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Year 3 Finals > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

How many units of alcohol per week should adults not exceed?

A

14

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2
Q

How many units of alcohol per week would constitute harmful drinking in women and men?

A

Women - 35+
Men - 50+

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3
Q

Which screening tool is used to assess alcohol harm?

A

AUDIT questionnaire

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4
Q

Which tool is used to assess alcohol withdrawal?

A

CIWA-AR

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5
Q

Which mediation is used for medically assisted alcohol withdrawal?

A

Chlordiazepoxide

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6
Q

How does chlordiazepoxide exert its effects?

A

Increases GABA transmission, calming the nervous system and reducing agitation

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7
Q

Name the 3 anti-craving medications used in alcohol withdrawal

A

Acamprosate, naltrexone, disulfiram

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8
Q

Which alcohol withdrawal medication produces a deterrent affect when combined with alcohol?

A

Dilsulfiram

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9
Q

What form of seizure do alcohol withdrawal seizures take?

A

Grand-mal/tonic-clonic

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10
Q

Name the Wernicke’s encephalopathy triad

A

Ophthalmoplegia + confusion + ataxia

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11
Q

Which substance are Wernicke’s encephalopathy patients deficient in?

A

Vitamin B1 (thiamine)

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12
Q

How long after their last alcoholic drink may a patient experience delirium tremens?

A

48-72 hours

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13
Q

Name the triad of Korsakoff’s syndrome

A

Retrograde amnesia + anterograde amnesia + confabulations

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14
Q

Compensated liver disease will show what levels of albumin, bilirubin and coagulation time in comparison to a healthy patient?

A

Normal

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15
Q

AST:ALT ratio over 1 on LFTs is suggestive of what?

A

Alcohol use disorder

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16
Q

What medication should be administered in opioid overdose?

A

Naloxone

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17
Q

Which substance should be administered in paracetamol overdose?

A

N-acetyl cysteine

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18
Q

According to the ICD10, how long must symptoms be present for a diagnosis of schizophrenia?

A

1 month

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19
Q

Prominent positive symptoms in schizophrenia are a good or poor prognostic factor?

A

Good
- prominent negative symptoms are a poor prognostic factor

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20
Q

What is the mechanism of typical antipsychotic medications?

A

Dopamine D2 receptor antagonists

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21
Q

Name the disorder:
PMH schizophrenia + haloperidol + lip smacking + excessive blinking

A

Tardive dyskinesia

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22
Q

Name the disorder:
PMH affective psychoses + pimozide + muscle rigidity + fever + elevated CK

A

Neuroleptic malignant syndrome

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23
Q

What is the hallmark blood test finding in neuroleptic malignant syndrome?

A

Elevated creatinine kinase

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24
Q

Akathisia is described as what?

A

The inability to remain still

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25
Q

Parkinsonism may occur in groups of patients taking what medications?

A

Antipsychotics

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26
Q

Which atypical antipsychotic has the highest risk of hyperprolactinaemia?

A

Risperidone

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27
Q

Which atypical antipsychotic is most likely to cause orthostatic hypotension?

A

Quetiapine

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28
Q

Clozapine is mostly associated with which haematological side effect?

A

Agranulocytosis + neutropenia

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29
Q

Which test should be regularly carried out in patients who take clozapine?

A

FBC

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30
Q

What is the most common presentation of delirium in elderly patients?

A

UTI

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31
Q

How long does a typical mania episode last?

A

1-3 months

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32
Q

What are 2 important physiological differentials for mania?

A

Cushing’s disease, hyperthyroidism

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33
Q

What are 2 important physiological differentials for depression?

A

Addison’s disease, hypothyroidism

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34
Q

What is the blood goal of lithium?

A

0.6-1.2mmol/l

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35
Q

Nausea, vomiting, convulsions and delirium are suggestive of toxicity of what medication in a patient with PMH of mania?

A

Lithium

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36
Q

How is lithium toxicity treated?

A

IV fluids and general supportive measures

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37
Q

Valproic acid can cause abnormalities in which blood cell?

A

Platelets - most commonly thrombocytopenia

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38
Q

What is the blood goal of valproic acid?

A

50-125mcg/ml

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39
Q

Which medication is indicated in mixed affective state with rapid cycling?

