from serine, is a necessary adjunct to glutamate at the NMDA receptor, inhibits its own receptors that open chloride ion channels, receptors are found mostly in the spinal cord, mutations cause hyperekplexia (exaggerated startle)
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contraindications for lumbar puncture
answer
recent hemorrhagic CVA, recent surgery, CPR > 10 minutes, AAA, uncontrolled HTN, some malignancies, non-compressible arterial punctures, recent head trauma, papilledema, thrombocytopenia
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Fragile x Syndrome
answer
Autism, Retardation, MacroOrchidism, Protruding Ears, Narrow Jaw, involves X chromosome and is the most frequent cause of MR in the general population
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persistent vegetative state
answer
someone who is in phase of being unconscious for more than 2 weeks. Eyes are open, no evidence of purposeful awareness, no communication; roving eye movements, spontaneous movements, eye tracking, and swallowing can be preserved
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apoptosis
answer
Programmed cell death mediated by calcium influx
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flumazenil
answer
Antidote to benzodiazepine overdose (antagonist that reverses the CNS effects)
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West's Syndrome
answer
triad of: infantile spasms, arrest of psychomotor development, hypsarrythmia pattern on EEG
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Papez circuit
answer
connects the hippocampus with the thalamus, hypothalamus, and cortex (includes mammillary bodies, fornix, and cingulate gyrus)
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PKU
answer
A human metabolic disease caused by a mutation in a gene which leads to mental retardation if not treated; inherited as an autosomal recessive phenotype; clinical features include: microcephaly, "mousy" odor, infantile spasms, light hair and skin
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c. jejuni
answer
What bacteria may contribute to Guillain-Barre syndrome?
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meralgia paresthetica
answer
lateral femoral cutaneous nerve neuropathy, impingement at the inguinal ligament, can be relieved by flexing the thigh
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fibrillation potentials
answer
spontaneous EMG activity seen in a DE-nervated muscle
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fasciculations
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may be caused by degenerative diseases of anterior horn cells, spinal nerve compression, peripheral nerve disease
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caudate nucleus
answer
Principle component of the basal gangial system, mediating MOVEMENT, affective behavior, learning, reward, and other cognitive processes (COGNITION) - lots of D2 receptors
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inclusion body myositis
answer
most frequent myopathy in patients > 50, DISTAL asymmetric weakness
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Ganser's syndrome
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patient has unconscious symptoms of confusion and dementia (giving approximate answers and talking past the point); considered to be a type of dissociative disorder
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entacapone and tolcapone
answer
COMT inhibitors used to treat Parkinson's
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selegiline
answer
MAO-B inhibitor which potentiates the effects of dopamine
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Todd's paralysis
answer
persistant paralysis/weakness that lasts up to 24 hours after a postictal period
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oxazepam, lorazepam, temazepam (LOT)
answer
3 benzodiazepines with no active metabolites
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tropical spastic paraparesis
answer
partial loss of voluntary motor function due to a spinal cord infection caused by HTLV-1
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trinucleotide repeat diseases
answer
Huntington's (CAG), Myotonic dystrophy (CTG), Fragile X (CGG), Friederich's ataxia (GAA)
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battle sign
answer
Brusing behind the ears that is a sign of skull injury.
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sodium oxybate and lioresal
answer
only GABA-B receptor agonists
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triphasic waves
answer
EEG in hepatic encephalopathy
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riluzole
answer
glutamate antagonist that treats ALS
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Anton's syndrome
answer
denial of blindness; occurs with damage to right occipital lobe or bilateral damage; people may make up stories about what they see
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transverse myelitis
answer
bilateral spinal cord pathology; back pain followed by rapid onset leg weakness and urinary incontinence; usually follows vaccination or infection or MS demyelination
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prosopagnosia
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inability to recognize faces
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anosognosia
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Lack of awareness of own neurological defects
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aprosodia
answer
-loss of emotional expression
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PCP intoxication
answer
pt presents with hypertension, paranoia, nystagmus, catatonia, convulsions, hallucinations, mood lability, violence, mydriasis, ataxia, and tachycardia
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syringomyelia
answer
Bilateral loss of pain and temperature sensations, usually with a cape-like distribution, would be associated with - Arnold-Chiari malformations.
