psych Tom dalton, ct1

PART 1: meds

PART 1: meds Which of the following is an SSRI: Vortioxetine Duloxetine Paroxetine Mirtazapine Pictures of baby animals SSRI Sertraline, Fluoxetine, Citalopram, Escitalopram, Paroxetine SNRI Duloxetine, Venlafaxine TCA Clomipramine, Amitriptyline, Imipramine NaSSA Mirtazapine NDRI Bupropion

PART 1: meds Which of the following medications is likely to be most well-tolerated: Venlafaxine Selegiline Olanzapine Sertraline Pictures of baby animals - [SSRI], hypotension, ++withdrawal effects - CHEESE - Sedation, metabolic, (EPSEs) - [SSRI] - None SSRI SIDE EFFECTS Early: GI symptoms, sleep disturbance, anxiety Ongoing: Sexual dysfunction

PART 1: meds Which of the following is not an atypical antipsychotic: Clozapine Paliperidone Clopixol Zuclopenthixol Amisulpride TYPICAL Haloperidol, Chlorpromazine, Zuclopenthixol, (old ones ending in “-azine”) ATYPICAL Clozapine, Olanzapine, Risperidone, Aripiprazole, Quetipine, Amisulpride,

PART 1: meds Which of the following is not an EPSE: Oculogyric crisis Intention tremor Bradykinesia Pacing up and down the ward Tardive dyskinesia EXTRAPYRAMIDAL SIDE-EFFECTS - Acute Dystonia - Parkinsonism/Akinesia - Akathisia - Tardive dyskinesia

PART 1: meds What is the most suitable treatment for oculogyric crisis? Procyclidine 5mg IM Procyclidine 10mg PO Midazolam 5mg IV Manage the airway A nice cup of tea ACUTE DYSTONIA Antimuscarinic (ie. Procyclidine 5-10mg) PO or IM/IV depending on swallowing Benzodiazepines not often used Have a cup of tea afterwards Procyclidine 5-10mg may be given regularly or PRN up to TDS for recurrent EPSEs

PART 1: meds Your patient has just been started on a mYsTERy pSYcHoTROpic mEDiCAtioN. They present with agitated delirium, hyperthermia, rigidity, shivering and myoclonus. What’s the most likely diagnosis? Influenza Serotonin Syndrome Neuroleptic Malignant Syndrome Ignore it they’re just a mad person lol SEROTONIN SYNDROME Presentation: Mental status change Myoclonus, hyperreflexia, rigidity D&V Autonomic instability Diaphoresis Tachycardia Hyperthermia Hypertension

PART 1: meds Which of the following is not a symptom of NMS: Palpitations High fever Muscle rigidity CK >1000 Confusion NEUROLEPTIC MALIGNANT SYNDROME Presentation: Mental status change (?catatonia) Muscular Rigidity Hyperthermia (commonly >40°C) Autonomic instability Tachycardia Labile BP Tachypnoea Ix Findings: Leucocytosis High CK AKI + other electrolyte abnormalities

PART 1: meds You accidentally gave someone too much diazepam and they are snoring. What do? Support the airway and wait for it to wear off Support the airway and prescribe flumazenil Monitor pulse oximetry Drop a few mg yourself and have a lovely afternoon

PART 1: meds Someone just accidentally consumed too much blow and have arrived in A&E shortly afterwards. What do? Naloxone 400mg IV, supportive management and monitor closely Activated charcoal Supportive management and consider benzodiazepines Supportive management and fomepizole, or ethanol Pop to the bathroom and check UrbanDictionary - Opioids <4h after PO OD - Methanol

PART 1: meds Match the medication to the vaguely sensible starting dose: Fluoxetine Lithium Carbonate Sertraline Olanzapine Super Saiyan Level >9000 units 20mg 5mg 400mg 50mg

PART 1: meds I would not be too concerned if my patient’s lithium level was: 0.1 0.5 1.5 4 40 Too damn high

PART 1: meds You have just started your patient on Lithium. Which of the following statements is a filthy lie? Levels should be taken 12 hours after the dose Aim for a serum-lithium concentration of 0.8–1 mmol/litre for acute episodes of mania Routine serum-lithium monitoring should be performed daily for the first week after initiation and after each dose change until concentrations are stable When doses are stable, and in the absence of significant intercurrent illness, levels should be taken every 3 months This is the best damn psychiatry quiz I have ever experienced Monitor BMI, serum electrolytes, eGFR, and thyroid function at baseline and every 6 months during treatment

PART 2: some other things Which of the following is the most useful part of the AMT-10 for diagnosing delirium: Months of the year backwards Orientation (time/place/person) Short-term memory test Who is the current prime-minister To know the Kings of England and to quote the fights historical, from Marathon to Waterloo in order categorical

PART 2: some other things A gentleman on AMU has UTI on BG of MCI and now has delirium. He is taking ramipril, oxybutynin, sinemet and sodium valproate. Overnight he thinks there are spiders everywhere and starts trying climb the furniture. What do? Stop his oxybutynin Grab‘n’Stab (lorazepam 2mg IM under restraint) Give haloperidol 5mg PO Guided relaxation exercises Help him kill the spiders oh lawd they're everywhere

PART 2: some other things Said gentleman later wakes up and tries to leave the ward, mumbling incoherently about spiders. What do? Send him on his merry way Fill out a Section 5(2) Cuff him to a chair and tell him he does not have to say anything but it may harm his defence if he does not mention when questioned something he later relies on in court Make a recommendation for Section 2 Fill out DoLS

PART 2: some other things MCA: Presumption of capacity Does the person have an impairment or disturbance of the functioning of their mind or brain? Does the impairment or disturbance of their mind or brain mean that the person is unable to make a particular decision? (understand, retain, weigh up, communicate)

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