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Year 3 > Block 33 Week 8 > Flashcards

Block 33 Week 8 Flashcards

1
Q

Criteria for an intellectual disability?

A
  • an IQ of under 70 - measured w WAIS4
  • loss of adaptive social functioning
  • onset before the age of 18
  • ALL OF WHICH NEED TO APPLY
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2
Q

ABAS-3 looks at?

A
  • 3 domains looked at: conceptual, social, practical
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3
Q

what is not counted as an intellectual disability?

A
  • specific learning difficulty e.g. dyslexia
  • adult brain injury
  • early onset dementia
  • autism diagnosis alone
  • cognitive and AFL impairment secondary to severe mental illness
  • below average IQ
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4
Q

evidence of LDs?

A
  • Sig developmental delay during childhood
  • special education
  • very limited to independent living skills
  • no employment
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5
Q

epidemiology of LDs?

A
  • 20 in 1000 ppl have some form of LD
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6
Q

mild LD affects?

A

1.5% of the population

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7
Q

features of mild ID?

A
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8
Q

Severe LD affects?

A

0.4%

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9
Q

mild LD?

A
  • IQ of 50-70
  • Language fair.
  • Little sensory or motor deficits slight, reasonable level of independence
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10
Q

35-49 IQ?

A
  • generally better receptive than expressive
    language
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11
Q

Severe LD?

A
  • 20-34
  • increased sensory and motor deficits
  • 50% will have epilepsy
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12
Q

Profound LD?

A
  • <20
  • Increased need and vulnerability.
  • Developmental level about 12 months.
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13
Q

Who is involved in an MDT for LDs?

A
  • Care Managers (Social Workers)
  • Receptionists
  • Psychologists
  • Secretaries
  • Speech & Language
  • Physiotherapy
  • Nursing
  • Psychiatry
  • Occupational Therapy
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14
Q

biological factors predisposing to mental illness?

A
  • Genetic vulnerability
  • Brain damage
  • Infection
  • Physical disability
  • Sensory impairment
  • Tumours
  • Medication or Physical treatment
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15
Q

social factors which predispose a person with disabilities to mental illness?

A
  • small circle of friends.
  • limited opportunity for social outings.
  • reduced employment opportunities.
  • lack of finance.
  • lack of support
  • reduced access to transport.
  • exploitation (sexual and financial)
  • poor housing.
  • family attitudes.
  • lack of Choice
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16
Q

psychogical factors predisposing a person with disabilities to mental illness?

A
  • Learning Experiences
  • Personality
  • Separation/Loss
  • Coping Style
  • Life Events
  • Self Esteem
  • Lack of assertiveness
  • Feeling helpless
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17
Q

capacity is the ability to:

A

—Receive and retain relevant information
—Balance costs benefit.
—Communicate decision

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18
Q

adults w capacity can refuse treatment unless

A

the treatment is for mental disorder when treated under the mental health act

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19
Q

core principles of the MCA 2005?

A

1.Adults are assumed to have capacity. A lack of capacity has to be clearly demonstrated.
2. No-one should be treated as unable to make a decision unless all practicable steps to help them have been exhausted and shown not to work.
3. A person can make an unwise decision.
4. If it is decided that a person lacks capacity then any decision taken on their behalf must be in their best interests.
5. Any decision should show that the least restrictive option or intervention is achieved.

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20
Q

what is required in order for conset to be valid?

A
  • Have Capacity
  • Act under free will (not pressurised)
  • Provided with enough information.
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21
Q

role of psychiatry?

A
  • work as part of the community team
  • diagnose and treat mental illness
  • assess risk
  • offer advice on medication
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22
Q

role of community nursing?

A
  • advice and support on:
  • Your mental health
  • Your physical health e.g. health screening and promotion
  • Epilepsy and seizures
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23
Q

role of social care nursing?

A
  • assessment needs - talking to the person and their carers to decice what support they need
  • making sure they get the support e.g. residental housing or respite or day services
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24
Q

speech and language therapy?

A
  • looks at total communication
  • communication books or aids w pictures or symbols
  • looks at ppls eating drinking and swallowing skills
  • looks at how much ppl understand
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25
Q

role pf physiotherapy?

A
  • help w mobility/ exercise
  • assist at wheelchair and orthotics clinics
  • help w 24hr postural management
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26
Q

role of OT?

A
  • Help w everyday tasks like:
  • domestic activities
  • help w finding: easier way of doing things
  • help to learn new skills and be more independent
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27
Q

health inequalities faced by ppl w LDs?

