Psychiatry Flashcards
1
Q
How many units of alcohol per week should adults not exceed?
A
14
2
Q
How many units of alcohol per week would constitute harmful drinking in women and men?
A
Women - 35+
Men - 50+
3
Q
Which screening tool is used to assess alcohol harm?
A
AUDIT questionnaire
4
Q
Which tool is used to assess alcohol withdrawal?
A
CIWA-AR
5
Q
Which mediation is used for medically assisted alcohol withdrawal?
A
Chlordiazepoxide
6
Q
How does chlordiazepoxide exert its effects?
A
Increases GABA transmission, calming the nervous system and reducing agitation
7
Q
Name the 3 anti-craving medications used in alcohol withdrawal
A
Acamprosate, naltrexone, disulfiram
8
Q
Which alcohol withdrawal medication produces a deterrent affect when combined with alcohol?
A
Dilsulfiram
9
Q
What form of seizure do alcohol withdrawal seizures take?
A
Grand-mal/tonic-clonic
10
Q
Name the Wernicke’s encephalopathy triad
A
Ophthalmoplegia + confusion + ataxia
11
Q
Which substance are Wernicke’s encephalopathy patients deficient in?
A
Vitamin B1 (thiamine)
12
Q
How long after their last alcoholic drink may a patient experience delirium tremens?
A
48-72 hours
13
Q
Name the triad of Korsakoff’s syndrome
A
Retrograde amnesia + anterograde amnesia + confabulations
14
Q
Compensated liver disease will show what levels of albumin, bilirubin and coagulation time in comparison to a healthy patient?
A
Normal
15
Q
AST:ALT ratio over 1 on LFTs is suggestive of what?
A
Alcohol use disorder
16
Q
What medication should be administered in opioid overdose?
A
Naloxone
17
Q
Which substance should be administered in paracetamol overdose?
A
N-acetyl cysteine
18
Q
According to the ICD10, how long must symptoms be present for a diagnosis of schizophrenia?
A
1 month
19
Q
Prominent positive symptoms in schizophrenia are a good or poor prognostic factor?
A
Good
- prominent negative symptoms are a poor prognostic factor
20
Q
What is the mechanism of typical antipsychotic medications?
A
Dopamine D2 receptor antagonists
21
Q
Name the disorder:
PMH schizophrenia + haloperidol + lip smacking + excessive blinking
A
Tardive dyskinesia
22
Q
Name the disorder:
PMH affective psychoses + pimozide + muscle rigidity + fever + elevated CK
A
Neuroleptic malignant syndrome
23
Q
What is the hallmark blood test finding in neuroleptic malignant syndrome?
A
Elevated creatinine kinase
24
Q
Akathisia is described as what?
A
The inability to remain still
25
Parkinsonism may occur in groups of patients taking what medications?
Antipsychotics
26
Which atypical antipsychotic has the highest risk of hyperprolactinaemia?
Risperidone
27
Which atypical antipsychotic is most likely to cause orthostatic hypotension?
Quetiapine
28
Clozapine is mostly associated with which haematological side effect?
Agranulocytosis + neutropenia
29
Which test should be regularly carried out in patients who take clozapine?
FBC
30
What is the most common presentation of delirium in elderly patients?
UTI
31
How long does a typical mania episode last?
1-3 months
32
What are 2 important physiological differentials for mania?
Cushing’s disease, hyperthyroidism
33
What are 2 important physiological differentials for depression?
Addison’s disease, hypothyroidism
34
What is the blood goal of lithium?
0.6-1.2mmol/l
35
Nausea, vomiting, convulsions and delirium are suggestive of toxicity of what medication in a patient with PMH of mania?
Lithium
36
How is lithium toxicity treated?
IV fluids and general supportive measures
37
Valproic acid can cause abnormalities in which blood cell?
Platelets - most commonly thrombocytopenia
38
What is the blood goal of valproic acid?
50-125mcg/ml
39
Which medication is indicated in mixed affective state with rapid cycling?
Carbamazepine
40
Which safety netting advice should be given when initiating lamotrigine therapy?
If ANY rash develops discontinue use immediately
- due to increased risk of Steven Johnson syndrome
41
For how long must symptoms be present for bipolar disorder to be considered?
2 weeks
42
Bipolar disorder type 2 is characterised by fully depressive and what type of manic episodes?
Hypomanic only
43
Which blood test is important to take at baseline before initiating a mood stabiliser therapy?
LFTs
44
Lithium is known to cause what disorder of the thyroid?
Hypothyroidism
45
Long term use of antipsychotics puts patients at risk of what cardiovascular event?
Stroke
- due to inducing metabolic disorders e.g. hyperlipidaemia
46
How long must symptoms be present for to diagnose ADHD?
6 months
47
Vanderbilt’s and Connors tools are used to assess what?
ADHD
48
Sodium valproate during pregnancy can predispose to what development disorder?
ADHD
49
What is the first line medication in ADHD?
Methylphenidate
50
What is the prolonged release version of Ritalin called?
Xaggitin
51
Atomoxetine and guanfacine can be used in ADHD complicated by what?
Anxiety or tics
52
What percentage of children with ADHD will continue to experience symptoms in adulthood?
50-60%
53
Autistic patients have a higher risk of experiencing what conditions?
Seizures and GI problems
54
SRS2 is a screening tool for what?
Autism
55
ADOS can be used to identify presence of behaviours characteristic of what disorder?
Autism
56
Which medication can be used in autism patients with sleep problems?
Melatonin
57
What 2 medications can be used in autism patients with irritability and aggression?
