Exam 3

Question 1

Criteria for drug/alcohol dependence (6)

Answer 1

-Compulsion to take the substance
-Physiological withdrawal state
-Persistence despite harm
-Neglect of alternative pleasures
-Tolerance
-Difficulty in controlling use
(need three or more)

Question 2

CAGE questionnaire includes what questions?

Answer 2

1. Do you ever think you should CUT-DOWN?
2. Do you get ANNOYED when someone asks you about..?
3. Do you ever feel GUILTY?
4. EYE-OPENER?

Question 3

Area of the brain which mediates impulse control. Which group of people is this undeveloped in?

Answer 3

The prefrontal cortex- underdeveloped in adolescents

Question 4

Role of the orbito-frontal cortex

Answer 4

Motivation in response to environmental cues. E.g. drug cues increase activation in this area and motivation to perform drug seeking behaviour

Question 5

How should patients whose drinking is harmful/mildly dependent be managed?

Answer 5

Brief intervention followed by motivational enhancement therapy

Question 6

What should be discussed in a brief intervention? (4)

Answer 6

Advice on dangers of drinking + leaflets
Info about support groups
Trying to find out what factors influence the patient to drink
Agreeing objectives and strategies to achieve these e.g. drinking weaker drinks , spacing

Question 7

What drug is used for medically-assisted withdrawal?

Answer 7

Chlordiazepoxide (benzo)

Question 8

Co-morbidities caused by B1 (thiamine) deficiency (4)

Answer 8

Wernickes
Korsakoffs
Peripheral/cerebellar neuropathy

Question 9

Treatment for Wernicke/Korsakoff

Answer 9

Pabrinex (thiamine + riboflavin)

Question 10

Triad of Wernickes and other features (2)

Answer 10

Nystagmus
Optalmoplegia
Ataxia
+ sensory peripheral neuropathy, confusion

Question 11

Drugs for alcohol relapse prevention (3)

Answer 11

Naltrexone (opioid blocker)
Acamprosate
Dilsufiram (induces an immediate “hangover” effect)

Question 12

Features of Korsakoff syndrome (3)

Answer 12

Anterograde and retrograde amnesia
Confabulation
Lack of insight

Question 13

Classifications of learning disability:

a) borderline
b) mild
c) moderate
d) severe
e) profound

Answer 13

a) around 70
b) 50-69
c) 35-49
d) 20-34
e) less than 20

Question 14

Chromosomal causes of learning disability (5)

Answer 14

Downs syndrome
Patau syndrome
Edward syndrome
Cri du chat syndrome
Angelman/Prader-Willi

Question 15

Drugs used in ADHD treatment and how they work?

Answer 15

Stimulants e.g. methylphenidate, dexamfetamine- improve dopaminergic transmission in exective function networks, particularly the pre-frontal cortex

Question 16

Autistic triad of impairments

Answer 16

Impaired social interaction
Impaired speech and language
Inflexible thought and behaviour

Question 17

Diagnostic features of delirium (5)

Answer 17

Impairment of consciousness
Disturbance of cognition
Psychomotor disturbance
Disturbed sleep-wake cycle
Emotional disturbance

Question 18

What does “sundowning” in the context of delirium mean?

Answer 18

Symptoms get worse at night

Question 19

What features of cognition may be impaired?

Answer 19

Disorientated in time and space
Impaired memory and attention
Disturbed perceptions

Question 20

What are the components of the confusion assessment method?

Answer 20

Need both ACUTE ONSET AND FLUCTUATING COURSE, and INATTENTION

and either DISORGANISED THINKING
or
ALTERED CONSCIOUS LEVEL

Question 21

Standard first-line treatment for agitation in delirium

Answer 21

Haloperidol (once non-pharmacological measures have been tried)

Question 22

What drug should be given for patients with Lewy body dementia or Parkinsons disease?

Answer 22

Lorazepam (antipsychotics worsen the extrapyramidal side effects)

Question 23

Defining clinical features of anorexia nervosa (3)

Answer 23

BMI less than 17.5
Having a dread of gaining weight
Over-evaluation of size

Question 24

Other key features of anorexia nervosa (4)

Answer 24

Amenorrheoa
Fatigue, fainting, dizziness (hypotension)
Lanugo
Enhanced weight loss by over-exercise, direutrics, laxatives

Question 25

Management of anorexia nervosa

Answer 25

Self-help, family interventions (best evidence). Hospitalisation (either voluntary or under MHA) if BMI less than 15

Question 26

How may fatal arrythmias arise in anorexia?

Answer 26

Hypokalaemia

Question 27

Distinguishing features of bulimia (3)

Answer 27

Binge-eating,with attempts to counter the effects of binge eating
Morbid dread of fatness
Preoccupation with eating

Question 28

Signs of bulimia (2)

Answer 28

Knuckle calluses

Parotid hypertrophy

Question 29

An alcohol history should take place in the context of what?

Answer 29

a psychiatric history

Question 30

Units present in

a) pint of lager
b) 70cl vodka/other spirits
c) bottle of wine

Answer 30

a) 3 units
b) 30 units
c) 9-10 units

Question 31

What are the four As of insight in the mental status exam?

Answer 31

Awareness of symptoms
Attribution of symptoms to a mental illness
Appraisal of the consequences of symptoms
Acceptance of treatment

Question 32

Important aspects of an attempted suicide history

Answer 32

Before (events leading up to, planning, precautions)
During (method, when and where, discovery, drugs/alcohol involved?)
After (feelings now, future intent)
Rest of psych history

Question 33

Aspects of the mental status exam

Answer 33

Appearance
Behaviour
Speech
Mood and affect (including suicidality)
Thoughts (form and content)
Perception (hallucinations/illusions)
Insight (awareness, attribution, appraisal, acceptance)

Question 34

Important aspects of a psych history (4)

Answer 34

Risk assessment particularly in depression
Previous psychiatric history
Detailed alcohol and illicit drugs history
Forensic history