141 questions Flashcards
strongest risk factor for suicide
substance use + indigenous
if a person has both ovaries and testes.
Hermaphroditism.
This scale has sections on symptoms, behaviour, social and functioning.
Answer: Brief psychiatric rating scale.
This scale detects psychiatric caseness. Choices, BPRS, GHQ, HoNOS
GHQ, general health questionnaire.
Erik Erikson, which one of the following is mentioned in a psychosocial theory
Answer: Generativity. This is the stage of generativity versus stagnation.
In which phase is one happy or relieved to have learnt a new skill?
Answer: Industry versus inferiority.
Female child seems normal then has learning problems after six months and appears like she has acquired microcephaly.
Answer: Rett syndrome.
Male child with hand biting and other self-injurious behaviours.
Lesch-Nyhan syndrome.
What differentiates normal age-related cognitive decline from dementia?
Progressive cognitive decline.
Other than age, which factor is associated with higher seizure thresholds?
Bilateral ECT
Male patient was admitted for detoxification, has had IV heroin 10 times a day, want substitution therapy.
Methadone high dose
This will be diagnostic in 70% of patients with sporadic CJD.
Answer EEG. The variant CJD shows pulvinar sign on regular MRI not fMRI.
My boss looks at me a certain way. He must hate me.
jumping to conclusions
A homosexual man thinks that the community will not accept him so he enters a heterosexual relationship.
Denial.
Which of the following would be most appropriately detected by diffusion tensor imaging in schizophrenia.
• Lateral ventricular enlargement.
• Enlarged parahippocampal gyrus.
• Parietal lobe blood flow abnormalities.
• Frontal and temporal white matter abnormality.
Frontal and temporal white matter. Schizophrenia has frontal and temporal involvement. Parietal lobe involvement indicates Alzheimer’s.
Decreased ability to concentrate urine.
Lithium.
A 17-year-old female reports hearing her friend say bad things about her.
Delusional perception
Mother leaves the child. Upon returning, he cries. She says, I’m back now and he freezes. Insecure avoidant, insecure resistant or disorganised.
Insecure resistant.
Child can play next to mother.
Mahler practicing
Lowest risk mood stabiliser in pregnancy.
Lamotrigine.
Overdose of benztropine amongst bradycardia, hypertension, miosis, tachycardia, tachypnoea, tremor and mydriasis.
Mydriasis
Mother who suffered from childhood sexual abuse previously finds a man who is attempting to sexually abuse her 6-year-old son. She defends her son by attacking the man and killing him.
provocation
Which childhood disorder can lead to panic disorder without agoraphobia. Choices, separation anxiety, major depression of adolescence and reactive attachment disorder of infancy
Separation anxiety.
Patient wants to kill his partner. Select the most relevant forensic concept.
Tarasoff Rule. Other choices were Durham rule not used.
Jacksonian seizures area of the brain.
Choices:
• Uncus which gives olfactory hallucinations
• medial basal temporal lobe - complex partial seizure symptoms
• postcentral gyrus
• occipital lobe.
Precentral motor area.
Which treatment shows best evidence in Tourette’s.
Answer: Amongst the choices, haloperidol would be first to risperidone. If tetrabenazine or risperidone given, then choose risperidone. D2 blockers should be considered.
Which neurotransmitter is related to pain - noradrenaline, dopamine, sertraline or substance P.
Substance P
Which is the most important step in assessing hoarding disorder?
home visit
Congenital amusia lesion
Left auditory cortex, right superior temporal gyrus, potentially right in congenital amusics. Right superior temporal gyrus is the most likely answer.
confused male enters the emergency department with gaze palsy and clear psychotic symptoms.
Thiamine
Patient with melancholic depression has had partial response to three different SSRIs. Next best step in management.
snri
Which drug interferes with alcohol enzyme breakdown.
Disulfiram - acetaldehyde dehydrogenase inhibitor.
An 8-year-old girl refuses to go to school, do her homework or read aloud in class when instructed by her teacher. She enjoys spending time overnight at her friends’ homes and staying with her grandparents. She has a normal IQ.
ODD
After which age is daytime enuresis considered normal.
After 4 years of age. Nocturnal enuresis by 5 to 7 should be achieved continence.
Apart from bifrontal ECT, which of the following is associated with increased cognitive problems following the procedure.
Bitemporal ECT is an option, age is another option.
