Viva Questions

Question 1

Give some screening tests for alcohol dependence

Answer 1

1. CAGE (have you tried to cut down, if challenged do you get angry, do you ever feel guilty, eye opener.
2. WHO 10 question AUDIT (alcohol use disorders identification test)

Question 2

What are the features of substance dependence?

Answer 2

3 or more of these in a year:

Tolerance
Withdrawal symptoms
Persistent desire/cravings
Failed efforts to cut down
Continued use despite knowing alcohol related harm (physical & psychological)
Spend time getting alcohol/recovering from
Interrupting/stopping work/social/recreational pursuits because of alcohol

Question 3

What are the signs and symptoms of chronic alcohol excess?

Answer 3

Brain- memory impairment, psychological - sleep disturbance, depression, anxiety, psychosis), wernicke’s encephalopathy, Kosakoffs psychosis, alcohol related dementia

GI- oesophageal cancer, chronic gastritis, pancreatitis, hepatitis, liver cirrhosis

Heart- cardiomyopathy

Blood- macrocyclic anaemia, Vitaminwater deficiencies, increased triglycerides leading to increased CVS complications

Peripheral stigmata- gynecomsdtia, palmar erythema, dupytrens contracture, testicular atrophy

Question 4

Describe wernicke’s and korsakoffs

Answer 4

Alcohol related brain injuries caused by vitamin B1 deficiency

Wernicke’s encephalopathy a triad of opthalmoplegia, ataxia and confusion, due to thiamine deficiency causing a brain lesion.

Korsakoffs- memory impairment- mainly anteretrograde amnesia and some retrograde amnesia, confabulation, aphasia, apraxia, agnosia, defect in executive functions

Question 5

What are the causes of delirium?

Answer 5

Infection: UTIs, pneumonia, encephalitis, meiningitis, sepsis

Metabolic: hypercalcaemia, hyponatraemia, thyroid dysfunction, AKI, liver failure

Cardio/Resp: MI, CVA, hypoxia

Drugs: sedetives, opiates, TCAs

NEVER FORGET: urinary retention / constipation

Question 6

What is the most important risk factor for delirium?

Answer 6

Having an underlying cognitive impairment

Question 7

How do you differentiate dementia from delirium?

Answer 7

ONSET - delirium is acute, dementia insidious
COURSE - delirium tends to fluctuate
AWARENESS - v impaired in delirium, late impairment in dementia
ATTENTION - disturbed in delirium/dementia late stages
MEMORY - delirium- poor working memory and immediate recall - dementia poor short term memory
DELUSIONS - delirium- changeable/short lived, dementia more fixed
SLEEP- dementia sleep wake reversal

Question 8

What is the most common type of dementia

Answer 8

Alzheimers - 80%

Question 9

What are the management strategies for delirium

Answer 9

Supportive - gentre re-orientation, calm introductions, clear communicatinon. Reduce sensory impairment e.g. hearing aids, glasses. Help with independence and also involve family/carers as much as possible

Environmental - clock, calendar, photos, good lighting, low noise

Meds - restrict if poss, if needed: haloperidol or lorazepam

Question 10

What should you make sure you also assess when considering a diagnosis of conduct disorder in a child?

Answer 10

• Any other underlying psych conditions e.g. ADHD, PTSD, depression
• Any learning disabilities
• Any substance misuse e.g cannabis/alcohol

Question 11

Who are the 5 people involved in a Section 2 or S3?

Answer 11

• Patient
• AMPH (allied mental health proffesional)
• Med doctor 1
• Med doc 2 (pref their GP)
• Nearest relative

Question 12

What is the psychometric test you can use to diagnose personality disorder?

Answer 12

MMPI - minnesota multiphasic personality inventory