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Year 3 Incorrect Questions > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Why do patients need regular bloods on clozapine?

A

Risk of agranulocytosis and neurogenic sepsis

Pt needs weekly bloods for first 6m and fortnightly onwards

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2
Q

CV drug increasing lithium toxicity

A

ACEi e.g. ramipril
Increases serum lithium level
Results in renal dyfunction -> dialysis req

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3
Q

What do the different sections of the MHA mean?

A

Sec 2 = assessment order and lasts up to 28 days
Sec 3 = treatment order that can last for up to 6 months
Sec 5 (2) = emergency holding order to keep pt in hospital for 72h
Sec 136 = police officer can take pt with acute MH to place of safety

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4
Q

Biochemistry and ABG changes in a purge

A

Hypokalaemia with metabolic alkalosis

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5
Q

Vitamin deficiency in alcohol misuse

A

B1 (thiamine)

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6
Q

Blurred vision can be caused by which type of antidepressant?

A

Tricyclic antidepressants

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7
Q

Antipsychotic causing reduced libido, low mood, amennorhea

A

Risperidone
- hyperprolactinaemia secondary

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8
Q

26yo 9 weeks gestation, depression well managed with venlafaxine, why would you not change meds in pregnancy?

A
  1. well stabilised on venlafaxine
  2. cardiac abnormalities caused by venlafaxine only occur within first 8w pregnancy
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9
Q

What antidepressant should you avoid in first trimester of pregnancy?

A

Paroxetine
- can cause heart defects

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10
Q

What antidepressant should be used in third trimester of pregnancy?

A

TCA (imipramine/amitryptiline)!

If SSRI necessary, use sertraline or fluoxetine

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11
Q

Can you use benzos in pregnancy?

A

NOOOOOOOO
Potential fetal malformation risk (cleft palate), floppy baby syndrome, and breastmilk accumulation
- the only acceptable one is in withdawal as least bad option

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12
Q

Sudden onset anterograde amnesia, with repetitive questioning and a preserved level of consciousness

A

Transient global amnesia
- up to 24 hours

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13
Q

What type f psych drug causes hyperprolactinaemia?

A

Dopamine antagonist e.g. metoclopramide
(manage with dopamine agonist e.g. cabergoline)

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14
Q

Which mood stabiliser can cause hypothyroidism?

A

Lithium
- e.g. bipolar pt presents with dry skin, fatigue and weight gain

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15
Q

Main GI side effect of donepezil vs memantine

A

Donepezil (mild-mod) = diarrhoea
Memantine (severe) = constipation

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16
Q

Anti-NMDA antibodies

A

Autoimmune encephalitis
- rapidly progressive cognitive decline and seizures (may not be noticed)
- manage with steroid and IVIG

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17
Q

What type of psych med is contraindicated in Lewy Body Dementia?

A

Antipsychotics e.g. haloperidol
- worsens parkinsonism symptoms

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18
Q

Thought blocking vs withdrawal

A

Stop in conversation for several minutes before speaking again
- blocking involves a change in conversation
- wihtdrawal pt believes thoughts are being taken from them

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19
Q

Liver transplant criteria

A

Arterial pH < 7.3 after 24 hours
OR all 3 of the following:
PT > 100
Creatinine > 300
Grade III or IV hepatic encephalopathy

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20
Q

MMSE grading for Alzheimer’s disease

A

<10 severe AD
10-20 moderate AD
21-26 mild AD

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21
Q

First line for acute episode of mania in bipolar

A

Olanzapine
- or another suitable mood stab antpsychotic

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22
Q

How long must symptoms be present for a PTSD diagnosis?

A

1 month
AND interfering with daily life

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23
Q

Anticholinergic side effects

A

Can’t see, pee, sh*t
+High HR

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24
Q

What is perceptional delusion?

A

delusion that is formed in response to an external stimulus without any logical sense
- e.g. from a TV show which is real, but pt is creating grandiose delusions from it

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25
Q

Management post partum psychosis

A

Almost always hospital admission if possible to mother and baby unit so they can bond while mum is treated

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26
Q

Short episodes of panic that feel like a heart attack but normal ECG

A

Panic disorder
- long term management with SSRI first line

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27
Q

Prominent U waves in a pt who has recently been admitted to hospital to treat an eating disorder

A

Refeeding syndrome
- caused by hypokalaemia

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28
Q

Acute confusion, impairment of short-term memory, seizures (often focal e.g. absence) and altered consciousness level

A

Limbic encephalitis

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29
Q

Investigations to rule out othwr causes of psychosis before diagnosing schizophrenia

A

Full blood count, serum electrolytes, liver function, urine drug screen, B12, folate and thyroid function tests
+ neuroimaging
+ ? HIV/syphilis

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30
Q

Antihistamine causing delirium in elderly

A

Chlorphenamine

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31
Q

How to diff between AI and viral encephalitis?

