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USMLE - Neuro, Kaplan USMLE Lecture Notes

Location of the Raphe nuclei? part of the reticular formation in brainstem (midbrain to medulla)
What does Raphe nuclei produce? Serotonin
Where is serotonin produced? raphe nuclei in reticular formation
What induces non-REM sleep? raphe nuclei
What plays role in mood and aggression? raphe nuclei
What nuclei in the reticular formation are degenerated in Alzheimer? raphe and locus coeruleus
What does locus caeruleus make? NE
What does the locus caeruleus control? arousal, cortical activation
what can reduce REM sleep? NE
what is periaqueductal gray? nuclei around the cerebral aqueduct in midbrain; have opioid receptors; modulate pain in sensory nerve tracts (dorsal horn of spinal cord)
what is the neurotransmitter in REM sleep? Ach
Axis I Clinical disorders
Axis II Personality disorders & mental retardation
Axis III Physical conditions
Axis IV Psychosocial/environmental problems
Axis V Global assessment of functioning
Fragile X X-linked mental retardation, affects boys mostly
Characteristics of Fragile X large testes (macroorchidism), characteristic but variable face with large ears, long face, high-arched palate
most common cause of mental retardation fetal alcohol syndrome
Most common genetic causes of mental retardation fragile X and down syndrome
How to treat autism behavioral techniques (shaping)
differential of schizophrenia 1. brief psychotic disorder (1 to 30 days) 2. schizophreniform (less than 6 mo) 3. schizophrenia (> 6 mo)
anhedonia can't experience pleasant emotion
clang associations illogical connections by ryhthm or puns
echolalia repeating in answer many of the same words as in question
echopraxia imitations of movements or gestures
perseveration responding to all questions the same way
Name 5 subtypes of schizophrenia DC-PUR 1. Disorganized 2. Catatonic 3. Paranoid 4. Undifferentiated 5. Residual
anaclictic depression depression in infant separated from caregiver --> FTT, withdrawn, unresponsive
asperger's mild autism, problems with social relationships and repetitive behavior; normal intelligence (unlike lower intelligence for autism)
rett disorder xlinked; only in girls because boys die in utero; age 4 - loss of development and MR; stereotyped handwriting
treatment for ADHD methylphenidate (Ritalin)
conduct disorder violating social norms, becomes antisocial personality disorder at greater than 18 yo
oppositional defiant disorder noncompliant, but not criminal
treatment for tourette's haloperidol
separation anxiety disorder fear of loss of attachment --> factitious physical complaints, avoidance of school
neurotransmitter changes in anxiety disorder increased NE; decreased GABA and serotonin; anxiety disorders happen more in the NE, and fewer people with the names of Gabby and Sera have anxiety disorders
Depression (change in NTs) decreased NE and serotonin; there's less depression in the NE, and also fewer people named Sera are depressed; NE has more anxiety, less depression
Alzheimer's (change in NTs) decreased Ach (A for Alz, A for Ach)
Huntington's disease (change in NTs) decreased GABA and Ach; people grab at you less and sneeze less in Huntington Beach
Schizophrenia (change in NTs) increased dopamine; schizo people are major dopes
Parkinson's disease (change in NTs) decreased dopamine (have to give them dopamine to treat)
In what disease would you have increased dopamine levels? In which would have decreased dopamine? Schizophrenia increased dopamine; parkinson's decreased dopamine
anosognosia not aware of one's illness
autotopagnosia can't locate your own body parts
depersonalization body seems unreal or dissociated
Order of loss when someone loses orientation time, place, person
anterograde amnesia no new memory
korsakoff's amnesia classic anterograde amnesia; confabulations - To fill in gaps in one's memory with fabrications that one believes to be facts; thiamine deficiency; alcoholics; bilateral destruction of mamillary bodies;
Delirium vs. Dementia Delirium is waxing and waning levels of consciousness and abnl EEG, while dementia is gradual decrease in cognition but no change in consciousness and normal EEG
sensorium sum of an organism's perception, the "seat of sensation" where it experiences and interprets the environments within which it lives
drug class that frequently causes delirium anticholinergics
hallucinations perceptions with no external stimuli
illusions misinterpretations of external stimuli
delusion false beliefs not shared by culture; person still believes them even with evidence to the contrary
visual and auditory hallucinations are common in.... schizophrenia
olfactory hallucinations common in... aura of psychomotor epilepsy
tactile hallucinations cocaine abusers and alcoholics (cocaine bugs and ants crawling on skin)
formication the sensation of ants crawling on skin
delirium tremens withdrawal or abstinence from alcohol following habitual excessive drinking; sensation of ants crawling on skin
HypnaGOgic hallucination while GOing to bed
Hypnopompic hallucination upon waking from sleep
schizophrenia periods of psychosis and disturbed behavior with decline in function (> 6 mo)
schizoaffective disorder schizophrenia with mood disorder (depression or mania)
criteria for diagnosis of schizophrenia Fulfill at least two criteria. HaNDDD: Hallucinations, Negative sx's (flat affect, social withdrawal, lack of motivation, lack of speech or thought), Delusions, Disorganized thought, Disorganized/catatonic behavior
Criteria for manic episode DIG FAST: 1. Distractability 2. Irresponsibility (seeks pleasure without thinking of consequences) 3. Grandiosity (inflated self esteem) 4. Flight of ideas (racing thoughts) 5. goal directed Activity and psychomotor Agitation 6. Sleep less 7. Talkativenes
Bipolar I bipolar + manic
Bipolar II bipolar + hypomanic
Definition of bipolar disorder one manic or one hypomanic episode defines the disorder
What is treatment for bipolar? lithium
cyclothymic disorder mild bipolar, lasts at least 2 years
Criteria for major depressive episode At least 5 for > 2wks SIG E CAPS: 1. Sleep disturbance 2. loss of Interest (anhedonia) 3. Guilt/worthlessness 4. Energy low 5. Concentration poor 6. Appetite/weight change 7. psychomotor retardation/agitation 8. Suicidal ideations 9. depressed mood
dysthymia mild depression, at least 2 years
Risk factors for suicide completion SAD PERSONS. Sex (male), Age (teen, elder), Depression, Previous attempt, EtOH/drugs, loss Rational thinking, Sickness (or >3meds), Organized plan, No spouse/child, Social support poor
Criteria for panic disorder PPANIICCCCSSS. Palpitations, Paresthesias, Abd stress, Nausea, Intense fear of dying or losing control, light-headedness, Chest pain, Chills, Choking, disConnectedness, Sweating, Shaking, Shortness of breath
EEG waveform for awake (eyes open) state B for Beta. BATS Drink Blood at night.
