Psychiatry

Question 1

What is first line treatment of GAD

Answer 1

SSRI (sertraline most cost-effective)

Question 2

What can be offered in GAD when SSRI and SNRI not tolerated

Answer 2

Pregabalin

Question 3

What is REM sleep behaviour disorder

Answer 3

Vivid dreams associated with simple/complex motor behaviour during REM sleep - violent re-enacting of dreams

Question 4

What condition is linked with REM sleep behaviour disorder

Answer 4

Parkinson’s disease

Question 5

What is the DSM4 criteria for anorexia nervosa

Answer 5

BMI <17.5, intense fear of being obese, disturbance of weight perception, amenorrhoea

Question 6

What are raised in anorexia nervosa

Answer 6

3Gs, 3Cs (growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia)

Question 7

What physiological abnormalities are seen in anorexia nervosa

Answer 7

Hyponatraemia, hypokalaemia, metabolic alkalosis (vomiting), increased amylase, hypocalcaemia, low FSH/LH/oestrogen, low T3, normal albumin

Question 8

What is lanugo hair associated with

Answer 8

Anorexia nervosa

Question 9

What is the difference between mania and hypomania

Answer 9

Mania has psychotic symptoms (delusions of grandeur, auditory hallucinations)

Question 10

What are Schneider’s first rank symptoms of schizophrenia

Answer 10

Auditory hallucinations, thought disorder, passivity phenomenon, delusional perceptions

Question 11

What is the chance of a child having schizophrenia if their parent has it

Answer 11

10-15%

Question 12

What are poor prognostic factors for schizophrenia

Answer 12

Strong FHx, gradual onset, low IQ, history of social withdrawal, lack of obvious precipitant

Question 13

What are the 4 classes of EPSE seen with antipsychotic use

Answer 13

Parkinsonism, acute dystonia, akathisia (severe restlessness), tardive dyskinesia

Question 14

What is the MOA of atypical antipsychotics

Answer 14

Block D2 dopamine receptors and 5-HT2 serotonin receptors

Question 15

What is the most common side effect of olanzapine

Answer 15

Weight gain

Question 16

What is the most common side effect of clozapine

Answer 16

Agranulocytosis

Question 17

What is the risk of prescribing antipsychotics in elderly patients

Answer 17

Increased stroke and VTE risk

Question 18

When is neuroleptic malignant syndrome most common

Answer 18

Within first 10 days of starting antipsychotic treatment/increasing dose

Question 19

What percentage of mothers will have baby blues

Answer 19

60-70%

Question 20

How long after birth does post-natal depression present

Answer 20

Within a month, peaks at 3 months

Question 21

When does pueperal psychosis present after birth

Answer 21

2-3 weeks

Question 22

What should be prescribed alongside an SSRI in a patient on NSAIDs

Answer 22

PPI

Question 23

Which antidepressant has the highest rate of discontinuation symptoms

Answer 23

Paroxetine

Question 24

What are the side effects of TCAs

Answer 24

Drowsiness, dry mouth, blurred vision, constipation, urinary retention

Question 25

What are the ECG changes associated with TCA overdose

Answer 25

Sinus tachycardia, widening of QRS, prolongation of QT interval

Question 26

What is the management of TCA overdose

Answer 26

IV bicarbonate

Question 27

What are the organic causes of restless leg syndrome

Answer 27

IDA, uraemia, DM, pregnancy

Question 28

What is an absolute contraindication to ECT

Answer 28

Raised ICP

Question 29

What is the best way to withdraw from benzodiazepines

Answer 29

Switch to diazepam and reduce dose by 1/8 of total every fortnight

Question 30

What is the MOA of barbiturates

Answer 30

GABAa drug - increases duration of chloride channel opening

Question 31

What is the MOA of benzodiazepines

Answer 31

GABAa drug - increases frequency of chloride channel opening

Question 32

Which condition causes recurrent complex hallucinations in clear consciousness, associated with visual impairment

Answer 32

Charles-Bonnet Syndrome

Question 33

Which condition is associated with severe depression and presents with patient believing they are dead

Answer 33

Cotard syndrome

Question 34

How often should lithium levels be checked once a stable dose is achieved

Answer 34

Every 3 months

Question 35

What are the features of Korsakoff’s syndrome

Answer 35

Opthalmoplegia+confusion+ataxia + anterograde amnesia + confabulation

Question 36

How should an SSRI be stopped

Answer 36

Withdrawal gradually over 4 weeks (except fluoxetine - can be stopped without withdrawal period)

Question 37

Which receptors do atypical antipsychotics block

Answer 37

D2 dopamine receptors and 5-HT2 serotonin receptors

Question 38

Which TCA are the least sedative

Answer 38

Imipramine, lofepramine, nortriptyline

Question 39

Which TCA has the lowest incidence of toxicity in overdose

Answer 39

Lofepramine

Question 40

Which TCAs are most dangerous in overdose

Answer 40

Amitriptyline, dosulepin

Question 41

What are the discontinuation symptoms seen in stopping SSRIs abruptly

Answer 41

Increased mood change, restlessness, difficulty sleeping, unsteadiness, sweating, GI symptoms, paraesthesia

Question 42

What is the treatment of Charles Bonnet Syndrome

Answer 42

Ensure no alternative cause, then reassure

Question 43

What is Othello syndrome

Answer 43

Belief that partner is committing infidelity with no evidence of this

Question 44

What is De Clerambault syndrome

Answer 44

Patient believes that person of higher social standing than them is in love with them

Question 45

What is Ekbom syndrome

Answer 45

Delusional parasitosis - ‘bugs’ under skin

Question 46

What are the 4 symptoms associated with narcolepsy

Answer 46

Excessive daytime sleepiness Cataplexy Sleep paralysis Hallucinations on going to sleep/waking

Question 47

Which screening tool is used for social anxiety disorder

Answer 47

Mini-social phobia inventory (Mini-SPIN)

Question 48

What presents with a compressible mass in the abdomen, significant malnutrition and patches of alopecia

Answer 48

Trichobezoar

Question 49

Which HLA is narcolepsy associated with

Answer 49

HLA-DR2

Question 50

When does acute stress reaction occur after trauma

Answer 50

Within one month

Question 51

What form of CBT is used to manage body dysmorphic disorder

Answer 51

Exposure and response prevention

Question 52

Atypical antipsychotics are associated with a risk of developing which condition

Answer 52

Type 2 diabetes