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Assessment > Laboratory and ECG assessment > Flashcards

Laboratory and ECG assessment Flashcards

1
Q

Medical conditions which are associated with depression

A 
Coronary artery disease
Diabetes
End stage renal disease
Malignancy
HIV
Degenerative neurological disorders
Stroke
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2
Q

Conditions which can mimic depression

A

Addison’s disease
Hypothyroidism
Vitamin B12 deficiency

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3
Q

Reason to take FBC when depression is suspected

A

Rule out infectious or inflammatory pathology

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4
Q

Reason to take TSH when depression is suspected

A

Rule out hypothyroidism

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5
Q

Reason to take B12 level when depression is suspected

A

Rule out deficiency which can mimic depression

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6
Q

Reason to take electrolyte levels such as calcium, magnesium when depression is suspected

A

Abnormalities can cause fatigue which could mimic depression

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7
Q

Reason to take renal function when depression is suspected

A

To prepare for starting antidepressants

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8
Q

Reason to take LFTs when depression is suspected

A

To rule out alcohol related damage is concomitant alcohol misuse is suspected
To prepare for starting antidepressants

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9
Q

Reason to take 24 hour free urinary cortisol when depression is suspected

A

To rule out Cushing’s disease if suspected - more common in patients with depression than the general population

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10
Q

Reason to take ACTH stimulation test when depression is suspected

A

To rule out Addison’s disease which can mimic depression

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11
Q

Depression related conditions in which a dexamethasone suppression test is more likely to be positive

A

Major depressive disorder
Psychotic affective disorder
Depression with suicidality
Somatic syndrome

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12
Q

Non-depression related psychiatric conditions in which a positive dexamethasone suppression test can be seen

A 
Anorexia nervosa
Bulimia nervosa
Alcoholism
OCD
Anxiety
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13
Q

Prognostic feature of a positive dexamethasone suppression test in depression

A

More likely to respond to medication

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14
Q

Common result of corticotropin releasing hormone test in major depression

A

Blunted ACTH due to HPA axis abnormality

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15
Q

Percentage of patients presenting with depression who have overt hypothyroidism

A

1-4%

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16
Q

Percentage of patients with depression who have subclinical hypothyroidism

A

4-40%

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17
Q

Differential diagnoses for anxiety attacks

A 
Paroxysmal atrial tachycardia
PE
Seizures
Meniere's disease
TIA
Carcinoid syndrome
Cushing's
Hyperthyroidism
Hypoglycaemia
Pheochromocytoma
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18
Q

Substance that causes a panic attack in 72% of patients with panic disorder when injected

A

IV sodium lactate

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19
Q

Infusion rarely used in clinical practice which worsens organic conditions, and improves non-organic conditions, causing anxiety

A

Amobarbitol

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20
Q

Differential diagnosis for psychosis

A

Head injury
Seizures
Recreational drug use
Dietary deficiencies e.g. B12, folate, niacin, thiamine

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21
Q

Reason to take FBC when investigating psychosis

A

Rule out infections or inflammatory causes

Baseline if starting antipsychotics

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22
Q

Reason to take TFTs when investigating psychosis

A

Rule out hypothyroidism or hyperthyroidism

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23
Q

Reason to take glucose and lipid profile when investigating psychosis

A

As a baseline prior to starting antipsychotics to rule out pre-existing metabolic syndrome

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24
Q

Reason to take an ECG when investigating psychosis

A

As a baseline prior to starting antipsychotics

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25
Q

Reason to take prolactin level when investigating psychosis

A

As a baseline prior to starting antipsychotics

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26
Q

Reason to take electrolytes when investigating psychosis

A

To rule out an underlying cause

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27
Q

Reason to take LFTs when investigating psychosis

A

To rule out chronic alcohol use if suspected
To investigate for Wilson’s disease if suspected
As a baseline prior to starting antipsychotics

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28
Q

Tests to consider if delirium suspected

A 
FBC
CRP
Urine MC&S
CXR
Blood culture
Blood alcohol
Blood glucose
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29
Q

Tests to consider if STDs suspected

A

HIV test
Syphilis
STD testing

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30
Q

Tests to consider if encephalitis suspected

A 
NMDA receptor antibodies
Voltage-gated potassium channel antibodies - LGI 1, CASPR 2, contactin-2
AMPA receptor
GABA-B
Glycine receptor
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31
Q

