Psych

Question 1

When do alcholic pts present with seizures?

Answer 1

36 hours after consuming alcohol

Question 2

What is the management for dementia with lewy bodies?

Answer 2

Acetylcholinesterase inhibitor - rivastigmine

later - memantine

Question 3

How is lewy body dementia diagnosed?

Answer 3

Clinical

Dat Scan/SPECT

Question 4

What is the difference between uncomplicated and prolonged grief disorder?

Answer 4

In prolonged grief disorder symptoms last more than 6 months

Pts usually have difficulty caring for themselves or others

Question 5

What is akathisia?

Answer 5

Inability to sit still

Question 6

How do you differentiate between Type I and II bipolar affective disorder?

Answer 6

Type II has severe depression and hypomania
Type I has sever depression and mania

Question 7

How do you manage heroin withdrawal?

Answer 7

symptomatic management

Diarrheoa - loperamide
Physical symptoms - lofexidine
Agitation - benzodiazepines

Question 8

What ECG changes do you see in hypokalaemia?

Answer 8

flattening and inversion of T waves in mild hypokalemia,
followed by Q-T interval prolongation,
visible U wave
and mild ST depression in more severe hypokalemia

Question 9

How does the formal thought disorder ‘circumstantiality’ present?

Answer 9

The patient moves onto different topics but there is a train of thought that can be followed and eventually returns to answer the original question

Question 10

How is opioid overdose managed?

Answer 10

Overdose can be managed with naloxone

Detox programmes use methadone and buprenorphine (the latter is a partial agonist of the opiate receptor, so can trigger withdrawal)
Relapse can be prevented using naltrexone once detox is complete.

Question 11

How is lithium toxicity investigated and managed?

Answer 11

Investigations
Serum lithium levels: This is the gold standard for diagnosing lithium toxicity.
Electrolyte levels
Thyroid function tests
Renal function tests
ECG: To assess for arrhythmias.

Management
Management of lithium toxicity is largely supportive and often requires specialist input. Key strategies include:

Maintaining electrolyte balance
Monitoring renal function
Seizure control
IV fluid therapy and urine alkalisation, which enhance the excretion of the drug
Benzodiazepines may be used to treat agitation and seizures
Haemodialysis might be required if renal function is poor

Question 12

What are the side effects caused by TCAs

Answer 12

Anticholinergic effects:

Dry mouth
Urinary retention
blurred vision
constipation
drowsiness

Question 13

What are side effects caused by SSRIs

Answer 13

GI upset
Anxiety and agitation
QT interval prolongation (especially associated with citalopram)
Sexual dysfunction
Hyponatraemia
Gastric Ulcer

Question 14

What are the physical symptoms often seen in Bullimia Nervosa?

Answer 14

Excessive vomiting:
Dental erosions
Parotid gland swelling
Russell’s sign - scarring on the back of the hand or knuckles
Borhaaves or mallory-weiss tear

Other:
Amenorrhea

Question 15

What are the side effects caused by carbamazepine use?

Answer 15

CARBA MEAN

Confusion
Ataxia
Rashes
Blurred vision
Aplastic anaemia
Marrow (bone marrow) suppression
Eosinophilia
ADH release
Neutropenia

Question 16

What are the side effects of ECT?

Answer 16

headaches
muscle aches
temporary memory loss
confusion
nausea

persistent memory loss

Question 17

What ECG change is associated with haloperidol use?

Answer 17

Prolonged QT interval

Question 18

What is the first line management of syphilis?

Answer 18

intramuscular benzathine penicillin is the first-line management
alternatives: doxycycline

Question 19

What is the first line management of a schizophrenia in a patient with a background of obesity, hypertension and type 2 diabetes?

Answer 19

Typical antipsychotic

atypical antipsychotic are best avoided as they are associated with multiple metabolic side-effects that increase the risk of developing cardiovascular disease

Question 20

What is the first line management of depression in adults with a background of heart disease?

Answer 20

Sertraline - SSRI of choice

SNRIs avoided as it may worsen hypertension and cardiac disease

Question 21

How does wernicke’s encephalopathy present?

Answer 21

acute and reversible and characterised by the classic triad of confusion, ataxia and ophthalmoplegia (diplopia, nystagmus or gaze palsy).

If Wernicke’s encephalopathy is left untreated, it can progress to Korsakoff’s psychosis,a chronic condition seen in patients with persistent alcohol use and long term thiamine deficiency. Patient’s will display personality changes, memory loss, hallucinations and confabulation.

If Wernicke’s encephalopathy is suspected or a patient is deemed at high risk of Wernicke’s encephalopathy, they should be started on thiamine replacement (usually in the form of Pabrinex®).

Question 22

How does neuroleptic malignant syndrome present?

Answer 22

Hyperthermia
Confusion
Muscle rigidity - can lead to rhabdomyolysis AKI and hyperkalaemia

Occurs after treatment with dopamine agonists e.g haloperidol

Question 23

How do you manage neuroleptic malignant syndrome?

Answer 23

Supportive - external cooling devices and rehydration with IV fluids

Question 24

How does serotonin syndrome present and how do you manage it?

Answer 24

Fever
Tachycardia
Confusion
Agitation

Supportive
- stopping causative agent
- Benzodiazepines - e.g midazolam
- active cooling
-ITU

Question 25

What are poor prognostic factors for schizophrenia?

Answer 25

strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant

Question 26

How would you treat a pt with schizophrenia who is not responding to 5mg haloperidol after 3 weeks?

Answer 26

increase dose

Question 27

What is factictious disorder?

Answer 27

also known as Munchausen’s syndrome
the intentional production of physical or psychological symptoms

Question 28

What is hypochindriasis?

Answer 28

Patients have excessive concern that they will develop a serious illness despite a lack of evidence.

Question 29

What are contraindications for an ECT?

Answer 29

Recent MI or unstable heart condition

Question 30

When do you manage a patient with anorexia medically and as an inpatient

Answer 30

medical management - physical complications, rapid weight loss, bmi<13.5

inpatient - bmi<13, high suicide risk, may need to feed under MHA

Question 31

What is malingering?

Answer 31

Patients fake symptoms for external gain e.g avoid prosecution

Question 32

What blood parameters are raised in Anorexia nervosa?

Answer 32

3Cs
Cortisol and GH
Hypercholesterolaemia
hypercarotinaemia

Question 33

How do you switch from fluoxetine to an SSRI?

Answer 33

Switching from fluoxetine to another SSRI
withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low-dose of the alternative SSRI