psych

Question 1

physical symptoms no explanation 2 years, patient refuses to accept reassurance or negative test results

Answer 1

somatisation disorder

Question 2

overdose on paracetamol treat with

Answer 2

N-Acetylcysteine

Question 3

overdose of amitriptyline

Answer 3

IV bicarbonate

Question 4

fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

Answer 4

Malingering

Question 5

autism 3 necessary features

Answer 5

global impairment of language and communication
impairment of social relationships
ritualistic and compulsive phenomena

Question 6

how do you stop SSRIs?

which SSRI is worst and best for stopping

Answer 6

When stopping a SSRI the dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine). Paroxetine has a higher incidence of discontinuation symptoms.

Question 7

SADPERSON score useful for?

Answer 7

suicide risk

Question 8

PHQ-9 score is

Answer 8

a 9 question tool for depression

Question 9

what percentage of Alzheimers is genetic?

what are the genes involved?

Answer 9

5-10%

Question 10

basic pathophysiology of Alzheimers

Answer 10

amyloid precursor protein is a intramembrane protein in cells in the brain. it is usally cleaved by gamma secretase and alpha secretase. if another enzyme beta secretase cleaves instead then you create an insoluble protein which builds up outside of cells forming plaques and causing tau phosphorylation (we think)
tau proteins inside neurons which normally support it are phosphorylated. they change shape and form clumps called neurofibrillary tangles

Question 11

what seperates mania from hypomania?

Answer 11

the presence of psychotic symptoms = mania

Question 12

which tool for post natal depression?

Answer 12

edinburough scale

Question 13

What is the most appropriate time to take blood samples for therapeutic monitoring of lithium levels?

Answer 13

12 hours after last dose

Question 14

do Phenytoin levels need to be monitored?

Answer 14

Phenytoin levels do not need to be monitored routinely but trough levels, immediately before dose should be checked if:

• adjustment of phenytoin dose
• suspected toxicity
• detection of non-adherence to the prescribed medication.0

Question 15

clozapine, what must you check?!

Answer 15

FBC for agranulocytosis

Question 16

true risk factors for suicide

Answer 16

The following is a list of suicide risk factors taken from the Preventing suicide in
England paper from the Government:
Gender - males are three times as likely to take their own life as females
Age - people aged 35-49 years now have the highest suicide rate
Mental illness
The treatment and care they receive after making a suicide attempt
Physically disabling or painful illnesses including chronic pain
Alcohol and drug misuse
The loss of a job
Debt
Living alone - becoming socially excluded or isolated;
Bereavement
Family breakdown and conflict including divorce and family mental health problems
Imprisonment

Question 17

which antidepressant should be used post-MI?

Answer 17

Sertaline has the most evidence

Question 18

Causes of visual hallucinations

Answer 18

Lewy body dementia
Alcohol induced
Frightening ones - - > delirium. 
Drug induced
Charles bonnet syndrome I  those who are visually impaired 
Sleep disturbance 
Cjd

Question 19

Diagnosis if dementia requirements?

Answer 19

Objective evidence of decline in two cognitive domains
Functional decline
Other pathology excluded

Question 20

Routine assessment for dementia

Answer 20

Screening cognitive test like 6CIT
FBC
RENAL LIVER FUNCTION 
THYROID FUNCTION 
RANDOM GLUCOSE 
B12 AND FOLATE 
CALCIUM
ONLY SYPHILIS FROM HIGH RISK GROUP

Question 21

Memory clinic assessment for dementia

Answer 21

History and mental state

Standardised cognitive assessment like MMSE, ACE-R, MOCCA

Question 22

Drugs that increase QT interval. It is essential to do an ecg as a preasssesment

Answer 22

Antipsychotics

Question 23

Factors associated with worse prognosis in schizophrenia

Answer 23

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

Question 24

balanoprosthitis, what is it and what to rule out and how to treat?

Answer 24

male candida, rule out glycosuria and treat with antifungals

Question 25

treatment for scabies?

Answer 25

Permethrin 5% cream

Question 26

pep drugs

Answer 26

Truvada 245, ftc and raltegravir 400Bd

Question 27

how long after UPSI can you use progesterone only emergency contraception?

Answer 27

3 days licensed, useful up to 5

Question 28

after 5 days upsi what emergency contraception would you be able to still use?

Answer 28

IUCD (copper coil)

Question 29

3 emergency contraceptives

Answer 29

uripristal acetate, IUD (copper coil)(most effective), progesterone pill

Question 30

when cant you have uripristal acetate as emergency because wont work

Answer 30

when taking inducers like carbemazipine or high stomach ph like ppi or after 120 hours