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MCQ Flashcards

1
Q

Anosognosia

A

A neurological condition in which the patient is unaware of their neurological deficit or psychiatric condition.

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2
Q

Autoscopy

A

A person visualizes or experiences a veritable hallucinatory image of his double.

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3
Q

Dysmetropsia

A

AKA Todd’s syndrome, ‘Alice in Wonderland’ syndrome.

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4
Q

Zoopsia

A

Hallucinations of animals.

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5
Q

Gedankenlautwerden

A

Thought echo; hearing thoughts as if spoken aloud.

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6
Q

Schneider’s “first-rank” symptoms of schizophrenia

A

Audible thoughts, voices arguing, commentary, somatic passivity, thought withdrawal & insertion, thought broadcasting, delusional perceptions, made affect.

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7
Q

Cataplexy

A

Sudden loss of muscle control or muscle weakness.

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8
Q

Echolalia

A

Repetition of others’ words or phrases.

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9
Q

Pareidolic illusion

A

Indistict and random visual stimulis is perceived as definite and meaningful.

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10
Q

Palinopsia

A

The recurrence of a visual percept after the visual stimulis has been removed.

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11
Q

Mitmachen

A

Can move patient’s body into any posture, despite instructions to resist; will immediately return to previous posture.

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12
Q

Mitgehen

A

Extreme form of mitgehen requiring only the slightest touch, only to return to original posture once force removed.

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13
Q

Dizygotic concordance rate of schizophrenia

A

17%

(80% heritability)

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14
Q

Kleine-Levin syndrome

A

(AKA Familial hibernation syndrome; Sleeping beauty syndrome)

Rare neurological disorder; Persistent, episodic hypersomnia + symptoms like disinhibiition, hypersexuality, hyperphagia, emotional lability, derealisation.

Follows viral infection. Thalamic hypoperfusion. 1/500K. Mostly teenage males.

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15
Q

Addison’s disease

A

Presentation: depression, fatigue, hyperpigmentation, salt cravings (low BP), weight loss.

Etiology: Adrenal dysfunction due to AI (anti-21OH Abs), tuberculosis, infections.

Labs: Low sodium, high potassium (both due to low aldosterone); high ACTH (lack of cortisol feedback); low cortisol & aldosterone.

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16
Q

Post-olanzapine injection syndrome

A

Prevalence = 7/10,000 (1 in 1400)

Signs Sedation, delirium, dizziness, weakness, ataxia, muscle spasms, HTN, seizures.

Usually within 1 hour; but can occur <3 hours. Recovery in 48-72 hours.

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17
Q

Lewy body dementia

Clinical presentation

A

Fluctuating cognition,
VH (70-80%),
Parkinsonism (80-90%),
REM sleep behaviour disorder (75-90%),
Low mood, anxiety, agitation.
Age >60.

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18
Q

Macroanatomical changes in Alzheimer’s

A

Atrophy of cerebral cortex, with hippocampus, parahippocampal gyrus and temporal amygdala.

Parietal and frontal lobes also affected. Occipital lobe spared.

Ventricular dilation in parallel with atrophy.

Depigmentation of locus coeruleus, and relative sparing of the substantia nigra.

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19
Q

Executive aprosody

(1) Meaning; (2) Associtated lobe.

A

Reduction in emotional tone of speech.

Dysfunction of non-dominant (right) frontal premotor cortex or basal ganglia.

Can be tested by asking patient to repeat sentence with different affective tones.

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20
Q

Bion’s basic assumption groups

A
  1. Dependency
  2. Fight-flight
  3. Pairing
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21
Q

Imprinting

A

Coined by Konrad Lorenz.

Phase-sensitive attachment.

Rapid; unreinforced; time-sensitive and irreversible.

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22
Q

BPRS

A

Clinician rated scale to assess change in patients with major mental illness.

18-24 items (rated 1 to 7 according to severity).
Min. score = 18.

Takes into account behaviour in recent days, collateral hx.

