Psych/Neuro Cases Flashcards
Case 1
Phyllis is a 74y.o. lady. Her husband Ernie died 2 years ago. They were very close and did everything together. They were involved in the local bowling club and seemed almost to live there. Ernie died suddenly of a heart attack at the club one day. Phyllis took it badly. She finds going out very difficulty. Everytime she knows she has to go out she gets shaky, palpitations, shortness of breath, lump in the throat. She now relies on most of her shopping being delivered or done by her daughter.
Questions
1) What’s happening with Phyllis?
2) What will help her situation?
1) What’s happening with Phyllis?
She’s developed functionally debilitating abnormal response to going out in public
- ¤ Agoraphobia
- ¤ A type of anxiety disorder
- ¤ Exclude
- ¤Dementia
- ¤Depression
- ¤Grief
2) What will help her situation?
- Understanding why she gets her symptoms
- Psychological therapy – graded exposure
- ¤ E.g. start by walking to the door and dealing with anxiety symptoms
- ¤ Then progress to opening the door but not stepping outside
- ¤ Then standing outside for 5 minutes
- ¤ Then go to front gate
- ¤ Etc
- ¤ Not to progress until anxiety levels well controlled¤
- Can sometimes consider medications
Case 2
Shirley is a new mum. She gave birth 1 week ago. She feels very emotional and teary.
Questions
1) What could be happening?
2) What help does she need?
Questions
1) What could be happening?
- She has post partum ‘baby blues’
- ¤Normal
- ¤As long as it lasts less than 2 weeks
- ¤Needs follow up to see that she gets better
2) What help does she need?
¤Good support at home
¤Breaks from caring for baby¤Ongoing review
¤In post partum depression
- ¤First line always psychological therapy
- ¤Sometimes antidepressants are indicated
- ¤Occasionally urgent psychiatric review is needed
Tom is 19 and lives with his parents. He is in his second year of studying engineering at university. His parents are concerned as his behaviour has markedly changed. They suspect he is using illicit drugs. Tom told them the TV said his role was to save the world and that he had to die to do so.
Questions
1) What symptoms is Tom displaying?
2) What could be the cause?
1) What symptoms is Tom displaying?
- ¤Behavioural change
- ¤Delusion of reference
- ¤Psychosis
2) What could be the cause?
- ¤Illicit drug use
- ¤?underlying schizophrenia
65y.o. woman Sybil has noticed a tremor. Other people have complained about not being able to read her handwriting any longer. It is recorded in her history that she drinks 40 standard drinks of alcohol per week back in 2010.
Questions
1) What is the most important question to differentiate between physiological and pathological tremor?
1) What is the most important question to differentiate between physiological and pathological tremor?
Is it unilateral or bilateral
¤Other features of a Parkinson’s disease tremor
- ¤ Coarse
- ¤ Pill-rolling
- ¤ May eventually affect both sides but will always be worse on
- one side
- ¤ Resting tremor that goes away with movement
Rosie is a 36y.o. Indigenous woman. Two days ago she wasn’t able to move her right arm for half an hour. She thought she was having a stroke and was relieved that her movement came back.
Past medical history: rheumatic heart disease, atrial fibrillation
Questions
1) Is this a medical emergency?
2) How do you think she came to have atrial fibrillation at age 36?
3) How is her atrial fibrillation related to her symptoms?
Questions
1) Is this a medical emergency?
Yes!
¤ Symptoms lasting <10 minutes = transient ischemic attack (TIA)
- ¤ Patients must present to a stroke unit on the same day
- ¤ Highest risk of stroke within first 48 hours
- ¤ Symptoms lasting >10 minutes in the acute setting treated like a strokeàif taken to emergency within 4 hours of symptom onset,chance to ‘lyse’ the clot
- ¤ Symptoms that occurred >4 hrs ago still represent a TIA/stroke and stroke work up still needs to occur
2) How do you think she came to have atrial fibrillation at age 36?
- ¤ Indigenous background
- ¤ Much higher risk of rheumatic fever
- ¤ Systemic reaction to group A streptococcus bacteria – sore throat or impetigo
- ¤ Autoimmune response – heart valve proteins look similar to bacteria so immune system attacks the heart valves
- ¤ This can cause valve damage which leads to structural changes of the heart that lead to electrical changes àatrial fibrillation
3) How is her atrial fibrillation related to her symptoms?
- ¤Virchow’s triad
- ¤Turbulent flow in left atrium
- ¤In particular in left atrial appendage¤Blood clots can shoot up to the brain
Joe is a 67y.o. retired truck driver. This year he went to a health promotion stand at a local show and he recorded a BMI of 39 kg/m2 and waist circumference 115cm. He doesn’t like going to the doctors. Over the last few months he’s noticed he can’t feel well in his hands and feet.
1) What condition does he have and what has caused it?
2) What are the complications?
1) What condition does he have and what has caused it?
- Peripheral neuropathy
- Most likely undiagnosed long standing diabetes
- Risk factors – age, morbid obesity, central adiposity
- Other risk factors – poor diet, lack of exercise, family history, PCOS, gestational diabetes
2) What are the complications?
Peripheral neuropathy
- Foot ulcers
- ¤In diabetics can become easily infected, difficult to treat
Diabetes
- ¤Increased cardiovascular risk¤Diabetic retinopathy
- ¤Renal disease
- ¤Peripheral neuropathy
