Charlie Rookes Psychiatry Flashcards
(186 cards)
1
Q
Citalopram
A
SSRI antidepressant
2
Q
Vanlafaxine
A
SNRI antidepressant
3
Q
Sulpiride
A
Antipsychotic (substituted benzamide)
4
Q
Olanzapine
A
Antipsychotic (atypical)
5
Q
Perehenazine
A
Antipsychotic (penothiazine)
6
Q
Mirtazepine
A
Antidepressant (presynaptic alpha2-antagonist)
7
Q
Lorazepam
A
Benzodiazepine
8
Q
Clomethiazole
A
Hypnotic
9
Q
Lofepramine
A
TCA
10
Q
Amisulpride
A
Antipsychotic (atypical)
11
Q
Procyclidine
A
Antimuscarinic
12
Q
Zuclopenthixol
A
Antipsychotic (Thioxanthene)
13
Q
Haloperidol
A
Antipsychotic (Butyrophenone)
14
Q
Clozapine
A
Antipsychotic (atypical)
15
Q
Amytal
A
Barbiturate
16
Q
Fluoxetine
A
SSRI antidepressant
17
Q
Amitriptyline
A
TCA
18
Q
Aripiprazole
A
Antipsychotic (atypical)
19
Q
Zopiclone
A
Hypnotic
20
Q
Fluphenazine
A
Antipsychotic (Phenothiazine)
21
Q
Lithium
A
Mood stabiliser
22
Q
Sodium Valproate
A
Mood stabiliser
23
Q
Moclobemide
A
Reversible MAOI Antidepressant
24
Q
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Postural Hypotension
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
A
Alpha adrenergic receptors
25
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Galactorrhoea
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
26
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Amenorrhoea
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
27
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Dystonia
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
28
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Drowsiness
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Histamine receptors
29
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Urinary retention
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Cholinergic receptors
30
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Gyanecomastia
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
31
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Akathisia
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
32
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Constipation
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Cholinergic receptors
33
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Dry mouth
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Cholinergic receptors
34
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Blurred vision
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Cholinergic receptors
35
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Tardive dyskinesia
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
36
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Rigidity
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
37
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Tremor
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
38
Does the following factor suggest poor or good prognosis in schizophrenia?
Sudden onset
Good
39
Does the following factor suggest poor or good prognosis in schizophrenia?
Older age at onset
Good
40
Does the following factor suggest poor or good prognosis in schizophrenia?
Prominent mood symptoms
Good
41
Does the following factor suggest poor or good prognosis in schizophrenia?
Long episode
poor
42
Does the following factor suggest poor or good prognosis in schizophrenia?
Negative symptoms
poor
43
Does the following factor suggest poor or good prognosis in schizophrenia?
Social isolation
Poor
44
Does the following factor suggest poor or good prognosis in schizophrenia?
Married
Good
45
Does the following factor suggest poor or good prognosis in schizophrenia?
Good work record
Good
46
Does the following factor suggest poor or good prognosis in schizophrenia?
Compliant with medication
Good
47
Emotional coldness is a characteristic feature of Schizoid peronality disorder?
True
False
True
Other features include:
- Anhedonia
- Indifference to praise or criticism
- Preference for solitary activities
- Excessive preoccupation with fantasy and introspection
- Insensitivity to social norms and conventions
- Limited capacity to express feelings
48
A series of suicidal threats of acts of DSH are well recognised phenomena in histrionic Personality Disorder
- True
- False
False - these characteristics are features of Borderline personality disorder.
Borderline PD features include:
- Affective instability
- Chronic feelings if emptiness
- Confusion about self-image, aims and internal preferences
- Repeated emotional crisis
Histrionic PD features include:
- Shallow, labile affect
- Theatrical, exaggerated expression of emotions
- Self-indulgent, lack of consideration for others
- Easily hurt feelings
- Continuously seeking appreciation, excitement and attention
49
A person suffering from paranoid personality disorder has callous unconcern for the feelings of others
True
False
False - commonly found in Dissocial/Antisocial personality disorder
Other features include:
- Gross and persistent irresponsibilty and disregard to social norms
- Incapacity to maintain enduring relationships
- Low tolerance to frustration
- Proneness to blame others
- Incapacity to experience guilt or to learn from punishment
Paranoid PD:
- Excessive sensitivity to setbacks and rebuffs
- Tendency to bear grudges persistently
- Suspiciousness
- Tenacious sense of personal rights out of keeping with actual situation
- Tendency to experience excessive self-importance
50
A 23-year-old man has recovered from his second episode of schizophrenia. Six months after discharge from inpatient care, he is symptom-free, and insists on stopping all his antipsychotic medication. He lives with his parents in what the clinical team have judged to be a high expressed emotion household. If he goes ahead and stops his medication, what is the probability that he will experience a relapse within nine months?
```
1%
5%
20%
50%
80%
```
80%
51
While giving his past psychiatric history, a 45-year-old man says that he was treated for depression in the past with medication. He cannot remember the name of the medication, but said that he recalls that when he started taking it, he experienced gastrointestinal discomfort. Also, he started taking it at night but had to switch to taking it in the morning because taking it at night disturbed his sleep even more than the depression itself had done. Which of the following medications is most likely to be the one he was taking?
```
Amitriptyline
Mirtazapine
Citalopram
Zolpidem
Olanzapine
```
Citalopram
52
A 24-year-old man presents with what appears to be an acute psychotic episode. Which of the clinical features below is most likely to discriminate between this being a schizophreniform psychosis or a manic episode?
The presence of auditory hallucinations
The presence of persecutory delusions
The presence of delusions that are incongruent with the patient's mood
The presence of cognitive impairment
The presence of a disorder of the form of thought
The presence of delusions that are incongruent with the patient's mood
53
A general practitioner refers a 20-year old woman for specialist assessment, stating that she has a phobia. Which of the following features is most likely to indicate a diagnosis of social phobia as opposed to agoraphobia
```
History of fear of the dark in childhood
Fear of standing in supermarket queues
Fear of travelling on the underground
Fear of blushing in public
Palpitations and sweating accompanying episodes of fear
```
Fear of blushing in public
54
A 15-year old girl is brought to her general practitioner by her mother, who suspects that her daughter has an eating disorder. Which of the following features makes it more likely that the daughters diagnosis is bulimia, as opposed to anorexia?
A body-mass index of 18
Visiting the gym daily for a vigorous workout
Making herself vomit after meals
Having very detailed knowledge of the calorific values of different foods
Being very self-conscious about her weight and appearance
A body-mass index of 18
55
A 22-year old man presents to his general practitioner with a history of gradually increasing concern about contamination. He worries for much of the day that he has become infected by bacteria, and reports that he has to wash his hands thoroughly whenever he touches objects that he thinks are dusty. He has a particular routine that he must follow when washing his hands and if this routine is interrupted, he must begin the routine again. What term best describes his hand-washing specifically?
```
Obsession
Compulsion
Delusion
Overvalued idea
Stereotypy
```
Compulsion
56
An 18-year old girl presents in the Accident and Emergency Department following an overdose of aspirin tablets. It appears that this was an impulsive gesture, in front of her boyfriend, during the course of an argument. She and her boyfriend had been drinking, but on examination, she did not appear intoxicated. Examination revealed no specific mental state abnormalities, and she denied wanting to kill herself. Statistically, what is the probability that she will present again with another episode of self-harm within the next 12 months?
```
50%
20%
5%
1%
0.1%
```
20%
57
A 22-year old man comes to the local general practice, asking to be signed on as a temporary patient. The circumstances of his presentation make the doctor suspect that the patient is abusing drugs. As he comes into the consulting room, the doctor notices that he seems to be sweating, has a runny nose and dilated pupils. Such symptoms are associated with withdrawal from one of the following drugs. Which one?
