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MD > MD3 Psych and accidentally some RAPP > Flashcards

MD3 Psych and accidentally some RAPP Flashcards

1
Q

3 pillars of bipolar tx?

A

lithium
anti-convulsant - valporate or lamotrigine
anti-psychotic to bridge lithium efficacy period

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2
Q

What psychotropic not to give in bipolar?

A

SSRI/SNRI - risk of mania.

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3
Q

Which benzo is best for sleep . eg. to tide an SSRI patient over in waiting period?

A

temazepam

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4
Q

PTSD therapy type?

A

EMDR

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5
Q

Organic causes of anxiety?

A
  • hyperthyroid
  • arrythmia
  • hyper cortisol
  • pheo
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6
Q

OCD Mx?

A

CBT + SSRI

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7
Q

Community equivalent to glycopyrolate?

A

Hyocine butylbromide

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8
Q

The 5 EOL symptoms to treat?

A

Pain and SOB, N+V, agitation, secretions.

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9
Q

Metaclopramide class?

A

D2 antagonist

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10
Q

Key to diabetic foot disease?

A

OFFLOAD

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11
Q

Two classes of medications that may cause incontinence?

A

diuretics and anti-cholinergics.

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12
Q

What age can you diagnose a personality disorder?

A

not until 18, the prelude is Conduct Disorder (can only have this prior to 18).

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13
Q

Therapy type for BPD?

A

DBT therapy

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14
Q

It is important to always take a _________ in mental health assessments where possible.

A

Collateral hx

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15
Q

Which observation is key in anorexia?

A

Standing BP

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16
Q

Typical Mx for First Episode Psychosis?

A

Inpatient stay (if they refuse, CAT team may be an option)

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17
Q

Necessary timeline for GAD?

A

6 months

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18
Q

Reasons pts avoid mental health treatment?

A

self-esteem
stigma
worry about employment

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19
Q

What is conversion disorder?

A

paralysis or other somatic manifestation of psych disorder

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20
Q

What is cyclothymia?

A

chronic mood disorder slightly less than hypomania

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21
Q

BMI cutoff for anorexia nervosa?

A

Under 18.5
(both types of anorexia)

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22
Q

What is atypical anorexia?

A

Consistent with anorexia but still above 18.5 BMI (usually overweight individuals)

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23
Q

What is PICA?

A

Eating things that aren’t food

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24
Q

What is rumination?

A

Regurgitating food

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25
Q

A systolic of ___ would warrant admission for eating disorder.

A

Under 80

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26
Q

Amennorhea in eating disorder pt’s indicates a risk of?

A

Osteopenia

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27
Q

Which allied health member is key in refeeding?

A

Dietician

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28
Q

Which 4x molecules should be given for refeeding?

A

phosphate, potassium, thiamine, magnesium

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29
Q

Therapy mode for young eating disorders:

A

family based therapy

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30
Q

How dangerous is opiate withdrawal?

A

Not dangerous just unpleasant

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31
Q

Key qns for PTSD?

A
  • hypervigilence
  • nightmares
  • sleep
  • flashbacks
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32
Q

What is suboxone?

A

mix of naloxone and buprenorphine for opioid withdrawal.

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33
Q

Ix for epilepsy?

A

24 hr EEG monitoring

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34
Q

Recorded seizure but normal EEG suggests?

A

Pyschogenic seizure

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35
Q

Does a good recall of events after a seizure suggest epileptic or psychogenic?

A

Pyshcogenic. Epileptics usually very confused with amnesia.

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36
Q

Length of psychogenic seizures?

A

Typically longer than one minute (usual epileptic length).

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37
Q

Primary vs secondary vs tertiary gain?

A

Primary gain - immediate gain to improve current situation/safety

Secondary gain - sick role/social benefit

Tertiary gain - gain for another, eg. caregiver.

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38
Q

Screening for post-natal depression?

A

Edinburgh depression score

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39
Q

4AT under 4 means?