Tests to consider if Cushing’s disease suspected

A

24 hour urinary free cortisol
Evening salivary cortisol
Dexamethasone suppression test

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32
Q

Symptoms of acute intermittent porphyria

A 
Muscle weakness
Seizures
Coma
Anxiety
Confusion
Hallucinations
Rarely overt psychosis
Abdominal pain
NOT a rash - unlike other types
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33
Q

Tests to consider if porphyria suspected

A

Spot urine sample for porphobilinogen during attack

24 hour urine for porphyrins, porphobilinogen and delta-aminolevulinic acid

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34
Q

Tests to consider if hyperparathyroidism suspected

A

Serum calcium

Serum parathyroid hormone

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35
Q

Neuropsychiatric symptoms of Wilson’s disease

A 
Cognitive deterioration
Clumsiness
Parkinsonism
Depression
Anxiety
Psychosis
Frontal lobe dysfunction
Migraine
Seizures
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36
Q

Non-neuropsychiatric manifestations of Wilson’s disease

A

Signs of chronic liver disease - oesophageal varices, splenomegaly, spider naevi
Kayser-Fleischer rings in the eyes on slit lamp examination
Renal tubular acidosis
Cardiomyopathy and heart failure

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37
Q

Tests to consider if Wilson’s disease suspected

A

Serum ceruloplasmin

24 hour copper excretion

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38
Q

Tests to consider if lysosomal storage diseases are suspected

A

Skin biopsy
Genetic testing
Serum alpha-galactosidase enzyme

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39
Q

Tests to consider if homocystinuria suspected

A

Homocysteine in urine and blood

Genetic testing

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40
Q

Tests to consider if CNS lesions suspected

A

MRI or CT

EEG if temporal lobe epilepsy suspected

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41
Q

Medications that can precipitate an episode of acute intermittent porphyria

A

Oestrogens
Benzodiazepines
Barbiturates
Diclofenac

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42
Q

Most common sex to suffer from anti-NMDA receptor encephalitis

A

Female

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43
Q

Malignancy found in 50% of women presenting with anti-NMDA receptor encephalitis

A

Ovarian teratoma

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44
Q

Most common first presentation of anti-NMDA receptor encphalitis

A

Psychosis

Mania

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45
Q

Prodrome associated with anti-NMDA receptor encephalitis

A

Fever
Headache
Malaise

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46
Q

Confirmatory test to diagnose anti-NMDA receptor encephalitis

A

CSF analysis

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47
Q

Treatment of anti-NMDA receptor encephalitis

A

Steroids

Plasma exchange

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48
Q

Complications caused by giving antipsychotics in cases of anti-NMDA receptor encephalitis

A

NMS-like syndrome

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49
Q

Tests to consider to investigate dementia

A 
FBC
CRP
TFT
Electrolytes
Thiamine
Syphilis and HIV if suspected
Glucose, lipids - if vascular dementia suspected
CT or MRI head
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50
Q

Endocrine abnormalities expected in anorexia nervosa

A 
Low LH, FSH, oestradiol
Low T3, normal T4, normal TSH
Mildly raised cortisol
Raised growth hormone
Low glucose
Low leptin
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51
Q

ECG abnormalities in anorexia nervosa

A 
Bradycardia
AV block
ST depression
TWI
Prolonged QT
Arrhythmias
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52
Q

Haematological abnormalities expected in anorexia nervosa

A

Normocytic normochromic anaemia
Mild leucopaenia
Thrombocytopaenia

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53
Q

Metabolic abnormalities expected in anorexia nervosa

A 
Raised cholesterol
Raised phosphate
Raised serum carotene
Low potassium
Raised chloride alkalosis
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54
Q

Electrolyte abnormalities seen in repetitive vomiting

A

Metabolic alkalosis

Hypokalaemia

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55
Q

Electrolyte abnormalities seen in laxative misuse

A

Metabolic acidosis
Hyponatraemia
Hypokalaemia

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56
Q

BMI for underweight

A

<18.5

57
Q

BMI for normal weight

A

18.5-24.9

58
Q

BMI for overweight

A

25-29.9

59
Q

BMI for obesity

A

30 or greater

60
Q

Method to calculate BMI

A

weight in kg/(height in metresxheight in metres)

