Practice Questions 2 Flashcards
What percentage of elderly patients with delirium will go on to develop dementia?
5%
How many elderly patients have delirium on admission?
10-15%
How many elderly patients develop delirium in hospital?
10-50%
Prevalence of dementtia in >65?
5%
Incidence of paraphrenia in >65
1-2%
Prevalence of depression >65
10-15%
What is late onset schizophrenia?
> 40
What is very late onset schizophrenia?
> 60
Features of cortical dementia
Aphasia
Acalculia
Significant memory loss
Wat does CAMDEX incorporate?
Blessed dementia rating scale
MMSE
Haschinki Ischaemia Indiex
Which scale is used to screen for dementia in LD?
DMR
Most important risk factor for paraphrenia?
Female gender
M:F ratio of paraphrenia?
1:4-9
Which antipsychotics is contraindicated in the elderly who are psychotic and have cognitive impairment?
Risperidone
Olanzapine
Good prognostic factors of Alzheimers?
Later onset
Female
No behavioural sx
Lack of depressive episodes
In which type of dementia is use of antidepressants often poor?
Vascular
Most prevalent anxiety disorder in the elderly?
Phobias
Risk of alzheimers in general population
5%
Which test is frequently used to test executive functioning?
Tower of Hanoi
Usual dose of Donepezil
10mg OD
Usual dose of Rivastigmine
6mg BD
Usual dose of Rivastigmine transdermal patch
9.5mg/24 hours
Usual dose of Galantamine
12mg BD
Usual dose of Memantine
10mg BD
CJD EEG
Generalised periodic 1-2 Hz sharp waves
How many people with sporadic CJD show EEG changes?
90%
How many people with vCJD show EEG changes?
0
EEG changes in HSE
Episodic discharges are recurring every 1-3 seconds with variable focal waves over the temporal areas.
EEG changes in Huntingtons
Initial loss of alpha; later flattened trace.
EEG changes in hepatic encephelopathy
Diffuse generalized slowing. Triphasic waves: 1.5 to 3.0 per second high-voltage slow waves especially in hepatic encephalopathy
Where is Prenisillen Gene 1?
Chromosome 14
Where is APOE4 gene?
Chromosome 19
Which antidementia drug can cause confusion and hallucinations?
Memantine
Which antidementia drug works on Nicotine receptors?
Galantamine
Which dementia drug is safest to give in patients with co-morbidities?
Rivastigmine
Which antidementia drug is a reversible noncompetitive inhibitor of Ach receptors?
Rivastigmine
Duration criteria for Tourettes
12 months
How do drugs work for Tourettes?
D2 antagonism at basal ganglia
Prevalence of ADHD in the UK?
2-5%
1st line medication for Tourettes
Clonidine
2nd line medication for Tourettes
Topirimate
3rd line medication for Tourettes
Haloperidol
M:F for ADHD
4:1
Prevalence of MI in adolescents
15-20%
Duration criteria for sibling rivalry disorder
Within 6/12 of the birth
Which drug is now specifically contraindicated in children and adolescents due to increased risk of suicide?
Paroxetine
How many children with CD develop antisocial PD?
50%
Most common co-morbid psych disorder in ADHD?
ODD
How many children with ADHD have ODD?
30-50%
How many children with ADHD have CD?
25%
How many children with ADHD have anxiety?
15%
First line Rx for bulimia
CBT
When is Atomoxetine preferable to Methylphenidate for ADHD in kids?
Stimulant abuse
Tics present
Prevalence of depression <18?
20%
Best anti-depressant for OCD in kids
Sertraline
How many 15-16 year olds admit to DSH?
6.9%
What are the PDDs in DSM V?
Autism
Retts
Childhood Disintegrative Disorder
PDD-not specified
M:F for Aspergers
9:1
M:F for Tourettes
3:1
M:F of written disorder
3:1
Prevalence of written disorder
3-8%
Monitoring for valproate in children
6 monthyl height & weight, LFTs and FBCs
Monitoring for methylphenidate in children
3 monthyl then 6 monthly height & weight, BP & HR
Prevalence of depression in LD
2-4%
How many people with LD have mild lD?