A

AI has normal MRI
Viral would have hyperintense temporal lobe lesion

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32
Q

Management iatrogenic opioid overdose

A

Fuuuuulll dose naloxone
- titrating dose risks further resp depression and hypoxic brain injury

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33
Q

3 key UEs changes in lithium toxicity

A

Incr creatinine
Reduced eGFR
Incr serum lithium

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34
Q

Metabolic acidosis, confusion, seizure, tachycardia, hypotension and dilated pupils in a suspected overdose…

A

Tricyclic antidepressant overdose
- lots of anticholinergics
- ECG may show prolonged QRS and QTc

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35
Q

When should duloxetine be taken?

A

In the morning to avoid insomnia

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36
Q

Mx Wernicke’s encephalopathy

A

Pabrinex

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37
Q

Drug given in acute benzo OD

A

Flumenazil

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38
Q

Mx depression in bipolar

A

Fluoxetine + olanzapine or another atypical
- never give SSRI on own to prevent mania

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39
Q

MoA of lithium in mania

A

Promotes GABAergic transmission

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40
Q

Management manic episode

A

Not on mood stab
- stop antidepressant
- start antipsych OR valproate OR lithium (if likely to adhere)
- consider short acting benzo

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41
Q

3 key drug reactions with lithium

A

ACE inhib
Thiazide diuretic
NSAID

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42
Q

What effect does D&V (or other dehydration) have on lithium levels?

A

Depletes sodium -> hyponatraemia -> incr plasma lithium levels

43
Q

Lithium target range

A

0.4-1.0* mmol/l

44
Q

Medical management of depression

A

SSRI
Different SSRI or SNRI
Switch or augment
- mirtazapine
- bupropion
- lithium
Alt drugs
- T3
- lamotrigine
Alt drugs
- TCA + something else

45
Q

What class of psych drugs do SSRIs interact with?

A

SSRIs and MAOIs should never be combined as there is a risk of serotonin syndrome

46
Q

What class is mirtazapine?

A

NaSSA

47
Q

Drugs causing gynaecomastia

A

Digoxin, isoniazid, spironolactone, cimetidine and other (estrogens)

48
Q

Metoclopramide and spironolactone have what effect on male breast tissue?

A

Meto = galactorrhoea (M for milk)
Spiro = gynaecomastia (S for swelling)

49
Q

Moans groans stones

A

Hypercalcaemia
- short QT

50
Q

Sweating, tremor, confusion and hyperreflexia

A

Serotonin syndrom

51
Q

Hyperparathyroidism and hypercalcaemia after long term use of …..

A

Lithium

52
Q

Medical management OCD

A

Sertraline
Clomipramine if ^CI or not tolerated

53
Q

Management of negative schizophrenia or treatment resistant schizophrenia symptoms

A

Clozapine

54
Q

Schizoid vs schizotypal PD?

A

SchizOID = avOIDant behaviour
SchizoTYPal = aTYPical (odd, eccentric) behaviour

55
Q

Toxicity with tinnitus that goes from resp alkalosis -> metabolic acidosis

A

Aspirin overdose

56
Q

Psych drug causing DI

A

Lithium

57
Q

Dystonia, chorea and athetosis (involuntary writhing movements) caused by which neuro drug?

A

levodopa

58
Q

Triptans and SSRIs?

A

No

59
Q

Symptoms of SSRI discontinuation syndrome

A

Flu like symptoms
Insomnia
Restlessness
Mood changes
Sweating
Tummy problems (pain, cramps, D&V)
Off balance
Parasthaesia

60
Q

When is blood test for lithium monitoring done?

A

12h post dose every 3 months
- also 1 week after a dose has been changed

61
Q

Key side effect of long term use of atypical antipsychotics

A

Impaired glucose tolerance
- polyuria and polydipsia

62
Q

Oculogyric crisis is assoc with which type of antipsychotic

A

First gen
- chlorpromazine

Manage with procyclidine

63
Q

Name 3 foods you can’t have with MAO inhibitors

A

Cheese (MAOuse)
Bovril
Marmite
- precipitates severe hypertensive crisis

64
Q

Which atypical has th most tolerable side effects?

A

Aripiprazole

65
Q

How to diff between tardive dyskinesia and acute dystonia?

A

Tardive dyskinesia - Taking antipsychotics -> Tetrabenezine
acute dySTonia - STarting antipsychotics -> procyclidine

66
Q

If pt needs to be on both NSAID and SSRI, what drug should be given as well?

