Neurology

Holoprosencephaly

(single forebrain) failure of cleavage of the forebrain, marked facial abnormalities but the dorsal and posterior parts of the skull form, controlled by molecules released by the notochord.

Leukocoria

Abnormal white reflection from the retina of the eye. DDx in children: congenital cataract, retinoblastoma, ROP (retinopathy of prematurity), or retinal disorder.

Thought Blocking

Abrupt halt in the train of thinking, often because of hallucinations

Ludwigs Angina

Abscess in floor of mouth, often from tooth infection. can cause airway obstruction from tongue being pushed up and back. Must drain the abscess

Anhedonia

Absence of pleasure in one's usual activities

Neuritic (Senile) Plaques

Extracellular deposits of B-amyloid seen in Alzheimer's disease

Proliferative diabetic retinopathy

New vessel formation (neovascularization) and scarring. Two serious complications are vitreal hemorrhage and retinal detachment. Can lead to neovascular glaucoma

Neuropathic pain

abnormality of peripheral nerves or the central nervous system. Neuropathic pain is often described as a burning, tingling, or electric shock sensation

Peritonsillar Abscess

abscess that collects in the potential space between the pharyngeal constrictor and the tonsil itself is termed a peritonsillar abscess or "quinsy." Classic signs are fullness of the anterior tonsillar pillar, deviated uvula, "hot-potato voice" (somewhat muffled sound to voice), severe dysphagia, and trismus (inability to open the jaw). Pt complains of sore throat for a few days that is now worse on one side. Treat by draining it and giving antibiotics and pain meds.

Coma

absence of consciousness, unarousable, unresponsive

Amyloid plaques

accumulations of insoluble proteins or prions

Polysomnogram

another derivative of EEG in combination with other measurements, is useful in identifying sleep disorders

Epilepsy

any of various disorders marked by abnormal electrical discharges in the brain and typically manifested by sudden brief episodes of altered or diminished consciousness, involuntary movements, or convulsions. Recurrent unprovoked seizures due to inherent brain dysfunction.

schizophrenia

at least one episode of psychosis and persistent disturbances of thought, behavior, appearance, speech, and affect. Impairment in social and occupational functioning. Alert, no clouding of consciousness, normal memory. symptoms must last longer than 6 months. symptoms classified as positive (excessive) or negative (decreased function). consists of three phases: prodromal, psychotic/active, and the residual phase. there are 5 subtypes: undifferentiated, paranoid, residual, disorganized, and catatonic. often have decreased prefrontal cortex activity.

Von hippel lindau

autosomal dominant, chromosome 3, that presents most often in young adulthood formation of tumors and cysts in many different parts of the body. hemangioblastomas of the CNS, no skin involvement, pheochromocytomas, renal angiomas and renal cell carcinoma

Hurler disease

autosomal recessive CNS metabolic storage disorder due to disturbance in glycosaminoglycan (GAG) metabolism leading to accumulation of mucopolysaccharides in the neurons. Typically expressed in infancy as reduced stature, corneal opacities, skeletal deformities, and hepatosplenomegaly

Phenylketonuria (PKU)

autosomal recessive disease in which phenylalanine accumulates because its conversion to tyrosine is blocked. Becomes apparent in the first few months of life with mental retardation, seizures, and impaired physical development. Treat by restricting phenylalanine in diet.

Metachromatic leukodystrophy (MLD)

autosomal recessive disorder characterized by deficiency of arylsulfatase A enzyme leading to accumulation of galactosyl sulfatide in the white matter of the brain forming cytoplasmic spherical granules. Most common leukodystrophy (predominates in infancy). Lethal within several years

Wernicke encephalopathy

classically described as triad of ophthalmoplegia, ataxia and confusion (only around 10% have all three). Due to thiamine (B1) deficiency and typically seen in alcoholics. atrophy of cerebellar cortex of the superior vermis and mammillary bodies

Microglia

bone marrow derived mononuclear phagocytes of the CNS which when activated can migrate to the site of injury

Coup injury

brain contusion occurs at point of injury

Contrecoup injury

brain contusion occurs contralateral to point of contact

Metabolic encephalopathy

brain malfunction due to systemic metabolic derangements (can result from a variety of diseases)

Choroid plexus

branching network of ependymal cells in the ventricles of the brain that produces CSF. Travels from lateral ventricles> foramen of monro (interventricular foramen)> 3rd ventricle> cerebral aqueduct> 4th ventricle> foramina Luschka & Magendie> subarachnoid space> arachnoid granulations> venous sinuses

argyll-robertson pupil

caused by tertiary neurosyphilis. Pupils will not constrict in response to light but will constrict in response to accomodation. Damage to the pretectal area

Analgesic rebound headaches

caused by the daily or near daily use of medications used for the immediate relief of headache pain. These headaches often develop if the analgesics are used more than 2-3 days per week on a regular basis

vermis

central region of the cerebellum responsible for posture and locomotion. superior vermis damage leads to gait impairment and leg coordination problems. inferior vermis damage leads to uncoordinated motion of arms and hands.

Alzheimer's Disease

cerebral cortical neurodegenerative disorder, cortical atrophy and hydrocephalus ex vacuo. Starts in the temporal lobe and hippocampus moving to parietal and frontal. Most common cause of dementia- involves extracellular senile plaques made up of B-amyloid and intracytoplasmic neurofibrillary tangles made up of tau protein. Prominent loss of memory, cognitive impairment, dementia, and word-finding difficulty without motor impairment. Late behavioral changes. Treatment that may help are acetylcholinesterase inhibitors or NMDA antagonist (memantine).

Pick Disease

cerebral cortical neurodegenerative disorder, of fronal temporal lobar degeneration characterized by loss of frontal executive function and early disruptive and inappropriate behavior. accumulation of abnormal tau protein. dementia

Lewy Body Dementia

cerebral cortical neurodegenerative disorder. Dementia characterized by alpha-synuclein inclusions forming lewy bodies mainly in the cingulate cortex, and often have amyloid plaques. Slow, progressive loss of cognitive function, hallucinations, movement disorders, and signs similar to parkinsonism. cognitive function varies greatly from day to day. many adverse affects to antipsychotic therapy.

Otitis Media with effusion (OME)

chronic eustachian tube dysfunction, fluid without infection, middle ear space doesn't vent. Often asymptomatic but can cause ear fullness or muffled hearing. Can cause temporary conduction hearing loss. Can be treated with steroid drops to reduce eustachian tube swelling, and sometimes PE tubes. In adults unilateral OME should always promt nasopharynx exam for possible nasopharyngeal carcinoma.

Cholesteatoma

chronic negative middle ear pressure can lead to retraction of part of pars flaccida back into middle ear, causing the the squamous epithelium of TM desquamates. Keratinous debrise builds up and accumulates, which expands and erodes bony structures, possibly infected (pseudomonas, proteus). Painless, unilateral drainage. Must treat by surgery or will progress

Subacute sclerosing panencephalitis (SSPE)

chronic, lethal, viral infection of the brain (caused by measles virus); denoted by cognitive and behavioral decline over months to years

Ependyma

ciliated simple epithelium which line the ventricles and separate the brain parenchyma from cerebrospinal fluid

Craniopharyngioma

circumscribed epithelial tumor that arises in the sella turcica region from the Rathke cleft remnants. Typically presents with endocrine and visual disturbances. Heterogeneous solid/cystic appearance on imaging. More common in children

Cerebrospinal fluid (CSF)

clear bodily fluid that occupies the subarachnoid space and the ventricular system around and inside the brain

hemineglect/hemiagnosia

decreased attention and awareness of the nondominant hemienvironment. Usually from damage to the right posterior parietal cortex

Hemianopsia

decreased vision or blindness in half the visual field of one or both eyes

Delta waves

deep sleep, 0.1 to 4 Hz. Stage 4 non REM sleep

Spongiform encephalopathy

degeneration of neurons and vacuolization due to accumulations of prion proteins

Juvenile nasopharyngeal angiofibroma

dx for recurrent nosebleeds of the back of the nose in teenager (typically male) until proven otherwise. often have nasal obstruction

Tympanocentesis

ear tap, may be appropriate to obtain a culture (for immunocompromised, resistent strain, treatment failure)

Hearing aids

effective in rehabilitation of hearing loss in most patients. Aids vary widely in their power (gain), frequency, response, size, and cost.

dandy walker malformation

enlarged posterior fossa and absence of cerebellar vermis. loss of motor coordination. hydrocephalus

Hydrocephalus ex vacuo

enlargement of the ventricles due to loss of brain parenchyma

Rosenthal fibers

eosinophilic collections of GFAP in astrocytic processes (abundant in Alexander disease and pilocytic astrocytoma)

Lateral medullary/wallenberg syndrome

infarction of PICA resulting in contralateral sensory deficits of trunk and extremities and ipsilateral sensory deficits of the face as the primary deficits

Acute Epiglottitis

infection of the supraglottic (above the vocal cords) structures (epiglottis) that causes swelling of the portion of the larynx above the vocal cords. Usually caused by Haemophilus influenzae type B organisms, less common now with HIB vaccination. Fatal, rapid airway obstruction, present with quick onset stridor, leaning over in a tripod, drooling. Treatment: secure airway, transfer to OR if compromised airway, double-drug therapy would be ceftriaxone and oxacillin. Appropriate single-drug therapy would be cefuroxime.

Prions

infectious agents devoid of nucleic acids. misfolded proteins (proteinaceous infectious particles)

Progressive multifocal leukoencephalopathy (PML)

infectious disease caused by polyoma virus (JC virus) killing oligodendrocytes that causes a patchy, multifocal demyelination of the CNS; virus has a high prevalence and disease is typically only seen in immunocompromised individuals. affects white matter. will see markedly enlarged nuclei. Rapid onset of dementia, ataxia, abnormal vision and speech.

Poliomyelitis

inflammation of the gray matter of the spinal cord anterior horn (in practice, implies infection by poliovirus). Poliovirus causes disease with neurologic involvement following a prodromal phase of fever, myalgia, malaise, and upper respiratory or gastrointestinal symptoms in a small number of cases. This leads to weakness or paralysis due to involvement of anterior horn lower motor neurons in the spinal cord and brainstem. Asymmetric weakness develops over the course of one or a few days with no sensory loss. Treatment is supportive and there is often useful recovery of strength.

(lepto)meningitis

inflammation of the meninges (between the pia and arachnoid matter) most commonly viral or bacterial etiology. neonates: group B strep, E. coli and listeria monocytogenes, children: strep pneumo and HIB, adults: strep pneumo and neisseria meningitidis. symptoms: stiff neck and headache. Potential complication of acute otitis media by blood born spread or thrombophlebitis. Aseptic (viral): most commonly caused by enterovirus (ssRNA: polio, cocksakie, and echo)

Adenoiditis

inflammation, infection and/or enlargement of adenoids, symptoms of airway compromise arise, such as nasal obstruction, chronic mouth breathing, and snoring.

Absence seizure (petit mal)

a nonconvulsive generalized seizure that is marked by the transient impairment or loss of consciousness usually with a blank stare that begins and ends abruptly and is usually unremembered afterward, and that is seen chiefly in mild types of epilepsy. Start in the temporal lobe

selective mutism

a rare disorder in which children speak in some social situations but not in others. May whisper or use hand gestures. They have normal social interactions

Atrophy

a wasting or decrease in size of a body organ, tissue, or part owing to disease, injury, or lack of use

Lewy Bodies

abnormal cellular inclusions made up of alpha synuclein protein and associated with Parkinson's Disease and Lewy Body Dementia

Astrogliosis

abnormal increase in the number of astrocytes due to the destruction of nearby neurons

school phobia and school refusal

the major manifestations of seperation anxiety disorder

Potency

the measure of drug activity in terms of the amount of drug required for that effect. For anesthetic drugs this is described by the MAC. A lower MAC value indicates a more potent volatile anesthetic

Hereditary motor and sensory neuropathies (HMSNs)

the most common form of hereditary neuropathies, these disorders affect both strength and sensation (sensorimotor neuropathies). They present as a spectrum of disorders, all caused by mutations in genes whose products are involved in peripheral nerve function.

Fragile X syndrome

the most common known cause of inherited intellectual disability. Trinucleotide repeat of the X chromosome (CCG). Usually worse in males, gets worse with every generation.

rigid esophagoscope

used to remove the foreign body from the esophagus or take biopsies. If the foreign body has been aspirated, then bronchoscopy is required

Ophthalmoplegia

weakness or paralysis of extraocular muscles often due to neurologic illness

neuromuscular junction disease (NMJ)

weakness, fatiguability, ptosis, normal sensation, and painless. examples include: myasthenia gravis, botulism, and lambert eaton

cerebellar lateral zone damage

ipsilateral hypotonia, dysarthria, dysmetria (problem judging distances), dysdiadocokinesis (inability to perform rapid alternating movements), tremors and reflex impairment.

reaction formation

less mature defense mechanism. Denying unacceptable feelings and adopting opposite attitude. ie: becoming a nun because you have a lot of sexual thoughts

rationalization

less mature defense mechanism. Giving seemingly reasonable explanations for unacceptable or irrational feelings

denial

less mature defense mechanism. Not believing personally intolerable facts about reality

displacement

less mature defense mechanism. Transfer of emotions from an unacceptable to acceptable person or object. ie: man beats up a random drunk after his son is killed by a drunk driver

somatization

less mature defense mechanism. Turning an unacceptable impulse or feeling into a physical symptom

identification

less mature defense mechanism. Unconsciously patterning one's behavior after that of someone who is more powerful

intellectualization

less mature defense mechanism. Using the minds higher functions to avoid experiencing uncomfortable emotions

Tabes dorsalis

loss of joint position sense and fine touch due to impairment of spinal dorsal column function and areflexia due to lower motor neuron involvement of the dorsal root (syphilitic sequelae)

horner's syndrome

loss of sympathetic innervation. Ptosis (eyelid drooping), miosis (pupillary constriction), anhidrosis (decreased sweating)

Anosmia

loss of the sense of smell

Adenoids

lymphoid tissue situated on the posterior pharyngeal wall and roof of the nasopharynx, just behind the soft palate and adjacent to the torus tubarius (eustachian tube openings).

retinoblastoma

malignant ocular tumor in children of the primitive retinal photoreceptors. Forms a white mass on the retina filling the whole eye and often leading to retinal detachment. Can be a somatic mutation or a germ line inheritance pattern. Most common treatment is removal of the eye. Chromosome 13 deletion. small cells forming occasional rosette structures.

Contrast

material which is injected during the scan in order to better visualize areas of breakdown of the blood brain barrier and is especially useful for visualizing tumor and abscess.

suppression

mature defense mechanism. Consciously putting aside but not repressing unwanted feelings

humor

mature defense mechanism. Expression of feeling without causing discomfort. ie: by cracking jokes.

sublimation

mature defense mechanism. Rerouting and unacceptable drive in a socially acceptable way. ie: fundraising for breast cancer research after your wife dies from it.

altruism

mature defense mechanism. unselfishly assisting others to avoid negative personal feelings

Meningomyelocele

more severe form of spina bifida with protrusion of meninges and spinal cord or nerve root

Non proliferative diabetic retinopathy (NPDR)

most common and progresses slowly. Progressive microangiopathy. Can see micro aneurysms, dot-and-blot hemorrhages, cotton wool spots, and venous beading.

