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1. Primary delusions
Primary delusions are supposed to arise out of the blue, however can lead to secondary delusions. They can be preceded by a delusional mood.
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2. Defense mechanisms include
Synopsis of Psychiatry by Kaplan and Saddock gives a fair account on defense mechanisms.
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3. Neurofibrillary tangles are seen in
Intracellular neurofibrillary tangles are seen several other conditions in addition to Alzheimer's disease. They are frequently asked about in MCQs. Companion to psychiatry studies gives an account.
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4. An elderly patient could present with confusion due to
Elderly can get confused quite easily. Causes can be varied including lack of sleep and change of environment.
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5. Parietal lobe lesions could produce
Lobar dysfunction is frequently asked about and therefore worth knowing well. Hemianopia tends to be inferior due to the anatomy of the optic radiation. Perseveration is a well known symptom of frontal lobe dysfunction. Oxford textbook of psychiatry and Sciences basic to Psychiatry by Puri and Tyrer give reasonable accounts.
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6. In heroin addiction
Endocarditis is an uncommon complication following the use of contaminated needles and syringes. Urine testing can be use to confirm the use only.
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7. Satisfactory system of classification should
Oxford textbook gives a fair account on classification.
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Following are true regarding factitious disorders
involves intentional production of physical or psychological signs or symptoms. t motivation for the behaviour is the need to assume sick role t economic gain for the behaviour can sometimes be demonstrated f Pseudologica Fantastica is a known association t normal EEG rules out epilepsy f
In malingering an external incentive for the behaviour can be demonstrated, however in factitious disorder the motivation is a need to assume sick role. A normal EEG only means that there was no electrical epileptic activity at the time of recording.
Grief reaction could occur after
a death of a pet t
moving house t
death of an aggressive father t
amputation of a limb t
migration t
Grief reaction can follow loss of any object, material or otherwise.
MSE
can have legitimate influence by the presence of another informant t is impossible if the patient is sufferring from organic brain disease. f can only be done using PSE f one long interview is preferred to many short ones. f can take more than a week in a 70 yr. old patient admitted with psychotic depression t
Easy. Oxford textbook of Psychiatry has a chapter on Clinical examination which gives a fair account.
Li therapy
could cause tremor within 7 days at therapeutic dose t
induced polyuruia can be reduced by giving Amiloride t
ataxia is a known complication t
worsens psoriasis t
can cause diabetes insipidus t
It is important to know side effects and toxic effects of Li. BNF, Oxford Textbook and Sciences basic to Psychiatry by Puri and Tyrer gives accounts on LI.
Lesions in the 8th nerve can have following associations
tinnitus t
neurofibroma t
ataxia t
loss of corneal reflex t
loss of facial innervation t
Neurofibromata is a common cause of 8th nerve palsy. Due to it's proximity to 7th nerve lesions can also be associated with signs of 7th nerve palsy.
13 Features seen in Wernicke's Syndrome ataxia t diplopia t peripheral neuropathy t dysphasia f confusion t Dysphasia is not a feature of Wernicke Korsakof's Syndrome but confabulation can be.
14 The DSM IV classification has aetiological concerns t has 5 axes t contains operational criteria t classes neurotic illness f contains prognostic features t While ICD 10 is essential reading, DSM IV [at least the first few chapters] are useful reading.
15 Peripheral parasympathetic stimulation can cause increased salivation t relaxation of sphincter tone t constriction of skin blood vessels f sweating f relaxation of cilliary muscles f It is a useful rule of thumb to remember that Sympathetics mediate Fright Flight or Fight Reaction. Para-Sympathetics in general have the opposite action to this. Sciences basic to Psychiatry by Puri and Tyrer gives an account.
16 Immediate feature after transection of the Spinal cord below the level of lesion muscle paralysis t absent reflexes t lost sensations t capillary constriction f spasticity f Immediate features after transection are collectively called spinal shock. Later on signs include lower motor signs at the level of the lesion and upper motor signs below
17 Clozaril has a specific antagonistic action on D1 receptors f has an action on D4 receptors f has a selective action on 5HT receptors f causes hyperprolactinaemia f is a benzodiazepine f Clozaril was the first atypical antipsychotic launched and is a dibenzodiazepine. It causes less EPSE and hyperprolactinaemia. BNF, Oxford text book and Sciences basic to Psychiatry by Puri and Tyrer gives reasonable accounts.
