march recall 2022 Flashcards
What drug class is mephedrone?
It’s a synthetic stimulant, like amphetamines, MDMA, and cocaine. It’s also a cathinone.
What is used to treat clozapine-induced hypersalivation?
Pirenzepine is used. Hyoscine is another option, although there is less evidence.
What is an appropriate drug to add to clozapine for persistent positive symptoms?
Amisulpride or Aripiprazole can be added for positive symptoms.
Which drug is unlikely to cause physical or psychological dependence?
LSD is unlikely to cause physical or psychological dependence.
Which SSRI has the least discontinuation symptoms?
Fluoxetine has fewer discontinuation issues than others.
Which antidepressant is preferred in hyponatremia?
Mirtazapine is preferred due to its reduced risk of SIADH.
What is the Hoover test used for?
To distinguish between organic and functional (non-organic) leg weakness. It uses a crossed extensor reflex principle.
What is the description of ‘insane automatism’?
An act performed unconsciously due to internal causes, like epilepsy. This can be used for an insanity defense.
What does automatism preceded by an aura suggest?
It suggests an epileptic seizure, which is classified as insane automatism.
What is a typical feature of cerebellar ataxia?
Staccato speech, characterized by broken and abrupt speech.
Which is the best measure of pre-morbid intelligence?
The National Adult Reading Test (NART) is used to assess pre-morbid intelligence.
Which type of dementia is associated with progressive loss of words?
Frontotemporal Dementia (FTD) causes progressive language decline.
What is the typical feature of Progressive Supranuclear Palsy?
Cervical dystonia, postural instability, and vertical gaze palsy are features.
What is the best predictor of long-term cognitive impairment after head injury?
Post-traumatic amnesia (PTA) and length of loss of consciousness (LOC) are the best predictors.
If someone is knocked unconscious and then becomes amnesic, what is this?
This is post-traumatic amnesia (PTA), not dissociative amnesia.
What kind of memory is most affected by ECT?
Retrograde memory (explicit memory) recall of events before treatment is most affected.
What kind of memory is affected in Korsakoff’s syndrome?
Episodic memory (personal events) is most affected.
What memory functions are preserved in Korsakoff?
Working memory, attention, and procedural memory are preserved.
Digit span is intact
What do the findings of macrocephaly and gaze avoidance suggest?
They are suggestive of Fragile X syndrome.
What is a common symptom of Lesch-Nyhan syndrome?
Self-harming behavior such as biting lips and fingers, along with gout.
What syndrome is associated with self-hugging and a prominent jaw?
These are characteristic features of Smith-Magenis syndrome.
What is a key feature of Prader-Willi syndrome?
Extreme obesity with compulsive eating (hyperphagia).
What symptoms can indicate Phenylketonuria?
Eczema, lack of pigment in skin/hair, and developmental delay.
What is the most likely diagnosis for a child skipping school and using drugs?
Conduct disorder due to repetitive antisocial behaviors and rule violations.
What condition has the highest heritability?
ADHD has the highest heritability of around 70-80%.
What is the most common comorbidity in children with ADHD?
Oppositional defiant disorder is the most common co-morbid disorder.
What is a sign of weak central coherence?
Focus on parts, not the whole, seen in ASD, like focusing on toy car wheels, not the shape.
What is the next treatment for a child with OCD if an SSRI doesn’t work?
Clomipramine, a tricyclic antidepressant, is the next step.
What does ‘habeas corpus’ mean?
The right to a hearing to check if detention is legal.
What is an ‘indictable offense’?
A more serious offense requiring a jury trial.
What is the ‘corpus delicti’?
The factual evidence that a crime has been committed.
Which graph type shows categories/discrete data?
Bar charts show categories and discrete data. Histograms are for continuous data.
Which type of bias is reduced by randomization?
Randomization primarily reduces selection bias.
Which type of bias is reduced by blinding?
Blinding helps to reduce measurement bias (also known as information bias).
What is allocation concealment designed to reduce?
Allocation concealment is designed to reduce selection bias.
A study has a pretest probability of 1 in 8 with 80% sensitivity and specificity. What is the post-test odds ratio?
Post-test odds ratio is 4 in 7.
What does a Galbraith plot assess?
