ENT and Psych Flashcards
Symptoms of SSRI discontinuation syndrome:
- Dizziness, electric shock sensations, anxiety
(eg. if stopped paroxetine)
Subdural Haematoma (damages bridging vein) presentation:
- History of patient with alcoholism, fluctuating consciousness- CT scan: hyper-dense(acute)/hypo-dense(chronic) crescent collection
Mx: Burr hole evacuation surgery is most likely done for chronic subdural bleeds.
-Ddx; Extradural haematoma/haemorrhage: -Presents as= convex shapes on CT, due to trauma, can lead to rupture of middle meningeal artery
Some symptoms of Schizophrenia:
- Persecutory delusions
- Poor organisation of thoughts
- Easily distracted and struggles to maintain good eye contact during conversations.
- Poor prognostic factors: Low Iq= as it can cause an increase in both positive and negative symptoms
and Strong family history
Nerves affected in Vestibular Schwannomas?
Cranial Nerves: 5, 7 and 8 (Trigeminal, Facial, Vestibulo-cochlear)
- Classic symptoms: vertigo, sensorineural hearing loss, tinnitus (unilateral deafness/tinnitus, is an important differential)
- Investigation of choice: MRI of cerebello-pontine angle: this condition pathology is best visualised in the cerebello-pontine angle region+ audiogram (both MRI and audiogram=1st line)
Mx: requires urgent referral to ENT for surgery, or by raditherapy.
Meniere’s disease main presentation:
Fullness of the ear
After how long should a patient under 25yrs started on antidepressants be reviewed?
1 week
According to ICD-10 criteria, how long does depressive symptoms need to go on for to be classified as depressive?
2 weeks
Delirium Tremens timeline: How long after?
72 hours
- Presents with tremors, seizures; generally happens AFTER 36 hours -72 hours after sudden alcohol withdrawal.
Example of somatic symptoms (depression) ?
- Early morning waking, changes in appetite and weight
- anhedonia
- loss of libido
- loss of emotional reactivity
-psychomotor agitation/retardation
Generalised Anxiety disorder Mx:
- 1st line) SSRI
- 2nd line) Duloxetine (SNRI or try another SSRI)
Diagnostic investigation for Obstructive Sleep Apnoea?
- Polysomnography (PSG) also known as sleep studies.
OBA mx: 1st line) weight loss, then CPAP if there is moderate/severe
Lithium toxicity can be precipitated by which condition?
- Thiazide diuretics eg. Bendroflumethiazide
Mx. of: Unilateral glue ear:
- 2 week wait referral to ENT: as unilateral finding= need to rule out: posterior nasal space tumour
Scale to measure and identify: Obstructive Sleep Apnoea
Epworth sleepiness scale
Cause of otitis externa (organism) vs. cause of RECURRENT otitis externa?
- Cause of singular: Staph aureus
- cause of RECURRENT: Candida Albicans- be suspicious of this if patient is taking abx and still getting otitis externa.
- Recent swimming can be a common trigger
Mx. of Mania/Hypomania in patients taking antidepressants (for eg. sertraline) ?
- Stop Anti-depressant and start anti-psychotics (Olanzapine/Haloperidol)
- could also use Lithium but this takes 2 weeks to start working so would try anti-psychotics first.
Give one medication that will reduce seizure threshold? (will cause seizures to happen)
Clozapine (is an atypical antipsychotic used for treatment-resistant schizophrenia)
- also has a significant risk of agranulocytosis
Korsakoff’s Syndrome: triad of symptoms that is a complication of Wernicke’s Encephalopathy?
- Anterograde amnesia
- Retrograde amnesia
- Confabulation
(short term and long term memory loss, and filling in gaps of stories)
Wernicke’s (triad)= Ophthalmoplegia, ataxia, confusion
Clozapine:
- Stopping smoking: can cause a RISE in clozapine blood levels.
- Reduces seizure threshold (increases chance of seizure)
- side effect: can cause Agranulocytosis
- if doses are missed for more than 48 hours, need to re-titrate the doses again slowly
What can long-term lithium use cause?
Hyper PTH resulting in hypercalcaemia
- Symptoms: stones, bones, moans and groans
How to stop antidepressants if symptoms are feeling better?
- Keep using it for 6 more months after it feels like symptoms have stopped.
Benzodiazepine: Mechanism of action-
ENHANCES the effect of GABA (the main inhibitory neurotransmitter)
Management of Mania: In patients already taking antidepressants=
- Consider STOPPING antidepressants and STARTING antipsychotic therapy.
eg. stop venlafaxine and start antipsychotics (eg. risperidone)
Alcohol Withdrawal Symptom timeline:
- 1) Symptom: 6-12 hours
- 2) Seizures: 36 hours
- 3) Delirium Tremens: 72 hours
Risk of using SSRIs in the third trimester?
Persistent pulmonary hypertension of the newborn
Risk of SSRI use in the first trimester to the unborn fetus?
- Congenital heart defects
