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Phase 4 - Katherine > Psychiatry and Neurology > Flashcards

Psychiatry and Neurology Flashcards

1
Q

Psychiatric assessment: what is modification?

A

Recognising when a process needs to be modified and how to modify e.g. distressed patient, reduced cognitive capacity, non-native speaker.

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2
Q

What is a forensic history?

A

Asking the patient about past juvenile crime, court appearances or convictions.

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3
Q

What 4 things are you assessing throughout a mental state examination?

A
  1. Appearance and behaviour.
  2. Speech.
  3. Mood.
  4. Thoughts, delusions and hallucinations.
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4
Q

Psychiatric assessment: what is a risk assessment?

A

Consideration of how likely an event will occur, when it will occur and how bad will it be. E.g. harm to self, harm to others, suicide, self-neglect.

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5
Q

Formulation: what are the 5 P’s?

A
  1. Presenting problem.
  2. Predisposing factors.
  3. Precipitating factors.
  4. Perpetuation factors.
  5. Protective factors.
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6
Q

What is psychopathology?

A

The study of abnormal experience, cognition and behaviour.

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7
Q

What are the 2 essential components of psychopathology?

A
  1. Observation of behaviour.
  2. Empathic assessment of subjective experience.
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8
Q

What is a concrete concept?

A

Real objects or situations e.g. tremor.

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9
Q

What is a defined concept?

A

Classes of concept e.g. delusions.

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10
Q

What are concept systems?

A

Sets of related concepts e.g. schizophrenia.

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11
Q

Give 3 examples of perceptual symptoms.

A
  1. Illusion.
  2. Hallucination.
  3. Pseudo-hallucination.
  4. Delusion.
  5. Over-valued idea.
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12
Q

Define illusion.

A

A misperception of real external stimuli.

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13
Q

What is a hallucination?

A

Perceptions occurring in the absence of an external physical stimulus. Can be auditory, visual or olfactory.

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14
Q

Define pseudo-hallucination?

A

Pseudo-hallucinations appear to arise in the subjective inner space of the mind, not through one of the external sensory organs - this is how they differ from hallucinations.

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15
Q

What is meant be the term ‘over-valued idea’?

A

An over-valued idea is a false or exaggerated belief sustained beyond logic or reason e.g. I am the best employee ever.

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16
Q

Define delusion.

A

A false, unshakable idea which is out of keeping with the patients educational, cultural and social background; it is held with extraordinary conviction and certainty.

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17
Q

Give 5 examples of different types of delusion.

A
  1. Persecutory.
  2. Grandiose.
  3. Self-referential.
  4. Nihilistic (Cotard’s syndrome).
  5. Misidentification.
  6. Religious.
  7. Hypochondriacal.
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18
Q

What is the Capgras delusion?

A

The idea that someone has been replaced by an impostor.

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19
Q

What is the Fregoli delusion?

A

The idea that various people are in fact the same person.

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20
Q

Thoughts are a common psychiatric sign. Name 5 types of thoughts patients may report/describe.

A
  1. Thought insertion.
  2. Thought withdrawal.
  3. Thought broadcast.
  4. Thought echo.
  5. Thought block.
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21
Q

What is concrete thinking?

A

A lack of abstract thinking, in adults this may be due to organic disease or schizophrenia.

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22
Q

Define loosening of association.

A

A lack of logical association between succeeding thoughts, often leads to incoherent speech. It is impossible to follow the patients train of thought.

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23
Q

Define circumstantiality.

A

Irrelevant wandering in conversation.

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24
Q

What is perseveration?

A

Repetition of a word, theme or action.

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25
Q

What is confabulation?

A

Giving a false account to fill a gap in memory. This is often seen in dementia patients.

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26
Q

Define somatic passivity.

A

The delusional belief that one is a passive recipient of bodily sensations from an external agency.

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27
Q

Define catatonia.

A

Excited or inhibited motor activity in the absence of a mood disorder or neurological disease.

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28
Q

What is psychomotor retardation and in what conditions would it be present?

A

Slowing of thoughts and movements.
It can be seen in depression, Parkinson’s disease etc.

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29
Q

Presentation: describe incongruity of affect.

A

Emotional responses that seem grossly out of tune with the situation or subject being discussed.

