Psychiatry/neurology

Question 1

De Clarambault’s syndrome?

Answer 1

Delusion of being loved, generally by someone of superior social status
‘Clara loves me, she does!’

Question 2

Fregoli syndrome?

Answer 2

A Familiar person ie wife, falsely identiFied in strangers
(‘Fs - Fregoli, familiar faces, falsely identiFied’)

Question 3

Capgras syndrome?

Answer 3

Familiar person is replACed by a stranger who is their exact double

Question 4

Othello syndrome?

Answer 4

Delusion of infidelity of partner ‘liking OTHEr person’

Question 5

Section 2?

Answer 5

Admission for assessment for up to 28 days
2=28

Question 6

Section 3?

Answer 6

Admission for TREAtment for up to 6 months

Question 7

Section 4?

Answer 7

72 hour assessment order

Question 8

5(2)?

Answer 8

Dr detaining power - 72 hours (voluntary patient in hospital only)

Question 9

5(4)?

Answer 9

Nurse detaining power - 6 hours (for patients voluntarily in hospital)

Question 10

Section 135?

Answer 10

Police can break into property to move person to place of safety

Question 11

Section 136?

Answer 11

Someone in public place can be taken by police to place of safety

Question 12

What is facticious disorder?

Answer 12

Patient Falsifies medical or psychiatric symptoms ie interfering with wound/causing infection

Question 13

Definition of Parkinsonism? (Symptoms)

Answer 13

Bradykinesia
Plus one of:
-tremor
-rigidity and/or postural instability

Question 14

If low mood symptoms with minimal effect on function within 10 days of giving birth, what is diagnosis?

Answer 14

‘Baby blues’

Question 15

Fridreich’s ataxia
-what is it?
-complications?

Answer 15

Autosomal recessive inherited degenerative disease that primarily affects nervous system and heart

-Cardiomyopathy
-Diabetes

Question 16

Questionnaire used to screen for eating disorders?

Answer 16

SCOFF

Question 17

1st line tx for trigeminal neuralgia?

Answer 17

Carbamazepine

Question 18

20 y/o man, weakness in both legs, viral URTI few weeks ago. Likely Dx? Tx?

Answer 18

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!!)

Question 19

After TIA, what driving advice?

Answer 19

Can start driving if symptom free after 1 month (no need to tell DVLA!)

Question 20

Treatment for cluster headache (acute)?
Prophylaxis?

Answer 20

Acute - sumatriptan (subcut), oxygen

Prophylaxis- prednisone, verapamil

Question 21

Corresponding GCS for AVPU:
A?
V?
P?
U?

Answer 21

A = 15
V = 12
P = 8
U = 3

Question 22

When to perform CTB within 1 hour

Answer 22

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

Question 23

When to do CTB within 8 hours?

Answer 23

If some LOC/amnesia plus:
-age >65
-hx bleeding/clotting disorders
-dangerous mechanism injury
>30 min retrograde amnesia of events immediately before head injury

Question 24

First line Tx for newly diagnosed tonic-clonic seizures?

Answer 24

Sodium valproate (unless premenopausal females - lamotrigine)

Question 25

Lithium side effects?

Answer 25

LITHIUM
Leukocytosis
Increased urine output
Tremors/thirst
Hypothyroidism
Increased weight
Upset stomach (N/V)
Muscle weakness/mental issues

Question 26

Lithium monitoring?

Answer 26

Lithium levels every 3 months
TFTs, U&Es, Calcium every 6-12m

Question 27

30 y/o man presents with wasting of small hand muscles, and loss of pain and temp over trunks and arms. Dx?

Answer 27

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

Question 28

How does Pseudobulbar palsy present? Who does it affect and what is it?

Answer 28

-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

Question 29

Recurrent pregnancy loss and positive lupus anticoagulant suggests what Dx?

Answer 29

Antiphospholipid syndrome

Question 30

What is myasthenia gravis and how does it present?

Answer 30

Acquired autoimmune disease
Antibodies against the nicotinic acetylcholine receptor at the neuromuscular junction

Easy fatigueability