A
  • people w IDs enjoy less good health and are less likely to attend GP
  • less likely to be invited for screening
  • much more likely to die young
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28
Q

additional health needs for those with learning difficulties?

A
  • 25% hearing or visual impairment, epilepsy
  • 5x increased risk of sudden death in epilepsy
  • upto 20% have mental health problems
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29
Q

risk of dementia w downs syndrome?

A
  • dementia - 4-5x greater and early onset in down’s syndrome
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30
Q

lower rates of ? cancer with LDs?

A

ower rates of lung, prostate, urinary tract cancers

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31
Q

higher rates of ? cancer with LDs?

A
  • higher rates of oesophageal, stomach and GB cancer and leukemia
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32
Q

what is inc with Downs syndrome?

A
  • CHD - upto half w Down’s
  • hypothyroisim - DS
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33
Q

? infection is prev in LDs?

A

H pylori

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34
Q

LD and schiz?

A
  • lifetime risk of someone w a LD of schiz is 3x that of the general population
  • depression 5x
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35
Q

increase risk of MH issues w LD in those w:

A
  • more likely to be broke, live in poor housing, no job, no social network
  • dependent on services and paid care providers
  • infatilised
  • protected from risk taking
  • overmedicated
  • co-morbities
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36
Q

schiz w LD?

A
  • simpler symptoms
  • often has an organic feel
  • monitor for adverse drug reactions - might not be able to tell you that something is wrong
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37
Q

barriers to healthcare w LDs?

A
  • not understanding letters
  • phone system
  • touch screen system
  • not being able to read badges
  • confusion between diff roles e.g. psychiatrist, nephrologist
  • using big words
  • talking to carers instead of them
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38
Q

improving care for those w LDs?

A
  • transforming care partnerships
  • community Tx reviews
  • LD mortality review
  • annual healchecks
  • hospital passports/ flagging systems
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39
Q

community treatment reviewS?

A
  • community treatment reviews - called when someone is admitted to hospital
  • expert and senior member of commissioning group which try and find altns to hospital admission
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40
Q

LD mortality review?

A
  • Learning disabilitity mortality review - anyone who dies w a LD is reported to this body, tasked w investigating the death to see if anything could ahve been done to prevent it
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41
Q

flagging system?

A
  • hospital passports/ flagging systems - identifies key details abt the person so the team caring for them know how to support them
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42
Q

acute liason nurses?

A

to ensure they recieve the same outcome as other ppl

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43
Q

green light toolkit?

A
  • green light toolkit - ensures ppl w LDs are not disadvantaged when they access MH services
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44
Q

reasonable adjustments for LDs?

A
  • easy read letters
  • longer appts
  • awareness training
  • flagging system
  • quieter areas to wait, not having to wait
  • visit to a department to look round prior to appt
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45
Q

MDT members in a community LD team?

A
  • MDT: psychiatrist, psychology, nursing, OT. physio, AHP (social care)
  • reasaonable adjustments made to meet the health needs of ppl w LDs
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46
Q

co-morbities w LD?

A
  • ADHD is the most common co-morbidities
  • anxiety, mood disorder, language disorder
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47
Q

What is diagnostic overshadowing?

A
  • Diagnostic overshadowing occurs when a health professional makes the assumption that a person with learning disabilities’ behaviour is a part of their disability without exploring other factors such as biological determinants
  • Attributing all other problems to the learning disability
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48
Q

when can diagnostic overshadowing occur?

A
  • Diagnostic overshadowing can occur during an assessment, such as when a health professional interprets a person with a learning disability rubbing their heads as a behaviour linked to their learning disability and fails to investigate any possible underlying health cause
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49
Q

people with learning disabilities have worse health outcomes than the general population. These include:

A
  • reduced access to and less likely to receive interventions for their obesity
  • greater risk of death from avoidable causes
  • low take up of national cancer screening programmes
  • low uptake of vaccinations
  • increased risk of death due to resp infection - one of the highest causes of amenable death
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50
Q

how can diagnostic overshadowing be avoided?

A
  • don’t make assumptions
  • always communicating with the patient directly
  • Assess people’s health and wellbeing so that any changes in behaviour that may signify changes in condition or an illness are not attributed to their learning disability
  • pay attention to non verbal communication e.g. body position, painm anx
  • seek help from patient’s family/ carers to get to know the person better
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51
Q

how can psychiatric disorders present in LDs?

