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MRCP PART 1 > psych > Flashcards

psych Flashcards

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1
Q

X linked inheritance. Children of men with condition ? Children of female carriers

A

All daughters carriers
Sons fine

Daughters 50% carrier
Sons 50% affected

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2
Q

EPS most likely from?
-Parkinsonism an easy one from question but what is described below:
Motor restlessness with inability to sit still?
Involuntary contractions of muscle groups?
Involuntary movements of face (and sometimes trunk) that occur after manny years?

A

Typical antipsychotics
Akathesia
Dystonia (includes oliguric crisis)
Tardive dyskinesia

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3
Q

Management of dysmorphophobia

A

CBT
Rarely cosmetic surgery

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4
Q

Presents with lots of symptoms which cannot be medically explained

A

Somatisation disorder

[Has poor prognosis due to iatrogenic medical / surgical interventions]

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5
Q

Deliberately acts medical symptoms to receive medical treatment or attention / sympathy

A

Factitious disorder

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6
Q

Deliberately making up symptoms to gain something (e.g opioids) or for the avoidance of work / another type of duty

A

Malingering disorder

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7
Q

Fear of scrutiny of others (eg people commenting or critisiing) leading to avoidance of social situations? How does this differ from Agoraphobia?

A

Social phobia

Agoraphobia - Fear of being away from home, crowds or public places rather than the pure fear of social contact. Often has a fear escape would be difficult

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8
Q

Loss of motor control and sensory functions not explained by physiological mechanisms

A

Conversion disorder (also dissociative disorder)
- often associated with psychological conflict

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9
Q

What is la belle indifference ?

A

Lack of concern over significant symptoms

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10
Q

What is Ganser syndrome

A

Psych - amnesia, stupour, possessive disorder, trance

Phys - Motor disorders, anaesthesia / sensory, motor disorders

Generally 4 points for diagnosis
-Approximate answers
-clouded consciousness
-conversion disorder
-Hallucinations

[DONT confuse with conversion disorder]

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11
Q

MRI of conversion disorder may demonstrate …

A

limbic system overriding sensory

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12
Q

Minimum duration of symptoms for ADHD diagnosis? Age?
Usually methylphenidate but what other drugs?

A

6 months
-Usually needs (6) symptoms occurring in multiple settings and present by age 12

Adderal - amphetamine
Noradrenalin and serotonin reuptake inhibitors - atomoxetine

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13
Q

Gout, renal problems, poor muscle control, learning difficulty

A

lesch-nyhan syndrome (x linked)

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14
Q

Short with a big forhead / head / ears and massive testis

A

fragile x

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15
Q

Screening tool for postpartum depression

A

Edinburgh postnatal depression scale

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16
Q

When does postpartum blues happen

A

Early - first week commonly

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17
Q

When does post partum psychosis occur?

A

Usually about 2 weeks post partum

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18
Q

Structural brain abnormalities on MRI linked to depression

A

Lesions in subcortical white matter
Reduced glial cells in pre frontal cortex
atrophy of hippocampus

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19
Q

Depression diagnosis

A

core Sx - low mood, energy and anhedonia

Lasting > 2 weeks

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20
Q

Chronic mild depression symptoms which may be associated with physical/psychological illness

A

Dysthymia

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21
Q

Depression and thinks dead

A

cortard syndrome

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22
Q

Key organic causes of depression to exclude

A

Hypothyroid
Drug induced - Eg benzos / propranolol / POP /

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23
Q

Pathophysiology in FTD

A

Tau proteins or other protein inclusions

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24
Q

Most common gene in FTD? What else can this gene cause?

A

C9orf72
-Also causes MND

[Just vaguely remember to recognise the shape of it]

