Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 exams > OSCE emergencies (Psychiatry) > Flashcards

OSCE emergencies (Psychiatry) Flashcards

1
Q

First-generation antipsychotics are associated with more side-effects that include:

A
  • Extrapyramidal: movement disorders like parkinsonism and dystonia
  • Anti-cholinergic: dry mouth, dry eyes, constipation, urinary retention
  • Anti-histamine: sedating
  • Cardiovascular: prolonged QT interval, arrhythmias
  • Neuroleptic malignant syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

second-gen antipsychotics side effects

A

lower side effect profile
- key: weight gain and hyperlipidaemia (check lipids before startin)

still risk of
- extrapyramidal side effects
- Long QT interval
- NMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

RF for NMS

A
  • high antipsychotic dose
  • concomitnat drug use e.g. lithium
  • depot
  • medical illness
  • previous NMS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

presentation of NMS

A

Occurs within 2 weeks of starting

  • Altered mental state (confusion)
  • Fever >38 degrees
  • Muscular rigidity
  • Dysautonomia (autonomic instability)
    o Tachycardia,
    o Labile blood pressure
    o Profuse sweating
    o Arrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

investigations for NMS

A

Bedside
- Obs
- Blood glucose
- GCS
- ECG

Bloods
- Uand Es
- ABG- metabolic acidosis
- LFT - derangement
- CK - critical in all suspecticed cases due to rhabodymyolysis

Imaging
- CT/MRI for alternative causes

Special
- Lumbar puncture e.g. autoimmune encephalitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

management of NMS

A

Largely supportive. Most episodes resolve within two weeks of removing offending drug
1) Stop causative agent
2) Determine if mild or severe case

Mild cases- supportive care
1) Cardiac monitoring
2) CK and U&Es monitoring
3) IV fluids
4) Antipyretics
5) Cooling blankets for hyperthermia
6) Antihypertensive agents
7) Benzos for agitation

Severe cases- medical therapy
1) Supportive care
2) Dantrolene: ryanodine receptor antagonist (causes skeletal muscle relaxation). Helps treat hyperthermia and rigidity.
3) Bromocriptine: dopamine agonist. Prescribed to restore ‘dopaminergic tone’.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

NMS may present similarly to

A

Seratonin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Serotonin syndrome

A

similar presentation to NMS in association with selective serotonin reuptake inhibitor (SSRI) drug use.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

presentation of seratonin syndrome

A
  • nausea, vomiting, diarrhoea
  • shivering
  • altered mental state
  • hyperreflexia
  • myoclonus
  • ataxia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

management of Seratonin syndrome

A

1) Discontinue agent
2) IV fluids
3) Benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

delirium tremens

A
  • Withdrawal delirium due to alcohol withdrawal
  • Only occurs in people with a high alcohol intake for more than a month
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

presentation of delirium tremens

A
  • cognitive impairment
  • vivid pereceptual abnormalities
  • tactile hallucinations e.g. bugs crawling on skin
  • paranoid delusion
  • marked trmor
  • autonomic arousal e.g. tachy, fever, pupillary dilation, increased sweating

Signs
- dehydratio
- electrolyte disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

management of DT

A
  • large dose of benzodiazepine e.g. lorazepam, chlordiazepoxide until sleeping
  • haloperidol for any psychotic features
  • intravenous pabrinex
    o Contains thiamine (B1), riboflavin (B2), pyridoxine (B6) and nicotinamide, and also benzyl alcohol as a local anaesthetic.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

wernickes

A
  • Confusion
  • Ataxia
  • Oculomotor dysfunction (Nystagmus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

presentation of korsakoffs

A
  • Chronic amnesic syndrome: Defects in Anterograde and retrograde memory
  • Confabulation: stories made up to fill gaps in memory
  • Poor insight: unaware of heir illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

investigations for WE

A
  • Clinical diagnosis normally
  • Cane criteria
    o Dietary def
    o Oculomotor dysfunction
    o Altered mentals status or mild memory impairment
  • Neuroimaging e.g. CT to exclude alternative cause of confusion
17
Q

managemnt of wernickes

A

Intravenous thiamine e.g. Pabrinex
- Should be give 2-3 pairs up to three times a day for 3-5 days
- Should be administered before or alongside any glucose infusion
- After initial treatment, patients should be given orqal thiamine replacement and continued until patient not at risk
At risk patients
- Pabrinex prophylactically

18
Q

acute dystonia background

A

Extrapyramidal side effect
- An acute medication-induced dystonia- movement disorders characterised by involuntary contractions of muscles, and typically develop within minutes or hours following a trigger such as a medication.

19
Q

presentation of acute dystonia

A

Extrapyramidal side effect within a few days of taking medication
o Onset of atypical posture or position of muscles within minutes or hours of taking medications
o Ocular muscles, jaw, tongue, face, neck and trunk of the body

20
Q

management of acute dystonia

A
  • Procyclidine hydrochloride can be given parenterally and is effective emergency treatment for acute drug-induced dystonic reactions.
  • If treatment with an antimuscarinic is ineffective, intravenous diazepam can be given for life-threatening acute drug-induced dystonic reactions.
21
Q

how is lithium prescribed to prevent toxicity

A
  • Before lithium is started: UEs, TFTs, pregnancy status, ECG

Due to its side effect profile and risk of toxicity lithium is strictly regulated

  • Lithium levels – 12 hours following first dose, then weekly until therapeutic level (0.5–1.0 mmol/L) has been stable for 4 weeks.
  • Once stable check every 3 months.
  • U&Es – every 6 months; TFTs – every 12 months.
22
Q

presentation of lithium toxicity

A

1.5–2.0 mmol/L
- N+V
- coarse tremor
- ataxia
- muscle weakness
- apathy.

23
Q

management of lithium toxicity

A

Supportive treatment should be initiated, which includes correction of fluid and electrolyte balance.

24
Q

Clozapine induced agranulocytosis

A
  • Antipsychotic used to treatment resistant Schizophrenia.
  • Decreases neutrophil count and susceptibility to infection.
  • Very effective antipsychotic but huge potential for side effects.
  • Doesn’t cause extrapyramidal side effects
25
Q

presentation of agranulocytosis

A

Occurs most frequently in the first 18 weeks of treatment
- Fever
- Sore mouth
- Sore throat
- infection

26
Q

manageging neutropenia

A

give granulocyte colony-stimulating factor (G-CSF)

27
Q

risk assessments in psych

A
  • risk to self
  • risk to others
  • driving risk?
28
Q

MSE

A

Behaviour
Mood
Speech
Thoughts
Perception
Cognition
Insight

Year 4 exams (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions