Functional
MISC Rx
Watch Your Language
Seizure
Defunct/Olde Time
100
Because sensory loss impairs function, patients with genuine sensory loss in their feet or hands cannot perform many tasks if their eyes are closed, and would have a normal result with this classic, common neurological sign.
What is the Romberg sign?
Those with true sensory loss in both feet – from severe peripheral neuropathy or injury of the spinal cord posterior columns, usually from vitamin B12 deficiency, tabes dorsalis, or MS – tend to fall when standing erect with their eyes shut: the Romberg sign. By contrast, patients with psychogenic sensory loss can still generally button their shirts, walk short distances, and stand with their feet together and their eyes closed.
100
You start a patient in your practice on an SSRI for treatment of panic disorder. Next, you can add this medication, FDA-approved for panic disorder, to help get a more rapid response:
A. Buspirone
B. Gabapentin
C. Propranolol
D. Topiramate
E. Clonazepam
What is E, clonazepam?
100
The two basic types of aphasia.
What are fluent or non-fluent?
Some use the terms receptive or expressive.
Paucity of speech characterizes nonfluent aphasia. Patients say little and usually only speak in response to direct questions. Whatever speech they produce consists almost exclusively of single words and short phrases. They rely on basic words, particularly nouns and verbs without proper conjugation. They cannot use the connective tissue of language, such as adjectives, adverbs, and conjunctions. Their longer phrases typically consist of stock phrases or sound bites, such as, “Not so bad” or “Get out of here.” Synonyms for nonfluent aphasia include “expressive” or “motor” aphasia because of the prominent impairment in language production.
Fluent aphasia's four major subdivisions are the following:
• Wernicke's aphasia: common, with loss of comprehension, naming, and repetition
• Transcortical sensory aphasia: similar to Wernicke's except repetition remains intact
• Anomic aphasia: inability to name objects
• Conduction aphasia: inability to repeat.
100
This AED is an inhibitor of cytochrome P450 enzymes:
A. Phenytoin
B. Phenobarbital
C. Carbamazepine
D. Valproate
What is D?
100
This term originates from the Latin word meaning "to deceive" or "to mock". It entered the English language in the early 15th century, initially referring to the act of misleading or deceiving someone.
What is "delusion"?
It originates from the Latin word deludere.
200
Loss of sensation to pinprick with a sharply demarcated boundary in the middle of the face and body constitutes the classic sign of an FND called "--------- --- -------."
What is "splitting the midline"?
200
This medication has U.S. Food and Drug Administration (FDA) approval for treatment of bipolar maintenance, thereby treating both mania and depression?
A. Topiramate
B. Carbamazepine
C. Lamotrigine
D. Valproic acid
E. Gabapentin
What is C, lamotrigine?
Lamotrigine has FDA approval for bipolar maintenance, and its efficacy has been demonstrated for both mania and depression. Topiramate is approved for seizures and migraines but is used off-label for mania. Carbamazepine is approved for treatment of acute mania. Valproic acid has been demonstrably effective for acute mania. Gabapentin is approved for seizures, postherpetic neuralgia, and neuropathic pain.
200
Word substitution, such as “clock” for “watch” or “spoon” for “fork” are this type of paraphasia.
What is a related or semantic paraphasia?
200
The most frequently occurring electrolyte disturbance associated with carbamazepine or oxcarbazepine treatment:
A. Hyponatremia
B. Hypernatremia
C.Hypokalemia
D. Hyperkalemia
What is A, hyponatremia?
200
Persistent Depressive Disorder used to be called this.
What is dysthymia/dysthymic disorder?
Previously, depressive personality disorder.
- Chronic Depressed Mood:A depressed mood most of the day, more days than not, for at least two years.
Additional Symptoms:Along with the depressed mood, individuals must experience at least two of the following symptoms:- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
- Poor appetite or overeating
300
From the Greek for 'inability to stand, inability to walk'. In this disturbance, patients stagger, balance momentarily, and appear to be in great danger of falling; however, catching themselves at “the last moment” by grabbing hold of railings, furniture, and even the examiner, they never actually injure themselves.
What is astasia abasia?
Pic:
A young man demonstrates astasia-abasia by seeming to begin to fall when walking, but then catching himself by balancing carefully. He even staggers the width of the room to grasp the rail. He sometimes clutches physicians and pulls them toward himself and then drags them toward the ground. While dramatizing his purported impairment, he actually displays good strength, balance, and coordination.
300
This inhibits the abnormal involuntary movements associated with Huntington’s disease.
A. Haloperidol
B. Stereotactic thalamotomy
C. Pramipexole
D. Lioresal
E. Benztropine
What is A, haloperidol?
The random movements of chorea are accentuated and often most noticeable during walking. The superimposition of chorea on the trunk and leg movements of the walking cycle gives the gait a dancing quality, and there is an exaggerated motion of the legs and arm swing. Chorea can also interrupt the walking pattern, leading to a hesitant gait. Additional voluntary compensatory movements appear in response to the chorea. Chorea in Sydenham’s chorea or chorea gravidarum may be sufficiently violent to throw patients off their feet; severe chorea of the trunk may render walking impossible. The chorea of Huntington’s disease usually causes a lurching or stumbling and stuttering gait with frequent steps forward, backward, or to the side. Walking is slow, the stance is wide-based, the trunk sways excessively, and steps are variable in length and timing. Spontaneous knee flexion and leg-raising movements are common. Haloperidol reduces chorea but does not improve gait in Huntington’s disease. Balance and equilibrium usually are maintained until the terminal stages of Huntington’s disease, when an akinetic-rigid syndrome may supervene. Stereotactic thalamotomy is a neurosurgical technique designed to alleviate symptoms of Parkinson’s disease. Pramipexole and benztropine are antiparkinsonian medications. Lioresal (baclofen) is a potent muscle relaxant used in the treatment of muscle spasticity, for example, in stroke and MS patients.
