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RACP Written Exam Cram Series > Adol & Psych Cram > Flashcards

Adol & Psych Cram Flashcards

1
Q

Lifetime prevalence of eating disorders?

A

7%

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2
Q

Risk of anorexia/bulimia if first degree relative affected?

A

6-10x greater

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3
Q

Biggest risk factor for development of an eating disorder?

A

Previous dieting

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4
Q

Signs of abnormal dieting behaviours?

A 
Successive weight goals
Increasing body self-criticism 
Social isolation
Loss of menstruation/failure to start menstruation
Vomiting
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5
Q

Criteria for dx of anorexia nervosa?

A

Restriction of energy intake relative to requirements leading to significantly low body weight
Intense fear of gaining weight or becoming fat, or persistent behaviour
Disturbance in the way in which one’s body weight or shape is experienced

*** loss of menstruation no longer considered

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6
Q

Criteria for dx of bulimia nervosa?

A

Eating an amount of food that is definitely larger than most would eat in a similar situation and time period + a sense of lack of control during episodes
Inappropriate compensatory behaviour (vomiting, excessive laxatives, exercising)
>1 per week for 1 month

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7
Q

Criteria for dx of binge eating disorder?

A

Binges associated with: rapid eating/ feeling uncomfortably full / eating when not hungry/ eating alone/ feeling disgusted after
Occur at least once a week for 3 months

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8
Q

Atypical AN?

A

Features of AN however normal or high body weight

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9
Q

Co-morbidities of anorexia?

A

OCD

Social phobia

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10
Q

Which complication of AN does not resolve with weight restoration?

A

Bone density

Healthy children = gain 45-60% BMD in second decade

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11
Q

Orofacial complications of AN?

A

Caries
Parotid enlargement
Submandibular adenopathy

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12
Q

Cardiovascular complications of AN?

A

Bradycardia: due to increased vagal tone, decreased metabolic rate
Postural hypotension
Decreased cardiac output: reduced exercise capacity, attenuated BP response to exercise
Decreased cardiac mass and myocardial fibrosis
Mitral valve prolapse in p to 20%
Pericardial effusions
May get small volume ST/ T wave changes and prolonged QT

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13
Q

Endocrine complications of AN?

A

Decreased estradiol, FSH, LH, testosterone
Amenorrhoea (due to decreased pulsatility of GnRH)
Hypogonadotrophic hypogonadism
sick euthyroid (↓T3/T4, normal or low TSH)
Increased cortisol

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14
Q

Renal complications of AN?

A

↑ urea (dehydration, ↓ GFR), low urea if malnutrition
Mild proteinuria, haematuria, pyuria
Renal calculi

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15
Q

Neurological complications of AN?

A

Brain pseudoatrophy
Ventricular enlargement
Reduced basal blood flow to brain, increased flow to medial temporal lobe areas (seen in psychosis)
Peripheral neuropathy
Hypothalamic dysfunction: thermoregulation, satiety , sleep

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16
Q

GI complications of AN?

A

Gastroparesis / Constipation
Esophagitis
Elevated LFTS + amylase
SMA syndrome (rare) = reduction of fatty tissue that separates superior mesentery artery and aorta leads to compression of duodenum between these two vessels resulting in small bowel obstruction

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17
Q

Treatment goals for AN?

A

Resume growth and puberty
Return to menstruation
Normalise eating
Treat underlying psychological conditions

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18
Q

Mortality rate in AN?

A

12x higher than all other causes in female adlescents
5% per decade
50% due to cardiovascular complications, 50% due to suicide

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19
Q

Average length of illness in AN?

A

5-7 years

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20
Q

Risk factors for poor outcome in AN?

A 
Onset <11 years of age, or onset in adulthood 
Psychiatric and somatic comorbidities
Obsessionality and impulsivity 
Purging and binging behaviour
More significant weight loss
Family dysfunction
Longer duration of illness
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21
Q

Risk factors for good outcome in AN?

A

Early age at onset/ adolescent onset (<14 years, but must be >11 years)
Good relationship with family
Shorter duration of illness

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22
Q

Treatment modality with best outcome for AN?

A

Family based therapy
Suitable for children with anorexia up to 19 years of age with less than 3 years duration
50-70% more effective than individual therapy

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23
Q

Phases of family based therapy?

A

1: intensive refeeding, parents take all control & siblings role is to support distress only
2: transition to adolescent control - completed at weight restoration/return of menses
3: return to adolescent control

24
Q

Core principles of FBT?

A
  • Causes of AN are NOT the focus of treatment; causes of AN are unknown
  • Separate client from the anorexia
  • Through separation parents encouraged to take action against the illness NOT child
  • Hospitalisation is temporary solution
  • The therapist only challenges the structural elements of the family that interfere with weight gain
  • Development of strong parental alliance, sibling sub-system and fostering open communication

Medical safety takes precedence

25
Q

Management of bulimia?

A
  • Psychoeducation/CBT
  • Dietary management, regular meals, DELAY purging (less likely to vomit if delayed by > 30 minutes), distraction
  • High dose SSRI: Fluoxetine
26
Q

Cause of melanosis coli?

