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1

What is a psychiatrist?

a doctor who assesses, diagnoses and manages mental illness

2

Describe the psychotic sieve

psychotic
mood
anxiety
organic
substance misuse
personality
no mental illness

3

What are the three main psychotic symptoms?

hallucinations
delusions
thought disorder

4

What is a delusion?

a false, unshakeable idea or belief which is out keeping with the person's educational, cultural and social background; it is held with extraordinary conviction and subjective certainty

5

What are the three core symptoms of depression?

low mood
anhedonia
low energy

6

What are the cognitive features of depression

slowed speed of thought
reduced concentration
reduced self esteem
ideas of guilt and unworthiness
bleak and pessimistic views of the future
hoplessness
ideas or acts of self-harm or suicide

7

What are the biological symptoms of depression?

disturbed sleep
diminished appetite
weight loss
loss of libido
low energy
constipation
amenorrhoea

8

what are the cognitive disorders associated with depression?

arbitary inference
selective abstraction
magnification
minimisation
over-generalization
personalisation

9

Give examples of SSRIs

sertaline, fluoxetine

10

WHat are the side effects of SSRIs?

nausea, vomiting, agitation, sexual dysfunction, hyponatraemia, sweating

11

Give examples of tricyclic antidepressants

amitryptaline

12

give examples of SNRIs

venlafaxine

13

Give examples of NASSAs

mirtazepine

14

Give examples of NARIs

Reboxetine

15

What are the 5 stages of adjustment?

denial
anger
bargaining
depression
acceptance

16

What are the types of abnormal grief

unexpected
ambivalent
chronic
delayed

17

What are the factors associated with abnormal grief reactions?

loss of child
loss of parent during childhood
sudden unexpected death
multiple deaths
attachment of blame to survivor

18

What is invasion?

growth by infiltration and destruction of surrounding tissues

19

WHat is metastasis?

spread of tumour to and growth at ectopic sites via blood, lymphatics, intraepithelial route or transcoelomic

20

What is a carcinoma?

malignant tumour derived from epithelial cells

21

What is a sarcoma?

malignant tumour derived from mesenchymal cells

22

What is melanoma?

malignant tumour derived from neural crest cells

23

What is leukaemia?

malignant tumour derived from circulating white blood cells

24

What is lymphoma?

malignant tumour derived from the lymphatic system

25

What is the metastatic cascade?

local invasion
angiogenesis
detachment
intravasation
transport
lodgement / arrest
extravasation
growth at ectopic site

26

What are the properties of a metastatic tumour?

reduced cell -cell adhesion
altered cell-substratum adhesion
increased motility
increased proteolytic ability
angiogenic ability
ability to intravasate and extravasate
ability to proliferate

27

How do carcinomas acquire the ability to escape the "glue" that binds them together?

via mutations in E-cadherin or in the molecules that regulate or interact with it

28

What are the names for the transcription factors that regulate E-cadherin?

snail, slug, twist

29

Describe the action of HGF

mitogen, mitogen and morphogen
Produced by stromal cells of the tumour
binds to c-met on tumour epithelial cells
increased phosphorylation of beta-catenin in tumour epithelial cells which leads to disrupted ECD-mediated adhesion

30

What is the stromal component of Cmet?

HGF

31

Where are chemokines produced in relation to cancer?

stromal cells

32

How are MMPs normally regulated?

transcriptional
synthesis of zymogen
activated by serine proteases
negative regulation by tissue inhibitors of metalloprteinases

33

What are the stages of extravasation?

rolling
activation
adhesion
diapedesis

34

Where do skin melanoma tumours usually spread to?

lungs, brain, skin, liver

35

What are possible mechanisms for organ tropism?

selective adhesion to endothelium to target organs
selective response to GFs at ectopic site
selective migration to CK source
Factors released by tumour cause changes in prospective TMW at secondary sites
balance of local and systemic angiogenic factors

36

WHat is the name of the chromosome mutation in chronic myeloid leukaemia?

the philadelphia gene

37

How does imatinib work?

binds to ATP binding region on Abl kinase and therefore prevent it from functioning properly

38

What drugs are VEGF inhibits?

sunitinib
pazopanib
axitinib

39

What are common mutations in melanoma?

