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MRCP - Part 1 > psych > Flashcards

psych Flashcards

1
Q

What is conversion disorder

A

Functional neurological symptom disorder

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2
Q

What is conversion disorder suggested by

A

Loss of motor control or sensory function
Not fully explained by physiological mechanisms
Assosiated with psychological conflict

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3
Q

What is hypochondriasis

A

Preoccupation with body illness
Accompanying anxiety and health seeking behaviour

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4
Q

Mechansim of buspirone

A

Partial serotonin receptor agonist

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5
Q

Treatment of PTSD

A

Eye movement desensitisation and reprocessing (EMDR)

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6
Q

Drugs known to increase lithium concentrations

A

Metronidazole
NSAIDs
ACEIs / ARBs
TTDs
Corticosteriods
Tetracyclines

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7
Q

Where is lithium excreted?

A

Kidneys

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8
Q

Causes of cortical dementia (damage to cerebral cortex - outer grey matter layer of the brain)

A

Alzheimers
FTD
CJ Disease

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9
Q

Features of cortical dementia

A

Severe memory loss
Cannot remember words / understand language

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10
Q

Causes of subcortical dementia (damage to area beneath the cortex and disruption of frontostriatal connections)

A

PD
VD
MS
NPH
Huntingtons
Wilsons
HIV dementia complex

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11
Q

Features of subcortical dementia

A

Planning difficulties
Poor verbal fluency
Personality change
Task swtiching
Reduced verbal output, slowed rate of response and reduced altertness

Complex motor tasks preserved in the early syages

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12
Q

What is splitting

A

Defense mechanism whereby people do not integrate the good and bad qualities of other people - rather they have representatinos of people at one extreme or the other (i.e. all good or all bad)

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13
Q

Inheritanc eof lesch nyhan syndrome

A

X linked recessive
Almost exclusively affects boys

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14
Q

Pathology of lesch nyhan syndrome

A

Inborn error of purine metabolism
Results in abnormally high levels of xanthine and uric acid in the blood

Gene mutation short arm of chromosome Xq26-27

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15
Q

Presentation of lesch nyhan syndrome

A

Severe mental disability
Wheelchair bound
Increased tendon reflexes
Microcephaly common
Epileptic seizures
Verbal and physical aggression
Self injurious behaviour (biting lips, inside of mouth, fingers, hitting head)

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16
Q

Common assosiation with downs syndrome

A

Accelerated alzheimers disease

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17
Q

Tx for GAD

A

SSRI e.g. citalopram

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18
Q

1st line Tx depression in the elderly

A

SSRI

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19
Q

Features of fragile X syndrome

A

Sometimes not detected until adult life
Short
Large head circumference
Macro-orchidism
Characteristic facial appearance - large forehead with supraorbital fullesness, long face, long nose, prominent jaw, high arched palate and large ears
Pale irises
Cognitive deficit
Epilepsy

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20
Q

Features of prader willi syndrome

A

Constant hynger/hyperphagia
Restricted growth
Hypogonadism
LDs

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21
Q

4 symptoms of narcolepsy

A

Chronic daytime sleepiness
Cataplexy
Hypnagogic/hypnopompic hallucinations
Sleep paralysis

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22
Q

Screening questionaire to identify those with postnatal depression

A

Edinburgh Postnatal depression scale (EPDS)

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23
Q

Features of borderline PD

A

Instability of mood, self image and interpersonal relationships
Problem with self harm and feelings of emptiness

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24
Q

Features of histrionic PD

A

Excessive attention seeking emotions
Innapropriately seductive behaviour
Excessive need for approval

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25
Q

Features of narcissistic PD

A

Inflated sense of their own importance
Deep need for admiration
Lack of empathy

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26
Q

How long do schizophrenia symptoms need to be present for for a diagnosis

A

1 month

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27
Q

Diagnosis of narcolepsy

A

Multiple sleep latency EEG (immediate entry into REM at sleep onset on two or more occassions)

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28
Q

Pathology of narcolepsy

A

Abnormality of REM sleep

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29
Q

Another name for munchausens syndrome

A

Facticious disorder

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30
Q

Example of an abnormal grief reaction

A

No obvious grief reaction since the event

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31
Q

Treatment of newly diagnosed schizophrenia

A

Atypical antipsychotics e.g.
- amisulpride
- olanzapine
- quetiapine
- risperidone
- zotepine

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32
Q

Which antidepressants should be avoided when on warfarin or heparin, and what should be used instead

A

SSRIs
Consider mirtazepine instead

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33
Q

What is used to reduce alcohol cravings in a patient with alcohol dependence

A

Naltrexone

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34
Q

Treatment of choice in treatment resistant schizophrenia

A

Clozapine

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35
Q

Treatment of ADHD

A

Methylphenidate

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36
Q

Post mortem findings of alzheimers dementia

A

Neurofibrillary tangles (NFTs)
Senile plaques
Protein tau
Extracellular depostis of amyloid beta peptides