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30
Q

Presentation: what is blunting of affect?

A

An absence of normal emotional responses.

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31
Q

Presentation: what is depersonalisation?

A

Feelings of detachment from one’s own body; the patient feels like a spectator of his own activities.

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32
Q

Presentation: describe derealisation.

A

A sense of one’s surroundings lacking reality, surroundings may appear dull, grey, lifeless.

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33
Q

Presentation: describe dissociation.

A

When a person feels disconnected from his/herself and/or their surroundings.

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34
Q

Psychiatric signs: what is obsession?

A

A recurrent persistent thought, image or impulse; it remains despite efforts to resist.

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35
Q

Psychiatric signs: what is compulsion?

A

Repetitive, purposeful behaviour accompanied by a subjective sense that it must be carried out despite the recognition of its senselessness and resistance.

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36
Q

Psychiatric signs: what is akathisia?

A

Motor restlessness, ranging from anxiety to the inability to lie/sit still.

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37
Q

Phenomenology: what is projection?

A

What is emotionally unacceptable in the self is unconsciously rejected and projected to others e.g. mother projects her anxiety onto her children claiming they are anxious instead.

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38
Q

Give 3 signs/symptoms of mania.

A
  1. Pressured speech.
  2. Lots of projects/things going on.
  3. Delusions.
  4. Increased energy/activity.
  5. Overfamiliarity.
  6. Impulsivity.
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39
Q

Give 2 examples of affective disorders.

A
  1. Depression.
  2. Bipolar disorder.
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40
Q

Give 3 symptoms of depression.

A
  1. Low mood.
  2. Lacking energy.
  3. Loss of pleasure.
  4. Sleep disturbance.
  5. Appetite change.
  6. Feelings of guilt, hopelessness.
  7. Suicidal thoughts.
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41
Q

Give 3 symptoms often seen in bipolar disorder.

A
  1. Increased energy.
  2. Pressured speech.
  3. Recklessness.
  4. Impaired judgement.
  5. Inflated self-esteem.
  6. Elevated mood.
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42
Q

When is the onset of schizophrenia most typical?

A

In the 2nd or 3rd decade.

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43
Q

Give a characteristic sign of schizophrenia.

A

Characteristic splitting of thoughts or a loss of contact with reality. Thoughts, perceptions, mood, personality, speech can all be affected.

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44
Q

Give 3 first rank symptoms of schizophrenia.

A
  1. Thought alienation.
  2. Passivity phenomena.
  3. 3rd person auditory hallucinations.
  4. Delusional perception.
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45
Q

Give 3 second rank symptoms of schizophrenia.

A
  1. Delusions.
  2. 2nd person auditory hallucinations.
  3. Thought disorder.
  4. Negative symptoms.
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46
Q

Name 3 types of psychoses.

A
  1. Schizophrenia.
  2. Delusional disorder.
  3. Schizotypal disorder.
  4. Depressive psychosis.
  5. Manic psychosis.
  6. Organic psychosis.
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47
Q

Give 3 physical signs and 3 psychological signs of panic disorder.

A

Physical:
1. Palpitations.
2. Chest pain.
3. Tachypnoea.
4. Dry mouth.
5. Dizziness.
Psychological:
1. Feeling of impending doom.
2. Fear of dying.
3. Fear of losing control.
4. Derealisation.

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48
Q

Give 3 positive signs/symptoms.

A
  1. Hallucinations.
  2. Delusions.
  3. Passivity phenomena.
  4. Thought alienation.
  5. Lack of insight.
  6. Mood disturbance.
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49
Q

Give 3 negative signs/symptoms.

A
  1. Blunting of affect.
  2. Amotivation.
  3. Poverty of speech and/or thought.
  4. Self-neglect.
  5. Lack of insight.
  6. Poor non-verbal communication.
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50
Q

What 2 classification systems are used for psychiatric conditions?

A
  1. DSM5.
  2. ICD10.
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51
Q

Give 2 pros and 2 cons of using classification systems for psychiatric conditions.

A

Pros:
1. Allows for population study and health planning.
2. Aids education.
Cons:
1. Over generalised.
2. Ignores individual characteristics.
3. Diagnostic labels may lead to stigma.

