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SAQ for finals > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

List 4 symptoms associated with mania

A

Increased energy
Decreased sleep
Grandiosity, ambitious plans, excessive spending and risk-taking behaviours
Disinhibition and sexually inappropriate behaviour
Flight of ideas
Pressured speech
Psychosis

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2
Q

Explain two possible detrimental social effects that acute mania can cause

A

Impulsive decisions
Risk taking behaviour

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3
Q

List 2 possible medications for mania

A

Antipsychotics
Benzodiazepines

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4
Q

What does being an informal patient mean?

A

Voluntary in-patient psych treatment

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5
Q

What 4 tests need to be done prior to treatment with lithium?

A

Renal function
TFTs
U&Es
FBC

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6
Q

What must be considered before starting lithium

A

Risk of overdose - suicidal ideation and history of deliberate self-harm

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7
Q

List 2 symptoms of lithium toxicity

A

Coarse tremor
Nausea/Vomiting
Diarrhoea
Siezures

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8
Q

List 5 symptoms of major depression

A

Loss of interest in hobbies the pt used to enjoy (anhedonia)
Feeling of low mood
Irritability
Thoughts of harm

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9
Q

Why is 1 advantage and 1 disadvantage of scores such as HADS in depression

A

Diagnostic, guide treatment, monitor symptoms

Significant variation of scores between different populations or cultures, not reflective on individual scenarios

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10
Q

What other conditions may be associated with depression which need to be screened for

A

Hypothyroidism
Dementia
Bipolar disorder
Perimenopause
Chronic disease e.g. diabetes

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11
Q

What is the difference between delirium and dementia?

A

Factors favouring delirium over dementia:
Acute onset
Impairment of consciousness
Fluctuation of symptoms (worse at night, periods of normality)
Abnormal perception (illusions, hallucinations)
Agitation, fear
Delusions

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12
Q

List 4 causes of delirium

A

Infection (particularly UTI)
Metabolic (hypercalcaemia, hypoglycaemia, hyperglycaemia)
Change of environment
Severe pain
Alcohol withdrawal
Constipation

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13
Q

List 4 causes of dementia

A

Alzheimer’s
Vascular dementia
Lewy body dementia
Huntington’s

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14
Q

Pt on ward unusually distressed and agitated

You prescribe IM 5mg haloperidol

a) what non-medication management could be used in acute agitation

b) what are the potential problems of using sedatives in the elderly and confused

A

a) Moving to a well lit and quiet room where the patient can be monitored

b) Increased confusion, falls risk

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15
Q

List 4 healthcare professionals involved in discharge

A

Doctors
Nurses
Pharmacists
Physiotherapists
Occupational therapists

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16
Q

Name 2 domains that a MSE should cover

A

Appearance
Behaviour
Speech
Perception
Thought
Insight
Cognition

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17
Q

What are the recommended safe alcohol limits per week

A

14 units / week

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18
Q

What is the definition of alcohol use disorder

A

Impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences

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19
Q

List 2 factors in alcohol consumption that might imply addiction

A

Have you ever felt that you ought to C ut down on your drinking?
Do you get A nnoyed by criticism of your drinking?
Do you ever feel G uilty about your drinking?
Do you ever take an E arly-morning drink (eye-opener) to get the day started or to get rid of a hangover?

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20
Q

What treatments could you offer a pt to reduce drinking

A

Alcoholics anonymous
Disulfram
Acamprosate
Admission for detox and benzodiazepine

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21
Q

What are 5 symptoms of alcohol withdrawal

A

6-12h: tremor, sweating, tachycardia, anxiety
36h: seizures
48-72h: coarse tremor, confusion, delusions, hallucinations, fever

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22
Q

What is the mechanism of action of chlordiazepoxide

A

Long acting benzodiazepine (GABA agonist to correct sudden imbalance after chronic GABA use)

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23
Q

Why is pabrinex given in alcohol withdrawal

A

High dose B and C vitamins prevent wernickes encephalopathy

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24
Q

Name a long-term complication of alcohol abuse of:

