Laboratory and ECG assessment Flashcards
(139 cards)
1
Q
Medical conditions which are associated with depression
A
Coronary artery disease Diabetes End stage renal disease Malignancy HIV Degenerative neurological disorders Stroke
2
Q
Conditions which can mimic depression
A
Addison’s disease
Hypothyroidism
Vitamin B12 deficiency
3
Q
Reason to take FBC when depression is suspected
A
Rule out infectious or inflammatory pathology
4
Q
Reason to take TSH when depression is suspected
A
Rule out hypothyroidism
5
Q
Reason to take B12 level when depression is suspected
A
Rule out deficiency which can mimic depression
6
Q
Reason to take electrolyte levels such as calcium, magnesium when depression is suspected
A
Abnormalities can cause fatigue which could mimic depression
7
Q
Reason to take renal function when depression is suspected
A
To prepare for starting antidepressants
8
Q
Reason to take LFTs when depression is suspected
A
To rule out alcohol related damage is concomitant alcohol misuse is suspected
To prepare for starting antidepressants
9
Q
Reason to take 24 hour free urinary cortisol when depression is suspected
A
To rule out Cushing’s disease if suspected - more common in patients with depression than the general population
10
Q
Reason to take ACTH stimulation test when depression is suspected
A
To rule out Addison’s disease which can mimic depression
11
Q
Depression related conditions in which a dexamethasone suppression test is more likely to be positive
A
Major depressive disorder
Psychotic affective disorder
Depression with suicidality
Somatic syndrome
12
Q
Non-depression related psychiatric conditions in which a positive dexamethasone suppression test can be seen
A
Anorexia nervosa Bulimia nervosa Alcoholism OCD Anxiety
13
Q
Prognostic feature of a positive dexamethasone suppression test in depression
A
More likely to respond to medication
14
Q
Common result of corticotropin releasing hormone test in major depression
A
Blunted ACTH due to HPA axis abnormality
15
Q
Percentage of patients presenting with depression who have overt hypothyroidism
A
1-4%
16
Q
Percentage of patients with depression who have subclinical hypothyroidism
A
4-40%
17
Q
Differential diagnoses for anxiety attacks
A
Paroxysmal atrial tachycardia PE Seizures Meniere's disease TIA Carcinoid syndrome Cushing's Hyperthyroidism Hypoglycaemia Pheochromocytoma
18
Q
Substance that causes a panic attack in 72% of patients with panic disorder when injected
A
IV sodium lactate
19
Q
Infusion rarely used in clinical practice which worsens organic conditions, and improves non-organic conditions, causing anxiety
A
Amobarbitol
20
Q
Differential diagnosis for psychosis
A
Head injury
Seizures
Recreational drug use
Dietary deficiencies e.g. B12, folate, niacin, thiamine
21
Q
Reason to take FBC when investigating psychosis
A
Rule out infections or inflammatory causes
Baseline if starting antipsychotics
22
Q
Reason to take TFTs when investigating psychosis
A
Rule out hypothyroidism or hyperthyroidism
23
Q
Reason to take glucose and lipid profile when investigating psychosis
A
As a baseline prior to starting antipsychotics to rule out pre-existing metabolic syndrome
24
Q
Reason to take an ECG when investigating psychosis
A
As a baseline prior to starting antipsychotics
25
Reason to take prolactin level when investigating psychosis
As a baseline prior to starting antipsychotics
26
Reason to take electrolytes when investigating psychosis
To rule out an underlying cause
27
Reason to take LFTs when investigating psychosis
