Neurology and Psychiatry Flashcards
What is ADHD?
A neurodevelopmental conditional with hyperactivity, impulsivity and inattention
What are the risk factors for ADHD?
low parental education, parental smoking, maternal depression, low birth weight, prematurity
What is there reduced function of in ADHD?
The frontal lobe which controls executive function
What is the first line medication for ADHD?
Methylphenidate
What is Methylphenidate?
ADHD medication that is a CNS stimulant and requires ECG baseline before starting
What is ASD?
A neurodevelopmental disorder with abnormal social interaction, communication and restricted, repetitive behaviours
What are the risk factors for ASD?
male, family history, chromosomal abnormality such as Downs
What are some presentations of autism?
Social interaction - unable to interpret cues, inability to form attachments and understand emotion
Communication - delayed or minimal speech, impaired make believe, lack of gestures, monologues, endless questions
Restricted behaviour - tendency to restrict change, inability to adapt to new environments
What are the features of anorexia nervosa?
excessive weight loss, lanugo hair, amenorrhoea, hypotension, hypokalaemia, hypothermia, depression, skin pallor and dryness, oedema, osteopenia, cardiac complications
What is the BMI for extreme anorexia nervosa?
Under 15
What is refeeding syndrome?
Occurs when there has been severe nutritional deficit for an extended period and patients start to eat again
What can refeeding syndrome cause?
Hypomagnesaemia, hypokalaemia, hypophosphataemia
What is bulimia nervosa?
Episodes of binge eating where a person suffers a loss of control and eats more than usual.
This goes alongside compensatory mechanisms to prevent weight gain including self-induced vomiting, laxatives and heavy exercise.
What is the presentation of bulimia nervosa?
binge eating, body image distress, uncomfortable eating with others, mood disturbance, purging, tooth erosion, weight fluctuation, swollen salivary glands, abdo pain
What is Russel’s sign?
Calluses on the knuckles where they have scraped their teeth in bulimia nervosa
What can hypokalaemia show on ECG for bulimia?
Increased P wave amplitude, prolonged PR, ST depression, T wave flattening and prominent U waves
What is the first line treatment for bulimia?
SSRI - fluoxetine then sertraline
Name 4 complications of bulimia nervosa?
Gastric ulcers, irregular menstrual cycles, osteoporosis, heart problems including heart failure
What is a febrile convulsion?
A type of seizure that occur in children with a high fever not caused by epilepsy or other neurological pathology.
What is the typical age of a febrile convulsion?
6 months to 5 years
What is a simple febrile convulsion?
Generalised tonic clonic seizure of less than 15 minutes
What is a complex febrile convulsion?
Partial or focal seizure lasting more than 15 minutes
What has to be excluded in febrile convulsions?
Epilepsy, meningitis, encephalitis, intracranial space occupying lesions, syncopal episode, trauma
What are the two branches of seizures?
Generalised and focal
What is a tonic clonic seizure?
Loss of consciousness with tonic (muscle tensing) and clonic (jerking) with tongue biting, irregular breathing, groaning and irritable confusion afterwards
What is the treatment for tonic clonic seizures?
Sodium valporate or lamotrigine in girls
What is an absence seizure
typically in childhood - stare into space then return to normal within 10-20 second
What is the treatment for absence seizures?
Ethosuximide or lamotrigine in girls
What are atonic seizures?
Brief lapses in muscle tone
What are myoclonic seizures?
Sudden brief muscle contractions where patient doesn’t lose consciousness
What are frontal lobe seizures?
Motor or premotor cortex that can lead to clonic movements travelling proximally (Jacksonian march)
What are temporal lobe seizures?
The most common with strange warnings, aura, lip smacking, automatisms and deja vu
What is the treatment of focal seizures?
Lamotrigine
What are the investigations for epilepsy?
History, EEG, brain MRI, ECG, electrolytes and blood glucose
How does sodium valporate work?
Increases GABA activity in the brain which has a relaxing effect
What are the side effects of sodium valporate?
Teratogenic, hair loss, tremor, weight gain
What are the side effects of carbmazepine?
Agranulocytosis, aplastic anaemia, ataxia, induces the P450 drug system
What is a side effect of lamotrigine?
Stevens Johnson syndrome
What is status epilepticus?
Seizure back to back without regaining consciousness or seizure more than 5 minutes
How do you manage status epilepticus?
Benzodiazepines, lorazepam then phenytoin
Which diagnostic tool is used for ADHD?
DSM-5
Describe inattention in ADHD
Easily distracted
Forgetful in daily activities
Finds it difficult to organise task + activities
Does not appear to be listening when spoken to directly
Describe ‘hyperactivity’ as applied to ADHD
Cannot remain seated and talks excessively
In some adults diagnosed with anxiety / depression, what underlying condition might they have?
ADHD
What is the treatment for autism?
No medication
Educational support
Verbal support
SLT