85%
How many people with LD have moderate LD?
10%
How many people with LD have severe LD?
4%
How many people with LD have profound LD?
1-2%
Incidence of Downs
1 in 700 live births
How many Downs fetus’s result in spontaneous abortion?
50%
How many Downs pregnancies result in stillbirths?
20%
Risk of autism in second child if first has autism
1-10%
Risk of child having autism if more than one previous child has had autism?
35%
MZ vs DZ for autism
87% vs 9%
Which LD has Attraction to water and laughing at minimal provocation?
Angelmann
Which LD has pseudomature language abilities and visuospatial motor deficit?
Williams
How many LDs are from genetic inheritance?
5%
How many LDs are from environment?
15-20%
How many LDs are pregnancy-related?
10%
How many LDS are acquired medical conditions?
5%
How many LDs have no clear aetiology?
30-40%
Prevalence of epilepsy in LD?
20-25%
Prevalence of ADHD in LD?
15-20%
Prevalence of selfi-inury in LD?
15-20%
Prevalence of epilepsy in Downs?
5-10%
Prevalence of epilepsy in Fragile X?
20-25%
Prevalence of epilepsy in tuberous sclerosis?
90%
Which LD is associated with OCD?
PRader-WIlli
Which LD has features in common with Marfans?
Homocystinuria
Which LD has dwarfism, claw hand, joint stiffness and hepatosplenomegaly?
Sanflippo
Describe surrogate endpoint
Not of direct practical importance but believed to reflect outcomes e.g. reduction in cholesterol level => reduced mortality
Calculation for relative benefit increase
Absolute benefit increase (EER-CER)/CER
Range of cronbachs alpha?
- infinity to 1
Importance of CONSORT flowchart
Too assess generalisability and validity of results
Name of study where exposure is determined at the outset?
Cohort
How long are methadone reductions usually carried out in the community for opioid detox?
3/12
How long are buprenorphine reductions usually carried out in the community for opioid detox?
14/7 - few weeks
How long does postnatal depression usually last for?
1/12
Peak onset of postnatal depression?
3-4 weeks post birth
Duration of onset of sx for diagnosis of postnatal depressoin?
Onset of sx within 6/12 of birth
RFs for PTSD
External locus of control
Female
Neuroticism
Low sense of security
Risk of suicide with those with epilepsy compared with those without
x25 greater
Prevalence of psychiatric sx at first presentation of Huntingtons Disease?
30%
Prevalence of somatoform pain disorder?
8-10%
What does SF-36 measure?
Health related QoL
How many patients with schizophrenia discontinue antipsychotics by 18 months?
70-75%
NICE requirement for clozapine to be started?
Patients with schizophrenia who are unresponsive to 2 or more antipsychotics, of which at least one must be atypical or who are intolerant of their SEs
Best developed treatment for conduct disorder?
Multisystemic therapy
How long is multisystemic therapy?
3/12
How is a person assessed in multisystemic therapy?
At home, in relationships with other systems e.g. peers, school
Underlying goal in multisystemic therapy?
Assessing and promoting strengths of the person
Which therapy uses reciprocal role reversal?
Psychodrama
Which 2 antipsychotics increase the risk of CVE in the elderly?
Risperidone
Olanzapine
Recurrence rate of siblings in children with autism?
2-8%
in which social classes is subcultural LD more common in?
Lower social classes
RFs for infanticide
DV and hx of childhood maltreatment
Suicidal ideation in pregnancy and previous suicide attempts
Concealed or denial of pregnancy
Unintended pregnancy in young women
Calculation for false +ve?
1-specificity or
False positives/total non-diseased
Calculation for false -ve?
