ENT and Psych

Question 1

Symptoms of SSRI discontinuation syndrome:

Answer 1

• Dizziness, electric shock sensations, anxiety
  (eg. if stopped paroxetine)

Question 2

Subdural Haematoma (damages bridging vein) presentation:

Answer 2

• 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

Question 3

Some symptoms of Schizophrenia:

Answer 3

• 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

Question 4

Nerves affected in Vestibular Schwannomas?

Answer 4

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.

Question 5

Meniere’s disease main presentation:

Answer 5

Fullness of the ear

Question 6

After how long should a patient under 25yrs started on antidepressants be reviewed?

Answer 6

1 week

Question 7

According to ICD-10 criteria, how long does depressive symptoms need to go on for to be classified as depressive?

Answer 7

2 weeks

Question 8

Delirium Tremens timeline: How long after?

Answer 8

72 hours
- Presents with tremors, seizures; generally happens AFTER 36 hours -72 hours after sudden alcohol withdrawal.

Question 9

Example of somatic symptoms (depression) ?

Answer 9

• Early morning waking, changes in appetite and weight
• anhedonia
• loss of libido
• loss of emotional reactivity
  -psychomotor agitation/retardation

Question 10

Generalised Anxiety disorder Mx:

Answer 10

• 1st line) SSRI
• 2nd line) Duloxetine (SNRI or try another SSRI)

Question 11

Diagnostic investigation for Obstructive Sleep Apnoea?

Answer 11

• Polysomnography (PSG) also known as sleep studies.

OBA mx: 1st line) weight loss, then CPAP if there is moderate/severe

Question 12

Lithium toxicity can be precipitated by which condition?

Answer 12

• Thiazide diuretics eg. Bendroflumethiazide

Question 13

Mx. of: Unilateral glue ear:

Answer 13

• 2 week wait referral to ENT: as unilateral finding= need to rule out: posterior nasal space tumour

Question 14

Scale to measure and identify: Obstructive Sleep Apnoea

Answer 14

Epworth sleepiness scale

Question 15

Cause of otitis externa (organism) vs. cause of RECURRENT otitis externa?

Answer 15

• 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

Question 16

Mx. of Mania/Hypomania in patients taking antidepressants (for eg. sertraline) ?

Answer 16

• 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.

Question 17

Give one medication that will reduce seizure threshold? (will cause seizures to happen)

Answer 17

Clozapine (is an atypical antipsychotic used for treatment-resistant schizophrenia)
- also has a significant risk of agranulocytosis

Question 18

Korsakoff’s Syndrome: triad of symptoms that is a complication of Wernicke’s Encephalopathy?

Answer 18

• Anterograde amnesia
• Retrograde amnesia
• Confabulation

(short term and long term memory loss, and filling in gaps of stories)

Wernicke’s (triad)= Ophthalmoplegia, ataxia, confusion

Question 19

Clozapine:

Answer 19

• 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

Question 20

What can long-term lithium use cause?

Answer 20

Hyper PTH resulting in hypercalcaemia
- Symptoms: stones, bones, moans and groans

Question 21

How to stop antidepressants if symptoms are feeling better?

Answer 21

• Keep using it for 6 more months after it feels like symptoms have stopped.

Question 22

Benzodiazepine: Mechanism of action-

Answer 22

ENHANCES the effect of GABA (the main inhibitory neurotransmitter)

Question 23

Management of Mania: In patients already taking antidepressants=

Answer 23

• Consider STOPPING antidepressants and STARTING antipsychotic therapy.
  eg. stop venlafaxine and start antipsychotics (eg. risperidone)

Question 24

Alcohol Withdrawal Symptom timeline:

Answer 24

• 1) Symptom: 6-12 hours
• 2) Seizures: 36 hours
• 3) Delirium Tremens: 72 hours

Question 25

Risk of using SSRIs in the third trimester?

Answer 25

Persistent pulmonary hypertension of the newborn

Question 26

Risk of SSRI use in the first trimester to the unborn fetus?

Answer 26

• Congenital heart defects