To rule out chronic alcohol use if suspected
To investigate for Wilson's disease if suspected
As a baseline prior to starting antipsychotics
28
Tests to consider if delirium suspected
```
FBC
CRP
Urine MC&S
CXR
Blood culture
Blood alcohol
Blood glucose
```
29
Tests to consider if STDs suspected
HIV test
Syphilis
STD testing
30
Tests to consider if encephalitis suspected
```
NMDA receptor antibodies
Voltage-gated potassium channel antibodies - LGI 1, CASPR 2, contactin-2
AMPA receptor
GABA-B
Glycine receptor
```
31
Tests to consider if Cushing's disease suspected
24 hour urinary free cortisol
Evening salivary cortisol
Dexamethasone suppression test
32
Symptoms of acute intermittent porphyria
```
Muscle weakness
Seizures
Coma
Anxiety
Confusion
Hallucinations
Rarely overt psychosis
Abdominal pain
NOT a rash - unlike other types
```
33
Tests to consider if porphyria suspected
Spot urine sample for porphobilinogen during attack
| 24 hour urine for porphyrins, porphobilinogen and delta-aminolevulinic acid
34
Tests to consider if hyperparathyroidism suspected
Serum calcium
| Serum parathyroid hormone
35
Neuropsychiatric symptoms of Wilson's disease
```
Cognitive deterioration
Clumsiness
Parkinsonism
Depression
Anxiety
Psychosis
Frontal lobe dysfunction
Migraine
Seizures
```
36
Non-neuropsychiatric manifestations of Wilson's disease
Signs of chronic liver disease - oesophageal varices, splenomegaly, spider naevi
Kayser-Fleischer rings in the eyes on slit lamp examination
Renal tubular acidosis
Cardiomyopathy and heart failure
37
Tests to consider if Wilson's disease suspected
Serum ceruloplasmin
| 24 hour copper excretion
38
Tests to consider if lysosomal storage diseases are suspected
Skin biopsy
Genetic testing
Serum alpha-galactosidase enzyme
39
Tests to consider if homocystinuria suspected
Homocysteine in urine and blood
| Genetic testing
40
Tests to consider if CNS lesions suspected
MRI or CT
| EEG if temporal lobe epilepsy suspected
41
Medications that can precipitate an episode of acute intermittent porphyria
Oestrogens
Benzodiazepines
Barbiturates
Diclofenac
42
Most common sex to suffer from anti-NMDA receptor encephalitis
Female
43
Malignancy found in 50% of women presenting with anti-NMDA receptor encephalitis
Ovarian teratoma
44
Most common first presentation of anti-NMDA receptor encphalitis
Psychosis
| Mania
45
Prodrome associated with anti-NMDA receptor encephalitis
Fever
Headache
Malaise
46
Confirmatory test to diagnose anti-NMDA receptor encephalitis
CSF analysis
47
Treatment of anti-NMDA receptor encephalitis
Steroids
| Plasma exchange
48
Complications caused by giving antipsychotics in cases of anti-NMDA receptor encephalitis
NMS-like syndrome
49
Tests to consider to investigate dementia
```
FBC
CRP
TFT
Electrolytes
Thiamine
Syphilis and HIV if suspected
Glucose, lipids - if vascular dementia suspected
CT or MRI head
```
50
Endocrine abnormalities expected in anorexia nervosa
```
Low LH, FSH, oestradiol
Low T3, normal T4, normal TSH
Mildly raised cortisol
Raised growth hormone
Low glucose
Low leptin
```
51
ECG abnormalities in anorexia nervosa
```
Bradycardia
AV block
ST depression
TWI
Prolonged QT
Arrhythmias
```
52
Haematological abnormalities expected in anorexia nervosa
Normocytic normochromic anaemia
Mild leucopaenia
Thrombocytopaenia
53
Metabolic abnormalities expected in anorexia nervosa
```
Raised cholesterol
Raised phosphate
Raised serum carotene
Low potassium
Raised chloride alkalosis
```
54
Electrolyte abnormalities seen in repetitive vomiting
Metabolic alkalosis
| Hypokalaemia
55
