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Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Who is excluded from the Mental Health Act?

A

People under the influence of drugs or alcohol

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2
Q

What are the cluster A personality types?

A

Schizoid
Schizotypal
Paranoid

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3
Q

What are the cluster B personality types?

A

EUPD
Histrionic
Narcisstic
Antisocial

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4
Q

What are the cluster C personality types?

A

OCPD
Dependant
Avoidant

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5
Q

What are the essential diagnostic features of a personality disorder?

A

Impairments in:
Self and interpersonal functioning
Personality functioning
Consistent across time and situations

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6
Q

What are the age requirements to be diagnosed with a personality disorder?

A

18.

OR under 18 with > 1 year symptoms. This does not apply for antisocial PD -> conductive disorder instead

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7
Q

What is the treatment of choice for personality disorders?

A

Dialectical behaviour therapy

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8
Q

Anhedonia

A

Reduced ability to experience pleasure

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9
Q

Anergia

A

Lack of energy

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10
Q

How can pseudodementia secondary to depression be differentiated from dementia?

A

Pseudodementia - idk
Dementia - confabulation

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11
Q

What is the 1st line medication for depression?

A

SSRI

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12
Q

How long is a depressive episode?

A

At least 2 weeks

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13
Q

Lithium use in depression

A

Add if antidepressants do not work

Contraindicated in low oral intake

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14
Q

Management of severe depressive episode which is life-threatening or requires a rapid response

A

ECT

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15
Q

Management of mild depression

A

Monitor and follow up

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16
Q

Indications for ECT in depression

A

Preference based on past experience
Rapid response needed
Other treatments unsuccessful

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17
Q

Dysthymia

A

Low mood which does not meet threshold for depressive disorder

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18
Q

Which SSRI is best for people who have had an MI?

A

Sertraline

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19
Q

Which SSRI is best for children?

A

Fluoxetine

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20
Q

What medication should be co-prescribed with SSRIs?

A

NSAIDs

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21
Q

How long should SSRIs be continued for after remission of symptoms?

A

6 months

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22
Q

Over how long of a period of time should SSRIs be weaned off?

A

4 weeks (except fluoxetine)

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23
Q

If a patient feels that an SSRI is ineffective, how quickly should their medication be switched?

A

Wait at least 6 weeks from start of medication

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24
Q

What medications can SSRIs interact with to cause serotonin syndrome?

A

TCAs
Triptans
Tramadol
St John’s Wort
Ecstacy
Amphetamines
Linezolid
MAOIs

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25
Q

Describe the symptoms of SSRI discontinuation syndrome.

A

Anxiety
Dizziness
Electric shock sensations
Diarrhoea

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26
Q

Which SSRI is most likely to cause SSRI discontinuation syndrome?

A

Paroxetine

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27
Q

What medications should not be prescribed if a patient is on an SSRI?

A

Heparin
Warfarin
Aspirin

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28
Q

What are the side effects of SSRIs?

A

Gastrointestinal upset
Hyponatraemia
Increased anxiety

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29
Q

Which SSRI is associated with congenital malformation?

A

Paroxetine

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30
Q

What is associated with the use of SSRIs during 1st trimester in pregnancy?

A

Congenital heart defects

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31
Q

What is associated with the use of SSRIs during 3rd trimester in pregnancy?

A

Persistent pulmonary hypertension of newborn

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32
Q

State an adverse effect of citalopram.

A

Lengthens QT inverval

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33
Q

Cyclothymia

A

Low and high mood which does not meet diagnosis for formal bipolar disorder

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34
Q

How many episodes of manic episodes are needed to diagnose bipolar disorder?

A

2 or more

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35
Q

What is the difference between type I and type II bipolar disorder?

A

Type I - mania
Type II - hypomonia

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36
Q

How should a manic episode be managed if a patient is on an antidepressant?

A

Stop antidepressant

Start antipsychotic e.g. olanzapine

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37
Q

State 2 mood stabilisers used in bipolar disorder.