A woman lost her husband suddenly in a car accident three weeks ago. She is tearful, agitated and has poor sleep. Amongst the choices, antidepressants, supportive care and regular monitoring, low-dose benzodiazepines.
Supportive care and regular monitoring.
A previously confident 27-year-old witnessed his best friend die in an accident two weeks ago. He is now constantly on edge and full of apprehension when he is anywhere near cars. He has difficulty concentrating.
acute stress disorder
A Sudanese refugee discharged from hospital, which is the most important risk factor for suicide.
recent admission
Middle-aged indigenous male with a history of substance use, not current, has a court hearing. Most important risk factor for suicide.
Answer: Likely the impending court hearing - risk to reputation.
Patient with diabetes on metformin dieting for two days attends emergency department cold and tremulous.
hypoglycemia
An 86-year-old man in hospital for two weeks develops confusion and tachypnoea, normal temperature.
PE
Young male admitted with mania on sodium valproate and chlorpromazine as prn continues to present in an irritable elevated state despite increasing the dose of chlorpromazine.
Anticholinergic intoxication.
businessman has continued sobriety now for four months, has a business trip coming and has decided to see GP about medication options and considering ways he can negotiate business catch-ups, which would usually be associated with alcohol.
maintenence
Young man goes to see the general practitioner. He wants to give up alcohol but is unsure.
contemplation
Female aged 22 admits to binging on cereals when feeling low. Afterwards she suffers some transient depressed feelings.
BED
Two symptoms of anorexia nervosa.
LANUGO, AMENORRHHOEA
This treatment works better with bulimia nervosa.
CBT
This treatment works better with anorexia.
FBT
Patient refuses any therapeutic intervention.
: Inpatient treatment - indicates a poor prognosis
Three weeks after being injured in a motor vehicle accident, a young man still has nightmares and intrusive memories, poor sleep, panic of the crash in which his friend was killed.
acute stress disorder
A 17-year-old from a Fundamentalist Christian household admitted for weight loss says she cannot eat as demons say they are spitting in my food.
schizophrenia
I am being followed. I have notes of all the car registrations and there is a clear pattern plus all the cars are white. A choice of delusional disorder versus schizophrenia.
schizophrenia
A 17-year-old man with fever and confusion along with neck stiffness.
meningitis
A lady with HIV gets sudden-onset headache, confusion, CSF shows high protein.
meningitis
A man with unilateral headaches with noise sensitivity.
migraine
A lady with lots of stress at work getting unilateral headaches sometimes with photophobia.
Cluster headache.
A 35-year-old man who gets unilateral headache at the same time every night. Hypnic headache for two to three hours.
Cluster headache.
In schizophrenia, what happens to: oestradiol
low
In schizophrenia, what happens to: progesterone
low
In schizophrenia, what happens to:FSH
low
Lady with recurrent leg wound presents to the emergency department on multiple occasions. Wound is infected with faecal bacteria.
Munchausen syndrome.
Patient presents to the general practitioner with multiple complaints, investigated but still thinks the doctor may have missed something.
illness anxiety disorder.
Patient presents to the general practitioner on multiple occasions unconvinced his HIV test is negative.
illness anxiety disorder.
A 45-year-old lady with chronic back injuries seven years ago sleeping more frequently lately has not been able to develop an intimate relationship for many years.
Pain disorder / Briquette’s syndrome, somatisation, clinically significant complaints about somatic symptoms.
A daughter comes in with an elderly mother concerned that she is now living in squalor and hoarding things.
Diogenes.
Middle-aged man with gastric varices, asterixis, confusion and ataxia.
Answer: Hepatic encephalopathy
Middle-aged lady with fatigue complaining of weight gain, low mood, tiredness and has constipation.
hypothyroid
Man whose wife is heavily pregnant and feels abdominal discomfort.
couvade
Older man on SSRI with depression for several years develops stiffness of right arm and fine tremor,
PD
GP thinks the man is likely drinking heavily. Which test is most likely to show an abnormality?
elevated MCV or macrocytic anaemia (GGT is not present, other one is carbohydrate deficient transferrin, CDT.)
Elderly man has visual hallucinations. Wife says it is worse since starting on antipsychotics.