Electrolyte abnormalities seen in laxative misuse
Metabolic acidosis
Hyponatraemia
Hypokalaemia
56
BMI for underweight
<18.5
57
BMI for normal weight
18.5-24.9
58
BMI for overweight
25-29.9
59
BMI for obesity
30 or greater
60
Method to calculate BMI
weight in kg/(height in metresxheight in metres)
61
BMI if weight is 60kg and height is 170cm
20.8
62
BMI if weight is 35kg and height is 150cm
15.6
63
Most specific and sensitive test for detecting heavy alcohol use over the last 10 days
Carbohydrate deficient transferrin
64
Neurological complications of alcohol abuse
```
Seizures
Wernicke's Korsakoff syndrome
Peripheral neuropathy
Coma
Amnesia
Cerebellar degeneration
```
65
GI complications of alcohol abuse
```
GI bleeds/oesophageal varices
Peptic ulcer
NAFLD
Malnutrition
Cirrhosis
Portal hypertension
Pancreatitis
Hypoglycaemia
```
66
Cardiovascular complications of alcohol abuse
Cardiomyopathy
HTN
Raised lipids
67
Haematological complications of alcohol abuse
Raised MCV anaemia
Folic acid and B12 deficiency
Pancytopaenia
Clotting disorders
68
Respiratory complications of alcohol abuse
Klebsiella pneumonia
| Lung cancer
69
Endocrine complications of alcohol abuse
Testicular atrophy
Sexual disorders
Menstrual irregularities
70
Complications of alcohol abuse in pregnancy
Low birth weight
Foetal alcohol syndrome
Developmental delays
Neural tube defects
71
Normal QTc in women
470ms
72
Normal QTc in men
440ms
73
QTc associated with an increased risk of torsades de pointes
>500ms
74
Medical causes of prolonged QTc
```
Hypokalaemia
Hypomagnesaemia
Hypocalcaemia
Hypothermia
MI
Congenital long QT syndrome
```
75
Common psychotropics that prolong the QTc
```
Haloperidol
Venlafaxine
Chlorpromazine
Quetiapine
Amisulpride
Olanzapine
Amitriptyline
Doxepin
Citalopram
Moclobemide
Escitalopram
Bupropion
```
76
Common non-psychotropic drugs that prolong QTc
```
Erythromycin
Clarithromycin
Sotalol
Amiodarone
Flecainide
Loratidine
Hydroxychloroquine
```
77
Antipsychotics with high effect on QTc
Haloperidol
Pimozide
High Dose Antipsychotic Therapy
78
Antipsychotics with moderate effect on QTc
Chlorpromazine
Quetiapine
Amisulpride
79
Antipsychotics with low effect on QTc
```
Clozapine
Flupentixol
Olanzapine
Prochlorperazine
Risperidone
Sulpride
Paliperidone
```
80
Antipsychotics with no effect on QTc
Aripiprazole
Zuclopenthixol
Lurasidone
81
Urine test to check for adulteration with tap water
Specific gravity
82
Time alcohol can be present in urine
Up to 12 hours
83
Time amphetamines can be present in urine
Up to 48 hours
84
Time benzodiazepines can be present in urine
Up to 3 days (depending on half life)
85
Time cannabis can be present in urine if occasional use
Up to 3 days
86
Time cannabis can be present in urine if regular use
Up to 4 weeks
87
Time cocaine can be present in urine
6-8 hours
88
Time cocaine metabolites can be present in urine
Up to 4 days
89
Time codeine can be present in urine
48 hours
90
Time heroin can be present in urine
1-3 days
91
Time methadone can be present in urine
3 days or more
92
Time morphine can be present in urine
2-3 days
93
Time phencyclidine (PCP) can be present in urine
8 days
94
Renal diseases associated with IV drug use
```
Nephrotic syndrome
Acute glomerulonephritis
Amyloidosis
Interstitial nephritis
Rhabdomyolysis
```
95
Plasma osmolality in diabetes insipidus
High
96
Urine osmolality in diabetes insipidus
Low
97
Urine osmolality after fluid deprivation in cranial diabetes insipidus
Low
98
Urine osmolality after desmopressin in cranial diabetes insipidus
High
99