Risperidone first line
- aripriprazole second line in those experiencing hyperprolactinaemia due to risperidone
58
What is the most important side effect of methylphenidate to monitor?
Growth failure
- methylphenidate causes appetite suppression
59
Development of tics is an indication to switch methylphenidate to what?
Atomoxetine or guanfacine
60
Exposure and response prevention CBT is useful in what disorder?
OCD
61
Which SSRI is licensed for use in under 18s?
Fluoxetine
62
Buspirone can be used for what?
Anxiety disorders
63
Benzodiazepines are mostly used in anxiety complicated by what?
Insomnia or parasomnia
64
Blocking dopamine in which brain pathway can can hyperprolactinaemia?
Tuberoinfundibular
65
Blocking dopamine in which brain pathway can cause Parkinson’s symptoms?
Nigrostriatal
66
Which brain pathway in schizophrenia produces positive symptoms (hallucinations, delusions)?
Mesolimbic
67
Which brain pathway in schizophrenia produces negative symptoms and cognitive disorders (apathy, lack of inhibition)?
Mesocortical
68
Dopamine release inhibits release of what?
Prolactin
69
Blocking dopamine release can lead to what?
Hyperprolactinaemia
70
Agoraphobia is the fear of what?
Going outside
71
Clomipramine can be used in what disorder?
OCD
72
Thyrotoxicosis, phaeochromocytoma and hypoglycaemia are all important physiological differentials of what disorder?
Anxiety
73
Eye movement desensitisation and reprocessing therapy can be used in what disorder?
PTSD
74
The triad of hyper-arousal + re-experiencing phenomena + avoidance of reminders is present in which disorder?
PTSD
75
Panic attacks can have what affect on blood gases?
Hypocapnia
- hyperventilation blows off CO2
76
Anxiety symptoms must be present for how many months in order to diagnose an anxiety disorder?
6 months
77
What is the first line medical treatment for panic disorder
SSRIs
78
How long do symptoms of PTSD need to present in order to make a diagnosis?
4 weeks
79
How long should acute stress reaction last no longer than?
4 weeks
- classed at PTSD if lasts more than 4 weeks
80
Erectile dysfunction is a side effect of which class of antidepressants?
SSRIs
81
Respiratory depression, pin point pupils and unresponsiveness are suggestive of overdose of what? How do we treat this?
Morphine overdose
Treated with IV Naloxone
82
Clozapine exerts what effect on neutrophils?
Neutropenia
83
BMI over under what is classed as anorexia nervosa?
18.5
- or over 20% weight loss in 6 months
84
Which psychiatric disorder has the highest mortality?
Anorexia nervosa
85
What is the average recovery time from anorexia nervosa?
6-7 years
86
Binging and compensatory behaviour must occur how often for a diagnosis of bulimia nervosa?
Minimum of once per week for at least a month
87
Why must insulin therapy be administered at low infusion rates in those with type 1 diabetes eating disorders?
To prevent hypokalaemia
- insulin allows potassium into cells
88
A HbA1c level of what is a red flag in type 1 diabetes eating disorders?
Over 86mmol/l
89
Which electrolyte disturbances are characteristic of refeeding syndrome?
Hypokalaemia
Hypomagnesaemia
Hypophosphataemia
90
Which questionnaire is used to assess for anorexia or bulimia?
SCOFF questionnaire
91
What is the limit for how long acute stress reaction lasts until it becomes a diagnosis of PTSD?
1 month
92
Which compound can be used to treat paracetamol overdose over 4 hours ago?
N-acetylcysteine
93
Which compound can be used to treat paracetamol overdose less than an hour ago?
Activated charcoal
94
Which scoring system is used to assess alcoholic hepatitis?
GAHS score
95
How should we initially treat alcoholic hepatitis?
Oral steroids + thiamine
96
How do we manage somatisation?
Reassurance, safety netting, analgesia if necessary
97
Alcoholism will have what effect on levels of GGT, MCV and Hb?
GGT - raised
MCV - raised
Hb - lowered
98
Dialectical behavioural therapy can be used in what disorder?
Borderline personality disorder
99
Mentalisation based therapy can be used in what disorder?
Borderline personality disorder
100
Which type of therapy is best in young patients with anorexia nervosa?
Family based therapy
101
Exposure and response prevention therapy is best for what disorder?
OCD
102
Learning disability is described as an IQ below what?
70
103
Profound learning disability is described as an IQ of below what?
20
104
Severe TBI is classified as GCS score below what?
8
105
Mild TBI is classed as GCS level between what?
13-15
106
Decorticate posturing scores how much on the GCS motor section?
3
107
Decereberate posturing scores how much on the motor section of GCS?
2
108
GFAP is a biomarker for what?
TBI
109
Which anti-epileptic should be chosen for mood stabilisation in TBI patients?
Lamotrigine
110
Time off work due to psychiatric symptoms requires which form to be filled out?
MED3
111
Prolonged grief disorder must last at least how long?
6 months
112
How long must insomnia persist for to require pharmacological treatment?
3 months
113
What can we give for long term insomnia in over 55s?
Melatonin
- OVER 55S ONLY
114
How many weeks maximum can melatonin be given for?
13 weeks
115
Zopiclone can be given in insomnia that lasts how long?
3-7 days
116
Which ECG finding is common in anorexia nervosa?
Prolonged QT interval
117
What is the first line treatment for delirium tremens?
Oral lorazepam
118
Which section of the mental health act allows detainment up to 72 hours?
Section 5
119
Which section of the mental health act allows detainment up to 28 days?
Section 2
120
Which section of the mental health act allows detainment up to 6 months?
Section 3
