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ppqs > Psych > Flashcards

Psych Flashcards

1
Q

Which is the most important test to routinely perform for patient on clozapine

A

FBC

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2
Q

Test to do in woman who is scantily dressed, agitated, sweating, tachycardic

A

TFTs

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3
Q

Drug to give for depression in a man who had a previous MI

A

Sertraline

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4
Q

Man on haloperidol experiences acute dystonia. What do you do - stop meds, reduce dose, prescribe something else etc?

A

Procyclidine

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5
Q

Man works as an IT engineer, doesn’t like sex, or people

A

Schizoid personality disorder

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6
Q

Woman blushes in public and gets nervous around people

A

Social phobia

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7
Q

Woman is anorexic, presents to GP with a BMI of 14.3

A

Urgent referral to AnE

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8
Q

Alcoholic wants to quit and wants something to reduce cravings

A

Acamprosate

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9
Q

Man on antipsychotic comes in with a tremor - what is the most likely drug?

A

Haloperidol or any typical antipsychotic

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10
Q

Husband brings in wife who has bipolar. She’s taken 20 ‘white’ tablets - has a tremor, hyperreflexia, and confusion. What has she overdosed on?

A

Lithium

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11
Q

Patient with lewy body dementia was given a drug but it has made him worse. What drug?

A

Haloperidol - these patients are very sensitive to EPSEs

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12
Q

Man comes in requesting for codeine for his back, concerned his painkiller use is spiralling. What do you do?

A

Buprenorphine (partial agonist) + addiction clinic referral

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13
Q

What would an alcoholic need to have to be classified as being dependent?

A

Giving up pleasurable activities to drink more alcohol (there are more but this was the only sba option)

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14
Q

Someone with dilated pupils, urinary retention, obs normal ish - cause of overdose?

A

TCAs

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15
Q

Lithum - what monitoring needed?

A

Lithium levels, U&Es, BMI and TFTs every 6 months

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16
Q

Man who drinks a bottle of wine a day for the last 10 year, has tried to quit before but failed. He now wants to cut down his alcohol intake.

A

Motivational interviewing, then inpatient chlorodiazepoxide when ready to fully quit

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17
Q

Addict presents with dilated pupils and goosebump flesh

A

Opiate withdrawal

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18
Q

Acute treatment for patient with manic episode

A

Olanzipine

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19
Q

Man on ward behaving aggressively, what do you do?

A

Verbal de-escalation

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20
Q

A chef who keeps washing his hands + a load of other obsessions + hearing voices

A

Psychotic episode (or OCD with psychotic features if thats an option? OCD normally does not have any psychotic features)

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21
Q

Woman witnesses car crash, and goes blind a few hours later

A

Conversion disorder

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22
Q

Man sticks out his tongue and grimaces involuntarily

A

Tardive dyskinesia

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23
Q

In dementia, which part of the brain is likely to be affected early on?

A

Hippocampus

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24
Q

35 y/o man presents to A&E agitated and requesting medication. He has mild tremor, cool and clammy skin, and goosebumps (piloerection). Ambulance staff found him in the street with an empty bottle of cider. Temperature 36.8, BP 140/100, HR 100. What is the most likely diagnosis?
a. Alcohol intoxication
b. Alcohol withdrawal syndrome
c. Opiate intoxication
d. Opiate withdrawal syndrome
e. Tricyclic antidepressant intoxication

A

Opiate withdrawal (hes asking for meds, plus goosebumps)

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25
Q

21 y/o woman admitted to psych ward for an acute episode. She has been prescribed Amisulpride for the past 3 weeks and is now worries she is pregnant because she has missed her period, however her pregnancy test is negative. Which blood test should be requested in addition to routine bloods?
a. Luteinising hormone
b. Progesterone
c. Prolactin
d. Thyroid stimulating hormone
e. Triglycerides

A

Prolactin - amisulpride increases prolactin levels

26
Q

45 y/o man presents with worsening tremor for a few weeks. Has a history of schizophrenia in remission for which he is taking Haloperidol. There is bilateral tremor and cog-wheel rigidity in upper limbs. What is the most appropriate treatment for his symptoms?
a. Co-beneldopa
b. Entacapone
c. Pramipexole
d. Procyclidine hydrochloride
e. Selegiline hydrochloride

A

Procyclidine - for EPSE

27
Q

Section in AnE - which one?

