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MRCP PART 1 > psych > Flashcards

psych Flashcards

1
Q

X linked inheritance. Children of men with condition ? Children of female carriers

A

All daughters carriers
Sons fine

Daughters 50% carrier
Sons 50% affected

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2
Q

EPS most likely from?
-Parkinsonism an easy one from question but what is described below:
Motor restlessness with inability to sit still?
Involuntary contractions of muscle groups?
Involuntary movements of face (and sometimes trunk) that occur after manny years?

A

Typical antipsychotics
Akathesia
Dystonia (includes oliguric crisis)
Tardive dyskinesia

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3
Q

Management of dysmorphophobia

A

CBT
Rarely cosmetic surgery

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4
Q

Presents with lots of symptoms which cannot be medically explained

A

Somatisation disorder

[Has poor prognosis due to iatrogenic medical / surgical interventions]

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5
Q

Deliberately acts medical symptoms to receive medical treatment or attention / sympathy

A

Factitious disorder

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6
Q

Deliberately making up symptoms to gain something (e.g opioids) or for the avoidance of work / another type of duty

A

Malingering disorder

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7
Q

Fear of scrutiny of others (eg people commenting or critisiing) leading to avoidance of social situations? How does this differ from Agoraphobia?

A

Social phobia

Agoraphobia - Fear of being away from home, crowds or public places rather than the pure fear of social contact. Often has a fear escape would be difficult

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8
Q

Loss of motor control and sensory functions not explained by physiological mechanisms

A

Conversion disorder (also dissociative disorder)
- often associated with psychological conflict

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9
Q

What is la belle indifference ?

A

Lack of concern over significant symptoms

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10
Q

What is Ganser syndrome

A

Psych - amnesia, stupour, possessive disorder, trance

Phys - Motor disorders, anaesthesia / sensory, motor disorders

Generally 4 points for diagnosis
-Approximate answers
-clouded consciousness
-conversion disorder
-Hallucinations

[DONT confuse with conversion disorder]

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11
Q

MRI of conversion disorder may demonstrate …

A

limbic system overriding sensory

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12
Q

Minimum duration of symptoms for ADHD diagnosis? Age?
Usually methylphenidate but what other drugs?

A

6 months
-Usually needs (6) symptoms occurring in multiple settings and present by age 12

Adderal - amphetamine
Noradrenalin and serotonin reuptake inhibitors - atomoxetine

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13
Q

Gout, renal problems, poor muscle control, learning difficulty

A

lesch-nyhan syndrome (x linked)

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14
Q

Short with a big forhead / head / ears and massive testis

A

fragile x

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15
Q

Screening tool for postpartum depression

A

Edinburgh postnatal depression scale

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16
Q

When does postpartum blues happen

A

Early - first week commonly

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17
Q

When does post partum psychosis occur?

A

Usually about 2 weeks post partum

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18
Q

Structural brain abnormalities on MRI linked to depression

A

Lesions in subcortical white matter
Reduced glial cells in pre frontal cortex
atrophy of hippocampus

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19
Q

Depression diagnosis

A

core Sx - low mood, energy and anhedonia

Lasting > 2 weeks

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20
Q

Chronic mild depression symptoms which may be associated with physical/psychological illness

A

Dysthymia

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21
Q

Depression and thinks dead

A

cortard syndrome

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22
Q

Key organic causes of depression to exclude

A

Hypothyroid
Drug induced - Eg benzos / propranolol / POP /

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23
Q

Pathophysiology in FTD

A

Tau proteins or other protein inclusions

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24
Q

Most common gene in FTD? What else can this gene cause?

A

C9orf72
-Also causes MND

[Just vaguely remember to recognise the shape of it]

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25
Q

Loss of vocab with maintained fluency of speech. Forget familiar faces but memory and visual spacial skills presented.

A

Semantic dementia - type of FTD

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26
Q

Slow, hesitant grammatically incorrect speech,
Impaired understanding of complex sentences - though understanding of individual words preserved.