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37
Q

What is anterograde amnesia

A

Inability to create new memories after an event

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38
Q

Conversion vs somatosation disorder

A

Somatosation - multiple physical illnesses affecting different body systems, spanning a period of 2 years or more
Conversion disorder - symptoms resemble neurological disorder, blindness, deadness, loss of feeling and muscle power

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39
Q

Which stage of sleep do dreams and nightmares occur

A

REM sleep

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40
Q

Cardinal features of LBD to distinguish from alzheimers dementia

A

LBD
- fluctating cognitive function
- varying levels of alertness
- significant daytime somnolence
- visual hallucinations

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41
Q

What type of drug is venlafaxine

A

SNRI

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42
Q

Genetic change of behavioural variant FTDD and MND overlap

A

C9orf72 gene

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43
Q

2nd line tx of bipolar disorder if lithium is contraindicated

A

Sodium valproate

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44
Q

What occurs in 20% of patients on long term treatment with lithium

A

Hypothyroidism

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45
Q

How does disulfiram work

A

Inhibits acetadelyhyde dehydrogenase

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46
Q

S/Es of buspirone (tx for anxiety)

A

Nasal congestion

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47
Q

What is somatic passivity

A

The belief that sensations are being imposed upon the body by an outside force

48
Q

Features of schizoid PD

A

Lack of interest in social relationships
Tendency towards a solitary or sheltered lifestyle
Secretiveness
Emotional coldness
Apathy

NO DELUSIONS / HALLUCINATIONS

49
Q

MRI and SPECT scanning of FTD / picks disease

A

MRI - increased T2 signal in the frontal lobe white matter
SPECT - decreased metabolism in the frontal region

50
Q

Poor prognostic factors of schiozphrenia

A

FH
Insidious onset
Poor pre morbid personality, especially “schizoid”
Low intellegence
Abscence of precipitating stress
Lack of affective components in the episode
Underlying organic disorder

51
Q

How many repeats of the abnormal triplet sequence would typically be found in a patient with huntingtons disease

A

> 37

52
Q

Treatment of ADHD

A

Methylphenidate

53
Q

Treatment of seasonal affective disorder

A

CBT

54
Q

What stage of sleep does sleepwalking occur

A

Stage 3 NREM

55
Q

S/Es of clozapine

A

Neutropenia
Agranulocytosis
Hypersalivation
Sedation
Weight gain
Reduced seizure threshold

56
Q

What drug class is clozapine

A

Atypical antipsychotic

57
Q

What is akathisia

A

Common and distressing drug induced movement disorder
Inability to sit still
Commonly seen in patients on antipsychotics, particularly those at high doses or following rapid dose uptitration

58
Q

What vitamin deficencies are common in anorexia nervosa

A

Zinc deficency

59
Q

Presentation of zinc deficiency

A

Poor wound healing
Hair loss
Glossitis

60
Q

3 core criteria for diagnosis of Learning disability

A

Significant impairment of intellectual functioning
Significant impairment of adaptive/social functioning
Age of onset before adulthood

61
Q

Normal IQ range

A

70 - 130

62
Q

Mild LD IQ

A

50-69

63
Q

Moderate LD IQ

A

35-49

64
Q

Severe LD IQ

A

20-34

65
Q

Profound LD IQ

A

< 20

66
Q

What is regression

A

Return to less mature levels of functioning
A defense mechanism which only appears when anxiety levels are high and not alleviated by more mature defecnes such as intellectuisation and humour

67
Q

Common features of schizoaffective disorder

A

Auditory hallucinations
Commentary on a patietnts actions
Major depression

68
Q

Treatment of OCD

A

CBT and exposure response prevention (ERP)

69
Q

What is a haptic hallucination

A

Experienced as sensations of being touched, strangled or the feeling that insects are crawling beneath the skin

70
Q

Who is haptic hallucinations common in

A

Cocaine users

71
Q

Presentation of tardive dyskinesia and what does this occur secondary to

A

Lip smacking, lateral jaw movements and tongue protrusion
Stererotyped movements

Caused by dopamine receptor blocking agents e.g. chlorpromazine

72
Q

What is cyclothymia

A

Individual has mood swings cycling from mild depression to hypomania (without psychotic features or significant functional impairment)

73
Q

Dementia vs depressive pseudo-dementia

A

Dementia - cognitive deficit insidious, unaware of difficulties and confabulate
Depressive pseudo-dementia - Acute and recent cognitive deficit, communicate a sense of distress or agitation and will complain of their cognitive difficulties

74
Q

Definition of illusion

A

Misperception of a real external stimulus

75
Q

Definition of hallucination

A

False sensory perception in the abscence of real external stimuli

76
Q

What is ganser syndrome

A

Patients mimic the symptoms of a psychosis

77
Q

Features of ganser syndrome

A

Pseudohallucinations
Poor eye contact
Prolonged periods of staring
Giving approximate answers (vorbierden)
Somatic conversion
Amnesia