Liver
CNS
CVS
GI

A

Cirrhosis
Dementia
Stroke/IHD
Pancreatitis

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25
How does disulfiram work in preventing relapse
Alcohol intake causes severe reaction (nausea, headache, vomiting)
26
What are the poor prognostic indicators for schizophrenia?
Family history Gradual onset Low IQ Prodromal phase of social withdrawal Lack of obvious precipitant
27
Explain the following symptoms: a) Thought broadcast b) Delusions c) Type of auditory hallucinations in schizophrenia
a) perceiving that other people can hear your thoughts b) false held belief with strong conviction in spite of evidence against it, not in keeping with cultural background c) two or more voices commenting on the patient's behaviour (3rd person)
28
List 2 negative symptoms of schizophrenia
4 A's Affective flattening (minimal emotional reaction) Alogia (poverty of speech) Anhedonia Avolition
29
3 tests performed prior to initiation of treatment of an antipsychotic
ECG HbA1c Prolactin Lipids Blood pressure Weight
30
Why can use of antipsychotic medication cause hyperprolactinaemia
*dopamine sends negative feedback to prolactin release* Dopamine receptor antagonists causes prolactin to be released from posterior pituitary due to lack of negative feedback
31
The day after starting an antipsychotic, pt develops distressing restlessness, facial tics, slowed movement and tremor a) what drug reaction is being described b) explain the mechanism behind it
a) Acute dystonia b) Dopamine from substantia nigra coordinates movement, antagonised dopamine allows EPSEs to occur
32
What regular monitoring of clozapine is needed
FBC - agranulocytosis
33
What are the following sections of the MHA used for and how long does each one last a) Section 2 b) Section 3 c) Section 4 d) Section 136
a) Admission for assessment: 28 days b) Admission for treatment: 6 months c) Emergency detainment for purpose of assessment: 72 hours d) Allows police to take somebody to a place of safety / assessment: 72 hours
34
'felt' stigma vs 'enacted' stigma
'Felt' stigma - not easily identifiable conditions where the person feels stigmatised against 'Enacted' stigma - easily identifiable conditions where the person is targeted
35
How can a patient appeal against a section 2
Appeal must be applied for in writing to a mental health tribunal within 14 days of detention
36
What are 2 possible physical consequences of anorexia nervosa
Subfertility Amenorrhoea Anaemia Electrolyte abnormalities Hypotension
37
What is an advantage of treating anorexia patients in a unit as opposed to community
Clustering of expertise in one place Supportive group therapy Continuous monitoring Capacity for refeeding
38
Why are electrolytes monitored in a feeding programme
Risk of hyperkalaemia (refeeding syndrome)
39
List 2 factors important in a history of an overdose
Any alcohol or illicit drugs also taken When was each medication taken? Same time or staggered Psychiatric history Medical history (liver disease) Suicidal intent Immediate trigger to current overdose
40
How does charcoal work for paracetamol overdose (<1h)
Provides a large surface area to absorb a potential poison and stop it being absorbed by the GI tract
41
4 scenarios where acetylcysteine should be given in paracetamol overdose
Plasma paracetamol conc above treatment line Staggered (>1h) overdose or doubt over time of ingestion Present within 8-24 hours >150mg/kg Present >24h with jaundice, RUQ tenderness, raised ALT
42
Explain how NAC works in reducing liver damage
Glutathione reserves are depleted in overdose NAC provides enough glutathione to conjugate with NAPQI and break it down
43
Name 1 blood test that should be performed regularly after taking NAC
INR (measurement of synthetic liver function)
44
After a paracetamol overdose, what services might the pt benefit from
Crisis intervention team Social services
45
Worrying clinical features of deliberate self-harm that indicate high likelihood of completed suicide in the future
Intention was death Current psychiatric illness Poor social resources Previous suicide attempts Social isolation Male Unemployed >50
46
How to assess if someone had suicidal intent for an episode of attempted suicide
Specific planning (where, when, how) Getting affairs in order Writing a will or suicide note Having the means to do it e.g. buying weapons, medication
47
What clinical features may lead you to suspect drug use and drug seeking behaviour
Legal problems and crime to purchase drugs Abnormal behaviour with signs of intoxification Injection marks Repeated requests for opioids
48
Explain the stages of transtheoretical model
Precontemplation Contemplation Preparation Action Maintanence
49
What is a possible criticism of the transtheoretical model
Arbitrary lines between stages when in reality pts may go between them quickly Assumes people make sane and rational choices about their behaviour
50
What advantages does using the transtheoretical model have in therapeutic intervention
Tailoring intervention to the stage of change the patient is in to help them move to the next
51
Name 4 medical complications of prolonged heroin use
Cellulitis and abscesses at injection sites DVT Blood-borne viruses e.g. Hep B, Hep C, HIV Opportunistic infections from being immunocompromised
52
What detoxification programmes could be used in heroin addiction
Methadone Psychological interventions Naltrexone
53
How does the onset and offset of action of naloxone affect your dosing
