Pastest/passmedicine

Question 1

Pharmacological treatment of mild to moderate Alzheimer’s

Answer 1

Acetylcholinesterase inhibitors e.g. rivastigmine, donepezil, gelantamine

Question 2

Pharmacological treatment of moderate to severe Alzheimer’s

Answer 2

NMDA antagonist- memantine

Question 3

Preferred SSRI post-MI

Answer 3

Sertraline

Question 4

MMSE cut-off suggestive of dementia

Answer 4

24 or less

Question 5

First-line drug treatment for anxiety disorders

Answer 5

SSRI e.g. sertraline

Question 6

SSRI of choice in adolescents and teenagers

Answer 6

Fluoexetine

Question 7

Process of “separating” certain memories from normal consciousness; differs from conversion disorder in that involves psychiatric symptoms e.g. amnesia, fugue

Answer 7

Dissociative disorder spectrum

Question 8

Rating scale used to detect post-natal depression

Answer 8

Edinburgh scale- 10 item questionnaire indicating how mother has felt over previous week. Score >13 indicates depressive illness

Question 9

Treatment of post-traumatic stress disorder

Answer 9

Watchful waiting (symptoms less than 4 weeks)
CBT or Eye Movement Desensitization and Reprocessing

Question 10

What is akathisia and what drugs can cause it?

Answer 10

Severe restlessness; antipsychotics

Question 11

Examples of acute dystonic reactions that can be caused by antipsychotics

Answer 11

Torticollis

Oculogyric crisis

Question 12

Possible side effects of antipsychotics (other than extrapyramidal/dystonic) (3)

Answer 12

Weight gain
Reduced seizure threshold
Galactorrhoea

Question 13

Factors which might suggestive depression over dementia as a cause of low MMSE score (4)

Answer 13

Short history
“Biological” symptoms
Patient worried about poor memory
Global memory loss rather than “recent” memory loss

Question 14

Things that are raised in anorexia

Answer 14

G’s and C’s: growth hormone, glucose, (salivary) glands, cortisol, cholesterol, carotin

Question 15

Important drugs with which St Johns Wort interacts (2)

Answer 15

COCP

Warfarin

Question 16

Patient with a history of flat affect, no interest in interpersonal relationships, prefers to work/play alone, but lacks weird/magical thinking/psychotic symptoms

Answer 16

Schizoid personality disorder

Question 17

What is adjustment disorder?

Answer 17

Depressive/anxiety symptoms presenting within 3 months of a stressor event, and lasting less than 6 months

Question 18

Raised creatine phospokinase, hyperpyrexia, rigidity and altered conscious state in a patient recently started on haloperidol

Answer 18

Neuroleptic malignant syndrome

Question 19

First-line treatment of generalised anxiety disorder

Answer 19

SSRI e.g. sertraline

Question 20

What can ECT be used for?(3)

Answer 20

Severe depression
Prolonged/severe mania
Catatonia

Question 21

Why do antipsychotics cause a) galactorrhoea and B) extrapyramidal effects?

Answer 21

a) dopamine blockade caused rising PRL levels

b) effect of dopamine blockade in the extrapyramidal system

Question 22

Poor prognosis in schizophrenia is associated with what kind of symptoms?

Answer 22

“Negative” symptoms

Question 23

Why might lithium cause weight gain, constipation, cold hands and bradycardia?

Answer 23

Lithium toxicity can cause hypothyroidism

Question 24

Parkinsonism + memory impairment + visual hallucinations

Answer 24

Lewy body dementia

Question 25

What should be done regarding anti-depressants at the outset of an acute manic episode?

Answer 25

Should be withdrawn

Question 26

For schizophrenic patients how many antipsychotics should be tried before commencing clozapine?

Answer 26

At least 2

Question 27

Consequence of the interaction between monoamine A oxidase inhibitors and SSRI

Answer 27

Serotonin syndrome- potentially life threatening condition

Question 28

Difference between an overvalued idea and a delusion

Answer 28

An overvalued idea is understandable when the patients background is known, whereas a delusion is not in keeping with the social context

Question 29

Regarding the “baby blues”

a) what proportion of women get it?
b) how long does it usually take to resolve?

Answer 29

a) 50%

b) 10-14 days

Question 30

PET scan in a schizphrenic patient with negative symptoms is likely to show…
b) what condition does this lie in contrast to?

Answer 30

Hypoactivity of the prefrontal lobes

b) OCD, where there is increased activity

Question 31

What symptoms would bilateral destruction of the hippocampus lead to?

Answer 31

Loss of capacity for new learning and short-term memory