New Revision

Question 1

Mental State Examination

What are the domains of the MSE

A, B, S, M, A, T, P, I, J, R

Answer 1

Appearance

Hygene, Clothing, Stigmata of disease, Weight, objects w/patient

Behaviour

Eye contact, Facial Expression, Body Language, Pscychomotor issues, Abnormal movements

Speech

Rate, Quanitity, Tone, Volume, Rhythm

Mood

Mood represents a patient’s predominant subjective internal state at any one time as described by them.

Affect

Affect represents an immediately expressed and observed emotion

Thoughts

Possession, and content of thoughts

Perceptions

Hallucinations and Illusions

Insight

Does pt have insight into their own condition

Judgement

How would pt react in certain situations (house fire)

Risk

Risk to self or others?

Question 2

Overdose of TCA

Answer 2

• IV bicarbonate may reduce the risk of seizures and arrhythmias in severe toxicity

Question 3

Overdose of Paracetamol

Answer 3

• activated charcoal if ingested < 1 hour ago
• N-acetylcysteine (NAC)

use normogram to assess

Question 4

Overdose of Aspirin

Aspirin, also known as acetylsalicylic acid

Answer 4

• urinary alkalinization with IV bicarbonate
• haemodialysis

Question 5

Overdose of Lithium

Answer 5

• mild-moderate toxicity may respond to volume resuscitation with normal saline
• haemodialysis may be needed in severe toxicity

Question 6

VOe

Overdose Benzodiazepnes or Opioids

Answer 6

Opiates: Naloxone

Benozos: Flumazenil

Question 7

Overdose of Antifreeze

Answer 7

ethanol has been used for many years
works by competing with ethylene glycol for the enzyme alcohol dehydrogenase
this limits the formation of toxic metabolites (e.g. Glycoaldehyde and glycolic acid) which are responsible for the haemodynamic/metabolic features of poisoning
fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol
haemodialysis also has a role in refractory cases

Question 8

Warfarin vs heparin

Answer 8

Warfarin: Vit K/Prothrombin Complex

Heparin: Protamine Sulfate

Question 9

Overdose of Beta blockers

Answer 9

• bradycardic then atropine
• in resistant cases glucagon may be used

Question 10

SECTIONS in MCA

2, 3, 4, 5.2, 5.4, 17a, 135, 136

Answer 10

2: 28d non-renewable, 2DRs, treatment can be given against pt’s wishes
3: same as above but 6m + renewable
4: 72h assessment order, emergency usually out of hosp, changed to section 2 when come into hosp.
5 (2): Voluntary Pt detained by DR for 24h
5(4): Voluntary Pt detained by Nurse for 6h
17a: recall a patient to hospital for treatment if they do not comply with conditions of the order in the community
135: Court Order for forced entry
136: Police to safety (24h)

Question 11

Driving Advice

Diabetes, Neuro, CVD

Answer 11

Diabetes

• for HGV: there has not been any severe hypoglycaemic event in the previous 12 months +
  the driver has full hypoglycaemic awareness
• For G1: on insulin can drive if have hypoglycaemic awareneness, if on tablets no need to inform DVLA

CVD

• Severe HTN (180/100) no drive
• Angioplasty: 1 week off
• CABG: 4wk
• ACS: 4wk
• PAcemaker: 1wk
• A Aneurysm: annual review if 6cm if 6.5> then banned
• Heart transplant: 6 wk off

Neuro

• first unprovoked/isolated seizure: 6 months off if uknoown cause then 12m
• regular seizures: 12m siezure free before get license.
• seizure free for 5y= fulllicense
• Unexplained syncope: 6m or 12m if more than 1 episode
• TIA/Stroke: 1m off
• multiple TIAs: 3m off
• Craniotomy: 12m off

Question 12

Treatment & Complications of Lyme disease