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Y3- TO LEARN > Psychiatry > Flashcards

Psychiatry Flashcards

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1
Q

What is somatic syndrome?

A

Depression with more physical symptoms

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2
Q

What is atypical depression?

A

Mood reactivity
Increase appetite and sleep
Leaden paralysis (heavy limbs)

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3
Q

What is psychotic depression?

A

Paranoid or hypochondriae or with nihilistic delusions

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4
Q

What are nihilistic delusions?

A

A nihilistic delusion of the nonexistence or dissolution of a body part; in extreme form, the delusion of being dead or nonexistent

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5
Q

Rate of suicidal thoughts/behaviour in depression?

A

25%

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6
Q

Onset age of bipolar disorder?

A

Late teens/early 20s

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7
Q

Bipolar disorder is a spectrum of..? (2 things)

A

Severity (mania vs hypomania)

Proportion (more depressed/manic)

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8
Q

Symptoms of hypomania + mania?

A 
Elevated mood
Restlessness
Increased talkativeness (pressure of speech)
Decreased need for sleep
Increased sexual energy
Difficulties concentrating
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9
Q

Symptoms of mania?

A

Flight of ideas
Loss of social inhibitions
Grandiosity
Reckless behaviour

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10
Q

Bipolar carries increased risk of … compared to other mental disorders

A

Suicide

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11
Q

Which kind of antidepressants are generally first line?

A

SSRIs

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12
Q

How long should antidepressants be used?

A

At least 6 months after remission

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13
Q

Treatment for bipolar in acute mania?

A

Anti-psychotics + Lithium
Benzodiazepines for symptom control
Hospitalisation if severe

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14
Q

Treatment of bipolar depressive phase?

A

Anti-depressant (SSRI- fluoxetine, lamotrigine)
+ Lithium
ECT if severe

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15
Q

What should be monitored in elderly people taking anti-depressants?

A

Sodium- risk of hyponatraemia

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16
Q

What do monoamine oxidase inhibitors (MAOIs) do?

A

Inhibit enzyme responsible for monoamine metabolism (less serotonin/noradrenaline metabolised)

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17
Q

Examples of MAOIs?

A

Moclobemide (reversible)
Phenelzine (irreversible)

When put fennel in food, it’s irreversible!

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18
Q

Side effects of MAOIs?

A 
Postural hypotension
Drowsiness
Nausea
Insomnia
Constipation
Peripheral Oedema
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19
Q

Depersonalisation?

A

Body not yours or disconnected from you

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20
Q

Derealisation?

A

Disconnected from world or “spaced out”

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21
Q

What are the dietary restrictions associated with MAOIs?

A

Tyramine foods (cheese, red wine, red meats etc)–> cause hypertensive crisis

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22
Q

How do tricyclic antidepressants work?

A

Block the reuptake of monoamines (5-HT and noradrenaline) at the presynaptic terminals

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23
Q

Examples of tricyclics?

A

amitriptyline, imipramine, dosulepin, lofepramine

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24
Q

When should tricyclics be avoided?

