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MBChB Finals > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

During a ward round consultation, the psychiatrist was assessing a patient’s current mental state. The patient’s reply to most of the questions consisted of sentences which did not make any sense such as - ‘painting pizza prince bus brush’. This is a good example of which thought disorder?

A

Word salad

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2
Q

Name the drug which can be given to prevent alcohol relapse in alcohol detoxification, acting as an anti-craving medication

A

Acamprosate

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3
Q

Name the drug which can be given to prevent alcohol relapse in alcohol detoxification, by causing unpleasant symptoms following the consumption of alcohol

A

Disulfiram

Acts as an irreversible inhibitor of acetaldehyde dehydrogenase, which causes the buildup of acetaldehyde → symptoms

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4
Q

What is buprenorphine?

A

A mixed opioid agonist/antagonist, typically given as a sublingual tablet and provides an alternative opiate replacement therapy to methadone

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5
Q

What is the first line treatment for OCD?

A

Exposure and response prevention (ERP) therapy

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6
Q

Define hypomania

A

Hypomania is characterised by elevated mood, pressured speech and flight of ideas but without psychotic symptoms

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7
Q

What is acute dystonia?

A

Sustained muscle contraction (e.g. torticollis, oculogyric crisis) which can occur as a side effect of first-generation antipsychotics e.g. chlorpromazine, haloperidol

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8
Q

What drug may be used in the management of acute dystonia

A

Procyclidine

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9
Q

What is the SSRI of choice following an MI?

A

Sertraline

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10
Q

What is post-concussion syndrome?

A

The persistence of concussion symptoms beyond the normal course of recovery; can be seen even after minor head trauma

Clinical features include headache, fatigue, anxiety/depression and dizziness

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11
Q

What is the second line medication used for treatment of OCD, following failure of CBD and an SSRI?

A

Clomipramine

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12
Q

What is the first line management for acute stress disorder?

A

Trauma-focused cognitive-behavioural therapy

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13
Q

When checking lithium levels, when should the sample be taken?

A

12 hours post-dose

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14
Q

When should patients under 25 years who have been started on an SSRI be reviewed?

A

After 1 week due to transient increased risk of suicide

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15
Q

What are the negative symptoms of schizophrenia?

A
  • Incongruity/blunting of affect
  • Anhedonia (inability to derive pleasure)
  • Alogia (poverty of speech)
  • Avolition (poor motivation)
  • Social withdrawal
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16
Q

Which drug is the most effective antipsychotic for dealing with the negative symptoms of schizophrenia?

A

Clozapine

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17
Q

What is the most appropriate treatment for a patient dianosed with borderline personality disorder?

A

Dialectical behaviour therapy (DBT)

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18
Q

What is the most appropriate course of action if you see a patient in GP with hypomanic symptoms?

A

Routine referral to CMHT

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19
Q

What investigation is indicated in a first episode of sudden onset psychosis in an elderly person?

A

CT head (rule out organic causes)

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20
Q

The risk of developing schizophrenia if one monozygotic twin is affected is approximately what percentage?

A

50% - concordance rate for schizophrenia in monozygotic twins, who share 100% of their genetic material, is around 50%

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21
Q

Name a common side effect of benzodiazepines

A

Anterograde amnesia

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22
Q

If a patient misses clozapine for 2 consecutive days, what is the best course of action?

A

Re-titrate the clozapine doses again slowly

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23
Q

What drug is most suitable to treat moderate/severe tardive dyskinesia?

A

Tetrabenazine

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24
Q

Name that personality disorder: rigid with respect to morals, ethics and values and often are reluctant to surrender work to others

A

Obsessive-compulsive personality

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25
Q

What are the somatic symptoms of depression?

A

Early morning waking and changes in appetite and weight

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26
Q

How would you treat severe OCD, or if unresponsive to CBT/exposure and response prevention?

A

SSRI e.g. fluoxetine and CBT

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27
Q

Name a drug class that can cause overflow incontinence

A

Tricyclic antidepressants e.g. amitriptyline (anti-cholinergic effect)

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28
Q

What is the typical onset of symptoms of alcohol withdrawal?

A

6-12 hours

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29
Q

What is the typical onset of seizures following alcohol withdrawal?

A

36 hours

30
Q

What is the typical onset of delirium tremens following alcohol withdrawal?

A

72 hours

31
Q

What are the risk factors for generalised anxiety disorder?

A
  • Aged 35- 54
  • Being divorced or separated
  • Living alone
  • Being a lone parent
31
Q

What are the clinical feature of sleep paralysis?

A
  • Sleep paralysis is a condition characterized by the inability to move or speak when transitioning between sleep and wakefulness, either when falling asleep or upon awakening
  • It can be accompanied by vivid hallucinations, which may explain the patient’s description of seeing another person in the room
31
Q

Why might a patient with bulimia have short, rounded teeth?

A

Repeated vomiting can lead to erosion of the teeth

32
Q

What is Knight’s move thinking?

A

Knight’s move thinking is a severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another

It is a feature of schizophrenia

32
Q

What is flight of ideas?

A

Flight of ideas, a feature of mania, is a thought disorder where there are leaps from one topic to another but with discernible links between them

33
Q

Why should SSRIs and MAOIs (e.g. selegilin) not be combined?