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52
Q

Define personality disorder.

A

Long-lasting, rigid patterns of thought and behaviour. Behaviour that differs from ‘normal’. Present in a range of situations and causes considerable distress. Tends to begin in adolescence.

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53
Q

What are the essential diagnostic features of a personality disorder?

A
  1. Impairments in self and interpersonal functioning.
  2. Impairments in personality functioning.
  3. Impairments are relatively stable across time and consistent across situations.
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54
Q

What daily life tasks might someone with a personality disorder struggle with?

A
  1. Forming/maintaining friendships and work relationships.
  2. Struggle to control feelings and behaviours.
  3. Struggle to trust others.
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55
Q

What is the main type of personality disorder?

A

Emotionally unstable personality disorder.

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56
Q

Give 3 symptoms of a borderline type personality disorder.

A
  1. Emotional instability.
  2. Difficult, intense relationships.
  3. Feelings of emptiness.
  4. Impulsive.
  5. Self injurious behaviour.
  6. Fear of abandonment/rejection.
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57
Q

Why might someone with a borderline personality disorder self-harm?

A
  • Relieve psychic pain.
  • Express anger.
  • Reduce anxiety.
  • Feel in control.
  • Feel something when numb.
  • Communicate how they feel.
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58
Q

How would you treat/manage someone with a personality disorder?

A
  1. Psychological therapies - dialectical behavioural therapy.
  2. Structured clinical management.

Medication is not mainstay.

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59
Q

What principles underly the Mental Health Act?

A
  1. Respect for patients’ wishes and feelings.
  2. Minimise restrictions on liberty.
  3. Public safety.
  4. Patient well-being and safety,
  5. Involving patients in planning, developing and delivering care.
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60
Q

Describe Section 2 of the MHA - purpose, duration, professionals involved.

A
  1. Purpose: assessment, treatment can be given without consent.
  2. Duration: 28 days.
  3. Professionals involved: 2 doctors, AMHP.
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61
Q

Describe Section 3 of the MHA - purpose, duration, professionals involved.

A
  1. Purpose: treatment.
  2. Duration: 6 months.
  3. Professionals involved: 2 doctors, AMHP.
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62
Q

Describe Section 4 of the MHA - purpose, duration, professionals involved.

A
  1. Purpose: emergency order.
  2. Duration: 72 hours.
  3. Professionals involved: 1 Dr and 1 AMHP.
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63
Q

Lithium is an effective treatment for many psychiatric conditions including mania, bipolar disorder, depression etc. Why should it be used with care?

A

Lithium has a narrow therapeutic range which can lead to renal failure.

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64
Q

What is dementia?

A

A progressive neurological disorder impacting cognition which causes functional impairment.

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65
Q

Name 3 types of Dementia.

A
  1. Alzheimer’s.
  2. Vascular.
  3. Lewy Body.
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66
Q

Give 3 differential diagnoses for dementia.

A
  1. Old age.
  2. Depression.
  3. Physical health problems e.g. DM, hypothyroid, vitamin deficiencies.
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67
Q

What is the main investigative screening tool used for dementia?

A

ACE-III screening tool.

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68
Q

Dementia: what 5 cognitive domains does the ACE-III screening tool assess?

A
  1. Attention.
  2. Memory.
  3. Fluency.
  4. Language.
  5. Visiospatial.
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69
Q

What drugs can be used in the treatment of dementia?

A
  1. Acetylcholinesterase inhibitors e.g. Donepezil, Rivastigimine.
  2. NMDA antagonist e.g. Memantine.
  3. RF reduction in vascular dementia is important too.
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70
Q

What is pseudo-dementia?

A

Cognitive impairments secondary to a mental illness e.g. depression/anxiety.

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71
Q

Give one way that you could distinguish between pseudo-dementia and dementia.

A

Patients with pseudo-dementia will use ‘don’t know’ answers whereas those with dementia will make up answers - confabulation.

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72
Q

What is delirium?

A

Delirium is an acute confusional state often with changes in consciousness. It is a medical emergency but is often reversible.

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73
Q

Give 3 causes of delirium.

