EMQ part 3 Flashcards
Recommended max alcohol intake for men
?300mg, 250mg, 20g, 10mg/kg, 50g, 600mg, 100mcg, 20-30mg/kg, 100mg
20g
Thiamine dose in WE
?300mg, 250mg, 20g, 10mg/kg, 50g, 600mg, 100mcg, 20-30mg/kg, 100mg
300mg
Deja vu/jamais vu
?NA, mediobasal temporal lobe, amygdala, L inferior frontal cortex, superior parietal cortex, fusiform gyrus, R dorsolateral PFC, medulla oblongata, post superior temporal lobe, uncus
Mediobasal temporal lobe
Olfactory hallucinations
?NA, mediobasal temporal lobe, amygdala, L inferior frontal cortex, superior parietal cortex, fusiform gyrus, R dorsolateral PFC, medulla oblongata, post superior temporal lobe, uncus
Uncus- medial to parahippocampal gyrus
Part of limbic system
Common origin of TLE
Fear and aggression
?NA, mediobasal temporal lobe, amygdala, L inferior frontal cortex, superior parietal cortex, fusiform gyrus, R dorsolateral PFC, medulla oblongata, post superior temporal lobe, uncus
Amygdala
Depersonalisation disorder
?NA, mediobasal temporal lobe, amygdala, L inferior frontal cortex, superior parietal cortex, fusiform gyrus, R dorsolateral PFC, medulla oblongata, post superior temporal lobe, uncus
R dorsolateral PFC- increased alertness observed in depresonalisation results from n activation of prefrontal attentional systems and reciprocal inhibition of the anterior cingulate, leading to experiences of mind emptiness and indifference to pain often seen.
On the other harn, a L sided PFC mechanism would inhibit the amygdala resulting in dampened autonomic output, hypoemotionality and lack of emotional colouring that would, in turn, be reported as feelings of unreality or detachment.
Prosopagnosia
?NA, mediobasal temporal lobe, amygdala, L inferior frontal cortex, superior parietal cortex, fusiform gyrus, R dorsolateral PFC, medulla oblongata, post superior temporal lobe, uncus
Fusiform gyrus
Separation and individuation phase beings in accordance with Margaret Mahler
In Mahler’s theory, child development takes place in phases, each with several sub phases:
Normal autistic phase – First few weeks of life. The infant is detached and self-absorbed. Spends most of his/her time sleeping. Mahler later abandoned this phase, based on new findings from her infant research.[2] She believed it to be non-existent. The phase still appears in many books on her theories.
Normal symbiotic phase – Lasts until about 5 months of age. The child is now aware of his/her mother but there is not a sense of individuality. The infant and the mother are one, and there is a barrier between them and the rest of the world.
Separation–individuation phase – The arrival of this phase marks the end of the Normal Symbiotic Phase. Separation refers to the development of limits, the differentiation between the infant and the mother, whereas individuation refers to the development of the infant’s ego, sense of identity, and cognitive abilities. Mahler explains how a child with the age of a few months breaks out of an “autistic shell” into the world with human connections. This process, labeled separation–individuation, is divided into subphases, each with its own onset, outcomes and risks. The following subphases proceed in this order but overlap considerably
Hatching – first months. The infant ceases to be ignorant of the differentiation between him/her and the mother. “Rupture of the shell”. Increased alertness and interest for the outside world. Using the mother as a point of orientation.
Practicing – 9-about 16 months. Brought about by the infant’s ability to crawl and then walk freely, the infant begins to explore actively and becomes more distant from the mother. The child experiences himself still as one with his mother.
Rapprochement – 15–24 months. In this subphase, the infant once again becomes close to the mother. The child realizes that his physical mobility demonstrates psychic separateness from his mother. The toddler may become tentative, wanting his mother to be in sight so that, through eye contact and action, he can explore his world. The risk is that the mother will misread this need and respond with impatience or unavailability. This can lead to an anxious fear of abandonment in the toddler. A basic ‘mood predisposition’ may be established at this point. Rapprochement is divided into a few sub phases: Beginning – Motivated by a desire to share discoveries with the mother.
Crisis – Between staying with the mother, being emotionally close and being more independent and exploring.
Solution – Individual solutions are enabled by the development of language and the superego.