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opsoclonus-myoclonus
answer
paraneoplastic syndrome assoc with neuroblastoma-> ataxia, intermittent jerking movement, jerky conjugate eye movement; "dancing eyes, dancing feet" syndrome
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belladonna alkaloid intoxication
answer
urinary retention
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Ramsay-Hunt syndrome
answer
Ear pain, external auditory canal vesicles, ipsilateral facial paralysis, deafness, herpes zoster
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glioblastoma multiforme
answer
Most common adult primary brain tumor- malignant, seen in cerebral hemispheres - looks like a butterfly on MRI; pseudopalisading
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caudate, thalamus, OFC
answer
areas affected by OCD
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AIDS lymphoma
answer
Agressive, b cell origin, the most common AIDS cancer
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toxoplasmosis
answer
the most frequent opportunistic infection in AIDS patients, with CD4 <200, presents with headache and focal neurological deficits, MRI reveals ring-enhancing lesions
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vacuolar myelopathy
answer
the most common cause of spinal cord pathology in AIDS patients, usuall seen in late states
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progressive multifocal leukoencephalopathy (PML)
answer
What condition is caused by John Cunningham virus (JC virus - a form of HPV) infection of oligodendrocytes that is reactivated by immunosuppression and causes demyelination in subcortical white matter of the parietal and/or occipital lobes
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carotid artery occlusion
answer
clinical syndrome that presents with the triad of HA, ipsi horner's syndrome and c/l hemiparesis (HHH)
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tetanus
answer
anterior horn cells
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botulism
answer
blocks acetylcholine release; clinical symptoms include dysphagia, dysarthria, ptosis, diplopia, and urinary retention; treat with trivalent equine antitoxin
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West Nile
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diagnosed by IgM antibodies in the CSF
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rabies
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hydrophobia common
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epidural spinal cord compression (ESCC)
answer
An oncologic emergency that is caused by a tumor pressing on the spinal cord, can cause various problems, including permanent paralysis if not treated properly. Caused by cancers of the lung, breast & prostate, which carry the greatest risk of metastasizing to the spinal cord.
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lateral and posterior columns of the spinal cord, macrocytic anemia
answer
neurologic symptoms of B12 deficiency
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internal capsule, basis pontis, corona radiata
answer
areas involved with a pure motor stroke
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PCP
answer
- acts on glutamate NMDA receptors and activates VTA DA - hallucination, euphoria, bizarre behavior - rhabdomyolysis, stupor, coma
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cocaine
answer
-blocks reuptake of serotonin, NE, DA -increases glutamate in the nucleus accumbens - lowers seizure threshold - most common cause of drug-induced stroke
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Balint's Syndrome
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A condition resulting from damage to a person's parietal lobe. One characteristic of this syndrome is an inability to focus attention on individual objects.
