notes from quesmed

Question 1

refeeding syndrome treatment

Answer 1

Rapidly increasing insulin levels lead to shifts of potassium, magnesium and phosphate from extracellular to intracellular spaces. This is potentially fatal if refeeding is too rapid and must be treated with phosphate replacement. Prophylactic phosphate supplementation may be considered in those deemed high risk of refeeding syndrome

provision of high-dose vitamins (eg. Pabrinex) before feeding commences

Monitoring with daily bloods and replenishing electrolytes early

Building caloric intake gradually with the help of a dietitian‚ NICE recommends that refeeding is started at no more than 50% of calorie requirement in ‘patients who have eaten little or nothing for more than 5 days’

regular ECGs as prone to arrhythmias

Question 2

core features of lewy body dementia

Answer 2

visual hallucinations
parkinsonism
fluctuating cognition

Question 3

extrapyramidal symptoms associsted with some antipsychotics

Answer 3

Acute Dystonia
Akathisia
Parkinsonism
Tardive Dyskinesia: Involuntary, repetitive movements, especially of the face.

Question 4

what is treatment resistnat schizophrenia

Answer 4

Schizophrenia that does not respond to two consecutive trials of antipsychotics

Clozapine is an antipsychotic medication reserved for these cases

Question 5

what is delirium tremens and when does it occur

Answer 5

characterized by agitation, hallucinations, and seizures

it typically occurs 48-96 hours after the last drink

Question 6

wernicke- korsakoff syndrome

Answer 6

neurological condition associated with thiamine (B1) deficiency and alcohol abuse
confusion, ataxia, and ophthalmoplegia

wernicke encephalopathy is the acute setting and reversible but korsakoff syndrome is not

treat with high dose thiamine and nutrition and abstinence from alcohol

Question 7

side effects of clozapine

Answer 7

Agranulocytosis
neutropenia
myocarditis
intestinal obstruction

Question 8

haloperidol is
and what needs to be watched

Answer 8

typical antipsychotic
ECG measurements are taken after dose changes of haloperidol, as well as annually due to QT interval prolongation (side effect of many antipsychotics)

Question 9

ECG changes in refeeding syndrome

Answer 9

prominent u waves
hypokalaemia
small (0.5 mm) deflection immediately following the T wave, usually in the same direction as the T wave.
hypokalaemia
hypomagnesia
hypophosphatemia
oedema
confusion
tachycardia

Question 10

depression treatment

Answer 10

SSRIs
mirtazepine helps with appeitite and sleep as sedative (tetracyclical antidepressant)
venlafaxine

Question 11

mini mental state exam for cognitive impairment results

Answer 11

mild Alzheimer’s disease: MMSE 21–26

moderate Alzheimer’s disease: MMSE 10–20

moderately severe Alzheimer’s disease: MMSE 10–14

severe Alzheimer’s disease: MMSE less than 10.

Question 12

treatment alzheimers

Answer 12

cholintesterase inhibitors- Donepezil, galantamine, rivastigmine

NMDA receptor blocker- memantine
used in moderate or severe AD or where cholinesterase inhibitors are not tolerated

Question 13

cluster A disorders

Answer 13

basic mistrust of others, and tend towards a withdrawal from ordinary sociality
paranoid
schizoid
schizotypal (not in ICD10, just on the schizophrenia spectrum)

odd and eccentric

Question 14

cluster B disorders

Answer 14

serious problems of behaviour and impulse control

borderline (emotionally unstable in ICD10)
narcissistic
antisocial
histrionic

dramatic and erratic

Question 15

cluster C disorders

Answer 15

constitutional difficulty in the way anxiety is managed,
particularly anxiety relating to ordinary social roles and responsibilities

OCPD
dependant personality disorder
avoidant personality disorder (anxious avoidant in ICD10)

anxious or fearful

Question 16

paranoid personality disorder

Answer 16

pervasive and enduring pattern of irrational suspicion and mistrust of others
hypersensitivity to criticism and potential slights
reluctance to confide in others
perceived conspiracies against themselves