A
  • response to frustration - impulsive, stubborn, aggressive
  • passitivity, withdrawal, compliance
  • poor frustration tolerance can cause aggression towards caregivers or self-injurious behaviour
  • challenging behaviour may be a way of asking for somthing - to be stopped, or for attention e.g.
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52
Q

biological factors involved in the onset of MH in problems w LDs?

A
  • pain or poor physical health -> impact on wellbeing
  • side effects of medications
  • Some genetic syndromes are associated with specific mental health problems (e.g. Prader Willi syndrome - OCD)
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53
Q

psychological factors involved in the onset of MH problems in ppl w LDs?

A
  • increased risk of abuse and neglect
  • bereavement
  • lack of support - difficulty with relationships
  • lack of access to resources
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54
Q

social factors involved in the onset of MH problems in people w LDs?

A
  • poverty - inability to wotk
  • isolation
  • loneliness
  • negative life events
  • undiagnosed autism
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55
Q

impact on carers where a person has a complex MH need?

A
  • stress and worry - about their future health
  • anxiety
  • loneliness - may feel like they don’t have time for other activtiies
  • financial strain - loss of job
  • anger and guilt
  • depression - feeling low due to the challenges faced whilst looking after someone else
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56
Q

problems that ppl w sensory impairments can have accessing MH services?

A
  • difficulty sitting in waiting rooms
  • difficulty in engaging with different healthcare professionals
  • new environment -> stress
  • being unable to hear conversations or see facial expressions -> sig obstacles in accessing social support and connection
  • reliance of telephone systems and GP touch screens
  • visual impairment -> difficulty with written information
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57
Q

strategies for managing behavioural problems in those w LDs?

A
  • Enable the child to express themselves.
  • Help the person to do what they enjoy.
  • Find coping strategies to reduce stress.
  • Stay alert and try to anticipate problems.
  • Create a firm support network of family, friends and professionals.
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58
Q

interventions for LDs?

A
  • personalised inteventions based on functional assessment if behaviour
  • assessment and modification of environmental behaviour that could trigger/ maintain the behaviour
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59
Q

when should AP be used for challenging behaviour?

A
  • psychological or other inteventions don’t produce change
  • the risk to the person or others is very severe (for example, because of violence, aggression or self-injury).
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60
Q

Interventions for a child under 12?

A
  • parent training programmes for parents with a child under 12:
  • focus on developing communication and social functioning
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61
Q

interventions for children aged 3-5?

A
  • preschool classroom based interventions for children aged 3-5:
  • curiculum design and development
  • social and communication skills training for the children
  • skills training in behavioural strategies
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62
Q

multi-agency approach for LDs?

A
  • children’s social care, adult services and other agencies need to undertake a multi-agency assesment using the agreed assesment framework to determine if parents with LDs require support
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63
Q

types of organ rejection?

A
  • within minutes to hours: B cells
  • after this: T cell mediated
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64
Q

Assessing suicide risk?

A

*What taken/done
*How much
*When
*What with – alcohol/drugs
*Where
*Anyone present
- How/when obtained

*Did they tell anybody afterwards?
*Delay in seeking help?
*How came to hospital?
*How long thinking about?
*How often – how intrusive?
*Degree of planning?
*saving or purchasing in advance
*were they expecting to be found
concealment/timing

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65
Q

self harm assessment - prepatory acts?

A
  • affairs – bills etc
  • will
  • pets
  • turning off services
  • visit to significant others beforehand
  • note ??
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66
Q

other things to ask in a self harm assessment?

A
  • past history of SH
  • past psych history
  • current psych history
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67
Q

DSH or failed suicide

A
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68
Q

self harm assessment - screening for social stresses?

A

*relationships
*housing
*employment
*debt
- criminal proceedings

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69
Q

section 2?

A
  • Detain inpatient 72 hours – for assessment to be made with a view to an application for admission being made -
  • mental disorder
  • risks
  • unwilling to remain informally
  • Does not authorise treatment
  • Start MHA assessment process
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70
Q

who can place a patient under a section 2?

A

*Doctor in charge of treatment or nominated deputy
*If no current psychiatric involvement - consultant medic/surgeon…
*If patient open to psych -medic or psychiatrist

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71
Q

RF for self harm?

A
  • Socio-economic disadvantage.
  • Socialisolation.
  • Stressful life events, for example relationship difficulties,
  • Bereavement by suicide.
  • Mental health problems
  • Chronic physical health problems.
  • Alcohol and/or drug misuse.
  • Involvement with the criminal justice system (with people in prison being at particular risk).
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72
Q

self harm rates peak in which age gr?