It assesses the heterogeneity of study results in meta-analysis.
What is a key assumption of a fixed-effect model?
That differences between study outcomes are due to chance.
In a negative skew, how do mean, median, and mode compare?
In a negative skew: Mean < Median < Mode.
What is the economic term for lost medical earnings if a physician does poetry?
Opportunity cost, the cost of the next best alternative forgone.
What is ‘intangible cost’ in health economics?
Intangible cost refers to costs such as pain and discomfort that are hard to quantify in monetary value.
What is concurrent validity?
Agreement of a new instrument with another already validated instrument.
What does predictive validity assess?
An instrument’s ability to predict future outcomes.
What does a CONSORT diagram need to report?
It needs to report the number of dropouts (attrition rate).
What type of test is the Kruskal-Wallis test?
It’s a non-parametric equivalent of a one-way ANOVA (compares >2 independent groups).
What is an ANCOVA used for?
ANCOVA is used to control for baseline differences when comparing groups.
What is Fisher’s test used for?
It’s used with small sample sizes, especially in contingency tables.
What is theoretical saturation in qualitative research?
The point at which no new themes emerge from data analysis.
What is an important prevention against selection bias in studies?
Randomization is the best preventative step.
What bias is avoided by blinding in RCTs?
Expectation bias is avoided.
What is a typical sign of Serotonin Syndrome?
Clonus and hyperreflexia, along with other symptoms like hyperthermia.
What defense mechanism is intellectualization?
A neurotic defense mechanism using logic to avoid emotions.
What does ‘jumping to conclusions’ represent?
It represents an arbitrary inference cognitive distortion.
Which therapies use hypothesis formulation?
Psychodynamic and systemic family therapy use hypothesizing.
What is the management of lithium during labor?
Suspend lithium 24-48 hours prior and check level 12 hours post last dose.
What is the correct dose of lithium to reduce to post-delivery in a stable pregnant patient?
The dose should be reduced to 400mg, and levels should be checked after a week.
What are the types of prevention for mental health?
Universal, selective, and indicated are types of prevention.
Which specific therapy is best for treatment-resistant social phobia?
A MAOI such as Moclobemide is used in treatment resistance.
What are the symptoms of heroin withdrawal in a baby?
Jitteriness, shaking, and rapid breathing (tachypnea). This is cocaine?
What is the first-line NICE treatment for bulimia?
Self-help.
What is the initial step for binge eating disorder according to NICE?
Guided self-help.
When should group CBT-ED be offered for binge eating disorder?
If self-help is ineffective after 4 weeks.
What should be offered if group CBT-ED is unavailable or declined?
Individual CBT-ED for adults, same treatment for children/young people.
Should medication be used as sole treatment for binge eating disorder?
No, medication should not be the sole treatment.
What is the most important criteria for hospitalization in anorexia nervosa?
Self-harm. (Not low heart rate or BMI)
Vivid dreams, increased sleep, and appetite likely indicate what?
Cocaine withdrawal.
Excessive sleeping, irritability, hyperphagia, and normal pupils suggest?
Amphetamine or cocaine withdrawal; screen may be negative by day 3.
Man with mutism, catalepsy, fever, and recent stimulant use most likely has?
Malignant catatonia.
Confused, unstable gait, double vision, in a homeless person?
Administer thiamine first. (Then glucose if needed)
Jittery, overaroused newborn, 2 hours after birth, likely due to?
Cocaine, heroin, or maternal smoking.
Man with seizures, sweating, muscular rigidity, tachycardia after drug use?
Likely amphetamine use/toxicity.
Two drugs with equal efficacy and safety, which study compares costs?
Cost minimization study.
Hospitalization costs vs. clinic costs are compared, which study type?
Cost minimization study.
Study comparing different clinical outcomes in monetary terms?
Cost-benefit study.
Loss of productivity due to hospitalization represents what cost?
Indirect cost.
What is the purpose of sensitivity analysis in research?
To assess how changes in assumptions impact outcomes.
Which of the following is NOT a subtype of sensitivity analyses?
Time trade-off measures.
What does standard error of the mean measure?
How close the sample mean is to the population mean.
What is the range of a correlation coefficient?
-1 to +1.
What study design uses a sample from a cohort for cases and controls?