A

Lithium
Valproate
Lamotrigine
Antipsychotics

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38
Q

Tests required when starting sodium valproate + frequency

A

LFTs
FBC
BMI

6 months after starting
Every 12 months thereafter

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39
Q

Side effects of sodium valproate

A

Weight gain
Dizziness
Hair loss
N&V
NTD in pregnancy
Tremor

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40
Q

State 4 side effects of lithium.

A

Hypothyroidism
Diabetes insipidus
Fine tremor
Weight gain
Intracranial HTN
Nephrotoxicity
Hyperparathyroidism

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41
Q

What congenital heart defect is associated with maternal lithium use?

A

Ebstein’s anomaly

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42
Q

Management of lithium use in pregnancy

A

Gradually switch to antipsychotic

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43
Q

Tests required when starting lithium + frequency

A

TFTs
Calcium
Renal function

Every 6 months

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44
Q

Describe the frequency of monitoring lithium levels.

A

Every time a dose is changed - 1 week after

Otherwise every 3 months for 1 year
Then 6 monthly

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45
Q

How long post-dose should lithium levels be checked?

A

12 hours

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46
Q

How does lithium toxicity manifest?

A

Coarse tremor
Blurred vision
Ataxia
Oliguria
Seizures
Coma

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47
Q

How should lithium toxicity be managed?

A

Fluid resuscitation
Monitor renal function
- Renal dialysis if poor
Seizure control

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48
Q

What is the risk recurrence of post partum psychosis?

A

25-50%

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49
Q

How should post partum depression be managed?

A

CBT
Otherwise SSRI - sertraline or paroxetine

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50
Q

How is post partum psychosis managed?

A

Hospitalisation - mother and baby unit

Do not separate them

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51
Q

What is the lifetime risk of developing schizophrenia?

A

1%

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52
Q

What is the risk of recurrence of a psychotic episode in schizophrenia?

A

75%

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53
Q

What are the risk factors for schizophrenia in order?

A

Family history
Black Caribbean
Migration
Urban environment
Cannabis use

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54
Q

What are the first rank symptoms of schizophrenia?

A

Thought disorder (withdrawal, insertion, broadcast)

Passivity phenomenon

3rd person auditory hallucinations

Delusional perception

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55
Q

What are the second rank symptoms of schizophrenia?

A

Any other hallucinations/delusions

Negative symptoms

Breaks in thought fluency

Catatonic behaviour

Significant and consistent change in overall personal behaviour

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56
Q

Mitmachen

A

Motor symptom associated with schizophrenia - limb can be moved without resistance but returns to original position when released

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57
Q

What are the diagnostic criteria for schizophrenia?

A

1 1st rank or 2 2nd rank, for at least 1 month, evidence of disturbed functioning for 6 months

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58
Q

State 3 negative symptoms of schizophrenia

A

Blunting of affect
Amotivation
Poverty of speech
Lack of insight
Self-neglect

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59
Q

What features indicate a poor prognosis for schizophrenia?

A

Low IQ
Gradual onset
Male
Younger age at diagnosis

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60
Q

State 3 complications which can arise from schizophrenia.

A

Increased suicide
risk
Death 25 years earlier than general population
2x CVD death, 3x respiratory disease, 4x infection

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61
Q

Name 2 typical antipsychotics.

A

Haloperidol
Chlorpromazine

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62
Q

Name 4 atypical antipschotics.

A

Olazapine
Risperidone
Clozapine
Aripiprazole
Quetiapine

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63
Q

What is the mechanism of typical antipsychotics?

A

Dopamine D2 receptor antagonists

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64
Q

Which atypical antipsychotic has the best side effect profile?

A

Aripiprazole

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65
Q

Mechanism by which antipsychotics can cause infertility

A

Dopamine inhibits prolactin
Antipsychotics inhibit dopamine so prolactin increases
Prolactin inhibits GnRH
Reduced LH/FSH

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66
Q

Why is aripiprazole best for minimal side effects?

A

It is a partial agonist

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67
Q

Why should use of antipsychotics be cautioned in the elderly?