```
Cannabis
Methamphetamine
Heroin
Diazepam
Cocaine
```
Heroin
58
An 82-year old woman is brought by her daughter-in-law to the general practitioner. Mental state examination reveals that she shows considerable cognitive impairment. Which of the following features would suggest that this presentation is of Alzheimer-type dementia rather than multi-infarct (vascular) dementia?
A history of adult-onset diabetes
A history of step-wise decline in her cognitive state
A history of a gradual decline in her cognitive state
The fact that her daughter-in-law first noticed her cognitive impairment a few months previously, when she was already 82 years old
The absence of any family history of cerebrovascular disease
A history of a gradual decline in her cognitive state
59
You are a medical house officer, asked to assess a 76-year old man, recently admitted to the medical ward because he had become cachectic, presumably because he was neglecting himself. His mental state fluctuates markedly. At times, he appears lucid, while at other times he is very distressed and appears to be responding to auditory and visual hallucinations. During his lucid times, he can find his way without difficulty to the toilet and back to his bed. When he is distressed, he easily gets lost on his way to or from the toilet. What should be the main focus of his management?
Start treatment with olanzepine, titrating dose against the effect on his mental state
Start treatment with diazepam, titrating dose against the effect on his mental state
Transfer him immediately to an old age psychiatry unit, where staff are trained to make specialist mental state assessments
Move him to a bed which is closer to the toilet
Conduct a thorough physical examination and investigations to identify an underlying organic cause for the presentation
Conduct a thorough physical examination and investigations to identify an underlying organic cause for the presentation
60
A 32-year old man presents to his general practitioner with a 5-week history of worsening low mood, which he attributes to tensions within his marriage. On direct questioning, he admits that he finds it very difficult to concentrate on his work, and finds no interest in it. He routinely wakes 3 hours before he was accustomed to previously, and feels unrefreshed when he wakes. He now feels hopeless about the future, and says that life isnt worth living, although on questioning, he has made no plans to end his life. Direct questioning reveals no relevant past or family history. Physical examination reveals no abnormalities. What would be the most appropriate management plan?
Ask him to return to the surgery in a week's time to review
Refer him to the practice counsellor
Prescribe temazepam to help with his sleep, and ask him to return for review in a week's time
Prescribe fluoxetine 20 mg once a day and ask him to return for review in a week's time
Refer him to the local community mental health team for an urgent assessment, in view of his thoughts about ending it all
Prescribe fluoxetine 20 mg once a day and ask him to return for review in a week's time
61
A 45-year old man is brought to Accident and Emergency, having collapsed in a local pub. The ambulance crew state that others in the pub said the man had been drinking heavily, on his own, for some hours, and then had what appears to have been a fit. When you assess him once he has sobered up, he reports that his wife and children left him two weeks earlier, and that he lost his job six months ago because of his drinking. He admits that he has to have a large tot of whisky each morning before he gets out of bed. He has undergone a detoxification regime twice before, once with his general practitioner and once with a specialist alcoholism service. On both occasions, he started drinking again within three weeks of ending the regime. Initial investigations include a raised mean corpuscular volume. What is the most appropriate immediate management plan?
Counsel him about his excessive drinking and discharge him to be followed up by his general practitioner
Admit him for medical observation and then treat him symptomatically
Admit him for medical observation, starting him on a descending regime of chlordiazepoxide, plus vitamin B1
Refer him to the local substance misuse service, asking for an urgent assessment
Refer him to the local inpatient psychiatric unit for admission
Admit him for medical observation, starting him on a descending regime of chlordiazepoxide, plus vitamin B1
62
A 20-year old man has just been discharged from inpatient psychiatric care. He has a definitive diagnosis of schizophrenia. There were no conspicuous precipitating factors apart from stress from his work at university. In particular, he has never taken illicit drugs, and there is no family history of psychosis. He has a non-identical twin brother. What is the lifetime risk of his twin developing schizophrenia?
```
80%
50%
10%
5%
1%
```
10%
63
Among patients on an acute medical inpatient ward, what is the likely prevalence of clinical depression?
```
1%
5%
10%
25%
60%
```
25%
64
A 16-year old boy is referred to Child and Adolescent Mental Health Services. His parents describe a 4-month history of increasingly bizarre behaviour, disorganised speech, and incongruent affect. On direct questioning, the boy himself admits to hearing voices, and also expresses delusional beliefs. He is diagnosed as having a psychotic episode. What is the overall probability that he will recover fully from this episode and experience no further relapses of psychosis?
```
80%
50%
20%
10%
1%
```
20%
65
A 20-year old man has been referred by his general practitioner for specialist mental health assessment. He says that people are talking about him all the time, especially when he turns on the television. He believes that the flight path of aircraft have been specially changed so that they fly over his home, and interfere with his brain waves. He complains that he cannot sleep at night because people come into his flat and talk incessantly. He admits that everything that is happening to him is making him feel depressed. The psychiatrist makes a working diagnosis, and prescribes some medication. Which medication would be most appropriate in these circumstances?
```
Diazepam
Temazepam
Fluoxetine
Chlorpromazine
Olanzepine
```
Olanzepine
66
Published research evidence supports the effectiveness of a number of interventions in bulimia nervosa. Which of the following interventions has to date not been supported by robust research evidence?
```
Fluoxetine (high dose)
Cognitive-behaviour therapy
Interpersonal therapy
Psychoanalytic psychotherapy
Self-help materials based on the cognitive model
```
Psychoanalytic psychotherapy
67
An 18-year old woman presents in Accident and Emergency having taken an overdose of aspirin tablets. Which of the factors below indicate a particularly increased risk of a further overdose in the future?
That the patient is female rather than male
That the patient binge-drinks alcohol, and the overdose was taken while intoxicated
That she was seen in A&E following another overdose a few months previously
That she lives in a chaotic and dysfunctional household
That the patient is 18 years old
That she was seen in A&E following another overdose a few months previously
68
Under the Mental Health Act (1983), who can make an application to have a patient admitted to an inpatient psychiatric unit under Section 2 or 3?
The patient's own general practitioner
The patient's psychiatrist
The managers of the unit to which the patient is to be admitted
Any doctor who is fully registered with the GMC
An Approved Social Worker
An Approved Social Worker
69
You are a general practitioner, asked to see an 8-year old boy by his mother, because he has been bed-wetting. Examining the child, you notice several bruises, at different stages of resolution, on the boys arms, and a burn mark on his back, the size of which is consistent with being burned by a lighted cigarette. The mothers explanation for these injuries appears implausible, and you suspect that the boy is being abused. What do you do?
Report your concerns to the police
Report your concerns to the local Primary Care Trust
Report your concerns to Social Services
Organise an urgent child protection case conference
Contact your local Child and Adolescent Mental Health Service (CAMHS) to discuss what best to do
Report your concerns to Social Services
70
A 23-year old woman presents in the Accident and Emergency Department with what appears to acute appendicitis, and a decision is taken to recommend appendectomy. She is accompanied by her mother, who says that her daughter has a learning disability. Although the daughter now lives independently, she attended a special school because of her learning difficulties. The mother does not think that her daughter will understand the need for surgery. What would be the most appropriate course of action?
Do not proceed with surgery, but manage the patient conservatively until the diagnosis and required treatment are more certain
Ask the patient's mother to sign the consent form on behalf of the patient
Explain to the patient what is considered to be the problem, and the need for surgery, to ascertain whether she can give informed consent
Go ahead with the appendectomy without the patient's informed consent, under Common Law, on the grounds that it is urgently necessary
Contact the Trust solicitors immediately, giving details of the case, and asking them to arrange an urgent hearing before a judge to get permission to carry out the appendectomy
Explain to the patient what is considered to be the problem, and the need for surgery, to ascertain whether she can give informed consent
71
A care home for the elderly contacts you as the local general practitioner to see an 86-year old widow who was previously frail but otherwise quite well, but now presents with a 3-day history of confusion. Talking with staff, you learn that she sometimes cannot find her way to the dining room, or back to her own room, and sometimes appears to mis-recognise people she has known for a long time. However, at other times, she appears to be her normal self. The home is finding her behaviour increasingly difficult to cope with. What would be your most appropriate initial response to this situation?
