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My MRCPsych Paper B > Quizzes > Flashcards

Quizzes Flashcards

1
Q

Psychotropic that can cause severe epigastric pain that radiates to the back, with associated vomiting.

A

Sodium valproate, pancreatitis

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2
Q

Mood stabilizer that can cause hypercalcemia

A

Lithium
*barbiturates, VA, carbamazepine, and haloperidol cause HYPOcalcemia

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3
Q

CASE: bipolar I disorder pregnant patient on lithium during 3rd trimester, serum level of 0.75mmol/L + no plans of breastfeeding. Course of management.

A

> Suspend lithium 24-48 hours before planned CS or induction, and at the onset of labour.
Lithium levels should be measured 12h after last dose
If within therapeutic range, restart lithium day 1 postnatal
Check serum levels after 1 week
*During pregnancy, due to the increase in total body water, lithium dose should be increased to maintain therapeutic range. However, requirements return to pre-pregnancy levels immediately after delivery.

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4
Q

ICD-11 trait domain specifiers

A

Borderline pattern
Anankastia
Detachment
Dissociality
Disinhibition
Negative affectivity

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5
Q

Likelihood of an individual completing suicide within two years following an initial act of DSH

A

1%

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6
Q

CASE: adolescent with mild depression. Course of management.

A

First line: 4 weeks - watchful waiting, with maintained contact with the family

If it persists: 2-3mos of individual non-directive supportive therapy, group CBT, guided self-help

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7
Q

CASE: adolescent with moderate to severe depression

A

First line: 3mos CBT, IPT or family therapy

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8
Q

Pattern of acts of assault, threats, humiliation, intimidation, or abuse that is used to harm, punish, or frighten a victim.

A

Coercive control

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9
Q

Risk of having another child with Down syndrome if a parents has balanced translocation (asymptomatic carriers with 45 chromosomes - enough genetic material but in the wrong location)

A

15%

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10
Q

Dementia with Capgras syndrome like delusion

A

Dementia with Lewy bodies

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11
Q

Only licensed treatment for moderate to severed TD in the UK

A

Tetrabenazine

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12
Q

Medication management of psychosis in Parkinson’s disease

A

> Consider reducing or stopping anticholinergics and dopamine agonists
Consider to give atypical antipsychotic (low dose quetiapine)
Consideration for cholinesterase inhibitor
Trial of clozapine

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13
Q

DBT treatment stages

A

Pre-treatment phase: assessment, orientation to therapy, commitment to therapeutic contract
Stage 1: reducing life threatening behaviour, behaviour that may interfere with progress and with quality of life
Stage 2: emotional processing of previous traumatic experiences, target post-traumatic stress-related symptoms
Stage 3: develop self-esteem, establish future goals

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14
Q

Stages of Cognitive analytic therapy

A

Reformulation - identification of patterns
Recognition - develop ways to recognise unhelpful patterns
Revision - interventions or alternatives to identified patterns

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15
Q

Drug of choice for the prevention and treatment of antipsychotic-induced weight gain

A

Metformin

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16
Q

First choice medication for akathisia

A

Low dose propanolol
*no contraindications: asthma, bradycardia, hypotension

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17
Q

Treatment for antipsychotic induced hypersalivation

A

Antimuscarinic agents: propantheline, diphenhydramine

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18
Q

Personality trait domains shared by ICD-11 and DSM-5

A

Detachment
Disinhibition
Dissociality/ antagonism
Negative affectivity
*5th domain: anankastic (ICD-11) & psychoticism (DSM-5)

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19
Q

NICE guidelines: youngest age that a child may be considered for antidepressant treatment for depression

A

5yo

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20
Q

McNemar test is particularly suitable when dealing with what kind of data

A

paired categorical data
> before-and-after studies
> repeated measures of proportions
> matched case control studies

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21
Q

Pre-requisite for providing a psychiatric report in clinical proceedings

A

Receiving instructions

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22
Q

Neuroimaging finding most commonly found in individuals with both Down syndrome and Alzheimer’s dementia

A

Cortical thinning

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23
Q

Progression rate of MCI to dementia in 1 year

A

10%

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24
Q

Heritability in frontotemporal dementia is accounted for by what type of mutation

A

Autosomal dominant

25
Q

Among the SGAs, what are the top 3 highest incidence of orthostatic hypotension

A

Quetiapine 27% → Clozapine 24% → Iloperidone 19.5.

