Psych

Question 1

Which markers are low and which are high in anorexia?

Answer 1

Most biochemical markers are low

High: growth hormone, salivary glands, cortisol, cholesterol, carotinaemia

Question 2

How does treatment for anorexia differ between adults and children?

Answer 2

Adults: CBT
Children: anorexia focussed family therapy

Question 3

What frequency of binge/purge behaviour must be seen before diagnosing bulimia?

Answer 3

At least once a week for 3 months

Question 4

How to manage a paracetamol overdose that has taken place over 15 hours?

Answer 4

Immediate N-acetylcysteine

Question 5

How to manage a paracetamol overdose that has taken place during a single incident?

Answer 5

Take a paracetamol level 4-15hrs after the incident and treat with NAC based on level

Question 6

What dementia treatment is contraindicated in patients with cardiac arrhythmia?

Answer 6

Anti-cholinesterase inhibitor such as donepezil

Question 7

What investigation is important to carry out in anorexic patients?

Answer 7

ECG

Question 8

Treatment for frontotemporal dementia?

Answer 8

No treatment, can only provide social support

Question 9

What electrolyte disturbances are seen in refeeding syndrome?

Answer 9

Low potassium, low magnesium, low phosphate

Question 10

Side effects of SSRI?

Answer 10

• Sexual dysfunction
• Hyponatraemia
• N&V
• Headache
• Anxiety
• Increased suicide risk at first (review after 1-2 weeks of starting)

Question 11

Features of serotonin syndrome

Answer 11

• Hyperthermia
• Confusion
• Tremor
• Diarrhoea

Question 12

How to avoid serotonin discontinuation syndrome?

Answer 12

Taper off medication over 4 weeks

Question 13

Symptoms of discontinuation syndrome?

Answer 13

• Diarrhoea
• Shivering
• Anxiety
• Dizziness
• Headache&nausea

Question 14

Examples of SNRI? What side effect must be monitored?

Answer 14

Venlafaxine, duloxetine

Hypertension

Question 15

What class is mirtazapine? What are its side effects?

Answer 15

NaSSA

-Sedation and weight gain, agranulocytosis

Question 16

Side effects of lithium?

Answer 16

• N&V
• Diarrhoea
• Polyuria, thirst
• Fine tremor
• Hypothyroidism
• Weight gain
• Leucocytosis

Question 17

Symptoms of lithium toxicity?

Answer 17

• Coarse tremor
• Hyperreflexia
• Acute confusion
• Vomiting
• Seizure
• Coma

Question 18

How to monitor lithium levels?

Answer 18

Levels should be taken weekly until stable. Once stable, check every 3 months. The levels should be checked 12 hours after a dose is taken

Question 19

Which antipsychotics are most effect in the management of mania?

Answer 19

Quetiapine/olanzapine

Question 20

How long must someone be suffering from symptoms to be diagnosed with depression?

Answer 20

2 weeks

Question 21

Which test must be done to rule out other causes of depression?

Answer 21

TFT - hypothyroidism is a known cause of depression

Question 22

After treating depression, how long should patients continue to take SSRIs? Why?

Answer 22

another 6 months to prevent relapse

Question 23

Cluster A personality disorders?

Answer 23

Paranoid, schizoid, schizotypal

Question 24

Cluster B personality disorders?

Answer 24

Narcissistic, histrionic, anti-social, borderline

Question 25

Cluster C personality disorders?

Answer 25

Obsessive compulsive, avoidant, dependant

Question 26

What are delusions of persecution, reference, misidentification?

Answer 26

Persecution - people conspiring against you Reference - unrelated and normal occurrences are somehow significant for you Misidentification - thinking people and objects are something else

Question 27

What is the definition of 1 unit of alcohol?

Answer 27

10ml of pure alcohol

Question 28

How to calculate units of alcohol from ABV?

Answer 28

(ABV x volume) / 1000

Question 29

When do alcohol withdrawal symptoms occur and what are the symptoms?

Answer 29

Occur 6-12 hrs after last drink - Coarse tremor - Sweating - Insomnia - N&V - Hallucination

Question 30

When is the onset of seizures in alcohol withdrawal?

Answer 30

36hrs after last drink

Question 31

When is the onset of delirium tremens in alcohol withdrawal? What are the symptoms?

Answer 31

72hrs after last drink - Autonomic instability (hypertension, tachycardia, sweating, pyrexia) - Visual/auditory hallucination - Paranoia - Disorientation - Altered consciousness

Question 32

What is the triad for Wernicke's encephalopathy?

Answer 32

- Ataxia - Confusion - Ophthalmoplegia/nystagmus

Question 33

How does Korsakoff syndrome occur?

Answer 33

If Wernicke's encephalopathy is not treated

Question 34

What 3 symptoms characterises Korsakoff?

Answer 34

- Anterograde and retrograde amnesia - Confabulation - Behaviour change

Question 35

What is given to treat withdrawal symptoms?

Answer 35

-Benzodiazepines (chlordiazepoxide)

Question 36

Symptoms of opiate withdrawal?

Answer 36

- Chills/fever - Body ache - Insomnia - Diarrhoea - Tiredness - Sweating - Depression - Anxiety

Question 37

What are the positive and negative symptoms of schizophrenia?

Answer 37

Positive: delusion, hallucination, thought disorder Negative: Impaired volition&motivation, flattened mood, social withdrawal, blunt affect, anhedonia

Question 38

What are the 1st rank symptoms of schizophrenia?

Answer 38

- Auditory hallucination - Delusions - Thought disorder - Passivity phenomena (thoughts and actions are being controlled by an external influence)

Question 39

Side effects of typical antipsychotics?

Answer 39

- Parkinsonism - Dystonia - Tardive dyskinesia - Akathisia

Question 40

How is acute dystonia managed?

Answer 40

Procyclidine

Question 41

How is tardive dyskinesia managed?

Answer 41

Tetrabenazine

Question 42

When would clozapine be considered?

Answer 42

When schizophrenia persists after use of 2 antipsychotics

Question 43

Side effects of olanzapine?

Answer 43

- Dyslipidaemia | - Obesity

Question 44

Side effects of risperidone?

Answer 44

Hyperprolactinaemia

Question 45

Cardiac side effect of anti-psychotics?

Answer 45

Torsades de pointes

Question 46

Side effects of aripiprazole?

Answer 46

Generally has a good side effect profile with less weight gain and hyperprolactinaemia

Question 47

Side effects of clozapine?

Answer 47

- Agranulocytosis - Neutropaenia - Reduced seizure threshold - Myocarditis - Hypersalivation - Constipation

Question 48

What monitoring needs to be done for clozapine?

Answer 48

FBC for agranulocytosis

Question 49

General monitoring tests for antipsychotic use?

Answer 49

- FBC, U&E, LFT - Lipids and weight - ECG - Blood pressre - Glucose, prolactin

Question 50

Symptoms of neuroleptic malignant syndrome?

Answer 50

4 main features: -Rigidity -Hyperthermia -Autonomic instability (hypotension, tachycardia) -Confusion NB can also have raised CK due to rhabdomyolysis

Question 51

What questions should you ask in a CAGE assessment of alcoholism?

Answer 51

- Do you feel like you should cut down on alcohol? - Have you ever become annoyed by criticisms of your drinking? - Do you feel guilty about your drinking? - Do you need a drink first thing in the morning to get you through the day? (eye opener)

Question 52

What ECG changes are seen in anorexia nervosa?

Answer 52

-Bradycardia, arrhythmia, QT prolongation

Question 53

Risk factors for anorexia?

Answer 53

- Caucasian - Female - Higher socioeconomic background - Higher family education