Carry out a physical examination, blood tests and urine screen to try to identify a physical cause for the patient's presentation
Arrange for the practice nurse to visit regularly, to build up a more detailed picture of the presenting problems
Ask for a domiciliary visit by the local psychiatry for the elderly team
Arrange for her to be transferred to a nursing home, where staff are better able to manage her current behaviour
Send her to the local Accident and Emergency Department, so that she can be thoroughly examined and investigated, and admitted if necessary
Carry out a physical examination, blood tests and urine screen to try to identify a physical cause for the patient's presentation
72
A 38-year old man comes to see you, his general practitioner, because of persistent gastrointestinal pains. You think his symptoms are likely to be due to a gastric ulcer. You elicit a history of binge-drinking with friends in the local pub at weekends, but the patient insists that he drinks only two cans of lager each evening during the week. He denies having to drink first thing in the mornings, or experiencing craving to drink during weekdays. What would be your most appropriate response to the psychiatric component of this history?
Refer him to the local specialist substance misuse service for further assessment and counselling
Recommend that he starts attending the local branch of Alcoholics Anonymous
Tell him that because he is probably showing the first indications of physical damage due to alcohol, he must now abstain from alcohol
Counsel him about the harmful effects of drinking alcohol, and about safe limits of alcohol intake
Tell him that because he is probably showing the first indications of physical damage due to alcohol, he must now abstain from alcohol, and prescribe a descending-dose regime of chlordiazepoxide
Counsel him about the harmful effects of drinking alcohol, and about safe limits of alcohol intake
73
You are asked, as a house officer, to assess a man in his 50s who has recently been admitted to an acute medical ward from the Accident and Emergency Department. Nursing staff are concerned that he appears to be disoriented. On examination, you note that, amongst other signs, he has a horizontal nystagmus, and some difficulties in heel-toe walking. What is the most likely diagnosis?
```
Wernicke's encephalopathy
Korsakoff's syndrome
Post-ictal state following a temporal lobe epileptic seizure
Cerebellar degeneration
Vitamin B12 deficiency
```
Wernicke's encephalopathy
74
A 26-year old woman on antidepressant prophylaxis following successful treatment of a first episode of depression six months previously, presents at a follow-up appointment at the local community mental health team with a two-week history of expansive mood and great confidence, feeling on top of the world, having boundless energy, and requiring hardly any sleep. What would be the most appropriate immediate intervention?
Leave her antidepressant medication unchanged and ask her to return again for review in two days' time
Leave her antidepressant medication unchanged, and prescribe temazepam to help her sleep
Leave her antidepressant medication unchanged, and start her on a moderate dose of olanzepine daily
Leave her antidepressant medication unchanged, and start her on lithium carbonate
Discontinue her antidepressant medication, and start her on lithium carbonate
Discontinue her antidepressant medication, and start her on lithium carbonate
75
A 28-year old woman lives in supported accommodation. She is able to manage most tasks of self-care, but needs help with taking her medications (in the form of a dosette box, filled by a carer). She has a flat occiput, and short, broad hands. On the basis of this information, what is the likelihood that she has an IQ under 50 and has multiple associated physical abnormalities?
```
0.1%
1%
10%
50%
80%
```
10%
76
A 42-year old man with a 25-year history of schizophrenia has been on regular monthly injections for approximately 18 years. This medication regime has been kept unchanged, because his mental state has been stable, and he has not had any positive symptoms of schizophrenia. The community mental health team consider that he would probably take oral medication as directed, but he has preferred to remain in the injections. However, he now presents with repetitive involuntary movements of his mouth and tongue, which have become progressively worse over the past two months or so. What would be the most appropriate intervention?
Discontinue the depot antipsychotic medication and start him on oral olanzepine
Discontinue the depot antipsychotic medication and start him on oral olanzepine plus procyclidine
Keep him on the same depot injection regime, but in addition ask him to take procyclidine regularly
Keep him on the same depot injection regime, but in addition ask him to take propranolol regularly
Increase the frequency of his depot antipsychotic medication injections
Discontinue the depot antipsychotic medication and start him on oral olanzepine
77
An 18-year old girl presents to a general psychiatry outpatient clinic. She has had what her mother describes as an eating problem for some years, but it has become considerably worse over the past year. She has lost considerable weight, and at the clinic, her weight is 40 kg and her Body Mass Index is 15 kg/m2. She admits that she is very fastidious about her food, carefully choosing what to eat, and disregarding her mothers advice. She goes to the gym daily for a work-out lasting at least 90 minutes. Her periods had been regular, but she has had none for the last 3 months. At the appointment, she is accompanied by her mother, who is clearly exasperated by her daughters behaviour, and expresses considerable criticism of her. What would be the most appropriate initial intervention?
Refer her to a dietician for specialist dietetic counselling, and arrange to see her again in the clinic after she has seen the dietician
Explain to her the potential hazards of her current behaviour, give her appropriate self-help materials, and tell her that appropriate advice on further interventions will depend on how much progress she makes
Refer her, along with her mother, for family therapy, and arrange further follow-up in the clinic
Refer her to a specialist eating disorders clinic, so that she can receive a combination of nutritional advice, individual and family therapy
Arrange to have her admitted to a specialist eating disorders unit
Refer her to a specialist eating disorders clinic, so that she can receive a combination of nutritional advice, individual and family therapy
78
A 19-year old woman is on the post-natal unit, having given birth to her first baby (at term) three days earlier. There were no complications during pregnancy or labour, but the baby is not feeding well (breast-feeding proved very difficult, and the baby is now being fed by bottle). During antenatal care, she told the midwives that her father told her that her own mother was never quite the same after giving birth to her (she is an only child). Three days after delivery, the woman tells the midwife that she is very worried that there is something seriously wrong with the baby, and over the next 24 hours, she is constantly seeking reassurance that the baby is alive and well. She is very tearful, and her mood appears to fluctuate considerably. When her partner visits, she snaps at him. Which of the statements below most accurately describes this presentation?
Such a presentation is common among women who have just had their first baby, and does not warrant further specific intervention
The patient is likely to have 'the baby blues', should be reassured and the clinical picture monitored over time
The patient is likely to have 'the baby blues', but given that she is bottle-feeding, she should be started on prophylactic fluoxetine because of the strong likelihood that this will otherwise develop into post-natal depression
The patient is likely to have post-natal depression and should be commenced immediately on fluoxetine
Because of the time of onset after labour, this is likely to be a prodromal presentation of a post-natal psychosis, and the patient should be started on a small dose of olanzepine
The patient is likely to have 'the baby blues', should be reassured and the clinical picture monitored over time
79
A 45 year old man seeks help from his general practitioner. He has never had paid employment but, having left school, devoted himself to looking after his widowed mother who had severe arthritis and was virtually housebound. She died 6 months ago, and he now feels that his life is empty. He thinks about his mother a great deal, and feels guilty that he could not do more to help her in the months before her death. On further questioning, he admits that he has felt this emptiness since childhood, and has never made friends, but has always been a loner. Which of the details below suggest that he has a personality disorder?
