Psychiatry

Question 1

Features of PTSD

Answer 1

re-experiencing
avoidance
hyperarousal
emotional numbing

Question 2

Management of PTSD

Answer 2

watchful waiting for symptoms less than 4 weeks
military personnel have access to Rx provided
CBT or eye movement desensitisation reprocessing (EMDR) for more severe cases
drugs not first line, paroxetine or mirtazapine can be used

Question 3

side effects of atypical antipsychotics

Answer 3

weight gain
clozapine - agranulocytosis
increased risk of strokes and VTE in elderly

Question 4

first line in schizophrenia

Answer 4

atypical eg olanzapine

Question 5

clozapine side effects

Answer 5

neutropenia (3%), agranulocytosis (1%), lowers seizure threshold

Question 6

how often do you monitor lithium levels?
when do you take the blood?
any other monitoring?

Answer 6

once stable, 3 monthly
levels taken 12 hours post dose
UEs TFT (can cause hypothyroid)

Question 7

symptoms of lithium toxicity

Answer 7

nausea and vomiting
drowsiness/apathy
ataxia, muscle twitching, coarse tremor
avoid lithium in hyponatraemic patients

Question 8

most dangerous TCAs in overdose

Answer 8

amitriptyline and dosulepin

Question 9

features of TCA overdose

Answer 9

anticholinergic features - dry eyes, dry mouth, blurred vision, urinary retention, constipation,
cardiac - resting sinus tachycardia, hypertension, VT/VF, prolonged QT
CNS - seizures, myoclonus, coma

Question 10

neuroleptic malignant syndrome
cause
features
Mx

Answer 10

pyrexia
tachycardia
rigidity
more common in young males, <10 days after starting/altering a dose of antipsychotic
IV fluids, stop antipsychotic +/- dantrolene