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Psych Flashcards

1
Q

Tx for benzo OD

A

Flumazenil

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2
Q

RFs for schizophrenia?

A

Urban living, born in winter months, birth trauma,

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3
Q

Benzo withdrawal

A

Presents 24hrs (short) to 3/52 (long) after discontinuing
- Headaches, nausea, sweating,
tremor, agitation
- Anxiety, insomnia, seizures,
delirium, depersonalisation


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4
Q

How do benzos work?

A

Enhance GABA

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5
Q

Preventing opioid relapse: pharamacological tx?

A

Naltrexone

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6
Q

Opioid Withdrawal

A

Dysphoria, insomnia & agitation
Diarrhoea, N&V, lacrimation & rhinorrhoea Feverish with abdominal & MSK cramps Piloerection
Irresistible yawning
Dilated pupils

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7
Q

Hallucinations

A

Perception in the absence of a stimulus

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8
Q

Treatment for moderate to severe alzheimer’s

A

Memantine

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9
Q

Contraindication to ECT

A

Recent MI

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10
Q

Catatonia assessment scale

A

Bush-Francis Catatonia Scale

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11
Q

What can be used in OCD as an alternative to SSRI?

A

Clomipramine

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12
Q

Discuss MMSE scores

A

MMSE scores:
* 24-30- no cognitive impairment
* 18-23- mild cognitive impairment
* 0-17- Severe cognitive impairment

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13
Q

What describes more severe depression on PHQ-9

A

> 16

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14
Q

What is mild depression on PHQ-9 scale?

A

Score of 9

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15
Q

Factors associated with poor prognosis of schizophrenia?

A
  • strong family history
  • gradual onset
  • low IQ
  • prodromal phase of social withdrawal
  • lack of obvious precipitant
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16
Q

Tricyclic antidepressants SEs?

A

Common side-effects
* drowsiness
* dry mouth
* blurred vision
* constipation
* urinary retention
* lengthening of QT interval

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17
Q

Clinical features on anorexia?

A

Anorexia features
* most things low
* G’s andC’s raised:growth hormone,glucose, salivaryglands,cortisol,cholesterol,carotinaemia

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18
Q

SRRI discontinuation syndrome

A
  • unsteadiness, vertigo or dizziness
  • altered sensations (for example, electric shock sensations)
  • altered feelings (for example, irritability, anxiety, low mood tearfulness, panic attacks, irrational fears, confusion, or very rarely suicidal thoughts)
  • restlessness or agitation
  • problems sleeping
  • sweating
  • abdominal symptoms (for example, nausea)
  • palpitations, tiredness, headaches, and aches in joints and muscles
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19
Q

Important SE of clozapine?

A

Agranulocytosis/neutropenia is a life-threatening side effect ofclozapine- monitor FBC
Decreased leucocytes

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20
Q

What electrolyte abnormality is associated with SSRIs?

A

Neutropenia

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21
Q

Tool to assess schizophrenia prodrome?

A

Evidence of ‘prodrome’ in 80-90% - screen using the PACE, COPS or SIPS tools

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22
Q

Hebephrenic schizophrenia?

A

Disorganised speech behaviour, flat/inapp. affect

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23
Q

Residual schizophrenia?

A

Less marked previous ‘+ve symptoms’ Prominent ‘-ve symptoms’

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24
Q

Side effect of risperidone?

A

risperidone →
hyperprolactinaemia)

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25
Q

Good schizophrenia prognosis criteria

A

Female, later/acute onset, DUP <3/12, high premorbid IQ, affective component prominent, good social support & medicine concordance, no family hx, precipitating features present, no substance misuse

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26
Q

Treatment for acute dystonia?

A

Procyclidine (anti-muscarinic)

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27
Q

Akathisia tx?

A

Propanalol

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28
Q

tx for tardive dyskinesia

A

Manage with vitamin E

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29
Q

Discuss neuroleptic malignant syndrome

A

Rare but life-threatening following new/dose
↑ antipsychotics.
Muscle stiffness, rigidity → rhabdomyolysis
ANS disturbance: fever, tachycardia, labile BP
Altered consciouness

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30
Q

Tx for neuroleptic malignant syndrome

A

Stop antipsychotics
2. UrgentICUmx: O2,fluids i.v., ↓body
temp.
3. Behavioural disturbance: BDZs
4. Rhabdomyolysis: fluidsi.v. ++,
NaHCO3 i.v. (alkalinisation of urine to
prevent renal failure)
Treat rigidity with dantrolene/lorazepam. Second line is bromocriptine.

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31
Q

Clozapine mode of action

A

Blocks D1 & D4 receptors

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32
Q

Clozapine dosing

A

Dose:
- 12.5mg od/bd day 1, then 25-50mg day 2 - ↑ gradually (25-50mg daily) over 14-21/7 to
max. 300mg in divided doses
- Further ↑ 50-100mg 1-2x weekly
- Usual dose 200-450mg (max. 900mg daily)

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33
Q

Which antipsychotics come as a depot?

