amk 14/10/23

Question 1

what drug can be used to tx the somatic sx of GAD

Answer 1

propanolol( non seletive BB)

Question 2

13yr boy, disruptive in class, poor academic performance and low rate of turning in homework,. distractable adn forgetful. started on ritalin what do you need to montiro

Answer 2

height and weight measurement

Question 3

low BMI, exercisses obsessivel. GP wants to test power of muscles what will she use

Answer 3

sit up squat and stand test

Question 4

Management of ptsd

Answer 4

watchful waiting may be used for mild symptoms lasting less than 4 weeks

military personnel have access to treatment provided by the armed forces

trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases

drug treatments for PTSD should not be used as a routine first-line treatment for adults.
If drug treatment is used then venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline should be tried. In severe cases, NICE recommends that risperidone may be used

Question 5

section 17 leabe

Answer 5

emproary shor tbasis if patietn deemed fit ( special occasion ie christmas)

Question 6

community treatmetn order

Answer 6

long term treatment in the community

Question 7

overdose of amitriptyline

Answer 7

IV sodium bicarb

Question 8

features of amitriptyline overodsse

Answer 8

arrhythmias
seiures vomit flsuhign dialted pupils

Question 9

benzo overdose

Answer 9

sluured speech
ataxia
reduced GCS

flumazenil

Question 10

diogxin overdose sx

Answer 10

visual haloes confusion
high potassium
palpiations and BB
yellow green colour disturbance

Question 11

paracetamol overdose

Answer 11

jaundice
abdo pain
coma
metabolic acidosis
n and v
loin pain
haematuria and proteinuria

Question 12

side effect of olanzapine

Answer 12

weight gain in frist 6 months therfore increased risk of T2DM

Question 13

risperidone se

Answer 13

galactorrhea

Question 14

clozapine se

Answer 14

myocarditis and arrhythmias
agranulocytosis - weekly blood tests needed to detect early signs

Question 15

haloperiodl se - typical

Answer 15

extrapyramidal se - dyskinesia

Question 16

chlorpormazine se

Answer 16

cholinergic side effects - dry mouth etc

Question 17

SSRI side effects and thigns to know

Answer 17

2 weeks before effective
ECG before starting
SSE - low sodiu,, QT elongations esp citalopram , GI distrubance and dry mouth , sleep
shoudl be continued for 6 motnhs post remission
shouldbe tapered when stoppign to avoid withdrawl

Question 18

mirtazapien

Answer 18

increase appetiite, weight gain adn imrpoves sleep

Question 19

lithium when to check levels

Answer 19

check levels 1 weeks after starting every week after therapetuic dose acheived - then every 3 months

Question 20

emotionally unstable personality disorder - 1st line for this

Answer 20

dialectical behaviour therapy

Question 21

what time period must sx be seen before a dx of depression can be made

Answer 21

no minimum time period2 weeks

Question 22

A 42-year-old man was admitted to the emergency department with tremors and anxiety. His wife explains he recently attempted to stop drinking alcohol after several years of habitually drinking 15 units a night. He has no complaints of hallucinations and has not had a seizure.

What is the most appropriate management for this patient?

Answer 22

Tapering dose of chlordiazepoxide

Question 23

pt has liver failure with alcohol withdrawal what tapering dose of what drug to you give

Answer 23

Lorazepam may be preferable in patients with hepatic failure

Question 24

what drug lowers the seizure threshold

Answer 24

clozapine

Question 25

ADHD do you need to be reffereed before starting methylphenidate

Answer 25

yes

Question 26

A 75-year-old woman telephones her GP for advice. Her late husband passed away from cancer, and she has now been widowed for 4 months. The patient has a supportive family and is not clinically depressed, though was initially very tearful following her husband’s death. She occasionally feels apathetic and low-spirited, though this has significantly improved with time. However, for the last 2 weeks, she has heard her late husband talking to her on several occasions. She also thought she could see him once when out shopping with her friend, though recognises this is not possible.

What is the most appropriate next step in management?

Answer 26

Reassure and safety-net

Pseudo hallucinations can form part of the normal grieving process. Sufferers describe hearing, visualising, or even smelling their deceased loved one. These phenomena are often associated with acute grief, though can occur at any stage of bereavement. The above patient can therefore be reassured.

Question 27

what is clang association

Answer 27

Clang associations - ideas related only by rhyme or being similar sounding

Question 28

unexplained sx

Answer 28

Unexplained symptoms
Somatisation = Symptoms
hypoChondria = Cancer