SPMM Part A(2) Practice Questions > Set 1 > Flashcards

Set 1 Flashcards

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1
Q

Which –> antidepressant induced hyponatraemia:
- age 30-40years
- low body weight
- normal renal function
- males

A

low body weight

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2
Q

Serotonin syndrome: what is it caused by?

A

excessive seccretion of serotoninn from 5-HT1A

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3
Q

6 weeks after admission, observed tremors, ataxia, twitching, restlessness, diarrhoea, vomiting and polyuria. Within a few days has fluctuating alterness. Diagnosis?
- serotonin syndrme
- water intoxication
- anticholinergic syndrome
- acute dystonia
- tyramine reaction

A

serotninin syndrome

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4
Q

Least cardiotoxic SSRI?
- sertraline
- citalopram
- paroxetine
- venlafaxine
- fluoxetine

A

sertraline
(not cardiotoxic, no anticholinergic activity) –> USED IN post-MI DEPRESSION

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5
Q

Which drug can increase teratogenic effect of carbamazepine?
- valproate
- topiramate
- buspirone
- fluoxetine

A

sodium valproate

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6
Q

What is an idiosyncratic reaction?
Which is an example of this?
- renal damage due to lithium
- SSRI dicontinuation syndrome
- lithium toicity post sepsis
- SJS on treatment with lamotrigine

A

unpredictable, abnormal, and uncommon response to a drug (or sometimes a food or other substance) that cannot be explained by the drug’s known pharmacological action or by dose, allergy, or toxicity.

–> SJS when on lamotrigine

(SJS also associated with phenytoin, penobarbital, lamotrigine, carbemazepine)

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7
Q

Which isn’t a SE of valproate?
- red cell hypoplasia
- thrombocytopenia
- leucopenia
- thrombocytosis
- weight gain
- tremor

A

thrombocytosis

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8
Q

Which drug is affected by acetylator (slow/fast) status?
- oxazepam
- nitrazepam
- lithium
- galantamine
- chlorpromazine

A

nitrazepam

Explaination:
- acetylation occurs in phase 2 of metabolism
- the enzyme group responsible= N=acetyltransferases
- based on polymorphisms, humans can be slow, fast, or intermediate acetylators
- slow acetylation –> prolonged half-life which causes increased side effects
e.g. peripheral neuropathy (isoniazid), lupus (hydralazine), allergic reactions, haemolysis (sulfonamides), handover (nitrazepam) and GI (sulfalazine)

Other drugs which impacted by acetylator status:
- isoniazid
- hydralazine
- procainamide
- some sulfonamides
- sulfalazine
- nirtazepam
- caffine

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9
Q

Topiramate: weight loss or gain?

A

weight loss

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10
Q

Which has potential to cause dependence?
- fluvoxamine
- tranylcypromine
- escitalopram
- phenelzine

A

tranylcypromine (MAOI)

amphetamine-like structure that makes it addictive

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11
Q

Which prolongs QTC?
- trazadone
- reboxetine
- duloxetine
- mirtazapine
- fluoxetine

A

trazodone

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12
Q

Cardiac arrythmia on dosulepin: what is the next course of action? (1)

which is the only TCA that doesn’t cause arrhythmogenicity? (1)

A

Stop the drug

–> it’s a TCA
causes potent blockade of Na channels and variable activity at potassium channels

lofepramine is the only TCA that doesn’t cause arrhythmogenicity of other TCAs

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13
Q

Risk factor for clozapine neutropenia:
- White caucasian
- increased white cell disorder
- polypharmacy
- young age
- high dose
Which ethnicity at increased risk? (1)

A

young age

Afro-Caribbean is a risk, also LOW BASELINE WCC

Risk factors for neutropenia: younger age, Afro-Caribbean, low baseline WCC
Risk factor for agranulocytosis: female, older age, Asian/ Ashkenazi Jewish

Usually seen in first 18 weeks of treatment

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14
Q

Which antidementia drug undergoes breakdown by chinesterase itself with no hepatic involvement in metabolism?
- rivastigmine
- donepezil
- galantamine
- memantine
- tacrine

A

rivastigmine

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15
Q

Phenelzine:
what MOA?
what does it treat
- agoraphobia
- social phobia
- obsessional symtpome
- generalized social phobia

A

MAOI

generalized social phobia

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16
Q

Which mood stabilised is not recommended for prophylaxis in BPAD?
- lithium
- carbemazepine
- topirarmate
- valproate
- lamotrigine

A

topiramate
(currently evidence sparce)

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17
Q

The efficacy of antipsychotic drugs is determined by the afffinitiy for: mesolimbic or nigrostriatal dopamine receptors?