A

Risk of serotonin syndrome

33
Q

Guess the personality disorder: lack close friends other than family and can have odd or eccentric behaviour, speech and beliefs

A

Schizotypal personality disorder

34
Q

What is an oculogyric crisis?

A

A type of acute dystonia which involves prolonged upward involuntary deviation of the eyes

34
Q

What is torticollis?

A

Type of acute dystonia which involves unilateral pain and deviation of the neck with pain on palpation and restricted range of motion

34
Q

What is the definition of an obsession in OCD?

A

An obsession is an intrusive, unpleasant and unwanted thought

34
Q

What is the definition of a compulsion in OCD?

A

Senseless action taken to reduce the anxiety caused by the obsession

35
Q

What is the first line treatment for schizophrenia?

A

Atypical antipsychotic e.g. olanzapine, clozapine and quetiapine

36
Q

What is the most common side effect of atypical antipsychotics?

A

Weight gain

37
Q

What are the metabolic side effects of anti-psychotics?

A

Include dysglycaemia, dyslipidaemia, and diabetes mellitus

38
Q

A patient with a history of bipolar presents to the GP after having routine bloods which revealed a leucocytosis. He feels well in himself. What would you advise the patient?

A

Safety net to return if symptoms develop, arrange repeat bloods under normal schedule

Lithium can precipitate a benign leucocytosis

39
Q

How long must symptoms of depression be present in order to be classified as a depressive episode?

A

2 weeks

40
Q

Which class of drug have the Medicines and Healthcare products Regulatory Agency warned may be associated with an increased risk of venous thromboembolism in elderly patients?

A

Atypical antipsychotics e.g. clozapine, risperidone, olanzapine, and quetiapine

41
Q

How can you differentiate between dementia and memory loss in depression (pseudodementia)?

A

Severe depression gives a pattern of global memory loss, dementia is more commonly a short-term memory loss

42
Q

What is the mechanism of venlafaxine?

A

SNRI - serotonin and noradrenaline reuptake inhibitor

43
Q

What is the first line treatment for severe depression recommended by NICE?

A

Combination of individual cognitive behavioural therapy (CBT) and an antidepressant

44
Q

What PHQ-9 score would indicate ‘more severe’ depression?

A

Over 15

45
Q

What are the biochemical features of anorexia?

A

Most things low

G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

46
Q

What is the mechanism of action of mirtazapine?

A

Noradrenergic and specific serotonergic antidepressant which increases release of neurotramsitters by blocking alpha2 adrenoreceptors

47
Q

What are the adverse effects of clozapine?

A
  • Agranulocytosis, neutropaenia
  • Reduced seizure threshold
  • Constipation
  • Myocarditis - baseline ECG should be taken before starting treatment
  • Hypersalivation
48
Q

A 45-year-old female with a history of bipolar disorder complains of lower back pain, constipation, headaches, low mood, and difficulty concentrating.

Her presentation is likely due to which of the following medications?

A

Lithuim - long-term litium use can result in hyperparathyroidism and resultant hypercalcaemia

49
Q

What is the first line drug for generalised anxiety disorder?

A

Sertraline

50
Q

What is the difference between pseudohallucinations and true hallucinations?

A

Patients with pseudohallucinations understand that what they are seeing isn’t real

51
Q

True or false: pseudohallucinations can form a part of the normal greiving process

A

True

52
Q

Which form of non-pharmacological therapy is most likely to be beneficial in a patient with schizophrenia?

A

CBT

53
Q

What is somatisation disorder?

A

Condition is characterised by the recurrent presentation of physical symptoms such as nausea, headaches, and palpitations in the absence of a detectable organic cause

54
Q

What is conversion disorder (FND)?

A
  • Typically presents with neurological symptoms such as paralysis, blindness, or seizures that cannot be explained by medical evaluation
  • The presented case does not describe any such neurological symptom
55
Q

Which drug has the most tolerable side effect profile of the atypical antipsychotics, particularly for prolactin elevation?

A

Aripiprazole

56
Q

What is catatonia?

A

Stopping of voluntary movement or staying still in an unusual position

57
Q

What is the definition of chronic insomnia?

A

Chronic insomnia may be diagnosed after three months, if a person has trouble falling asleep or staying asleep at least three nights per week

58
Q

Which gender is most often affected by anti-social personality disorder?

A

Men

59
Q

What is tangentiality?

A

Tangentiality refers to wandering from a topic without returning to it

60
Q

What is circumstantiality?

A

Patients give unnecessary and excessive detail before finally answering a question

61
Q

If a first line SSRI such as sertraline is ineffective or not tolerated for generalised anxiety disorder, what should be tried?

A

Try another SSRI or an SNRI

62
Q

What is a potential risk of SSRIs when used in the third trimester of pregnancy?

A

Persistent pulmonary hypertension of the newborn

63
Q

What should be monitored at initiation and dose titration of SNRIs e.g. venlafaxine?

A

Blood pressure - association with hypertension

64
Q

What should be monitored prior to starting citalopram or escitalopram?

A

ECG - association with QT prolongation/ventricular arrhytmias including TdP

65
Q

A patient taking a SSRI has had their dose recently increased. They present to A&E with new onset confusion. What is the likely diagnosis?

A

Hyponatraemia - check U&Es

MBChB Finals (18 decks)

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