which EEG waveform is highest frequency, lowest amplitude? Beta - awake state. BATS Drink Blood at night
EEG waveform for awake (eyes closed) state A for alpha. BATS Drink Blood at night
EEG waveform for light sleep (Stage 1) T for theta. BATS Drink Blood at night
EEG waveform for Deeper Sleep (Stage 2) Sleep spindles & K complexes. BATS Drink Blood at night
EEG waveform for Deepest non-REM Sleep (Stage 3/4) D for delta. BATS Drink Blood at night
which EEG waveform is lowest frequency, highest amplitude? D for Delta. BATS Drink Blood at night
When do sleepwalking, bedwetting take place in sleep? Stages 3/4 -- deepest sleep, delta waves (lowest frequency, highest amplitude)
When do erections take place? REM sleep (stage 5)
What stage of sleep does brain use the most O2? REM
What is responsible for extraocular movement in REM sleep? PPRF
what drug given for night terrors or sleepwalking? benzodiazapines (shortens stage 4 sleep)
What drug given for enuresis? Bed-wetting - imipramine (shortens stage 4 sleep)
Classical conditioning pair natural response with artificial stimulus (salivate when hear bell ring)
Operant conditioning positive/negative reinforcement
Id Primal urges/sex/aggression
Ego mediate between unconscious and external world
Superego morality and conscience
Displacement mom yells at kids because she's mad at dad
identification abused child becomes abuser
isolation isolate events from feelings - describe murder with no emotion
projection man thinks wife is cheating on him (he wants another woman)
reaction formation pervert becomes a monk
gamophobia gamete-phobia; fear of marriage
algophobia alg - pain; fear of pain
acrophobia fear of heights (Father)
agoraphobia fear of open spaces
adjustment disorder psychosocial stressor --> anxiety/depression --> impairment (< 6 mo)
generalized anxiety disorder uncontrollable anxiety for at least 6 months; unrelated to specific person/event/thing; bad sleep, fatigue, bad concentration.
Malingering fakes a disorder for gain (avoid work, obtain drugs)
factitious disorder creates symptoms to assume sick role and get medical attn
Munchausen's syndrome chronic hx of multiple hospital admissions and willingness to receive invasive procedures
Munchausen's syndrome by proxy illness in child is caused by parent; unconscious motivation; form of child abuse - must report.
somatoform disorders psych drive create physical symptoms; tests are negative for something wrong.
conversion motor or sensory sx's that suggest a neuro or physical disorder, but tests show nothing wrong
somatoform pain disorder prolonged pain not completely explained by illness
hypochondriasis preoccupation with having a serious illness in spite of medical reassurance
somatization disorder complaints in multiple organ systems with no identifiable underlying physical findings
body dysmorphic disorder preoccupation with minor or imagined physical flaws; seek cosmetic surgery
pseudocyesis false belief of being pregnant associated with objective physical signs of pregnancy
Cluster A personality disorders Weird PiSS; Paranoid, Schizoid, Schizotypal; can't develop meaningful social relationships; no psychosis; genetic assc with schizophrenia;
Cluster B personality disorders Wild BAHN; Borderline, Antisocial, Histrionic, Narcississtic; dramatic, emotional, erratic; genetic assn with mood do's and substance abuse
Cluster C personality disorders Worried to be DOA; Dependent, OCD, Avoidant; genetic assn with anxiety do's
Paranoid Cluster A, personality do - distrust, suspicious
Main defense of paranoid person projection - you say someone else is feeling something, but really, it's what you want.
Schizoid Cluster A, personality do; voluntary social withdrawal, limited social expression; content with being isolated; hermit
Schizotypal Cluster A, personality do; interpersonal awkwardness, odd beliefs or magical thinking; eccentri appearance; Merlin
Antisocial Cluster B, personality do; disregard for rights of others; criminal
Borderline Cluster B, personality do; unstable mood and interpersonal relationships; impulsiveness; sense of emptiness; females more than males
Histrionic excessive emotion; attn seeking; sexually provocative
Narcissistic Cluster B, personality do; grandiosity, sense of entitlement; react to criticism with rage; demand top/best services
avoidant cluster C personality do; sensitive to rejection, socially inhibited; timid, feelings of inadequacy
obsessive-compulsive cluster c personality do; preoccupation with order, perfectionism, control
dependent cluster c, personality do; submissive and clinging, excessive need to be taken cared of, low self confidence
Created by: Christina Pham Christina Pham