Cryptococcal meningitis

most common fungal meningitis. Opportunistic infection typically seen only in immunocompromised. "soap bubble" micro abscesses. Birds are the primary reservoir of spores that are inhaled

Tension headache

most common headache, a diffuse, mild to moderate pain that many people describe as feeling as if there is a tight band around their head

otitis media

most common pediatric disorder seen by the otolaryngologist and pediatrician

subglottic stenosis

most commonly caused by scarring from long-term placement of an endotracheal tube

Duret hemorrhages

multiple linear hemorrhages in midbrian and pons caused by downward displacement of the brainstem by herniation

Tracheotomy

operation of cutting into trachea for surgical airway

separation anxiety disorder

overwhelming fear of loss of a major attachment figure in a school age child

Acute pain

pain lasting less than 3 months

Chronic pain

pain lasting longer than 3 months

Psychogenic pain

pain primarily or entirely related to a psychological disorder

Hemiplegia

paralysis of one side of the body

Nightmare Disorder

parasomnia. Repetitive, frightening dreams that occur during REM sleep and are recalled on nighttime awakenings

Encephalitis

parenchymal infection of the brain; usually denoting viral etiology with necrosis, perivascular lymphocytic cuffing, and microglial nodules

floccular nodular lobe

part of cerebellum that connects vestibular nuclei. detects head movements and adjusts eye movements accordingly. damage leads to defect in visual tracking and occulomotor control, nyastagmus, and vertigo

caudate nucleus

part of the basal ganglia. important for learning, memory systems, and language comprehension. affected in huntingtons disease, tourettes, and OCD. forms dorsal striatum with the putamen.

Global aphasia

partial or total loss of the ability to communicate verbally or using written words as a result of widespread injury to the language areas of the brain

Broca's aphasia

partial or total loss of the ability to express oneself, either through speech or writing. Hearing comprehension is not affected. Damage to the left anterior frontal cortex

Wernicke's aphasia

partial or total loss of the ability to understand what is being said or read. The individual maintains the ability to speak but speech may contain unnecessary or made up words. Damage to the left superior temporal lobe

Presbyopia

progressively deficient near vision associated with aging

Gliosis

proliferation/hypertrophy of glial cells; usually in response to CNS damage

Arachnoid villi

protrusions of arachnoid membrane into dural sinuses which return CSF to venous system

Heliotrope rash

purple rash over the upper eyelids, often seen in dermatomyositis

Empyema

purulent collection in a body cavity, in the epidural or subdural space it is usually due to trauma or spread of infection from sinuses or ear. usually result of a bacterial infection

Cerebritis

purulent parenchymal infection of the brain; usually bacterial or fungal

Nystagmus

rapid uncontrollable eye movements (often side to side or up and down)

Krabbe disease (globoid cell leukodystrophy)

rapidly progressive, fatal, autosomal recessive neurologic disorder caused by deficiency of beta-galactosidase. Appears in infancy and is characterized by "globoid cells" in the white matter (macrophages containing undigested galactosylceramide/galactocerebroside). severe motor, sensory and cognitive defects due to CNS and PNS myelin defects

basal ganglia

responsible for movement, learning, cognition, emotion, etc. hemiballisum results from contralateral lesion of the subthalamic nucleus

tremor

rhythmic movements due to alternating contractions between agonist and antagonist muscles

laryngotracheal reconstruction

rib cartilage is grafted into the cricoid cartilage and upper tracheal rings to allow for a more dramatic expansion

Perinuclear halo ("fried egg" appearance)

round nuclei surrounded by a small rim of clear cytoplasm. seen in oligodendroglioma

Negri body

round, eosinophilic cytoplasmic inclusion found in the hippocampus, brainstem and cerebellar purkinje cells of rabies infected subjects. Resemble erythrocytes

Leprosy (Hansen Disease)

schwann cells are invaded by mycobacterium leprae, resulting in segmental demyelination and remyelination and loss of both myelinated and unmyelinated axons. Clinically results in symmetric polyneuropathy affecting the cool extremities prominently involving the pain fibers.

Generalized seizure

seizure (as an absence seizure or tonicclonic seizure) that originates in both cerebral hemispheres

Pierre Robin Syndrome

sequence of 3 characteristic congenital malformations: cleft palate, micrognathia (small jaw), and glossopthosis (tongue protruding back into airway)

Sleepwalking Disorder

somnambulism. Disorder characterized by repetitive walking during sleep; No memory of the episode on awakening; Occurs during delta sleep; Begins in childhood (usually at 4-8 years of age); Has a genetic component; Associated with enuresis (bed wetting)

Virchow robin spaces

spaces between pia and penetrating blood vessels of the brain

Myelomalacia

spinal cord necrosis and edema caused by severe contusion

subglottic hemangioma

stridor presents within the two- to four month age range, when hemangiomas go through a characteristic rapid growth phase. About half will have head and neck hemangiomata visible on the skin. Laser treatment, systemic steroids or interferon may help

industry versus inferiority

the fourth stage that Erik Erikson identified in his theory of psychosocial development, in which a school age child develops (or fails to develop) a sense of pride in his accomplishments

Pharmacodynamics

the effects of a drug on the body, or relationship between the plasma concentration of a drug and the pharmacologic response to it

Pharmacokinetics

the effects of the body on a drug, and are determined by the volume of distribution for the drug (Vd) and clearance of that drug from the body. Intravenous anesthetics exhibit multicompartmental that is, the drugs are distributed into peripheral tissues, and at the same time cleared from the body pharmacokinetics

Anterograde Amnesia

Loss of ability to form new memories

Loose Associations

Loss of logical meaning between words or thoughts

Retrograde Amnesia

Loss of previously formed memories

Modeling

Observational learning where an individual observes others and imitates their behavior.

Hoarding

Obsession about discarding something valuable that leads to an inability to discard anything

Schizotypal Personality Disorder

Odd dress, behavior, thought patterns, thinking styles, magical thinking without psychosis. behaves strangely and even more inappropriately when ill.

Cataracts

Opacity of lens, reversible vision loss. Aging is the most common cause. Mature- all opaque, immature-only part. Treat with lens replacement

Anterior Ischemic Optic Neuropathy

Optic nerve ischemia due to overcrowding of nerve fibers and compromised vascular supply at the nerve head

Acute stress disorder (ASD)

PTSD symptoms lasting from 2 days to 4 weeks

Otalgia

Pain in the ear

Odynophagia

Pain on swallowing

dermoid cyst

a cystic teratoma that contains a variety of developmentally mature tissue. Congenital mass between the eyes

Spina bifida occulta

a defect of the vertebral arches which is usually asymptomatic and may only cause a dimple or small tuft of hair on lower back, mildest form of spina bifida

Glaucoma

a disease of the optic nerve often associated with elevated intraocular pressures (I.e. the pressure inside the eye) that results in progressive permanent loss of vision if not adequately treated.

Thyroglossal duct cysts

a fibrous cyst that forms from a persistent thyroglossal duct, occur in the midline, usually over the thyrohyoid membrane. They are usually associated with the hyoid bone and move with swallowing. Surgically excised by sistrunk operation

Hamartoma

a focal overgrowth of otherwise normal cells

CAGE questionnaire

a frequently used screening tool used to identify patinets who may have alcohol abuse. C:cutting back, A: angry when people comment on your drinking, G: guilty, E: eye opener.

Herpes encephalitis

a fulminant infection of the CNS by HSV1; the most common viral encephalitis. Temporal lobe. Cowdry A inclusions: intranuclear eosinophilic viral inclusions in neurons and glial cells, usually surrounding by a halo

Complex seizure

consciousness is impaired

Simple seizure

consciousness is not impaired

Perivascular pseudorosette

cuff of radiating tumor cell cytoplasmic processes surrounding small blood vessels. Characteristic of ependymomas

Periventricular leukomalacia

damage to deep periventricular white matter as complication of intrauterine or perinatal hypoxic ischemia

neonatal conjunctivitis

day 1: chemical conjunctivitis from silver nitrate drops. day 2-5 : neisseria gonorrhea. day 5-14 chlamydia trachomatis.

Altered mental status

decrease in attention and arousal

Falx cerebri

dura which divides right and left comparments of the intracranial vault

epistaxis

nose bleed; typically from Kiesselbachs plexus (anterior septum); commonly by digital trauma. Treat in children with oxymetazoline or phenylephrine nasal spray and pressure for 5 to 10 minutes

electrocochleography

not really a test of the vestibular system, but is a useful test of hearing in the evaluation of Ménière's disease

Potts disease

tuberculosis of the spine, epidural mass can lead to spinal cord compression

Asterixis

tremor of the hands when wrists are extended (flapping)

electronystagmography

"gold standard" for detecting unilateral peripheral vestibular disorders.

Rotatory chair testing

"gold standard" for diagnosing bilateral vestibular weakness, patient is slowly spun in a rotating chair and dizziness is measured with optokinetic testing and a fixation test.

Pure tone audiometry

"the hearing test", used to assess the patient's hearing level, determine hearing threshold between 250 to 8000hz

Slit Lamp

A microscope that projects a linear slit beam of light onto the eye; allows viewing of the conjunctiva, cornea, iris, aqueous humor, lens, and eyelid

Childhood Disintegrative Disorder

A pervasive developmental disorder characterized by collapse in all develomental areas after years (2 to 10) of normal development. Very rare.

Mania

1. Inflated self-esteem or grandiosity 2. Decreased need for sleep 3. Talkativeness or pressured speech 4. Flight of ideas 5. Distractibility 6. Increased activity or agitation 7. Engagement in activities that are likely to have negative consequences 8. increased appetite for sex and loss of modesty manic episode requires 3 to 4 symptoms lasting a week.

Parkinson's Disease

A loss of pigmented dopaminergic neurons in substantia nigra, locus ceruleus, and pars compacta and accumulation of lewy bodies. Leads to decreased stimulation of the direct pathway and decreased inhibition of the indirect pathway. Movement disorder characterized by resting (pill rolling) tremors, cogwheel rigidity, expressionless face, postural instability, bradykinesia (difficulty initiating and sustaining voluntary movement), shuffling gait, and mask like facies. Can have orthostatic hypertension (shy draggers syndrome: pass out as soon as they stand up), depression, cognitive impairment, or dementia. more common in men. First line treatment is levadopa/carbidopa combo. Can get off/on phenomena (sudden rigidity) if levadopa is not maintained at a constant dose.

Somatoform Disorders

A class of emotional disorders with physical symptoms suggesting organic (non-psychological) pathology or masked depression. 5 classifications: somatization disorder, conversion disorder, hyperchondriasis, body dysmorphic disorder and pain disorder. Although not consciously aware, primary or secondary gain may result from their condition. treatment requires a multidisciplinary approach

Autism Spectrum Disorders (ASD)

A class of pervasive developmental disorders including autism and Asperger's disorder. characterized by delays in social interaction and language development along with stereotyped repetitive movements and a strong affinity for order and routine. Characteristics are seen before age 3. Mental capacity ranges from savant skills to mental retardation. Brain overgrowth in the first year of life, amygdala and hippocampus may have abnormal size and structure, and the cerebellum has less purkinje cells. Serotonin synthesis is dysregulated. There is a genetic component, also associated with tuberous sclerosis and fragile x syndrome

Cerebellar tremor

A coarse tremor that is worse at the end of purposeful movements

Brachytherapy

A form of radiotherapy where a radiation source is placed inside or next to the area requiring treatment; used in order to obtain a high localized dose

Cognitive Disorders

A group of disorders of memory, orientation, level of consciousness, or executive functioning

countertransference

A health care provider's own repressed feelings in reaction to the emotions, experiences, or problems of a person undergoing treatment.

Dysthymia

A less severe form of MDD lasting for at least 2 years without episodic nature. Low self-esteem and decreased productivity, without the extreme symptoms of Major Depressive Disorder, such as anhedonia and suicidality. never associated with psychosis

substance abuse

A maladaptive pattern of substance use over at least 12 months that leads to impairment of occupational, physical, or social functioning--not diagnosed when the patient meets the criteria for substance dependence.

Autistic Disorder

A pervasive developmental disorder characterized by delays in social interaction and language development along with stereotyped repetitive movements and a strong affinity for order and routine. Characteristics are seen before age 3. Mental capacity ranges from savant skills to mental retardation. Brain overgrowth in the first year of life, amygdala and hippocampus may have abnormal size and structure, and the cerebellum has less purkinje cellls. Serotonin synthesis is dysregulated. There is a genetic component, also associated with tuberous sclerosis and fragile x syndrome

Asperger's Disorder

A pervasive developmental disorder characterized by delays in social interaction but normal language development and normal cognition. Children have intense obsessional interests that can be learned by memorization. A no longer clinically used term, although common in the community. Described as a mild form of ASD

Rett's Disorder

A pervasive developmental disorder that is nearly exclusively in girls characterized by delay in social, language, and cognitive development following a period of normal development (up to 4 years). With age, motor skills decline but social skills improve. Can have breathing problems, abnormal EEG, mental retardation, psychomotor abnormalities (ie: ataxia). X linked disease.

Jean Piaget

A psychologist who described development in terms of cognitive or learning capabilities of the child at each age. object permanence, concrete operations, concept of conversation, and formal operations.

Erik Erikson

A psychologist who described development in terms of critical periods for the achievement of social goals. Trust vs mistrust, industry vs inferiority, intimacy vs isolation, generativity vs stagnation, ego integrity vs despair, and autonomy.

Margaret Mahler

A psychologist who described early development as a sequential process of separation of the child from the mother or primary caregiver. attachment and rapproachement.

Chalazion

A small lump (round cyst) and refers to a swelling in the eyelid caused by chronic granulomatous inflammation of one of the small oil producing glands (meibomian glands) located in the upper and lower eyelids. this is painless. Treat by draining.

Pain Disorder

A somatoform disorder. A disorder wherein the patient complains of a pain that has a significant psychological contribution to its onset or other aspects. SSRIs may be helpful

Somatization Disorder

A somatoform disorder. A multi-year history of 4 pain symptoms, 2 GI symptoms, one sexual symptom, and one neurological symptom, all physically unexplainable, beginning before age 30

Body Dysmorphic Disorder

A somatoform disorder. A preoccupation with an imagined problem with one's appearance not attributable to anorexia nervosa. Often not fixed with plastic surgery. SSRIs may be helpful

Conversion Disorder

A somatoform disorder. An apparently neurological symptom affecting motor or sensory function, usually triggered by a psychological stressor. Often are not worried about their serious symptom: la belle indifference

Hypochondriasis

A somatoform disorder. At least 6 months' preoccupation with having a serious illness that persists despite negative medical tests and reassurance. SSRIs may be helpful

Seasonal Affective Disorder

A specifier used with MDD, associated with the winter season and short days. Commonly presents with atypical symptoms, often can be treated effectively with full-spectrum light exposure used alone or along with antidepressants.

Laser Photocoagulation

A surgical technique using an intense beam of light from a laser or a xenon-arc bulb to seal blood vessels or coagulate tissue

Delirium

A syndrome of waxing and waning impairment of consciousness

Speech discrimination

A test of the patient's ability to understand spoken words, done by presenting phonetically balanced words (love,boat,pool) into the audio gram

Rest tremor

A tremor which occurs at rest and is improved with purposeful movement. common in Parkinson's disease

Postural tremor

A tremor which occurs when maintaining upright posture and resolves with rest. alcohol makes it better

cricoid split

A way to surgically enlarge the airway. Vertical incision in the anterior cricoid ring, allowing it to expand while an endotracheal tube remains in the airway for a week to 10 days.

Hordeolum (stye)

Acute presentation of abscess of eye lash follicle, associated with meibomian gland or gland of zeis or moll. Treat by draining, usually accomplished with warm compresses

Secondary Gain

Additional benefits from a symptom or disorder such as the attention or care of others

Relative afferent pupillary defect

Afferent pathway issue in either the optic nerve before the chiasm or the retina. Diagnosed with the swinging flash light test. A positive test is when the light is shown in the affected eye and there is decreased constriction

subthalamic nuclei

Afferents come in from the globus pallidus in the form of GABAergic signals, from the cerebral cortex (especially motor) as excitatory glutaminergic input, and from the substantia niagra as neuromodulatory input in the form of dopamine. Efferents leave the subthalamic nuclei dorsally as excitatory glutaminergics.

