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
 A: Age less than 19 more than 45
 D: Depression (50% of suicides)
 P: Previous attempt
 E: Ethanol abuse
 R: Rational thinking loss(10% suicide is schizo with prominent delusions command hallucinations is
the worst)
 S: Social supports lacking
 O: Organized plan
 N: No spouse( 2×if single 4-widowed/divorced(doh marry ppl and then buss it tabancre is serious
business)
 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.