Neurology and Psychiatry

Question 1

What is ADHD?

Answer 1

A neurodevelopmental conditional with hyperactivity, impulsivity and inattention

Question 2

What are the risk factors for ADHD?

Answer 2

low parental education, parental smoking, maternal depression, low birth weight, prematurity

Question 3

What is there reduced function of in ADHD?

Answer 3

The frontal lobe which controls executive function

Question 4

What is the first line medication for ADHD?

Answer 4

Methylphenidate

Question 5

What is Methylphenidate?

Answer 5

ADHD medication that is a CNS stimulant and requires ECG baseline before starting

Question 6

What is ASD?

Answer 6

A neurodevelopmental disorder with abnormal social interaction, communication and restricted, repetitive behaviours

Question 7

What are the risk factors for ASD?

Answer 7

male, family history, chromosomal abnormality such as Downs

Question 8

What are some presentations of autism?

Answer 8

Social interaction - unable to interpret cues, inability to form attachments and understand emotion
Communication - delayed or minimal speech, impaired make believe, lack of gestures, monologues, endless questions
Restricted behaviour - tendency to restrict change, inability to adapt to new environments

Question 9

What are the features of anorexia nervosa?

Answer 9

excessive weight loss, lanugo hair, amenorrhoea, hypotension, hypokalaemia, hypothermia, depression, skin pallor and dryness, oedema, osteopenia, cardiac complications

Question 10

What is the BMI for extreme anorexia nervosa?

Answer 10

Under 15

Question 11

What is refeeding syndrome?

Answer 11

Occurs when there has been severe nutritional deficit for an extended period and patients start to eat again

Question 12

What can refeeding syndrome cause?

Answer 12

Hypomagnesaemia, hypokalaemia, hypophosphataemia

Question 13

What is bulimia nervosa?

Answer 13

Episodes of binge eating where a person suffers a loss of control and eats more than usual.

This goes alongside compensatory mechanisms to prevent weight gain including self-induced vomiting, laxatives and heavy exercise.

Question 14

What is the presentation of bulimia nervosa?

Answer 14

binge eating, body image distress, uncomfortable eating with others, mood disturbance, purging, tooth erosion, weight fluctuation, swollen salivary glands, abdo pain

Question 14

What is Russel’s sign?

Answer 14

Calluses on the knuckles where they have scraped their teeth in bulimia nervosa

Question 15

What can hypokalaemia show on ECG for bulimia?

Answer 15

Increased P wave amplitude, prolonged PR, ST depression, T wave flattening and prominent U waves

Question 16

What is the first line treatment for bulimia?

Answer 16

SSRI - fluoxetine then sertraline

Question 17

Name 4 complications of bulimia nervosa?

Answer 17

Gastric ulcers, irregular menstrual cycles, osteoporosis, heart problems including heart failure

Question 18

What is a febrile convulsion?

Answer 18

A type of seizure that occur in children with a high fever not caused by epilepsy or other neurological pathology.

Question 19

What is the typical age of a febrile convulsion?

Answer 19

6 months to 5 years

Question 20

What is a simple febrile convulsion?

Answer 20

Generalised tonic clonic seizure of less than 15 minutes

Question 21

What is a complex febrile convulsion?

Answer 21

Partial or focal seizure lasting more than 15 minutes

Question 22

What has to be excluded in febrile convulsions?

Answer 22

Epilepsy, meningitis, encephalitis, intracranial space occupying lesions, syncopal episode, trauma

Question 23

What are the two branches of seizures?

Answer 23

Generalised and focal

Question 24

What is a tonic clonic seizure?

Answer 24

Loss of consciousness with tonic (muscle tensing) and clonic (jerking) with tongue biting, irregular breathing, groaning and irritable confusion afterwards

Question 25

What is the treatment for tonic clonic seizures?

Answer 25

Sodium valporate or lamotrigine in girls

Question 26

What is an absence seizure

Answer 26

typically in childhood - stare into space then return to normal within 10-20 second

Question 27

What is the treatment for absence seizures?

Answer 27

Ethosuximide or lamotrigine in girls

Question 28

What are atonic seizures?

Answer 28

Brief lapses in muscle tone

Question 29

What are myoclonic seizures?

Answer 29

Sudden brief muscle contractions where patient doesn't lose consciousness

Question 30

What are frontal lobe seizures?

Answer 30

Motor or premotor cortex that can lead to clonic movements travelling proximally (Jacksonian march)

Question 31

What are temporal lobe seizures?

Answer 31

The most common with strange warnings, aura, lip smacking, automatisms and deja vu

Question 32

What is the treatment of focal seizures?

Answer 32

Lamotrigine

Question 33

What are the investigations for epilepsy?

Answer 33

History, EEG, brain MRI, ECG, electrolytes and blood glucose

Question 34

How does sodium valporate work?

Answer 34

Increases GABA activity in the brain which has a relaxing effect

Question 35

What are the side effects of sodium valporate?

Answer 35

Teratogenic, hair loss, tremor, weight gain

Question 36

What are the side effects of carbmazepine?

Answer 36

Agranulocytosis, aplastic anaemia, ataxia, induces the P450 drug system

Question 37

What is a side effect of lamotrigine?

Answer 37

Stevens Johnson syndrome

Question 38

What is status epilepticus?

Answer 38

Seizure back to back without regaining consciousness or seizure more than 5 minutes

Question 39

How do you manage status epilepticus?

Answer 39

Benzodiazepines, lorazepam then phenytoin

Question 40

Which diagnostic tool is used for ADHD?

Answer 40

DSM-5

Question 41

Describe inattention in ADHD

Answer 41

Easily distracted Forgetful in daily activities Finds it difficult to organise task + activities Does not appear to be listening when spoken to directly

Question 42

Describe ‘hyperactivity’ as applied to ADHD

Answer 42

Cannot remain seated and talks excessively

Question 43

In some adults diagnosed with anxiety / depression, what underlying condition might they have?

Answer 43

ADHD

Question 44

What is the treatment for autism?

Answer 44

No medication Educational support Verbal support SLT