A

In suicidal patients

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25
Side effects of triCyCliCs? (3Cs= clue)
``` Cardiovascular= postural hypotension, tachycardia, arrythmias Cognitive= impairment in elderly anti-Cholinergic= blurred vision, dry mouth, constipation, urinary retention ``` + Weight gain, sedation
26
How do SSRIs work?
Selectively inhibit reuptake of serotonin
27
Examples of SSRIs?
Fluoxetine, citalopram, escitalopram, sertraline
28
Side effects of SSRIs?
N+V, headache, transient anxiety, agitation, sweating, sexual dysfunction, insomnia, HYPONATRAEMIA in elderly
29
Examples of dual reuptake inhibitors?
Venlafaxine, Duloxetine
30
Name an atypical anti-depressant and its use?
Mirtazapine | Supplement SSRIs to block serotonin side effects e.g. nausea can cause weight gain, sedation
31
When is Reboxetine good to use?
In patients with reduced energy | won't get tired with your Reeboks on
32
How is lithium monitored?
Lithium levels U+Es TFTs ECG
33
Side effects of lithium?
GI upset, Tremor, HYPOTHYROIDISM, Weight gain, renal impairment, polydipsia, polyuria, sedation
34
Lithium toxicity signs include?
Vomiting, diarrhoea, ataxia, tremor, drowsiness, convulsions
35
What is sodium valproate?
Anti-convulsant- sometimes used in mania
36
Side effects of sodium valproate?
sedation, tremor, dizziness, GI upset, weight gain, TERATOGENIC
37
Features of addiction?
``` Strong desire Difficulties in control Psychological withdrawal Tolerance Neglect of alternative pleasures Persistence despite harm ```
38
CAGE questions for alcohol abuse?
1. Have you ever felt you needed to Cut down on your drinking? 2. Have people Annoyed you by criticizing your drinking? 3. Have you ever felt Guilty about drinking? 4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
39
Why does neglect of other pleasures occur in addiction?
Relative lack of dopamine release
40
Why does tolerance occur in addiction?
Less dopamine released than in non-addicts (more needed for pleasure)
41
What is the role of the prefrontal cortex in addiction (3 roles)?
Helps intention guide behaviour + reward pathways + impulse control
42
Why is prefrontal cortex development relevant to addiction?
Last part of brain to develop- in early 20s | Shows lower activity in addicts
43
Craving in addictions is mediated by which parts of the brain?
Hippocampus Striatum Amygdala
44
What is heroin metabolised to?
Morphine
45
Effects of heroin?
``` Euphoria Analgesia Respiratory depression Constipation Contricted pupils Hypotension/bradycardia ```
46
Heroin withdrawal symptoms?
Dysphoria, agitation, tachycardia/hypertension, piloerection (hairs on end), diarrhoea, N+V, dilated pupils, joint pains
47
Complications of IV drug use?
Infection- cellulitis, abscess, endocarditis, HIV, Hep B/C DVT PE Ischaemic limb
48
Treatment of heroin addiction?
OST- opiate substitution therapy - replace short acting for long acting - methadone
49
Why is opiate detoxification risky?
10% of completers dead after 4 months | Increased overdose- go back to previous dose
50
How to calculate number of units?
(% x volume)/10
51
What is high risk drinking?
>35 units/week
52
Harmful effects of alcohol?
N+V, gastritis, mallory-weiss tears, ulcers, malnutrition, vitamin deficiency, hepatitis, arrythmias, dementia, cancer etc
53
Which LFT indicates liver injury? (in e.g. alcohol)
Gamma GT
54
What causes alcohol withdrawal?
Excess glutamate and less GABA activity
55
Symptoms of delirium tremens?
Confusion, agitation, disorientation, hypertension, fever, hallucinations (V+A), paranoia
56
Treatment of delirium tremens/alcohol withdrawal?
Benzodiazepines (e.g. chlordiazepoxide) | Vitamin supplementation
57
How does Antabuse work?
inhibits acetyldehyde dehydrogenase (cause unpleasant effects)
58
Drug name of antabuse?
Disulfiram
59
What is Acamprosate used for in alcohol relapse prevention?
Reduces cravings
60
First line for alcohol relapse prevention?
Naltrexone
61
Physical symptoms of anxiety?
Sweating, tremor, muscle tension, numbness, lightheadedness, dizzy, difficulty breathing, increase HR, nausea, chest pain etc
62
Behavioural symptoms of anxiety?
Avoidance, exaggerated response, sleep disturbance, restlessness, irritability, alcohol/drugs, checking behaviours
63
Cognitive symptoms of anxiety?
Feelings of losing control, on edge/tense, difficulty concentrating, derealisation, depersonalisation. hypervigilance, racing thoughts