18 MAOI can interact with Pseudoephedrine t Salbutamol f Pethidine t Li f Haloperidol f Salbutamol is a beta-2 agonist and has no hypertensive action. Reference as in Q-17 above.
19 Internal Capsule is closer to lentiform nucleus t divides corpus striatum t contains afferent and efferent fibres t contains optic radiation t exclusively supplied by middle cerebral artery f Sciences basic to Psychiatry by Puri and Tyrer gives an account.
20 Obsessions could occur in the form of craving f delusions f panic f sexual impulses t mental images t Can also be thoughts. Symptoms of the mind by Simms, gives an account.
21 Following indicates depressive illness in a child with learning disabilities inability to read f early morning awakening t diurnal variation of behaviour t non suicidal self-mutilation f mutism t In learning disability the patient will find it difficult to verbalise, depressive symptoms. However they can withdraw, be mute or even commit suicide. Oxford textbook gives an account.
22 EEG changes are commonly found in antisocial personality f complex partial seizures-interictal phase t acute confusional state t hypoglycaemia t acute subdural haemorrhage t Scientific basis of Psychiatry by Puri and Tyrer gives an account.
23 In a patient diagnosed as having Manic Depressive Psychosis, it is important to ask about family H/O affective illness t sleep disorders t eating and weight disorders t forensic history t suicidal ideation t Easy. Oxford textbook of Psychiatry gives a fair account of the clinical features of Manic Depressive Psychosis.
24 Physical symptoms of anxiety include rotational vertigo f fainting t frequency of micturition t sweating t globus hystericus t Somatic symptoms of anxiety can also include palpitations, butterflies in the stomach, light headedness, tremors etc.
25 Hysterical fugue is characterised by wandering behaviour t associated with loss of personal identity t acute in onset t associated with emotionally involved matters t usually stops within 3 weeks t ICD 10 describes these clinical features
26 Ideas of reference could occur in normal people t could occur in PTSD t are always delusional f occur in mania t can lead to secondary delusions t Ideas of reference are not delusions but can lead to delusions of references.
27 Frontal lobe damage is associated with emotional changes t visual distortion f difficulty in planning tasks t grasp reflex t incontinence t References as in Q-5 above
28 Anhedonia is seen in schizophrenia t has an identifiable onset f an essential feature of ICD t is the same as retardation f is subjected to diurnal variation t Anhedonia means inability to enjoy anything in life. It is seen in depression and other psychiatric conditions. Symptoms of the mind by Simms gives an account. an essential feature of ICD t
29 Alcohol withdrawal symptoms include anxiety t sweating t paranoid delusions t loss of memory t tremors t Everything about alcohol is essential knowledge. Fair accounts are given in Oxford Textbook, Companion to Psychiatric studies, and Revision notes by Puri and Hall.
30 Schneider's first rank symptoms include thought block f thought withdrawal t somatic passivity t delusions of perception t third person auditory hallucinations t Easy. You must have this sort of basic knowledge at your fingertips.
31 Acute organic syndrome is characterised by visual hallucinations t lability of affect t paranoid delusions t worsening at night t disorientation t ICD 10 describes these clinical features
32 Following are indications of good orientation knowledge of what the doctor is doing f name days of the week from the end to the beginning f lack of visual hallucinations f gives the date of birth correctly f ability to do serial sevens f none of the responses indicate orientation in time place or person
33 Following are suggestive of pseudodementia in a 50 yr. old person presenting for the first time significant apathy f loss of short term memory f retardation f depressed mood t don't know' answers t Apathy (blunting of flattening of affect) and retardation are features of depression but would not suggest pseudodementia by themselves.
34 In the H/O a patient with a P/H of schizophrenia, following are important to be questioned eagerly about the previous illness. compliance with medication t first rank symptoms t last dose of medication t minor affective symptoms f age of onset t Little bit of common sense and Oxford Textbook is adequate to answer.
