Formative Questions

Question 1

1. A 19 year old student presents to his GP with a three month history of hearing a voice commenting on what he is doing and making derogatory comments about him. It has recently started telling him to do things. He has started to believe that his flatmates are against him and wish to harm him. He uses no illicit drugs.

What is the most likely diagnosis?

Answer 1

Schizophrenia

Question 2

1. A 24 year old man is admitted to the acute psychiatric ward with a history of psychotic symptoms and is given a diagnosis of schizophrenia.

Which of the following symptoms is a first rank symptom of schizophrenia?
   a. Nihilistic delusion
   b. Confabulation (memory disturbance – unintentional fabrication)
   c. Pressure of speech
   d. Thought insertion
   e. Apathy (indifference, lack of emotion/motivation)

Answer 2

d. Thought insertion

Question 3

Which classification system is used for mental illness

Answer 3

ICD-10

Question 4

1. An 8 year old boy is referred with behavioural problems to the child Psychiatry Department. He is always active at home and moves from task to task. He finds it difficult to concentrate to read or watch TV. He often puts himself into dangerous situations like climbing onto high roofs. His performance at school is poor where he is distractible and causes distractions to others.

what is the most likely Dx?

Answer 4

ADHD

Question 5

1. An elderly man has been admitted to hospital with acute onset disorientation, visual hallucinations and agitation. He has no psychiatric history and lives alone and requires no support.

What is the most likely diagnosis?

Answer 5

Delirum (acute confusional state)

Question 6

1. You are a GP and have diagnosed a 27 year old lady with depression. You are confident that she does not require to be treated in hospital and wish to start her on treatment.

Which of the following would be appropriate first line treatment?

Answer 6

SSRI (1st line antidepressant, e.g Sertraline)

Question 7

Which are SSRIs 1st line

Answer 7

They have a relatively low side effect profile

and have relatively high efficacy

Question 8

You are a foundation doctor in an orthopaedic ward in Inverness and a patient with a moderate learning disability is admitted to the ward. The team believe that he does not have capacity to consent to an operation.

Which piece of legislation would be most appropriate to use in this circumstance?

Answer 8

Adults with Incapacity (Scotland) Act 2000

Question 9

1A 29 year old junior doctor is being treated for depression with CBT.

Which of the following is a term used in CBT?

a. Interpersonal map
b. Negative Automatic Thoughts
c. Pre-contemplation
d. Separation Anxiety
e. Thought blocking

Answer 9

Negative Automatic Thoughts

Question 10

A middle aged man is admitted to hospital with gall stones. Part of the admission history is to screen for alcohol problems.

Which of the following is an appropriate questionnaire to screen for alcohol problems?

a. FAST
b. GCS
c. BDI
d. MADRS
e. MOCA

Answer 10

A. FAST score

Question 11

A 43 year old man is seen in Accident & Emergency after having taken an overdose of Citalopram and Lithium.

Which of the following statements is true?

a. Lithium has a wide range therapeutic index
b. Rebound mania is a risk of lithium toxicity
c. Lithium is not a suitable treatment for unipolar depression
d. There is no point continuing lithium if the patient doesn’t respond within 1 months
e. Serum lithium levels should be measures every 3 months

Answer 11

Serum lithium should be measured every 3/12

Question 12

A 45 year old man is assessed in the outpatient department. He has an intense interest in rare woods and has a very rigid timetable which he sticks to each day. He is upset that the doctor assessing him was 10 minutes late. What is the most likely diagnosis?

Answer 12

Autism

Question 13

A 39 year old woman presents with a complaint that she is fearful that something bad may happen to her. This fear occurs where-ever she goes and she cannot describe what might happen. She also complains of pains in her chest, a tremor and sweating at times.

What is the most likely diagnosis?

Answer 13

Generalised anxiety disorder

Question 14

A 23 year old man is assessed by his GP. He has a severe dermatological condition affecting his hands which is caused by his washing them 13 times before he leaves his house.

What is the most likely diagnosis?

Answer 14

OCD (obsessive compulsive disorder)

Question 15

A 67 year old woman arranges for her daughter to be able to manage her money as her own mother developed dementia at the age of 70.

Which power has been used in this situation

Answer 15

Power of Attorney

Question 16

A 28 year old woman with severe depression is admitted to the acute medical assessment ward having taken an overdose. She requires treatment but tries to leave the hospital. The FY2 is the only doctor available.

Which is the most appropriate legal power to use in this situation?

Answer 16

Emergency Detention Certificate

Question 17

A 24 year old man has recently been started on new medication by his psychiatrist. One of the side effects is an unpleasant sensation of restlessness.

What is the correct term for this?

Answer 17

Akathisia

Question 18

A 28 year old man has recently started on antipsychotics. He has been told about a side effect of muscle stiffness and contraction sometimes caused by antipsychotics.

What is the correct term for this?

