MCQ Flashcards
1
Q
Anosognosia
A
A neurological condition in which the patient is unaware of their neurological deficit or psychiatric condition.
2
Q
Autoscopy
A
A person visualizes or experiences a veritable hallucinatory image of his double.
3
Q
Dysmetropsia
A
AKA Todd’s syndrome, ‘Alice in Wonderland’ syndrome.
4
Q
Zoopsia
A
Hallucinations of animals.
5
Q
Gedankenlautwerden
A
Thought echo; hearing thoughts as if spoken aloud.
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.
7
Q
Cataplexy
A
Sudden loss of muscle control or muscle weakness.
8
Q
Echolalia
A
Repetition of others’ words or phrases.
9
Q
Pareidolic illusion
A
Indistict and random visual stimulis is perceived as definite and meaningful.
10
Q
Palinopsia
A
The recurrence of a visual percept after the visual stimulis has been removed.
11
Q
Mitmachen
A
Can move patient’s body into any posture, despite instructions to resist; will immediately return to previous posture.
12
Q
Mitgehen
A
Extreme form of mitgehen requiring only the slightest touch, only to return to original posture once force removed.
13
Q
Dizygotic concordance rate of schizophrenia
A
17%
(80% heritability)
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.
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.
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.
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.
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.
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.
20
Q
Bion’s basic assumption groups
A
- Dependency
- Fight-flight
- Pairing
21
Q
Imprinting
A
Coined by Konrad Lorenz.
Phase-sensitive attachment.
Rapid; unreinforced; time-sensitive and irreversible.
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.
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.
24
Q
Enzyme which coverts L-DOPA to dopamine
A
DOPA decarboxylase
Tyrosine (tyrosine hydroxylase) - L-DOPA (dopa decarboxylase) - depoamine.
25
**Dentate gyrus**
| Location; function; connections; associated conditions.
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.
26
**Frontal assessment battery**
**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)
27
**Thomas & Chess** are known for which concept?
**Temperament**
1.** Easy child **(40%)
**2. Difficult child **(10%)
**3. Slow to warm up **(15%)
(also 'goodness of fit', between temperament and environment)
28
**Hayling test**
Tests executive function.
**Sentence completion test.**
29
Most common teratogenic effect of **lithium** therapy
**Ebstein's anomaly **= congenital prolapse of tricuspid valve to RV.
Especially if taken in first trimester.
(this is now contentious)
30
**Lithium contraindications**
Addison's disease
Brugada syndrome
Arrythmia disorders
Renal impairment
Low sodium diets
31
How can **lithium** cause hypercalcaemia & hyperparathyroidism?
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**.
32
Clinical manifestations of **hypercalcaemia**
Fatigue, headache, nausea, muscle weakness, dyspnoea, insomnia, arthralgia, dizziness, abdominal pain.
33
**Gestmann's syndrome**
**Dyscalculia, dysgraphia, finger agnosia, right-left disorientation.**
Lesions affecting **left angular gyrus** (i.e., the junction of temporal, occipital and parietal lobes).
34
Medications which can reduce efficacy of **oral contraceptives**
**St John's Wort
Carbamazepine
Phenytoin
Topiramate
Barbiturates**
35
Medications which **increase levels of lamotrigine**
**Sertraline** and **valproate**.
36
**Argyll Robertson pupil**
**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).
37
**Location of CYP450 system**
**Endoplasmic reticulum**
38
**Wilson's disease**
| Clinical presentation
**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.
39
**Wilson's disease**
| Diagnostic tests
Reduced **serum ceruloplasmin**
Reduced **serum copper**
Increased **24 hr urine copper**
40
**Autism stats**
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.
41
**Likelihood ratio for a negative result**
(1 - sensitivity) / specificity
42
**Odds ratio indicating no difference between groups**
1.0
43
**Treatment for pathological crying after a stroke**
**Sertraline** or **citalopram**
44
***Delphi* method**
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.***
45
**Nominal variable**
A variable that categorises data without a natural order or ranking.