A

-Risperidone
-Olanzapine
-Flupenthixol
- Haloperidol


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34
Q

Treatment for Acute & Transient Psychotic Disorder

A

Acute - benzos
Long-term - mood stabilisers/antidepressants

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35
Q

Schizophreniform Disorder tx?

A

Antipsychotics ± mood stabiliser & psychotherapy

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36
Q

What can be given for schizotypal disorder?

A

Risperidone

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37
Q

What is classical conditoning?

A

Classical conditioning associates involuntary behavior with a stimulus (Pavlov’s dogs)

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38
Q

What is operant conditioning?

A

Operant conditioning associates voluntary action with a consequence.

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39
Q

Describe serotonin syndrome

A

Acute toxic syndrome from↑5-HT
Symptoms include: Agitation/restlessness, ataxia, Sweating, shivering, confusion, Tremor, diarrhoea, myoclonus, Hyperreflexia, fever

40
Q

What is the diagnostic screening for serotonin syndrome?

A

Sternbach’s diagnostic criteria: need at least 3 symptoms

41
Q

Bipolar manic episode tx if on lithium?

A

Already on Li prophylaxis:
* Optimise drugs: ensure compliance, therapeutic dose * Consider adding antipsychotic
* Short-term BDZ may be helpful

42
Q

What do you measure in neuroleptic malignant syndrome?

A

Creatinine Kinase

43
Q

8Man on ward behaving aggressively, what do you do?

A

verbal de-escalation

44
Q

What drugs can cause sexual dysfunction?

A

SSRIs

45
Q

Treatment for torticollis?

A

Procyclidine

46
Q

What symptom strongly suggests social phobia?

A

Blushing

47
Q

Woman with dementia, which part of brain is likely to be affected early?

A

Hippocampus

48
Q

Women, who since her husband has died as started forgetting things, left oven on, diagnosis?

A

Pseudodementia

49
Q

Woman with borderline personality disorder treatment

A

Dialectical behavioural therapy

50
Q

What drug can cause hyperreflexia and tremor?

A

Lithium

51
Q

Which drug is most likely to cause neuroleptic malignant syndrome?

A

Haloperidol

52
Q

Section for a 38 year old woman who lacks capacity and wants to kill herself in A&E?

A

Deprivation of liberty safeguards

53
Q

What does it mean when urine specific gravity is low?

A

Diluted urine - diabetes insipidus

54
Q

Girl goes to pakistan. Develops macular rash. High fever for 5 days. HR was 70bpm. Cause?

A

Typhoid

55
Q

Infrahyoid lump on neck

A

lymphadenitis

56
Q

You are in GP, Child with croup comes in. What do you do?

A

Oral dexamethasone + review in 48 hours

57
Q

Cyanosis in 6 week old with clubbing and systolic stenosis heard at left sternal

A

Tetralogy of fallot

58
Q

4hr old new born baby has raised respiratory rate, everything else is normal. Diagnosis?

A

Transient tachynpoea of the newborn

59
Q
  1. Maternal T1DM increases risk of what condition in newborn?
A

Neural tube defects

60
Q
  1. Kid with bilateral calf hypertrophy - what should be measured?
A

Creatinine kinase

61
Q
  1. Definitive test for patient with recurrent chest infections and FTT
A

Sweat test

62
Q

Maintenance fluid to give to kid with diabetes mellitus ?

A

0.9% saline with 5% dextrose

63
Q

Kid with crash and burn symptoms, and coronary aneurysm?

A

Kawasaki disease

64
Q

Hearing exams for different ages

A

Hearing Exam (I.E. to check for CMV infection sensorineural hearing loss) – MEASURED AT BIRTH:

o 1st line: Evoked Otoacoustic Emission (EOAE) Testing – all babies receive this test!
Sound emitted into earphone to evoke an echo or emission from the ear if cochlear function is normal
2nd line: Automated Auditory Brainstem Response (AABR) Audiometry: Indications = fails EOAE or if they are too young for a regular test / severe learning difficulty, etc.

o If missed EOAE = 7m to 9m distraction testing – make sounds and observe infant’s behaviour to sound

o Toddler = 6m to 3yo (best 10m-18m) à visual reinforcement audiometry (VRA) – condition child to respond to sound and once they are trained, reduce the volume until no longer respond as expected from conditioning

o Toddler = 18m to 4yo à performance and speech discrimination testing

o Older child = ≥4yo à pure tone audiometry – child wears headphones and responds when they hear a sound

65
Q

Signs of fetal alcohol syndorme

A

Microcephaly, absent philtrum, cardiac abnormalities, reduced IQ, IUGR, small upper lip

66
Q

Effects of Cigarette smoking on baby?

A

IUGR, miscarriage, stillbirth

67
Q

Signs of congenital syphillus infection

A

Rhinitis, saddle-nose, deafness (sensorineural), hepatosplenomegaly, jaundice

68
Q

What is Hereditary angioedema?