64
2 definitions of anxiety disorder?
More extreme anxiety than normal | Anxiety is abnormal situations
65
Treatment of GAD?
CBT SSRI/SNRI Pregabalin benzodiazepines (short-term)
66
Characteristics of panic disorder?
Unpredictable, recurrent attacks of severe anxiety with no pattern
67
What co-exists with panic disorder in 50-65%?
Agoraphobia | phobia of having panic attacks in public
68
Characteristics of phobia?
Irrational/Excessive fear Marked and persistent Avoidance and anticipatory anxiety
69
What is social anxiety disorder?
Persistent fear of social performance with unfamiliar people/scrutiny of others Fear of embarrassment/humiliation
70
Obsessional thoughts associated with OCD?
Ideas/images/impulses Patient's own thoughts Unpleasant + resisted thoughts
71
Compulsive acts associated with OCD?
Repeated rituals/stereotyped behaviour | No purpose- view as neutralising
72
Treatment of OCD?
CBT SSRIs Clomipramine (TCAD)
73
Definition of major incident?
Situation with multiple casualties due to natural/unnatural causes, that is beyond what normal emergency services can cope with
74
What is tonic immobility?
Involuntary state of profound motor inhibition due to fear
75
Main events leading to PTSD?
``` Sexual assault Burns Combat veterans RTAs Intensive care ```
76
Symptoms of PTSD?
Intrusive thoughts Avoidance behaviours (reminders, amnesia, detachment) Hyperarousal- sleep disturbance, anger, low conc Dissociation Survivor guilt
77
Neurobiological features of PTSD?
Hippocampal atrophy Increase amygdala activity Low cortisol
78
Treatment of PTSD?
Trauma focused CBT EMDR Exposure therapy Meds: paroxetine, mirtazapine
79
Reasons for deliberate self harm?
Die Escape situation/anguish Display desperation Influence others
80
What do brain scans show in recent self-harmers?
Decreased frontal lobe activity
81
What are the most common methods of suicide in UK?
Hanging/poisoning
82
What pathology causes Alzheimer's disease?
Amyloid plaques and neuro-fibrillary tangles
83
At what age is Alzheimer's disease considered early onset?
<60 years
84
How do benzodiazepines work?
Enhancing action of GABA- open Cl channels- less APs produced
85
Examples of benzodiazepines?
Lorazepam, diazepam, chlordiazepoxide
86
What do benzodiazepines do?
Reduce anxiety, aggression Sedation Muscle relaxation Anti-convulsant
87
What can benzodiazepines cause with alcohol?
Respiratory depression
88
Symptoms of benzodiazepine withdrawal?
Confusion, tachycardia, psychosis, sweating, hypertension, tremor, agitation, abdo cramps
89
What is a functional disorder?
Cannot easily associate symptoms with classically identifiable organic disease (like a 'software' problem- no obvious cause)
90
Common functional symptoms?
Pain, altered sensation, dizziness, movement disorder, weakness, seizures (non-epileptic attacks), cognitive symptoms
91
Important history for functional symptoms?
``` Timeline of symptoms Disability PMH ICE Psychiatric/mood history ```
92
Should you exam functional symptoms?
ALWAYS EXAMINE | inconsistent findings common
93
Management of functional disorders?
Reassure CBT Tricyclic antidepressants
94
Classic symptoms of psychosis?
Hallucinations, delusions, disorder of form of thoughts Impaired communication/relating to others Unable to recognise reality
95
What are neologisms?
Assuming you understand strange words they're using
96
Differential of psychosis?
``` Schizophrenia Substance abuse (drug induced) Mania with psychosis Depressive psychosis Dementia Delirium ```
97
Positive symptoms of schizophrenia?
Hallucinations (often 3rd person auditory) Delusions Passivity of thought Thought interference Passivity (outside control of affect, impulses etc.)
98
Negative symptoms of schizophrenia?
``` Reduced speech BLUNTED affect Reduced motivation Reduced interest Reduced social interaction ```
99
Causes of schizophrenia?
Multifactorial GENETIC (often seen in same families)
100
Risk factors for schizophrenia?
``` Obstetric problems (pre-eclampsia, fetal hypoxia, prolonged labour) Childhood viral CNS infection Drug use (esp. cannabis) Urban dwelling Social adversity/deprivation ```
101
Neurological findings in schizophrenia?
Reduced frontal lobes volume + grey matter Enlarged ventricles Altered dopamine signalling (overactivity)
102
Prognosis of schizophrenia?
