Psychiatry

Question 1

Class of Venlafaxine

Answer 1

SNRI

Question 2

First line treatment for fibromyalgia?

Answer 2

Amytriptyline / citalopram / duloxetine / pre-gabalin

Question 3

Memantine mechanism of action

Answer 3

NDMA Antagonist

Question 4

What are the features of discontinuation syndrome?

Answer 4

Dizziness, electric shock sensations and anxiety are symptoms of SSRI discontinuation syndrome.

Question 5

Common GI side effect of clozapine

Answer 5

Constipation

Question 6

What is circumstantiality?

Answer 6

Circumstantialityis the inability to answer a question without giving excessive, unnecessary detail. However, this differs from tangentiality in that the person does eventually return to the original point.

Question 7

What is a word salad?

Answer 7

Word salad describes completely incoherent speech where real words are strung together into nonsense sentences.

Question 8

What is knight’s move thinking?

Answer 8

Knight’s move thinking is a severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another. It is a feature of schizophrenia.

Question 9

What are the first rank symptoms of schizophrenia?

Answer 9

First rank features:
Auditory hallucinations
Thought disorders
Delusional perceptions
Passivity phenomena

Question 10

Side-effects of TCA’s?

Answer 10

Can’t see, can’t pee, can’t spit can’t shit!

Question 11

A 45-year-old man with schizophrenia taking chlorpromazine develops an oculogyric crisis. What side-effect of antipsychotic medication is this an example of?

Answer 11

Acute dystonia (involuntary contractions)

Question 12

Oculogyric crisis

Answer 12

Prolonged involuntary upward deviation of the eyes (painful and distressing)

Question 13

Anti-psychotics in the elderly = increased risk of what?

Answer 13

Stroke

Question 14

Full management of OCD:

Answer 14

1. CBT and Exposure and response prevention.
2. SSRI - 12 weeks before benefit, continue for a year. (FLuoxetine for body dysmorphia and children).

Question 15

Management of panic disorder / GAD

Answer 15

SSRI first line drug. Then SNRI 2nd line.

Treatment in primary care - STEPWISE
NICE recommend either cognitive behavioural therapy or drug treatment
SSRIs are first-line. If contraindicated or no response after 12 weeks then imipramine or clomipramine should be offered.

Question 16

SSRI’s used in the first trimester of pregnancy are associated with what?

Answer 16

Cardiac defects

Question 17

Blood changes seen in anorexia

Answer 17

Anorexia features
most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

Question 18

SSRI + NSAID = ?

Answer 18

= inc bleeding risk give a PPI

Question 19

Clomipramine is what class of drug and has what common side effects?

Answer 19

Dry mouth (anticholinergic) and weight gain (antihistaminic) are side effects of clomipramine (TCAs)

Question 20

Post MI antidepressant?

Answer 20

Sertraline

Question 21

Citalopram is what class of drug?

Answer 21

SSRI

Question 22

Bipolar type 1 vs type 2

Answer 22

Type 1 = psychotic symptoms
Type 2 = no psychotic symptoms

Question 23

How to manage personality disorders?

Answer 23

Dialectical behaviour therapy

DBT is the mainstay in managing personality disorders.

MBT also sometimes used.

Question 24

Triptans should be avoided in patients taking a SSRI

Answer 24

Triptans should be avoided in patients taking a SSRI

Question 25

What type of therapy is offered for children with anorexia?

Answer 25

Anorexia focused family therapy is the first-line treatment for children and young people with anorexia nervosa.

Question 26

Mirtazapine drug class?

Answer 26

Mirtazapine is a noradrenergic and specific serotonergic antidepressant which increases release of neurotramsitters by blocking alpha2 adrenoreceptors

Question 27

First line med for ptsd

Answer 27

Venlafaxine or an SSRI Risperidone if these both fail

Question 28

What key tetrad is seen in NMS?

Answer 28

Altered mental status, fever, rigidity and autonomic instability.

Question 29

What is meant by autonomic instability aka dysautonomia?

Answer 29

Tachycardia, labile blood pressure, profuse sweating, arrhythmias.

Question 30

Memantine what class?

Answer 30

Memantine = NDMA receptor antagonist

Question 31

Before starting citalopram do what?

Answer 31

ECG to check for long QT

Question 32

Serotonin syndrome - what electrolyte abnormality?

Answer 32

Low Na+!!

Question 33

First line for acute dystonia?

Answer 33

Procyclidine (anti-muscarinic)

Question 34

Serotonin syndrome tx

Answer 34

Benzo's can treat agitation and provide symptom control More severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine.

Question 35

What is section 2?

Answer 35

28 days assessment section, tx can be given against. Needs 1 doctor approved under MHA

Question 36

What is section 3?

Answer 36

6 months, treatment order. AMHP + 2 doctor`s

Question 37

Section 4?

Answer 37

72hr assessment order in the ED

Question 38

Section 5(2)?

Answer 38

Doctors power 72hr hold order

Question 39

Section 5(4)

Answer 39

Nurses power 6hrs

Question 40

Section 136

Answer 40

Police order take a patient from outside to a place of safety can hold for 24hrs until mental health assessment.

Question 41

Section 135

Answer 41

Police can break into a home to remove a person to take them to a place of safety

Question 42

A patient believes that everyone they meet is the same person but with different disguises.

Answer 42

Fregoli

Question 43

Misidentification syndrome in which the patient believes that someone close to them has been replaced by a clone.

Answer 43

Caprgras

Question 44

Invg before starting donepezil

Answer 44

ECG