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23
Q

QTc interval

Normal range; Prolongation RFs

A

Normal: Men <440; Women <470

Cardiac: Bradycardia, IHD, myocarditis, MI, LVH.

Metabolic: Low K, Mg, Ca.

Other: Stress/shock, anorexia nervosa, age extremes, female sex, drugs.

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24
Q

Enzyme which coverts L-DOPA to dopamine

A

DOPA decarboxylase

Tyrosine (tyrosine hydroxylase) - L-DOPA (dopa decarboxylase) - depoamine.

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25
Q

Dentate gyrus

Location; function; connections; associated conditions.

A

Located in medial temporal lobe (hippocampus).

Function: New episodic memory formation; spatial memory. Aids capacity to distinguish between similar yet distinct experiences.

Receives input from entorhinal cortex; sends output to CA3 region of hippocampus.

Atrophic in Alzheimer’s. Structural changes may predispose to seizures.

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26
Q

Frontal assessment battery

A

1. Conceptualisation (abstract reasoning)
2. Mental flexibility (verbal fluency)
3. Motor programming (Luria’s motor series)
4. Conflicting instructions
5. Inhibatory control (Go-No Go test)
6. Prehension behaviour (impulse inhibition)

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27
Q

Thomas & Chess are known for which concept?

A

Temperament

1.** Easy child **(40%)
**2. Difficult child **(10%)
**3. Slow to warm up **(15%)

(also ‘goodness of fit’, between temperament and environment)

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28
Q

Hayling test

A

Tests executive function.

Sentence completion test.

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29
Q

Most common teratogenic effect of lithium therapy

A

**Ebstein’s anomaly **= congenital prolapse of tricuspid valve to RV.

Especially if taken in first trimester.

(this is now contentious)

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30
Q

Lithium contraindications

A

Addison’s disease
Brugada syndrome
Arrythmia disorders
Renal impairment
Low sodium diets

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31
Q

How can lithium cause hypercalcaemia & hyperparathyroidism?

A

It increases renal calcium reabsorption and stimulates parathyroid hormone release.

Directly inhibits secretion of PTH from parathyroid glands.

Prolonged use may lead to increased bone resorption.

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32
Q

Clinical manifestations of hypercalcaemia

A

Fatigue, headache, nausea, muscle weakness, dyspnoea, insomnia, arthralgia, dizziness, abdominal pain.

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33
Q

Gestmann’s syndrome

A

Dyscalculia, dysgraphia, finger agnosia, right-left disorientation.

Lesions affecting left angular gyrus (i.e., the junction of temporal, occipital and parietal lobes).

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34
Q

Medications which can reduce efficacy of oral contraceptives

A

St John’s Wort
Carbamazepine
Phenytoin
Topiramate
Barbiturates

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35
Q

Medications which increase levels of lamotrigine

A

Sertraline and valproate.

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36
Q

Argyll Robertson pupil

A

React poorly to light (and dilating agents), but normally to near stimuli (i.e., accommodation and convergence).

Small and irregular in shape. No change to visual acuity.

Pathognomic of tertiary syphilis (?also diabetes).

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37
Q

Location of CYP450 system

A

Endoplasmic reticulum

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38
Q

Wilson’s disease

Clinical presentation

A

Liver: hepatitis, cirrhosis
Neurological: basal ganglia degeneration, speech and behavioural problems are often the first manifestations. Also: asterixis, chorea, dementia (reversible)
Kayser-Fleischer rings (a brown ring on the edge of the cornea), “sunflower cataract”.
Renal tubular acidosis, haemolysis, blue nails.

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39
Q

Wilson’s disease

Diagnostic tests

A

Reduced serum ceruloplasmin
Reduced serum copper

Increased 24 hr urine copper

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40
Q

Autism stats

A

60-90% concordance in monozygotic twins.
30% in dizygotic twins.
Heritability about 90%.
Prevalence 1% worldwide.
Male to female ratio 4:1.
8-fold risk if sibling has autism.
2-fold increase if cousin has it.
Risk factors: premature birth, low birth weight, valproate exposure during pregancy, older parental age.