The fact that the patient is male
His comment that his feelings of emptiness have been with him since childhood
The fact that he devoted himself to looking after his mother
His comment that he feels guilty about how he cared for his mother
The fact that he has never had paid employment
His comment that his feelings of emptiness have been with him since childhood
80
Which of the above diagnoses is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 67 year old man is visited at home by his GP who finds him in squalor, grossly self neglected and expressing ideas that his heart is 'rotten' and he believes he is guilty of genocide by causing crops to fail in Africa.
```
Grief reaction
Hebephrenic schizophrenia
Depression with psychotic features
Paranoid schizophrenia
Depression without psychotic features
None of the above
Schizophrenia with mainly negative symptoms
Mania/hypomania
Acute organic brain syndrome (delirium)
Mental state shows no specific abnormality
```
Depression with psychotic features
81
Which of the above diagnoses is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 25 year old man says his thoughts are being controlled and that people are reading his thoughts. For the past 2 weeks he has been convinced of a conspiracy against him by his previous employer and he feels certain there are messaged from this person in the newspaper headlines.
```
Grief reaction
Hebephrenic schizophrenia
Depression with psychotic features
Paranoid schizophrenia
Depression without psychotic features
None of the above
Schizophrenia with mainly negative symptoms
Mania/hypomania
Acute organic brain syndrome (delirium)
Mental state shows no specific abnormality
```
Paranoid schizophrenia
82
Which of the above diagnoses is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 32 year old man talking quickly with lots of ideas that are difficult to follow. He expresses ideas that he has special powers and can control the weather.
```
Grief reaction
Hebephrenic schizophrenia
Depression with psychotic features
Paranoid schizophrenia
Depression without psychotic features
None of the above
Schizophrenia with mainly negative symptoms
Mania/hypomania
Acute organic brain syndrome (delirium)
Mental state shows no specific abnormality
```
Mania/hypomania
83
Which of the above diagnoses is best applied to the following presentations? Each option can be used once, more than once or not at all.
An 80 year old woman is brought to the Accident and Emergency Department with acute shortness of breath. From her history, it appears that she is in heart failure. She knows her name, but thinks she's in her local church, and that the doctor is a visiting priest
```
Grief reaction
Hebephrenic schizophrenia
Depression with psychotic features
Paranoid schizophrenia
Depression without psychotic features
None of the above
Schizophrenia with mainly negative symptoms
Mania/hypomania
Acute organic brain syndrome (delirium)
Mental state shows no specific abnormality
```
Acute organic brain syndrome (delirium)
84
Which of the above diagnoses is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 25 year old man is brought for an assessment by his parents. They give a history of deterioration in social functioning over the past 4-5 months. On examination, the patient displays affect that does not seem to fit with the conversation, and seems to move from one topic to another in an illogical manner.
```
Grief reaction
Hebephrenic schizophrenia
Depression with psychotic features
Paranoid schizophrenia
Depression without psychotic features
None of the above
Schizophrenia with mainly negative symptoms
Mania/hypomania
Acute organic brain syndrome (delirium)
Mental state shows no specific abnormality
```
Hebephrenic schizophrenia
85
Which of the above phenomena is best applied to the following presentations? Each option can be used once, more than once or not at all.
A man holds a strange pose that looks uncomfortable, bending half way over, and when you examine him you notice you can move his limbs to other positions, which he doesn't resist and he then hold the pose you put him in until you move him again.
```
Thought broadcast
Catatonic symptom
Hallucinatory voices
Thought echo
Passivity phenomena
Negative symptom
Delusional perception
Neologism
Overvalued idea
Paranoid delusion
```
Catatonic symptom
86
Which of the above phenomena is best applied to the following presentations? Each option can be used once, more than once or not at all.
A man wearing metal helmet to stop his thoughts being projected out of his head, because he believes other people can hear his thoughts unless he wears the helmet.
```
Thought broadcast
Catatonic symptom
Hallucinatory voices
Thought echo
Passivity phenomena
Negative symptom
Delusional perception
Neologism
Overvalued idea
Paranoid delusion
```
Thought broadcast
87
Which of the above phenomena is best applied to the following presentations? Each option can be used once, more than once or not at all.
A woman keeps repeatedly saluting, and says someone is making her do this using a remote control beaming device.
```
Thought broadcast
Catatonic symptom
Hallucinatory voices
Thought echo
Passivity phenomena
Negative symptom
Delusional perception
Neologism
Overvalued idea
Paranoid delusion
```
Passivity phenomena
88
Which of the above phenomena is best applied to the following presentations? Each option can be used once, more than once or not at all.
A woman has stopped going out as she has the feeling that she is being followed. She says she can't be sure about this, but she has read in the newspapers about high crime rates, and she has heard from her neighbours that a few people have been followed home and mugged in the local area recently.
```
Thought broadcast
Catatonic symptom
Hallucinatory voices
Thought echo
Passivity phenomena
Negative symptom
Delusional perception
Neologism
Overvalued idea
Paranoid delusion
```
Overvalued idea
89
Which of the above phenomena is best applied to the following presentations? Each option can be used once, more than once or not at all.
A woman has been seeing a CPN for many years and when you review her you notice she odes very little daytime activities, seems unmotivated and apathetic but not depressed, and she has a limited range of emotional expression.
```
Thought broadcast
Catatonic symptom
Hallucinatory voices
Thought echo
Passivity phenomena
Negative symptom
Delusional perception
Neologism
Overvalued idea
Paranoid delusion
```
Negative symptom
90
Which of the above diagnoses is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 28 year old man feels uneasy and is unable to relax during the day, worried something dreadful might happen. This feeling of unease is with him throughout her waking hours, but sometimes becomes worse. He tends to feel exhausted by the end of the day.
```
Social phobia
Agoraphobia
GAD
None of the above
Specific phobia
OCD
Hypochondriasis
Mental sate shows no specific abnormality
```
Generalised anxiety disorder
91
Which of the above diagnoses is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 33 year old woman is convinced that the salmonella germ may be in her kitchen, so she is making her family follow a ritual whereby plates must be dipped in bleach and placed on the drainer to dry for 2 minutes before the plate can be used to eat off. She is really upset by having to perform this ritual but cannot stop herself because she is so worried about contaminating the children.
```
Social phobia
Agoraphobia
GAD
None of the above
Specific phobia
OCD
Hypochondriasis
Mental sate shows no specific abnormality
```
Obsessive-compulsive disorder
92
Which of the above diagnoses is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 45 year old woman is repeatedly presenting to her GP convinced that she has a brain tumour. She says she has headaches and sometimes a tightness across her forehead. Investigations have been negative but she keeps coming back to ask for further brain scans to find the cancer.
```
Social phobia
Agoraphobia
GAD
None of the above
Specific phobia
OCD
Hypochondriasis
Mental sate shows no specific abnormality
```
Hypochondriasis
93
Which of the above diagnoses is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 20 year old student is unable to go to the pub with friends, or to travel on the Underground, because he is very worried that if someone looks at him, he'll blush and embarrass himself.
```
Social phobia
Agoraphobia
GAD
None of the above
Specific phobia
OCD
Hypochondriasis
Mental sate shows no specific abnormality
```
Social phobia
94
A 30 year old woman describes episodes when she cannot catch her breath and her fingers tingle.
```
Social phobia
Agoraphobia
GAD
None of the above
Specific phobia
OCD
Hypochondriasis
Mental sate shows no specific abnormality
```
Panic disorder
95
Which of the above medications is best applied to each of the following presentations? Each option can be used once, more than once, or not at all.
An 80 year old woman who lives alone, and presents with increasing forgetfulness, which she finds very distressing. Her score on the Mini Mental State Exam is 22/30
```
Sertraline
Procyclidine
Temazepam
Diazepam
Haloperidol
Doneprazil
Olanzepine
Acamprosate
Methadone
None of the above
```
Doneprazil
96
Which of the above medications is best applied to each of the following presentations? Each option can be used once, more than once, or not at all.
