Psychiatry

Question 1

Serotonin Syndrome

Answer 1

Excess SSRI (Fluoxetine, sertraline)
Fever, Tachy., Muscle rigidity, neck stiffness )

Question 2

Neuroleptic malignant syndrome

Answer 2

Excess dopamine antagonist (metoclopramide, haloperidol)
Fever, Tachy., Muscle rigidity, neck stiffness )

CLOZAPINE can cause this too.

Question 3

Psychotic depression

Answer 3

Low moods + Signs of psychosis (Feeling guilty etc.)

Question 4

Tx. for parkinsons d/s. And contra indicated meds for Parkinson’s.

Answer 4

Tx. I/M Lorazepam

C/I- Haloperidol (Contra indicated in Parkinson’s and alzeimers)
(If pt. was only schizophrenic without mania, then HALOPERIDOL could have been given)

also, olanzepine & risperidone can exacerbate Parkinson’s d/s

Question 5

Spit on surgeon and then apologise. Diag. and tx.

Answer 5

BPD (Borderline personality disorder)
Mood swings, self harm, inability to control anger

TX- Lithium (Mood stabiliser)

Question 6

Acute psychosis tx

Answer 6

Elderly without Parkinson’s/alzeimers- Haloperidol

Young/ anyone with Parkinson’s/alzeimers- Lorazepam

Question 7

Panic disorder tx

Answer 7

tx. before attack- Propanalol
While- rebreathe into paper bag
Long term tx- 
1st- CBT
2nd- SSRI

Question 8

Tardive dyskinesia tx.

Answer 8

Tardive and schizophrenia have same tx.

Olanzepine and risperidone

Question 9

Liver transplantation criteria

Answer 9

Arterial Ph <7.3
Pt>100
Creatinine >300
Grade 3 or 4 encephalopathy

Question 10

Critical dose for paracetamol OD

Answer 10

150mg/kg in 24 hours (approx 24 tabs for adult, ie-12 grams)

Question 11

Acute alcoholic. Tx.

Answer 11

Acute withdrawal symptoms. only- Chlordiazepoxide

+ seizures or hallucinations (delirium tremens)- Lorazepam

As deterrent- disulfiram

reduce cravings- acamprosate

Question 12

Signs and Management of lithium toxicity

Answer 12

Signs- Coare tremor, HYPERCALCEMIA, Abd pain

Do serum lithium levels-

Mild to moderate toxicity- Resucitation with saline
Severe- Haemodialysis

Question 13

Lithium in pregnancy

Answer 13

Woman on lithium, Planning to get preg.-
>Reduce gradually and stop before preg confirmed

Woman on lithium, becomes preg.-
>Stop lithium gradually over 4 weeks

Taking lithium, while preg-
>Check plasma lithium level monthly till 36th week,
>then check weekly till birth

Question 14

Normally when is lithium levels checked

Answer 14

Checked 1 week after initiating
after that, checked every 3 months
while, LFT and urea and electrolytes checked every 6 months

Last, lithium levels checked 12 hrs after taking last dose.

Question 15

When SSRI shouldn’t be given

Answer 15

Bipolar pt. on lithium, shouldn’t be given SSRI, or else mania will worsen

Question 16

Opioid signs and tx.

Answer 16

AKA heroin

SIgns- everything low (BP,HR,RR) and pinpoint pupil

Tx.- Naloxone.

for withdrawal- Methadone

Question 17

Willis EKBOM synd. tx

Answer 17

AKA restless leg synd.

Check iron(ferritin)

Low- Give iron supplements
Normal- Dopamine antagonist

Question 18

Anti- depressants of choice In children/adolescants-

Answer 18

Fluoxetine

Question 19

Side effect of Haloperidol and fluoxetine

Answer 19

Haloperidol- Sexual dysfunction and gynacomastia

Fluoxetine- Delayed ejaculation

Question 20

Rapid transquilization

Answer 20

L-H-O

Lorazepam-Haloperidol-Olanzepine

Question 21

Patient depressed + warfarin + antidepressant. What is med to give in such a condition?

Answer 21

Mirtazapine

Question 22

Blood report seen high in chronic alchoholic

Answer 22

Raised MCV and GGT.

GGT is given more preference.

Question 23

PTSD tx.

Answer 23

CBT used first

then SSRI