Psych Flashcards
Tx for benzo OD
Flumazenil
RFs for schizophrenia?
Urban living, born in winter months, birth trauma,
Benzo withdrawal
Presents 24hrs (short) to 3/52 (long) after discontinuing
- Headaches, nausea, sweating,
tremor, agitation
- Anxiety, insomnia, seizures,
delirium, depersonalisation
How do benzos work?
Enhance GABA
Preventing opioid relapse: pharamacological tx?
Naltrexone
Opioid Withdrawal
Dysphoria, insomnia & agitation Diarrhoea, N&V, lacrimation & rhinorrhoea Feverish with abdominal & MSK cramps Piloerection Irresistible yawning Dilated pupils
Hallucinations
Perception in the absence of a stimulus
Treatment for moderate to severe alzheimer’s
Memantine
Contraindication to ECT
Recent MI
Catatonia assessment scale
Bush-Francis Catatonia Scale
What can be used in OCD as an alternative to SSRI?
Clomipramine
Discuss MMSE scores
MMSE scores:
* 24-30- no cognitive impairment
* 18-23- mild cognitive impairment
* 0-17- Severe cognitive impairment
What describes more severe depression on PHQ-9
> 16
What is mild depression on PHQ-9 scale?
Score of 9
Factors associated with poor prognosis of schizophrenia?
- strong family history
- gradual onset
- low IQ
- prodromal phase of social withdrawal
- lack of obvious precipitant
Tricyclic antidepressants SEs?
Common side-effects
* drowsiness
* dry mouth
* blurred vision
* constipation
* urinary retention
* lengthening of QT interval
Clinical features on anorexia?
Anorexia features
* most things low
* G’s andC’s raised:growth hormone,glucose, salivaryglands,cortisol,cholesterol,carotinaemia
SRRI discontinuation syndrome
- 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
Important SE of clozapine?
Agranulocytosis/neutropenia is a life-threatening side effect ofclozapine- monitor FBC
Decreased leucocytes
What electrolyte abnormality is associated with SSRIs?
Neutropenia
Tool to assess schizophrenia prodrome?
Evidence of ‘prodrome’ in 80-90% - screen using the PACE, COPS or SIPS tools
Hebephrenic schizophrenia?
Disorganised speech behaviour, flat/inapp. affect
Residual schizophrenia?
Less marked previous ‘+ve symptoms’ Prominent ‘-ve symptoms’
Side effect of risperidone?
risperidone →
hyperprolactinaemia)
Good schizophrenia prognosis criteria
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
Treatment for acute dystonia?
Procyclidine (anti-muscarinic)
Akathisia tx?
Propanalol
tx for tardive dyskinesia
Manage with vitamin E
Discuss neuroleptic malignant syndrome
Rare but life-threatening following new/dose
↑ antipsychotics.
Muscle stiffness, rigidity → rhabdomyolysis
ANS disturbance: fever, tachycardia, labile BP
Altered consciouness
Tx for neuroleptic malignant syndrome
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.
Clozapine mode of action
Blocks D1 & D4 receptors
Clozapine dosing
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)
Which antipsychotics come as a depot?
-Risperidone
-Olanzapine
-Flupenthixol
- Haloperidol
Treatment for Acute & Transient Psychotic Disorder
Acute - benzos
Long-term - mood stabilisers/antidepressants
Schizophreniform Disorder tx?
Antipsychotics ± mood stabiliser & psychotherapy
What can be given for schizotypal disorder?
Risperidone
What is classical conditoning?
Classical conditioning associates involuntary behavior with a stimulus (Pavlov’s dogs)
What is operant conditioning?
Operant conditioning associates voluntary action with a consequence.
Describe serotonin syndrome
Acute toxic syndrome from↑5-HT
Symptoms include: Agitation/restlessness, ataxia, Sweating, shivering, confusion, Tremor, diarrhoea, myoclonus, Hyperreflexia, fever
What is the diagnostic screening for serotonin syndrome?
Sternbach’s diagnostic criteria: need at least 3 symptoms
Bipolar manic episode tx if on lithium?
Already on Li prophylaxis:
* Optimise drugs: ensure compliance, therapeutic dose * Consider adding antipsychotic
* Short-term BDZ may be helpful
What do you measure in neuroleptic malignant syndrome?
Creatinine Kinase
8Man on ward behaving aggressively, what do you do?
verbal de-escalation
What drugs can cause sexual dysfunction?
SSRIs
Treatment for torticollis?
Procyclidine
What symptom strongly suggests social phobia?
Blushing
Woman with dementia, which part of brain is likely to be affected early?