A
  1. Infection e.g. UTI.
  2. Dehydration.
  3. Iatrogenic e.g. medication changes or surgery.
  4. Constipation.
  5. Urinary retention.
74
Q

Patients with what psychiatric disorder may be more prone to delirium?

A

Patients with dementia - bidirectional relationship.

75
Q

How can you treat delirium?

A

Treat the underlying cause and consider environmental support. Antipsychotics can be used in extreme cases if the patient is suffering from hallucinations.

76
Q

Give 5 potential causes of depression.

A
  1. Drugs e.g. beta-blockers, opioids.
  2. Metabolic e.g. anaemia, B12/folate def, cancer.
  3. Infective e.g. post-viral, UTI.
  4. Inflammatory e.g. temporal arteritis.
  5. Intracranial e.g. post-stroke, Parkinson’s, Delirium, Dementia.
77
Q

Give 3 treatment/management strategies for depression.

A
  1. Antidepressants e.g. SSRI’s.
  2. Talking therapies.
  3. Social inclusion and community support.
  4. ECT.
78
Q

What type of depression often responds poorly to antidepressants?

A

Vascular depression.

79
Q

What is Charles Bonnet Syndrome?

A

A condition characterised by visual hallucinations.

80
Q

What is the recovery model?

A

A non-pharmacological, psychosocial approach to treatment e.g. supporting housing, living, money, social inclusion, therapy, counselling, family work.

81
Q

What is formulation?

A

A meaningful narrative - summarising a patients condition.
The 5 P’s demonstrates a good formulation model.

82
Q

Give examples of psychosocial therapies.

A
  1. Psychotherapy.
  2. CBT.
  3. Counselling.
  4. Cognitive analytic therapy.
  5. Interpersonal therapy.
  6. Dialectic behaviour therapy.
  7. Family therapy.
83
Q

What questions should you ask when taking a developmental history.

A
  1. Pre and post-natal: maternal substance use, birth, milestones.
  2. Who was the main carer?
  3. Life events and early childhood adverse experiences.
  4. Teenage years: drug/alcohol use, changes in academic level, bullying.
84
Q

What is attachment disorder?

A

When a child is unable to develop relationships with parents/carers.

85
Q

Define a seizure.

A

Disordered electrical activity in the brain leading to clinical manifestations.

86
Q

Give 5 differentials for blackouts.

A
  1. Vasovagal syncope.
  2. Cardiac syncope.
  3. Non-epileptic attacks.
  4. Intermittent hydrocephalus (rare).
  5. Migraine (if no loss of awareness).
87
Q

What questions should you ask when taking a history from someone complaining of blackouts?

A
  1. Trigger?
  2. Prodrome - what happened immediately before the event?
  3. Attack - what happened during the event?
  4. Recovery - what happened immediately after?
  5. PMH - have they had similar attacks previously?
88
Q

Define epilepsy.

A

Recurrent seizures.

89
Q

What is focal epilepsy?

A

Abnormal electrical activity in a localised area of the brain.

90
Q

Describe a focal aware seizure.

A

Focal aware seizures aka. aura, simple partial seizure.

Symptoms depend on the site of the focus e.g. limb jerking (frontal lobe), paraesthesia (parietal lobe), speech arrest.

91
Q

Focal seizures: what lobe of the brain would be affected if a patient had limb jerking?

A

The frontal lobe.

92
Q

Focal seizures: what lobe of the brain would be affected if a patient had paraesthesia?

A

The parietal lobe.

93
Q

Name 2 types of seizure that can result from the spread of a focal seizure.

A
  1. Focal impaired awareness seizure (complex partial seizure).
  2. Focal to bilateral tonic-clonic seizure (secondary generalised tonic clonic).
94
Q

Name 3 types of generalised seizure.

A
  1. Myoclonic jerks.
  2. Absence.
  3. Primary generalised tonic clonic.
95
Q

Give 3 signs/symptoms of a stereotypical seizure.

A
  1. Patient will struggle to describe the event.
  2. Duration 1-3 minutes.
  3. Tonic-clonic phase.
  4. Vocalisations.
  5. Eyes/mouth open.
  6. Post-event amnesia.
96
Q

Describe the triggers, prodrome, attack, duration and recovery of an epileptic seizure.

