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Question 1

What can be used to reduce the reward pathway in alcoholics?

Answer 1

Naltrexone

Question 2

What are the features of borderline personality disorder (A.K.A EUPD) ?

What must be present for a diagnosis?

Answer 2

• Fluctuating mood - highs and lows THROUGHOUT THE DAY
• intense and immediate relationships (romantic and friendly)
• “empty” feeling
• self-harm

3 Ps for diagnosis
Persistance (been there from teenager)
Pervasive (impacts all parts of life)
Problematic (pt sees it as a problem)

Question 3

Explain in terms of physiology the difference between anti-cholingeric and acetylcholinesterase inhibitors?

Answer 3

Noradrenaline = sympathetic
acetylcholine (ACh) = para

Anti-cholingeric - block ACh from binding (increasing symphatetic response as no parasympthateic can bind)

Acetylocholinersterase inhibitors - stop the break down of ACh - increased binding of ACh (increasing para response)

Question 4

For each of the following match a dementia:
- Visual hallucinations, personality change and early onset
- later onset, forgetting of appointments, forgetting faces and names
- step-wise decline after vascular incident
- problems with multitasking and complex cognitive actions + later Parkinson’s features

Answer 4

1. Frontotemporal
2. Alzheimer’s
3. Vascular
4. Lewy body dementia

Question 5

What medications should be avoided in dementia unless patient in severe distress?

Answer 5

Anti-psychotics

Question 6

Anticholingeratase inhibitors are the main stay of treatment for Alzheimer’s - give the 3 examples

What is the second line (or add on) treatment?

Answer 6

Don Riva went to the Gala

Don(epezil) Riva(stigmine) went to the Gala(ntamine)

2. Memantine (NDMA receptor antagonist)

Question 7

For each of the following descriptions, name the diagnosis:
- pt constantly coming in with new physical symptoms that never have any positive investigations
- pt who has episodes of disruption to memory, awareness, thoughts etc.
- pt who deliberately makes up/exaggerates their symptoms
- pt who does the above for financial gain
- pt who is convinced they have a certain condition e.g. lung cancer

Answer 7

1. somatisation disorder
2. dissociative disorder
3. factitious disorder
4. malignering
5. illness anxiety disorder/hypochondriac

Question 8

Migraine presentation

Migraine management

Answer 8

POUND

Pulistile headache
One day duration
Unilateral
Nausea
Disabling

Acute
- use pain meds at early symptoms
- tripatans as early as poss

Preventative (if >3/month)
- propranolol
- tropimate (anti-epelitc)

Question 9

What assoc. symptom is common in migraines with kids

Answer 9

N+V, diarrhoea, tummy pain

Kids can have N+V without headache = abdominal migraine

Question 10

Complete the headache flowchart

Question 11

What medication is used to manage trigeminal neuralgia?

Answer 11

Carbamazepine (anti-epeletic)

Question 12

Cluster headache management

Answer 12

Avoid triggers

Acute - S/C triptans + 100% O2

~prophylaxis - verampil

Question 13

What medication should be started in a subarachnoid haemarroghe?

Answer 13

Nimodipine - reduces vasospasm

Question 14

How should meds be stopped in medication overuse headache?

Answer 14

Immediately unless need step down e.g. opiates

Question 15

Prolonged diarrhoea is associated with what ABG findings and what electrolyte imbalance?

What should be done to manage the electrolyte imbalance

Answer 15

Metabolic acidosis with HYPOkalaemia

Telemetry
Check Mg+ and deliver IV replacement

Question 16

In what kind of ABG is the anion gap relevant?

How is it interperted?

Answer 16

Metabolic acidosis

Anion gap = the balance of positive and negative ions in the body - should be balanced and normal

If high = too many -ve ions

Lactate - shock
Keto acids - DKA
Salycitate - aspirin OD

If normal = losing HCO3-

Kidneys - Addisons, RTA, dieurtics
GI - severe diarrhoea

Question 17

What type of pneumonia is associated with cavitating lesions?

Answer 17

Staph aureus