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Passmed wrong questions Flashcards

1
Q

What is Acute stress disorder

A

Acute (transient) stress reaction that occurs within the first 4 weeks after a traumatic event

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2
Q

TCA anticholinergic side effects

A

Anticholinergic: tachycardia, dry mouth, mydriasis and urinary retention

Remember - no cholinergic = no PSNS tf you can’t relax

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3
Q

What is not recommended in PTSD

A

Single-session interventions/debriefing

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4
Q

PTSD management (mild; severe)

A
  • Watchful waiting for mild symptoms lasting less than 4 weeks
  • CBT or eye movement desensitisation and reprocessing (EMDR) = first line
  • Venlafaxine/SSRI = 2nd line
  • Severe cases = risperidone
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5
Q

SSRI choice post MI

A

Sertraline - most evidence for safe use

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6
Q

What drug is clozapine

A

Atypical antipsychotic

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7
Q

Main risk of clozapine - how do we account for this

A

Agranulocytoisis - FBC monitoring needed

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8
Q

Clozapine side effects

A
  • Agranulocytosis
  • Reduced seizure threshold
  • Constipation
  • Myocarditis - do ECG before starting
  • Hypersalivation

C = constipation. lo = low WBC, Zap = myocarditis/seizures. Pine = saliv

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9
Q

Clozapine indication

A

If the use of 2+ antipsychotics still isn’t working in SCZ

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10
Q

Most likely SSRI to cause tornadoes de pointes

A

Citalopram - don’t use in patients with long QT

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11
Q

History of recurrent self harm and intense interpersonal relationships that alternate between idealisation and devaluation

A

Borderline personality disorder

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12
Q

Alcohol withdrawal timeframe

A

6-12 hours - symptoms
36 hours - seizures
72 hours - delirium tremens

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13
Q

ECT memory loss side effect

A

Retrograde amnensia

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14
Q

SSRI weaning period

A

4 week period of dose reduction

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15
Q

SSRI with most discontinuation symptoms

A

Paroxetine

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16
Q

SSRI discontinuation symptoms

A

PG DRUMS:
- Paraesthesia
- GIT: pain, cramping, D&V
- Difficulty sleeping
- Restlessness
- Unsteadiness
- Mood changes
- Sweating

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17
Q

What is akathisia

A

Inner restlessness and inability to keep still

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18
Q

What is acute dystonia

A

Sustained muscle contraction:
- Spasms of facial muscles
- Torticollis
- Oculogyric crisis