61
Q

BMI if weight is 60kg and height is 170cm

A

20.8

62
Q

BMI if weight is 35kg and height is 150cm

A

15.6

63
Q

Most specific and sensitive test for detecting heavy alcohol use over the last 10 days

A

Carbohydrate deficient transferrin

64
Q

Neurological complications of alcohol abuse

A 
Seizures
Wernicke's Korsakoff syndrome
Peripheral neuropathy
Coma
Amnesia
Cerebellar degeneration
65
Q

GI complications of alcohol abuse

A 
GI bleeds/oesophageal varices
Peptic ulcer
NAFLD
Malnutrition
Cirrhosis
Portal hypertension
Pancreatitis
Hypoglycaemia
66
Q

Cardiovascular complications of alcohol abuse

A

Cardiomyopathy
HTN
Raised lipids

67
Q

Haematological complications of alcohol abuse

A

Raised MCV anaemia
Folic acid and B12 deficiency
Pancytopaenia
Clotting disorders

68
Q

Respiratory complications of alcohol abuse

A

Klebsiella pneumonia

Lung cancer

69
Q

Endocrine complications of alcohol abuse

A

Testicular atrophy
Sexual disorders
Menstrual irregularities

70
Q

Complications of alcohol abuse in pregnancy

A

Low birth weight
Foetal alcohol syndrome
Developmental delays
Neural tube defects

71
Q

Normal QTc in women

A

470ms

72
Q

Normal QTc in men

A

440ms

73
Q

QTc associated with an increased risk of torsades de pointes

A

> 500ms

74
Q

Medical causes of prolonged QTc

A 
Hypokalaemia
Hypomagnesaemia
Hypocalcaemia
Hypothermia
MI
Congenital long QT syndrome
75
Q

Common psychotropics that prolong the QTc

A 
Haloperidol
Venlafaxine
Chlorpromazine
Quetiapine
Amisulpride
Olanzapine
Amitriptyline
Doxepin
Citalopram
Moclobemide
Escitalopram
Bupropion
76
Q

Common non-psychotropic drugs that prolong QTc

A 
Erythromycin
Clarithromycin
Sotalol
Amiodarone
Flecainide
Loratidine
Hydroxychloroquine
77
Q

Antipsychotics with high effect on QTc

A

Haloperidol
Pimozide
High Dose Antipsychotic Therapy

78
Q

Antipsychotics with moderate effect on QTc

A

Chlorpromazine
Quetiapine
Amisulpride

79
Q

Antipsychotics with low effect on QTc

A 
Clozapine
Flupentixol
Olanzapine
Prochlorperazine
Risperidone
Sulpride
Paliperidone
80
Q

Antipsychotics with no effect on QTc

A

Aripiprazole
Zuclopenthixol
Lurasidone

81
Q

Urine test to check for adulteration with tap water

A

Specific gravity

82
Q

Time alcohol can be present in urine

A

Up to 12 hours

83
Q

Time amphetamines can be present in urine

A

Up to 48 hours

84
Q

Time benzodiazepines can be present in urine

A

Up to 3 days (depending on half life)

85
Q

Time cannabis can be present in urine if occasional use

A

Up to 3 days

86
Q

Time cannabis can be present in urine if regular use

A

Up to 4 weeks

87
Q

Time cocaine can be present in urine

A

6-8 hours

88
Q

Time cocaine metabolites can be present in urine

A

Up to 4 days

89
Q

Time codeine can be present in urine

A

48 hours

90
Q

Time heroin can be present in urine

A

1-3 days

91
Q

Time methadone can be present in urine

A

3 days or more

92
Q

Time morphine can be present in urine

A

2-3 days

93
Q

Time phencyclidine (PCP) can be present in urine

A

8 days

94
Q

Renal diseases associated with IV drug use

A 
Nephrotic syndrome
Acute glomerulonephritis
Amyloidosis
Interstitial nephritis
Rhabdomyolysis
95
Q

