25/3/22 Flashcards
What is the most effective form of emergency contraception?
Cu-IUD
What other manifestions can you see in psoriasis?
Nail changes = peeling
Psoriatic arthritis
When cut self get little plaques appearing = Koeber phenoneum
What do you recemmond to patient who has missed taking her progesterone only pill?
Take missed pill -> continue as normal -> use condoms for 2 days
What is the acronym to remember MSE?
ASEPTIC
Apperance and behaviour Speech Emotion (mood and affect) Perception Thought content and process Insight and judgement Cognition
What things do you mention under the A of ‘Aseptic’ for MSE?
Appearance and Behaviour
Appearance
- Age
- Weight
- Distinguishing features e.g. scars inc. self harm, tattoos
- Clothing - appropraite? able to dress themselves?
- Any objects with them?
Behaviour
- Eye contact
- Facial expressions
- Body language - disinhibited?
- abnormal movements/posture - akathisia
- engangment and rapport
For each of the following presentations state what word you would use to describe this in a MSE?
- someone who appears to not be able to sit still and constantly moving?
- speech is rapid and there is an urgency to it?
- patient is overly sexual and constantly trying to flash/come on to you?
- speech is very slow and one tone
- experiences their own thoughts spoken/repeated out loud
- patient makes up a new word or phrase or uses exisiting words or phrases in bizarre ways
Akathisisa Pressure of speech Disinhibited Monotonous Thought echo Neologism
What is the most important thing that you do not miss asking in a mental health comms?
Suicide and self harm risk/attempt
What is the difference between 2nd and 3rd person auditory hallucinations?
2nd person - directly addresses the paitent
3rd person - discuss the paitent/provide a running commentary
How would you describe a hallucination where people feel things crawling beneath their skin?
Somatic hallucination = any bodily hallucination
What is the name of the phenomena where people feel as though there is an external body controlling their behaviour?
Passivity phenomena
What is this an example of:
I’m absolutely fine, and terribly busy, so I can’t give you long that’s a nice tie you are wearing did you buy it in Paris? I love Paris in the spring time I love Paris in the fall. Fallen arches, you look as though you could have those would you like me to cure them for you?
What condition is this associated with?
Flight of ideas
Hypomania
What is ‘Knight’s move thinking’ or ‘loosening of associations’?
Speech is muddled, difficult to follow and cannot be clarified.
Jump from topic to topic with no logical connection
Delusion is when someone strongly believes something and nothing and no experience will change their mind.
There are different themes of delusion that are assoc. with certain conditions. Name what condition is assoc. with each group of delusions;
- disease, nihilism, poverty, sin and guilt
- control, persecution, reference, religion and love
- grandiosity, persecution, religion
- depression
- schizo
- mania
A previously depressed patient says that generally they are feeling a lot better but today they feel “very low” and at interview looks unhappy but is able to laugh at jokes. What would be the best description of their mood and affect at interview?
Mood ‘very low’
Affect low but reactive
What is the term used to describe each of the following thought conditions:
- someone is putting thoughts in their head
- someone is taking thoughts out of their head
- others can hear their inner thoughts
- Thought insertion
- Thought withdrawl
- Thought broadcasting
How would you quickly assess a patient’s cognition?
Orientated to time, place and self
- where are we
- what day is it
- who are you, age and DOB
How could you assess if a patient has insight?
‘Do you feel like you could have a problem?’
Is re-feeding permitted under the Mental Health Act?
Yes
Alzheimer’s is a diagnosis of exclusion. What is done before to rule it out?
Must rule out causes of delirium
Drugs Electrolyte imbalance/environment Lack of drugs (withdrawl) Infection Reduced sensory input/pain Intracranial Urinary retention Metabolic
Blood tests for B12, blood sugar
CT scan
Polypharmacy?
Increase in lymphocytes in the CSF?
How is it managed?
Autoimmune encephalitis
Steroids and IV Ig
What is the triad of symptoms in normal pressure hydrocephalus?
How can it be differentiated from Parkinson’s?
What is the definitve treatment?
Dementia
Urinary incontinence
Gait disturbance
L-dopa response
Ventriculo-peritoneal shunting
New onset of palpatations - how do you invx?
48hr ECg
What symptom can differ mania from hypomania?
Delusions or hallucinations is a feature of main over hypomania
What are the contradictions to theCOCP?
- vascular and heart conditions
- BP >160/100
- Liver disease
- History of VTE
- Migraine with aura
- More than 15 cigarettes a day
- current or recent breast cancer
Explain how you take both the COCP and progesterone only pill?
COCP
= for 21 days with 7 day break
= can take continually for 3 months
= if get breakthrough bleeding >4days then stop for 4 days (no unprotected sex) and restart again
Mini Pill
= everyday within a 12hr window
What is the name given to the ulcer found in primary syphilis?
Chancre
What treatment is required for molloscum contagisum?
None - viral infection that is self-limiting
What is a well recognised side effect of tubal ligation?
Ectopic pregnancy