A

Carbamazepine

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40
Q

Which safety netting advice should be given when initiating lamotrigine therapy?

A

If ANY rash develops discontinue use immediately
- due to increased risk of Steven Johnson syndrome

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41
Q

For how long must symptoms be present for bipolar disorder to be considered?

A

2 weeks

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42
Q

Bipolar disorder type 2 is characterised by fully depressive and what type of manic episodes?

A

Hypomanic only

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43
Q

Which blood test is important to take at baseline before initiating a mood stabiliser therapy?

A

LFTs

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44
Q

Lithium is known to cause what disorder of the thyroid?

A

Hypothyroidism

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45
Q

Long term use of antipsychotics puts patients at risk of what cardiovascular event?

A

Stroke
- due to inducing metabolic disorders e.g. hyperlipidaemia

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46
Q

How long must symptoms be present for to diagnose ADHD?

A

6 months

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47
Q

Vanderbilt’s and Connors tools are used to assess what?

A

ADHD

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48
Q

Sodium valproate during pregnancy can predispose to what development disorder?

A

ADHD

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49
Q

What is the first line medication in ADHD?

A

Methylphenidate

50
Q

What is the prolonged release version of Ritalin called?

A

Xaggitin

51
Q

Atomoxetine and guanfacine can be used in ADHD complicated by what?

A

Anxiety or tics

52
Q

What percentage of children with ADHD will continue to experience symptoms in adulthood?

A

50-60%

53
Q

Autistic patients have a higher risk of experiencing what conditions?

A

Seizures and GI problems

54
Q

SRS2 is a screening tool for what?

A

Autism

55
Q

ADOS can be used to identify presence of behaviours characteristic of what disorder?

A

Autism

56
Q

Which medication can be used in autism patients with sleep problems?

A

Melatonin

57
Q

What 2 medications can be used in autism patients with irritability and aggression?

A

Risperidone first line
- aripriprazole second line in those experiencing hyperprolactinaemia due to risperidone

58
Q

What is the most important side effect of methylphenidate to monitor?

A

Growth failure
- methylphenidate causes appetite suppression

59
Q

Development of tics is an indication to switch methylphenidate to what?

A

Atomoxetine or guanfacine

60
Q

Exposure and response prevention CBT is useful in what disorder?

A

OCD

61
Q

Which SSRI is licensed for use in under 18s?

A

Fluoxetine

62
Q

Buspirone can be used for what?

A

Anxiety disorders

63
Q

Benzodiazepines are mostly used in anxiety complicated by what?

A

Insomnia or parasomnia

64
Q

Blocking dopamine in which brain pathway can can hyperprolactinaemia?

A

Tuberoinfundibular

65
Q

Blocking dopamine in which brain pathway can cause Parkinson’s symptoms?

A

Nigrostriatal

66
Q

Which brain pathway in schizophrenia produces positive symptoms (hallucinations, delusions)?

A

Mesolimbic

67
Q

Which brain pathway in schizophrenia produces negative symptoms and cognitive disorders (apathy, lack of inhibition)?

A

Mesocortical

68
Q

Dopamine release inhibits release of what?

A

Prolactin

69
Q

Blocking dopamine release can lead to what?

A

Hyperprolactinaemia

70
Q

Agoraphobia is the fear of what?

A

Going outside

71
Q

Clomipramine can be used in what disorder?

A

OCD

72
Q

Thyrotoxicosis, phaeochromocytoma and hypoglycaemia are all important physiological differentials of what disorder?

A

Anxiety

73
Q

Eye movement desensitisation and reprocessing therapy can be used in what disorder?

A

PTSD

74
Q

The triad of hyper-arousal + re-experiencing phenomena + avoidance of reminders is present in which disorder?

A

PTSD

75
Q

Panic attacks can have what affect on blood gases?

A

Hypocapnia
- hyperventilation blows off CO2

76
Q

Anxiety symptoms must be present for how many months in order to diagnose an anxiety disorder?

A

6 months

77
Q

What is the first line medical treatment for panic disorder

A

SSRIs

78
Q

How long do symptoms of PTSD need to present in order to make a diagnosis?