A 35 year old heavy goods vehicle driver with a past history of alcohol dependence who has been strongly advised to remain abstinent from alcohol
```
Sertraline
Procyclidine
Temazepam
Diazepam
Haloperidol
Doneprazil
Olanzepine
Acamprosate
Methadone
None of the above
```
Acamprosate
97
Which of the above medications is best applied to each of the following presentations? Each option can be used once, more than once, or not at all.
A 22 year old man with a history of schizophrenia who has been admitted as an inpatient on Section 3, acutely psychotic.
```
Sertraline
Procyclidine
Temazepam
Diazepam
Haloperidol
Doneprazil
Olanzepine
Acamprosate
Methadone
None of the above
```
Olanzepine
98
Which of the above medications is best applied to each of the following presentations? Each option can be used once, more than once, or not at all.
A 24 year old woman who is considerably handicapped by having to wash her hands repeatedly, in a particular way
```
Sertraline
Procyclidine
Temazepam
Diazepam
Haloperidol
Doneprazil
Olanzepine
Acamprosate
Methadone
None of the above
```
Sertraline
99
Which of the above medications is best applied to each of the following presentations? Each option can be used once, more than once, or not at all.
A 19 year old man who regularly uses amphetamines and other stimulants but wishes to discontinue these
```
Sertraline
Procyclidine
Temazepam
Diazepam
Haloperidol
Doneprazil
Olanzepine
Acamprosate
Methadone
None of the above
```
None of the above
100
Which of the above professionals is most appropriate to take the lead in the following circumstances? Each option can be used once, more than once or not at all.
A 23 year old man has been an inpatient under Section 3. Who is responsible for arranging the Care Programme Approach meeting?
```
Approved social worker
Consultant psychiatrist
GP
Nurse (based at mental health unit)
Key worker
OT
Patient advocate
Community psychiatric nurse
Music therapist
Clinical psychologist
```
Key worker
101
Which of the above professionals is most appropriate to take the lead in the following circumstances? Each option can be used once, more than once or not at all.
A 17 year old man with severe learning disability shows repeated self-injurious behaviour, that has not responded to any pharmacological intervention
```
Approved social worker
Consultant psychiatrist
GP
Nurse (based at mental health unit)
Key worker
OT
Patient advocate
Community psychiatric nurse
Music therapist
Clinical psychologist
```
Clinical psychologist
102
Which of the above professionals is most appropriate to take the lead in the following circumstances? Each option can be used once, more than once or not at all.
A 20 year old woman is presents in the Accident and Emergency Department after an impulsive overdose of 10 aspirin tablets, taken during an argument with her mother. Assessment reveals no mental state abnormality, and no suicidal intent is elicited.
```
Approved social worker
Consultant psychiatrist
GP
Nurse (based at mental health unit)
Key worker
OT
Patient advocate
Community psychiatric nurse
Music therapist
Clinical psychologist
```
General practitioner
103
Which of the above professionals is most appropriate to take the lead in the following circumstances? Each option can be used once, more than once or not at all.
A 28 year old man is assessed under the Mental Health Act. Whose responsibility is it to consider interventions other than inpatient admission?
```
Approved social worker
Consultant psychiatrist
GP
Nurse (based at mental health unit)
Key worker
OT
Patient advocate
Community psychiatric nurse
Music therapist
Clinical psychologist
```
Approved social worker
104
Which of the above professionals is most appropriate to take the lead in the following circumstances? Each option can be used once, more than once or not at all.
A 45 year old woman with a history of bipolar affective disorder has been well and stable in the community for the past 18 months. She is due a Care Programme Approach Meeting. Who is responsible for organising this?
```
Approved social worker
Consultant psychiatrist
GP
Nurse (based at mental health unit)
Key worker
OT
Patient advocate
Community psychiatric nurse
Music therapist
Clinical psychologist
```
Key worker
105
Which of the above terms is best applied to the following presentations? Each option can be used once, more than once or not at all.
Carries a small but important risk of neutropenia and possibly agranulocytosis
```
Diazepam
Temazepam
Olanzepine
Lithium
Procyclidine
Clozapine
Sertraline
Amitryptyline
Zolpidem
Haloperidol
```
Clozapine
106
Which of the above terms is best applied to the following presentations? Each option can be used once, more than once or not at all.
Carries a small but important risk of hypothyroidism
```
Diazepam
Temazepam
Olanzepine
Lithium
Procyclidine
Clozapine
Sertraline
Amitryptyline
Zolpidem
Haloperidol
```
Lithium
107
Which of the above terms is best applied to the following presentations? Each option can be used once, more than once or not at all.
Has, amongst its most common adverse effects, headache, gastrointestinal disturbance and insomnia
```
Diazepam
Temazepam
Olanzepine
Lithium
Procyclidine
Clozapine
Sertraline
Amitryptyline
Zolpidem
Haloperidol
```
Sertraline
108
Which of the above terms is best applied to the following presentations? Each option can be used once, more than once or not at all.
Needs clinical monitoring, particularly when treatment is first started, for extra-pyramidal effects
```
Diazepam
Temazepam
Olanzepine
Lithium
Procyclidine
Clozapine
Sertraline
Amitryptyline
Zolpidem
Haloperidol
```
Haloperidol
109
Which of the above terms is best applied to the following presentations? Each option can be used once, more than once or not at all.
Carries a small but important risk of renal failure
```
Diazepam
Temazepam
Olanzepine
Lithium
Procyclidine
Clozapine
Sertraline
Amitryptyline
Zolpidem
Haloperidol
```
Lithium
110
Which of the above Sections or legal procedures is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 38 year old man, well know to the police as well as mental health services for his long history of schizophrenia with recurrent relapses, is brought to the attention of the police because he is causing a disturbance in a local shopping mall
```
Section 2
Involve an IMCA
Section 3
Further treatment cannot be given without the patient’s consent
Section 136
Treat under common law
Section 12
Section 5(2)
```
Section 136
111
Which of the above Sections or legal procedures is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 25 year old woman has recently been admitted as an inpatient. She appears willing to remain in hospital and to accept medication, but is very deluded and the psychiatrist judges that she cannot make decisions about his treatment. She has no known relatives or friends.
```
Section 2
Involve an IMCA
Section 3
Further treatment cannot be given without the patient’s consent
Section 136
Treat under common law
Section 12
Section 5(2)
```
Involve an independent mental capacity advocate
112
Which of the above Sections or legal procedures is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 23 year old man is brought to the Accident and Emergency Department in a highly excitable state. He is overfamiliar, expansive, and shows pressure of speech. He says that he is invincible, and to demonstrate this, has been wandering in the traffic. He is not known to mental health services, and denies any past psychiatric history. There is a suspicion that he might be using illicit drugs.
```
Section 2
Involve an IMCA
Section 3
Further treatment cannot be given without the patient’s consent
Section 136
Treat under common law
Section 12
Section 5(2)
```
Section 2
113
Which of the above Sections or legal procedures is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 32 year old man who has had several previous Mental Health Act admissions, usually when he relapses after stopping his medications, tells his community psychiatric nurse that he stopped his medications last week. He is unwilling to resume treatment, or to consider any other intervention. Currently, there is no evidence of any mental state abnormalities.
```
Section 2
Involve an IMCA
Section 3
Further treatment cannot be given without the patient’s consent
Section 136
Treat under common law
Section 12
Section 5(2)
```
Further treatment cannot be given without the patient's consent
114
Which of the above Sections or legal procedures is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 47 year old woman with a clear history of bipolar disorder appears to be relapsing. She has numerous features of hypomania, including being sexually disinhibited and reckless.