Disruptions in the fundamental process of separation–individuation can result in a disturbance in the ability to maintain a reliable sense of individual identity in adulthood
According to Freud this is the phase of development of the Electra complex
?3-6 mo, 1-5y, 24-36mo, 15-24 mo, 0-24mo, 2-3y, 2-10y, 7-11 y, 4-8y, 2-3y
3-6 y
- Oral 0-1
- Anal 1-3
- Phallic 3-6
- Latency 6-puberty
- Genital puberty->
Oedipus and electra (Jung) complex occur during phallic stage
Piaget’s stage of transductive reasoning
?3-6 mo, 1-5y, 24-36mo, 15-24 mo, 0-24mo, 2-3y, 2-10y, 7-11 y, 4-8y, 2-3y
2-4 y
Subset of pre-conceptual thinking phase of pre-operational
Faulty type of logic that involves making inferences from one specific to another.
Pre-operational phase of Piaget
?3-6 mo, 1-5y, 24-36mo, 15-24 mo, 0-24mo, 2-3y, 2-10y, 7-11 y, 4-8y, 2-3y
2-7 y
- preconceptual thinking
- intuitive thinking
Concrete operational phase
?3-6 mo, 1-5y, 24-36mo, 15-24 mo, 0-24mo, 2-3y, 2-10y, 7-11 y, 4-8y, 2-3y
7-11
Rules govern logic- reversibility, identity, compensation
classification
Object constancy according to Mahler
?3-6 mo, 1-5y, 24-36mo, 15-24 mo, 0-24mo, 2-3y, 2-10y, 7-11 y, 4-8y, 2-3y
24-36 months children begin to be more comfortable separating from their mothers
Antipsychotic not metabolised by the liver so preferred in patients with liver impairment
Amisulpride-> no dose adjustment needed
Haloperidol-> low dose can be used
Associated with persistent pulmonary hypertension of the newborn
?Paroxetine, fluvoxamine, haloperidol, amisulpride, lithium, dotheipin, valproate, sertraline, citalopram, olanzapine
Paroxetine-> 3 peer reviewed studies showed no increase in CV malformations
Safest choice of medication for mania in pregnancy
?Paroxetine, fluvoxamine, haloperidol, amisulpride, lithium, dotheipin, valproate, sertraline, citalopram, olanzapine
Haloperidol
TCA should be avoided in breastfeeding
?Paroxetine, fluvoxamine, haloperidol, amisulpride, lithium, dotheipin, valproate, sertraline, citalopram, olanzapine
Dotheipin
Antidepressant with the lowest milk/maternal plasma ratio
?Paroxetine, fluvoxamine, haloperidol, amisulpride, lithium, dotheipin, valproate, sertraline, citalopram, olanzapine
Sertraline
Has verbal and performance scales
?Halstead-Reitan, MMPI, Stanford-Binet, HAM-D, Wisconsin card sorting, Rorschack inkblot, Raven’s progressive matrices, Weschler adult intelligence, YBOCS, MADRS
WAIS
Projective test of personality
Halstead-Reitan, MMPI, Stanford-Binet, HAM-D, Wisconsin card sorting, Rorschack inkblot, Raven’s progressive matrices, Weschler adult intelligence, YBOCS, MADRS
Inkblot
Test of executive
Halstead-Reitan, MMPI, Stanford-Binet, HAM-D, Wisconsin card sorting, Rorschack inkblot, Raven’s progressive matrices, Weschler adult intelligence, YBOCS, MADRS
Wisconsin card sorting
Frontal lobe
Stroop test->Test of attentional conflict, measure disinhibition and set shifting
Tower of london and trail making test also test forntal lobe
Test of visio-spatial orientation
Halstead-Reitan, MMPI, Stanford-Binet, HAM-D, Wisconsin card sorting, Rorschack inkblot, Raven’s progressive matrices, Weschler adult intelligence, YBOCS, MADRS
Raven’s progressive matrices
10 clinical scales and 4 validity scales
Halstead-Reitan, MMPI, Stanford-Binet, HAM-D, Wisconsin card sorting, Rorschack inkblot, Raven’s progressive matrices, Weschler adult intelligence, YBOCS, MADRS
Minnesota Multiphasic Personality Inventory
Gestalt therapy
?Durkheim, Wilfred Bion, ENgel, Tyrer, Piaget, Irving Yalo, Klein, Fritz Perls, Adler, Minuchin
Fritz Perls
Differentiated types of suicide
?Durkheim, Wilfred Bion, ENgel, Tyrer, Piaget, Irving Yalo, Klein, Fritz Perls, Adler, Minuchin
Durkheim
Structural family therapy
?Durkheim, Wilfred Bion, ENgel, Tyrer, Piaget, Irving Yalo, Klein, Fritz Perls, Adler, Minuchin
Minunchin
Adaptation and assimilation
?Durkheim, Wilfred Bion, ENgel, Tyrer, Piaget, Irving Yalo, Klein, Fritz Perls, Adler, Minuchin
Piaget
Inferiority complex
?Durkheim, Wilfred Bion, ENgel, Tyrer, Piaget, Irving Yalo, Klein, Fritz Perls, Adler, Minuchin
Adler
34 yo treated with citalopram 40mg, recently prescribed pain medication for back
