Psych

Question 1

What are the features of dementia with lewy bodies?

Answer 1

This is a cause of dementia

This will usually present with extrapyramidal symptoms and visual hallucinations

The patient will have gait or movement abnormalities on examination which makes Parkinson plus syndromes more likely

Question 2

Wilson’s disease is a possible cause of dementia, what features would present with this?

Answer 2

This would usually present with psychosis, extrapyramidal symptoms, jaundice, Kayser-fleischer rings and a history of onset at a younger age

Question 3

What features would present with Progressive Supranuclear Palsy?

Answer 3

Whilst this is a possible cause of dementia, there would usually be speech disturbance and vertical gaze dysfunction mentioned

Question 4

Normal-pressure hydrocephalus is one of the causes of dementia, what features would it present with?

Answer 4

Would usually present with incontinence and ataxia of gait. (Triad of “Wet, Wobbly & Weird”)

Question 5

Wernicke’s encephalopathy presents with which classic tetrad:

Answer 5

Ataxia, opthalmoplegia, nystagmus and acute confusional state and is associated with lesions in the mamillary bodies.

Question 6

Vascular Dementia happens as a result of what? What type of patients present with cv illnesses?

Answer 6

Vascular dementia, a result of multiple infarcts in the brain tends to present with sudden onset cognitive decline and stepwise deterioration in someone with previous cardiovascular illness or events, as a result of the developing infarcts.

Question 7

What is Lewy body dementia?

Answer 7

In Lewy Body Dementia, abnormal protein deposits called Lewy Bodies cause cognitive decline associated with parkinsonism (rigidity, tremor, bradykinesia)

Question 8

Fronto-temporal Dementia (also known as Pick’s disease) presents with:

Answer 8

Cognitive impairment, personality change and disinbition, in keeping with the frontal area of the brain which is affected

Atrophy of the frontal and temporal lobes is seen

Question 9

Risk factors and Signs on clinical examination of bulimia nervosa:

Answer 9

• Number of risk factors for an eating disorder (previous diagnoses of depression and anxiety, previous self-harm)
• Tooth decay and laxative use point towards a habit of purging
• This patient needs to be investigated for the likely diagnosis of bulimia nervosa
• Parotid gland swelling
• Russell’s sign (scarring on fingers from induced vomiting)

The repeated vomiting leading to tooth decay is more characteristic of bulimia nervosa than anorexia nervosa.

Management: All patients should be referred for specialist care and CBT is the first line treatment.

Question 10

Features of bulimia nervosa vs anorexia nervosa:

Answer 10

• The repeated vomiting leading to tooth decay is more characteristic of bulimia nervosa than anorexia nervosa
• Unlike anorexia nervosa, sufferers may have a normal BMI
• Bulimia nervosa has features of binge eating and purging

Question 11

Delusions of grandeur/grandiose delusions is seen:

Answer 11

mania

delusions with a strong positive affect where patients believe they have highly positive traits e.g “I’m rich” “I’m the Prime Minister”. Associated with mania.

Question 12

Nihilistic delusions is seen in:

Answer 12

depressed patients

feelings of hopelessness

negative delusions that are typically mood-congruent and see in depressed patients.

Question 13

Delusions of control is and is seen in:

Answer 13

to a sensation that an external party is controlling an individuals thoughts or actions

Seen in psychosis

Question 14

Persecutory delusions is seen in:

Answer 14

a set of delusional conditions in which the patient believes they are being persecuted.

May be seen in psychosis.

Question 15

Delusions is seen:

Answer 15

They are seen in a number of psychiatric conditions, such as schizophrenia, bipolar disorder and psychotic depression.

Delusions can be defined as a belief that is held in spite of superior evidence to the contrary.

Question 16

Cotard’s syndrome is:

Answer 16

Cotard’s syndrome is the fixed, false belief that the person themselves is dying or dead

Question 17

Fregoli delusion is:

Answer 17

the fixed, false belief that strangers are familiar to the individual and may even all be the same person

Question 18

Capgras delusion is:

Answer 18

the fixed, false belief that a close relative or partner has been replaced by an impostor

Question 19

Othello syndrome, otherwise known as delusional jealousy, or pathological jealousy, is a

Answer 19

form of delusional disorder in which an individual believes their partner is unfaithful, despite the absence of proof

It usually affects males and can result in stalking behaviour or even homicide.

