Psychiatry/neurology Flashcards
De Clarambault’s syndrome?
Delusion of being loved, generally by someone of superior social status
‘Clara loves me, she does!’
Fregoli syndrome?
A Familiar person ie wife, falsely identiFied in strangers
(‘Fs - Fregoli, familiar faces, falsely identiFied’)
Capgras syndrome?
Familiar person is replACed by a stranger who is their exact double
Othello syndrome?
Delusion of infidelity of partner ‘liking OTHEr person’
Section 2?
Admission for assessment for up to 28 days
2=28
Section 3?
Admission for TREAtment for up to 6 months
Section 4?
72 hour assessment order
5(2)?
Dr detaining power - 72 hours (voluntary patient in hospital only)
5(4)?
Nurse detaining power - 6 hours (for patients voluntarily in hospital)
Section 135?
Police can break into property to move person to place of safety
Section 136?
Someone in public place can be taken by police to place of safety
What is facticious disorder?
Patient Falsifies medical or psychiatric symptoms ie interfering with wound/causing infection
Definition of Parkinsonism? (Symptoms)
Bradykinesia
Plus one of:
-tremor
-rigidity and/or postural instability
If low mood symptoms with minimal effect on function within 10 days of giving birth, what is diagnosis?
‘Baby blues’
Fridreich’s ataxia
-what is it?
-complications?
Autosomal recessive inherited degenerative disease that primarily affects nervous system and heart
-Cardiomyopathy
-Diabetes
Questionnaire used to screen for eating disorders?
SCOFF
1st line tx for trigeminal neuralgia?
Carbamazepine
20 y/o man, weakness in both legs, viral URTI few weeks ago. Likely Dx? Tx?
Guillain-Barré syndrome
-ascending progressive symmetrical weakness, starting in lower extremities
-usually 3 weeks post viral illness
-sensory signs rare
High dose IVIG or plasma exchange (no tolerance for steroids!!)
After TIA, what driving advice?
Can start driving if symptom free after 1 month (no need to tell DVLA!)
Treatment for cluster headache (acute)?
Prophylaxis?
Acute - sumatriptan (subcut), oxygen
Prophylaxis- prednisone, verapamil
Corresponding GCS for AVPU:
A?
V?
P?
U?
A = 15
V = 12
P = 8
U = 3
When to perform CTB within 1 hour
GCS <13 on initial asssessment in ED
GCS <15 at 2h post injury in ED
Suspected skull #
Post-traumatic seizure
Focal neurological deficit
>1 episode vomiting
When to do CTB within 8 hours?
If some LOC/amnesia plus:
-age >65
-hx bleeding/clotting disorders
-dangerous mechanism injury
>30 min retrograde amnesia of events immediately before head injury
First line Tx for newly diagnosed tonic-clonic seizures?
Sodium valproate (unless premenopausal females - lamotrigine)
Lithium side effects?
LITHIUM
Leukocytosis
Increased urine output
Tremors/thirst
Hypothyroidism
Increased weight
Upset stomach (N/V)
Muscle weakness/mental issues
Lithium monitoring?
Lithium levels every 3 months
TFTs, U&Es, Calcium every 6-12m
30 y/o man presents with wasting of small hand muscles, and loss of pain and temp over trunks and arms. Dx?
SYRINGOMELIA
-fluid filled tubular cavitation in (usually cervical) spinal cord
-more common in men, age 20-30s
-loss of pain/temp sensation due to spinothalamic tract damage in ‘shawl’ like distribution
-wasting and weakness of muscles - starts in hands and ascends
-condition is progressive, no cure
How does Pseudobulbar palsy present? Who does it affect and what is it?
-upper motor neuron lesion to corticobulbar pathways
(Occurs in MS, MND, and BL strokes)
-difficulty chewing, swallowing and may have slurred speech. ‘Donald Duck’ voice, brisk jaw jerk
-inappropriate emotional outburst
Recurrent pregnancy loss and positive lupus anticoagulant suggests what Dx?