Subcutaneous emphysema

Air in the subcutaneous tissue; can occur from rupture bronchus or trachea; generally in trauma situation. crepitus

Sleep Paralysis

Alarming symptom identified by the inability to move the body for a few seconds after waking

Ramsay-Hunt's Syndrome

Also known as herpes zoster oticus. Facial nerve paralysis is accompanied by severe pain and a vesicular eruption in the external auditory canal and auricle in the distribution of the facial nerve. Prognosis for recovery is worse than bells palsy. Treat with antivirals and steroids.

lymphatic malformation

Also known as lymphangioma or cystic hygroma, congenital multiloculated lymphatic lesion that can arise anywhere, but is classically found in the left posterior triangle of the neck. Can cause airway obstruction, but usually elective surgery.

Psychosis

Alterations in sensory perceptions, such as hallucinations, and abnormalities in thought processes, such as delusions. impairment in reality testing

Papez Circuit

Alternate name for the limbic system

Glutamate

Amino acid neurotransmitter very important for excitation of neuronal firing. NMDA is its major receptor and its disruption is associated with schizophrenia. promotes REM sleep. Its is also associated with maintenance of addictive behavior, NMDA blockers are part of addiction treatment.

Snellen Chart

An eye chart used by eye care professionals and others to measure visual acuity. Recorded as the distance pt reads chart over the distance at which a pt with perfect vision could read the same size font.

Endophthalmitis

An inflammatory condition of the intraocular cavities (ie, the aqueous and/or vitreous humor) seen as a complication after eye surgery. Inflammation forms a hypopyon (layer of pus) which can block the retina. Treat by tapping and injecting antibiotics or vitrectomy.

Polymyalgia Rheumatica

An inflammatory disorder that causes muscle pain and stiffness, that is associated with temporal arteritis

Strabismus

Anomaly of ocular alignment

Panic Disorder

Anxiety disorder of episodic attacks of sudden-onset, intense anxiety usually lasting less than 30 minutes and associated with cardiac or respiratory symptoms and fear of impending death. Can occur with or without agoraphobia. Not triggered by a specific stimuli. Long term treatment with antidepressants

Posttraumatic stress disorder (PTSD)

Anxiety symptoms following a traumatic event including re-experiencing, hyperarousal, emotional numbing, and avoidance

Anxiety Disorder

Anxiety symptoms that are present for an extended period. Interfere with normal functioning and cause significant distress

Hyperarousal symptoms

Anxiety, increased startle response, impaired sleep, and hypervigilance (e.g., jumping at every sound).

air-bone gap

Any blockage to sound transmission in the pathway from extenal and middle ear to cochlea

Intention tremor

Any tremor that occurs during purposeful movements and disappears during rest.

Action tremor

Any tremor that occurs with voluntary contraction of the muscle and can be further divided into postural, and intention tremor. alcohol temporarily alleviates tremor.

retinopathy of prematurity

Areas of the peripheral retina have not yet developed in premature babies and the blood supply can become ischemic. An ischemic retina produces VEGF with resulting neovascularization which can bleed, create traction, and lead to retinal detachment. Can present as leukocoric. Treat with PRP laser or cryotherapy to ablate the ischemic retina and shut down VEGF production

Echolalia

Associating words by their sounds, not by their logical meanings

Samters Triad

Asthma, nasal polyposis, aspirin allergy

Cognitive-behavioral therapy

Attempts to identify and then change problematic cognitions

Histrionic Personality Disorder

Attention-seeking, sexually provocative, emotional, vain, unable to keep intimate relationships. Dramatic reporting of symptoms, approaches doctor in a sexual or inappropriate manner during illness.

Sjogren's Sydnrome

Autoimmune disease against exocrine glands; typically manifests as dry eyes, dry mouth as the lacrimal and salivary glands are affected (xerostomia and keratoconjuctivitis); associated with other rheumatologic diseases; may also see parotid enlargement; serologic studies may show anti SSA and SSB

Bacterial Parotitis

Bacterial infection of the parotid gland. typically caused by S. Aureus. Sx: may see pus draining from Stensen's Duct, tumor (swelling), calor, dolor, and rubor. tx with hydration and IV antibiotics, warm pads and sialagogues (make you salivate) may help, drainage may be necessary.

hemotympanum

Basilar skull fracture that communicates with the auditory canal resulting to bleeding in the middle ear behind the tympanic membrane.

Prodromal Phase of schizophrenia

Before the first psychotic episode. Typically, the patient avoids social activities and is quiet and passive. can be irritable

Tangentiality

Beginning a response in a logical fashion but then getting further and further from the point

Conditioned Respone

Behavior that is learned by an association made between a conditioned stimulus and an unconditioned stimulus

Sleep Hygiene/Sleep Ritual

Behavioral interventions designed to combat insomnia such as taking a warm bath, listening to music, developing and following a fixed sleeping and waking schedule, daily exercise, preferably performed early in the day and not immediately before sleep, and relaxation techniques

Epidermal inclusion cyst

Benign cyst usually found on the skin developing from ectodermal tissue; Histologically, it is composed of a thin layer of squamous epithelium.

Inverted papilloma

Benign tumor of the sinuses caused by HPV; suggested by unilateral sinusistis

Definitive test for Temporal arteritis

Biopsy of Temporal artery

Septal hematoma

Blood clot in nasal septum between perichondrium and cartilage that disrupts the nourishment to nasal cartilage; tx with incision, drainage, and packing. Can lead to necrosis and perforation. risk of secondary infection if untreated; most common organism for secondary infection is Staph aureus

Hyphema

Blood in the anterior chamber of the eye

Anorexia nervosa

Body weight < 85% of normal (BMI < 17.5) or failure to gain weight during expected growth period with disturbance in body image and, in women of menstruating age, 3 consecutive missed periods. One of the few life threatening psychiatric disorders: can lead to cardiac arrhythmias (hypokalemia) and malnutrition. Treat: restore body weight and save life, focus on long term relapse prevention. Antihistamine (cyproheptadine) can help increase appetite.

Cervical echymosis

Bruising of the cervical region

Toxoplasmosis

CNS infection (encephalitis) of toxoplasma spp. (protozoan); most common mass lesion in AIDS patients; typically only seen in severely immunocompromised

Neurocysticercosis

CNS infection of Taenia solium, the pig tapeworm. Causes parasitic cysts to grow in brain parenchyma. One of the most common causes of epilepsy and intracranial mass lesions worldwide. Treatment can lead to massive cerebral edema due to robust immune response

Primary CNS lymphoma (PCNSL)

CNS lymphomas of variable presentation (tend to be B cell predominant), with highly infiltrative neoplastic lymphocytes. Commonly associated with EBV infection in severely immunocompromised patients and elderly. Treat with radiation and chemo.

HIV encephalopathy

CNS repercussions of HIV infection; symptoms can range from mild dementia to severe cognitive impairment to bradykinesia

Communicating hydrocephalus

CSF build up due to a block outside of the ventricles leading to dilation of all the ventricles

congenital cataract

Can be idiopathic, genetic, from metabolism disorders, child abuse trauma, or a TORCH infection. Replace the lens ASAP

mediastinitis

Can result from ingestion of button batteries, leading to caustic damage, lodged in esophagus, fatal perforation with mediastinitis

benign paroxysmal positional vertigo

Caused by sediment, such as otoconia (calcium carbonate crystals) that have become free floating within the inner ear. When the patient turns his or her head quickly or into a certain position, this free-floating material moves the balance canal fluid (endolymph) in the inner ear and stimulates the vestibular division of the eighth cranial nerve. Vertigo that lasts less than 60 seconds initiated by a certain change in position. Treated by canolith reposition maneuver, brandt-daroff exercises can be done at home

Complications of sphenoid sinusitis

Cavernous sinus thrombosis (most severe): can affect nerves occulomotor, trochlear, trigeminal, and abducens, treat with IV antibiotics and drainage. opthalmoplegia, meningitis.

cervical adenitis

Cervical lymph nodes become infected, usually with Staphylococcus or Streptococcus. Usually have fever and tender nodes. suppurative adenitis without associated constitutional symptoms ( fever, malaise, localized tenderness), suspect cat-scratch disease or atypical mycobacterial infection. atypical TB can produce non tender, nodes appear stuck to the skin and overlying skin is red. TB presents with matted nodes.

Sleep Apnea

Cessation of breathing for periods during sleep; leads to anoxia and nighttime awakenings and results in chronic daytime sleepiness. central apnea: airway open but no respiratory effort. Risk factors for obstructive apnea include: male, obesity, large neck circumference, older, snoring, and hypertension.

Parasomnias

Characterized by abnormalities in physiology or behavior associated with sleep. They include bruxism, nightmare disorder, sleep terror disorder, sleepwalking disorder, and RBD

Depression

Characterized by feelings of hopelessness, helplessness, and even suicidal thoughts or psychotic symptoms. usually diurnal (depression is worse in the morning). If one SWAG symptom is positive, pt is most likely depressed (suicidal thoughts, weight loss, anhedonia (disinterest in pleasurable activities), and guilt). Decreased sleep latency, decreased delta sleep, and increased REM. Treatment includes SSRIs, MAOIs, and heterocyclic antidepressants and if they do not respond well, lithium, thyroxine, or an atypical antipsychotic can be added. Electroconvulsive therapy effective in severe depression. Cognitive therapy

Rhinoplasty

Controlled chiseled cuts of bone (osteotomie) to reshape the nose

Chronic Tonsillitis

Chronic low-grade infection of the tonsils, often have large crypts, or spaces within the tonsils that collect food and debris, that are difficult to treat with antibiotics. Can get chronic halitosis (bad breath)

Tauopathies

Class of neurodegenerative diseases involving aggregation of abnormal Tau protein

Tanner Staging

Classification scheme for evaluation of development of primary and secondary sex characteristics

Parkinsonism

Clinical triad of bradykinesia, resting tremor, and postural instability seen most commonly in Parkinson's disease. group of disorders with a loss of pigmented dopaminergic neurons in the substantia niagra: neurodegeneration of basal ganglia. others include: MPTP induced (illicit drug), post infectious, striatonigral degeneration, and progressive supranuclear palsy

Borderline Personality Disorder

Cluster B personality disorder. Erratic unstable mood, fear of abandonment, self-injury/suicide attempts, impulsive, boredom, often comorbid with mood or eating disorders. May show mini psychotic episodes, overidealizes then overreacts to perceived rejection by the doctor. uses splitting defense mechanism

Dependent Personality Disorder

Cluster C. Low self-confidence/self-esteem, seeks others to decide for them, may end up as an abused spouse. Excessive need to be cared for, helplessness during illness.

Obsessive-Compulsive Personality Disorder

Cluster C. Orderly, perfectionst, stubborn, inefficient, indecisive. Fears loss of control and may try to control the doctor during illness, follows the doctors orders exactly.

Avoidant Personality Disorder

Cluster C. Timid, withdrawn, sense of inferiority, sensitive to rejection. Fears rejection by doctor, avoids tests and treatment .

Macular Degeneration

Common cause of irreversible blindness caused by degenration of the macula. Usually affects people over the age of 55. Risk factors: female, smoking, Caucasian, family history, and mild to severe loss of central vision (blurriness). Can be dry or wet. Dry (atrophic): most common, painless loss of central vision, drusens in Bruch's membrane. Vitamin C, E, beta caroteine and zinc can slow progression. Wet (exudative): more rapid severe vision change, break in Bruch's membrane allowing neovascularization which can hemorrhage. Treat with VEGF inhibitors, photodynamic therapy or laser treatment.

vascular rings

Compression of the trachea caused by either the innominate artery or any number of mediastinal vascular rings that can occur embryologically. Causes stridor. diagnosed with CT or MRI

Major Depressive Disorder (MDD)

Cyclic** Unhappiness, decreased interest and pleasure in one's usual activities and decreased appetite for pleasurable stimuli such as sex and food. difficulty maintaining sleep leads to chronic fatigue. Defined by one episode or recurrent episodes of major depression. Factors are both biological and psychosocial. SWAG (suicide, weight loss, anhedonia, guilt) present for at least 2 weeks

Diabetic Retinopathy

Damage to the small blood vessels in the retina, resuling from chronically high blood glucose levels in people with poorly controlled diabetes. Glycosylation of vessel walls promotes denaturation of collagen in the wall, capillary thickening, and break down and leakage. Chronic hyperglycemia, hypertension, hypercholesterolemia, and smoking are all risk factors for development and progression of retinopathy.Can be non proliferative (NPDR) or proliferative. Treat with laser photocoagulation

Obstructive Sleep Disorders

Daytime lethargy, obstructive symptoms, growth retardation, behavioral problems, including poor school performance and hyperactivity, and nocturnal enuresis are often associated with the obstructive sleep disorder. A severe form occurs in children with Downs syndrome.

Extinction

Decrease and ultimate disappearance of the conditioned response resulting from the unpairing of conditioned and unconditioned stimuli

open angle glaucoma

Decreased aqueous drainage due to clogging of the trabecular network. risk factors: high IOP, age, family history, race (african american), suspicious optic nerves (large vertical nerve cupping), thin corneas. Chronically elevated eye pressure leading to gradual visual loss as ganglion nerves die. Present with papilledema, increased cup to disk ratio (cupping), and visual field loss (often peripheral). Treat by decreasing IOP, with beta blockers or topical carbonic anyhydrase inhibitors (these two decrease aqueous production), alpha agonists, and prostaglandin analogs (these increase outflow). Can do trabeculectomy.

Emotional numbing symptoms

Decreased emotionality, an inability to experience happiness, and difficulty connecting emotionally with others

Infraorbital nerve hypesthesia

Decreased sensation in the distribution of the infraorbital nerve (the portion of the maxillary nerve after it enters the infraorbital canal); sensation is lost in the lower eyelid, upper lip, and part of the nasal vestibule

HIV Dementia

Dementia caused by direct brain infection by the virus and resulting atrophy and demyelination. An ominous prognostic sign

Vascular Dementia

Dementia caused by many small brain infarctions. Stepwise pattern of decline, with sudden onset or increases in symptoms. Focal neurologic signs common

Pseudodementia

Dementia-like manifestation of depression in the elderly

withdrawal

Development of physical or psychological symptoms after the reduction or cessation of intake of a substance

cross-tolerence

Development of tolerance to one substance because of using another substance

Separation Anxiety

Developmentally normal fear in toddlers of being apart from attachment figures

Rapprochement

Developmentally normal period of alternating exploration and return to attachment figures. Described by Margaret Mahler

Terrible Twos

Developmentally normal period of self-assertion and independence seeking during toddlerhood

Hypertropia

Deviation of eye more superior to relative vertical deviation

Esotropia

Deviation of the eyes toward the nose and may involve one or both eyes

Continuous Positive Airway Pressure (CPAP)

Device applied to the face at night which provides persistent, gentle pressure to keep the airway open. Used to treat sleep apnea

Insomnia

Difficulty falling asleep or staying asleep that is present for at least 1 month and leads to daytime sleepiness or problems fulfilling social or occupational obligations

Dysphagia

Difficulty swallowing

Flooding

Direct exposure to actual fear stimulus while preventing avoidance/escape behaviors theoretically leading to disassociation of the stimulus with the fear response

Bipolar Disorder Type I

Discreet episodes of both depression and mania. Psychotic symptoms common usually in manic episodes. Treated with lithium but anticonvulsants (carbamazepine or divalproex) are second line or combination therapy. Sedative agents used in ER (lorazepam and clonazepam: benzodiazepines)

Microangiopathy

Disease of the small blood vessels, where the walls of the small blood vessels become so thick and weak that they bleed, leak protein, and slow the flow of blood

Antisocial Personality Disorder

Dishonest, disinterested in social norms, lack of empathy, association with conduct disorder in childhood and criminality in adulthood. Commonly called psychopaths or sociopaths. Has no concern for others, fails to learn from experiences.

