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A 72 year old lady has become severely depressed after the death of her husband. She believes her body is rotting away. She has stopped eating and drinking and has become very frail. What would be your preferred treatment modality

A. Olanzapine
B. Clozapine
C. ECT
D. Referal for CBT
E. SSRI

C. ECT

Psychotic depression where the patient has stopped eating and drinking is an emergency for which ECT is the preferred treatment

Drug treatments take weeks to work so are therefore unsuitable in this scenario

1

An 18 year old boy presents with auditory hallucinations and believes there is a conspiracy to have him murdered. He is, however eating and drinking sufficently and feel safe with his parents. What would your 1st line of treatment be?

A. Olanzapine
B. Clozapine
C. ECT
D. Referral for CBT
E. Lithium

A. Olanzapine

Evidence base in the treatment of psychosis. CBT is unlikely to be helpful in someone who is acutely unwell but may play a role once the patient improves with antipsychotics

2

A 28 year old secretary finds herself becoming increasingly anxious about leaving home. She worries about fainting and making a fool of herself in crowds. She has panic attacks when she tries to leave the house. What would be the preferred treatment?

A. Benzodiazepines
B. Olanzapine
C. Referral for CBT
D. ECT
E. Clozapine

Referal for CBT

SSRI would also be appropriate
Risk of addiction if use benzodiazepines

3

Marion complains of a low mood and low energy which have been present for the past 6 weeks. She has lost approximately a stone in weight. She says she had a similar episode 4 years ago following the birth of her first child. What is the most likely diagnosis

A. Postnatal depression
B. bipolar 2 disorder
C. Dysthymia
D. Depressive episode
E. Recurrent depressive disorder

E - recurrent depressive disorder

Recurrent as she has had a previous depressive episode. The fact this was postnatal has no bearing on diagnosis in this instance

4

Brian is described by his wife as someone who is "glad half empty". He rarely get enjoyment out of activities and expresses a generally negative outlook on life. However, up untill the last 3 week he has functioned well both at work and at home. At present he is preoccupied with the fact his bowels are rotting away and that he is undeserving of food. He says very little in the assessment and appears psychomotor retarded. What is the most likely diagnosis

A. Schizophrenia
B. Psychotic depression and dysthymia
C. Bipolar depression
D. Drug induced psychosis
E. Bowel cancer

B

history is suggestive of dysthymia whereas current presentation suggestive of psychotic depression

5

Which of the following is true about biploar disorder
A. Antideppressant are the main stay of treatment
B. bipolar 2 disorder is associated with the need for hospital admission when mood is elated
C. Bipolar disorder can be limmitted to episodes of mania
D. Bipolar disorder is much more common in women
E. Puerperal psychosis is less common in women who have a history of bipolar disorder

C. A diagnosis of bipolar can apply in the absence of deprressive episodes

If hospital admission is required for mania it suggest a diagnosis of type 1 as the mania is severe in nature

6

Charles is a 24-year-old man who presents with thoughts of shouting obscenities in a church. His psychiatrist thinks that theses are obsessional in nature. Which of the following is true about obsessional thought

A. They are egosyntonic
B. they are necessary to make a diagnosis of OCD
C. They can take the form of vivid imagery
D. They do not respond to pharmacotherapy with SSRI's
E. They are commonly associated with antisocial PD

C - they can take the form of vivid imagery

Obssesion are egodystonic, repetitive and intrusive thoughts or images that are distressing to the patients
Only need evidence of either obsession or compulsion to make a diagnosis of OCD
SSRI and CBT are currently first line treatment for OCD
Associated with anankastic PD

7

A 32 year old sergeant returned from an advanced military post in a conflict zone 6 months ago and is being assessed for the development of PTSD. Which of the following would yo consider not to be a recognized feature of PTSD
A. Flashbacks
B. Nightmares
C. Disinhibited behavior
D. Exaggerated startle response
E. Anxiety

C. Disinhibited behavior

8

Which of the following statements about anxiety disorder is true

A. Agoraphobia is more common in men
B. primary and secondary gain are associated with somatoform disorders
C. Glove and stocking anesthesia is recognized feature of dissociative disorders
D. Malingering is a psychiatric disorder
E. Somatization disorder only occurs in females