A
  • Triggers: sleep deprivation, early morning, alcohol withdrawal.
  • Prodrome: aura, deja vu, olfactory/gustatory aura.
  • Attack: tonic clonic.
  • Duration: 30-120 seconds.
  • Recovery: confusion, headache, amnesia, prolonged recovery.
97
Q

Define syncope.

A

A transient loss of consciousness, loss of postural tone e.g. fainting.

98
Q

Describe the triggers, prodrome, attack, duration and recovery of syncope.

A
  • Triggers: prolonged standing, hot, pain, venepuncture.
  • Prodrome: pale, sweating, visual clouding, muffled hearing.
  • Attack: reduced body tone.
  • Duration: 5-30 seconds.
  • Recovery: quick.
99
Q

What are the 3 P’s suggestive of syncope?

A
  1. Position e.g. standing.
  2. Precipitating factors e.g. venepuncture, pain, nervous, hot.
  3. Prodromal signs: sweating, pale, visual clouding etc.
100
Q

What is a non-epileptic attack disorder (NEAD)?

A

NEAD resembles an epileptic seizure but without the abnormal electrical discharge, often has a psychological cause e.g. panic attacks.

101
Q

Describe the triggers, attack, duration and recovery of a non-epileptic attack.

A
  • Triggers: situational.
  • Attack: arms flexing and extending, pelvic thrusting, back arching, wax and wane, eyes closed, gaze aversion, may lie completely still.
  • Duration: variable, can be prolonged.
  • Recovery: may be tearful.

NB. may have a history of other functional disorders.

102
Q

What investigations should you do in a patient who presents with blackouts?

A
  1. 12-lead ECG is very important - look for prolonged corrected QT interval.
  2. Brain imaging.
  3. EEG.
  4. Video telemetry.
  5. Heart scan.
  6. Tilt table test.
103
Q

Why should you be cautious interpreting the results of an EEG?

A

EEG’s have high false positive rates leading to over-diagnosis.

104
Q

What is one of the most valuable things you can do when taking a history from someone presenting with blackouts?

A

Ask about and obtain an eye witness account.

105
Q

Give 3 red flag signs for patient’s presenting with new onset headaches.

A
  1. Thunderclap: ‘worst headache I’ve ever had’.
  2. Infective symptoms.
  3. History of malignancy.
  4. Worse in the morning.
106
Q

What can you ask the patient to recall in an abbreviated mental test?

A
  1. Recall an address.
  2. Age and DOB.
  3. What time is it?
  4. What year is it?
  5. Dates of WW2.
  6. Name of present monarch.
  7. Count backwards from 20.
107
Q

Define stroke.

A

A clinical syndrome consisting of rapid onset neurological deficit which is the result of a vascular lesion and is associated with infarction of central nervous tissue.

108
Q

What are the 2 types of stroke?

A
  1. Ischaemic e.g. embolism, thrombosis.
  2. Haemorrhagic stroke.
109
Q

Give 5 risk factors for stroke.

A
  1. HTN.
  2. Diabetes Mellitus.
  3. Cigarette smoking.
  4. Hyperlipidaemia.
  5. Obesity.
  6. Alcohol.
  7. AF.
110
Q

Give 3 signs of a stroke that has affected the ACA.

A
  1. Lower limb weakness and loss of sensation to the lower limb.
  2. Gait apraxia.
  3. Incontinence.
  4. Drowsiness.
  5. Decrease in spontaneous speech.
111
Q

Give 3 signs of a stroke that has affected the MCA.

A
  1. Upper and lower limb weakness.
  2. Homonymous hemianopia.
  3. Aphasia.
  4. Dysphasia.
  5. Facial drop.
112
Q

Give 3 signs of a stroke that has affected the PCA.

A
  1. Speech impairment and dysphagia.
  2. Cerebellar dysfunction e.g. vertigo, nausea and vomiting, nystagmus, ataxia.
  3. Visual disturbances.
113
Q

What classification can be used for an acute ischaemic stroke?

A

The Oxford stroke (Bamford) classification.

114
Q

The Oxford stroke (Bamford) classification: give 3 signs of a Lacunar infarction stroke.