A

Increased risk of VTE, stroke

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68
Q

Starting clozapine

A

Dose must be titrated up to therapeutic dose

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69
Q

Clozapine + infection

A

Infection can precipitate toxicity of clozapine
Clozapine levels should be checked

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70
Q

State 2 side + adverse effects of clozapine

A

Constipation
Hypersalivation

Agranulocytosis
Reduced seizure threshold
Myocarditis
Arrhythmias

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71
Q

What is a contraindication to the use of haloperidol?

A

Parkinson’s disease

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72
Q

Why is it important to keep an up to date social history from patients who are taking clozapine?

A

Smoking affects the efficiency of clozapine

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73
Q

What are the common side effects of typical antipsychotics?

A

Hyperprolactinaemia
Extrapyramidal side-effects

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74
Q

How should dystonia caused by antipsychotics be treated?

A

Procyclidine and benztropine

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75
Q

Treatment of tardive dyskinesia

A

Tetrabenazine

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76
Q

Why is it important for a baseline ECG to be carried out for patients on clozapine?

A

Increased risk of myocarditis

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77
Q

What kind of medication is mirtazapine?

A

Tetracyclic antidepressant
NASSA (noradrenergic and specific serotonergic antidepressant)

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78
Q

What is the mechanism of mirtazapine?

A

Blocks alpha 2 adrenergic receptors

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79
Q

Tyramine cheese reaction

A

MAOIs + cheese

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80
Q

What side effects are associated with mirtazapine?

A

Increases appetite

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81
Q

Give 3 examples of MAOIs.

A

Rasagiline
Isocarboxazid
Phenelzine
Selegiline
Tranylcypromine

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82
Q

What foods/drugs can MAOIs interact with?

A

Cheese
Cured meats
Soy products
Draft beer

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83
Q

Name 3 tricyclic antidepressants.

A

Amitriptyline
Clomipramine
Dosulepin
Trazodone
Nortriptyline
Imipramine
Lofepramine

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84
Q

State 3 side effects of TCAs.

A

Drowsiness
Anticholinergic effects - dry mouth, eyes etc.
Lengthens QT interval

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85
Q

How should TCA overdose be managed?

A

Activated charcoal within 2-4 hours
IV sodium bicarbonate for arrhythmias

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86
Q

How does TCA overdose present?

A

Metabolic acidosis
Seizures
Coma
Arrhythmias

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87
Q

How should a missed dose of clozapine be managed?

A

Take ASAP if just 1 - unless almost time for 2nd dose then miss 1st dose

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88
Q

How should two missed doses of clozapine be managed?

A

Re-titrate doses slowly

Never take more than 1 dose at once!

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89
Q

Clozapine monitoring

A

FBC monitored
Weekly for 18 weeks
Fortnightly 20-52 weeks
Then monthly

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90
Q

Antipsychotic monitoring

A

Monitor glucose and HbA1C
0, 3 months then annuallly

For olanzapine + clozapine, monitor at 0, 1 month and then every year

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91
Q

Antipsychotic monitoring prolactin levels

A

All typical antipsychotics + risperidone

6 months then every 12 months

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92
Q

State 4 extrapyramidal side effects of antipsychotics.

A

Acute dystonia
Tardive dyskinesia
Parkinsonism
Akathisia

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93
Q

What is the mortality rate of neuroleptic malignant syndrome?

A

10%

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94
Q

Describe the presentation of neuroleptic malignant syndrome.

A

Lead pipe rigidity
Fever, tachycardia, hypertension

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95
Q

Describe the onset of neuroleptic malignant syndrome.

A

Gradual onset

96
Q

Describe the investigation results of neuroleptic malignant syndrome.

A

Increased CK
Increased WBC

97
Q

What can cause neuroleptic malignant syndrome?

A

Antipsychotics - atypical
Dopaminergic drugs - when dose is changed/drug is started

98
Q

How should neuroleptic malignant syndrome be managed?

A

Stop antipsychotic
IV fluids
Diazepam - rigidity
DA agonist- Bromocroptine
Dantrolene - malignant hyperthermia

99
Q

What complication can arise as a result of neuroleptic malignant syndrome?

