Pre-placement Flashcards
Image of seeing one self in an external space is known as
Autoscopic hallucination
This is where patient experiences complex visual hallucinations associated with no other psychiatric symptoms and no impairment of consciousness. Associated with loss of vision
CHARLES BONNET SYNDROME
Liliputian hallucination
miniature people or animals.
associated with acute alcohol withdrawal.
Explain differences between simple and complex hallucinations
Simple = unstructured sounds (buzzing, whirring, whistling)
Complex = occurs as spoken phrases
Somatic hallucinations: Superficial
1. tactile
–> being toughed or pricked
–> formication (sensation of insects crawling on or below skin associated w/ cocaine use)
2. thermal
–> false perception of heat or cold
3. hygric
–> false perception of fluid
Somatic hallucinations: Visceral
False perceptions of the internal organs (throbbing, stretching)
Somatic hallucinations: Kinaesthetic hallucinations
false perceptions of joint or muscle
Limbs vibtrating
What condition is important to rule out in the onset of olfactory and gustatory hallucinations :
temporal lobe epilepsy
Hypnagogic hallucinations
brief hallucinations that take place as you’re falling asleep
Hypnopomic halluncations
false perceptions that occur as a person awakens
Extracampine hallucinations
e.g. seeing somebody standing behind you
occurs outside the limits of a person’s normal sensory field
Functional hallucinations
normal sensory stimulus required to precipitate hallucination in the same sensory modality
- voices heard when doorbell rings
Reflex hallucinations
normal sensory stimulus in one modality which stimulates a hallucination in another
–> voices heard when a light is switched on
Pseudohallucinations
patients may have insight to what they are hallucinating
Primary (autochthonous) delusion
don’t occur in response to any previous psychopathological state
may be preceded by delusional atmosphere
example
–> suddenly without apparent cause having the delusional that you are an alien
Secondary delusion
- secondary to morbid event
-
these delusions match the patients mood, they are commonly seen in mania with psychotic features and in psychotic depression
mood congruent delusions
these delusions are extremely implausible content, and are characteristic of schizophrenia
bizarre delusions
e.g. belief that aliens have planted radioactive detonators in the patients brain
partial delusion
belief that was previously held with delusional intensity, but then becomes held with less conviction
occurs when a patient is recovering
paranoid delusions
umbrella term that includes grandiose, persecutory
erotomanic
delusion of love
othello syndrome
delusion of jealousy
Capragas syndrome, Fregoli syndrome
delusion of misidentification
Capragas syndrome
–> characterised by false belief that someone important to them has been replaced by a clone
Fregoli syndrome
–> different people who are in fact a single person who changes appearance
delusion of infestation
Ekbom syndrome
–> delusion that you are infested with parasites
Cotard syndrome
nihilistic delusion
–> patient believes they are dead, do not exist
delusion of control
false belief that external forces such as machines or other people are controlling ones thoughts
overinclusion of details and unnecessary asides and diversions
circumstantial thinking
diverting from initial train of thought and never returning to original point
tangential thinking
markedly accelerated thinking, resulting in stream of connected concepts
flight of ideas
loosening of associations
train of thought shifts suddenly from one very loosely related idea to the next.
worst form –> word salad
AKA –> KNIGHTS MOVE THINKING
new words created by the patient, often combining syllables if other known words
neologisms
echolalia
patients seamlessly repeats words or phrases spoken around others
Motor symptoms: catatonic rigidity
maintaining fixed position and rigidly resisting all attempts to be moved
Motor symptoms: catatonic posturing
adopting unusual or bizarre position that is then maintained for some time
Motor symptoms: catatonic negativism
seemingly motiveless resistance to all instructions or attempts to be moved.
Patient may do opposite of what is asked
Catatonic waxy flexbility
patient can be moulded like wax into a position that is then maintained
catatonic excitement
agitated, excited and seemingly purposeless motor activity
catatonic stupor
- lack of voluntary movement
- extreme unresponsiveness
Echopraxia
patient senselessly repeats or imitated the actions of those around them
Mannerisms
goal orientated movements
performed repeatedly
or at socially inappropriate times
Stereotypes
complex, identically repeated movements
Tics
sudden, involuntary rapid recurrent, non-rhythmic motor movements or vocalisations
Performance status score for cancer
ECOG performance status
0 –> fully active, able to carry out pre-disease tasks
1 –> restricted in physically strenuous activity
2 –> ambulatory and capable of self care but unable to carry out any work activities
3 –> capable of limited self care, confined to bed or chair more than 50% of waking hours
4–> completely disabled, cannot carry on self care
Myelodysplastic syndromes are characterised by
–> pre-leukaemia
–> pancytopenia
–> dysplastic morphology
What drug might be given for high risk myelodysplastic syndromes?
AZACITIDINE
- restores expression of silenced tumour suppressor genes
Chronic lymphocytic leukaemia treatments
- Chemotherapy
- CD20 antibody –> rituximab
- B-cell receptor signalling inhibitors –> ibrutinib or acalbrutinib
- Bcl-2 inhibitor
- venetoclax
Lymphoma imaging done with that imaging modality
FDG PET
–> detect metabolically active malignancy lesions
Lymphoma treatment
- chemotherapy
- CD2- antibodies
- radiotherapy
- stem cell transplant
- antibody drug conjugate
- immune checkpoint inhibitors
- chimeric antigen receptor T cells
Examples of chemotherapy which may be used in treatment of myeloma
- cyclophoshamide
melphalan
Treatment of myeloma
- chemotherapy
- steroids
- lenalidomide
- proteasome inhibitor
- bisphosphonate
- anti-cd38 monoclonal antibody (daratumumab)
- autologus stem cell transplant
Hyperkalaemia > 5.5
repolarisation abnormalities
–> peaked T waves
Hyperkalaemia > 6.5
progressive paralysis of the atria
–> P wave flattening
–> PR prolongation
Hyperkalaemia > 7
conduction abnormalities / cardiac arrest
–> wide QRS
–> AV conduction blocks
–> sine wave
–> asystole, VF, PEA
Indications for dialysis
Very serious CAN’T WAIT
–> refractory hyperkalaemia
–> refractory pulmonary oedema
Others
–> severe metabolic acidosis (pH < 7.2)
- Symptomatic uraemia (e.g. pericarditis, encephalopathy)
Haemodialysis
Diffusion of uraemic solutes across a semi permeable membrane
Haemofiltration
Convection of water with soluble drag across memrbane and replacement with fluid balanced solution
Peritoneal dialysis
fluid exchange between peritoneal capillary blood and dialysis solution in the peritoneal cavity
What features may be seen in a thyroid exam?
Legs
- pre-tibial myxedema (non pitting oedema)
- ankle reflexes; brisk in hyperthyroidism
What is Pemberton’s test?
- raising both arms produces facial congestion and cyanosis
- due to mass in superior mediastinum
- produces obstruction of superior vena cava
In a split thickness skin graft, how long does it take donor site to heal?
will heal within 7-14 days
Examples of a regional flap
Gastroscnemius flap
Regional / pedicled flap
–> used when there is insufficient volume of adjacent tissue to close wound
What is a DIEP flap?
performed by taking lower abdominal tissue on its blood supply, plumbing it into the internal mammary vein
will require later nipple reconstruction