A

C1 esterase deficiency AD inheritance
S/S: recurrent facial swelling & abdominal pain

69
Q

What can cause cerebral palsy?

A

Hypoxic Ischaemic Encephalopathy

70
Q

Risk factors for cerebral palsy

A

o Antenatal: preterm birth, chorioamnionitis, maternal infection

o Perinatal: LBW, HIE, neonatal sepsis

o Postnatal: meningitis

71
Q

What are the three types of cerebral palsy

A

spastic, ataxic and dyskinetic

72
Q

Cause of postnatal CP?

A

PVL (periventricular leukomalacia)
2nd to ischemia ± severe intraventricular haemorrhage

73
Q

How many levels of CP are there?

A

Gross motor function classified by GMFCS (Gross Motor Function Classification System):
Level 1 Walks no limitations
Level 2 Walks some limitations
Level 3 Walks with handheld mobility device
Level 4 Self-mobility with limitations; may use powered mobility
Level 5 Manual wheelchair

74
Q

Where is the damage is dyskinetic CP?

A

Basal ganglia

75
Q

Causes of dyskinetic CP and symptoms?

A

Hypoxic ischaemic encephalopathy, kernicterus
Variable muscle tone predominated by primitive motor reflexes

· Chorea → irregular, sudden, brief non-repetitive movements

· Athetosis → slow, writhing movements distally → fanning fingers

· Dystonia → simultaneous contraction of agonist/antagonist muscles → twisted appearance

76
Q

Where is the damage of ataxic CP?

A

Cerebellum
Hypotonia, ataxia, mal-coordination, delayed motor development ± intention tremor

77
Q

Where is the damage in spastic CP?

A

Pyramidal tracts

78
Q

Investigation for NEC?

A

X-ray

79
Q

What staging is used for NEC management?

A

‘Bell’ staging to decide on management

80
Q

Meconium ileus management?

A

o 1st line = gastrograffin enema (N-acetylcysteine can also be used)

o 2nd line = surgery

81
Q

What does the ‘double bubble’ sign on AXR indicate?

A

Duodental atresia

82
Q

What condition has an increased risk of secretory otitis media?

A

Cleft palate
Surgery (definitive) – 3m for lip; 6-12m for palate

83
Q

Treatment for Tracheoesophageal Fistula (TOF)?

A

Management:

o 1st = Replogle tube (drain saliva from oesophagus)

o 2nd = Surgical repair (few days of birth/neonatal) à NICU and ventilator support

84
Q

Procedure for malrotation?

A

Ladd’s procedure

85
Q

What to do if unilateral undescended testis picked up?

A

Review at 6-8 weeks and 3 months. If still present, refer to paediatric surgeon to be seen before 6 months of age

86
Q

Name of skin darkening in PCOS?

A

Acanthosis nigricans

87
Q
  1. HIV positive woman - what is the most important factor deciding her mode of delivery?
A

HIV viral load. Should be <40 for vaginal delivery

88
Q
  1. Woman with dribbling all the time and had to wear a pad
A

Vesicovaginal fistula

89
Q
  1. Which test for Down syndrome screening at 15 weeks?
A

NIPT (non-invasive prenatal testing). Only SCREENING test at this time

90
Q

Best test for predicting preterm labour?

A

Measuring cervical length using TVUSS.
High chance of preterm labour if <15mm

91
Q

Definition of 3rd and 4th degree tears?

A

Third-degree tear: Injury to perineum involving the anal sphincter complex: Grade 3a tear: Less than 50% of external anal sphincter (EAS) thickness torn. Grade 3b tear: More than 50% of EAS thickness torn. Grade 3c tear: Both EAS and internal anal sphincter (IAS) torn. Fourth-degree tear: Injury to perineum involving the anal sphincter complex (EAS and IAS) and anorectal mucosa

92
Q

Indication for cervical cerclage

A

A history of spontaneous preterm birth (up to 34+0 weeks of pregnancy) or loss (from 16+0 weeks of pregnancy onwards), and results from a transvaginal ultrasound scan carried out between 16+0 and 24+0 weeks of pregnancy that show a cervical length of 25 mm or less. Discuss the risks and benefits of both options with the woman, and make a shared decision on which treatment is most suitable.

93
Q

What causes lynch syndrome?

A

Caused by mutations in mismatch repair genes

94
Q

Metabolic alkalosis is usually accompanied by which electrolyte imbalance?

A

Hypokalaemia

95
Q

When should semen analysis be conducted?

A

3-5 days after sexual abstinence

96
Q

Presentation of ovarian hyperstimulation syndrome?

A

. It occurs after the administra- tion ofexogenous hCG or after the natural rise in hCG with conception. Patients present with abdominal pain and distension, nausea, bowel disturbance, shortness of breath and poor urinary output. These patients may require inpatient care by a specialist team.

97
Q

What AMTS score indicates delirium or dementia?

A

<6 (marked out of 10)

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