Transcript Neuropsychiatry MCQs The final day challenge

Neuropsychiatry MCQs
The final day challenge
John O’Donovan
Rules of the game
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2 teams
May confer
Negative marking
Option not to answer and pass question to
other team.
• Questions will be MCQs and some others.
1-10 epilepsy
Chronic interictal psychosis
Forced normalisation
• The commonest pathology is
mesial temporal lobe sclerosis
• Frequently begins as post ictal
psychosis
• Has delusional perception as a
symptom more often then
schizohprenia
• Shows less blunting then
schizophrenia
• Clozapine is not a suitable
treatment
• Is an EEG phenomena
• Clinically is referred to as
“alternative psychosis”
• Is strongly associated with the
effects of antipsychotic drugs
• Was originally described by
Landolt
• Occurs in 18% of patients with
a chronic interictal psychosis.
11-20 epilepsy
Depression in epilepsy
Seizure types
• Occurs in up to fifty percent of
patients
• Is associated with
monotherapy
• Is more common in idiopathic
generalised epilepsies
• Should not be treated with
SSRIs due to seizure risk
• means avoiding primidone as a
treatment
• Absence seizures are a type of
general seizure
• Absence seizures show 3-4hz
polyspike and wave
• GTCS are associated with
cortical maldevelopment.
• A partial motor seizure will not
impair consciousness
• GTCS have a well understood
pathophysiology.
Clinical neuroanatomy 21-30
Cerebellar disease
• Is ipsilateral
• Reflexes are hypotonic and
pendular
• May be caused by wheat
sensitivity
• Is associated with a spastic
dysarthria
• Is most commonly caused
by alcohol
Causes of posterior column
spinal disease
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B12 deficiency
Tabes Dorsalis
Brown Sequard Syndrome
An acute inflamatory
myelitis
• Sjorgen’s Syndrome via the
dorsal root ganglion
Clinical neuroanatomy 31-40
Language
• Semantic dementia may cause
“pure word deafness”
• Broca’s aphasia may result from a
lesion to the angular gyrus
• Wernicke’s is classically a
transcortical sensory with
secondary conduction block
• Conduction dysphasia is caused
by a lesion of the cingulate
connection fibres
• Problems with naming to
confrontation suggest language
problems
Eyes signs
• Light-near dissociation
occurs in syphilitic eye
disease
• May occur with a pontine
stroke
• May be a normal variant
• Suggests a lesion in the
occipital cortex
• May occur in a RAPD
secondary to optic neuritis
Hysteria 41-50
In psychogenic non epileptic
seizures
Fugue states
• The problem is dissociation
• Patients have comorbid
epilepsy 40% of the time
• During events, there is loss
of alpha on the EEG
• A history of sexual abuse is
common
• Events tend to be
wittnessed
• Cannot occur if the patient is
locked in a small room.
• Typically present acutely after
a stressful event.
• May have an organic cause as
in TGA
• Are more common in times of
war
• May be associated with
autobiographical memory loss
EEG and sleep 51-60
Normal EEG
• Alpha is abolished by
opening eyes
• Beta is the best
• Theta should not occur
when awake
• Delta has a frequency of 68hz
• Of children is slower then of
adults
REM sleep disorder
• Occurs in Alzheimer’s
disease.
• Shows equal sex incidence
• May predate
synucleinopathies
• Can result in assault
• may respond well to dopa
agonists
Brain injury and stroke 61-70
In TBI
In stroke
• PTA is made up of retrograde
and anterograde memory loss
• PTA of under 24 hours
suggests a good outcome
• PTA of greater then 2 weeks is
associated with a poor
outcome
• Being a teenage male is the
strongest risk factor for TBI
• Prolonged agitated delirium
during recovery is to be
expected
• Depression is strongly associated
with lesion location
• Depression may occur in fifty
percent of stroke patients at one
year
• Psychosis is uncommon
• Catastrophic reactions occur in
response to minor disabilities
• Reboxetine may be superior to
SSRIs
• ACAM aneurysms may produce
an amnestic syndrome with
prominent olfactory
hallucinations and confabulation
Memory and dementia 71-80
Alzheimer’s disease
FTDs
• Early onset AD must be before
65 years of age to satisfy ICD10
• Autoprosopagnosia is seen in
3% of AD patients
• Normally presents with an
amnestic syndrome
• Death is within ten years from
onset.(average)
• Is associated with BPSDs in
40% of patients.
• Semantic dementia may be
associated with a reverse
autobiographical gradient
• Dominant SD is associated
with reduced ability to read
aloud.
• Non dominant SD can show
prosopagnosia for famous
people.
• bvFTD diagnosis is made
complex by phenocopies
• PPA is the most common of
the FTDs
Parkinson’s Disease 81-90
In PD
• Antemortem diagnostic
accuracy is 99%
• Bradykinesia is reduced
with caffeine
• Psychosis responds best to
replacing dopamine with
dopa agonists
• Dementia is similar to LBD
• Clozapine may improve
motor function
PD
• Was originally described as not
showing any cognitive decline.
• Visuospatial deficits are
common.
• Is an example of a sub cortical
dementia
• Hypersexuality may be
associated with punding
• Depression is the most
common psychiatric problem
White matter disorders 91-100
MS
White matter psychiatry
• Is associated with BPAD
• Shows some similarities with
the neurodevelopmental
hypothesis of schizophrenia
• Causes dementia in 10% of
patients
• Treatments may exacerbate
depression
• Is associated with psychosis in
15% of patients
• SLE typically causes a
schizophreniform psychosis
• CADASIL is associated with severe
depression and uncomplicated
migraine.
• PML is unlikely to be seen by
psychiatrists
• Lacunar strokes in the white
matter may present with a
treatment refractory depression
• Mitochondrial disorders are
associated with normal IQ and
short stature.
Tie breakers
Question 1
• Describe the functional anatomy of the frontal
lobes?
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Size
Boundaries
Functions
Clinical functions
Laterality
Question 2
• Describe the core features of the amnestic
state?
need to get five. 2 marks each
Demonstrate the examination of the cranial nerves on a team colleague and
give a list of ten causes of cranial nerve palsies
• Exam-5 points.
• Ten causes is 5 points.
Define chronic interictal psychosis and discuss the
psychopathology in relation to schizophrenia
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Definition is five points
Psychopathology is five points
Affect
Mood
Thought
Perception
Cognition