78
Q

What is oculogyric crisis and when does it occur

A

A type of dystonia seen in patients on antipsychotics
Painful upwards deviation of the eyes

79
Q

Treatment of oculogyric crisis

A

Anticholingergics e.g. procyclidine

80
Q

What can risperidone be significantly assosiated with

A

Significant hyperprolactinaemia

81
Q

What is seen on an EEG in narcolepsy

A

Rapid onset of REM sleep

82
Q

Drug treatment to prevent relapse of opiod dependency

A

Naltrexone

83
Q

The CAGE questionare screens for which disorder

A

Alcohol dependence

84
Q

Pathological changes of wernicke korsakoffs syndrome

A

Neuronal loss in the mammilary bodies

85
Q

What side effect is seen in 50% of individuals taking lithium during the first month of therapy

A

Fine tremor

86
Q

Management of specific phobias

A

Graded exposure

87
Q

Features of schizotypical PD

A

Socially withdrawn
Reduced capacity for close relationships
Eccentric behaviour or beliefs and possibly paranoid ideas
Delusions of reference where they believe something innocuous in the public domain (e.g. newspaper) has a special reference to them

88
Q

What is bupropion used for and what is the mechanism of action

A

Smoking cessation
Noradrenaline dopamine reuptake inhibitor

89
Q

What is cotard syndrome

A

Hallmark is nilhilistic delusions concerning ones own body, which range from believing that one person is missing organs or limbs to the belief that one is dead

90
Q

Symptoms of benzodiazepine withdrawl

A

Anziety
insomnia
psychosis
seizures

91
Q

What is acrophobia

A

Extreme or irrational fear of heights

92
Q

What is agoraphobia

A

Irrational fear of open spaces, crowds or umfamilial settings

93
Q

How to switch from selegiline (MAOI) to paroxetine (SSRI)

A

Stop selegiline, wait 14 days, then start paroxetine
To minimise risk of serotonin syndrome

94
Q

What is isolation

A

Seperation of thought from its attached emotional tone, thereby making it tolerable
Well described during highly stressful events such as death of a loved one

95
Q

What is conversion disorder

A

Motor or sensory deficit
Although no organic cause is identified for the deficit

96
Q

WHat is hyochondriacal disorder (also known as illness anxiety disorder)

A

Persistent preoccupation with the possibility of having a serious disease

97
Q

How long do the baby blues usually last for

A

Occur 4-5 days after birth for about 2-3 days

98
Q

What is used (drug treatment) for maintenance of abstinence from alcohol vs physiological alcohol dependence

A
  1. maintenance of abstinence - acamprosate
  2. physiological alcohol dependence - disulfiram
99
Q

Test for fragile X syndrome

A

Molecular genetic testing of the FMR1 gene

100
Q

What is alot more common in vascular dementia than alzheimers

A

Seizures
Also more acute onset, occurs in a step like manner with acute exacerbations

101
Q

Treatment of neuroleptic malignant syndrome

A

Dantrolene (mulscle relaxant)
Dopamine agonists (bromocriptine)
IV fluids

102
Q

Pathology of lithium induced nephrogenic diabetes insipidus

A

Decreased aquaporin-2 expression

103
Q

Treatment for psychotic symptoms in PD

A
  1. Quetiapine
  2. if fails - clozapine
104
Q

What proteins accumulate in alzheimers disease

A

Tau

105
Q

Treatment of lithium overdose (with a level > 5)

A

Haemodialysis

106
Q

Features of adjustment disorder

A

Short term, stress related, non psychotic disturbance as a result of e.g. a traumtic event
Absent features of PTSD such as replaying the event
Features consistent with depression

107
Q

What would make you think of schizoaffective disorder

A

Hallucinations with intermittent periods of depression

108
Q

What is ethylene glycol

A

anti-freeze

109
Q

treatment of antifreeze (ethylene glycol) overdose and how does this work

A

Fomepizole
Inhibitor of alcohol dehydrogenase

110
Q

Treatment of HTN for patients already on lithium therapy

A

CCBs e.g. amlodipine
NOT VALSARTAN OR RAMIPRIL

111
Q

Which PD drug causes risk taking behaviours

A

Ropinirole

112
Q

What time frame is adjustment disorder before it turns into depression

A

adjustment - 3 - 6 months
depression - after 6 months

113
Q

Features of charles bonnet syndrome

A

Complex visual hallucinations
- repeated geometric patterns of people or patterns for example, standing at the edge of the bed
Reduced visual acuity

114
Q

Presentation of MDMA toxicity

A

Agitation
Pyrexia
HTN
Tachycardia
Thirsty
Rhabdomyolysis in severe toxicty

115
Q

Treatment ladder of tourettes

A
  1. Psychoeducation
  2. CBT
  3. Clonidine
  4. Risperidone
116
Q
A

MRCP - Part 1 (20 decks)

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