Question 20

Delusions of persecutions is also known as paranoid delusions, what do patients believe:

Answer 20

Most common type of delusions

Classically seen in schizophrenia

Patients believe they are being followed, spied on, or conspired against

Question 21

If a patient they deserve to be punished, what delusion is this called:

Answer 21

Delusion of guilt, it is usually an innocent error out of proportion to the guilt felt

Typically associated with severe depression

Referred to as delusions of sin or worthlessness

Question 22

Psychiatric differential diagnoses include for depression:

Answer 22

• Bipolar disorder
• Schizophrenia
• Dementia
• Seasonal affective disorder
• Bereavement
• Anxiety

Question 23

Patients who have benefitted from antidepressants should be continued for at least how many months after remission to reduce the risk of relapse:

Answer 23

6 months

Question 24

Delusion of thought possession is what and is seen in what patients:

Answer 24

These are false beliefs around the ownership of your thoughts

They can be subdivided into insertion, withdrawal, and broad-casting

They are classically seen in schizophrenia

Question 25

A 42 year old lady assessed for a chronic decline in memory. On examination she has a protruding tongue, prominent epicanthal folds and a single transverse palmar crease. Cognitive testing shows profound decline in memory. She has Down’s syndrome confirmed on karyotyping when she was an infant. Pathological examination of her brain would show changes in keeping with which of the following conditions?

Answer 25

Alzheimer’s disease is caused by an accumulation of amyoid plaques, and the tau protein is also implicated. Down Syndrome is caused by Trisomy 21, and the amyloid precursor protein is found on chromosome 21

The extra copy of APP leads to early onset beta-amyloid plaques

Question 26

Parkinson’s disease is caused by build up of:

It frequently leads to which type of dementia:

It is also in the same spectrum as:

Answer 26

alpha-synuclein, starting in the substantia nigra and then progressing often to include the majority of the cerebral cortex

It frequently leads to Parkinson’s disease dementia, and is also in the same spectrum as Dementia with Lewy Bodies (where dementia precedes or occurs within 1 year of the onset of motor symptoms)

It is a synucleinopathy not an amyloid related pathology

Question 27

Symptoms of Anxiety in symptoms:

Answer 27

Psychological: Fears, worries, poor concentration, irritability, depersonalization, derealisation, insomnia (can’t fall asleep), night terrors
Motor symptoms: Restlessness, fidgeting, feeling on edge
Neuromuscular: tremor, tension headache, muscle ache, dizziness, tinnitus
GI: Dry mouth, can’t swallow, nausea, indigestion, butterflies, flatulence, frequent or loose motions
CVS: Chest discomfort, palpitation
Respiratory: Difficulty inhaling, Tight/constricted chest
GI: Urinary frequency, erectile dysfunction, Amenorrhoea

Question 28

Patients with severe anxiety which treatment is the first line of patients:

Answer 28

Selective Serotonin reuptake inhibitors (SSRIs) are first-line in patients with severe anxiety or those in which psychological interventions have not led to improvement.

They target the cognitive aspect, not the somatic manifestations which beta blockers will such as propranolol, these include hand tremors and sweating

Benzodiazepines such as Diazepam are a controlled drug due to the high burden of dependence, and NICE explicitly advises against their use in anxiety disorders. They are only recommended as a short-term measure during crises.

Question 29

Which is the second line choice in those whom SSRIs or Serotinin-Norepinephrine reuptake inhibitors (SNRIs) are unsuitable for anxiety:

Answer 29

Pregabalin

Question 30

Baclofen is used for what:

Answer 30

muscle relaxant used in MS

Question 31

What are the two side effects of Salbutamol:

Answer 31

it is a beta agonist

side effects include anxiety and hand tremors

Question 32

What anticholinergic can be used to treat extrapyramidal side effects in Parkinson’s medications?

Answer 32

Benzhexol

Question 33

B-blockers effective in patients with somatic anxiety symptoms, it is CI in what?

Answer 33

Asthma

Heart block

Question 34

Chlordiazepoxide is used for:

Answer 34

Is a benzodiazepine used in the medical management of alcohol withdrawal

Question 35

Loperamide is a:

Answer 35

medication used to treat diarrhoea

Question 36

Following acute management, what treatments is most appropriate to treat this patient’s drug dependence of opoids?

Answer 36

If acute opiate intoxication and is likely to have intravenously injected heroin.

Methadone or Buprenorphine can be used as pharmacological support in the detoxification from opiates, and in maintenance therapy in order to prevent further use.

Both Methadone and Buprenorphine are opioids.