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41
Q

Likelihood ratio for a negative result

A

(1 - sensitivity) / specificity

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42
Q

Odds ratio indicating no difference between groups

A

1.0

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43
Q

Treatment for pathological crying after a stroke

A

Sertraline or citalopram

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44
Q

Delphi method

A

A structured communication technique, originally developed as a systematic, interactive forecasting method which relies on a panel of experts. The experts answer questionnaires in two or more rounds. After each round, a facilitator provides an anonymous summary of the experts’ forecasts and reasons for their judgments. This process is intended to reduce the range of responses and arrive at a converged consensus.

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45
Q

Nominal variable

A

A variable that categorises data without a natural order or ranking.

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46
Q

Supranuclear palsy

Clinical presentation

A

(AKA Steele-Richardson-Olszewski syndrome)

>60 years old (M>F)
Loss of balance (fall backwards)
Gaze dysfunction (look up)
Dysarthria & dysphagia (late)
Executive dysfunction (i.e., frontal)
Rigid facial expressions (surprised)
Photosensitivity
Fatigue, low mood, apathy
Usually sporadic (rarely MAPT gene)

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47
Q

SPECT findings in Alzheimer’s

A

Decreased (medial) temporal perfusion

(Cf. Lewy body, which has decreased occipital cortex perfusion)

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48
Q

Parkinsonian tremor

Characteristics / etiology

A

5 Hz (4-6)
Assymetrical in early disease

Degeneration of DA neurons in pars compacta of the substantia nigra due to accumulations of alpha-synuclein (i.e., Lewy bodies) within the cells.

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49
Q

Tests of correlation

A

Parametric data (i.e., normally distrubuted), then use Pearson’s coefficient.

If data not normally distributed, then use Spearman’s coefficient.

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50
Q

Type II error

Beta

A

Acceptance of null hypothesis when it’s false (i.e., false negative)

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51
Q

Statistical power =

A

Probability of correctly rejecting the null hypothesis.

I.e., the ability of the test to detect an effect when there is one.

= 1 minus beta (Type II error; failing to reject false null)

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52
Q

Antidepressant to avoid if patient on Temoxifen

A

Fluoxetine (CYP2D6)

(also paroxetine, bupropion, duloxetine)

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53
Q

Who coined the term ‘sick role’?

A

Talcott Parsons

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54
Q

RNA –> DNA?

A

Transcription

by RNA polymerase

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55
Q

Arterial occlusion resulting in Broca’s aphasia?

A

Middle cerebral

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56
Q

Another term for Parkinsonian gait

A

Festinating

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57
Q

Lesion resulting in prosopagnosia

A

Fusiform gyrus (Temporal lobe)

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58
Q

MECP2 gene

Associated disease

A

Rett syndrome

Xq28

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59
Q

PGRN (progranulin)

Associated disease

A

Frontotemporal dementia

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60
Q

Wernicke and Korsakoff syndrome

Lesion in what part of brain?

A

Medial thalamus and mamillary bodies of the hypothalamus

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61
Q

Early signs of neurosyphilis

A

Loss of proprioception and** vibration sensation**.

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62
Q

Logorrhoea

A

Incoherent talkativeness
(in catatonia)

63
Q

Boston Naming test

A

Language

(lesion to left temporal gyrus)

64
Q

Ray Auditory Verbal Learning Test

A

Memory

65
Q

Alexia

Where’s the lesion?

A

Parietal lobe

66
Q

Procyclidine

MOA

A

Antimuscarinic

67
Q

Apraxias

Lesion location

A

Parietal lobe

68
Q

Trails A test

A

Attention

(connect numbered circles in order)

69
Q

Cells affected in GBS

A

Schwann

70
Q

Kluver-Bucy syndrome

Part of brain affected?

A

Amygdala

71
Q

Sumatriptan

MOA

A

5-HT1 agonist

72
Q

Neurosyphilis

Presentation

A

Loss of proprioception and vibration sensation
(no motor deficit)

73
Q

Supraoptic nucleus

Lesion

A

Diabetes insipidus

ADH (vasopression) synthesised in SON, transported to the posterior pituitary gland for storage.

