PassMed wrong Qs

Question 1

What is the first-line management of delirium tremens?

Answer 1

Chlordiazepoxide

Question 2

What effect does schizophrenia have on sleep?

Answer 2

Circadian rhythm disturbance –> insomnia

Question 3

What is circumstantiality?

Answer 3

Inability to answer a question without giving excessive unnecessary detail

Question 4

How long should a patient be reviewed after starting SSRIs?

Answer 4

2 weeks
If <25 –> 1 week

Question 5

What are the first-line management options for acute stress disorders and PTSD?

Answer 5

Acute stress disorder = (trauma-focused) CBT
PTSD = eye movement desensitisation and processing

Question 6

What is Hoover’s sign?

Answer 6

Test to differentiate between organic and non-organic paresis
-Place hand under heel of paretic leg and ask patient to raise non-paretic leg against resistance –> pressure felt on hand due to involuntary contralateral hip extension

Question 7

Why should FBC be monitored in patients taking clozapine?

Answer 7

Monitor leukocytes –> clozapine can cause neutropenia

Question 8

When is the peak incidence of delirium tremens following alcohol withdrawal?

Answer 8

symptoms = 6-12h
seizures = 36h
delirium tremens = 72h

Question 9

How should patients with depression exhibiting mania symptoms be managed?

Answer 9

Consider stopping SSRI and starting an antipsychotic

Question 10

What class of drug is dosulepin?

Answer 10

TCA
-Dangerous in overdose

Question 11

What risk is associated with taking SSRIs in the third trimester of pregnancy?

Answer 11

Persistent pulmonary hypertension

Question 12

What medication can be used as a deterrent for drinking alcohol? Causes violent vomiting if taken with alcohol

Answer 12

Disulfiram

Question 13

What medication can be used as anti-craving for alcohol? Can be taken safely with alcohol

Answer 13

Acamprosate

Question 14

What antipsychotic has the biggest effect on seizures?

Answer 14

Clozapine - reduces seizure threshold

Question 15

Which antipsychotic tends to have the most tolerable side effects?

Answer 15

Aripiprazole

Question 16

How can borderline personality disorder be managed?

Answer 16

Dialectical behaviour therapy

Question 17

What features does Knight’s move speech have?

Answer 17

Illogical leaps from one idea to the other
-Flight of ideas = discernible link between ideas

Question 18

What is the strongest risk factor for psychotic disorders?

Answer 18

Family history

Question 19

What benign finding can be common in patients taking lithium?

Answer 19

Benign leucocytosis on FBC

Question 20

What risks are associated with antipsychotics in the elderly?

Answer 20

Increased risk of stroke and VTE

Question 21

When should lithium levels be checked?

Answer 21

-12h post-dose
-1 week after starting / dose changes
-Then 3-monthly once stable

Question 22

What are the symptoms of tardive dyskinesia and how can it be treated?

Answer 22

-Repetitive movements of lip smacking, tongue protrusion, pill-rolling
-Treat with tetrabenzine

Question 23

What metabolic side effects are there for antipsychotics?

Answer 23

-Dyslipidaemia
-Dysglycaemia
-DM

Question 24

What is a known side effect of SNRIs that should be monitored when starting and titrating?

Answer 24

Hypertension - measure BP

Question 25

What are the symptoms of acute dystonia and how can it be managed?

Answer 25

Uncontrolled muscle spasm - can be painful and frightening, may be unable to swallow
Procyclidine

Question 26

What is akathisia and how can it be managed?

Answer 26

Inner restlessness where there is a strong compulsion to move eg crossing legs, pacing, stamping feet
Manage by reducing and switching antipsychotic

Question 27

What is neuroleptic malignant syndrome?

Answer 27

Muscular rigidity
Can be fatal - evolves over 24-72h

Question 28

What is the next management option for PTSD if CBT has not helped?

Answer 28

SSRI or venlafaxine

Question 29

What is the difference between type1 and type 2 bipolar disorder?

