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MRCP - Part 1 > psych > Flashcards

psych Flashcards

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1
Q

What is conversion disorder

A

Functional neurological symptom disorder

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2
Q

What is conversion disorder suggested by

A

Loss of motor control or sensory function
Not fully explained by physiological mechanisms
Assosiated with psychological conflict

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3
Q

What is hypochondriasis

A

Preoccupation with body illness
Accompanying anxiety and health seeking behaviour

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4
Q

Mechansim of buspirone

A

Partial serotonin receptor agonist

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5
Q

Treatment of PTSD

A

Eye movement desensitisation and reprocessing (EMDR)

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6
Q

Drugs known to increase lithium concentrations

A

Metronidazole
NSAIDs
ACEIs / ARBs
TTDs
Corticosteriods
Tetracyclines

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7
Q

Where is lithium excreted?

A

Kidneys

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8
Q

Causes of cortical dementia (damage to cerebral cortex - outer grey matter layer of the brain)

A

Alzheimers
FTD
CJ Disease

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9
Q

Features of cortical dementia

A

Severe memory loss
Cannot remember words / understand language

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10
Q

Causes of subcortical dementia (damage to area beneath the cortex and disruption of frontostriatal connections)

A

PD
VD
MS
NPH
Huntingtons
Wilsons
HIV dementia complex

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11
Q

Features of subcortical dementia

A

Planning difficulties
Poor verbal fluency
Personality change
Task swtiching
Reduced verbal output, slowed rate of response and reduced altertness

Complex motor tasks preserved in the early syages

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12
Q

What is splitting

A

Defense mechanism whereby people do not integrate the good and bad qualities of other people - rather they have representatinos of people at one extreme or the other (i.e. all good or all bad)

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13
Q

Inheritanc eof lesch nyhan syndrome

A

X linked recessive
Almost exclusively affects boys

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14
Q

Pathology of lesch nyhan syndrome

A

Inborn error of purine metabolism
Results in abnormally high levels of xanthine and uric acid in the blood

Gene mutation short arm of chromosome Xq26-27

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15
Q

Presentation of lesch nyhan syndrome

A

Severe mental disability
Wheelchair bound
Increased tendon reflexes
Microcephaly common
Epileptic seizures
Verbal and physical aggression
Self injurious behaviour (biting lips, inside of mouth, fingers, hitting head)

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16
Q

Common assosiation with downs syndrome

A

Accelerated alzheimers disease

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17
Q

Tx for GAD

A

SSRI e.g. citalopram

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18
Q

1st line Tx depression in the elderly

A

SSRI

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19
Q

Features of fragile X syndrome

A

Sometimes not detected until adult life
Short
Large head circumference
Macro-orchidism
Characteristic facial appearance - large forehead with supraorbital fullesness, long face, long nose, prominent jaw, high arched palate and large ears
Pale irises
Cognitive deficit
Epilepsy

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20
Q

Features of prader willi syndrome

A

Constant hynger/hyperphagia
Restricted growth
Hypogonadism
LDs

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21
Q

4 symptoms of narcolepsy

A

Chronic daytime sleepiness
Cataplexy
Hypnagogic/hypnopompic hallucinations
Sleep paralysis

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22
Q

Screening questionaire to identify those with postnatal depression

A

Edinburgh Postnatal depression scale (EPDS)

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23
Q

Features of borderline PD

A

Instability of mood, self image and interpersonal relationships
Problem with self harm and feelings of emptiness

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24
Q

Features of histrionic PD

A

Excessive attention seeking emotions
Innapropriately seductive behaviour
Excessive need for approval