```
Section 2
Involve an IMCA
Section 3
Further treatment cannot be given without the patient’s consent
Section 136
Treat under common law
Section 12
Section 5(2)
```
Section 3
115
Which of the above diagnoses is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 63 year old man presents with a 6-month history of progressive memory loss, with prominent dysphasia. Prior to the onset of the cognitive impairment, he developed bradykinesia and rigidity. His wife noted that his memory and intellect seemed to fluctuate markedly and he sometimes appeared to be hallucinating.
```
Huntingdon’s chorea
Depressive pseudodementia
Lewy body dementia
Mild cognitive impairment
Creutzfeld-Jakob disease
Vascular Dementia
Alzheimer’s disease
Delirium
Pick’s disease
Korsakoff’s syndrome
```
Lewy body dementia
116
Which of the above diagnoses is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 78 year old woman presents in a memory clinic with a long history of hypertension and, according to her general practitioner's letter, a history of several transient ischaemic attacks. She has a Mini Mental State Exam (MMSE) score of 21/30.
```
Huntingdon’s chorea
Depressive pseudodementia
Lewy body dementia
Mild cognitive impairment
Creutzfeld-Jakob disease
Vascular Dementia
Alzheimer’s disease
Delirium
Pick’s disease
Korsakoff’s syndrome
```
Vascular dementia
117
Which of the above diagnoses is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 49 year old woman is brought to the doctor by her husband, who notes that she has become more careless in her daily activities, and seems to have great difficulty in changing from one activity to another. On examination, she shows some brief but repetitive facial grimacing, and slight dysarthria.
```
Huntingdon’s chorea
Depressive pseudodementia
Lewy body dementia
Mild cognitive impairment
Creutzfeld-Jakob disease
Vascular Dementia
Alzheimer’s disease
Delirium
Pick’s disease
Korsakoff’s syndrome
```
Huntingdon's chorea
118
Which of the above diagnoses is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 58 year old man is brought to the clinic by his daughter. He appears to recall his early life in detail, and gives a consistent account of this. However, when asked what he did the previous day, his answer, though elaborate, is inconsistent. On examination, he has horizontal nystagmus.
```
Huntingdon’s chorea
Depressive pseudodementia
Lewy body dementia
Mild cognitive impairment
Creutzfeld-Jakob disease
Vascular Dementia
Alzheimer’s disease
Delirium
Pick’s disease
Korsakoff’s syndrome
```
Korsakoff's syndrome
119
Which of the above diagnoses is best applied to the following presentations? Each option can be used once, more than once or not at all.
An 82 year old woman, who has previously enjoyed reasonably good health and was not on any long-term medication, presents with a history of gradually worsening memory. She cannot remember three objects after five minutes, but is able to describe the journey from her home (where she has lived some years) to the local shopping mall. She clearly pays less attention to her appearance than she did in the past. She appears to have some awareness of her memory problems, and become distressed on formal testing. Her MMSE score is 23/30.
```
Huntingdon’s chorea
Depressive pseudodementia
Lewy body dementia
Mild cognitive impairment
Creutzfeld-Jakob disease
Vascular Dementia
Alzheimer’s disease
Delirium
Pick’s disease
Korsakoff’s syndrome
```
Alzheimers disease
120
Which of the above interventions is the main treatment of choice in the following presentations? Each option can be used once, more than once or not at all.
A 12 year old girl has become increasingly faddish about her diet. By a combination of refusing a variety of foods and vigorous exercise, her Body Mass Index (BMI) has come down to 13.5. Her mother has become increasing angry and frustrated by her behaviour, but her father has withdrawn from the problem, spending more time than before at work.
```
Counselling
Family therapy
Behaviour therapy
No specific treatment indicated
Psychodynamic psychotherapy
Treatment with medication
CBT
Motivational interviewing
```
Family therapy
121
Which of the above interventions is the main treatment of choice in the following presentations? Each option can be used once, more than once or not at all.
A 65 year old woman is encouraged by her daughter to see her general practitioner. She was widowed six weeks earlier, and cannot stop herself from becoming tearful when she thinks about her husband.
```
Counselling
Family therapy
Behaviour therapy
No specific treatment indicated
Psychodynamic psychotherapy
Treatment with medication
CBT
Motivational interviewing
```
No specific treatment indicated
122
Which of the above interventions is the main treatment of choice in the following presentations? Each option can be used once, more than once or not at all.
A 25 year old man seeks help from his general practitioner because he feels that his life is unhappy and unfulfilled, to the extent that he gets thoughts of killing himself. On questioning, he denies experiencing any biological features of depression, and says that, apart from the thoughts of suicide which started relatively recently, he has felt as he now does as long as he can remember.
```
Counselling
Family therapy
Behaviour therapy
No specific treatment indicated
Psychodynamic psychotherapy
Treatment with medication
CBT
Motivational interviewing
```
Psychodynamic psychotherapy
123
Which of the above interventions is the main treatment of choice in the following presentations? Each option can be used once, more than once or not at all.
A 30 year old man diagnosed with diabetes is being followed up by his general practitioner. Despite the patient clearly have a good knowledge about diabetes, his diabetes is poorly controlled. Neither the general practitioner not the diabetes clinic can identify any physiological reason why the diabetes might be so difficult to control.
```
Counselling
Family therapy
Behaviour therapy
No specific treatment indicated
Psychodynamic psychotherapy
Treatment with medication
CBT
Motivational interviewing
```
Motivational interviewing
124
Which of the above interventions is the main treatment of choice in the following presentations? Each option can be used once, more than once or not at all.
A 42 year old lecturer develops an irrational fear of speaking in public, worrying that she will make a mistake in a lecture that will show her in a bad light and cause her great embarrassment. She has started to seek ways to avoid giving lectures.
```
Counselling
Family therapy
Behaviour therapy
No specific treatment indicated
Psychodynamic psychotherapy
Treatment with medication
CBT
Motivational interviewing
```
Cognitive-behaviour therapy
125
Which of the above is the initial treatment of choice for the following presentations? Each option can be used once, more than once or not at all.
A 43 year old man, with a long history of alcohol abuse, who presents in the Accident and Emergency Department with a 2-day history of confusion and increasing difficulty walking.
```
Prescribe Naloxone
Prescribe Acamprosate
Recommend gradual reduction in amount of drug consumed
Give IV vitamin B1
Outpatient detoxification
Prescribe methadone
Give IV Flumezanil
Inpatient detoxification
```
Give intravenous vitamin B1
126
Which of the above is the initial treatment of choice for the following presentations? Each option can be used once, more than once or not at all.
A 50 year old woman with a longstanding dependence on diazepam whose friends bring her to the Accident and Emergency Department saying that she couldn't sleep and has taken an overdose of diazepam. She is unrousable, and her breathing is very shallow.
```
Prescribe Naloxone
Prescribe Acamprosate
Recommend gradual reduction in amount of drug consumed
Give IV vitamin B1
Outpatient detoxification
Prescribe methadone
Give IV Flumezanil
Inpatient detoxification
```
Give intravenous flumazanil
127
Which of the above is the initial treatment of choice for the following presentations? Each option can be used once, more than once or not at all.
A 27 year old sales executive who has to hide alcohol at work so that he can drink there, and always has alcohol by his bedside to consume before he gets up in the morning. He recognises that his drinking is a problem and seeks the help of his general practitioner for this.
```
Prescribe Naloxone
Prescribe Acamprosate
Recommend gradual reduction in amount of drug consumed
Give IV vitamin B1
Outpatient detoxification
Prescribe methadone
Give IV Flumezanil
Inpatient detoxification
```
Outpatient detoxification
128
Which of the above is the initial treatment of choice for the following presentations? Each option can be used once, more than once or not at all.