A

No delirium

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40
Q

Screening tool for first nations dementia?

A

KICA

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41
Q

Best anti-psychotic for FEP?

A

Aripiprazole/brex (lowest weight impact)

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42
Q

Mnemonic for breaking bad news?

A

SPIKES
Setting
Perception
Initiation
knowledge
emotion
summary

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43
Q

4 x dopamine paths and their psychiatric relevance?

A

Mesolimbic - positive symptoms of schizhophrenia

Mesocortical - negative symptoms of schizophrenia

Niagral striatal - EPSE

Infundibular - prolactin levels

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44
Q

HR up and SOB in a patient on clozapine? Which Ix?

A

Suspect myocarditis.
ECG
Troponin
CK
CRP

Imaging - cardiac MRI (best) or ECHO

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45
Q

Aspects of the mental health act:

A

pt needs immediate tx for psychiatric issue due to risk of harm

pt can be treated under the act

there are no less restrictive measures

46
Q

How long to treat FEP?

A

At least 2 yrs

47
Q

When to consider clozapine?

A

Fail to reach effect twice on 8 week trials of other agents.

48
Q

What is chlorpromazine?

A

First gen anti-psychotic AND anti-epileptic so can be used in bipolar too.

49
Q

Negatives for anti-psychotic depot?

A
  • feels restrictive
  • can’t change dose quickly
50
Q

What is zuclopenthixol?

A

ACCUPHASE
2-3 day treatment for agitation.

51
Q

Types of EPSE?

A

Tardive dyskinesia, akathisia, dystonia, parkinsonism.

52
Q

Which ix would you use to monitor a pt on anti-psychotics long term?

A

BSL, lipids, BMI etc. Due to metabolic syndrome risk.

53
Q

Lithium serum concentration aim?

A

Aim under 1 mmol/L

54
Q

Which anti-convulsant for bipolar is best for pregnancy/non-teratogenic?

A

Lamotrigine.
Valporate is teratogenic.

55
Q

What is acute dystonic reaction and how to Mx?

A

Sudden EPSE to first doses of anti-psychotics.
Mx = do not change or reduce dose of anti-psychotic, commence benzotropine (Parkinsons Tx) and wait.

56
Q

Finding on brain scan for Huntingtons?

A

box shaped ventricles

57
Q

Best imaging for brain aneurysm?

A

MRI angiogram

58
Q

Timeline in order to diagnose mania?

A

episode must be a week or more.

59
Q

Ddx never to forget in suspected mania?

A

Drug induced mania.

60
Q

2 pharm approaches to GAD?

A

SSRI and benzos

61
Q

Risks of neurostimulation?

A

memory loss, headache, anaesthetic risk

62
Q

Big 4 considerations when prescribing a TCA?

A
  • QT enlongation
  • sedating/weight gain
  • anti-cholinergic
  • ORTHOSTATIC HYPOTENSION
63
Q

Best anti-depressant for geris?

A

Mirtazepine

64
Q

clomipramine is used in which condition?

65
Q

Best benzo for sleep?

66
Q

agents that contribute to serotonin syndrome?

A

Anti depressants (SSRIs, SNRIs, TCAs), tryptans, tramadol, LITHIUM, illegal drugs.

67
Q

signs of serotonin syndrome?

A

sweat, shiver, hyper reflexia, myoclonus, dilated pupils.

68
Q

Receptor for opioids?

A

mu receptor

69
Q

Which 2 things should be given to drinkers just as they quit?

A

thiamine and benzos

70
Q

How many manic episodes are needed to Dx BPAD?

71
Q

How often to monitor Lithium levels?

A

every 3 - 6 months

72
Q

Carbonate medications eg. antacids make which psychotropic less effective?

73
Q

Which benzo is used for alcohol withdrawal in those with liver disease?

A

Oxazepam NOT diazepam

74
Q

MOA of thiamine and when in the day to give?

A

Helps in carb metabolism
Give BEFORE food so it can help out.

