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years 5 > PACES revision > Flashcards

PACES revision Flashcards

1
Q

ADHD management?

A

Mild: watchful waiting, parent’s training and education program. Refer to CAMHS or child psychiatrist or paediatricin and medicate- involve MDT
moderate: CBT + medical treatment
support group- UK ADHD partnership

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2
Q

history for alcohol abuse?

A

first CAGE- if 2/4 ask dependence questions:

desire, neglect, pervasive, withdrawal, tolerance, control lost

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3
Q

history for alcohol abuse?

A

first CAGE- if 2/4 ask dependence questions:

desire, neglect, pervasive, withdrawal, tolerance, control lost

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4
Q

investigations for alcohol abuse?

A

FBC, LFT, b12, folate, UnE, clotting screen, glucose, blood alcohol level, urine drug screen
rating scale- FAST, audit, sadq= dependence questionnaire

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5
Q

management of alcohol abuse?

A

support group- alcohol anonymous
acute detox- admit if risk of DT or seizures- involve MDT
motivational interviewing?
Long term- self help groups
psychological therapies- CBT
mediction- disulfiram(prevents relapse) acamprostate(stops craving)

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6
Q

ICD 10 definition of autism?

A

occurs before 3, impaired social interaction and communication, repititive behaviour, more common in boys

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7
Q

things to ask in autism history?

A 
how is interatction with other children, plays with them? 
eye contact?
teacher say about him?
any concerns with hearing or language
does he take word or phrases literally?
any toy or toys he like playing with
does he like a certain routine
unusual interests?
react to change?
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8
Q

Investigations for ADHD?

A

hearing test, speech and language assessment, neuropsychological testing, CARS- childhood autism rating scale

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9
Q

Management for autism?

A

support and advice for family- national autistic society and portage
Behavioural issue: parent training and education programmes approach = TEACCH- visual learning strategies
CBT + medication treatment:
1st risperidone
2nd methylphenidate
3rd melatonin for sleep

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10
Q

BMI cut off for anorexia nervosa?

A

BMI <17.5

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11
Q

what are the SCOFF questions for anorexia?

A

do you make yourself sick because you feel uncomfortably full?
do you worry you’ve lost control over how much you eat?
lost more than one stone in 3 months?
food dominate life?
believe fat when other say thin?

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12
Q

what areas to focus on in eating disorder?

A

eating, pysical, mood, risk

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13
Q

when to admit an anorexia patient?

A

BMI < 13.5
significant suicide risk
severe sequelae of starvation and purging with weight loss more than 1kg per week

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14
Q

investigations for anorexia?

A

physical exam: weigh, height, lanugo hair, bp, squat test
Blood and UDS- low: ESR, Hb, Plt, WCC, Na, K, Ph, T4
High: glucose, GH, cortisol, cholesterol, LFT
ECG- bradycardia, arrhythmia and prolonged QT
DEXA- osteoporosis if more than 2 years history
Rating scale- Eating attitutes test

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15
Q

Management of anorexia?

A

specialist referral and assessment
Support group BEAT- beat eating disorders
psych- advice on balanced diet, laxative and diuretics. negotiate target weight. refer to dietician and OT.
anorexia- self help and family therpay, MDT
Bulimia- CBT, family therapy, interpersonal therapy and SSRI- fluoxetine

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16
Q

ICD 10 mania how long does it have to go on for?

A

1 week

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17
Q

Bipolar mania things to ask about?

A 
Energy, mood, irritation?
Appetite
Sleep
Sex
Memory
Spending
Concentation
depression before?
delusions- special powers?
hallucination- famous spoken to you?
alcohol, drugs, home? supported?
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18
Q

Investigation for bipolar?

A 
collateral hisotry
physical examination
blood- FBC, TSH, LFT, ECG
Urine- urine drug screen
Rating scale- young mania rating scale
Risk assessment
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19
Q

management of mania?

A

admit and record suicidal?
stop antidepressants
consider olanzapine and benzo if not sleeping or agitated
if resistant give lithium monitor LFT and renal function
consider CBT MDT and psychoeducation
Support groups- MIND and bipolar Uk

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20
Q

Delirium diagnosis criteria?

A

impaired conciousness and attention?
perception or cognitive disturbance
sudden onset and fluctuates
underlying physical cause

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21
Q

causes of delerium?

A 
Drugs- steroids, alcohol
Infection (UTI)
Metabolic (thyroid, adrenal)
Trauma
Oxygen
Poisoning
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22
Q

NOTEPAD for delirium?

A

tell me what happened
when did it start
is it worse at night, dawn, after certain medications?
exacerbation: drugs, UTI
progression- better now, worse, more frequent? change for hyper to hypo?
association: hallucination, illusions

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23
Q

investigation for delirium?

