Psych

Question 1

ou are an FY2 working in a GP practice. See an 30 year old man with a year history of low mood, inability to concentrate in his job and lack of interest in socialising with others. He reports some recent episodes of self-harm and says he feels worthless and guilty most days. He is currently on 50mg OD PO sertraline.
What are the core symptoms of depression and some others?

Answer 1

Low mood
Anergia
Anhedonia
Difficulty sleeping 
Not eating as well 
Loss of libido 
Loss of confidence 
Loss of concentration 
Suicidal ideation/self harm 
Feelings of guilt

Question 2

How long do the symptoms have to be ongoing for to make a diagnosis of depression?

Answer 2

2 weeks minimum

Question 3

Using the bio psychosocial model , what are the risk factors for depression?

Answer 3

Biological: genetics
Psychological: low self esteem, past history of child abuse or loss of parent, anxious personality
Social: recent tragic life incidents eg. loss of someone ,unemployment, homelessness. Lack of friends.
Chronic pain eg. fibromyalgia

Question 4

What screening tool can be used in GP for depression?

Answer 4

PHQ-9

Question 5

What are the treatment options used in depression?

Answer 5

1. CBT, group therapy, IAPT in Sheff
   May also need medication if more severe:
2. SSRI eg. sertraline, citalopram
3. Mirtazipine (NAssA) or SNRI- venlafaxine
   3rd; MOA inhibitors e.g rasigiline or TCA- clomipramine , amitryptilline

Question 6

What are some side effects of SSRIs?

Answer 6

Initially- suicidal ideation increases
Sexual dysfunction 
Weight loss
Diarrhoea 
Insomnia

Question 7

What are some side effects of TCAs?

Answer 7

Can’t spit, can’t shit, can’t see , can’t pee
Dry mouth, constipation, blurred vision, urinary retention
cardiac problems

Question 8

What do you need to warn patients about who are on MAO inhibitors?

Answer 8

eating any tyramine rich foods eg. cheese, red wine, beer

Question 9

What can be tried to treat severe depression not responding to any treatment?

Answer 9

ECT

Question 10

What are side effects of ECT?

Answer 10

Memory loss- retrograde, aching muscles, headaches, confusion

Question 11

What are some risk factors for suicide?

Answer 11

Risk factors:

• Unemployed
• No family or friends nearby
• Multiple previous attempts of self harm/sucicide
• Planning the next attempt i.e leaving a note or making sure no one finds them
• Male
• Alcohol or drug misuse
• History of mental illness
• History of chronic disease
• Sorting out any final acts eg. selling belongings/ paying bills

Question 12

Miss L is a 23 year old, single and shares a flat with her mother. She received SSRI treatment for depression 2 years ago following a termination of pregnancy. Her mother has brought her to see the GP as she is concerned that Miss L is “not herself”. Miss L appears excessively cheerful and talks loudly and quickly. She is wearing a lot of makeup in vivid colours. She tells you she is absolutely fine although sometimes she has trouble sleeping. She believes she is going to achieve stardom and become a world famous popstar next month. It is difficult to get a history from her as she changes the subject frequently, appears offended by some questions and laughs inappropriately at others. What is the likely diagnosis -specifically?

Answer 12

Bipolar disorder

Type 1 - mania and depression

Question 13

What is the difference between hypomania and mania?

Answer 13

Mania will have psychotic symptoms eg. grandiose delusions, persecutory delusions

Question 14

How will you manage an acute manic episode?

Answer 14

Antipsychotics eg. olanzapine

Question 15

What is good to give to help treat the acute depressive episode?

Answer 15

Lamotrigine

Fluoxetine and olanzipine

Question 16

You have diagnosed Miss L with bipolar disorder and treated her acute manic episode with olanzapine. You now need to manage her chronically. What are the options for treatment? Which one can you give 25 year old Miss L who doesn’t take any medication ?

Answer 16

Lithium
Sodium valproate
Antipsychotics eg. olanzapine

Lithium! - don’t need to be on contraception
Need to be on contraception to give sodium valproate

Question 17

What are the side effects of lithium?

Answer 17

LITHIUM
Leucycottosis, inspidus, tremor, hydration- polyuria, polydipsia , GI disturbances, underactive thyroid- hypothyroid, metallic taste in mouth

Question 18

Patient starts on lithium. Is having levels regularly monitored (weekly to begin with), 3 monthly once stable. Then presents to A+E with coarse tremor, blurred vision, jerking of her arms, diarrhoea and vomiting. What has happened and how do you manage?

