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MSRA 2 > Psych/Neuro > Flashcards

Psych/Neuro Flashcards

1
Q

What are the essential features of schizophrenia?

A

Psychotic features
Functional deterioration
Onset before the age of 45
The illness lasts for months not days

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2
Q

How do we treat brief psychotic disorder?

A

Atypical antipsychotics

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3
Q

When can we diagnose brief psychotic disorder?

A

After 1/12 of no sx if lasts less than 1/12

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4
Q

How does facioscapulohumeral dystrophy present?

A

Progressive difficulty whistling and sucking through a straw

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5
Q

Can you see psychotic features in depression?

A

Yes, in severe depression

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6
Q

How does NPH present?

A

Triad of urinary incontinence, gait disturbance and dementia

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7
Q

For how long do we continue antidepressant therapy?

A

For 6m after resolution of sx

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8
Q

Where do you see subhyaloid haemorrhages?

A

SAH

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9
Q

What are the early signs of lithium toxicity?

A

Diarrhoea, vomiting, drowsiness, muscular weakness and lack of coordination

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10
Q

What are the signs of moderate lithium toxicity?

A

Giddiness, ataxia, blurred vision, tinnitus and increased volume of dilute urine

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11
Q

What are the signs of severe lithium toxicity?

A

Hyperreflexia, convulsions, renal failure, collapse, coma and death

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12
Q

What is seen on ECG in lithium toxicity?

A

Reversible flattening, isoelectricity or inversion of T waves

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13
Q

Where should lithium levels be maintained?

A

0.5-1.2mmol/l, and should be taken 12-18hrs after last dose (at least 12hrs)

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14
Q

What is post-herpetic neuralgia?

A

Pain after shingles infection

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15
Q

A 76y.o M presents with worsening sleep disturbance with restless legs, painful cramps and difficulty turning in bed. Dx?

A

Parkinson’s

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16
Q

What is restless leg syndrome?

A

Subjective experience of restlessness interfering with sleep

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17
Q

What is akathisia?

A

Prominence of lower limb restlessness

Occurs within hours to weeks of starting/increasing the dose of antipsychotics

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18
Q

Which antipsychotic is most associated with EPSES?

A

Risperidone

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19
Q

What is coital cephalgia?

A

Headache related to sexual activity at or near orgasm

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20
Q

How do we manage mild-moderate depression?

A

Low-intensity psychological intervention

Try to avoid antidepressant usage - only use in moderate-severe depression

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21
Q

Where do you see bitemporal hemianopia?

A

Pituitary tumour

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22
Q

What is bitemporal hemianopia?

A

Loss of temporal vision in both eyes

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23
Q

What is homonymous hemianopia?

A

Loss at one side in both sides - damage in unilateral optic tract

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24
Q

What is seen ophthalmologically in temporal lesion?

A

Superior homonymous quadriplegia

Loss of top quarter bilaterally

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25
Q

What is seen ophthalmologically in parietal lesion?

A

Inferior homonymous quadriplegia

Loss of inferior quarter bilaterally

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26
Q

How does acute angle-closure glaucoma present?

A

Blurring of vision, pain in one eye, redness, headache, N&V

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27
Q

How do we investigate myasthenia gravis?

A

Acetylcholine receptor antibody test

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28
Q

Where do you see periorbital ecchymosis?

A

Racoon or panda eyes - basal skull fracture

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29
Q

What is Friedreich’s ataxia?

A

Most common inherited autosomal recessive ataxia in the UK

Degenerative disease that primarily affects the nervous system and the heart

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30
Q

Which populations is Friedreich’s ataxia not seen in?

A

East Asian and Native Americans

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31
Q

How does Friedreich’s ataxia present?

A

Onset before 20 y.o.
Unsteadiness of gait
General clumsiness or deterioration in athletic performance
Sometimes scoliosis or pes cavus

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32
Q

What is pes cavus?

A

High arch feet which do not flatten when weight is applied

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33
Q

What causes valproate toxicity?

A

Influence of increased GABA

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34
Q

Which electrolyte abnormality can SSRIs cause in the elderly?

A

Hyponatraemia

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35
Q

What is hemiballismus?

A

Involuntary flinging motions of the extremities due to infarction/haemorrhage in the contralateral subthalamic nucleus

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36
Q

What are chorea?

A

Involuntary, irregular, random and flowing movements which flit one one part of the body to another. Can be seen in Huntington’s disease and with levodopa use

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37
Q

What is the SCOFF questionnaire used for?

A

Screening tool for eating disorders

38
Q

What is dermatotillomania?

A

Constant urge to pick at one’s own skin, often to the extent that damage is caused

39
Q

How does social phobia present?

A

A fear of being scrutinised, humiliated or ridiculed by other people

40
Q

How does hepatic encephalopathy present?

A

Personality changes, intellectual impairment and reduced levels of consciousness

41
Q

What are the chances an unprovoked seizure will recur?

A

30-50%

After a second, 70-80%

42
Q

How do tension headaches present?

A

Band-like nature and bilateral

43
Q

How do migraines present?

A

Unilateral and throbbing w/ or w/o aura

44
Q

Why do we give prednisolone in acute temporal or giant cell arteritis?

A

Prevents blindness

45
Q

How does optic neuritis present on slit-lamp examination?

A

2/3 fundus normal
1/3 swollen optic disk
Maybe pale optic nerve

46
Q

How do we treat acute optic neuritis?

A

High dose pred

47
Q

What is compensation?

A

Defence mechanism to help people cope with feelings of inferiority which can have +ve or -ve effects. +ve could be becoming highly skilled at their work. -ve could be sacrificing their life to become good at their work

48
Q

What is displacement?

A

A defence mechanism where a person redirects a negative emotion from its original source to a less threatening recipient

49
Q

What is identification?