35 According to psychoanalytical theory neurosis can occur due to failure of achieving development t impairment of relationship with the mother f when a child is preoccupied with faeces by the age of 12 f due to unconscious mental conflicts resulting from unacceptable sexual or aggressive impulses t due to repression of impulses of aggression. t Synopsis of Psychiatry by Kaplan and Saddock, Oxford textbook, and Revision notes by Puri and Hall gives basic accounts.
36 In psychoanalytical theory ego strength is a good predictor of outcome in psychotherapy t was first proposed by Freud t is a major feature of Obsessive Compulsive personality f is not a feature of Jungian psychology f can be weakened by developmental failure in childhood t references as in Q-35 above
37 Anxiety in psychoanalytic theory is due to threat from superego forces t is due to threat from id forces t is a warning to superego t is always due to castration fear f improves with age f as in Q-35 above
38 Obsessive Compulsive phenomena in psychoanalytic theory are understood as dramatisation f are always due to oedipal conflict f reduce anxiety t reflect undoing t due to projection f as in Q-35 above
39 Explanations in psychoanalytical theory for the contents of dreams include condensation t sublimation f idealisation f displacement t dissociation f Symbolisation is another example of dream content.
40 Counter transference is the therapists emotional reaction to the patient t can give useful information about the emotional state of the patient t was initially seen as unhelpful by Freud t is therapeutically useful in chronic rehabilitation f Is a reason why the therapist should have his own analysis t Countertranference refers to the reaction of the therapist to the transference by the patient. It is also helpful to gain an understanding of the patient's emotional state.
41 To be successful in psychotherapy the patient should be motivated t accept the tenets of psychoanalysis t be prepare to re examine things about himself he has always accepted t come from a stable family f be of superior intelligence f Examination notes in Psychiatry by Bird and Harrison is a good text for learning lists such as these.
42 Tremor is common with Li t Haloperidol t Phenelzine t Buspirone f Diazepam f Diazepam and Buspirone will relieve tremors if at all.
43 Patients on MAOI's should not eat cottage cheese f broad beans out of their pulses f pickled herrings t fresh calf liver f yeast extract t BNF, Oxford Textbook and Scientific Basis of Psychiatry by Puri and Hall gives reasonable accounts.
44 Recognised side effects of Trifluoperazine include salivation t sedation t reduced threshold for convulsions t dystonia t tremor t As in Q-43 above
45 Recognised side effects of Chlorpromazine include monocular diplopia f hypertensive encephalopathy f photosensitivity t impotence t leucocytosis t As in Q-43 above
46 Haloperidol can cause Akathesia t jaundice t a dangerous reaction with MAOI's f spastic paraparesis f weight loss t As in Q-43 above
47 Benzodiazepines reduce serum folate f can cause fits on withdrawal t can potentiate antidepressant effect of tricyclics f produce fast activity in the frontal region of the brain t cause increase in REM activity in the first few weeks following administration f REM rebound follows after withdrawal of Benzodiazepines. They are used to treat fits and can cause them on withdrawal. EEG changes due to common medication can appear in the exam. Examination notes in Psychiatry by Bird and Harrison and Sciences basic to Psychiatry by Puri and Tyrer gives an account.
48 Following are parts of neo cortex Broca's area t operculum t superior temporal gyrus t hippocampus f cingulate gyrus f hippocampus is a part of archicortex, and cingulate gyrus is a part of mesocortex
49 Bell's palsy can occur with loss of smell f alteration of sense of taste t an increase in the number of lymphocytes in the CSF f change in auditory accuracy t diplopia f 7th cranial nerve anatomy is complicated but frequently examined in MRCPsych exam. Textbook of Medicine by Kumar and Clerk gives an account of Bell's palsy.
50 A frontal meningioma can cause visible changes on the skull x-ray t unilateral papillidoema t epilepsy t loss of smell t gait disturbances t A space occupying lesion in the frontal lobe can give rise to all these features. Reference as in Q-49 above.