Psych/Neuro Flashcards
What are the essential features of schizophrenia?
Psychotic features
Functional deterioration
Onset before the age of 45
The illness lasts for months not days
How do we treat brief psychotic disorder?
Atypical antipsychotics
When can we diagnose brief psychotic disorder?
After 1/12 of no sx if lasts less than 1/12
How does facioscapulohumeral dystrophy present?
Progressive difficulty whistling and sucking through a straw
Can you see psychotic features in depression?
Yes, in severe depression
How does NPH present?
Triad of urinary incontinence, gait disturbance and dementia
For how long do we continue antidepressant therapy?
For 6m after resolution of sx
Where do you see subhyaloid haemorrhages?
SAH
What are the early signs of lithium toxicity?
Diarrhoea, vomiting, drowsiness, muscular weakness and lack of coordination
What are the signs of moderate lithium toxicity?
Giddiness, ataxia, blurred vision, tinnitus and increased volume of dilute urine
What are the signs of severe lithium toxicity?
Hyperreflexia, convulsions, renal failure, collapse, coma and death
What is seen on ECG in lithium toxicity?
Reversible flattening, isoelectricity or inversion of T waves
Where should lithium levels be maintained?
0.5-1.2mmol/l, and should be taken 12-18hrs after last dose (at least 12hrs)
What is post-herpetic neuralgia?
Pain after shingles infection
A 76y.o M presents with worsening sleep disturbance with restless legs, painful cramps and difficulty turning in bed. Dx?
Parkinson’s
What is restless leg syndrome?
Subjective experience of restlessness interfering with sleep
What is akathisia?
Prominence of lower limb restlessness
Occurs within hours to weeks of starting/increasing the dose of antipsychotics
Which antipsychotic is most associated with EPSES?
Risperidone
What is coital cephalgia?
Headache related to sexual activity at or near orgasm
How do we manage mild-moderate depression?
Low-intensity psychological intervention
Try to avoid antidepressant usage - only use in moderate-severe depression
Where do you see bitemporal hemianopia?
Pituitary tumour
What is bitemporal hemianopia?
Loss of temporal vision in both eyes
What is homonymous hemianopia?
Loss at one side in both sides - damage in unilateral optic tract
What is seen ophthalmologically in temporal lesion?
Superior homonymous quadriplegia
Loss of top quarter bilaterally
What is seen ophthalmologically in parietal lesion?
Inferior homonymous quadriplegia
Loss of inferior quarter bilaterally
How does acute angle-closure glaucoma present?
Blurring of vision, pain in one eye, redness, headache, N&V
How do we investigate myasthenia gravis?
Acetylcholine receptor antibody test
Where do you see periorbital ecchymosis?
Racoon or panda eyes - basal skull fracture
What is Friedreich’s ataxia?
Most common inherited autosomal recessive ataxia in the UK
Degenerative disease that primarily affects the nervous system and the heart
Which populations is Friedreich’s ataxia not seen in?
East Asian and Native Americans
How does Friedreich’s ataxia present?
Onset before 20 y.o.
Unsteadiness of gait
General clumsiness or deterioration in athletic performance
Sometimes scoliosis or pes cavus
What is pes cavus?
High arch feet which do not flatten when weight is applied
What causes valproate toxicity?
Influence of increased GABA
Which electrolyte abnormality can SSRIs cause in the elderly?
Hyponatraemia
What is hemiballismus?
Involuntary flinging motions of the extremities due to infarction/haemorrhage in the contralateral subthalamic nucleus
What are chorea?
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
What is the SCOFF questionnaire used for?
Screening tool for eating disorders
What is dermatotillomania?
Constant urge to pick at one’s own skin, often to the extent that damage is caused
How does social phobia present?
A fear of being scrutinised, humiliated or ridiculed by other people
How does hepatic encephalopathy present?
Personality changes, intellectual impairment and reduced levels of consciousness
What are the chances an unprovoked seizure will recur?
30-50%
After a second, 70-80%
How do tension headaches present?
Band-like nature and bilateral
How do migraines present?
Unilateral and throbbing w/ or w/o aura
Why do we give prednisolone in acute temporal or giant cell arteritis?
Prevents blindness
How does optic neuritis present on slit-lamp examination?
2/3 fundus normal
1/3 swollen optic disk
Maybe pale optic nerve
How do we treat acute optic neuritis?
High dose pred
What is compensation?