A

Defence mechanism where an individual changes to become like someone else

50
Q

What are defence mechanisms?

A

In Freudian psychoanalytic theory, defence mechanisms are psychological strategies to cope with reality

51
Q

How does intracranial idiopathic hypertension present?

A

Obese females
Diffuse headache worse in the morning, in the evening and with the valsalva manouevre
Greying out of vision lasting 1-5s
Diplopia due to 6th nerve palsy
N&V, tinnitus

52
Q

Which blood tests must we check with lithium tx?

A

Lithium levels
TFT, U&E, calcium and creatinine

53
Q

How does histrionic personality disorder present?

A

Excessive emotionality and attention-seeking behaviour

54
Q

What are pseudohallucinations, and where may you see them?

A

Borderline PD

Auditory hallns that the pt realises aren’t real

55
Q

What is Pick’s disease?

A

Frontotemporal dementia

56
Q

What is De Clerembault’s syndrome?

A

Erotomania - delusion of being loved by someone often of superior social status to you

57
Q

What is Fregoli syndrome?

A

Where a familiar person is identified in strangers

58
Q

What is Ekbom’s syndrome?

A

Believing you are infested with insects

59
Q

What is Ganser syndrome?

A

Syndrome of approximate answers

60
Q

Where do you see lupus anticoagulant?

A

Antiphospholipid syndrome

61
Q

Why must we be careful with administering glucose in a pt with thiamine deficiency?

A

Can precipitate Wernicke’s

62
Q

What is syringomyelia?

A

Fluid-filled tubular cavitation (syrinx) in the (normally cervical) spinal cord

63
Q

How does syringomyelia present?

A

Muscle wasting and weakness
Temperature and pain sensation deficit

64
Q

What is pseudobulbar palsy?

A

UMN lesion to the corticobulbar pathways in the pyramidal tract. Occurs in MS, MND and bilateral strokes

65
Q

How does pseudobulbar palsy present?

A

Difficulty chewing, swallowing and slurred speech

Can have emotional outburts

66
Q

When do we use disulfiram or antibuse?

A

Alcohol dependency - causes extremely unpleasant systemic reactions in the body after ingesting even a small amount of alcohol as it leads to the build up of acetaldehyde

67
Q

How do we treat Guillian-Barré syndrome?

A

IV immunoglobulins or plasma exchange

68
Q

How may we solidify the diagnosis of Guillian-Barré syndrome?

A

Nerve conduction studies

Sometimes LP

69
Q

What is the pattern of weakness in Guillian-Barré syndrome?

A

Ascending pattern of progressive symmetrical weakness, often starting in the lower limbs

70
Q

What impact does migration have on risk of developing schizophrenia? What is the second-generation effect?

A

3x

This risk is carried on to their children

71
Q

What is first-line for new onset tonic clonic seizures?

A

Sodium valproate

Lamotrigine second line but can increase risk of myoclonic seizures

72
Q

What is the difference between conversion and somatisation disorder?

A

Conversion - presumed to be the expression of an underlying psychological conflict or need - the purpose is to bind anxiety and keep a conflict internal

Somatisation = multiple somatic complaints with no organic pathology

73
Q

What is factitious disorder?

A

Where a patient intentionally falsifies medical or psychiatric conditions; motivated purely by internal gains. Desire to assume the sick role

74
Q

What is malingering?

A

Where patients present for external incentives, e.g. desired medications, sick notes and disability benefits.

75
Q

What is the difference between baby blues and post-natal depression?

A

Baby blues occurs within 10/7

76
Q

How does myotonic dystrophy present?

A

Triad of cataracts, muscle weakness and frontal balding in the middle-age

77
Q

What is the HADS scale?

A

Self-screening questionnaire for anxiety and depression

Score >10 makes it likely

78
Q

How does bacterial meningitis present on LP?

A

Polymorphonuclear cells often, ++ protein, low glucose (<50% serum)

79
Q

How does viral meningitis present on LP?

A

Mononuclear, protein +/normal, normal glucose

80
Q

How does TB/fungal/malignant meningitis present?

A

Mononuclear, ++/+++ protein, low glucose

81
Q

What are Schneider’s first-rank sx of schizophrenia?

A

Auditory hallucinations
Thought withdrawal, insertion or interruption
Thought broadcasting
Somatic hallns
Delusional perception
Feelings or actions experiences as made or influenced by external agents

82
Q

How do we treat active TB w/o CNS involvement?

A

RIPE for 2/12 then RI for further 4/12

83
Q

How do we treat active TB with CNS involvement?

A

RIPE for 2/12 then RI for further 10/12

84
Q

What is in the SCOFF questionnaire?

A

Sick, control, one, fat, food

Have you every felt so full you have had to make yourself sick?
Do you worry that you have lost control over how much you eat?
Have you recently lost or gained more than one stone in a 3/12 period?
Do you believe youself to be fat when others say you are too thin?
Would you say that food dominates your life?

85
Q

What is the CAGE questionnaire?

A

Have you ever felt that you need to Cut down on your drinking?
Have people ever Annoyed you by critising your drinking?
Have you ever felt Guilty about your drinking?
Have you ever felt you needed to drink first thing in the morning (Eye-opener)

86
Q

V in AVPU on GCS?

A

12 GCS

87
Q

P in AVPU on GCS?

A

8 GCS

88
Q

Grade 1 MRC scale for muscle power?

A

Flicker of contraction

89
Q

Grade 2 MRC scale for muscle power?

A

Some active movement

90
Q

Grade 3 MRC scale for muscle power?

A

Active movement against gravity

91
Q

Grade 4 MRC scale for muscle power?

A

Active movement against resistance

92
Q

Grade 5 MRC scale for muscle power?

A

Normal power

MSRA 2 (12 decks)

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