1- sensitivity or
False negatives/total diseased
Calculation for sensitivity
True +ve/total diseased
Calculation for specificity
True -ve/total non diseased
Calculation for PPV
True positive/total positive
Calculation for NPV
True -ve/total -ve
What are random errors?
Caused by unknown and unpredictable changes in the experiment, including the measuring instruments
What type of error is recall bias?
Systematic error
What type of error is normally distributed?
Random error
Define minimisation
Allocation of each participant is done methodically to ensure balance of confounding factors between groups
Define allocation concealment
Maintaining secrecy with regard to the allocation itself at the start of the study
Define blinding
Maintaining secrecy about the status of a patient as to which arm he or she belongs, once the allocation is complete
What measurement can tell us the burden of a disease?
Prevalence
What is the denominator of incidence density?
Person-years
Denominator of incidence calculation?
Total number of people at risk in population per unit time
What does incidence density account for that incidence doesnt?
Varying time periods of follow-up
Which 2 antipsychotics are least likely to cause sexual SEs?
Aripirazole
Quetiapine
Which 2 antipsychotics are least likely to cause high prolactin?
Aripiprazole
Quetipine
Which neurodegenerative disorder affects the striatum?
Huntingtons
Which neurodegenerative disorder shows box-car shaped ventricles on MRI?
Huntingtons
What parts of the brain does corticobasal degeneration affect?
Cerebral cortex
Basal ganglia
Sx of corticobasal degeneration?
Disorder of movement
Cognitive dysfunction
Which scale measures aggression and conduct problems in kids 7-17 years?
Child & Adolescent functional assessment scale
Which scale helps to obtain information from school regarding psych problems?
Strengths and difficulties questionnaire
Which scale tests for TD?
AIMs
Which scale tests for EPSEs?
Simpson-Angus
Which antidepressants should not be px with Tamoxifen?
Fluoxetine
Paroxetine
Bupropion
Duloxetine
What does Giant Panda Sign on MRI suggest?
Wilsons Disease
What does sparing of medial temporal lobe suggest?
LBD
Which LD has Salaam attacks?
TS
What percentage of patients taking benzodiazepines for nearly a year develop dependence syndrome?
40%
Which guidelines give guidance on reporting of meta-analyses and systematic reviews?
PRISMA
Which guidelines give guidance on meta-analyses reporting on RCTs?
QUORUM
The number that will repeat DSH (deliberate self harm) within one year
30%
The percentage of patients in contact with mental health services within a year of death
25%
EEG of grand mal seizure
EEG shows multispikes followed by multispikes and slow waves
EEG of absence seizure
EEG shows generalised 3 Hz spike and slow wave activity
Prevalence of any PD in the community
5%
SMR for antisocial PD?
8-9
RR of psychosis in prisons compared to general population?
20
How many homicide offenders are women?
11%
Which age group in females is at highest risk of committing a homicide?
30-39
Cause of Cornelia de Lange?
Lack of pregnancy-associated plasma protein A (PAPPA) linked to chromosome 9q33.
Incidence of fetal alcohol syndrome?
1.9 per 1000 live births
Which type of dementia has impaired executive function and apathy?
Subcortical dementia
Which type of dementia has normal alertness?
Cortical dementia
Which type of dementia has apraxia?
Cortical
Most common behavioural and psychological symptom of dementia?
Apathy - 59%
Name the behavioural and psychological symptoms of dementia
Apathy - 59% Depression - 58% Irritability - 44% Anxiety - 44% Agitation - 41%
What does the therapist use in Rational Emotive therapy to guide the discussion?
Humour
Guided discussion
Logic
Real-life challenges
Which genetic disease is due to deficiency in L-iduronidase activity?
Hurler
Which genetic disease is due to deficiency of iduronate sulfatase?
Hunter
What is the mode of transmission of Hunters?
X-linked recessive
SPECT finding in older depressed patients
Reduced cerebral blood flow sparing the posterior parietal cortex
MRS findings of Alzheimers
Abnormal synthesis of membrane phospholipids