300
This type of paraphasia consists of altered words, such as “bed” for “bread”, "tar" for "car", or "bapple" for "apple".
What is a phonemic paraphasia?
This is not the same as a clang association.
300
This AED undergoes almost complete renal clearance and would, strictly from a pharmacologic viewpoint, would be most appropriate for patients with hepatic insufficiency:
A. Carbamazepine
B. Valproic acid
C. Levetiracetam
D. Lamotrigine
E. Gabapentin
What is C Keppra?
Excreted unchanged by the kidneys.
300
In this specific delusion, wealthy, aristocratic people from roughly the 14th to as recent as the 19th century believed they were made of this.
What is glass?
https://www.inspirethemind.org/post/glass-delusion-a-rare-and-sometimes-royal-disorder
One man travelled to Murano, an Italian island famous for its beautiful glass, hoping to fling himself into a kiln and be transformed into a goblet.
It is rare. There was a case report from the 1960s.
King Charles VI, ruler of France from 1380 to 1422, held a strange conviction: he believed he was made of glass. To protect his fragile body, he dressed in special reinforced clothing. Terrified that he would shatter at their touch, he forbade his courtiers to come near him.
400
A psychogenic gait impairment occurs when patients drag a “weak” leg as though it were a completely lifeless object. In contrast, patients with a true hemiparetic gait swing their paretic leg outward with a circular motion, i.e., “----------” their leg
What is circumduct?
400
An elderly bipolar patient is brought into the emergency room. He was found comatose at home by his son. His serum sodium is 115 mmol/L.
This medication is the most likely cause of his sodium imbalance:
A. Lithium
B. Olanzapine
C. Carbamazepine
D. Quetiapine
E. Topiramate
What is C, carbamazepine?
The addition of a benzodiazepine to a patient on an SSRI for panic disorder will lead to a more rapid resolution of the anxiety. The SSRI will take 2 to 4 weeks to work in most cases. The benzodiazepine can effectively control the patient’s symptoms until the SSRI is fully working. The other choices will take longer to titrate or become effective and are not good choices for rapid resolution of panic symptoms. Propranolol is indicated only for performance anxiety and should not be used in other anxiety disorders.
400
To circumvent their word-finding difficulty, fluent aphasia patients often speak in this round about way, such as describing a pencil as "wood writing thing", giving detailed descriptions versus use a specific term, or simply say "You know what I mean" repeatedly.
What is/are circumlocutory language/circumlocutions?
400
This statement is true concerning the risk of seizures with clozapine use:
A. The risk of seizures is independent of the dose of clozapine.
B.With increasing dosage of clozapine, the risks of seizures and agranulocytosis both increase.
C. With increasing dosage of clozapine, the risk of seizures increases but the risk of agranulocytosis remains constant.
D. If seizures pose a threat during high-dose clozapine treatment, physicians should add carbamazepine.
What is C?
Most studies have found that seizures complicate clozapine treatment in a dose-related pattern, but agranulocytosis develops independent of dosage. Adding carbamazepine in clozapine greatly increases the risk of agranulocytosis.
400
This 1486 book contained legal and theological theories to endorse the extermination of witches. This became the standard handbook used to detect witches until well into the 18th century, and it served to spur on and sustain witch-hunting hysteria.
What is the Malleus Maleficarum?
Most often translated as The Hammer of Witches. Written by the Catholic clergyman, Inquisitor, and professor of theology Heinrich Kramer (Henricus Institoris).
500
True or false:
Crying out right before a seizure starts is a good sign of a psychogenic seizure.
What is false?
Seizures can start with an "epileptic cry" caused by air being squeezed out suddenly in the tonic phase.
Crying out during the seizure is a sign of PNES. Also, the tonic phase involves muscle stiffening, a fall, and loss of consciousness. PNES patients don't seem to fall over and get injured. I often see seizures wherein they are already lying in bed or found down, unharmed.
500
A 35-year-old woman with bipolar disorder gives birth to a child with an abnormally formed tricuspid valve. This is the medication she was most likely taking:
A. Haloperidol
B. Lithium
C. Valproic acid
D. Lamotrigine
E. Carbamazepine
What is B, lithium?
The abnormal formation of the tricuspid valve you should be concerned with here is Ebstein’s anomaly. It is the result of taking lithium during pregnancy, especially during the first trimester. Also worth noting is that valproic acid taken during pregnancy causes neural tube defects in the fetus.
500
In Wernicke's Aphasia, comprehension and repetition are lost. In ---------- aphasia, comprehension is intact but the patient loses the ability to repeat. For a contrast, comprehension is lost in transcortical sensory aphasia but repetition is lost. In transcortical motor aphaisa, both are intact but language production is impaired. In Broca's, they cannot repeat.
What is conduction aphasia?
500
The duration of the serum prolactin level elevation after a generalized tonic-clonic or complex partial seizure:
A. 24 hours
B. 12 hours
C. 2 hours
D. Less than 1 hour
What is D, less than 1 hour?
Following a majority of tonic-clonic, most ECT-induced, and a minority of focal seizures, the serum prolactin level rises for approximately 10 to 20 minutes. It does not rise following psychogenic or most focal seizures.
500
Tarantism
What is a psychological illness characterized by an extreme impulse to dance, prevalent in southern Italy from the 15th to the 17th century, and widely believed at the time to have been caused by the bite of a tarantula??
Dancing is believed to save their lives by removing the venom via perspiration.
