80-87 2009.docx

80-87 80. Organophosphate poisoning Ans:B Organophosphate inhibits acetylcholine breakdown so cholinergic activity "DUMBBELLS" Diarrhoea Urination Miosis Bradycardia (usually but may be tachycardia nicotinic) Bronchorrhea Emnesis Lacrymation Lethargy Salivation Rx: Atropine then pralidoxime 81. Suicide A. Risk factorsThe score is calculated from ten yes/no questions, with one point for each affirmative answer: 

S: Male sex

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A: Age less than 19 more than 45

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D: Depression (50% of suicides)

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P: Previous attempt

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E: Ethanol abuse

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R: Rational thinking loss(10% suicide is schizo with prominent delusions command hallucinations is the worst)

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S: Social supports lacking

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O: Organized plan

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N: No spouse( 2×if single 4-widowed/divorced(doh marry ppl and then buss it tabancre is serious business)

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S: Sickness

This score is then mapped onto a risk assessment scale as follows: 0–4 Low 5–6 Medium 7–10 High

Others: Unambiguous wish to die: if you get a suicide for exam end by asking them whether they will try kill themselves if they leave and go home!!! Rescue unlikely Unemployment Family History Access to lethal agents/ firearms(there aint no coming back from blowing out ur brains with buckshot) Family history Fantasies of reunion with deceased loved ones Occupation: dentist(good thing I didn’t choose that!), physician(oops!), nurse, scientist, police, farmer. Childhoood abuse.

82. Lithium therapeutic level: 0.4 -0.8 maintenance better tolerated most patients but 0.8 t0 1.2 is most effective, 1-1.5 acute mania check after 5days rx Prelithium: CBC, ECG, TFT, BUN, Cr Start rx with 300mgtid. COMMON SE: thirst, polyuria, tremor, metallic taste, cognitive dulling, GI upset Uncommon: Hypothyroidism(must test TFTs if depression on lithium), Rare: renal toxicity Poisoning>2mmol/l: apathy & restlessness then vomiting, diarrhea, ataxia, weakness, dysarthria, muscle twitch, tremor Severe: convulsion, coma, renal failure, electrolyte imbalance, dehydration, hypotension note slow onset symptoms cuz time to cross BB barrier Rx. Acute overdose before symptoms: increase fluid intake After : possibly haemodialysis 83. B Atypicals(serotonin dopamine antagonists): both positive and negative symptoms, fewer EP side effects, do not elevate prolactin less likely to cause tardive dyskinesia. Highly sedating, more wt gain (Except risperidone) Typicals: High Potency(butyrophenones: haloperidol): extrapyramidal SE likely: akithisia, acute dystonia, pseudoparkinsonism. Low potency(phenothiazines) more sedating, hypotensive, anticholinergic.

84. B blunted affect Positive Symptoms: Delusions Hallucinations Disorganized Behaviour Negative Smptoms 4 As Affective flattening-don’t feel Alogia-don’t think Avolition -don’t do Anhedonia-don’t be interested

85. A. delusion: a fixed false belief that is not in keeping with social norms Hallucination: false sensory perception not associated with real sensory perception Stereotypy: Repetitive fixed pattern of physical action or speech 86. Paranoid schizophrenia: delusions of persecutions or grandeur, frequent auditory hallucinations related to single theme, tense suspicious guarded, intelligence remains intact, later age of onset and better prognosis. Generalized anxiety disorder: anxiety and worry most days 3 0f 6 C concentration difficult/mind going blank F esily Fatigued I Irritability R Restlessness/keyed up/ on edge S sleep disturbance(difficult to fall asleep/ remain awake) T muscle Tension Obsessive Compulsive Disorder:involuntary Obsessions(recurrent persistent thoughts images with insight) or Compulsion(repetitive behaviours meant to relieve stress or prevent a dreaded event behavior not connected or excessive)

87. d 25 Behaviour significantly affected by delusions or hallucinations This one kinda subjective and unfair.