A

collateral history + MSE+MMSE
physical examination: neuro
bloods- FBC, white cells, neutrophils, CRP, ESR(infection), UnE(dehydration), blood glucose, thyroid, LFT, Ca(hypercalcaemia), folate and b12 and vdrl for syphilis

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24
Q

management of delirium?

A

Maximise orientation- sensory impairments, clear signage, clocks, calendar and clear lighting and staff explaining who they are, same nurse entering side room.
Drug chart check for polypharmacy, decrease anti ACh load, constipation and dehydration
promote: pain management, sleep hygiene, healthy diet and enough fluids, social interaction

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25
Q

Dementia diagnosis criteria?

A

acquired progressive, irreversible global impairment ongoing for more than 6 months.

1) multiple cog defects- memory language, attentions and cognition
2) impaired ADL- washing, dressing and handling money
3) clear conciousness

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26
Q

alzheimer questions: MOLD PPR?

A 
Memory
Orientation
Language
Depression
Praxis
Personality
Recognise
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27
Q

what features to ask for in lewy body dementia?

A

bradykinesia
rigidity
tremor
fluctuation?

28
Q

Investigation for dementia?

A

assesing cognition using AMTS, then MMSE then addenbrooke’s cognitive examination
Delirium screen
Neuroimaging- CT/MRI, SPECT- LBD 100% specific

29
Q

management of dementia?

A

reassurance and support: Age UK, old age psychiatry community team, MDT, memory clinic?
Alzheimer’s: medications
mild- donepezil, galantamine, rivastigmine
moderate- NMDA antagonist memantine
Parkinson- don’t use antipsych
1st levodopa, Ldopa
ACHe inhibs

30
Q

Depression severity ICD-10 ?

A

mild- 2 core 4 total
moderate- 2 core 5-6 total
severe- 3 core 7 total or psych or suicidal

31
Q

history ask Core + ASS + GMC

A 
energy, anhedonia, low mood
Appetite
Sleep
Sex
Guilt
Memory
Concentration
32
Q

Investigation for depression?

A 
collateral histroy
physical examination
blood- FBC, TSH, UnE
Urine- urine dip, USD
Rating scale- PHQ, HADS, CDI if child
risk assessment
33
Q

Management of depression?

A

dependant on severity take on biopsychosocial approach:
boderline: psychoeducation, follow up, leaflets, mindfullness
mild: self help CBT on top
moderate: CBT led by trained psych, anti depressants
severe- ECT? catatonia? hospital admission or crisis team if suicide risk high, otherwise refer to CMHT,
psychotic- atypical antipsych

Support group for patients: MIND and depression alliance

34
Q

GAD criteria?

A

excessive anxiety or worry occuring most days for 6 months

35
Q

symptoms fo GAD?

A

Autonomic: palpitations, sweating, trembling, shaking
chest: SOB pain
mental health- comorbid depression?
general- fluses, tension

36
Q

Management of anxiety?

A

GAD2 screening tool
reassurance: anxiety UK
NICE stepwise approach in biopsychosocial:
Education and active monitoring
low intensity psych interventions: self help, psychoeducation groups
step3: high intensity psych: CBT, applied relaxation or SSRI/SNRI
highly stepped input combination therapy in multiagency team

37
Q

OCD diagnosis criteria?

A

2 weeks onoging

1) egodystonic
2) repetitive and unpleasant- excessive and unreasonable
3) unable to resist

38
Q

OCD history taking?SEDATED

A 
Symptoms of anxiety= SOB palpitations, relax, swtich off?
Episodic or continuous
Drinks and drugs
Avoidance and escape
Timing and triggers
Effect on life
Depression
39
Q

investigations for OCD?

A

oraganise causes- FBC, TSH

rating scale- yale brown OCD

40
Q

Management of OCD?

A

Mild: brief individual or group

moderate: CBT or SSRI
severe: CBT and SSRI + TCA if resistant (clomipramine)

41
Q

overdose history what to ask?

A 
act- what happened- method
how long ago
trigger
feeling before? alcohol use or drugs?
note left?
discovery precautions?
how stopped?
did you think you would die?
how discovered?
Now: do you regret?
attempt again?
symptoms?
how do you see future?
help for stress
42
Q

Investigations of suicide attempt?

A

rating scale- columbia suicide severity rating scale
physical examination: pupils, heart rate, abdo, neuro, cardio
IV- bloods, LFT, INR, paracetamol?, ABG, ECG, CT if neuro signs
Normogram- graph for plotting paracetamol levels

43
Q

management of suicide attemt short term?

