Mock SBAs

Question 1

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

Answer 1

Blushing in public

Question 2

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?

Answer 2

Heroin

Question 3

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

Answer 3

olanzapine

Question 4

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?

Answer 4

0.1%

1%

10%

50%

80%

Question 5

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?

Answer 5

20%

Question 6

Among patients on an acute medical inpatient ward, what is the likely prevalence of clinical depression?

1%
5%
10%
25%
60%

Answer 6

25%

Question 7

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?

Self-help materials based on the cognitive model

Fluoxetine (high dose)

Cognitive-behaviour therapy

Interpersonal therapy

Psychoanalytic psychotherapy

Self-help materials based on the cognitive mode

Answer 7

psychoanalytic psychotherapy

Question 8

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?

Answer 8

An approved social worker

Question 9

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?

Organise an urgent child protection case conference

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

Answer 9

Report your concerns to social services

Question 10

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?

Answer 10

Wernicke’s encephalopathy

Question 11

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?

Answer 11

Discontinue her anidepressant meds and start on lithium carbonate

Question 12

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?

Answer 12

discontinue the depot antipsychotic and start him on olanzapine (remember to aoid procyclidine as it can make tardive dyskinesia WORSE)

Question 13

likely diagnosis? 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.

Answer 13

Depression with psychotic features

Question 14

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.

Answer 14

Hebenephric schizophrenia

Question 15

A 23 year old man has been an inpatient under Section 3. Who is responsible for arranging the Care Programme Approach meeting?

Answer 15

KEY WORKER

Question 16

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?

Answer 16

Key worker

Question 17

Carries a small but important risk of hypothyroidism and renal failure

Answer 17

Lithium

Question 18

Has, amongst its most common adverse effects, headache, gastrointestinal disturbance and insomnia

Answer 18

Sertraline

Question 19

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

A. Section 2
B. Involve an independent mental capacity advocate
C. Section 3
D. Further treatment cannot be given without the patient's consent
E. Section 136
F. Treat under Common Law
G. Section 12
H. Section 5(2)

Answer 19

Section 136

Question 20

32.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.

A. Section 2
B. Involve an independent mental capacity advocate
C. Section 3
D. Further treatment cannot be given without the patient's consent
E. Section 136
F. Treat under Common Law
G. Section 12
H. Section 5(2)

Answer 20

. Involve an independent mental capacity advocate

Question 21

33.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.

Answer 21

Section 2 - dont know his diagnosis need to assess!!

Question 22

43.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.

Answer 22

Psychodynamic psychotherapy

Question 23

Among monozygous twins, the concordance for the condition is approximately 60-70%

Answer 23

Schizophrenia