46
**Supranuclear palsy**
| Clinical presentation
(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)**
47
**SPECT findings in Alzheimer's**
**Decreased (medial) temporal perfusion**
(Cf. Lewy body, which has decreased occipital cortex perfusion)
48
**Parkinsonian tremor**
| Characteristics / etiology
**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**.
49
**Tests of correlation**
**Parametric data (i.e., normally distrubuted), then use *Pearson's coefficient*.**
**If data not normally distributed, then use *Spearman's coefficient*.**
50
**Type II error**
| Beta
**Acceptance of null hypothesis when it's false** (i.e., false negative)
51
**Statistical power =**
**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)
52
Antidepressant to avoid if patient on **Temoxifen**
**Fluoxetine** (CYP2D6)
(also paroxetine, bupropion, duloxetine)
53
Who coined the term 'sick role'?
**Talcott Parsons**
54
**RNA --> DNA?**
**Transcription**
by RNA polymerase
55
**Arterial occlusion resulting in Broca's aphasia?**
**Middle cerebral**
56
**Another term for Parkinsonian gait**
**Festinating**
57
**Lesion resulting in prosopagnosia**
**Fusiform gyrus** (Temporal lobe)
58
**MECP2 gene**
| Associated disease
**Rett syndrome**
Xq28
59
**PGRN (progranulin)**
| Associated disease
Frontotemporal dementia
60
**Wernicke and Korsakoff syndrome**
| Lesion in what part of brain?
**Medial thalamus** and **mamillary bodies** of the hypothalamus
61
**Early signs of neurosyphilis**
Loss of **proprioception** and** vibration sensation**.
62
**Logorrhoea**
Incoherent talkativeness
(in catatonia)
63
**Boston Naming test**
**Language**
(lesion to left temporal gyrus)
64
**Ray Auditory Verbal Learning Test**
Memory
65
**Alexia**
| Where's the lesion?
Parietal lobe
66
**Procyclidine**
| MOA
Antimuscarinic
67
**Apraxias**
| Lesion location
Parietal lobe
68
**Trails A test**
Attention
(connect numbered circles in order)
69
**Cells affected in GBS**
Schwann
70
**Kluver-Bucy syndrome**
| Part of brain affected?
**Amygdala**
71
**Sumatriptan**
| MOA
5-HT1 agonist
72
**Neurosyphilis**
| Presentation
**Loss of proprioception and vibration sensation**
(no motor deficit)
73
**Supraoptic nucleus**
| Lesion
**Diabetes insipidus**
ADH (vasopression) synthesised in SON, transported to the posterior pituitary gland for storage.
74
**Extradural (epidural) haematoma**
| Key features
**Head injury, lucid interval (hours)**
Confusion --> loss of consciousness
+/- seizures, dysphasia, visual disturbances
75
Perinatal **psychosis**
| Prevalence
**1-2 in 1000**
(i.e., 0.1-0.2%)
76
**Wolpe**
**Systemic desensitisation**
(a type of exposure therapy)
77
**Cingulate gyrus**
| Location; function
**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
**Balloon cells**
| Which disease?
**Pick's disease**
(i.e., frontotemporal lobar degeneration)
79
**Progranulin**
| Gene involved in what disease?
**FTD**
80
Drugs which can precipitate **porphyria**
Barbiturates
Benzodiazepines
Supiride
Some mood stabilisers
81
**Porphyria**
| Clinical presentation
**Abdo pain
Mental state changes
Constipation
Vomiting
Muscle weakness**
82
Fenestrated **cavum septum pellucidum**
| Which disease?
**Dementia pugilistica**
83
**Hypnic jerks** and **theta waves**
**Stage I sleep**
84
**Medial geniculate nucleus**
| Function and location
**Auditory information processing**
**Located in the thalamus** and relays information between inferior colliculus and auditory cortex
85
**Fusiform gyrus**
Propspagnosia
86
**Medial temporal lobe**
Unable to acquire new factual knowledge.
87
**Conduction aphasia**
| Neuroanatomy / Clinical signs
Damage to **arcuate fasciculus** which connects Wernicke's to Broca's area.
Comprehension (mostly) intact. **Disruption of repetition.** Mild paraphasic contamination.