Raf kinase
MAP kinase

40

What can be used to chemically castrate a man?

GnRH agonist
GnRH antagonist
oestrogens
AR antagonist

41

WHat are the advantages of targeted treatments for cancer?

more selective for cancer cells
less selective for normal cells
less side effects
higher doses
more anti-cancer effects

42

Describe drug resistance in targeted therapy

kinase mutations emerge which are no longer sensitive to drug
cancers eventually begin to grow again

43

Describe predictive markers

predict which patients will benefit from a specific treatment
what drug to use

44

WHat are prognostic markers?

inform about outcome regardless of treatment
may help choose which patients to treat but not which drugs

45

Describe the innate immune system mediated tumour control

innate IR recognises tumour cell establishment
NK cells and other effectors recruited to site by chemokines, which also target tumour growth directly
tumour specific T-cells home to tumour site, along with macrophages and other effectors to eliminate tumour cells

46

What are the three Es of immunoediting?

elimination
equilibrium
escape

47

Describe IFN a/b treatment

affects MHC class I expression and cell division
prolongs survival and stabilises disease in cancers such as RCC

48

Describe IL-2 treatment

therapy for RCC and metastatic melanoma
expansion of tumour specific T cells
high dose only
must be in hospital

49

WHat is the problem with single peptide vaccines against cancer?

tumour escape through selection of non-antigen variants

50

How can preformed antibodies work?

directly target cancer cells and mediate tumour destruction

51

How can monoclonal antibodies destroy a tumour?

apoptosis induction
complement mediated cytotoxicity
ADCC
conjugated to toxin

52

What is the target of ipilimumab?

CTLa4

53

what does biTEs stand for?

bi-specific T cell engager

54

Give examples of cell therapy

haematopoetic stem cells
tumour infiltrating T cells
dendritic cell vaccines
NK cells
gamma-delta T cells
virus specific T cells
genetically engineered T cells

55

What are the stages of stem cell therapy?

mobilise patient or donor cells
condition patient with radio / chemo
manipulate graft
re-infuse cells to "clean system"
innate immune system reconstitutes
adaptive system reconstitutes

56

Describe receptor engineering in T cell therapy

tumour antigen-specific artificial receptor generated, containing signalling functions
transferred into patient T cells to attack cancer cells

57

Describe a MSE

an assessment of current state of mind
snapshot during interaction
carried out with psychiatric history
observations and specific questions

58

What is the format of a MSE?

appearance and behaviour
speech
mood and affect
though form and content
perception
cognition
insight

59

Describe appearance in MSE

how person looks
ethnicity. build, hair colour, clothing
biological vs chronological age
well kemp?
self neglect?
unwell or intoxicated?

60

Describe behaviour in MSE

how they act
motor activity
eye contact
rapport and engagement
body language
unusual or socially unacceptable behaviour

61

Describe speech in MSE

how they talk
rate and quantity
rhythm
volume
tone
spontaeity

62

What is mood

a person's emotional state overall

63

What is affect?

changes in the person's emotions that you observe moment to moment during the interview

64

What types of mood are there?

subjective and objective

65

What types of affect are there?

reactive
flattened
blunted
labile

66

Give examples of thought disorders

flight of ideas
loosing of associations / knight's move thinking

67

What types of delusion are there?

paranoid
grandiose
nihilistic
delusions of reference
thought interference

68

What are over -valued ideas?

a false belief, not totally fixed but causing great disability

69

What are obsessions?

recurrent, intrusive, distressing ideas, impulses or images that the patient recognises as their own

70

How is cognition assessed?

alertness
orientation
attention / concentration
memory

71

WHat is insight?

the patient's understanding of their presentation and their need of treatment