Impairment of orofacial muscles Eg swallow, yawn
Stuttering, repetition inability, difficulty reading/writing

A

Progressive non-fluent aphasia - Type of FTD

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27
Q

Reversible cause of dementia? Sx?

A

Normal pressure hydrocephalus
apathy
Inattention
urinary incontinence
gait apraxia

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28
Q

Presents like schitz but with Macrocytoisis, thrombocytopenia and anaemia on bloods

A

Delerium tremens

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29
Q

Nerve palsy in Wernicke encephalopathy

A

CN VI - lat rectus
[confusion + nystagmus]

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30
Q

2 parts of korsakovs sx

A

short term memory loss
confabulation

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31
Q

Which drug makes drinking feel shite? Which reduces alcohol craving?

A

Disulfiram

Naltrexone

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32
Q

Management of mania in bipolar

A

Antipsychotics Eg risperidone / olanzapine

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33
Q

Who cant get lithium

A

Pregnant
Renal / thyroid / cardiac / Addison’s disease

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34
Q

Monitoring in clozapine

A

weekly blood counts for 18 weeks
Then fortnightly for 1 year
Then monthly

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35
Q

External factors Eg ‘spirits’ or friends controlling ones actions

A

External locus of control

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36
Q

History of depression + evidence of post-natal depression Rx

A

SSRI - Sertraline good as only minimal in breast milk

If didn’t have history of depression - CBT is good

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37
Q

Which antihypertensives are bad to take with lithium

A

thiazides - reduce lithium excretion -> toxicity

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38
Q

Withdrawal from social contact leads to isolation and inability to display feelings/experience pleasure

A

Schizoid personality disorder

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39
Q

Narcissistic vs histrionic disorder

A

N - Belief they are perfect / successful

H- Shallow with a tendency to seek attention / excitement

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40
Q

Psychodynamic therapy?

A

Examines ways events are perceived by a person -> develop adaptive mode of response

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41
Q

CBT

A

Explores how people think and allows to reformulate behaviour

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42
Q

Borderline personality disorder therapy

A

Dialectical behaviour therapy - develop coping skills and impulse control

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43
Q

Lithium monitoring

A

1 week after starting / dose change
Once stable 1-2monthly for 6 months
Then every 3-6 months

Thyroid and renal function before starting and every 6 months

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44
Q

Narcolepsy gene

A

HLA DQ0602

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45
Q

Who gets sudden loss of muscle tone (cataplexy) and hypnagogic/hypnopompic hallucinations ? Rx? Rx if cataplexy?

A

Narcolepsy
Modafinil

sodium oxybate
[get hallucinations as early REM sleep]

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46
Q

GAD treatment + length

A

SSRI - continued for at least 1 year
CBT

Monitored every 2 weeks for 3 months then every three months

-Treatment continued for a minimum of 1 year

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47
Q

Most common cause of death in schitx

A

CV disease - unhealthy lifestyle and effects of antipsychotics

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48
Q

Delirium in parkinsons

A

Lorazapam

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49
Q

Most common trait in antisocial personality disorder

A

neglect for rights of others

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50
Q

Mild mod severe profound learning difficulty IQ

A

Mild <70
mod <50
severe< 35
Profound <20

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51
Q

Body dysmorphic disorder 1st line is CBT
If severe which is 1st line choice of SSRI

A

Fluoxetine
[worried they are Fat Fux-]

Clomipramine is second line

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52
Q

Called when separate ones thoughts from emotion. Eg staying calm and no emotion if a child suddenly dies?

A

isolation

53
Q

What is a haptic hallucination

A

Flase sensory perception
- Eg being touched / strangled / insects crawling under skin

54
Q

What is dissociative amnesia

A

amnesia when trying to avoid current stressors

Eg unable to remember name/job/address after a marriage breakdown

55
Q

When do delta waves begin to occur in sleep? Which stage is deepest?