A 22 year old woman who has been taking heroin for five years orally and also intravenously seeks help because she developed severe cellulitis and a deep vein thrombosis from injecting herself. Twice previously, she has tried on her own to withdraw from heroin, and is very reluctant to consider supervised withdrawal.
```
Prescribe Naloxone
Prescribe Acamprosate
Recommend gradual reduction in amount of drug consumed
Give IV vitamin B1
Outpatient detoxification
Prescribe methadone
Give IV Flumezanil
Inpatient detoxification
```
Prescribe methadone
129
Which of the above is the initial treatment of choice for the following presentations? Each option can be used once, more than once or not at all.
A 36 year old unemployed single man who has been dependent on alcohol for some years presents in the Accident and Emergency Department having been hit by a car when he wandered into the road while drunk. He has undergone two previous detoxifications, but resumed drinking soon after each had ended. He is now asking for further treatment
```
Prescribe Naloxone
Prescribe Acamprosate
Recommend gradual reduction in amount of drug consumed
Give IV vitamin B1
Outpatient detoxification
Prescribe methadone
Give IV Flumezanil
Inpatient detoxification
```
Inpatient detoxification
130
Which of the above terms is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 12 year old boy has a history of repeated purposeless shrugging of the shoulders, eye-blinking, and repetition of socially unacceptable and obscene words, which he appears unable to stop despite sanctions.
```
Separation anxiety
Childhood autism
Depressive disorder
Secondary enuresis
Encopresis
Attachment disorder
Oppositional Defiant Disorder
Conduct disorder
Primary enuresis
Tourette’s syndrome
```
Tourette's syndrome
131
Which of the above terms is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 10 year old girl has been wetting the bed at night about twice a week for the past 6 months. She had been continent from the age of 3 until 6 months ago. Her step-father has been charged with sexual offences against his daughter from a previous marriage.
```
Separation anxiety
Childhood autism
Depressive disorder
Secondary enuresis
Encopresis
Attachment disorder
Oppositional Defiant Disorder
Conduct disorder
Primary enuresis
Tourette’s syndrome
```
Secondary enuresis
132
Which of the above terms is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 9 year old boy with normal intelligence repeatedly passes faeces on the floor of his bedroom and sometimes hides them in his mother's shoes. He is one of 6 children all of whom have behaviour problems. His parents are separated and he lives with his mother who is a heroin addict.
```
Separation anxiety
Childhood autism
Depressive disorder
Secondary enuresis
Encopresis
Attachment disorder
Oppositional Defiant Disorder
Conduct disorder
Primary enuresis
Tourette’s syndrome
```
Encopresis
133
Which of the above terms is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 6 year old boy throws severe tantrums when he does not get his wishes. Both his parents and teachers complain that he does not do as told. He often argues and is easily provoked. Other children avoid him because of his temper.
```
Separation anxiety
Childhood autism
Depressive disorder
Secondary enuresis
Encopresis
Attachment disorder
Oppositional Defiant Disorder
Conduct disorder
Primary enuresis
Tourette’s syndrome
```
Oppositional defiant disorder
134
Which of the above terms is best applied to the following presentations? Each option can be used once, more than once or not at all.
A 7 year old is having difficulty attending school because she fears that her mother may die while she is at school. She is an only child and lives with her mother. She refuses to stay with grandparents unless her mother comes along. She often has nightmares of getting lost while out with her mother.
```
Separation anxiety
Childhood autism
Depressive disorder
Secondary enuresis
Encopresis
Attachment disorder
Oppositional Defiant Disorder
Conduct disorder
Primary enuresis
Tourette’s syndrome
```
Separation anxiety
135
Which of the above diagnoses is best associated with the following statements? Each option can be used once, more than once or not at all.
The diagnosis is more common in men than in women
```
Alzheimer-type dementia
Social Phobia
BPAD
Schizophrenia
Alcohol dependence
Agoraphobia
Depressive disorder
```
Alcohol dependence
136
Which of the above diagnoses is best associated with the following statements? Each option can be used once, more than once or not at all.
The peak age of onset is in the late 30's
```
Alzheimer-type dementia
Social Phobia
BPAD
Schizophrenia
Alcohol dependence
Agoraphobia
Depressive disorder
```
Depressive disorder
137
Which of the above diagnoses is best associated with the following statements? Each option can be used once, more than once or not at all.
The condition is recognised to have a better prognosis in developing countries than in Westernised cultures
```
Alzheimer-type dementia
Social Phobia
BPAD
Schizophrenia
Alcohol dependence
Agoraphobia
Depressive disorder
```
Schizophrenia
138
Which of the above diagnoses is best associated with the following statements? Each option can be used once, more than once or not at all.
The prevalence of the disorder is the same in first degree relatives of those affected as in the general population
```
Alzheimer-type dementia
Social Phobia
BPAD
Schizophrenia
Alcohol dependence
Agoraphobia
Depressive disorder
```
Agoraphobia
139
Which of the above diagnoses is best associated with the following statements? Each option can be used once, more than once or not at all.
Among monozygous twins, the concordance for the condition is approximately 60-70%
```
Alzheimer-type dementia
Social Phobia
BPAD
Schizophrenia
Alcohol dependence
Agoraphobia
Depressive disorder
```
Schizophrenia
140
Which of the following is true of hyperventilation?
Important factor in generation of panic attacks
Primarily caused by increased O2 levels
Best treated by re-breathing into brown plastic bag
Helped by education and controlled breathing
Common in GAD
Caused by decreased CO2 levels
Important factor in generation of panic attacks
| Helped by education and controlled breathing
141
Which of these are recommended first line medication treatments for anxiety disorders?
```
TCA
SSRIs
MAOIs
Benzodiazepines
Atypical antipsychotics
```
SSRIs
142
Neurosis
Neurotic disorders are those whether a person retains some insight into his/her condition
143
Psychosis
Psychotic disorders are those where the patient lacks insight. A psychotic disorder trumps a neurotic disorder when both a present. E.g. a patient with both OCD and schizophrenia will have a primary diagnosis of the latter.
144
True/False:
| Rates of mental disorders are similar in men and women
False
145
True/False:
With the exception of functional psychoses and alcohol/drug dependence women are more likely to suffer from mental illness
True
146
True/False:
| In women without a past psych history, pregnancy is associated with a decreased rate of major mental illness and suicide
True
147
True/False:
| Following childbirth the incidence of psych disorders increases
True
148
True/False:
| Following childbirth the incidence of psych disorders decreases because mothers experience "parental bliss"
False
149
True/False:
| Postpartum blues occurs in 50-60% of mothers
True
150
True/False:
| Postpartum blues is the same as postnatal depression
False
151
True/False:
| Postnatal depression is uncommon with an incidence of <1%
False
152
True/False:
| Postnatal depression is well recognised in primary care
False
153
True/False:
| Incidence of postnatal depression is 10-15% and is often under diagnosed
True
154
True/False:
| Incidence of postnatal depression is similar across countries and cultures
True
155
True/False:
| Incidence of puerperal psychoses is 0.2%
True
156
True/False:
| Incidence of puerperal psychoses is similar to that of postnatal depression
False
157
True/False:
| In puerperal psychoses there is a substantial increase in the risk of a mother being admitted to psychiatric hospital
True
158
True/False:
| Women with puerperal psychoses very rarely are admitted to a psych hospital
False
159
True/False:
| Puerperal psychoses are mainly affective but can be schizophrenic or organcic
True
160
True/False:
| Aetiology of postnatal blues is well established and is associated with changes in adrenal steroids
False
Aetiology of postnatal blues is unknown
161
True/False:
| Postnatal blues is a risk factor for developing postnatal depression
True
162
True/False:
| Previous psych history is a risk factor for developing postnatal depression
True
Others include: stressful life events, younger age, poor marital relationship and lack of social support
163
True/False:
| Failure to breastfeed is not associated with postnatal depression
False
164
True/False:
| Psych stressors such as delivery by C-section may be an important risk factor in developing puerperal psychoses
True
165
True/False:
| History of bipolar affective disorder leads to substantial increase in risk of developing puerperal psychoses
True
166
True/False:
| Risk of relapse of puerperal psychoses after further births is very low
False
High (50%)
167
True/False:
| Symptoms of PND do not differ significantly from those of depression occurring at any other time of life
True
168
True/False:
| 80% of cases of puerperal psychosis is predominantly schizophrenic
False
80% predominantly affective
169
True/False:
| Edinburgh Post Natal Depression Scale (EPNDS) is a validated screening questionnaire for PND
True
```
Score each answer out of:
As much as I always could
Not quite so much now
Definitely not so much now
Not at all
```
1. I have been able to laugh and see the funny side of things.
2. I have looked forward with enjoyment to things.
3. I have blamed myself unnecessarily when things went wrong.
4. I have been anxious or worried for no good reason.
5. I have felt scared or panicky for no very good reason.
6. Things have been getting on top of me.
7. I have been so unhappy that I have had difficulty sleeping.
8. I have felt sad or miserable.
9. I have been so unhappy that I have been crying.
10. The thought of harming myself has occurred to me.
170
True/False:
| Post natal blues occurs 48hrs after birth
False
3-5 days after birth
171
True/False:
| Post natal blues usually resolves spontaneously
True
Characterised by tearfulness, irritability, low mood, labile mood
172
True/False:
| Onset of PND is within 6-8 weeks of childbirth
True
Usually resolves by 6months after birth
173
True/False:
| Puerperal psychoses occurs within 4-5days after birth
True
174
True/False:
| Antidepressants are effective in postnatal blues
False
Best helped by education, reassurance and support
175
True/False:
| Antidepressants are effective in PND
True
176
True/False:
| Breastfeeding is an absolute contraindication to the use of antidepressents
False
But better to use a short-acting antidepressent
177
True/False:
| Psychological interventions are ineffective in PND
False
CBT is effective in mild/moderate PND
178
True/False:
| Anti psychotics are first line treatment for puerperal psychoses
True
ECT is also a treatment option
179
A 25 year old unemployed gentlemen who gives you a chequered forensic history. When he describes some of these violent offences there is hardly any empathy noticed. He tells you that he doesn't stay with his partners more than a few months. He blames others for all the difficult times he has faced.
```
A. Paranoid PD
B. Anankastic PD
C. Schizoid PD
D. Borderline PD
E. Dissocial PD
```
E. Dissocial PD
Features include:
Gross & Persistent irresponsibility & disregard to social norms
Incapacity to maintain enduring relationships
Low tolerance to frustration
Low threshold for aggression
Proneness to blame others
Incapacity to experience guilt or to learn from punishment
180
22 yr old female patient presents to A&E at 1am. She has numerous fresh superficial wounds on her left wrist. She tells you that she has used the kitchen knife to make these wounds. In the past she has taken overdoses on a number of occasions. The history also reveals that she has turbulent relationships with boyfriends. She is also somewhat confused about her goals in life as well as having insecurities around her self-image.
```
A. Paranoid PD
B. Anankastic PD
C. Schizoid PD
D. Borderline PD
E. Dissocial PD
```
D. Borderline PD
```
Features include:
Affective instability
Chronic feelings of emptiness
Confusion about self image, aims and internal preferences (including sexual)
Repeated emotional crisis
```
181
John tells you that he has been avoiding shopping at the local supermarket recently. You wonder whether he may be suffering from agoraphobia.
Which of the following is true regarding agoraphobia?
Agoraphobia is a specific fear of open spaces
Onset is usually in childhood
Exposure therapy is an effective treatment for agoraphobia
The presence of a companion does not usually help in anxiety-inducing situations
Exposure therapy is an effective treatment for agoraphobia.
In exposure therapy, the therapist helps the patient to identify a goal and then construct a ‘hierarchy’ of feared situations to tackle, from the least to the most frightening.
Tasks might include going shopping in a small local shop, before progressing to a big supermarket. At each step, the aim is to stay in the situation until the anxiety has abated.
182
You are a Psychiatric F2 doctor seeing John, a 35 year old man who has presented to A&E with the following symptoms:
• Feeling worried and tense
• Poor sleep
You suspect that he may be suffering from an anxiety disorder.
Which of the following statements is true in relation to anxiety disorders?
Men and women are affected equally
Chest pain is not a recognized symptom of anxiety
Childhood adversity can predispose to anxiety disorders
Depersonalisation is incompatible with the diagnosis of an anxiety disorder
Childhood adversity can predispose to anxiety disorders
Women are affected roughly twice as often as men.
Chest pain is a recognized symptom of anxiety
Depersonalisation (a feeling of unreality involving a disturbance in one’s sense of self) can occur in anxiety disorders.
183
John tells you that he has been feeling ‘tense all the time’. You decide to explore whether he could be suffering from generalized anxiety disorder (GAD).
Which of the following is true in relation to generalized anxiety disorder?
Anxiety is triggered by specific stimuli
The presence of panic attacks excludes a diagnosis of GAD
Hypothyroidism can present with symptoms similar to GAD
Symptoms must be present for at least 6 months before the diagnosis can be made.
Symptoms must be present for at least 6 months before the diagnosis can be made.
Hyperthyroidism can present with continuous anxiety and should be excluded by checking thyroid function (TFTs)
184
You diagnose John with Post Traumatic Stress Disorder (PTSD).
Which of the following statements regarding PTSD is TRUE?
In the general population, men are at a higher risk of developing PTSD than women
About 10% of people who experience an extreme trauma develop PTSD
The risk of developing PTSD after a traumatic event is not affected by a family history of psychiatric problems.
The amygdala is hypoactive in PTSD.
About 10% of people who experience an extreme trauma develop PTSD
In the general population, women are at higher risk of PTSD. Being in the military is associated with an increased of PTSD – and in this population, a higher proportion of men are affected than in the general population - since men are over-represented in the armed forces.
Risk factors include neurotic traits, a personal or family history of psychiatric problems, childhood abuse, and poor early attachment.
In PTSD, the amygdala (emotional processing) is hyperactive and the hippocampus (memory storage) is atrophied.
185
Which of the following is NOT a first-line treatment for PTSD?
Olanzapine
Cognitive behavioural therapy (CBT)
Eye movement desensitization and reprocessing
Sertraline
Olanzapine is an antipsychotic and is not commonly used as a first-line treatment for PTSD (occasionally as an adjunct)
EMDR is an effective treatment for PTSD and consists of the patient deliberately re-experiencing the trauma (e.g. by narrating the story of the trauma), while fixing their eyes on an object moving from side to side in front of them (e.g. the therapist’s finger).
186
You review PTSD John 3 months later in your out-patient clinic. He has received a course of CBT and has been receiving sertraline 50mg. He is finding it difficult to cope with the feelings of anxiety and has started using diazepam to help with this. He is now taking up to 40mg of diazepam daily and you fear that he may be dependent.
Which of the following statements is TRUE in relation to diazepam?
Naloxone can be used to treat an overdose of diazepam
Seizures are seen in barbiturate withdrawal, but not in benzodiazepine withdrawal.
Formication commonly occurs in diazepam-dependent patients
The dose of diazepam should be reduced gradually in dependent patients.
The dose of diazepam should be reduced gradually in dependent patients.
Naloxone is the antidote for opiate overdoses. Flumazenil is a benzodiazepine antagonist and can be used to treat benzodiazepine overdoses.
Seizures are a serious complication of both benzodiazepine and barbiturate withdrawal syndromes.
Formication is the sensation of insects crawling under the skin and occurs in cocaine dependence.