?Ataxia and confusion, fever and rigidity, flu like, sudden collapse in pt with fhx sudden death, tremors/myoclonus/confusion, agranulocytosis, increase i self harm, worsening of psoriasis, polydipsia and polyuria, chest pain/fever/SOB
Tremors/myoclonus/confusion-> tramadol + SSRI, suggest serotonin syndrome (hyperreflexia and myoclonus)
22 yo agitated Indigenous male given Zuclopenthixol acetate 200mg IMI
?Ataxia and confusion, fever and rigidity, flu like, sudden collapse in pt with fhx sudden death, tremors/myoclonus/confusion, agranulocytosis, increase i self harm, worsening of psoriasis, polydipsia and polyuria, chest pain/fever/SOB
Fever and rigidity-> NMS
Risks include young males, high potency and high dose neuroleptic, rapid increase, depot, prior episodes of agitation, dehydration, exhaustion, organic illness, recent episode catatonia
30 yo Caucasian F started on li within normal range
?Ataxia and confusion, fever and rigidity, flu like, sudden collapse in pt with fhx sudden death, tremors/myoclonus/confusion, agranulocytosis, increase i self harm, worsening of psoriasis, polydipsia and polyuria, chest pain/fever/SOB
Polyuria, polydipsia 50% patients. Worsening of psoriases is potential but less common
Overweight male started on Ziprasidone 80mg BD
?Ataxia and confusion, fever and rigidity, flu like, sudden collapse in pt with fhx sudden death, tremors/myoclonus/confusion, agranulocytosis, increase i self harm, worsening of psoriasis, polydipsia and polyuria, chest pain/fever/SOB
Sudden collapse. Ziprasidone and sertindole have high propensity to prolong QTc.
Risks: hypokalemia, female, hypomagnesemia, kidney/heart failure, or congenital predisposition.
A clinic is asked to be financially accountable and responsible
?clinical governance, corporate governance, equal opportunities, OHS, Aus council of health standards, Audit, roo cause analysis, discount rate, restraint of trade, impaired doctors program
Corporate governance
Quality improvement cycle
?clinical governance, corporate governance, equal opportunities, OHS, Aus council of health standards, Audit, roo cause analysis, discount rate, restraint of trade, impaired doctors program
Audit
RANZCP limit fellows so in demand and paid well
?clinical governance, corporate governance, equal opportunities, OHS, Aus council of health standards, Audit, roo cause analysis, discount rate, restraint of trade, impaired doctors program
Restraint of trade
Risk management tool in sentinel events
?clinical governance, corporate governance, equal opportunities, OHS, Aus council of health standards, Audit, roo cause analysis, discount rate, restraint of trade, impaired doctors program
Root cause analysis
Sharps management
?clinical governance, corporate governance, equal opportunities, OHS, Aus council of health standards, Audit, roo cause analysis, discount rate, restraint of trade, impaired doctors program
ohs
Error- falsely accepting the null hypothesis
Type 1 and 2 error
Type of regression analysis used in Kaplan-Meir curve
?Face validity, ordinal data, dichotomous datd, T1 error, Cox’s proportional hazards model, T2 error, confidence intervals, confounder, concurrent validity, dependent variable
Cox’s proportional hazards model.
Survival analysis in a graph called the Kaplan-Meir curve.
Time to event in modelling.
Used to assess the importance of various covariates in the survival times of individual objects through the hazard function. Hazard is the rate at which the events happen, so the probability of the event happening in a short interval is the length of time multiplied by the hazard . The hazard (proportion) in one group compared to the other is the Hazard ratio
A diagnostic test for depression compared with the HDRS
?Face validity, ordinal data, dichotomous datd, T1 error, Cox’s proportional hazards model, T2 error, confidence intervals, confounder, concurrent validity, dependent variable
Concurrent validity- type of criterion validity. Degree to which a new tool’s ability to measure a construct compares the best measure of that construct.
Second type is predictive validity, how well the test can be used to accurately predict outcome or other patient-related events.