A

Stage 3
stage 4 is deep sleep and has the most delta waves

56
Q

Most toxic ssri in overdose

A

Citalopram

57
Q

Which ssri has particularly problems with withdrawal

A

paroxetine

->isomnia, anxiety, agitation…

58
Q

Differentiate lewy body and Alzheimer’s

A

Fluctuating cognitive function
Excessive somnolence
Visual hallucinations
Parkinsonism

[Both get auditory hallucinations, lewy body gets more visual]

59
Q

What are lewy bodies made of

A

a-synuclein

60
Q

Buspirone class? used for? most common side effect

A

Partial Serotonin reuptake inhibitor - used for anxiety

Nasal congestoin

61
Q

How long symptoms GAD for diagnosis

A

6 months minimum

62
Q

Mild learning difficulty (IQ<70) - most common cause

A

Idiopathic

63
Q

Only absolute CI to ECT

A

Raised ICP

64
Q

What is st johns wot used for?

A

mild depression

65
Q

Characteristic on CT of wernike/korsakov

A

Loss of neurones in mamillary body

(eventually -> cerebral atrophy though this is less specific)

66
Q

visual loss pattern in conversion disorder

A

spiralling loss

67
Q

seen in 50% of people taking lithium in first month

A

fine tremor

68
Q

How many people get hypothyroid with lithium?

A

20%

69
Q

Why no lithium in pregnancy

A

Babies born with ebstein’s anomaly
-Malformed tricuspid valve
(especially in early preg)

70
Q

4 features of ganser

A

HACC (not a good hack)

-Hallucinations
-Approximate answers
-clouded consciousness
-conversion disorder

71
Q

Cortisol in anorexia

A

Raised due to stress response to starvation

72
Q

Class is clozapine

A

atypical

73
Q

Which antipsychotic most linked with high prolactin

A

risperidone

74
Q

Genetic disorder with severe learning difficulty, wheelchair bound and often aggressive / self-injuring behaviour ? Caused by what

A

lesch-nyhan syndrome
X-linked recessive

Disorder of purine metabolism -> high uric acid / xanthine

75
Q

<18 depression rx?

A

CBT only as high risk of suicide with SSRIs

76
Q

What % of PTSD recover spontaneously? Rx otherwise ?

A

80-90%

Trauma focused CBT
eye movement desensitisation and reprocessing

SSRI/venlafaxine

77
Q

What BMI for anorexia

A

<18.5

78
Q

Pathological findings hungtintons

A

Neuronal loss in caudate and putamen

79
Q

Picks disease pathological finding? what are they?

A

Pick bodies
-Round silver staining inclusions (contain hyperphosphorylated tau protein)

80
Q

Chronic traumatic encephalopathy usually called? Seen on pathology?

A

Punch drunk syndrome [first described in boxers]

Neurofibrinilary tangles

81
Q

Lithium is first line for bipolar. What is second

A

Valproate

82
Q

What is cyclothymia

A

Chronic mild bipolar with less severe symptoms either side

83
Q

Most common cause of inherited learning difficulty? Gene?

A

Fragile X
FMR1 gene

[long face, big ears, autism…]

84
Q

Class are antipsychotics

A

Dopamine antagonists

85
Q

Rx of dystonic reaction eg oculogyric crisis

A

Anticolinergics

Eg procyclidine / benztropine

86
Q

Pt had read passage in bible which refers to him having special powers. Now has ability to control other peoples movements.. What is this

A

Delusion of reference

[Delusion of control is that of people controlling your thoughts/movements]

87
Q

What is bathophobia

A

Fear of depths

88
Q

Fear of open spaces, crowds and unfamiliar settings?

A

Agoraphobia

[Social phobia is fear of interacting with people]

89
Q

How does dilsufiram work

A

Inhibits Acetylealdehyde dehydrogenase

90
Q

Acamprosate class

A

GABA-like drug that acts on glutamatergic NMDA receptor

[same receptor as alcohol to reduce craving]

91
Q

which antidepressants cause anticholinergic side effects?