Neurodegenerative Disease

Disorder involving death of functionally related neurons

Astigmatism

Distorted vision due to multiple focal points. correct with spherical

Reward Circuit

Dopamine activated brain network active in pleasure-seeking and addiction

Enkephalins

Endogenous opioid compound

Choline Acetyltransferase

Enzyme involved in the synthesis of acetylcholine

Narcolepsy

Episodes of sudden daytime sleepiness that occur daily for at least 3 months despite a normal amount of sleep at night, but associated with abnormal REM sleep. Cataplexy (sudden physical collapse) and sleep paralysis (inability to move right when you wake up) are commonly seen. Treated with stimulant agents

Social phobia/social anxiety disorder

Exaggerated fear of embarrassing oneself in a social or performance setting such as while giving a speech, eating in public, or using a public restroom.

Rhinorrhea

Excessive discharge of mucous from the nose

Amblyopia "lazy eye"

Failure of growth of afferent nerves and atrophy in one eye because of disuse of that eye resulting in decreased vision in that eye. Three main causes are strabismus, unequal refractive error (anisometropia), and visual deprivation. Treat by patching the good eye.

Sleep Attacks

Falling asleep suddenly during the daytime

Delusions

False belief

Ideas of Reference

False conviction that one is the subject of attention by other people or the media. Ie: the people on TV are talking about him

Hallucination

False perception

Hyperopia

Farsightedness. Can see far. Image falls behind the retina. Eye is to short. Treat with convex/converging lens.

Agoraphobia

Fear of going outside or of crowds

Claustrophobia

Fear of small, enclosed spaces

Grandiosity

Feeling of self-importance

Tarsal plate

Fibrous layer that gives the lids shape, strength, and a place for muscles to attach

Unilateral serous otitis

Fluid in the middle ear of only one side as oppossed to bilateral serous otitis; can be a sign of occult malignancy if present in adult that has not presented with cold symptoms

Orbital blow out fracture

Fracture of the walls or floor of the orbit; Intraorbital material may be pushed out into one of the paranasal sinuses; most commonly caused by blunt trauma of the head; i.e. getting hit in the face with a baseball or a baseball bat

Malar fracture

Fracture of the zygomatic bone

Complications of frontal sinusitis

Frontal sinusitis needs to be treated as the draining veins have no valves and directly connect to the dura; therefore this can lead to meningitis, frontal lobe abscess. Treated in the hospital with aggressive antibiotics and possibly drained.

Presenilin

Gene associated with familial Alzheimer's disease

Dementia

Gradual loss of intellectual ability without impairment of consciousness. Include Alzheimer's disease, Lewy body dementia, and vascular dementia.

Crepitus

Grating, cracking, or popping sound; a finding on PE; can indicate air in subcutaneous tissue

Spinocerebellar Ataxias

Group of genetic disorders which lead to dysfunction of the cerebellum and an inability to do motor tasks smoothly

Cluster C personality disorders

Group of personality disorders characterized by fear or anxiety. Includes avoidant, obsessive-compulsive, and dependent.

Cluster B personality disorders

Group of personality disorders characterized by inconsistent, dramatic, emotional behavior. Includes histrionic, narcissistic, antisocial, and borderline.

Cluster A personality disorders

Group of personality disorders characterized by unusual actions or social withdrawal. Includes paranoid, schizoid and schizotypal.

cochlear implant

Hearing aid device with direct stimulation of the cochlear nerve

Otosclerosis

Hereditary disease process that involves bony proliferation with in the temporal bone. Bony changes usually occur at footplate region of the stapes, causing gradual fixation of the ossification chain. conductive hearing loss.

McArdle's disease

Hereditary metabolic myopathy. deficiency of phosphorylase resulting in a disorder of glycogen metabolism. Associated with exercise induced pain and rhabdomyolysis. Second wind phenomena

herpatic keratitis

Herpes type 1 infection of the cornea. It lies dormant in the trigeminal ganglia. Can have red, injected eye that is painful. See dendritic ulcer when stain with fluorescein and slit lamp. Multiple reactivations can lead to corneal scarring. Debridement of eye and topical antiviral like viroptic or oral acyclovir which is continued prophylactically. NO steroids!

glioma

Heterotopic brain tissue, can be a congenital neck mass

Physiologic tremor

High frequency, low amplitude tremor, which occurs in normal individuals

Tardive dyskinesia

Hyperkinetic movement disorder caused by chronic use of dopamine antgonists that commonly involves the mouth and tongue.

Monoamine Theory of Mood Disorder

Hypothesis that mood problems are related to imbalances in the monoamines (dopamine, serotonin, norepinephrine, acetyl choline, histamine)

Autonomy

In Erikson's model, the ability to spend time away from primary caregivers

Radical neck dissection

Includes removal of SCM, internal jugular vein, and spinal accessory nerve in addition to nodes, fat, and fascia removed in selective neck dissection

Hyperkinesia

Increased involuntary movement (seen in Huntington's disease)

Factitious Disorder by proxy

Inducing or claiming an illness in another person for unconscious gain

corneal ulcer

Infected corneal abrasion; ulceration, scarring and ultimately permanent vision changes. Treat aggressively with antibiotics like flouroquinolones (ciprofloxacin), can culture if it is severe. Can be caused by facial nerve paralysis (eye not kept moist)

Conjunctivitis (Pink Eye)

Inflammation of conjunctiva due to viral, bacterial and allergic reactions. Viral: most cases in adults. adenovirus. redness, watery, enlarged follicular bumps on inside of eyelid, swelling of preauricular nodes. Educate on hygiene. Bacterial: mucopurulent discharge and redness. Caused by staph, strep, and HIB. Treat with erythromycin ointment. Allergic: itchy, swelling around the eyes. Avoid allergens, treat with antihistamines, mast cell stabilizers, and possibly steroids.

Orbital Cellulitis (post-septal)

Inflammation of eye tissues posterior to the orbital septum, characterized by soft tissue swelling, chemosis, proptosis, painful and decreased eye movement and decreased vision. Usually caused by sinus infection that erodes through the ethmoid bone

orbital cellulitis (pre-septal)

Inflammation of the eye in front of the septum.

Blepharitis

Inflammation of the eyelids specifically the eyelid margin. Treat with warm compresses and and baby shampoo. Can use doxycycline which changes the oil composition. Stinging, tearing and gritty sensation. Anterior: build up with debri (scurf) that forms at the base of the eyelashes. can get small ulcerations and eyelash loss. Posterior: clogged meiobian glands.

Polymyalgia rheumatica

Inflammatory disorder that causes muscle pain and stiffness, that is associated with temporal arteritis

Bruch's membranes

Innermost layer of the choroid

Topopen (tonometer)

Instrument used to determine intraocular pressure

Malingering

Intentionally producing or pretending to have some symptom with some gain in mind. Tend to avoid doctors and treatment

Neurofibrillary Tangles

Intracellular collections of polymerized tau protein seen in Alzheimer's and frontotemporal lobe dementias

Intranasal steroid spray

Intranasal corticosteroids used for allergic rhinitis; does not have sytemic effects; takes 6 weeks to reach full effectiveness

Re-experiencing symptoms

Intrusive thoughts or memories of the event that occur unexpectedly (flashbacks) as well as recurrent nightmares of the event.

Neologisms

Inventing new words

Chorea

Involuntary irregular, asymmetric movements that are random and continuous - "dance-like".

Athetosis

Involuntary slow twisting and writhing movments that typically involve more distal musculature - "snake-like"

Sibling Rivalry

Jealousy of a brother or sister

Flattened Affect

Lack of appropriate display of mood variations

Alogia/Poverty of Speech

Lack of the informative content typically seen in normal speech

Ataxia

Lack of voluntary coordination of motor function. inability to execute motor tasks smoothly

Amyloid Precursor Protein (APP)

Large protein from which B-amyloid is derived- mutation associated with early-onset Alzheimer's disease

Subacute rhinosinusitis

Lasting 30 days - 3 months

Chronic rhinosinusitis

Lasting longer than 3 months

Acute rhinosinusitis

Lasting up to 30 days

Operant Conditioning

Learning occurs because of the consequences to the individual of a previous behavior which either encourage or discourage repetition of that behavior

Cyclothymic Disorder

Less severe form of bipolar. Discreet episodes of both dysthymia and hypomania. never associated with psychosis

Bipolar Disorder Type II

Less severe. Discreet episodes of both depression and hypomania. Treated with lithium but anticonvulsants (carbamazepine or divalproex) are second line or combination therapy. Sedative agents used in ER (lorazepam and clonazepam: benzodiazepines)

Alexander disease

Leukodystrophy. astrocytic storage disease. Uncommon neurologic disorder of infants and children characterized by loss of myelin in the brain and accumulation of GFAP (glial fibrillary acid protein) in astrocytic processes. Clinically marked by psychomotor retardation, progressive dementia, paralysis and eventually death.

delirium tremens

Life threatening alcohol withdrawal syndrome characterized by altered mental status. May also occur with benzodiazepine withdrawal. Occurs around third day of withdrawal.

Critical Periods

Limited intervals during which a developing animal is more sensitive to certain stimuli than at other times in its development.

Nasal polyps

Localized extremely edematous nasal or sinus mucosa. Treat with nasal steroids and possibly surgery. in kids think cystic fibrosis.

Adenoid cystic carcinoma

Malignant tumor of the salivary glands; has propensity to invade nerves

Amnestic Disorder

Memory loss without other cognitive impairments

Tay sachs disease

Metabolic storage disorder of the neurons. lethal, autosomal recessive disorder caused by an inborn deficiency of hexosaminidase A leading to GM2 ganglioside accumulation in CNS neurons. Often see cherry-red spot in the macula, whorled myelin figures in the lysosomes of the nerve cells. Normal at birth but delayed motor development at 6 mo. Then flaccid weakness, blindness, and severe mental impairment.

Acute otitis media

Middle ear infection, due to Eustachain tube dysfunction. TM is white or yellow, bulging, with dilated vessels, and decreased movement of the TM. Present with recent onset of fever, ear pain, and fussiness. Common organisms: strep pneumo, H flu, Moraxella. Treat with amoxicillin and can add clavulanic acid. Can place PE tubes for recurrent episodes. Complications: tympanosclerosis, mastoiditis, meningitis, and perforation of the ear drum.

Hypomania

Mild symptoms of mania such as increased sexual interest and talkativeness are present for at least a 4-day period.

Dopamine

Monoamine (more specifically a catecholamine) known to be involved in parkinsonism, mood, fear, pleasure, addiction, and schizophrenia. The most important "feel good" neurotransmitter". Acts in three main neurological tracts: nigrostriatal (muscle tone and movement), tuberoinfundibular (dopamine inhibits secretion of prolactin from anterior pituitary), and mesolimbic-mesocortical (emotion expression). promotes wakefulness

Biogenic Amine Neurotransmitters

Monoamines, such as dopamine, serotonin, norepinephrine, and acetylcholine

Substance-Induced Mood Disorder

Mood symptoms caused or exacerbated by the use or withdrawal of drugs of use or abuse

Mood Disorder Resulting from General Medical Condition

Mood symptoms in a medically ill patient resulting directly from the illness or its treatment rather than from a primary mood disorder

Adjustment Disorder

Mood symptoms that do not meet the full criteria for a major depressive episode. Follow within 3 months of a significant psychosocial stressor (but is not better explained by bereavement), and persist for up to 6 months after the stressor has terminated

Obstructive Sleep Apnea

More common sleep apnea where respiratory effort occurs, but an airway obstruction prevents air from reaching the lungs. It occurs most often in people 40 to 60 years of age and is found more often in men (8:1 male-to- female ratio) and in the obese.

Atypical Depression

More likely to show weight gain rather than loss, and more likely to show excessive somnolence, feelings of heaviness in the arms and legs (leaden paralysis) and may also have a craving for carbohydrate-rich food.

Agger nasi cell

Most anterior ethmoid sinus, frequently clouded. best seen on saggital CT

Pleomorphic adenoma

Most common benign tumor of the salivary gland

Sensorineural hearing loss

Most common form of hearing loss. hearing loss due to the inner ear (chochlea) or the 8th cranial nerve. Causes: acoustic neuromas, persistent noise exposure, age related changes in the 8th nerve, infectious, or post inflammatory process. Generally not treated with surgery, choclear implants may help

Mucoepidermoid carcinoma

Most common malignant tumor of the salivary glands

CNS Metastases

Most common primary tumors include lung, breast, melanoma, kidney and GI tract. Most commonly found at the gray white junction of the cerebral hemispheres. ring enhancing. tend to involve dura mater

Dyssomnias

Most common sleep disorders which are characterized by problems in the timing, quality, or amount of sleep. They include insomnia, sleep apnea, narcolepsy, and hypersomnias.

Friedrich Ataxia

Most common type of spinocerebellar degeneration, most common inherited ataxia. degeneration of the posterior columns, cortical spinal pathways, and spinocerebellar tracts. autosomal recessive trinucleotide repeat, or sporadic. cerebellar inflow disorder. Symptoms begin before age 25 and including ataxia of limbs, dysarthria, extensor plantar reflexes, lower limb areflexia, sensory loss. Can have skeletal deformities, hypertrophic cardiomyopathy, and diabetes. progression and death after 30 years.

Dysarthria

Motor dysfunction of speech due to dysfunction of neurologic input to muscles involved with speaking

Postnasal drainage

Mucous draining from the nasal cavity into the pharynx

Factitious Disorder

Munchausen syndrome. Conscious feigning or inducing symptoms for unconscious gain. Seek attention of doctors

Polycythemia vera

Myeloproliferative blood disorder that results in an overproduction of red blood cells

Classical Conditioning

Natural, reflexive, or unconditioned response (a behavior) is elicited by a learned or conditioned stimulus (a cue from an internal or external event).

Myopia

Nearsightedness. Can see near. Image falls in front of retina. Eyeball is too long or the lens focuses to strongly. Treat with concave/diverging lens.

tolerence

Need for increased amounts of the substance to achieve the same positive physical and psychological effects

Endorphins

Neuropeptide that acts on behavior. Endogenous opioid compound in the body that decreases pain and anxiety.

Folstein Mini-Mental State Examination

Neuropsychological test commonly used at the bedside to follow improvement or deterioration in function in patients with suspected neurological dysfunction such as delirium or dementia.

Conditioned Stimulus

Neutral stimulus that produces a response following learning

Compulsion

Nonpleasurable, nonsatisfying, repetitive actions which relieve anxiety associated with obsessions

Sleep Deprivation

Normal individuals experience impaired physical and mental performance. If the condition persists, they may show psychiatric symptoms such as confusion, agitation, and, ultimately, pathological anxiety and psychotic symptoms such as paranoid delusions and hallucinations

Stranger Anxiety

Normal reaction around 8 - 10 months of age of concern or upset at being handled by someone other than attachment figures

Opthalmoplegia

Paralysis of the extraocular muscles

Substantia Nigra

Part of the midbrain which appears dark due to neuromelanin in dopaminergic neurons. important for initiating movement. receive inhibition in the form of GABA and acetylcholine. Involved in parkinson's disease.

Psychotic/Active Phase of schizophrenia

Patient loses touch with reality. This loss is commonly associated with additional or positive symptoms such as hallucinations and delusions

Masked Depression

Patients are unaware of or deny that they are depressed; instead they report vague physical symptoms and tend to first seek help from primary care doctors

Parallel Play

Playing side-by-side, but not interactively

Anisometropia

Prescription between the eyes is very different.

