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Anxiety and Coping Mechanisms Phil Copeman and Alex Hammant & some practice exam questions.

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Presentation on theme: "Anxiety and Coping Mechanisms Phil Copeman and Alex Hammant & some practice exam questions."— Presentation transcript:

1 Anxiety and Coping Mechanisms Phil Copeman and Alex Hammant & some practice exam questions

2 What are the psychological symptoms of General Anxiety Disorder? Worry Interrupted sleep Poor concentration Increased sensitivity to noise

3 Criteria for diagnosis of GAD Anxiety and worry occuring more days than not for at least 6 months associated with at least 3 of these 6 symptoms: Restlessness Easily fatigued Difficulty concentrating Irritability Muscle Tension Sleep Disturbance

4 Name 4 broad methods of treating anxiety Pharmacological treatments Relaxation-mindfulnessCBT Thought Diary (emotions with physical symptoms)

5 Name 3 ways in which people with GAD might perceive events Selective attention (to negative features) Magnification (of importance of undesirable events) Overgeneralisation (drawing broad negative conclusions)

6 What are the 4 classes of effects of stress? AffectiveBehaviouralCognitivePhysiological

7 What are the possible ‘physiological’ effects of stress on in-patients on the ward? Slower wound healing More post-surgery complications Longer in-patient stay More staff time per day More analgesia use Less satisfaction with treatment (poor adherence)

8 What are the possible ‘physiological’ effects of stress on in-patients after discharge? Longer recovery More service Less use of rehabilitation services Increased risk of co-morbidity and early mortality

9 What are the 3 stages of the physiological response to stress? 1.Alarm – fight or flight 2.Resistance – conservation response to return to homeostasis 3.Exhaustion – depletion of resources

10 Describe the physiology behind the stress response Hypothalamus Anterior Pituitary gland Adrenal gland ACTH (Adrenocorticotrophic hormone) Adrenaline and Cortisol

11 What are the physical symptoms of GAD? Dizziness, irritability Tachypneoa, Breathlessness Palpitations Chest pain Raised BP Abdominal pain Sweating Increased muscle tension and trembling

12 What are the 3 dimensions in which stressors can impact a person? ChronicityMagnitudeInclusiveness

13 What is the transactional model of stress? The stimulus events are indirectly related to the stress experience Stimulus Event (a potential stressor) Primary Appraisal (event demands) Secondary Appraisal (oneself) Response (Coping) Health-Related Outcome (Stress)

14 What were those three intervening processes again? Primary appraisal: hello, hello what’s all this then? Is this something that could do me down? Secondary appraisal: am I a strong independent man/woman and therefore able to handle these threats/threats? Coping: activities – thought or behavioural – brought about to handle the event.

15 How can ‘coping’ be hierarchically ordered? 1.Activities: anything one does in order to manage stress e.g. doing research or getting smashed. 2.Strategies: coping activities which can be made up into meaningful groups e.g. making a plan 3.Dimensions: strategies which themselves can be separated into either problem-focussed coping or emotion focussed coping

16 When is problem focussed coping most effective? When the stressor is amenable to change

17 When is emotion focused coping most effective? When the stressor can not be changed

18 Some practice questions

19 A 73 year old man attends the movement disorder clinic for his regular check-up. He was diagnosed with Parkinson’s disease 8 years ago, but has noticed that his movement is getting harder on his current medication. The neurologist decides to change his medication to levodopa. Which of the following drugs is co-administered with Levodopa to prevent the peripheral breakdown of levodopa by dopa-decarboxylase? a)Benserazide b)Entacapone c)Orphenadrine d)Rasagiline e)Tolcapone

20 A 53 year old man has suffered a spinal cord injury resulting from a vascular insufficiency occurring at the T3 level. He has UMN signs in both legs and bilateral loss of pain and temperature sensation below the level of the lesion. Which lesion of the spinal cord is most likely to result in these symptoms? a)Anterior b)Central c)Hemicord d)Posterior e)Transverse

21 A 47 year old woman visits her optician as she is suffering from visual loss. Her field of vision is shown below: Where is the most likely site of a lesion in her visual pathway? a)Optic chiasm b)Optic nerve c)Optic radiation (occipital lobe) d)Optic radiation (temporal lobe) e)Optic tract

22 A 67 year old man who had suffered a recent stroke is brought to the stroke rehabilitation centre for his physiotherapy session. His main problem is that whilst his lower limbs function normally, his hands and wrist are functional and his cranial nerve exam is normal, his arms and torso are immobile and have reduced sensation. What is the most likely type of stroke that this man has suffered? a)Lacunar infarct b)Partial anterior circulation infarct c)Posterior circulation infarct d)Total anterior circulation infarct e)Watershed infarct

23 A 12 year old boy was hit by a car whilst out playing. He was taken to the Emergency Department and given an urgent CT scan: What type of haemorrhage does the CT show a)Extradural b)Intraparenchymal c)Intraventricular d)Subarachnoid e)Subdural

24 a)Action b)Contemplation c)Maintenance d)Precontemplation e)Preparation A 43 year-old man attends his GP for a check-up. He has a history of alcohol dependency but proudly announces that he went to his first support group (alcoholics anonymous) meeting last night and that he has stopped socialising with his usual ‘drinking buddies.’ At what stage of the transtheoretical model of behaviour change is the patient?