Answer 29

Type 1 = mania
Type 2 = hypomania

Question 30

What group of prescribed drugs can induce psychosis shortly after starting?

Answer 30

Steroids

Question 31

What is a short term side effect of ECT?

Answer 31

Cardiac arrhythmias

Question 32

What effect can amitriptyline have on the urinary system?

Answer 32

Can cause overflow incontinence

Question 33

When is thiamine / pabrinex given in alcohol withdrawal?

Answer 33

-To prevent / treat Wernicke’s encephalopathy

Question 34

What does chlordiazepoxide do in alcohol withdrawal?

Answer 34

Works to detoxify the patient
–CIWA-ar score used to assess severity and hence calculate appropriate dose

Question 35

How is abnormal / prolonged grief reaction defined?

Answer 35

-Persistent and pervasive longing or preoccupation with the deceased
-Intense emotional pain
-For at least 6 months
-Significant impairment to functioning

Question 36

What is dissociative fugue?

Answer 36

When someone with amnesia goes wandering / travels (dangerous)

Question 37

What is the first line management for phobias?

Answer 37

CBT

Question 38

What causes dry mouth, blurred vision and headaches in someone taking amitriptyline?

Answer 38

Anti-cholinergic side effects

Question 39

What contraception is most appropriate for women taking enzyme-inducers?

Answer 39

-Depo-provera
-Cu-IUD

Question 40

What is the most significant risk factor for endometrial cancer?

Answer 40

Nulliparity

Question 41

What features of a history would be suggestive of frontal lobe dementia?

Answer 41

-Difficulty with spacial reasoning (on cognitive testing)
-Weight loss
-Hypomania

Question 42

How should mania with depressive episodes be managed?

Answer 42

Sodium valproate

Question 43

What would a very labile mood be suggestive of?

Answer 43

Borderline personality disorder

Question 44

What features in a history would be suggestive of dysthymia?

Answer 44

-No impact on daily functioning
-Long-term history

Question 45

What is the first-line treatment for post-natal depression?

Answer 45

SSRIs
NOT antipsychotics

Question 46

Which pathway is being activated when someone exhibits positive symptoms of schizophrenia?

Answer 46

Mesolimbic pathway

Question 47

Which pathway is being inhibited when someone exhibits negative symptoms of schizophrenia?

Answer 47

Mesocortical pathway

Question 48

What pathways are being activated at a normal level in schizophrenia?

Answer 48

Nigrostriatal pathway (movement stimulation)
Tuberoinfundibular pathway (increased dopamine –> prolactin inhibition)

Question 49

What are the 5P’s in the 5P’s model?

Answer 49

Presenting
Predisposing
Precipitating
Perpetuating
Protective

Question 50

How do 1st generation antipsychotics compare to 2nd generation?

Answer 50

1st = TYPICAL
–Treat positive symptoms only
–Cause EPSEs
–Raise prolactin
2nd = ATYPICAL
–Treat positive + negative
–Do not cause EPSEs
–Do not affect prolactin

Question 51

What are the 4 main EPSEs?

Answer 51

ADAPT
1. Dystonia = uncontrolled muscle spasm
2. Akathisia = inner restlessness
3. Pseudo-parkinsonism = tremor, rigidity
4. Tardive dyskinesia = lip-smacking, tongue protrusion

Question 52

How does neuroleptic malignant syndrome present?

Answer 52

MUSCULAR RIGIDITY
-Occurs with high potency drugs, rapid dose changes, multiple APs
-Dehydration + alcohol also
-Evolves rapidly over 24-72h

Question 53

What drugs typically cause weight gain?

Answer 53

Clozapine + olanzapine

Question 54

What does raised prolactin do and what drug can reduce levels?

Answer 54

-Sexual dysfunction
-Menstrual disturbances
-Breast growth
-ARIPIPRAZOLE can reduce levels

Question 55

What drug is used for treatment-resistant schizophrenia and what are its main side effects?

Answer 55

CLOZAPINE
-Neutropenia
-Myocarditis
-GI hypomotolity –> constipation
-Hypersalivation