29 - Anxiety / 30 - self harm

Question 1

GAD - characterised by what?

Sx?

Answer 1

by excessive fear and irrational worry.

Focuses of anxiety include family, finance, social situations, eschatology, friendship, health and employment.

Symptoms include apprehension, sweating, tachycardia, palpitations, rashes, hot flushes, somatisation, insomnia.

Question 2

Mx of GAD

Answer 2

CBT > long term meds

SSRIs (fluoxetine), Benzos (Lorazepam)

Question 3

How many panic attacks for panic disorder?

Answer 3

> 4 in 1 month

Question 4

Panic disorder Sx

Answer 4

sweating, palpitations, dizziness, a feeling of impending doom, difficulty breathing, chest pain, hyperventilation, sensation of choking.

Question 5

Mx of panic disorder

Answer 5

SSRIs.

May also use propranolol to reduce ANS symptoms.

Therapy is best, CBT

Question 6

mx of PTSD

Answer 6

Treat with trauma focussed CBT or eye movement desensitisation and reprocessing.

Drug management is not first line.
Paroxetine (SSRI) is the only medication with a UK licence for PTSD

Question 7

Which tumour classically makes you anxious?
Why?
Other sx?

Answer 7

Phaechromocytoma = Adrenal tumour. Neuroendocrine.
Causes increased sympathetic nervous system activity.
Flank pain, tachycardia, hypertension with orthostatic hypotension, anxiety, palpitations, headaches, weight loss, sweating

Question 8

Ix of phaeochromocytoma ?

Mx?

Answer 8

Diagnose by 24 catecholamine and metanephrine in urine collection. Scan to localise tumour.
Treat with surgical resection.

Question 9

4 Rfs for suicide

Answer 9

middle age, male, unemployed, mental illness, recent divorce or bereavement, single, substance abuse, previous self-harm, recent psych admission

Question 10

Ix of paracetamol OD, whats seen?

Answer 10

Non specific abdominal symptoms progressing to live injury signs: hypoglycaemia, coagulopathy, hepatic encephalopathy, liver failure.

Metabolic acidosis in ABG

Monitor with INRs

Question 11

what causes toxicity in paracetamol OD

Answer 11

NAPQI not being metabolised by glutathione

Question 12

Mx paracetamol OD

Answer 12

activated charcoal within two hours.

N-acetylcysteine to treat based on blood levels

Question 13

Aspirin OD Sx?

Answer 13

Nausea and vomiting, abdo pain, lethargy, tinnitus, dizziness.

Vauge

Question 14

What happens to acid/alk of blood in aspirin OD

Answer 14

Resp centre stimulation results in respiratory alkalosis for up to 12 hours progressing to metabolic acidosis and hypokalemia

Question 15

Ix/Mx in aspirin OD?

Answer 15

Monitor ABGs and U and Es and treat underlying symptoms.
Salicylate levels can be observed

Iv fluids, sodium bicarb

Question 16

Sx in TCA OD

Answer 16

Cardiac and neurological symptoms. Seizures, tachycardia, dry mouth, nausea, headache, confusion, hypotension, arrhythmia,

Question 17

Seen on ECG in TCA OD ?

Answer 17

broad QRS and PR and QT lengthening plus changes based on sodium and hypokalemia.

Question 18

Mx of TCA OD ?

Answer 18

Iv Sodium bicarb for metabolic acidosis.

Magnesium for cardiac dysrhythmia.

Usually need admission to ICU

Question 19

Sx of digoxin OD

Answer 19

Nausea, vertigo, vomiting, arrhythmia, dizziness, confusion, yellow vision often reported with blurring.

Question 20

Seen on ECG digoxin OD

Answer 20

ECG shows premature ventricular beats. Bradycardia and bigeminy.

Hyperkalemia

Question 21

MX digoxin OD

Answer 21

digoxin antibody