A
  1. Pure motor hemiparesis (motor weakness on one side).
  2. Ataxic hemiparesis.
  3. Mixed sensorimotor.
  4. Pure sensory stroke.
115
Q

What investigations might you do in someone who you suspect has had a stroke?

A
  1. Bloods: FBC, U+E’s, ESR, Lipids, CRP, Glucose and HbA1c.
  2. ECG (check for MI or AF).
  3. Carotid doppler USS.
  4. Echocardiogram.
  5. CT head.
  6. MRI to confirm diagnosis.
116
Q

Why is it good to do a CT head in a patient who you suspect has had a stroke?

A

It is quick, readily available and can distinguish the site affected and whether it was ischaemic or haemorrhagic.

117
Q

What medication should you give to someone within 4.5 hours of having an ischaemic stroke?

A

Thrombolysis - Alteplase (IV).

118
Q

What are the contraindications for alteplase?

A
  1. Haemorrhage.
  2. Suspected SAH.
  3. Active bleeding.
  4. Recent GI infection or UTI.
  5. Recent surgery.
  6. Malignancy.
119
Q

Describe the secondary management for a patient who has had a stroke.

A
  1. Lifestyle changes - smoking, alcohol, exercise, diet.
  2. Medical - antiplateletes e.g. aspirin, anticoagulation, manage HTN and hypercholesterolaemia, VTE assessment, monitor for infection.
  3. Surgical - carotid endarterectomy, stenting.
  4. Rehabilitation.
120
Q

Who might be involved in the rehabilitation of a patient who has had a stroke?

A
  1. Physiotherapist.
  2. OT.
  3. SALT.
  4. Dieticians.
  5. Orthoptics.
121
Q

Give 3 differentials for a stroke.

A
  1. Seizures.
  2. Migraines.
  3. Metabolic events e.g. hypoglycaemia.
  4. Tumours.
122
Q

Give 4 signs of UMN weakness.

A
  1. Increased muscle tone.
  2. Hyperreflexia.
  3. Spasticity.
  4. Minimal muscle atrophy.
123
Q

Give 5 signs of LMN weakness.

A
  1. Decreased muscle tone.
  2. Hyporeflexia.
  3. Flaccid.
  4. Muscle atrophy.
  5. Fasciculations.
124
Q

If a patient describes difficulty getting out of a chair and up stairs etc. does that suggest a proximal or a distal problem?

A

This is suggestive of a proximal muscular problem.

125
Q

Muscle weakness: if a patient presents with symmetrical signs what is the likely cause?

A

It is likely to be a genetic or metabolic cause.

126
Q

Muscle weakness: if a patient presents with asymmetrical signs what is the likely cause?

A

It is likely to be a vasculitic or inflammatory cause e.g. entrapment.

127
Q

Give an example of a post-synaptic disorder affecting NMJ?

A

Myasthenia Gravis.

128
Q

Give 3 signs of Myasthenia Gravis.

A

Generalised fatiguability:
1. Proximal limbs.
2. Neck/face - head drop, ptosis.
3. Extra-occular - diplopia.
4. Speech and swallowing problems.
5. Risk of other auto-immune disorders.

129
Q

What investigations would you do in someone who you suspect has Myasthenia Gravis?

A
  1. Tensilon test.
  2. Bloods for autoantibodies.
  3. Ask the patient to count to 50 or hold their arms outstretched.
130
Q

What is the treatment for myasthenia gravis?

A
  1. Acetylcholinesterase inhibitors e.g. pyridostigmine.
  2. Immunosuppressants e.g. prednisolone.
131
Q

Give an example of a acetylcholinesterase inhibitor.

A

Pyridostigmine.

132
Q

Carpal tunnel syndrome is an example of what kind of peripheral neuropathy?

A

A mononeuropathy - median nerve entrapment.

133
Q

Peripheral Neuropathy: describe mononeuritis multiplex.

A

A patchy process where individual nerves are picked off randomly. Often it has an inflammatory or immune mediated cause. Chronic, slow progression.

134
Q

Give 2 causes of mononeuritis multiplex.

A
  1. Vasculitides.
  2. Connective tissue disorders.
135
Q

What metabolic disorder can cause peripheral neuropathy?

A

Diabetes.

136
Q

Describe the treatment for peripheral neuropathies.