Answer 18

Lithium toxicity
Bloods: FBC, U&E, LFTs, lithium level, TFTs
Stop lithium and supportive tx- rehydrate

Question 19

Ms M is 32 years old with a known history of alcohol has been attending Alcoholics Anonymous. Members of these groups have asked her to seek help as she believes that a number of them are talking about her and calling her “paedo” (though they have reassured her that this is not the case). During the interview she seems nervous and distracted. Her speech is sometimes garbled, and she flits from one subject to a seemingly unrelated other one frequently. She says there is a conspiracy to frame her as a “paedo”. She tells you that staying clean and sober is extremely important to her, but that she feels she can no longer trust the other group members and is now reluctant to attend 12‐step meetings. What symptoms of schizophrenia is she showing?

Answer 19

Delusions
Thought disorder- Knight’s move thinking (flits from one subject)
Pressure of speech

Question 20

What are the first rank symptoms of schizophrenia? What are some others?

Answer 20

First rank:
3rd person auditory hallucinations
Delusional perceptions
Passivity phenomenon 
Thought disorder- thought broadcast, thought echo, thought insertion, thought withdrawal 

Others: delusions, 2nd person auditory hallucinations, visual hallucinations, thought disorder eg. Knight’s move thinking- jumping from topic to topic, negative symptoms- apathy, blunted responses, catatonia

Question 21

What is schizoaffective disorder and how is it treated?

Answer 21

Experience symptoms of mood disorder and schizophrenia at the same time and of the same intensity Tx: antipsychotic and mood stabiliser.

Question 22

What is schizotypal?

Answer 22

It is a personality disorder with some schizophrenia symptoms

Question 23

What is schizophreniform?

Answer 23

Fail to meet the criteria for schizophrenia but have some symptoms with deterioration in function.

Question 24

Ms M is 32 years old with a known history of alcohol has been attending Alcoholics Anonymous. Members of these groups have asked her to seek help as she believes that a number of them are talking about her and calling her “paedo” (though they have reassured her that this is not the case). During the interview she seems nervous and distracted. Her speech is sometimes garbled, and she flits from one subject to a seemingly unrelated other one frequently. She says there is a conspiracy to frame her as a “paedo”. She tells you that staying clean and sober is extremely important to her, but that she feels she can no longer trust the other group members and is now reluctant to attend 12‐step meetings. She is diagnosed with schizophrenia.
What is her bio psychosocial plan for management?

Answer 24

Biological: atypical antipsychotic eg. olanzapine, risperidone
Psychological: CBT, alcoholic support groups - maybe a different one or involve the substance abuse team.
Social: address any job or housing issues, family issues?

Question 25

What are some first generation (typical) antipsychotics? How do they work?

Answer 25

Haloperidol, Chlorpromazine, prochlorpromazine, sulpiride. They block D2 (dopamine) receptors

Question 26

What are some side effects of 1st generation antipyschotics?

Answer 26

ESPEs Tardive dyskinesia - lip smacking, chewing, grimacing Akasthisia - pacing, inner restlessness Parkinsonism Acute dystonic reaction - muscular spasms, acute torticollis, ocular gyrate crisis

Question 27

How do you treat acute dystonic reaction?

Answer 27

IV fluids, procyclidine (anticholinergics)

Question 28

How do you treat tardive dyskinesia?

Answer 28

Very difficult - tetrabenazine

Question 29

How do you treat akathisia?

Answer 29

Propranolol and switch to second gen antipschyotic

Question 30

How do 2nd gen antipsychotics work and what are there side effects?

Answer 30

Block dopamine D2 receptors and serotonin receptors Side effects: weight gain, diabetes, hyperlipidaemia, hyperprolactinaemia- galactorrhea, amenorrhea, infertility, erectile dysfunction

Question 31

What needs to be monitored when a patient is on antipsychotics?