A

4

28
Q

Section for already admitted? Cant be AnE

A

5(2)

29
Q

84 y/o man presents with gradual deterioration in memory for 3 years. He forgets details of conversations and to attend doctor’s appointments, though he can still manage his finances and cook and clean for himself. He regularly goes to the local shops and never gets lost. Which part of the brain is likely to be affected?
a. Cerebellum
b. Frontal lobe
c. Occipital lobe
d. Parietal lobe
e. Temporal lobe

A

Temporal lobe

30
Q

18 y/o man admitted under MHA to inpatient mental health unit for anorexia nervosa. He is commenced on nasogastric feeds and begins to show signs of confusion, weakness, and dyspnoea. Which electrolyte abnormality is most likely to be seen?
a. Hypercalcaemia
b. Hyperkalaemia
c. Hypomagnesaemia
d. Hyponatraemia
e. Hypophosphataemia

A

Hypophosphataemia - also with hypoK and hypomag BUT phosphate is main and most common

31
Q
  1. 48 y/o man has hypertension, anxiety, gout, and back pain. His routine ECG shows a QT interval of 460ms (380-440 normal range). Which is the most likely causative medication?
    a. Allopurinol
    b. Amitriptyline
    c. Co-codamol
    d. Diazepam
    e. Ramipril
A

Amitriptyline

32
Q

High prolactin caused by?
a. Diazepam
b. Metformin
c. Risperidone
d. Sertraline
e. Zopiclone

A

Antipsychotics - Risperidone

33
Q

70 y/o woman known to community mental health team sees her GP with new onset tremor, painful muscle contractions, dry mouth, and weight gain. Which medication is likely to be causing her symptoms?
a. Amitriptyline
b. Levodopa
c. Olanzapine
d. Paroxetine
e. Propranolol

A

Olanzapine

34
Q

20 y/o medical student attends A&E on the eve of an exam with difficulty breathing, palpitations, and chest tightness. She says she feels close to collapse, and feels like she is going to die. This has happened before and she was prescribed Propranolol but this is no longer effective, and she has routinely declined psychological interventions. Routine blood tests, ECG, and CXR are all normal. What is the most appropriate next step in her management?
a. Diazepam
b. Fluoxetine
c. Mirtazapine
d. Risperidone
e. Venlafaxine

A

Fluoxetine

35
Q

60 y/o man with schizophrenia is taking haloperidol and has developed uncontrolled repetitive movements of his jaw with grimacing and protrusion of his tongue. What phenomenon is this?

A

Tardive dyskinesia

36
Q

97 y/o woman has dementia and frequently tries to leave her nursing home an 03:00 in her nightgown to feed the swans. What legal framework may be considered in order to prevent her from leaving?

A

Deprivation of liberty safeguards

37
Q

27 y/o woman reviewed by community mental health team for schizophrenia follow-up. She describes experiences where she thinks she isn’t real. What phenomenon is this?

A

Derealisation

38
Q

55 y/o man admitted to hospital 3 days ago for knee replacement. Now complaining of seeing ants crawling up his legs and appears confused and tremulous. What is the most likely diagnosis?

A

Delirium tremens

39
Q

50 y/o man believes wife is cheating on him, gathering evidence by repeated obsessive examination of her underwear. What is the most likely psychiatric diagnosis?

A

Othello syndrome

40
Q

40 y/o woman attends A&E after her mother’s funeral with sudden onset blindness, but seems largely unconcerned about this new development. Physical examination and investigations are normal. What is the most likely disorder?

A

Conversion disorder

41
Q

87 y/o woman with indwelling catheter presents with sudden onset agitation and visual hallucinations. What is the most likely diagnosis?

A

Delirium

42
Q

20 y/o man with schizophrenia tells his support worker that the TV news presenter talks about him. What psychotic phenomenon is he describing?

A

Delusion of reference

43
Q

78 y/o woman has 2 weeks of progressive lethargy, nausea, and dizziness. She has depression and has recently increased her dose of Citalopram. What is the most likely biochemical abnormality?

A

Hyponatraemia - SSRI side effect

44
Q

22 y/o woman has 6 months of restricted eating, amenorrhea, social anxiety, and low mood. She has fine hair on her face and her BMI is 16.8. Her observations are otherwise normal. What is the most appropriate first-line pharmacological intervention?

A

SSRI - fluoxetine

45
Q

16 y/o attends GP with difficulties at college: she fears sitting on public transport and feels scared to leave her house. She avoids the supermarket and now does her grocery shopping online. What is the most likely diagnosis?

A

Agoraphobia

46
Q

A 72 year old man has a 6 month history of low mood, poor sleep and poor appetite. His wife died 1 year ago. He complains of poor memory, forgetting to take his medication and forgetting appointment dates and neglecting to pay bills. He used to attend the community
centre but no longer enjoys doing so. He feels hopeless about the future. He denies social ideation. What is the most likely diagnosis?

