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Questions from past papers-Any answers??

82 posts in this topic

1) In alexia with agraphia, naming errors occur

2) Having a seizure is more suggestive of Pick’s disease than Alzheimer’s dementia

3) In Huntington’s chorea, retrograde amnesia is consistent throughout life.

4) Acamprosate is an NMDA antagonist

5) Carbamazepine is associated with hypothyroidism

6) The Lithium level increases when given with Fluoxetine.

7) Relatives of a patient with depression have increased genetic risk of alcoholism.

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1) In alexia with agraphia, naming errors occur

False.

alexia with agraphia

posteriorly placed focal lesion that damages the posterior parietal and lateral occipital regions

Anomia

atrophy of the deep temporal lobe

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2) Having a seizure is more suggestive of Pick’s disease than Alzheimer’s dementia FALSE

DIFFERENCES BETWEEN PICK'S DISEASE AND ALZHEIMER'S DISEASE:

The main difference between Pick's disease and Alzheimer's disease is that the damage occurs in different areas of the brain, at least in the early stages. In most cases of Pick's disease, the frontal and temporal lobes of the brain are the areas affected and with Alzheimer's disease, the temporal and parietal lobes are affected. Mendez and co-workers (1993) found, even in the absence of temporal or frontal lobe atrophy on CT brain scans, that Pick's disease can be distinguished from Alzheimer's disease if three of the following five characteristics are present early in the disease: presenile onset (under 65 years old); initial personality change; hyperorality (loss of normal controls, ie., excessive eating, indiscriminate putting things in one's mouth); disinhibition; roaming behaviour. Compared with Alzheimer's disease, impairment of intellect and memory occur later. As well, epilepsy is uncommon, delusions and hallucinations are rare, and apraxia (inability to perform, command, or imitate a familiar action) and agnosia (inability to recognise objects) are less common. Gait and muscle tone are less affected. In the late stages, Parkinsonism symptoms, immobility, incontinence and mutism occur. In the terminal stage, the different dementias are clinically undistinguishable.

http://www.zarcrom.com/users/alzheimers/odem/pk5.html

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3) In Huntington’s chorea, retrograde amnesia is consistent throughout life. TRUE

Neurobiol Aging. 1988 Mar-Apr;9(2):181-6. Related Articles, Links

Retrograde amnesia in patients with Alzheimer's disease or Huntington's disease.

Beatty WW, Salmon DP, Butters N, Heindel WC, Granholm EL.

Department of Psychology, North Dakota State University, Fargo 58105.

Retrograde amnesia (RA) was studied in patients with Huntington's disease (HD) or Alzheimer's disease (AD) using an updated version of the remote memory battery originally developed by Albert, Butters and Levin. Regardless of whether remote memory was measured by unaided recall or cued recall, HD patients exhibited deficits that were equally severe across decades. RA was more severe in AD than in HD patients and the AD patients recalled significantly more items from the 1940s and 50s than from the 60s, 70s or 80s. The AD patients also displayed dysnomia, while the HD patients did not. Naming difficulties appeared to contribute to the poor overall performance of the AD patients, but did not account for the temporal gradient of their RA. These findings, like recent reports focusing on these patients' ability to learn new information and to search semantic memory, indicate that the processes underlying AD and HD patients' memory failures are distinct.

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4) Acamprosate is an NMDA antagonist TRUE

Neuropharmacology. 2001 May;40(6):749-60. Related Articles, Links

The anti-craving compound acamprosate acts as a weak NMDA-receptor antagonist, but modulates NMDA-receptor subunit expression similar to memantine and MK-801.

Rammes G, Mahal B, Putzke J, Parsons C, Spielmanns P, Pestel E, Spanagel R, Zieglgansberger W, Schadrack J.

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5) Carbamazepine is associated with hypothyroidism

TRUE

1/Long-term treatment of children with epilepsy with valproate or carbamazepine may cause subclinical hypothyroidism.