Plasma osmolality in diabetes insipidus

A

High

96
Q

Urine osmolality in diabetes insipidus

A

Low

97
Q

Urine osmolality after fluid deprivation in cranial diabetes insipidus

A

Low

98
Q

Urine osmolality after desmopressin in cranial diabetes insipidus

A

High

99
Q

Urine osmolality after fluid deprivation in nephrogenic diabetes insipidus

A

Low

100
Q

Urine osmolality after desmopressin in nephrogenic diabetes insipidus

A

Low

101
Q

Plasma osmolality in psychogenic polydipsia

A

Low

102
Q

Urine osmolality in psychogenic polydipsia

A

Low

103
Q

Urine osmolality after fluid deprivation in psychogenic polydipsia

A

High

104
Q

Urine osmolality after desmopressin in psychogenic polydipsia

A

High

105
Q

Plasma osmolality in SIADH

A

Low

106
Q

Urine osmolality in SIADH

A

High

107
Q

Symptoms of mild/moderate hyponatraemia

A 
Lethargy
Muscle cramps
Anorexia
Nausea
Vomiting
108
Q

Symptoms of severe hyponatraemia

A

Coma
Convulsions
Death

109
Q

Medications which can trigger an episode of acute intermittent porphyria in a susceptible individual

A 
Oestrogens/progesterone/testosterone
Barbiturates
Benzodiazepines
Diclofenac
Fluconazole/ketoconazole
HIV medication
Nifedipine
Chloramphenicol
Anticonvulsants
110
Q

Times when REM sleep patterns can be seen during the daytime

A

Narcolepsy
Sleep deprivation
Withdrawal from stimulants

111
Q

ECG abnormality associated with TCAs

A

Heart blocks

112
Q

Psychotropic medications associated with bradycardia on ECG

A

SSRIs
Lithium
Acetylcholinesterase inhibitors

113
Q

Psychotropic medications associated with tachycardia on ECG

A 
Clozapine
TCAs
MAOIs
Antiparkinsonian drugs
Antipsychotics
114
Q

Psychotropic medications associated with ST and T wave abnormalities on ECG

A

Thioridazine

Chlorpromazine

115
Q

Raised levels of metabolites found in a phaeochromocytoma

A

Vanillylmandelic acid

Homovanillic acid

116
Q

Prolactin levels following seizures and non-epileptic seizures

A

Usually raised following seizures to >500

Usually normal following non-epileptic seizures

117
Q

Laboratory findings in Wilson’s disease

A

Reduced serum caeruloplasmin
Reduced serum copper
Increased 24 hour urinary copper excretion

118
Q

Normal rate on ECG

A

60-100

119
Q

Normal PR interval on ECG

A

0.12-0.2s

120
Q

Causes of U waves

A

Normal ECG

Hypokalaemia

121
Q

T waves seen in hyperkalaemia

A

Tall, tented

122
Q

T waves seen in hypokalaemia

A

Flat, prolonged

123
Q

Most common thyroid function abnormality seen in sick euthyroid syndrome

A

Low T3

124
Q

Waist circumference in men considered normal

A

94-102cm

125
Q

Waist circumference in women considered normal

A

80-88cm

126
Q

Waist circumference in men considered high

A

> 102cm

127
Q

Waist circumference in women considered high

A

> 88cm

128
Q

Drug causes of hypercalcaemia

A

Thiazide diuretics
Lithium
Vitamin D
Vitamin A

129
Q

Use of the carbohydrate deficient transferrin blood test

A

To detect recent heavy alcohol consumption

130
Q

Abnormal blood tests seen in alcohol depenence

A

Raised GGT
Raised ALT and AST
Raised MCV
Decreased WCC

131
Q

BMI under which an ECG should be carried out in patients with anorexia

A

16

132
Q

ECG changes seen in Huntington’s disease

A

Conduction abnormalities

Bradycardia

133
Q

Normal ratio of CSF to serum glucose

A

0.6:1

134
Q

Proteins in the CSF associated with CJD

A

14-3-3

135
Q

Most sensitive test to investigate for clozapine induced myocarditis

A

Troponin

136
Q

CSF finding associated with aggressive and impulsive behaviour, and increased suicidality

A

Low 5-HIAA

137
Q

Psychiatric disorders which show a reduced CSF concentration of somatostatin

A

Depression
Bipolar disorder
Alzheimer’s dementia

138
Q

Type of heart block where there is gradual prolongation of the PR interval until there is a p wave not followed by a QRS complex

A

Second degree AV block, Mobitz type 1

139
Q

Type of heart block where there are intermittent p waves without a following QRS without gradual prolongation of the PR interval

A

Second degree AV block, Mobitz type 1

Assessment (22 decks)

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