A

depression - pseudodementia in the stem points towards this

47
Q

A 35 year old man has been feeling low in mood and has disturbed sleep. He has been taking fluoxetine 40 mg daily for 3 months, with no improvement. His treating doctor intends to commence him on citalopram 20 mg daily. Which is the most appropriate next step in regards to changing his medication?

A

Taper fluox, 1 week washout, then start citalopram. Fluoxetine has the longest half life hence need to washout

48
Q

Which presenting feature most characteristically indicates a diagnosis of anorexia nervosa?
a. Amenorrhoea
b. Anxiety when discussing food
c. BMI of 18.5 kg/m2
d. Preoccupation with food
e. Purging behaviour

A

Anxiety when discussing food

49
Q

A 30 year old woman with type I diabetes mellitus has developed end-stage renal failure and requires dialysis. She believes that the hospital (where she is admitted) has conspired to intentionally give her diabetes. She is therefore refusing to have dialysis and is actively attempting to leave the hospital. She is able to retain the relevant information and communicate her decision to refuse dialysis, which she justifies based on her thoughts that dialysis will cause her further harm. Blood investigations: potassium 6.7 mmol/L (3.5 - 5.3), Urea 50 mmol/L (2.5 - 7.8), creatinine 1200 micromol/L (60 - 120). Which is the most appropriate next step in regards to her management?
a. Detain the patient under Section 5(2) of the Mental Health Act and provide emergency dialysis
b. Facilitate a Mental Health Act assessment
c. Facilitate an urgent best interests assessment
d. Facilitate dialysis under common law, using sedation if required
e. Facilitate discharge and continue discussions with the patient in the community

A

Urgent best interests assessment - Urea is super high –> physiological cause of delirium

Physiological cause hence can’t MHA/ section
Can’t discharge because she is delirious

50
Q

Psych drug to avoid in women of childbearing age/ must prescribe with contraception

A

Sodium valproate

51
Q

A 22 year old woman in the ED describes an episode where she saw an unfamiliar man in her house at sunset. Her boyfriend, who was with her at the time, did not see this man in her house, but noted that she was disoriented to time and place. She reported no other difficulties at the time and she has no previous psychiatric history. Her AMTS is 6/10 and her temperature 37.9C. Investigations: GGT 11 IU/L (9 - 40), CRP 70 mg/L (<5); urine drug screen negative for all substances. Which is the most likely diagnosis?

A

Delirium - CRP is high

52
Q

A 30 year old woman attends the Urgent Treatment Centre after cutting her wrists superficially. She suffers from depression and is taking sertraline 50mg daily. Her partner walked out on her this morning. She feels distressed but her sister has offered to stay with her. She has previously cut her wrists with no threat to her life. She has no thoughts of suicide. She intends to attend her appointment with the psychiatrist tomorrow. Which is the next most appropriate step in management?
a. Arrange a Mental Health Act assessment
b. Call an ambulance
c. Call the duty psychiatrist for an urgent assessment
d. Give her the 24 hour mental health crisis number
e. Increase her dose of sertraline

A

MHA assessment

53
Q

A 28 year old man is prescribed regular medication for bipolar disorder. He has also been taking naproxen for a sports injury. He presents to the Emergency Department with ataxia, confusion and tremor. Which medication is most likely to have resulted in his symptoms?
a. Carbamazepine
b. Lithium
c. Olanzapine
d. Sertraline
e. Sodium valproate

A

Lithium - NSAIDs will increase lithium levels as both are excreted in kidneys

54
Q

A 30 year old man with a brain injury following a road traffic accident reports experiencing an odd smell of burnt plastic. He is surprised that this is not bothering his flatmates. He recently reported seeing an image of Jesus on the walls of his bedroom reciting the ten commandments. What is the most likely diagnosis?

A

Post concussion syndrome - Jesus thing + burnt plastic after accident

55
Q

14yo girl needs inpatient treatment for anorexia. How would you give her treatment?
Deprivation of liberty safeguards, Section 5(2) of MHA, Section 2 MHA, no official holding powers for children <16yo.

A

Section 2 MHA (MHA has no age limit)

56
Q

Wet wacky wobbly

A

Normal pressure hydrocephalus

57
Q

Lady w schizophrenia and actively psychotic declines some physical health intervention, which is the best framework to provide treatment under?

A

Mental Capacity Act 2005

58
Q

What medication causes gynecomastia in this patient taking these 4 drugs:
rosuvastatin, lamotrigine, Clopidogrel, amitryptilline

A

Amitryptilline

59
Q

Women presenting with hyperreflexia, tremor etc, what drugs did she likely overdose on?

A

Lithium

60
Q

When would you prescribe typical over atypical antipsychotics?

A

T2DM, htn, obesity etc as atypicals increase risk of cardiovascular disease

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