Answer 18

Dystonia

Question 19

A 34 year old man develops depression and suffers the inability to experience pleasure but can experience other emotions.

What is the correct term for this?

Answer 19

Anhedonia

Question 20

A 68 year old woman has been diagnosed with severe depression. One of the symptoms is that she believes her bowels are rotting.

What is the correct term for this?

Answer 20

Nihilistic Delusion

Question 21

A 22 year old man with no previous psychiatric illness sees a street lamp flicker and suddenly knows that he is the next Scottish ambassador to Wales.

What is the correct term for this?

Answer 21

Delusional Perception (perception because there has been a real stimulus, but then put delusion on top of that)

Question 22

A 23 year old man experiences irritability, grandiose delusions and a reduced need for sleep. He has previously been in a psychiatric hospital treated for depression.

Which is the most likely diagnosis?

Answer 22

Bipolar

Question 23

A 24 year old woman who has a one month history of low mood, early morning wakening, irritability, reduced appetite and some suicidal thoughts. She also feels guilty that she feels too tired to take her two year old daughter to nursery.

Which is the most likely diagnosis?

Answer 23

Depression

Question 24

Within what time scale is post-natal depression diagnosed

Answer 24

Within 6 months

Question 25

A 79 year old man who has had two hospital admissions for depression in the past is brought to the GP by his daughter. She is concerned that he is spending lots of money, has a reduced need to sleep, is full of energy and wants to run a marathon. 

Which is the most likely diagnosis?

Answer 25

Bipolar

Question 26

A 28 year old woman is an inpatient in the general adult ward. She is being treated for schizophrenia and her symptoms are improving on medication. She is allowed to go to the cinema with a friend and on return to the ward is convinced the nurses have been replaced by aliens, the radio is playing songs especially for her and she can hear voices telling her to sit up all night. 

What is the most appropriate investigation to order?

Answer 26

Urinary Drug Screen

Question 27

A rather thin young student presents to her GP complaining that she has not had a menstrual period for over a year although she is not taking the contraceptive pill. She
has been ‘very stressed’ by her university course but is still doing well academically,
and belongs to the University triathlon club. She becomes tearful when the GP suggests weighing her, and insists she eats very well, indeed she ads herself often eating far more than she intended and is worried that she may gain weight. Blood results are normal apart from a low potassium value, low total white count and mild neutropaenia and slightly low TSH. The most likely diagnosis is:

Answer 27

Anorexi nervosa: binge-purge subtype

Question 28

2. You are an FY2 in a general surgical ward. You have decided to detain one of your patients under the Mental Health (Care and Treatment) (Scotland) Act 2003. Which of the following is the most appropriate order to use?

Answer 28

Emergency Detention Certificate

Question 29

What is the only detention that can be completed by a non-approved medical practitioner such as an FY1 or FY2

Answer 29

Emergency Detention Certificate

Question 30

A woman presents hearing the national anthem playing when there is no music in the house. Which of the following symptoms is this an example of?

Answer 30

Auditory Hallucination

Question 31

An 80 year old man is admitted with weight loss, poor motivation, social isolation, lack of interest in bowling which he previously did regularly, suicidal ideation and tearfulness. Which of the following is the most likely diagnosis:

Answer 31

Depression

Question 32

A 20 year old man is arrested by the police following stabbing his neighbor whom he believes is an alien who is poisoning the neighbours with gases from his home planet. He is assessed by the on-call forensic psychiatrist in the court cells who decides to admit him to hospital what order should be used?

Answer 32

Assessment order

Question 33

A 20 year old man with no history of illicit drug use is admitted believing his neighbour is an alien who is poisoning with gases from his home planet. The man says he can smell the gas in the hospital and his neighbour is speaking to him through the wardrobe telling him to harm others. He believes his neighbour is putting thoughts into his mind. 
Which of the following is the most likely diagnosis?

Answer 33

Paranoid Schizophrenia

Question 34

The 20 year old patient with beliefs that his neighbour is an alien poisoning him with 
 gas is deemed to require treatment. Which of the following drug types is the most appropriate treatment? ``` A. Mood stabilizer 
 B. Clozapine 
 C. Atypical Antipsychotic D. Typical Antipsychotic 
 E. Antidepressant 
 ```

Answer 34

Atypical Antipsychotic

Question 35

A soldier who has recently returned from active combat attends his GP as he has frequent nightmares, startles easily, tries to avoid his army friends and anything to do with his job and is always on edge. 
What is the likely diagnosis?

Answer 35

PTSD

Question 36

A 38 year old woman has consulted her GP and a diagnosis of moderate depression has been made. Which of the following would be an appropriate first-line treatment? 


Answer 36

SSRI (such as Sertraline, Fluoxetine, Citalopram)

Question 37

Which psychological treatments is recommended in the first line treatment of depression?

Answer 37

Cognitive Behaviour Therapy