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