A
  • 16 to 24 women
  • 25 to 34-year-old men.
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73
Q

suicide rates peak in the ? age

A
  • Suicide rates are highest in both men and women aged 45–49 years.
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74
Q

RF for suicide?

A
  • Male
  • Older
  • Widowed/separated/single
  • Living alone/social isolation
  • Low income/unemployed
  • Certain occupation (e.g. doctor, farmer)
  • Family history of suicide
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75
Q

epidemiology of self harm and suicide?

A
  • 1:10 young ppl
  • F>M 1.5-2.2:1
  • age
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76
Q

groups of people more likely to self harm?

A
  • divorced people more likely to self harm
  • adversity
  • substance misuse
  • childhood abuse
  • gay and bisexual
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77
Q

suicide rates after self harming?

A
  • 50X higher suicide rates within 5-10 yrs
  • higher suicide rate in men and higher self harm rates for women
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78
Q

commonest form of self harm?

A
  • overdose - 80%
  • cutting
  • RF for later cutting
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79
Q

management of Self harm?

A
  • CBT or problem solving therapy that is spec tailored for self harming - ASAP
  • dialectical behaviour therapy adapted for adolescents - DBT-A for young ppl and children
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80
Q

creating a safety plan for self harm?

A
  • establish the means of self-harm
  • recognise the triggers and warning signs of increased distress, further self-harm or a suicidal crisis
  • identify individualised coping strategies, including problem solving any factors that may act as a barrier
  • identify social contacts and social settings as a means of distraction from suicidal thoughts or escalating crisis
  • identify family members or friends to provide support and/or help resolve the crisis
  • include contact details for the mental health service, including out‑of‑hours services and emergency contact details
  • keep the environment safe by working collaboratively to remove or restrict lethal means of suicide.
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81
Q

harm minimisation - self harm?

A
  • distraction techniques or coping strategies
  • approaches to self care
  • wound hygiene and aftercare
  • providing factual information on the potential complications of self-harm
  • the impact of alcohol and recreational drugs on the urge to self-harm.
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82
Q

when should a person be referred to MH services (community mental health teams and liason psychiatry teams)?

A
  • The person’s levels of concern or distress are rising, high or sustained.
  • The frequency or degree of self-harm or suicidal intent is increasing.
  • The person providing assessment in primary care is concerned.
  • The person asks for further support from mental health services.
  • Levels of distress in family members or carers of children, young people and adults are rising, high or sustained, despite attempts to help.
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83
Q

neural tube vs neural crest?

A

neural tube develops into the central nervous system while the neural crest develops into parts of the peripheral nervous system and endocrine cell

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84
Q

sepsis triggers release of?

A

Sepsis triggers the release of IL-1 causing vasodilation → hypotension

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85
Q

causes of paralytic ileus?

A

Hyperkalemia, acidosis and handling of the bowel during surgery are all causes of paralytic ileus

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86
Q

adhesions after a bowel surgery?

A

long term side effects than paralytic ileus

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87
Q

igA vs IgG?

A

IgA = breast milk
IgG = placenta

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88
Q

Organ rejection cells?

A

organ rejection within 6 months = B cells, after this its acute or chronic so its cytotixic T cells

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89
Q

what leads to bronchoconstriction>?

A

leukotriene

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90
Q

neural tube ->

A

retina

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91
Q

neonatal sepsis, vaginal delivery ->

A

group B streptoccocus

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92
Q

IgD ->

A

B cell activation

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93
Q

source of vit B?

A

The only source of vitamin B12 for humans is animal-based foods -> vegan diet can lead to macrocytic anemia

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94
Q

How does tetanus cause paralysis?

A

tetanus blocks release of GABA -> overexcitation of muscles -> muscle paralysis

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95
Q

long term metformin use is associated w?

A

vitamin B12 deficiency due to reduced vitamin B12 absorption

96
Q

allopurinol inc risk of ? toxicity

A

azathioprine

97
Q

which ab can prolong QT?

A

Macrolides like erythromycin may cause prolongation of the QT interval

98
Q

what is the principle inhibitory NT of the SC?

A

Glycine is the principal inhibitory neurotransmitter of the spinal cord - GABA main inhib in the brain

99
Q

Organophosphate poisoning?

A

Organophosphate poisoning occurs due to inhibition of acetylcholinesterase leading to upregulation of nicotinic and muscarinic cholinergic neurotransmission

100
Q

meningitis causes in 0-3 months?

A
  • group B strep - most common in neonates
  • e coli
  • listeria
101
Q

meningitis causes in 3 months to 6 yrs?