A

20% are idiopathic and so there is no treatment available. Otherwise the underlying cause should be treated and managed e.g. diabetes management.

Prednisolone may be given for inflammatory neuropathies.

137
Q

A patient describes a 2 week history of muscle weakness that began in his toes and is now affecting his whole legs. He reported having an infection (EBV) 2 weeks ago and also mentions that he has noticed changes in feeling and sensation. Give a possible diagnosis.

A

Guillian-Barré syndrome (GBS): typically post-infectious.

Important sign = ASCENDING weakness and a short history!

138
Q

What investigation would you do in a patient who you suspect has Guillian-Barré syndrome?

A

Nerve conduction studies.

139
Q

What is the treatment for Guillian-Barré syndrome?

A

IV immunoglobulin or plasma exchange.

140
Q

What are the 3 main components of the Glasgow Coma scale?

A
  1. Best motor response.
  2. Best vocal response.
  3. Best eye-opening response.
141
Q

A lesion in which cranial nerve could result in a fixed dilated pupil?

A

Cn 3 - Oculomotor.

142
Q

What spinal tract is responsible for motor response?

A

Corticospinal tract.

143
Q

What signals does the spinothalamic tract carry?

A

Crude touch, pain, temperature, light touch, vibration.

144
Q

At what level does the spinal cord end in an adult?

A

L1/2.

145
Q

What is the function of the Basal Ganglia?

A

Control of voluntary movement.

146
Q

Give 2 population groups who may be at increased risk of a subdural haematoma.

A

Elderly and alcoholics - due to cerebral atrophy.

147
Q

Give 3 symptoms of a subdural haematoma.

A
  1. Headache.
  2. Drowsiness.
  3. Alternating consciousness.
148
Q

What investigation might you do in someone who you suspect has a subdural haematoma?

A
  1. CT - look for the crescent shaped appearance on the scan.

(GCS will fluctuate).

149
Q

What can cause an extradural haematoma?

A

Trauma to the temporal bone -> bleeding from MMA.

150
Q

Give 2 signs of an extradural haematoma.

A
  1. Rapid deterioration in conscious level.
  2. Focal neurological signs.
151
Q

What is the treatment for an an extradural haematoma?

A

Immediate surgical drainage.

152
Q

Give 3 symptoms of a subarachnoid haemorrhage.

A
  1. ‘Thunderclap’, maximum severity headache within seconds.
  2. Photophobia.
  3. Neck stiffness.
  4. Nausea and vomiting.
153
Q

What investigations might you do in someone who you suspect has a subarachnoid haemorrhage?

A
  1. CT head (star shaped).
  2. Cerebral angiography.
  3. Lumbar puncture - xanthochromia.
154
Q

How do you manage and treat a patient who has had a subarachnoid haemorrhage?

A
  1. Nimodipine (CCB).

Early intervention, support and close monitoring is essential.

155
Q

What is status epilepticus?

A

5or more minutes of either continuous seizure activity or repetitive seizures without regaining consciousness. It is a medical emergency.

156
Q

What is the immediate treatment for someone with status epilepticus?

A

Benzodiazepines e.g. Lorazepam.

157
Q

Give 3 symptoms of Cauda Equina syndrome.

A
  1. Bilateral sciatica - pain radiates down leg to foot.
  2. Saddle anaesthesia.
  3. Bladder/bowel dysfunction.
  4. Erectile dysfunction.
  5. Leg weakness.
158
Q

Define frailty.

A

A state of increased vulnerability resulting from an ageing associated decline in reserve and function across multiple physiologic systems; the ability to cope with everyday stressors is therefore compromised.

159
Q

What are the 4 geriatric giants?

A
  1. Instability.
  2. Intellectual impairment.
  3. Immobility.
  4. Incontinence.

(All lead to a loss of independence and are complicated to sort out. But not diagnoses in themselves).

160
Q

Describe the components of a delirium screen.

A
  1. Bloods - FBC, U+E, B12/Folate, TFT, CRP etc.
  2. AMT.
  3. CT head if fall history.
  4. MSU.
  5. Enquire about history of constipation.
161
Q

Give 4 non-haematological investigations/components of a delirium screen.