Ménière's disease

Patients develop intense, episodic vertigo, usually lasting from 30 minutes to four hours, and associated with fluctuating hearing loss, roaring tinnitus, and the sensation of aural fullness. The hearing loss can last after the vertigo. Symptoms are believed to be secondary to a distention of the endolymphatic space within the balance organs of the inner ear. Salt restriction and thiazide diuretics, vestibular ablation by instillation of ototoxic medication (i.e. gentamicin), surgical options (endolymphatic sac decompression into the mastoid cavity, vestibular nerve section, and labyrinthectomy)

acoustic trauma/noise exposure

Patients suffering from noise-induced hearing loss have a symmetric "noise notch" in bone-conduction thresholds at approximately 4000 Hz.

Complications of ethmoid sinusitis

Periorbital cellulitis or abscess, treat by surgically draining. Sinusitis treated with IV antibiotics, nasal flushes, and decongestants.

Generalized anxiety disorder (GAD)

Persistent symptoms of anxiety, including hyperarousal and excessive worrying over at least a 6-month period. Symptoms cause significant distress but cannot be related to a specific person or situation

Shaping

Person is rewarded or reinforced when he or she randomly (by trial and error) shows something like the desired behavior. Closer and closer approximations of the wanted behavior are then reinforced until the correct behavior is achieved

Personality Disorder

Personality traits resulting in personal distress or impairment of social function. Must be present by early adulthood, but cannot be diagnosed before age 18 (conduct disorder). No pharmacologic treatment, treat secondary anxiety or depression, psychotherapy and self help groups may be beneficial.

Object Permanence

Piaget. The understanding that objects or people not in view continue to exist, appears around a year of age

Endotracheal intubation

Placing a tube through the mouth into the trachea to secure and airway and ventilation of a patient

Concha bullosa

Pneumatized (air filled) cavity within a turbinate of the nose; normal anatomic variant seen in up to 1/2 of the population; can lead to obstruction of sinus --> recurrent sinusisitis

Cribiform plate

Portion of the ethmoid bone; most superior portion of the nasal cavity seperating it from the cranial vault

Bacterial rhinosinusitis

Presentation is typical, sinus sx's lasting longer than 7-10 days or worsening after 5 days. Sxs include facial pressure and pain, purulent nasal discharge, anosmia, and nasal obstruction. can not differentiate viral from bacterial by CT or X ray; most commonly caused by Streptococcus pneumoniae; other common bugs are H flu and Moraxella Catarrhalis; tx with 10 days antibiotics (amoxicillin or TMP/SMX)

Vasomotor rhinosinusitis

Presentation of clear rhinorrhea without other allergic sx's; Caused by leaking of fluid from dilated vessels; Triggers include: temperature, foods, light; tx with intranasal steroid spray

Fixed Interval Reinforcement

Presented after a designated amount of time

Fixed Ratio Reinforcement

Presented after a designated number of responses

Variable Interval Reinforcement

Presented after a random and unpredictable amount of time

Variable Ratio Reinforcement

Presented after a random and unpredictable number of responses

Continuous Reinforcement

Presented after every response

Reality Testing

Process by which an individual determines what is real and what is imagined, impairment in this process manifests as psychosis

Response Acquisition

Process by which the conditioned response is acquired or learned

Imprinting

Process where an animal makes an association with and then follows the first thing it sees after birth or hatching.

Stimulus Generalization

Process whereby a new stimulus that resembles a conditioned stimulus causes the conditioned response

Rhinitis medicamentosa

Prolonged use of decongestants that after discontinuation get rebound effect of vasodilation causing rhinitis sx's to resume; tx is stopping decongestant and can use intranasal corticosteroids. can be caused by cocaine use.

Treatment Options for Glaucoma

Prostaglandin analogs, Beta blockers, carbonic anhydride inhibitors, topical alpha-agonists, surgery (trabeculectomy or tube shunt), and lasers (iridotomy, trebeculotomy)

Apolipoprotein E (apo E)

Protein involved in cholesterol metabolism whose allele (E4) is associated with increased risk Alzheimer's disease

Fibrils

Proteins misfolded into B-pleated sheets which may polymerize to form toxic aggregates and are involved in the pathology of neurodegenerative diseases

Postpartum Psychosis

Psychosis (hallucinations, delusions) arising within one month of giving birth

Schizophreniform Disorder

Psychotic and residual symptoms lasting 1-6 months. Precipitating psychosocial factors. No prominent mood symptoms

chronic otitis Media

Purulent discharge present. Most common organism is pseudomonas aeruginosa, but includes staph and proteus.

Hypopyon

Pus or leukocyte exudate (macrophage) in the anterior chamber of the eye.

Tic

Rapid, random, repetitive, semi-voluntary movements that the patient may be able to temporarily suppress. can be motor or vocal.

REM Sleep Behavior Disorder (RBD)

Rare condition that includes episodes of REM without muscle atonia (skeletal muscle paralysis). The resulting physical activity associated with dreaming or nightmares can lead the patient with this disorder to harm himself or his sleep partner during REM sleep

Fatal Familial Insomnia

Rare disorder resulting from mutations in the prion protein gene. Leads to degeneration of the thalamus, a brain region associated with arousal and consciousness, resulting in the complete inability to sleep, followed by dementia. It is also fatal within 1 to 2 years

Bulimia nervosa

Recurrent (twice or more weekly for at least three months) episodes of binge eating combined with purging or some other compensatory mechanism with a near normal body weight. Treat with antidepressants and psychotherapy

Obsession

Recurrent, unwanted, intrusive, negative feelings, thoughts, and images

Obsessive-compulsive disorder (OCD)

Recurrent, unwanted, intrusive, negative feelings, thoughts, and images which are relieved to some extent by performing nonpleasurable, nonsatisfying, repetitive actions. Treat with antidepressants long term

Unconditioned Response

Reflexive, natural, or unlearned response to a stimulus

Primary Reinforcer

Reinforcer that fulfills a biological need (i.e. food)

Secondary Reinforcer

Reinforcer that is not intrinsically rewarding, (i.e. money)

Negative Reinforcement

Removal of an aversive stimulus that results in an increase in the rate of behavior

Odontectomy

Removal of teeth

Habituation

Repeated stimulation results in a decreased response

Sensitization

Repeated stimulation results in an increased response

Perseveration

Repeating the same word or phrase over and over

Sleep Terror Disorder (Night Terrors)

Repetitive experiences of fright in which a person (usually a child) screams in fear but cannot be awakened and has no memory of having a dream. Occurs during delta (slow-wave) sleep.

Pick bodies

Round cytoplasmic inclusions made up of tau proteins seen in Pick disease

pyriform sinus squamous cell carcinoma

SCC of the pyriform sinus; the pyriform sinus is located in the hypopharynx lateral to the epiglottis

Sialolithiasis

Salivary gland stones; generally radioopaque; most common in submandibular duct; can lead to obstruction of duct and secondary bacterial infection of gland. Stone must be removed

Positive Symptoms (schizophrenia)

Schizophrenia symptoms that are additions to normal experience, e.g. hallucinations and delusions

Negative Symptoms

Schizophrenia symptoms that are subtractions from normal experience, e.g. restricted emotional range or affect

Apgar

Score to evaluate neonate survival, assessing appearance, pulse, grimace, activity, and respiration. Scored out of 10. Assessed at 1 and 5 minutes of life

Meibomian glands

Sebaceous glands at the rim of the eyelids inside the tarsal plate, responsible for the supply of meibum, an oily substance that prevents evaporation of the eye's tear film

Narcissistic Personality Disorder

Sense of superiority and entitlement, lacks empathy for others. Perfect self-image threatened by illness, demanding when ill, avoids treatment that affects physical appearance.

Temporal Bone Fractures

Significant head trauma can produce fracture lines through the temporal bone that may affect the facial nerve (by direct transection or causes swelling and distention). Treat by direct reanastomosis, or interposition graft with (greater auricular or sural nerve). Hearing loss may occur

Central Sleep Apnea

Sleep apnea where the airway is open but little or no respiratory effort occurs (more common in the elderly)

Pickwickian Syndrome

Sleep apnea-related condition in which daytime sleepiness results from airway obstruction. It is seen primarily in people who have central obesity and a short, fat neck, a body habitus that leads to mechanical obstruction of diaphragmatic movement

Rapid Eye Movement (REM)

Sleep stage characterized by fast eye movements, decreased muscle tone, and low-amplitude, high-frequency brain waves (saw tooth), dreaming, as well as suppression of sympathetic activity as shown by miosis (pupil constriction), and penile and clitoral erection. most skeletal muscles are paralyzed in REM sleep. 25% of sleep in young adults, usually during the second half of the sleep cycle.

Bradykinesia

Slowness of movement

Lingual frenulum

Small fold of mucous membrane extending from the floor of the mouth to the midline of the underside of the tongue.

Tragus

Small pointed emminence in front of the ear

Laryngeal papillomatosis

Small tumors (papillomas) occurring in the larynx; this condition is due to HPV serotypes 6 and 11

Social Smile

Smile in response to others' faces, appears in first month or two of life

Pressured Speech

Speech that seems forced and rapid. seen in mania

Dopamine Hypothesis

States that the positive symptoms of schizophrenia result from excessive dopaminergic activity. this is most likely due to its effects in the mesocortical/mesolimbic neuron pathways

Unconditioned Stimulus

Stimulus that automatically produces a reflexive, natural, or unlearned response

Aversive Stimulus

Stimulus which a subject seeks to avoid (i.e. scolding)

Sleep Architecture

Structure of a night's sleep including five to six cycles of NREM sleep (from 4 to 1) followed by a REM period. Each cycle takes about 90 minutes.

Temporal Arteritis

Subacute granulomatous inflammation and damage to the blood vessels that supply blood to the head. If the inflammation affects the arteries in your neck, upper body and arms, it is called giant cell arteritis. This is a medical emergency due to the risk of vision loss due to occlusion of the central retinal artery. symptoms: pain with chewing, pain in temple or neck, scalp tenderness and headaches. Treat with corticosteroids. elevated ESR and biopsy to diagnose.

Disinhibited Type

Subset of reactive attachment disorder - approaches people indiscriminately, no clear attachment figures

Inhibited Type

Subset of reactive attachment disorder - withdrawn and unresponsive

substance dependence

Substance abuse plus withdrawal symptoms, tolerance, or a pattern of compulsive use

Cataplexy

Sudden physical collapse caused by the loss of all muscle tone after a strong emotional stimulus, such as anger, laughter, or sexual stimulation. Seen in narcolepsy

Selective neck dissection

Surgery to remove only nodes, fat, and fascia in neck when mets from cancer is suspected

Stapedectomy

Surgical correction done to remove the fixed stapes ossicle and placing a prosthesis between the incus and the vestibule of the inner ear, which re-establish ossicular continuity

Paranoid Personality Disorder

Suspicious, distrustful, litigious, and seeking to attribute problems to others. Sees others as hostile, blames their physician, oversensitive to a perceived lack of caring from a physician.

Papilledema

Swelling of optic disk secondary to increased intracranial pressure. Signs of ICP: headache that is positional and worse in the morning, nausea and vomiting, intermittent visual problems. Diagnose by fundoscopic exam, BP, then MRI, then lumbar puncture. Treat by reducing ICP.

Otitis externa

Swimmer's ear, infeciton of the external auditory canal, P. aeruginosa is the usual bug. Pain on traction of the pinna. Treat with topic otic solution.

Prefrontal Lobe Syndrome

Syndrome of disinhibition, perseveration, return of immature reflexes

Temporal mandibular joint syndrome

Syndrome of pain associated with muscles of mastication and temporomandibular joint; palpation of the TMJ generally elicits pain on exam. most common cause of ear pain when ear exam is normal

Paranoid Subtype of Schizophrenia

Systematized delusions of persecution. Has an older age of onset and better functioning than other subtypes

Frontotemporal Lobar Degenerations (Dementias)

Tauopathies with prominent degeneration of frontal and temporal lobes. example: pick disease

Time Out

Technique in which an individual (usually a child) is temporarily removed from the social situation each time he or she misbehaves

Hirschberg test

Test can be done to check the alignment of the eyes in children. Shine a light in the eyes and look at the corneal reflex of the light. Compare the reflexes position in comparison to the pupil and they should be at the same place in both eyes

Spontaneous Recovery

Unexpected recurrence of conditioned response following extinction

Specific phobia

Unfounded, irrational fears of certain things (such as snakes or elevators)

Hypnopompic

Upon awakening

Hypnagogic

Upon falling asleep

retinoscopy

Use a light shot into the eye to get an idea of the reflection to estimate prescription. See how the red reflex moves. In a normal eye the reflection should stay in the same place

Primary Gain

Use of somatization to express an unwanted or unacceptable emotion. An internal motivator that is often unconscious.

Tympanometry

Used to evaluate the mobility of the TM and responses to pressure changes in the external auditory canal.

Word Salad

Uttering unrelated combinations of words or phrases

Viral rhinosinusitis

The common cold; tx symptomatically (antipyretics, hydration, etc); resolution in 7-10 days

concept of conservation

The concept that the quantity of any substance remains the same regardless of the size of the container it is in which according to Piaget's developmental theory is first acquired around age 7

Resistance to Extinction

The force that prevents a behavior from disappearing when the reward is withheld

Magical Thinking

The idea that thoughts cause or prevent external events from happening

Positive Reinforcement

The introduction of a stimulus that results in an increase in the rate of a behavior

Punishment

The introduction of an aversive stimulus aimed at reducing the rate of an unwanted behavior

Emmetropia

The normal refractive condition of the eye in which there is clear focus of light on the retina

Uvea

The pigmented layer of the eye, lying beneath the sclera and cornea, and comprising the iris, choroid, and ciliary body.

Osteomeatal complex

The region at which the maxillary sinus drains into the nose; removal of this region is called a uninectomy

ego integrity versus despair

The stage Eric Erickson described in old age in which the person either the satisfaction and pride in his past accomplishments or feels he has wasted his life

concrete operations

The stage in Piaget's developmental theory in which children roughly 7 years of age acquire the capacity for logical thought

Electroconvulsive therapy (ECT)

Therapy in which a grand mal seizure is induced by passing an electric current across the brain, a socially maligned, but effective treatment for severe depression

formal operations

This the stage at which according to Piaget most adolescents develop the ability for abstract hypothetical or formal reasoning occurring in late adolescence

Flight of Ideas

Thoughts move quickly from one to another

Lemierre's syndrome

Thrombophlebitis of the internal jugular vein. caused by fusobacteria in a peritonsilar abscess. Can lead to pulmonary embolism.

Tourette's syndrome

Tic disorder with multiple motor tics and at least one vocal tic. This must be for over a year without a 3 month period that is tic free. Involves degeneration of the caudate nucleus. dysregulation of dopamine. treated with antipsychotics

REM Latency

Time to the first REM period after falling asleep; average is 90 minutes

Bruxism

Tooth grinding most commonly during stage 2 non-REM sleep. It is a chronic condition that can lead to tooth and gum problems, jaw pain, and headaches.

Amaurosis Fugax

Transient Monocular vision loss due to embolization. TIA of the eye. Temporary central retinal artery occlusion. This is a sign of carotid disease

Systematic desensitization

Treatment used primarily in the treatment of phobias. Involves exposure to increasing doses of fear provoking stimulus while pairing it with a relaxing stimulus

Down Syndrome

Trisomy 21 a common genetic cause for mental retardation

Central Retinal Artery Occlusion (CRAO)

True ophthalmic emergency. Sudden, painless, unilateral and often complete loss of vision due to stroke of the retina. Cherry red spot on the fovea and retinal swelling and whiteness surrounding fovea. Immediate treatment by decreasing IOP, ocular massage, high flow oxygen, IV acetozolamide, or intra-arterial thrombolysis of ophthalmic artery.

arnold chiari malformation

Type 1: congenital herniation of the cerebellar tonsils through the foramen magnum, associated with syringomyelia Type 2: congenital herniation of the cerebellar vermis through the foramen magnum. associated with spina bifida

Lefort Fracture

Type of fx of the face (3 different types) resulting in maxillary instability. requires surgical plating

Exotropia

Type of strabismus in which the eyes are divergent/wall-eyed

Baby Blues

Very common period lasting up to several days postpartum of emotionality and tearfulness

Ballismus

Violent, involuntary flailing of the extremities. results from subthalamic nucleus or basal ganglia damage.