A
  • neisseria meningitidis
  • strep pneu
  • haemophilus influenza
102
Q

6 - 60 years meningitis?

A
  • neisseria meningitis
  • strep pneumoniae
103
Q

> 60 yrs meningitis?

A
  • most common: strep pneumonia
  • nesisseria meningitis
  • listeria
104
Q

nicrorandil side effects?

A
  • lethargy
  • flush
  • hypotension
  • dyspepsia
  • chest pain
  • anal ulceration
105
Q

Bbs side effects?

A
  • cold peripheries
  • bronchospasm
  • sleep disturbance
106
Q

CCBs SE?

A
  • ankle oedema
  • constipation
  • dyspepsia - relax lower OS
107
Q

vitamin D inc plasma?

A

calcium and phosphate levels

108
Q

when does paracetamol overdose occur?

A

Paracetamol overdose occurs when glutathione stores run-out leading to an increase in NAPQI - NAC replenishes glutathione stores

109
Q

wernicke’s encephalopathy triad?

A

nystagmus, ophthalmoplegia and ataxia

110
Q

Korsakoffs syndrome?

A

Korsakoff’s syndrome develops from Wernicke’s and presents as amnesia and confabulation.

111
Q

Lab features suggestive ofPseudomonas aeruginosainclude:

A
  • Gram-negative rod
  • non-lactose fermenting
  • oxidase positive
  • commonly associated w wound infections post op
112
Q

insulin binds to?

A

tyrosine kinase receptors

113
Q

factors affecting wound healing

A
114
Q

immunocompromised meningitis?

A

listeria

115
Q

vitamin D deficiency?

A
  • poor wound healing
  • general malaise and capillary fragility causing bleeding from the gums.
  • This is caused by defective synthesis of collagen.
116
Q

phospholipids converted to arachdonic acid by?

A

phospholipase A2

117
Q

Neural crest ->

A

parafollicular cells of the thyroid

118
Q

RF for pulm HTN?

A

sleep apnoea, cocaine use, and previous pulmonary embolism (PE).

119
Q

Management of PHTN?

A
  • vasoactive agents likeprostacyclin (or PGI-2)are the first-line management option to promote vasodilation.
120
Q

Use of ? during pregnancy is related to gray baby syndrome?

A

chloramphenicol

121
Q

how does chloramphenicol work?

A

inhibits protein synthesis by acting on 50s ribosomal subunit

122
Q

first order kinetics?

A
  • majority of drugs exhibit’first-order’ elimination kinetics i.e. the rate of drug elimination is proportional to drug concentration
123
Q

zero order kinetics?

A
  • certain drugs exhibit zero-order kinetics where therate of excretion is constant despite changes in plasma concentration, this is due to saturation of the metabolic process
124
Q

examples of 0 order drugs?

A
  • phenytoin
  • salicyclates
  • heparin
  • aspirin
125
Q

which ab fix complement?

A

Only IgM and IgG immunoglobulins fix complement

126
Q

IL-8 functions?

A

IL-8 - main functions include: neutrophil chemotaxis

127
Q

INF-g?

A

Interferon-gamma is produced primarily by natural killer cells and T helper cells

128
Q

calcitonin?

A

Calcitonin causes a decrease in plasma calcium and phosphate by inhibiting osteoclasts

129
Q

PTH?

A

PTH increases plasma calcium but decreases phosphate levels

130
Q

Severe benzodiazepine overdose is treated by

A

Severe benzodiazepine overdose is treated by flumazenil - high risk of seizures though

131
Q

Which drug dereases iron abs?

A

omeprazole - inhibits stomach acid which promotes iron abs

132
Q

warfarin and ? interact

A

valproate

133
Q

rifampicin causes inc in ? clearance?

A
  • Rifampicin causes inc clearance of the COCP
  • leading to a reduction in its effectiveness
134
Q

tetracyclines are teratogenic bc?

A
  • They are teratogenic due to their ability to bind to calcium ions in developing bones and teeth - cause teeth discoloration
  • They should not be taken with high calcium foods or drinks such as milk for this same reason.
135
Q

tetracyclines can also cause?

A

tetracyclines can also increase the sensitivity of the skin, cause gastrointestinal disturbances and cause kidney impairment.

136
Q

viral infections result in raised ? count?

A

Viral infections typically result in a raised lymphocyte count, fungal infections result in a raised eosinophil count and protozoan infections often result in a raised monocyte count.

136
Q
A
137
Q

summary of tetracyclines, aminoglycosides and macrolides?