Some have relapsing/remitting, some have progressively worse 10-15% commit suicide
103
Which anti-psychotics are first line?
Atypicals (2nd generation- newer)
104
Which type of anti-psychotic can be used if compliance is an issue?
Depot
105
Name some mood stabilisers?
Lithium Sodium Valproate Carbamazepine Lamotrigine
106
How do typical anti-psychotics work?
Block D2 receptors
107
Examples of typical anti-psychotics?
``` Chlorpromazine Thioridazine Fluphenazine Haloperidol Zuclopentixol ```
108
Side effects of typical anti-psychotics?
Acute dystonic reaction (muscle spasms) Parkinsonism Tardive dyskinesia (repetitive involuntary purposeless movements + inner restlessness) Hyperprolactinaemia (due to lack of prolactin inhibition by dopamine)
109
Treatment of acute dystonic reactions?
Anti-cholinergics
110
What is akathisia?
Inner restlessness
111
Symptoms of hyperprolactinaemia in antipsychotics?
Sexual dysfunction, galactorrhoea, gynaecomastia, amennorhea, infertility
112
How do atypical anti-psychotics work?
Transient block D2 receptors, and block 5HT2 receptors too
113
Examples of atypical anti-psychotics?
Olanzapine Risperidone Quetiapine Clozapine
114
Side effects of atypical anti-psychotics?
``` MUSCARINIC BLOCKADE (blurred vision, dry eyes, dry mouth, constipation, urinary retention) Metabolic syndrome (high CV risk) Sedation Increased appetite Postural hypotension ```
115
Major side effects of clozapine?
Agranulocytosis (fever, sore throat) | Myocarditis
116
Monitoring for clozapine?
FBC | ECG + BP
117
Psychiatric illness is 3 times as common in people with LD. How can it be managed?
``` Improve skills + relaxation CBT Antidepressants Physical e.g. headgear, guards Aid communication ```
118
Define violence?
Intentional use of physical force or power, threatened or actual against self or others Results in injury, psychological harm or deprivation
119
Predictors of violent behaviour?
Severe mental illness Substance abuse History of violence
120
Define aggression?
Intentionally hurting or gaining advantage over another
121
What can be used as rapid tranquillisation in aggression?
oral Lorazepam or Haloperidol | Then IM injection
122
What are personality disorders and when are they diagnosed?
Enduring pattern of inner experience + behaviour that deviates markedly from the expectations of an individuals culture Diagnosed >18 years
123
Manifestations of personality disorders? (4)
1. Cognition (perceptions) 2. Affectivity (range/ intensity of emotion) 3. Interpersonal functioning 4. Impulse control
124
Which personality disorder is most inheritable?
Obsessive compulsive personality
125
How many people are affected by personality disorders?
10%
126
Which personality disorders are until Cluster A: odd and eccentric?
Paranoid Schizoid Schizotypical
127
Which personality disorders are until Cluster B: dramatic, emotional, erratic?
Antisocial Borderline Histrionic Narcissistic
128
Which personality disorders are until Cluster C: anxious and fearful?
Avoidant Dependent Obsessive-Compulsive
129
Features of paranoid PD?
Distrust and suspicion of others that motives are malevolent Doubts of loyalty and partner fidelity Bears grudges No confiding in others
130
Features of schizoid PD?
``` Detachment from social relationships and restricted range of emotion No close relationships Solitary Detachment/emotional coldness Aloof/fantasy world ```
131
Features of antisocial PD?
``` Disregard for rights of others Deceitful No conform to laws Impulsivity, aggression Disregard for safety Irresponsible Lack of REMORSE ```
132
Features of borderline PD?
``` Instability of interpersonal relationships, self-image, affect + impulsivity (money, sex, driving etc.) Avoid abandonment Unstable/intense relationships Extreme moods Suicidal/DSH ```
133
Features of histrionic PD?
``` Excessive emotionality + attention seeking Centre of attention Provocative behaviour Self-dramatisation Suggestible ```
134
Features of avoidant PD?
Social inhibition, feeling inadequate, hypersensitive to negative evaluation Avoid activities leading to criticism Reluctant for new activities- embarrassment
135
Features of dependent PD?
``` Excessive need to be taken care of Submissive/clingy behaviour Fear of separation Seeking advice/reassurance Uncomfortable alone Seeks new relationships when others end ```
136
