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PAN - Psychiatry > Cases > Flashcards

Cases Flashcards

1
Q

What is the triad of delirium tremens?

A

Delirium
Visual hallucinations
Tremor

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2
Q

What are some of the differentials for delirium tremens?

A

Could be a stroke
Infection e.g. sepsis
Dementia (lewy body - hallucinations)

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3
Q

What could contribute to delirium?

A 
New environment
New people in hospital - staff and patients
Lack of sleep
Natural lighting
Medication - can cause delirium
Hyponatraemia
Dehydration
Do they have glasses
Do they have hearing aids
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4
Q

How do you score delerium tremens?

A

CIWA - Clinical institute withdrawing from alcohol

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5
Q

What are some of the symptoms included in the CIWA score?

A 
Sweating
Visual hallucinations
Tactile hallucinations
Headache
Anxiety
Aggitation
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6
Q

What is benzodiazepine that is used for the treatment of delirium tremens? When should this not be used?

A

Chlordiazepoxide

Should not use in liver disease as renally secreted, can use lorazepam instead

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7
Q

How should delirium tremens be treated?

A

Chlordiazepoxide
IV pabrinex - to treat Wernicke-korsakoff’s
Diazepam in seizures
Clocks and windows to allow them to orientate themselves

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8
Q

What is a good way to open a dialogue with a patient that has hallucinations?

A

Asking how they make them feel, say that it sounds really scary

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9
Q

What is wernickes triad?

A

Ataxia
Opthalmoplegia
Confusion

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10
Q

How would you ask about alcohol addiction?

A 
CAGE 
Considered cutting down
Annoyed about other people critisising drinking
Guilty
Eye opener
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11
Q

How would you ask about alcohol dependence?

A

DSM IV alcohol dependence syndrome questions
Tolerance
Withdrawl
Activities - given up due to alcohol

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12
Q

What help do you offer people who are about to be discharged with alcohol dependence?

A

Bio - acamprosate - helps block brain signalling in withdrawl
Psycho - addiction psychiatry can be referred to, CBT, councelling
Social - Aqerius or AA - if homeless then need housing support

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13
Q

How would you assess competence for an individual with delirium tremens?

A

Determine if they are:

  • taking in the information
  • Weighing up the decision
  • Making a decision
  • Communicating a decision
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14
Q

How do you detain someone under the mental capacity act?

A

DOLS

Deprivation of Liberty safeguards

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15
Q

What are the main questions for differentiating generalised anxiety disorder and PTSD?

A

Asking what they are anxious about

Sleep disturbance - nightmares vs depression

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16
Q

For a panic attack what should you ask patients about?

A 
Physical :
-Hyperventialation
-Tachycardia
-Sweating
-Central crushing chest pain
-Dizziness
Psychological:
-Feel like they are going to die
-Fight or flight response
-out of body experience
17
Q

What are the requirements for PTSD?

A 
Need a traumatic events
4-6 weeks following event
Flashbacks
Avoidance
Hyperarousal
18
Q

What is the management of PTSD?

A

Bio - SSRIs are used with Paroxetine being first line
Zopiclone can be used for sleeping until SSRIs start working
Psyc - eye movement desensitisation, CBT

19
Q

How does eye movement desensitisation work?

A

They do this following CBT when they have come to terms with event itself
During the eye movement desensitisation they read a script of the event to retrigger the memory and then they move their eyes from left to right following a que, this helps to desensitise them

20
Q

What could be a differential of anorexia with no insight?

A

Could be a first episode psychosis

21
Q

What are the effects on the body of starvation?

A

Hair falls out - grow thin hair

Cardio - palpatations, faintness

22
Q

What are the ecg changes with anorexia?

A

Inverted T waves with hypokalaemia

Prolonged qt from hypocalcaemia

23
Q

What tests are done for anorexia?

A

Sit up, squat and stand tests

Tests core muscle mass for being able to stand up without hands

24
Q

What do you test for risk of refeeding syndrome?

A

Phosphate, if it starts to fall then stop refeeding

25
Q

Can an fy1 do a section 5(2)?

A

No as they are not fully registered by the GMC

26
Q

What are the metabolic consequences of bulimia?

A

Repeated vomiting can cause hypokalaemia and metaboli acidosis from low hydrogen ions

27
Q

What is a depression and depression picture in an older person called?

A

This is pseudodementia

28
Q

What are the reversible causes of cognitive impairment?

A 
Hypothyroid
B12 and folate deficiencies
Normal pressure hydrocephalus
SOL
Delerium - UTI/constipation
29
Q

What is some of the first senses lost in frontal lobe dementia?

A

Sense of smell

30
Q

What are some of the features of lewy body dementia?

A

Visual hallucinations
Falls
Parkinsonian changes
Fluctuating consciousness

31
Q

What change does a frontal lobe dementia cause?

A

This causes a personality change

Agressive, socially unacceptable things to do

32
Q

What does a temporal lobe dementia affect?

A

This is mainly memory loss

33
Q

What is the name of a dementia that doesnt affect social life much?

A

Minimal cognitive impairment

34
Q

How does lewy body dementia appear on CT?

A

Normal but will show lack of uptake of dopamine on DAT scan

35
Q

What does a mini mental exam test?

A

Orientation to space and time
Attention - parietal and temporal
Does not include Clock drawing - frontal lobe (planning involved)

36
Q

What is a better cognitive exam thatn mental state test?

A

The addenbrookes cognitive exam (ACE)

37
Q

What is the management of alzheimers?

A

Bio - acetastigmine - acetyacoestaerase inhibitors SEs - bradycardia so do ECG, D and V, COPD worsening
-memantine - MNDA system
psycho- cognitive stimulation groups
Social - support network

PAN - Psychiatry (11 decks)

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