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19
Q

What is tardive dyskinesia

A

Late onset of abnormal involuntary movements e.g. licking lips or pouting of jaw

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20
Q

How is acute dystonia managed

A

Procyclidine

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21
Q

Common atypical antipsychotic side effects

A

Metabolic e.g. weight gain and hyperprolactinaemia

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22
Q

Schizophrenia management

A

Oral atypical antipsychotics = first line
CBT offered to all patients

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23
Q

SCZ comorbidities

A

Cardiovascular disease ∴ monitor patients - due to antipsychotics and smoking

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24
Q

Supportive psychotherapy vs CBT

A
  • SP: Enhances self esteem, reduces anxiety and improves adaptive skills
  • CBT: Helps patients deal with the way they think and behave
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25
How is OCD severity measured
Yale brown Obsessive compulsive scale
26
What is mild OCD
Symptoms for less than one hour per day with minimal impact on daily living
27
Mild OCD management
- CBT including exposure and response prevention (ERP) - Can then offer additional SSRI or more intense CBT including ERP
28
Which disorder is associated with a history of recurrent self-harm and intense interpersonal relationships that alternate between idealization and devaluation
BPD/EUPD
29
SSRI associated with long QT
Citalopram - can cause torsades du pointes - sertraline and fluoxetine may also cause to but citalopram = big boy | It sertainly floxuates but citalopram is causing it...
30
PSTD first line
- ?Watchful waiting if mild (<4 weeks of symptoms) - Trauma-focused CBT and EMDR
31
PSTD second line
Venlafaxine or SSRI
32
PSTD severe cases management
Risperidone
33
TCA antimuscarinic effects
Dry mouth Blurry vision Constipation Urinary retention
34
GAD drug treatment
- Sertraline - If that doesnt work - offer alternative SSRI or SNRI - If that doesn't work - offer pregabilin
35
Alcohol withdrawal management
Decreasing doses of long-acting benzos: chlordiazepoxide or diazepam - Offer lorazepam with hepatic failure - Carbamazepine may also work
36
SSRI of choice in children
Fluoxetine
37
Physical findings of anorexia nervosa
- Lanugo hair - Failure of secondary sexual characteristics - Bradycardia - Cold intolderance - Yellow tinge - hypercarotenemia - Enlarged salivary glands
38
Memory loss in depression vs dementia
Severe depression may cause global memory loss whereas dementia causes short-term memory loss
39
Why should SSRIs never be used with MAOIs
MAOIs prevent serotonin breakdown therefore cause serotonin syndrome
40
What is illness anxiety disorder (hypochondriasis)
Persistent belief in the presence of an underlying serious disease
41
Hypochondriasis vs somatisation disorder
Somatisation disorder - focus on unexplained symptoms for at least 2 years and rejection of reassurance Hypochondriasis - they have symptoms but are convinced of a specific underlying disease e.g. cancer Soma = Symtpoms Chrondriasis = Cancer
42
What is cluster A of personality disorders
Odd or eccentric: - Paranoid - Schizoid - Schizotypal
43
Schizotypal features
Ideas of reference Odd beliefs about magical thinking Unusual perceptual disturbances Paranoia Odd/eccentric behaviour Social pariah Inappropriate affect Odd speech with incoherency
44
Less severe depression management
Guided self help before offering CBT
45
Patients ≤25 who have been started on an SSRI should be reviewed when?
After 1 week due to increased risk of suicide. Nb/ Normally review after 2 weeks for older people
46
What is catatonia
Stopping of voluntary movement/staying in an unusual position
47
Anorexia nervosa biochemistry
Most things are low but Gs and Cs raised: - GH - Glucose - salivary Glands - Cortisol - Cholesterol - Carotinaemia
48
Important SSRI interactions
- NSAIDs - GI bleeding risk ∴ give PPI - Warfarin/heparin - offer mirtazapine instead - Aspirin - Triptans - risk of serotonin syndrome - MAOIs
49
Difference between Knight's move and flight of ideas
Knight's move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas
50
What is circumstantiality
Inability to answer question without going into excess detail - however the question ends up being answered
51
Before starting lithium what must be checked
renal (U+Es), cardiac (ECG), and thyroid function (TFTs). BMI and FBC should also be done beforehand.
52
What antihypertensives interfere with lithium clearance
- Thiazide diuretics - ACEi - ARB
53
What metabolic disturbance is seen in bulimia
Hypochloraemic, hypokalaemia metabolic alkalosis
54
When and where to admit if anorexic
Admit to AMU for immediate stabilisation if patient has signs of bradycardia, hypotension or physical instability
55
Features of LSD ingestion
- Mood changes - Hallucinations - Hypertension - Tachycardia - Hyperthermia
56
Symptoms of SSRI discontinuation
- increased mood change - restlessness - difficulty sleeping - unsteadiness - sweating - gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting - paraesthesia
57
Switching from fluoxetine to another SSRI
Withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low dose of the alternative SSRI
58
PHQ-9 scores for less and more severe depression
<16 = less severe depression ≥16 = more severe depression
59
FIRM STOP for SSRI discontinuation syndrome
Flu like Sx Insomnia Restlessness Mood swings Sweating Tummy problems (pain, cramps, D+V) Off balance Parasthaesia
60
Causes of serotonin syndrome = STEAM
SSRI + St Johns Wart Tramadol + Triptans Ecstasy (MDMA) Amphetamines + Anti-emetics (ondansetron +metoclopramide) MAOI
61
SSRIs and pregnancy
- BNF says to weigh up benefits and risk when deciding whether to use in pregnancy. - Use during the first trimester gives a small increased risk of congenital heart defects - Use during the third trimester can result in persistent pulmonary hypertension of the newborn - Paroxetine has an increased risk of congenital malformations, particularly in the first trimester
62
OCD: all patients with severe functional impairment should be referred to
secondary mental health team - treatment can be initiated during this waiting process
63
Capgras syndrome
Irrational delusion of misidentification where patients believe that a relative or friend has been replaced by an identical impostor. - Associated with SCZ, brain trauma, dementia
64
What is thought preservation
This is where a patient repeats ideas or words despite attempting to change the topic. For example, if a patient were to be asked to describe a cat, and then describe other things, the patient would continually describe cats and keep the topic on that despite being asked to describe other things.
65
What is the only absolute contraindication to ECT
Raised ICP
66
What must be done if clozapine/antipsychotics are missed for 2 days?
Dose should be re-titrated like when they first started. - this is because resuming the regular dose means that effects may be worse eg. BP/dizziness
67

Pyschiatry (9 decks)

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