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
What is displacement?
A defence mechanism where a person redirects a negative emotion from its original source to a less threatening recipient
What is identification?
Defence mechanism where an individual changes to become like someone else
What are defence mechanisms?
In Freudian psychoanalytic theory, defence mechanisms are psychological strategies to cope with reality
How does intracranial idiopathic hypertension present?
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
Which blood tests must we check with lithium tx?
Lithium levels
TFT, U&E, calcium and creatinine
How does histrionic personality disorder present?
People with histrionic personality disorder (HPD) struggle with low self-esteem and are dependent on the approval of others, similar to dependent personality disorder. These feelings give them an intense desire to be the center of attention. They may engage in dramatic, provocative, or inappropriate behaviors in an attempt to be noticed.
Different to EUPD which makes it difficult for people to regulate their emotions
What are pseudohallucinations, and where may you see them?
Borderline PD
Auditory hallns that the pt realises aren’t real
What is Pick’s disease?
Frontotemporal dementia
What is De Clerembault’s syndrome?
Erotomania - delusion of being loved by someone often of superior social status to you
What is Fregoli syndrome?
Where a familiar person is identified in strangers
What is Ekbom’s syndrome?
Believing you are infested with insects
What is Ganser syndrome?
Syndrome of approximate answers
Where do you see lupus anticoagulant?
Antiphospholipid syndrome
Why must we be careful with administering glucose in a pt with thiamine deficiency?
Can precipitate Wernicke’s
What is syringomyelia?
Fluid-filled tubular cavitation (syrinx) in the (normally cervical) spinal cord
How does syringomyelia present?
Muscle wasting and weakness
Temperature and pain sensation deficit
What is pseudobulbar palsy?
UMN lesion to the corticobulbar pathways in the pyramidal tract. Occurs in MS, MND and bilateral strokes
How does pseudobulbar palsy present?
Difficulty chewing, swallowing and slurred speech
Can have emotional outburts
When do we use disulfiram or antibuse?
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
How do we treat Guillian-Barré syndrome?
IV immunoglobulins or plasma exchange
How may we solidify the diagnosis of Guillian-Barré syndrome?
Nerve conduction studies
Sometimes LP
What is the pattern of weakness in Guillian-Barré syndrome?
Ascending pattern of progressive symmetrical weakness, often starting in the lower limbs
What impact does migration have on risk of developing schizophrenia? What is the second-generation effect?
3x
This risk is carried on to their children
What is first-line for new onset tonic clonic seizures?
Sodium valproate
Lamotrigine second line but can increase risk of myoclonic seizures
What is the difference between conversion and somatisation disorder?
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
What is factitious disorder?
Where a patient intentionally falsifies medical or psychiatric conditions; motivated purely by internal gains. Desire to assume the sick role
What is malingering?
Where patients present for external incentives, e.g. desired medications, sick notes and disability benefits.
What is the difference between baby blues and post-natal depression?
Baby blues occurs within 10/7
How does myotonic dystrophy present?
Triad of cataracts, muscle weakness and frontal balding in the middle-age
What is the HADS scale?
Self-screening questionnaire for anxiety and depression
Score >10 makes it likely
How does bacterial meningitis present on LP?
Polymorphonuclear cells often, ++ protein, low glucose (<50% serum)
How does viral meningitis present on LP?
Mononuclear, protein +/normal, normal glucose
How does TB/fungal/malignant meningitis present?
Mononuclear, ++/+++ protein, low glucose
What are Schneider’s first-rank sx of schizophrenia?
Auditory hallucinations
Thought withdrawal, insertion or interruption
Thought broadcasting
Somatic hallns
Delusional perception
Feelings or actions experiences as made or influenced by external agents
How do we treat active TB w/o CNS involvement?
RIPE for 2/12 then RI for further 4/12
How do we treat active TB with CNS involvement?
RIPE for 2/12 then RI for further 10/12
What is in the SCOFF questionnaire?
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?
What is the CAGE questionnaire?
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)
V in AVPU on GCS?
12 GCS
P in AVPU on GCS?
8 GCS
Grade 1 MRC scale for muscle power?
Flicker of contraction
Grade 2 MRC scale for muscle power?
Some active movement
Grade 3 MRC scale for muscle power?
Active movement against gravity
Grade 4 MRC scale for muscle power?
Active movement against resistance
Grade 5 MRC scale for muscle power?
Normal power