Answer 31

``` ECG- long QT Bloods: FBC, U&E, LFTs, prolactin, glucose, lipids , HBA1c Side effects Weight and waist circumference BP ```

Question 32

What are the 3 clusters of personality disorders and an example from each?

Answer 32

Cluster A: odd/eccentric 'Mad'- schizotypal, paranoid PD Cluster B: dramatic/emotional 'Bad' - emotionally unstable , antisocial, histrionic, PD Cluster C: anxious/avoidant 'Sad' - dependent, obsessive compulsive PD

Question 33

A 23 year old man has a history of being very suspicious of everyone around him. He has often accused his friends for trying to kill him or trying to hurt him even though they try and reassure him that they aren't. He doesn't have any close family or friends as he doesn't trust anyone. What type of PD is this?

Answer 33

Paranoid PD - tends to be males, very suspicious and mistrusting about everyone's actions

Question 34

A 23 year old man has a history of being very distant with his friends. His girlfriend (now ex girlfriend) said that he never showed any emotion or care to her and was always very cold and distant. He says he prefers to spend time by himself with his own thoughts. What type of PD is this?

Answer 34

Schizoid - tends to be males, very emotionally distant and cold. Limited capacity for expressing emotion, prefers to be alone.

Question 35

A 25 year old man has a history of violent behaviour. He has a criminal record for violent offences against people. He doesn't care what people think about him and is very easily frustrated by small things which make him violent. On asking whether he regrets his violent offences, he says he does not and doesn't care how they feel. What type of PD is this?

Answer 35

Antisocial PD- history of criminal behaviour, lack of guilt about behaviour, no concern for others, aggressive and can be violent.

Question 36

A 25 year old female has a history of having random outbursts in her mood, she is known for having frequent mood swings which are unpredictable. She has very intense relationships which then rapidly become unstable. She has scars on her arms showing she has a previous history of self harm and continues to. You ask her to tell you about her and she says she doesn't even really know who she is. What type of PD is this?

Answer 36

Emotionally unstable - borderline / impulsive if more impulsive acts in question - Intense and unstable relationships - Unclear self image - Self harm/suicide - Mood swings

Question 37

A 25 year old female has a history of being quite overdramatic. She will exaggerate stories about things that have happened to her in order to get attention. She often takes any sort of criticism or instruction poorly and her feelings get hurt very easily. What type of PD is this?

Answer 37

Histrionic: overdramatic, exaggerates, self centred- wants attention, easily hurt feelings

Question 38

A 25 year old man has a history of obsessive behaviours. He compulsively worries and doubts everything he has done and spends an hour in the morning checking all the switches are off numerous times. He is quite rigid in this routine and gets anxious if he cannot do this. What type of PD is this?

Answer 38

Anankastic- obsessive compulsive

Question 39

A 25 year old female has a history of very low self confidence. She wants to be liked by everyone and doesn't respond well to criticism or any sort of rejection. She is very insecure and feels she is not a good as everyone else. What type of PD is this?

Answer 39

Avoidant/anxious

Question 40

A 25 year old female has a history of repeated relationships that don't end well. She has never had a period of time where she has had a partner and would struggle to be alone. She feels very incompetent without someone there and says she cannot function unless there is someone she can rely on. She is scared everyone in her life will leave her and she wouldn't know what to do. What type of PD is this?

Answer 40

Dependent

Question 41

How do you treat personality disorder?

Answer 41

DBT- dialectical behaviour therapy- uses individual and group therapy with CBT and mindfulness CBT can be used Social interventions Only medication to treat a co-morbid issue eg. antidepressants if depressed

Question 42

Ms C is a 25 year old woman who is referred to your clinic by her GP. She has been on anti‐depressants for over one year with little effect. Before you see her you have a look at her notes. You discover that she was neglected as a child and often left alone for long periods of time by both her parents who had problems with substance misuse. She was eventually placed into foster care. Whilst in foster care she was sexually abused by one of her carers and at this point began drinking alcohol regularly. She tells you that her mood is “all over the place” and has recently experienced relationship breakdown, has no friends, and can’t cope anymore. She feels unsafe in her current accommodation. She says that she constantly wants to kill herself and regularly cuts herself with a Stanley knife. What are the causes of her presentation based on the biopsychosocial model based on 3 Ps?

Answer 42

P's- predisposing P's- precipitating P- perpetuating Predisposing: bio: genetics, psych: neglected as child, social: unsafe environment Precipitating: bio: alcohol use, psych: sexual abuse by carers, social: unsafe foster home Perpetuating: bio: alcohol intake, psych: self harm, social: lack of friends and support system, no where safe to live

Question 43

Ms C is a 25 year old woman who is referred to your clinic by her GP. She has been on anti‐depressants for over one year with little effect. Before you see her you have a look at her notes. You discover that she was neglected as a child and often left alone for long periods of time by both her parents who had problems with substance misuse. She was eventually placed into foster care. Whilst in foster care she was sexually abused by one of her carers and at this point began drinking alcohol regularly. She tells you that her mood is “all over the place” and has recently experienced relationship breakdown, has no friends, and can’t cope anymore. She feels unsafe in her current accommodation. She says that she constantly wants to kill herself and regularly cuts herself with a Stanley knife. What is the biopsychosocial model for management?