A

mesolimbic dopamine receptors

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18
Q

How can dosages of lithium be changed to reduce tremors?

A
  • smaller, more frequent doses
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19
Q

Which is a pro-drug, whos metabolite is used as an individual compound theraputically?
- risperidone
- fluoxetine
-zopliclone
- haloperidol

A

risperidone

–> 9-hydroxyrisperidone (paliperidone) which has a half life of 21 hrs

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20
Q

Which is a partial nicotine agonist?

A

varenicline

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21
Q

Gabapentin binds to which receptor?
- GABA-B
- GABA-A
- NMDA
- voltage-dependent calcium channel

A

treats neuropathic pain and seizures

DOESN’T bind to GABA
works on voltage gated calcium channels in brain (despite its name)

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22
Q

hyperprolactinaemia –> amenorrhoea, galactorrhoea due to D2 blocakde of which pathway
- mesocortical
- tuberoinfundibular
- mesolimbic pathway
- papex circuit
- niagrostriatal pathway

A

tuberoinfundibular pathway

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23
Q

Whcih antidepressant can influence gene transciption via nuclear receptors
- L tryptophan
- phenelzine
- fluoxetine
- imipramine
- tri-iodothyronin

A

tri-iodothyronine

T₃ enters cells and binds to thyroid hormone receptors (TRα and TRβ) located in the cell nucleus.
These receptors function as transcription factors.
When activated, they bind to thyroid response elements on DNA, modulating gene expression and thereby influencing neuronal growth, neurotransmission, and energy metabolism.

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24
Q

All reduce renal clearance of lithum except:
- thophylline
- tiazides
- NSAIDs
- furosemide

A

theophylline

Furosemie–> REDUCES renal clearance of lithium because: the kidney can’t tell lithium and sodium apart — so when it reabsorbs sodium, it also reabsorbs more lithium, leading to higher lithium levels and risk of toxicity.