88
**Delta waves**
**1-4 Hz**
Frontal in adults; posterior in kids
**Slow wave sleep (3 & 4).** If present when awake it's pathological.
89
**Theta waves**
**4-8 Hz**
Generalised.
Young children and **drowsy and sleeping adults (Stage 1)**, with certain meds, meditation. Occasionally in awake adults.
89
**Alpha waves**
**8-12 Hz**
Posterior.
**Relaxed, eyes closed, meditating.**
(decreased in Hungtington's, delirium)
89
**Sigma waves**
**12-14 Hz**
Frontal and central.
**Stage 2 sleep; the bursts of oscilattory activity known as sleep spindles.**
90
**Beta waves**
**12-30 Hz**
Frontally.
**When busy, concentrating.**
91
**Schnauzkrampf**
A grimace resembling a pout in catatonic patients.
92
**Multisystem atrophy**
| Presenting triad
Parkinsonism, cerebellar ataxia, and autonomic failure
93
**Multisystem atrophy**
| Macro- and microanatomical pathology
**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
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Characteristics of **sleep in schizophrenia**
**Decreased REM latency**
and
**Decreased proportion of SWS**
95
**Da Costa syndrome**
Characterised by **symptoms of heart disease (fatigue, breathlessness on exertion, palpitations, chest pain)** but for which no organic cause can be found
96
**Cloz:Norcloz >2.5**
| Interpretations
1. Last dose <11 hrs
2. Saturated metabolism (e.g., high doses)
3. If enzyme inhibitor Rx
4. Recent smoking cessation
97
**Cloz:Norcloz < 0.5**
| Interpretation
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
**Neutropoenia**
| Prevalence in clozapine therapy
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
**Agranulocytosis**
| Prevalence
**ANC < 0.5**
**Prevalence 0.8%**
With monitoring, **3% will die**
**Risk factors:**
Older age
Race (Asian 2.4 x than white)
100
**Myocarditis**
| Risk and related facts
**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
**Where is most degeneration seen in Wilson's disease?**
**Lenticular nucleus**
i.e., putamen and globus pallidus
(AKA hepatolenticular degeneration)
102
**Wilson's etiology / presentation**
**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
**Agent to counteract cardiotoxic effects in TCA overdose**
**Sodium bicarbonate**
If QRS >100 ms or ventricular arrhythmias
**Activated charcoal**
If within 2 hours of ingestion
104
**Delta waves**
| Sleep stage; frequency
**Stage 3** sleep
High amplitude waves
**0.5-2 Hz frequency**
105
**Kuru plaques**
| Associated condition
**CJD**
Host-encoded proteins
106
**Angular gyrus**
| Location / function
**Parietal**
**Language, maths, cognition**
107
**Cingulate gyrus**
| Location / function
**Adjacent to corpus collusum**
**Emotion, learning, memory**
108
**Fusiform gyrus**
| Location / function
**Temporal lobe**
**Face & body recongition**
**(Visual) word and number recognition**
109
**Precentral gyrus**
| Location / function
**Frontal lobe**
**Voluntary movement control**
110
**Postcentral gyrus**
| Location / function
**Parietal lobe**
**Touch sensation**
111
**Lingual gyrus**
| Location / function
**Occipital lobe**
**Dreaming, (visual) word recognition**
112
**Dentate gyrus**
| Location / function
**Hippocampus**
**Episodic memory formation**
113
**From which nuclei does DA originate?**
**Arcuate, ventromedial, periventricular and supraoptic nuclei** in the **hypothalamus**
114
**Presents like hyperthyroidism, but T4 is normal**
**Pheochromocytoma**
Anxiety, tremor, tachycardia, diaphoresis, weight loss
115
**Buprenorphine MOA**
**Partial agonist at mu receptor**
116
**Kasanin**
**Coined term 'schizoaffective disorder'.**
117
**Genomic imprinting**
**Portions of DNA function differently dependending on whether maternal or paternal in origin**
118
**Balint's syndrome**
| Anatomical focus / symptoms
**Bilateral parieto-temporal dysfunction**
**Symptoms:**
(1) Simultanagnosia
(2) Oculomotor apraxia
(3) Optic ataxia
119
**Author of first book on medical ethics**
**Ishaq bin Ali Rahawi**
9th century
120
# o
**ECG signs of hypo-K+**
**PR interval prolongation**
**ST/T-wave depression**
**U-waves**
121
**Sites of 5-HT production**
**Raphe nuclei**
Midline brainstem
**Enterochromaffin cells**
GI tract
122
**Serotonin synthesis pathway**
**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
**Serotonin breakdown**
**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
**Terratogenic causes of cleft lip/palate**
**1. Benzos
2. Valproate
3. Alcohol**
Lip/pallate is formed by week 12
125
**Pathophysiology of Lesch-Nyhan syndrome**
Overproduction and accumulation of **uric acid**, resulting in **hyperuricemia, nephrolithiasis, gouty arthritis, subcutaneous tophi.**
126
**Gene associated with Lesch Nyhan syndrome**
**HPRT1 gene** (long arm of X)
**X-linked recessive **(basically only males)
Codes enzyme HGPRT, responsible for recycling purines hypoxanthine and guanine.