75
Q

4 Medications for alc withdrawal?

A
  1. Benzo
  2. thiamine
  3. naltrexone
  4. acamprosate
76
Q

3 typical delusions in geri depression with psychosis?

A

nihilistic, financial, constipation/continence.

77
Q

8 P’s of delirium?

A

-poo (constipated)
-pee (retention)
-pain
-pills (polypharmacy)
-pus (infection)
-potassium (electrolytes)
-puffed (hypoxia)
-parched (dehydrated)

78
Q

How to differentiate somatic symptom disorder from hypochondriasis?

A

Somatic symptom disorder has no diagnosis in mind.
Hypochondriasis are fixated on a disease.

79
Q

Factitious disorder is also known as?

A

Munchausen’s

80
Q

immediate symptoms of lithium dose?

A

N+V, fatigue.

81
Q

2 big groups of meds that cause delirium?

A

anti-cholinergics (TCAs, benzos, lithium, opioids)
diuretics
AND STEROIDS

82
Q

What is neuroleptic malignant syndrome? Mx?

A

Sudden fever, sweating, rigidity and confusion after starting an anti-dopamine drug. Mx by withdrawing agent, cooling, hydrating and potentially dialysis for CK level.

83
Q

Ix for neuroleptic malignant syndrome?

A

FBE for WBC and CK levels

84
Q

Why isn’t valporate used in pregnancy? What is the mood stabiliser of choice?

A

Spinal defects.
Lamotrigine.

85
Q

What is Ebstein’s anamoly and which psychotropic causes this?

A

Congenital displacement of tricuspid valve. Caused by Lithium.

86
Q

Autistic patients may suffer from which type of eating disorder?

A

ARFID - sensory issues

87
Q

Eating disorder symptoms?

A

tachycardia, increased body hair, constipation/gastroparesis, dehydration, amenorrhea, leukopenia.

88
Q

Most important vital sign for eating disorder?

A

Postural BP

89
Q

Ix for Eating disorder?

A

ECG, BSL, ketones. Height and weight. - for screen.

FBE, iron, UEC, LFT, CMP, albumin, b12, folate, vit D, LH, FSH, TFTs, thiamine, DEXA.

90
Q

Great way to tell Parkinsons apart from EPSE?

A

Unilateral (Parkinsons) pill rolling tremor vs bilateral pill rolling tremor (EPSE)

91
Q

what is echolalia?

A

mimicking speech

92
Q

what is coprolalia?

A

swearing like tourettes

93
Q

What are capgras delusions?

A

Think people are being replaced by clones/copies.

94
Q

Expressive dysphasia is also known as?

95
Q

4 components of speech in MSE?

A

Volume, rate, rhythym, tone

96
Q

What is most weight safe antidepressant?

A

agomelatine

97
Q

Which anti-psychotic tends to impact prolactin the most?

A

Risperidone and paliperidone

98
Q

Parkinson’s triad:

A

cogwheel rigidity
bradykinesia
unilateral pill rolling tremor

99
Q

SSRI efficacy?

100
Q

What is paroxetine?

101
Q

Classic examples of tardive dyskinesia?

A

Face movements - blinking, jaw and mouth movements like lip smacking. Tongue darting.

102
Q

Bowel obstruction is a risk with which anti-psychotic?

103
Q

Pharm Mx for acute agitation that is a threat to staff?

A

Droperidol

104
Q

What is NMS and best mx?

A

neuroleptic malignant syndrome - withdraw agent

105
Q

Best Pharm mx for catatonia?

106
Q

Which symptom of depression is the most accurate predictor of risk?

A

Hopelessness

107
Q

Anti-depressant with worst discontinuation symptoms?

A

Venlafaxine

108
Q

Mood stabiliser of choice in pregnancy?

A

Lamotrigine

109
Q

Why can eating disorders cause parotidomegaly?

A

excessive vomiting

110
Q

Smoking cessation pharm mx?

A

nicotine replacement
buproprion

MD (18 decks)

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