A

ABCDE + iv access + glucose and NAC infusion if paracetamol
Immediate intervention= problem solving approach, make a plan to deal with future suicide idealation and thoughts of self harm: crisis team number
High risk: admit
LFT- if acute fulimant liver failure go to ICU
acidotic- consider dialysis

44
Q

long term management of suicide attempt?

A

follow up withn a week via CMHT or GP

support groups = samaritans, PAPYRUS for children and adolescent

45
Q

aetiology of postnatal depression?

A

starts 1st month with peak at 3 months 10%

46
Q

history taking for postnatal depression?

A 
similar to depression with core ASS + GMC
anhedonia, low mood, low energy
appetite, sleep, sex
guilt
memory
concentration
for baby ask TBH PC
thoughts about baby
bonding?
thoughts about harming?
children at home?
planned birth?
47
Q

investigation for postnatal depression?

A

same as depression, rating scale- EDPS

48
Q

management of postnatal depression

A

reassurance and support- PANDAS pre and post natal depression advice and support
Mild - moderate= facilitated self help strategies, with support practitioner (CBT)
Severe- SSRI- paroxetine, mother baby unit if severe or children at home, ECT if very severe

49
Q

post traumatic stress disorder diagnosis criteria?

A

within 6 months, at least 1 months after stress event

50
Q

questions to ask for PTSD?

A

HATER
hyperarousal- do you feel edgy or jumpy?
avoidance- are there certain situations or places you tend to avoid or can’t face since this happened?
trauma- able to talk, what happened ik its difficult would it be possible?
emotional numbing- do you feel numb
re experiencing- any flashback or bad dreams nightmares

51
Q

investigations for PTSD?

A

HADS and clinician administered PTSD scale for DSM5 (CAPS5)

52
Q

management of PTSD?

A

reassurance and support- MIND
safegaurd vulnerable minors
empowerement, communication and wider support

53
Q

treatment for PTSD?

A

Watchful waiting if less than 4 weeks
if more than 4 weeks- trauma focused CBT, EMDR- eye movement disensitisation and reprocessing
12 weeks- TCA

54
Q

psychosis diagnosis criteria?

A

1 month losing touch with reality, experience hallucination and delusion. 1 symptoms of first rank or 2 of second rank

55
Q

questions to ask: panic at the disco, PATD for psychosis?

A

passivity? do you have full control of everything you do?
auditory hallucination?- do you hear anything other people can’t? first, second, third person? thought echo?
delusion of perception: have you ever recived a sign which has meant something for you?
thought interference= do you feel you’re in control of your thoughts? do you ever feel other people know what you’re thinking?

56
Q

investigations for psychosis?

A

collateral history
physical examination
blood- FBC, UnE, lipids and LFT, VDRL, CT if organic suspected
UDS
rating scale- brief psychiatric rating scale
Assess status- ADL assessment and housing and finance

57
Q

manageent of psychosis?

A

acute- Early intervention service- to minimise the duration of untreated psychosis to 3 months. provide psychoeducation and reduce relapse
antipsychotics
Reduce relapse: family therapy- decrease expressed emotion, concordance therapy, art therapy, psychological CBT
support with employment, study, benefits and groups
support group examples: SANE and MIND

58
Q

AMTS questios?

A 
what is your age?
what is the time currently?
what is the year?
give address to remember
where are we?
recognise two people?
what is your date of birth?
when did world war 1 begin?
name the present monarch?
count backward 20 down to 1?
recall address?
59
Q

AMTS scoring?

A 
<7 = mild
4-6 = moderate
0-3 = severe
60
Q

causes of amennorrhea?

A

PCOS
prolactinoma
thyroid
hypothalamic hypogonadism

61
Q

questions to ask for amennorrhea presentation?

A

abnormal hair growth? weight gain? diabetes? acne?
visual disturbance? headache, nipple discharge?
temperature intolerance?
palpitations, change in bowel habit?
excessive exercise? stress at home or work? weight loss?
pregnant?- sexually active, preg test, last menstrual period?

62
Q

investigations for amenorrhoea?

A

urinary or serum bHCG

bloods- tft, prolactin, androgens, oestrodial, gonadotrophins

63
Q

questions to ask in contraception station?

A

sexual history- active? one or multiple? gender? age? how met? gynae history

64
Q

key point in counselling in contraception station

A

all contraceptive methods apart from condoms do not protect from STI
STI screen 3 weeks and 3 months after unprotected sex
emergency contraception available at GP, pharmacy and AnE

65
Q

ectopic pregnancy history questions to ask?

A

type of pain socrates
LMP first day!
discharge- amount colour smell blood?
ever been pregnant before?

years 5 (4 decks)

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