C. Primary and secondary gain are associated with dissociative disorders

9

Preoccupation with weight

A. Is absent in bulima nervosa
B. emerges in girls from the age of 7 onwards
C. Is never seen in males
D. Is unusal in EDNOS

B - a preoccupation with weight often precedes the emergence of an eating disorder behaviors in early puberty

10

Which of the following should be monitored during refeeding

A. Weight
B. phosphate
C. Ankle swelling
D. Pottasium
E. Heart rate
F. All of the above

F. All of the above

11

A 22 yr old man present with his mother. She has noted over the last few days, he has been keeping to himself, appears perplexed and frightened, believing that a secret spy agency has conspired to murder him. He has slept with large kitchen under his pillow so as to tackle assailants. Prior to this he was attending university but his academic perforamance has been failing. Which line of management would you follow?

A. Watch and wait - advise coming back in 2 weeks to see if it resolves spontaneously
B. refer for psychological assessment to clarify and challenge beliefs
C. Admit for assessment and treatment
D. Prescribe an antipsychotic and suggest taking time of uni
E. Prescribe a benzodiazepine and refer as outpatient to the early intervention service

C. Given the risk of running away, fearing for saftey and use of wepon it would be safest to admit him

12

An 82 year old with no previous psychiatric contact has been increasingly agitated last few days. She is brought to hospital where she describes seeing ghost at the end of the bed and is frightened by them. She remains awake at night during the day. The nursing team on the medical assessment unit feel that she psychiatrically Unwell in light of her reports and ask for psychiatric opinion. What do you do next.

A. Suggest commencing a benzodiazepine to reduce agitation and help sleep
B. suggest commencing an antipsychotic drug to help hallucinations
C. Ask for an opthalmogy opinion
D. Ask for urine dip, blood test and TPR Chart ( temp, pulse, RR)
E. Suggest urgent transfer to in-patient psych unit

D - this lady could be presenting with a delirium

13

Which of the following facts about schizophrenia is incorrect
A majority of individuals with schizophrenia are dangerous
B. people with schizophrenia are more likely to get in trouble with the law
C. People with schizophrenia are more likely to use illicit drugs
D. Some people with schizophrenia may need support for many years
E. People with schizophrenia can make up to contributions to socitey

A

14

What is the most common type of dementia
A. Alzheimer disease
B . Vascular dementia
C. Dementia with lewy bodies
D. Frontotemporal dementia
E. Metabolic disorder

Alzhiemer account for 50-60% of dementia

15

Which dementia most commonly presents with a fluctuating presentation, visual hallucinations, parkinsonism and sleep disturbances?

A. Alzheimer's disease
B. vascular dementia
C. Dementia with lewy bodies
D. Frontotemporal dementia
E. Metabolic disorder

C

16

What type of drug is memantine

A. Cholinesterase inhibitor
B. NMDA receptor antagonist
C. NMDA receptor agonist
D. Antideprresant
E. Anti-inflammatory

B

Memantine is liscened for use in moderate to severe AD

17

What is the first line treatment for delirium
A oral lorazepam
B. IM Lorazepam
C. Oral haloperidol
D. IM Haloperidol
E. Treat underlying organic cause

E

18

Which psychological problem is not associated with epilepsy
A. Increased rate of anxiety disorder
B. ataxia
C. Increased rate of depressive disorder
D. Delirium
E. Reduced rate of suicide

E - suicide rate elevated

19

A 20yr old man who reports being an opiate user is seen in general practise. He complains of feeling nauseous, suffering with diarrhoea, watering eyes, a runny nose and describes experincing abdo pain. You see him constantly yawning. His pupils are dilated, his skin is clammy and looks like goose flesh. What is the most appropriate first line treatment
A. Lofexidine
B. Naloxone
C. Naltrexone
D. Methadone
E. Buprenorphine