A

tetracyclines and aminogycosides -> 30s ribosomes inhibition
macrolides -> 50s inhibition

138
Q

quinolones mechanism?

A

Quinolones (e.g. ciprofloxacin) - inhibits DNA synthesis - topoisomerase inhibition

139
Q

PE management?

A

Massive PE + hypotension - thrombolyse: alteplase
haemadynamically stable: DOAC

140
Q

sarcoid features?

A

FABLE
Fevers
Arthralgia
Bilateral hilar lymphadenopathy
Lupus pernio
Erythema nodosum

141
Q

SSRI monitoring?

A

ssri: monitor for hyponatreamia, urea+ electrolytes

142
Q

sick day rules - stop DAAMN drugs?

A

Diuretics
ACEi
ARBs
Metformin
NSAIDs

143
Q

Takotsubo cardiomyopathy?

A
  • Takotsubo cardiomyopathy also known as ‘Broken heart syndrome
  • apical balooning of LV - resembling octopus pot
144
Q

management of broad complex tachys?

A

IV amiodarone is the first-line treatment for regular broad complex tachycardias without adverse features

145
Q

factors associated w poor schiz prognosis?

A
  • strong family history
  • gradual onset
  • low IQ
  • prodromal phase of social withdrawal
  • lack of obvious precipitant
146
Q

SSRI use in the 3rd trimester?

A

SSRI use during third trimester - risk of persistent pulmonary hypertension of the newborn

147
Q

how long should AD be continued after remission?

A

Antidepressants should be continued for at least 6 months after remission of symptoms to decrease risk of relapse

148
Q

acute dystonia vs tardive dyskinesia?

A

acute dystonia: involves sustained muscle contractions leading to abnormal postures, not repetitive movements as seen in tardive dyskinesia.

149
Q

tangentiality?

A

Tangentiality refers to wandering from a topic without returning to it

150
Q

circumstantiality?

A

Circumstantialityis where patients give unnecessary and excessive detail before finally answering a question

151
Q

flight of ideas vs tangentiality?

A
  • patients jump from one topic to the next with discernible links between them
  • in flight of ideas the question would’ve first been answered, then the patient would have jumped to the next topic - patient doesn’t answer ques in tangentiality
  • In flight of ideas the speech would also be at a faster rate.
152
Q

knights move thinking?

A
  • unexpected and illogical and unexpected leaps from one idea to another.
  • While this patient is leaping from one topic to another there are loose associations between each topic.
153
Q

review one week after ? commencement

A

SSRI

154
Q

Stages of alcohol withdrawal?

A
  • symptoms: 6-12 hours
  • seizures: 36 hours
  • delirium tremens: 72 hours
155
Q

SSRI discontinuation syndrome?

A

Dizziness, electric shock sensations and anxiety are symptoms of SSRI discontinuation syndrome

156
Q

Most likely SSRI to cause QT prolongation?

A

Citalopram is the most likely SSRI to lead to QT prolongation and Torsades de pointes

157
Q

long term lithium use can cayse?

A

hyperparathyroidism and resultant hypercalcaemia.

158
Q

Factors suggesting diagnosis of depression over dementia?

A
  • short history, rapid onset
  • biological symptoms e.g. weight loss,sleep disturbance
  • patient worried about poor memory
  • reluctant to take tests, disappointed with results
  • mini-mental test score: variable
  • global memory loss (dementia characteristically causes recent memory loss)
159
Q

conversion disorder?

A

Functional neurological disorder (conversion disorder) - typically involves loss of motor or sensory function

160
Q

antimuscarinic side effects are more common w?

A

antimuscarinic side-effects are more common with imipramine than other types of tricyclic antidepressants - dry mouth and blurred vision

161
Q

what is not a first rank symp of schiz?

A

visual hallucinations

162
Q

acute dystonic reactions more common w ?

A

Acute dystonic reactions are more common with first-generation (or typical) antipsychotics such as haloperidol.

163
Q

what are acute dystonic reactions?

A

Acute dystonic reactions includetorticollis, opisthotonus, dysarthria and oculogyric crises.

164
Q

SSRI of choice in children and adolescents?

A

Fluoxetine

165
Q

type 1 vs type 2 bipolar?

A

Type I bipolar is associated with mania and type 2 is associated with hypomania

166
Q

Clozapine side effects?

A
  • SCAM
  • Seizures
  • Constipation/clozapine-induced gastrointestinal hypomotility (CIGH)
  • Agranulocytosis
  • Myocarditis
167
Q

Tx of delirium tremens?