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25
Features of narcissistic PD
Inflated sense of their own importance Deep need for admiration Lack of empathy
26
How long do schizophrenia symptoms need to be present for for a diagnosis
1 month
27
Diagnosis of narcolepsy
Multiple sleep latency EEG (immediate entry into REM at sleep onset on two or more occassions)
28
Pathology of narcolepsy
Abnormality of REM sleep
29
Another name for munchausens syndrome
Facticious disorder
30
Example of an abnormal grief reaction
No obvious grief reaction since the event
31
Treatment of newly diagnosed schizophrenia
Atypical antipsychotics e.g. - amisulpride - olanzapine - quetiapine - risperidone - zotepine
32
Which antidepressants should be avoided when on warfarin or heparin, and what should be used instead
SSRIs Consider mirtazepine instead
33
What is used to reduce alcohol cravings in a patient with alcohol dependence
Naltrexone
34
Treatment of choice in treatment resistant schizophrenia
Clozapine
35
Treatment of ADHD
Methylphenidate
36
Post mortem findings of alzheimers dementia
Neurofibrillary tangles (NFTs) Senile plaques Protein tau Extracellular depostis of amyloid beta peptides
37
What is anterograde amnesia
Inability to create new memories after an event
38
Conversion vs somatosation disorder
Somatosation - multiple physical illnesses affecting different body systems, spanning a period of 2 years or more Conversion disorder - symptoms resemble neurological disorder, blindness, deadness, loss of feeling and muscle power
39
Which stage of sleep do dreams and nightmares occur
REM sleep
40
Cardinal features of LBD to distinguish from alzheimers dementia
LBD - fluctating cognitive function - varying levels of alertness - significant daytime somnolence - visual hallucinations
41
What type of drug is venlafaxine
SNRI
42
Genetic change of behavioural variant FTDD and MND overlap
C9orf72 gene
43
2nd line tx of bipolar disorder if lithium is contraindicated
Sodium valproate
44
What occurs in 20% of patients on long term treatment with lithium
Hypothyroidism
45
How does disulfiram work
Inhibits acetadelyhyde dehydrogenase
46
S/Es of buspirone (tx for anxiety)
Nasal congestion
47
What is somatic passivity
The belief that sensations are being imposed upon the body by an outside force
48
Features of schizoid PD
Lack of interest in social relationships Tendency towards a solitary or sheltered lifestyle Secretiveness Emotional coldness Apathy NO DELUSIONS / HALLUCINATIONS
49
MRI and SPECT scanning of FTD / picks disease
MRI - increased T2 signal in the frontal lobe white matter SPECT - decreased metabolism in the frontal region
50
Poor prognostic factors of schiozphrenia
FH Insidious onset Poor pre morbid personality, especially "schizoid" Low intellegence Abscence of precipitating stress Lack of affective components in the episode Underlying organic disorder
51
How many repeats of the abnormal triplet sequence would typically be found in a patient with huntingtons disease
>37
52
Treatment of ADHD
Methylphenidate
53
Treatment of seasonal affective disorder
CBT
54
What stage of sleep does sleepwalking occur
Stage 3 NREM
55
S/Es of clozapine
Neutropenia Agranulocytosis Hypersalivation Sedation Weight gain Reduced seizure threshold
56
What drug class is clozapine
Atypical antipsychotic
57
What is akathisia
Common and distressing drug induced movement disorder Inability to sit still Commonly seen in patients on antipsychotics, particularly those at high doses or following rapid dose uptitration
58
What vitamin deficencies are common in anorexia nervosa
Zinc deficency
59
Presentation of zinc deficiency
Poor wound healing Hair loss Glossitis
60
3 core criteria for diagnosis of Learning disability
Significant impairment of intellectual functioning Significant impairment of adaptive/social functioning Age of onset before adulthood
61
Normal IQ range
70 - 130
62
Mild LD IQ
50-69
63
Moderate LD IQ
35-49
64
Severe LD IQ
20-34
65
Profound LD IQ
< 20
66
What is regression
Return to less mature levels of functioning A defense mechanism which only appears when anxiety levels are high and not alleviated by more mature defecnes such as intellectuisation and humour
67
Common features of schizoaffective disorder
Auditory hallucinations Commentary on a patietnts actions Major depression
68
Treatment of OCD
CBT and exposure response prevention (ERP)
69
What is a haptic hallucination
Experienced as sensations of being touched, strangled or the feeling that insects are crawling beneath the skin
70
Who is haptic hallucinations common in
Cocaine users
71
Presentation of tardive dyskinesia and what does this occur secondary to
Lip smacking, lateral jaw movements and tongue protrusion Stererotyped movements Caused by dopamine receptor blocking agents e.g. chlorpromazine
72
What is cyclothymia
Individual has mood swings cycling from mild depression to hypomania (without psychotic features or significant functional impairment)
73
Dementia vs depressive pseudo-dementia