Answer 43

Biological: antidepressants Psychological: DBT, alcohol therapy, CBT- past trauma Social: find her supportive housing, support group for social support, look for job

Question 44

20 year old female, reports palpitations and feeling of impending doom. She has been struggling to concentrate at work. Her sleep quality has been poor for the last few months. She reports these symptoms occurring everyday for the majority of the day. She has previously been on propranolol for anxiety. Given the likely diagnosis, what treatment can be offered?

Answer 44

Psychological: progressive relaxation training, CBT with relaxation Medication: 1. SSRI- sertraline 2. SNRI/TCA Can give benzo's for acute anxiety attacks and beta blockers for symptoms

Question 45

A patient presents to clinic as she has had a few episodes where she has had intense feelings of fear, feeling her heart beating, chest pain and struggling to breathe. Often she gets quite dizzy as well. In these episodes she feels like she is going to die and doesn't have control to stop herself falling over or anything. The episodes last 10 minutes and then stop and she feels worn out but physically fine afterwards. What is the likely diagnosis? and how are you going to treat?

Answer 45

Panic disorder - <20 min episodes of intense fear with autonomic symptoms. Tx: CBT Meds: 1. SSRI . 2nd line : TCA

Question 46

Mrs B is a 34 year old married mother of two. She is currently on maternity leave after having her second child who is now 7 months old. When her baby was a few weeks old, he caught Norovirus and was very ill with diarrhoea and vomiting. Mrs B has always been “house proud” but has become more fixated on cleaning and washing since this incident. She spends “hours” sterilising all the baby’s bottles and feeding implements. She herself washes her hands 40‐ 50 times daily (they are raw and chapped). Her mood, sleeping and energy are all fine. What is the difference between obsessions and compulsions?

Answer 46

Obsessions: repeated purposeless words/ thoughts Compulsions: repeated senseless acts to help to deal with the obsessions

Question 47

Mrs B is a 34 year old married mother of two. She is currently on maternity leave after having her second child who is now 7 months old. When her baby was a few weeks old, he caught Norovirus and was very ill with diarrhoea and vomiting. Mrs B has always been “house proud” but has become more fixated on cleaning and washing since this incident. She spends “hours” sterilising all the baby’s bottles and feeding implements. She herself washes her hands 40‐ 50 times daily (they are raw and chapped). Her mood, sleeping and energy are all fine. Given the likely diagnosis , how are you going to treat her?

Answer 47

CBT/exposure therapy | Meds: clomipramine (TCA) or SSRI- fluoxetine if higher impairment

Question 48

A 50 year lady comes into clinic by her husband. He says that she won't leave the house anymore at all and it was a big effort to get her here. On questioning her, she says she is very scared of going outside her house now and doesn't feel safe in open spaces. When she gets there, she feels panicky, her heart starts racing and she feels nauseous. This is happening nearly every time they go out eg. in a park or in a queue or on public transport. She is fine at home, her mood is stable and she has no psychotic symptoms. What is the likely diagnosis and how can you treat?

Answer 48

Agoraphobia. | Tx: exposure therapy

Question 49

Mr A is a 28 year old ex‐soldier who returned from Iraq 18 months ago. Since then, he has been living at home and unable to work. He does not want to leave the house because he gets into conflicts with strangers which have led to physical fights. When interviewed, he is jumpy and overreacts to the slamming of a car door outside. He does not watch television because any news story about war or conflict brings back “bad memories”. His wife is struggling to cope with him and their three young children. She reports that he is drinking heavily, although he denies this. He has no contact with the rest of his family or friends. What are the symptoms of PTSD?

Answer 49

Hypervigilance Flashbacks / nightmares of trauma - autonomic sx with this - hyperventilation, palpitations Insomnia Detachment from other people Poor concentration Depression may have substance abuse and suicidal thoughts

Question 50

You have diagnose your patient with PTSD. What should you immediately NOT do?

Answer 50

Debrief- don't go into the event straight away= makes symptoms worse

Question 51

What is the biopsychosocial model for management of PTSD?

Answer 51

Biological: 2nd line to therapy/in combo with: SSRI, mirtazipine Psychological: trauma focused CBT or EMDR- eye movement desenitisation and reprocessing Social: support groups- particularly if ex military - groups for them in particular

Question 52

How do you treat alcohol withdrawal acutely?

Answer 52

Chlordizepoxide Pabrinex supplements - vitamin b1 Same staff member, well lit room

Question 53

You see the alcohol withdrawal pt a week later. Is now out of hospital. Wants help with abstinence long term. How will you manage?

Answer 53

Alcohol support groups Medications: acamprosate- anti-craving, disulfiram- hangover like effects, naltrexone- anti-craving, makes features less pleasurable.

Question 54

Miss D is a 20 year old student who has been admitted to Medical Assessment Unit (MAU) after a collapse in her Hall of Residence. She is 5’4” and weighs 5 stone. She has a body mass index of 12. On examination, she is emaciated, and she has a pulse of 50 bpm, BP 86/60, respiratory rate 8/ per minute. She has angular stomatitis and proximal muscular weakness with some small fine hair growth on her ams. Given the diagnosis, what abnormalities might you find on blood tests?

Answer 54