127
**Russell's sign**
**Scarred knuckles** of a person with an eating disorder
128
**SUSS test**
| Condition
**Sit up squat and stand**
Anorexia nervosa
129
**Bouffee delirante**
An historic term for **a short-lived psychosis.**
Characterised by acute-onset, florid psychotic sympotms with complete remission (<3 mo).
130
**False + benzos on UDS**
**Sertraline**
**NSAIDs**
131
**False + cannabis on UDS**
**Efavirenz (HIV drug)
Dronabinol (appetite stim; chemo)
NSAIDs
PPIs**
132
**False + cocaine on UDS**
**Topical anaesthetics**
133
**False + PCP on UDS**
**Lamotrigine
NSAIDS
Ketamine
Tramadol
Venlafaxine**
134
**False + amphetamine on UDS**
**Ofloxacin
Bupropion
Lebtolol
Phenothiazines
Trazodone
Methylphenidate
Metformin
Promethazine
Phenylephrine**
135
**False + opioids on UDS**
**Poppy seeds
Verapamil
Amisulpride/sulpiride
Quetiapine
Rifampicin
Diphenhydramine
Ofloxacin
Quinine**
136
**St John's Ward induces which CYP enzyme?**
**CYP3A4**
137
**Antidepressants which should be avoided in patient prescribed temoxifen**
| CYP2D6 inhibitors
Paroxetine, fluxetine, buproprion, duloxetine (also other SSRIs and venlafxine to an extent).
138
**Cerletti and Bini**
**First use of ECT for schizophrenia**
139
**MDD recurrence %**
**If single episode, 50-85% risk of recurrence.
If 2 episodes, 80-90% recurrence.**
140
**Refeeding EUC results**
**Low phosphate
Low K
Low Mg**
*Normal sodium and calcium*
141
**Standard drink equation**
**ml alcohol x percentage / 1000
= standard drinks**
142
**Prevalence of signs in Wernicke's encephalopathy**
**MS changes 82%
Ocular signs 29%
Abnormal gait 23%**
143
**Nitrous oxide MOA**
**NMDA antagonism**
144
**Timing of etoh withdrawal seizures**
**12-18 hrs after last drink**
145
**Timing of delirium tremens onset**
| Also prevalence and mortality %
**3-4 days after last drink**
*Prevalence 3-5%*
*Mortality 10-20% if untreated*
146
**Medical conditions associated with rapid cycling BPAD**
**Hypothyroidism
Grave's disease
Stroke
MS
ABI
Some drugs** (propranolol, levodopa, cyproheptadine)
147
** **
**1%**
Then doubles every 5 years.
Age 85 = 35 - 50%
148
**Leptin**
| Where it's produced & function
**Produced by adipose tissue**
**Reduces appetite**
149
**Grehlin**
| Where it's produced & function
**Produced by gut**
**Increases appetite**
150
**Cholecystokinine**
**Produced by gut**
**Reduces appetite**
151
**BDI**
**Self-rated
21 questions
Scored 0-3
Max score 63
Covers 2 week period
Assess severity**
152