A

AKI secondary to rhabdomyolysis

100
Q

What is the pathophysiology of serotonin syndrome?

A

Excess serotonin in CNS

101
Q

Describe the onset of serotonin syndrome.

A

Sudden onset

102
Q

Describe the presentation of serotonin syndrome.

A

Clonus (hyperreflexia)
Diarrhoea
Mydriasis
Fever, tachycardia, hypertension

103
Q

How should serotonin syndrome be managed?

A

IV fluids
Benzodiazepines
Severe: serotonin antagonists (cyproheptadine, chlorpromazine)

104
Q

What is generalised anxiety disorder?

A

Excessive anxiety across different situations without a specific associated person or event > 6 months

105
Q

What are the 3 core symptoms of GAD?

A

Apprehension
Motor tension
Autonomic overactivity

106
Q

Which part of the brain is responsible for the activation of the ‘fight or flight’ response?

A

Amygdala

107
Q

State 3 risk factors for developing GAD.

A

Divorcee
Living alone
Lone parent
Aged 35-54

108
Q

What is the first-line medication offered for GAD?

A

Sertraline

109
Q

What is the second-line medication offered for GAD?

A

Alternative SSRI or SNRI to sertraline

110
Q

Describe the psychological symptoms of panic disorder.

A

Feeling of impending doom
Depersonalisation
Derealisation
Fear of dying

111
Q

1st line management for panic disorder

A

CBT

112
Q

What medications are offered for panic disorder?

A

1: SSRI e.g. escitalopram
2: TCA e.g. Imipramine or clomipramine

113
Q

How long should SSRIs be trialled for panic disorder before switching to a new medication?

A

12 weeks

114
Q

Follow up of pharmacological management of panic disorder / GAD

A

2, 4, 8, 12 week follow up
If continued, arrange 8-12 week follow ups

115
Q

What is the abortive treatment for panic disorder?

A

Benzodiazepines

116
Q

State 3 features of GAD according to ICD-10 criteria.

A

Apprehension
Motor tension
Autonomic overactivity

117
Q

State 3 features of panic disorder according to ICD-10 criteria.

A

Recurrent attacks of severe anxiety
Secondary fears of dying, losing control or going mad
Attacks last for minutes, with crescendo of fear and autonomic symptoms
Comparative freedom from anxiety symptoms between attacks

118
Q

What is the preferred treatment of panic disorder?

A

CBT

119
Q

What are the 1st and 2nd line medications given for panic disorder?

A

1st: SSRI
2nd: TCA e.g. Imipramine, clomipramine

120
Q

How long must symptoms be present to diagnose PTSD?

A

4 weeks

121
Q

What are 5 key manifestations of PTSD?

A

Re-experiencing
Avoidance
Hyperarousal
Emotional numbing
Inability to recall

122
Q

What is the 1st line treatment for PTSD?

A

Trauma-focused CBT
OR
EDMR therapy

123
Q

What are the 1st, 2nd and 3rd line medications used for PTSD?

A

1st: Venlafaxine
2nd: SSRI
3rd: Risperidone

124
Q

What is the mechanism of venlafaxine?

A

SNRI - serotonin and noradrenergic reuptake inhibitor

125
Q

What is the difference between PTSD and acute stress disorder?

A

Acute stress disorder < 4 weeks of symptoms

126
Q

What is the preferred treatment of acute stress disorder?

A

Trauma-focused CBT

127
Q

What is the 2nd line treatment for acute stress disorder?

A

Benzodiazepines

128
Q

Define compulsion.

A

Repetitive behaviours or mental acts that a person feels required to perform

129
Q

Define obsession.

A

Unwanted, intrusive thoughts, images or urges entering the mind

130
Q

How long must OCD symptoms be present for to make a diagnosis?

A

2 weeks

131
Q

Describe the epidemiology of OCD.

A

1-2% population

132
Q

How is mild impairment OCD managed?

A

1st: CBT including exposure and response prevention
2nd: SSRI

133
Q

How is moderate impairment OCD managed?