Antiphospholipid syndrome
What is myasthenia gravis and how does it present?
Acquired autoimmune disease
Antibodies against the nicotinic acetylcholine receptor at the neuromuscular junction
Easy fatigueability
What is tardive dyskinesia?
Examples
Repetitive, involuntary, purposeless movements
Grimacing
Tongue protrusion
Lip smacking
Pursing lips
Rapid blinking
Patient during blood transfusion - becomes tachycardic, hypotensive, high temp 40
Bacterial contamination
What is a section 2?
WHO needs to be present?
Admission for ASSESSMENT up to 28 days (2 = 28 days)
GP, psychiatrist, approved social worker
What is section 3?
Who needs to be present?
Admission for TREATMENT for up to 6 months (3 = TREAtment)
Nearest relative or social worker & 2 DOCTORS
What is a section 4?
Who is needed to do it?
72 hour assessment order, used of section 2 involves unacceptable delay
Needs GP + approved social worker or relative! (No need for psychiatrist, usually changed to section 2 when arrives to hospital!)
Section 5 (2)?
VOLUNTARY PATIENT IN HOSPITAL can be detained by DOCTOR for 72 hours
5(2) =72
What visual defect does a pituitary adenoma characteristically give?
Bitemporal hemianopia
What visual defect do you get in
-temporal lesion
-parietal lesion?
-temporal - superior homonymous quadrantopia
Parietal - inferior homonymous quadrantopia
‘Superior temple, inferior Parish church!!’
How does IIH (idiopathic intracranial HTN) usually present
Who does it normally affect?
Headache - WORSE IN MORNING, relieved on standing
Diplopia
Transient visual obscurations (greying of vision up to 5 secs)
Nausea/vomiting
Tinnitus
Obese females in 3rd decade of life
Tests for Myasthenia Gravis?
Electromyography under repetition stimulation (repetitive nerve stimulation studies)
Serum anti-AChR antibodies
CT thorax - to look for thymoma
What is conversion disorder?
Alteration/loss of FUNCTION (typically motor/sensory) suggestive of physical disorder, but presumed to be expression of underlying conflict/need - the purpose being to bind anxiety and keep conflict internal
Treatment for myasthenia gravis?
Acetylcholinesterase inhibitors ie pyridostigmine (temporary symptomatic treatment) ‘Build MY pyramids!’
As becomes generalised - steroids, azathioprine, ciclosporin
Monoclonal antibodies ie rituximab
Very shy patient, no friends, never had a girlfriend…Dx?
‘Social phobia’
Causes of SIADH?
-IDIOPATHIC (most common)
-CNS disease- tumour, trauma, infection, CVA, SAH, GBS, Delerium tremens, MS
-Pulmonary disease - tumour, pneumonia, COPD, lung abscess, TB, CF
-Carcinoma - lung/pancreas/thymoma, ovary, lymphoma
-Drugs - NSAIDs, nicotine, diuretics, carbamazepine, TCAs, SSRIs, vincristine
-Surgery (post-op)
30’y/o with cataracts, frontal balding and muscle weakness. Dx?
MYOTONIC DYSTROPHY (classic triad)
Drugs for Alzhemier’s?
‘Don’t Get Rubbish Memory’
Donepezil
Galantamine
Rivastigmine
Memantine (NMDA receptor antagonist)
(First 3 options are reversible inhibitors of acetylcholinesterase and are the first line options)
First line for tonic-clonic seizures?
Males?
Females?
Males - sodium valproate
Females - Lamotrigine or Levetiracetam
First line tx for focal seizures?
Lamotrigine or levetiracetam (focaL)
First line for absence seizures?
ETHOSUXIMIDE (‘sucks to miss out (absence)’)
Which (number) gene is the defected Hungtingtin gene in Huntington’s on?
Chromosome 4
Difference between malingering and factitious disorder
Malingering - EXTERNAL INCENITIVES present ie desired medications
Factitious - FALSIFIED symptoms for sick role, no other incentive! (Munchausen is an extreme form of this!)