Nested case-control study.
What is used to assess heterogeneity or publication bias in meta-analysis?
Galbraith plot or funnel plot.
What is block randomization used for?
Ensuring an equal number of participants in each arm.
Why is Intention-to-treat analysis (ITT) used?
Gives more accurate results despite non-adherence.
What is the order of evidence hierarchy (highest to lowest)?
Meta-analysis, systematic review, RCT, non-RCT, cohort, case-control.
What does an area under the curve (AUC) of 0.86 signify?
Good accuracy, with 100% sensitivity mentioned in the question.
What does a Kaplan-Meier curve assess?
Time to event, e.g., time to hospitalization or death.
What are connected bars used in continuous data called?
Histogram, used to show distribution.
What is the role of imputation in research?
Used to represent missing data or reduce publication bias.
What sampling technique is used for getting MDT views?
Purposive sampling.
What is triangulation used for?
Combine multiple sources of data.
What condition is most commonly comorbid with gender dysphoria?
Depression.
Which genetic disorder has the weakest association with autism?
Patau syndrome.
Which medication is preferred for ADHD with co-morbid tics?
Clonidine.
What is a key feature of avoidant personality disorder, more so than social phobia?
Fear of criticism.
What is a first-line treatment for malignant catatonia?
ECT.
First-line treatment for affective stupor?
Lorazepam.
Most common symptom in adults with Fragile X?
Social anxiety. (Hyperactivity more common in children)
Which drug reduces seizure duration in ECT?
Chlordiazepoxide.
What is a contraindication for lithium use?
Myasthenia gravis. (Not hypothyroidism or epilepsy)
Preferred antidepressant for someone with intracerebral bleed?
Lofepramine. (TCA, not SSRI)
What is true about sex distribution in schizophrenia?
Equal sex distribution. (Not socioeconomic status)
What brain imaging findings are seen in alcohol-related damage?
Enlarged lateral ventricles, white matter anisotropy.
Lifetime risk of completed suicide in emotionally unstable PD?
10%.
Most common disorder in those who commit arson?
Alcohol use disorder.
Most common disorder associated with violence?
Substance use disorder or personality disorder. (Both increase risk)
Most common predictor of violence?
Previous history of violence. (Not substance use alone)
Treatment for Parkinson’s-like movements from antipsychotics?
Procyclidine.
Preferred antipsychotic for postural hypotension?
Aripiprazole.
Which antipsychotic is preferred in poorly controlled diabetes and epilepsy?
Aripiprazole.
What is a feature of Marchiafava-Bignami syndrome?
Demyelination of the corpus.
What is the most common predictor of violence?
Previous history of violence
Substance use alone is not a predictor
What is the treatment for Parkinson’s-like movements from antipsychotics?
Procyclidine
Which antipsychotic is preferred for postural hypotension?
Aripiprazole
Which antipsychotic is preferred in poorly controlled diabetes and epilepsy?
Aripiprazole
What is a feature of Marchiafava-Bignami syndrome?
Demyelination of the corpus callosum
Which drug is least likely to induce tardive dyskinesia?
Clozapine
What is the treatment for tardive dyskinesia?
Tetrabenazine
What defines a dynamic risk factor?
It’s fluctuating and modifiable
Examples include loss of insight and active psychosis
What is the treatment of choice for schizoaffective disorder?
Antipsychotics, mood stabilizers, and antidepressants
What action is recommended if a pregnant woman is stable on lithium?
Consider stopping lithium gradually, consider antipsychotic
What are key features of narcolepsy?
Sleep paralysis, cataplexy, hypnagogic hallucinations
What is a common symptom of epilepsy that presents in A&E?
Carbamazepine-induced hyponatremia
What is a defense mechanism of a drug lord donating to charity?
Could be altruism, sublimation, or intellectualization
What is the defense mechanism when parents help with accident prevention after a child’s death?
Could be altruism or sublimation
What is negative reinforcement in OCD?
Obsessions reduce anxiety by compulsions
What is the therapy technique to deal with a client who finds it funny to imitate behaviors?
Intensive Interaction Techniques
What is the key role for CBT in psychosis?
Acceptance, normalization, decreasing stress, validation
What is the correct approach for using motivational interviewing?