A
  1. AMT.
  2. CT head.
  3. MSU.
  4. Ask about history of constipation.
162
Q

What are DOLS?

A

Deprivation of Liberty Safeguards are a part of the MCA (2005). They are a set of rules that apply when a patient can’t make decisions about how they’re cared for.

163
Q

When do DOLS apply?

A
  1. When a patient is in a hospital or care home.
  2. When the staff keep the patient under continuous supervision.
  3. The patient or the family members are unhappy about the care/limitations of the care.
164
Q

Give 3 broad causes of malnutrition.

A
  1. Reduced nutrient intake.
  2. Increased nutrient requirements.
  3. Malabsorption.
165
Q

What are the consequences of malnutrition in the elderly?

A

Reduced immune response, muscle wasting an impaired wound healing -> reduced QOL, poorer prognosis, increased length of stay, complications and risk of re-admittance.

166
Q

What screening tool can be used for diagnosing malnutrition?

A

MUST (BAPEN, 2003).

167
Q

Give 3 treatment options for malnutrition.

A
  1. Encouraging food and drink intake.
  2. ONS - yoghurts, milkshakes, juices etc.
  3. Enteral feeding.
  4. Parenteral feeding.
168
Q

What is enteral feeding?

A

Direct feeding into the gut e.g. NG or PEG.

169
Q

What are the risks of enteral feeding?

A
  1. Diarrhoea.
  2. Nausea.
  3. Early satiety.
  4. Uncomfortable.
  5. Reduced QOL.
170
Q

What is a potential consequence of the reinstitution of nutrition in a malnourished person?

A

Re-feeding syndrome - metabolic disturbances.

171
Q

Name 5 different cognitive assessment tools.

A
  1. MoCA.
  2. 6CIT.
  3. MMSE.
  4. GP-COG.
  5. Addenbrookes
172
Q

What 4 things are considered in a comprehensive geriatric assessment?

A
  1. Medical plan and assessment.
  2. Mental health – old age psychiatry.
  3. Functional assessment e.g. ADL’s – physio and OT.
  4. Social history and background.
173
Q

What 4 questions should be considered in a mental capacity assessment?

A
  1. Can the patient understand the information relevant to the decision?
  2. Can the patient retain the information long enough to make a decision?
  3. Can the patient weight up the information as part of the decision making process?
  4. Can the patient communicate that decision?
174
Q

Describe the treatment for bipolar disorder.

A
  1. Mood stabilisers e.g. Lithium, sodium valporate or aripiprazole.
  2. Psychological therapies e.g. CBT.
175
Q

What do you need to monitor for when treating a patient with Lithium?

A

Kidney function and Thyroid function.

176
Q

Give examples of the following anti-depressants:
- SNRI.
- MAOI.
- SSRI.
- Tri-cyclic.
- Tetra-cyclic.

A
  1. SNRI: Duloxetine.
  2. MAOI: Isocarboxazid, Phenelzine.
  3. SSRI: Sertraline, Citalopram, Fluoxetine.
  4. Tri-cyclic: amitriptyline.
  5. Tetra-cyclic: Mirtazapine.
177
Q

What type of anti-depressant is associated with a hypertensive crisis if too much cheese/wine is consumed? Give an example of one of these drugs.

A

MAOI e.g. Isocarboxazid, Phenelzine.

Hypertensive crisis related to tyrosine.

178
Q

A 27 year old man has a long history of interpersonal difficulties. He has feelings of doubt and caution, is preoccupied with detail and is pedantic. These features cause him considerable distress and dysfunction.
Which personality disorders best describes this man?

A

Anankastic Personality Disorder (Obsessive).

179
Q

Who can release someone from their section?

A
  1. RMO.
  2. Consultant psychiatrist.
  3. MH Tribunal.
180
Q

What is relative afferent pupillary defect (RAPD)?

A

It is observed during the swinging light test. The patient’s pupils dilate when the light is swung from the unaffected to the affected eye. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced.

181
Q

What is another name for RAPD?

A

Marcus Gunn pupil.

182
Q

In what conditions might you see RAPD?

A
  1. MS.
  2. Glaucoma.
  3. Severe retinal disease.
  4. Optic nerve lesion.

Phase 4 - Katherine (26 decks)

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