25 a)Paracetamol b)Diclofenac c)Codeine d)Co-codamol e)Naproxen A 34 year old woman visits the GP as she has been suffering with painful lower limbs. She has been taking Nurofen plus (ibuprofen + caffeine) to no effect and would like to add something else to see if that would work. What of the following drugs would give her the strongest analgesic combination, when added to her current intake?

26 a)Angiogram b)CT c)DWI d)PET e)TI-MRI A 34 year old woman visits the GP as she has been suffering with painful lower limbs. She has been taking Nurofen plus (ibuprofen + caffeine) to no effect and would like to add something else to see if that would work. What of the following drugs would give her the strongest analgesic combination, when added to her current intake?

27 a)ACE-3 b)AMT c)CAMCOG d)DemTect e)MMSE An 87 year old man is visited by his general practitioner (GP) following concerns raised by the local occupational therapist. He tells the GP that he was asked a huge number of questions by the occupational therapist when she saw him, but he couldn’t remember why. Which of the following assessment schedules is generally used by occupational therapists to assess cognitive function?

28 a)5HT reuptake blocker b)NA reuptake blocker c) α 1 adrenoreceptor antagonist d)H 1 receptor antagonist e) M 1 receptor antagonist A 39 year old man who has been receiving amitriptyline for treatment of neuropathic pain visits his GP as he is concerned about how sleepy he feels all the time since starting the drugs, and it is beginning to affect his work. Which mechanism could account for his symptoms?

29 a)Black b)Dark grey c)Light – mid grey d)Mid grey e)White-light grey A 49 year old woman is brought into the emergency department by her daughter. The daughter states that whilst they were out shopping her mother had suddenly complained about an excruciating headache and then collapsed. An emergency CT scan is ordered by the attending doctor. What colour is acute blood in a CT scan?

30 a)ACA b)MCA c)Middle Meningeal Artery d)Posterior Cerebral Artery e)Superior cerebellar Artery The CT scan shows a region of infarct. The infarct corresponds to which arterial supply?

31 a)Amygdala b)Caudate Nucleus c)Hippocampus d)Insula e)Mammillary Bodies A 67 year old woman is being treated for dementia. In order to determine whether the patient has Alzheimer’s or Dementia with Lewy bodies, an MRI scan is ordered. Degeneration of which structure would enable you to differentiate between DLB and Alzheimer’s?

32 a)Extradural b)Intraparenchymal c)Intraventricular d)Subarachnoid e)Subdural A 72 year old man with a history of Parkinson’s disease presents with right-sided weakness one week after a fall. What type of haemorrhage does the CT show?

33 a)Inferior sagittal sinus b)Sigmoid sinus c)Straight sinus d)Superior sagittal sinus e)Transverse sinus A 52 year old woman is brought to the emergency department after becoming disoriented and uncoordinated whilst at a garden party. She complained of a severe headache and nausea and was found to be hypertensive and have papilloedema. MRI showed the presence of a large sinus thrombosis, cerebral oedema and bilateral infarcts in the thalamus. Where is the thrombus most likely to be located?

34 a)Inferior sagittal sinus b)Sigmoid sinus c)Straight sinus d)Superior sagittal sinus e)Transverse sinus A 52 year old woman is brought to the emergency department after becoming disoriented and uncoordinated whilst at a garden party. She complained of a severe headache and nausea and was found to be hypertensive and have papilloedema. MRI showed the presence of a large sinus thrombosis, cerebral oedema and bilateral infarcts in the thalamus. Where is the thrombus most likely to be located?

35 a)Foramen lacerum b)Foramen magnum c)Hypoglossal formaen d)Internal auditory meatus e)Jugular foramen A 73 year old man visits his general practitioner as he is having difficulty swallowing food. He has had recurring headaches for the last month and more recently has had a few bouts of vomiting. The GP notices that his voice is hoarse and gravelly and that he is unable to lift his right shoulder. An MRI scan showed the presence of a tumour in the base of skull, occluding one of the foramen. Which foramen is most likely to be occluded by the tumour?


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