A

Senna based laxatives (anthraquinones)

27
Q

Paracetamol overdose dosages?

A

Single ingestion >200mg/kg
150mg/kg (or 6g) per 24hr period over the previous 48 hours
100mg/kg (or 4g) per 24hr period for more than 48 hours who also have symptoms

28
Q

Risk factors for hepatic injury in paracetamol overdose?

A

Chronic alcohol use
Use of enzyme-inducing drugs
Dehydration and prolonged
Glutathione deficiency from regular panadol dosing

29
Q

Indications for NAC prior to confirming paracetamol level?

A

Presentation > 8 hours since toxic ingestion (>200 mg/kg)
Symptoms (RUQ tenderness or pain, N+V)
Slow release paracetamol >200 mg/kg or 10g

30
Q

Side effects of NAC?

A

rash, bronchospasm, hypotension

31
Q

Predictors of mortality/need for liver transplant?

A

Grade III encephalopathy – or any change in mentation
Acute kidney injury
Progressive increase in INR
Degree of ALT elevation is not considered a prognostic factor - is used to guide NAC duration

32
Q 
Paranoia
Increase HR
Increased BP
Dilated pupils
Increased temperature
A

Cocaine

33
Q 
Increase HR
Increased BP
Dilated pupils
Seizures
Cardiac arrhythmia
Hyperthermia
Rhabdomyolysis
Acute renal failure
A

Amphetamines

34
Q

Low HR
Low BP
Decreased resp rate
Pinpoint pupils

A

Opiates

35
Q

Major depressive disorder criteria

A 
2 weeks of depressed/irritable mood and loss of pleasure
AND
Feelings of worthlessness/guilt
Weight change
Sleep change
Psychomotor agitation/retardation
Reduced concentration/decisiveness 
Suicidal ideation
AND
Impairment of function
No other organic cause
36
Q

Comorbidity in depression?

A 
Anxiety (50%)
ADHD (10%)
conduct disorder
ODD
substance abuse
37
Q

Treatment of depression?

A

CBT & SSRI

Beware: Paroxetine – higher suicide rates than others

38
Q

Generalised Anxiety Disorder criteria?

A

Excessive anxiety and worry occurring more days than not for the last 6 months. Difficult to control the worry
Restlessness or feeling keyed up /on edge
Being easily fatigued
Difficulty concentrating/ mind going blank
Irritability
Muscle tension
Sleep disturbance
AND
Impairment of function
Not due to organic cause

39
Q

Treatment of generalised anxiety disorder?

A

CBT

40
Q

Risk factors for anxiety disorders?

A

Parent with anxiety disorder

Parent with substance abuse disorder

41
Q

Most heritable psychiatric disorder?

A

Bipolar

42
Q

Most common comorbidity in ADHD?

A

ODD
Learning disorder 2nd most
Anxiety
Depression

43
Q

Most common comorbidity in selective mutism?

A

Speech/language disorders

44
Q

MRI B changes in anorexia?

A

Increased activation of amygdala

45
Q

Mechanism of NAC in paracetamol overdose?

A

Inactivation of NAPQI by glutathione

46
Q

Echolalia associations?

A

Catatonia
Autism
Tourettes
Fragile X

47
Q

Risk factors for suicide?

A 
Male
Family Hx of suicide
Previous attempt
Lethality of method
Mental health condition - depression, substance abuse, conduct disorder
48
Q

Mental changes - agitation, delerium
Autonomic instability - tachycardia, labile BP, diaphoresis, flushing, hyperthermia
Tremor, rigidity, hyperreflexia

A

Serotonin Syndrome

49
Q 
Delirium
Fever
Muscle rigidity
Autonomic instability
High CK
metabolic acidosis
A

Neuroleptic Malignant Syndrome

50
Q

Serotonin Syndrome VS Neuroleptic Malignant Syndrome

A

Serotonin Syndrome

  • Serotonergic Agents (SSRIs, triptans, metoclopramide)
  • Short onset (<12hrs)
  • HypERreflexia, clonus and DILATED pupils

NMS

  • Dopamine antagonists (risperidone, chlorpromazine, quetiapine)
  • 1-3 days onset
  • High CK
  • HypOreflexia and normal pupils
51
Q

Conversion disorder VS somatic symptom disorder?

A

Conversion disorder
- nervous system symptoms

Somatic symptom disorders
- physical symptoms (pain/irritation)

52
Q

Atomoxetine mechanism?

A

Noradrenergic

53
Q

Risperidone mechanism?

A

Dopamine antagnoist

54
Q

Nightmares VS Night terrors?

A

Night terrors

  • NREM sleep (first 1/2 of night)
  • Unrousable
  • Amnesia
  • FHx

Nightmares

  • REM sleep, second 1/2 night
  • Easily roused
  • Remembered
55
Q

Contraindications for stimulant medication use in ADHD?

A 
Anxiety
Tics/Tourettes
FHx cardiac disease/sudden cardiac death
Glaucoma
Hyperthyroidism

SCD has been associated with stim use in children with underlying cardiac abnormalities

RACP Written Exam Cram Series (19 decks)

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