A

SSRI

134
Q

How is severe impairment OCD managed?

A

Combined SSRI + CBT

135
Q

Difference between overt and covert impulsions.

A

Overt – observable, covert – mental act

136
Q

What is emotional splitting?

A

Perceiving something as “all good” or “all bad”

137
Q

De Clerambault syndrome

A

Erotomania
Delusional belief that another individual is infatuated with them

138
Q

Charles Bonnet syndrome

A

Significant visual loss + vivid visual hallucinations

139
Q

Cotard syndrome

A

Delusion that they are/part of their body is dead
Associated with severe depression/psychotic disorders

140
Q

Munchausen’s syndrome/Factitious disorder

A

Factitious disorder
Intentional production of symptoms
Can be by proxy

141
Q

Illness anxiety disorder

A

Hypochondriasis
Persistent belief of underlying SERIOUS disease
Patient refuses reassurance or negative results

142
Q

Somatisation disorder

A

Multiple physical symptoms present over 2 years
Patient refuses to accept reassurance or negative test results

143
Q

Dissociative disorder

A

Process of separating off certain memories from normal consciousness
DID (dissociative identity disorder) = multiple personality disorder - severe form of dissociative disorder

144
Q

Conversion disorder

A

Loss of motor or sensory function
May be caused by stress e.g. exams/competition

145
Q

La Belle indifference

A

Lack of concern over symptoms
Associated with conversion disorder

146
Q

De Frégoli syndrome

A

Delusion of identifying a familiar person in various people they encounter

147
Q

Delusional parasitosis

A

Belief that they are infested with bugs

148
Q

Ekbom syndrome

A

Belief that they are infested with bugs (same as parasitosis)

149
Q

Oppositional defiant disorder

A

Precedes conduct disorder
Younger children, problems with anger

150
Q

Conduct disorder

A

< 18 years old, behavioural disorder
Aggression, violence towards animals

151
Q

Folie a deux

A

Shared hallucinations/delusions between individuals

152
Q

Othello syndrome

A

Delusional jealousy, usually believing partner is unfaithful

153
Q

What is Hoover’s sign?

A

Identifies non-organic paresis – pressure under paretic leg when lifting non-paretic leg against pressure - involuntary contralateral hip extension

154
Q

3 indications for ECT

A

E uphoria
C atatonia
T earful (severe treatment resistant depression)

155
Q

State a contraindication to ECT.

A

Raised ICP

156
Q

How should antidepressants be managed before ECT?

A

Reduce dose

157
Q

What are the short term side effects of ECT?

A

Headache
Nausea
Short-term memory impairment
Cardiac arrhythmia

158
Q

What are the long term side effects of ECT?

A

Impaired memory

159
Q

Circumstantiality

A

Inability to answer a question without giving excessive, unnecessary detail
Does eventually answer the question

160
Q

Tangentiality

A

Wandering from a topic without returning to it

161
Q

Neoligisms

A

New word formations

162
Q

Clang associations

A

Ideas are related to each other only by the fact they sound similar or rhyme

163
Q

Word salad

A

Incoherent speech comprised of nonsense sentences with real words

164
Q

Knight’s move thinking

A

Unexpected and illogical leaps from one idea to another
Featured in schizophrenia

165
Q

Flight of ideas

A

Discernible links between ideas
Featured in mania
Does not answer question

166
Q

Perseveration

A

Repetition of ideas or words despite an attempt to change the topic

167
Q

Echolalia

A

Repetition of someone else’s speech, including the question that was asked

168
Q

Echopraxia

A

Repetition of someone else’s movements

169
Q

Incongruity of affect

A

Emotional responses grossly out of tune with the situation

170
Q

Blunting of affect

A

Absence of normal emotional response

171
Q

Passivity phenomenon

A

Someone is controlling your actions or feelings

172
Q

Thought Insertion

A

Someone put the thought there

173
Q

Thought Withdrawal

A

Someone taking thoughts out of head

174
Q

Thought Broadcast

A

Belief that people know what you are thinking

175
Q

Alcohol effect on GABA and glutamate activity

A

Increases GABA
Decreases glutamate

176
Q

At what stage of alcohol withdrawal does delirium tremens occur?