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25
When given orally, which benzo has shortest half life? - lorazepam - triazolam - nitrazepam - alprazolam - chlordiazepoxide
triazolam (2-3hr) alprazolam 6-12hr lorazepam 10-20hr nirazepam 15-38hr
26
The rate limiting step in dopamine metabolism is catalysed by: - tyrosine hydroxylase - monoamina oxidase - tryptophan hydroxylase - catechol O methy transferase - dopamine hydroxylase
tyrosine hydroxylase. (converts tyrosine --> L-dopa) Monoamine oxidase (MAO): breaks down dopamine (metabolism, not synthesis). Tryptophan hydroxylase: used in serotonin synthesis, not dopamine. Catechol-O-methyltransferase (COMT): also breaks down catecholamines (dopamine, adrenaline, etc.). Dopamine hydroxylase: converts dopamine → noradrenaline, not the rate-limiting step.
27
Which is true RE MAOIs: - mainly exreted unchanged in kidney - short elimination half life - irreversible MAOIs are highly water soluble - acetylation status is polygenetically inherited - 90% of white people are fast acetylators
short elimination half-life they are - highly lipid soluble - rapidly absorbed - widely distributed - shower half-life - metabolised by the liver - only 1-2% unchanged in urine Acetylators: - ~60% of white people and ~10-20% of Asians are slow acetylators - ~50% of white people and much more Asians are fast acetylators **however MOAIs aren't impacted by acetylator status so unsure why this question mentioned them!**
28
Having 2 copies of fully active CYP450 enzyme allele will result in? (1): - ultrarapid metaboliser - extensive metaboliser - intermediate metaboliser What about having 1 copy? (1)
ULTRARAPID metabooliser 1 copy --> intermediate metabolism 0 copy --> poor metaboliser
29
Which is safest in oral contraceptive pill use? - carbemazepine - valproate - phenytoin - topiramate - pehnobarbitone
valproate
30
When switching from MAOIs to SSRI how long to wait
withdrawal and wait 2 weeks before starting new drug (prevent serotonin syndrome)
31
Which hypnotic medicaton causes unpleasant, metalic taste?
zopiclone
32
Clozapine induced SOB, tacycardia and fever. What to request urgently? - troponin - ECG - D dimer - CXR
TROPONIN (most common 6-8weeks post clozapine) monitoring protocol: baseline troponin, CRP,a nd Echo then monitor trop and CRP on day 7, 14, 21, and 28
33
Prolonged QTc is associated with - methadone - buprenoprhine - naltrezone - naloxone - diazepam
methadone (--> ECG monitoring recommended on methadone)
34
When does cardiomyopathy tend to occur on clozapine? (1) how does this compare to myocarditis? (1)
~9 months (compared to myocarditis usually in first 6 weeks)
35
What does AIMS (abnormal involunrary movement scale) aim to asses: - psychomotor agitation - akathisia - tardive dyskineisia - torticollis
tardic dyskinesia
36
Which is least likely associated with neuroleptic malignant syndrome? - raised CPK level - autonomic lability - hyperthemia - muscle rigidity - bradycardia
bradicardia Sx you do get: hypertemia rigidity agitation altered consciousness tachycardia tachypnoea HTN trmor diaphoresis raised CPK leukocytosis metabolic acidosis
37
which has not been reported in SSRI use as an adverse effect: - hallucinations - photosensitivty - galactorrhoea - HTN - akathisia
HTN you can get akathisia, dyskinesia, parkinsonism, occasionally dystonia/ bruxism (in SNRI like venlafaxine you can get HTN)
38
the risk of seizures with clozapine is increased by what percentage
1-5% Overall, the cumulative risk is around 1–5% at standard doses. At higher doses (>600 mg/day), the risk rises to about 5–10%. In very high doses (>900 mg/day), risk can approach ~15–20%.
39
GI SEs of SSRis is due to what receptor
5HT-3 STIMULATION
40
which psychotropic used as preoperatuve antihistamine prior to general anesthetsia - lithium - phenytoin - chlorpromazine - clomipramine - carbamazepina
chlorpromazine
41
Which is the most potnet inhibitor of CYP2D6? - paroxetine - sertraline - St Johns Word - escitalopram - reboxetine
paroxetine paroxtetine, fluoxetine and duloxetine --> POTNET INHIBITORS
42
Which antibiotic might cause disulfiram-like reactions - cefuroxime - ciprofloxacin - metronidazole - amoxicillin - co-amoxiclav
metronidazole (facial flushing and drop in BP)
43
How does smoking impact clozapine levels
STOPPING --> INCREASED LEVELS
44
Which drug needs to be used in cution with SSRI: - haloperidol - amoxicillin - lithium - quetiapine - naproxen
naproxen NSAID and SSRI cause alterations of thombocyte aggregation and --> GI side effects
45
Antidepressant with good efffiacy in atypical depression - mitarzapine - amitriptyline - fluoetine - phenelzine - venlafaxine
phenelzine (MAOI)
46
Sigma-1 receptors associated with: - pain perception - dissociation - impulsivity - flashbacks
pain perception Pain perception: Sigma-1 receptor activation can enhance pain signals. Depression: Sigma-1 receptor activation can improve mood via neuroplastic and neurotransmitter effects.
