Psychiatry

Question 1

Paracetamol overdose <1 hour + dose <150mg/kg - managament?

Answer 1

activated charcoal

Question 2

Paracetamol staggered overdose or ingestion >15 hours ago - management?

Answer 2

Start N-acetylcysteine immediately

Question 3

When do you consider a liver transplant for paracetamol overdose?

Answer 3

Arterial pH < 7.3, 24 hours after ingestion
OR
All of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

Question 4

Patients who present 8-24 hours after ingestion of an acute overdose of more than 150 mg/kg of paracetamol - management?

Answer 4

N-acetylcysteine

Question 5

patients who present > 24 hours with paracetamol overdose if they are clearly jaundiced or have hepatic tenderness + high ALT - management?

Answer 5

N-acetylcysteine

Question 6

Difference between type I and type II bipolar disorder?

Answer 6

Type I - mania and depression
Type II - hypomania and depression

Question 7

Severe lithium toxicity management?

Answer 7

Haemodialysis

Question 8

Criteria for anorexia nervosa?

Answer 8

DSM 5

Question 9

Management of anorexia nervosa in young people?

Answer 9

‘anorexia focused family therapy - 1st line
CBT - 2nd line

Question 10

Management of anorexia nervosa in adults?

Answer 10

one of:
- individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
- Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
- specialist supportive clinical management (SSCM).

Question 11

Clinical features of anorexia nervosa?

Answer 11

• reduced body mass index
• bradycardia
• hypotension
• enlarged salivary glands

Question 12

Physiological signs of anorexia nervosa?

Answer 12

• hypokalaemia
• low FSH, LH, oestrogens and testosterone
• raised cortisol and growth hormone
• impaired glucose tolerance
• hypercholesterolaemia
• hypercarotinaemia
• low T3

Question 13

Criteria for bulimia nervosa?

Answer 13

DSM 5

• recurrent binge eating
• lack of control when eating
• compensatory behaviour - laxatives, vomiting
• at least once a week for 3 months.

Question 14

Management of bulimia nervosa in adults?

Answer 14

bulimia-nervosa-focused guided self-help - 1st line
Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED) - 2nd line

Question 15

Management of bulimia nervosa in children?

Answer 15

bulimia-nervosa-focused family therapy

Question 16

Pharmacological option for bulimia nervosa?

Answer 16

Fluoxetine

Question 17

Difference between bipolar type 1 and type 2?

Answer 17

Type 1 - mania and depression
type 2 - hypomania and depression

Question 18

How do you differentiate mania from hypomania?

Answer 18

psychotic symptoms (e.g.delusions of grandeur or auditory hallucinations)

Question 19

Management of bipolar disorder?

Answer 19

Lithium - mood stabiliser (valproate is an alternative)

mania - antipsychotics e.g. olanzapine or haloperidol
depression - talking therapies, fluoxetine

Question 20

Acute stress disorder vs PTSD time frame?

Answer 20

first 4 weeks = acute stress
>4 weeks = PTSD

Question 21

Management of acute stress disorder?

Answer 21

trauma-focused cognitive-behavioural therapy (CBT) - 1st line

Benzodiazepines - acute symptoms

Question 22

Delirium tremens - how many hours after withdrawal?

Answer 22

48-72hours

Question 23

Symptoms of delirium tremens?

Answer 23

coarse tremor
confusion
delusions
auditory and visual hallucinations
fever
tachycardia

Question 24

Management of alcohol withdrawal?

Answer 24

• long-acting benzodiazepines e.g. chlordiazepoxide or diazepam (lorazepam in hepatic failure)
• carbamazepine

Question 25

Classification of severity used for depression?

Answer 25

PHQ-9 score of <16 = mild depression score of >/=16 = moderate/severe depression

Question 26

Management of less severe depression?

Answer 26

guided self-help - 1st line SSRI - only if patient preference CBT

Question 27

Management of moderate/severe depression?

Answer 27

a combination of individual cognitive behavioural therapy (CBT) and an antidepressant - first line

Question 28

Investigation findings in neuroleptic malignant syndrome?

Answer 28

- raised CK - due to muscle rigidity - raised WCC - Deranged LFT - acute renal failure - metabolic acidosis

Question 29

What is somatisation disorder?

Answer 29

Excessive worry about physical symptoms (for at least 2 years) which can't be explained by any disease e.g. abdominal pain (somatisation - symptoms)

Question 30

what is conversion disorder?

Answer 30

Nervous system symptoms such as blindness which occur as a result of anxiety or stressful events and have no specific physical cause. (loss of motor or sensory function) (Conversion - conduction)

Question 31

What is delusions of passivity?

Answer 31

Delusions of being controlled (feelings, impulses, thoughts or actions) by an external force.

Question 32

What is delusional perception?

Answer 32

When someone sees something in reality and attributes a false meaning to this (e.g. sees a stranger cough and thinks this means they are a spy.)

Question 33

What is 'running commentary' in psych?

Answer 33

Auditory hallucination where the voices are commenting on the persons actions

Question 34

What is somatic hallucination?

Answer 34

Tactile hallucinations e.g. bugs under the skin

Question 35

What is thought broadcasting?

Answer 35

Thinking that people can read your thoughts

Question 36

Management of ADHD?

Answer 36

1st line - methylphenidate (always 1st line in children) 2nd line - Dexamfetamine (also 1st line in adults)

Question 37

Management of bipolar?

Answer 37

mood stabiliser - lithium (1st line) or sodium valproate (2nd line) management of mania/hypomania - stop antidepressant + antipsychotic (e.g. olanzapine or haloperidol) management of depression - talking therapy +/- fluoxetine

Question 38

Personality disorder management?

Answer 38

dialectal behaviour therapy

Question 39

which criteria is used for alcohol withdrawal?

Answer 39

AUDIT

Question 40

What is catatonia?

Answer 40

Stopping of voluntary movement or staying still in an unusual position

Question 41

What is Circumstantiality?

Answer 41

the inability to answer a question without giving excessive, unnecessary detail

Question 42

What is Tangentiality?

Answer 42

wandering from a topic without returning to it.

Question 43

What are Neologisms?

Answer 43

new word formations, which might include the combining of two words.

Question 44

What are clang associations?

Answer 44

when ideas are related to each other only by the fact they sound similar or rhyme.

Question 45

What is word salad?

Answer 45

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

Question 46

knights move of thinking - what is it?

Answer 46

a severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another

Question 47

What is 'flight of ideas'?

Answer 47

a thought disorder where there are leaps from one topic to another but with discernible links between them.

Question 48

What is Perseveration?

Answer 48

the repetition of ideas or words despite an attempt to change the topic.

Question 49

What is Echolalia?

Answer 49

the repetition of someone else's speech, including the question that was asked.

Question 50

Management of bipolar presenting with mania/hypomania in community?

Answer 50

- mania or severe depression = urgent referral to CMHT - hypomania or non-severe depression - routine referral to CMHT