A. Lofexidine

Alpha-adrenergic agonist

20

A 25yr old female is brought to A&E with hyperthermia and tachyarrhythmia after a party. She is excited, restless and fidgety, constantly picking at the skin of her arms. Which is the best explanation for her symptoms
A. Heroin intoxication
B. Cannabis intoxication
C. Ketamine intoxication
D. Cocaine intoxication
E. Cocaine withdrawal

D - cocaine intoxication

21

A 22 yr old woman presents with severe mood swings, impulsive behaviour and alcohol misuse. She has taken 4 overdoses in the past 2 months, many in the context of relationship breakdowns. You are asked to asses her. What else would you need to do to confirm a diagnosis of borderline PD
A. Enquire about dissociative symptoms
B. explore whether she has had abusive experiences in her childhood
C. Establish the presence of FH of bipolar disorder
D. Take a corroborative history from a friend or family member to confirm the pervasive nature of her symptoms

D

22

A 45 year old man is referred to you following the death of his mother 1 year ago. He feels unable to cope. He has never moved out of the family home and has never worked. He appears unable to make decisions and is requesting that he is taken into resedential care although he has no physical ailment. What is the most likely primary diagnosis
A. Delayed grief reaction
B. adjustment disorder
C. Dependant personality disorder
D. Normal bereavement

C . The fact he has never moved out points to a pervasive rather than situational problem

23

A 10 year old boy is brought to clinic with school refusal. His mother reports that the boy has never had clear friends at school and tend to "talk over" other children. He has been bullied frequently, but teacher also report that he sometime is aggresive to other children without an identiiable reason. Which is the best explanation for his difficulties

A. Schizophrenia
B. social phobia
C. Generalised anxiety disorder
D. Asperger's syndrome
E. Conduct disorder

D. Aspergers syndrome

Often targeted by bullies as noticeably different in interaction style and confidence.
Schizophrenia is rare before 16
Conduct disorder is linked to school truancy rather than school refeusal

24

A 17 year old girl attends clinic with low mood, poor sleep and appetite. She always feels tired at school and no longer enjoys her hobbies of netball and dancing. Which is the most appropriate 1st line treatment
A. Family therapy
B. cognitive analytic therapy
C. Citalopram
D. CBT
E. Fluoxetine

D - CBT

Family therapy would be a valid choice if she is known to be willing to involve her family
Fluoxetine would be the first line medication

25

A 16yr old boy with learning disability present with hearing voices and strange behaviour. His parent are concerned that he has unusual beliefs. He was born with a cleft palate and has suffered repeatedly from infection since he was born. He has a heart murmur. What do you suspect
A. Fragile X syndrome
B. DiGeorge syndrome
C. Downs syndrome
D. Neurofibromatosis
E. Williams syndrome

B

Higher prevlance of schizophrenia in Digeorge and velo-cardio-facial syndrome. Though to be due to the COMT gene on 22q11 which is the site of deletion in thesse syndromes

26

A 24 year old man with severe learning disabillity has become increasingly agitated over the last few days. He is intermittently pyrexial. There is no history of seizures. There has been no change to his eating habits and his carer reports that he is defecating regularly. What would you do next?
A. Wait and watch
B. suggest a low dose antipsychotic to help with the agitation
C. Admit to general hospital
D. Ask for urine dipstick
E. Admit to psych in-patients

D

Physical cause must be considered in new onset agitation with a patient with learning disability

Diagnosing and treating underlying cause will reduce agitation
Unplanned admission must be avoided as patients can destabilise in unfamiliar surroundings

27

Which of the following is not a first rank symptoms of schizophrenia

A. Thought disorder
B. thought insertion
C. Thought echo
D. Thought withdrawal
E. Thought broadcasting

A

28

Which of the following is true of obsession

A. They are not always percieved as intrusive
B. they are always diagnostic of OCD
C. They are also known as overvalued ideas
D. They are often secondary to compulsive behaviours
E. They may be a medication side effect

A

Obsession can occur in other psychiatric disease
Compulsion are secondary to obsession

29

Which of the following is true of hallucination?

A. They can occur in severe depression
B. they are misperceptions of external stimuli
C. If they are visual this suggest schizophrenia
D. Voices talking to the person are characteristic of schizophrenia
E. Hallucinations that occur on falling asleep are called hypnopompic

A