A

Omeprazole/PPI
- to reduce risk of GI bleeding

67
Q

4 key S side effects of SSRIs

A

Stomach Upset
Sexual Dysfunction
Sodium Low
Serotonin Syndrome

68
Q

Name an MAOi

A

Rasagiline
- as well as being used in depression it’s used for Parkinson’s but is one that can induce the gambling/binging habits

69
Q

Antipsychotics in elderly key adverse effect?

A

Stroke or VTE

70
Q

Tardive vs akithisia?

A

Tardive - repetitive invol movements e.g. smacking lips, blinking
Akithisia - internal sense of restlessness causing repetitive movement e.g. bouncing leg

71
Q

SSRI of choice in CAMHS

A

Fluoxetine

72
Q

ECG changes with citalopram

A

Prolonged QT
Torsades de pointes (as a result of long QT)

73
Q

Alcohol sobriety maintenance drug that causes vomiting when alcohol is ingested

A

Disulfiram

74
Q

Anti craving drug used in long term alcohol sobriety, safe when consumed with alcohol

A

Acamprosate

75
Q

2nd line opioid antagonist that is a tablet that goes under the tongue

A

Buprenorphine

76
Q

Complication of Wernicke’s encephalopathy presenting with anterograde amnesia, retrograde amnesia, and confabulatio

A

Korsakoff syndrome

77
Q

Sudden loss of motor or sensory function, positive Hoover sign

A

Conversion disorder (type of FND)

78
Q

What happens to sertraline dose before pt starts ECT?

A

Reduce dose but don’t stop

79
Q

Cholesterol in anorexia?

A

Hypercholesterolaemia

80
Q

What are the two R parkinson’s drugs?

A

Rasigiline
Ropinirole

  • both caution for impulsivity, gambling, binging etc
81
Q

First line in acute stress disorder/reaction

A

(Trauma-focussed) CBT

82
Q

78yo, post hip replacement opioid overdose, RR 8 breaths/min, what’s the management?

A

Naloxone, titrated
- full dose at this age and with this much pain is mad

83
Q

Confusion, ataxia and bone marrow suppression are side effects of which antipsych?

A

Carbamazepine

84
Q

Monitoring for venlafaxine

A

Blood pressure

85
Q

4 components of a delirium diagnosis

A

1) acute onset with fluctuating course,
2) inattention,
3) disorganised thinking,
4) altered level of consciousness

86
Q

Define circumstantiality

A

The patient moves onto different topics but there is a train of thought that can be followed. She eventually returns to answer the original question

87
Q

Mechanism behind the seizure, behaviour change symptoms of auotimmune encephalitis

A

Demyelination

88
Q

Patient has a significant focus on physical symptoms, such as pain, weakness or shortness of breath, to a level that results in major distress and/or problems functioning.

A

Somatisation disorder

89
Q

Anxiety med likely to cause peptic ulcer disease

A

SSRI sertraline

90
Q

Most common side effect of clozapine

A

Constipation

91
Q

FL for delirium tremens

A

Oral lorazepam

92
Q

Management of acute opioid withdrawal

A

Treat symptoms
e.g. constipation = loperamide
e.g. agitation = benzos

93
Q

Restlessness, diaphoresis, clonus, hyperthermia, rigidity, hyperreflexia - taken amphetamine today and symptoms have come on in 4 hours

A

Serotonin syndrome

94
Q

Tetrad of: hypertonia, hyperthermia, autonomic instability and mental state change in the context of an anti-psychotic medication over the course of 4 days

A

Neuroleptic malignant syndrome

95
Q

Lab findings in NMS

A

Incr creatine kinase
Incr AST and ALT
Incr white cells

96
Q

Two symptoms in SS that you don’t get in NMS

A

ClonuS
GI Upset (shitting)

97
Q

Management of dementia with long QT and chronic diarrhoea and urge incontinence

A

Cog stimulation therpy
- or memantine if more severe dementia
- can’t give anticholinesterases as they will make his symptoms wors e

98
Q

FL management for agitated patient with falls risk

A

One-to-one nursing and re-orientation

99
Q

Intention or resting tremor in parkinson’

A

Resting tremor

100
Q

Most common cause of postural hypotension in the elderly

A

Dehydration

101
Q

Management of OCPD

A

DBT

102
Q

Indication for ECT

A

catatonia
a prolonged or severe manic episode
severe depression that is life-threatening
treatment resistant depression

103
Q

Key feature of weakness in FND/conversion disorder

A

does not correspond to a dermatomal distribution

104
Q
A

Year 3 Incorrect Questions (6 decks)

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