Features of obsessive-compulsive PD?
``` Preoccupation with orderliness, perfectionism at expense of flexibility and efficiency Details, rules, lists, order, schedules Devoted to work Overconscientious Rigid ```
137
Treatments of PD?
Antidepressant (borderline) DBT- dialectical behavioural therapy Mindfulness Topiramate for aggression
138
What causes Karsakoff's amnesia?
``` Severe thiamine (vit B1) deficiency In chronic alcoholism ```
139
How long do dementia symptoms last for a diagnosis?
At least 6 months
140
What must be considered when interpreting cognition score?
Pre-morbid cognition (e.g. doctor, lawyer etc. may have higher scores)
141
Symptoms of Alzheimer's disease?
Memory loss (esp. short term) Dysphasia Dyspraxia Agnosia (cannot recognise objects)
142
Neuropathology of Alzheimer's disease?
Amyloid plaques and neurofibrillary tangles | Temporal lobe atrophy
143
Posterior Frontal Atrophy is a type of Alzheimer's disease. What are its special features?
Visual/ visuo-spatial symptoms
144
Symptoms of vascular dementia?
``` Dysphasia Dyscalculia (number difficulties) Frontal lobe symptoms Apathy Decreased processing speed Focal neurology ```
145
Progression of vascular dementia?
Step-wise decline
146
What does a CT/MRI show in vascular dementia?
Small vessel disease or multiple lacunar infarcts
147
Symptoms of frontotemporal dementia?
``` Behaviour changes Executive functioning Disinhibition +Impulsivity Decreased social skills PRIMARY PROGRESSIVE APHASIA- lack of words, impaired understanding of words ```
148
What does a CT/MRI show in frontotemporal dementia?
Frontotemporal atrophy
149
Features of Lewy-Body Dementia?
Cognitive impairment + parkinsonism Triad of FALLS, VISUAL HALLUCINATIONS + FLUCTUATING COGNITIVE IMPAIRMENT REM sleep disorders
150
Features of dementia with Parkinson's?
Parkinsonism for >1 year BEFORE dementia onset
151
How is all Alzheimer's, Lewy Body and Parkinson's Dementia treated?
Cholinesterase Inhibitors
152
Examples of Cholinesterase Inhibitors?
Donepezil, Rivastigmine, Galantamine
153
How do Cholinesterase Inhibitors work?
Increase cholinergic transmission | SLOWS PROGRESSION
154
Side effects of Cholinesterase Inhibitors?
N+V, diarrhoea, headache, muscle cramps, bradycardia, worsen COPD/asthma
155
Contraindications of Cholinesterase Inhibitors?
Active peptic ulcer Asthma COPD
156
Apart from Cholinesterase Inhibitors, what else is commonly prescribed in Alzheimer's, and how does it work?
Memantine Blocks NMDA-type glutamate receptors
157
What is Memantine used for?
Slows progression + prevent "challenging behaviour" (hallucinations/delusions, insomnia, anxiety/depression, aggression, disinhibition)
158
Side effects of Memantine?
Hypertension, dizziness, sedation, headache, constipation, insomnia
159
What are all people diagnosed with dementia and their families offered?
Post-diagnosis support (information, advance planning, advice, counselling)
160
Who else needs to know about a diagnosis of dementia?
DVLA
161
What is more common in ASD?
Gender dysphoria
162
Core features of ASD?
Difficulties in Social Communication, Social Interaction and Social Imagination + Repetitive behaviours + sensory problems
163
Causes of ASD?
``` Rubella is pregnant mother Tuberous sclerosis Fragile X Encephalitis Untreated PKU Birth injury/foetal distress ```
164
Neuropathological changes in ASD?
Large amygdala + cerebellum pathology
165
Diagnostic tools for ASD?
ADOS- autism diagnostic observation schedule
166
Common co-morbidities in ASD?
``` Anxiety/depression Eating disorders Learning disability OCD Tourette's Self harm etc ```
167
What can be used to manage aggression and self-injury in ASD?
Risperidone
168
Triad of ADHD?
Inattention Hyperactivity Impulsivity
169
What is the typical feature of adult ADHD?
Inattention or "inner restlessness"
170
Impact of ADHD on children?
``` Parenting difficulties Home stress Reckless behaviour Emotional dysregulation Barrier to learning Impaired decision making ```
171
Impact of ADHD on adults?
Increased psychiatric problems Criminality Antisocial behaviour Substance misuse
172
Causes of ADHD?
Genetics (increases through generations) Alcohol + smoking in pregnancy Prematurity Psychosocial adversity (economic class, crime, parent martial status, trauma)
173
Neuropathological changes in ADHD?
Frontal lobe underactivity | Decreased noradrenaline, serotonin and dopamine