has very short onset and offset (within 5 to 10 mins) with IV and opioid toxicity will continue, IM should be considered
54
List 4 symptoms associated with anxiety
Tremor Racing thoughts Sweating Palpitations
55
How would CBT be helpful in anxiety
associative thinking
56
Why is using diazepam for anxiety in the long term not a good strategy
Tolerance Dependence Addiction
57
Name 2 classes of medications used for the long-term treatment of anxiety
SSRIs SNRIs
58
List 3 symptoms of PTSD
Avoidance Hypervigilance Flashbacks
59
Name one difference between mania (type 1) and hypomania (type 2)
In mania sx must have lasted for at least 1 week, whereas in hypomania they have only lasted for 4 days A manic episode includes psychotic features (delusions/hallucinations) whereas a hypomanic episode does not A manic episode is severe enough to cause marked impairment in social or occupational functioning or necessitate hospitalisation, whereas a hypomanic episode is not this severe
60
GP assessment of patient's risk to self and others to judge urgency of admission or referral
Does Maggie have any dependents (children, family members) at risk of neglect? Is there a risk to the public / does Maggie have a history of violence / is she currently experiencing aggressive thoughts? Is Maggie consuming alcohol/recreational drugs currently? Are there potential harmful consequences of her current behaviour? E.g. employment risk, finances, personal relationships, sexual activity, risks posed by driving Does Maggie have any thoughts of harming herself?
61
2 side effects of first-generation antipsychotics
EPSEs (dystonic, parkinsonism, akathisia, tardive dyskinesia) Hyperprolactinaemia Anticholinergic effects Impaired gluocose tolerance
62
Positive predictive value calculation
True positive / Total positive
63
Negative predictive value calculation
True negative / Total negative
64
Sensitivity calculation
True positive / (True positive + False negative)
65
Specificity calculation
True negative / (True negative + False positive)
66
1 strength and 1 weakness of cross-sectional studies
Relatively quick and cheap Prone to selection bias
67
What medico-legal term describes parents being able to overrule a child's consent to treatment if they do not understand the risks or the court overruling if there is risk of death
Gillick competence
68
Risk factors for refeeding syndrome
BMI <16 Excessive exercise Rapid weight loss Fasting for 5+ days
69
Give a brief overview of refeeding syndrome
Sudden introduction of glucose after prolonged starvation causes insulin to push glucose into cells and sudden demand for phosphate, potassium and magnesium (leading to hypo-e)
70
ECG changes in tricyclic overdose e.g. amytriptyline
Sinus tachycardia QT prolongation
71
Tricyclic overdose >10mg/kg with ECG changes treatment
IV sodium bicarbonate
72
What are the 4 components of a mental capacity assessment
Understands information e.g. do you understand why you need to be admitted/have procedure? Retains information e.g. can you remember what the doctor told you? Weigh up information to decide e.g. What can happen if you do or don't get admitted/have procedure? Communicate the decision/summarise e.g. can you summarise why we think this is the best decision
73
Key positive symptoms in schizophrenia
Auditory hallucinations Somatic passivity Thought insertion or thought withdrawal Thought broadcasting Persecutory delusions Ideas of reference Delusional perceptions
74
Side effects of olanzapine
Weight gain Hyperglycaemia Prolonged QT interval Erectile dysfunction Gynaecomastia
75
Initial management of neuroleptic malignant syndrome
A-E Stop antipsychotic IV fluids Benzodiazepines Bromocriptine, dantrolene
76
Outline a structured A to E (1 component from each)
Airway: patent? Check no obstruction. Breathing: Respiratory rate, oxygen saturations, ABG, general inspection, tracheal position, chest expansion, percussion, auscultation, chest x-ray. Circulation: heart rate, blood pressure, fluid balance, temperature, capillary refill time, pulse, JVP, auscultation. IV cannula, bloods, blood cultures, ECG, fluid output. Disability: ACVPU, pupils, medications, blood glucose and ketones. CT head. Exposure: Inspection for rashes, bleeding, bruising. Abdominal palpation, body temperature.
77
List 2 signs of raised ICP on examination
Widened pulse pressure Bradycardia Irregular breathing (Cushing's triad) Fixed and dilated pupils Pupil asymmetry
78
Indications for intubation
GCS 8 or less (protecting the airway), Respiratory failure (hypoxic or hypercapnic), Upper airway obstruction, neuromuscular weakness, increased work of breathing (patient nearing respiratory failure).
79
List 2 social determinants of health
Physical and mental health Access to peer support FH of e.g. substance abuse Structural racism
80
3 approaches to a health needs assessment
Epidemiological Corporate Comparative
81
If a Deprivation of Liberty Safeguard needs to be put in place, state two core requirements that need to be followed to ensure it is valid
Avoid if possible In patients best interests only Only for immediate intervention required For as short as period as possible Alternatives considered
82
State the most appropriate good medical practice principle that will support your decision-making
Make the care of your patient your first concern

SAQ for finals (20 decks)

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