MBBS Psychiatry Flashcards

24 sample cards from the Psychiatry deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. According to the dopamine hypothesis, which pathway hyperactivity underlies positive symptoms of schizophrenia?

   Hyperactivity (excess dopamine) in the mesolimbic pathway produces positive symptoms; hypoactivity in the mesocortical pathway is linked to negative and cognitive symptoms. Antipsychotics block $D_{2}$ receptors.

2. Which antipsychotic is reserved for treatment-resistant schizophrenia, and what serious adverse effect requires monitoring?

   Clozapine. It requires regular white blood cell/neutrophil monitoring because of the risk of agranulocytosis; it also carries risks of myocarditis, seizures, and metabolic effects.

3. What are the four CAGE questions used to screen for alcohol use disorder?

   Have you tried to Cut down? Have people Annoyed you by criticizing your drinking? Have you felt Guilty about drinking? Have you needed an Eye-opener (a morning drink to steady nerves)? Two or more 'yes' answers suggest problem drinking.

4. What is delirium tremens and when does it typically occur after stopping alcohol?

   Delirium tremens is a severe alcohol withdrawal syndrome with confusion, agitation, autonomic hyperactivity, fever, and visual hallucinations, typically appearing $48$ to $72$ hours after the last drink. It is a medical emergency treated with benzodiazepines.

5. Describe Wernicke encephalopathy and its triad, and the vitamin deficiency responsible.

   Wernicke encephalopathy results from thiamine (vitamin $B_{1}$) deficiency, common in alcohol use disorder. The classic triad is confusion (encephalopathy), ophthalmoplegia/nystagmus, and ataxia. Untreated it can progress to Korsakoff amnestic syndrome.

6. What is the difference between tolerance, dependence, and withdrawal in substance-related disorders?

   Tolerance is needing increased amounts for the same effect. Dependence is a physiological/psychological need for the substance to function. Withdrawal is the characteristic syndrome of physical/psychological symptoms on reducing or stopping the substance.

7. What are the core features of Autism Spectrum Disorder (ASD)?

   Persistent deficits in social communication and social interaction across contexts, plus restricted, repetitive patterns of behaviour, interests, or activities (e.g., stereotypies, insistence on sameness, fixated interests, sensory abnormalities), with onset in the early developmental period.

8. List the two core symptom domains of ADHD and the required age of onset.

   Inattention and hyperactivity/impulsivity. Several symptoms must be present before age $12$, occur in $\geq 2$ settings, persist $\geq 6$ months, and impair functioning. First-line treatment is stimulants (methylphenidate/amphetamines).

9. How is intellectual disability defined and graded?

   Intellectual disability is deficits in intellectual functioning (reasoning, problem solving) and adaptive functioning with onset during the developmental period. Severity is based on adaptive functioning, traditionally graded mild, moderate, severe, and profound (historically IQ bands: mild $\approx 50$–$70$).

10. What is the difference between Cluster A, B, and C personality disorders?

    Cluster A (odd/eccentric): paranoid, schizoid, schizotypal. Cluster B (dramatic/erratic): antisocial, borderline, histrionic, narcissistic. Cluster C (anxious/fearful): avoidant, dependent, obsessive-compulsive personality disorder.

11. What are hallmark features of Borderline Personality Disorder?

    A pervasive pattern of instability in relationships, self-image, and affect, with marked impulsivity: frantic efforts to avoid abandonment, identity disturbance, recurrent self-harm/suicidal behaviour, chronic emptiness, intense anger, and transient stress-related paranoia/dissociation.

12. What is the general definition of a personality disorder?

    An enduring, inflexible, pervasive pattern of inner experience and behaviour that deviates markedly from cultural expectations, manifests in cognition, affect, interpersonal functioning, or impulse control, begins by adolescence/early adulthood, and causes distress or impairment.

13. What characterizes Somatic Symptom Disorder under DSM-5?

    One or more distressing somatic symptoms plus excessive thoughts, feelings, or behaviours about the symptoms (disproportionate worry, high anxiety, excessive time/energy devoted), persisting typically $> 6$ months. The symptom need not be medically unexplained.

14. Differentiate conversion disorder, illness anxiety disorder, and factitious disorder.

    Conversion (functional neurological) disorder: neurological symptoms incompatible with disease. Illness anxiety disorder: preoccupation with having a serious illness with minimal somatic symptoms. Factitious disorder: deliberate falsification of symptoms to assume the sick role (no external incentive, unlike malingering).

15. What is the key distinction between somatoform/factitious disorders and malingering?

    In somatoform disorders symptoms are genuinely experienced (not produced intentionally). In factitious disorder symptoms are intentionally produced for the psychological role of being sick. In malingering symptoms are intentionally produced for an external incentive (money, drugs, avoiding work/legal duty).

16. What are the main dissociative disorders recognized in DSM-5?

    Dissociative amnesia (with or without dissociative fugue), Dissociative Identity Disorder (DID), and Depersonalization/Derealization disorder.

17. Define depersonalization and derealization.

    Depersonalization is a feeling of detachment or being an outside observer of one's own self, thoughts, or body. Derealization is a sense of unreality or detachment from one's surroundings, as if the external world is dreamlike or distorted. Reality testing remains intact.

18. What are the diagnostic features of Anorexia Nervosa?

    Restriction of energy intake leading to significantly low body weight, intense fear of gaining weight or behaviour preventing weight gain, and disturbance in body image / undue influence of weight on self-evaluation. Subtypes: restricting and binge-eating/purging.

19. Name characteristic physical/biochemical complications of Anorexia Nervosa.

    Amenorrhoea, bradycardia, hypotension, hypothermia, lanugo hair, osteoporosis, and electrolyte disturbances (hypokalaemia). Refeeding syndrome (hypophosphataemia) is a dangerous complication of rapid nutritional restoration.

20. What are the diagnostic features of Bulimia Nervosa?

    Recurrent binge eating with a sense of loss of control, recurrent inappropriate compensatory behaviours (self-induced vomiting, laxatives, fasting, excessive exercise), both occurring on average $\geq 1$ time per week for $3$ months, with self-evaluation unduly influenced by body shape/weight. Body weight is usually normal.

21. What physical signs suggest self-induced vomiting in Bulimia Nervosa?

    Russell's sign (calluses/scarring on the knuckles), dental enamel erosion, parotid (salivary) gland swelling, and hypokalaemic metabolic alkalosis from loss of gastric acid.

22. How does Binge-Eating Disorder differ from Bulimia Nervosa?

    Binge-eating disorder involves recurrent binge eating with loss of control and marked distress, occurring $\geq 1$ time per week for $3$ months, but WITHOUT the regular inappropriate compensatory behaviours seen in bulimia. It is frequently associated with overweight/obesity.

23. What are the diagnostic features of Insomnia Disorder?

    Dissatisfaction with sleep quantity/quality (difficulty initiating sleep, maintaining sleep, or early-morning awakening) occurring $\geq 3$ nights per week for $\geq 3$ months despite adequate opportunity to sleep, causing daytime impairment. First-line treatment is CBT for insomnia (CBT-I) and sleep hygiene.

24. Describe Obstructive Sleep Apnea Hypopnea and a key diagnostic measure.

    A sleep-related breathing disorder with repetitive upper-airway collapse causing apneas/hypopneas, snoring, and daytime sleepiness. Diagnosis uses polysomnography; severity is graded by the Apnea-Hypopnea Index (AHI) = events per hour, with $\geq 5$ obstructive events/hour required (mild $5$–$15$, moderate $15$–$30$, severe $> 30$). CPAP is first-line treatment.

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