Bruckner test

Vision test technique for small children. Dilate their pupils and look for the crescent of the red reflex to estimate their prescription. Inferior crescent: myopic. Superior crescent: hyperopic. Difference in brightness could suggest ocular misalignment.

Schizoid Personality Disorder

Voluntary withdrawal from others, restricted emotions/affect, without psychosis. shows little emotion or connection with doctor, becomes even more withdrawn during illness.

Pilocystic astrocytoma

WHO grade I astrocytoma. Very slow growing, well circumscribed tumors that typically arise in children and young adults. Not prone to anaplastic progression to higher grade tumor. May also display Rosenthal fibers, pseudopallisading (circle of nuclei around necrotic core), they are contrast enhancing due to vascular proliferation. Commonly found in the cerebellum, brainstem, optic nerve and third ventricle.

Choroid plexus papilloma (CPP)

WHO grade I. Tumor of children that most commonly arises in the lateral ventricles and in adults it arises in the 4th ventricle. Typically benign and curable by surgery (assuming no CSF dissemination). Leads to increased CSF production

Low grade fibrillary astrocytoma

WHO grade II astrocytoma. Well differentiated astrocytic tumor cells with low grad nuclear atypia and low proliferation

Oligodendroglioma (ODG)

WHO grade II. Highly infiltrative, but with a favorable response to treatment. Seen in adults in the 4th to 5th decade. Often arise in the white matter of the cerebral hemispheres with infiltration in the cortex. Display monotonous population of "fried egg" cells (round nucleus with clear rim of cytoplasm) and "chicken wire" pattern of branching blood vessels. Undergo anaplastic progression

Ependymoma

WHO grade II. Slow growing neoplasms of children and young adults that originate from the ependymal lining of the cerebral ventricles. Pathological characteristic is the perivascular pseudorosette and express EMA and GFAP antigens. In children they commonly occur in the 4th ventricle.

Anaplastic astrocytoma

WHO grade III astrocytoma. More cellular and pleomorphic version of low-grade fibrillary astrocytoma. Typically progress to glioblastoma within a few years

Gliomatosis cerebri

WHO grade III diffuse astrocytoma. Infiltrating glial cells involve at lease three cerebral lobes (often more)

Germinomas

WHO grade III. Typically exhibit large malignant cells interspersed with small reactive lymphocytes in a midline orientation (specifically the pineal gland and third ventricle). Pure germinoma is highly radiosensitive, treated with radiation and chemo.

Glioblastoma multiforme (GBM)

WHO grade IV. Single most common primary malignant brain tumor. Highly pleomorphic cells with high rates of cellular proliferation. Characteristic features include high degree of vascular proliferation and foci of tumor necrosis. Large ring enhancing mass with central necrosis and surrounding edema and often crosses the corpus callosum. pseudopallisading. amplification/overexpression of EGFR

Learned Helplessness

When a person who has repeatedly tried and failed to control external events becomes hopeless, apathetic, and depressed when faced with a new life stressor.

Consensual Pupillary Reaction

When light is shone in one eye, the pupillary reaction seen in the other eye, It is a normal reflex

Drusen

Yellow lipid deposits that form in Bruch's membrane in the retina.

Syringomyelia

a cavitation in the spinal cord filled with fluid. bilateral loss of pain to the arms

Retropharyngeal cellulitis or abscess

a cervical adenitis that occurs in the space behind the pharynx, can therefore present with a stiff neck (meningismus) and fever. Excise abscess and treat with IV antibiotics.

Multiple sclerosis (MS)

a chronic demyelinating disease defined by multifocal demyelinated plaques with lipid laden macrophages, and oligodendrocyte depletion. Most common chronic CNS disease of young adults in the USA. young women in northern climates. relapsing course, often begins with visual impairments (optic neuritis) and can include motor, visceral or sensory impairments. diagnosed by increased IgG in the CSF with oligoclonal bands.

Stridor

a high-pitched, noisy respiration emanating from the larynx or upper trachea that is a sign of respiratory obstruction.Causes: several that can be life threatening: acute epiglottitis, croup, or foreign body aspiration.

Internuclear ophthalmoplegia

a lesion of the medial longitudinal fasciculus (MLF). Disorder of conjugate lateral gaze in which the affected eye fails to adduct when the contralateral eye abducts (w/ nystagmus). Most commonly due to MS plaques when presenting in a young person.

Malignant hyperthermia

a life threatening adverse reaction to inhaled anesthetics (minus NO) and succinylcholine causing fever, rigidity, and organ failure. increased metabolism due to increased intracellular calcium in muscle. Treated with dantrolene

Electromyography (EMG)

a measure of the electrical properties of the muscles themselves, and abnormalities associated with motor nerves and muscles. Electrodes are inserted directly into the muscles and resting activity and activation data is recorded

posturography

a method of quantifying balance, but should not be used alone to diagnose vestibular disorders.

Fetal alcohol syndrome

a pattern of mental and physical defects that can develop in a fetus in association with high levels of alcohol consumption during pregnancy

transference

a phenomenon characterized by unconscious redirection of feelings from one person to another. ie: patient treating her doctor like her husband

Partial seizure

a seizure (as of Jacksonian epilepsy or temporal lobe epilepsy) that originates in a localized part of the cerebral cortex, that involves motor, sensory, autonomic, or psychic symptoms (as twitching of muslces, localized numbness, or auras), and that may or may not progress to a generalized seizure

Status epilepticus

a seizure that lasts more than 30 minutes. The seizure may be continuous or intermittent without recovery of consciousness between episodes. Considered to be a neurological emergency with a mortality rate greater than 20%

temperament

a set of behavioral characteristics that seem to be inborn and generally persist throughout life

Spina bifida

a set of neural tube defects resulting from failure of neural tube closure in the more caudal regions

nucleus accumbens (NA)

a small nucleus in the basal ganglia associated with addiction. The mesolimbic tract in the ventral tegmentum of the brain extends to the medial forebrain and when stimulated release dopamine to the nucleus accumbens and the frontal cortex.

essential tremor

action tremor. usually symmetrical and often involves the hands*, jaw, voice and head. relieved by consumption of alcohol and worsened by stress. treated with beta blockers (propanolol) and anticonvulsants.

Transverse myelitis

acute demyelination within the spinal cord causing weakness of one or both legs and numbness in the lower extremities

closed angle glaucoma

acute glaucoma, medical emergency because patients can lose vision within hours. Most commonly caused by pupillary block. Present with extremely red, painful eye, nausea, vomiting, seeing halos around lights. Pupil is sluggish and mid dilation. Drugs that dilate the pupil can cause this in people who are genetically predisposed. Treat by reducing IOP, can use meds but always go to surgery (laser iridotomy). Meds: beta blockers, carbonic anyhydrase inhibitors reduce the production of aqueous humor, Mannitol or glycerin can help drain the fluid, pilocarpine can constrict the pupil and iris which can help open up the angle.

Guillain barre (AIDP)

acute onset inflammatory/immune mediated peripheral demyelinating polyradiculoneuropathy. Inflammation and demyelination of spinal nerve roots and peripheral nerves (radiculoneuropathy) Approximately two thirds of cases are preceded by an acute influenza like illness from which the affected individual has recovered by the time the neuropathy becomes symptomatic. Clinically characterized by ascending paralysis and early loss of deep tendon reflexes (areflexia) that can continue for many weeks requiring mechanical ventilation.

Waterhouse friderichsen syndrome

adrenal hemorrhage as a result of fulminant meningococcemia (more common with gonoccocal meningitis)

Presbycusis

age-related changes of the 8th cranial nerve leading to sensorineural hearing loss. can have tinnitus and troubles with speech discrimination

Minimum alveolar concentration (MAC)

alveolar concentration of inhaled anesthetic that prevents movement in 50% of patients in response to a stimulus (such as surgical stimulation). It can also be considered an anesthetic's ED50. the goal of an anesthetic is obviously not MAC, since 50% of patients move in response to a stimulus at this concentration.

Gama-Aminobutyric Acid (GABA)

amino acid, principal Inhibitory neurotransmitter of the CNS allowing Na to enter the neuron hyperpolarizing it. Formed from glutamate by glutamate decarboxylase. An increase in GABA will lead to sedation and decrease in anxiety. Three sedative that activate GABA include alcohol, barbituates, and benzodiazepines.

vertigo

an illusion of motion, primarily associated with the balance organs of the inner ear (vestibular system)

Adrenoleukodystrophy (ALD)

an x linked disorder in which dysfunction of the adrenal cortex and nervous system demyelination are associated with high levels of saturated very long chain fatty acids (VLCFAs). Disease of CNS (mostly posterior brain and spinal cord) and PNS. Storage cells found in the adrenal cortex and testes.

Infantile spinal muscular atrophy (Werdnig hoffmann disease or SMA I)

autosomal recessive disorder of lower motor neurons (anterior horn) leading to denervation, usually manifests itself within the first 3 months of life. Extreme muscle weakness and atrophy. The infant is floppy and may have difficulty with sucking, swallowing or ventilation. The disorder is rapidly progressive, generally leading to death from respiratory complications by approximately 3 years of age.

Gaucher disease

autosomal recessive neuronal storage disease due deficiency of glucocerebrosidase leading to the accumulation of glucocerebroside in macrophages. Severe neuronal loss with diffuse astrogliosis. Infants fail to thrive and die at early age

Niemann pick disease

autosomal recessive neuronal storage disorder due deficiency in sphingomyelinase leading to the accumulation of sphingomyelin in neurons. See foamy histiocytes. Appears as failure to thrive in infancy, may also produce cherry red spot as in tay sachs, children usually die by age 3. Ashkenazi Jews

Saccular (berry) aneurysms

balloonlike outpouchings of cerebral arteries especially at branch points of circle of willis. Common in ADPKD, marfans syndrome, and danlos syndrome. Can rupture (not as common as in Charcot-bouchard) leading to subarachnoid hemorrhage, can lead to vasospasms a few days later that is treated with calcium channel blockers.

disruptive behavior disorders

behavior disorders characterized by inappropriate behavior that causes problems in social relationships and school performance

Schwannoma

benign slow growing tumor arising from schwann cells of the cranial nerves or peripheral nerves. Vestibular schwannoma (acoustic neuroma) of the 8th cranial nerve cause sensorineural hearing loss and can enlarge to compress cranial nerves 5 and 7, usually unilateral (often associated with neurofibromatosis 2). Spinal schwannomas are usually in the dorsal (sensory) spinal roots. Usually well demarcated tumors, two histological patterns include antoni A pattern (interwoven fasicles and verocay bodies) and antoni B pattern (indistinct cytoplasm in a vaculoated background).

acoustic neuroma

benign tumor of the schwann cells of the eighth cranial nerve (vestibular schwannoma). Often present bilaterally in neurofibromatosis 2

Obstructive or non communicating hydrocephalus

blockage within a ventricle leading to accumulation of CSF and dilation of ventricles proximal to the block

Seizure

clinical manifestation of 1. an abnormal, excessive, hypersynchronous discharge of a population of cortical neurons, or 2. a massive disruption of electrical communication between neurons in the brain. Both lead to the temporary release of excessive energy in a synchronized form. Caused by increased excitatory synaptic transmission (increased glutamate), decreased inhibitory synaptic transmission (decreased GABA), or alteration in voltage gated ion channels to favor depolarization. Involuntary changes in awareness or behavior are the clinical symptoms.

Migraine headache

common headache with often unilateral severe pulsating/throbbing pain that lasts for a few hours to days. Associated with nausea, vomiting, photophobia, phonophobia, auras. Improves with rest

White matter

composed of myelinated axons and oligodendrocytes

MRI

computer generated image compiled from thousands of data points and arranged in slices showing cross sectional anatomy. The color of each pixel is determined by the electromagnetic properties of the dominant molecules in the pixel as measured by the energy they emit when placed in a magnetic field with a radio frequency applied

computed tomography

computer generated image compiled from thousands of tiny xrays and arranged in slices showing cross sectional anatomy. Tissues appear according to their densities with the most dense being the most white.

Anencephaly

congenital absence of all or part of the brain. Failure of the rostral neural tube to close. Face is fairly well developed

Lissencephaly

congenital disorder of cortical development leading to a smooth brain surface

branchial cleft cyst

congenital epithelial cyst that arises on the lateral part of the neck due to failure of obliteration of the second branchial cleft, found along the anterior border of the sternocleidomastoid muscle. The cyst can occasionally become infected and swell, only to respond to antibiotic therapy, shrink, and then recur.

encephalocele

congenital herniation of the intracranial tissues (neural tube defect characterized by sac-like protrusions of the brain and the membranes that cover it through openings in the anterior skull). congenital mass between the eyes.

Craniorachischisis

congenital malformation in which the neural tube does not close at all, neural tissue is continuous with the skin of the back. This is fatal

putamen

connected to the substantia niagra and the globus pallidus. forms the dorsal striatum with the caudate nucleus. uses dopamine in running its processes, involved in Parkinson's disease. regulates movement

Subacute combined degeneration (spinal cord)

degeneration of the posterior and lateral columns of the spinal cord as a result of vitamin B12 deficiency (pernicious anemia). Starts with burning in the feet leads to extremity weakness, defective postural sensibilty, incoordination, ataxia. Rapidly progressive, poorly reversible.

Myotonia

delayed/poor relaxation after voluntary muscle contraction or electrical stimulation

Luetic dementia (dementia paralytica)

dementia/psychosis due to long standing syphilitic infection; pathology: loss of cortical neurons, "windblown" residual neurons; marked gliosis.

Central pontine myelinolysis (osmotic demyelination syndrome)

demyelinating disorder of the pons due to rapid overcorrection of hyponatremia (particularly in alcoholics or those with electrolyte instability)

Pb KTL ("lead kettle" acronym)

denotes origin of some of the most common cranial/vertebral bone metastases (prostate, breast, kidney, thyroid, lung/lymphoma/leukemia).

Pseudopalisading necrosis

densely cellular cuffs surrounding foci of tumor necrosis (characteristic of glioblastomas)

Amyloid angiopathy

deposition of B amyloid protein in vascular walls in the brain making them weak and more likely to bleed

bereavement

depression within 2 months after the death of a loved one

Attention Deficit/Hyperactivity Disorder (ADHD)

developmental disorder characterized by excessive activity and/or inattention. Diagnosis requires presence of symptoms before age 7, persistence for more than 6 months, and must occur in at least 2 settings. Treated with educational intervention and stimulants

pervasive developmental disorder (PDD)

developmental disorders characterized by failure to acquire (or early loss of) reciprocal social interactions and communication skills such as language, despite normal hearing.

Homer Wright rosettes

differentiated tumor cells surrounding a neuropil (area of nervous system composed mostly of unmyelinated axons, dendrites, and glial cell processes)

Dysarthria

difficult poorly articulated speech resulting from interference in the control and execution over the muscles of speech usually caused by damage to a central or peripheral motor nerve

Diffuse pontine astrocytoma (pontine glioma)

diffusely infiltrating astrocytoma that arises in the pons and brainstem of young children. All cases ultimately exhibit lethal growth.

mydriasis

dilated pupils

Neuropathy

disease or dysfunction of one or more peripheral nerves, typically causing numbness or weakness

Amyotrophic lateral sclerosis (ALS)

disorder caused by degeneration of upper and lower motor neurons. Rapidly progressive disorder characterized by weakness, muscle atrophy, fasiculations, spasticity, dysarthria, dysphagia and dyspnea that typically starts in the limbs. Generally progressive and fatal. EMG demonstrates diffuse denervation, but a clinical diagnosis. death usually after 1 decade of symptoms

conduct disorder

disorder characterized by behavior that violates social norms, such as torturing animals, stealing, setiing fires, etc...

oppositional defiant disorder

disorder characterized by defiant, resentful, non-compliant behavior that does not violate basic social norms.

