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Part II ISQ Club - Organic

34 posts in this topic

Part II ISQs on two topics will be posted twice a week. You are encouraged to post a reply in the thread, stating whether you think an ISQ is true or false and why (eg. a short explanation, with reference to the textbook you used). Please only deal with one ISQ in each post and include the question as the first line of your post. All ISQs are taken from previous posts by Forum members.

In a few days this ISQ Club thread will be moved to the Question Bank board. If you submit an answer, your status will be changed to 'Question Bank member' and you will be able to see the Question Bank board. Please allow up to 48 hours for this change to happen.

1. HIV enters the brain through infected macrophages

2. HIV disease progression is measured by CD4 counts

3. Increased sensitivity to neuroleptics is a recognised complication of HIV infection

4. The suicide rate in HIV is 10% higher than expected

5. Hypothyroidism causes bone pain

6. Hirsuitism can be caused by hypothyroidism

7. Primary generalized epilepsy is usually associated with an aura

8. Suggestibility is increased in complex partial seizures

9. A seizure lasting longer the 30 minutes is more indicative of pseudo-seizure than epilepsy

10. Delirium may be caused by Wilson’s disease

11. If a healthy couple have a baby with phenylketonuria, the chances of the next baby having the same condition are less than 1%

12. Disorders of praxis are associated with Pick’s disease

13. Delusions of persecution commonly precedes dementia

14. Stepwise cognitive decline is a recognised feature of lewy body dementia

15. Determining Apoprotein E genotype is useful for counselling relatives of the risk of Alzheimer’s disease

16. Tonsillar biopsy showing prion protein is highly specific for variant CJD

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1. HIV enters the brain through infected macrophages

TRUE

(Pg 303, Comp to Psych St, 6th Ed, Johnstone et al)

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2. HIV disease progression is measured by CD4 counts

TRUE

(Pg 366, Synopsis of Psy, 8th Ed, Kaplan & Sadock)

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3. Increased sensitivity to neuroleptics is a recognised complication of HIV infection

TRUE

(Pg 373, Synopsis of Psy, 8th Ed, Kaplan & Sadock)

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7. Primary generalized epilepsy is usually associated with an aura

FALSE

Secondary generalised

(Pg 335-6, Oxford Txt of Psych, 3rd Ed, Gelder et al)

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8. Suggestibility is increased in complex partial seizures

FALSE

Increased suggestibility in pseudoseizures

(Pg 357, Synopsis of Psy, 8th Ed, Kaplan & Sadock)

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9. A seizure lasting longer the 30 minutes is more indicative of pseudo-seizure than epilepsy

FALSE

Status epilepticus

(Pg 335 & 339, Oxford Txt of Psych, 3rd Ed, Gelder et al)

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10. Delirium may be caused by Wilson’s disease

FALSE

Causes dementia

(Pg 312-3, Oxford Txt of Psych, 3rd Ed, Gelder et al)

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12. Disorders of praxis are associated with Pick’s disease

FALSE

(Pg 323, Oxford Txt of Psych, 3rd Ed, Gelder et al)

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13. Delusions of persecution commonly precedes dementia

FALSE

Not common

(Pg 296, Comp to Psych St, 6th Ed, Johnstone et al)

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14. Stepwise cognitive decline is a recognised feature of lewy body dementia

FALSE

Vascular dementia

(Pg 524-5, Oxford Txt of Psych, 3rd Ed, Gelder et al)

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15. Determining Apoprotein E genotype is useful for counselling relatives of the risk of Alzheimer’s disease

FALSE

(Pg 728, Comp to Psych St, 6th Ed, Johnstone et al)

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16. Tonsillar biopsy showing prion protein is highly specific for variant CJD

FALSE

Specificity not proven

“More recently, tonsil biopsy has been used for the presumptive identification of vCJD. Immunohistochemical testing for the prion protein in these tissues has demonstrated that the protein is present in patients with vCJD but not in patients with sCJD (Hill et al., 1999; WHO, 2001a). The postulated reasons for this difference include a strain effect, a species-barrier effect, or the oral route of exposure in vCJD (Hill et al., 1999). There have been too few case series to determine the sensitivity or specificity of this ancillary test.”

Advancing Prion Science: Guidance for the National Prion Research Program -- Interim Report (2003)

http://books.nap.edu/books/0309087449/html/45.html#pagetop

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11. If a healthy couple have a baby with phenylketonuria, the chances of the next baby having the same condition are less than 1%

FALSE

25%. Autosomal recessive condition.

(Pg 179, Sciences Basic to Psych, Puri & Tyrer)

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:'(4. The suicide rate in HIV is 10% higher than expected . false

studies based on coroners reports suggest that patients with advanced HIV disease have a thirtyfold risk of commiting suicide compared to seronegative persons matched for age and sex.... page 332 Comp textbook Kap and SAd

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10. Delirium may be caused by Wilson’s disease

TRUE

The most common presentations, in descending order, are neurological, hepatic, psychiatric, orthopedic, ophthalmological, hemolytic anemia, and cardiac. Neurological presentations are protean, but typically begin with basal ganglia signs of tremor or rigidity. The classic 'wingbeating' tremor is localized to the arms, usually absent at rest, and is elicited by extension. Parkinsonian or intention tremors may also be seen. Parkinsonian rigidity, dystonic postures, and occasionally choreo-athetotic movements are seen. Dystonia and rigidity of laryngeal, pharyngeal, and facial musculature may result in dysarthria, dysphagia, hoarseness, drooling, and the classic vacuous or fixed open-mouthed smile. The tendency for motor disorders to predominate in the bulbar musculature contrasts with parkinsonism. Loss of coordination, convulsions, coma, and delirium may occur. ...

KSCTP Ch 2.6

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1. True - HIV targets microglial cells and macrophages within the CNS through CD4 and chemokine cell surface receptors.

Companion to Psychiatric Studies (p. 79)

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2. True - The optimum time for initiation of antiviral treatment will depend primarily on the CD4 count; the plasma viral load and clinical symptoms may also help.

BNF

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3. True - HIV results in considerable neuronal loss, with evidence of synaptic, dendritic and axonal damage in HIV encephalitis.  Due to exposure to proinflammatory cytokines (TNFa and IL-1b).  One can only assume that such CNS compromise will render patients more susceptible to the side-effects of neuroleptics.

Companion to Psychiatric Studies (p. 79)

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4. True - increased risk of suicide has been associated with many physical illnesses, particularly chronic neurological, GI, CV and malignant disorder.  Some well-known associations are indirect, e.g. link between suicide and peptic ulcer disease is explained by coexisting alcohol dependence.  I think it is likely that such a link may exist secondary to the mode of contracting HIV, e.g. IVDA.

Companion to Psychiatric Studies (p. 669)

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5. False - while hypothyroidism can present with muscular aches and pains, bone pain is not described. Primary hyperparathyroidism can result in osteitis fibrosa, in which there is increased bone resorption by osteoclasts with fibrous replacement in the lacunae and cystic expansion. These changes may present clinically as bone pain, fracture and deformity.

Davidson's Principles and Practice of Medicine, 17th Edition (p.702)

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6. False - Hypothyroidism is associated with dry, flaky skin and hair, alopecia.

Davidson's Principles and Practice of Medicine (17th Ed.)

(p.693)

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7. False - Primary generalised epilepsy usually causes tonic-clonic seizures without an aura, or less often, classical absences.

Davidson's Principles and Practice of Medicine (17th Ed.)

(p.1066)

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