74
Q

Extradural (epidural) haematoma

Key features

A

Head injury, lucid interval (hours)

Confusion –> loss of consciousness

+/- seizures, dysphasia, visual disturbances

75
Q

Perinatal psychosis

Prevalence

A

1-2 in 1000

(i.e., 0.1-0.2%)

76
Q

Wolpe

A

Systemic desensitisation

(a type of exposure therapy)

77
Q

Cingulate gyrus

Location; function

A

Processing emotions and regulating endocrine and autonomic responses; rewards-based decision-making

A fold of the cortex on medial cerebral hemisphere, next to corpus collusum

78
Q

Balloon cells

Which disease?

A

Pick’s disease

(i.e., frontotemporal lobar degeneration)

79
Q

Progranulin

Gene involved in what disease?

A

FTD

80
Q

Drugs which can precipitate porphyria

A

Barbiturates
Benzodiazepines
Supiride
Some mood stabilisers

81
Q

Porphyria

Clinical presentation

A

Abdo pain
Mental state changes
Constipation
Vomiting
Muscle weakness

82
Q

Fenestrated cavum septum pellucidum

Which disease?

A

Dementia pugilistica

83
Q

Hypnic jerks and theta waves

A

Stage I sleep

84
Q

Medial geniculate nucleus

Function and location

A

Auditory information processing

Located in the thalamus and relays information between inferior colliculus and auditory cortex

85
Q

Fusiform gyrus

A

Propspagnosia

86
Q

Medial temporal lobe

A

Unable to acquire new factual knowledge.

87
Q

Conduction aphasia

Neuroanatomy / Clinical signs

A

Damage to arcuate fasciculus which connects Wernicke’s to Broca’s area.

Comprehension (mostly) intact. Disruption of repetition. Mild paraphasic contamination.

88
Q

Delta waves

A

1-4 Hz

Frontal in adults; posterior in kids

Slow wave sleep (3 & 4). If present when awake it’s pathological.

89
Q

Theta waves

A

4-8 Hz

Generalised.

Young children and drowsy and sleeping adults (Stage 1), with certain meds, meditation. Occasionally in awake adults.

89
Q

Alpha waves

A

8-12 Hz

Posterior.

Relaxed, eyes closed, meditating.

(decreased in Hungtington’s, delirium)

89
Q

Sigma waves

A

12-14 Hz

Frontal and central.

Stage 2 sleep; the bursts of oscilattory activity known as sleep spindles.

90
Q

Beta waves

A

12-30 Hz

Frontally.

When busy, concentrating.

91
Q

Schnauzkrampf

A

A grimace resembling a pout in catatonic patients.

92
Q

Multisystem atrophy

Presenting triad

A

Parkinsonism, cerebellar ataxia, and autonomic failure

93
Q

Multisystem atrophy

Macro- and microanatomical pathology

A

Macro Pallor of substantia nigra, greenish & atrophied putamen, cerebellar atrophy.

Micro Papp-Lantos bodies (alpha-synuclein inclusions in oligodendrocytes found SN, cerebellum and basal ganglia)

94
Q

Characteristics of sleep in schizophrenia

A

Decreased REM latency
and
Decreased proportion of SWS

95
Q

Da Costa syndrome

A

Characterised by symptoms of heart disease (fatigue, breathlessness on exertion, palpitations, chest pain) but for which no organic cause can be found

96
Q

Cloz:Norcloz >2.5

Interpretations

A
  1. Last dose <11 hrs
  2. Saturated metabolism (e.g., high doses)
  3. If enzyme inhibitor Rx
  4. Recent smoking cessation
97
Q

Cloz:Norcloz < 0.5

Interpretation

A
  1. Level > 13 hrs since last dose
  2. Low cloz level (e.g. <0.3)
  3. Recent doses missed
  4. Rapid metabolism (starting smoking or taking induction agent)
98
Q