Lowest: Lurasidone & Asenapine (<2%)

26
Q

The only 2 drugs licensed in the UK for the management of non-cognitive symptoms associated with dementia

A

Haloperidol

Risperidone
> drug of choice for geriatric population due to haloperidol’s adverse effects
> optimal dose for dementia 1mg BID
> specifically indicated for short term (6 weeks) treatment for persistent aggression
> drug review 4-6w → 3mos → q6mos

27
Q

Case: opioid dependent patient wanting quick detox within a couple of weeks

A

Lofexidine
> 10-day course, withdrawn over 2-4 days
*other meds that can ameliorate symptoms - loperamide, metoclopromide, ibuprofen

28
Q

Case: opioid dependent pregnant patient who is in her first trimester and also currently breastfeeding that wants to quit

A

Methadone
*Buprenorphine - contraindicated due to risk of withdrawal in the foetus
*Suboxone - avoid during pregnancy
*still breastfeed even if they continue opioids

29
Q

Neuroimaging: CT/MRI ventricular dilation of temporal horns + thinning cortex

A

NPH

30
Q

Neuroimaging: SPECT temporal and posterior parietal hypoperfusion

A

Alzheimer’s disease

31
Q

Neuroimaging: CT/MRI relative sparing of medial temporal lobes; frequent periventricular lucencies on MRI

A

DLB

32
Q

Neuroimaging: CT/MRI atrophy of basal ganglia, with boxing of caudate and dilation of ventricles

A

Huntington’s disease

33
Q

Neuroimaging: PET asymmetrically decreased dopamine activity in the basal ganglia

A

Parkinson’s disease

34
Q

Tetrad of narcolepsy

A

Sleep paralysis
Cataplexy
Hypnagogic hallucinations
Excessive sleepiness
[SCHEep]

35
Q

Peak onset of schizophrenia in children and adolescent

A

> 15yo

36
Q

Susser’s Triad of Causal Properties

A

Direction
Association
Time order

37
Q

Most common BPSD seen in Alzheimer’s dementia

A

Apathy

38
Q

Interventions in ID: others mirror his BODY LANGUAGE and pleasantly imitate his vocalizations

A

Intensive interactions

39
Q

Interventions in ID: changes in daily routine via visual displays

A

Now and next cards

40
Q

ECG tracings: 19yo with eating disorder and induced vomiting (hypokalemia)

A

ST segment depression with U waves
*severe hypokalemia can casuse U waves

41
Q

ECG tracings: Clozapine initiation + chest pain (myocarditis)

A

diffuse ST elevation

42
Q

ECG tracings: adult woman Citalopram 40mg OD + recent intake of diphenhydramine

A

QTc proloongation

43
Q

ECG tracings: elderly Alzheimer’s patient on donepezil

A

Sinus bradycardia

44
Q

Opioid effect that do not show any tolerance

A

Constipation and miosis

45
Q

Adjunct to aid formerly opiate dependent patients who want to remain abstinent

A

Natlrexone
*must have been abstinent for 7-10 days to prevent precipitating withdrawals

46
Q

CASE: alcohol dependence, no physical sequelae, seeking pharmacological intervention to reduce alcohol cravings

A

Acamprosate + behavioral couple therapy

47
Q

Paradoxical injunction is originally used in which family therapy technique

A

Systemic family therapy

48
Q

Empty chair technique is usually used by which therapy technique

A

Gestalt therapy

49
Q

NICE guidelines: for bipolar individuals with a manic episode, what should be offered in the first instance

A

Haloperidol, olanzapine, quetiapine, risperidone

50
Q

Baseline likelihood of having a child with ASD

A

1.5%
* if already with 1 child with ASD = 15%
* if already with 2 children with ASD = 30%

51
Q

NICE Guidelines: person developing moderate or severe bipolar depression, not taking any drug to treat the bipolar depression

A

fluoxetine + olanzapine
quetiapine

52
Q

Symptomatic relief of cannabis withdrawal, especially agitation, impulsivity, and irritability

A

Benzodiazepines

53
Q

Increased need for handling in babies is seen in withdrawal of which drug

A

Nicotine

54
Q

Benzodiazepines for those with hepatic impairment

A

alt/ast TOL
Temazepam
Oxazepam
Lorazepam
*short half-lives with no active metabolites

55
Q

Treatment guidelines for ADHD

A

Mild-mod - 1st line: behavior therapy and psychoeducation. No medications.

Severe - Medication treatment
> 1st line: Methylphenidate & dexamfetamine (70% of children improve), atomoxetine (it is an alternative 1st line, NOT second line)

56
Q

Imprinting of chromosome 15 is seen in…

A

Angelman syndrome - loss of maternal contribution
Prader-Willi - loss of paternal contribution

57
Q

Core features of Ganser syndrome

A

Clouding of consciousness
Pseudo visual hallucinations
Approximate answers
Somatic conversion symptoms

58
Q

CASE: 45yo bipolar disorder, currently compliant with lithium therapy only. Recently complained of hypomanic symptoms. Lithium dose was increased to max but no effect. Most appropriate medication to add to prevent relapse of mania.

A

Sodium valproate
*NICE Guidelines:
> acute mania - Optimise lithium monotherapy. If still not effective, add olanzapine, risperidone, or quetiapine
> for maintenance phase - adding VA is the first recommendation when lithium is ineffective

59
Q
A

My MRCPsych Paper B (8 decks)

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