Urine osmolality after fluid deprivation in nephrogenic diabetes insipidus
Low
100
Urine osmolality after desmopressin in nephrogenic diabetes insipidus
Low
101
Plasma osmolality in psychogenic polydipsia
Low
102
Urine osmolality in psychogenic polydipsia
Low
103
Urine osmolality after fluid deprivation in psychogenic polydipsia
High
104
Urine osmolality after desmopressin in psychogenic polydipsia
High
105
Plasma osmolality in SIADH
Low
106
Urine osmolality in SIADH
High
107
Symptoms of mild/moderate hyponatraemia
```
Lethargy
Muscle cramps
Anorexia
Nausea
Vomiting
```
108
Symptoms of severe hyponatraemia
Coma
Convulsions
Death
109
Medications which can trigger an episode of acute intermittent porphyria in a susceptible individual
```
Oestrogens/progesterone/testosterone
Barbiturates
Benzodiazepines
Diclofenac
Fluconazole/ketoconazole
HIV medication
Nifedipine
Chloramphenicol
Anticonvulsants
```
110
Times when REM sleep patterns can be seen during the daytime
Narcolepsy
Sleep deprivation
Withdrawal from stimulants
111
ECG abnormality associated with TCAs
Heart blocks
112
Psychotropic medications associated with bradycardia on ECG
SSRIs
Lithium
Acetylcholinesterase inhibitors
113
Psychotropic medications associated with tachycardia on ECG
```
Clozapine
TCAs
MAOIs
Antiparkinsonian drugs
Antipsychotics
```
114
Psychotropic medications associated with ST and T wave abnormalities on ECG
Thioridazine
| Chlorpromazine
115
Raised levels of metabolites found in a phaeochromocytoma
Vanillylmandelic acid
| Homovanillic acid
116
Prolactin levels following seizures and non-epileptic seizures
Usually raised following seizures to >500
| Usually normal following non-epileptic seizures
117
Laboratory findings in Wilson's disease
Reduced serum caeruloplasmin
Reduced serum copper
Increased 24 hour urinary copper excretion
118
Normal rate on ECG
60-100
119
Normal PR interval on ECG
0.12-0.2s
120
Causes of U waves
Normal ECG
| Hypokalaemia
121
T waves seen in hyperkalaemia
Tall, tented
122
T waves seen in hypokalaemia
Flat, prolonged
123
Most common thyroid function abnormality seen in sick euthyroid syndrome
Low T3
124
Waist circumference in men considered normal
94-102cm
125
Waist circumference in women considered normal
80-88cm
126
Waist circumference in men considered high
>102cm
127
Waist circumference in women considered high
>88cm
128
Drug causes of hypercalcaemia
Thiazide diuretics
Lithium
Vitamin D
Vitamin A
129
Use of the carbohydrate deficient transferrin blood test
To detect recent heavy alcohol consumption
130
Abnormal blood tests seen in alcohol depenence
Raised GGT
Raised ALT and AST
Raised MCV
Decreased WCC
131
BMI under which an ECG should be carried out in patients with anorexia
16
132
ECG changes seen in Huntington's disease
Conduction abnormalities
| Bradycardia
133
Normal ratio of CSF to serum glucose
0.6:1
134
Proteins in the CSF associated with CJD
14-3-3
135
Most sensitive test to investigate for clozapine induced myocarditis
Troponin
136
CSF finding associated with aggressive and impulsive behaviour, and increased suicidality
Low 5-HIAA
137
Psychiatric disorders which show a reduced CSF concentration of somatostatin
Depression
Bipolar disorder
Alzheimer's dementia
138
Type of heart block where there is gradual prolongation of the PR interval until there is a p wave not followed by a QRS complex
Second degree AV block, Mobitz type 1
139
Type of heart block where there are intermittent p waves without a following QRS without gradual prolongation of the PR interval
Second degree AV block, Mobitz type 1
