Neuro/psych

Question 1

Varenicline
- MoA?
- Cautions and contraindications?

Answer 1

NIcotinic receptor partial agonist

Caution in depression
Contraindicated in pregnancy and breastfeeding

Question 2

Buproprion
- MoA?
- Contraindications?

Answer 2

Noradrenaline and dopamine reuptake inhibitor
Nicotinic receptor antagonist

Contraindicated in pregnancy and breastfeeding

Question 3

When commencing medication for depression, what would you recommend in someone who also takes a triptan?

Answer 3

NOT an SSRI (risk of serotonin syndrome)

• recommended:
• Mirtazapine, ruboxetine

Question 4

When commencing medication for depression, which one would you recommend in someone who also takes an NSAID/aspirin/anticoagulation?

Answer 4

Recommend Mirtazapine (risk of PUD with SSRIs)
In elderly, coprescribe a PPI

Question 5

Recommended antidepressant medication for a pt with epilepsy?

Answer 5

Sertraline is first line

Question 6

CT findings in idiopathic intracranial hypertension

Answer 6

normal/small ventricles

Question 7

Symptoms of idiopathic intracranial hypertension?

Answer 7

overweight woman

• headache worse in mornings and at night
• blurred vision
• nausea

Question 8

Positive lupus anticoagulant
likely diagnosis?

Answer 8

antiphospholipid syndrome

Question 9

Investigations for suspected myasthenia gravis

Answer 9

anti acetylcholine receptor antibodies (serum)

repetitie nerve stimulation studies

CT THORAX - for ?thymoma

Question 10

Fundoscopy finding suggestive of SAH?

Answer 10

subhyaloid haemorrhage

Question 11

2 common forms of TB Infection of CNS

Answer 11

Meningitis

Tuberculoma (slowly growing focal lesion)

Question 12

1st rank symptoms of schizophrenia

Answer 12

• Delusions
• Thought insertion/withdrawal/broadcasting
• Auditory hallucination
• Passivity

Question 13

Signs of TCA overdose

Answer 13

Tachycardia
Dilated pupils
Dry eyes
Urinary retention
Hyperreflexia

Question 14

symptoms of normal pressure hydrocephalus

Answer 14

Wet wacky wobbly

Urinary incontinence
Dementia
Ataxia - mimics parkinsons

Question 15

What is dissociative fugue

Answer 15

Purposeful travel ++
Dissociative amnesia

Question 16

lower limb restlessness after commencing an antipsychotic
diagnosis?

Answer 16

Akathisia

Question 17

Friedrichs ataxia
- what systems does it affect?
- what age and population does it tend to affect
- ‘structural’ manifestations of disease?

Answer 17

Autosomal recessive
Affects CNS and heart

often presents in young men.
Never in east asian and native americans.

Can be preceded by pes cavus and scoliosis

Question 18

Initial test used in suspected duchennes?

Answer 18

CK

Question 19

De clerembaults

Answer 19

Believing someone is in love with you of superior status

Question 20

Fregoli syndrome

Answer 20

Believing you’re seeing someone you know as many strangers

Question 21

Most common cause of death in duchennes

Answer 21

respiratory and cardiac complications

Resp: resp muscle weakness –> increased LRTIs
Cardiac: DCM, arrhythmia, heart failure

Question 22

Muscular dystrophy
Inheritance pattern?
Features?

Answer 22

Autosomal dominant

• muscular weakness
• ptosis, cataracts
• ## frontal balding

Question 23

Diabetic amyotrophy
How does it present?
Reflexes?
Reversibility?

Answer 23

• Excruciating pain in hips/buttocks/thighs
• Absent reflexes
• Resolves with good diabetic control

Question 24

Baby blues
- when does it peak? when does it tend to improve?

Answer 24

Peaks day 3-5
resolves by day 10

Question 25

Worsening neurological symptoms in hot environment
- what is the name of this sign?
- cause?

Answer 25

Uthoffs
MS

Question 26

Lhermittes sign - describe

Answer 26

electric shock sensation on neck flexion

Question 27

loss of pain and temp sensation over shoulders and upper body ?cause

Answer 27

syringomyelia

Question 28

1st line treatment for gtc seizure prophylaxis

Answer 28

sodium valproate

but if woman of child bearing age –> lamotrigine/levetiracetam

Question 29

1st line treatment for absence seizures

Answer 29

ethosuximide

Question 30

section 5(2) what is it and how long does it last for

Answer 30

allows a patient already in hospital to detained for mental health assessment - 72 hours

Question 31

section 2 - what is it, who is required, and how long does it last for

Answer 31

detains for metnal health ASSESSMENT - reqested by 2 doctors (1 is usually a consultant psychiatrist) to be performed by AMHP
lasts for 28 days

Question 32

section 135 vs 136

Answer 32

135 in private property
136 in public place

Question 33

Which bloods to monitor in pts taking lithium?

Answer 33

TFTs
calcium (affects PTH glands)
U&Es (can cause K derangement)

Question 34

difference in CSF findings with viral vs TB meningitis?

Answer 34

both cause raised monocytes
viral = normal glucose
TB = low glucose

Question 35

important bloods to monitor if taking CBZ? why?

Answer 35

FBC
- risk of aplastic anaemia

Question 36

timing of CT Brain for suspected SAH - why does it matter

Answer 36

if taken within 6 hours of headache starting - can rule out SAH

If done at >6hrs post - do an LP?

Question 37

diagnostic investigations for MS

Answer 37

MRI brain - high signal T2 lesions
CSF - oligoclonal bands
Visual evoked potentials

Question 38

signs of valproate toxicity

Answer 38

increased GABA

• reduced GCS
• hypoglycemia
• low BP
• high Na

Question 39

serotonin syndrome vs neuroleptic malignant syndrome

Answer 39

Serotonin syndrome -
- hypERreflexia
- clonus
- dilated pupils

Neuroleptic malignant syndrome
- hypOreflexia
- lead pipe rigidity
- normal pupils

Question 40

what hospital treatment can often precipitate wernickes encephalopathy

Answer 40

IV glucose can worsen wernicke’s

Question 41

tremor, hyperreflexia, ataxia, flattened T waves –> which drug has been OD’d?

Answer 41

Lithium

Question 42

what blood test should be monitored in pts taking carbemazepine

Answer 42

FBC - risk of aplastic anaemia

Question 43

1st line tx of myoclonic seizures

Answer 43

men: valproate
women: levetiracetam