Neurology
Theory and Development
Diagnostics
Psychopharm
Neurotransmitters and Hormones
100
Previously pleasant mom becomes profane and irresponsible over 6 months. Most likely a pathology in:
Frontal lobe
100
Children demonstrate a preference for the human voice and speech over other sounds at what age?
Birth
100
7 yo child is brought in by parents, who report he's been hyperactive since age 4, talks constantly, interrupts, has trouble sitting still to do homework, will not play quietly outdoors. What else do you need to make the diagnosis of ADHD?
teacher report
100
Antidepressant less likely to cause sexual dysfunction
Bupropion
100
norepinephrine is made here
locus ceruleus
200
The visual problem that results when a pituitary tumor is compressing the optic chiasm
bitemporal hemianopsia
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200
This situation is child development is used to assess the infant's attachment per attachment theory:
200
The parent of a 43 yo patient died 5 years ago from pancreatic cancer. Four years ago, the patient began feeling full after eating large fatty meals, fearing it was pancreatic cancer. Constantly weighs himself so that he is not losing weight. Now avoids going to the doctor to avoid being diagnosed with cancer. No other psychiatric symptoms. What is the diagnosis?
Illness anxiety disorder
200
This is the first line treatment for restless legs syndrome
Pramipexole
A dopamine agonist - super agonist at some dopamine receptors and partial at others, including D3.
Dysfunction of central dopaminergic systems of neurons may be implicated in the pathophysiology of RLS. Levodopa and dopamine agonists are known to be efficacious in RLS, while dopamine antagonists worsen the syndrome. Furthermore, dopamine levels have a known circadian rhythmicity and RLS symptoms coincide with lower central dopamine levels...
200
This hormone is shown to be critical to the development of maternal-infant bonding in animals and is also important for social bonding
oxytocin
Greek
oxus = sharp, swift
tokos = childbirth
Fun facts - produced in the brain. but also produced outside the brain, including in females - corpus luteum, placenta; in males - testicles interstitial cells of Leydig; in both sexes the retina, the adrenal medulla, they thymus, and pancreas
A 2023 study found that zebrafish utilize oxytocin in reaction to the fear of other fish - zebrafish that had their oxytocin production removed by gene editing could not respond to the fear of other fish. When oxytocin is injected back into the fish, they reacted again in a way that suggested they may have empathy in regards to this emotion. Oxytocin-based empathy evolved from a common ancestor many millions of years ago?
300
Patient is walking with unsteady, lurching, broad-based gait, has appendicular ataxia in LE only, with normal eye movement. Imaging is likely to reveal degeneration of this region of the brain:
Cerebellar.
Alcohol-related cerebellar degeneration is one of the commonest causes of acquired cerebellar ataxia. The pathophysiology is unclear but proposed factors include: direct toxic effects of alcohol on cerebellar cells, thiamine deficiency drives this, more recently autoimmune responses?
300
Developed the theory of "good enough" mothering
Donald Winnicott, a British pediatrician and psychoanalyst (1896-1971)
300
What predicts bipolarity in adolescents with depression?
Psychotic symptoms
300
This drug has a curvilinear therapeutic window
Nortriptyline
This is a tricyclic antidepressant, active metabolite of amitriptyline, sertotonin and norepinephrine reuptake inhibitor.
Curvilinear - meaning non-linear. As nortriptyline plasma levels initially increase, see response, but only up until a point. Inverted U.
300
Dopamine release in what structure represents the common final event associated with reinforcing effects of opiates, cocaine, amphetamines, nicotine, PCP, and alcohol?
Nucleus accumbens
400
42 yo male with gradually progressive cognitive deficit also develops jerking movements of the extremities, head, and trunk. Imaging shows atrophy of the caudate nuclei bilaterally. Patient's father had a similar illness that started at age 50. DNA analysis shows repeats of
C A G
400
A 5 yo whose mother was a in a minor car accident believes he is responsible for causing the accident because he yelled "I hate you" in protest when his mother left him with a babysitter an hour earlier. This belief represents:
Age appropriate egocentric thinking
This is part of Jean Piaget's theory of cognitive development, which posits that children may exhibit egocentric thinking at different ages.
400
Patient reports that an identical-appearing imposter has replaced his father. What is the name of this delusion?
Capgras syndrome
400
What did the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) demonstrate about the effectiveness of 2nd generation antipsychotics compared to 1st generation in the treatment of schizophrenia?
Second generation antipsychotics were no more effective than first generations.
400
Role of gycline at NMDA receptor?
Obligate coagonist
500
Patient with several days of fever and severe headaches presents to the ED with generalized seizures. Patient is confused and somnolent, reported to have been irritable and has been reporting foul spells. T2 MRI displayed hyperintensity of the left temporal lobe. Top of differential?
Herpes encephalitis
Why temporal lobe? The current thinking is that primary or recurrent herpes infection (usually HSV-1) ascends to the temporal lobe via trigeminal or olfactory tracts. Adult-onset HSE typically localizes to the temporal and frontal lobes; in neonates the encephalitis is characteristically more diffuse.
500
According to Margaret Mahler's developmental theory of psychology, which of the following indicates a successful resolution of the process of separation-individuation in a toddler?
Object constancy
500
Name a Schneiderian first-rank symptom of schizophrenia
hearing voices and arguing about oneself
Kurt Schneider was a German psychiatrist (1887-1967). He classified symptoms of schizophrenia in his publication "First Rank Symptoms." First-rank symptoms were considered by Schenider to be particularly indicative of schizophrenia - these include thought alienation, delusional perceptions, passivity, and third-person auditory hallucinations (running commentary or voices talking about the patient among themselves).
Second-rank symptoms are common symptoms of schizophrenia but also often occur in other forms of mental illness. They include delusions of reference and paranoid and persecutory delusions.
The reliability of using first-rank symptoms for the diagnosis of schizophrenia has since been questioned.
500
Clinical significant increase in lamotrigine concentration may occur if co-administered with
valproic acid
Lamotrigine is protein-bound and metabolized by the liver, where its clearance is subject to significant inhibition by valproate, which causes lamotrigine levels to rise up to several fold.
Oral contraceptives can induce metabolism of both lamotrigine and valproate, causing those levels to fall.
Lamotrigine can caused modest metabolic induction of some agents, including valproate.
500
Dopaminergic neurons project to the nucleus accumbens. Cell bodies of these neurons reside in which area of the brain?
Ventral tegmental area