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inhalants
answer
distal sensorimotor polyneuropathy can result in chronic use of this drug
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Meige's syndrome
answer
blepharospasm + oromandibular dysonia
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M'Naughten rule
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if you meet this test, then you can be declared not guilty by reason of insanity
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Ford vs. Wainwright
answer
Constitution forbids insane people to be penalized by the death penalty
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scanning speech
answer
cerebellar dysfunction; words are pronounced slowly without melody, tone or rhythm, and ataxia is present
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aphemia
answer
loss of speech; motor aphasia; individual knows what they want to say but cannot coordinate muscles that control speech
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NMDA receptor
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A receptor site on the hippocampus that influences the flow of information between neurons by controlling the initiation of long-term potentiation; allows sodium, potassium, and calciium to pass through and can be blocked by PCP
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comatose patients
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CT required before LP
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amygdyla
answer
Memory tied to emotion
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lasegue's sign
answer
-tests for sciatica or disc bulge/herniation
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gegenhalten
answer
Sudden increase in tone making motion more difficult is called? "Clasped knife" rigidity
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tiagabine
answer
Action: inhibits the reuptake of GABA
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gabapentin
answer
Action: binds Ca2+ channels, Increases GABA synthesis
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pregabalin
answer
binds alpha-2-delta subunit of the voltage gated calcium channel, increase GABA synthesis
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Lioresal
answer
GABA -B agonist approved for stroke and MS
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Memantine
answer
NMDA antagonist approved for severe Alzheimer's disease
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galantamine, donepizil, rivastigmine (GuaRD)
answer
acetylcholinesterase inhbitors used to treat early Alzheimer's disease
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GABA-A
answer
Chloride ion channel that has more affinity for GABA-B in the presence of Benzos
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vagal nerve stimulation
answer
Surgical Management used in control of Simple or Complex Partial Seizures
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AVM
answer
abnormal connection between mass of arteries and veins that can easily rupture and cause internal bleeding; detected by bruit with auscultation; seizures are presenting sign
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colloid cyst
answer
benign tumor of remnants of rathke's pouch. bend over to tie shoes and pass out. 3rd ventricular tumor.
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buprenorphine
answer
Agonist/Angatagonist opioid, agaonist for mu; used in the treatment of heroin addiction
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naltrexone
answer
Opioid antagonist that is given orally in alcohol dependency programs
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naloxone
answer
A drug that blocks opiate receptors. Treats heroin OD.
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anterograde amnesia
answer
most often seen with alcohol abuse, so keep Wernicke-Korsakoff syndrome in mind
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subacute combined degeneration
answer
B12 anemia - CNS changes, altered gait, proprioception
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Isoniazid
answer
Anti-tuberculin agent, can cause B6 (pyridoxine)deficiency with distal paresthesias
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alzheimer's disease
answer
result of cholinergic neuronal demise predominantly in the nycleus basalis of Meynert
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Mirtazapine
answer
presynaptic A2-blocker (↑ release of NE) and Serotonin receptor blocker.
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temazepam, oxazepam, lorazepam (LOT)
answer
best benzos for people with liver disease
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aspergillus
answer
fungus that colonizes paranasal sinuses and cause hypersensitivity pneumonitis; originates in lungs of immucompromised patients; can cause vertebrobasilar strokes and cerebral vasculitis
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histoplasma
answer
-Bird or bat dropping - Hepatosplenomegaly, - Acute-self limited pneumonia, asymptomatic to severe, self resolving and can survive in granulomas
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Candida albicans
answer
most common fungus in humans, in pts with AIDs, it can manifest in the form of intracranial abscesses, vasculitis, and mycotic intraceerebral aneurysms that can rupture
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GABA-A
answer
chloride channel receptor
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Wernicke's encephalopathy
answer
A brain disorder caused by thiamine deficiency and characterized by visual disturbances, ataxia, somnolence, stupor, and , without thiamine replacement, death.
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niacin deficiency
answer
Pellagra: Dermatitis, Diarrhea, Dementia. Associated with chromatolysis
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GGT
answer
best test for picking up alcohol abuse, elevated in 80% of alcohol-related disorders, Found in liver with increased levels due to HEAVY DRINKING, obesity, fatty acids, or meds
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pimozide
answer
What is the DOC for treating Tourette syndrome?
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drugs that increase carbamazepine
answer
Digoxin, dopamine, dobutamine, epinephrine, erythromycin
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thioridazine side effects
answer
RETROGRADE ejaculation*, RETINITIS PIGMENTOSA. Neuromalignant syndrome, tardive dyskinesia (extrapyramidal side effect), hyperprolactinemia leading to galactorrhea. Antimuscarinic effects (dry mouth, constipation) and anti-alpha adrenergic effects (hypotension) and anti histamine effects (sedation).
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ecstacy neurotransmitters
answer
DA and 5HT
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Kleine-Levin Syndrome
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a neurological disorder characterized by recurring periods of excessive amounts of sleeping and eating
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