Question 17

schizoid personality disorder

Answer 17

enduring pattern of detachment from social relationships and a restricted range of emotional expression
pervasive lack of interest in or desire for interpersonal relationships, often preferring solitary activities
emotional coldness, detachment, or flattened affectivity

Question 18

schizotypal personality disorder

Answer 18

impaired social interactions, distorted cognitions and perceptions, and eccentric behaviours
inappropriate or constricted affect, and peculiar, eccentric or bizarre behaviour
odd thinking and speech, such as magical thinking, peculiar ideas, paranoid ideation, and belief in the influence of external forces
maintains a more intact grasp on reality than schizophrenia

Question 19

antisocial personality disorder

Answer 19

pervasive pattern of disregard for and violation of the rights of others.
lack of empathy and frequently engage in manipulative, impulsive actions.
aggressive, unremorseful behaviour, and consistent irresponsibility

Question 20

borderline personality disorder

Answer 20

recurring pattern of abrupt mood swings, unstable personal relationships, and self-image instability.
propensity towards self-harm
splitting in relationships - extremes of idealisation and devaluation
inability to control temper and manage affective responses
history of previous trauma

Question 21

histrionic personality disorder

Answer 21

attention-seeking behaviours and excessive displays of emotion.
inappropriate sexual behaviours
emotional expressions tend to be shallow, dramatic, and often perceived as exaggerated
often perceive relationships as being more intimate than they truly are

Question 22

avoidant personality disorder

Answer 22

intense feelings of social inadequacy, fear of rejection and hypersensitivity to criticism
self-impose isolation to avoid potential criticism despite a strong desire for social acceptance and interaction

Question 23

narcissistic personality disorder

Answer 23

persistent pattern of grandiosity, a strong need for the admiration of others, and a marked lack of empathy.
sense of entitlement and will exploit others to fulfil their own desires.

Question 24

dependent personality disorder

Answer 24

pervasive and excessive need to be taken care of, leading to submissive and clinging behaviour
lack self-confidence and initiative
urgently seek new relationships as a source of care and support when existing ones end

Question 25

obsessive compulsive personality disorder

Answer 25

excessive preoccupation with orderliness, perfectionism, and control, often at the expense of flexibility, openness, and efficiency
not associated with recurrent, intrusive thoughts or rituals

ego-syntonic, meaning the patient perceives them as rational and desirable, thereby differentiating OCPD from OCD, where symptoms are typically ego-dystonic and distressing to the individual.

Question 26

what do u give for rapid cycling bipolar

Answer 26

sodium valproate

Question 27

treatment bipolar

Answer 27

acute manic episode- Atypical antipsychotics first line, mood stabilisers (lithium, valproate, lamotrigene) second line

depressive episode- atypical antipsychotic, add anticonvulsant if doesnt work

avoid usage of antidepressants in bipolar disorder as they can exacerbate the symptoms and cause rapid cycling mood and mania

long term management- lithium

Question 28

autism presentation

Answer 28

a triad of communication impairment + impairment of social relationships + ritualistic behaviour

Question 29

extrapyramidal side-effects common in

Answer 29

typical antipsychotics. can occur in atypical as well but not as common

drugs which have activity at dopamine receptors.

eg haloperidol, Chlorpromazine

Question 30

pseudohallucinations

Answer 30

involuntary sensory experience. They are vivid enough to be regarded as a hallucination, but considered as subjective and unreal.

symptom of PTSD

Question 31

commonest drugs to cause hyperprolactinaemia

Answer 31

haloperidol (a conventional antipsychotic) and risperidone (an atypical antipsychotic)

Question 32

chlordiazepoxide vs lorazepam

Answer 32

In patients with hepatic failure, lorazepam is preferred over chlordiazepoxide for alcohol withdrawal syndrome to avoid the risk of increased sedation

normally chlordiazepoxide or diazepam first