Eiris-Punal J, Del Rio-Garma M, Del Rio-Garma MC, Lojo-Rocamonde S, Novo-Rodriguez I, Castro-Gago M.

2/Our data suggest that children treated with carbamazepine may have subclinical signs of hypothyroidism, and these changes are more evident if carbamazepine is given in association with valproic acid, while no alteration in thyroid hormones can be found with valproic acid monotherapy. Thyroid-stimulating hormone and thyrotropin-releasing hormone levels do not seem to be affected by these drugs, suggesting that hypothalamic function is not affected in these children.

Pediatr Neurol. 2001 Jul;25(1):43-6.

Thyroid hormones in epileptic children receiving carbamazepine and valproic acid.

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6) The Lithium level increases when given with Fluoxetine. FALSE

Lithium concentration is not influenced by cyt p450 as it is not metabolised at all.

I actually found an abstract that says the opposite (li cc decrease when given with fluoxetine):

Pharmacokinetic interactions between lithium and fluoxetine after single and repeated fluoxetine administration in young healthy volunteers.

Breuel HP, Muller-Oerlinghausen B, Nickelsen T, Heine PR.

Department of Psychiatry, Free University of Berlin, Germany.

Pharmacokinetic interactions following coadministration of fluoxetine and lithium were investigated in 10 young healthy subjects. Both drugs were administered orally in a non-blinded design with 3 consecutive treatment periods: single oral dose of lithium (32.4 mmol lithium as acetate, Quilonum; coadministration of single oral doses of lithium (32.4 mmol) and fluoxetine (Fluctin, 60 mg); and single oral dose of lithium after 7-day pretreatment with fluoxetine (20 mg t.i.d.). Periods 1 and 2 were separated by a 1-week washout phase, while period 3 followed on immediately after period 2. Lithium serum concentrations were practically identical in periods 1 and 3 (administration of lithium alone and after chronic fluoxetine dosing). However, in period 2, when the 2 drugs were coadministered as single oral doses, the lithium concentrations were lower in the first 4 hours after medication compared with treatment periods 1 and 3. Cmax was also significantly lower in period 2. The times to peak, however, were not significantly changed by any fluoxetine comedication. The parameters AUC0 --> infinity, t1/2, total clearance (Cltot) and renal clearance (Clren) determined after administration of lithium alone did not differ statistically from values determined after single or after repeated fluoxetine dosing. Coadministration of lithium and fluoxetine did not produce any clinically relevant changes in hemodynamics, ECGs or laboratory parameters. After single doses of both drugs the most frequently reported symptoms were gastrointestinal complaints, while mild sedative symptoms were predominant when lithium was given after repeated fluoxetine medication

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7) Relatives of a patient with depression have increased genetic risk of alcoholism. TRUE

from today's news...

Scientists say they've identified a gene that appears to be linked to both alcoholism and depression, a finding that may one day help identify those at higher risk for the diseases and guide new treatments.

Previous studies of twins and adopted siblings have suggested there likely are genes in common underlying alcoholism and depression, and that the two disorders seem to run in families. But the lead researcher of the new study says this is the first report of a specific gene that seems to increase risk for both disorders.

http://www.cbsnews.com/stories/2004/09/08/health/main641832.shtml

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1.Nicotine receptors in the brain are ion gated

2.Duloxitine has significant benefit in urgent incontinence

3.Duloxetine is serotonine and NA reuptake inhibitor

4.Duloxitine has a halfe life of 24 hours

5.Mirtazapine blocks H1 receptors

6.Clozapine causes akathesia less than risperidone in any dosage.