47
flumazenil reverses action on benzos by: - closing potassium channels - noncompetative inhibition at GABA-A receptor - noncompetative inhibition at GABA-B receptor - competative inhibition of GABA-A receptor - closing chloride channels
competative inhibition of GABA-A
48
In cognitive impairment due to HIV, what cells is least likely to be affected - lymphocytes - neurons - macrophages - microglia
neurons all the other cell types in the CNS have HIV-1 receptors
49
Regional blood flood is likely affected in schizophrenia. Which area likely to be affected - left medial temporal - prefrontal cortex - raphe nuclei - basal ganglia - bilateral perietal
prefrontal cortex In schizophrenia: HYPOperfusion: frontal lobes, anterior and medial cingulate gyro, parietal lobes HYPERperfusion: cerebellum, brainstem and thalaus
50
A postmortem of an elderly man who had progressive non0-amnesic cognitive impairment, disinhibition, and pill rolling trmors revelas ubiquiton inclusions. Which gene mutation caused it - progranulin - prion protein - neurexin - presenilin-2 -dysbindin
FTD = progranulin (PGRN)
51
The density of D2 receptors is seen in children <5 years of age is greater than in adulthood. This regresses in the second decade. The process of this is called - downregulation - pruning - desensitisation - waning - habituation
pruning synaptic 'pruning' = the natural elimnination of unnecesssary synapses that normally occurs in adolescence, making the brain more organised and efficient
52
Most common opporutunistic infection in AIDS CNS? - cryptococcal meningitis - neurocysticercosis - toxoplasma gondii - cytomegalocirus - tuberculosis menginigits
toxoplasma gondii
53
disturbance in cerebral torque is underlying pathological change in - OCD - autism - grand mal epilepsy - PTSD - psychosis
pscyhosis 'Cerebral torque'= opposing R-L asymmetries of frontal and parieto-occipital regions of brain
54
EEG: multiple spike and wave activity - absence seizure - CJD - subactue sclerosing pancencephalitis - herpes encephalitis - myoclonic epilpsey
myoclonic epilepsy - Absence seizure 3 Hz (3 cycles/sec) generalized spike-and-wave discharges - Creutzfeldt–Jakob disease (CJD) Periodic sharp wave complexes — typically biphasic or triphasic, occurring at about 1 Hz - Subacute sclerosing panencephalitis (SSPE) Periodic, high-amplitude slow-wave complexes every 4–10 seconds (synchronous with myoclonic jerks) - Herpes simplex encephalitis Periodic lateralized epileptiform discharges (PLEDs) — often over temporal lobes - Myoclonic epilepsy (e.g. juvenile myoclonic epilepsy) Generalized polyspike and wave discharges, typically 4–6 Hz
55
substance secreted by hypothalamus and enhances food intake - Neuropeptide Y - beta endorphins - neurotensin - vasopressin - cholecytokinin
neuropeptide Y
56
increased concentration in axion prior to depolarisation - calcium - nitrogen - sodum - hydrogen - potassium
potassium
57
REM latency and depression: which is true - REM latency distinguishes subtypes of depression - shortened REM latency is not a specific marker of depression - depression is associated with increased REM - most antidepressants reduce REM latency - there is no relation ship between REM and depression
shortened REM larency is not specific similar chnages seen in mania, schizophrenia, schizoaffective, OCD, panic disorder, eating disorders (in depression you get shortened REM latency, shorteden slepe onset RE periods, proljnged first REM, enhanced REM density)
58
Occasional sleep spindles and K complexes seen in which stage of sleep
NREM stage 2 (Sleep spindles= Sleep spindles: short bursts (~0.5–2 seconds) of 12–14 Hz activity)
59
EEG waves frequency 5-7.5Hz
theta
60
EEG waves frequency 8-12
alpha
61
MMSE what doesn't it test - executive function - orientation - concentration - attention - comprehension
executive function (it is insensitive to FRONTAL executive function and visuospatial deficits)
62
EEG trace in Huntingtons - flattened - 3Hz spike trace - focal delta activity - spike and wave complexes - 1-2Hz sharp waves
flattened trace
63
Frontal lobe degeneration gender split - 1:3 - 2:1 - 1:2 - 1:1 - 3:1
1:1
64
Multiple deep white matter hyperintesities in neuroimaging are predominantly seen in older adults with - OCD - depression - bipolar - schizoophrenia - ASD
depression (in younger people its less conclusive)
65
a genetic disorder is X linked recessive. Probability of male having it is 1/100. What is probability of same disease in women
1/10000
66
Patient with discomfort in legs which prevents her sleeping. No psychiatric or neurolgoical Hx - neuroleptic malginant syndrome - REM sleep disorder - serotonin syndrome - tardive dyskinaesia - restless leg syndrome