Roll with resistance
What is the most common neuropsychiatric sequelae of head injury in children?
Depression
Not mania
Schools supporting low-income families are considered what type of prevention?
Selective prevention
What is a key feature of sleep terrors that differentiates them from nightmares?
Lack of recall of the episode
What commonly improves with clonidine in ADHD?
Attention and impulsivity
Not aggression
What is often seen in ASD?
Heritability of 90%, intellectual disability in up to 70%
When is hospital admission preferred for children with schizophrenia?
For MDT assessment
Prevalence around 0.5-1%
What is the first step to take when a child with PTSD comes into the clinic?
Talk to the child directly, apart from their parents
What is a simple motor tic example?
Head shaking, eye blinking, grimacing
Throat clearing is vocal
A woman kills her baby due to psychosis, saying ‘end the misery’, it’s?
Diminished responsibility, not insanity
What is associated with increased risk of suicide in prisons?
More common in males, lifers, physical health issues
Do patients with learning disabilities have the right to withdraw consent?
Yes, at any time
What does the Bournewood case relate to?
Liberty
Capacity
What is the Tarasoff principle about?
Duty to warn potential victims of violence
What should you avoid giving with Tamoxifen?
Fluoxetine
Which drug has GABA and NMDA antagonist effects?
Ketamine
Which drug should you avoid when on lithium?
Sodium valproate
Teratogenic during pregnancy
A patient is on risperidone and citalopram with a prolonged QTc, what should you do?
Reduce risperidone, repeat ECG
If a patient has no response to citalopram after 2 months, what to do next?
Increase the dose or switch to another SSRI
Patient with epilepsy and hyponatremia on carbamazepine, also depressed, what to prescribe?
Mirtazapine
Avoid SSRIs/TCAs due to interactions
What is the first step to take if a 30-year-old female is having mutism and immobility?
Give lorazepam
Then consider ECT if severe/no improvement
What antipsychotic is best in elderly with eGFR >25?
Haloperidol, amisulpride, sulpiride can be considered
What medication can be used for alcohol maintenance?
Naltrexone or Acamprosate
What is a common side effect of lithium?
Fine tremor, polyuria, polydipsia
Toxicity >1.2mg/L: myoclonic twitches
What do you avoid prescribing for mania in moderate LD?
Lamotrigine
Which antipsychotic has the highest risk of weight gain?
Olanzapine
Which antipsychotic causes the most significant QTc prolongation?
Ziprasidone
What is the diagnostic criteria for dementia?
Significant cognitive decline impacting daily function
What is a key thing about audit and quality improvement?
Should lead to implementation of change
If a patient is on a high dose of methadone and now pregnant, what should you do?
Continue with the same dose
What is the most common symptom in postpartum with intrusive thoughts?
OCD
If symptoms causing distress
What is the clinical definition of paralytic ileus?
Abdominal distention, vomiting, constipation
What is often seen as a precursor to violence?
Past violence and previous suicide attempt
What do you see in an upper motor neuron lesion?
Scissoring gait
What is the main reason for lower life expectancy in Schizophrenia?
Cardiovascular disease
Which is more likely to cause an EPS symptom?
Bradykinesia/Paramydial clasp knife rigidity
Intentional tremor is associated with cerebellar lesions
If you are using a new antipsychotic, what is the best way to check for side effects?
Case series
What is the most appropriate for testing selective attention?
Stroop or Trail making test
Not ROCF
What happens to T/wave/ST segment when on clozapine?
Saddle-shaped ST segment
What is the primary role of family therapy?
To improve communication between family members
What is the main feature of motor dissociative disorder?
Aphonia, immobility, paralysis
What does the F stat measure?
The ratio of two variances
Which of the following increases in severity and prevalence between 10-12?
Tourette’s
What are the stages of Prochaska’s model?
Pre-contemplation, contemplation, preparation, action, maintenance
Which medication is more effective in refractory OCD?
Clomipramine and antipsychotic
What is the NNT for ARR of 9?
11.1%
NNT = 1/ARR. ARR = 1/9 = 0.11 = 11.1%
How does a funnel plot look in the presence of publication bias?
Asymmetrical
How many more years do patients with Schizophrenia die earlier?
10 years