7.duolextine is an ssri and nari

8.Grapefruit juice inhibits CYP450

9.Tinnitus is seen more often in Benzo withdrawal than GAD

10.Pantothenic acid deficiency can cause dementia

11.Treating niacin deficiency related delirium is associated with improvement in 5 days

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1.Conduct disorder has 0.1-0.2 inheritance

2.when the mother remary girls are more distressed than boys

3.social cohesion protects against influenza

4.maternal deprivation is significantly associated with alcohol dependence

5.Somnambolism occurs in stage 3 and 4 NREM sleep

6.Eysenk personality inventory is idiographic

7.EEG in Huntington disease shows characteristic spikes and waves

8.Delirium is associated with theta waves in EEG

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5.Mirtazapine blocks H1 receptors TRUE

Mirtazapine is a presynaptic alpha-2 antagonist that has dual action by increasing noradrenergic and serotonergic neurotransmission. The enhancement of serotonergic neurotransmission is specifically mediated via 5-HT1 receptors because mirtazapine is a postsynaptic serotonergic 5-HT2 and 5-HT3 antagonist. In addition, mirtazapine has only a weak affinity for 5-HT1 receptors and has very weak muscarinic anticholinergic and histamine (H1) antagonist properties. As a consequence of its unique pharmacodynamic properties, mirtazapine is an effective, safe and well-tolerated addition to the antidepressant armamentarium. Mirtazapine is well absorbed from the gastrointestinal tract following oral administration, and it is extensively metabolized in the liver to four metabolites via demethylation and hydroxylation, followed by glucuronide conjugation.

http://www.biopsychiatry.com/mirtazapine.html

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10.Pantothenic acid deficiency can cause dementia

False

Pantothenic acid is not stored in the body. Although no specific deficiency syndrome has been recorded, pantothenic acid deficiency may occur as part of the overall problem in people who are severely malnourished. No toxic intakes have been recorded. There is no biochemical method for measuring pantothenic acid status in humans.

Oxford Textbook of Medicine.

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11.Treating niacin deficiency related delirium is associated with improvement in 5 days

True.

Niacin (B3)

Deficiency

Because of the current niacin supplementation of grains and breads, the classical deficiency syndrome of pellagra (dermatitis, dementia, diarrhea) is rare in the United States. Deficiency is seen most often in patients with chronic alcoholism, malabsorption syndromes, or carcinoid syndrome, in which a large amount of tryptophan (niacin precursor) is converted instead to serotonin.

Central nervous system dysfunction includes irritability, headache, insomnia, psychosis, hallucinations, and seizures.

Treatment

Isolated niacin deficiency is unusual in the United States, so treatment with other B vitamins often accompanies niacin replacement. Depending on their severity, the symptoms of pellagra respond to oral doses of 100 to 500 mg of niacin per day. Mental, gastrointestinal, and oral symptoms clear rapidly, but the resolution of skin lesions may require weeks to months. Large doses of nicotinic acid (1–3 g/d) used to treat hypercholesterolemia can cause flushing, pruritus, burning sensations, nausea, vomiting, heartburn, diarrhea, dizziness, and tachycardia. Hyperglycemia and increased serum transaminase and bilirubin levels can occur at doses as low as 750 mg of nicotinic acid per day.

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5.Somnambolism occurs in stage 3 and 4 NREM sleep

True.

Sleepwalking disorder tends to occur between 4 to 8 years of age and, like night terrors, tends to dissipate in adolescence. Episodes occur out of slow wave sleep; during them, patients appear confused and disoriented.

Kaplan

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8.Delirium is associated with theta waves in EEG

EEG is exquisitely sensitive to changes in brain electrical activity in delirium, showing generalized slowing into the theta and delta ranges and slowing of the posterior dominant (alpha) frequency. In hyperadrenergic states, increased beta activity is seen. During an episode of delirium, EEG can be performed serially to determine whether the syndrome is resolving or worsening as a function of treatment of the presumed etiology.

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1.Buliemia is associated with significant increase in rectal carcinoma

2.exessive alcohol drinking is significantly associated with incresed oesophageal carcinoma

3.Hachiniski score can differentiate alzheimers from mixed vascular and alzheimers disease

4.Lewy bodies are seen in about 30% of people with dementia

5.screening for ApoE is useful in councelling of family members in alzheimers disease

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