Tentorium cerebelli

dura which divides brain into supra and infratentorial compartments

Squamous cell carcinoma

epithelial orgin, cuboidal cells of the basement mucosal membrane. tends to metastisize early to lymph nodes; obtain CXR at time of dx to check for mets to lungs/liver- if it has metastisize therapy becomes palliative; if only mets to lymph nodes in neck then neck dissection is performed. Most common met to the parotid gland. Constitutes 95% of head and neck cancers

Lymphoma

especially Hodgkin's, can present as cervical adenopathy.

serotonin syndrome

excessive increase in serotonin due to use of multiple drugs. Symptoms include diarrhea, restlessness, hyperreflexia**, autonomic instability, hyperthermia, rigidity, and delirium. Similar symptoms to neuroleptic syndrome but this one has hyperreflexia.

Locked in syndrome

flaccid paralysis from the neck down, accompanied by facial paralysis, anarthria (loss of the motor ability that enables speech), and aphonia (inability to produce voice). Locked in syndrome is caused by severe damage to the brain stem, dysfuntion of the descending motor pathways or peripheral nerves, secondary to bilateral destruction of the basis of pons or medulla and sparing of tegmentum, caused by infarcts or central pontine myelinolysis. Patients are conscious and alert, but only capable of communicating by moving their eyes voluntary eye movement, and eyelids blinking

laryngomalacia

floppy supraglottic structures and an omega-shaped epiglottis, noise is thought to be due to high-speed airflow through the narrow, redundant tissue of the supraglottic area. Visualized with laryngoscopy. If asymptomatic, watch for child to grow out of it. If symptomatic, can place a tracheostomy or trim the epiglottis.

Transient ischemic attack (TIA)

focal cerebral dysfunction of less than 24 hours and often only lasting a few minutes. Angina of the brain

"nuclei" of the CNS

focal collections of neuronal cell bodies that share a common task

Encephalomyelitis

focal perivascular demyelination that presents 3-21 days following some viral infections. May be associated with headache, vomiting, fever and meningismus

Evoked potentials

for intraoperative monitoring during spine surgery. A derivative of EEG, measure the brain waves that are evoked by an electrical stimulus in the limbs

Meningocele

form of spina bifida defect allowing the protrusion of the meninges in the form of a fluid filled sac

proptosis

forward displacement and entrapment of the eye from behind by the eyelids

open globe injuries

full thickness wound of the cornea and/or sclera causing exposure of intraocular contents. Suspect this if you see: bullous subocnjunctival hemorrhage, intraocular hemorrhage (hyphema), prolapsed uvea, non circular peaked pupil. Avoid intraocular pressure, emergent evaluation by ophtamologist, sedation & analgesia, eye shield.

angioneurotic edema (hereditary angioedema)

functional or quantitive deficiency of C1 esterase inhibitor; dramatic swelling of tongue, lips, pharyngeal tissue, and subglottic airway. Treated often with a surgical airway, IV steroids, and H1 and H2 blockers.

Mucormycosis

fungal infection (Rhizpos species) in immunocompromised hosts (often diabetics), of the sinonasal cavity. Causes thrombosis, distal ischemia and necrosis. shows up as blackened eschar on nasal exam; This leads to an acidic environment where fungus thrives. Diagnose by biopsy. tx is metabolic stabilization, surgical debridement and IV amphotericin B

Myopathy

general term for muscular disorder in which the primary symptom is muscle weakness, proximal greater than distal, due to dysfunction of muscle fibers. normal sensation, sometimes muscle pain, elevated CK. Diseases include myositis, muscular dystrophy

Tonic clonic seizure (grand mal)

generalized seizure that is initially tonic and then becomes clonic and is characterized by the abrupt loss of consciousness

Kayser fleischer rings

golden brown bands that look like they are in the iris but are in the limbus (descements membrane) of the cornea seen on slit lamp exam of the eye Sign of Wilsons disease

Normal pressure hydrocephalus

gradual enlargement of ventricles leading to dementia, gait impairment, and urinary incontinence in elderly

"soap bubble" abscesses

gross pathological finding of parenchymal cryptococcal infection; microabcesses surrounded by fungal capsule have soap like appearance

Secondary headaches

headaches caused by other illnesses as a symptom of another problem

conductive hearing loss

hearing loss due to dysfunction of the conductive pathway of the ear: cerumen impaction, swelling of external canal, TM perf, ossicular abnormalities, middle ear fluid. more likely to be unilateral. Weber will be louder in the ear with hearing loss. Rinne air conduction will be about the same as bone conduction

Hematomyelia

hematoma within the spinal cord

Charcot marie tooth disese (HMSN 1: hereditary motor and sensory neuropathies)

hereditary demyelinating neuropathy caused by a mutation in a myelin associated gene. Most often autosomal dominant. Usually presents in childhood or early adulthood. A characteristic progressive muscular atrophy of the leg below the knee seen in these patients gives rise to the common clinical term of preoneal muscular atrophy. Affected individuals may be asymptomatic, but when they present, it is often with symptoms such as distal muscle weakness, atrophy of the leg below the knee, or secondary orthopedic problems of the foot (such as pes cavus), but normal life span. Histopathology shows onion bulb around axon.

Wilson disease (hepatolenticular degeneration)

hereditary disease defined by decreased level of ceruloplasm leading to impaired excretion of copper in the bile, increasing serum copper. Deposition in the liver, kidneys, eyes, and brain (basal ganglia). Cystic degeneration of the putamen. Kayser fleischer rings, liver disease, movement disorders, and psychological impairment. treat with pennicillamine, a copper chelator.

Hemangioblastoma

highly vascular tumors that typically arise in the cerebellum (especially common in von hippel lindau disease). Secrete erythropoietin and can induce polycythemia. Appear as cyst with mural nodule on imaging, low grade and well circumscribed

Sudden Sensorineural Hearing Loss

idiopathic, unilateral hearing loss in a 72 hour period. start steroids immediatly and anti viral (acyclovir/fancyclovir); cause unknown but thought to be viral; most resolve, but is a medical emergency.

T2 weighted MRI

imaging modality where air and bone appear dark while CSF, blood and edema appear bright

T1 weighted MRI

imaging modality where water and CSF appear dark while fatty tissues and blood appear bright

Romberg sign

inability to maintain balance with eyes closed. Reflects severe posterior column dysfunction.

Optic neuritis

incomplete (blurred vision) or complete loss of vision due Multiple Sclerosis lesions of the optic nerve

subependymal giant cell astrocytoma (SEGA)

indolent, low grade glioma that arises from the wall of the lateral ventricle. Typically presents with signs of obstructive hydrocephalus. Associated with tuberous sclerosis

watershed infarcts

infarct occurring at junctions of distal regions of arterial supply zones to global brain ischemia

Inclusion body myositis

inflammatory myopathy characterized by asymmetric weakness and selective involvement of finger flexor and quadriceps. Most common inflammatory myopathy after age 50 and affects males more than females

Polymyositis

inflammatory myopathy characterized by subacute onset proximal muscle weakness and sometimes pain as well as elevated CK. More commonly seen in females. Treated with corticosteroids. Muscle biopsy is the diagnostic gold standard. Can be a paraneoplastic.

Dermatomyositis

inflammatory myopathy characterized by subacute onset proximal muscle weakness, elevated CK, and skin involvement (gottron's sign, heliotrope rash). Associated with malignancy 24 to 40% of the time (paraneoplastic)

Neuronal storage disorders

inherited enzyme defects that lead to accumulation of normal metabolic products within lysosomes. Often lead to seizures and cognitive decline. Examples: Hurler syndrome, Tay sachs, niemann pick, gauchers.

Excitotoxicity

injury by abnormally released neurotransmitters

globus pallidus

involved in regulation of voluntary movement at the subconscious level. relays information from other nuclei to the thalamus. made of the GP interna and externa. GP interna is responsible for sending major inhibitory output from basal ganglia to the thalamus and some projections to the midbrain to help with postural control

Brain death

irreversible coma; irreversible brain damage as manifested by absolute unresponsiveness to all stimuli, absence of all spontaneous muscle activity, and an isoelectric electroencephalogram for 30 minutes, all in the absence of hypothermia or intoxication by central nervous system depressants.

Kernig sign

knee pain with hip flexion (due to meningeal inflammation)

Brudzinski sign

knee/hip flexion when the neck is flexed (as a result of meningeal inflammation)

vestibular neuronitis

labyrinthisis. inflammation, secondary to a viral infection, of the vestibular portion of the eighth cranial nerve or of the inner ear balance organs (vestibular labyrinth). often associated with URI symptoms. Awake with vertigo that dissipates over 24-48 hours. Extreme nausea and vomiting, but hearing is normal. Treatment is supportive including anticholinergics and antihistamines. May take several weeks to completely resolve, residual vestibulopathy can last for years.

Truncal ataxia

lack of coordination of core muscles due to spinocerebellar dysfunction (wide-based, uncoordinated gate)

Psammoma bodies

laminated calcifications seen in a variery of conditions (common in meningiomas)

macroglossia

large tongue

Creutzfeldt Jakob disease

largely sporadic human prion disease. Usually due to an inherited mutation of the prion gene, iatrogenic or dietary exposure to prions. causes spongiform encephalopathy

Croup

laryngotracheobronchitis, a viral infection of the upper airway causing swelling in the subglottic (below the vocal cords) area and stridor that is high pitched on inspiration and expiration. Barking cough. Steeple sign on X ray. Treatment: humidity, oxygen, and, if necessary, racemic epinephrine treatments or steroids, or both.

Syphilitic obliterative endarteritis

late stage effect of neurosyphilis. Fibroblastic response causes damage to small cerebral arteries resulting in multiple small infarcts

regression

less mature defense mechanism. Appearances childlike patterns of behavior during stressful situations

projection

less mature defense mechanism. Attributing one's own personally unacceptable feelings to others

acting out

less mature defense mechanism. Avoiding personally unacceptable feelings by behaving in an attention-getting often socially inappropriate manner

splitting

less mature defense mechanism. Believing people or events are either all bad or all good because of intolerance of ambiguity. common defense mechanism of people with borderline personality disorder

Carcinomatous meningitis

meningitis caused by infiltration of subarachnoid space by cancerous cells

MICA patients

mentally ill chemically addicted patients. Must be treated for substance abuse as well as psychiatric illness in the hospital.

Norepinephrine

monoamine (more specifically a catecholamine) important for mood, anxiety, arousal, learning, and memory. dopamine synthesized in the noradrenergic neurons is converted to norepinephrine by dopamine B hydroxylase. most noradrenergic neurons are located in the locus cerulus. promotes wakefulness

Serotonin

monoamine (more specifically indolamine) important for mood, sleep, pain, appetite, sexual drive, and impulse regulation. It is synthesized from tryptophan. most located in the dorsal raphe nucleus (pons and midbrain). low serotonin is associated with OCD, violent behavior, poor impulse control, depression, alcoholism, chronic pain syndromes, sleep disorders and anxiety. promotes sleep. metabolized to 5-HIAA (5-hydroxyindoleacetic acid)

Acetylcholine

monoamine (specifically quartenary amine) involved in regulation of behavior (muscarinic), mood, and cognitive function (cholinergic). Synthesized from acetyl coA and choline by choline acetyltranferase. Alzheimers is associated with cholinergic neurons. promotes sleep: inducing REM sleep.

Myotonic dystrophy

myopathy. most common form of muscular dystrophy with autosomal dominant inheritance. Type 1 affects distal muscles more and type 2 affects proximal muscles. Characterized by myotonia (poor muscle relaxation), weakness and muscle wasting, frontal balding, temporal wasting, low intelligence, arrhythmias, and cataracts.

Becker's muscular dystrophy

myopathy. recessive x linked muscular dystrophy similar to but more mild than duchenne's. affects boys aged 5 to 15.

Duchenne's muscular dystrophy

myopathy. recessive x linked muscular dystrophy that results in muscle degeneration and eventually death. Caused by mutation in dystrophin gene, a muscle membrane stabilizer preventing cell degredation. Most commonly affects boys between 2-3 years. Key features are calf psuedohypertrophy, gower's sign, proximal muscle weakness and atrophy, dysphagia and respiratory weakness, and possible cardiomyopathy. Can have scoliosis, pes cavus, hyperlordosis, and scapula winging. CK is elevated.

Septal deviation

nasal septum is not centered (deviated to one side) between the right and left nasal cavity causing nasal obstructions sx's

Huntington's Disease

neruodegeneration of basal ganglia, and less severe frontal cortex atrophy. Autosomal dominant disorder with atrophy of caudate nucleus (and putamen) due to loss of GABA containing neurons (inhibitory neurons). Characterized by involuntary movements, hyperkinesia, chorea (involuntary rapid twitching), athetosis (writhing dance like movements), deterioration of cognitive function, and emotional disturbances. personality changes usually occur before motor symptoms. symptoms begin around age 40. trinucleotide repeat expansion syndrome on chromosome 4 of CAG nucleotide sequence. Displays anticipation: each generation has longer nucleotide repeats leading to increased gene instability

Neurofibromatosis type 2

neurocutaneous tumor disorder. autosomal dominant, chromosome 22, bilateral 8th nerve sheath tumors (vestibular schwannomas), meningiomas, juvenille supcapsular cataracts. cafe au lait spots, and skin neurofibromas.

Tuberous sclerosis

neurocutaneous tumor syndrome. autosomal dominant disease often involving chromosome 9 or 16 Due to mutation in gene for hamartin or tuberin. characterized by cortical tumors leading to developmental disabilities and epilepsy, mental retardation and behavioral problems . SEGAs (subependymal giant cell astrocytoma) resemble "candle drippings" that can cause hydrocephalus. Also present with cardiac rhabdomyomas and mesenchymal tumors of the kidney. facial adenoma sabaceum (angiofibromas, like acne), hypopigmented macules, shagreen patches, periungal fibromas (on finger cuticles), and subependymal nodules

Neurofibromatosis type 1

neurocutaneous tumor syndrome. autosomal dominant, chromosome 17. risk of cognitive or learning disabilities, café au lait spots, axillary freckling, lisch nodules of the iris, dermal and plexiform neurofibromas, optic nerve gliomas (pilocytic astrocytoma), Malignant peripheral nerve sheath tumors (schwann cell tumors), glioblastoma, scoliosis

Neurosyphilis

neurological sequelae of treponema pallidum infection. demyelination and axon injury of dorsal roots and sensory axons in dorsal columns. decreased proprioception, ataxia, argyll robertson pupils.

reactive attachment disorder

no normal caregiver attachment formed due to constant hospitalization, orphanage, etc. The constellation of disturbances and social relatedness see him otherwise normal infants and young children who are exposed to grossly pathological care. inhibited or disinhibited type.

Stage 2 Sleep

non REM Sleep stage associated with spindle-shaped waves at 12 to 14 cps (sleep spindles) and slow, high-amplitude groups of waves called K-complexes. It makes up 45% of sleep time in young adults, more than any other one stage. This stage is associated with bruxism (tooth grinding).

Stage 3 and 4 Sleep

non REM Sleep stages collectively known as slow-wave or delta sleep that is characterized by high-voltage delta waves at 1 to 3 cps. It takes up about 25% of sleep time in young adults and occurs mainly during the first half of the sleep cycle. Delta is the deepest part of NREM sleep and can be associated with unusual behavioral characteristics such as somnambulism (sleep walking), enuresis (bed wetting), and night terrors.