A

Tricyclics

92
Q

Which infection is associated with development of OCD

A

B-haemolytic strep

93
Q

First line pharma rx for OCD

A

Citalopram

94
Q

Lack of interest in social relationships, solitary lifestyle, emotional coldness / apathy

A

Schizoid personality disorder

95
Q

Indicator of poor prognosis in schitz

A

Negative symtoms predominate - Eg long history of social withdrawal

96
Q

Screening tool for eating disorders

A

SCOFF

[Do you make yourself SICK because you feel uncomfortably full?

Do you worry you have lost CONTROL over how much you eat?

Have you recently lost more than ONE stone in a 3 month period?

Do you believe yourself to be FAT when others say you are too thin?

Would you say that FOOD dominates your life?]

97
Q

What is main indication for ECT

A

Depression with life threatening features

(Eg psychotic - auditory hallucination ‘worthless and deserve to die’

98
Q

Pseudo dementia key features ? And differentiate from dementia

A

Depression with relatively acute onset cognitive impairment

Often complain about cognitive difficulties

99
Q

How to move from a MAOinhibitor to SSRI

A

Stop MAO wait 14 days then start SSRI
[Otherwise risk of serotonin syndrome]

100
Q

Complains one person cunning bad, selfish…
And another kind, helpful and generous

What is this? How is it different from idealisation?

A

Splitting
-Splits people into Good or bad

In idealisation there is over-emphasis on good persons qualities

101
Q

What is fabricated or induce illness commonly called

A

Munchausens by proxy

102
Q

Buspirone used for? Class

A

Acute anxiety
Partial serotonin receptor agonist

103
Q

Which stage of sleep for sleepwalking

A

Stage 3 NREM

104
Q

What is sublimation

A

Filtering of behaviour so only socially acceptable forms displayed

105
Q

What is altruism

A

acting in a selfless manner to benefit others

106
Q

Nephrogenic DI which osmolalities are low/high

A

Urine low
Serum high

107
Q

When are SSRIs not first line for depression

A

Bleeding risk Eg on warfarin / heparin

->mirtazapine

108
Q

Rx of diarrhoea if opiate withdrawal and don’t know how much methadone been taking?

A

Loperamide

109
Q

How long continue antidepressants after recovery? if multiple relapses?

A

6 months

2 years if recurrent relapses

110
Q

Erectile dysfunction. Still getting morning erections 1st line Rx

A

Psychosexual counciling

111
Q

How many CAG repeats for huntingtons

A

> 37

112
Q

Strange thing which is a good prognostic factor for shitz

A

History of a mood disorder or
FHx of mood disorder

113
Q

Buproprion used for

A

Antidepressant used for smoking cessation

114
Q

Insomnia, low mood, delusions (eg of guilt) and psychomotor agitation

A

Major depression

115
Q

belief your actions are being controlled by external source

A

Made actions

116
Q

Streetlights came on because the spies are watching them

A

Delusion of perception

117
Q

Feelings controlled by external source

A

Made feelings

118
Q

Sensations being imposed on by a outside force

A

Somantic passivity

119
Q

Motor or sensory deficit with no organic cause

A

Conversion disorder

120
Q

Increased risk of suicide in depression when

A

Feeling of hopelessness

121
Q

Difference between alcohol abuse and dependence

A

Dependence - symptoms of withdrawal and tollerance

122
Q

When does benzo withdrawal start
Paroxetine withdrawal

A

48-72hrs
24-48hrs

123
Q

Socially withdrawn, eccentric behaviour / beliefs, paranoia, possible some mild “psychotic” symptoms

A

Schitzotypal

124
Q

what is key aspect of a phobia

A

The patient believes it is irrational

125
Q

Unpredictable behaviour.
chronic loneliness or boredom.
Self-harm. Poor relationships

A

Borderline personality disorder

126
Q

Key risks for young person suicide

A

Parental divorce

127
Q

Anorexic with poor wound healing, hair loss and glositis is deficient in what?

A

Zinc deficiency

[Vit C (scurvy) causes the same but less common in anorexic

128
Q

Panic disorder if no option for CBT in q

A

SSRI eg citalopram

129
Q

What social factors are assoc with completed suicide

A

Loss of job
Homelessness
Low socioeconomic status

[living along is not one]

MRCP PART 1 (22 decks)

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