A

4 weeks

79
Q

How long should acute stress reaction last no longer than?

A

4 weeks
- classed at PTSD if lasts more than 4 weeks

80
Q

Erectile dysfunction is a side effect of which class of antidepressants?

A

SSRIs

81
Q

Respiratory depression, pin point pupils and unresponsiveness are suggestive of overdose of what? How do we treat this?

A

Morphine overdose
Treated with IV Naloxone

82
Q

Clozapine exerts what effect on neutrophils?

A

Neutropenia

83
Q

BMI over under what is classed as anorexia nervosa?

A

18.5
- or over 20% weight loss in 6 months

84
Q

Which psychiatric disorder has the highest mortality?

A

Anorexia nervosa

85
Q

What is the average recovery time from anorexia nervosa?

A

6-7 years

86
Q

Binging and compensatory behaviour must occur how often for a diagnosis of bulimia nervosa?

A

Minimum of once per week for at least a month

87
Q

Why must insulin therapy be administered at low infusion rates in those with type 1 diabetes eating disorders?

A

To prevent hypokalaemia
- insulin allows potassium into cells

88
Q

A HbA1c level of what is a red flag in type 1 diabetes eating disorders?

A

Over 86mmol/l

89
Q

Which electrolyte disturbances are characteristic of refeeding syndrome?

A

Hypokalaemia
Hypomagnesaemia
Hypophosphataemia

90
Q

Which questionnaire is used to assess for anorexia or bulimia?

A

SCOFF questionnaire

91
Q

What is the limit for how long acute stress reaction lasts until it becomes a diagnosis of PTSD?

A

1 month

92
Q

Which compound can be used to treat paracetamol overdose over 4 hours ago?

A

N-acetylcysteine

93
Q

Which compound can be used to treat paracetamol overdose less than an hour ago?

A

Activated charcoal

94
Q

Which scoring system is used to assess alcoholic hepatitis?

A

GAHS score

95
Q

How should we initially treat alcoholic hepatitis?

A

Oral steroids + thiamine

96
Q

How do we manage somatisation?

A

Reassurance, safety netting, analgesia if necessary

97
Q

Alcoholism will have what effect on levels of GGT, MCV and Hb?

A

GGT - raised
MCV - raised
Hb - lowered

98
Q

Dialectical behavioural therapy can be used in what disorder?

A

Borderline personality disorder

99
Q

Mentalisation based therapy can be used in what disorder?

A

Borderline personality disorder

100
Q

Which type of therapy is best in young patients with anorexia nervosa?

A

Family based therapy

101
Q

Exposure and response prevention therapy is best for what disorder?

A

OCD

102
Q

Learning disability is described as an IQ below what?

A

70

103
Q

Profound learning disability is described as an IQ of below what?

A

20

104
Q

Severe TBI is classified as GCS score below what?

A

8

105
Q

Mild TBI is classed as GCS level between what?

A

13-15

106
Q

Decorticate posturing scores how much on the GCS motor section?

A

3

107
Q

Decereberate posturing scores how much on the motor section of GCS?

A

2

108
Q

GFAP is a biomarker for what?

A

TBI

109
Q

Which anti-epileptic should be chosen for mood stabilisation in TBI patients?

A

Lamotrigine

110
Q

Time off work due to psychiatric symptoms requires which form to be filled out?

A

MED3

111
Q

Prolonged grief disorder must last at least how long?

A

6 months

112
Q

How long must insomnia persist for to require pharmacological treatment?

A

3 months

113
Q

What can we give for long term insomnia in over 55s?

A

Melatonin
- OVER 55S ONLY

114
Q

How many weeks maximum can melatonin be given for?

A

13 weeks

115
Q

Zopiclone can be given in insomnia that lasts how long?

A

3-7 days

116
Q

Which ECG finding is common in anorexia nervosa?

A

Prolonged QT interval

117
Q

What is the first line treatment for delirium tremens?

A

Oral lorazepam

118
Q

Which section of the mental health act allows detainment up to 72 hours?

A

Section 5

119
Q

Which section of the mental health act allows detainment up to 28 days?

A

Section 2

120
Q

Which section of the mental health act allows detainment up to 6 months?

A

Section 3

Year 3 Finals (7 decks)

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