A

2-3 days without alcohol

177
Q

What symptoms are present in delirium tremens?

A

Confusion
Lack of orientation
Delusional parasitosis
Lilliputian hallucinations

178
Q

How should delirium tremens be managed? What is 1st line?

A

1st line: Benzodiazepines e.g. diazepam/chlordiazepoxide

IV pabrinex

179
Q

State the difference between the presentation of delirium tremens and alcoholic hallucinosis.

A

DT: 48-72 hours, orientation not intact
AH: 12-48 hours, orientation intact

180
Q

Name 4 stimulant drugs.

A

Ecstasy
Cocaine
Nicotine
Methamphetamine

181
Q

Name a hallucinogen.

A

LSD
Ecstasy

182
Q

What is Marchiafava-Bignami disease?

A

Complication of chronic alcohol intake
Neuropsychiatric symptoms due to corpus callosum degeneration

183
Q

Disulfiram mechanism and trade name

A

Antabuse

Inhibits acetaldehyde dehydrogenase - leads to build up of acetaldehyde
Causes unpleasant symptoms if alcohol is consumed

184
Q

Acamprosate mechanism and trade name

A

Campral

Anti-craving, mechanism unknown
Safe with alcohol, minimal side effects

185
Q

State 3 symptoms of opioid intoxication.

A

Pin-prick pupils
Euphoria
Constipation
Respiratory depression

186
Q

State 3 symptoms of opioid withdrawal.

A

Yawning
Dilated pupils
Lacrimation
Sweating
N+V+D

187
Q

Mechanism of methadone and form

A

Opioid mu receptor agonist

Liquid form

1st line for detox

188
Q

How often must heroin be used in heroin dependency to avoid withdrawal?

A

8 hourly

189
Q

What can be offered in primary care for a newly presenting drug user?

A

Health check
Screen for blood borne viruses
Contraception, smear
Sexual health advice
Check immunisation and Hep A/B
Signpost to additional help
Information on local drug services

190
Q

Management of missed doses of methadone/buprenorphine

A

1, 2, 3 days - carry on as normal
4 days - reduce dose
5 days of more - urgent assessment

191
Q

Mechanism of naltrexone and indication

A

Opioid receptor antagonist
Used in overdose / relapse prevention

192
Q

Mechanism of buprenorphine and form

A

Mixed opioid agonist/antagonist
Sublingual tablet

193
Q

Caution of opioid antagonist use

A

Can make co-codamol ineffective

194
Q

Opiate overdose management

A

Naloxone - works for 5 minutes
May need to be readministered to maintain effects

195
Q

What is the most important investigation to carry out before starting substitute medication for opioid dependence?

A

Urine toxicology screen to confirm dependence and identify other substances used - in case of potential interactions

196
Q

Methamphetamine mechanism

A

Stimulates release of monoamines

197
Q

Methamphetamine intoxication

A

Pupil dilation
Euphoria
Tactile hallucinations
Agitation
Alertness

198
Q

Methamphetamine withdrawal

A

Sleepiness
Hunger
Depression

199
Q

Cocaine intoxication

A

Pupil dilation
Euphoria
Agitation
Alertness

200
Q

Cocaine withdrawal

A

Sleepiness
Hunger
Depression

201
Q

Cocaine mechanism

A

Blocks reuptake of monoamines

202
Q

Cannabis intoxication

A

Calm
Munchies

203
Q

Cannabis withdrawal

A

Decreased appetite
Insomnia
Irritable

204
Q

Cannabinoid hyperemesis syndrome

A

Profuse vomiting
Better with heat

205
Q

Cannabis mechanism

A

Stimulates (endocannabinoid) CB1 and CB2 receptors

206
Q

Benzodiazepine mechanism

A

Enhances effect of inhibitory neurotransmitter GABA
Increases frequency of chloride channel opening

207
Q

Mechanism by which GABA causes neuronal inhibition

A

Enhanced flow of chloride ions
Neuron hyperpolarised
Neuronal inhibition

208
Q

Benzodiazepine intoxication symptoms + treatment of overdose

A

Ataxia
Somnolence
Mild respiratory depression

Flumazenil

209
Q

Benzodiazepine withdrawal

A

Insomnia
Anxiety
Seizures (later)

210
Q

3 indications for use of benzodiazepines as treatment.