Dementia - cognitive deficit insidious, unaware of difficulties and confabulate Depressive pseudo-dementia - Acute and recent cognitive deficit, communicate a sense of distress or agitation and will complain of their cognitive difficulties
74
Definition of illusion
Misperception of a real external stimulus
75
Definition of hallucination
False sensory perception in the abscence of real external stimuli
76
What is ganser syndrome
Patients mimic the symptoms of a psychosis
77
Features of ganser syndrome
Pseudohallucinations Poor eye contact Prolonged periods of staring Giving approximate answers (vorbierden) Somatic conversion Amnesia
78
What is oculogyric crisis and when does it occur
A type of dystonia seen in patients on antipsychotics Painful upwards deviation of the eyes
79
Treatment of oculogyric crisis
Anticholingergics e.g. procyclidine
80
What can risperidone be significantly assosiated with
Significant hyperprolactinaemia
81
What is seen on an EEG in narcolepsy
Rapid onset of REM sleep
82
Drug treatment to prevent relapse of opiod dependency
Naltrexone
83
The CAGE questionare screens for which disorder
Alcohol dependence
84
Pathological changes of wernicke korsakoffs syndrome
Neuronal loss in the mammilary bodies
85
What side effect is seen in 50% of individuals taking lithium during the first month of therapy
Fine tremor
86
Management of specific phobias
Graded exposure
87
Features of schizotypical PD
Socially withdrawn Reduced capacity for close relationships Eccentric behaviour or beliefs and possibly paranoid ideas Delusions of reference where they believe something innocuous in the public domain (e.g. newspaper) has a special reference to them
88
What is bupropion used for and what is the mechanism of action
Smoking cessation Noradrenaline dopamine reuptake inhibitor
89
What is cotard syndrome
Hallmark is nilhilistic delusions concerning ones own body, which range from believing that one person is missing organs or limbs to the belief that one is dead
90
Symptoms of benzodiazepine withdrawl
Anziety insomnia psychosis seizures
91
What is acrophobia
Extreme or irrational fear of heights
92
What is agoraphobia
Irrational fear of open spaces, crowds or umfamilial settings
93
How to switch from selegiline (MAOI) to paroxetine (SSRI)
Stop selegiline, wait 14 days, then start paroxetine To minimise risk of serotonin syndrome
94
What is isolation
Seperation of thought from its attached emotional tone, thereby making it tolerable Well described during highly stressful events such as death of a loved one
95
What is conversion disorder
Motor or sensory deficit Although no organic cause is identified for the deficit
96
WHat is hyochondriacal disorder (also known as illness anxiety disorder)
Persistent preoccupation with the possibility of having a serious disease
97
How long do the baby blues usually last for
Occur 4-5 days after birth for about 2-3 days
98
What is used (drug treatment) for maintenance of abstinence from alcohol vs physiological alcohol dependence
1. maintenance of abstinence - acamprosate 2. physiological alcohol dependence - disulfiram
99
Test for fragile X syndrome
Molecular genetic testing of the FMR1 gene
100
What is alot more common in vascular dementia than alzheimers
Seizures Also more acute onset, occurs in a step like manner with acute exacerbations
101
Treatment of neuroleptic malignant syndrome
Dantrolene (mulscle relaxant) Dopamine agonists (bromocriptine) IV fluids
102
Pathology of lithium induced nephrogenic diabetes insipidus
Decreased aquaporin-2 expression
103
Treatment for psychotic symptoms in PD
1. Quetiapine 2. if fails - clozapine
104
What proteins accumulate in alzheimers disease
Tau
105
Treatment of lithium overdose (with a level > 5)
Haemodialysis
106
Features of adjustment disorder
Short term, stress related, non psychotic disturbance as a result of e.g. a traumtic event Absent features of PTSD such as replaying the event Features consistent with depression
107
What would make you think of schizoaffective disorder
Hallucinations with intermittent periods of depression
108
What is ethylene glycol
anti-freeze
109
treatment of antifreeze (ethylene glycol) overdose and how does this work
Fomepizole Inhibitor of alcohol dehydrogenase
110
Treatment of HTN for patients already on lithium therapy
CCBs e.g. amlodipine NOT VALSARTAN OR RAMIPRIL
111
Which PD drug causes risk taking behaviours
Ropinirole
112
What time frame is adjustment disorder before it turns into depression
adjustment - 3 - 6 months depression - after 6 months
113
Features of charles bonnet syndrome
Complex visual hallucinations - repeated geometric patterns of people or patterns for example, standing at the edge of the bed Reduced visual acuity
114
Presentation of MDMA toxicity
Agitation Pyrexia HTN Tachycardia Thirsty Rhabdomyolysis in severe toxicty
115
Treatment ladder of tourettes
1. Psychoeducation 2. CBT 3. Clonidine 4. Risperidone
116

MRCP - Part 1 (20 decks)

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