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NMF: Psychiatry > EXAM QUESTIONS > Flashcards

EXAM QUESTIONS Flashcards

1
Q

What is early morning wakening defined as?

A

waking up 2 hours before normal

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2
Q

What are the core symptoms of depression?

A

low mood
anhedonia
anergia

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3
Q

What are the somatic symptoms of depression?

A 
decreased energy
decreased appetite
sleeping problems: disturbance, emw
concentration problems 
loss of libido
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4
Q

How long do anti-depressants need to be given for to assess response?

A

at least 4 weeks (6 weeks if elderly)

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5
Q

When can anti-depressants be used?

A 
moderate-severe depression
dysthymia 
GAD
panic disorder
OCD
PTSD
bulimia
PMS
neuropathic pain
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6
Q

What is globus hystericus?

A

the experience of not being able to swallow/eat

associated with anxiety

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7
Q

How long can a panic attack last?

A

45 minutes

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8
Q

criteria for anorexia

A

1 - weight <85% of predicted or BMI < 17.5kg/m2
2 - fear of weight gain, even when underweight, leading to dieting, induced vomiting or excessive exercise
3 - feeling fat when thin
4 - amenorrhoea or decreased libido (due to hypothalamic-pituitary-gonadal dysfunction)

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9
Q

What happens to cortisol levels in unipolar depression?

A

they are chronically high

- not suppressed by dexamethasone

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10
Q

What is a schema?

A

the rules someone has about the world

- content of assumptions and automatic thoughts

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11
Q

Will a patient need further treatment after ECT?

A

yes, only effective short-term

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12
Q

How can you detain a patient who is refusing treatment and is confused?

A

emergency detention certificate (cannot treat)

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13
Q

features of PTSD

A 
FAANDER
flashbacks
avoidance
arousal
nightmares
dissociation
emotional numbness
re-enactment
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14
Q

how long does GAD need to be present before diagnosis?

A

6 months

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15
Q

how long must an episode last to be classed as depressive?

A

2 weeks

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16
Q 
How many symptoms present in
a) mild
b) moderate
c) severe
depression?
A

a) 4 symptoms
b) 2 core + 4 extra = 6 symptoms
c) 3 core + 5 extra = 8 symptoms

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17
Q

when does bipolar disorder tend to present?

A

20s

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18
Q

what is bipolar I ?

A

at least one manic episode + depressive/hypomanic

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19
Q

what is bipolar II?

A

hypomanic + depressive

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20
Q

what is bipolar III?

A

hypomania after treatment for depression

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21
Q

How long does elevated mood have to be present to classify

a) hypomania?
b) mania?

A

a) 4 consecutive days

b) 7 consecutive days

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22
Q

What distinguishes mania from hypomania?

A

delusions of grandeur
reckless behaviour
flight of ideas
loss of social inhibitions

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23
Q

combining MAOI with another antidepressant can cause which disorder?

A

serotonin syndrome

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24
Q

how does serotonin syndrome present

A 
neuromuscular excitation (e.g. hyperreflexia, myoclonus, rigidity)
autonomic nervous system excitation (e.g. hyperthermia)
altered mental state
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25
Q

criteria for bulimia

A

1 - recurrent episodes of binge eating characterised by uncontrolled overeating
2 - preoccupation with control of body weight
3 - regular use of mechanism to overcome the fattening effects of binges e.g. starvation, vomit-induction, laxatives, over-exercise
4 - BMI > 17.5

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26
Q

How long until you can diagnose PTSD?

A

3 months

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27
Q

Treatment of PTSD

A

EMDR

trauma-focused CBT

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28
Q

Parts of the brain implicated in OCD

A

orbitofrontal cortex

caudate nucleus

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29
Q

Psychological treatment of OCD

A

ERP

CBT

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30
Q

Who is likely to complete suicide after DSH?

A

Older. Male. Unemployed. Single/Separated/Divorced. Isolated. Poor Health. Violent DSH. Suicide note. Hx of DSH.

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31
Q

Who is likely to repeatedly DSH?

A

previous DSH. Personality disorder. Unemployed. Low socio-economic group. Criminal record. 25-54 years of age. Single/Separated/Divorced

32
Q

Can an adult develop learning disability?

A

no, onset must be before age 18

33
Q 
How do we classify
a) mild
b) moderate
c) severe
d) profound
learning disability?
A 
Mild = IQ 50-69
Moderate = IQ 35-49
Severe = IQ 20-34
Profound = IQ < 20
34
Q

What is affected in ADHD?

A

executive functioning and self-regulation

35
Q

Triad of symptoms in ADHD

A

inattention, hyperactivity and impulsivity

36
Q

What is delirium tremens?

A

a complication of alcohol withdrawal (2 days after)

  • often presents insidiously with night time confusion
  • coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
37
Q

alcohol relapse prevention

A
  • 1st line = Naltrexone (Decreases desire)
  • Disulfiram [Antabuse] = S.E = flushed skin, tachycardia, N+V, arrhythmia, hypotension

Acamprosate = started as soon as detox complete and continue through relapse. Helps with alcohol cravings. S.E. = headache, diarrhoea, nausea

38
Q

What does increased arousal in PTSD mean?