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25
Loss of vocab with maintained fluency of speech. Forget familiar faces but memory and visual spacial skills presented.
Semantic dementia - type of FTD
26
Slow, hesitant grammatically incorrect speech, Impaired understanding of complex sentences - though understanding of individual words preserved. Impairment of orofacial muscles Eg swallow, yawn Stuttering, repetition inability, difficulty reading/writing
Progressive non-fluent aphasia - Type of FTD
27
Reversible cause of dementia? Sx?
Normal pressure hydrocephalus apathy Inattention urinary incontinence gait apraxia
28
Presents like schitz but with Macrocytoisis, thrombocytopenia and anaemia on bloods
Delerium tremens
29
Nerve palsy in Wernicke encephalopathy
CN VI - lat rectus [confusion + nystagmus]
30
2 parts of korsakovs sx
short term memory loss confabulation
31
Which drug makes drinking feel shite? Which reduces alcohol craving?
Disulfiram Naltrexone
32
Management of mania in bipolar
Antipsychotics Eg risperidone / olanzapine
33
Who cant get lithium
Pregnant Renal / thyroid / cardiac / Addison's disease
34
Monitoring in clozapine
weekly blood counts for 18 weeks Then fortnightly for 1 year Then monthly
35
External factors Eg 'spirits' or friends controlling ones actions
External locus of control
36
History of depression + evidence of post-natal depression Rx
SSRI - Sertraline good as only minimal in breast milk If didn't have history of depression - CBT is good
37
Which antihypertensives are bad to take with lithium
thiazides - reduce lithium excretion -> toxicity
38
Withdrawal from social contact leads to isolation and inability to display feelings/experience pleasure
Schizoid personality disorder
39
Narcissistic vs histrionic disorder
N - Belief they are perfect / successful H- Shallow with a tendency to seek attention / excitement
40
Psychodynamic therapy?
Examines ways events are perceived by a person -> develop adaptive mode of response
41
CBT
Explores how people think and allows to reformulate behaviour
42
Borderline personality disorder therapy
Dialectical behaviour therapy - develop coping skills and impulse control
43
Lithium monitoring
1 week after starting / dose change Once stable 1-2monthly for 6 months Then every 3-6 months Thyroid and renal function before starting and every 6 months
44
Narcolepsy gene
HLA DQ0602
45
Who gets sudden loss of muscle tone (cataplexy) and hypnagogic/hypnopompic hallucinations ? Rx? Rx if cataplexy?
Narcolepsy Modafinil sodium oxybate [get hallucinations as early REM sleep]
46
GAD treatment + length
SSRI - continued for at least 1 year CBT Monitored every 2 weeks for 3 months then every three months -Treatment continued for a minimum of 1 year
47
Most common cause of death in schitx
CV disease - unhealthy lifestyle and effects of antipsychotics
48
Delirium in parkinsons
Lorazapam
49
Most common trait in antisocial personality disorder
neglect for rights of others
50
Mild mod severe profound learning difficulty IQ
Mild <70 mod <50 severe< 35 Profound <20
51
Body dysmorphic disorder 1st line is CBT If severe which is 1st line choice of SSRI
Fluoxetine [worried they are Fat Fux-] Clomipramine is second line
52
Called when separate ones thoughts from emotion. Eg staying calm and no emotion if a child suddenly dies?
isolation
53
What is a haptic hallucination
Flase sensory perception - Eg being touched / strangled / insects crawling under skin
54
What is dissociative amnesia
amnesia when trying to avoid current stressors Eg unable to remember name/job/address after a marriage breakdown
55
When do delta waves begin to occur in sleep? Which stage is deepest?
Stage 3 stage 4 is deep sleep and has the most delta waves
56
Most toxic ssri in overdose
Citalopram
57
Which ssri has particularly problems with withdrawal
paroxetine ->isomnia, anxiety, agitation...
58
Differentiate lewy body and Alzheimer's
Fluctuating cognitive function Excessive somnolence Visual hallucinations Parkinsonism [Both get auditory hallucinations, lewy body gets more visual]
59
What are lewy bodies made of
a-synuclein
60
Buspirone class? used for? most common side effect
Partial Serotonin reuptake inhibitor - used for anxiety Nasal congestoin
61
How long symptoms GAD for diagnosis
6 months minimum
62
Mild learning difficulty (IQ<70) - most common cause
Idiopathic
63
Only absolute CI to ECT
Raised ICP
64
What is st johns wot used for?
mild depression
65
Characteristic on CT of wernike/korsakov
Loss of neurones in mamillary body (eventually -> cerebral atrophy though this is less specific)
66
visual loss pattern in conversion disorder
spiralling loss
67
seen in 50% of people taking lithium in first month
fine tremor
68
How many people get hypothyroid with lithium?
20%
69
Why no lithium in pregnancy
Babies born with ebstein's anomaly -Malformed tricuspid valve (especially in early preg)
70
4 features of ganser
HACC (not a good hack) -Hallucinations -Approximate answers -clouded consciousness -conversion disorder
71
Cortisol in anorexia
Raised due to stress response to starvation
72
Class is clozapine
atypical
73
Which antipsychotic most linked with high prolactin
risperidone
74
Genetic disorder with severe learning difficulty, wheelchair bound and often aggressive / self-injuring behaviour ? Caused by what
lesch-nyhan syndrome X-linked recessive Disorder of purine metabolism -> high uric acid / xanthine
75
<18 depression rx?
CBT only as high risk of suicide with SSRIs
76
What % of PTSD recover spontaneously? Rx otherwise ?