174
Prognosis of ADHD?
Some will 'grow out of it' | Some have symptoms persistent into adulthood
175
First line medication in ADHD?
Methylphenidate (block dopamine transport) or Dexamphetamine
176
Other second line treatments of ADHD?
Atomoxetine (SNRI) | Clonidine (alpha agonist)
177
What is one of the biggest predictors for serious antisocial behaviour, criminality and substance misuse?
``` Oppositional Defiant Disorder (<12s) Conduct Disorder (>12s) ```
178
How is separation anxiety recognised?
Age appropriate, excessive and disabling anxiety
179
6 features of anorexia?
1. BMI <17.5 2. Self-induced weight loss 3. Fear of fatness 4. Body image disturbance 5. Delayed puberty/amonorrhea 6. Sexual dysfunction (men)
180
Physical symptoms of anorexia?
``` Muscle wasting Hair loss Lanugo hair Dry skin Hypotension Cold, blue peripheries Bradycardia Bruising Hypercarotenaemia (orange skin) ```
181
High risk anorexia?
BMI <13, >1kg loss/week, HR <40, Prolonged QT, sBP<80, temp <34 Unable to rise from squat without help Confusion
182
Specific investigations of anorexia?
LFTs- show liver damage (catabolism of liver for calories) FBC- anaemia ECG DEXA- osteopenia/porosis
183
What causes re-feeding syndrome?
Due to depletion of already inadequate nutrient stores (quickly used up when body starts repairing)
184
How to prevent re-feeding syndrome?
Slow pace initial feeding | Frequent bloods
185
5 features of bulimia?
1. Preoccupation with food 2. Irresistible craving for food 3. Bingers 4. Counter effects of binges (starvation, vomiting, laxatives) 5. Morbid dread of fatness
186
Physical symptoms of bulimia?
Calluses of knuckles (Russell's sign) Parotid hypertrophy Dental caries Abnormal U+Es
187
Complications of bulimia?
Oesophageal reflux/tears/rupture Hypokalaemia Subconjunctival haemorrhage
188
What MMSE scores could suggest dementia?
``` 21-26 = mild 10-20= moderate <10= severe dementia ```
189
Features of puerperal psychosis and when does it occur?
Sudden psychotic/manic symptoms, disinhibition, confusion 2-4 weeks post-birth
190
Risk factors for puerperal psychosis?
``` Mental illness Thyroid disorder FH First pregnancy C-section Perinatal death ```
191
Risk factors of post-natal depression and when does it occur?
``` Hx of depression/anxiety Complicated pregnancy Traumatic birth Domestic violence Trauma/abuse Financial difficulties ``` 2-6 week post-birth
192
When is urgent referral needed in perinatal mental health? (3)
Significant change in mental state/new symptoms Thoughts/acts of violent self-harm Incompetency as mother/estrangement from baby
193
Risk factors for perinatal mental health problems?
``` Young Single Domestic issues Lack of support Substance abuse Unplanned pregnancy Pre-existing MH condition ```
194
How many people with bipolar will relapse during pregnancy?
50%
195
Management of puerperal psychosis?
``` EMERGENCY admission to mother + baby unit Antidepressants Antipsychotics Mood stabilisers ECT ```
196
What is the recurrence rate of puerperal psychosis?
80% in 10 years | 25% will develop bipolar
197
3 general prescribing principles in pregnancy mental health?
1. Low risk medication + low dose monotherapy 2. Beware altered pharmacokinetics e.g. lithium 3. Encourage breastfeeding- relatively less that exposure in-utero
198
Which 2 anti-depressives to avoid in pregnancy?
Paroxetine (heart defects) | Citalopram
199
Can benzodiazepines be used in pregnancy?
NO | Increase malformations + floppy baby syndrome
200
Which anti-psychotics are safe to use in pregnancy?
Typicals better AVOID clozapine (agranulocytosis) + olanzapine (diabetes, weight gain)
201
Can lithium be used during pregnancy?
Yes | Monitor serum levels closely (toxicity can mimic pre-eclampsia)
202
Can lithium be used during breastfeeding?
NO | concentrated to baby
203
Is sodium valproate safe in breastfeeding?
Yes
204
Is tetracycline safe in breastfeeding?
No | absorbed by breastmilk- can discolour infant teeth permanently
205
Is carbamazepine safe in pregnancy?
No | Neural tube + facial defects
206
Is lamotrigine safe in pregnancy?
No | Oral cleft + stevens-johnson syndrome
207
Management of illicit drug misuse in pregnancy?
``` Methadone Child protection/social work Early IV access Vitamins Contraception! ```

Y3- TO LEARN (13 decks)

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