Neutropoenia

Prevalence in clozapine therapy

A

Defined as ANC < 1.5

2.7% will develop
(50% by 18 wks; 75% by 1 yr)

Risk factors:
1. Race (black 77% increased risk)
2. Young age
3. Low baseline WCC

NOT dose-related

99
Q

Agranulocytosis

Prevalence

A

ANC < 0.5

Prevalence 0.8%

With monitoring, 3% will die

Risk factors:
Older age
Race (Asian 2.4 x than white)

100
Q

Myocarditis

Risk and related facts

A

1/500 to 1/1000

Sx Fever, CP, tachy, SOB, flu, ^eosinophils, ^cardiac enxymes

Median = 16 days from initiation
(80% within 4 weeks; 90% within 8 weeks)

Postmortem: damaged myocytes and eosinophilic infiltration (Type 1, IgE-mediated reaction).

101
Q

Where is most degeneration seen in Wilson’s disease?

A

Lenticular nucleus
i.e., putamen and globus pallidus

(AKA hepatolenticular degeneration)

102
Q

Wilson’s etiology / presentation

A

Defect in ATP7B gene, Ch13
(codes enzyme that transports copper into bile, incorporating it into ceruloplasmin)

Onset 10-25 years
In children, presents with liver disease
In adolescents, neurological disease

103
Q

Agent to counteract cardiotoxic effects in TCA overdose

A

Sodium bicarbonate
If QRS >100 ms or ventricular arrhythmias
Activated charcoal
If within 2 hours of ingestion

104
Q

Delta waves

Sleep stage; frequency

A

Stage 3 sleep

High amplitude waves
0.5-2 Hz frequency

105
Q

Kuru plaques

Associated condition

A

CJD

Host-encoded proteins

106
Q

Angular gyrus

Location / function

A

Parietal

Language, maths, cognition

107
Q

Cingulate gyrus

Location / function

A

Adjacent to corpus collusum

Emotion, learning, memory

108
Q

Fusiform gyrus

Location / function

A

Temporal lobe

Face & body recongition

(Visual) word and number recognition

109
Q

Precentral gyrus

Location / function

A

Frontal lobe

Voluntary movement control

110
Q

Postcentral gyrus

Location / function

A

Parietal lobe

Touch sensation

111
Q

Lingual gyrus

Location / function

A

Occipital lobe

Dreaming, (visual) word recognition

112
Q

Dentate gyrus

Location / function

A

Hippocampus

Episodic memory formation

113
Q

From which nuclei does DA originate?

A

Arcuate, ventromedial, periventricular and supraoptic nuclei in the hypothalamus

114
Q

Presents like hyperthyroidism, but T4 is normal

A

Pheochromocytoma

Anxiety, tremor, tachycardia, diaphoresis, weight loss

115
Q

Buprenorphine MOA

A

Partial agonist at mu receptor

116
Q

Kasanin

A

Coined term ‘schizoaffective disorder’.

117
Q

Genomic imprinting

A

Portions of DNA function differently dependending on whether maternal or paternal in origin

118
Q

Balint’s syndrome

Anatomical focus / symptoms

A

Bilateral parieto-temporal dysfunction

Symptoms:
(1) Simultanagnosia
(2) Oculomotor apraxia
(3) Optic ataxia

119
Q

Author of first book on medical ethics

A

Ishaq bin Ali Rahawi

9th century

120
Q

o

ECG signs of hypo-K+

A

PR interval prolongation

ST/T-wave depression

U-waves

121
Q

Sites of 5-HT production

A

Raphe nuclei
Midline brainstem

Enterochromaffin cells
GI tract

122
Q

Serotonin synthesis pathway

A

1. Hydroxylation (rate limiting step)
Dietary L-tryptophan (can cross BBB) undergoes hydroxylation by tryptophan hydroxylase to form 5-hydroxytryptophan.

2. Decarboxylation
5-hydroxytryptophan then undergoes decarboxylation by L-aromatic amino acid decarboxylase to become 5-hydroxytryptomine (serotonin).