LBD
12-year-old boy is the father of a 3-year-old girl next door. Parents are mortified.
sex education
Teenage girl kills her parents, suggest history of abuse
parricide
Mother kills her three children age 3 to 12 years.
filicide
Young man enjoys collecting women’s lingerie for sexual excitement.
paraphillia
Decreased activity and lack of ability to execute action despite effort to do so.
abulia
Feeling that the insides are rotten.
cotard
Visual hallucination of oneself on the outside.
autoscopic
Differentiate between Asperger’s and autism
language
kernig
meningitis
Argyll Robertson pupil
neurosyphilis
A 60-year-old male with Parkinson’s, regular medications not working.
ECT
Answer: ECT.
Accepted management for ADHD in children.
Stimulant treatment plus behavioural therapy.
Self-rating tools in depression.
Beck’s depression inventory
Patient imitates the movement of the interviewer.
echopraxia
A 25-year-old female with anorexia nervosa. The most important abnormality to be concerned about amongst choices of leukopenia, low FSH and lymphocytosis.
leukopenia
Young soccer player sustains a head injury, 12 hours later father notices him urinating in dust bin.
SDH
Feeling of penis shrinking into the abdomen.
Koro
Sudden bout of aggression followed by period of brooding.
Amok
Floppy baby syndrome.
BDZ
Tourette’s disorder localisation.
Caudate
Parkinson’s disease
SN
Wilson’s disease
Globus pallidus
Behavioural therapy
Skinner
Borderline personality organisation.
Otto Kemberg.
Primary excitatory neurotransmitter
Glutamate
Primary inhibitory neurotransmitter.
GABA
This neurotransmitter is decreased in CSF of violent individuals
5-HIAA. (Linked to impulsivity). If they ask enzyme then MAO-A linked to antisocial behaviour.
Young man started on antipsychotics. Which side effects is he at most risk of developing.
Choices: Dystonia, akathisia, Parkinson’s.
Dystonia.
Which movement disorder is associated with the highest rate of suicide?
Akasthesia
Side effect that develops one week when starting antipsychotic treatment.
Dystonia
Amphetamine-like substance often in ethnic groups such Somali community.
Khat
Anterograde and retrograde amnesia localisation.
Mammillary body
Male presents saying that he has auditory hallucinations requesting benefits. His mother was recently diagnosed with a life-threatening illness. He is distressed.
Diagnosis: Malingering, factitious disorder, Munchausen. This is a difficult one to answer as it will be important not to jump to conclusions that - unclear but would be helpful to see whether any additional info have been provided.
DBT based on which philosophy.
buddhism
Which is one of Bleuler’s cardinal symptoms of schizophrenia.
Answer: Ambivalence. Others include Autism, Affective disturbance, ambivalence and disturbance of thought which is (Associations). The 4 A’s.
A man comes in requesting Viagra for sexual dysfunction. He is not aware of the link between alcohol use and sexual dysfunction.
precontemplation
Which ventricles are enlarged with schizophrenia?
Answer: Lateral ventricles.
In schizophrenia in PET scan- frontotemporal hypometabolism.
Second day postpartum, patient tearful and unable to sleep.
Answer: Adjustment disorder with depressed mood or postnatal blues.
Similar to CJD, with longer duration to death
Gerstmann-Straussler Syndrome
PML
Caused by JCV, and is one of the most feared complications of HIV1. Can occur when CD4 counts are higher than those associated with AIDS.
Most common prion disease
CJD (sporadic type)
Variant: onset in young adults, median duration is 13-14 months. Prominent behavioural/psychiatric symptoms with painful dysthaesias. Neurological signs delayed.
Sporadic CJD: most common form of CJD. Onset in 5-6th decade. Median duration of illness = 4-5 months. Dementia occurs earl with neurological signs.
Prion diseases
CJD
Gerstmann-Straussler-Schinker disease
Fatal familial insomnia
Kuru
Psychogenic polydypsia
Serum osmol low
Urine osmol low
SIADH
Serum osmol low
Urine osmol high
Fred, aged 24 has a history of seizures of various forms since 4yo. Later in life he developed multiple red or brown nodules including on face in a butterfly distribution over cheeks and bridge of the nose.
In 20s, mental condition worsened with IQ measuring borderline despite above average academic success previously.
Tuberous scelerosis
Rare multisystem autosomal dominant genetic disease that causes non-cancerous tumours to grow in the brain and on other vital organs such as the kidneys, heart, liver, eyes, lungs and skin. A combination of symptoms may include seizures, intellectual disability, developmental delay, behavioral problems, skin abnormalities, lung disease, and kidney disease
Matt, aged 22 has had emerging clumsiness since his teenage years. His gait is now broad based and lurching in style with an action tremor in his arms. On exam, a kyphoscoliosis is noted. No specific mental difficulties.