A 
disturbed sleep
irritable
decreased concentration
hyper-vigilance
exaggerated startle response
39
Q

Which 3 areas of symptoms are needed to diagnose PTSD?

A 
intrusive symptoms (1+)
avoidance symptoms (3+)
increased arousal (2+)
40
Q

name some avoidance symptoms in PTSD

A 
avoid thoughts/conversations/reminders
amnesia
loss of interest
detachment
emotional numbness
41
Q

name some intrusive symptoms of PTSD

A

recurrent recollections, nightmares or flashbacks

physiological reaction eg. being sick

42
Q

What is an idea of reference?

A

false beliefs that random or irrelevant occurrences in the world directly relates to a person

43
Q

“Everywhere I go there is this terrible smell, I keep washing but I can’t get rid of it, other people say they can’t smell it but I think they’re just being polite”

A

olfactory hallucination

44
Q

Who can use a short-term detention certificate? and what does it do?

A

A psychiatrist

Detention + treatment

45
Q

A 24 year old man with schizophrenia is brought to hospital by the police. He is very agitated and attempts to punch one of the nurses. He is restrained and given 5mg haloperidol intramuscularly. He initially becomes calmer but an hour later begins screaming. On review he complains of an extremely sore back and neck, saying he cannot move his neck.

A

An acute dystonic reaction is an extrapyramidal side effect which tends to occur within hours of administration of an antipsychotic.

46
Q

A 55 year old man takes olanzapine for schizoaffective disorder. He presents to the emergency department with chest pain and is found to be having a myocardial infarction.

A

metabolic syndrome due to atypical antipsychotic

47
Q

Which neurotransmitter would be involved in “A 21 year old man with known illicit drug use who attends the Emergency Department following a suspected epileptic fit.”

A

In withdrawal from sedative-hypnotic drugs there is a reduced GABA.

48
Q

Which drug can be used to sedate someone with delirium?

A

haloperidol

lorazepam if hx of parkinsons

49
Q

What investigation needs to be done prior to starting someone on lithium?

A

Us+Es

50
Q

Which certificate allows detention of a patient in hospital for 6 months in the first instance?

A

a compulsory treatment order

51
Q

treat mania in pregnancy

A

olanzapine

52
Q

treatment resistant schizophrenia

A

clozapine

53
Q

What does alcohol do to neurotransmitters?

A

alcohol is a depressant so it will decrease glutamate activity and increase GABA activity

54
Q

What does alcohol withdrawal do to neurotransmitters?

A

since you no longer have the inhibitory effect it will increase glutamate and decrease GABA

55
Q

How do you manage alcohol withdrawal?

A

a benzodiazepine like chlordiazepoxide

thiamine (vitamin B1)

56
Q

A 45 yr old woman comes to you with fatigue, weight gain and constipation. Examination reveals cool and dry hands, bradycardia and slow-relaxing reflexes. She has been taking a psychiatric medication for a long-time what is it likely to be?

A

signs of hypothyroidism –> lithium

57
Q

How long can a patient be held with a

a) emergency detention certificate
b) short term detention certificate
c) compulsory treatment order

A

a) 72 hours
b) 28 days
c) 6 months then 6 months then 1 year

58
Q

What is the difference between PoA and welfare guardianship?

A

PoA is granted when patient has capacity

Welfare guardian is appointed by a court to someone without capacity

59
Q

What do you do if you think someone cannot consent?

A

fill out a section 47 certificate

60
Q

Treating a patient in an emergency is covered by which law?

A

common law

61
Q

What is an intervention order of the adults with incapacity act?

A

This is a court appointment which authorises a person to act and take a one-off action or make decisions on behalf of an adult with incapacity.

62
Q

What is the difference between dystonia and dyskinesia?

A

dystonia = abnormal tone eg neck position, eye position

dyskinesia = abnormal movements eg. pouting/chewing

63
Q

management of mania

A

consider stopping antidepressant if the patient takes one; antipsychotic therapy e.g. olanzapine or haloperidol

64
Q

What is pica?

A

an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, and paint chips

65
Q

Which neurotransmitter helps with sleep?

A

serotonin

66
Q

What drug reduces alcohol cravings?

A

acamprosate

67
Q

What drug causes severe reaction to alcohol? why?

A

disulfram: alcohol intake causes severe reaction due to inhibition of acetaldehyde dehydrogenase

68
Q

Are pupils small in opiod use or withdrawal?

A

use

69
Q

Reverse paracetamol overdose

A

n-acetylcysteine

70
Q

reverse benzodiazepine overdose

A

flumazenil

71
Q

reverse TCA overdose

A

Iv bicarbonate

72
Q

can bipolar be diagnosed after one manic episode

A

no need 2

73
Q

autistic triad

A

social communication + social interaction + repetitive behaviour

74
Q

What is the hereditability of schizophrenia?

A

monozygotic twins: 50%

80% hereditability

75
Q

How should painful neck muscle spasms following haloperidol be managed?

A

acute dystonia –> procylidine

76
Q

How is neuroleptic malignant syndrome diagnosed?

A

raised creatinine kinase

NMF: Psychiatry (10 decks)

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