Hippocampus
Women, who since her husband has died as started forgetting things, left oven on, diagnosis?
Pseudodementia
Woman with borderline personality disorder treatment
Dialectical behavioural therapy
What drug can cause hyperreflexia and tremor?
Lithium
Which drug is most likely to cause neuroleptic malignant syndrome?
Haloperidol
Section for a 38 year old woman who lacks capacity and wants to kill herself in A&E?
Deprivation of liberty safeguards
What does it mean when urine specific gravity is low?
Diluted urine - diabetes insipidus
Girl goes to pakistan. Develops macular rash. High fever for 5 days. HR was 70bpm. Cause?
Typhoid
Infrahyoid lump on neck
lymphadenitis
You are in GP, Child with croup comes in. What do you do?
Oral dexamethasone + review in 48 hours
Cyanosis in 6 week old with clubbing and systolic stenosis heard at left sternal
Tetralogy of fallot
4hr old new born baby has raised respiratory rate, everything else is normal. Diagnosis?
Transient tachynpoea of the newborn
- Maternal T1DM increases risk of what condition in newborn?
Neural tube defects
- Kid with bilateral calf hypertrophy - what should be measured?
Creatinine kinase
- Definitive test for patient with recurrent chest infections and FTT
Sweat test
Maintenance fluid to give to kid with diabetes mellitus ?
0.9% saline with 5% dextrose
Kid with crash and burn symptoms, and coronary aneurysm?
Kawasaki disease
Hearing exams for different ages
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
Signs of fetal alcohol syndorme
Microcephaly, absent philtrum, cardiac abnormalities, reduced IQ, IUGR, small upper lip
Effects of Cigarette smoking on baby?
IUGR, miscarriage, stillbirth
Signs of congenital syphillus infection
Rhinitis, saddle-nose, deafness (sensorineural), hepatosplenomegaly, jaundice
What is Hereditary angioedema?
C1 esterase deficiency AD inheritance
S/S: recurrent facial swelling & abdominal pain
What can cause cerebral palsy?
Hypoxic Ischaemic Encephalopathy
Risk factors for cerebral palsy
o Antenatal: preterm birth, chorioamnionitis, maternal infection
o Perinatal: LBW, HIE, neonatal sepsis
o Postnatal: meningitis
What are the three types of cerebral palsy
spastic, ataxic and dyskinetic
Cause of postnatal CP?
PVL (periventricular leukomalacia)
2nd to ischemia ± severe intraventricular haemorrhage
How many levels of CP are there?
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
Where is the damage is dyskinetic CP?
Basal ganglia
Causes of dyskinetic CP and symptoms?
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
Where is the damage of ataxic CP?
Cerebellum
Hypotonia, ataxia, mal-coordination, delayed motor development ± intention tremor
Where is the damage in spastic CP?
Pyramidal tracts
Investigation for NEC?
X-ray
What staging is used for NEC management?
‘Bell’ staging to decide on management
Meconium ileus management?
o 1st line = gastrograffin enema (N-acetylcysteine can also be used)
o 2nd line = surgery
What does the ‘double bubble’ sign on AXR indicate?
Duodental atresia
What condition has an increased risk of secretory otitis media?
Cleft palate
Surgery (definitive) – 3m for lip; 6-12m for palate
Treatment for Tracheoesophageal Fistula (TOF)?
Management:
o 1st = Replogle tube (drain saliva from oesophagus)
o 2nd = Surgical repair (few days of birth/neonatal) à NICU and ventilator support
Procedure for malrotation?
Ladd’s procedure
What to do if unilateral undescended testis picked up?
Review at 6-8 weeks and 3 months. If still present, refer to paediatric surgeon to be seen before 6 months of age
Name of skin darkening in PCOS?
Acanthosis nigricans
- HIV positive woman - what is the most important factor deciding her mode of delivery?
HIV viral load. Should be <40 for vaginal delivery
- Woman with dribbling all the time and had to wear a pad
Vesicovaginal fistula
- Which test for Down syndrome screening at 15 weeks?
NIPT (non-invasive prenatal testing). Only SCREENING test at this time
Best test for predicting preterm labour?
Measuring cervical length using TVUSS.
High chance of preterm labour if <15mm
Definition of 3rd and 4th degree tears?
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
Indication for cervical cerclage
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.
What causes lynch syndrome?
Caused by mutations in mismatch repair genes
Metabolic alkalosis is usually accompanied by which electrolyte imbalance?
Hypokalaemia
When should semen analysis be conducted?
3-5 days after sexual abstinence
Presentation of ovarian hyperstimulation syndrome?
. 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.
What AMTS score indicates delirium or dementia?
<6 (marked out of 10)