A

Severe insomnia
Mania
Epilepsy
Alcohol withdrawal
Severe anxiety
Acute back pain

211
Q

Phencyclidine mechanism

A

NMDA receptor antagonist

212
Q

Phencyclidine intoxication

A

Violence
Analgesia
Psychosis

213
Q

Phencyclidine withdrawal

A

Insomnia
Mood disturbance

214
Q

Phencyclidine associations

A

Rotary nystagmus
Flashback phenomenon

215
Q

MDMA intoxication

A

Euphoria
Disinhibition
Altered sensation

216
Q

MDMA withdrawal

A

Anxiety
Depression
Difficulty concentrating

217
Q

MDMA mechanism

A

Blocks reuptake of dopamine and serotonin

218
Q

Chronic insomnia diagnosis

A

> 3 months
At least 3 nights a week

219
Q

Narcolepsy

A

Hypersomnolence
Associated with sleep paralysis, vivid hallucination on going to sleep/waking up, cataplexy

220
Q

HLA narcolepsy

A

HLA DR2

221
Q

Narcolepsy EEG

A

Multiple sleep latency

222
Q

Narcolepsy management

A

Daytime stimulant e.g. modafinil
Night-time sodium oxybate

223
Q

Cataplexy

A

Sudden muscle weakness occurring while person is awake caused by strong emotion

224
Q

Nearest relative

A

Having sausages for breakfast:
- Husband, wife or civil partner (including cohabitee for more than 6 months).
- Son or daughter
- Father or mother (an unmarried father must have parental responsibility in order to be nearest relative)
- Brother or sister
- Grandparent
- Grandchild
- Uncle or aunt
- Nephew or niece

225
Q

Anorexia nervosa mortality

A

10%

226
Q

Investigations in anorexia nervosa

A

ECG
Blood glucose
U&Es

227
Q

Anorexia nervosa diagnostic criteria

A

BMI < 18.5

SCOFF screening

Fear of fatness

228
Q

SCOFF screening questions

A

Do you make yourself Sick because you feel uncomfortably full?

Do you worry you have lost Control over how much you eat?

Have you recently lost more than One stone in a 3 month period?

Do you believe yourself to be Fat when others say you are too thin?

Would you say that Food dominates your life?

229
Q

SUSS test

A

Sit up squat test
Assess muscle wasting in anorexia nervosa

230
Q

Anorexia nervosa BMI categories

A

≥ 17: mild
16 – 17: moderate
15 – 16: severe
14 – 15: extreme

231
Q

Lab test results for anorexia nervosa

A

Increase cortisol, cholesterol, beta-carotene, GH
Decrease GnRH oestrogen, testosterone, FSH, LH, T3, glucose, WCC, Hb, potassium

232
Q

Preventing refeeding syndrome

A

If not eaten for > 5 days, refeed < 50% for first 2 days
1200 calories, increase by 200 each day

233
Q

Refeeding syndrome investigation results

A

Hypophosphatemia
Hypokalaemia
Abnormal fluid balance
Hypomagnesaemia

234
Q

Refeeding syndrome treatment

A

Phosphate replacement

235
Q

Bulimia nervosa clinical manifestations

A

Erosion of teeth
Russell’s sign - calluses on knuckles
Recurrent binge eating

236
Q

Paracetamol overdose: paracetamol levels for N-acetyl-cysteine treatment

A

100 at 4 hours and 15 at 15 hours
Or
Staggered dose - 1st and last tablets taken an hour apart

237
Q

Paracetamol overdose: Indication for liver transplant

A

> 24 hours and ph < 7.3

Medicine (13 decks)

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