``` Anorexia nervosa Most thing's low eg. potassium, testosterone, oestrogen. FSH and LH G's and C's raised - Growth hormone - Glucose - Salivary gland enlargement -Carotenes -Cortisol - Cholesterol ```

Question 55

What are the signs and symptoms of anorexia nervosa?

Answer 55

``` Fatigue Loss of concentration Intense FEAR of putting on weight Low BMI Amenorrhea Failure of secondary sexual characteristics Cold intolerance Dry skin and hair Proximal muscle weakness Lanuga hair - fine hair growth ```

Question 56

How do you manage a patient with anorexia?

Answer 56

May need admitting to hospital Refeeding - slowly CBT- eating disorder focused Family therapy if under 18

Question 57

What is this? Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain Options: somatisation disorder, hypochondries disorder, malingering, conversion disorder, fictious/munchausen's

Answer 57

Malingering

Question 58

What is this? The intentional production of physical or psychological symptoms due to the psychological goal of receiving attention/care/comfort Options: somatisation disorder, hypochondries disorder, malingering, conversion disorder, fictious/munchausen's

Answer 58

Munchausen's

Question 59

What is this? Loss of motor or sensory function, may be brought on by stressful life event. Options: somatisation disorder, hypochondries disorder, malingering, conversion disorder, fictious/munchausen's

Answer 59

Conversion disorder

Question 60

What is this? Multiple physical SYMPTOMS present for at least 2 years. Patient refuses to accept reassurance or negative test results Options: somatisation disorder, hypochondries disorder, malingering, conversion disorder, fictious/munchausen's

Answer 60

Somatisation disorder

Question 61

What is this? Persistent belief in the presence of an underlying serious DISEASE, e.g. cancer. Patient again refuses to accept reassurance or negative test results Options: somatisation disorder, hypochondries disorder, malingering, conversion disorder, fictious/munchausen's

Answer 61

Hypochondrial disorder

Question 62

Go through a MMSE

Answer 62

Appearance: well kempt, well dressed Behaviour: fidgety? anxious? making eye contact? responding to any hallucinations? self harm? Speech: rate, rhythm and volume- loud/quiet. Pressure of speech or mutism? Thought disorder- jump from topic to topic Mood: subjective- their mood. objective- your assessment and affect Thought- delusions or obsessions and what the form is Perceptions- hallucinations and modality or illusions Cognition- orientated to time and place? Insight- insight into illness, do they want help?

Question 63

You are an FY2 working on A+E. Pt has attempted overdose. Pt states when leave are going to jump off nearby bridge. Pt is leaving now and liaison psych who you have bleeped have not answered. There are no other staff present. What section of mental health act will you use?

Answer 63

Section 4- emergency order | In A&E so can't use 5(2)

Question 64

Once sectioned with mental health act- patient is displaying symptoms of pneumonia. Can you treat?

Answer 64

No - you can only treat the mental disorder until MHA. You can only force treatment for physical under the mental capacity act

Question 65

You are an FY2 working on a general medicine ward. Patient is being treated for overdose. She now is demanding to leave and saying she will go take another overdose. What section of the MHA will you use?

Answer 65

5(2)- patients already admitted. | 72 hours.

Question 66

What is a section 2 and 3?

Answer 66

Section 2- assessment- 28 days Section 3- treatment - 6months need 2 doctors and 1 approved mental health professional for both

Question 67

What sections can police use?

Answer 67

135- home | 136- public place

Question 68

Pt on ward is acting aggressively, refusing medication, asking to leave. They are under a DOLS. Thrown hot coffee at nurse. What are you going to try first?

Answer 68

De-escalation techniques- speaking softly, explaining what's happening, asking them their concerns

Question 69

Pt on ward is acting aggressively, refusing medication, asking to leave. They are under a DOLS. Thrown hot coffee at nurse. You have tried de-escalation techniques. What can you do now?

Answer 69

Oral lorazepam or oral haloperidol + promethazine If oral doesn't work: IM

Question 70

What are the key side effects to watch out for when you give lorazepam or haloperidol?

Answer 70

Acute dystonic reaction | Respiratory depression- lorazepam

Question 71

What antidote should you have to hand when giving lorazepam for the respiratory depression?

Answer 71

Flumenazil

Question 72

What can you give for a paracetamol OD?

Answer 72

Activated charcoal within the hour | NAC - plot on graph and give. If staggered OD: give anyway.

Question 73

Sam is a 26-year-old female who is brought in to the Emergency Department unconscious after having been found slumped on the floor in town. She has pinpoint pupils, GCS 8, hypothermic, muscle spasms and evidence of track marks on her arms. What is your initial management? What is your long term management?

Answer 73

Naloxone IV | Detox: methadone or buprenorphine

Question 74

A 25 year old presents with A&E with new onset confusion and agitation. She also looks very sweaty. You do a neuro exam due to the presence of her tremor which shows hyperreflexia. She says she takes sertraline regularly for months now but 2 days ago they started a new anti-depressant. What is the likely diagnosis?

Answer 74

Serotonin syndrome

Question 75

What is the triad of symptoms in serotonin syndrome?

Answer 75

Autonomic sx: sweating, tachycardia Neuromuscular: hyperreflexia, tremor Mental state: confusion, aviation

Question 76

How do you manage a patient with serotonin syndrome?

Answer 76