Stage 1 Sleep

non REM sleep. Takes up about 5% of total sleep time and is characterized by low-voltage theta wave activity at 3 to 7 cps. Quickly changes to the next stage

Temporal lobe epilepsy

partial rather than generalized seizure that typically originates in the temporal lobe and is marked by impairment of consciousness, automatisms, unusual changes in behavior, and hallucinations (as of odors)

Whorled "myelin figures"

pathological sign of tay sachs seen on electron microscopy. Reveals "whorled" lipids within lysosomes

Radiculopathy

pathology associated with damage to a nerve root, often due to compression. Can be associated with pain, change in sensation and weakness in a dermatomal (sensory) and myotoma (motor) distribution, often worsened by movement. example is shingles

Adenoidectomy

performed in older children who have recurrent acute otitis media or chronic otitis media with effusion, especially if effusion has returned after tympanostomy tube extrusion.

tonsillectomy

performed on adult and pediatric patients with recurrent or chronic tonsillitis, obstructive sleep apnea, asymmetric tonsils, and peritonsillar abscess. Recurrent tonsillitis of 7 per year for one year, 5 for two years, or 3 for 3 years.

Diabetic neuropathy

peripheral neuropathy characterized by mainly axonal degradation as well as segmental demyelination. Usually bilateral

Axonal neuropathy

peripheral neuropathy of axonal degeneration. Nerve conduction velocity is near normal. Muscle weakness, muscle atrophy, sensory loss, paresthesis, pain and autonomic dysfunction

Demyelinating neuropathy

peripheral neuropathy of segmental demyelination. nerve conduction velocity is decreased.Muscle weakness, muscle atrophy, sensory loss, paresthesis, pain and autonomic dysfunction

Gottron's sign/papules

pink patches on the knuckles and other extensor surfaces, associated with dermatomyositis

Decerebrate posturing

position of a comatose patient in which the arms are extended and internally rotated and the legs are extended with the feet in forced plantar flexion. It is usually observed in patients afflicted by compression of the brainstem at a low level

Myasthenia gravis

post synaptic disease of the neuromuscular junction caused by antibodies to acetylcholine receptors that break them down. Characterized by fatigable weakness and amplitude decremental response on repetitive nerve stimulation, predilection for ptosis. Can be associated with thymoma.

Mastoiditis

potential complication of AOM, infeciton of the air cells and bony structures in the mastroid

criothyrotomy

preferred method of emergent surgical airway; through cricothyroid membrane

Beta waves

present when awake, 13 to 60 Hz

Alpha waves

present when relaxed, 7 to 13 Hz

Theta waves

present with reduced consciousness, 2 to 7 Hz

foreign body in nose

presents with unilateral, foul-smelling, purulent rhinorrhea.

Botulism

presynaptic disease of the neuromuscular junction caused by a toxin produced by clostridium bacteria. Results in a defect in the release of acetylcholine and descending paralysis with pupillary involvement. Incremental response to repetitive stimulation. Floppy baby and honey

Lambert eaton

presynaptic disease of the neuromuscular junction caused by antibodies to voltage gated calcium channels. Characterized by symmetric proximal muscle weakness predominately in the lower limbs, areflexia or hyporeflexia, some autonomic symptoms and amplitude facilitation on repetitive nerve stimulation. Can be associated with small cell lung cancer. Incremental response to repetitive stimulation

Oligodendroglia

produce and maintain the myelin sheaths around the axons in the CNS

neuroleptic malignant syndrome

rare idiosyncratic reaction to the dopamine blockade of antipsychotic drugs. usually occurs within a week of starting the new drug. symptoms include: confusion, vital sign instability, extreme hyperthermia, rhabdomyolysis, cardiovascular collapse, renal failure, and death. The problem originates in the brain, not the muscle. treated by stopping drug and administering dantrolene.

Sturge weber syndrome

rare, nonfamilial neurocutaneous congenital disorder characterized by angiomas of the brain and face (port wine stain/nevus flammeus) in trigeminal distribution with involvement of underlying meninges. hypoxia leading to calcification of the angiomas in the cerebrum can cause significant mental impairment. epilepsy, glaucoma.

Electroencephalogram (EEG)

recording in which an array of electrodes is applied to the surface of the scalp and connected to amplifiers to detect the weak electrical signals transmitted from the brain through the skull.

Electromyography (EMG)

records the electrical activity of muscles

Cherry red spot (retina)

red spot of the macular. seen in Tay sachs and several other neuronal storage diseases due to increasing macular transparency

Gray matter

regions of the CNS containing neuronal cell bodies and supporting glial cells, includes cerebral cortex, cerebellar cortex, basal ganglia, and central gray matter of the spinal cord

Adenoidectomy

removeal of the adenoids, sometimes done after patients has had 2 ear tubes, helps with prevention of reaccumulation of fluids

Tympanoplasty

repair of the hole in the TM

Immune reconstitution inflammatory syndrome (IRIS)

severe exacerbation of neurological symptoms due to an overrobust immune response in previously immunocompromised patients with CNS disease (most commonly seen as significant cerebral edema in HIV patients started on HAART)

Malignant/Necrotizing Otitis Externa

severe infection of external auditory canal usually caused by pseudomonas; can spread to involve temporal bone leading to osteomyelitis or brain abscess. clinical picture: granulation tissue on exam at bony-cartilaginous junction, deep ear pain, temporal headaches, purulent drainage, and in severe cases cranial neuropathies. typically in diabetics, AIDS. tx with IV quinilones, control diabetes, and aural cleanings.

Cluster headache

severe unilateral headaches which are associated with unilateral ptosis anisocoria (miosis on affected side), eye watering, nose running. Usually occur everyday at the same time and last 15 min to three hours in clusters for weeks to months with symptom free periods in between

Red neurons

shrunken eosinophilic neurons present 6 to 24 hours after infarct of brain tissue

Gower's sign

sign that indicates weakness of the proximal muscles, namely those of the lower limb. The sign describes a patient that has to use his hands and arms to "walk" up his own body from a squatting position due to lack of hip and thigh muscle strength

Neurofibroma

slow growing benign tumor of schwann cells in the PNS that are poorly circumscribed

Lacunar infarcts

small infarcts in the territory of the deep penetrating arteries (thalamus and internal capsule, etc) often due to hypertension. Can cause no or profound clinical symptoms

micrognathia

small jaw

Charcot-bouchard aneurysms

small microaneurysms in the brain caused by weakening of arteriole walls secondary to hypertension which may rupture and cause intracerebral hemorrhage of basal ganglia, internal capsule, pons and thalamus.

Arachnoid granulations

small protrusions of the arachnoid layer of the meninges which allows CSF to leave the subarachnoid space into the blood stream

Pressure equalization tube

small tube placed in the tympanic membrane to "vent" the middle ear and prevent negative pressure build up. Is NOT for drainage of fluid.

Nociceptive pain

somatic or visceral pain caused by injury to body tissues, most common type of pain seen in an acute care setting. Classically stabbing or aching for somatic and dull or crampy for visceral

Central Retinal Vein occlusion (CRVO)

subacute onset of painless vision loss. Inreased risk with hypertension, arteriosclerotic disease, polycythemia vera, sickle cell, lymphoma/leukemia. optic disc swelling, venous engorgement, cotton wool spots, and diffuse retinal hemorrhage. treat with laser photocoagulation therapy.

corneal abrasion

superficial corneal epithelial defect that are very painful. Often have photophobia and gritty eye. Fluorescein staining and slit lamp to diagnose. Treat with lubrication

Astrocytes

supporting cells of the CNS which can react to any pathological insult, analogous to fibroblasts

tympanomastoidectomy

surgical procedure to remove growths or infected bone from inside the ear

Dystonia

sustained, involuntary muscle contractions that cause twisting or abnormal postures. seen in torticollis. focal dystonias more effectively treated with botulinum toxin

chemosis

swelling of the conjunctiva

amotivational syndrome

syndrome associated with chronic marajuana use, characterized by decreased desire to work and increased apathy

Arteriovenous malformation

tangle of abnormal arteries and veins without intervening capillaries

Primary headaches

tension, migraine and cluster headaches

Medulloblastoma

the 2nd most common brain tumor in children (most common malignant). By definition, arise in the cerebellum (most commonly the vermis in children and the hemispheres in adults). Pathologically: a "small blue cell" tumor often with Homer Wright rosettes. aggressive!

Clearance

the amount of a drug removed by the kidneys and/or metabolized in the liver during a specified period of time (mL/min)

Leukodystrophy

the disruption of myelin metabolism

mesolimbic dopaminergic tract

the dopaminergic neurons in the tegmentum of the brain stem which project forward to the nucleus accumbens and frontal cortex

residual phase of schizophrenia

the period between psychotic episodes. show negative symptoms.

Decorticate posturing

the position of a comatose patient in which the upper extremities are rigidly flexed at the elbows and at the wrists. The legs are extended Indicates a lesion in a mesencephalic (midbrain) region of the brain

Partial pressure

the pressure of an ideal gas if it occupied a fixed volume alone. Gases dissolve, diffuse, and react according to their partial pressures, and not necessarily according to their concentrations in a gaseous mixture, although the two terms are often used interchangeably. Gases always flow or equilibrate from a region of higher partial pressure to one of lower pressure.

Wallerian degeneration

the process resulting from a nerve fiber injury that separates the axon from the neurons cell body. The distal portion degenerates followed by degredation of the myelin sheath and infiltration by macrophages

Blood/gas partition coefficient or solubility

the ratio of the partial pressures of the anesthetic in the blood and alveolar gas at equilibrium

generativity versus stagnation

the seventh stage that Erik Erikson identified in his theory of psychosocial development, in which middle aged adults develop (or fails to develop) a sense of contributing to the world

intimacy versus isolation

the sixth stage that Erik Erikson identified in his theory of psychosocial development, in which a young adult develops (or fails to develop) a loving, emotional and sexual relationship with another person

Context sensitive half time

the time for the plasma concentration of a drug to decrease by 50% from an infusion that maintains a constant concentration. The context is the duration of the infusion

Volume of distribution (Vd)

the volume that relates the plasma concentration of a drug to the total amount of drug in the body. It can be though of as the "size of the tank". By rearranging the terms defining concentration, Vd becomes the dose of drug given intravenously divided by its plasma concentration

Maxillary alveolus

thickened ridge of bone that contains tooth sockets for upper teeth located in the maxilla

Cavernous sinus syndrome/thrombosis

thrombosis of the cavernous sinus; generally from rhinosinusistis; retrograde spread of thrombophlebitis from draining facial veins to cavernous sinus; results in paralysis of CN III, IV, V1, V2, and VI (all of which run through the cavernous sinus); dx with MRI/CT; tx with IV antibiotics, drainage of sinuses; anticoagulation

Syncopy

transient loss of consciousness and postural tone for few seconds to few minutes with prompt recovery

Concussion

transient loss of consciousness caused by biomechanical force on central nervous system

detoxification

treatment of withdrawal symptoms of substance abuse

Meningioma

tumors derived from the middle layer of arachnoid cells; often well-circumscribed dura-based masses (often near the dural sinuses) that compress, but do not invade brain parenchyma. Finely dispersed chromatin and inconspicuous nucleus, form whorls around vessels and stromal elements. May infiltrate adjacent bone. Generally slow growing and rarely metastasize. Are more common in women and often express progesterone receptors. psammoma bodies often present. Tumor shows NF2 gene mutation. NOT ring enhancing, but is contrast enhancing.

PCA stroke

type of stroke where contralateral homonymous hemianopia as primary deficit

MCA stroke

type of stroke where face and arm deficits are greater than leg, plus hemianopsia, aphasia/neglect as primary deficits

ACA stroke

type of stroke where leg is more affected than arm upper motor neuron weakness as primary deficit

tyramine induced hypertensive crisis

tyramine is a potent releaser of norepinephrine leading to vasoconstriction and elevated blood pressure. Tyramine is normally degraded by MAOa, so when you take MAOIs you can get hypertensive crisis. symptoms include nausea/vomiting, stiff neck, occipital headache and sweating. Foods containing tyramine: red wine, aged meats and cheeses, and soybean products.

pachymetry

ultrasound to measure how thick the cornea is

Anosognaosia

unawareness or denial of a neurological deficit such as hemiplegia and associated with a lesion in the right parietal lobe

identification

unconsciously patterning ones behavior after that of someone who is more powerful.

Port wine stain (nevus flammeus)

unilateral facial lesion due to underlying angiomas (associated with sturge weber syndrome)

Bell's palsy

unilateral facial nerve paralysis that is, by definition, idiopathic. PCR have shown herpetic infection in most cases, so aka viral or herpetic facial paralysis. This is a lower motor neuron cranial nerve 7 so the entire side of the face is affected. Onset is over hours.

Asymmetric tonsils

usually due to recurrent scarring from infections, but they may harbor tumors (such as lymphoma) and should be removed for pathologic examination.

Bullous Myringitis

variant of AOM (acute otitis media) when blisters form on the outer surface of the tympanic membrane, exquisitely painful until blisters burst.

Varicella zoster virus

viral infection of the peripheral nervous system that follows infection with chickenpox. Reactivation leads to a painful, vesicular skin eruption in the distribution of sensory dermatomes (shingles), most frequently thoracic or trigeminal (radiculopathy).

anterior horn disorder

wasting and weakness of affected muscles, fasiculations, normal sensation, painless. examples include: ALS, polio virus infection, spinal muscular atrophy (SMA).

Cytotoxic edema

water crosses an intact blood brain barrier due to osmotic forces. Increased pressure in the cells, most likely to occur in the gray matter

Wernicke korsakoff syndrome

wernicke encephalopathy (ophthalmoplegia, ataxia, and confusion) with addition of disordered recent memory, often with prominent confabulation (distorted memories). Commonly see atrophy of the thalamus and the mammillary bodies. Due to vitamin B1 (thiamin) deficiency, which is very common in alcoholism.

Xanthochromia

yellowish appearance of CSF (which is normally clear) due to the presence of blood. Commonly due to subarachnoid hemorrhage

Schizoaffective Disorder

• Fit criteria for both a mood disorder and schizophrenia • Psychotic symptoms present for at least 2 week without mood symptoms • Mood symptoms present during the psychotic and residual phases • Chronic social and occupational impairment

Delusional Disorder

• Fixed, nonbizarre delusional system present for at least 1 month • Absence of other thought disorders

Psychotic Disorder Caused by General Medical Condition (PDMC)

• Hallucinations that are visual and changeable rather than auditory and recurrent • Occurs in the context of an acute medical illness • Symptoms not due to delirium or dementia

Substance-Induced Psychotic Disorder

• Prominent hallucinations (often visual or tactile) or delusions directly related to use (particularly stimulants and hallucinogens) or withdrawal of a drug

Brief Psychotic Disorder

• Psychotic and residual symptoms lasting more than 1 day but less than 1 month • Precipitating psychosocial factors (e.g., job loss)

Primary Hypersomnias (Klein-Levin and Menstrual-Associated Syndromes)

• Recurrent bouts of excessive sleepiness occurring almost daily for at least 1 month • Sleepiness is not relieved by daytime naps • Often accompanied by hyperphagia (overeating)

Circadian Rhythm Sleep Disorder

• Sleepiness at inappropriate times during the day because of inability to sleep at appropriate times • Delayed sleep phase type involves falling asleep and waking later than desired • Jet lag type lasts 2-7 days after a change in time zones • Shift work type involves changes in scheduled work hours that cause mixed insomnia and sleepiness, leading to errors in performance at work and home

Restless Leg syndrome

• Uncomfortable sensation in the legs (and sometimes arms) necessitating frequent motion and causing insomnia and repetitive (every 25-40 s) limb jerking during sleep • More common with aging, pregnancy, and kidney disease • Associated with dopamine deficiency in subcortical brain areas and iron deficiency, which disrupts dopamine production in brain and low levels of magnesium