restless leg syndrome unpleasant sensation inside legs, occuring in evenings, an urge to move legs and relief by movement leads to repetiative movement which disrupts sleep. pt may have daytime fatigue and difficulty initiating sleep
67
ECG changes in Huntingtons - tachycarida - silent MI - conducton abnormalities and bradycardia - ventricular ectopics - atrial fibrilation
conduction abnormalities and bradycardia increasing evidence that Huntingtons impacts peripheral tissues and can --> cardiac dysregulation can get bradycardia, prolonged intrave ntricular condution and unexplained QTc elevation
68
Fagile X inheritance: - disorder of unknown etiology - autosomal dominant - autosomal recessive - x linked revessive - x linekdf dominant
X-linked dominant in addition you get anticipation with tpyical trinucleotide repeat diusorders
69
which is protective of Alzheimers disease - Apolipoprotein E2 - women - Parkinsons disease - head injury downs syndrome
Apolipoprotein E2 others (although these have small impact..): - exercise - oestrogen replacement - higher IQ - educatioin
70
Elfin facial features and hoarse voice - Downs - Smith Magenis syndrome - Di George - Williams - Patau
Williams 50% get hypercalacemia supravalcular aortic stenosis unusual facies
71
deletion on chromosome 15 - which syndrome: - Prader Willi - Di George - Downs - Cri du chat - Edwards
Prader Willi Angelman is also due to loss on chromsome 15!
72
What processes emotionally salient memories - prefrontal cortex - amygdala - basal ganglia - angular gyrus - cerebellum
amygdala the amygdala and hippocampal complex are linked to two independent memory systems, each with unique functions. amygdala= modulates the encoding and storage hippocampal coplex= forms episodic represnetations of emotional signiificnace and interpretation of events, which can nfluence the amygdala response when emotional stimular are encounter
73
thermoregularion is what brain region: - prefrontal cortex - pontine nucleus - medfial temporal lobe - pre-optic area - ventral striatum
pre-optic area (in hypothalamus)
74
'Pulvinar sign' seen in CJD is what part of brain - thalamus - striatum - basal ganlgia - pons - cerebrallum
thalamus hymetrical hyperintensive of the pulvinar (posterior) neuclis in the thalamus on MR images is specific, noninvasive, diagnositc sign of vCJD
75
sense of smell is what brain region (i.e.frontal/ temporal etc)
frontal anosmia (olfactory receptor nuerons)
76
1 day Hx of sudden onset akinetic mutism. what vascular origin - posteiror cerebral artery - anterior cererbral artery - basilar artery - middle cerbral artery - posterior inferior cererballar artery
antiorior cerebral artery
77
where is melatonin made - posterior piutuatiaryu - pineal gland - hypothalamus - antior pituitary - caudate nucleaus
pineal gland
78
comprehension centre for language is where - inferior frontal - dorsal lateranl prefrontal - medial parietal - posterior superior temporal - inferior temporal
posterior superior temporal region (WERNICKES)
79
CSF and glucose: is it lower, higher or same than in blood?
LOWER (in bacterial meningitis the CSF drops. normal ratio is 0.6)
80
Alzhiemers disease: what is true - decreased acetylcholine with decreased serotonin - decreased acetylcholine with increased glutamate
- decreased acetylcholine with increased glutamate
81
HIV is spread to brain via - vascular endothelial cells - upstream migration via axon terminals - direct entry via blood-brain barrier - infected macrophages - CD4 infected T-lympocytes
infected macrophces the major HIV-1 receptors are CD4 and CD8 preivascular macrophages and microglia are the most commmonly afected cells in the brain
82
detection of 14-3-3 proteins in the CSF supports diagnosis of: - parkinsons - CJD - AD - Picks - Binswangers
CJD 14-3-3 proteins are neuronal proteins released into CSF when there is rapid neuronal destruction.
83
Phenelzine: what type of antidepresant? (1) what condition would it be contraindicated in - phaeochromocytoma - diabetes - breast cancer - cushings - addiosns
MAOI contraindicated in phaeochromocytoma and other tumors of adrenal medulla as inhibit breakdown of pressor amines and accumulation can --> hypertensive crisis
84
what artery supplies corpus callosum - posterior cererbral - anteiror cerebral - middle cerebral - vertebral artery
anteiror cerebreal arteral
85
mutaiton of this protein is NOT associarted with neurodegeneration - Tubulin - superoxide dismutase - tau - synuclein - huntingtin
tubulin Huntingtin= huntingtons disease Tau= FTD Synuclein = Lewy body dementia and PArkinsons superoxide dismutase (SOD) = MALS tubulin= cancers mostly with no neurodegenerative features
86
which is a glucocorticoid receptor antagonist - D-cycloserine - clozapine - mifepristone - agomelatine - gabapentin
mifepristone blocks type 2 glucocorticoide and progestin receptors (*progesterone receptor antagonist*) --> used in medical abortions and management of cushings
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