A

Chlordiazepoxide or diazepam are used in the treatment of delirium tremens/alcohol withdrawal

168
Q

most tolerable AP?

A

Aripiprazole has the most tolerable side effect profile of the atypical antispsychotics, particularly for prolactin elevation

169
Q

Use of antipsychotics in the elderly causes inc risk of?

A

stroke and VT

170
Q

lambert eaton syndrome?

A
  • weakness that is worse in the legs.
  • It can be differentiated from myasthenia gravis, which typically affects the face and arms earlier, and lambert eaton syndrome gets slightly better with muscle use, whereas myasthenia gravis is worsened by muscle use.
171
Q

signs and symptoms of lung abcess?

A

characterised by swinging fevers, night sweats, pleuritic chest pain, dyspnoea, and cough

172
Q

Tx of torsades?

A

IV magnesium sulfate

173
Q

thiazide diuretics ->

A

hypokalaemia -> Flattened T waves

174
Q

Young male smoker with symptoms similar to limb ischaemia - think?

A

Buerger’s disease

175
Q

Aortic stenosis management?

A

AVR if symptomatic, otherwise cut-off is gradient of 40 mmHg

176
Q

statins can’t be used in?

A

pregnancy

177
Q

side effect of mesalazine?

A

Pancreatitis is significantly more common as a side-effect with mesalazine than sulfasalazine.

178
Q

aminosalicylates are assoc w ?

A

agranulocytosis

179
Q

dysphagia suggestive of achalasia?

A

Dysphagia equally to both solids and liquids from the outset is suggestive of achalasia

180
Q

achalasia barium swallow?

A

A barium swallow which shows a grossly expanded oesophagus that tapers at the lower oesophageal sphincter (‘bird’s beak’ appearance)

181
Q

oral contraceptive assoc w ?

A

drug induced cholestasis

182
Q

crypt abcesses + rectal bleeding ->

A

points more towards UC than CD

183
Q

CD associated w ?

A

gallstones

184
Q

RF for gallstones?

A

SOLIDC

Sudden weight loss
OCP
Loss of bile salts
Increasing age
Diabetes
CD

185
Q

SSRI and MAOI should not be?

A

SSRIs and MAOIs should never be combined as there is a risk of serotonin syndrome (also can’t be used w triptans)

186
Q

tricyclic AD can cause?

A

urinary retetntion e.g. amitryptiline

187
Q

what can cause upper zone lung fibrosis?

A

asbestos and methotrexate

188
Q

what can cause lower zone fibrosis?

A

prev radiotherapy

189
Q

inhaled beclomethasone can cause?

A

inhaled beclomethasone can cause oral candiassis - pred is not typically given in an inhaler, usually oral

190
Q

tension pneumothorax?

A
  • The patient will be hypotensive due to the expanding pleural space obstructing cardiac outflow. This does not occur in simple pneumothoraces.
  • tracheal deviation away
191
Q

Persistent productive cough +/- haemoptysis in a young person with a history of respiratory problems →

A

? bronchiectasis

192
Q

restrictive pattern + normal gas transfer ->

A

obesity

193
Q

All cases of pneumonia should have a repeat chest X-ray at

A

6 weeks after clinical resolution

194
Q

Pneumothorax can occur following

A

high pressure non-invasive ventilation

195
Q

Older patient, progressive exertional dyspnoea, dry cough, clubbing, non-smoker →

A

idiopathic pulmonary fibrosis

196
Q

HF XR findings?

A
  • Alveolar oedema (bat’s wings)
  • KerleyBlines (interstitial oedema)
  • Cardiomegaly
  • Dilated prominent upper lobe vessels
  • Effusion (pleural)
197
Q

alzheimers dementia RF?

A
  • age
  • women
  • Down’s syndrome.
  • Vascular risk factors
198
Q

gene linked to AD?

A

ApoE4

199
Q

Pathology in alzheimers?

A
  • Extracellular β amyloid plaques and
  • intracellular tangles of hyperphosphorylated tau
200
Q

AD clinical features?

A
  • Gradual onset often with episodic memory –forgetting conversations, where put things, things that done, repeating questions
  • Progressive decline and spreads to other aspects of cognition
201
Q

4 As of alzheimers?

A
  • Aphasia –expressing/understanding language
  • Apraxia –carry out complex tasks
  • Agnosia –recognising objects, people
  • Amnesia
  • Executive functions –planning and sequencing - when it spreads to frontal lobe
202
Q

summary of 4 As in alzheimerS?