80-90% Trauma focused CBT eye movement desensitisation and reprocessing SSRI/venlafaxine
77
What BMI for anorexia
<18.5
78
Pathological findings hungtintons
Neuronal loss in caudate and putamen
79
Picks disease pathological finding? what are they?
Pick bodies -Round silver staining inclusions (contain hyperphosphorylated tau protein)
80
Chronic traumatic encephalopathy usually called? Seen on pathology?
Punch drunk syndrome [first described in boxers] Neurofibrinilary tangles
81
Lithium is first line for bipolar. What is second
Valproate
82
What is cyclothymia
Chronic mild bipolar with less severe symptoms either side
83
Most common cause of inherited learning difficulty? Gene?
Fragile X FMR1 gene [long face, big ears, autism...]
84
Class are antipsychotics
Dopamine antagonists
85
Rx of dystonic reaction eg oculogyric crisis
Anticolinergics Eg procyclidine / benztropine
86
Pt had read passage in bible which refers to him having special powers. Now has ability to control other peoples movements.. What is this
Delusion of reference [Delusion of control is that of people controlling your thoughts/movements]
87
What is bathophobia
Fear of depths
88
Fear of open spaces, crowds and unfamiliar settings?
Agoraphobia [Social phobia is fear of interacting with people]
89
How does dilsufiram work
Inhibits Acetylealdehyde dehydrogenase
90
Acamprosate class
GABA-like drug that acts on glutamatergic NMDA receptor [same receptor as alcohol to reduce craving]
91
which antidepressants cause anticholinergic side effects?
Tricyclics
92
Which infection is associated with development of OCD
B-haemolytic strep
93
First line pharma rx for OCD
Citalopram
94
Lack of interest in social relationships, solitary lifestyle, emotional coldness / apathy
Schizoid personality disorder
95
Indicator of poor prognosis in schitz
Negative symtoms predominate - Eg long history of social withdrawal
96
Screening tool for eating disorders
SCOFF [Do you make yourself SICK because you feel uncomfortably full? Do you worry you have lost CONTROL over how much you eat? Have you recently lost more than ONE stone in a 3 month period? Do you believe yourself to be FAT when others say you are too thin? Would you say that FOOD dominates your life?]
97
What is main indication for ECT
Depression with life threatening features (Eg psychotic - auditory hallucination 'worthless and deserve to die'
98
Pseudo dementia key features ? And differentiate from dementia
Depression with relatively acute onset cognitive impairment Often complain about cognitive difficulties
99
How to move from a MAOinhibitor to SSRI
Stop MAO wait 14 days then start SSRI [Otherwise risk of serotonin syndrome]
100
Complains one person cunning bad, selfish... And another kind, helpful and generous What is this? How is it different from idealisation?
Splitting -Splits people into Good or bad In idealisation there is over-emphasis on good persons qualities
101
What is fabricated or induce illness commonly called
Munchausens by proxy
102
Buspirone used for? Class
Acute anxiety Partial serotonin receptor agonist
103
Which stage of sleep for sleepwalking
Stage 3 NREM
104
What is sublimation
Filtering of behaviour so only socially acceptable forms displayed
105
What is altruism
acting in a selfless manner to benefit others
106
Nephrogenic DI which osmolalities are low/high
Urine low Serum high
107
When are SSRIs not first line for depression
Bleeding risk Eg on warfarin / heparin ->mirtazapine
108
Rx of diarrhoea if opiate withdrawal and don't know how much methadone been taking?
Loperamide
109
How long continue antidepressants after recovery? if multiple relapses?
6 months 2 years if recurrent relapses
110
Erectile dysfunction. Still getting morning erections 1st line Rx
Psychosexual counciling
111
How many CAG repeats for huntingtons
>37
112
Strange thing which is a good prognostic factor for shitz
History of a mood disorder or FHx of mood disorder
113
Buproprion used for
Antidepressant used for smoking cessation
114
Insomnia, low mood, delusions (eg of guilt) and psychomotor agitation
Major depression
115
belief your actions are being controlled by external source
Made actions
116
Streetlights came on because the spies are watching them
Delusion of perception
117
Feelings controlled by external source
Made feelings
118
Sensations being imposed on by a outside force
Somantic passivity
119
Motor or sensory deficit with no organic cause
Conversion disorder
120
Increased risk of suicide in depression when
Feeling of hopelessness
121
Difference between alcohol abuse and dependence
Dependence - symptoms of withdrawal and tollerance
122
When does benzo withdrawal start Paroxetine withdrawal
48-72hrs 24-48hrs
123
Socially withdrawn, eccentric behaviour / beliefs, paranoia, possible some mild "psychotic" symptoms
Schitzotypal
124
what is key aspect of a phobia
The patient believes it is irrational
125
Unpredictable behaviour. chronic loneliness or boredom. Self-harm. Poor relationships
Borderline personality disorder
126
Key risks for young person suicide
Parental divorce
127
Anorexic with poor wound healing, hair loss and glositis is deficient in what?
Zinc deficiency [Vit C (scurvy) causes the same but less common in anorexic
128
Panic disorder if no option for CBT in q
SSRI eg citalopram
129
What social factors are assoc with completed suicide
Loss of job Homelessness Low socioeconomic status [living along is not one]

MRCP PART 1 (22 decks)

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