PassMed wrong Qs Flashcards
What is the first-line management of delirium tremens?
Chlordiazepoxide
What effect does schizophrenia have on sleep?
Circadian rhythm disturbance –> insomnia
What is circumstantiality?
Inability to answer a question without giving excessive unnecessary detail
How long should a patient be reviewed after starting SSRIs?
2 weeks
If <25 –> 1 week
What are the first-line management options for acute stress disorders and PTSD?
Acute stress disorder = (trauma-focused) CBT
PTSD = eye movement desensitisation and processing
What is Hoover’s sign?
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
Why should FBC be monitored in patients taking clozapine?
Monitor leukocytes –> clozapine can cause neutropenia
When is the peak incidence of delirium tremens following alcohol withdrawal?
symptoms = 6-12h
seizures = 36h
delirium tremens = 72h
How should patients with depression exhibiting mania symptoms be managed?
Consider stopping SSRI and starting an antipsychotic
What class of drug is dosulepin?
TCA
-Dangerous in overdose
What risk is associated with taking SSRIs in the third trimester of pregnancy?
Persistent pulmonary hypertension
What medication can be used as a deterrent for drinking alcohol? Causes violent vomiting if taken with alcohol
Disulfiram
What medication can be used as anti-craving for alcohol? Can be taken safely with alcohol
Acamprosate
What antipsychotic has the biggest effect on seizures?
Clozapine - reduces seizure threshold
Which antipsychotic tends to have the most tolerable side effects?
Aripiprazole
How can borderline personality disorder be managed?
Dialectical behaviour therapy
What features does Knight’s move speech have?
Illogical leaps from one idea to the other
-Flight of ideas = discernible link between ideas
What is the strongest risk factor for psychotic disorders?
Family history
What benign finding can be common in patients taking lithium?
Benign leucocytosis on FBC
What risks are associated with antipsychotics in the elderly?
Increased risk of stroke and VTE
When should lithium levels be checked?
-12h post-dose
-1 week after starting / dose changes
-Then 3-monthly once stable
What are the symptoms of tardive dyskinesia and how can it be treated?
-Repetitive movements of lip smacking, tongue protrusion, pill-rolling
-Treat with tetrabenzine
What metabolic side effects are there for antipsychotics?
-Dyslipidaemia
-Dysglycaemia
-DM
What is a known side effect of SNRIs that should be monitored when starting and titrating?
Hypertension - measure BP
What are the symptoms of acute dystonia and how can it be managed?
Uncontrolled muscle spasm - can be painful and frightening, may be unable to swallow
Procyclidine
What is akathisia and how can it be managed?
Inner restlessness where there is a strong compulsion to move eg crossing legs, pacing, stamping feet
Manage by reducing and switching antipsychotic
What is neuroleptic malignant syndrome?
Muscular rigidity
Can be fatal - evolves over 24-72h
What is the next management option for PTSD if CBT has not helped?
SSRI or venlafaxine
What is the difference between type1 and type 2 bipolar disorder?
Type 1 = mania
Type 2 = hypomania
What group of prescribed drugs can induce psychosis shortly after starting?
Steroids
What is a short term side effect of ECT?
Cardiac arrhythmias
What effect can amitriptyline have on the urinary system?
Can cause overflow incontinence
When is thiamine / pabrinex given in alcohol withdrawal?
-To prevent / treat Wernicke’s encephalopathy
What does chlordiazepoxide do in alcohol withdrawal?
Works to detoxify the patient
–CIWA-ar score used to assess severity and hence calculate appropriate dose
How is abnormal / prolonged grief reaction defined?
-Persistent and pervasive longing or preoccupation with the deceased
-Intense emotional pain
-For at least 6 months
-Significant impairment to functioning
What is dissociative fugue?
When someone with amnesia goes wandering / travels (dangerous)
What is the first line management for phobias?
CBT
What causes dry mouth, blurred vision and headaches in someone taking amitriptyline?
Anti-cholinergic side effects
What contraception is most appropriate for women taking enzyme-inducers?
-Depo-provera
-Cu-IUD
What is the most significant risk factor for endometrial cancer?
Nulliparity
What features of a history would be suggestive of frontal lobe dementia?
-Difficulty with spacial reasoning (on cognitive testing)
-Weight loss
-Hypomania
How should mania with depressive episodes be managed?
Sodium valproate
What would a very labile mood be suggestive of?
Borderline personality disorder
What features in a history would be suggestive of dysthymia?
-No impact on daily functioning
-Long-term history
What is the first-line treatment for post-natal depression?
SSRIs
NOT antipsychotics
Which pathway is being activated when someone exhibits positive symptoms of schizophrenia?
Mesolimbic pathway
Which pathway is being inhibited when someone exhibits negative symptoms of schizophrenia?
Mesocortical pathway
What pathways are being activated at a normal level in schizophrenia?
Nigrostriatal pathway (movement stimulation)
Tuberoinfundibular pathway (increased dopamine –> prolactin inhibition)
What are the 5P’s in the 5P’s model?
Presenting
Predisposing
Precipitating
Perpetuating
Protective
How do 1st generation antipsychotics compare to 2nd generation?
1st = TYPICAL
–Treat positive symptoms only
–Cause EPSEs
–Raise prolactin
2nd = ATYPICAL
–Treat positive + negative
–Do not cause EPSEs
–Do not affect prolactin
What are the 4 main EPSEs?
ADAPT
1. Dystonia = uncontrolled muscle spasm
2. Akathisia = inner restlessness
3. Pseudo-parkinsonism = tremor, rigidity
4. Tardive dyskinesia = lip-smacking, tongue protrusion
How does neuroleptic malignant syndrome present?
MUSCULAR RIGIDITY
-Occurs with high potency drugs, rapid dose changes, multiple APs
-Dehydration + alcohol also
-Evolves rapidly over 24-72h
What drugs typically cause weight gain?
Clozapine + olanzapine
What does raised prolactin do and what drug can reduce levels?
-Sexual dysfunction
-Menstrual disturbances
-Breast growth
-ARIPIPRAZOLE can reduce levels
What drug is used for treatment-resistant schizophrenia and what are its main side effects?
CLOZAPINE
-Neutropenia
-Myocarditis
-GI hypomotolity –> constipation
-Hypersalivation