Fredreiches ataxia
Autosomal-recessive genetic disease that causes difficulty walking, a loss of sensation in the arms and legs, and impaired speech that worsens over time. Symptoms generally start between 5 and 20 years of age. Many develop hypertrophic cardiomyopathy and require a mobility aid such as a cane, walker, or wheelchair in their teens. As the disease progresses, some affected people lose their sight and hearing. Other complications may include scoliosis and diabetes mellitus.
Arnold is a 55yo man with a history of slowly developing unusual gait that is wide based and high stepping, accompanied by sharp pains that are brief and stabbing in the legs and feet. Arnold also complains of recurrent attacks of epigastric stomach pains, with vomiting. His family say he has become increasingly suspicious of others.
Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum subspecies pallidum
The primary stage classically presents with a single chancre (a firm, painless, non-itchy skin ulceration usually between 1 cm and 2 cm in diameter) though there may be multiple sores.
In secondary syphilis, a diffuse rash occurs, which frequently involves the palms of the hands and soles of the feet. There may also be sores in the mouth or vagina.
In latent syphilis, which can last for years, there are few or no symptoms.
In tertiary syphilis, there are gummas (soft, non-cancerous growths), neurological problems, or heart symptoms.
Sam is a 57yo man who has noticed gradual weakening of both his hands and arms. On exam, atrophy of small muscles of hand are noted as is prominent twitching and hyper reflexia
MND
Motor neuron diseases or motor neurone diseases (MNDs) are a group of rare neurodegenerative disorders that selectively affect motor neurons, the cells which control voluntary muscles of the body. They include amyotrophic lateral sclerosis (ALS), progressive bulbar palsy (PBP), pseudobulbar palsy, progressive muscular atrophy (PMA), primary lateral sclerosis (PLS), spinal muscular atrophy (SMA) and monomelic amyotrophy (MMA), as well as some rarer variants resembling ALS.
Mark is a 19yo man with a history of developing muscular rigidity including decreased facial expression, tremor and writhing or flapping movements of arms and wrists. A history of jaundice is also noted.
Wilson’s disease
Wilson’s disease is a genetic disorder in which excess copper builds up in the body. Symptoms are typically related to the brain and liver. Liver-related symptoms include vomiting, weakness, fluid build up in the abdomen, swelling of the legs, yellowish skin and itchiness. Brain-related symptoms include tremors, muscle stiffness, trouble in speaking, personality changes, anxiety, and psychosis.
Movement disorder when patients exhibit grimacing and bon bon sign?
TD
50M with FEP, tremor of facial muscles, speech disturbance and optic neuritis
Neurosyphillis
60M cortical blindness following head injury, but denies he has any visual disturbance
Anton Babinski Syndrome
When is child able to achieve mental representation and perform make believe play
2-5yo
When does the child develop capacity for emotional self awareness
2-5yo
When does the child become emotionally responsive to feelings of others
6-11yo
Cognitive distortion for ‘my boss must hate me, because I feel so bad when he talks to me?’
Emotional reasoning
Cognitive distortion for ‘I am just a great big, A grade, all time loser, that’s all there is to it.’
Labelling and mislabelling
Cognitive distortion for ‘my coach said I played well, but that’s not what she really thought. She was just saying that to be nice. I could tell.’
Disqualifying the negative
Frotteurism
A type of paraphillia
the act of touching or rubbing one’s genitals against another non-consenting individual in a sexual manner, to attain sexual gratification.
Complex behaviours initiated in first third of the night during non-REM sleep
Sleep terror disorder
Repetitive leg movements every 20-60 seconds without patient distress
Nocturnal myoclonus
Decreased REM latency
MDD
What cognitive distortion ‘’medications don’t seem to work for me, I tried an antidepressant a few years ago which did nothing so I don’t see how another would work now’
Over generalisation
What cognitive distortion - ‘I spilt coffee all over the floor, everything seems to be going wrong today. Nothing ever goes right for me’
All or nothing thinking
50yo with OCD with increasing thoughts and compulsion related to contamination and cleaning. What symptom.
Dermatitis
What is the health performance indicator for 28 day Re admission rate
Effectiveness
What is the health performance indicator for average length of inpatient stay
Efficiency