A
  • apahasia
  • apraxia
  • agnosia
  • amnesia
203
Q

Vasc dementia?

A
  • slightly more common in men
  • vascular RF
204
Q

2 common phenotypes of VD - stepwise progression?

A
  • stepwise progression - new infarct -> progression, variable/focal deficits,
  • speech, memory, executive function
  • localised problems
205
Q

2 common phenotypes of VD - marche a petit pas?

A
  • marche a petit pas - small steps, bradyphrenia - think more slowly, executive function - planning judgement, emotional lability - change emotions quickly, urinary incontinence
206
Q

LBD CF - 4 common features?

A
  • fluctuating cognition
  • complex visual hallucinations
  • Parkinsonism (tremor, rigidity, bradykinesia)
  • REM Sleep disorder (shout/move as act out dreams)
207
Q

pathology of LBD?

A
  • Lewy Bodies –eosinophilic inclusions in the neurones, build up of α-synuclein protein
  • LB stain pink/red
208
Q

FTD?

A
  • 2% of dementia, younger people 45-65, men=women
  • More genetic, 1/3 Autosomal Dominant, can now test for some genes
209
Q

Pathology of FTD?

A
  • Atrophy of frontal and anterior temporal lobes - wasting and knife edge pattern
  • Some have “Pick bodies” with abnormal tau protein
  • Others have an accumulation of different proteins e.g. TDP-43, FUS, UPS
210
Q

CF of the behavioural variant of FTD?

A
  • Disinhibition
  • Apathy/inertia - don’t doo much w/o the executive functions
  • Loss of sympathy/empathy
  • Perseveration –stuck on repeated behaviours
  • Hyperorality –just like sweet foods, things in mouth
  • Loss of executive functions –planning, judgement
  • need 3/6 for diagnosis of frontotemporal dementia
211
Q

less common variants of FTD?

A
  • Primary progressive aphasia
  • progressive non fluent aphasia
  • semantic dementia
212
Q

rare causes of dementia?

A
  • parkinsons disease
  • huntingtons disease
  • Creutzfeldt Jakob disease
  • HIV assoc
213
Q

huntingtons disease?

A
  • Huntington’s Disease –autosomal dominant, dementia with chorea “dancing movements” in arms and legs
  • often at a young age
214
Q

Creutzfeldt Jakob disease?

A

prion disease causing a rapidly progressive Dementia

215
Q

dementia subtypes summary table

A
216
Q

what is methylphenidate?

A

dopamine and norepinephrine reuptake inhibitor

217
Q

apiprazole?

A

D2 partial agonist

218
Q

Atomoxetine?

A

selective NA reuptake inhibitor

219
Q

suicide rate in major depression?

A

10-15%

220
Q

depression causes inc?

A

coronary atherosclerosis later in life

221
Q

what specifically supports diagnosis of acute schiz?

A

acute schizophrenia: delusional perceptions specifically support diagnosis

222
Q

best Tx for phobias?

A

phobias -> best treatment: behavioural therapy like desenitisation

223
Q

clock drawing test early impairment in?

A

clock drawing test more likely to be impaired at an early stage in small vessel vascular dementia

224
Q

autism key features?

A

autism: pointing at things rarely even when he wants them - key feature of autism is impaired verbal and non-verbal communication.

225
Q

hallucinations are diff to?

A

difficult to distinguish from a real perceptio

226
Q

4 year old adopted girl frequently does the opposite of what her adoptive parents tell her to do and can be controlling in their company.She struggles to get on with her peers, but is usually charming to strangers, although can seem hyper alert to what is going on around her.

What is the most likely diagnosis?

A

reactive attachment disorder

227
Q

assertive outreach team?

A

provide ongoing care upon discharge for MH condition

228
Q

LT lithium use can lead to?

A

hyperparathyroidism and resultant hypercalcaemia

229
Q

SS vs NMS?

A

Dilated pupils in serotonin syndrome, Hyperreflexia in serotonin syndrome (Hyporeflexia in NMS)

230
Q

clozapine is good for?

A

clozapine is effective for negative symptoms when other AP have failed

231
Q

first line in PTSD?

A

The first-line drug treatment for PTSD is venlafaxine or a selective serotonin reuptake inhibitor (SSRI) such as sertraline.

232
Q

SSRI + ? -> bleeding risk

A

SSRI + NSAID = GI bleeding risk - give a PPI

233
Q

Mirtazapine may be prescribed due to useful side effects like

A

sedation and inc appetite

234
Q
A

Year 3 (45 decks)

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