``` ABCDE Remove offending drug Supportive treatment eg. IV fluids BENZO- midazolam/diazepam cyprohepatidine can help - serotonin receptor antagonists ```

Question 77

A 26 year old with a background of schizophrenia presents with A&E with a new onset high fever. Her muscles are very rigid when you examine her. She is also sweating. Obs show a high fever and tachycardia. She is confused but she manages to tell you they started her on a new drug for her schizophrenia yesterday. What is the likely diagnosis and how will you manage her?

Answer 77

``` Neuroleptic malignant syndrome ABCDE Stop drug. IV fluids, cooling blankets IV benzo - lorazepam Dopaminergic drugs- bromocriptine, amantadine ```

Question 78

50 year old man reports feeling increasingly anxious, sweating and experiencing episodes where he sees insects that aren't there. He is acutely confused but m manages to tell you he has decided to stop drinking 12 hours ago. Was drinking 5 pints of beer a night for many years. What is the diagnosis and how are you going to manage him?

Answer 78

``` Delirium tremens - psychotic symptoms ABCDE Chlordiazepoxide - PO/ IV if vomiting Pabrinex- IV If having seizures: diazepam ```

Question 79

50 year old man with a history of severe chronic alcohol abuse presents to A&E with new onset confusion, blurred vision and unstable gait. He walks with a very wide stance and on testing eyes- there is some nystagmus present. What is the likely diagnosis and management?

Answer 79

Wernicke's encephalopathy - triad of confusion, ophthalmoplegia- nystagmus, ptosis and ataxia Mx: Thaimine /pabrinex Check glucose and give this before

Question 80

You have diagnosed your patient with chronic alcohol abuse with Wernicke's encephalopathy. What other condition is he at risk of developing? what would be the symptoms?

Answer 80

Korsakoff's - chronic | Confabulation due retrograde amnesia- invent memory, antegrade amnesia- can't make new memories, apathy, ataxia

Question 81

You have a patient who is addicted to his lorazepam but is now willing to slowly withdraw from them with your help. How will you help?

Answer 81

Change to diazepam first- helps and withdraw by 2mg a week