123
Q

Serotonin breakdown

A

1. Uptake by SERT (monoamine transporter)

2. Breakdown by MAO (oxidative deamination)

3. Then by aldehyde dehydrogenase

4. Excreted in urine as 5-hydroxyindoleacetic acid (5-HIAA)

124
Q

Terratogenic causes of cleft lip/palate

A

1. Benzos
2. Valproate
3. Alcohol

Lip/pallate is formed by week 12

125
Q

Pathophysiology of Lesch-Nyhan syndrome

A

Overproduction and accumulation of uric acid, resulting in hyperuricemia, nephrolithiasis, gouty arthritis, subcutaneous tophi.

126
Q

Gene associated with Lesch Nyhan syndrome

A

HPRT1 gene (long arm of X)

**X-linked recessive **(basically only males)

Codes enzyme HGPRT, responsible for recycling purines hypoxanthine and guanine.

127
Q

Russell’s sign

A

Scarred knuckles of a person with an eating disorder

128
Q

SUSS test

Condition

A

Sit up squat and stand

Anorexia nervosa

129
Q

Bouffee delirante

A

An historic term for a short-lived psychosis.

Characterised by acute-onset, florid psychotic sympotms with complete remission (<3 mo).

130
Q

False + benzos on UDS

A

Sertraline

NSAIDs

131
Q

False + cannabis on UDS

A

Efavirenz (HIV drug)
Dronabinol (appetite stim; chemo)
NSAIDs
PPIs

132
Q

False + cocaine on UDS

A

Topical anaesthetics

133
Q

False + PCP on UDS

A

Lamotrigine
NSAIDS
Ketamine
Tramadol
Venlafaxine

134
Q

False + amphetamine on UDS

A

Ofloxacin
Bupropion
Lebtolol
Phenothiazines
Trazodone
Methylphenidate
Metformin
Promethazine
Phenylephrine

135
Q

False + opioids on UDS

A

Poppy seeds
Verapamil
Amisulpride/sulpiride
Quetiapine
Rifampicin
Diphenhydramine
Ofloxacin
Quinine

136
Q

St John’s Ward induces which CYP enzyme?

A

CYP3A4

137
Q

Antidepressants which should be avoided in patient prescribed temoxifen

CYP2D6 inhibitors

A

Paroxetine, fluxetine, buproprion, duloxetine (also other SSRIs and venlafxine to an extent).

138
Q

Cerletti and Bini

A

First use of ECT for schizophrenia

139
Q

MDD recurrence %

A

**If single episode, 50-85% risk of recurrence.

If 2 episodes, 80-90% recurrence.**

140
Q

Refeeding EUC results

A

Low phosphate
Low K
Low Mg

Normal sodium and calcium

141
Q

Standard drink equation

A

ml alcohol x percentage / 1000
= standard drinks

142
Q

Prevalence of signs in Wernicke’s encephalopathy

A

MS changes 82%
Ocular signs 29%
Abnormal gait 23%

143
Q

Nitrous oxide MOA

A

NMDA antagonism

144
Q

Timing of etoh withdrawal seizures

A

12-18 hrs after last drink

145
Q

Timing of delirium tremens onset

Also prevalence and mortality %

A

3-4 days after last drink

Prevalence 3-5%

Mortality 10-20% if untreated

146
Q

Medical conditions associated with rapid cycling BPAD

A

Hypothyroidism
Grave’s disease
Stroke
MS
ABI
Some drugs (propranolol, levodopa, cyproheptadine)

147
Q
A

1%

Then doubles every 5 years.

Age 85 = 35 - 50%

148
Q

Leptin

Where it’s produced & function

A

Produced by adipose tissue

Reduces appetite

149
Q

Grehlin

Where it’s produced & function

A

Produced by gut

Increases appetite

150
Q

Cholecystokinine

A

Produced by gut

Reduces appetite

151
Q

BDI

A

Self-rated
21 questions
Scored 0-3
Max score 63
Covers 2 week period
Assess severity

152
Q
A

MCQ (1 decks)

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